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Burden of colonoscopy compared to non-cathartic CT-colonography in a colorectal cancer screening programme: randomised controlled trial
  1. Thomas R de Wijkerslooth1,2,
  2. Margriet C de Haan1,
  3. Esther M Stoop3,
  4. Patrick M Bossuyt4,
  5. Maarten Thomeer5,
  6. Marie-Louise Essink-Bot6,
  7. Monique E van Leerdam3,
  8. Paul Fockens2,
  9. Ernst J Kuipers3,7,
  10. Jaap Stoker1,
  11. Evelien Dekker2
  1. 1Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
  2. 2Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
  3. 3Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
  4. 4Department of Clinical Epidemiology & Biostatistics, Academic Medical Center, Amsterdam, The Netherlands
  5. 5Department of Radiology, Erasmus University Medical Center, Rotterdam, The Netherlands
  6. 6Department of Public Health, Academic Medical Center, Amsterdam, The Netherlands
  7. 7Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
  1. Correspondence to Dr Evelien Dekker, Gastroenterologist, Department of Gastroenterology and Hepatology C2-115, Academic Medical Center, PO Box 22700, 1100 DE Amsterdam, The Netherlands; e.dekker{at}


Objective CT-colonography has been suggested to be less burdensome for primary colorectal cancer (CRC) screening than colonoscopy. To compare the expected and perceived burden of both in a randomised trial.

Design 8844 Dutch citizens aged 50–74 years were randomly invited for CRC screening with colonoscopy (n=5924) or CT-colonography (n=2920). Colonoscopy was performed after full colon lavage, or CT-colonography after limited bowel preparation (non-cathartic). All invitees were asked to complete the expected burden questionnaire before the procedure. All participants were invited to complete the perceived burden questionnaire 14 days later. Mean scores were calculated on 5-point scales.

Results Expected burden: 2111 (36%) colonoscopy and 1199 (41%) CT-colonography invitees completed the expected burden questionnaire. Colonoscopy invitees expected the bowel preparation and screening procedure to be more burdensome than CT-colonography invitees: mean scores 3.0±1.1 vs 2.3±0.9 (p<0.001) and 3.1±1.1 vs 2.2±0.9 (p<0.001). Perceived burden: 1009/1276 (79%) colonoscopy and 801/982 (82%) CT-colonography participants completed the perceived burden questionnaire. The full screening procedure was reported as more burdensome in CT-colonography than in colonoscopy: 1.8±0.9 vs 2.0±0.9 (p<0.001). Drinking the bowel preparation resulted in a higher burden score in colonoscopy (3.0±1.3 vs 1.7±1.0, p<0.001) while related bowel movements were scored more burdensome in CT-colonography (2.0±1.0 vs 2.2±1.1, p<0.001). Most participants would probably or definitely take part in a next screening round: 96% for colonoscopy and 93% for CT-colonography (p=0.99).

Conclusion In a CRC screening programme, colonoscopy invitees expected the screening procedure and bowel preparation to be more burdensome than CT-colonography invitees. In participants, CT-colonography was scored as more burdensome than colonoscopy. Intended participation in a next screening round was comparable.

  • Mass screening
  • colorectal neoplasms
  • colonoscopy
  • CT Colonography
  • burden
  • screening
  • colonoscopy
  • colorectal cancer
  • colorectal carcinoma
  • family cancer
  • gastrointestinal bleeding
  • gastroesophageal reflux disease
  • Barretts oesophagus
  • gastrointesinal endoscopy
  • endoscopic ultrasonography
  • endoscopic procedures
  • Helicobacter pylori
  • gastric cancer
  • gastritis
  • abdominal MRI
  • imaging
  • anorectal disorders
  • abdominal pain
  • small bowel
  • endoscopic polypectomy
  • CRC surveillance
  • advanced endoscopic imaging
  • narrow band imaging

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  • TRW and MCH contributed equally to this work.

  • Funding The study was funded by The Netherlands Organization for Health Research and Development (ZonMw 120720012 and 121010005), the Center for Translational Molecular Medicine (CTMM DeCoDe-project) and the Nuts Ohra Foundation (Amsterdam, The Netherlands).

  • Competing interests None.

  • Ethics approval Ethics approval was provided by Dutch Health Council (2009/03WBO, The Hague, The Netherlands).

  • Provenance and peer review Not commissioned; externally peer reviewed.