Journal of General Internal Medicine

, Volume 27, Issue 10, pp 1349–1360 | Cite as

Preference for Colonoscopy Versus Computerized Tomographic Colonography: A Systematic Review and Meta-analysis of Observational Studies

  • Otto S. LinEmail author
  • Richard A. Kozarek
  • Michael Gluck
  • Geoffrey C. Jiranek
  • Johannes Koch
  • Kris V. Kowdley
  • Shayan Irani
  • Matthew Nguyen
  • Jason A. Dominitz


In recent years, colorectal cancer (CRC) screening using computerized tomographic colonography (CTC) has attracted considerable attention. In order to better understand patient preferences for CTC versus colonoscopy, we performed a systematic review and meta-analysis of the available literature. Data sources included published studies, abstracts and book chapters, in any language, with publication dates from 1995 through February 2012, and with prospective or retrospective enrollment of diagnostic or screening patients who had undergone both procedures and explicit assessment of their preference for colonoscopy versus CTC. A predefined algorithm identified eligible studies using computer and hand searches performed by two independent investigators. We used a mixed effects model to pool preference differences (defined as the proportion of subjects who preferred CTC minus the proportion who preferred colonoscopy for each study). Twenty-three studies met inclusion criteria, totaling 5616 subjects. In 16 of these studies, patients preferred CTC over colonoscopy, while colonoscopy was preferred in three studies. Due to the high degree of heterogeneity, an overall pooled preference difference was not calculated. Stratified analysis revealed that studies published in radiology journals (preference difference 0.590 [95 % CI 0.485, 0.694]) seemed more likely than studies in gastroenterology (0.218 [–0.015–0.451]) or general medicine journals (–0.158 [–0.389-0.072]) to report preference for CTC (p < 0.001). Studies by radiology authors showed a trend towards stronger preference for CTC compared with studies by gastroenterology authors. Symptomatic patients expressed no preference, but screening patients preferred CTC. There was no difference in preferences between studies using “masked” and “unmasked” preference ascertainment methods. Three studies featuring limited bowel preparations for CTC reported marked preference for CTC. There was no evidence of publication bias, while cumulative and exclusion analysis did not show any temporal trend or dominant study. Limitations included data heterogeneity and preference ascertainment limitations. In conclusion, most included studies reported preference for CTC. On stratified analysis, screening patients preferred CTC while diagnostic patients showed no preference. Studies published in radiology journals showed significantly stronger preference for CTC compared with studies in gastroenterology or general medicine journals.


colorectal cancer adenoma screening colonoscopy computerized tomographic colonography 



The authors would like to thank Jane Babione for her assistance and input.

There was no internal or external funding or grant support provided for this study.

Dr. Otto Lin gave an oral presentation of a preliminary version of this study at Digestive Disease Week in June of 2010 in New Orleans.

Conflict of Interest

None of the authors have any financial conflicts of interest to report, with the following exceptions: 1) A research grant from Cumberland Pharmaceuticals to Dr. Otto Lin, for a pilot study assessing the efficacy and safety of crystalline lactulose as a colonoscopy bowel preparation agent; 2) Consultancies for Epigenomics Inc. and Salix Pharmaceuticals for Dr. Jason Dominitz.

Grant Support or Funding


Supplementary material

11606_2012_2115_MOESM1_ESM.doc (46 kb)
ESM 1 (DOC 46 kb)


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Copyright information

© Society of General Internal Medicine 2012

Authors and Affiliations

  • Otto S. Lin
    • 1
    Email author
  • Richard A. Kozarek
    • 1
  • Michael Gluck
    • 1
  • Geoffrey C. Jiranek
    • 1
  • Johannes Koch
    • 1
  • Kris V. Kowdley
    • 1
  • Shayan Irani
    • 1
  • Matthew Nguyen
    • 1
  • Jason A. Dominitz
    • 2
  1. 1.C3-Gas, Gastroenterology SectionVirginia Mason Medical CenterSeattleUSA
  2. 2.Gastroenterology DivisionVA Puget Sound Health Care System and University of WashingtonSeattleUSA

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