Gastrointestinal specialists comment on new study on 'Virtual' colonoscopy

December 01, 2003

Arlington, VA, December 1, 2003 - New colorectal cancer screening strategies, including virtual colonoscopy and fecal DNA testing, offer the potential to enhance the acceptability of colorectal cancer screening to some persons. Virtual colonoscopy has not yet been endorsed by any multidisciplinary guideline group as an effective colorectal cancer screening strategy. The principle obstacle to endorsement thus far has been the wide range and frequent lack of effectiveness in clinical trials.

The American College of Gastroenterology congratulates the investigators of a new study on virtual colonoscopy that will appear in the New England Journal of Medicine next week. The results represent a remarkable improvement on previous results. The results appear to rest on fundamental changes in the method of performance of virtual colonoscopy. Excellent results have been seen in some previous studies that could not be repeated by others. It will be important to verify these results to confirm their generalizability.

Conventional colonoscopy is itself a dynamic technology. Improvements in bowel preparation, sedation and sensitivity for adenomas are being actively investigated and developed.

"Considering all available literature, conventional colonoscopy as currently performed remains the clear gold standard for the diagnosis of colorectal cancer and adenomas. Patients should be aware that in this study of virtual colonoscopy and in some others, they are more likely to experience significant discomfort with virtual colonoscopy than they are with conventional colonoscopy," stated Douglas K. Rex, M.D., FACG, President of the American College of Gastroenterology and Director of Endoscopy at Indiana University Hospital in Indianapolis, IN.

As was demonstrated in the NEJM study, at least 30 percent of patients (in some studies higher percentages) undergoing virtual colonoscopy will require conventional colonoscopy to remove polyps 6mm or larger.

Dr. Rex added, "Thus virtual colonoscopy is a diagnosis-only test, whereas conventional colonoscopy remains the only strategy that allows both diagnosis and treatment in a single session. The relative cost-effectiveness of virtual colonoscopy, the intervals at which it would be performed, and the risks associated with radiation, remain uncertain."

Porter Novelli

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