1. What is a colonoscopy? Study of lining of colon and rectum by a gastoenterologist Study of lining of colon and rectum by a gastoenterologist

2. Long, thin, flexible instrument connected to camera and video display monitor is inserted into rectum and up to T.I. Colonoscopy

4. Colonoscopy recommended if: bowel habits change bowel habits change blood in stool blood in stool persistent abdominal pain persistent abdominal pain patient is aged 50 years or older patient is aged 50 years or older

5. Major step towards preventing colon cancer! Colorectal cancel 2 nd leading cause death in US Colorectal cancel 2 nd leading cause death in US 1 in 20 adults will develop colon cancer 1 in 20 adults will develop colon cancer Colonoscopy more accurate than all other methods to detect polyps and early cancer Colonoscopy more accurate than all other methods to detect polyps and early cancer Simpler than exploratory surgery Simpler than exploratory surgery

6. Colonoscopy vs. Sigmoidoscopy Colonoscopy inserted into rectum-moved through entire colon Colonoscopy inserted into rectum-moved through entire colon Sigmoidoscopy - inserted into rectum-final 2 ft colon Sigmoidoscopy - inserted into rectum-final 2 ft colon

7. Sigmoidoscopy No drugs! No drugs! Major pain and cramping Major pain and crampingColonoscopy Good drugs! No cramping Colonoscopy vs. Sigmoidoscopy

8. Polyps Benign growths on inner wall of colon Benign growths on inner wall of colon Size: pinhead to several inches Size: pinhead to several inches Painless Painless Slow growing- years before become aggressive cancer Slow growing- years before become aggressive cancer

9. Polyp cont’d If encountered- If encountered- –thin wire snare is used to lasso it –electrical heat (electrocautery) applied to remove painlessly

11. Colonoscopy (cont’d) Takes less than an hour Takes less than an hour Mild sedation - relieve anxiety and discomfort (someone must drive you home) Mild sedation - relieve anxiety and discomfort (someone must drive you home) Often not remembered by pt. Often not remembered by pt. May experience bloating- will quickly improve. May experience bloating- will quickly improve. Can resume eating a regular diet later that day Can resume eating a regular diet later that day

12. Prep Similar to BE and ACBE Similar to BE and ACBE Low residue foods 2 day before Low residue foods 2 day before Eat jello, drink clear liquids day before AM appt. Eat jello, drink clear liquids day before AM appt. Afternoon before: Afternoon before: –laxative –gallon of liquid (Golytely) –Starve AM appt.! AM appt.!

13. Advantages over Barium Studies No x-ray! No x-ray! Can perform polyp removal, tissue sampling during study Can perform polyp removal, tissue sampling during study More accurate than BE, pneumocolon More accurate than BE, pneumocolon

14. Virtual Colonoscopy (VC) (CT Colonography)

15. What is a VC? Procedure to look for signs of precancercous growths (polyps), other diseases of large bowel Procedure to look for signs of precancercous growths (polyps), other diseases of large bowel 1st introduced 1994 as alternative to regular colonoscopy 1st introduced 1994 as alternative to regular colonoscopy Produces 2 and 3 dimensional images and video Produces 2 and 3 dimensional images and video Uses CT scanner, sometimes MRI Uses CT scanner, sometimes MRI

16. Advantages of Virtual Colonoscopy over previously accepted forms of determining colorectal cancer Less rigorous bowel prep Less rigorous bowel prep short procedure – 15- 20 minutes short procedure – 15- 20 minutes no sedation or anesthesia no sedation or anesthesia no invasiveness-no scope- more compliance! (thin tube to pump air to inflate colon) no invasiveness-no scope- more compliance! (thin tube to pump air to inflate colon) no risk of perforation of colon no risk of perforation of colon more complete exam of colon (often can’t reach end- blockage, redundant bowel with conventional colonoscopy more complete exam of colon (often can’t reach end- blockage, redundant bowel with conventional colonoscopy Faster- more pts can be done ($$$) Faster- more pts can be done ($$$)

17. Besides colon you see: liver liver gallbladder gallbladder pancreas, spleen pancreas, spleen kidneys, adrenals, lymph nodes organs (Dr. Graham) kidneys, adrenals, lymph nodes organs (Dr. Graham) uterus uterus ovaries ovaries prostate prostate assessment of aorta to exclude aortic aneurysm assessment of aorta to exclude aortic aneurysm

18. Disadvantages - Virtual Colonoscopy over Colonoscopy Cannot remove polyps! Cannot remove polyps! Uses radiation Uses radiation Pt. confined in tight area Pt. confined in tight area

19. Cost Though just as effective in diagnosing lesions larger than 6mm Though just as effective in diagnosing lesions larger than 6mm Insurance companies won’t pay unless Insurance companies won’t pay unless –Severe coagulopathy –Can’t tolerate sedation –Must pay for it yourself! Special offer! $425 Body Scan ($800 for two people) $825 Body Scan/ Virtual Colonoscopy combination($1550 for two people) Prices include physician consultation!

20. How often do you need to have test? No cancer or positive finding - 10 years No cancer or positive finding - 10 years Cancer or positive finding - 5 years Cancer or positive finding - 5 years

21. The End