Risk Factors for Colonic Perforation after Screening Computed Tomographic Colonography: A Multicentre Analysis and Review of the Literature

Atalla, Mohamed A.; Rozen, Warren M.; Niewiadomski, Olga; Croxford, Matthew; Cheung, Wa; Ho, Yik‐Hong

doi:10.1258/jms.2010.010042

Cited by 15 publications

(13 citation statements)

References 26 publications

(59 reference statements)

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“…As previously reported in literature by Atalla et al, even in our survey no correlation between the incidence of perforation and the institutional experience was observed [46]. This event was demonstrated by the fact that 5 out of 7 perforations occurred in two centers with a large number of monthly CTC examination performed.…”

Section: Discussionsupporting

confidence: 57%

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Adverse events of computed tomography colonography: An Italian National Survey

Iafrate¹,

Iussich²,

Correale³

et al. 2013

Digestive and Liver Disease

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a b s t r a c tAim: To retrospectively study the frequency and magnitude of complications associated with computed tomography (CT) colonography in clinical practice. Methods: A questionnaire on complications of CT colonography was sent to Italian public radiology departments identified as practicing CT colonography with a reasonable level of training. The frequency of complications and possible risk factors were retrospectively determined. Responses were collated and row frequencies determined. A multivariate analysis of the factors causing adverse events was also performed. Results: 40,121 examinations were performed in13 centers during the study period. No deaths were reported. Bowel perforations occurred in 0.02% (7 exams). All perforations were asymptomatic and occurred in patients undergoing manual insufflation. Five perforations (71%) occurred in procedures performed following a recent colonoscopy. There was no significant difference between perforations associated with rectal balloon (0.017%) and those that were not (0.02%). Complications related to vasovagal reaction (either with or without spasmolytic) occurred in 0.16% (63 exams). All vasovagal reactions resolved in less than 3 h, without any sequelae. Conclusions: Perforation rate at CT colonography in Italy is comparable with elsewhere in the world, occurring regardless of the experience of radiology centers. Although the risk is very small, it may not be negligible when compared with the risk of diagnostic colonoscopy.

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Section: Discussionsupporting

confidence: 57%

“…However, there is little evidence about a safe interval between colonoscopy and CTC [45]. Therefore, the possibility of a perforation following a recent optical colonoscopy, must be carefully investigated before CTC procedure [22,45,46]. In our study, 2 perforations occurred in patients undergoing a same-day optical colonoscopy.…”

Section: Discussionmentioning

confidence: 73%

Adverse events of computed tomography colonography: An Italian National Survey

Iafrate¹,

Iussich²,

Correale³

et al. 2013

Digestive and Liver Disease

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“…The incidence of symptomatic colonic perforation associated with CTC has previously been found to be 0.05% in a series of 17,067 patients [11] and 0.06% in a series of 11,870 patients [12] and 3458 patients, respectively [13]. Increased intraluminal pressures can lead to colonic rupture.…”

Section: Discussionmentioning

confidence: 99%

Computed Tomography Colonography Technique: The Role of Intracolonic Gas Volume

McLaughlin

Murphy

Crush

et al. 2013

Radiology Research and Practice

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Introduction. Poor distention decreases the sensitivity and specificity of CTC. The total volume of gas administered will vary according to many factors. We aim to determine the relationship between the volume of retained gas at the time of image acquisition and colonic distention and specifically the presence of collapsed bowel segments at CTC. Materials and Methods. All patients who underwent CTC over a 12-month period at a single institution were included in the study. Colonic luminal distention was objectively scored by 2 radiologists using an established 4-point scale. Quantitative analysis of the volume of retained gas at the time of image acquisition was conducted using the threshold 3D region growing function of OsiriX. Results. 108 patients were included for volumetric analysis. Mean retained gas volume was 3.3 L. 35% (38/108) of patients had at least one collapsed colonic segment. Significantly lower gas volumes were observed in the patients with collapsed colonic segments when compared with those with fully distended colons 2.6 L versus 3.5 L (P = 0.031). Retained volumes were significantly higher for the 78% of patients with ileocecal reflux at 3.4 L versus 2.6 L without ileocecal reflux (P = 0.014). Conclusion. Estimation of intraluminal gas volume at CTC is feasible using image segmentation and thresholding tools. An average of 3.5 L of retained gas was found in diagnostically adequate CTC studies with significantly lower mean gas volume observed in patients with collapsed colonic segments.

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“…36 Furthermore, we assumed a small risk of complications such as bowel perforations after colonography and colonoscopy. 37,38 The costs of these complications are also taken into account. Since there are no data on costs of complications after colonography, we assumed these to be equal to the costs of complications after colonoscopy.…”

Section: Screening Strategiesmentioning

confidence: 99%

The potential of imaging techniques as a screening tool for colorectal cancer: a cost-effectiveness analysis

Greuter¹,

Berkhof²,

Fijneman³

et al. 2016

BJR

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Objective: Imaging may be promising for colorectal cancer (CRC) screening, since it has test characteristics comparable with colonoscopy but is less invasive. We aimed to assess the potential of CT colonography (CTC) and MR colonography (MRC) in terms of (cost-effectiveness) using the Adenoma and Serrated pathway to Colorectal CAncer model. Methods: We compared several CTC and MRC strategies with 5-or 10-yearly screening intervals with no screening, 10-yearly colonoscopy screening and biennial faecal immunochemical test (FIT) screening. We assumed trial-based participation rates in the base-case analyses and varied the rates in sensitivity analyses. Incremental lifetime costs and health effects were estimated from a healthcare perspective. Results: The health gain of CTC and MRC was similar and ranged from 0.031 to 0.048 life-year gained compared with no screening, for 2-5 screening rounds. Lifetime costs per person for MRC strategies were €60-110 higher than those for CTC strategies with an equal number of screening rounds. All imaging-based strategies were cost-effective compared with no screening. FIT screening was the dominant screening strategy, leading to most LYG and highest cost-savings. Compared with three rounds of colonoscopy screening, CTC with five rounds was found to be cost-effective in an incremental analysis of imaging strategies. Assumptions on screening participation have a major influence on the ordering of strategies in terms of costs and effects. Conclusion: CTC and MRC have potential for CRC screening, compared with no screening and compared with three rounds of 10-yearly colonoscopy screening. When taking FIT screening as the reference, imaging is not costeffective. Participation is an important driver of effectiveness and cost estimates. Advances in knowledge: This is the first study to assess the cost-effectiveness of MRC screening for CRC.

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Risk Factors for Colonic Perforation after Screening Computed Tomographic Colonography: A Multicentre Analysis and Review of the Literature

Cited by 15 publications

References 26 publications

Adverse events of computed tomography colonography: An Italian National Survey

Adverse events of computed tomography colonography: An Italian National Survey

Computed Tomography Colonography Technique: The Role of Intracolonic Gas Volume

The potential of imaging techniques as a screening tool for colorectal cancer: a cost-effectiveness analysis

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