Enter Your Email Address to Receive a
Copy of MedicExhange Member Demograhpics

According to the study published in the November issue of American Journal of Roentology, removal of small polyps found during computed tomography colonography (CTC) is costly and unnecessary. The study was conducted by Perry J. Pickhardt, MD and his team of the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.

The study was designed as a decision analysis model to represent the clinical and economic consequences of performing 3-year colorectal cancer surveillance, immediate colonoscopy with polypectomy, or neither on patients who had 6- to 9-mm polyps found on CTC. The analysis model was accompanied by a hypothetical population of 100,000 adults aged 60 years with 6- to 9-mm polyps detected at CTC screening.

Results showed that, "by excluding large polyps and masses, CTC screening can place a patient in a very low-risk category making colonoscopy for small polyps probably not warranted," said Dr. Pickhardt. "Approximately 10,000 colonoscopy referrals would be needed for each theoretical cancer death prevented at a cost of nearly $400,000 per life-year gained. We would also expect an additional 10 perforations and probably 1 death related to these extra colonoscopies. There may be no net gain in terms of lives, just extra costs."

"The clinical management of small polyps detected at colorectal cancer screening has provoked controversy between radiologists and gastroenterologists. Patients should be allowed to have the choice between immediate colonoscopy and imaging surveillance for 1 or 2 isolated small polyps detected at colorectal cancer screening," he said.

"If patients with small polyps are monitored, only 5% of adults undergoing CTC screening will need to undergo immediate invasive colonoscopy."