Imaging alternatives to colonoscopy: CT colonography and colon capsule. European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastrointestinal and Abdominal Radiology (ESGAR) Guideline – Update 2020

Cristiano Spada; Cesare Hassan; Davide Bellini; David Burling; Giovanni Cappello; Cristina Carretero; Evelien Dekker; Rami Eliakim; Margriet de Haan; Michal F. Kaminski; Anastasios Koulaouzidis; Andrea Laghi; Philippe Lefere; Thomas Mang; Sebastian Manuel Milluzzo; Martina Morrin; Deirdre McNamara; Emanuele Neri; Silvia Pecere; Mathieu Pioche; Andrew Plumb; Emanuele Rondonotti; Manon CW Spaander; Stuart Taylor; Ignacio Fernandez-Urien; Jeanin E. van Hooft; Jaap Stoker; Daniele Regge

doi:10.1055/a-1258-4819

Endoscopy, Table of Contents

Endoscopy 2020; 52(12): 1127-1141
DOI: 10.1055/a-1258-4819

Guideline

Imaging alternatives to colonoscopy: CT colonography and colon capsule. European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastrointestinal and Abdominal Radiology (ESGAR) Guideline – Update 2020

Authors

Cristiano Spada

¹Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy

²Department of Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
Cesare Hassan

³Gastroenterology Unit, Nuovo Regina Margherita Hospital, Rome, Italy
Davide Bellini

⁴Department of Radiological Sciences, Oncology and Pathology, La Sapienza University of Rome, Diagnostic Imaging Unit, I.C.O.T. Hospital Latina, Italy
David Burling

⁵St. Mark’s Hospital, Harrow, London, UK
Giovanni Cappello

⁶Radiology Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
Cristina Carretero

⁷Department of Gastroenterology. University of Navarre Clinic, Healthcare Research Institute of Navarre, Pamplona, Spain
Evelien Dekker

⁸Department of Gastroenterology and Hepatology, Amsterdam University Medical Center location AMC, The Netherlands
Rami Eliakim

⁹Department of Gastroenterology, Sheba Medical Center , Sackler School of Medicine, Tel-Aviv, Israel
Margriet de Haan

¹⁰Department of Radiology, University Medical Center, Utrecht, The Netherlands
Michal F. Kaminski

¹¹Departments of Gastroenterological Oncology and Cancer Prevention, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
Anastasios Koulaouzidis

¹²Endoscopy Unit, Centre for Liver and Digestive Disorders, University Hospitals, NHS Lothian, Edinburgh, UK
Andrea Laghi

¹³Department of Surgical-Medical Sciences and Translational Medicine, La Sapienza University of Rome, Italy
Philippe Lefere

¹⁴Department of Radiology, Stedelijk Ziekenhuis, Roeselare, Belgium
Thomas Mang

¹⁵Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
Sebastian Manuel Milluzzo

¹Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy

²Department of Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
Martina Morrin

¹⁶RCSI Radiology, Royal College of Surgeons in Ireland, Dublin, Ireland
Deirdre McNamara

¹⁷TAGG Research Centre, Department of Clinical Medicine, Trinity Centre, Tallaght Hospital, Dublin, Ireland
Emanuele Neri

¹⁸Diagnostic Radiology 3, Department of Translational Research, University of Pisa, Italy
Silvia Pecere

²Department of Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
Mathieu Pioche

¹⁹Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
Andrew Plumb

²⁰Centre for Medical Imaging, University College London, London, UK
Emanuele Rondonotti

²¹Gastroenterology Unit, Ospedale Valduce, Como, Italy
Manon CW Spaander

²²Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands
Stuart Taylor

²⁰Centre for Medical Imaging, University College London, London, UK
Ignacio Fernandez-Urien

²³Gastroenterology, Hospital de Navarra, Pamplona, Spain
Jeanin E. van Hooft

²⁴Department of Gastroenterology and Hepatology, Leiden University Medical Center, The Netherlands
Jaap Stoker

²⁵Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
Daniele Regge

⁶Radiology Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy

²⁶University of Turin Medical School, Turin, Italy

Abstract

Main recommendations

1 ESGE/ESGAR recommend computed tomographic colonography (CTC) as the radiological examination of choice for the diagnosis of colorectal neoplasia.
Strong recommendation, high quality evidence.

ESGE/ESGAR do not recommend barium enema in this setting.
Strong recommendation, high quality evidence.

2 ESGE/ESGAR recommend CTC, preferably the same or next day, if colonoscopy is incomplete. The timing depends on an interdisciplinary decision including endoscopic and radiological factors.
Strong recommendation, low quality evidence.

ESGE/ESGAR suggests that, in centers with expertise in and availability of colon capsule endoscopy (CCE), CCE preferably the same or the next day may be considered if colonoscopy is incomplete.
Weak recommendation, low quality evidence.

3 When colonoscopy is contraindicated or not possible, ESGE/ESGAR recommend CTC as an acceptable and equally sensitive alternative for patients with alarm symptoms.
Strong recommendation, high quality evidence.
Because of lack of direct evidence, ESGE/ESGAR do not recommend CCE in this situation.
Very low quality evidence.

ESGE/ESGAR recommend CTC as an acceptable alternative to colonoscopy for patients with non-alarm symptoms.
Strong recommendation, high quality evidence.
In centers with availability, ESGE/ESGAR suggests that CCE may be considered in patients with non-alarm symptoms.
Weak recommendation, low quality evidence.

4 Where there is no organized fecal immunochemical test (FIT)-based population colorectal screening program, ESGE/ESGAR recommend CTC as an option for colorectal cancer screening, providing the screenee is adequately informed about test characteristics, benefits, and risks, and depending on local service- and patient-related factors.
Strong recommendation, high quality evidence.

ESGE/ESGAR do not suggest CCE as a first-line screening test for colorectal cancer.
Weak recommendation, low quality evidence.

5 ESGE/ESGAR recommend CTC in the case of a positive fecal occult blood test (FOBT) or FIT with incomplete or unfeasible colonoscopy, within organized population screening programs.
Strong recommendation, moderate quality evidence.

ESGE/ESGAR also suggest the use of CCE in this setting based on availability.
Weak recommendation, moderate quality evidence.

6 ESGE/ESGAR suggest CTC with intravenous contrast medium injection for surveillance after curative-intent resection of colorectal cancer only in patients in whom colonoscopy is contraindicated or unfeasible
Weak recommendation, low quality evidence.

There is insufficient evidence to recommend CCE in this setting.
Very low quality evidence.

7 ESGE/ESGAR suggest CTC in patients with high risk polyps undergoing surveillance after polypectomy only when colonoscopy is unfeasible.
Weak recommendation, low quality evidence.

There is insufficient evidence to recommend CCE in post-polypectomy surveillance.
Very low quality evidence.

8 ESGE/ESGAR recommend against CTC in patients with acute colonic inflammation and in those who have recently undergone colorectal surgery, pending a multidisciplinary evaluation.

Strong recommendation, low quality evidence.

9 ESGE/ESGAR recommend referral for endoscopic polypectomy in patients with at least one polyp ≥ 6 mm detected at CTC or CCE.
Follow-up CTC may be clinically considered for 6 – 9-mm CTC-detected lesions if patients do not undergo polypectomy because of patient choice, comorbidity, and/or low risk profile for advanced neoplasia.

Strong recommendation, moderate quality evidence.

Full Text

References

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