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Preference for Colonoscopy Versus Computerized Tomographic Colonography: A Systematic Review and Meta-analysis of Observational Studies

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Abstract

In recent years, colorectal cancer (CRC) screening using computerized tomographic colonography (CTC) has attracted considerable attention. In order to better understand patient preferences for CTC versus colonoscopy, we performed a systematic review and meta-analysis of the available literature. Data sources included published studies, abstracts and book chapters, in any language, with publication dates from 1995 through February 2012, and with prospective or retrospective enrollment of diagnostic or screening patients who had undergone both procedures and explicit assessment of their preference for colonoscopy versus CTC. A predefined algorithm identified eligible studies using computer and hand searches performed by two independent investigators. We used a mixed effects model to pool preference differences (defined as the proportion of subjects who preferred CTC minus the proportion who preferred colonoscopy for each study). Twenty-three studies met inclusion criteria, totaling 5616 subjects. In 16 of these studies, patients preferred CTC over colonoscopy, while colonoscopy was preferred in three studies. Due to the high degree of heterogeneity, an overall pooled preference difference was not calculated. Stratified analysis revealed that studies published in radiology journals (preference difference 0.590 [95 % CI 0.485, 0.694]) seemed more likely than studies in gastroenterology (0.218 [–0.015–0.451]) or general medicine journals (–0.158 [–0.389-0.072]) to report preference for CTC (p < 0.001). Studies by radiology authors showed a trend towards stronger preference for CTC compared with studies by gastroenterology authors. Symptomatic patients expressed no preference, but screening patients preferred CTC. There was no difference in preferences between studies using “masked” and “unmasked” preference ascertainment methods. Three studies featuring limited bowel preparations for CTC reported marked preference for CTC. There was no evidence of publication bias, while cumulative and exclusion analysis did not show any temporal trend or dominant study. Limitations included data heterogeneity and preference ascertainment limitations. In conclusion, most included studies reported preference for CTC. On stratified analysis, screening patients preferred CTC while diagnostic patients showed no preference. Studies published in radiology journals showed significantly stronger preference for CTC compared with studies in gastroenterology or general medicine journals.

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REFERENCES

  1. Johnson CD, Chen MH, Toledano AY, et al. Accuracy of CT colonography for detection of large adenomas and cancers. N Engl J Med. 2008;359(12):1207–17.

    Article  PubMed  CAS  Google Scholar 

  2. Levin B, Lieberman DA, McFarland B, et al. 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. Gastroenterology. 2008;134(5):1570–95.

    Article  PubMed  CAS  Google Scholar 

  3. Rex DK, Johnson DA, Anderson JC, Schoenfeld PS, Burke CA, Inadomi JM. American College of Gastroenterology guidelines for colorectal cancer screening 2008. Am J Gastroenterol. 2009;104(3):739–50.

    Article  PubMed  Google Scholar 

  4. Schenck AP, Peacock SC, Klabunde CN, Lapin P, Coan JF, Brown ML. Trends in colorectal cancer test use in the medicare population, 1998-2005. Am J Prev Med. 2009;37(1):1–7.

    Article  PubMed  Google Scholar 

  5. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264–9. W64.

    PubMed  Google Scholar 

  6. Sutton AJ, Abrams KR, Jones DR, Sheldon TA, Song F. Methods for meta-analysis in medical research. 1st ed. Chichester: Wiley; 2000:317.

    Google Scholar 

  7. Gotzsche PC. Patients' preference in indomethacin trials: an overview. Lancet. 1989;1(8629):88–91.

    Article  PubMed  CAS  Google Scholar 

  8. Lin OS, Gerson LB, Soon MS, Schembre DB, Kozarek RA. Risk of proximal colon neoplasia with distal hyperplastic polyps: a meta-analysis. Arch Intern Med. 2005;165(4):382–90.

    Article  PubMed  Google Scholar 

  9. Hedges LV, Pigott TD. The power of statistical tests for moderators in meta-analysis. Psychol Methods. 2004;9(4):426–45.

    Article  PubMed  Google Scholar 

  10. Jensch S, de Vries AH, Pot D, et al. Image quality and patient acceptance of four regimens with different amounts of mild laxatives for CT colonography. AJR Am J Roentgenol. 2008;191(1):158–67.

    Article  PubMed  Google Scholar 

  11. Von Wagner C, Knight K, Halligan S, et al. Patient experiences of colonoscopy, barium enema and CT colonography: a qualitative study. Br J Radiol. 2009;82(973):13–9.

    Article  Google Scholar 

  12. Edwards JT, Mendelson RM, Fritschi L, et al. Colorectal neoplasia screening with CT colonography in average-risk asymptomatic subjects: community-based study. Radiology. 2004;230(2):459–64. Epub 2003 Dec 19.

    Article  PubMed  Google Scholar 

  13. Taylor SA, Slater A, Burling DN, et al. CT colonography: optimisation, diagnostic performance and patient acceptability of reduced-laxative regimens using barium-based faecal tagging. Eur Radiol. 2008;18(1):32–42.

    Article  PubMed  Google Scholar 

  14. Zalis ME, Perumpillichira JJ, Magee C, Kohlberg G, Hahn PF. Tagging-based, electronically cleansed CT colonography: evaluation of patient comfort and image readability. Radiology. 2006;239(1):149–59.

    Article  PubMed  Google Scholar 

  15. Lefere PA, Gryspeerdt SS, Dewyspelaere J, Baekelandt M, Van Holsbeeck BG. Dietary fecal tagging as a cleansing method before CT colonography: initial results polyp detection and patient acceptance. Radiology. 2002;224(2):393–403.

    Article  PubMed  Google Scholar 

  16. Liedenbaum MH, de Vries AH, Gouw CI, et al. CT colonography with minimal bowel preparation: evaluation of tagging quality, patient acceptance and diagnostic accuracy in two iodine-based preparation schemes. Eur Radiol. 2009;20(2):367–76.

    Article  PubMed  Google Scholar 

  17. Hawley ST, Volk RJ, Krishnamurthy P, Jibaja-Weiss M, Vernon SW, Kneuper S. Preferences for colorectal cancer screening among racially/ethnically diverse primary care patients. Med Care. 2008;46(9 Suppl 1):S10–6.

    Article  PubMed  Google Scholar 

  18. Taylor SA, Bomanji JB, Manpanzure L, et al. Nonlaxative PET/CT colonography: feasibility, acceptability, and pilot performance in patients at higher risk of colonic neoplasia. J Nucl Med. 2010;51(6):854–61.

    Article  PubMed  Google Scholar 

  19. Nagata K, Okawa T, Honma A, Endo S, Kudo SE, Yoshida H. 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. 2009;16(7):780–9.

    Article  PubMed  Google Scholar 

  20. Farrell RJ, Morrin MM, Silas A, Raptopoulos V, McGee JB. Virtual colonoscopy in patients undergoing elective colonoscopy: diagnostic accuracy and patient tolerance. Gastroenterology. 2000;118(4):A258.

    Article  Google Scholar 

  21. Leung WK, Lam WW, Wu JC, et al. Magnetic resonance colonography in the detection of colonic neoplasm in high-risk and average-risk individuals. Am J Gastroenterol. 2004;99(1):102–8.

    Article  PubMed  Google Scholar 

  22. Goehde SC, Descher E, Boekstegers A, et al. Dark lumen MR colonography based on fecal tagging for detection of colorectal masses: accuracy and patient acceptance. Abdom Imaging. 2005;30(5):576–83.

    Article  PubMed  CAS  Google Scholar 

  23. Florie J, Birnie E, van Gelder RE, et al. MR colonography with limited bowel preparation: patient acceptance compared with that of full-preparation colonoscopy. Radiology. 2007;245(1):150–9.

    Article  PubMed  Google Scholar 

  24. Achiam MP, Logager V, Chabanova E, Thomsen HS, Rosenberg J. Patient acceptance of MR colonography with improved fecal tagging versus conventional colonoscopy. Eur J Radiol. 2010;73(1):143–7.

    Google Scholar 

  25. Langhorst J, Kuhle CA, Ajaj W, et al. MR colonography without bowel purgation for the assessment of inflammatory bowel diseases: diagnostic accuracy and patient acceptance. Inflamm Bowel Dis. 2007;13(8):1001–8.

    Article  PubMed  Google Scholar 

  26. Kinner S, Kuehle CA, Langhorst J, et al. MR colonography vs. optical colonoscopy: comparison of patients' acceptance in a screening population. Eur Radiol. 2007;17(9):2286–93.

    Article  PubMed  Google Scholar 

  27. Bielen D, Thomeer M, Vanbeckevoort D, et al. Dry preparation for virtual CT colonography with fecal tagging using water-soluble contrast medium: initial results. Eur Radiol. 2003;13(3):453–8.

    PubMed  Google Scholar 

  28. Pineau BC, Sevick MA, Mikulaninec C, Vining DJ. Evaluation of patient preference: virtual colonoscopy versus Endoscopic. Gastroenterology. 1999;116(4):A486.

    Google Scholar 

  29. Forbes GM, Mendelson RM. Patient acceptance of virtual colonoscopy. Endoscopy. 2000;32(3):274–5.

    PubMed  CAS  Google Scholar 

  30. Akerkar GA, Yee J, Hung R, McQuaid K. Patient experience and preferences toward colon cancer screening: a comparison of virtual colonoscopy and conventional colonoscopy. Gastrointest Endosc. 2001;54(3):310–5.

    Article  PubMed  CAS  Google Scholar 

  31. Svensson MH, Svensson E, Lasson A, Hellstrom M. Patient acceptance of CT colonography and conventional colonoscopy: prospective comparative study in patients with or suspected of having colorectal disease. Radiology. 2002;222(2):337–45.

    Article  PubMed  Google Scholar 

  32. Thomeer M, Bielen D, Vanbeckevoort D, et al. Patient acceptance for CT colonography: what is the real issue? Eur Radiol. 2002;12(6):1410–5.

    Article  PubMed  CAS  Google Scholar 

  33. Gluecker TM, Johnson CD, Harmsen WS, et al. Colorectal cancer screening with CT colonography, colonoscopy, and double-contrast barium enema examination: prospective assessment of patient perceptions and preferences. Radiology. 2003;227(2):378–84.

    Article  PubMed  Google Scholar 

  34. Pickhardt PJ, Choi JR, Hwang I, et al. Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults. N Engl J Med. 2003;349(23):2191–200.

    Article  PubMed  CAS  Google Scholar 

  35. Ristvedt SL, McFarland EG, Weinstock LB, Thyssen EP. Patient preferences for CT colonography, conventional colonoscopy, and bowel preparation. Am J Gastroenterol. 2003;98(3):578–85.

    Article  PubMed  Google Scholar 

  36. Taylor SA, Halligan S, Saunders BP, Bassett P, Vance M, Bartram CI. Acceptance by patients of multidetector CT colonography compared with barium enema examinations, flexible sigmoidoscopy, and colonoscopy. AJR Am J Roentgenol. 2003;181(4):913–21.

    PubMed  Google Scholar 

  37. Cotton PB, Durkalski VL, Pineau BC, et al. Computed tomographic colonography (virtual colonoscopy): a multicenter comparison with standard colonoscopy for detection of colorectal neoplasia. JAMA. 2004;291(14):1713–9.

    Article  PubMed  CAS  Google Scholar 

  38. Iannaccone R, Laghi A, Catalano C, et al. Computed tomographic colonography without cathartic preparation for the detection of colorectal polyps. Gastroenterology. 2004;127(5):1300–11.

    Article  PubMed  Google Scholar 

  39. van Gelder RE, Birnie E, Florie J, et al. CT colonography and colonoscopy: assessment of patient preference in a 5-week follow-up study. Radiology. 2004;233(2):328–37. Epub 2004 Sep 9.

    Article  PubMed  Google Scholar 

  40. Juchems MS, Ehmann J, Brambs HJ, Aschoff AJ. A retrospective evaluation of patient acceptance of computed tomography colonography ("virtual colonoscopy") in comparison with conventional colonoscopy in an average risk screening population. Acta Radiol. 2005;46(7):664–70.

    Article  PubMed  CAS  Google Scholar 

  41. Bosworth HB, Rockey DC, Paulson EK, et al. Prospective comparison of patient experience with colon imaging tests. Am J Med. 2006;119(9):791–9.

    Article  PubMed  Google Scholar 

  42. Florie J, van Gelder RE, Schutter MP, et al. Feasibility study of computed tomography colonography using limited bowel preparation at normal and low-dose levels study. Eur Radiol. 2007;17(12):3112–22.

    Article  PubMed  Google Scholar 

  43. Rajapaksa RC, Macari M, Bini EJ. Racial/ethnic differences in patient experiences with and preferences for computed tomography colonography and optical colonoscopy. Clin Gastroenterol Hepatol. 2007;5(11):1306–12.

    Article  PubMed  Google Scholar 

  44. Roberts-Thomson IC, Tucker GR, Hewett PJ, et al. Single-center study comparing computed tomography colonography with conventional colonoscopy. World J Gastroenterol. 2008;14(3):469–73.

    Article  PubMed  Google Scholar 

  45. Jung HS, Park DK, Kim MJ, et al. A comparison of patient acceptance and preferences between CT colonography and conventional colonoscopy in colorectal cancer screening. Korean J Intern Med. 2009;24(1):43–7.

    Article  PubMed  Google Scholar 

  46. White TJ, Avery GR, Kennan N, Syed AM, Hartley JE, Monson JR. Virtual colonoscopy vs conventional colonoscopy in patients at high risk of colorectal cancer–a prospective trial of 150 patients. Colorectal Dis. 2009;11(2):138–45.

    Article  PubMed  CAS  Google Scholar 

  47. Graser A, Stieber P, Nagel D, et al. Comparison of CT colonography, colonoscopy, sigmoidoscopy and faecal occult blood tests for the detection of advanced adenoma in an average risk population. Gut. 2009;58(2):241–8.

    Article  PubMed  CAS  Google Scholar 

  48. Jensch S, Bipat S, Peringa J, et al. CT colonography with limited bowel preparation: prospective assessment of patient experience and preference in comparison to optical colonoscopy with cathartic bowel preparation. Eur Radiol. 2010;20(1):146–56.

    Article  PubMed  Google Scholar 

  49. Moawad FJ, Maydonovitch CL, Cullen PA, Barlow DS, Jenson DW, Cash BD. CT colonography may improve colorectal cancer screening compliance. AJR Am J Roentgenol. 2010;195(5):1118–23.

    Article  PubMed  Google Scholar 

  50. Cash BD, Riddle MS, Baumel MJ, et al. Patient opinions of screening CT colonography: Results of a multicenter survey of more than 1400 patients. Gastroenterology. 2011;140(5):S409.

    Google Scholar 

  51. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11):1539–58.

    Article  PubMed  Google Scholar 

  52. Wardle J, Sutton S, Williamson S, et al. Psychosocial influences on older adults' interest in participating in bowel cancer screening. Prev Med. 2000;31(4):323–34.

    Article  PubMed  CAS  Google Scholar 

  53. Harewood GC, Wiersema MJ, Melton LJ 3rd. A prospective, controlled assessment of factors influencing acceptance of screening colonoscopy. Am J Gastroenterol. 2002;97(12):3186–94.

    Article  PubMed  Google Scholar 

  54. Subramanian S, Klosterman M, Amonkar MM, Hunt TL. Adherence with colorectal cancer screening guidelines: a review. Prev Med. 2004;38(5):536–50.

    Article  PubMed  Google Scholar 

  55. Lafata JE, Williams LK, Ben-Menachem T, Moon C, Divine G. Colorectal carcinoma screening procedure use among primary care patients. Cancer. 2005;104(7):1356–61.

    Article  PubMed  Google Scholar 

  56. Holden DJ, Jonas DE, Porterfield DS, Reuland D, Harris R. Systematic review: enhancing the use and quality of colorectal cancer screening. Ann Intern Med. 2010;152(10):668–76.

    PubMed  Google Scholar 

  57. Stock C, Haug U, Brenner H. Population-based prevalence estimates of history of colonoscopy or sigmoidoscopy: review and analysis of recent trends. Gastrointest Endosc. 2010;71(2):366–81. e2.

    Article  PubMed  Google Scholar 

  58. Marshall DA, Johnson FR, Phillips KA, Marshall JK, Thabane L, Kulin NA. Measuring patient preferences for colorectal cancer screening using a choice-format survey. Value Health. 2007;10(5):415–30.

    Article  PubMed  Google Scholar 

  59. Padron MC, Jimenez B, Urma D, Mitty RD. Patients' preferences and perceptions on virtual and conventional colonoscopy: a systematic review. Am J Gastroenterol. 2006;101(9):S548–9.

    Google Scholar 

  60. Burroughs TE, Waterman BM, Gilin D, Adams D, McCollegan J, Cira J. Do on-site patient satisfaction surveys bias results? Jt Comm J Qual Patient Saf. 2005;31(3):158–66.

    PubMed  Google Scholar 

  61. Gribble RK, Haupt C. Quantitative and qualitative differences between handout and mailed patient satisfaction surveys. Med Care. 2005;43(3):276–81.

    Article  PubMed  Google Scholar 

  62. Hodlewsky RT, Decker FH. The problem of bias when nursing facility staff administer customer satisfaction surveys. Jt Comm J Qual Improv. 2002;28(10):546–54.

    PubMed  Google Scholar 

  63. von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370(9596):1453–7.

    Article  Google Scholar 

  64. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25(9):603–5.

    Article  PubMed  Google Scholar 

  65. von Wagner C, Halligan S, Atkin WS, Lilford RJ, Morton D, Wardle J. Choosing between CT colonography and colonoscopy in the diagnostic context: a qualitative study of influences on patient preferences. Health Expect. 2009;12(1):18–26.

    Article  Google Scholar 

  66. Angtuaco TL, Banaad-Omiotek GD, Howden CW. Differing attitudes toward virtual and conventional colonoscopy for colorectal cancer screening: surveys among primary care physicians and potential patients. Am J Gastroenterol. 2001;96(3):887–93.

    Article  PubMed  CAS  Google Scholar 

  67. Marshall DA, Johnson FR, Kulin NA, et al. How do physician assessments of patient preferences for colorectal cancer screening tests differ from actual preferences? A comparison in Canada and the United States using a stated-choice survey. Health Econ. 2009;18(12):1420–39.

    Article  PubMed  Google Scholar 

  68. Kim DH, Pickhardt PJ, Taylor AJ, et al. CT colonography versus colonoscopy for the detection of advanced neoplasia. N Engl J Med. 2007;357(14):1403–12.

    Article  PubMed  CAS  Google Scholar 

  69. Ho W, Broughton DE, Donelan K, Gazelle GS, Hur C. Analysis of barriers to and patients' preferences for CT colonography for colorectal cancer screening in a nonadherent urban population. AJR Am J Roentgenol. 2010;195(2):393–7.

    Article  PubMed  Google Scholar 

  70. Scott RG, Edwards JT, Fritschi L, Foster NM, Mendelson RM, Forbes GM. Community-based screening by colonoscopy or computed tomographic colonography in asymptomatic average-risk subjects. Am J Gastroenterol. 2004;99(6):1145–51.

    Article  PubMed  Google Scholar 

  71. Griffith JM, Lewis CL, Brenner AR, Pignone MP. The effect of offering different numbers of colorectal cancer screening test options in a decision aid: a pilot randomized trial. BMC Med Inform Decis Mak. 2008;8:4.

    Article  PubMed  Google Scholar 

  72. Jones LE, Cash BD, Stamps K. Computed tomographic colonography increases colorectal cancer screening compliance. Gastroenterology. 2011;140(5):S565–6.

    Google Scholar 

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Acknowledgments

The authors would like to thank Jane Babione for her assistance and input.

There was no internal or external funding or grant support provided for this study.

Dr. Otto Lin gave an oral presentation of a preliminary version of this study at Digestive Disease Week in June of 2010 in New Orleans.

Conflict of Interest

None of the authors have any financial conflicts of interest to report, with the following exceptions: 1) A research grant from Cumberland Pharmaceuticals to Dr. Otto Lin, for a pilot study assessing the efficacy and safety of crystalline lactulose as a colonoscopy bowel preparation agent; 2) Consultancies for Epigenomics Inc. and Salix Pharmaceuticals for Dr. Jason Dominitz.

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  1. C3-Gas, Gastroenterology Section, Virginia Mason Medical Center, 1100 Ninth Avenue, Seattle, WA, 98101, USA

    Otto S. Lin MD, MSc, Richard A. Kozarek MD, Michael Gluck MD, Geoffrey C. Jiranek MD, Johannes Koch MD, Kris V. Kowdley MD, Shayan Irani MD & Matthew Nguyen MPH

  2. Gastroenterology Division, VA Puget Sound Health Care System and University of Washington, Seattle, WA, USA

    Jason A. Dominitz MD, MHS

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  1. Otto S. Lin MD, MSc
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Correspondence to Otto S. Lin MD, MSc.

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Lin, O.S., Kozarek, R.A., Gluck, M. et al. Preference for Colonoscopy Versus Computerized Tomographic Colonography: A Systematic Review and Meta-analysis of Observational Studies. J GEN INTERN MED 27, 1349–1360 (2012). https://doi.org/10.1007/s11606-012-2115-4

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