What are the most commonly observed indications for CTC?
The most common indication for CTC is incomplete OC, which can be performed the same day as OC, as well as a history of prior difficult OC. Less frequently encountered indications include sedation risk, chronic anticoagulation, evaluation of the colon proximal to an obstructing mass or stricture that precludes passage of an endoscope, and characterization of an indeterminate colorectal lesion on OC. Of note, CTC can be performed safely in patients with colonic anastomoses.
Coverage for screening CTC remains controversial due to concerns over cost-effectiveness, the ability of CTC to reach the previously unscreened population, extracolonic findings (findings outside of the colonic lumen visible on CTC but not OC), and radiation risk. In some regions of the country, CTC is reimbursed as a method of colorectal cancer screening, although most insurers including the Centers for Medicaid and Medicare (CMS) do not currently cover this modality for screening.