Computed tomography colonography compared with conventional colonoscopy for the detection of colorectal polyps.

OBJECTIVE: To determine the diagnostic accuracy of computed tomography colonography (CTC) compared with conventional colonoscopy (CC). METHODS: Patients with an indication of CC were included. Fifty patients underwent CTC using multidetector CT before diagnostic colonoscopy was performed by an expert colonoscopist. Diagnostic accuracy was assessed individually both for each polyp and for each patient. RESULTS: Fifty patients were included and 40 polyps were analyzed. The by-polyp sensitivity of CTC was 15% for polyps 5 mm or less, 75% for polyps 5- 10 mm and 75% for polyps 10 mm or larger. By-patient specificity was 6% for polyps 5 mm or less, 75% for polyps 5-10 mm and 80% for polyps 10 mm or larger. The specificity of CTC was 94%. CTC was preferred over CC by 90% of the patients. The mean colonoscopy examination time was 30 minutes for CC and 35 minutes for CTC (p < 0.05). CONCLUSIONS: The sensitivity of CTC is moderate in detecting polyps larger than 10 mm, low in detecting 5-10 mm polyps and very low in detecting those less than 5 mm. The overall specificity of the procedure was 94%. Procedure time was lower with CC than with CTC but the latter was better tolerated by most patients.

Computed tomography colonography compared with conventional colonoscopy for the detection of colorectal polyps

OBJETIVO: Determinar la exactitud diagnóstica de la colonoscopia virtual (CV) comparada con la colonoscopia convencional (CC).MÉTODOS: Se incluyeron pacientes con indicación de CC. Seles realizó una CV y, posteriormente, se llevó a cabo la CC sin sedación por parte de un colonoscopista experto. El análisis del rendimiento diagnóstico se efectuó tanto individualmente para cada pólipo como por paciente.RESULTADOS: Se han incluido 50 pacientes, y se contabilizóun total de 40 pólipos. La CV tuvo una sensibilidad del 15% para pólipos menores de 5 mm, aumentó hasta el 75% para pólipos de entre 5 y 10 mm, y fue del 75% para los mayores de 10 mm. La sensibilidad respecto al diagnóstico de pacientes con lesiones fue del 6% para pólipos menores de 5 mm, del 75% para pólipos de 5-10 mm y del 80% para los mayores de 10 mm. La especificidad de la colonoscopia virtual fue del 94%. La CV fue la exploración preferida por el 90% de los pacientes. La duración media de la CC fue de 30 min, mientras que la de la CV fue de 35 min (p < 0,05).CONCLUSIONES: La CV es una técnica moderadamente sensiblepara la detección de pólipos mayores de 10 mm; dichasensibilidad desciende considerablemente en los pólipos de5-10 mm y es muy baja para los menores 5 mm. La especificidad global de la prueba ha sido del 94%. La duración de la CC fue menor que la de la CV, y esta última fue mejor tolerada por la mayoría de los pacientes

OBJECTIVE: To determine the diagnostic accuracy of computed tomography colonography (CTC) compared with conventional colonoscopy (CC).METHODS: Patients with an indication of CC were included.Fifty patients underwent CTC using multidetector CT beforediagnostic colonoscopy was performed by an expert colonoscopist.Diagnostic accuracy was assessed individuallyboth for each polyp and for each patient.RESULTS: Fifty patients were included and 40 polyps wereanalyzed. The by-polyp sensitivity of CTC was 15% forpolyps 5 mm or less, 75% for polyps 5- 10 mm and 75%for polyps 10 mm or larger. By-patient specificity was 6% for polyps 5 mm or less, 75% for polyps 5-10 mm and 80%for polyps 10 mm or larger. The specificity of CTC was94%. CTC was preferred over CC by 90% of the patients.The mean colonoscopy examination time was 30 minutesfor CC and 35 minutes for CTC (p < 0.05).CONCLUSIONS: The sensitivity of CTC is moderate in detecting polyps larger than 10 mm, low in detecting 5-10 mm polyps and very low in detecting those less than 5 mm. The overall specificity of the procedure was 94%. Procedure time was lower with CC than with CTC but the latter was better tolerated by most patients

Relapsing upper bleeding in non-Hodgkin's oesophageal lymphoma associated with achalasia.

Achalasia is a disease of unknown origin in which there is a denervation of the myenteric plexus on the smooth muscle of the lower oesophageal sphincter, causing a cardial stenosis and a loss of efficacy of oesophageal peristalsis. The predominant symptoms are dysphagia for solids and liquids and regurgitation of the retained food. Occasionally, there may be oesophageal haemorrhage as a consequence of oesophagitis and stasis ulcers. An important but uncommon complication is the development of oesophageal cancer, which is typically squamous cell carcinoma. We report an exceptional case of a 77-year-old woman with a long-term achalasia and mega-oesophagus who presented four episodes of upper gastrointestinal bleeding in a 2 month period. The patient underwent surgical resection of the 10 cm of distal oesophagus, performing a partial fundoplication, and the pathological study revealed an oesophageal infiltration by a low-grade non-Hodgkin's lymphoma. After an insidious outcome, she died on the 47th day after admission.