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CT Colonography and Colonoscopy: Assessment of Patient Preference in a 5-week Follow-up Study¹

¹ From the Departments of Radiology (R.E.v.G., J.F., M.P.S., J.S.L., J.S.), Social Medicine (Public Health) (E.B., G.J.B.), and Gastroenterology (J.F.B.), Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; and Department of Gastroenterology, Slotervaart Hospital, Amsterdam, the Netherlands (P.S.). From the 2003 RSNA scientific assembly. Received August 4, 2003; revision requested September 30; revision received December 17; accepted February 4, 2004. Supported by the Netherlands Organization for Health Research and Development (grant no. 2100.0059). Address correspondence to R.E.v.G. (e-mail: r.e.vangelder@amc.uva.nl).

PURPOSE: To prospectively evaluate short- and midterm patient preference of computed tomographic (CT) colonography relative to colonoscopy in patients at increased risk for colorectal cancer and to elucidate determinants of preference.

MATERIALS AND METHODS: Consecutive patients at increased risk for colorectal cancer underwent CT colonography prior to scheduled colonoscopy. Patient experience and preference were assessed both directly after the examinations and 5 weeks after the examinations. Differences in pain, embarrassment, discomfort, and preference were assessed with the Wilcoxon signed rank sum test or a binomial test. Potential determinants of preference were investigated with logistic regression analyses.

RESULTS: Data for 249 patients were included. Fewer patients experienced severe or extreme pain during CT colonography (seven [3%] of 245) than during colonoscopy (81 [34%] of 241) (P < .001). Directly after both examinations, 168 (71%) of 236 patients preferred CT colonography; 5 weeks later, 141 (61%) of 233 patients preferred CT colonography (P < .001). Initially, a painful colonoscopy examination (odds ratio, 0.17; 95% confidence interval [CI]: 0.08, 0.38) was a determinant of CT colonography preference. Similarly, a painful (odds ratio, 3.70; 95% CI: 1.54, 8.92) or an embarrassing (odds ratio, 4.46; 95% CI: 1.18, 16.88) CT colonography examination was a determinant of colonoscopy preference. After 5 weeks, the presence of polyps emerged as a determinant of colonoscopy preference (odds ratio, 1.94; 95% CI: 1.02, 3.70), while the role of experiences waned.

CONCLUSION: Patients preferred CT colonography to colonoscopy; however, this preference decreased in time, while outcome considerations gradually replaced temporary experiences of inconvenience.

© RSNA, 2004

Index terms: Cancer screening • Colon, CT, 76.12115 • Colonoscopy

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