Patient acceptability of CT colonography compared with double contrast barium enema: results from a multicentre randomised controlled trial of symptomatic patients

Abstract

Objectives

To determine patient acceptability of barium enema (BE) or CT colonography (CTC).

Methods

After ethical approval, 921 consenting patients with symptoms suggestive of colorectal cancer who had been randomly assigned and completed either BE (N = 606) or CTC (N = 315) received a questionnaire to assess experience of the clinical episode including bowel preparation, procedure and complications. Satisfaction, worry and physical discomfort were assessed using an adapted version of a validated acceptability scale. Non-parametric methods assessed differences between the randomised tests and the effect of patient characteristics.

Results

Patients undergoing BE were significantly less satisfied (median 61, interquartile range [IQR] 54–67 vs. median 64, IQR 56–69; p = 0.003) and experienced more physical discomfort (median 40, IQR 29–52 vs. median 35.5, IQR 25–47; p < 0.001) than those undergoing CTC. Post-test, BE patients were significantly more likely to experience ‘abdominal pain/cramps’ (68% vs. 57%; p = 0.007), ‘soreness’ (57% vs. 37%; p < 0.001), ‘nausea/vomiting’ (16% vs. 8%; p = 0.009), ‘soiling’ (31% vs. 23%; p = 0.034) and ‘wind’ (92% vs. 84%; p = 0.001) and in the case of ‘wind’ to also rate it as severe (27% vs. 15%; p < 0.001).

Conclusion

CTC is associated with significant improvements in patient experience. These data support the case for CTC to replace BE.

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References

  1. 1.

    Jemal A, Siegel R, Ward E et al (2008) Cancer statistics, 2008. CA Cancer J Clin 58:71–96

    PubMed  Article  Google Scholar 

  2. 2.

    Cancer Research UK (2006) Cancer stats report - large bowel cancer - UK, Cancer Research UK

  3. 3.

    Rex DK, Rahmani EY, Haseman JH, Lemmel GT, Kaster S, Buckley JS (1997) Relative sensitivity of colonoscopy and barium enema for detection of colorectal cancer in clinical practice. Gastroenterology 112:17–23

    PubMed  Article  CAS  Google Scholar 

  4. 4.

    Warren JL, Klabunde CN, Mariotto AB et al (2009) Adverse events after outpatient colonoscopy in the Medicare population. Ann Intern Med 150:849–857

    PubMed  Google Scholar 

  5. 5.

    Hill JC (1988) Selection of elderly patients for barium enema examination with respect to significant bowel pathology especially carcinoma of the colon and rectum: the results of a retrospective study. Age Ageing 17:134–136

    PubMed  Article  CAS  Google Scholar 

  6. 6.

    Day JJ, Freeman AH, Coni NK, Dixon AK (1993) Barium enema or computed tomography for the frail elderly patient? Clin Radiol 48:48–51

    PubMed  Article  CAS  Google Scholar 

  7. 7.

    Yucel C, Lev-Toaff AS, Moussa N, Durrani H (2008) CT colonography for incomplete or contraindicated optical colonoscopy in older patients. AJR Am J Roentgenol 190:145–150

    PubMed  Article  Google Scholar 

  8. 8.

    Morrin MM, Kruskal JB, Farrell RJ et al (1999) Endoluminal CT Colonography after an incomplete endoscopic colonoscopy. AJR Am J Roentgenol 172:913–918

    PubMed  CAS  Google Scholar 

  9. 9.

    Macari M, Berman P, Dicker M et al (1999) Usefulness of CT Colonography in patients with incomplete colonoscopy. AJR Am J Roentgenol 173:561–564

    PubMed  CAS  Google Scholar 

  10. 10.

    Tolan DJ, Armstrong EM, Chapman AH (2007) Replacing barium enema with CT colonography in patients older than 70 years: the importance of detecting extracolonic abnormalities. AJR Am J Roentgenol 189:1104–1111

    PubMed  Article  Google Scholar 

  11. 11.

    Fenlon HM, Nunes DP, Schroy PC III, Barish MA, Clarke PD, Ferrucci JT (1999) A comparison of virtual and conventional colonoscopy for the detection of colorectal polyps. N Engl J Med 341:1496–1503

    PubMed  Article  CAS  Google Scholar 

  12. 12.

    Halligan S, Altman DG, Taylor SA, Mallett S, Deeks JJ, Bartram CI, Atkin W (2005) CT Colonography in the detection of colorectal polyps and cancer: Systematic review, meta-analysis, and proposed minimum dataset for study level reporting. Radiology 237:893–904

    PubMed  Article  Google Scholar 

  13. 13.

    Rosman AS, Korsten MA (2007) Meta-analysis Comparing CT Colonography, air contrast barium enema, and colonoscopy. Am J Med 120:203–210

    PubMed  Article  Google Scholar 

  14. 14.

    Ferrucci JT (2006) Double contrast barium enema: use in practice and implications for CT Colonography. AJR Am J Roentgenol 187:170–173

    PubMed  Article  Google Scholar 

  15. 15.

    Taylor SA, Halligan S, Saunders BP, Bassett P, Vance M, Bartram CI (2003) Acceptance by patients of multidetector CT Colonography compared with barium enema examinations, flexible sigmoidoscopy, and colonoscopy. AJR Am J Roentgenol 181:913–921

    PubMed  Google Scholar 

  16. 16.

    Bosworth HB, Rockey DC, Paulson EK et al (2006) Prospective comparison of patient experience with colon imaging tests. Am J Med 119:791–799

    PubMed  Article  Google Scholar 

  17. 17.

    Gluecker TM, Johnson CD, Harmsen WS, Offord KP, Harris AM, Wilson LA et al (2003) Colorectal cancer screening with CT Colonography, colonoscopy, and double-contrast barium enema examination: prospective assessment of patient perceptions and preferences. Radiology 227:378–384

    PubMed  Article  Google Scholar 

  18. 18.

    Halligan S, Lilford RJ, Wardle J, Mortin D, Rogers P, Wooldrage K, Edwards R, Kanani R, Shah U, Atkin W (2007) Design of a multicentre randomized trial to evaluate CT colonography versus colonoscopy or barium enema for diagnosis of colonic cancer in older symptomatic patients: The SIGGAR study. Trials 8:32

    PubMed  Article  Google Scholar 

  19. 19.

    MRC guidelines for good clinical practice. Medical Research Council. http://tiny.cc/birg4. Published March, 1998. Accessed September 13, 2010

  20. 20.

    Von Wagner C, Knight K, Halligan S, Atkin W, Lilford R, Morton D, Wardle J (2009) Patient experiences of colonoscopy, barium enema and CT colonography: a qualitative study. B J Radiol 82:13–19

    Article  Google Scholar 

  21. 21.

    Salmon P, Shah R, Berg S, Williams C (1994) Evaluating consumer satisfaction with colonoscopy. Endoscopy 26:342–346

    PubMed  Article  CAS  Google Scholar 

  22. 22.

    Noble M, McLennan D, Wilkinson K, Whitworth A, Barnes H, Dibben C (2008) The English indices of deprivation 2007. Department for Communities and Local Government, London

    Google Scholar 

  23. 23.

    Tabachnick BG, Fidell LS (2007) Using multivariate statistics, 5th edn. Allyn and Bacon, Boston

    Google Scholar 

  24. 24.

    von Wagner C, Halligan S, Atkin WS, Lilford RJ, Morton D, Wardle J (2009) Choosing between CT Colonography and colonoscopy in the diagnostic context: a qualitative study of influences on patient preferences. Health Expect 12:18–26

    Article  Google Scholar 

  25. 25.

    Keeling AN, Slattery MM, Leong S, McCarthy E, Susanto M, Lee MJ, Morrin MM (2010) Limited-preparation CT colonography in frail elderly patients: a feasibility study. AJR Am J Roentgenol 194:1279–1287

    PubMed  Article  Google Scholar 

  26. 26.

    Jensch S, Bipat S, Peringa J et al (2010) CT colonography with limited bowel preparation: prospective assessment of patient experience and preference in comparison to optical colonoscopy with cathartic bowel preparation. Eur Radiol 20:146–156

    PubMed  Article  Google Scholar 

  27. 27.

    Stevenson G (2008) Colon imaging in radiology departments in 2008: goodbye to the routine double contrast barium enema. Can Assoc Radiol J 59:174–182

    PubMed  Google Scholar 

  28. 28.

    Taylor PN, Beckley DE (1991) Use of air in double contrast barium enema—is it still acceptable? Clin Radiol 44:183–184

    PubMed  Article  CAS  Google Scholar 

  29. 29.

    Xiong T, McEvoy K, Morton DG, Halligan S, Lilford RJ (2006) Resources and costs associated with incidental extracolonic findings from CT colonography: a study in a symptomatic population. Br J Radiol 79:948–961

    PubMed  Article  CAS  Google Scholar 

Download references

Acknowledgements

This trial was funded by the UK Department of Health through the Health Technology Assessment programme of the UK National Institute for Health Research (NIHR grant HTA 02/02/01). This work was undertaken at UCL/UCLH and Imperial College London, each of whom received a proportion of funding from the NIHR Comprehensive Biomedical Research Centre funding scheme. The views expressed in this publication are those of the authors and not necessarily those of the UK Department of Health. We wish to thank the SIGGAR investigators and independent data monitoring and trial steering committees for their time and help (see web-Appendix 1).

SH is remunerated for R/D advice by Medicsight PLC, a company that develops CAD software for CTC.

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Correspondence to Steve Halligan.

Appendices

Appendix

Table 4 Patient experience questionnaire by subscale

The SIGGAR* investigators

*Special Interest Group in Gastrointestinal and Abdominal Radiology

Trial Office staff

Mr E Dadswell (Trial Manager), Mrs R Kanani (Trial Manager), Ms K Wooldrage (Statistician), Mrs P Rogers (Statistician), Dr Rob Edwards (Statistician), Mrs U Shah (Senior Data Manager), Dr I Kralj-Hans (Senior Data Manager), Mr A Ghanouni (Data Clerk), Mr K Pack (Data Clerk), Miss J Waddingham (Data Clerk), Miss A Thomson (Data Clerk), Ms A Verjee (Projects Manager), Dr C Monk (Projects Manager)

Research nurses/radiographers/local co-ordinators

Mrs R Kanani, Mr E Dadswell, Mr A Ghanouni, Mrs J Muckian (St Mark’s Hospital, Harrow)

Mrs N Gibbons, Mrs D Bastable, Ms L Coni (Queen Alexandra Hospital, Portsmouth)

Mrs J Martin, Mrs S Stephenson, Ms C Jackson, Mr A Wormald (Bradford Hospitals NHS Trust)

Dr D Beech, Ms C Lynn, Ms C Bloor, (Royal Cornwall Hospital, Truro)

Mrs S Wilkinson, Mrs L Pickles, Mrs J Scothern, Mrs A Hennedy, Mrs T Larkin, Mrs P Pearson, Mr S Preston, Mrs L Smith, Mrs L Wright (Royal Lancaster Infirmary/Furness General Hospital)

Dr J Blackstock, Ms R Thomas, Ms L Young (Royal United Hospital, Bath)

Mrs J Butler-Barnes, Mrs V Adamson, Mrs T Larcombe, Mrs V Bradshaw, Mrs S Chapman, Mr M Slater, Mrs J Stylan, Mr D Wood (Leighton Hospital, Crewe)

Mrs J Bradbury, Mr J Breedon, Mrs M Coakes, Mrs L Crutch, Mrs A Leyland, Mrs W Pringle, Mrs L Rowe, Mrs M White (Queen Elizabeth Hospital, Birmingham)

Ms A Worley, Mr D Kumar (Nottingham City Hospital/Queens Medical Centre)

Mrs M Gandy, Mrs J Pascoe (Derriford Hospital, Plymouth)

Mr J Wood, Mrs W Cook, Ms Y Memory (Royal Oldham Hospital, Oldham)

Mrs M Avery, Miss K Pearson, Mrs D Shivapatham, Mrs S Thomas, Mr C Ong, Ms B Poppinga-Scholz (Charing Cross Hospital, London/Hammersmith Hospital, London)

Mrs B Shanahan (Oxford Radcliffe Hospital, Oxford)

Ms L Turner, Ms K Fellows, Ms A Duffy, Ms A Owen, Ms A Usansky (South Manchester University Hospital, Manchester)

Mr F Naim, Mr V Bohra, Mr S Prabhudesai (St Mary’s Hospital, London)

Ms M Hayes, Ms N Lancelotte, Ms T James, Miss S Johnston, Miss J Stevenson (Frimley Park Hospital, Frimley)

Mrs D Whetter (University Hospital North Tees, Stockton-on-Tees)

Radiologists

Prof C Bartram, Dr D Burling, Dr A Gupta, Prof S Halligan, Dr M Marshall, Dr S A Taylor, (St Mark’s Hospital, Harrow)

Dr A Higginson, Dr J Atchley (Queen Alexandra Hospital, Portsmouth)

Dr C Kay, Dr A Lowe (Bradford Hospitals NHS Trust)

Dr G F Maskell (Royal Cornwall Hospital, Truro)

Dr A Taylor, Dr E Tan, Dr J McGregor (Royal Lancaster Infirmary/Furness General Hospital)

Dr S Hayward, Dr A Philips, Dr M Noakes (Royal United Hospital, Bath)

Dr S Zaman (Leighton Hospital, Crewe)

Dr P Guest, Dr I McCafferty, Dr P Riley, Dr D Tattersall (Queen Elizabeth Hospital, Birmingham)

Dr C Jobling, Dr R Dhingsa (Nottingham City Hospital/Queens Medical Centre)

Dr S A Jackson, Dr B M Fox, Dr J Shirley (Derriford Hospital, Plymouth)

Dr M Kumar (Royal Oldham Hospital, Oldham)

Dr D Blunt, Dr M Roddie (Charing Cross Hospital, London)

Dr A Slater (Oxford Radcliffe Hospital, Oxford)

Dr S A Sukumar (South Manchester University Hospital, Manchester)

Dr N Hughes (Frimley Park Hospital, Frimley)

Dr P Woolfall (University Hospital North Tees, Stockton-on-Tees)

Surgeons/endoscopists

Dr B Saunders, Prof J M A Northover (St Mark’s Hospital, Harrow)

Dr P Goggin, Mr D O’Leary (Queen Alexandra Hospital, Portsmouth)

Mr J Ausobsky, Dr C Beckett, Mr J Davies, Mr J Griffith, Mr M Steward (Bradford Hospitals NHS Trust)

Mr P J Arumugam (Royal Cornwall Hospital, Truro)

Mr I Crighton, Miss C Bronder, Dr C Brown, Dr A Higham, Dr R Lea, Dr C Meaden, Mr W Morgan, Mr P Patel, Mr G Nasmyth (Royal Lancaster Infirmary/Furness General Hospital)

Mr M Williamson (Royal United Hospital, Bath)

Mr D Cade (Leighton Hospital, Crewe)

Prof D Morton (Queen Elizabeth Hospital, Birmingham)

Prof J Scholefield (Nottingham City Hospital/Queens Medical Centre)

Mr K Hosie, Dr E Whitehead (Derriford Hospital, Plymouth)

Dr P Conlong, Dr B Rameh, Mr A Rate, Mr D Richards (Royal Oldham Hospital, Oldham)

Dr D Bansi, Mr G Buchanan, Mr P Dawson, Dr J Martin, Dr G Smith, Mr N A Theodorou, Dr A Thillainayagam (Charing Cross Hospital, London)

Mr C Cunningham, Dr S Travis (Oxford Radcliffe Hospital, Oxford)

Dr G M Hyde, Mr D J Jones, Miss S T O’Dwyer (South Manchester University Hospital, Manchester)

Mr P Ziprin (St Mary’s Hospital, London)

Col D Edwards, Miss S Burton, Dr P Fabricius, Mr M Gudgeon, Mr I Jourdan (Frimley Park Hospital, Frimley)

Dr M Rutter (University Hospital North Tees, Stockton-on-Tees)

Data Monitoring and Ethics Committee

Prof DG Altman (Chair), Prof R Steele, Dr A Walker

Trial Steering Committee

Prof A Dixon (Chair), Mrs L Foulds-Wood, Prof T Marteau, Dr R Valori

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von Wagner, C., Smith, S., Halligan, S. et al. Patient acceptability of CT colonography compared with double contrast barium enema: results from a multicentre randomised controlled trial of symptomatic patients. Eur Radiol 21, 2046–2055 (2011). https://doi.org/10.1007/s00330-011-2154-y

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Keywords

  • CT
  • Colonography
  • Virtual colonoscopy
  • Barium enema
  • Colon
  • Cancer
  • Patient preference