Year: 2019
Type: conference-paper
Study design: Observational Study
Abstract: Introduction In Kettering General Hospital (KGH) we perform almost 500 CT colonograms (CTCs) annually for patients who; do not want, are unable to tolerate, or have failed a colonoscopy (which is considered the “gold standard” colonic examination). The most common reasons for CTC are iron deficiency anaemia, and change in bowel habit, often with the aim of detecting colorectal cancer (CRC). We have seen an increase over time, in the use of CTC in elderly patients, as a first line investigation. With an ageing population, we explore the significance of performing this examination, in an elderly population who may not be suitable for further investigation/intervention. Methods We reviewed 1479 patients who had undergone a CT Colonogram between October 2015 and October 2018. Of these, we focused on patients aged ≥80 at the time of scanning. CTC reports were analysed and categorised into those with positive, indeterminate findings, and those with no significant findings. All patients ≥80 years old were followed up (via their electronic records) to observe their outcomes. Results 1479 patient underwent a CTC at KGH during the 3-year period. 454 patients were aged ≥80 years old (30.7%) – mean & median age 84, range 8–7. 69 patients had positive colonic findings (15.2% - see figure). Of which, 31 had CRC reported (14 operated straight away, 5 had endoscopy then surgery, 1 had endoscopy only (no tumour seen), 11 were not operated on). 22 had polyps reported (13 had endoscopy at which 12 had polypectomy, 9 did not have endoscopy). 16 had indeterminate findings (10 had endoscopy which nil significant found). Of the 385 patients who had CTCs with nil significant colonic findings, 9 had extra colonic tumours. At follow up (105 patients in 12 months from October 2015, 137 patients in 201–7, 143 patients in 201–8, range 0 – 36 months), none of the patients have been diagnosed with CRC thus far. Conclusion In this study, CT colonography was used in elderly patients aged ≥80 years old as a first or second line colonic examination. The yield of diagnosing colorectal cancer was 6.9% (31/454). CTC that reported negatively for colonic findings seems to protect patients for –6 months. Whilst colonoscopy may be the preferred diagnostic test for colonic disease, it is an invasive test with a small risk of perforation. CTC is safer, and better tolerated. The reports are generally accurate with regards to significant colonic findings, especially when diagnosing CRC. This study does confirm the safety and efficacy of CTC and suggests that it is an appropriate colonic investigation for elderly patients (aged ≥80 years old) first or second line.
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
OpenAlex ID: W3023813121