Virtual Colonoscopy shows high diagnostic yield after failed colonoscopy

Virtual Colonoscopy shows high diagnostic yield after failed colonoscopy May 6, 2010 Virtual colonoscopy finds significant pathology in patients referred after failed colonoscopy, according to a study presented at the Digestive Disease Week (DDW) meeting in New Orleans. The results show the need for a complete colon exam and highlight VC’s strengths in detecting extracolonic abnormalities. A significant percentage of conventional colonoscopy exams — generally, about 20%, but as many as half in some studies — fail because the colonoscope does not reach the cecum for several reasons. In an effort to determine the value of virtual colonoscopy (also known as CT colonography or CTC), researchers from Utrecht University in the Netherlands reviewed 96 consecutive cases of VC performed after failed colonoscopy to determine the virtual study’s diagnostic yield. The most frequent indications for colonoscopy were iron deficiency anemia (24%), a change in bowel habits (19%), rectal bleeding (18%), colorectal cancer (CRC) screening or surveillance (12%), diarrhea (7%), constipation (8%), abdominal pain (5%), and suspicion of CRC on abdominal ultrasound (2%), Dr. Paul Pullens and colleagues explained in an abstract accompanying their poster presentation. When colonoscopies in these patients failed to reach the cecum, virtual colonoscopies were ordered. After VC, the researchers reviewed all intra- and extracolonic findings and evaluated them for further diagnostic or therapeutic workup. All of the patients were symptomatic and therefore considered to be at above-average risk of colonic polyps or cancer, they wrote. The reasons for incomplete colonoscopy were a fixated sigmoid colon (33%), strong angulation of the sigmoid colon (18%), intractable pain during colonoscopy (7%), spastic or atonic colon (7%), obstructive CRC (4%), dolichocolon (3%), abdominal wall herniation (3%), insufficient bowel preparation (3%), undetermined colonic stricture (2%), other (9%), or unreported reasons (9%), the authors reported. The colonoscope was limited to the left side of the colon in 51% of the cases, the authors noted. By itself, colonoscopy detected six patients (6%) with colorectal cancer and 19 (20%) with polyps. Subsequent virtual colonoscopy found additional polyps in five patients (5%) and an additional colorectal cancer in two cases (2%), Pullens and his colleagues reported. Virtual colonoscopy found an additional 12 lesions considered clinically significant in 11 of 96 patients (11%) whose colonoscopy exams had been incomplete. If patients with known CRC are added to the analysis, virtual colonoscopy yielded additional information in seven patients. “Of the five patients with polyps, a polyp in one patient was found to harbor CRC at second colonoscopy. This polyp was located in a colon part that had been inspected at prior colonoscopy (missed colorectal cancer),” Pullens and colleagues wrote in their abstract. Significant extracolonic abnormalities were found at CTC in five patients (5%), including fistulizing diverticulitis (n = 2), gastric lymphoma (n = 1), liver abscess (n = 1), and infected embolisms in the renal arteries (n = 1). “CTC revealed 12 relevant additional lesions (both intra- and extracolonic) in 11 of 96 (11%) patients with incomplete colonoscopy,” they concluded. If staging patients with known colorectal cancer are also considered, virtual colonoscopy yielded additional information in seven patients (six colorectal cancers found with colonoscopy plus one missed cancer), for a total of eight patients (19%) who had clinically relevant additional findings as a result of CTC. By Eric Barnes staff writer May 6, 2010