Evaluation of two minimal-preparation regimes for CT colonography: optimising image quality and patient acceptability

Abstract

Objective: To compare a 2 day bowel preparation regime of barium, iodine and a mild stimulant laxative with a 1 day iodine-only regime for CT colonography (CTC). Methods: 100 consecutive patients underwent CTC. The first 50 patients (Regime 1) ingested 1 bisacodyl tablet twice a day 3 days before CTC and 1 dose each of 50 ml of barium and 20 ml of iodinated contrast per day starting 2 days before CTC. The second 50 patients (Regime 2) ingested 3 doses of iodinated contrast over 24 h prior to CTC. Volumes of residual stool and fluid, and the effectiveness of stool and fluid tagging, were graded according to methods established by Taylor et al (Taylor S, Slaker A, Burling D, Tam E, Greenhalgh R, Gartner L, et al. CT colonography: optimisation, diagnostic performance and patient acceptability of reduced-laxative regimens using barium-based faecal tagging. Eur Radiol 2008; 18: 32-42). A 3 day low-residue diet was taken by both cohorts. Questionnaires rating the side-effects and burden of the bowel preparation were compared to a control cohort of patients undergoing barium enema. Results: The proportion of colons producing none/scattered stool (score 1) was 90.3% with Regime 1 and 65.0% with Regime 2 (p,0.005). Any residual stool was significantly better tagged with Regime 1 (score 5), with 91.7% of Regime 1 exhibiting optimum tagging vs 71.3% of Regime 2 (p,0.05). No significant differences in side-effects between the bowel preparation regimes for CTC were elicited. Bowel preparation for barium enema was tolerated significantly worse than both of the CTC bowel preparation regimes. Conclusion: Regime 1, containing a 3 day preparation of a mild laxative, barium and iodine, produced a significantly better prepared colon, with no difference in patient acceptability.

Acceptability of oral iodinated contrast media: a head-to-head comparison of four media

“…Conversely, this cathartic side effect is beneficial in the setting of CTC, reducing the volume of colonic residue and resulting in a "cleaner" colon. This has allowed some investigators to institute reduced-cathartic bowel preparation regimes combining satisfactory image quality and good patient tolerability [1,12,14]. There remains a paucity of evidence regarding the efficacy of low-osmolality contrast media in the context of CTC.…”

“…Each contrast medium was anonymised and labelled A, B, C or D. The contrast media were diluted with mineral water to a standard concentration of 30 mg iodine per ml, which is the standard dilution used for faecal tagging in our institution [14]. 20-ml samples were prepared from these pre-mixed jugs in clear 200-ml plastic cups, ensuring an identical volume and appearance of each contrast medium.…”

“…Finally, the participants were asked if they would be willing to drink three 200-ml servings of each of the contrast media (yes, no or unsure) with a meal over a 48-h period as part of bowel preparation for CTC as per our institution's current bowel preparation protocol [14].…”

Errors in CT colonography

“…There is no consensus on an optimal regimen and variations include permutations of diet modification (e.g., fiber-restricted diet or liquid diet) and cathartic preparation (e.g., polyethylene glycol, bisacodyl sodium, magnesium citrate) of variable duration and quantity. There is ongoing investigation into performing reduced or even non-cathartic examinations which have the potential to increase patient comfort and compliance [16].…”

Comparative assessment of barium tagging options for residual colonic contents at virtual colonoscopy

“…ФМ подразумевает под собой увеличение денситометрических показателей остаточного кишечного содержимого [6]. Для этого используются рентген-позитивные контрастные препараты на основе бария или йода с пероральным их применением [7].…”