1
|
Baccaro LM, Markelov A, Wilhelm J, Bloch R. Pneumoperitoneum after Virtual Colonoscopy: Causes, Risk Factors, and Management. Am Surg 2020. [DOI: 10.1177/000313481408000617] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Computed tomographic virtual colonoscopy (CTVC) is a safe and minimally invasive modality when compared with fiberoptic colonoscopy for evaluating the colon and rectum. We have reviewed the risks for colonic perforation by investigating the relevant literature. The objectives of this study were to assess the risk of colonic perforation during CTVC, describe risk factors, evaluate ways to reduce the incidence complications, and to review management and treatment options. A formal search of indexed publications was performed through PubMed. Search queries using keywords “CT colonography,” “CT virtual colonoscopy,” “virtual colonoscopy,” and “perforation” yielded a total of 133 articles. A total of eight case reports and four review articles were selected. Combining case reports and review articles, a total of 25 cases of colonic perforation after CTVC have been reported. Causes include, but are not limited to, diverticular disease, irritable bowel diseases, obstructive processes, malignancies, and iatrogenic injury. Both operative and nonoperative management has been described. Nonoperative management has been proven safe and successful in minimally symptomatic and stable patients. Colonic perforation after CTVC is a rare complication and very few cases have been reported. Several risk factors are recurrent in the literature and must be acknowledged at the time of the study. Management options vary and should be tailored to each individual patient.
Collapse
Affiliation(s)
- Leopoldo M. Baccaro
- Department of General Surgery, Easton Hospital, Drexel University College of Medicine, Easton, Pennsylvania
| | - Alexey Markelov
- Department of General Surgery, Easton Hospital, Drexel University College of Medicine, Easton, Pennsylvania
| | - Jakub Wilhelm
- Department of General Surgery, Easton Hospital, Drexel University College of Medicine, Easton, Pennsylvania
| | - Robert Bloch
- Department of General Surgery, Easton Hospital, Drexel University College of Medicine, Easton, Pennsylvania
| |
Collapse
|
2
|
Kato T, Muroya T, Goda T, Takabayashi K, Sasaki K, Takahashi T, Horita S. Iatrogenic Colonic Perforation due to Computed Tomographic Colonography. Case Rep Gastroenterol 2015; 9:171-8. [PMID: 26120298 PMCID: PMC4478309 DOI: 10.1159/000430947] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Although the complications of computed tomographic colonography (CTC) are very rare, CTC is associated with potential risk of colonic perforation. In the present report we describe two cases of colonic perforation secondary to CTC. In the first case with ascending colonic carcinoma, insertion of a rigid double-balloon catheter caused direct rectal wall perforation. In the second case with obstructive colonic carcinoma, pneumoperitoneum developed due to automated carbon dioxide insufflation. Both patients were asymptomatic after examination and recovered without any complications. Based on the findings of the current cases, we recommend that a soft-tip catheter be used for CTC, and suggest that colonic perforation can occur even with automatic insufflation, depending on patient characteristics.
Collapse
Affiliation(s)
- Takashi Kato
- Departments of Internal Medicine, Hokkaido Gastroenterology Hospital, Sapporo, Japan
| | - Tsukasa Muroya
- Departments of Radiology, Ishikari Hospital, Ishikari, Japan
| | - Takayuki Goda
- Departments of Gastroenterology, Ishikari Hospital, Ishikari, Japan
| | - Ken Takabayashi
- Departments of Radiology, Hokkaido Gastroenterology Hospital, Sapporo, Japan
| | - Kiyotaka Sasaki
- Departments of Internal Medicine, Hokkaido Gastroenterology Hospital, Sapporo, Japan
| | - Toshiyuki Takahashi
- Departments of Pathology, Hokkaido Gastroenterology Hospital, Sapporo, Japan
| | - Shoichi Horita
- Departments of Internal Medicine, Hokkaido Gastroenterology Hospital, Sapporo, Japan
| |
Collapse
|
3
|
Clinical indications for computed tomographic colonography: European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastrointestinal and Abdominal Radiology (ESGAR) Guideline. Eur Radiol 2015; 25:331-45. [PMID: 25278245 PMCID: PMC4291518 DOI: 10.1007/s00330-014-3435-z] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
4
|
Steffey MA, Daniel L, Taylor SL, Chen RX, Zwingenberger AL. Computed tomographic pneumocolonography in normal dogs. Vet Radiol Ultrasound 2014; 56:278-85. [PMID: 25545308 DOI: 10.1111/vru.12235] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Accepted: 11/04/2014] [Indexed: 01/22/2023] Open
Abstract
Objectives of this prospective study were to describe effects of varying technical components that may contribute to an optimal protocol for computed tomographic pneumocolonography (CTP) in dogs, and to develop a standardized methodology for CTP as a future potential diagnostic tool in canine clinical patients with large bowel disease. Eight purpose-bred intact male hound cross-research dogs were enrolled and randomized to groups based on variables of pressure/body position (n = 4) and insufflation time (n = 4). For each segment of large bowel (rectum, colorectal junction, descending colon, transverse colon, ascending colon), the adequacy of bowel preparation, % of bowel lumen filled with fecal material, and bowel tortuosity or folding were assessed. Measurements of bowel wall thickness (cm), cross-sectional bowel lumen diameter (cm), and cross-sectional bowel luminal area (cm(2) ) were obtained at standardized locations within the large bowel. False discovery rates (FDR) were calculated to adjust for multiple testing. Values of FDR < 0.05 were considered significant. Differences in mean cross-sectional area and diameter and bowel wall thickness under increasing pressure were not significant after adjusting for multiple testing; some had raw p values <0.05. Ascending colon diameter and ascending colon area significantly increased with insufflation time (FDR < 0.05). No other response variables showed a significant change with insufflation time. The optimal insufflation pressure for maintaining pneumocolon in this study was determined to be 20 mmHg. CTP is a feasible technique to provide consistent distension for imaging of the large bowel and further study on application of CTP in clinical patients is warranted.
Collapse
Affiliation(s)
- Michele A Steffey
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA, 95615
| | | | | | | | | |
Collapse
|
5
|
Maple JT, Banerjee S, Barth BA, Bhat YM, Desilets DJ, Gottlieb KT, Pfau PR, Pleskow DK, Siddiqui UD, Tokar JL, Wang A, Song LMWK, Rodriguez SA. Methods of luminal distention for colonoscopy. Gastrointest Endosc 2013; 77:519-25. [PMID: 23415258 DOI: 10.1016/j.gie.2012.09.025] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 09/20/2012] [Indexed: 02/08/2023]
|
6
|
DeBarros M, Steele SR. Colorectal cancer screening in an equal access healthcare system. J Cancer 2013; 4:270-80. [PMID: 23459768 PMCID: PMC3584840 DOI: 10.7150/jca.5833] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 02/13/2013] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION The military health system (MHS) a unique setting to analyze implementation programs as well as outcomes for colorectal cancer (CRC). Here we look at the efficacy of different CRC screening methods, attributes and results within the MHS, and current barriers to increase compliance. MATERIALS AND METHODS A literature search was conducted utilizing PubMed and the Cochrane library. Key-word combinations included colorectal cancer screening, racial disparity, risk factors, colorectal cancer, screening modalities, and randomized control trials. Directed searches were also performed of embedded references. RESULTS Despite screening guidelines from several national organizations, extensive barriers to widespread screening remain, especially for minority populations. These barriers are diverse, ranging from education and access problems to personal beliefs. Screening rates in MHS have been reported to be generally higher at 71% compared to national averages of 50-65%. CONCLUSION CRC screening can be highly effective at improving detection of both pre-malignant and early cancers. Improved patient education and directed efforts are needed to improve CRC screening both nationally and within the MHS.
Collapse
Affiliation(s)
| | - Scott R. Steele
- Department of Surgery, Madigan Healthcare System, Tacoma, Washington, USA
| |
Collapse
|
7
|
Bildzukewicz NA, Weinstein MS. Appendicitis following virtual colonoscopy: a case report. J Gastrointest Surg 2012; 16:2291-3. [PMID: 22918862 DOI: 10.1007/s11605-012-1994-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 08/06/2012] [Indexed: 01/31/2023]
|
8
|
Pendsé DA, Taylor SA. Complications of CT colonography: a review. Eur J Radiol 2012; 82:1159-65. [PMID: 22595505 DOI: 10.1016/j.ejrad.2012.04.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Accepted: 04/04/2012] [Indexed: 12/23/2022]
Abstract
Since its inception, one of the main advantages of computed tomography colonography (CTC) over colonoscopy has been its assumed superior safety profile. However CTC is not without complication and adverse events are well described. Although the risks of insufflation, bowel preparation, contrast media and radiation dose are very small, they are not insignificant. This review discusses the potential hazards and complications associated with the technique, and discuss precautions, which may lessen the risk of occurrence.
Collapse
Affiliation(s)
- D A Pendsé
- Department of Imaging, University College London Hospitals NHS Foundation Trust, London, UK.
| | | |
Collapse
|
9
|
Abstract
Traditional methods for colorectal cancer (CRC) screening have reduced rates of malignancy and death; however, low compliance and morbidities associated with invasive techniques have encouraged efforts for establishing equally effective, less invasive novel screening approaches. We review the current state of novel screening approaches in CRC to include CT colonography, fecal DNA, DNA methylation, micro-RNA, and protein and molecular markers.
Collapse
Affiliation(s)
- Seth Miller
- Department of General Surgery, Madigan Army Medical Center, Tacoma, Washington 98431, USA
| | | |
Collapse
|
10
|
O’Connor OJ, McSweeney SE, McWilliams S, O’Neill S, Shanahan F, Quigley EMM, Maher MM. Role of Radiologic Imaging in Irritable Bowel Syndrome: Evidence-based Review. Radiology 2012; 262:485-94. [DOI: 10.1148/radiol.11110423] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
11
|
Boellaard TN, de Haan MC, Venema HW, Stoker J. Colon distension and scan protocol for CT-colonography: an overview. Eur J Radiol 2011; 82:1144-58. [PMID: 22154604 DOI: 10.1016/j.ejrad.2011.10.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Accepted: 10/31/2011] [Indexed: 12/18/2022]
Abstract
This article reviews two important aspects of CT-colonography, namely colonic distension and scan parameters. Adequate distension should be obtained to visualize the complete colonic lumen and optimal scan parameters should be used to prevent unnecessary radiation burden. For optimal distension, automatic carbon dioxide insufflation should be performed, preferably via a thin, flexible catheter. Hyoscine butylbromide is - when available - the preferred spasmolytic agent because of the positive effect on insufflation and pain/burden and its low costs. Scans in two positions are required for adequate distension and high polyp sensitivity and decubitus position may be used as an alternative for patients unable to lie in prone position. The great intrinsic contrast between air or tagging and polyps allows the use of low radiation dose. Low-dose protocol without intravenous contrast should be used when extracolonic findings are deemed unimportant. In patients suspected for colorectal cancer, normal abdominal CT scan protocols and intravenous contrast should be used in supine position for the evaluation of extracolonic findings. Dose reduction can be obtained by lowering the tube current and/or voltage. Tube current modulation reduces the radiation dose (except in obese patients), and should be used when available. Iterative reconstructions is a promising dose reducing tool and dual-energy CT is currently evaluated for its applications in CT-colonography. This review also provides our institution's insufflation procedure and scan parameters.
Collapse
Affiliation(s)
- Thierry N Boellaard
- Department of Radiology, Academic Medical Center, University of Amsterdam, PB 22660, 1100 DD Amsterdam, The Netherlands.
| | | | | | | |
Collapse
|
12
|
Atalla MA, Rozen WM, Niewiadomski OD, Croxford MA, Cheung W, Ho YH. Risk factors for colonic perforation after screening computed tomographic colonography: a multicentre analysis and review of the literature. J Med Screen 2010; 17:99-102. [PMID: 20660440 DOI: 10.1258/jms.2010.010042] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Computed tomographic (CT) colonography (or 'virtual' colonoscopy) has become an increasingly popular tool for colorectal cancer screening. Colonic perforation, an uncommon complication, is a risk that has not been widely reported. METHODS A systematic review of the literature was undertaken to identify all reported risk factors for colonic perforation following CT colonography. In addition, a retrospective multicentre study was undertaken, evaluating all CT colonographies in 10 major metropolitan tertiary referral centres. All colonic perforations were assessed for risk factors. RESULTS A range of 'patient'-related and 'procedure'-related risk factors were identified in the literature. Among 3458 CT colonographies, there were two cases of colonic perforation contributing to an incidence of perforation of 0.06%. There was no statistical correlation between the incidence of perforation and institutional experience (P = 0.66). Risk factors common to both cases and the literature included age, recent colonoscopy and manual colonic insufflation. Diverticular disease and recent colonic biopsy were also notable factors. CONCLUSION There is a small but real risk of perforation following CT colonography. Patient selection and preventative procedural measures may reduce this risk. The importance of the consent process is emphasized.
Collapse
Affiliation(s)
- Mohamed Anwar Atalla
- Department of Surgery, Western Hospital, Gordon St, Footscray, Victoria, Australia
| | | | | | | | | | | |
Collapse
|
13
|
de Gonzalez AB, Kim KP, Yee J. CT colonography: perforation rates and potential radiation risks. Gastrointest Endosc Clin N Am 2010; 20:279-91. [PMID: 20451817 PMCID: PMC2956272 DOI: 10.1016/j.giec.2010.02.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Computed tomographic colonography (CTC) has emerged as an alternative screening tool for colorectal cancer due to the potential to provide good efficacy combined with greater acceptability than optical colonoscopy or fecal occult blood testing. However, some organizations have raised concerns about the potential harms, including perforation rates and radiation-related cancer risks, and have not recommended that it currently be used as a screening tool in the general population in the US. In this article the authors review the current evidence for these potential harms from CTC and compare them to the potential harms from the alternatives including colonoscopy and double-contrast barium enema.
Collapse
Affiliation(s)
| | - Kwang Pyo Kim
- Department of Nuclear Engineering, Kyung Hee University, 1 Seocheondong, Giheung-gu, Yongin-si, Gyeonggi-do, Republic of Korea
| | - Judy Yee
- University of California, San Francisco, VA Medical Center, 4150 Clement Street, San Francisco, CA 94121, USA.
| |
Collapse
|
14
|
Abstract
Computed tomographic colonography (CTC) is a promising emerging technology for imaging of the colon. This concise review discusses the currently available data on CTC technique, test characteristics, acceptance, safety, cost-effectiveness, follow-up strategy, and extracolonic findings. In summary, CTC technique is still evolving, and further research is needed to clarify the role of automated colonic insufflation, smooth-muscle relaxants, intravenous and oral contrast, software rendering, and patient positioning. Currently, full bowel preparation is still required to achieve optimal results. The sensitivity for detecting large polyps (> 1 cm) can be as high as 85%, with specificity of up to 97%. These test characteristics are almost comparable to those of conventional colonoscopy. Patient acceptance of CTC is generally higher than that for colonoscopy, especially in patients who have never undergone either procedure. CTC is generally safe, although uncommon instances of colonic perforation have been documented. In terms of cost-effectiveness, most decision analyses have concluded that CTC would only be cost-effective if it were considerably cheaper than conventional colonoscopy. The proper follow-up strategy for small polyps or incidental extracolonic findings discovered during CTC is still under debate. At present, the exact clinical role of virtual colonoscopy still awaits determination. Even though widespread CTC screening is not available today, in the future there may eventually be a role for this technology. Technological advances in this area will undoubtedly continue, with multi-detector row CT scanners allowing thinner collimation and higher resolution images. Stool-tagging techniques are likely to evolve and may eventually allow for low-preparation CTC. Perceptual and fatigue-related reading errors can potentially be minimized with the help of computer-aided detection software. Further research will define the exact role of this promising technology in our diagnostic armamentarium.
Collapse
|
15
|
McFarland EG, Fletcher JG, Pickhardt P, Dachman A, Yee J, McCollough CH, Macari M, Knechtges P, Zalis M, Barish M, Kim DH, Keysor KJ, Johnson CD. ACR Colon Cancer Committee white paper: status of CT colonography 2009. J Am Coll Radiol 2010; 6:756-772.e4. [PMID: 19878883 DOI: 10.1016/j.jacr.2009.09.007] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2009] [Accepted: 09/02/2009] [Indexed: 12/21/2022]
Abstract
PURPOSE To review the current status and rationale of the updated ACR practice guidelines for CT colonography (CTC). METHODS Clinical validation trials in both the United States and Europe are reviewed. Key technical aspects of the CTC examination are emphasized, including low-dose protocols, proper insufflation, and bowel preparation. Important issues of implementation are discussed, including training and certification, definition of the target lesion, reporting of colonic and extracolonic findings, quality metrics, reimbursement, and cost-effectiveness. RESULTS Successful validation trials in screening cohorts both in the United States with ACRIN and in Germany demonstrated sensitivity > or = 90% for patients with polyps >10 mm. Proper technique is critical, including low-dose techniques in screening cohorts, with an upper limit of the CT dose index by volume of 12.5 mGy per examination. Training new readers includes the requirement of interactive workstation training with 2-D and 3-D image display techniques. The target lesion is defined as a polyp > or = 6 mm, consistent with the American Cancer Society joint guidelines. Five quality metrics have been defined for CTC, with pilot data entered. Although the CMS national noncoverage decision in May 2009 was a disappointment, multiple third-party payers are reimbursing for screening CTC. Cost-effective modeling has shown CTC to be a dominant strategy, including in a Medicare cohort. CONCLUSION Supported by third-party payer reimbursement for screening, CTC will continue to further transition into community practice and can provide an important adjunctive examination for colorectal screening.
Collapse
|
16
|
Abstract
CT colonography (CTC), also termed virtual colonoscopy, is increasingly accepted at sites throughout the world as a new effective tool for the diagnosis and screening of colorectal carcinoma. This article presents information of related issues of bowel cleansing, stool and fluid tagging, bowel distention and multidetector CT scanning parameters. The author presents discussion of interpretation of CTC, appropriate applications of CTC and potential complications.
Collapse
Affiliation(s)
- Judy Yee
- University of California, San Francisco, VA Medical Center, 4150 Clement Street, San Francisco, CA 94121, USA.
| |
Collapse
|
17
|
Nagata K, Näppi J, Cai W, Yoshida H. Minimum-invasive early diagnosis of colorectal cancer with CT colonography: techniques and clinical value. ACTA ACUST UNITED AC 2008; 2:1233-46. [DOI: 10.1517/17530059.2.11.1233] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
18
|
Re: Colonic perforation during screening CT colonography using automated CO2 insufflation in an asymptomatic adult. ACTA ACUST UNITED AC 2008; 33:748-9. [DOI: 10.1007/s00261-008-9429-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
|