Expert commentary--virtual colonoscopy: utility as a screening test for colorectal cancer?

Virtual colonoscopy represents a noninvasive test for the examination of the colonic lumen that involves the generation of both 2-dimensional and 3-dimensional views of the colon and rectum using data derived from computed tomography. This imaging modality has been explored as an alternative to conventional endoscopic colonoscopy, in particular as an alternative screening tool for colorectal cancer. Although virtual colonoscopy does not require sedation and requires less time for completion, the study requires the same bowel-cleansing preparation as conventional colonoscopy as well as gas insufflation of the intestine, which may be associated with patient discomfort. In the December 4, 2003 issue of The New England Journal of Medicine, Pickhardt and colleagues reported results of the largest prospective evaluation to date regarding the utility of virtual colonoscopy as a screening tool for colorectal cancer. To explore the potential implications for clinical practice, Medscape asked 2 leading authorities to provide focused commentary to contextualize these study findings and offer perspective for both the gastroenterology and oncology communities, respectively.