Colonoscopy vs Barium Enema for Colon Cancer Screening

[jmpr]

I am 58 years old, have never had a colonoscopy and my doctor is recommending one for colon cancer screening. I need antibiotic prophylaxis because of mitral valve prolapse with regurgitation, plus the other two valves have regurgitation and the aortic valve is sclerosed. I have a repaired VSD from 1964 and also had a atrial myxoma removed with a septum patch in 2003.
I am allergic to both Penicillin and Vancymycin, however, and my doctor is trying to convince me to have the colonoscopy without prophylaxis, saying there is more danger of colon cancer than endocarditis. The GI who would do the test also says no antibiotic is necessary.
I had a double contrast barium enema 5 years ago and am afraid enough of endocarditis that I'm thinking of saying no to the colonoscopy and only having another barium enema even though it's not as good of a screening test.
I have not been having any symptoms, except for occasional constipation and my stools have lately usually been much darker brown than they used to be. I do have benign hypertrophic papilla which cause bleeding sometimes and so a FOB test wouldn't be of value.
Is a double contrast Barium Enema a good enough screening test to be of value? Has virtual Colonoscopy advanced enough to be better than the BE? Is there some way to have a medicine given along with the Vancymycin to counteract a reaction? Is there another antibiotic besides Penicillin and Vancomycin which can be used as prophylaxis?
I am worried sick over this, it is a very difficult decision.
Thank you for any help.

[menghini]

I HAVE A QUESTION ON COLAN CANCER. I WAS DIAGNOSED WITH COLAN CANCER STAGE 3 ALMOST 3 YEARS AGO. HAVING CHEMO, RADIATION, AND SURGERY. ALL SEEM FINE NOW. MY LAST BLOOD TEST SHOWED THE CEA LEVEL TO BE 1.7. ALL THE OTHER MARKERS LOOKED GOOD. MY TESTS FOR CEA HAVE BEEN ANYWHERE FROM 0.5-0.9. WHAT TO I HAVE TO DO TO BRING MY CEA DOWN OR AM I WORRING MY SELF FOR NO REASON. I AM VERY CONCERENED THAT THIS IS RETURNING!

[chrisr]

Dear Dr. Would you also recommend the same Barium enema procedure for someone like myself who has a mechanical AOV and is on a daily regimen of Comadin and wants to check for colon polyps?
Thanks,
ChrisR

[Kevin Pho, MD]

A double contrast barium enema is an acceptable screening test for colon cancer.  It can be done every 5 years.  The one disadvantage is that you cannot take biopsy samples if a suspicious lesion was found.

Virtual colonoscopy is still in the investigational stages an cannot be recommended yet.  

There is no indication for endocarditis prophylaxis during a colonoscopy - your GI doc is correct.  

If you are concerned about undergoing a colonoscopy, you can certainly consider the barium enema, which would be acceptable for cancer screening.

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