CTC has been shown to be superior to double contrast barium enema following incomplete conventional colonoscopy and, in fact, failed colonoscopy was the first established indication for CTC. An incomplete colonoscopy is defined as failure to intu-bate up to the cecum. The reported rate of failed colonoscopy ranges from 8% to as high as 35%. Patients with a history of an incomplete colonos-copy have a significantly increased risk of failing a second attempt. A multitude of reasons contribute to a failed conventional colonoscopy: poor bowel preparation, redundant colon, strictures, history of failed colonoscopies and patient discomfort. Double contrast barium enema was usually the next step in the algorithm of colon evaluation and in most cases performed the same day. On some occasions, however, DCBE is suboptimal as well, sometimes due to poor bowel prep, patient's inability to move on the table or inadequate barium coating of the colonic mucosa secondary to an air block from the previous incomplete colonoscopy (Macari et al. 1999).
In patients with failed colonoscopy, Macari et al. reported CTC sensitivities of polyp detection of 87%, compared with 45% for DCBE. The specificity was also better for CTC than DCBE; 98 vs 89%, respectively (Macari et al. 1999). Therefore, in this subset of patients who have failed conventional colo-noscopy, CTC rather than a second attempt of conventional colonoscopy or DCBE may be prudent.
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