Low rate of perforation during CT colonography: results from a recent meta-analysis

CT colonography (CTC) is now endorsed by radiological and non-radiological scientific societies as a leading modality for colon imaging. It has a recognized role in cases of incomplete or failed colonoscopy and in the primary investigation of symptomatic patients, particularly those who are elderly and frail. In asymptomatic individuals referred for colorectal cancer screening, in the absence of definite data on cost-effectiveness, CTC cannot be recommended as the primary screening test at this stage. However, it may be suggested as a screening test on an individual basis provided that the screenee is adequately informed about the characteristics, benefits and risks of the examination in comparison with other available modalities.
One of the major advantages of CTC, making it suitable for the investigation of both elderly and frail patients on one hand and asymptomatic individuals on the other, is its superior safety profile to colonoscopy. However, despite being generally regarded as safer than colonoscopy, CTC has been associated with potentially serious adverse events, in particular large bowel perforation. Several studies have estimated the CTC-related perforation rate, with the most recent ones reporting values ranging between 0.02 % [ 1] and 0.06 % [ 2].