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Replacing Barium Enema with CT Colonography in Patients Older Than 70 Years: The Importance of Detecting Extracolonic Abnormalities

¹ Department of Clinical Radiology, St. James's University Hospital, Leeds, West Yorkshire LS9 7TF, United Kingdom.
² Department of Clinical Radiology, Derriford Hospital, Plymouth, Devon, United Kingdom.

OBJECTIVE. The objective of our study was to evaluate the significance of extracolonic abnormalities in patients older than 70 years referred for CT colonography (CTC).

MATERIALS AND METHODS. We performed a retrospective analysis of 400 consecutive patients older than 70 years undergoing CTC over a 14-month period. All patients presented with weight loss, alteration of bowel habits, rectal blood loss, abdominal pain, or anemia; these symptoms led to clinical suspicion of lower gastrointestinal abnormalities.

RESULTS. Five hundred five separate extracolonic abnormalities were detected in 268 of 400 patients (67%). One hundred thirty-nine pathologic processes were deemed significant in 116 patients. Of these, 110 lesions (79%) were previously unknown in 96 of the 400 patients (24.0%). Forty-nine of the 400 patients (12.3%) had at least one malignancy, including 23 extracolonic malignancies and 29 colorectal malignancies. Thirteen patients had early cancers (T1N0M0 or T2N0M0). Twenty of the colon cancer patients had significant previously unknown extracolonic abnormalities, half of which were related to the primary tumor and half of which were unrelated extracolonic abnormalities.

CONCLUSION. In patients older than 70 years being examined because of lower gastrointestinal symptoms, CTC findings yield a high number of new significant extracolonic abnormalities. This finding makes a compelling case for targeting this group of patients for a CTC service.

Keywords: barium enema • colorectal cancer • colorectal cancer screening • CT colonography • elderly patients

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