Adverse events during CT colonography for screening, diagnosis and preoperative staging of colorectal cancer: a Japanese national survey

• Published in: European radiology Vol. 27; no. 12; pp. 4970 - 4978
• Main Authors: Nagata, Koichi, Takabayashi, Ken, Yasuda, Takaaki, Hirayama, Michiaki, Endo, Shungo, Nozaki, Ryoichi, Shimada, Takenobu, Kanazawa, Hidenori, Fujiwara, Masanori, Shimizu, Norihito, Iwatsuki, Tatema, Iwano, Teruaki, Saito, Hiroshi
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.12.2017; Springer Nature B.V
• Subjects: Cancer; Colon; Colonography, Computed Tomographic - adverse effects; Colonography, Computed Tomographic - methods; Colonoscopy - methods; Colorectal cancer; Colorectal carcinoma; Colorectal Neoplasms - diagnostic imaging; Colorectal Neoplasms - mortality; Computed tomography; Diagnosis; Diagnostic Radiology; Female; Gastrointestinal; Humans; Imaging; Institutions; Insufflation - methods; Internal Medicine; Interventional Radiology; Intestinal Perforation - etiology; Intestine; Male; Mass Screening - adverse effects; Mass Screening - methods; Medical diagnosis; Medicine; Medicine & Public Health; Neoplasm Staging - adverse effects; Neoplasm Staging - methods; Neuroradiology; Perforation; Radiology; Retrospective Studies; Risk; Screening; Surgery; Syncope, Vasovagal - etiology; Ultrasound; Virtual colonoscopy; Computed tomography; Vasovagal syncope; Intestinal perforation; Colonography
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-017-4920-y

Objectives To retrospectively evaluate the frequencies and magnitudes of adverse events associated with computed tomographic colonography (CTC) for screening, diagnosis and preoperative staging of colorectal cancer. Methods A Japanese national survey on CTC was administered by use of an online survey tool in the form of a questionnaire. The questions covered mortality, colorectal perforation, vasovagal reaction, total number of examinations, and examination procedures. The survey data was collated and raw frequencies were determined. Fisher’s exact test was used to determine differences in event rates between groups. Results At 431 institutions, 147,439 CTC examinations were performed. No deaths were reported. Colorectal perforations occurred in 0.014% (21/147,439): 0.003% (1/29,823) in screening, 0.014% (13/91,007) in diagnosis and 0.028% (7/25,330) in preoperative staging. The perforation risk was significantly lower in screening than in preoperative staging CTC procedures ( p  = 0.028). Eighty-one per cent of perforation cases (17/21) did not require emergency surgery. Vasovagal reaction occurred in 0.081% (120/147,439): 0.111% (33/29,823) in screening, 0.088% (80/91,007) in diagnosis and 0.028% (7/25,330) in preoperative staging. Conclusions The risk of colorectal perforation and vasovagal reaction in CTC is low. The frequency of colorectal perforation associated with CTC is least in the screening group and greatest in the preoperative-staging group. Key points • The colorectal perforation rate during preoperative - staging CTC was 0.028  %. • The perforation rates for screening and diagnosis were 0.003  % and 0.014  %, respectively . • The perforation risk is significantly lower in screening than in preoperative staging . • Eighty - one per cent of perforation cases did not require emergency surgery . • Use of an automatic colon insufflator can reduce the risk of bowel perforation .