Top doctors: The virtual colonoscopy

A "virtual colonoscopy" certainly sounds tolerable, compared with the traditional kind. "People think it's magic," said Great Neck surgical oncologist Dr. James Sullivan III.

Truth be told, however, virtual colonoscopies are quite similar to the traditional procedure, even down to the preparation that so many dread. Here's what you should know:

Virtual colonoscopies detect polyps in the colon with the help of three-dimensional CT scans instead of scopes that are inserted into the rectum. But the preparation is the same. Prospective patients must clear their bowels before the procedure, typically by drinking a laxative solution and staying near the toilet.

"That's the worst part of the exam, and you have to do it for both types of colonoscopy," said Sullivan, who's board-certified in colorectal surgery.

In addition, a virtual colonoscopy includes having air pumped into your intestines -- a procedure Sullivan likened to an "air enema."

The purpose of a colonoscopy is to detect signs of abnormal growths and other problems in the colon. But virtual colonoscopies only allow physicians to see polyps and other problems. The doctors can't actually do anything about them unless the person comes back for a traditional colonoscopy, Sullivan said. Only then can suspicious polyps be removed.

It would be extremely unusual to immediately perform a traditional colonoscopy -- complete with polyp removal -- after a virtual one, he said.

The procedure may not detect the tiniest polyps, unlike traditional colonoscopies that are more sensitive, explained Dr. John Procaccino Jr., chief of colon and rectal surgery at North Shore University Hospital in Manhasset.

It's possible that a virtual colonoscopy may miss a polyp that would then have a chance to grow for another 10 years until it's noticed when the person has his or her next regularly scheduled colonoscopy, Procaccino said.

For one thing, they have a lower risk for complications. Few people who have traditional colonoscopies -- one in several hundred -- suffer from perforations, but even that risk drops sharply for those who have the virtual procedure. "There's a smaller chance of a problem," Sullivan said. "It's not zero, but it's smaller."

And despite the cons of undergoing a virtual colonoscopy, Procaccino said that the procedure is appropriate for some people -- such as those who are on blood thinners and face an increased risk for bleeding during traditional colonoscopies. The virtual type also can be appropriate if a problem or condition prevents a person from having the traditional procedure, he said.

However, he noted that insurance companies might not pay for a virtual colonoscopy unless there's a good reason for it. "It's not an accepted standard as a screening tool," he said.

A colonoscopy is "not horrific," Procaccino said. The preparation is uncomfortable, he said, but "three hours of diarrhea can save your life."

Colon & rectal, thoracic and vascular surgeons

This is the 17th installment of a 26-week series in which Newsday presents Castle Connolly's list of top Long Island doctors.

310 E. Shore Rd.

516-482-8657

3400 Nesconset Hwy.

631-689-2600

60 Cuttermill Rd.

Great Neck

516-487-8738

Div. of Colon & Rectal Surgery

900 Northern Blvd.

Great Neck

516-730-2100

222 Middle Country Rd.

631-638-2800

North Shore Oncology Assoc.

600 Northern Blvd.

Great Neck

516-487-9454

444 Merrick Rd.

516-255-5010

Stony Brook Univ. Med. Ctr.

Dept. Surgery, HSC Bldg.

Stony Brook

631-444-1820

North Shore Univ. Hospital

Dept. Cardiothoracic Surgery

300 Community Drive

516-562-4970

Stony Brook University Medical Center, Cardiothoracic Surgery Division

444 Merrick Rd.

516-255-5010

225 Community Dr.

Great Neck

516-918-4388

North Shore Univ. Hosp.

Div. Cardiothoracic Surgery

300 Community Dr.

Manhasset

516-562-4970

Summit Thoracic Institute

410 Lakeville Rd.

516-233-1952

15 Park Ave., Bay Shore

631-581-4400

100 Port Washington Blvd.

Vizza Bldg.

516-627-2173

Stony Brook Univ. Med. Ctr.

Health Science Center

Cardiothoracic Surg., HSC-T19

Stony Brook

631-444-7875

754 Old Country Rd.

516-931-0182

120 Mineola Blvd.

516-663-4400

225 Community Dr.

Great Neck

516-918-4388

1110 Hallock Ave.

631-476-9100

2001 Marcus Ave.

516-328-9800

2201 Hempstead Tpke.

516-572-4848

1110 Hallock Ave.

631-476-9100

560 Northern Blvd.

Great Neck

516-466-0485

Stony Brook Univ. Med. Ctr.

HSC Bldg.

Stony Brook

631-444-4545

How they were picked

Castle Connolly Medical Ltd. is a health care research and information company founded in 1991 by a former medical college board chairman and president to help guide consumers to America's top doctors and hospitals. Castle Connolly's established survey and research process, under the direction of a doctor, involves tens of thousands of doctors and the medical leadership of leading hospitals.

Castle Connolly's team of researchers follows a rigorous screening process to select doctors on national and regional levels. Using mail and telephone surveys, and electronic ballots, they ask physicians and the leadership of top hospitals to identify exceptional doctors. Careful screening of doctors' educational and professional experience is essential to the committee. Not every good physician makes the list. Rather, the list is a way for patients to get started on their search for the best medical professional. Newsday is not part of the selection process.

Doctors do not and cannot pay to be selected and profiled as Castle Connolly Top Doctors.

To see the whole list . . .

Who else is on the list of Top Doctors? More than 6,000 listings are in the New York Metro Area edition of "Top Doctors," published by Castle Connolly Medical Ltd. The softcover list price is $34.95. For more information, go to castleconnolly.com, or call 800-399-DOCS.