Cardiovascular effects at multi-detector row CT colonography compared with those at conventional endoscopy of the colon.
OBJECTIVE
To compare the cardiovascular effects of computed tomographic (CT) colonography and conventional endoscopy in a group of patients undergoing both procedures.


METHODS
A total of 144 patients underwent CT colonography followed by flexible sigmoidoscopy (40 patients) or colonoscopy (104 patients). Pulse, blood pressure, and oxygen saturation were measured before, during, and after the procedures. Forty patients also underwent continuous Holter electrocardiographic (ECG) monitoring. Periprocedural pain was assessed by using a handheld counting device. Outcome variables were assessed by using a combination of paired t testing and multilevel linear regression.


RESULTS
When a spasmolytic was not used, CT colonography was associated with only a small increase in oxygen saturation (P =.03), while use of a spasmolytic caused an increase in pulse (mean increase, 19.9 beats per minute; P <.001) and diastolic blood pressure (mean increase, 5 mm Hg; P <.001). Compared with that at CT, oxygen saturation decreased significantly during and after colonoscopy and sigmoidoscopy (mean decrease after colonoscopy with sedation, 1.0%; P <.001). Systolic and diastolic blood pressure also decreased during and after colonoscopy (mean systolic decrease after colonoscopy with sedation, 16.6 mm Hg, P <.001; mean diastolic decrease after colonoscopy with sedation, 7.5 mm Hg, P <.001). Patients were 30.3 times more likely to develop bradycardia after endoscopy (95% CI: 2.65, 346; P =.006). Ventricular couplets were significantly higher at endoscopy than at CT in patients with a history of cardiac disease (odds ratio: 72.5 and 95% CI: 4.56, 1,153 at CT vs odds ratio: 14.6 and 95% CI: 0.96, 222 at endoscopy; P =.002). Patients were 1.89 times more likely to register pain during colonoscopy than during CT (95% CI: 1.06, 3.38; P =.03).


CONCLUSIONS
CT colonography had no significant cardiovascular effect other than spasmolytic-induced tachycardia. Endoscopy-and colonoscopy in particular-causes cardiovascular effects that are largely related to sedation. CT colonography is less painful than colonoscopy and is comparable to flexible sigmoidoscopy.
Taylor
Stuart A
SA
Department of Intestinal Imaging, St. Mark's Hospital, Level 4V, Watford Road, Northwick Park, London HA1 3UJ, England, United Kingdom.
Halligan
Steve
S
O'Donnell
Colm
C
Morley
Simon
S
Mistry
Hitesh
H
Saunders
Brian P
BP
Vance
Maggie
M
Bassett
Paul
P
Windsor
Alistair
A
Stern
Yvonne
Y
Bethel
Hugh
H
Atkin
Wendy
W
Bartram
Clive I
CI
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000502:physiology; D002320:Cardiovascular Physiological Phenomena; D023881:Colonography, Computed Tomographic / Q000009:adverse effects*; D003113:Colonoscopy / Q000009:adverse effects*; D015716:Electrocardiography, Ambulatory; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D010146:Pain / Q000209:etiology; D010276:Parasympatholytics / Q000009:adverse effects; D011674:Pulse; D012812:Sigmoidoscopy / Q000009:adverse effects*
D010276:Parasympatholytics; D010100:Oxygen