Endoluminal CT colonography after an incomplete endoscopic colonoscopy.

Abstract

We evaluated the clinical usefulness of endoluminal CT colonography after an incomplete colonoscopy. SUBJECTS AND METHODS. We prospectively studied 40 patients in whom the cecum could not be reached endoscopically despite adequate bowel preparation. Endoluminal CT colonography (120 kVp, 120 mA, 3-mm collimation, pitch of 2, 1.5-mm interval reconstruction) was performed within 2 hr of incomplete colonoscopy. Two-dimensional multiplanar reformatted images and three-dimensional endoluminal images were analyzed. Twenty-six patients (65%) underwent barium enema immediately after endoluminal CT colonography. We analyzed colonic distention; duration of endoluminal CT colonography; patient tolerance: number of colonic segments seen at colonoscopy, endoluminal CT colonography, and barium enema; and reasons for incomplete colonoscopy as well as colonic and extracolonic findings. RESULTS. Duration of endoluminal CT colonography was 14.2 ± 4.6 mm (mean ± SD). Endoluminal CT colonography was better tolerated than colonoscopy or barium enema (p < .001). Probable causes for incomplete colonoscopy were identified at endoluminal CT colonography in 74% of 40 patients. Baseline colonic distention in the region of the transverse and right colon was considered adequate before additional air insufflation; however, the addition of air significantly enhanced colonic distention throughout the entire colon (p < .001). Endoluminal CT colonography adequately revealed 96% of all colonic segments; in comparison, barium enema adequately revealed 91 % of all segments (p < .05). CONCLUSION. In patients with incomplete colonoscopy, endoluminal CT colonography successfully showed the previously unrevealed colon in more than 90% of patients. Endoluminal CT colonography is a rapid, well-tolerated technique that provides clinically useful colonic and extraco-Ionic information and should be considered for all patients who undergo incomplete colonoscopy.

CT colonography after incomplete colonoscopy in subjects with positive faecal occult blood test

“…Previous studies on CTC after incomplete colonoscopy have been conducted [6][7][8][9][10] . These studies were inhomogeneous regarding the patients' selection, because they included asymptomatic as well as symptomatic subjects.…”

“…In order to complete evaluation of the colon, radiological examinations can be performed such as double contrast barium enema (DCBE) [5] and computed tomography colonography (CTC). In particular, several studies have shown that CTC is a valuable tool to evaluate the proximal colon after incomplete colonoscopy [6][7][8][9][10] , and the American Gastroenterologists Association (AGA) recognized that CTC is indicated for adults with failed colonoscopy [11] . We report the results of CTC systematically performed in subjects with positive FOBT and incomplete colonoscopy in the context of a population-based screening programme for CRC with FOBT.…”

Current Status of CT Colonography

“…When an optical colonoscopy cannot be completed, CTC has been shown to allow examination of the area in 90% of the patients (86). A study on 34 patients with clinical suspicion of CRC and 20 patients without suspicion of CRC found that the incomplete optical colonoscopy had a sensitivity and specificity of 56% and 92%, respectively.…”

The impact of new technology on surgery for colorectal cancer

“…Virtual colonoscopy has the ability to examine the proximal colon above an obstructing o r impassable lesion. Morrin [15] compared virtual colonoscopy with bariu m enema in 40 patients who had a failed endoscopy. Virtual colonoscopy had significantly better views of all colonic segments and was better tolerated by the patient.…”