Clinical indications for computed tomographic colonography: European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastrointestinal and Abdominal Radiology (ESGAR) Guideline

Cristiano Spada; Jaap Stoker; Onofre Alarcon; Federico Barbaro; Davide Bellini; Michael Bretthauer; Margriet C. De Haan; Jean-Marc Dumonceau; Monika Ferlitsch; Steve Halligan; Emma Helbren; Mikael Hellstrom; Ernst J. Kuipers; Philippe Lefere; Thomas Mang; Emanuele Neri; Lucio Petruzziello; Andrew Plumb; Daniele Regge; Stuart A. Taylor; Cesare Hassan; Andrea Laghi

doi:10.1055/s-0034-1378092

Endoscopy, Table of Contents

Endoscopy 2014; 46(10): 897-915
DOI: 10.1055/s-0034-1378092

Guideline

Clinical indications for computed tomographic colonography: European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastrointestinal and Abdominal Radiology (ESGAR) Guideline

Cristiano Spada

¹Digestive Endoscopy Unit, Catholic University, Rome, Italy

,

Jaap Stoker

²Department of Radiology, Academic Medical Center, University of Amsterdam, The Netherlands

,

Onofre Alarcon

³Department of Gastroenterology, Hospital Universitario de Canarias, Facultad de Medicina, Universidad de La Laguna, La Laguna, Tenerife, Spain

,

Federico Barbaro

¹Digestive Endoscopy Unit, Catholic University, Rome, Italy

,

Davide Bellini

⁴Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome; I.C.O.T. Hospital, Latina, Italy

,

Michael Bretthauer

⁵Department of Health Economy and Health Management, University of Oslo, and Department of Transplantation Medicine, Gastroenterology Unit, Oslo University Hospital, Oslo, Norway

,

Margriet C. De Haan

²Department of Radiology, Academic Medical Center, University of Amsterdam, The Netherlands

,

Jean-Marc Dumonceau

⁶Gedyt Endoscopy Center, Buenos Aires, Argentina

,

Monika Ferlitsch

⁷Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria

,

Steve Halligan

⁸Centre for Medical Imaging, University College London, London, UK

,

Emma Helbren

⁸Centre for Medical Imaging, University College London, London, UK

,

Mikael Hellstrom

⁹Department of Radiology, Sahlgrenska University Hospital and Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden

,

Ernst J. Kuipers

¹⁰Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands

,

Philippe Lefere

¹¹Virtual Colonoscopy Teaching Centre, Hooglede, Belgium, and AZ Delta, Roeselare, Belgium

,

Thomas Mang

¹²Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria

,

Emanuele Neri

¹³Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy

,

Lucio Petruzziello

¹Digestive Endoscopy Unit, Catholic University, Rome, Italy

,

Andrew Plumb

⁸Centre for Medical Imaging, University College London, London, UK

,

Daniele Regge

¹⁴Institute for Cancer Research and Treatment, Candiolo-Torino, Italy

,

Stuart A. Taylor

⁸Centre for Medical Imaging, University College London, London, UK

,

Cesare Hassan

¹Digestive Endoscopy Unit, Catholic University, Rome, Italy

,

Andrea Laghi

⁴Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome; I.C.O.T. Hospital, Latina, Italy

› Author Affiliations

Abstract

This is an official guideline of the European Society of Gastrointestinal Endoscopy (ESGE) and the European Society of Gastrointestinal and Abdominal Radiology (ESGAR). It addresses the clinical indications for the use of computed tomographic colonography (CTC). A targeted literature search was performed to evaluate the evidence supporting the use of CTC. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was adopted to define the strength of recommendations and the quality of evidence.

Main recommendations

1 ESGE/ESGAR recommend computed tomographic colonography (CTC) as the radiological examination of choice for the diagnosis of colorectal neoplasia. ESGE/ESGAR do not recommend barium enema in this setting (strong recommendation, high quality evidence).

2 ESGE/ESGAR recommend CTC, preferably the same or next day, if colonoscopy is incomplete. Delay of CTC should be considered following endoscopic resection. In the case of obstructing colorectal cancer, preoperative contrast-enhanced CTC may also allow location or staging of malignant lesions (strong recommendation, moderate quality evidence).

3 When endoscopy is contraindicated or not possible, ESGE/ESGAR recommend CTC as an acceptable and equally sensitive alternative for patients with symptoms suggestive of colorectal cancer (strong recommendation, high quality evidence).

4 ESGE/ESGAR recommend referral for endoscopic polypectomy in patients with at least one polyp ≥ 6 mm in diameter detected at CTC. CTC surveillance may be clinically considered if patients do not undergo polypectomy (strong recommendation, moderate quality evidence).

5 ESGE/ESGAR do not recommend CTC as a primary test for population screening or in individuals with a positive first-degree family history of colorectal cancer (CRC). However, it may be proposed as a CRC screening test on an individual basis providing the screenee is adequately informed about test characteristics, benefits, and risks (weak recommendation, moderate quality evidence).

Full Text

References

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