Clinical indications for computed tomographic colonography: European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastrointestinal and Abdominal Radiology (ESGAR) Guideline

Abstract

This is an official guideline of the European Society of Gastrointestinal Endoscopy (ESGE) and the European Society of Gastrointestinal and Abdominal Radiology (ESGAR). It addresses the clinical indications for the use of computed tomographic colonography (CTC). A targeted literature search was performed to evaluate the evidence supporting the use of CTC. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was adopted to define the strength of recommendations and the quality of evidence. Main recommendations 1 ESGE/ESGAR recommend computed tomographic colonography (CTC) as the radiological examination of choice for the diagnosis of colorectal neoplasia. ESGE/ESGAR do not recommend barium enema in this setting (strong recommendation, high quality evidence). 2 ESGE/ESGAR recommend CTC, preferably the same or next day, if colonoscopy is incomplete. Delay of CTC should be considered following endoscopic resection. In the case of obstructing colorectal cancer, preoperative contrast-enhanced CTC may also allow location or staging of malignant lesions (strong recommendation, moderate quality evidence). 3 When endoscopy is contraindicated or not possible, ESGE/ESGAR recommend CTC as an acceptable and equally sensitive alternative for patients with symptoms suggestive of colorectal cancer (strong recommendation, high quality evidence). 4 ESGE/ESGAR recommend referral for endoscopic polypectomy in patients with at least one polyp ≥ 6 mm in diameter detected at CTC. CTC surveillance may be clinically considered if patients do not undergo polypectomy (strong recommendation, moderate quality evidence). 5 ESGE/ESGAR do not recommend CTC as a primary test for population screening or in individuals with a positive first-degree family history of colorectal cancer (CRC). However, it may be proposed as a CRC screening test on an individual basis providing the screenee is adequately informed about test characteristics, benefits, and risks (weak recommendation, moderate quality evidence)

Colorectal cancer

“…CT colonography has been recommended as one of the options for colorectal cancer screening in guidelines in the United State and Europe 104,105 . In many countries, CT colonography has replaced double-contrast barium enema (the conventional X-ray-based imaging modality for the colon) examination and is increasingly being used as an alternative to conventional colonoscopy.…”

Appearances of screen-detected versus symptomatic colorectal cancers at CT colonography

“…CTC is commonly applied in two distinct patient groups–firstly, those with symptoms suggesting CRC; and secondly, asymptomatic subjects undergoing screening. International consensus recommends CTC as suitable for investigation of symptomatic patients [7, 8]; a recent multicenter randomized trial showed no significant difference in detection rates of CRC and polyps ≥10 mm between CTC and colonoscopy [9]. Regarding screening, diagnostic sensitivity of 90 % for CRC and polyps ≥10 mm was achieved in one large, prospective, multicenter study [10], and a randomized trial found higher participation rates at screening CTC (vs. colonoscopy) [11] that translated to higher per-invitee advanced adenoma detection rates once surveillance procedures were included [12].…”

“…CTC can also be employed in screening programs using fecal occult blood testing (FOBt) because it is highly sensitive in this specific scenario [13]. In such cases, colonic imaging (usually colonoscopy) is reserved for those testing positive to FOBt—CTC is recommended by international consensus when colonoscopy is incomplete or not feasible [7, 8]. …”

The role of CT colonography in large bowel investigation

“…Podrobně se indikacím k CTC věnují doporučení vydaná v roce 2014 ESGE a ESGAR [9]. V případě nedokončené endoskopie doporučují doplňující CTC optimálně tentýž či následující den za podmínky, že při OC nebyla provedena polypektomie či mukosektomie.…”

“…Kontraindikacemi vyšetření jsou podezření na perforaci, ileus, toxické megalokolon, dále symp tomatická břišní kýla obsahující tračník, akutní průjem, kolitida, divertikulitida cca do 6 týdnů po odeznění, stav po recentním chirurgickém výkonu na tračníku (4-6 týdnů), stavy po endoskopických resekcích (2 týdny) [4,8,9].…”