Ratnasingham Kumaran, Lo Tammy, Jamal Karim, Varatharajan Lavanya, Tabbakh Yasmin, Kaderbhai Husein, West Nicholas J
General Surgery Department, Epsom and St Helier University Hospitals NHS Trust, Carshalton, UK.
Br J Radiol. 2017 May;90(1073):20160147. doi: 10.1259/bjr.20160147. Epub 2017 Mar 3.
There is controversy whether constipation as a primary presenting complaint is an indication for diagnostic colonoscopy. CT colonography (CTC) is a less invasive and more acceptable alternative. We compared the completion and sensitivity of colonoscopy with CTC in patients who presented with the primary symptom of constipation.
A retrospective study was conducted which examined the first 100 colonoscopies and 100 CTCs carried out for the primary symptom of constipation from June 2012 to December 2013. The primary outcome measure was failure rate of the investigations. Secondary outcomes included reasons for failure and comparison of cost effectiveness between the two modalities.
A total of 200 patients were included in this study. Of these, the first consecutive 100 colonoscopies and 100 CTCs were included. One colonic cancer was detected in each of the CTC and the colonoscopy arm, respectively. 37 (37%) attempted colonoscopies were incomplete examinations. The most common reasons were discomfort (51.4%) and poor bowel preparation (27%). There was no failure of CTC. For 100 patients, CTC as a primary investigation was a more cost-effective investigation (p ≤ 0.01) costing £55,016 as compared with colonoscopy costing £73,666.
There is an unacceptably high failure rate of colonoscopy in patients who presented with the primary symptom of constipation. Hence, we propose that CTC may be an acceptable first-line investigation with a further colonoscopy/flexible sigmoidoscopy if lesions are detected. Advances in knowledge: First study to examine the use of CTC in patients with constipation.
以便秘作为主要就诊主诉时，是否应进行诊断性结肠镜检查存在争议。CT结肠成像（CTC）是一种侵入性较小且更易被接受的替代方法。我们比较了以便秘为主要症状的患者中结肠镜检查与CTC的完成情况及敏感性。
进行一项回顾性研究，检查了2012年6月至2013年12月期间因便秘主要症状而进行的前100例结肠镜检查和100例CTC检查。主要结局指标是检查的失败率。次要结局包括失败原因以及两种检查方式的成本效益比较。
本研究共纳入200例患者。其中，连续的前100例结肠镜检查和100例CTC检查被纳入。CTC组和结肠镜检查组分别检测出1例结肠癌。37例（37%）尝试的结肠镜检查未完成。最常见的原因是不适（51.4%）和肠道准备不佳（27%）。CTC检查没有失败的情况。对于100例患者，CTC作为主要检查手段更具成本效益（p≤0.01），费用为55,016英镑，而结肠镜检查费用为73,666英镑。
以便秘为主要症状的患者中，结肠镜检查的失败率高得令人难以接受。因此，我们建议，如果检测到病变，CTC可能是一种可接受的一线检查方法，随后可进行进一步的结肠镜检查/乙状结肠镜检查。知识进展：首次研究探讨CTC在便秘患者中的应用。
