House Calls / Dr. Michael Schwartz

Many patients celebrate their 50th birthday by scheduling their first colonoscopy. More than 10 million colonoscopies are performed each year, and statistics show that these screenings may reduce the risk of colon cancer by almost 90 percent. Colonoscopies are the most effective way to detect and often treat colon lesions, ultimately preventing the disease.

The traditional endoscopic exam "colonoscopy" is performed with the use of a flexible fiber-optictube. The instrument, which is inserted into the rectum, contains a small video camera which enables the doctor to see the inside of the colon. The scope is long enough to visualize the entire large intestine and enables the doctor to help identify polyps, bleeding, tumors and inflammation. In addition, procedures such as biopsies or removal of polyps can also be performed directly through this scope. The entire colon can be screened for pre-cancerous lesions which can easily be removed at the same time with little pain or discomfort. Risks, although quite rare, include possible perforation or tearing of the colon (which may require surgery), abdominal bloating and bleeding.

Colonoscopies are generally performed in a hospital or outpatient facility. Before the procedure, an intravenous tube is inserted into a vein so that anesthesia may be administered. You will undergo a brief examination, which will include basic vitals such as blood pressure, temperature, etc., and will be asked a few questions regarding your medical history, medications and allergies. The test itself typically takes less than 30 minutes. Following the procedure, you will be taken to the recovery area to allow the anesthesia to wear off. Most patients are discharged within an hour following the test. You will need someone to drive you home, since the complete effects of the anesthesia may take several hours to pass.

Screening success can depend on several factors. Specifically, the experience of the doctor performing the test is one of the most important factors. The next critical factor in a successful screening is proper preparation. Many patients fear the prep more than the actual procedure. The prep involves cleaning out the colon the day before. There are many different preps available including pills, liquids, powders and suppositories. Your doctor will advise which prep is recommended. You should not be anxious about this part of the procedure. Most patients exhibit few, if any, side effects. Mild abdominal cramping, watery stool and bloating can occur and will typically resolve a few hours after the prep is completed. Proper prep is critical; poor preparation often impairs the doctor's ability to find all suspicious lesions and may require that the colonoscopy be repeated.

The cost of the procedure varies depending on where it is performed. Procedures performed in a hospital tend to be more expensive than outpatient "surgi-centers." This is due to a separate fee often charged by the facility. In addition, there may be fees for the anesthesiologist, medications used during the procedure and the cost of having any polyps removed for biopsy. Most insurance plans cover screening colonoscopies for patients older than 50 and may cover the procedure if an indication exists such as rectal bleeding, sudden unexplained weight loss, abdominal pain or a change in bowel habits. Medicare rules on coverage for colonoscopies vary.

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A virtual colonoscopy is performed by using a CT scan of the abdomen in order to detect any masses or lesions within the colon. It is non-invasive, sedatives are not needed and there is no risk of perforation. Patients do receive a small amount of radiation, and if a mass or polyp is identified, a traditional colonoscopy will need to be performed. A colon prep is still necessary before this procedure. This test should be reserved for patients too ill to undergo a regular colonoscopy.

Hemoccult slides are used to detect blood loss in the intestines. Your doctor will provide you with several cards and have you place a small amount of stool on each; these samples are then tested to measure whether any trace amounts of blood are present. If positive, it may indicate polyps or hemorrhoids and a colonoscopy may be ordered.

Barium enema is a test where a contrast material is inserted into the colon through a small tube. An X-ray is then taken to visualize the large intestine. Polyps and other abnormal lesions can be visualized. A colon prep needs to be performed before the test. Once the test is completed, the contrast is removed as you move your bowels.

Sigmoidoscopy is a procedure typically performed in the physician's office. It entails using a shorter colonoscope and is performed without anesthesia. Since the majority of colon cancers occur within a few centimeters of the rectum, sigmoidoscopy offers patients another option, especially if they cannot tolerate anesthesia.

Some studies suggest that as many as 50 percent of Americans over age 50 do not have their screening colonoscopy. Whether due to the perceived embarrassment of having the test, the anxiety of the procedure, the fear that the doctors may discover a problem or just the fact that scheduling the test may be inconvenient, millions of Americans risk not detecting colon cancer until it is too late. Make an appointment today -- this birthday present may save your life.

Dr. Michael Schwartz is board certified in internal medicine with a private practice in Darien. For comments or questions, visit his website at