A feasibility study on laxative-free bowel preparation for virtual colonoscopy

Objective: To investigate the feasibility of laxative-free bowel preparation to relieve the patient stress in colon cleansing for virtual colonoscopy. Materials and Methods: Three different bowel-preparation protocols were investigated by 60 study cases from 35 healthy male volunteers. All the protocols utilize low-residue diet for two days and differ in diet for the third day - the day just prior to image acquisition in the fourth day morning. Protocol Diet-1 utilizes fluid or liquid diet in the third day, Diet-2 utilizes a food kit, and Diet-3 remains the low-residue diet. Oral contrast of barium sulfate (2.1%, 250 ml) was added respectively to the dinner in the second day and the three meals in the third day. Two doses of MD-Gastroview (60 ml) were ingested each in the evening of the third day and in the morning before image acquisition. Images were acquired by a single-slice detector spiral CT (computed tomography) scanner with 5 mm collimation, 1 mm reconstruction, 1.5-2.0:1.0 pitch, 100-150 mA, and 120 kVp after the colons were inflated by CO 2 . The contrasted colonic residue materials were electronically removed from the CT images by specialized computer-segmentation algorithms. Results: By assumptions that the healthy young volunteers have no polyp and the image resolution is approximately 4 mm, a successful electronic cleansing is defined as “no more than five false positives and no removal of a colon fold part greater than 4 mm” for each study case. The successful rate is 100% for protocol Diet-1, 77% for Diet-2 and 57% for Diet-3. Conclusion: A laxative-free bowel preparation is feasible for virtual colonoscopy.