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



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


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.


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).


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

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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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Corresponding author

Correspondence to Steve Halligan.



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)


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)


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).

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