Adverse events during CT colonography for screening, diagnosis and preoperative staging of colorectal cancer: a Japanese national survey
- 316 Downloads
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.
• 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.
KeywordsComputed 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.
Written informed consent was waived by the institutional review board.
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.
• multicentre study
- 9.Levin B, Lieberman DA, McFarland B et al (2008) American Cancer Society Colorectal Cancer Advisory Group; US Multi-Society Task Force; American College of Radiology Colon Cancer Committee. 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. CA Cancer J Clin 58:130–160CrossRefPubMedGoogle Scholar
- 12.NHS Cancer Screening Programmes (2012) Guidelines for the use of imaging in the NHS Bowel Cancer Screening Programme, 2nd edn. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/423848/nhsbcsp05.pdf. Accessed 9 June 2017
- 17.Nagata K, Okawa T, Honma A, Endo S, Kudo SE, Yoshida H (2009) Full-laxative versus minimum-laxative fecal-tagging CT colonography using 64-detector row CT: prospective blinded comparison of diagnostic performance, tagging quality, and patient acceptance. Acad Radiol 16:780–789CrossRefPubMedGoogle Scholar