The Benefits of Computed Tomographic Colonography in Reducing a Long Colonoscopy Waiting List

Canadian Association of Radiologists Journal - Tập 61 - Trang 33-40 - 2010
Carola Behrens1, Giles Stevenson1, Richard Eddy1, David Pearson2, Allen Hayashi3, Louise Audet1, John Mathieson1
1Department of Radiology, Vancouver Island Health Authority, Royal Jubilee Hospital, Victoria, British Columbia, Canada
2Department of Gastroenterology, Vancouver Island Health Authority, Royal Jubilee Hospital, Victoria, British Columbia, Canada
3Department of Surgery, Vancouver Island Health Authority, Royal Jubilee Hospital, Victoria, British Columbia, Canada

Tóm tắt

Purpose The Radiology Department, Royal Jubilee Hospital, Victoria, BC, with the support of gastroenterologists and surgeons, was awarded a BC Innovation fund to run a pilot project of computed tomographic colonography to reduce an unacceptably long 2-year colonoscopy waiting list. Funds were approved in April 2007 for a 1-year project, which was completed on March 31, 2008. Methods This article describes the challenges of delivering a high-volume computed tomographic colonography program at a busy community hospital, with discussion of the results for the 2,005 patients who were examined. Results Colonoscopy was avoided in 1,462 patients whose computed tomographic studies showed no significant lesions. In the remainder of patients, only lesions larger than 5 mm were reported, with a total of 508 lesions identified in 433 patients. There were 57 cancers of which 52 were reported as either definite or possible cancers, whereas 5 were not seen on initial scans. Some of the patients with cancer had been on the colonoscopy waiting list for 2 years. In addition, there were 461 patients with significant extracolonic findings, including 84 who required urgent or semi-urgent further management for previously unsuspected conditions, such as pneumonia, aneurysms larger than 5 cm, and a range of solid renal, hepatic, and pancreatic masses. There were no procedural complications from the computed tomographic colon studies. Conclusions We have shown that it is feasible to run a high volume CTC service in a general hospital given hospital support and funding. The benefits in this group of over 2000 patients included avoidance of colonoscopy in over 70% of patients, detection of significant polyps or cancer in approximately 20% of patients, and identification of clinically important conditions in 7%–18% depending on the definition used. The estimated costs including capital, operating, and professional fees were in the range of $400.

Tài liệu tham khảo

Vining D.J., 1994, Radiology, 193, 446 10.1111/j.1365-2036.2007.03414.x 10.1056/NEJMoa0800996 10.1056/NEJMoa070543 Gryspeerdt S., 2005, CT colonography with fecal tagging after incomplete colonoscopy Eur Radiol, 15, 1192 10.3748/wjg.14.4499 10.1016/S0016-5107(92)70517-3 10.1148/radiology.157.1.3929328 10.1148/radiol.2392052002 10.1148/radiol.2392051101 10.2214/ajr.184.5.01841581 10.2214/AJR.05.1643 10.1259/0007-1285-49-580-303 10.1148/radiol.2291021151 10.1148/radiol.2353040007 10.1007/s00330-003-2012-7 Behrens C., 2008, CARJ, 59, 183 10.1016/j.crad.2008.02.008 10.1503/cmaj.050553 10.1148/radiology.192.2.8029400 10.1148/radiol.2441061122 10.1093/jnci/djm050 10.2214/AJR.06.0451 10.1016/j.acra.2004.10.055 10.1109/TBME.2007.909506 10.1111/j.1572-0241.2005.00337.x 10.1053/gast.2003.50158 10.2214/AJR.07.2026 10.1148/radiology.215.2.r00ap33353 10.1007/s00330-005-2798-6 10.1148/radiol.2361041926 StreetA, VitikainenK, BjorvatnA, Introducing activity-based financing: a review of experience in Australia, Denmark, Norway and Sweden. Working Papers 030cherp, Centre for Health Economics, University of York, York, England; 2007. Wallis M.G., 2008, J Appl Commun Res, 5, 737
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Canadian Association of Radiologists Journal

Tập 61

33-40

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