title: The role of colonoscopy and CT colonography in patients presenting with symptoms of constipation.
abstract: OBJECTIVE
  There is controversy whether constipation as a primary presenting complaint is an indication for diagnostic colonoscopy. CT colonography (CTC) is a less invasive and more acceptable alternative. We compared the completion and sensitivity of colonoscopy with CTC in patients who presented with the primary symptom of constipation.
  
  
  METHODS
  A retrospective study was conducted which examined the first 100 colonoscopies and 100 CTCs carried out for the primary symptom of constipation from June 2012 to December 2013. The primary outcome measure was failure rate of the investigations. Secondary outcomes included reasons for failure and comparison of cost effectiveness between the two modalities.
  
  
  RESULTS
  A total of 200 patients were included in this study. Of these, the first consecutive 100 colonoscopies and 100 CTCs were included. One colonic cancer was detected in each of the CTC and the colonoscopy arm, respectively. 37 (37%) attempted colonoscopies were incomplete examinations. The most common reasons were discomfort (51.4%) and poor bowel preparation (27%). There was no failure of CTC. For 100 patients, CTC as a primary investigation was a more cost-effective investigation (p ≤ 0.01) costing £55,016 as compared with colonoscopy costing £73,666.
  
  
  CONCLUSIONS
  There is an unacceptably high failure rate of colonoscopy in patients who presented with the primary symptom of constipation. Hence, we propose that CTC may be an acceptable first-line investigation with a further colonoscopy/flexible sigmoidoscopy if lesions are detected. Advances in knowledge: First study to examine the use of CTC in patients with constipation.
authors.affiliation: General Surgery Department, Epsom and St Helier University Hospitals NHS Trust, Carshalton, UK.
authors.forename: Kumaran
authors.initials: K
authors.lastname: Ratnasingham
authors.affiliation: General Surgery Department, Epsom and St Helier University Hospitals NHS Trust, Carshalton, UK.
authors.forename: Tammy
authors.initials: T
authors.lastname: Lo
authors.affiliation: General Surgery Department, Epsom and St Helier University Hospitals NHS Trust, Carshalton, UK.
authors.forename: Karim
authors.initials: K
authors.lastname: Jamal
authors.affiliation: General Surgery Department, Epsom and St Helier University Hospitals NHS Trust, Carshalton, UK.
authors.forename: Lavanya
authors.initials: L
authors.lastname: Varatharajan
authors.affiliation: General Surgery Department, Epsom and St Helier University Hospitals NHS Trust, Carshalton, UK.
authors.forename: Yasmin
authors.initials: Y
authors.lastname: Tabbakh
authors.affiliation: General Surgery Department, Epsom and St Helier University Hospitals NHS Trust, Carshalton, UK.
authors.forename: Husein
authors.initials: H
authors.lastname: Kaderbhai
authors.affiliation: General Surgery Department, Epsom and St Helier University Hospitals NHS Trust, Carshalton, UK.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: West
mesh_terms: D000368:Aged; D023881:Colonography, Computed Tomographic / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D003113:Colonoscopy / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D003248:Constipation / Q000175:diagnosis* / Q000209:etiology; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity