EU Radiology: Patients prefer CT colonography with limited prep

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A study published in the August issue of European Radiology presented evidence that patients prefer to undergo a CT colonography (CTC) with limited bowel preparation rather than a full-preparation colonoscopy

Although CTC is a widely used European imaging technique both for patients with colorectal cancer symptoms and for screening average-risk individuals, it does “require a cathartic bowel preparation that is burdensome and often considered the most unpleasant part of the examination,”  said Sebastiaan Jensch, MD, from the department of radiology at University of Amsterdam. Jensch and his colleagues sought to determine how undergoing a CTC with a less-extensive bowel preparation would impact a patient’s experience and treatment preference when compared with the full-preparation colonoscopy.

Individuals who had family histories of colorectal polyps or cancer were asked to volunteer for the study, and 173 individuals ended up participating, each undergoing both the CTC with limited preparation and a full preparation optical colonoscopy. The participants filled out six questionnaires at different times, giving their:

1. Pretest appraisals and assessment of their post-test experience with the preparation for CTC and the preparation for optical colonoscopy;

1. Pretest appraisals and assessment of their post-test experience with the CTC and optical colonoscopy procedures; and

1. Preference for future exams.

For the CTC with limited bowel preparation, participants were prepared with a low-fiber diet two days before the procedure. A combination of 80 ml barium sulphate suspension and 180 ml diatrizoate meglumine was prescribed for fecal tagging, while Bisacodyl was given the day before and on the day of the exam to reduce the amount of feces in the colon. The CTC was performed one to four weeks before the optical colonoscopy.

For the optical colonoscopy preparation, a polyethylene glycol solution was used. Patients received sedatives or analgesics on request and Butylscopolamine bromide was administered intravenously.

The researchers found that “[t]he cathartic bowel preparation and pain and discomfort experienced during optical colonoscopy were such that optical colonoscopy was considered a more burdensome test than CTC with limited preparation.”

Patients found CTC less burdensome despite the fact that almost every participant in the study—158 out of 168—experienced diarrhea during the CTC preparation, and 29 percent thought that side effect was “severely or extremely burdensome.”

Consequently, the authors concluded that CTC was better tolerated by study participants--despite the occurrence of diarrhea as a side effect.

“CTC with a limited bowel preparation can be of value in increasing participation rates in screening programs for colorectal cancer,” they concluded.