Perforation rate in CT colonography: a systematic review of the literature and meta-analysis
The primary aim was to assess the perforation rate of CTC; the secondary aim was to identify potential clinical/technical predictors of this complication.
Methods for analysis were based on PRISMA (preferred reporting items for systematic reviews and meta-analyses). From the selected studies, the rate of CTC perforation and patient/technical characteristics potentially associated with this event were extracted. Forest plots showing individual and pooled estimates of the perforation rate were obtained for all analyses. I2 was used to evaluate heterogeneity between studies.
Eleven articles out of the 187 initially identified were selected for the analysis (103,399 patients). There were 29,048 (28 %) asymptomatic individuals and 30,773 (30 %) symptomatic patients; this characteristic was not reported in the remaining subjects (42 %). Colon distension was obtained manually in 69,222 (67 %) and using an automated carbon dioxide insufflator in 26,479 (26 %) patients; in the remaining 7 % of patients, this information was missing. Twenty-eight colonic perforations were reported, with the CTC perforation rate estimated to be 0.04 % (95 % CI. 0.00-0.10), 19-fold higher in symptomatic than in screening subjects (OR: 19.2, CI 3.3-108 and P = 0.001). The surgical rate was 0.008 %. No CTC-related deaths were reported.
The perforation rate in CTC is very low, particularly considering asymptomatic individuals.
• This is the first meta-analysis on this topic, based on 100,000 patients.
• The CTC-related colorectal perforation rate is 0.04 %, 0.02 % in asymptomatic subjects.
• The CTC-induced surgery rate is 0.008 % (1:12,500).
• The perforation rate in CTC is low, particularly in average-risk, asymptomatic individuals.
KeywordsComputed tomographic colonography Intestinal perforation Mass screening Insufflation General surgery
Abbreviations and acronyms
Computed tomographic colonography
Double-contrast barium enema
The scientific guarantor of this publication is Andrea Laghi. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors has significant statistical expertise. Institutional Review Board approval was not required because this is a meta-analysis. Written informed consent was not required for this study because this is a meta-analysis. Methodology: Systematic review with meta-analysis.
- 5.Hassan C, Di Giulio E, Marmo R, Zullo A, Annibale B (2011) Appropriateness of the indication for colonoscopy: systematic review and meta-analysis. J Gastrointest Liver Dis 20:279–286Google Scholar
- 8.Levin B, Lieberman DA, McFarland B et al (2008) Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. Gastroenterology 134:1570–1595PubMedCrossRefGoogle Scholar
- 38.Burling D, Patnick J (2012) Guidelines for the use of imaging in the NHS Bowel cancer Screening Program. 2nd edn. NHSBSCP. Pubblication No. 5. Department of Health, LondonGoogle Scholar