Virtual colonoscopy versus traditional colonoscopy

Virtual colonoscopy versus traditional colonoscopy

Introduction and Rationale:

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Colorectal cancer is second leading cause f cancer morbidity and mortality in the Western world. Conventional colonoscopy is the gold standard for detection of colorectal cancer; however, it is invasive and not without risk.

This study aims to evaluate the effectiveness of CTC in community based practices by comparing board certified gastroenterologists, trained using American College of Radiology, ACR practice guidelines for performing and interpreting diagnostic computed tomography, in the identification of colorectal neoplasia using CT colonoscopy as compared to board certified radiologists.

Recent Literature:

Early detection and removal of polyps (i.e., precursors of colorectal cancer) using screening tests such as colonoscopy are reduce the risk and incidence of, and death from colorectal cancer (Aschoff, Ernst,  Brambs, & Juchems, 2008). Computed tomographic colonography (CTC) or virtual colonoscopy, has been reported to be reasonably accurate, however studies have shown that CT has a lower sensitivity and specificity and that there is variability in the results between observers and the performance of CTC in community-based medical practices remains uncertain (Angtuaco, Banaad-Omiotek, & Howden, 2001; Pineau, Paskett, Chen, Espeland, Phillips, Han, et al., 2003 ).

Hypothesis:

Training using American College of Radiology, ACR practice guidelines for performing and interpreting diagnostic computed tomography can improve the identification of colorectal neoplasia using CT colonoscopy compared with conventional colonoscopy.

Specific Research Objectives:

To evaluate the effectiveness of training in the detection of polyps
To evaluate the performance CTC in community-based medical practices
To evaluate patient acceptance in the use of CTC at community-based medical practices

Methodology and Procedures:

Colonoscopy training that includes computer-simulator training (computer assisted diagnosis) for community-based medical practitioners
Prospective study at community-based medical practice where participants sent for conventional colonoscopy will be asked to the participate in CT colonoscopy examination
Ethics approval – Human Subjects and Informed Consent Forms

Data Analysis:

Comparison of polyps and neoformations identified by CT colonoscopy with those found on conventional colonoscopy by team of independent researchers (radiologist)
Comparison of colonoscopic and radiological data with surgical findings where possible
Assessment of patients perceptions of pain and discomfort during colonoscopy and overall satisfaction with the procedure using a 10-point visual-analog scale

Expected Outcomes:

After colonoscopy training identification of colorectal neoplasia using CT colonoscopy will be as good as that using conventionally colonoscopy in community-based medical practices.
Implementation of CT colonoscopy at community-based practices
Patient acceptance of CT colonoscopy

References

Akerkar, G. A., Yee, J., Hung, R., & McQuaid, K. (2001). Patient experience and preferences toward colon cancer screening: a comparison of virtual colonoscopy and conventional colonoscopy. Gastrointestinal Endoscopy, 54(3), 310-315.

Angtuaco, T. L., Banaad-Omiotek, G. D., & Howden, C. W. (2001). Differing attitudes toward virtual and conventional colonoscopy for colorectal cancer screening: surveys among primary care physicians and potential patients. American Journal of Gastroenterology, 96(3), 887-893.

Aschoff, A. J., Ernst, A. S., Brambs, H-J., & Juchems, M. S. (2008). CT colonography: an update. European Radiology, 18, 429–437.

Cotton, P. B., Durkalski, V. L., Pineau, B. C., Palesch, Y. Y., Mauldin, P. D., Hoffman, B., et al. (2004). Computed tomographic colonography (virtual colonoscopy): a multicenter comparison with standard colonoscopy for detection of colorectal neoplasia. Journal of the American Medical Association, 291(14), 1713-1719.

Fenlon, H. M., Nunes, D. P., Schroy, P. C., 3rd, Barish, M. A., Clarke, P. D., & Ferrucci, J. T. (1999). A comparison of virtual and conventional colonoscopy for the detection of colorectal polyps.[see comment][erratum appears in N Engl J Med 2000 Feb 17;342(7):524]. New England Journal of Medicine, 341(20), 1496-1503.

Juchems, M. S., Ehmann, J., Brambs, H. J., & Aschoff, A. J. (2005). A retrospective evaluation of patient acceptance of computed tomography colonography (“virtual colonoscopy”) in comparison with conventional colonoscopy in an average risk screening population. Acta Radiologica, 46(7), 664-670.

Pineau, B. C., Paskett, E. D., Chen, G. J., Espeland, M. A., Phillips, K., Han, J. P., et al. (2003). Virtual colonoscopy using oral contrast compared with colonoscopy for the detection of patients with colorectal polyps. Gastroenterology, 125(2), 304-310.

Sonnenberg, A., Delco, F., & Bauerfeind, P. (1999). Is virtual colonoscopy a cost-effective option to screen for colorectal cancer? American Journal of Gastroenterology, 94(8), 2268-2274.

Spinzi, G., Belloni, G., Martegani, A., Sangiovanni, A., Del Favero, C., & Minoli, G. (2001). Computed tomographic colonography and conventional colonoscopy for colon diseases: a prospective, blinded study. American Journal of Gastroenterology, 96(2), 394-400.

Taylor, S. A., Iinuma, G., Saito, S., Zhang, J., & Halligan, S. (2008). CT colonography: computer-aided detection of morphologically flat T1 colonic carcinoma. European Radiology, 18, 1666–1673.

 

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