Usefulness of CT colonography after incomplete or failed colonoscopy
OBJECTIVE To evaluate the clinical usefulness of CT Colonography after an incomplete or failed colonoscopy. MATERIALS AND METHODS After incomplete or failed colonoscopy, seventeen patients underwent CT Colonography before and after intravenous injection of iodinated contrast agent, in supine an...
| Main Authors: | , , , , , , , |
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| Format: | Conference or Workshop Item |
| Language: | English |
| Published: |
2012
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| Subjects: | |
| Online Access: | http://irep.iium.edu.my/23337/ http://irep.iium.edu.my/23337/ http://irep.iium.edu.my/23337/1/CTC-COR_2012.pdf |
| Summary: | OBJECTIVE
To evaluate the clinical usefulness of CT Colonography after an incomplete or failed colonoscopy.
MATERIALS AND METHODS
After incomplete or failed colonoscopy, seventeen patients underwent CT Colonography before and after intravenous injection of iodinated contrast agent, in supine and prone positions. Two-dimensional multiplanar reformatted images and three-dimensional endoluminal images were analyzed. The endoluminal navigations were performed from rectum to caecum, in both retrograde and antegrade directions in order to visualize both sides of haustral folds.
We analyzed reasons for incomplete colonoscopy as well as colonic and extracolonic findings.
RESULTS
Reasons for incomplete colonoscopy includes stenosing or constricting tumour (5 patients), redundant colonic segments or difficulty in manipulating the endoscopes (8 patients), and unable to tolerate the pain (1 patient). Failed CT Colonography for 3 patients were due to intolerable pain. Proximal colon and undiagnosed colonic lesions on colonoscopy were assessed via CT Colonography, making it a useful tool for this group of patients. Additional findings of tumour invasion, nodal and liver metastasis were also identified in this study, apart from other extracolonic findings like ovarian tumour, cholelithiasis and inguinal hernias.
DISCUSSION
Colonoscopy is regarded as the gold standard for the evaluation of the colon for colorectal tumors, but it may be incomplete due to tumor obstruction, difficult manipulation or patient’s intolerance. Failure to visualize the entire colonic surface occurs in 5-10% of colonoscopy examinations (1). In these instances, further evaluation is necessary.
Many reports described the ability of CT colonography to show the colon proximal to occlusive cancer, and in evaluation of entire colon in incomplete or failed colonoscopy cases (1-5). The results of CTC in occlusive colorectal tumors are encouraging and evaluation of the whole colon by CTC is reportedly effective.
CTC not only provide knowledge of whole colorectal lesions, but accurate tumor localization and tumor extent, tumor/nodal staging, and extra-colic abnormalities can also be assessed, which are critical for the proper management of patients with colorectal tumors (5).
CONCLUSION
CT colonography is a rapid, well-tolerated technique that provides useful colonic and extracoIonic informations and should be considered for all patients who undergo incomplete colonoscopy or failed colonoscopy. This preliminary data suggest that CT colonography has an adjunctive role in this group of patients.
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