Endoscopy 2014; 46(10): 897-915
DOI: 10.1055/s-0034-1378092
Guideline
© Georg Thieme Verlag KG Stuttgart · New York

Clinical indications for computed tomographic colonography: European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastrointestinal and Abdominal Radiology (ESGAR) Guideline

Cristiano Spada
1  Digestive Endoscopy Unit, Catholic University, Rome, Italy
,
Jaap Stoker
2  Department of Radiology, Academic Medical Center, University of Amsterdam, The Netherlands
,
Onofre Alarcon
3  Department of Gastroenterology, Hospital Universitario de Canarias, Facultad de Medicina, Universidad de La Laguna, La Laguna, Tenerife, Spain
,
Federico Barbaro
1  Digestive Endoscopy Unit, Catholic University, Rome, Italy
,
Davide Bellini
4  Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome; I.C.O.T. Hospital, Latina, Italy
,
Michael Bretthauer
5  Department of Health Economy and Health Management, University of Oslo, and Department of Transplantation Medicine, Gastroenterology Unit, Oslo University Hospital, Oslo, Norway
,
Margriet C. De Haan
2  Department of Radiology, Academic Medical Center, University of Amsterdam, The Netherlands
,
Jean-Marc Dumonceau
6  Gedyt Endoscopy Center, Buenos Aires, Argentina
,
Monika Ferlitsch
7  Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
,
Steve Halligan
8  Centre for Medical Imaging, University College London, London, UK
,
Emma Helbren
8  Centre for Medical Imaging, University College London, London, UK
,
Mikael Hellstrom
9  Department of Radiology, Sahlgrenska University Hospital and Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
,
Ernst J. Kuipers
10  Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
,
Philippe Lefere
11  Virtual Colonoscopy Teaching Centre, Hooglede, Belgium, and AZ Delta, Roeselare, Belgium
,
Thomas Mang
12  Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
,
Emanuele Neri
13  Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy
,
Lucio Petruzziello
1  Digestive Endoscopy Unit, Catholic University, Rome, Italy
,
Andrew Plumb
8  Centre for Medical Imaging, University College London, London, UK
,
Daniele Regge
14  Institute for Cancer Research and Treatment, Candiolo-Torino, Italy
,
Stuart A. Taylor
8  Centre for Medical Imaging, University College London, London, UK
,
Cesare Hassan
1  Digestive Endoscopy Unit, Catholic University, Rome, Italy
,
Andrea Laghi
4  Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome; I.C.O.T. Hospital, Latina, Italy
› Author Affiliations
Further Information

Publication History

submitted 18 August 2014

accepted after revision 25 August 2014

Publication Date:
30 September 2014 (online)

This is an official guideline of the European Society of Gastrointestinal Endoscopy (ESGE) and the European Society of Gastrointestinal and Abdominal Radiology (ESGAR). It addresses the clinical indications for the use of computed tomographic colonography (CTC). A targeted literature search was performed to evaluate the evidence supporting the use of CTC. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was adopted to define the strength of recommendations and the quality of evidence.

Main recommendations

1 ESGE/ESGAR recommend computed tomographic colonography (CTC) as the radiological examination of choice for the diagnosis of colorectal neoplasia. 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. Delay of CTC should be considered following endoscopic resection. In the case of obstructing colorectal cancer, preoperative contrast-enhanced CTC may also allow location or staging of malignant lesions (strong recommendation, moderate quality evidence).

3 When endoscopy is contraindicated or not possible, ESGE/ESGAR recommend CTC as an acceptable and equally sensitive alternative for patients with symptoms suggestive of colorectal cancer (strong recommendation, high quality evidence).

4 ESGE/ESGAR recommend referral for endoscopic polypectomy in patients with at least one polyp ≥ 6 mm in diameter detected at CTC. CTC surveillance may be clinically considered if patients do not undergo polypectomy (strong recommendation, moderate quality evidence).

5 ESGE/ESGAR do not recommend CTC as a primary test for population screening or in individuals with a positive first-degree family history of colorectal cancer (CRC). However, it may be proposed as a CRC screening test on an individual basis providing the screenee is adequately informed about test characteristics, benefits, and risks (weak recommendation, moderate quality evidence).

This is an official guideline of the European Society of Gastrointestinal Endoscopy (ESGE) and the European Society of Gastrointestinal and Abdominal Radiology (ESGAR), published in Endoscopy and European Radiology simultaneously. It addresses the clinical indications for the use of computed tomographic colonography (CTC). A targeted literature search was performed to evaluate the evidence supporting the use of CTC. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was adopted to define the strength of recommendations and the quality of evidence.


Appendix e1 and e2