Imaging alternatives to colonoscopy: CT colonography and colon capsule. European Society of Gastrointestinal Endoscopy (
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GUIDELINE
Imaging alternatives to colonoscopy: CT colonography and colon capsule. European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastrointestinal and Abdominal Radiology (ESGAR) Guideline – Update 2020 Cristiano Spada 1,2 & Cesare Hassan 3 & Davide Bellini 4 & David Burling 5 & Giovanni Cappello 6 & Cristina Carretero 7 & Evelien Dekker 8 & Rami Eliakim 9 & Margriet de Haan 10 & Michal F. Kaminski 11 & Anastasios Koulaouzidis 12 & Andrea Laghi 13 & Philippe Lefere 14 & Thomas Mang 15 & Sebastian Manuel Milluzzo 1,2 & Martina Morrin 16 & Deirdre McNamara 17 & Emanuele Neri 18 & Silvia Pecere 2 & Mathieu Pioche 19 & Andrew Plumb 20 & Emanuele Rondonotti 21 & Manon CW Spaander 22 & Stuart Taylor 20 & Ignacio Fernandez-Urien 23 & Jeanin E. van Hooft 24 & Jaap Stoker 25 & Daniele Regge 6,26
# Thieme and European Society of Radiology 2020
Main recommendations 1. ESGE/ESGAR recommend computed tomographic colonography (CTC) as the radiological examination of choice for the diagnosis of colorectal neoplasia. Strong recommendation, high quality evidence. ESGE/ESGAR do not recommend barium enema in this setting. Strong recommendation, high quality evidence. 2. ESGE/ESGAR recommend CTC, preferably the same or next day, if colonoscopy is incomplete. The timing depends on an interdisciplinary decision including endoscopic and radiological factors. Strong recommendation, low quality evidence. ESGE/ESGAR suggests that, in centers with expertise in and availability of colon capsule endoscopy (CCE), CCE preferably the same or the next day may be considered if colonoscopy is incomplete. Weak recommendation, low quality evidence. 3. When colonoscopy is contraindicated or not possible, ESGE/ESGAR recommend CTC as an acceptable and equally sensitive alternative for patients with alarm symptoms. Strong recommendation, high quality evidence. Because of lack of direct evidence, ESGE/ESGAR do not recommend CCE in this situation. Very low quality evidence. ESGE/ESGAR recommend CTC as an acceptable alternative to colonoscopy for patients with non-alarm symptoms. Strong recommendation, high quality evidence. In centers with availability, ESGE/ESGAR suggests that CCE may be considered in patients with non-alarm symptoms. Weak recommendation, low quality evidence. 4. Where there is no organized fecal immunochemical test (FIT)-based population colorectal screening program, ESGE/ESGAR recommend CTC as an option for colorectal cancer screening, providing the screenee is adequately informed about test characteristics, benefits, and risks, and depending on local service- and patient-related factors. Strong recommendation, high quality evidence. ESGE/ESGAR do not suggest CCE as a first-line screening test for colorectal cancer. Weak recommendation, low quality evidence. 5. ESGE/ESGAR recommend CTC in the case of a positive fecal occult blood test (FOBT) or FIT with incomplete or unfeasible colonoscopy, within organized population screening programs. Strong recommendation, moderate quality evidence. ESGE/ESGAR also sug
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