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Patient acceptability of CT colonography compared with double contrast barium enema: results from a multicentre randomised controlled trial of symptomatic patients

  • Gastrointestinal
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Abstract

Objectives

To determine patient acceptability of barium enema (BE) or CT colonography (CTC).

Methods

After ethical approval, 921 consenting patients with symptoms suggestive of colorectal cancer who had been randomly assigned and completed either BE (N = 606) or CTC (N = 315) received a questionnaire to assess experience of the clinical episode including bowel preparation, procedure and complications. Satisfaction, worry and physical discomfort were assessed using an adapted version of a validated acceptability scale. Non-parametric methods assessed differences between the randomised tests and the effect of patient characteristics.

Results

Patients undergoing BE were significantly less satisfied (median 61, interquartile range [IQR] 54–67 vs. median 64, IQR 56–69; p = 0.003) and experienced more physical discomfort (median 40, IQR 29–52 vs. median 35.5, IQR 25–47; p < 0.001) than those undergoing CTC. Post-test, BE patients were significantly more likely to experience ‘abdominal pain/cramps’ (68% vs. 57%; p = 0.007), ‘soreness’ (57% vs. 37%; p < 0.001), ‘nausea/vomiting’ (16% vs. 8%; p = 0.009), ‘soiling’ (31% vs. 23%; p = 0.034) and ‘wind’ (92% vs. 84%; p = 0.001) and in the case of ‘wind’ to also rate it as severe (27% vs. 15%; p < 0.001).

Conclusion

CTC is associated with significant improvements in patient experience. These data support the case for CTC to replace BE.

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Acknowledgements

This trial was funded by the UK Department of Health through the Health Technology Assessment programme of the UK National Institute for Health Research (NIHR grant HTA 02/02/01). This work was undertaken at UCL/UCLH and Imperial College London, each of whom received a proportion of funding from the NIHR Comprehensive Biomedical Research Centre funding scheme. The views expressed in this publication are those of the authors and not necessarily those of the UK Department of Health. We wish to thank the SIGGAR investigators and independent data monitoring and trial steering committees for their time and help (see web-Appendix 1).

SH is remunerated for R/D advice by Medicsight PLC, a company that develops CAD software for CTC.

Author information

Authors and Affiliations

  1. Department of Epidemiology and Public Health, University College London, London, UK

    Christian von Wagner, Samuel Smith, Alex Ghanouni, Emily Power & Jane Wardle

  2. Centre for Medical Imaging, University College London, London, UK

    Steve Halligan

  3. Department of Epidemiology, Birmingham University, Birmingham, UK

    Richard J. Lilford

  4. Department of Surgery, Birmingham University, Birmingham, UK

    Dion Morton

  5. Department of Surgery and Cancer, Imperial College London, London, UK

    Edward Dadswell & Wendy Atkin

  6. Centre for Medical Imaging, University College Hospital, Podium, Level 2, 235 Euston Road, London, NW1 2BU, UK

    Steve Halligan

Authors
  1. Christian von Wagner
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  2. Samuel Smith
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  3. Steve Halligan
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  4. Alex Ghanouni
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  5. Emily Power
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  6. Richard J. Lilford
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  7. Dion Morton
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  8. Edward Dadswell
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  9. Wendy Atkin
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  10. Jane Wardle
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Consortia

For the SIGGAR Investigators

Corresponding author

Correspondence to Steve Halligan.

Appendices

Appendix

Table 4 Patient experience questionnaire by subscale
Full size table

The SIGGAR* investigators

*Special Interest Group in Gastrointestinal and Abdominal Radiology

Trial Office staff

Mr E Dadswell (Trial Manager), Mrs R Kanani (Trial Manager), Ms K Wooldrage (Statistician), Mrs P Rogers (Statistician), Dr Rob Edwards (Statistician), Mrs U Shah (Senior Data Manager), Dr I Kralj-Hans (Senior Data Manager), Mr A Ghanouni (Data Clerk), Mr K Pack (Data Clerk), Miss J Waddingham (Data Clerk), Miss A Thomson (Data Clerk), Ms A Verjee (Projects Manager), Dr C Monk (Projects Manager)

Research nurses/radiographers/local co-ordinators

Mrs R Kanani, Mr E Dadswell, Mr A Ghanouni, Mrs J Muckian (St Mark’s Hospital, Harrow)

Mrs N Gibbons, Mrs D Bastable, Ms L Coni (Queen Alexandra Hospital, Portsmouth)

Mrs J Martin, Mrs S Stephenson, Ms C Jackson, Mr A Wormald (Bradford Hospitals NHS Trust)

Dr D Beech, Ms C Lynn, Ms C Bloor, (Royal Cornwall Hospital, Truro)

Mrs S Wilkinson, Mrs L Pickles, Mrs J Scothern, Mrs A Hennedy, Mrs T Larkin, Mrs P Pearson, Mr S Preston, Mrs L Smith, Mrs L Wright (Royal Lancaster Infirmary/Furness General Hospital)

Dr J Blackstock, Ms R Thomas, Ms L Young (Royal United Hospital, Bath)

Mrs J Butler-Barnes, Mrs V Adamson, Mrs T Larcombe, Mrs V Bradshaw, Mrs S Chapman, Mr M Slater, Mrs J Stylan, Mr D Wood (Leighton Hospital, Crewe)

Mrs J Bradbury, Mr J Breedon, Mrs M Coakes, Mrs L Crutch, Mrs A Leyland, Mrs W Pringle, Mrs L Rowe, Mrs M White (Queen Elizabeth Hospital, Birmingham)

Ms A Worley, Mr D Kumar (Nottingham City Hospital/Queens Medical Centre)

Mrs M Gandy, Mrs J Pascoe (Derriford Hospital, Plymouth)

Mr J Wood, Mrs W Cook, Ms Y Memory (Royal Oldham Hospital, Oldham)

Mrs M Avery, Miss K Pearson, Mrs D Shivapatham, Mrs S Thomas, Mr C Ong, Ms B Poppinga-Scholz (Charing Cross Hospital, London/Hammersmith Hospital, London)

Mrs B Shanahan (Oxford Radcliffe Hospital, Oxford)

Ms L Turner, Ms K Fellows, Ms A Duffy, Ms A Owen, Ms A Usansky (South Manchester University Hospital, Manchester)

Mr F Naim, Mr V Bohra, Mr S Prabhudesai (St Mary’s Hospital, London)

Ms M Hayes, Ms N Lancelotte, Ms T James, Miss S Johnston, Miss J Stevenson (Frimley Park Hospital, Frimley)

Mrs D Whetter (University Hospital North Tees, Stockton-on-Tees)

Radiologists

Prof C Bartram, Dr D Burling, Dr A Gupta, Prof S Halligan, Dr M Marshall, Dr S A Taylor, (St Mark’s Hospital, Harrow)

Dr A Higginson, Dr J Atchley (Queen Alexandra Hospital, Portsmouth)

Dr C Kay, Dr A Lowe (Bradford Hospitals NHS Trust)

Dr G F Maskell (Royal Cornwall Hospital, Truro)

Dr A Taylor, Dr E Tan, Dr J McGregor (Royal Lancaster Infirmary/Furness General Hospital)

Dr S Hayward, Dr A Philips, Dr M Noakes (Royal United Hospital, Bath)

Dr S Zaman (Leighton Hospital, Crewe)

Dr P Guest, Dr I McCafferty, Dr P Riley, Dr D Tattersall (Queen Elizabeth Hospital, Birmingham)

Dr C Jobling, Dr R Dhingsa (Nottingham City Hospital/Queens Medical Centre)

Dr S A Jackson, Dr B M Fox, Dr J Shirley (Derriford Hospital, Plymouth)

Dr M Kumar (Royal Oldham Hospital, Oldham)

Dr D Blunt, Dr M Roddie (Charing Cross Hospital, London)

Dr A Slater (Oxford Radcliffe Hospital, Oxford)

Dr S A Sukumar (South Manchester University Hospital, Manchester)

Dr N Hughes (Frimley Park Hospital, Frimley)

Dr P Woolfall (University Hospital North Tees, Stockton-on-Tees)

Surgeons/endoscopists

Dr B Saunders, Prof J M A Northover (St Mark’s Hospital, Harrow)

Dr P Goggin, Mr D O’Leary (Queen Alexandra Hospital, Portsmouth)

Mr J Ausobsky, Dr C Beckett, Mr J Davies, Mr J Griffith, Mr M Steward (Bradford Hospitals NHS Trust)

Mr P J Arumugam (Royal Cornwall Hospital, Truro)

Mr I Crighton, Miss C Bronder, Dr C Brown, Dr A Higham, Dr R Lea, Dr C Meaden, Mr W Morgan, Mr P Patel, Mr G Nasmyth (Royal Lancaster Infirmary/Furness General Hospital)

Mr M Williamson (Royal United Hospital, Bath)

Mr D Cade (Leighton Hospital, Crewe)

Prof D Morton (Queen Elizabeth Hospital, Birmingham)

Prof J Scholefield (Nottingham City Hospital/Queens Medical Centre)

Mr K Hosie, Dr E Whitehead (Derriford Hospital, Plymouth)

Dr P Conlong, Dr B Rameh, Mr A Rate, Mr D Richards (Royal Oldham Hospital, Oldham)

Dr D Bansi, Mr G Buchanan, Mr P Dawson, Dr J Martin, Dr G Smith, Mr N A Theodorou, Dr A Thillainayagam (Charing Cross Hospital, London)

Mr C Cunningham, Dr S Travis (Oxford Radcliffe Hospital, Oxford)

Dr G M Hyde, Mr D J Jones, Miss S T O’Dwyer (South Manchester University Hospital, Manchester)

Mr P Ziprin (St Mary’s Hospital, London)

Col D Edwards, Miss S Burton, Dr P Fabricius, Mr M Gudgeon, Mr I Jourdan (Frimley Park Hospital, Frimley)

Dr M Rutter (University Hospital North Tees, Stockton-on-Tees)

Data Monitoring and Ethics Committee

Prof DG Altman (Chair), Prof R Steele, Dr A Walker

Trial Steering Committee

Prof A Dixon (Chair), Mrs L Foulds-Wood, Prof T Marteau, Dr R Valori

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von Wagner, C., Smith, S., Halligan, S. et al. Patient acceptability of CT colonography compared with double contrast barium enema: results from a multicentre randomised controlled trial of symptomatic patients. Eur Radiol 21, 2046–2055 (2011). https://doi.org/10.1007/s00330-011-2154-y

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  • DOI: https://doi.org/10.1007/s00330-011-2154-y

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