Perforation rate in CT colonography: a systematic review of the literature and meta-analysis

• Published in: European radiology Vol. 24; no. 7; pp. 1487 - 1496
• Main Authors: Bellini, Davide, Rengo, Marco, De Cecco, Carlo Nicola, Iafrate, Franco, Hassan, Cesare, Laghi, Andrea
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.07.2014; Springer Nature B.V
• Subjects: Colon - injuries; Colonography, Computed Tomographic - adverse effects; Colorectal Neoplasms - diagnostic imaging; Diagnostic Radiology; Gastrointestinal; Global Health; Humans; Imaging; Internal Medicine; Interventional Radiology; Intestinal Perforation - epidemiology; Literature reviews; Medicine; Medicine & Public Health; Neuroradiology; Radiology; Ultrasound; Computed tomographic colonography; General surgery; Intestinal perforation; Mass screening; Insufflation
• ISSN: 0938-7994; 1432-1084; 1432-1084
• DOI: 10.1007/s00330-014-3190-1

Purpose The primary aim was to assess the perforation rate of CTC; the secondary aim was to identify potential clinical/technical predictors of this complication. Methods Methods for analysis were based on PRISMA (preferred reporting items for systematic reviews and meta-analyses). From the selected studies, the rate of CTC perforation and patient/technical characteristics potentially associated with this event were extracted. Forest plots showing individual and pooled estimates of the perforation rate were obtained for all analyses. I 2 was used to evaluate heterogeneity between studies. Results Eleven articles out of the 187 initially identified were selected for the analysis (103,399 patients). There were 29,048 (28 %) asymptomatic individuals and 30,773 (30 %) symptomatic patients; this characteristic was not reported in the remaining subjects (42 %). Colon distension was obtained manually in 69,222 (67 %) and using an automated carbon dioxide insufflator in 26,479 (26 %) patients; in the remaining 7 % of patients, this information was missing. Twenty-eight colonic perforations were reported, with the CTC perforation rate estimated to be 0.04 % (95 % CI. 0.00-0.10), 19-fold higher in symptomatic than in screening subjects (OR: 19.2, CI 3.3-108 and P  = 0.001). The surgical rate was 0.008 %. No CTC-related deaths were reported. Conclusions The perforation rate in CTC is very low, particularly considering asymptomatic individuals. Key Points • This is the first meta-analysis on this topic, based on 100,000 patients . • The CTC-related colorectal perforation rate is 0.04 %, 0.02 % in asymptomatic subjects . • The CTC-induced surgery rate is 0.008 % (1:12,500) . • The perforation rate in CTC is low, particularly in average-risk, asymptomatic individuals .