Monday, August 1, 2016

Colonoscopy vs. CT-Colonography for Detection of High-Risk Polyps

IJspeert et al published in the American Journal of Gastroenterology findings from a randomized trial in which computed tomography colonography (CTC) and colonoscopy were compared for the detection of high-risk sessile serrated polyps (SSP) in average-risk individuals.

Sessile serrated polyps (SSPs) are considered to be the precursors of 15–30% of all colorectal cancers (CRCs). Therefore, CRC screening modalities should be designed to detect high-risk SSPs.

The authors invited 8,844 individuals to join in the trial, of which 1,276 colonoscopy and 982 CTC invitees participated in the study. In the colonoscopy arm, 4.3% of individuals were diagnosed with ≥1 high-risk SSPs, compared with 0.8% in the CTC arm. In total, 3.1% of individuals in the colonoscopy arm were diagnosed with high-risk SSPs as most advanced lesion, compared with 0.4% in the CTC arm.  The current CTC strategy showed a marked lower detection for especially flat high-risk SSPs (17 vs. 0), high-risk SSP located in the proximal colon (32 vs. 1), and SSPs with dysplasia (30 vs. 1).

As sessile serrated polyps are considered precursors of colorectal cancers screening modalities should detect them with high rate of accuracy.  Findings from this trial suggest that the detection rate of high-risk SSPs was significantly higher with colonoscopy than computed tomographic colonography.

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