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Between 5 and 10% of the patients undergoing a colonoscopy cannot have a complete procedure mainly due to stenosing neoplastic lesion of rectum or distal colon. Nevertheless the elective surgical treatment concerning the stenosis is to be performed after the pre-operative assessment of the colonic segments upstream the cancer. The aim of this study...
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OBJETIVO: Avaliar o grau de aceitação do paciente submetido a colonografia por tomografia computadorizada (CTC) em comparação com a colonoscopia, quando realizadas para rastreamento de doença colorretal. MATERIAIS E MÉTODOS: Cinquenta pacientes com suspeita de doença colorretal foram submetidos a CTC e colonoscopia. Questionários foram aplicados an...
Background/Aims:
Optical colonoscopy (OC) is the primary modality for investigation of colonic pathology. Although there is data on demographic factors for incomplete OC, paucity of data exists for anatomic variables that are associated with an incomplete OC. These anatomic variables can be visualized using computed tomographic colonography (CTC)....
Colonic endometriosis has been reported in the literature to mimic colon cancer. Patients can present with symptoms almost identical to colon cancer. We present an exemplary case of a woman who was found to have a mass on conventional colonoscopy. Virtual colonoscopy was instrumental in characterizing the obstructive sigmoid mass. A biopsy of the m...
Citations
... [24][25][26] Two studies used 'stenosing' cancers, tumours or masses in their description, but both failed to define this term. 27,28 Two studies used a combination of stenosing, occlusive or obstructing throughout the text in their descriptions. 29,30 This study defined obstructing CRC as those in which the colonoscope could not traverse to visualize the proximal colon. ...
... Nine of the 17 included CTC studies reported whether the surgical management was changed due to the findings of CTC. 11,13,15,16,18,20,25,28,30 The surgical plan was changed in 2.4-14.3% of patients after the use of CTC. Changes to surgical resection due to findings of synchronous proximal CRC included subtotal colectomy and ileorectal anastomosis rather than sigmoid colectomy (n = 1), 16 left hemicolectomy rather than a sigmoid colectomy alone (n = 2), 13,16 subtotal colectomy rather than a left hemicolectomy (n = 5), 13,18,28 Sigmoid resection and right hemicolectomy instead of sigmoid resection alone for CRC (n = 1). ...
... 11,13,15,16,18,20,25,28,30 The surgical plan was changed in 2.4-14.3% of patients after the use of CTC. Changes to surgical resection due to findings of synchronous proximal CRC included subtotal colectomy and ileorectal anastomosis rather than sigmoid colectomy (n = 1), 16 left hemicolectomy rather than a sigmoid colectomy alone (n = 2), 13,16 subtotal colectomy rather than a left hemicolectomy (n = 5), 13,18,28 Sigmoid resection and right hemicolectomy instead of sigmoid resection alone for CRC (n = 1). 13 Other changes to surgical management following the use of CTC included left hemicolectomy to left hemi and appendectomy for a neuroendocrine tumour detected by CTC (n = 1), low anterior resection to low anterior and cystectomy (n = 1), and total mesorectal excision to total proctocolectomy for numerous tubullo villous polyps in proximal colon (n = 1). ...
Purpose:
15-20% of patients present with near obstructing left-sided colorectal cancer. CT colonography (CTC) or PET-CT has been used to detect synchronous lesions, which may alter preoperative planning of colonic resection. We aim to synthesize the usefulness of CT colonography and/or PET-CT in detecting synchronous proximal colon carcinomas in patients who have undergone an incomplete colonoscopy due to a stenosing or obstructing distal colorectal cancer.
Methodology:
A systematic review was performed by searching the databases up to December 2021. Data collected included demographics of the study population, rate of detection of synchronous carcinomas and impact on management of detection of synchronous carcinomas.
Results:
A total of 22 studies were included: 17 studies focused on CTC, 3 on PET-CT, and 2 integrated PET-CT with CTC; 2855 patients were included; 53% of patients were male, and 47% were female. All studies reported detection of synchronous proximal colorectal carcinomas using CTC, PET-CT or CTC, and PET-CT combined. CTC detected synchronous carcinomas in 0.2-12.2% of patients. PET-CT was useful in detecting synchronous carcinomas in 4.05-23% of patients. Integrated PET-CT and CTC detected synchronous carcinomas in 2-15% of patients. The surgical plan was changed in 2.4-14.3% of patients after the use of CTC. One PET-CT study reported a change in management in 13.5%. No complication was reported by the use of CTC.
Conclusion:
CTC is an effective and useful adjunct to colonoscopy in assessing the proximal colon when colonoscopy fails to do so. However, more evidence is needed with the use of PET-CT for this patient population.
... Double contrast barium enema (DCBE) is an investigative option when the endoscopic instrument cannot surmount the stenosis. Unfortunately, this approach shows low sensitivity and specificity, particularly in the right-sided colon, which results in inaccurate evaluation [9]. This may be contraindicated for fear of complicating the situation by precipitating obstruction and colonic perforation, with a resulting need for intraoperative colonoscopy [10]. ...
... It is less invasive than CC, and is a better diagnostic test [12]. It allows exploration of the colon safely with higher sensitivity reaching 83.7% and a morbidity and mortality similar to those of the DCBE (perforation rate of 1:10000 and mortality rate of 1:50000), which is much lower than those of CC (perforation occurs in 1:1000 patients, and an associated mortality rate of 1:5000) [9]. Therefore, we believe that CTC is more accurate than CC for preoperative assessment of the entire colon in patients with SCRCIO patients, and that CTC findings will result in changes in the surgical management approach. ...
... evaluated 43 patients with stenotic colorectal cancer and concluded that CTC is a valid preoperative investigation (sensitivity 83.7%) for synchronous proximal lesions [9]. This study concurs with the literature that shows 98-100% sensitivity of CTC for polyps >10mm, and 71-90% sensitivity for 5-9mm polyps [26,28]. ...
Background and aims
Stenotic colorectal carcinoma impending obstruction (SCRCIO) is a frequently encountered situation complicating 10% to 19% of colorectal cancers. This group of patients cannot undergo complete colonoscopic assessment. The aim of this study is to examine the accuracy of computed tomographic colonography (CTC) as preoperative assessment of the colon of patients with SCRCIO and to measure the effect on the surgical decision.
Materials and methods
This was a prospective study, from September 2009 through December 2012, on a cohort of symptomatic adult patients with SCRCIO. Patients underwent CTC evaluation after failed conventional colonoscopy (CC), followed by a follow-up endoscopic examination 3–6 months after surgical treatment.
Results
Twenty-nine patients with an average age of 55 were included in this study; the majority of stenotic masses were located in the sigmoid colon. Preoperative CTC matched the colonoscopy location of the stenotic masses (17 patients). CTC sensitivity per stenotic lesion detection was 100% and 92.5% for the location. Sensitivity was 100% for synchronous lesions, and CTC changed surgical plan in 17% of the patients.
Conclusion
CTC presented high sensitivity, specificity and accuracy for the identification of colonic lesions of any size. Preoperative CTC may possibly become the diagnostic procedure of choice for SCRCIO patients. It enables surgeons to evaluate the entire colon, minimizing the possibility of surgical re-intervention if there is a finding of synchronous neoplastic lesions at postoperative follow-up endoscopy.
... Several studies have investigated the accuracy of CTC for detecting synchronous colonic lesions proximal to an occlusive cancer, and have demonstrated a high sensitivity of CTC for the detection of proximal synchronous cancers [28,[35][36][37][38][39] (Table 1). Most of these studies were preliminary studies that included a small number of patients [35][36][37][38][39] ; however, one recent large study (the largest report thus far) [28] included 427 consecutive patients with stenosing colorectal cancer, of which 284 were ultimately analyzed to determine the accuracy of CTC. ...
... Several studies have investigated the accuracy of CTC for detecting synchronous colonic lesions proximal to an occlusive cancer, and have demonstrated a high sensitivity of CTC for the detection of proximal synchronous cancers [28,[35][36][37][38][39] (Table 1). Most of these studies were preliminary studies that included a small number of patients [35][36][37][38][39] ; however, one recent large study (the largest report thus far) [28] included 427 consecutive patients with stenosing colorectal cancer, of which 284 were ultimately analyzed to determine the accuracy of CTC. The results showed 100% and 88.6% sensitivities of CTC for detecting patients harboring synchronous colorectal cancer and advanced neoplasia (i.e., advanced adenoma [40] or cancer), respectively, in the proximal colon. ...
... Park et al [28] 284 Adenocarcinoma 100% (6/6) 100% (8/8) 87.9 (181/206) Advanced neoplasia 1 88.6% (39/44) 80% (52/65) Fenlon et al [35] 29 Adenocarcinoma 100% (2/2) 100% (2/2) NA Neri et al [36] 17 Adenocarcinoma 100% (3/3) 100% (3/3) NA Coccetta et al [37] 43 Adenocarcinoma 100% (1/1) 100% (1/1) NA Galia et al [38] 19 Adenocarcinoma 100% (2/2) 100% (2/2) NA Kim et al [39] 67 tal Cancer) stipulate that early postoperative follow-up colonoscopy to evaluate the proximal colon should be performed 3-6 mo after surgical removal of an occlusive cancer in addition to the routine colonoscopic surveillance approximately 1 year after surgery or perioperative clearance of the colon [41,42,47] . These "current" guidelines are largely based on the data and experience from the pre-CTC era. ...
This article addresses the use of computed tomographic colonography (CTC) for the diagnosis and management of colorectal cancer, focusing on presurgical evaluation of the colon proximal to an occlusive cancer and surveillance after cancer resection surgery. The key evidences accumulated in the literature and future work needed are summarized. CTC is a technically robust and the most practical method to evaluate the colon proximal to an occlusive cancer, which prevents colonoscopic examination past the occlusion, either before or after metallic stent placement. The high sensitivity of CTC for detecting cancers and advanced adenomas in the proximal colon can help prevent additional surgical procedures in patients showing negative results. However, the accuracy of CTC for distinguishing intramural cancers from adenomas is low, and the technique is limited in guiding management when a medium-sized lesion that do not show invasive features such as pericolic extension or nodal metastasis is found in the proximal colon. A maximal diameter ≥ 15 mm has been proposed as a criterion for surgical removal of proximal lesions. However, this needs to be verified in a larger cohort. In addition, the influence of presurgical CTC results on the current post-cancer resection colonic surveillance timeline remains to be determined. CTC can be readily added to the routine abdominopelvic CT in the form of contrast-enhanced CTC, which can serve as an effective stand-alone tool for post-cancer resection surveillance of both the colorectum and extracolonic organs. Although the accuracy of CTC has been demonstrated, its role in the current colonoscopy-based postoperative colonic surveillance protocols remains to be determined. Readers of CTC also need to be knowledgeable on the colonic lesions that are unique to the postoperative colon.
... Patients with failed or incomplete colonoscopy (5%-10%), those who are reluctant to undergo OC or those who may be at an increased risk with OC can be evaluated by CTC (Figures 1 and 2) [21,22] . CTC has been used in the evaluation of patients presenting with obstructing colonic neoplasms and rarely in inflammatory bowel disease [23][24][25] . However, CTC is contraindicated in the presence of any acute inflammatory condition of the bowel, such as acute inflammatory bowel disease or diverticulitis, due to the increased risk of perforation following insufflation of colon [26][27][28] . ...
Computed tomography (CT) colonoscopy is a well-established technique for evaluation of colorectal cancer. Significant advances have been made in the technique of CT colonoscopy since its inception. Excellent results can be achieved in detecting both colorectal cancer and significant sized polyps as long as a meticulous technique is adopted while performing CT colonoscopy. Furthermore, it is important to realize that there is a learning curve involved in interpreting these studies and adequate experience is essential to achieve high sensitivity and specificity with this technique. Indications, contraindications, technique and interpretation, including potential pitfalls in CT colonoscopy imaging, are reviewed in this article. Recent advances and the current role of CT colonoscopy in colorectal cancer screening are also discussed.
Objectives
Preoperative colonoscopy is often incomplete for stenotic colorectal cancers (CRC). This prospective observational study aimed to evaluate the ability of an ultrathin colonoscope (UTC) to inspect the whole colon by passing through the stenotic CRC.
Methods
All patients who underwent preoperative colonoscopy for stenotic CRCs at Shizuoka Cancer Center were examined for eligibility. If a standard colonoscope (PCF‐H290ZI) could not pass because of a stenosis, the patients were recruited. All of eligible patients were prospectively enrolled when informed consent could be obtained, and complete colonoscopy was attempted again using an UTC (PCF‐PQ260L). Patients with stent placement and those requiring right hemicolectomy were not recruited. Primary endpoints were pass‐through and cecal intubation rates. The detected synchronous neoplasias (adenomas and cancers) and their pathological findings after resection were evaluated.
Results
A total of 100 patients were enrolled between September 2017 and February 2019. The mean age was 65.6 ± 10.8 years, and 59% were male. The pass‐through and cecal intubation rates were 67% (67/100) and 58% (58/100), respectively. Synchronous lesions located proximal to the stenoses were detected in 65.5% (38/58) of the complete colonoscopies, with a total of 86 lesions, including 18 advanced neoplasias with three invasive cancers.
Conclusion
When standard colonoscopy cannot pass through stenotic CRC, ultrathin colonoscopy can be considered as an option to inspect the whole colon proximal to the stenosis because treatment strategy can potentially be changed by detecting synchronous neoplasias proximal to the stenosis before surgery. (UMIN000028505)
Colorectal cancer is associated with high mortality and morbidity and is currently the second leading cause of cancer-related deaths in the United States. Early detection and treatment of colorectal carcinoma can significantly improve the prognosis. Although optical colonoscopy has been the gold standard for the diagnosis of this condition, computed tomography colonoscopy is increasingly playing an important role in the diagnosis and staging of colorectal carcinoma.
This is an official guideline of the European Society of Gastrointestinal Endoscopy (ESGE) and the European Society of Gastrointestinal and Abdominal Radiology (ESGAR). It addresses the clinical indications for the use of computed tomographic colonography (CTC). A targeted literature search was performed to evaluate the evidence supporting the use of CTC. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was adopted to define the strength of recommendations and the quality of evidence. Main recommendations 1 ESGE/ESGAR recommend computed tomographic colonography (CTC) as the radiological examination of choice for the diagnosis of colorectal neoplasia. 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. Delay of CTC should be considered following endoscopic resection. In the case of obstructing colorectal cancer, preoperative contrast-enhanced CTC may also allow location or staging of malignant lesions (strong recommendation, moderate quality evidence). 3 When endoscopy is contraindicated or not possible, ESGE/ESGAR recommend CTC as an acceptable and equally sensitive alternative for patients with symptoms suggestive of colorectal cancer (strong recommendation, high quality evidence). 4 ESGE/ESGAR recommend referral for endoscopic polypectomy in patients with at least one polyp ≥ 6 mm in diameter detected at CTC. CTC surveillance may be clinically considered if patients do not undergo polypectomy (strong recommendation, moderate quality evidence). 5 ESGE/ESGAR do not recommend CTC as a primary test for population screening or in individuals with a positive first-degree family history of colorectal cancer (CRC). However, it may be proposed as a CRC screening test on an individual basis providing the screenee is adequately informed about test characteristics, benefits, and risks (weak recommendation, moderate quality evidence).
This is an official guideline of the European Society of Gastrointestinal Endoscopy (ESGE) and the European Society of Gastrointestinal and Abdominal Radiology (ESGAR). It addresses the clinical indications for the use of computed tomographic colonography (CTC). A targeted literature search was performed to evaluate the evidence supporting the use of CTC. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was adopted to define the strength of recommendations and the quality of evidence.
The aim of this study is to illustrate our experience of Virtual Colonoscopy (VC) for investigation of lesions of the large intestine in patients with iron deficiency anaemia, comparing its results to those from classical colonoscopy. Colorectal cancer (CRC) is the third most common cancer and the second leading cause of death in the United States. Several options have been developed as screening methods, each with its advantages and drawbacks. Optical colonoscopy (OC) is currently the gold standard for evaluation of the entire colonic mucosa, possessing the therapeutic capacity for resecting detected lesions. Virtual Colonoscopy has evolved as a result of technological advances in imaging and, specifically, in computed tomography.
Objective To investigate CT colonography (CTC) performance for detecting and characterising synchronous lesions proximal to a stenosing colorectal cancer and to suggest patient management strategies according to the CTC findings.
Methods 411 consecutive patients underwent CTC for proximal colonic evaluation after failed colonoscopy past a newly diagnosed stenosing colorectal cancer. Pathological examination of colectomy specimen and/or postsurgical colonoscopy with pathological confirmation of the proximal synchronous lesions to serve as reference standards existed in 284 patients. Per-patient and per-lesion diagnostic performance measures of CTC for diagnosing proximal synchronous lesions ≥6 mm analysed by histopathological categories were obtained for the 284 patients. Per-lesion sensitivity and positive predictive value (PPV) of various CTC lesion size criteria and lesion size combined with other CTC findings for diagnosing cancer in the proximal colon were determined.
Results Both per-patient and per-lesion CTC detection sensitivities for proximal synchronous cancers were 100% (6/6 patients and 8/8 lesions; 95% CI 64.3% to 100% and 70.7% to 100%, respectively) with the corresponding per-patient negative predictive value (NPV) of a negative CTC of 100% (194/194 patients; 95% CI 98.3% to 100%). Per-patient NPV of a negative CTC for advanced neoplasia (ie, advanced adenomas and colorectal cancers) was 97.4% (189/194 patients; 95% CI 93.9% to 99.1%). A lesion size ≥15 mm on CTC as the criterion to specifically diagnose proximal cancer yielded 87.5% (7/8 lesions; 95% CI 50.8% to 99.9%) per-lesion sensitivity, rendering one 8-mm submucosal cancer mischaracterised as a non-cancerous lesion, and 70% (7/10 lesions; 95% CI 39.2% to 89.7%) per-lesion PPV. Additional CTC findings did not improve the sensitivity.
Conclusion CTC is highly sensitive in detecting synchronous cancers proximal to a stenosing colorectal cancer. CTC has limited capability in differentiating advanced adenomas from colorectal cancer and this compromises the PPV of CTC for the presence of proximal cancer.
