Patient acceptance for CT colonography: what is the real issue?

Abstract

The aim of this study was to evaluate the discomfort associated with CT colonography compared with colonoscopy and bowel purgation cleansing, and to evaluate patient preference between CT colonography and colonoscopy. In a total of 124 patients, scheduled for multidetector virtual CT colonography and diagnostic colonoscopy, patient acceptance and future preference were assessed during the different steps of the procedure (colon preparation, CT examination, and conventional colonoscopy). Patients who described contradictory findings between the degree of discomfort and their preference regarding follow-up examinations were retrospectively reinterviewed regarding the reason for this discrepancy. Colonoscopy was graded slightly more uncomfortable than virtual CT colonography, but the preparation was clearly the most uncomfortable part of the procedure. Concerning their preference regarding follow-up examinations, 71% of the patients preferred virtual CT colonography, 24% preferred colonoscopy, and 5% had no preference. Twenty-eight percent of the patients preferred virtual CT colonography despite that they thought it was equally or even more uncomfortable than colonoscopy. This was mainly due to the faster procedure (17 patients), the lower physical challenge (14 patients), and the lack of sedation (12 patients) of virtual CT colonography. Factors other than the discomfort related to the examinations play an important role in the patient's preference for virtual CT colonography, namely the faster procedure, the lower physical challenge, and the lack of sedation. Since the preparation plays a major decisive factor in the patient acceptance of virtual CT colonography, more attention should be given to fecal tagging.

Clinical validation of high‐resolution fast spin‐echo MR colonography after colon distention with air

“…Inflation was sustained in accordance with the level of patient discomfort. Relief could be obtained by releasing the pressure on the bag to allow backflow of inflated air and residual preparation fluid (7).…”

“…The participation rate of the target population is often neglected, even though all current techniques require a specific preparation protocol that is associated with definite discomfort for the patient (7).…”

MR colonography with fecal tagging: Do individual patient characteristics influence image quality?

“…However, there have been reports about a possible correlation between nephrogenic fibrosing dermopathy (NFD) and the intravenous administration of gadolinium compounds (20). As far as patient acceptance is concerned, several trials revealed a higher acceptance rate for virtual colonography compared to optical endoscopy (21)(22)(23). The need to undergo bowel cleansing yet is rated as the most unpleasant part of the virtual colonography exam (21-25) and patient discomfort scores can be significantly improved with tagging preparations previously shown for CT colonoscopy (CTC) (26).…”

The sensitivity of MR colonography using dark lumen technique for detection of colonic lesions

“…Conventional colonoscopy is the gold standard method for detection of colonic pathologies (16,17). However, the method is invasive and disturbing, reducing its acceptability (18,19). Ionizing radiation exposure is an important disadvantage for CT colonography (7,8).…”