Perforation rate in CT colonography: a systematic review of the literature and meta-analysis

Abstract

Purpose: The primary aim was to assess the perforation rate of CTC; the secondary aim was to identify potential clinical/technical predictors of this complication.

Methods: Methods for analysis were based on PRISMA (preferred reporting items for systematic reviews and meta-analyses). From the selected studies, the rate of CTC perforation and patient/technical characteristics potentially associated with this event were extracted. Forest plots showing individual and pooled estimates of the perforation rate were obtained for all analyses. I(2) was used to evaluate heterogeneity between studies.

Results: Eleven articles out of the 187 initially identified were selected for the analysis (103,399 patients). There were 29,048 (28%) asymptomatic individuals and 30,773 (30%) symptomatic patients; this characteristic was not reported in the remaining subjects (42%). Colon distension was obtained manually in 69,222 (67%) and using an automated carbon dioxide insufflator in 26,479 (26%) patients; in the remaining 7% of patients, this information was missing. Twenty-eight colonic perforations were reported, with the CTC perforation rate estimated to be 0.04% (95% CI. 0.00-0.10), 19-fold higher in symptomatic than in screening subjects (OR: 19.2, CI 3.3-108 and P = 0.001). The surgical rate was 0.008%. No CTC-related deaths were reported.

Conclusions: The perforation rate in CTC is very low, particularly considering asymptomatic individuals.

Key points: • This is the first meta-analysis on this topic, based on 100,000 patients. • The CTC-related colorectal perforation rate is 0.04%, 0.02% in asymptomatic subjects. • The CTC-induced surgery rate is 0.008% (1:12,500). • The perforation rate in CTC is low, particularly in average-risk, asymptomatic individuals.