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Which will give the best results between a standard colonoscopy, a virtual colonoscopy and a capsule endoscopy?

Gastroenterology Cancer Colorectal Surgery

How reliable is a standard colonoscopy versus a virtual colonoscopy (CT colonoscopy) or capsule endoscopy? Do they all serve the same purposes? The capsule and virtual colonoscopy “methods” seem less scary, but I am confused as to why or when one is chosen over the other.

DOCTOR’S ANSWER (1)

To find out more about getting a colonscopy in Singapore, you can read my Complete Guide To Colonoscopies In Singapore (2018)

A standard colonoscopy’s sensitivity is in the range of 95 – 98% accurate, while a CT Colonography’s sensitivity can range from 90 – 95%.  However, it is imperative to note that the sensitivity and accuracy of either investigation is highly dependent on the quality of the bowel preparation before the procedure.  The poorer the bowel preparation, the lower the accuracy.

In general, a colonoscopy is the preferred mode of investigation as it has the benefits of higher accuracy (with the ability to directly visualize and differentiate lesions through the lens) and the ability to remove or biopsy these lesions during the procedure itself.  However, it carries a 1 in 1000 risk of bowel perforation from the procedure, as well as the risks of bleeding, which might need major surgery to treat. 

As such, for patients who are aversed to the risks of a colonoscopy, or patients who are too frail medically to undergo the procedure, the option of a virtual colonoscopy (aka CT Colonography) or a barium enema will be considered, with the caveat that the patient understands that they have to accept a lower accuracy of the imaging findings, as well as the possible need for a colonoscopy to clarify, confirm and biopsy suspected lesions noted on the imaging tests.

Capsule endoscopy is used for the small intestines and is not considered an alternative to a colonoscopy. 

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