CT COLONOSCOPY
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Transcript of CT COLONOSCOPY
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CT COLONOSCOPY
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Turki Alhazmi ,MB.CHB, FRCPC , dABR Interventional Radiology-Body MRI
Ass. Prof. Faculty of MedicineUmm Al Qura University
Makkah-Saudi Arabia
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Colorectal Cancers
• 3rd most common cancer in men and women
• The age range is late 40s to 70s in average-risk patients
• 20% occur in high risk genetically predisposed patients
• 80% occur sporadically in otherwise low risk individuals
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“The adenoma carcinoma sequence”
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“The adenoma carcinoma sequence”
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“The adenoma carcinoma sequence”
risk factors for transformation into colorectal cancer through the “adenoma-
carcinomasequence
• Polyps greater than 10 mm in diameter
• >3 in number, regardless of their size
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“The adenoma carcinoma sequence”
Interruption of this progression by:
detection and removal of threatening pre-cursor adenomas by endoscopic polypectomy results in a decrease of cancer related mortality by 30%
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Colorectal Cancers
• Arise from pre-existing adenomatous polyp
• Requiring10–15 years
• The majority of adenomas that will develop into cancer are polypoid or villous in shape
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Colorectal Cancers
The risk of an adenoma (5 mm or less )to develop into cancer is significantly low, approximating 0.9%
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Screening
• Asymptomatic
• At age of 50 years
• Fecal occult blood + Colonoscopy or CTC
• Every five years, the combination of fecal occult blood and colonoscopy or CTC
• Every five years, double contrast barium enema
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Screening
• Conventional colonoscopy is still the gold standard for colon cancer screening
• Cancers have also been missed by conventional colonoscopy
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Screening
Why cancers are missed on conventional colonoscopy:
1.poor bowel prep
2.Slippage of the endoscope around flexures
3. redundant colon
4.misinterpretation of findings
5.failure to biopsy
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Conventional ColonoscopyAdverse Outcome
• Hemorrhage & Perforation : most common
• Perforation rate 0.2 - 0.4% after diagnostic colonoscopy
• 5% increases in perforation with polypectomy
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SENSETIVITY
CTC CC
10 mm polyp 93.9 % 87.5 %
8 mm polyp 93.8 % 92.3 %
6 mm polyp 88.7 % 91.5 %
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SPECIFICITY
CTC CC
10 mm polyp 96 % 96.1 %
8 mm polyp 92.2 % 91.6 %
6 mm polyp 79.6 % 77.1 %
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Screening
• The sensitivity and specificity per patient and per polyp were similar
• There is no statistically difference between CT COLONOSCOPY (CTC) and Conventional Colonoscopy for adenomas detection greater than 10 mm
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CTC VS DCBE
sensitivity and specificity of polyp detection is higher for CTC compared to DCBE
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Indications
The indications for CTC closely follow the indications for conventional optical colonoscopy with few exceptions
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CTC VS CC
If you have a patient who is Elderly
With cardiovascular disease
With bleeding diathesis
With history of failed colonoscopies
CTC > CC> DCBE
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CTC VS CC
• CTC is relatively fast without the need for sedation
• Less post procedure discomfort CTC than CC
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Virtual disection
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• Proper cleansing of the colon is essential
• Bowel cleansing for CTC is similar to barium enema and standard colonoscopy
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