CT Colongraphy vs. Colonoscopy
QUESTION: Is CT Colonography better or worse than colonoscopy for diagnostic screening? (No regard is given to treatment – which is not possible with CT colonography – nor cost analysis.)
METHOD: Peer reviewed English language publications of human, Theraputic Studies only – investigating the efficacy and safety of Alloderm in breast reconstruction. Repetitive evaluation and similar results of same data sets were not included.
TOTAL: 18 CT COLONOGRAPHY STUDIES
2 Level III
9 Studies 2 Level IV
5 Level V
5 Studies 2 Level I
3 Level II
2 Level II
4 Studies 1 Level IV 1 Level V
Preponderance of studies favorable are Favorable and > 25% are Level IV or better.
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Colonography vs. Colonoscopy
Studies Favorable: Total 9
Level III: 2 Studies
1. Feasibility study of computed tomography colonography using limited bowel preparation at normal and low-dose levels study.
Florie J, van Gelder RE, Schutter MP, van Randen A, Venema HW, de Jager S, van der Hulst VP, Prent A, Bipat S, Bossuyt PM, Baak LC, Stoker J.
Eur Radiol. 2007 Dec;17(12):3112-22. Epub 2007 Jun 5.
Department of Radiology, Academic Medical Center, G1-230, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands. J.Florie@amc.uva.nl
Prospective patients undergoing CTC without bowel prep and for eval of lesion only > 10 mm compared to colonoscopy in same. For CTC – only for lesions > 10mm
Level III – Favorable: Level due to limitation of endpoint – as in case control study – to only lesions > 10 mm
2. Performance of multidetector computed tomography colonography compared with conventional colonoscopy.
Gluecker T, Dorta G, Keller W, Jornod P, Meuli R, Schnyder P.
Gut. 2002 Aug;51(2):207-11.
For CTC – for lesions > 10 mm
Level III – Favorable: Non-consecutive study patients
Level IV: 2 Studies
1. Usefulness of virtual colonoscopy in the diagnosis of symptomatic large colonic lipomas.
Koktener A, Erden A.
Australas Radiol. 2007 Oct;51 Spec No.:B144-6.
Case report – 2 patients. For CTC –
Level IV – Favorable: Case series, uncontrolled
2. A retrospective evaluation of patient acceptance of computed tomography colonography (“virtual colonoscopy”) in comparison with conventional colonoscopy in an average risk screening population.
Juchems MS, Ehmann J, Brambs HJ, Aschoff AJ.
Acta Radiol. 2005 Nov;46(7):664-70.
Department for Diagnostic Radiology, University Hospitals of Ulm, Ulm, Germany.
markus.juchems@medizin.uni-ulm.de
For CTC
Level IV – Favorable: Case control, poor reference standard.
Level V: 5 Studies
1. Virtual colonoscopy: clinical application.
Laghi A.
Eur Radiol. 2005 Nov;15 Suppl 4:D138-41.
University of Rome La Sapienza, Polo Didattico Pontino – Latina, Via Franco Faggiana 34, 04100 Latina, Italy.
andrea.laghi@uniroma1.it
For CTC
Level V – Favorable
2. Virtual colonoscopy for colorectal cancer screening: current status.
Peterson CM, Menias CO.
Cancer Imaging. 2005 Nov 23;5 Spec No A:S133-9.
For CTC
Level V – Favorable: Expert opinion
3. Mass screening with CT colonography: should the radiation exposure be of concern?
Brenner DJ, Georgsson MA.
Gastroenterology. 2005 Jul;129(1):328-37.
For CTC
Level V – Favorable
4. CT colonography (virtual colonoscopy) for the detection of colorectal polyps and neoplasms. current status and future developments.
Gluecker TM, Fletcher JG.
Eur J Cancer. 2002 Nov;38(16):2070-8. >For CTC
Level V – Favorable
5. Computed tomography colonography (virtual colonoscopy): review.
Mendelson RM, Forbes GM.
Australas Radiol. 2002 Mar;46(1):1-12.
Level V – Favorable
CT COLONOGRAPHY vs. COLONOSCOPY
Studies Unfavorable: Total 5
Level I: 2 Studies
1. Single-center study comparing computed tomography colonography with conventional colonoscopy.
Roberts-Thomson IC, Tucker GR, Hewett PJ, Cheung P, Sebben RA, Khoo EE, Marker JD, Clapton WK.
World J Gastroenterol. 2008 Jan 21;14(3):469-73.
Testing of previously developed diagnostic criteria of colonoscopy in series of 227 consecutive patients against CTC in same patients with blinding of colonscopists
Against CTC – Sensitivity for detecting smaller polyps currently not adequate compared to colonoscopy
Level I – Unfavorable: Testing of previously developed diagnostic criteria in series of consecutive patients (with universally applied reference “gold” standard)
2. Meta-analysis of air contrast barium enema, computed tomography colonography, and colonoscopy.
Smith LA, Sidhu P, Sidhu S, Rembacken B.
Am J Med. 2008 Jan;121(1):e7; author reply e9.
Meta analysis of 30 studies comparing the three entities for effectiveness of CTC
Against CTC – Sensitivity for detecting smaller polyps currently not adequate compared to colonoscopy
Level I – Unfavorable: Systematic review of Level I studies.
Level II: 3 Studies
1. Diagnostic performance of computed tomography colonography in symptomatic patients and in patients with increased risk for colorectal disease.
Reuterskiöld MH, Lasson A, Svensson E, Kilander A, Stotzer PO, Hellström M.
Acta Radiol.2006 Nov;47(9):888-98.
Department of Radiology, The Sahlgrenska Academy at Göteborg University, Göteborg, Sweden. maria.r@telia.com
Prospective study of patients undergoing CTC and colonoscopy
Against CTC – low sensitivity for lesions < 10mm
Level II – Unfavorable
2. Diagnostic performance of computed tomography colonography and colonoscopy: a prospective and validated analysis of 231 paired examinations.
Arnesen RB, von Benzon E, Adamsen S, Svendsen LB, Raaschou HO, Hansen OH.
Acta Radiol. 2007 Oct;48(8):831-7.
Department of Surgery and Department of Radiology, Hillerød Hospital, Hillerød, Denmark.
Prospective blinded study in 241 patients undergoing CTC and colonoscopy
Against CTC – lesions under 10 mm missed by significantly greater amount
Level II – Unfavorable.
3. Computed tomography colonography compared with conventional colonoscopy for the detection of colorectal polyps.
Chaparro Sánchez M, del Campo Val L, Maté Jiménez J, Cantero Perona J, Barbosa A, Olivares D,Khorrami S, Moreno-Otero R,Gisbert JP.
Gastroenterol Hepatol. 2007 Aug-Sep;30(7):375-80.
Department of Gastroenterology and Hepatology, University Hospital La Princesa, Madrid, Spain.
mariachs2005@gmail.com
Prospective study 54 patients undergoing CTC and colonoscopy
Against CTC – low sensitivity for lesions under 10 mm
Level II – Unfavorable
CT COLONOGRAPHY vs. COLONOSCOPY
Studies Neutral: Total 4
Level II: 2 Studies
1. Computed tomography colonography in routine clinical practice.
Galatola G, Fracchia M, Defazio G, De Bei F, Regge D.
Eur J Gastroenterol Hepatol. 2003 Dec;15(12):1323-31.
Neutral – CTC can be used when colonoscopy not possible
Level II – Neutral: Diagnostic criteria based on consecutive patients
2. CT colonography versus colonoscopy in the follow-up of patients after diverticulitis – a prospective, comparative study.
Hjern F, Jonas E, Josephson T, Mellgren A, Johansson C.
Clin Radiol. 2007 Jul;62(7):645-50. Epub 2007 Apr 6.
Division of Surgery, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institut, Stockholm, Sweden. fredrik.hjern@ds.se
Prospective study 50 patients undergoing CTC and colonoscopy
Neutral – CTC “reasonable” for diverticulitis f/u
Level II – Neutral
Level IV: 1 Study
1. A comparison of colorectal neoplasia screening tests: a multicentre community-based study of the impact of consumer choice.
The Multicentre Australian Colorectal-neoplasia Screening (MACS) Group
Med J Aust. 2006 Jun 5;184(11):546-50.
1679 patients offered one of six screening methods for colon cancer to evaluate change in participation rate by choice of testing. None found.
Level IV – Neutral: Prospective cohort
Level V: 1 Study
1. Computed tomography colonography: current issues.
Nio Y, Stoker J.
Scand J Gastroenterol Suppl. 2006 May;(243):139-45.
Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. c.y.nio@amc.uva.nl
Neutral CTC
>Level V – Neutral
LEVEL I
Randomized, controlled clinical trials. Researchers would use a computer program to randomly assign patients with back pain into two groups of 20. The first group (placebo group known as the control) would drink water (that only tasted like pomegranate juice but was not) for 10 days. The second group would drink real pomegranate juice for 10 days. None of the patients would know if they were drinking the real pomegranate juice or not. (This is called a blinded study). Then a researcher who does not know which person drank what (which now makes this a what’s called a “double blinded” study) would interview the patients to determine if their back pain was reduced, worsened or stayed the same. After this was all done, the information about which patients drank what would then be revealed. One could then see if those who drank the real pomegranate juice were better or not than the water drinking group.
LEVEL II
Non-randomized, prospective comparative study. A researcher looks at 40 patients medical records to select 20 patients for the pomegranate drinking group and 20 patients for the control group who will drink water. This is called a “cohort,” namely a control and experimental patient make a cohort. Here the researcher may introduce his own bias whether he intends to or not. If he believes pomegranate is a safe, effective treatment for back pain then whether he means to or not he may put the healthier patients with less back pain in the pomegranate group and patients complaining of more back pain in the water-drinking group. (This particular bias is called “selection bias.” See section on types of research bias.)
LEVEL III
Retrospective (already occurred) comparative study or case controlled study (each “experimental“ patient is matched to a patient that never had the experimental). This is not a reliable standard for determining one treatment over another, though it can be helpful to, say, see how many complications a certain treatment has. Researchers do a retrospective study for example reviewing 20 patient records of patients who reported they have been drinking pomegranate juice in the past and then 20 patients who have not reported drinking pomegranate juice. Then the researchers review the patients’ medical records determine if the back pain was reported better, worse or stayed the same. Here again, the selection process may introduce bias intentionally or not. In this case it may not only be selection bias, but could involve “recall” bias, or “expectation bias” or “attention bias.” (See Bias in Research section).
LEVEL IV
Case series do not determine success or failure of a treatment compared to other treatments or no treatment at all. Researchers or a physician does a case study on 20 patients who drink pomegranate juice for 10 days and then report the results. In this case there is no control group or comparison to patients who are not drinking pomegranate juice. It does not take into consideration that back pain could get better in 10 days if the patient takes nothing at all for the pain. These studies are easier and cheaper. They can be of value to determine better methods of doing a particular treatment, or what the complications of a certain treatment are, but NOT for determining if one treatment is better than another.
LEVEL V
Expert opinion. One physician expert’s opinion on if pomegranate juice helps reduce back pain. No original research is conducted. Instead, just a written opinion or editorial that may talk about other research and give opinions, but no clinical study is conducted. AME considers this to be one step above hearsay for determining one treatment over another, though it may be valuable for stimulating discussion and ideas on a particular topic.
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