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The safety of same-day CT colonography following incomplete colonoscopy with polypectomy
Luis F Lara1, Danny Avalos1, Huan Huynh1
1Cleveland Clinic Florida, USA.
Background:
Concerns about the risk of bowel perforation for same-day computed tomography colonography (CTC) following an incomplete colonoscopy with polypectomy may lead to unnecessarily postponing the CTC.
Objective:
The objective of this article is to describe the complications including colon perforations associated with same-day CTC in a cohort who had polypectomies but an incomplete colonoscopy.
Design:
We conducted a retrospective study.
Setting:
Our study took place in a single, tertiary referral center.
Patients:
We studied consecutive patients who had CTC the same day as an incomplete colonoscopy with polypectomy.
Interventions:
Interventions included optical colonoscopy (OC), endoscopic polypectomies, and same-day CTC.
Main Outcome Measurements:
Our main outcome measurements included perforation rate with long-term follow-up.
Results:
A total of 3% of patients undergoing colonoscopy from January 2008 to December 2012 had same-day CTC following incomplete OC, and 72 polypectomies were performed in 34 (or 17%) of these patients. Incomplete colonoscopies were due to colon tortuosity and looping (25), severe angulations (five), colon mass (two), colon stenosis (one), bradycardia (one). Fifty-three percent of the OCs were screening for colon neoplasia, 29% diagnostic and 18% were surveillance of colon polyps. Most polyps were ≤ 5 mm, and found in the left colon. There were no reported complications or perforations associated with same-day CTCs during short- and long-term follow-up.
Limitations:
Limitations of our analysis included retrospective single-center design, small number of patients for the occurrence, referral to same-day CTC was not standardized, inability to establish safety of CTC for specific scenarios such as after complex polypectomies, strictures, or advanced IBD.
Conclusions:
Radiologists' apprehension to perform a CTC the same day as an incomplete colonoscopy following polypectomies because of perceived risk of perforation may be unfounded. More data are needed to determine the safety of same-day CTC in patients with high-risk findings during colonoscopy such as a stricture, severe IBD, and after complex polypectomies.
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