Radiographic Studies Unreliable for Polyp Detection in Patients With Incomplete Colonoscopy

Colorectal

Douglas K. Rex, MD, MASGE reviewing Parsa N, et al. Gastrointest Endosc 2020 Feb 4.

In a single U.S. center with a large experience performing colonoscopy in patients with previous incomplete colonoscopies, 65 patients were identified with a radiographic study (either CT colonography [CTC] or barium enema [BE]) within 3 years of the repeat colonoscopy. The radiographic studies were generally performed at the outlying community hospital where the incomplete colonoscopy had been performed. All examinations were complete to the cecum at the referral hospital.

For patients with adenomas, the per-patient sensitivity was 70% with CTC and 26.7% for BE. The overall per-polyp sensitivity for the radiographic exams was 19.2% (54 of 281 lesions detected at repeat colonoscopy were identified by radiology). This metric was worse for both CTC and BE in the right side of the colon compared to the left, and both imaging studies missed substantial numbers of lesions ≥10 mm in size.

Comment:

When colonoscopy is incomplete to the cecum, radiographic studies may still be appropriate when the primary purpose is to exclude malignancy in the more proximal colon. However, these data, along with other recent data suggesting that previous studies have overestimated the sensitivity of CTC and BE, indicate that across a range of community hospitals where CTC and BE were performed after incomplete colonoscopy, the sensitivity for polyps was quite poor. Thus, when screening or surveillance for polyps is the primary goal, a repeat attempt at colonoscopy or referral to a regional center for complex colonoscopy may be the best course.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

Douglas K. Rex, MD, MASGE

Bio and Disclosures

Citation(s):

Parsa N, Vemulapalli KC, Rex DK. Performance of radiographic imaging after incomplete colonoscopy for nonmalignant causes in clinical practice. Gastrointest Endosc 2020 Feb 4. (Epub ahead of print) (https://doi.org/10.1016/j.gie.2020.01.043)