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Perforation rate in CT colonography: a systematic review of the literature and meta-analysis

  • Gastrointestinal
  • Published:
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Abstract

Purpose

The primary aim was to assess the perforation rate of CTC; the secondary aim was to identify potential clinical/technical predictors of this complication.

Methods

Methods for analysis were based on PRISMA (preferred reporting items for systematic reviews and meta-analyses). From the selected studies, the rate of CTC perforation and patient/technical characteristics potentially associated with this event were extracted. Forest plots showing individual and pooled estimates of the perforation rate were obtained for all analyses. I2 was used to evaluate heterogeneity between studies.

Results

Eleven articles out of the 187 initially identified were selected for the analysis (103,399 patients). There were 29,048 (28 %) asymptomatic individuals and 30,773 (30 %) symptomatic patients; this characteristic was not reported in the remaining subjects (42 %). Colon distension was obtained manually in 69,222 (67 %) and using an automated carbon dioxide insufflator in 26,479 (26 %) patients; in the remaining 7 % of patients, this information was missing. Twenty-eight colonic perforations were reported, with the CTC perforation rate estimated to be 0.04 % (95 % CI. 0.00-0.10), 19-fold higher in symptomatic than in screening subjects (OR: 19.2, CI 3.3-108 and P = 0.001). The surgical rate was 0.008 %. No CTC-related deaths were reported.

Conclusions

The perforation rate in CTC is very low, particularly considering asymptomatic individuals.

Key Points

• This is the first meta-analysis on this topic, based on 100,000 patients.

• The CTC-related colorectal perforation rate is 0.04 %, 0.02 % in asymptomatic subjects.

• The CTC-induced surgery rate is 0.008 % (1:12,500).

• The perforation rate in CTC is low, particularly in average-risk, asymptomatic individuals.

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Abbreviations

CTC:

Computed tomographic colonography

CRC:

Colorectal cancer

CC:

Conventional colonoscopy

ES:

Effect size

OR:

Odds ratio

PR:

Perforation rate

DCBE:

Double-contrast barium enema

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Acknowledgements

The scientific guarantor of this publication is Andrea Laghi. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors has significant statistical expertise. Institutional Review Board approval was not required because this is a meta-analysis. Written informed consent was not required for this study because this is a meta-analysis. Methodology: Systematic review with meta-analysis.

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Authors and Affiliations

  1. Department of Radiological Sciences, Oncology and Pathology, “Sapienza” University of Rome, ICOT Hospital, Via Franco Faggiana 34, 04100, Latina, Italy

    Davide Bellini, Marco Rengo, Carlo Nicola De Cecco & Andrea Laghi

  2. Department of Radiological Sciences, Oncology and Pathology, “Sapienza” University of Rome, Policlinico Umberto I Hospital, Rome, Italy

    Franco Iafrate

  3. Gastroenterology and Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy

    Cesare Hassan

Authors
  1. Davide Bellini
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  2. Marco Rengo
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  3. Carlo Nicola De Cecco
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  4. Franco Iafrate
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  5. Cesare Hassan
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  6. Andrea Laghi
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Correspondence to Davide Bellini.

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Bellini, D., Rengo, M., De Cecco, C.N. et al. Perforation rate in CT colonography: a systematic review of the literature and meta-analysis. Eur Radiol 24, 1487–1496 (2014). https://doi.org/10.1007/s00330-014-3190-1

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  • DOI: https://doi.org/10.1007/s00330-014-3190-1

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