Elsevier

Medicina Clínica

Volume 129, Issue 19, November 2007, Pages 725-728
Medicina Clínica

Originales
Colonografía tomográfica computarizada frente a enema opaco en el estudio preoperatorio del cáncer colorrectal en pacientes con colonoscopia incompletaCT colonography vs barium enema for the preoperative study of colorectal cancer in patients with incomplete colonoscopy

https://doi.org/10.1157/13113286Get rights and content

Fundamento y objetivo

La evaluación preoperatoria completa del colon es necesaria, ya que el cáncer colorrectal se asocia con frecuencia a tumores sincrónicos. El objetivo de este trabajo es valorar la utilidad de la colonografía tomográfica computarizada (CTC) frente al enema opaco de doble contraste (EODC) cuando la colonoscopia fue incompleta o imposible de realizar.

Pacientes y método

Grupo A: 50 pacientes con cáncer colorrectal, colonoscopia incompleta y EODC posterior. Grupo B: 40 pacientes con cáncer colorrectal, colonoscopia incompleta y CTC posterior. Como método de referencia para comparar los resultados obtenidos se utilizaron el estudio anatomopatológico de la pieza quirúrgica y la colonoscopia a los 3 meses de la cirugía. Además, se estudiaron el grado de satisfacción, los efectos secundarios y el coste por prueba.

Resultados

No hubo tumores sincrónicos. Para la detección de pólipos colónicos obtuvimos para la CTC valores de sensibilidad (S) del 85,7%, especificidad (E) 96,1%, valor predictivo positivo (VPP) 92,3%, valor predictivo negativo (VPN) 92,6%, coeficiente de probabilidad positivo (CPP) 21,97 y coeficiente de probabilidad negativo (CPN) 0,15, y para el EODC valores de S del 23,5%, E del 92,8%, VPP del 80%, VPN del 71,7%, CPP del 3,26 y CPN del 0,82 (p < 0,001). El grado de satisfacción del paciente fue mayor con la CTC que con el EODC (p < 0,05). No hubo diferencias en cuanto a efectos secundarios. El coste de la CTC fue de 33,18 euros y el de la EODC, de 42,42 euros.

Conclusión

La CTC es mejor que el EODC, tanto para confirmar la presencia de pólipos en el colon como para descartar la ausencia de éstos, en pacientes en los que no ha sido posible completar el estudio del colon por colonoscopia.

Background and objective

The complete preoperative evaluation of the colon is necessary in colorectal cancer owing to the frequency of synchronous tumors. The objective of this paper was to evaluate the utility of the computed tomography colonography (CTC) as opposed to barium enema (BEDC) when the colonoscopy was incomplete or impossible to perform.

Patients and method

Group A: 50 patients with colorectal cancer with subsequent incomplete colonoscopy and BEDC. Group B: 40 patients with colorectal cancer with subsequent incomplete colonoscopy and CTC. As gold standard to match the tests, we carried out the pathological study of the surgical piece and the colonoscopy 3 months after surgery. In addition, we studied the degree of satisfaction, indirect effect and cost by test.

Results

There were no synchronous tumors. For the detection of colonic polyps, we obtained for the CTC the following values: Sensitivity = 85.7%, Specificity = 96.1%, PPV = 92.3%, NPV = 92.6%, CPP = 21,97 and CPN =0,15. And for BEDC, the values were: Sensitivity = 23.5%, Specificity = 92.8%, PPV = 80%, NPV = 71.7%, CPP = 3.26 and CPN = 0.82 (p < 0.001). The degree of satisfaction was greater with CTC than with BEDC (p < 0.05). There were no differences as far as indirect effect was concerned. The cost of CTC was 33.18 Euros and it was 42.42 Euros for BEDC.

Conclusion

CTC is better than BEDC both to confirm the presence of polyps in colon and to rule out the absence of them in patients in whom a complete the study of the colon by colonoscopy has not been possible.

Referencias bibliográficas (21)

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