Table 6. Optimal Strategy For Workup/Diagnosis for
Those With Symptoms
Basic Limited Enhanced Maximal
4.4 For those with
contraindications
to colonoscopy (or
colonoscopy not
available) but no
contraindications
to flexible
sigmoidoscopy
– if the patient
can't tolerate
colonoscopy then
full visualization.
(Weak
Recommendation;
L)
Flexible sigmoidoscopy
with biopsy, if no
contraindication, may be
performed with barium
enema.
Flexible sigmoidoscopy with biopsy,
if no contraindication, may be
performed with full visualization of
the colon (either barium enema or CT
colonography).
4.5 Patients with
contraindications
to colonoscopy
and to flexible
sigmoidoscopy.
(Moderate
Recommendation;
H)
N/A – refer to 4.2 CT colonography
if suspicious
findings and if
other two tests
contraindicated
may be performed.
Or if 2nd tier
DCBE is not
possible.
CT colonography
if suspicious
findings and if
other two tests
contraindicated
may be performed.
2nd tier DCBE if
CT colonography
not possible.
4.6 Patients
who have had
an incomplete
colonoscopy
N/A
(patient
would not
have received
colonoscopy
in basic)
Barium
enema (Note:
colonoscopy
may not have
been available,
therefore
incomplete
colonoscopy
would not
apply)
(Strong Rec;
IC-Ins)
If a patient in the
Enhanced setting
had an incomplete
colonoscopy,
then patients
may receive an
double contrast
enhanced-barium
enema or CT
colonography (for
CT colonography,
if the local
radiolog y service
can demonstrate
competency in
this technique).
(Strong
Recommendation;
I)
Repeat
colonoscopy or, if
not feasible, the
next tier would
be one of the two
following :
CT colonography,
if the local
radiolog y service
can demonstrate
competency in
this technique OR
Barium enema
may be offered
(if nothing else is
possible).
(cont'd)
