Dr Robin Spiller is a professor of gastroenterology in the Faculty of Medicine and Health Sciences at the University of Nottingham and member of the Board of the Rome Foundation.
What is your opinion on avoiding colonoscopy in frail older patients in order to lessen burden to the patient and replacing it with barium enema radiography?
Robin Spiller, MB BChir (Cantab), MSc, MD: I agree, colonoscopy can be quite traumatic for an elderly patient. I have to say that preparation is probably the worst bit. Actually, putting the endoscope, if it is done by a skilled operator, may not be as bad as the prep.
We certainly do use computed tomography (CT) colonography, and we do not use barium enemas anymore. With CT you can reconstruct the colon and detect small polyps. It is pretty sensitive: around 95% sensitive for polyps over 5 mm, which is the ones we are interested in.
The downside of CT colonoscopy would be that it may then lead to a colonoscopy. The upside is that it detects other disease outside the colon, for example, which might not have been suspected, such as a mass outside the colon that would be picked up by that, not by colonoscopy.
I think if we have a frail patient who maybe has had colonoscopy before and says they do not want to have it again, we would certainly consider CT colonoscopy. Remember, though, they do have to have the same prep, so you do not get around that problem.