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October 14, 2009

Computed Tomographic Colonography for Detecting Advanced Neoplasia—Reply

JAMA. 2009;302(14):1527-1529. doi:10.1001/jama.2009.1437

In Reply: Dr Pisarik questions the acceptance of CT colonography by patients and the accuracy of polyp size determination by CT colonography. He doubts the assumption in the study by Regge et al1 that CT colonography will be better tolerated by patients and thus improve adherence to screening and surveillance programs. Pisarik argues that the 1.4 days off work and the 2 colon cleansings for 2 CT colonographies over a 10-year period is more of an onus to patients than 1 day off work and 1 colon cleansing for optical colonoscopy. I believe that these differences are quite small and unlikely to have a major effect on patient preferences. Moreover, if future studies continue to report high rates of sensitivity and specificity for CT colonography, the currently recommended screening interval of 5 years may be prolonged. In the meantime, patient preference for colorectal cancer screening in the era of CT colonography should be further investigated. It is not known how individual patients will weigh the trade-offs between CT colonography (more frequent intervals, potential missed lesions, need for subsequent therapeutic endoscopy) and optical colonoscopy (invasive procedure requiring sedation with risks of bleeding and perforation).

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