Endoluminal CT colonography after an incomplete endoscopic colonoscopy

OBJECTIVE. We evaluated the clinical usefulness of endoluminal CT colonogra phy after an incomplete colonoscopy. SUBJECTS AND METHODS. We prospectively studied 40 patients in whom the cecu m could not be reached endoscopically despite adequate bowel preparation. E ndoluminal CT colonography (120 kVp, 120 mA, 3-mm collimation, pitch of 2, 1.5-mm interval reconstruction) was performed within 2 hr of incomplete col onoscopy. Two-dimensional multiplanar reformatted images and three-dimensio nal endoluminal images were analyzed. Twenty-six patients (65%) underwent b arium enema immediately after endoluminal CT colonography, We analyzed colo nic distention; duration of endoluminal CT colonography; patient tolerance; number of colonic segments seen at colonoscopy, endoluminal CT colonograph y, and barium enema; and reasons for incomplete colonoscopy as well as colo nic and extracolonic findings. RESULTS. Duration of endoluminal CT colonography was 14.2 +/- 4.6 min (mean +/- SD). Endoluminal CT colonography was better tolerated than colonoscopy or barium enema (p < .001), Probable causes for incomplete colonoscopy wer e identified at endoluminal CT colonography in 74% of 40 patients. Baseline colonic distention in the region of the transverse and right colon was con sidered adequate before additional air insufflation; however, the addition of air significantly enhanced colonic distention throughout the entire colo n (p < .001). Endoluminal CT colonography adequately revealed 96% of all co lonic segments; in comparison, barium enema adequately revealed 91% of all segments (p < .05). CONCLUSION. In patients with incomplete colonoscopy, endoluminal CT colonog raphy successfully showed the previously unrevealed colon in more than 90% of patients. Endoluminal CT colonography is a rapid, well-tolerated techniq ue that provides clinically useful colonic and extracolonic information and should be considered for all patients who undergo incomplete colonoscopy.