Virtual colonoscopy is more comfortable. Just thought you should know:
Wake Forest University Baptist Medical Center researchers have found that "virtual" colonoscopy using a computer tomography (CT) scanner is considerably more expensive than the traditional procedure due to the detection of suspicious images outside of the colon.
"Virtual colonoscopy will certainly play a role in the future of colon cancer screening," said gastroenterologist Richard S. Bloomfeld, M.S., M.D., assistant professor of medicine at Wake Forest Baptist and a member of the research team. "It is important to understand the implications of findings outside the colon before we advocate wide-spread use of this technology."
Virtual colonoscopy, also known as CT-colonography (CTC), was developed at Wake Forest Baptist. It allows doctors to use CT scanners to look at the colon to detect polyps (small growths in the colon that may become cancerous if they are not removed) and cancers. Virtual reality software allows them to look inside the body without having to insert a long tube (conventional colonoscopy) into the colon or without having to fill the colon with liquid barium (barium enema).
Research performed at Wake Forest Baptist and elsewhere has shown that CTC is better able to see polyps than barium enemas and is nearly as accurate as conventional colonoscopy. Most patients report that CTC is more comfortable than either procedure. (Emphasis mine.)
I wasn't under the impression that there was a great deal of debate about which was more comfortable. I mean I was operating under the impression that given the choice between rectal insertion and rectal non-insertion, the preference for rectal non-insertion is a cross-cultural law of nature.
This issue is that if they find something on CTC, they have to go in with a regular colonoscopy to fix it. Regular colonoscopies have the rather considerable benefit of not having to go in for a second look. If you see a polyp, you can just zap it right there. That is why I kind of doubt that other procedures will ever really supplant it.
- Log in to post comments
It was my experience that the colonoscopy itself is painless. I remember absolutely nothing about mine other than getting a needle in the arm and being asked to roll onto my side. The worst part of it was having to drink 50 gallons (or whatever) of a disgusting liquid flavored with a disgusting imitation of artificial fruit flavors to clean out the colon. If you have to do that before a CTC, then why bother with the CTC? You have already gone through the most uncomfortable part of the colonoscopy process. Besides, if you get the colonoscopy, you get to have the strange experience afterwards of walking around with a totally blank mind but acting as if you were actually mentally present.
In comments to a Pharyngula (I believe) post regarding torture and pain, I used my colonoscopy experience to advance the notion that not remembering pain is for all intents and purposes the equivalent of not experiencing pain. I was criticized fairly strongly for advancing that notion.
Jake, I think you are spot-on.
People seem to have widely differing experiences with colonoscopy, pain-or-discomfort-wise. I have had one every 6 to 18 months over the past 20 years, and I always find the procedure excruciatingly painful, but on every single occasion except one my doctor found polyps that needed to be zapped with a laser or yanked out for pathology. Virtual colonoscopy would save me nothing, I'd just have to do double the preps, which are a tiresome business and, as Mark observes, no fun in themselves, plus double the time and double the cost for the procedures.
To underline that there is a purpose to all this, last year my doc found a Dukes Stage 1 cancer that required a partial colectomy. That wasn't any fun either, but I guess it beats an agonising and undignified early death by a considerable margin.
I also think Mark is right, the one occasion I managed not to retain any conscious memory of the procedure was the one time it seemed bearable after the event. I wish the bastards would shoot me full of enough happy juice to make me pass out for the hour or so it takes to do the rectal insertion procedure/polyp spotting and zapping every time, but the doc says the patient needs to remain responsive to avoid perforating the wall of the colon.
I think maybe virtual colonoscopy might be useful for first-time screening to encourage more people to have it. Apparently a lot of people who should be screened avoid the rectal insertion procedure on the grounds of embarrassment or anticipated pain/discomfort or just not fancying a garden hose up the poop chute (cross-cultural), and a non-invasive procedure might encourage more people to be screened. Also, perhaps it avoids any risk associated with the rectal insertion procedure.
But once they find something in the colon, there's no practical substitute for going in there to get it, and if there's a reasonable probability they will, the virtual procedure becomes pointless at the present time.
I actually enjoyed the procedure - I asked for the lightest dose of drugs, so I was "all there," and happened to be positioned so that I could watch the TV monitor. It was absolutely fascinating to see.
I had to laugh when they paused the procedure and dimmed the room to try and see the light from the scope through my abdomonem - trying, as I recall, to get a fix on their location.
A couple weeks later I got to expereance the 'scope from the other end. That was unpleasant.
My mother has had a painful colonoscopy. I think if it's done correctly, the patient should have no memory of the procedure. The odd thing about the sedative or whatever they use is that it apparently leaves the patient responsive but without any memory. During the recovery, I was apparently walking and talking as if I were mentally all there, but I have only flashes of the period between the end of the procedure and waking up in my bed. In the meantime, I spoke to my fiance, walked down the hall, went to a hamburger place, went home, argued that I didn't need to go to bed and a number of other things I have not been told about. I cannot testify that any of it actually happened, because, as I said, I remember only flashes of it. I presume I was in a similar state during the procedure, in that I could respond and move as directed. That, it seems to me, is the way it should be: no memory of pain or discomfort. If it's hurting when you have it done, I suggest a different gastro specialist.
Sorry, I think that should have been Dukes Stage A. First stage. Whatever. Means I'm really fortunate it was found that early.
Mark, yes I agree that's no doubt the intended/desired state and what should happen, what I think is called 'twilight sleep', but it seems the drugs affect different people differently. If they pump too much into me, it doesn't put me out, I just start dry retching violently, which is not very clever of me with 5 feet of scope up my backside and the doc trying to get the procedure done. Straight after the procedure I'm fully conscious and have total recall. I think I'd be deeply resentful if I had a hamburger and didn't recall the experience - haven't had one in years.
The doc told me I have a real tight bend between the descending colon and the transverse colon, I guess that is what causes some of the trouble. Unfortunately it seems the colon becomes less elastic with age, so the pain increases with time. Being physically fit certainly seems to help speed of recovery afterwards, but doesn't seem to make the procedure any easier for me, although the doc says it makes it easier for him. I have diverticular disease quite badly, so maybe that's a factor, but lots of people have that as they get older to varying degrees.
I've had 3 different gastro specialists, and the current guy is the best/most sympathetic pain-wise that I've found. I've been told by other doctors he's the best in the place that I'm in. He has his own private operating theatre and all the latest gear, and good theatre nurses who have known me for 14 years and are alert to the pain problem. Just seems like I'm unlucky in that department.
The scope from the other end didn't bother me at all, and after the surgery last year I had to have a tube up my nose which I had to swallow down into my stomach to drain it, and that didn't bother me at all either. I seem to be good at swallowing tubes, the nurses were impressed. It would be kind of depressing if I was bad at everything :)
But in the grand scheme of things it's a day of prep and an hour of painful procedure every 6-12 months, no doubt many other people have much worse to suffer. And I'd still sooner have the invasive procedure and get it all done with in one go than bother with the virtual procedure, in the almost certain knowledge that it would have to be followed by the insertion procedure anyway.
For initial screening and for people who are not found to have problems and only need to be re-screened as a precaution say every 5 years, maybe the virtual procedure will have something to recommend it once they iron out the bugs.
As I recall, the "if they can't remember it, it's like they can't feel it" argument was once used to justify the administration of memory-blocking drugs to burn victims undergoing tissue debridement. Then patients started having strokes because of the elevated blood pressure associated with excruciating pain.
There's probably a lesson there, somewhere.
Caledonian, that same argument (you perhaps made it?) was offered in the original exchange regarding remembered pain. I have not seen actual data on what you mention.