?Virtual? colonoscopy less obtrusive to patient

According to the American Cancer Society, 48,100 Americans died of colon cancer last year, and most of these cancers would have been curable if caught and treated early. Unfortunately, colonoscopy is an unpleasant, intrusive procedure, requiring bowl-cleansing laxatives, anesthesia, and half a day’s recovery time.

Among a growing number of clinics nationwide, Colorado Heart & Body Imaging (CHBI) in Denver offers an alternative procedure, electron beam tomography (EBT), or virtual colonoscopy, which reduces patient discomfort.

Dr. James Ehrlich, medical director of the Denver clinic and of similar facilities in Houston and Washington, D.C., also hopes to offer EBT colonoscopy in Cherry Creek by year end, and possibly Broomfield next year.

?We’re hoping by offering a more agreeable screening, that these people (putting off the test) will get a colonoscopy,? Ehrlich said.

?This is an alternative; we’re not trying to be competitive with traditional colonoscopy,? he added. ?There’s a several month waiting list to get a traditional one.?

However, north of Denver this is not the case.

Representatives of Boulder Community Hospital, Longmont United Hospital, Centura Health/Avista Adventist Hospital in Louisville and Healthone Hospital in Broomfield all confirmed that they have no colonoscopy patient backlog.

According to Ehrlich, colons screening should occur every three to 10 years from age 40 or 50, depending upon the patient’s personal risk factors as determined by their physician.

Ted Epstein, a retiree from Denver, has experienced both a traditional and EBT colonoscopy.

?The virtual one was quite easy,? he said. ?There’s nothing to worry about or be afraid of.?

An EBT colonoscopy at Colorado Heart & Body Imaging costs $975, a few hundred less than a traditional procedure; however, most insurance companies do not yet cover EBTs, according to Ehrlich.

Ehrlich’s clinic performs approximately 80 EBT colonoscopies per month using a Viatronix system. The equipment cost $2 million.

In a traditional colonoscopy, the technician inserts a 1.5-inch diameter telescope tube five feet into the large intestine.

For an EBT colonoscopy, a technician or the patient inserts a miniature rubber tube one inch to allow air to expand the colon for easier viewing.

The EBT has an immediate recovery time, unlike the half-day traditional colonoscopy, and mild laxatives and more brief special diet replace harsh bowel cleansers and longer special diet.

EBT colonoscopy uses digital imaging, not a physical probe to see inside the colon, so drastic measures to cleanse the bowels are unnecessary. Any remaining stool residue can be removed from the photos electronically.

EBT colonoscopy was approved by the Food and Drug Administration in 1999 and has been offered by CHBI since then.

There is no standardized training for EBT technicians; however, several medical universities offer two-day fellowships in the procedure, and various conferences also offer training.

According to Ehrlich, EBT colonoscopy is as effective as traditional screenings.

?When we look at the lesions or polyps that have a reasonable chance of becoming cancerous, virtual colonoscopy has been proven to be of equivalent accuracy as traditional,? he said.

?Traditional colonoscopy can often see very small lesions that the virtual one will miss,? Ehrlich said. ?The message is that of the polyps we should find, 10mm or larger, are readily detected by our method.?

Another difference is how much of the colon EBT can explore.

?EBT sees 100 percent of the organ,? Ehrlich said, ?which is a primary characteristics of any screening test. A traditional colonoscopy cannot see in the reverse direction under the various folds.?

Ehrlich estimates that at least 5 percent of traditional colonoscopies fail because they do not reach the end of the large intestine.

?A virtual colonoscopy is always able to do so,? he added.

Colonoscopy is routinely performed before operating to remove an obstruction.

?A traditional scope cannot look beyond that obstruction,? Ehrlich said. ?A virtual colonoscopy can look beyond that obstruction to see if there are other obstructions or lesions.?

The EBT also comes with an abdominal scan, an extra not part of a traditional colonoscopy. ?We find significant things in the abdomen, like kidney stones or plaque in the aorta,? Ehrlich said.

Because the EBT is non-intrusive, the procedure is safe, according to Ehrlich.

?There is zero chance for complications,? he said. ?There’s nothing we can do that can cause a complication. Traditional colonoscopy has about a one in 200 chance of complication.?

Many patients worry about complications, according to Epstein.

?With (virtual colonoscopy) you don’t have the anxiety of perforating the colon,? he said. ?I know someone who that happened to, and it’s a big problem because of the infection.?

One disadvantage of the virtual screening is that if a polyp is found, the EBT technician cannot remove it.

?We refer patients to traditional colonoscopy physicians when we have detected problems,? Ehrlich said.

Armed with the EBT images and initial diagnosis, physicians can perform the removal more easily, according to Ehrlich.

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