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PubMedDate not supplied

[Cytopathological test performed during colonoscopy in the diagnosis of colorectal stenosis].

The etiological diagnosis for the colorectal strictures can be very difficult. With the colonoscopy, it was possible to obtain samples with direct vision of the lesion. Consequently, the cytologic efficiency improved, with similar or even better results than histopathology. In the present study (107 patients) it was used the cytopathology performed during colonoscopy. After a specimen was obtained, it was smeared on glass slide, fixed in 95% alcohol, stained by HE, and examined microscopically, with conclusions during the procedure. The results were compared and further correlated to the histopathology of surgical specimen or based on clinical follow-up in those case not submitted to operation. The results showed a striking degree of correlation between both exams. For the cytopathology there were no inconclusive results, false-negative were less frequent than with histopathology, and only one case of false-positive (rectal villus adenoma) was observed. Considering the type, localization and perviousness of the lesion, similar conclusions were drawn, and did not affect the results, except that there were more false-negatives in both exams when the lesions were impervious. The cytopathological and histopathological studies were both highly sensitive and specific for the diagnosis of carcinoma. In conclusion, cytopathology performed during colonoscopy is safe and efficient in the study of colorectal strictures, which contributes to improve the orientation of these patients.

Adult↗
PubMed1992

Postoperative follow-up of patients with colorectal carcinoma by colonoscopy.

OBJECTIVE: To find out if colonoscopy is of use in the follow-up of patients who have been operated on for colorectal carcinoma. DESIGN: Retrospective study. SETTING: Department of diagnostic radiology, university hospital. SUBJECTS: 390 consecutive patients operated on for colorectal carcinoma during the 10-year period 1981 to 1990. MAIN OUTCOME MEASURES: Number of recurrences, synchronous of metachronous tumours, and number and size of adenomas found on colonoscopy. RESULTS: Neoplastic lesions were found in 175 (45%) of the 390 patients studied. There were 14 anastomotic recurrences and 12 new primary carcinomas. At operation for recurrent tumours Dukes' A or B lesions were found in half of the 14 patients who had no symptoms, and a quarter of the 12 who had had symptoms. Those with recurrent carcinoma were younger than those without. Adenomas 1 cm in diameter or more were found in 44 patients and 104 had adenomas less than 1 cm. In addition one carcinoid was found. CONCLUSION: Colonoscopy gave a high yield of neoplastic lesions when used to follow-up patients after resection of colorectal carcinoma, particularly at six months, and resulted in half the recurrent carcinomas being diagnosed before the patients had symptoms. We recommend its use for follow-up of high risk patients, but further studies are needed to establish the optimum time intervals.

Adenoma↗
PubMed1976

Flexible colonoscopy.

Colonoscopy with fiberoptic instruments has opened new vistas in diagnosis and treatment of colonic disease. Such endoscopy requires skill, experience, and judgment to be accomplished readily and safely but permits visual examination of the entire colon and, frequently, the terminal ileum as well. Although in experienced hands colonoscopy may have greater diagnostic accuracy than the barium enema, particularly with respect to colorectal cancer and polyps, the two are complementary modalities and with their combined use an extremely high rate of detection and confirmed diagnosis can be expected. The Beth Israel group introduced the technique of snare-cautery removal of colonic polyps via the colonoscope and has now successfully resected over 2500 such polyps without a single death. This is the largest world experience. Selected polyps can be removed endoscopically as an ambulatory procedure, reducing costs and incapacitation time. Neoplastic polyps often harbor invasive cancer and their extirpation is expected to reduce the incidence of overt colorectal cancer. Colonoscopy and endoscopic polypectomy offers the opportunity to check the rising incidence, morbidity, and mortality related to colorectal cancer.

Adenoma↗
PubMed1979

Extent of inflammatory lesions in ulcerative colitis assessed by radiology, colonoscopy, and endoscopic biopsies.

Radiography of the colon with double-contrast technique was performed directly after total colonoscopy with multiple biopsies in 50 patients with ulcerative colitis. In two-thirds of the series the inflammatory lesions were found to be more widespread at colonoscopy than on radiography. Signs of colitis in an even larger part of the bowel were found on examination of the biopsies in half of the cases. The distribution of characteristic inflammatory changes seen at colonoscopy was also studied. The frequency of the lesions was found to be relatively low in the rectum and highest in the descending and sigmoid parts of the colon.

Adult↗
PubMed1979

Complications of diagnostic and therapeutic colonoscopy in the Federal Republic of Germany. Results of an inquiry.

In April, 1978, we carried out a survey covering 27 hospitals, in which colonoscopy is performed on a routine basis. With respect to the size of the hospital, the equipment available and the level of training of the examiner, this selection may be regarded as representative. A total of 35,892 colonoscopies, 7,365 polypectomies, 58 electrocoagulations and 14 rugectomies were analysed with respect to the nature, localization and treatment of any complications that arose. The rate of complications seen in diagnostic colonoscopy was 0.008% for bleeding and 0.14% for perforation, the mortality rate being 0.02%. As expected, the complication rate for colonoscopic polypectomy was higher. Bleedings were reported in 2.24%, perforations in 0.34% and deaths in 0.1% of the examinations. Of particular importance would seem to be the possibilities of preventing complications. It was shown on the basis of the survey that a good, standardized training of the endoscopist, the strict observance of the contraindications, the non-use of analgesics and general anaesthesia, fluoroscopic control of "difficult" colons and the use of the best instruments and aids presently available, reduce the complication rate to a minimum.

Colon↗
PubMed1977

Colonoscopy in surgical practice.

Colonoscopy is a rewarding new technique with a potential for early and more accurate diagnosis. One hundred and seventy colonoscopies carried out over the past three years showed or confirmed colonic cancer in 14 patients, and solitary or multiple colonic polyps were found in 28 cases, of which 18 were excised endoscopically. A large villous adenoma was diagnosed in one patient, and the absence of a suspected sinister lesion was shown by direct examination and biopsy in 110 cases. There were 17 examination failures, including two perforations of the bowel. Colonoscopy complements rather than supplants barium enema examination and will make diagnostic laparotomy for colonic lesions unnecessary. The use of the diathermy snare allows endoscopic removal of colonic polyps and should greatly reduce the need for formal surgery in these cases. The financial saving to the Health Service will greatly outweigh the expense of the procedure, but it should be undertaken only in well organised centres as a specialist service for selected patients. In skilled hands it is safe, but potential hazards exist for the inexperienced endoscopist.

Colon↗
PubMed1979

Fibreoptic colonoscopy. Indications, results and complications.

Fibreoptic colonoscopy was commenced in the Edward Wilson Colon and Rectum Unit at Sydney Hospital in June, 1973. The experience of the first five years of its use is reported. Six hundred and twenty-six examinations have been performed in 568 patients. Fibreoptic colonoscopy has been of particular value in the diagnosis and treatment of colonic polyps. A total of 318 polyps were removed from 184 patients. Their distribution, size and histological features are recorded. Eight complications occurred in the 628 examinations (1.6%). There were six colonic perforations (1.2%) with one death, and two significant haemorrhages (0.4%). This incidence of complications is acceptably low, especially in view of the great benefits obtained by the patient from fibreoptic colonoscopy. The newer instruments, especially the medium length Olympus MB3 colonoscope, have greatly facilitated the examination and, combined with increasing experience, may significantly lower the incidence of complications in the future.

Adolescent↗
PubMed1976

Colonoscopy and polypectomy.

Experience with 100 colonoscopies in 88 patients in a community hospital is presented. The instrument used was the F09000PL 165 cm ACMI colonoscope for the first 88 cases, and the F9A 160 cm ACMI colonoscope for the last 12. There were no complications. The preparation of the patient and the technique of colonoscopy and polypectomy are detailed. Indications and contraindications are outlined and discussed. Colonoscopy in this series has definitely saved 16 patients and possibly another 20 patients from laparotomy.

Adult↗
PubMed1979

Complications in colonoscopy.

Colonoscopy, when performed for appropriate indications and by experienced, competent personnel, is a remarkably safe procedure. The occasional complications which occur may be the result of pneumatic, mechanical or electrical injuries to the colon or may develop as secondary disorders involving other organ systems. Most complications can be successfully prevented by adequately preparing both the endoscopist and the patient and by avoiding colonoscopy when specific contraindications are present. Should complications occur, their management generally follows established surgical principles. Even though colonoscopy has made a dramatic impact upon the diagnosis of and therapy for disease of the large intestines, it is important for practitioners to be mindful of its limitations. Future developments, applied rationally, can be expected to extend its usefulness and further improve its safety.

Burns, Electric↗
PubMedDate not supplied

The role of colonoscopy in complicated diverticular disease. A review.

Colonoscopy in complicated diverticular disease may assist the clinician in establishing the diagnosis of associated strictures. A review of the literature shows that carcinoma was identified in 21 (17%) of 125 patients and that an additional diagnosis was made in 40 (32%) patients. Although colonoscopy may be a difficult procedure in patients with diverticular disease the caecum was reached in 27 (61%) of 44 patients and took no longer than routine colonoscopic orpcedures. Further analysis of these results confirms that the barium enema frequently produces both false positive and false negative diagnoses of carcinoma and polyps. The presence of bleeding strongly suggests the presence of a concomitant lesion. Fifteen (11%) carcinomas were identified in a group of 135 patients with persistent rectal bleeding whose barium enema showed only diverticular disease and an additional diagnosis was made in 50 (37%) of these patients. Colonoscopy is an important investigation in patients with complicated diverticular disease.

Aged↗
PubMedDate not supplied

Value of colonoscopy in the detection of sigmoid malignancy in patients with diverticular disease.

Sixty patients with diverticular disease, referred because a barium enema examination could not exclude a co-existing malignanty, were studied in a retrospective manner, to find out the contribution of colonoscopy in the diagnosis of sigmoid carcinoma in such patients. All X-ray studies were blindly reviewed and divided in two categories: a) diverticular disease with malignancy or strong suspicion for malignancy and b) diverticular disease without suspicion for malignancy. The accuracy of the endoscopical examination was evaluated by a follow-up study with a range of 3 months-3 years. Colonoscopy appeared to be accurate in more than 3/4 of the referred patients but was not helpful when there was a severe stenoisis and/or the diseases segment could not be reached for biopsy. The incidence diminished when a small calibre fiberendoscope was used, practically always allowing to reach or to pass the stenotic segment. There were no false positive nor false negative endoscopical results in our study. In a substantial number of patients major surgical exploration could be prevented. We consider colonoscopy therefore a valuable adjunct in detecting or eliminating cancer in colonic diverticular disease. The availability of various fiberendoscopic instruments is a prerequisite for reaching an acceptable success rate and diagnostic accuracy.

Colon↗
PubMed1977

Fiberoptic endoscopy of the gastrointestinal tract in infants and children. II. Fiberoptic colonoscopy and polypectomy in 15 children.

Fiberoptic colonoscopy was performed on 15 patients between the ages of 1 1/2 years and 16 years. Ten patients were hospitalized and five were outpatients. Of 12 with frank or microscopic blood in stools, fiberoptic colonoscopy revealed single polyps in six patients, ulcerative colitis in two and negative results in four with prior nondiagnostic radiographic studies, colonoscopy revealed ulcerative colitis in one, granulomatous colitis in one and negative findings in one. Polypectomy through the colonoscope was accomplished in all six patients with polyps. Perforation of the sigmoid colon during polypectomy with the snare loop was the single complication encountered. Lower intestinal endoscopy should be selectively considered for diagnosis and therapy of unexplained bleeding or recurrent lower abdominal pain in children in whom proctosigmoidoscopic laboratory and radiographic examinations do not achieve a diagnosis.

Abdomen↗
PubMed1977

Benign pneumoperitoneum after fiberoptic colonoscopy. A prospective study of 100 patients.

A prospective study of 100 consecutive unselected patients undergoing both diagnostic and therapeutic firoptic colonoscopy was undertaken. Our incidence of colonic perforation is 1%, which is similar to the incidence reported in the literature. This study suggests that even when immediate postcolonoscopic supine and erect abdominal radiographs as well as pre- and postcolonoscopic total blood counts and enzyme levels to supplement clinical impressions are obtained, the incidence of perforation of the colon after fiberoptic colonoscopy is low and not any higher than that reported in the literature. Pneumoperitoneum may occur after fiberoptic colonoscopy with minimal or no clinical evidence suggesting perforation. Perforation in some patients may be treated conservatively without the need of emergency laparotomy.

Adult↗
PubMedDate not supplied

[The complications of diagnostic colonoscopy].

Major complications of diagnostic colonoscopy based on a series of 17.583 procedures performed from 1980 throughout 1991 are reported. No higher risk of colon perforation was registered either performing total or partial colonoscopy, for the site of perforation was in most cases the sigmoid colon.

Colon↗
PubMed1979

The management of suspected tumours of the colon: the role of colonoscopy in general surgery.

The role of colonoscopy in the management of 100 cases of suspected large bowel tumour is described. Forty out of 47 patients with an equivocal barium enema examination were satisfactorily examined and the possibility of a tumour being present was either confirmed or refuted. Examination of 30 patients with otherwise unexplained blood loss from the bowel revealed the cause in 50 per cent of them. Twenty-nine patients had pedunculated polyps which were snared and removed, thus avoiding laparotomy and colotomy. The problem of distinguishing tumours from other lesions or retained faeces by radiology arises most often in the sigmoid colon. This segment is easily examined using a short flexible endoscope. General surgeons taking up colonoscopy will find a 1-m single-channel instrument convenient to use and capable of reaching approximately 90 per cent of colonic tumours that require further investigation or endoscopic resection. Facilities for the examination of the whole colon should be available in established endoscopy units.

Adult↗
PubMed1978

Colonoscopy and polypectomy.

An overview of colonoscopy and polypectomy is presented. The merits of this procedure are pointed out, highlighting the newer technics and those technics that have survived. The complications of colonoscopy and polypectomy are reviewed in detail.

Colon↗
PubMed1978

Colitis, cancer, and colonoscopy.

Colonoscopy has added a new dimension to the diagnosis of colonic diseases. In the field of inflammatory bowel disease, colonscopy is indicated only when certain specific problems arise. Patients with acute colitis and those who are too sick to withstand cleansing enemas should not undergo colonoscopy. A major use of the colonoscope is in the detection of carcinoma in the colitic colon either in the form of colonic strictures or filling defects discovered by barium enema x-ray, or in the long-term surveillance of patients with universal ulcerative colitis. Criteria are listed to assist in the colonoscopic differential diagnosis between ulcerative and granulomatous colitis. By using different criteria than the radiographer, and with the help of biopsy specimens, a high degree of accuracy in proper diagnosis can be achieved.

Colitis↗