Skip to main content
SpringerLink
Log in

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

  • Gastrointestinal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

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.

Methods

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.

Results

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.

Conclusions

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Pickhardt PJ, Choi JR, Hwang I et al (2003) Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults. N Engl J Med 349:2191–2200

    Article  CAS  PubMed  Google Scholar 

  2. Johnson CD, Chen MH, Toledano AY et al (2008) Accuracy of CT colonography for detection of large adenomas and cancers. N Engl J Med 359:1207–1217

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Zalis ME, Blake MA, Cai W et al (2012) Diagnostic accuracy of laxative-free computed tomographic colonography for detection of adenomatous polyps in asymptomatic adults: a prospective evaluation. Ann Intern Med 156:692–702

    Article  PubMed  Google Scholar 

  4. Graser A, Stieber P, Nagel D et al (2009) Comparison of CT colonography, colonoscopy, sigmoidoscopy and faecal occult blood tests for the detection of advanced adenoma in an average risk population. Gut 58:241–248

    Article  CAS  PubMed  Google Scholar 

  5. Regge D, Laudi C, Galatola G et al (2009) Diagnostic accuracy of computed tomographic colonography for the detection of advanced neoplasia in individuals at increased risk of colorectal cancer. JAMA 301:2453–2461

    Article  CAS  PubMed  Google Scholar 

  6. Nagata K, Endo S, Honda T et al (2017) Accuracy of CT colonography for detection of polypoid and nonpolypoid neoplasia by gastroenterologists and radiologists: a nationwide multicenter study in Japan. Am J Gastroenterol 112:163–171

    Article  PubMed  Google Scholar 

  7. Utano K, Nagata K, Honda T et al (2017) Diagnostic performance and patient acceptance of reduced-laxative CT colonography for the detection of polypoid and non-polypoid neoplasms: a multicenter prospective trial. Radiology 282:399–407

    Article  PubMed  Google Scholar 

  8. Tutein Nolthenius CJ, Boellaard TN, de Haan MC et al (2016) Computer tomography colonography participation and yield in patients under surveillance for 6-9 mm polyps in a population-based screening trial. Eur Radiol 26:2762–2770

    Article  PubMed  Google Scholar 

  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 58:130–160

    Article  PubMed  Google Scholar 

  10. Preventive Services Task Force US (2016) Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. JAMA 315:2564–2575

    Article  Google Scholar 

  11. Spada C, Stoker J, Alarcon O et al (2015) Clinical indications for computed tomographic colonography: European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastrointestinal and Abdominal Radiology (ESGAR) guideline. Eur Radiol 25:331–345

    Article  PubMed  Google 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

  13. Nagata K, Endo S, Kudo SE et al (2004) CT air-contrast enema as a preoperative examination for colorectal cancer. Dig Surg 21:352–358

    Article  PubMed  Google Scholar 

  14. Filippone A, Ambrosini R, Fuschi M, Marinelli T, Genovesi D, Bonomo L (2004) Preoperative T and N staging of colorectal cancer: accuracy of contrast-enhanced multi-detector row CT colonography–initial experience. Radiology 231:83–90

    Article  PubMed  Google Scholar 

  15. Kijima S, Sasaki T, Nagata K et al (2014) Preoperative evaluation of colorectal cancer using CT colonography, MRI, and PET/CT. World J Gastroenterol 20:16964–16975

    Article  PubMed  PubMed Central  Google Scholar 

  16. Bellini D, Rengo M, De Cecco CN et al (2014) Perforation rate in CT colonography: a systematic review of the literature and meta-analysis. Eur Radiol 24:1487–1496

    Article  PubMed  Google Scholar 

  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 16:780–789

    Article  PubMed  Google Scholar 

  18. Burling D, Halligan S, Slater A, Noakes MJ, Taylor SA (2006) Potentially serious adverse events at CT colonography in symptomatic patients: national survey of the United Kingdom. Radiology 239:464–471

    Article  PubMed  Google Scholar 

  19. Reumkens A, Rondagh EJ, Bakker CM, Winkens B, Masclee AA, Sanduleanu S (2016) Post-colonoscopy complications: a systematic review, time trends, and meta-analysis of population-based studies. Am J Gastroenterol 111:1092–1101

    Article  PubMed  Google Scholar 

  20. Iafrate F, Iussich G, Correale L et al (2013) Adverse events of computed tomography colonography: an Italian national survey. Dig Liver Dis 45:645–650

    Article  PubMed  Google Scholar 

  21. Pickhardt PJ (2006) Incidence of colonic perforation at CT colonography: review of existing data and implications for screening of asymptomatic adults. Radiology 239:313–316

    Article  PubMed  Google Scholar 

  22. Pendsé DA, Taylor SA (2013) Complications of CT colonography: a review. Eur J Radiol 82:1159–1165

    Article  PubMed  Google Scholar 

  23. Eckardt VF, Kanzler G, Schmitt T, Eckardt AJ, Bernhard G (1999) Complications and adverse effects of colonoscopy with selective sedation. Gastrointest Endosc 49:560–565

    Article  CAS  PubMed  Google Scholar 

  24. Herman LL, Kurtz RC, McKee KJ, Sun M, Thaler HT, Winawer SJ (1993) Risk factors associated with vasovagal reactions during colonoscopy. Gastrointest Endosc 39:388–391

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

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

Author information

Authors and Affiliations

  1. Committee for Quality Assessment of Colorectal Cancer Screening, Japanese Society of Gastrointestinal Cancer Screening, Tokyo, Japan

    Koichi Nagata, Ryoichi Nozaki, Takenobu Shimada & Hiroshi Saito

  2. Gastrointestinal Advanced Imaging Academy, Tochigi, Japan

    Koichi Nagata, Ken Takabayashi, Takaaki Yasuda, Michiaki Hirayama, Shungo Endo, Ryoichi Nozaki, Masanori Fujiwara, Norihito Shimizu, Tatema Iwatsuki & Teruaki Iwano

  3. Division of Screening Technology, Centre for Public Health Sciences, National Cancer Centre, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Koichi Nagata, Ken Takabayashi, Takaaki Yasuda & Hidenori Kanazawa

  4. Department of Radiology, Hokkaido Gastroenterology Hospital, Honcho 1-jo, 1-chome, Higashi-ku, Sapporo, 065-0041, Japan

    Ken Takabayashi

  5. Department of Radiology, Nagasaki Kamigoto Hospital, 1549-11, Aokatago, Shinkamigoto, Minami-matsuura, Nagasaki, 857-4404, Japan

    Takaaki Yasuda

  6. Department of Gastroenterology, Tonan Hospital, 3-8, Kita 4-jo Nishi 7-chome, Chuo-ku, Sapporo, 060-0004, Japan

    Michiaki Hirayama

  7. Department of Coloproctology, Aizu Medical Centre, Fukushima Medical University, 21-2, Aza, Maeda, Tanisawa, Kawahigashi-machi, Aizu-Wakamatsu, Fukushima, 969-3492, Japan

    Shungo Endo

  8. Coloproctology Centre, Takano Hospital, 4-2-88, Obiyama, Chuo-ku, Kumamoto, 862-0924, Japan

    Ryoichi Nozaki

  9. Cancer Detection Centre of the Miyagi Cancer Society, 5-7-30, Kamisugi, Aoba-ku, Sendai, Miyagi, 980-0011, Japan

    Takenobu Shimada

  10. Department of Radiology, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan

    Hidenori Kanazawa

  11. Radiology Section, Kameda Medical Centre Makuhari, 1-3, Nakase, Mihama-ku, Chiba, 261-8501, Japan

    Masanori Fujiwara

  12. Radiology Section, Matsuoka Clinic, 2-9-15, Oji, Oji-cho, Kita-Katsuragi-gun, Nara, 636-0002, Japan

    Norihito Shimizu

  13. Radiology Section, Matsuda Hospital, 753 Irinocho, Nishi-ku, Hamamatsu, Shizuoka, 432-8061, Japan

    Tatema Iwatsuki

  14. Radiology Section, Tokushima Kensei Hospital, 4-9, Shimosuketo-cho, Tokushima, 770-0805, Japan

    Teruaki Iwano

  15. Division of Screening Assessment & Management, Centre for Public Health Sciences, National Cancer Centre, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Hiroshi Saito

Authors
  1. Koichi Nagata
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ken Takabayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Takaaki Yasuda
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michiaki Hirayama
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shungo Endo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ryoichi Nozaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Takenobu Shimada
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hidenori Kanazawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Masanori Fujiwara
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Norihito Shimizu
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Tatema Iwatsuki
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Teruaki Iwano
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Hiroshi Saito
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Koichi Nagata.

Ethics declarations

Guarantor

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.

Funding

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.

Methodology

• retrospective

• observational

• multicentre study

Electronic supplementary material

Below is the link to the electronic supplementary material.

ESM 1

(DOCX 35 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nagata, K., Takabayashi, K., Yasuda, T. et al. Adverse events during CT colonography for screening, diagnosis and preoperative staging of colorectal cancer: a Japanese national survey. Eur Radiol 27, 4970–4978 (2017). https://doi.org/10.1007/s00330-017-4920-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-017-4920-y

Keywords

Search

Navigation