Use of multidetector-row computed tomographic colonography before flexible sigmoidoscopy in the investigation of rectal bleeding

Abstract New research has addressed many of the early concerns of Computed Tomographic colonography (CTC) and these studies are now beginning to shape clinical practices. A review of the literature demonstrates that the sensitivity of CTC in screening for large polyps (≥ 1cm) or cancers in the large intestine is as high as that of conventional optical colonoscopy, however, the sensitivity decreases with the diameter of the polyp. Despite this, CTC is well tolerated, more acceptable to patients than optical colonoscopy and therefore may improve colorectal cancer screening compliance. This review not only describes the diagnostic accuracy and sensitivity of CTC, and the evolving role of CTC as a primary colon cancer screening option, but also the recent studies that have demonstrated the additional value of CTC utilization for practicing clinicians.

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Efficiency Assessment of Multidetector-Row Computed Tomographic Angiography Using Reconstruction With Locoregional Perforator Flaps

Plastic Surgery ◽

10.1177/22925503211024750 ◽

2021 ◽

pp. 229255032110247

Author(s):

Pavlo O. Badiul ◽

Sergii V. Sliesarenko ◽

Nataliia O. Cherednychenko ◽

Olga V. Morgun

Keyword(s):

Perforator Flap ◽

Computed Tomographic Angiography ◽

Surgical Reconstruction ◽

Patient Treatment ◽

Controlled Study ◽

Control Group ◽

Perforator Flaps ◽

Multidetector Row ◽

Computed Tomographic ◽

Tomographic Angiography

Background: Reconstruction with the use of perforator flaps makes it possible to make the skin surface resistant to the influence of mechanical factors and as similar to the lost skin cover as possible. However, while planning any flap, along with the design of the required shape and size, its blood supply should be taken into account to ensure optimal viability. Therefore, the task to precisely determine the topographic–anatomical relationships suitable for the formation of a pedicle of perforators is still relevant. The aim of this study was to increase the efficiency of surgical reconstruction of wound defects by transposition of locoregional perforator flaps. Methods: The authors conducted a retrospective analysis of 72 cases of reconstruction by means of locoregional perforator flaps with vascular pedicle detachment to determine the efficiency of preoperative diagnostic preparation with the help of multidetector-row computed tomographic angiography (MDCT) in the process of reconstruction. Thirty-seven individual cases of surgical interventions were chosen using a case-controlled study from the study group when MDCT with angiography was used for preoperative planning of perforator flaps, as well as 35 control cases similar in terms of important predictive peculiarities with the reconstruction at the same level of difficulty. The patient groups were precisely matched by gender ( P = .950), age ( P = .804), flap area ( P = .192), and type of reconstruction that was performed. Results: In all cases, the location of the perforator with a diameter greater than 1.0 mm was marked. All perforators determined during MDCT scanning were faultlessly localized intraoperatively. The distance between the intraoperative position of the perforator and the position obtained in the result of the examination did not exceed 1 cm. There was no need to change the planned design of the flap intraoperatively. In all cases where MDCT was performed, the duration of the surgical procedure varied from 60 to 150 minutes (average: 120.77 [18.90] minutes) and was reduced by 49.40 minutes (95% CI: 39.17-59.63) compared with the patients who did not undergo preoperative visualization of perforators where the average duration of the operation was 170.17 (19.19) minutes (from 140 to 220 minutes). Among the patients examined by MDCT, surgical complications were noted in 5 cases (13.51%) compared to 14 cases (40.00%) in the control group. Conclusions: The preoperative MDCT for the locoregional perforator flap reconstruction makes it possible to increase the efficiency of patient treatment given the reduction in surgery duration by 49.40 minutes (95% CI: 39.17-59.63) on average and the reduction in the level of postsurgery complications from 40% to 13.5% compared with the group of patients in whom presurgical visualization was not performed ( P = .031).

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Response: Re: Cost-Effectiveness of Computed Tomographic Colonography Screening for Colorectal Cancer in the Medicare Population

JNCI Journal of the National Cancer Institute ◽

10.1093/jnci/djq383 ◽

2010 ◽

Vol 102 (21) ◽

pp. 1676-1677

Author(s):

A. B. Knudsen ◽

I. Lansdorp-Vogelaar ◽

C. M. Rutter ◽

J. E. Savarino ◽

M. Van Ballegooijen ◽

...

Keyword(s):

Colorectal Cancer ◽

Cost Effectiveness ◽

Computed Tomographic Colonography ◽

Computed Tomographic ◽

Medicare Population

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Computed Tomographic Colonography: Assessment of Radiologist Performance With and Without Computer-Aided Detection

Gastroenterology ◽

10.1053/j.gastro.2006.09.051 ◽

2006 ◽

Vol 131 (6) ◽

pp. 1690-1699 ◽

Cited By ~ 102

Author(s):

Steve Halligan ◽

Douglas G. Altman ◽

Susan Mallett ◽

Stuart A. Taylor ◽

David Burling ◽

...

Keyword(s):

Computed Tomographic Colonography ◽

Computer Aided Detection ◽

Computed Tomographic ◽

Computer Aided

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Comparison Study of Different Bowel Preparation Regimens and Different Fecal-Tagging Agents on Tagging Efficacy, Patients' Compliance, and Diagnostic Performance of Computed Tomographic Colonography

Journal of Computer Assisted Tomography ◽

10.1097/rct.0b013e3181926570 ◽

2009 ◽

Vol 33 (5) ◽

pp. 657-665 ◽

Cited By ~ 7

Author(s):

Soon Ho Yoon ◽

Se Hyung Kim ◽

Sang Gyun Kim ◽

Soo Jin Kim ◽

Jeong Min Lee ◽

...

Keyword(s):

Bowel Preparation ◽

Diagnostic Performance ◽

Computed Tomographic Colonography ◽

Comparison Study ◽

Fecal Tagging ◽

Computed Tomographic

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Diagnostic and therapeutic treatment modalities for acute lower gastrointestinal bleeding: a systematic review

Endoscopy International Open ◽

10.1055/s-0043-117958 ◽

2017 ◽

Vol 05 (10) ◽

pp. E959-E973 ◽

Cited By ~ 7

Author(s):

Kathryn Oakland ◽

Jennifer Isherwood ◽

Conor Lahiff ◽

Petra Goldsmith ◽

Michael Desborough ◽

...

Keyword(s):

Gastrointestinal Bleeding ◽

Flexible Sigmoidoscopy ◽

Meta Analysis ◽

Computed Tomographic Angiography ◽

Lower Gastrointestinal Bleeding ◽

Treatment Modalities ◽

Computed Tomographic ◽

Meta Analyses ◽

Tomographic Angiography ◽

Risk Ratios

Abstract Background and study aims Investigations for lower gastrointestinal bleeding (LGIB) include flexible sigmoidoscopy, colonoscopy, computed tomographic angiography (CTA), and angiography. All may be used to direct endoscopic, radiological or surgical treatment, although their optimal use is unknown. The aims of this study were to determine the diagnostic and therapeutic yields of endoscopy, CTA, and angiography for managing LGIB, and their influence on rebleeding, transfusion, and hospital stay. Patients and methods A systematic search of MEDLINE, PubMed, EMBASE, and CENTRAL was undertaken to identify randomized controlled trials (RCTs) and nonrandomized studies of intervention (NRSIs) published between 2000 and 12 November 2015 in patients hospitalized with LGIB. Separate meta-analyses were conducted, presented as pooled odds (ORs) or risk ratios (RR) with 95 % confidence intervals (CIs). Results Two RCTs and 13 NRSIs were included, none of which examined flexible sigmoidoscopy, or compared endotherapy with embolization, or investigated the timing of CTA or angiography. Two NRSIs (57 – 223 participants) comparing colonoscopy and CTA were of insufficient quality for synthesis but showed no difference in diagnostic yields between the two interventions. One RCT and 4 NRSIs (779 participants) compared early colonoscopy (< 24 hours) with colonoscopy performed later; meta-analysis of the NRSIs demonstrated higher diagnostic and therapeutic yields with early colonoscopy (OR 1.86, 95 %CI 1.12 to 2.86, P = 0.004 and OR 3.08, 95 %CI 1.93 to 4.90, P < 0.001, respectively) and reduced length of stay (mean difference 2.64 days, 95 %CI 1.54 to 3.73), but no difference in transfusion or rebleeding. Conclusions In LGIB there is a paucity of high-quality evidence, although the limited studies on the timing of colonoscopy suggest increased rates of diagnosis and therapy with early colonoscopy.

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