Virtual colonoscopy: The pain comes later

David L. Shenkenberg

Patients typically report less discomfort with virtual colonoscopy than with the traditional procedure, but a study shows that this benefit may come with monetary drawbacks.

A virtual colonoscopy involves a CT scan of the entire abdomen and pelvis, and the acquired images can contain suspicious findings that sometimes reveal previously unknown conditions outside the colon or that are sometimes artifacts. These findings can entail extra diagnostic procedures that cause increased patient discomfort as well as add to overall medical costs.

To determine the cost of virtual colonoscopy relative to that of traditional colonoscopy, researchers at Wake Forest University Baptist Medical Center in Winston-Salem, N.C., analyzed records from 136 patients who had undergone both methods. The study included patients for whom routine colon cancer screening is recommended: They were at least 50 or had a history of disease that predisposed them to colon cancer.

Virtual colonoscopy detected potential conditions outside of the colon in 98 percent of patients, every one of whom was healthy. Although some of these findings were discounted as clinically insignificant, one-fourth of the patients had additional procedures performed on them, including blood work, radiological studies such as MRI, and endoscopic techniques such as laparoscopy and cystoscopy. These added procedures cost $231 per patient.

The researchers presented these determinations at the annual meeting of the American College of Gastroenterology in October.

Dr. Richard S. Bloomfield, an author of the study, said that radiologists need to understand that these insignificant findings can be discovered with virtual colonoscopy, and he recommended that they establish standards for their classification.