Colorectal cancer is reliably excluded in the frail and elderly population by minimal preparation CT

Saunders, Jimmy; Mišković, Danilo; Bowman, Cara; Panto, Philip N.; Menon, Ashvini

doi:10.1007/s10151-013-1045-4

Cited by 8 publications

(10 citation statements)

References 21 publications

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“…Seventeen papers were found. [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] Of these, 10 papers evaluated the clinical utility of MPCT. Results are summarized in Table 2.…”

Section: Resultsmentioning

confidence: 99%

“…Minimal preparation computed tomography is limited by low positive predictive values. Saunders et al 23 and Table 4. CT findings of colorectal cancer • Soft tissue attenuation colonic mass or mural thickening that narrows the lumen.…”

Section: Discussionmentioning

confidence: 99%

“…Minimal preparation computed tomography is limited by low positive predictive values. Saunders et al . and Kealey both used subjective stratification in their reporting, for example, ‘certain’, ‘possible’ or ‘probable’ CRC.…”

Section: Discussionmentioning

confidence: 99%

“…The addition of i.v. contrast has been shown to increase diagnostic accuracy for ECF's . Contrast does have the potential to diminish accuracy for enhancing polyps which may be harder to spot against tagged faecal residue.…”

Section: Discussionmentioning

confidence: 99%

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Minimal preparation CT: A literature review of a minimally invasive imaging technique for colorectal cancer in a frail, aged population

et al. 2017

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SummaryColorectal cancer (CRC) is a common malignancy with increased incidence in the elderly. When CRC is suspected, patients are typically evaluated with optical colonoscopy (OC) or CT Colonography (CTC). Unfortunately, in the frail and elderly patient, these investigations can be difficult to perform and are often not tolerated. Minimal preparation computed tomography (MPCT) is a CT technique to evaluate the colon. Although protocols vary, typically, no preparation is required apart from administration of oral contrast for faecal tagging. The patient is scanned in the supine position only and without colonic insufflation. The study is reserved for 'old-old' frail patients with clinically suspected CRC who cannot tolerate or have failed OC or CTC. In the context of an ageing population, MPCT provides a simple, minimally invasive, readily available and well-tolerated test that is able to demonstrate clinically relevant disease. We review the literature on MPCT and discuss the benefits and limitations of this investigation.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Minimal preparation CT: A literature review of a minimally invasive imaging technique for colorectal cancer in a frail, aged population

et al. 2017

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“…• Minimal preparation CT of the colon with tagging of the bowel content with iodinated contrast media (with or without iodinated contrast media intravenously) such as the technique used in the article by Saunders and colleagues [11]. This technique can be improved with minimal distention of the colon with gas [12].…”

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confidence: 99%

Imaging for suspected colorectal cancer in frail and elderly patients

Bacigalupo

Paparo

2013

Tech Coloproctol

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Medicine faces many challenges, among which that of the growing number of old and often frail patients needs to be particularly addressed. In our hospital, that serves one of the oldest population on earth (about 10 % of the inhabitants of Genoa are over 80 years old) problems related to diagnosing and treating pathologies in this type of patients are part of our daily practice. Many old patients enter our hospital for gastrointestinal symptoms possibly related to colorectal cancer, often via the emergency room.In these patients (in which it is frequently difficult to obtain a good clinical history), there is the need to make a diagnosis, preferably noninvasively, to plan appropriate treatment.In colorectal cancer, computed tomography (CT) offers different modalities that allow to diagnose and stage correctly the disease. The most commonly used are two that require good bowel preparation:• CT colonography requires distention of the colon with gas (room air or, preferably, carbon dioxide), usually without iodinated contrast media intravenously but often with orally administered iodinated contrast media (and/or barium) before the examination to properly ''tag'' residual feces and liquids in the colon [1,2]. It is possible to add intravenous contrast media to CT colonography before the examination in patients with high pretest likelihood of positive findings (colon cancer or significant extra-colic findings) [3]. Intravenous contrast media can also be added when required during the CT colonography itself after the first (usually supine) acquisition; but this requires the presence the immediate evaluation of the radiologist during the CT examination, which can be difficult in a real clinical setting (because of the high workflow in the CT suite) and since often colorectal cancer is depicted only after extensive review of the CT images. In CT colonography performed after tagging, intravenous contrast media may, in our experience, make more difficult the assessment/depiction of enhancing bowel wall lesions located in segments with superimposable hyperdensity of the adjacent bowel content. In our opinion, CT colonography should be mainly reserved for old outpatients in good condition, in whom significant colon pathology must be ruled out and there is a low pretest likelihood of significant findings. Hospitalized old and frail patients may have problems in completing the full CT colonography preparation and even in undergoing the CT scan itself with the two required positions of the patient (supine and prone).• Water enema CT is performed after distension of the colon with water and, always, with intravenous iodinated contrast media [4]. This technique can be modified to obtain distention of the small bowel with oral administration of a negative contrast medium such as a polyethylene glycol electrolyte solution [5]. Water enema CT is mainly used in our hospital in those old and frail patients with a high pretest likelihood of colon cancer, based on clinical suspicion. The use of iodinated contrast media intravenously al...

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Appendicectomy in older patients with acute appendicitis is not an indication for routine colonoscopy

Hamid¹,

Hamedelneel

2019

Int J Colorectal Dis

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Colorectal cancer is reliably excluded in the frail and elderly population by minimal preparation CT

Cited by 8 publications

References 21 publications

Minimal preparation CT: A literature review of a minimally invasive imaging technique for colorectal cancer in a frail, aged population

Minimal preparation CT: A literature review of a minimally invasive imaging technique for colorectal cancer in a frail, aged population

Imaging for suspected colorectal cancer in frail and elderly patients

Appendicectomy in older patients with acute appendicitis is not an indication for routine colonoscopy

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