The safety of same-day CT colonography following incomplete colonoscopy with polypectomy. Issue 4 (August 2015)

• Record Type: Journal Article
• Authors: Lara, Luis F; Avalos, Danny; Huynh, Huan; Jimenez-Cantisano, Brenda; Padron, Mariann; Pimentel, Ronnie; Erim, Tolga; Schneider, Alison; Ukleja, Andrew; Parlade, Albert; Castro, Fernando
• Is Part Of: United European Gastroenterology journal. Volume 3:Issue 4(2015:Aug.)
• Page Start: 358
• Page End: 363
• Publication Date: 2015-08
• Subjects: Medical subject headings (MeSH): colonography -- computed tomographic -- colonoscopy -- endoscopy -- digestive system -- colonic polyps; Gastroenterology -- Periodicals; Periodicals; 616.33005
• DOI: 10.1177/2050640615577881
• Languages: English
• ISSNs: 2050-6406

Abstract

Background: Concerns about the risk of bowel perforation for same-day computed tomography colonography (CTC) following an incomplete colonoscopy with polypectomy may lead to unnecessarily postponing the CTC. Objective: The objective of this article is to describe the complications including colon perforations associated with same-day CTC in a cohort who had polypectomies but an incomplete colonoscopy. Design: We conducted a retrospective study. Setting: Our study took place in a single, tertiary referral center. Patients: We studied consecutive patients who had CTC the same day as an incomplete colonoscopy with polypectomy. Interventions: Interventions included optical colonoscopy (OC), endoscopic polypectomies, and same-day CTC. Main outcome measurements: Our main outcome measurements included perforation rate with long-term follow-up. Results: A total of 3% of patients undergoing colonoscopy from January 2008 to December 2012 had same-day CTC following incomplete OC, and 72 polypectomies were performed in 34 (or 17%) of these patients. Incomplete colonoscopies were due to colon tortuosity and looping (25), severe angulations (five), colon mass (two), colon stenosis (one), bradycardia (one). Fifty-three percent of the OCs were screening for colon neoplasia, 29% diagnostic and 18% were surveillance of colon polyps. Most polyps were ≤ 5 mm, and found in the left colon. There were no reported complications or perforations associated with same-day CTCs during short- and long-term follow-up. Limitations: Limitations of our analysis included retrospective single-center design, small number of patients for the occurrence, referral to same-day CTC was not standardized, inability to establish safety of CTC for specific scenarios such as after complex polypectomies, strictures, or advanced IBD. Conclusions: Radiologists' apprehension to perform a CTC the same day as an incomplete colonoscopy following polypectomies because of perceived risk of perforation may be unfounded. More data are needed to determine the safety of same-day CTC in patients with high-risk findings during colonoscopy such as a stricture, severe IBD, and after complex polypectomies.