Update on Flexible Sigmoidoscopy, Computed Tomographic Colonography, and Capsule Colonoscopy

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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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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Prospective blinded evaluation of computed tomographic colonography for screen detection of colorectal polyps

Gastroenterology ◽

10.1016/s0016-5085(03)00894-1 ◽

2003 ◽

Vol 125 (2) ◽

pp. 311-319 ◽

Cited By ~ 275

Author(s):

C.Daniel Johnson ◽

William S Harmsen ◽

Lynn A Wilson ◽

Robert L Maccarty ◽

Timothy J Welch ◽

...

Keyword(s):

Colorectal Polyps ◽

Computed Tomographic Colonography ◽

Computed Tomographic

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Accuracy of Computed Tomographic Colonography for the Detection of Polyps and Colorectal Tumors: A Systematic Review and Meta-Analysis

Digestion ◽

10.1159/000215387 ◽

2009 ◽

Vol 80 (1) ◽

pp. 1-17 ◽

Cited By ~ 56

Author(s):

María Chaparro ◽

Javier P. Gisbert ◽

Lourdes del Campo ◽

José Cantero ◽

José Maté

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Computed Tomographic Colonography ◽

Colorectal Tumors ◽

Computed Tomographic

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Performance of computed tomographic colonography for the screening of colorectal polyp in acromegalic patients: a prospective study

Arquivos de Gastroenterologia ◽

10.1590/s0004-28032009000200003 ◽

2009 ◽

Vol 46 (2) ◽

pp. 90-96 ◽

Cited By ~ 5

Author(s):

Odery Ramos Jr. ◽

César Luiz Boguszewski ◽

Sandra Teixeira ◽

Ricardo De Bem ◽

Benito Parolim ◽

...

Keyword(s):

Prospective Study ◽

Virtual Colonoscopy ◽

Colorectal Polyp ◽

Colorectal Polyps ◽

High Risk Group ◽

Conventional Colonoscopy ◽

Intestinal Loop ◽

Computed Tomographic Colonography ◽

Computed Tomographic ◽

A Prospective Study

CONTEXT: Acromegalic patients have better chances to develop colorectal polyps and cancer and, considered a high-risk group, need to undergo frequent screening examinations. Moreover, in acromegalia, the increased bowel length and the intestinal loop complexity can lead to higher levels of technical difficulties and increase the risks of complications at conventional colonoscopy. Computed tomographic colonography, also known as virtual colonoscopy, is an innovative and secure technology which is revolutionizing the diagnosis of colon and rectum neoplasias. OBJECTIVE: To analyze computed tomographic colonography performance for the screening of colorectal polyps in acromegalic patients. METHODS: A prospective study of 21 asymptomatic acromegalic patients, 12 male and 9 female, average age 49, who underwent computed tomographic colonography and conventional colonoscopy. Computed tomographic colonography was performed with a GE Helical Multislice Computed Tomography Apparatus. Conventional colonoscopy was performed in the same day, without previous knowledge of the computed tomographic colonography diagnostics. The study evaluated the capacity of computed tomographic colonography to detect patients with colorectal polyps and identify each colorectal lesion described by the colonoscopy. RESULTS: In two patients (2/21), conventional colonoscopy was incomplete. However, in all patients computed tomographic colonography was complete. In Phase I ("per patient"), computed tomographic colonography diagnosed eight of the nine patients with colorectal polyps and showed 88% sensitivity, 75% specificity and 81% accuracy. In Phase II ("per polyp"), out of the 21 acromegalic patients included in this study, 12 presented normal findings at conventional colonoscopy. A total of 19 polyps were identified in 9 patients. Ten of the 19 polyps were smaller than 10 mm, and 9 were equal to or larger than 10 mm. Computed tomographic colonography identified 7 of the 9 polyps >10 mm described by conventional colonoscopy and only 6 of the 10 small polyps identified at conventional colonoscopy were detected by computed tomographic colonography. The histological analysis of resected lesions revealed 12 tubular adenomas, 6 hyperplastic polyps and 1 colonic tubulo-villous adenoma with an adenocarcinoma focus. CONCLUSION: The authors present the first reports of computed tomographic colonography in the screening of colorectal polyps in acromegalic patients. In this study, computed tomographic colonography was performed without complications and a complete and safe colorectal evaluation was possible in all acromegalic patients. Moreover, computed tomographic colonography presented good sensitivity, specificity and accuracy for the identification of acromegalic patients with polyps of any size and better results in the diagnosis of large polyps, when they were compared to small polypoid lesions.

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