Article Text

Systematic review and meta-analysis: does colonic mural thickening on CT correlate with endoscopic findings at colonoscopy?
  1. Subashini Chandrapalan1,
  2. Faraz Tahir2,
  3. Peter Kimani3,
  4. Rakesh Sinha4,
  5. Ramesh Arasaradnam3,5,6
  1. 1 Department of Gastroenterology, County Durham and Darlington Foundation Trust, Durham, UK
  2. 2 Department of Gastroenterology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
  3. 3 Warwick Medical School, University of Warwick, Coventry, UK
  4. 4 Department of Radiology, South Warwickshire Hospital, Warwick, UK
  5. 5 Department of Gastroenterology, University Hospital Coventry and Warwickshire, Coventry, UK
  6. 6 Applied Biological and Experimental Sciences, University of Coventry, Coventry, UK
  1. Correspondence to Dr Subashini Chandrapalan, Department of Gastroenterology, County Durham and Darlington Foundation Trust, Durham DL3 6HX, UK; subashini.chandrapalan{at}


Background Colonic mural thickening (MT) is often reported on standard CT examinations of the abdomen and pelvis. It often presents a dilemma for the clinician on whether any further evaluation is needed, especially in the absence of any set guidelines.

Objective To evaluate the significance of colonic MT and to assess its correlation with colonoscopy.

Methods The search strategy was initially developed in Medline and adapted for use in Embase, Medline, NHS Evidence and TRIP. Studies were included if they had reported colonic MT and subsequent colonoscopy in adults.

Results A total of 9 cohort studies examining 1252 patients were selected having undergone both CT and colonoscopy. Of the 1252 patients with MT, 950 had an abnormal colonoscopy. In the presence of MT, the pooled positive predictive value (PPV) of having any abnormal findings at colonoscopy was 0.73 (95% CI 0.60 to 0.84). The pooled PPV for colorectal cancer, in the presence of MT reporting suspicion of cancer, was 0.63 (95% CI 0.49 to 0.75), and MT suggestive of inflammation confirmed at colonoscopy was 0.97.

Conclusion The probability of having an abnormal colonoscopy in the presence of MT identified on CT is high, especially for inflammation. Asymptomatic cancers may also be detected; hence, further endoscopic confirmation is reasonable when a finding of MT is demonstrated on CT examinations. Small sample sizes of the available studies and lack of data on the description of MT detected are the main limiting factors in this review.

Trial registration number CRD42016039378.

  • computed tomography
  • colon
  • colonoscopy
  • mural thickening
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  • Contributors SC: data collection, preparation of manuscript. PK: statistical analysis and manuscript preparation. RS, RA: critical revision of the manuscript for important intellectual content and project supervision. All authors have approved the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

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

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