ABSTRACT
Background and study aims: colonoscopy remains the gold standard for the examination of the colon. However, its use in the elderly is not well tolerated, and there is often a need for general anaesthesia, thus increasing the risk, especially if there are co-morbidities. Water enema computed tomography has been suggested to be a satisfactory alternative as a non-invasive, fast and effective means for the diagnosis of colorectal supra-centimetric lesions
Background and study aims: the aim of our study was to assess the performance of water enema computed tomography as first-line examination by calculating its negative predictive value [NPV] for the diagnosis of supra-centimetric lesions in symptomatic elderly referred to colonoscopy
Patients and methods: this was a prospective study including 57 symptomatic patients older than 65 years. All patients were explored by water enema computed tomography at first, followed by colonoscopy, and responded to a questionnaire on the tolerance to the preparation and both procedures
Results: the mean age of patients was 73 years. The M:F sex ratio was 1.59. The most frequent indication for colonoscopy was bowel disorders associated with abdominal pain [30%]. Water enema computed tomography allowed the diagnosis of tumours [n = 2], polyps [n = 6], diverticulosis [n = 7], inflammatory wall thickening [n = 1] and extra-colic lesions [n = 28]. NPV of water enema computed tomography for supra-centimetric lesions was 96.5%. Sensitivity and specificity were 87.3% and 98%, respectively. However, for sub-centimetric lesions, water enema computed tomography had a low sensitivity estimated at 6%, specificity at 89.9%, positive predictive value at 91.9% and NPV at 27.7%
Conclusion: water enema computed tomography has proven to be a valuable and non-invasive method indicated as a first-line examination in case of colonic symptoms in the elderly to diagnose supracentimetric lesions