[Malignant colorectal polyps].
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Colonic Polyps↗
Biomedical subjects
L Bat
Publications and source records attributed to L Bat.
The association of biliary and pancreatic anomalies with periampullary duodenal diverticula. Correlation with clinical presentations.
Fifty-eight symptomatic patients with periampullary duodenal diverticula (PDD) were examined for pancreatic and biliary anomalies using endoscopic retrograde cholangiopancreatography (ERCP), ultrasonography, and other imaging modalities. The pathologic findings in these patients were compared with those in a matched group of 58 patients without PDD, who were simultaneously undergoing a similar investigation for the same clinical presentations. Pathologic findings in the pancreas and/or biliary tree were detected in 70.7% of all patients with PDD, compared with 39.7% in the control group. In patients with PDD, pancreatobiliary anomalies were detected in all patients who presented with jaundice, 85% of patients with pancreatitis, and 27.8% of patients with abdominal pain, as compared with 60%, 40%, and 17%, respectively, in the control group. In 23 patients, ERCP findings demonstrated pancreatobiliary abnormalities that were not detected by other imaging modalities. Fifteen of the patients with PDD and pancreatobiliary anomalies had undergone cholecystectomy between six months and five years previously. We conclude that ERCP is essential in the investigation of all patients with PDD, especially those presenting with jaundice or pancreatitis. Biliary surgery in patients with PDD and a dilated bile duct should include a biliary drainage procedure to prevent recurrence of pancreatobiliary disease.
Aged↗
Jejunogastric intussusception. A new diagnostic test.
Jejunogastric intussusception is a rare complication of gastrojejunal reconstruction of unknown cause. There are two types of jejunogastric intussusception: the acute type, presenting as a surgical emergency, and the chronic intermittent type, which is difficult to diagnose and is usually of mild symptomatology but which may progress to the acute type with the incarceration of the intussusceptum. With two case reports and a literature review, an endoscopic diagnostic maneuver is proposed, hinting at disordered motility with reversed peristalsis as a possible causative factor. Corrective surgical treatment to prevent recurrence and incarceration in chronic cases is advocated. Treatment should include dismantling of the efferent loop, which is the most frequent intussusceptum.
Aged↗
Endoscopic retrograde cholangiography in the detection of small stones in the gallbladder.
Multiple small (2-5 mm in size) gallstones were demonstrated only by endoscopic retrograde cholangiopancreatography in eight patients who had recurrent upper abdominal pain and vomiting. Three patients had mild, rapidly resolving abnormalities of liver biochemistry and serum amylase. In the other five, both serum amylase and liver biochemistry were repeatedly normal. We conclude that endoscopic retrograde cholangiography may be useful in the detection of small gallstones in patients with symptoms suggestive of biliary tract disease, even in the presence of normal oral cholecystography, ultrasonography, serum amylase, and liver biochemistry.
Amylases↗
Prolonged rectal bleeding associated with hemorrhoids: the diagnostic contribution of colonoscopy.
We studied 387 patients with prolonged rectal bleeding and hemorrhoids (grades 2 and 3) routinely examined by anoscopy, proctoscopy, single contrast barium enema, and hemoglobin measurements. Normal results were obtained in 86 patients above the age of 40. Total colonoscopy in these patients revealed one patient (1.2%) with cancer, 19 (22.1%) with colorectal polyps, and one (1.2%) with angiodysplasia. These findings indicate that in patients above age 40, a full investigation of the large bowel should be done in every case of prolonged rectal bleeding despite the presence of substantial hemorrhoids. Double contrast barium enema or colonoscopy must be used, rather than single contrast barium enema, which proved to be an inaccurate method of investigating prolonged rectal bleeding.
Barium Sulfate↗
Change in the extent of colonic involvement in ulcerative colitis: a colonoscopic study.
The change over time in the extent of colonic involvement in ulcerative colitis has, to date, been assessed only by radiological means. To study this issue further, we examined, with repeated colonoscopies, 31 patients with ulcerative colitis. Serial biopsies were taken every 5 cm from the most proximal area reached by the colonoscope down to rectum. The endoscopic and histological extents were evaluated, and the severity of the inflammatory process was graded. Clinical scoring also was performed at the time of both colonoscopies. A change of extent was found in 77% of the patients endoscopically, and in 58% histologically, during a mean follow-up period of 17 months. Extension and regression were demonstrated in the same number of patients. In 61% of 62 procedures, there was complete agreement between colonoscopic and histological extents. The histological extent exceeded the colonoscopic extent in 28% of the procedures. We have the impression that change in the disease extent is a frequent event, and may be a part of the natural history of ulcerative colitis, rather than the exception.
Adult↗
Colorectal adenomatous polyps and carcinoma in Ashkenazi and non-Ashkenazi Jews in Israel.
In Israel, the incidence of colorectal cancer among European-American-born Jews is approximately 2.5 times that of African-Asian-born Jews. To determine the risk of all colorectal tumors for the two ethnic groups, 335 patients with colorectal adenomatous polyps and 295 with colorectal cancer, diagnosed between 1980-1984 at the Sheba Medical Center, were compared to the 35,094 persons attending the outpatient clinics at the same hospital, during September and October 1984. Ashkenazi patients (European-American-born) had a 2.5-fold risk (95% confidence interval 1.9-3.3) of colorectal polyps compared to non-Ashkenazi patients (African-Asian-born). The risk was similar for males (odds ratios [OR] = 2.3) and females (OR = 2.8). Ashkenazis also had a significantly enhanced risk of carcinoma: OR = 3.1; 95% confidence interval 2.2-4.3. The risk ratio was slightly higher for males (OR = 3.5) than females (OR = 2.7). Age-specific analyses demonstrated an elevated risk of both malignant and benign neoplasms among Ashkenazi patients at all ages at diagnosis. Among the polyp patients, the highest risk ratio was for patients between 30 and 49 years old, while among the cancer patients the risk was highest in the group of 60-69-year-olds. The distribution by size of polyps, number of polyps, as well as polyp subsite, was similar for Ashkenazi and non-Ashkenazi patients; however non-Ashkenazis tended to have slightly more right-sided colon cancer.
Adult↗
Esophageal perforation after fiberoptic endoscopic injection sclerotherapy for esophageal varices.
Esophageal perforation is a rare major complication of fiberoptic endoscopic injection sclerotherapy for bleeding esophageal varices. This complication occurred in 1% (two) of our patients. Both patients recovered with conservative treatment. Although mild symptoms continued for a long period after the procedure, esophageal stenosis did not occur.
Aged↗
Solitary rectal ulcer syndrome--clinical, endoscopic, and histological spectrum.
Nineteen patients with solitary rectal ulcer syndrome are presented. The diagnosis was established on sigmoidoscopic and histopathological grounds; the clinical, endoscopic, and histological states were assessed at presentation and on last follow-up. Most of the patients suffered from rectal bleeding, abdominal and anorectal pains, constipation, and straining at defecation. Thirteen patients had macroscopic ulcerations on presentation and six patients did not. These six patients did not develop ulcer during the follow-up period. Four patients entered clinical and endoscopic remission with no histological improvement. Three of them managed conservatively and one underwent suturing of the ulcer and internal anal sphincter dilatation. They remained in remission for a mean follow-up of 1 yr.
Adult↗
A community-based program of colorectal screening in an asymptomatic population: evaluation of screening tests and compliance.
The incidence of colorectal cancer in Ashkenazi Jews is two to three times higher than in non-Ashkenazis. For a community colorectal screening program 1339 asymptomatic Ashkenazis over 40 yr old were asked to participate. Of these 1012 (75%) took Hemoccult II kits [fecal occult blood tests (FOBT)], and 614 (46%) personally returned them. Screenees were interviewed regarding family and personal medical history. Fourteen persons (2.3%) had positive tests, in whom colonoscopy revealed two with cancer (Dukes' B,C) and two with a greater than 2 cm polyp. The remaining 600 persons were invited for flexible sigmoidoscopy (FS) but only 287 (48%) appeared. The mean depth of insertion of the instrument was 50.3 cm (range 30-120), but was poorer for women. FS identified lesions in 28 (9.7%) persons: three had Dukes' A carcinomas and 25 had less than 2 cm adenomatous polyps. Significantly more women than men accepted FOBT, but among those completing FOBT, there was no difference by sex for use of FS. Middle-aged persons (50-69 yr) found screening more acceptable than young or older persons. Among screenees who agreed to undergo FS, a significantly larger fraction had a first relative with colon cancer, or a personal history of colon or female genital neoplasia, compared to those not agreeing to FS. There were no differences in screenees with relatives with noncolon cancer. Eighty-eight couples completed FOBT and were invited for FS. The decision whether or not to participate was made for both members in 81 (92%) couples. In conclusion, effective screening programs have to take into consideration compliance patterns of the target population.
Adult↗
[Early endoscopic sphincterotomy after cholecystectomy with T-tube drainage].
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Aged↗
The association of synchronous neoplasms with occluding colorectal cancer.
To find and eradicate synchronous neoplasms, colonoscopy was performed before and after resectional surgery in 50 patients with "occluding colorectal cancer," defined as encroachment of the lumen by tumor to a degree that prevented passage of a colonoscope. Synchronous, frequently multiple adenomas were found in 29 (58 percent) of these patients. Three patients (6 percent) had synchronous invasive cancer as well. None of these lesions was detected by intraoperative palpation, even though 46 percent of them measured more than 1.0 cm in diameter. Synchronous neoplasms were found significantly more often in patients with occluding cancer than in patients with non-occluding cancer, investigated concurrently at the same hospital. The former patients appear to be in double jeopardy with respect to synchronous neoplasms, these being more prevalent and less accessible than in patients with non-occluding tumors. Moreover, most of the synchronous lesions are undetectable by palpation. These findings bear out the importance of early postoperative, as well as preoperative, colonoscopy in all patients with occluding colorectal cancer.
Adenoma↗
Bacterial endocarditis after Hurst bougienage in a patient with a benign esophageal stricture and mitral valve prolapse.
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Anti-Bacterial Agents↗
Colonoscopic findings in patients with hemorrhoids, rectal bleeding and normal rectoscopy.
Within a period of 18 months, 387 patients were referred to the Proctologic Service at the Chaim Sheba Medical Center because of recurrent rectal bleeding. Hemorrhoids were found in 194 of these patients and further investigation showed that 45 of the 194 patients (23.2%) had other coexisting colonic pathology (12 cancers, 28 polyps, 4 inflammatory bowel diseases and 1 angiodysplasia). Sixteen of 40 patients with diverticulosis and 13 of 30 patients with hemoglobin less than 11 g/dl had additional colonic pathology. Single-contrast barium enema, which was used in this survey for screening of the colon, proved to be inaccurate. In view of the issue of cost-effectiveness, this study suggests that patients with recurrent rectal bleeding and hemorrhoids (Grades II and III) who had normal rectoscopy should be further investigated by double-contrast barium enema if they are greater than 40 years of age. All patients with anemia, diverticulosis or abnormal findings in barium enema should undergo total colonoscopy.
Adult↗
Management of bleeding esophageal varices by repeated endoscopic injection sclerotherapy--4 years' experience.
Endoscopic injection sclerotherapy (EIS) is successful in arresting bleeding from esophageal varices and has been used increasingly in recent years. Repeated EIS results in eradication of esophageal varices. Fifty patients were treated by emergency EIS and then by repeated elective injections; 177 EIS procedures were performed, with a mean follow-up period of 12.6 months. Most patients had nonalcoholic cirrhosis; 56% were in Child's Class C. Emergency EIS arrested variceal bleeding in 88% of patients, with a hospital mortality of 22%. In nine patients, bleeding persisted or recurred and was treated by repeated EIS or surgery. Complications occurred in five patients, all of whom recovered with conservative treatment. Patients in Child's Class C had a poor prognosis after EIS. Gastric varices were found frequently in patients classified as Child's C, but rarely in Child's Class A or B patients. Thus, the presence of gastric varices may be a marker for poor prognosis. Long-term observations demonstrate the effectiveness and safety of EIS in patients with bleeding esophageal varices.
Esophageal and Gastric Varices↗
Treatment of bleeding hemorrhoids by injection sclerotherapy and rubber band ligation.
Between March 1981 and September 1982, 178 patients with first- to third-degree bleeding hemorrhoids were treated by injection sclerotherapy and rubber band ligation, as outpatients. Of the treated patients 85 to 90% were asymptomatic during 1 year of follow-up. Complications, ranging from mild to moderate, occurred in only 5.6% of the patients. We conclude that injection sclerotherapy and rubber band ligation, when properly used, are efficient, inexpensive and safe methods for the treatment of bleeding hemorrhoids.
Hemorrhage↗
A prospective evaluation of the upper gastrointestinal tract and periampullary region in patients with Gardner syndrome.
Neoplasms of the upper gastrointestinal tract and periampullary region occur in patients with Gardner syndrome (GS), but their true incidence is not yet established. Fourteen patients with GS underwent esophagogastroduodenoscopy prior to colectomy and every 1-3 years thereafter. In 10 patients the pancreatobiliary system was also investigated: nine by endoscopic retrograde cholangiopancreatography and one at autopsy. All of the patients underwent ultrasound examination of liver, biliary tree, and pancreas. Adenomas in the upper gastrointestinal tract were found in all of the patients: Vater's papilla--12, duodenum--nine, and gastric antrum--seven. Only five patients had adenomas at the time of diagnosis of GS, and all the others developed adenomas within a mean of 2.5 years. One patient had hyperplastic polyps in the stomach fundus. Adenomas of the papilla of Vater demonstrated a higher degree of dysplasia compared to dysplasia in other locations of the gastrointestinal tract. Endoscopic retrograde cholangiopancreatography helped in detecting adenomas in distal common bile duct not visible at endoscopy. We conclude that adenomas at the upper gastrointestinal tract occur frequently in patients with GS and, therefore, periodic endoscopic systematic investigation of all patients with GS is mandatory.
Adenoma↗