BACKGROUND/AIMS: Because of the national screening program for colorectal carcinoma in The Netherlands, the number of colonoscopies has increased. In case of incomplete colonoscopy, computed tomography colonography (CTC) and double-balloon colonoscopy (DBc) are alternative options. This study evaluated cecal intubation rate and pathology detection rate in the previously unexplored part of the colon, complication rate of DBc, and CTC results after incomplete colonoscopy. METHODS: Retrospective observational study in a tertiary referral hospital regarding DBc and CTC reports from cases with incomplete colonoscopy. RESULTS: Sixty-three DBcs were performed after incomplete colonoscopy. Cecal intubation rate was 95%. Detection rate was 58% (5% carcinoma and 3% high-grade dysplastic adenoma). CTC preceded 54% of DBcs and 62% of CTC findings were confirmed. In 16%, a biopsy was taken, and in 60%, an intervention (mostly polypectomy) was performed. One major complication (1.5%) occurred, i.e., arterial bleeding due to polypectomy necessitating right hemicolectomy. CTC (n=213) showed a possible lesion in 35%, and could be confirmed by follow-up endoscopy or surgery in 65%. CONCLUSIONS: DBc is effective and safe for completion of colon inspection in incomplete colonoscopy. In patients with a high likelihood of pathology, DBc is preferred over CTC.
Biopsy ; Cecum ; Colon ; Colonography, Computed Tomographic ; Colonoscopy ; Colorectal Neoplasms ; Endoscopy ; Follow-Up Studies ; Hemorrhage ; Humans ; Intubation ; Mass Screening ; Netherlands ; Observational Study ; Pathology ; Retrospective Studies ; Tertiary Care Centers

Objective To explore the feasibility of reducing radiation dose of CT colonography (CTC) while preserving image quality using the third-generation dual-source CT at 70 kV tube voltage with advanced modeled iterative reconstruction (ADMIRE). Methods This prospective study consecutively included 53 patients. All patients underwent CTC at 120 kV in supine position with filtered back projection reconstruction and at 70 kV in prone position with ADMIRE with the same scan range. Radiation dose and image quality were compared between these two protocols. Results CT dose index volume,dose-length product,and effective dose of 70 kV were (1.47±0.23)mGy,(68.85±13.82)mGy·cm,and (1.03±0.21)mSv,respectively,which were significantly lower than 120 kV mode [(2.96±0.61)mGy (t=25.356,P=0.000),(136.97±32.77)mGy·cm (t=22.246,P=0.000),and (2.05±0.49)mSv (t=22.293,P=0.000)]. Signal to noise ratio of 70 kV with ADMIRE was 3.60±0.58,which was obviously higher than that of 120 kV as 2.34±0.47 (t=-18.036,P=0.000). Noise of 70 kV with ADMIRE was (11.81±1.93)HU,which was obviously lower than that of 120 kV as (14.39±2.57)HU (t=7.856,P=0.000). The κ value of two radiologists' overall subjective image score was 0.843 (P=0.000). For 2D images,the noise score of 70 kV with ADMIRE was significantly lower (Z=325.000,P=0.000) and the overall image quality was significantly higher (Z=78.000,P=0.001) compared with 120 kV;however,the sharpness had no significant difference. All scores ranged from 4 to 5. For 3D virtual endoscopy,the overall image quality of 70 kV with ADMIRE and 120 kV was not significantly different (Z=4.000,P=0.059),and all scores ranged from 4 to 5. Conclusion CTC at 70 kV tube voltage combined with ADMIRE can remarkably reduce the radiation dose while maintaining imaging quality than 120 kV at third-generation dual-source CT.
Colon ; diagnostic imaging ; Colonography, Computed Tomographic ; methods ; Humans ; Prone Position ; Prospective Studies ; Radiation Dosage ; Radiographic Image Interpretation, Computer-Assisted ; Radionuclide Imaging ; Signal-To-Noise Ratio

PURPOSE: Virtual colonoscopy is the most recently developed tool for detecting colorectal cancers and polyps, but its effectiveness is limited. In our study, we compared the result of preoperative virtual colonoscopy to result of preoperative and postoperative colonoscopy. We evaluated also the accuracy of preoperative virtual colonoscopy in patients who had obstructive colorectal cancer that did not allow passage of a colonoscope. METHODS: A total of 164 patients who had undergone preoperative virtual colonoscopy and curative surgery after the diagnosis of a colorectal adenocarcinoma between November 2008 and August 2013 were pooled. We compared the result of conventional colonoscopy with that of virtual colonoscopy in the nonobstructive group and the results of preoperative virtual colonoscopy with that of postoperative colonoscopy performed at 6 months after surgery in the obstructive group. RESULTS: Of the 164 patients, 108 were male and 56 were female patients. The mean age was 62.7 years. The average sensitivity, specificity, and accuracy of virtual colonoscopy for all patients were 31.0%, 67.2%, and 43.8%, respectively. In the nonobstructive group, the average sensitivity, specificity, and accuracy were 36.6%, 66.2%, and 48.0%, respectively, whereas in the obstructive group, they were 2%, 72.4%, and 25.4%. Synchronous cancer was detected via virtual colonoscopy in 4 of the 164 patients. CONCLUSION: Virtual colonoscopy may not be an effective method for the detection of proximal colon polyps, but it can be helpful in determining the therapeutic plan when its results are correlated with the results of other studies.
Adenocarcinoma ; Colon* ; Colonic Polyps ; Colonography, Computed Tomographic* ; Colonoscopes ; Colonoscopy ; Colorectal Neoplasms* ; Diagnosis ; Female ; Humans ; Male ; Methods ; Polyps ; Sensitivity and Specificity

BACKGROUND/AIMS: Colonoscopy and computed tomography (CT) are used primarily to exclude organic diseases in patients with irritable bowel syndrome (IBS), rather than to assess the pathophysiology of IBS. We aimed to evaluate colonic dysmotility and morphology in Japanese patients with IBS. METHODS: One hundred eighty-four patients with IBS and 49 asymptomatic controls who underwent colonoscopy in combination with CT colonography or barium enema were retrospectively reviewed between 2008 and 2012. Water-aided colonoscopy was performed without sedation by a single endoscopist. The duration and pattern of colonic movement and cecal intubation time were recorded. To assess colonic morphology, barium enema or CT colonography were performed immediately after colonoscopy. RESULTS: Colonic dysmotility was more frequent in the IBS group (28.8% vs. 2.0% in controls, P<0.001), especially in cases of IBS with diarrhea (IBS-D) (IBS with constipation [IBS-C] 28.8% vs. IBS-D 60.0% vs. mixed IBS [IBS-M] 5.1%, P<0.001). Colonic morphological abnormality was more frequent in the IBS group than in the control group (77.7% vs. 24.5%, P<0.001), especially in IBS-M and IBS-C groups (IBS-C 77.5% vs. IBS-D 48.9% vs. IBS-M 100%, P<0.001). Most patients with IBS with colonic dysmotility had experienced stress related to their symptoms. Cecal intubation time was significantly longer in the IBS group than in the control group (12.1±6.9 minutes vs. 4.6±1.9 minutes, P<0.001). CONCLUSIONS: Unsedated colonoscopy, combined with radiographic findings, can detect colonic dysmotility and morphological abnormality. Technical difficulties observed during cecal intubation may partially explain the pathophysiology of IBS.
Asian Continental Ancestry Group* ; Barium ; Colon* ; Colonography, Computed Tomographic ; Colonoscopy ; Constipation ; Diarrhea ; Enema ; Humans ; Intubation ; Irritable Bowel Syndrome* ; Radiography ; Retrospective Studies

Colon capsule endoscopy (CCE) is a noninvasive technique for diagnostic imaging of the colon. It does not require air inflation or sedation and allows minimally invasive and painless colonic evaluation. The role of CCE is rapidly evolving; for example, for colorectal screening (colorectal cancer [CRC]) in average-risk patients, in patients with an incomplete colonoscopy, in patients refusing a conventional colonoscopy, and in patients with contraindications for conventional colonoscopy. In this paper, we comprehensively review the technical characteristics and procedure of CCE and compare CCE with conventional methods such as conventional colonoscopy or computed tomographic colonography. Future expansion of CCE in the area of CRC screening for the surveillance of polyps and adenomatous lesions and for assessment of inflammatory bowel disease is also discussed.
Capsule Endoscopy* ; Colon* ; Colonography, Computed Tomographic ; Colonoscopy ; Diagnostic Imaging ; Humans ; Inflammatory Bowel Diseases ; Inflation, Economic ; Mass Screening ; Polyps

OBJECTIVE: To determine the effect of reduced abdominal compression in prone position on ascending colonic movement during supine-to-prone positional change during CT colonography (CTC). MATERIALS AND METHODS: Eighteen consecutive patients who had undergone prone CTC scanning with cushion blocks placed under the chest and hip/thigh to reduce abdominal compression and had confirmed sessile polyps > or = 6 mm in the well-distended, straight, mid-ascending colon, were included. Radial location along the ascending colonic luminal circumference (degrees) was measured for 24 polyps and 54 colonic teniae on supine and prone CTC images. The supine-to-prone change ranging between -180degrees and +180degrees (- and + for internal and external colonic rotations, respectively), was determined. In addition, possible causes of any ascending colonic rotations were explored. RESULTS: Abdominal compression during prone CTC scanning completely disappeared with the use of cushion blocks in 17 of 18 patients. However, some degrees of ascending colonic rotation were still observed, with the radial location changes of -22degrees to 61degrees (median, 13.9degrees) for the polyps and similar degrees for teniae. Fifty-four percent and 56% of polyps and teniae, respectively, showed changes > 10degrees. The radial location change of the polyps was significantly associated with the degree of anterior shift of the small bowel and mesentery (r = 0.722, p < 0.001) and the degree of posterior displacement of the ascending colon (r = 0.566, p = 0.004) during supine-to-prone positional change. CONCLUSION: Ascending colonic rotation upon supine-to-prone positional change during CTC, mostly in the form of external rotation, is not eliminated by removing abdominal compression in prone position.
Aged ; Colon/*pathology/*radiography ; Colonic Polyps/*radiography ; Colonography, Computed Tomographic/*methods ; Female ; Humans ; Male ; Middle Aged ; Movement ; Prone Position/*physiology ; Retrospective Studies ; Rotation

Contrast-enhanced computed tomography colonography (CE-CTC) is a useful guide for the laparoscopic surgeon to avoid incorrectly removing the colonic segment and the failure to diagnose of synchronous colonic and extra-colonic lesions. Lymph node dissection and vessel ligation under a laparoscopic approach can be time-consuming and can damage vessels and organs. Moreover, mesenteric vessels have extreme variations in terms of their courses and numbers. We describe the benefit of using an abdominal vascular map created by CE-CTC in laparoscopic colorectal surgery candidates. We describe patients with different diseases (colorectal cancer, diverticular disease, and inflammatory bowel disease) who underwent CE-CTC just prior to laparoscopic surgery.
Adult ; Aged ; Colectomy/*methods ; Colon/blood supply/pathology/radiography ; Colonography, Computed Tomographic/*methods ; Colorectal Neoplasms/pathology/*radiography/*surgery ; Contrast Media ; Female ; Humans ; Laparoscopy/*methods ; Lymph Node Excision/methods ; Male ; Middle Aged ; Neoplasm Staging/methods

OBJECTIVETo explore the value of computed tomography colonography with low radiation dose combined with the enhanced scanning in the diagnosis of colorectal carcinoma.

METHODSA total of 120 patients with clinical suspected colorectal carcinoma undergoing CT colonography and enhanced scanning were randomly divided into routine dose group and low dose group. Conventional colonoscopy and/or surgical pathology were used as the gold standard. Sensitivity, specificity and Youden's index of colorectal cancer TNM staging accuracy were calculated in two groups. The radiation dose of two groups was compared.

RESULTSFor conventional dose and low dose group, in the diagnosis of colorectal cancer (including cancer and adenoma), the sensitivity was 100% (45/45 and 44/44), specificity was 93.3%(14/15) and 87.5%(14/16), the Youden's index was 0.93 and 0.88. There were no significant differences between two groups in T, N and M staging accuracy preoperatively (P>0.05). The effective radiation dose of low dose group was significantly lower than that of conventional dose group [(15.9 ± 4.3) mSv vs. (21.4 ± 5.5) mSv, P<0.01].

CONCLUSIONLow dose CTC combined with enhanced scanning not only reduces the radiation dose of patients, but can possesses similar value of conventional dose CTC in the early diagnosis and preoperative pathological staging of colorectal cancer.

Colorectal carcinoma is a common lethal disease with signs and symptoms that may be nonspecific. Computed tomography (CT) of the abdomen and pelvis with or without contrast is frequently performed for various general abdominal complaints, but unlike CT colonography, the large bowel may not be optimally prepared for evaluation. As such, careful and diligent assessment of the non-prepared colon in all CT images of the abdomen and pelvis is important, as it ensures that incidental colorectal malignancy is not missed, especially in older patients. This article gives an overview of multidetector CT imaging signs and subtle clues to aid in the diagnosis of colorectal carcinoma, as well as their pitfalls.
Colonic Polyps ; pathology ; Colonography, Computed Tomographic ; Colorectal Neoplasms ; diagnosis ; diagnostic imaging ; Diagnosis, Differential ; Humans ; Incidental Findings ; Pelvis ; diagnostic imaging ; Radiography, Abdominal ; Tomography, X-Ray Computed

Colorectal cancer is the third most common cancer in Korea; it is the second most common cancer in men and the third most common in women. The incidence rate in Korea has continuously increased since 1999 when the National Cancer Registry statistics began. Currently; there are several screening modalities; that have been recommended by expert societies, including fecal occult blood test, colonoscopy, computed tomographic colonography The annual fecal immunochemical test (FIT) has been used in adults aged 50 and older as part of the National Cancer Screening Program in Korea since 2004. Although several study results from regional or national colorectal cancer screening programs in other countries have been reported, the National Cancer Screening Program in Korea has not yet been evaluated with evidence-based methods. Herein report the consensus statements on the National Screening Guideline for colorectal cancer developed by a multi-society expert committee in Korea, as follows: 1) We recommend annual or biennial FIT for screening for colorectal cancer in asymptomatic adults, beginning at 45 years of age and continuing until 80 years (recommendation B). 2) There is no evidence for the risks or benefits of FIT in adults older than 80 years (recommendation I). 3) Selective use of colonoscopy for colorectal cancer screening is recommended, taking into consideration individual preference and the risk of colorectal cancer (recommendation C). 4) There is no evidence for the risks or benefits of double-contrast barium enema for colorectal cancer screening in asymptomatic adults (recommendation I). 5) There is no evidence for the risks or benefits of computed tomographic colonography for colorectal cancer screening in asymptomatic adults (recommendation I).
Adult ; Barium ; Colonography, Computed Tomographic ; Colonoscopy ; Colorectal Neoplasms* ; Consensus ; Early Detection of Cancer ; Enema ; Female ; Humans ; Incidence ; Korea ; Male ; Mass Screening* ; Occult Blood