European Radiology

, Volume 15, Issue 6, pp 1192–1202

CT colonography with fecal tagging after incomplete colonoscopy

  • S. Gryspeerdt
  • P. Lefere
  • M. Herman
  • R. Deman
  • L. Rutgeerts
  • G. Ghillebert
  • F. Baert
  • M. Baekelandt
  • B. Van Holsbeeck


The objective of this study was to evaluate dietary fecal tagging (FT) as a cleansing method prior to CT colonography (CTC) in patients with incomplete conventional colonoscopy (CC). After written informed consent was obtained, 24 patients had standard colonoscopic preparation (ScCl), and 25 patients had FT as cleansing method. Segmental distention, fluid levels, fecal residues, tagged appearance of fluid levels, and residual stool were evaluated. Mann–Whitney U test was used to test for significant differences between FT and ScCl groups. Compared with ScCl, FT improved distention (p=0.001), reduced the amount of fluid (p=0.043), but suffered from residual stool (p=0.046). A clear correlation was found between distention and fluid. No differences were found in stool size between FT and ScCl. FT showed a good labeling of fecal residues, and acceptable labeling of fluid levels. Compared with ScCl, FT reduces fluid, favors distention, but suffers from fecal residues. The tagged nature of these residues, however, allows differentiation from polyps.


CT colonography Preparation technique Tagging incomplete colonoscopy 


  1. 1.
    Gelfand DW (1988) Gastrointestinal radiology: a short history and predictions for the future (commentary). Am J Roentgenol 150:727–730Google Scholar
  2. 2.
    Marshall JB, Barthel JS (1993) The frequency of total colonoscopy and terminal ileal intubation in the 1990s. Gastrointest Endosc 39(4):518–520Google Scholar
  3. 3.
    Waye JD, Bashkoff E (1991) Total colonoscopy: is it always possible? Gastrointest Endosc 37(2):152–154PubMedGoogle Scholar
  4. 4.
    Anderson JC, Messina CR, Cohn W, Gottfried E, Ingber S, Bernstein G, Coman E, Polito J (2001) Factors predictive of difficult colonoscopy. Gastrointest Endosc 54(5):558–562Google Scholar
  5. 5.
    Cirocco WC, Rusin LC (1995) Factors that predict incomplete colonoscopy. Dis Colon Rectum 38(9):964–968Google Scholar
  6. 6.
    Mitchell RM, McCallion K, Gardiner KR, Watson RG, Collins JS (2002) Successful colonoscopy: completion rates and reasons for incompletion. Ulster Med J 71(1):34–37Google Scholar
  7. 7.
    Nelson DB, McQuaid KR, Bond JH, Lieberman DA, Weiss DG, Johnston TK (2002) Procedural success and complications of large-scale screening colonoscopy. Gastrointest Endosc 55(3):307–314Google Scholar
  8. 8.
    Church JM (1994) Complete colonoscopy: how often? And if not, why not? Am J Gastroenterol 89(4):556–560Google Scholar
  9. 9.
    Wexner SD, Garbus JE, Singh JJ, SAGES Colonoscopy Study Outcomes Group (2001) A prospective analysis of 13,580 colonoscopies: reevaluation of credentialing guidelines. Surg Endosc 15(3):251–261CrossRefPubMedGoogle Scholar
  10. 10.
    Cucino C, Buchner AM, Sonnenberg A (2002) Continued rightward shift of colorectal cancer. Dis Colon Rectum 45(8):1035–1040Google Scholar
  11. 11.
    Arenas RB, Fichera A, Mhoon D, Michelassi F (1997) Incidence and therapeutic implications of synchronous colonic pathology in colorectal adenocarcinoma. Surgery 122(4):706–709; discussion 709–710Google Scholar
  12. 12.
    Luo M, Shan H, Zhou K (2002) CT virtual colonoscopy in patients with incomplete conventional colonoscopy. Chin Med J (Engl) 115(7):1023–1026Google Scholar
  13. 13.
    Chong A, Shah JN, Levine MS, Rubesin SE, Laufer I, Ginsberg GG, Long WB, Kochman ML (2002) Diagnostic yield of barium enema examination after incomplete colonoscopy. Radiology 223(3):620–624Google Scholar
  14. 14.
    Neri E, Giusti P, Battolla L, Vagli P, Boraschi P, Lencioni R, Caramella D, Bartolozzi C (2002) Colorectal cancer: role of CT colonography in preoperative evaluation after incomplete colonoscopy. Radiology 223(3):615–619PubMedGoogle Scholar
  15. 15.
    Rex DK, Goodwine BW (2002) Method of colonoscopy in 42 consecutive patients presenting after prior incomplete colonoscopy. Am J Gastroenterol 97(5):1148–1151Google Scholar
  16. 16.
    Brown AL, Skehan SJ, Greaney T, Rawlinson J, Somers S, Stevenson GW (2001) Value of double-contrast barium enema performed immediately after incomplete colonoscopy. Am J Roentgenol 176(4):943–945Google Scholar
  17. 17.
    Britton I, Dover S, Vallance R (2001) Immediate CT pneumocolon for failed colonoscopy: comparison with routine pneumocolon. Clin Radiol 56(2):89–93Google Scholar
  18. 18.
    Johnson CD, Dachman AH (2000) CT colonography: the next colon screening examination? Radiology 216(2):331–341Google Scholar
  19. 19.
    Gollub MJ, Flaherty F (1999) Barium enema following incomplete colonoscopy. Clin Imaging 23(6):367–374Google Scholar
  20. 20.
    Morrin MM, Farrell RJ, Raptopoulos V, McGee JB, Bleday R, Kruskal JB (2000) Role of virtual computed tomographic colonography in patients with colorectal cancers and obstructing colorectal lesions. Dis Colon Rectum 43(3):303–311PubMedGoogle Scholar
  21. 21.
    Morrin MM, Kruskal JB, Farrell RJ, Goldberg SN, McGee JB, Raptopoulos V (1999) Endoluminal CT colonography after an incomplete endoscopic colonoscopy. Am J Roentgenol 172(4):913–918Google Scholar
  22. 22.
    Macari M, Berman P, Dicker M, Milano A, Megibow AJ (1999) Usefulness of CT colonography in patients with incomplete colonoscopy. Am J Roentgenol 173(3):561–564Google Scholar
  23. 23.
    Lefere P, Gryspeerdt S, Dewyspelaere J, Baekelandt M, Van Holsbeeck B (2000) Dietary fecal tagging as a cleansing method prior to computed tomographic colonography: initial results—polyp detection and patient acceptance. Radiology 224:393–403Google Scholar
  24. 24.
    Fletcher JG, Johnson CD, Welch TJ et al (2000) Optimization of CT colonography technique: prospective trial in 180 patients. Radiology 216:704–711PubMedGoogle Scholar
  25. 25.
    Bruzzi JF, Moss AC, Brennan DD, MacMathuna P, Fenlon HM (2004) Colonic surveillance by CT colonography using axial images only. Eur Radiol 14(5):763–767CrossRefPubMedGoogle Scholar
  26. 26.
    Sciallero S, Bonelli L, Aste H, Casetti T, Bertinelli E, Bartolini S, Parri R, Castiglione G, Mantellini P, Costantini M, Naldoni C, Bruzzi P (1999) Do patients with rectosigmoid adenomas 5 mm or less in diameter need total colonoscopy? Gastrointest Endosc 50(3):314–321Google Scholar
  27. 27.
    Schoen RE, Corle D, Cranston L, Weissfeld JL, Lance P, Burt R, Iber F, Shike M, Kikendall JW, Hasson M, Lewin KJ, Appelman HD, Paskett E, Selby JV, Lanza E, Schatzkin A (1998) Is colonoscopy needed for the nonadvanced adenoma found on sigmoidoscopy? The Polyp Prevention Trial. Gastroenterology 115(3):533–541PubMedGoogle Scholar
  28. 28.
    Collett JA, Platell C, Fletcher DR, Aquilia S, Olynyk JK (1999) Distal colonic neoplasms predict proximal neoplasia in average-risk, asymptomatic subjects. J Gastroenterol Hepatol 14(1):67–71Google Scholar
  29. 29.
    Read TE, Read JD, Butterly LF (1997) Importance of adenomas 5 mm or less in diameter that are detected by sigmoidoscopy. N Engl J Med 336(1):8–12PubMedGoogle Scholar
  30. 30.
    Chen HS, Sheen-Chen SM (2000) Synchronous and “early” metachronous colorectal adenocarcinoma: analysis of prognosis and current trends. Dis Colon Rectum 43(8):1093–1099PubMedGoogle Scholar
  31. 31.
    McPherson A, Payne JE (1983) Importance of total colonoscopy in the diagnosis of colonic disorders. Med J Aust 1(4):170–172Google Scholar
  32. 32.
    Takeuchi H, Toda T, Nagasaki S, Kawano T, Minamisono Y, Maehara Y, Sugimachi K (1997) Synchronous multiple colorectal adenocarcinomas. J Surg Oncol 64(4):304–307Google Scholar
  33. 33.
    Adloff M, Arnaud JP, Bergamaschi R, Schoegel M (1989) Synchronous carcinoma of the colon and rectum: prognostic and therapeutic implications. Am J Surg 157:299–302Google Scholar
  34. 34.
    Fenlon HM, McAneny DB, Nunes DP, Clarke PD, Ferruci JT (1999) Occlusive colon carcinoma: virtual colonoscopy in the preoperative evaluation of the proximal colon. Radiology 210:423–428PubMedGoogle Scholar
  35. 35.
    Macari M, Lavelle M, Pedrosa I, Milano A, Dicker M, Megibow AJ, Xue X (2001) Effect of different bowel preparations on residual fluid at CT colonography. Radiology 218(1):274–277PubMedGoogle Scholar
  36. 36.
    Gryspeerdt S, Lefere P, Dewyspelaere J, Baekelandt M, van Holsbeeck B (2002) Optimisation of colon cleansing prior to computed tomographic colonography. J Belge Radiol 85(6):289–296Google Scholar
  37. 37.
    Pickhardt PJ, Choi JR, Hwang I, Butler JA, Puckett ML, Hildebrandt HA, Wong RK, Nugent PA, Mysliwiec PA, Schindler WR (2003) Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults. N Engl J Med 349(23):2191–2200CrossRefPubMedGoogle Scholar
  38. 38.
    Thomeer M, Carbone I, Bosmans H, Kiss G, Bielen D, Vanbeckevoort D, Van Cutsem E, Rutgeerts P, Marchal G (2003) Stool tagging applied in thin-slice multidetector computed tomography colonography. J Comput Assist Tomogr 27(2):132–139Google Scholar
  39. 39.
    Luboldt W, Hoepffner N, Hollzer K (2003) Multidetector CT of the colon. Eur Radiol 13[Suppl 5]:M50–M70PubMedGoogle Scholar
  40. 40.
    Chen SC, Lu DS, Hecht JR, Kadell BM (1999) CT colonography: value of scanning in both the supine and prone positions. Am J Roentgenol 172(3):595–599Google Scholar
  41. 41.
    Gryspeerdt SS, Herman MJ, Baekelandt MA, Van Holsbeeck BG, Lefere PA (2004) Supine/left decubitus scanning: a valuable alternative to supine/prone scanning in CT colonography. Eur Radiol 14 (5):768–777CrossRefPubMedGoogle Scholar
  42. 42.
    Bruzzi JF, Moss AC, Brennan DD, MacMathuna P, Fenlon HM (2003) Efficacy of IV Buscopan as a muscle relaxant in CT colonography. Eur Radiol 13(10):2264–2270Google Scholar
  43. 43.
    Taylor SA, Halligan S, Goh V, Morley S, Bassett P, Atkin W, Bartram CI (2003) Optimizing colonic distention for multi-detector row CT colonography: effect of hyoscine butylbromide and rectal balloon catheter. Radiology 229(1):99–108PubMedGoogle Scholar
  44. 44.
    Fletcher JG, Johnson CD, Krueger WR, Ahlquist DA, Nelson H, Ilstrup D Harmsen WS, Corcoran KE (2002) Contrast-enhanced CT colonography in recurrent colorectal carcinoma: feasibility of simultaneous evaluation for metastatic disease, local recurrence, and metachronous neoplasia in colorectal carcinoma. Am J Roentgenol 178(2):283–290Google Scholar
  45. 45.
    Oto A, Gelebek V, Oguz BS, Sivri B, Deger A, Akhan O, Besim A (2003) CT attenuation of colorectal polypoid lesions: evaluation of contrast enhancement in CT colonography. Eur Radiol 13(7):1657–1663CrossRefPubMedGoogle Scholar
  46. 46.
    Laghi A, Iannaccone R, Bria E, Carbone I, Trasatti L, Piacentini F, Lauro S, Vecchione A, Passariello R (2003) Contrast-enhanced computed tomographic colonography in the follow-up of colorectal cancer patients: a feasibility study. Eur Radiol 13(4):883–889PubMedGoogle Scholar
  47. 47.
    Sosna J, Morrin MM, Kruskal JB, Farrell RJ, Nasser I, Raptopoulos V (2003) Colorectal neoplasms: role of intravenous contrast-enhanced CT colonography. Radiology 228(1):152–156PubMedGoogle Scholar
  48. 48.
    Morrin MM, Raptopoulos V (2001) Contrast-enhanced CT colonography. Semin Ultrasound CT MR 22(5):420–424Google Scholar
  49. 49.
    Taylor SA, Halligan S, Burling D, Morley S, Bassett P, Atkin W, Bartram CI (2004) CT colonography: effect of experience and training on reader performance. Eur Radiol 14(6):1025–1033CrossRefPubMedGoogle Scholar
  50. 50.
    Lefere P, Gryspeerdt S, Baekelandt M, Dewyspelaere J, Van Holsbeeck B (2003) Diverticular disease in CT colonography. Eur Radiol 13[suppl 4]:L62PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • S. Gryspeerdt
    • 1
  • P. Lefere
    • 1
  • M. Herman
    • 1
  • R. Deman
    • 2
  • L. Rutgeerts
    • 3
  • G. Ghillebert
    • 3
  • F. Baert
    • 3
  • M. Baekelandt
    • 1
  • B. Van Holsbeeck
    • 1
  1. 1.Department of RadiologyStedelijk ZiekenhuisRoeselareBelgium
  2. 2.Department of RadiologyH. Hart ZiekenhuisRoeselareBelgium
  3. 3.Department of GastroenterologyH. Hart ZiekenhuisRoeselareBelgium

Personalised recommendations