Colonoscopy for colonic wall thickening at computed tomography: a worthwhile pursuit?

Area of Science:

• Radiology
• Gastroenterology
• Oncology

Background:

• Clinical management of colonic wall thickening on computed tomography (CT) lacks official guidance.
• This uncertainty leads to a common dilemma regarding the necessity of subsequent colonoscopies.

Purpose of the Study:

• To determine if colonic wall thickening identified by CT consistently necessitates colonoscopy.
• To evaluate the diagnostic accuracy of CT compared to colonoscopy and histology for colonic pathology.

Main Methods:

• Retrospective analysis of consecutive colonoscopies performed at Leeds Teaching Hospitals Trust in 2008.
• Inclusion criteria: colonoscopies recorded as "possible colonic lesion on cross-sectional abdominal CT" with complete clinical, radiologic, colonoscopic, and histologic data.
• Data extraction from medical records for analysis.

Main Results:

• Of 4,702 colonoscopies, 94 met inclusion criteria. Primary diagnoses included adenocarcinoma (26.6%), adenoma (24.5%), and normal findings (11.7%).
• CT and colonoscopy concordance for specific pathology was 79.8%. CT demonstrated high specificity (96.5%) and negative predictive value (96.5%).
• CT identified significant pathology requiring intervention in 63.8% of cases, while 28.7% required no further intervention based on CT findings.

Conclusions:

• Computed tomography (CT) is highly predictive of colonic pathology when compared to colonoscopy and biopsy outcomes.
• For patients without a pre-existing diagnosis, colonic wall thickening identified by CT warrants further investigation with colonoscopy.
• CT findings can help guide the decision-making process for further endoscopic evaluation.