Figure 1 Clinical management algorithm for patients who have had an incomplete or technically difficult OC Note that the pathway from incomplete colonoscopy to CTC (dashed line) is at present only possible with documentation that the patient underwent the colonoscopy within the previous three months. Patients with contraindications to colonoscopy, other than suspected colon perforation (a contraindication to both OC and DCBE) or high-grade obstruction, cannot currently be reimbursed for CTC (also shown by way of dashed line), but may receive DCBE (solid line). Abbreviations: OC, optical colonoscopy; DCBE, double contrast barium enema; CTC, computed tomography colonography; TBD, to be defined. Symptomatic patient or patient at high risk of colorectal neoplasm, with previous incomplete or technically difficult OC > 3mo Proposed pathways Current pathways CTC DCBE Cancer or significant polyp Normal Extra-colonic disease Normal Surgery program No further colon investigation OR Colonoscopic No further colon Further imaging for extracolonic disease Appropriate management investigation OR (therapeutic) management OR Follow-up in surveillance program OR Follow-up in surveillance Health outcomes Health outcomes
Figure 1 Clinical management algorithm for patients who have had an incomplete or technically difficult OC Note that the pathway from incomplete colonoscopy to CTC (dashed line) is at present only possible with documentation that the patient underwent the colonoscopy within the previous three months. Patients with contraindications to colonoscopy, other than suspected colon perforation (a contraindication to both OC and DCBE) or high-grade obstruction, cannot currently be reimbursed for CTC (also shown by way of dashed line), but may receive DCBE (solid line). Abbreviations: OC, optical colonoscopy; DCBE, double contrast barium enema; CTC, computed tomography colonography; TBD, to be defined. Symptomatic patient or patient at high risk of colorectal neoplasm, with previous incomplete or technically difficult OC > 3mo Current pathways Proposed pathways DCBE CTC Normal Cancer or significant polyp Normal Extra-colonic disease No further colon investigation OR Further imaging for extracolonic disease OR Follow-up in surveillance program Colonoscopic management (therapeutic) OR Surgery No further colon investigation OR Follow-up in surveillance program Appropriate management Health outcomes Health outcomes
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