Colonoscopy and Alternatives

Colonoscopy is the gold standard for diagnosing conditions of the colon. Most important of these conditions is colon cancer. Colonoscopy is also an effective and non-invasive means to treat conditions of the colon that are believed to lead to colon cancer.

Early diagnosis of colon cancer and identifying pre-malignant conditions of the colon are the best ways to prevent death from colon cancer.

For many years the American Cancer Society and the American College of Surgeons have recommended screening colonoscopy starting at age fifty. Hundreds of thousands of lives have been saved because of this. In fact this may have been the most significant innovation in medicine since antibiotics.

The cost of total colonoscopy for an uninsured patient is about $2,400. Unfortunately this price keeps many patients who need an examination of the colon from getting the care that they need.

There are alternatives to colonoscopy. They are inferior in their accuracy and cannot treat premalignant conditions of the colon. Never the less, they are better than doing nothing.

Air contrast barium enema

The average cost for an air contrast barium enema without insurance is about $600. For fifty years before the advent of endoscopy it was the gold standard for diagnosing conditions of the colon.

The procedure is performed using conventional fluoroscopic x-rays. The patients takes some laxatives the day before the procedure to clear the colon of feces. In the x-ray suite the patient lays on an x-ray table and a radiologist using fluoroscopy examines the patients abdomen. During the examination an enema containing barium contrast and air is administered to the patient. Usually this is done without anesthesia and is only mildly uncomfortable.

With the contrast outlining the inner wall of the colon the radiologist can examine in good detail the colon under fluoroscopy. If anything is found then colonoscopy is mandatory for biopsy. If nothing is found and the patient does not have blood in his stool then his colon is likely healthy.

Rigid proctosigmoidoscopy

This is an office based procedure that is done without anesthesia. Rigid proctoscopy average cost is about $300 without insurance.

A rigid proctoscopy is a 10 inch tube with a light and a lens at one end. The doctor introduces the scope through the patient's anus into the rectum and inflates the rectum with air. Looking thru the lens the doctor then can examine the rectum which is the lowest portion of the colon and is where most colon cancers occur. Biopsies can be preformed if necessary and even small polyps may be removed. The disadvantage of this procedure is that it only examines 10% of the colon.

Flexible sigmoidoscopy

Flexible sigmoidoscopy is an office based procedure which is done without anesthesia. Average cost without insurance is $400.

A flexible sigmoidoscope allows the doctor to examine the lowest third of the colon. This is significantly better than the rigid proctoscope. As an office procedure without anesthesia it can be very uncomfortable.

Anoscopy and digital anal examination

These are normally done as part of a routine physical examination which costs an average of $100 without insurance. This is a very limited examination of the colon.

Stool blood test

Stool can be tested for microscopic traces of blood for about $20. If traces of blood are found then colonoscopy is mandatory. A negative test in no way indicates that the colon is healthy.

CT Virtual colonoscopy

Average cost for CT virtual colonoscopy is $1,200. In principle and in accuracy it is very similar to an air contrast barium enema but is double the cost. Fluoroscopic air contrast barium enema has an advantage because the patient is being examined in real time and the doctor may want to focus on one area. Virtual colonoscopy is static imaging that is reviewed by the doctor after the examination is completed.

It is preformed by giving the patient an air enema and then doing a conventional CT scan of the abdomen. The images are then reconstructed in software to produce a 3D picture of the colon. It is high tech and compelling because of this but suffers from inaccuracy. If the test is abnormal then colonoscopy is mandatory. If the test is negative and the patient does not have blood in the stool then the colon is likely healthy.

Colonoscopy

Colonoscopy is the gold standard by which all other colon tests are measured.

A colonoscope is similar to a flexible sigmoidoscope except that it is twice as long and is able to examine the entire colon. This examination is usually done under anesthesia because it may otherwise be very uncomfortable

Colonoscopy in addition to finding cancer may find small benign polyps which are pre-malignant. These polyps can be removed during colonoscopy preventing a future cancer. If you need cancer screening and can afford it then this is the test to get.

The alternatives to colonoscopy are only recommended where colonoscopy is not an option