EP.TU.313Colorectal cancer follow up: Can CT Colonography replace Colonoscopy?

Abstract

Abstract Aims Current guidelines recommend surveillance colonoscopy at one year following Colorectal Cancer Resection (CCR), yearly CT chest, abdomen and pelvis, CEA, and colonoscopy in 3 years. Previous studies showed no significant difference between CTC and colonoscopy detection rates of colorectal cancer or polyps >6mm. A review of abnormalities detected on surveillance colonoscopies one year following CCR. If the incidence is low CT Colonography (CTC) would be an alternative to colonoscopy and, when performed simultaneously with surveillance CT chest would be cost-effective, and help in the selective use of colonoscopy. Methods A retrospective analysis of one-year surveillance colonoscopies following CCR in 2016 at a health board with three different sites. Normal colonoscopy criteria included: no polyps, no tumour, and no abnormality at the anastomosis. Subtotal colectomy, panproctocolectomies and incomplete colonoscopies were excluded. Results 111 surveillance colonoscopies were performed one-year post CCR. Age range 30-87 years (39 patients were above 75). Ninety scopes were normal (81.1%). Eight identified only hyperplastic polyps (7.2%); indirectly making over 88% of surveillance colonoscopies unremarkable. Detected abnormalities: nine low-grade adenomas (8.1%), one anastomotic recurrence (0.9%), and only three new cancers (2.7%). There were no complications related to the procedure. Each colonoscopy costs £996 at this health board, CTC is significantly cheaper. Conclusion New cancer or recurrence post-CCR detected at one-year colonoscopy is very low; therefore, CTC would be ideal alternative surveillance. Adding it to CT Chest would significantly reduce the number of hospital attendances per patient, which is more cost-effective and reduces risk.