title: Clinical indications for computed tomographic colonography: European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastrointestinal and Abdominal Radiology (ESGAR) Guideline.
abstract: This is an official guideline of the European Society of Gastrointestinal Endoscopy (ESGE) and the European Society of Gastrointestinal and Abdominal Radiology (ESGAR). It addresses the clinical indications for the use of computed tomographic colonography (CTC). A targeted literature search was performed to evaluate the evidence supporting the use of CTC. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was adopted to define the strength of recommendations and the quality of evidence. Main recommendations 1 ESGE/ESGAR recommend computed tomographic colonography (CTC) as the radiological examination of choice for the diagnosis of colorectal neoplasia. 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. Delay of CTC should be considered following endoscopic resection. In the case of obstructing colorectal cancer, preoperative contrast-enhanced CTC may also allow location or staging of malignant lesions (strong recommendation, moderate quality evidence). 3 When endoscopy is contraindicated or not possible, ESGE/ESGAR recommend CTC as an acceptable and equally sensitive alternative for patients with symptoms suggestive of colorectal cancer (strong recommendation, high quality evidence). 4 ESGE/ESGAR recommend referral for endoscopic polypectomy in patients with at least one polyp  ≥  6  mm in diameter detected at CTC. CTC surveillance may be clinically considered if patients do not undergo polypectomy (strong recommendation, moderate quality evidence). 5 ESGE/ESGAR do not recommend CTC as a primary test for population screening or in individuals with a positive first-degree family history of colorectal cancer (CRC). However, it may be proposed as a CRC screening test on an individual basis providing the screenee is adequately informed about test characteristics, benefits, and risks (weak recommendation, moderate quality evidence).
authors.affiliation: Digestive Endoscopy Unit, Catholic University, Rome, Italy.
authors.forename: Cristiano
authors.initials: C
authors.lastname: Spada
authors.affiliation: Department of Radiology, Academic Medical Center, University of Amsterdam, The Netherlands.
authors.forename: Jaap
authors.initials: J
authors.lastname: Stoker
authors.affiliation: Department of Gastroenterology, Hospital Universitario de Canarias, Facultad de Medicina, Universidad de La Laguna, La Laguna, Tenerife, Spain.
authors.forename: Onofre
authors.initials: O
authors.lastname: Alarcon
authors.affiliation: Digestive Endoscopy Unit, Catholic University, Rome, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Barbaro
authors.affiliation: Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome; I.C.O.T. Hospital, Latina, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Bellini
authors.affiliation: Department of Health Economy and Health Management, University of Oslo, and Department of Transplantation Medicine, Gastroenterology Unit, Oslo University Hospital, Oslo, Norway.
authors.forename: Michael
authors.initials: M
authors.lastname: Bretthauer
authors.affiliation: Department of Radiology, Academic Medical Center, University of Amsterdam, The Netherlands.
authors.forename: Margriet C
authors.initials: MC
authors.lastname: De Haan
authors.affiliation: Gedyt Endoscopy Center, Buenos Aires, Argentina.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Dumonceau
authors.affiliation: Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria.
authors.forename: Monika
authors.initials: M
authors.lastname: Ferlitsch
authors.affiliation: Centre for Medical Imaging, University College London, London, UK.
authors.forename: Steve
authors.initials: S
authors.lastname: Halligan
authors.affiliation: Centre for Medical Imaging, University College London, London, UK.
authors.forename: Emma
authors.initials: E
authors.lastname: Helbren
authors.affiliation: Department of Radiology, Sahlgrenska University Hospital and Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
authors.forename: Mikael
authors.initials: M
authors.lastname: Hellstrom
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
authors.forename: Ernst J
authors.initials: EJ
authors.lastname: Kuipers
authors.affiliation: Virtual Colonoscopy Teaching Centre, Hooglede, Belgium, and AZ Delta, Roeselare, Belgium.
authors.forename: Philippe
authors.initials: P
authors.lastname: Lefere
authors.affiliation: Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria.
authors.forename: Thomas
authors.initials: T
authors.lastname: Mang
authors.affiliation: Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Neri
authors.affiliation: Digestive Endoscopy Unit, Catholic University, Rome, Italy.
authors.forename: Lucio
authors.initials: L
authors.lastname: Petruzziello
authors.affiliation: Centre for Medical Imaging, University College London, London, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Plumb
authors.affiliation: Institute for Cancer Research and Treatment, Candiolo-Torino, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Regge
authors.affiliation: Centre for Medical Imaging, University College London, London, UK.
authors.forename: Stuart A
authors.initials: SA
authors.lastname: Taylor
authors.affiliation: Digestive Endoscopy Unit, Catholic University, Rome, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Hassan
authors.affiliation: Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome; I.C.O.T. Hospital, Latina, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Laghi
mesh_terms: D003111:Colonic Polyps / Q000000981:diagnostic imaging* / Q000628:therapy; D023881:Colonography, Computed Tomographic / Q000009:adverse effects; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D000075202:Contraindications; D003287:Contrast Media; D055088:Early Detection of Cancer; D006801:Humans; D009367:Neoplasm Staging; D011300:Preoperative Care; D057832:Watchful Waiting
chemical_list: D003287:Contrast Media