Incomplete Colonoscopy

[LittlePete]

I'm having a series of tests this month to determine unexplained 20 lb weight loss since January. Had bouts of nausea and vomiting in the Spring, but now feel reasonably well for 74 year old, but primary Md somewhat concerned.  I do have some family history of colorectal cancer.  A colonscopy done in 2000 removed a benign polyp.  

Upper GI was negative.  Upper endoscopy resulted in pyloric dilation, apparently due to old ulcer scarring. Now taking Protonix.  Yesterday I had a colonscopy, which couldn't be completed due to "multiple sharp angulations, associated with diverticulosis in sigmoid colon preventing passage beyond 60 cm."  Doctor recommended virtual colonoscopy or Barium enema to complete evaluation of colon.  

Question:  Why not have both virtual colonoscopy AND barium enema? One might catch what the other missed. If insurance won't pay I am willing to pay for one or both.

Question: If these tests do find polyps in the part of the colon the colonoscope couldn't get to, what then?  How are the polyps removed and evaluated? I assume they would need to be sent for pathology?  Abdominal surgery, laparoscopic surgery, or what?  Surely there is some easier way.  Please?

[Kevin Pho, MD]

To answer your questions:
1) You're right in that one test might catch something the other missed, but each test is pretty comprehensive.  I agree that one should be enough in most cases.

2) You're right - colonoscopy would be the only way to remove any suspicious lesions for pathology.  Heavier sedation, or a transfer to a larger academic medical center, can be considered in these more difficult cases.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
Medical Weblog:
kevinmd_b

[candyland22]

A related discussion, Incomplete Colonoscopy was started.