Utility of minimal preparation computed tomography colonography in detecting colorectal cancer in elderly and frail patients

Meiklejohn, D. J.; Ridley, Lloyd J; Ngu, Meng C.; Cowlishaw, James L.; Duller, Alex; Ridley, William E

doi:10.1111/imj.13999

Cited by 5 publications

(7 citation statements)

References 15 publications

(34 reference statements)

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“…Minimal preparation CTC (MPCTC) protocol limited to an extended fecal tagging protocol reviewed by Meiklejohn et al 1 used neither catharsis nor insufflation, and achieved a high negative predictive value of 0.99 (95% confidence interval 0.97–1.01) in detecting colorectal cancer (CRC) in symptomatic elderly and frail patients. However, MPCTC had a low sensitivity for smaller lesions, as unlike our study no intravenous contrast was used in MPCTC nor was an attempt made to distend the large bowel.…”

Section: Discussionmentioning

confidence: 99%

“…However, it is an invasive procedure which involves extensive catharsis, colon instrumentation, and insufflation, risks of serum electrolyte disturbance, renal failure, perforation, and anesthesia/sedation, especially in those who are frail and elderly. 1 Computed tomographic colonography (CTC), a structural examination of the colon similar to optical colonoscopy, is an alternative investigation for patients who refuse to undergo the latter and in patients with failure of colonoscopy. CTC is also useful in conditions where colonoscopy is contraindicated or not possible.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Diseases of the large bowel like colorectal carcinomas, 1 adenomas, and other types of polyps, inflammatory bowel diseases, and tuberculosis (TB), in India, are a common cause of significant morbidity and mortality. Colonoscopy is the gold standard for diagnosis of large bowel diseases, as it incorporates the ability to perform a biopsy or excision.…”

Section: Introductionmentioning

confidence: 99%

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Feasibility of Simple Oral Preparation Contrast-Enhanced CT Colonography (SOP-CE-CTC) Using Mannitol as a Neutral Oral Contrast Agent

Rathi

2022

Journal of Gastrointestinal and Abdominal Radiology

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Purpose This article prospectively assesses the feasibility of simple oral preparation contrast-enhanced computed tomography colonography (SOP-CE-CTC) using a large volume of oral 3% mannitol for good colonic distension along with mural and mucosal fold visualization. Methods A total of 100 patients in whom contrast CT abdomen was requested, recruited as per selection criteria, were advised to take mild oral bowel preparation for two nights, prior to the investigation. Then, after fasting overnight, they were asked to consume 1,500 to 2,000 mL of 3% mannitol solution in about an hour. Thirty minutes after completing the ingestion of oral mannitol, intravenous contrast was injected and SOP-CE-CTC was acquired at 55 seconds. Distension of six segments of the colon was evaluated by assigning scores 1 to 4 for qualitative assessment; and measuring the maximum luminal diameter of the colon, for quantitative assessment. Colonic mucosal and mural visualization were evaluated subjectively. All observations were recorded by two reviewers (with varying levels of experience) independently. Results On qualitative analysis, the colon showed optimal distension (score 4) in 58 to 89% cases on SOP-CE-CTC. There was agreement between both the reviewers in 89 to 99% cases (weighted kappa 0.820–0.979; p < 0.001). On quantitative analysis, the mean of the maximum colonic diameter ranged between 3.4 and 5.2 cm; and both the reviewers agreed in 89 to 97% cases (weighted kappa 0.777–0.967; p < 0.001). Mural and mucosal fold visualization in the proximal four segments of the colon was excellent (in 90–98%) but in the rectum and sigmoid it was 45 and 66%, respectively; both the reviewers agreed in 100% cases (weighted kappa 1.0 and p < 0.001). Conclusion Good colonic distension, mural, and mucosal fold visualization can be achieved on SOP-CE-CTC using 1,500 to 2,000 mL of 3% oral mannitol and mild oral bowel preparation agents.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Feasibility of Simple Oral Preparation Contrast-Enhanced CT Colonography (SOP-CE-CTC) Using Mannitol as a Neutral Oral Contrast Agent

Rathi

2022

Journal of Gastrointestinal and Abdominal Radiology

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“…Sedation is also required which increases the risk especially in old aged patients [6]. Sedation is not required in computed tomography colonography [7]. Computed tomography colonography has a high sensitivity for large polyps in asymptomatic [8] and symptomatic [9] population but it images outside the organ [10], requires additional reassurance endoscopy to biopsy lead to increases the cost and burden of the diagnosis [11], and requires quality assurance for radiologists [12].…”

Section: Introductionmentioning

confidence: 99%

Computed tomography colonography versus colonoscopy for detection of colorectal cancer: a diagnostic performance study

Sha

Liu

et al. 2020

BMC Med Imaging

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Background: Colonoscopy is the reference standard for the detection of colorectal cancer but it is an invasive technique and has the risk of bowel perforation and bleeding. Unlike colonoscopy, sedation is not required in computed tomography colonography and requires additional reassurance endoscopy. The objectives of the study were to compare the diagnostic performance of computed tomography colonography against colonoscopy for a diagnosis of colorectal cancer. Methods: Data regarding any polyp ≥10 mm diameter (ø) and < 10 mm ø but suspicious polyps of computed tomography colonography (n = 318), colonoscopy (n = 318), and surgical pathology (n = 77) for symptomatic colorectal cancer patients were collected and analyzed. Lesion ulceration, extramural invasion, and/ or lesion shouldering was considered as a suspicious polyp. Beneficial scores for decision making of curative surgeries were evaluated for each modality. The cost of diagnosis of colorectal cancer was also evaluated. Results: Either of diagnosis showed polyps ≥10 mm ø in 27 patients and polyps of 50 patients were < 10 mm ø but suspicious. Therefore, a total of 77 patients were subjected to surgery. With respect to surgical pathology, sensitivities for computed tomographic colonography and colonoscopy were 0.961 and 0.831. For detection of ≥10 mm ø polyp, benefit score for computed tomographic colonography and colonoscopy were 0-0.906 diagnostic confidence and 0.035-0.5 diagnostic confidence. For polyps, ≥ 10 mm ø but not too many large polyps, colonoscopy had the risk of underdiagnosis. For < 10 mm ø but suspicious polyps, < 0.6 mm ø and < 2.2 mm polyps could not be detected by computed tomographic colonography and colonoscopy, respectively. The computed tomographic colonography had less cost than colonoscopy (1345 ± 135 ¥/ patient vs. 1715 ± 241 ¥/ patient, p < 0.0001) for diagnosis of colorectal cancer. Conclusion: Computed tomographic colonography would be a non-inferior alternative than colonoscopy for a diagnosis of colorectal cancer. Level of evidence: III.

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CT Colonography in Review With Tips and Tricks to Improve Performance

Ricci

Kobi

Flusberg

et al. 2021

Seminars in Roentgenology

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Utility of minimal preparation computed tomography colonography in detecting colorectal cancer in elderly and frail patients

Cited by 5 publications

References 15 publications

Feasibility of Simple Oral Preparation Contrast-Enhanced CT Colonography (SOP-CE-CTC) Using Mannitol as a Neutral Oral Contrast Agent

Feasibility of Simple Oral Preparation Contrast-Enhanced CT Colonography (SOP-CE-CTC) Using Mannitol as a Neutral Oral Contrast Agent

Computed tomography colonography versus colonoscopy for detection of colorectal cancer: a diagnostic performance study

CT Colonography in Review With Tips and Tricks to Improve Performance

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