Burden of colonoscopy compared to non-cathartic CT-colonography in a colorectal cancer screening programme: randomised controlled trial

• Published in: Gut Vol. 61; no. 11; pp. 1552 - 1559
• Main Authors: de Wijkerslooth, Thomas R, de Haan, Margriet C, Stoop, Esther M, Bossuyt, Patrick M, Thomeer, Maarten, Essink-Bot, Marie-Louise, van Leerdam, Monique E, Fockens, Paul, Kuipers, Ernst J, Stoker, Jaap, Dekker, Evelien
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Society of Gastroenterology 01.11.2012; BMJ Publishing Group; BMJ Publishing Group LTD
• Subjects: abdominal MRI; abdominal pain; advanced endoscopic imaging; Aged; anorectal disorders; Anxiety - epidemiology; Barretts oesophagus; Biological and medical sciences; burden; Cathartics - administration & dosage; Colonography, Computed Tomographic - methods; colonoscopy; Colonoscopy - methods; Colorectal cancer; colorectal carcinoma; colorectal neoplasms; Colorectal Neoplasms - diagnosis; Colorectal Neoplasms - diagnostic imaging; CRC surveillance; CT Colonography; Digestive system; Digestive system. Abdomen; Early Detection of Cancer - methods; endoscopic polypectomy; endoscopic procedures; endoscopic ultrasonography; Endoscopy; family cancer; Female; gastric cancer; gastritis; Gastroenterology. Liver. Pancreas. Abdomen; gastroesophageal reflux disease; gastrointesinal endoscopy; gastrointestinal bleeding; Helicobacter pylori; Humans; imaging; Investigative techniques, diagnostic techniques (general aspects); Male; Mass screening; Mass Screening - methods; Medical sciences; Medical screening; Middle Aged; Mortality; narrow band imaging; Netherlands; Pain Measurement; Patient Satisfaction - statistics & numerical data; Patients; Population; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Risk Assessment; screening; small bowel; Statistics, Nonparametric; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Studies; Surveys and Questionnaires; Therapeutic Irrigation - methods; Tumors; Virtual colonoscopy; Rectal disease; Radiodiagnosis; Colorectal cancer; Malignant tumor; Medical screening; Colonic disease; Colonoscopy; Gastroenterology; Medical imagery; Digestive diseases; Intestinal disease; Computerized axial tomography; Endoscopy; Cancer
• ISSN: 0017-5749; 1468-3288
• DOI: 10.1136/gutjnl-2011-301308

Objective CT-colonography has been suggested to be less burdensome for primary colorectal cancer (CRC) screening than colonoscopy. To compare the expected and perceived burden of both in a randomised trial. Design 8844 Dutch citizens aged 50–74 years were randomly invited for CRC screening with colonoscopy (n=5924) or CT-colonography (n=2920). Colonoscopy was performed after full colon lavage, or CT-colonography after limited bowel preparation (non-cathartic). All invitees were asked to complete the expected burden questionnaire before the procedure. All participants were invited to complete the perceived burden questionnaire 14 days later. Mean scores were calculated on 5-point scales. Results Expected burden: 2111 (36%) colonoscopy and 1199 (41%) CT-colonography invitees completed the expected burden questionnaire. Colonoscopy invitees expected the bowel preparation and screening procedure to be more burdensome than CT-colonography invitees: mean scores 3.0±1.1 vs 2.3±0.9 (p<0.001) and 3.1±1.1 vs 2.2±0.9 (p<0.001). Perceived burden: 1009/1276 (79%) colonoscopy and 801/982 (82%) CT-colonography participants completed the perceived burden questionnaire. The full screening procedure was reported as more burdensome in CT-colonography than in colonoscopy: 1.8±0.9 vs 2.0±0.9 (p<0.001). Drinking the bowel preparation resulted in a higher burden score in colonoscopy (3.0±1.3 vs 1.7±1.0, p<0.001) while related bowel movements were scored more burdensome in CT-colonography (2.0±1.0 vs 2.2±1.1, p<0.001). Most participants would probably or definitely take part in a next screening round: 96% for colonoscopy and 93% for CT-colonography (p=0.99). Conclusion In a CRC screening programme, colonoscopy invitees expected the screening procedure and bowel preparation to be more burdensome than CT-colonography invitees. In participants, CT-colonography was scored as more burdensome than colonoscopy. Intended participation in a next screening round was comparable.