P4757 - Comparison of Colonoscopy and CT Colonography for Colorectal Cancer Screening: A Systematic Review

Siddhi P. Shah, MBBS¹, Faizan ul Hussain Mohammed, MBBS², Chandana Tadigotla, MBBS³, Afreen Begum, MBBS⁴, Diksha Mahadeva Gowda, MBBS⁵, Dheeraj Kumar Maheshwari, MBBS⁶, Adarsh Gande, MBBS⁷, Omer Farooq Mohammed, MBBS⁸, Binay Panjiyar, MD⁹, Adi Prasad Bodapati, MD¹⁰, Ashwith Reddy Gaddam, MD¹¹, Sri Lakshmi Ananya Bokka, MBBS¹²
1HBT Medical College and Dr. R.N. Cooper Municipal General Hospital, Thane, Maharashtra, India; 2Osmania Medical College, Karimnagar, Telangana, India; 3PES INSTITUTE OF MEDICAL SCIENCES AND RESEARCH, Ananthapur, Andhra Pradesh, India; 4ESIC Medical College and Hospital, Washington, DC; 5Mayo Clinic, Rochester, MN; 6Liaquat University of Medical and Health Science, Pensacola, FL; 7JIPMER, Pondicherry, India, Southlake, TX; 8Osmania General Hospital and Medical College, Hyderabad, Telangana, India; 9NorthShore University Hospital, Manhasset, NY; 10Texas Tech University Health Sciences Center, Odessa, TX; 11NYMC at St. Mary’s General hospital amd st clares health, Parsippany, NJ; 12Gandhi Medical College & Hospital, Hyderabad, Telangana, India

Introduction: Colorectal cancer (CRC) ranks among the top causes of cancer-related illness and death globally. Timely detection through effective screening is vital for lowering CRC rates and enhancing survival rates. Although colonoscopy has long been considered the definitive method for CRC screening, CT colonography (CTC) has emerged as a non-invasive alternative. This systematic review sought to assess and compare the diagnostic effectiveness, patient-centered outcomes, procedural factors, and cost efficiency of colonoscopy and CTC in screening for CRC.

Methods: A thorough literature search in the PubMed and PMC databases identified 16 pertinent articles, of which 7 studies were chosen according to specific inclusion criteria. These studies compared colonoscopy and CTC in populations at average risk for CRC. The primary variables extracted included sensitivity, specificity, detection thresholds for polyp size, patient preference, adverse events, bowel preparation techniques, the necessity for follow-up colonoscopy, and financial data. The QUADAS-2 tool was used to evaluate the risk of bias across four areas: patient selection, index test, reference standard, and flow and timing.

Results: The seven selected studies—Johnson et al. (2008), Graser et al. (2009), Pickhardt et al. (2011, 2015), Weinberg et al. (2011), Regge et al. (2014), and de Haan et al. (2011)—included sample sizes ranging from 200 to over 10,000. For lesions ≥10 mm, CTC showed high sensitivity (90–96%) and specificity (86–95%), comparable to colonoscopy. CTC was associated with minimal adverse events and generally well tolerated. While positive CTC findings required follow-up colonoscopy, non-cathartic prep improved patient acceptance. One study favored colonoscopy for post-op surveillance, though overall compliance appeared higher with CTC. Three studies supported CTC as a cost-effective screening option. Risk of bias was low in five studies; two had high or unclear risk due to limited data or selection bias.

Discussion: CT colonography provides diagnostic accuracy similar to colonoscopy for detecting significant colorectal neoplasms, with fewer risks and better patient tolerance. While colonoscopy remains the standard for its therapeutic use, CTC is a valid alternative, especially for those unwilling or unable to undergo colonoscopy. Further studies should assess long-term outcomes, cost-effectiveness, and adherence.

Disclosures:
Siddhi Shah indicated no relevant financial relationships.
Faizan ul Hussain Mohammed indicated no relevant financial relationships.
Chandana Tadigotla indicated no relevant financial relationships.
Afreen Begum indicated no relevant financial relationships.
Diksha Mahadeva Gowda indicated no relevant financial relationships.
Dheeraj Kumar Maheshwari indicated no relevant financial relationships.
Adarsh Gande indicated no relevant financial relationships.
Omer Farooq Mohammed indicated no relevant financial relationships.
Binay Panjiyar indicated no relevant financial relationships.
Adi Prasad Bodapati indicated no relevant financial relationships.
Ashwith Reddy Gaddam indicated no relevant financial relationships.
Sri Lakshmi Ananya Bokka indicated no relevant financial relationships.

Siddhi P. Shah, MBBS¹, Faizan ul Hussain Mohammed, MBBS², Chandana Tadigotla, MBBS³, Afreen Begum, MBBS⁴, Diksha Mahadeva Gowda, MBBS⁵, Dheeraj Kumar Maheshwari, MBBS⁶, Adarsh Gande, MBBS⁷, Omer Farooq Mohammed, MBBS⁸, Binay Panjiyar, MD⁹, Adi Prasad Bodapati, MD¹⁰, Ashwith Reddy Gaddam, MD¹¹, Sri Lakshmi Ananya Bokka, MBBS¹². P4757 - Comparison of Colonoscopy and CT Colonography for Colorectal Cancer Screening: A Systematic Review, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.