European Radiology

, Volume 27, Issue 12, pp 4970–4978 | Cite as

Adverse events during CT colonography for screening, diagnosis and preoperative staging of colorectal cancer: a Japanese national survey

  • Koichi Nagata
  • Ken Takabayashi
  • Takaaki Yasuda
  • Michiaki Hirayama
  • Shungo Endo
  • Ryoichi Nozaki
  • Takenobu Shimada
  • Hidenori Kanazawa
  • Masanori Fujiwara
  • Norihito Shimizu
  • Tatema Iwatsuki
  • Teruaki Iwano
  • Hiroshi Saito



To retrospectively evaluate the frequencies and magnitudes of adverse events associated with computed tomographic colonography (CTC) for screening, diagnosis and preoperative staging of colorectal cancer.


A Japanese national survey on CTC was administered by use of an online survey tool in the form of a questionnaire. The questions covered mortality, colorectal perforation, vasovagal reaction, total number of examinations, and examination procedures. The survey data was collated and raw frequencies were determined. Fisher’s exact test was used to determine differences in event rates between groups.


At 431 institutions, 147,439 CTC examinations were performed. No deaths were reported. Colorectal perforations occurred in 0.014% (21/147,439): 0.003% (1/29,823) in screening, 0.014% (13/91,007) in diagnosis and 0.028% (7/25,330) in preoperative staging. The perforation risk was significantly lower in screening than in preoperative staging CTC procedures (p = 0.028). Eighty-one per cent of perforation cases (17/21) did not require emergency surgery. Vasovagal reaction occurred in 0.081% (120/147,439): 0.111% (33/29,823) in screening, 0.088% (80/91,007) in diagnosis and 0.028% (7/25,330) in preoperative staging.


The risk of colorectal perforation and vasovagal reaction in CTC is low. The frequency of colorectal perforation associated with CTC is least in the screening group and greatest in the preoperative-staging group.

Key points

The colorectal perforation rate during preoperative-staging CTC was 0.028 %.

The perforation rates for screening and diagnosis were 0.003 % and 0.014 %, respectively.

The perforation risk is significantly lower in screening than in preoperative staging.

Eighty-one per cent of perforation cases did not require emergency surgery.

Use of an automatic colon insufflator can reduce the risk of bowel perforation.


Computed tomography Colonography Intestinal perforation Vasovagal syncope Virtual colonoscopy 



The authors thank the clinical staff of the participating institutions (Supplementary Appendix) for the excellent response provided during this national survey.

Compliance with ethical standards


The scientific guarantor of this publication is Koichi Nagata.

Conflict of interest

The authors of this manuscript declare relationships with the following companies: Koichi Nagata is co-inventor of a method of bowel preparation with faecal tagging for CTC and holds a licensing agreement with EA Pharma Co., Ltd., Tokyo, Japan without associated royalties.


This study has received funding from a Health, Labour and Welfare Policy Research Grant (H27-006) in Research for Promotion of Cancer Programs.

Statistics and biometry

One of the authors, Hidenori Kanazawa, has significant statistical expertise.

Informed consent

Written informed consent was waived by the institutional review board.

Ethical approval:

Institutional review board approval was not required since the review board considered this study to be a clinical audit in which patients would not be approached.


• retrospective

• observational

• multicentre study

Supplementary material

330_2017_4920_MOESM1_ESM.docx (35 kb)
ESM 1 (DOCX 35 kb)


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Copyright information

© European Society of Radiology 2017

Authors and Affiliations

  • Koichi Nagata
    • 1
    • 2
    • 3
  • Ken Takabayashi
    • 2
    • 3
    • 4
  • Takaaki Yasuda
    • 2
    • 3
    • 5
  • Michiaki Hirayama
    • 2
    • 6
  • Shungo Endo
    • 2
    • 7
  • Ryoichi Nozaki
    • 1
    • 2
    • 8
  • Takenobu Shimada
    • 1
    • 9
  • Hidenori Kanazawa
    • 3
    • 10
  • Masanori Fujiwara
    • 2
    • 11
  • Norihito Shimizu
    • 2
    • 12
  • Tatema Iwatsuki
    • 2
    • 13
  • Teruaki Iwano
    • 2
    • 14
  • Hiroshi Saito
    • 1
    • 15
  1. 1.Committee for Quality Assessment of Colorectal Cancer ScreeningJapanese Society of Gastrointestinal Cancer ScreeningTokyoJapan
  2. 2.Gastrointestinal Advanced Imaging AcademyTochigiJapan
  3. 3.Division of Screening Technology, Centre for Public Health SciencesNational Cancer CentreTokyoJapan
  4. 4.Department of RadiologyHokkaido Gastroenterology HospitalSapporoJapan
  5. 5.Department of RadiologyNagasaki Kamigoto HospitalNagasakiJapan
  6. 6.Department of GastroenterologyTonan HospitalSapporoJapan
  7. 7.Department of Coloproctology, Aizu Medical CentreFukushima Medical UniversityAizu-WakamatsuJapan
  8. 8.Coloproctology CentreTakano HospitalKumamotoJapan
  9. 9.Cancer Detection Centre of the Miyagi Cancer SocietySendaiJapan
  10. 10.Department of RadiologyJichi Medical UniversityShimotsukeJapan
  11. 11.Radiology SectionKameda Medical Centre MakuhariMihama-kuJapan
  12. 12.Radiology SectionMatsuoka ClinicNaraJapan
  13. 13.Radiology SectionMatsuda HospitalHamamatsuJapan
  14. 14.Radiology SectionTokushima Kensei HospitalTokushimaJapan
  15. 15.Division of Screening Assessment & Management, Centre for Public Health SciencesNational Cancer CentreTokyoJapan

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