Clinical indications for computed tomographic colonography: European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastrointestinal and Abdominal Radiology (ESGAR) Guideline

Abstract

Colorectal cancer (CRC) is a major cause of morbidity and mortality [1, 2]. CRC screening by fecal occult blood testing (FOBT) has been shown to reduce CRC mortality [3, 4], and is currently used in several European countries. Colonoscopy is highly effective for detecting advanced neoplasia, and endoscopic polypectomy reduces subsequent CRC-specific incidence and mortality [5]. In Europe, colonoscopy is mainly used to investigate FOBT-positive or symptomatic patients, or as a preventive strategy in those with increased CRC risk [6].\ud \ud Computed tomographic colonography (CTC) is a minimally invasive imaging technique that is highly accurate for detecting colorectal cancer (CRC) and adenomatous polyps. The technique is standardized [7], and CTC is more easily performed than barium enema. Evidence-based data suggest that CTC is the natural replacement for barium enema and a complementary rather than an alternative examination to colonoscopy. However, the clinical scenarios for which CTC is indicated remain unclear. To address this uncertainty – 20 years after the first presentation of CTC at a radiological meeting [8] – the European Society of Gastrointestinal Endoscopy (ESGE) and the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) decided to produce a common guideline regarding indications for CTC in clinical practice. Technical and quality issues of CTC have been deliberately excluded from this work as these have already been discussed separately [7]

S3-Leitlinie – Kolorektales Karzinom

“…Bei Patienten mit stenosierenden Tumoren oder inkompletter Koloskopie aus anderen Gründen konnten in Fallserien mittels CT- [408 -411] oder MR-Kolonografie [438,439] proximale Tumoren oder Polypen nachgewiesen werden, sodass gemeinsame Leitlinien von ESGE und ESGAR von 2014 hier den Einsatz der CT-Kolografie empfehlen [440]. Allerdings gibt es inzwischen Evidenz für die Kolon-Kapselendoskopie bei inkompletter Koloskopie (natürlich nicht bei Stenosen), die in einer 2015 veröffentlich-ten kleineren randomisierten Studie (n = 100) hier doppelt soviele Adenome ≥ 6 mm wie die CT-Kolonografie fand (24,5 vs. 12,2 %) [441].…”

Editorial on the European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastrointestinal and Abdominal Radiology (ESGAR) guideline on clinical indications for CT colonography in the colorectal cancer diagnosis

“…In fact, the first guideline on indications for CTC was recently and simultaneously published on European Radiology [5], the official journal of the European Society of Radiology (ESR) and its sub-specialty societies, in this case the European Society of Gastrointestinal and Abdominal Radiology (ESGAR), and on Endoscopy [6], the official journal of the European Society of Gastrointestinal Endoscopy (ESGE). This guideline, the result of the collaboration between ESGAR and ESGE was generated jointly by a team of researchers, including gastrointestinal radiologists and endoscopists, and represents the first full collaborative effort between the two specialties after years of turf battles involving CTC and Colonoscopy (CS).…”

“…In that case, the exam needs to be rescheduled on a different day with a new bowel preparation. Delay of CTC for approximately 2 weeks should also be considered after an endoscopic resection [5,6]. If the reason for incomplete CS was an obstructing colorectal cancer, good clinical practice includes the use of intravenous contrast medium to perform a complete pre-operative staging of the neoplastic lesion [11].…”

Benign Diseases of the Colon and Rectum (incl. CT colonography)

“…CTC has been shown to be as accurate as optical colonoscopy (OC) for the detection of advanced colonic neoplasia, including advanced adenomas and cancers [1]. Since its performance is clearly superior to that of the barium enema, it is now recommended as the radiological method of choice for the detection of colorectal neoplasia [2,3]. The barium enema is no longer recommended for this indication.…”