New endoscopic finding associated with hyperplastic polyps.
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Colon↗
Biomedical subjects
E Y Rahmani
Publications and source records attributed to E Y Rahmani.
Z-stent for malignant esophageal obstruction.
The Z-stent was one of the first self-expanding metal prostheses used for palliation of malignant esophageal obstruction and respiratory esophageal fistula. Its placement has proved to be effective and relatively safe. This article reviews the evolution of the Z-stent; its multiple designs, placement technique, efficacy, complications, and assets and limitations.
Biocompatible Materials↗
Relative sensitivity of colonoscopy and barium enema for detection of colorectal cancer in clinical practice.
BACKGROUND & AIMS: The relative sensitivities of barium enema and colonoscopy for colorectal cancer are still debated. The aim of this study was to determine the relative sensitivity of barium enema and colonoscopy in general clinical practice. METHODS: Medical records of 2193 consecutive colorectal cancer cases identified in 20 central Indiana hospitals were reviewed. All procedures performed within 3 years of the diagnosis were identified. RESULTS: The sensitivity of colonoscopy for colorectal cancer (95%) was greater than that for barium enema (82.9%), with an odds ratio of 3.93 for a missed cancer by barium enema compared with colonoscopy. The sensitivity of double-contrast barium enema (85.2%) was not different from that of single-contrast (81.8%). Barium enema performed no better in the right than the left colon. Cancers detected by colonoscopy were more likely to be Dukes' class A (24.9%) than cancers detected by barium enema (9.8%). Colonoscopy performed by gastroenterologists was more sensitive (97.3%) for cancer than colonoscopy by nongastroenterologists (87%), with an odds ratio of 5.36 for a missed cancer by a nongastroenterologist compared with a gastroenterologist. CONCLUSIONS: Hospital quality assurance committees and/or third-party payors should review the sensitivity of barium enema and colonoscopy by practitioners in their institutions. Corrective measures are recommended when sensitivity deviates significantly below the standard set by gastroenterologists performing colonoscopy in this study.
Barium Sulfate↗
Colonoscopic miss rates of adenomas determined by back-to-back colonoscopies.
BACKGROUND & AIMS: The miss rate of colonoscopy for neoplasms is poorly understood. The aim of this study was to determine the miss rate of colonoscopy by same day back-to-back colonoscopy. METHODS: Two consecutive same day colonoscopies were performed in 183 patients. The patients were randomized to undergo the second colonoscopy by the same or a different endoscopist and in the same or different position. RESULTS: The overall miss rate for adenomas was 24%, 27% for adenomas < or = 5 mm, 13% for adenomas 6-9 mm, and 6% for adenomas > or = 1 cm. Patients with two or more adenomas at the first examination were more likely than patients with no or one adenoma detected at the first examination to have one or more adenomas at the second examination (odds ratio, 3.3; 95% confidence interval, 1.69-6.46). Right colon adenomas were missed more often (27%) than left colon adenomas (21%), but the difference was not significant. There was evidence of variation in sensitivity between endoscopists, but significant miss rates for small adenomas were found among essentially all endoscopists. CONCLUSIONS: Using current colonoscopic technology, there are significant miss rates for adenomas < 1 cm even with meticulous colonoscopy. Miss rates are low for adenomas > or = 1 cm. The results suggest the need for improvements in colonoscopic technology.
Adenoma↗
Failure of colonoscopy to detect colorectal cancer: evaluation of 47 cases in 20 hospitals.
BACKGROUND: Colonoscopy is the gold standard for the detection of colon polyps and cancers, but failed detections can occur and the reasons are incompletely understood. METHODS: During a retrospective evaluation of the sensitivity of barium enema and colonoscopy in 20 Indiana Hospitals, we encountered 47 cases of colorectal cancer in which a colonoscopy performed within 3 years of the diagnosis had not detected the cancer. Cases were reviewed for location of tumor, extenuating factors, pathologic features, delay in diagnosis from failed detection, and who performed the examination. RESULTS: Failed detection was more likely when colonoscopy was performed by a nongastroenterologist than a gastroenterologist (odds ratio 5:36, 95% CI [2.94,9.77]). Twenty-seven cancers were "missed," and 20 were estimated to be not reached. However, the location of missed tumors and a general absence of adequate documentation of cecal intubation suggested that some cecal and ascending colon cancers recorded as missed may actually have been not reached. Variation in sensitivity among gastroenterologists suggested that meticulous examination is also important in maximizing sensitivity. CONCLUSIONS: These cases suggest several factors that might improve the quality and sensitivity of colonoscopy: (1) examiners should receive adequate training, (2) cecal intubation rates should be high, (3) cecal intubation should be verified by specific landmarks in all cases, (4) failure to reach the cecum should be followed by prompt barium enema, and (5) meticulous examination would appear to improve sensitivity for cancer detection.
Aged↗