RPS 2401b - Diagnosis and preoperative planning of colon pathology: advances in knowledge

Author Block: S. Vicini1, D. M. Bellini1, N. Panvini1, M. Rengo2, I. Carbone2; 1Latina/IT, 2Rome/IT
Purpose or Learning Objective: To determine whether the quality of low-volume reduced bowel preparation (LV-RBP) for CT colonography (CTC) is non-inferior to full-volume reduced bowel preparation (FV-RBP) regimen.
Methods or Background: In this randomised controlled trial, consecutive participants referred for CTC were randomly assigned to receive LV-RBP (52.5 g of PMF104 in 500 mL of water) or FV-RBP (105 g of PMF104 in 1000 mL of water). Images were independently reviewed by five readers who rated the quality of bowel preparation from 0 (best score) to 3 (worst score). The primary outcome was the non-inferiority of LV-RBP to FV-RBP in the proportion of colonic segments scored 0 for cleansing quality, with a non-inferiority margin of 10%. The volume of residual fluids, colonic distension, lesions and polyps detection rates and patient tolerability were secondary outcomes.
Results or Findings: 110 participants (mean age 65 years±14 SD) were allocated to LV-RBP (n=55) or FV-RBP (n=55) arms. There was 92% segment scored 0 in colon cleansing quality in LV-RBP and 94% in FV-RBP for prone scans, and 94% vs 92% for supine scans. The risk difference was -2.1 (95% CI −5.9 to 1.7) and 1.5 (95%CI −2.4 to 5.4) for prone and supine positions, respectively. Residual fuids and colonic distension were also non-inferior in LV-RBP. LV-RBP was associated with a lower number of evacuations during preparation (7±5 vs 10±6, p=0.002).
Conclusion: The LV-RBP demonstrated the non-inferior quality of colon cleansing with improved gastrointestinal tolerability compared to the FV-RBP regimen.
Limitations: The number of participants enrolled was relatively small. Second, we were not able to evaluate CTC diagnostic accuracy for polyps detection. Third, the quality of colon cleansing was assessed exclusively by subjective analysis.
Ethics committee approval: Approval was obtained from the ethics committee of the Sapienza University of Rome.
Funding for this study: No funding was received for this study.

Author Block: F. Testa, G. Di Guardia, M. Lo Bello, V. Verna, P. Lasciarrea; Verduno/IT
Purpose or Learning Objective: The oral contrast medium does not seem mandatory in defecography procedures; however, to demonstrate an enterocele (critical information for the surgeon), it is necessary to opacify the small bowel. A decade of case studies to illustrate the opportunity of oral contrast in all patients who undergo the procedure.
Methods or Background: Our series of 353 defecographies conducted on patients with various degrees of evacuation disorders were reviewed in detail. For each procedure, we considered the enterocele and its extension. In all of our procedures, contrast medium (barium sulphate or iodate) was administered orally between 40 and 60 minutes before the examination.
Results or Findings: 353 defecographs in 333 females and 20 males (mean age 60.3, median age 62) showed a total of 132 cases of enterocele (37.4%), classified in 75 cases of mild enterocele (56.8%, non-interfering with the evacuation dynamics) and 57 of severe enterocele (43.2%), interfering with the evacuation dynamics. No significant differences were recognised in the use of barium sulphate or iodate oral contrast medium.
Conclusion: The prevalence of enterocele suggests the use of oral contrast medium in all patients undergoing defecography, with an advantageous cost-benefit balance. The choice between barium and iodate contrast can be made on the basis of the constipation tendency, which tends to be aggravated by barium-based compounds.
Limitations: No limitations were identified.
Ethics committee approval: No ethics committee approval was needed.
Funding for this study: No funding was received for this study.

Author Block: R. Rastogi, V. Khare, A. Mishra; Moradabad/IN
Purpose or Learning Objective: Colorectal disease, especially carcinoma, are an important cause of morbidity and mortality in the modern era. With the rising incidence of colorectal diseases and due to limitations of conventional flexible fiberoptic colonoscopy (gold standard tool), imaging plays a significant role in the evaluation of these patients. Recent developments in magnetic resonance imaging (MRI) coupled with its advantages of noninvasive and radiation-free nature, it has recently become a screening tool in colorectal diseases.
Methods or Background: Forty-four patients with signs and symptoms of the colorectal disease were evaluated by 1.5T MRI followed by conventional, flexible, fiberoptic colonoscopy on the same day. Bowel preparation was done using polyethene glycol. Data from MRI and colonoscopy were recorded and compared with the final diagnosis.
Results or Findings: The majority of patients in the study were in the 21-40yrs age group with male predominance. Altered bowel habits followed by bleeding per rectum were the commonest presentations. Both MRI and colonoscopy overdiagnosed the lesions as malignant with higher errors by MRI. MRI was very effective in the detection of growth, strictures, diverticulosis, mucosal thickening/oedema and extracolonic manifestation but failed in detecting small polyps and ulcers. MRI had high sensitivity and negative predictive value of 100% with an accuracy of more than 70%.
Conclusion: MRI with its noninvasive and radiation-free nature along with its high sensitivity and negative predictive value for malignant lesions should be considered over colonoscopy as well as computed tomography in the evaluation of colorectal diseases.
Limitations: The study was performed on 1.5T MR scanner.
Ethics committee approval: The ethics committee approval was obtained.
Funding for this study: No funding was provided for this study.