How to Look Into a Colon

Colonoscopy, Barium Enema, Virtual Colonoscopy

The colon is often the site of development of overgrowths of the lining called polyps.  Polyps are usually benign and harmless.  However, polyps can transform into colon cancers and it is for this reason that your doctor may recommend a screening test to evaluate the colon lining.

If you need a colon evaluation in Los Angeles or Beverly Hills, your colon and rectal surgeon, also known as a proctologist, may recommend that you undergo a colonoscopy. This a test in which your colorectal surgeon inserts a small tube into your anal opening and guides the tube through the colon while watching a screen with the visual, real time image of the colon.  You will be sedated during the examination.  If there are any polyps, your doctor will remove them.

Many patients have questions as to which screening technique is “the best”,  colonoscopy, barium enema, or virtual colonoscopy.  Each procedure has its risks and benefits, its pros and cons, its admirers and detractors.  Which is “the best”?

Colonoscopy

Also called optical colonoscopy, this is the traditional method used in examining the colon.  It is the “gold standard.”

Pros:

  • Most common test used to evaluate the colon.
  • Most thorough and accurate.
  • Allows for biopsies or removal of polyps if any are found.
  • No radiation needed.
  • Costs covered by insurance

Cons:

  • Requires a complete bowel preparation
  • Risk of bleeding, perforation or injury to the spleen.
  • Requires sedation (Which is safe.  However, some patients are frightened at the thought of “being put to sleep” or at the loss of control.
  • More expensive than other screening tests (usually performed at a surgicenter or hospital)

Barium Enema

The old “gold standard.”

Pros:

  • No sedation required
  • Quicker than a colonoscopy (usually performed at a radiologists office).
  • Costs usually covered by insurance

Cons:

  • Requires a complete bowel preparation.
  • Mild cramping during this 20 minute procedure.  Barium is infused into the colon.
  • Polyps or other growths cannot be removed.  A repeat bowel preparation is needed and a colonoscopy is needed.
  • Slightly less thorough than a colonoscopy
  • X-ray (radiation) is used.
  • Smaller polyps can be missed (a false negative)  and small pieces of stool can be confused with a polyp (a false positive), necessitating a colonoscopy.
  • Rare complications such as perforation.

Virtual Colonoscopy

Pros:

  • No sedation required
  • Quicker than a colonoscopy (usually performed at a radiologists office).

Cons:

Requires a complete bowel preparation.

  • Mild cramping during this 20 minute procedure.  Air is infused into the colon.
  • Polyps or other growths cannot be removed.  A repeat bowel preparation is needed and a colonoscopy is needed.
  • Slightly less thorough than a colonoscopy
  • X-ray (radiation) is used.
  • Smaller polyps can be missed (a false negative)  and small pieces of stool can be confused with a polyp (a false positive), necessitating a colonoscopy.
  • Costs not covered by insurance.
  • Not accepted as a screening procedure for colon polyps or cancer.
  • Rare complications such as perforation.

As always, you should discuss your situation with your colorectal surgeon in Los Angeles or Beverly Hills.  The board certified surgeons of Los Angeles Colon and Rectal Surgical Associates are available to help you understand your options.  Call (310)273-2310 to schedule a confidential consultation.