Imaging alternatives to colonoscopy: CT colonography and colon capsule. European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastrointestinal and Abdominal Radiology (ESGAR) Guideline – Update 2020

Abstract

Main recommendations1. ESGE/ESGAR recommend computed tomographic colonography (CTC) as the radiological examination of choice for the diagnosis of colorectal neoplasia. Strong recommendation, high quality evidence. ESGE/ESGAR do not recommend barium enema in this setting. Strong recommendation, high quality evidence. 2. ESGE/ESGAR recommend CTC, preferably the same or next day, if colonoscopy is incomplete. The timing depends on an interdisciplinary decision including endoscopic and radiological factors. Strong recommendation, low quality evidence. ESGE/ESGAR suggests that, in centers with expertise in and availability of colon capsule endoscopy (CCE), CCE preferably the same or the next day may be considered if colonoscopy is incomplete. Weak recommendation, low quality evidence. 3. When colonoscopy is contraindicated or not possible, ESGE/ESGAR recommend CTC as an acceptable and equally sensitive alternative for patients with alarm symptoms. Strong recommendation, high quality evidence. Because of lack of direct evidence, ESGE/ESGAR do not recommend CCE in this situation. Very low quality evidence. ESGE/ESGAR recommend CTC as an acceptable alternative to colonoscopy for patients with non-alarm symptoms. Strong recommendation, high quality evidence. In centers with availability, ESGE/ESGAR suggests that CCE may be considered in patients with non-alarm symptoms. Weak recommendation, low quality evidence. 4. Where there is no organized fecal immunochemical test (FIT)-based population colorectal screening program, ESGE/ESGAR recommend CTC as an option for colorectal cancer screening, providing the screenee is adequately informed about test characteristics, benefits, and risks, and depending on local service-and patient-related factors. Strong recommendation, high quality evidence. ESGE/ESGAR do not suggest CCE as a first-line screening test for colorectal cancer. Weak recommendation, low quality evidence. 5. ESGE/ESGAR recommend CTC in the case of a positive fecal occult blood test (FOBT) or FIT with incomplete or unfeasible colonoscopy, within organized population screening programs. Strong recommendation, moderate quality evidence. ESGE/ESGAR also suggest the use of CCE in this setting based on availability. Weak recommendation, moderate quality evidence.This article is published simultaneously in the journals Endoscopy (

Convolution neural network for the diagnosis of wireless capsule endoscopy: a systematic review and meta-analysis

“…It has been used to detect small intestinal lesions that cannot be reached by traditional endoscopy. At the same time, although it is not the mainstream diagnostic method, capsule endoscopy is also used to explore some esophageal, gastric, and colorectal diseases [ 42 ]. Although WCE is convenient and painless, the high rate of miss diagnosis has always been its disadvantage, which is mostly related to people’s limited reading ability and energy [ 43 ].…”

Recent trends in the prevalence and distribution of colonic diverticula in Japan evaluated using computed tomography colonography

“…Conducting clinical studies on the prevalence of diverticulosis determined that the use of barium enema is difficult, given the widespread use of colonoscopy. According to the European Society of Gastrointestinal Endoscopy and the European Society of Gastrointestinal and Abdominal Radiology Guideline - Update 2020[ 20 ], barium enema for the diagnosis of colorectal neoplasia was not recommended (strong recommendation); in this regard, barium enema cannot be used in this setting.…”

“…In recent years, CTC has become more popular for screening and diagnosing colorectal cancer[ 21 , 22 ]; therefore, CTC could be used as an alternative to colonoscopy due to its diagnostic ability and safety[ 20 , 23 ]. It might be superior for detecting diverticula because it can evaluate the colon from more advantageous perspectives and avoid impediments caused by overlapping adjacent sections of the colon.…”

Diagnostic Yields and Clinical Impacts of Capsule Endoscopy

“…CCE is safe and feasible for obtaining sufficient colonic images without obstruction in patients who underwent incomplete colonoscopy [89]. Recent publications have indicated CCE investigations as feasible after incomplete colonoscopy [16,90,91].…”