Endoluminal CT colonography after an incomplete endoscopic colonoscopy

We evaluated the clinical usefulness of endoluminal CT colonography after an incomplete colonoscopy.

We prospectively studied 40 patients in whom the cecum could not be reached endoscopically despite adequate bowel preparation. Endoluminal CT colonography (120 kVp, 120 mA, 3-mm collimation, pitch of 2, 1.5-mm interval reconstruction) was performed within 2 hr of incomplete colonoscopy. Two-dimensional multiplanar reformatted images and three-dimensional endoluminal images were analyzed. Twenty-six patients (65%) underwent barium enema immediately after endoluminal CT colonography. We analyzed colonic distention; duration of endoluminal CT colonography; patient tolerance; number of colonic segments seen at colonoscopy, endoluminal CT colonography, and barium enema; and reasons for incomplete colonoscopy as well as colonic and extracolonic findings.

Duration of endoluminal CT colonography was 14.2 +/- 4.6 min (mean +/- SD). Endoluminal CT colonography was better tolerated than colonoscopy or barium enema (p < .001). Probable causes for incomplete colonoscopy were identified at endoluminal CT colonography in 74% of 40 patients. Baseline colonic distention in the region of the transverse and right colon was considered adequate before additional air insufflation; however, the addition of air significantly enhanced colonic distention throughout the entire colon (p < .001). Endoluminal CT colonography adequately revealed 96% of all colonic segments; in comparison, barium enema adequately revealed 91% of all segments (p < .05).

In patients with incomplete colonoscopy, endoluminal CT colonography successfully showed the previously unrevealed colon in more than 90% of patients. Endoluminal CT colonography is a rapid, well-tolerated technique that provides clinically useful colonic and extracolonic information and should be considered for all patients who undergo incomplete colonoscopy.