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 Referral Letter
    Interactive PDF form, save to your
    computer, fill in details and print
    out to give to you patient. (733kb)

 Information kits request
    Patient info Brochures,
    waiting room posters etc.

Bulletin Board

VIRTUAL COLONOSCOPY - HAS IT ARRIVIED?

I attended an overview of developments of Virtual Colonoscopy at the Digestive Diseases Week, San Diego in May.

Virtual Colonoscopy has potential major advantages in surveillance and screening for polyps and cancer. What are the problems?

Technology
Present spiral CT or slower MR scanning can provide images of the entire colon in 15 to 20 seconds, that is a single breath hold. A Radiologist's assessment of the 2D slices or three-dimensional images produced by computer manipulation may take between 30 and 60 minutes. Although automated fly throughs are being developed.

Patient preparation
(a) Colon cleasing is still required and is a significant deterrent to patient compliance. However, computer faecal deletion techniques are being explored.
(b) Gaseous distension is necessary and uncomfortable for the patient.

Accuracy of results
For 6 - 9 mm polyps, sensitivity compared with present colonoscopy is about half (50 to 80%) and for sessile polyps, which have a greater malignant potential, is even worse.

In summary, in its present state of development, Virtual colonoscopy is not an appropriate technique particularly for surveillance or screening because of:

(a) Colon preparation and distension are still required limiting patient compliance.
(b) More expensive than colonoscopy due to
(1) equipment and (2) radiological interpretation.

Overall, real colonoscopy still remains the "gold standard" and retains both its diagnostic and therapeutic application.

PETER GRAY
M.B.B.S. (Melb), F.R.C.S., (Ed), F.R.A.C.S. M.B. B.S. F.R.A.C.P.
 

 

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