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Virtual Colonoscopy Study

1. JAMA study, "Computed Tomographic Colonography (Virtual Colonoscopy): A Multicenter Comparison With Standard Colonoscopy for Detection of Colorectal Neoplasia" and also Dr. Ransohoff's editorial in JAMA
2. "Computed Tomographic Virtual Colonoscopy to Screen for Colorectal Neoplasia in Asymptomatic Adults"
   New England Journal of Medicine (NEJM) by Perry J. Pickhardt, M.D., and colleagues.
   Vol 349 :2191-2200, dec 4 2004, number 23

The NEJM study, involving military personnel and dependents, found a sensitivity for CTC (Computed Tomographic colonoscopy) of 93.8 percent for adenomatous polyps at least 10 mm in diameter, 93.9 percent for those at least eight mm in diameter and 88.7 percent for polyps at least six millimeters in diameter.

Data from the Wake Forest group, led by CTC pioneer David J. Vining, M.D., contributed the most participants and had the best results, with a primary outcome sensitivity of 86 percent for the detection of polyps greater than 10 mm.

A study at Wake Forest, published last fall in Gastroenterology, in which CTC had a sensitivity of 90 percent for the detection of polyps 10 mm or greater. "We had well-prepared patients, both in terms of getting rid of the stool and distending the bowel with gas," he says. "In that study, we used a sodium phosphate laxative followed by an iodine oral contrast agent—the advantage of this approach is that inside the bowel the residual water is clear so a colonoscopist going in later that day can see through the water or suck it out, whereas barium-tagging agents cloud the water and the patient has to go back for a second bowel prep."

Professional Competition

Another concern is how other professional groups, particularly gastroenterologists, will approach CTC.

"Fifteen years ago an intense competition occurred among gastroenterologists, radiologists and surgeons about who would perform and control the new technology of gallstone lithotripsy," writes Dr. Ransohoff in the JAMA editorial. "The episode was short-lived and has largely been forgotten because the technology so quickly proved to have limited practical use, but the fact that it occurred exposed a kind of competition that may affect virtual colonoscopy. Professional collaboration and experimentation regarding logistics would make sense both for patient service and for long-term professional relationships."