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

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

3. How often do you need to have test? If no cancer or positive finding - 10 years If cancer or positive finding - 5 years Discontinued after 75 if no findings previously

4. Long, thin, flexible instrument connected to camera and video display monitor Inserted into rectum and up to T.I. Colonoscope

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

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

7. Sigmoidoscopy No drugs! Major pain and cramping Colonoscopy Good drugs! No cramping Colonoscopy vs. Sigmoidoscopy (cont’d)

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

9. Polyp cont’d If encountered- thin wire snare is used to lasso it or electrical heat (electrocautery) applied to remove painlessly Some may disappear on own

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

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

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

15. Virtual Colonoscopy (VC) ( aka: CT Colonography)

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

17. VC

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

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

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

22. Cost Much cheaper than standard colonoscopy ($800 vs $3,000) But Insurance companies won’t pay for routine diagnostic VC exam: