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Virtual colonoscopy performed poorly in detecting colorectal neoplasia

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 Q In patients presenting for colonoscopy, what is the accuracy of computed tomographic (CT) colonoscopy (virtual colonoscopy [VC]) in detecting colororectal neoplasia?

Clinical impact ratings GP/FP/Primary care ★★★★☆☆☆ IM/Ambulatory care ★★★★★★☆ Gastroenterology ★★★★★☆☆


Embedded ImageDesign:

blinded, non-inferiority comparison of VC with conventional colonoscopy.

Embedded ImageSetting:

8 clinical centres in the US and 1 centre in the UK.

Embedded ImagePatients:

615 patients (mean age 61 y, 55% women) presenting for colonoscopy because of overt and occult rectal bleeding, change in stool habit, abdominal pain, or surveillance after polypectomy. Patients who had had colonoscopy within the past 3 years were excluded.

Embedded ImageDescription of tests:

the colon was insufflated with room air or carbon dioxide. VC was done using 2 and 4 section CT scanners with nominal slice thicknesses of 2.5 or 5 mm and reconstruction increments of 1.5 or 1 mm, depending on equipment. Scans were read in 2 dimensional slices and 3 dimensional snapshot reconstructions when necessary. Radiologist interpretations were recorded in a sealed envelope for each colon segment. Conventional colonoscopy was done within 2 hours of VC. Endoscopists were blinded …

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  • For correspondence: Dr P B Cotton, Medical University of South Carolina, Charleston, SC, USA.

  • Source of funding: Office of Naval Research, US Department of Defense.

  • Abstract and commentary also appear in ACP Journal Club.