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PubMed2005

Appropriateness of indication and diagnostic yield of colonoscopy: first report based on the 2000 guidelines of the American Society for Gastrointestinal Endoscopy.

AIM: To assess the appropriateness of referrals and to determine the diagnostic yield of colonoscopy according to the 2000 guidelines of the American Society for Gastrointestinal Endoscopy (ASGE). METHODS: A total of 736 consecutive patients (415 males, 321 females; mean age 43.6+/-16.6 years) undergoing colonoscopy during October 2001-March 2002 were prospectively enrolled in the study. The 2000 ASGE guidelines were used to assess the appropriateness of the indications for the procedure. Diagnostic yield was defined as the ratio between significant findings detected on colonoscopy and the total number of procedures performed for that indication. RESULTS: The large majority (64%) of patients had colonoscopy for an indication that was considered "generally indicated", it was "generally not indicated" for 20%, and it was "not listed" for 16% in the guidelines. The diagnostic yield of colonoscopy was highest for the "generally indicated" (38%) followed by "not listed" (13%) and "generally not indicated" (5%) categories. In the multivariable analysis, the diagnostic yield was independently associated with the appropriateness of indication that was "generally indicated" (odds ratio=12.3) and referrals by gastroenterologist (odds ratio =1.9). CONCLUSION: There is a high likelihood of inappropriate referrals for colonoscopy in an open-access endoscopy system. The diagnostic yield of the procedure is dependent on the appropriateness of indication and referring physician's specialty. Certain indications "not listed" in the guidelines have an intermediate diagnostic yield and further studies are required to evaluate whether they should be included in future revisions of the ASGE guidelines.

Adolescent↗

PubMedDate not supplied

The role of sigmoidoscopy for asymptomatic patients. Results of three annual screening sigmoidoscopies, polypectomy, and subsequent surveillance colonoscopy in a primary-care setting.

A total of 329 asymptomatic patients (aged 50 or older) underwent flexible sigmoidoscopy to screen for colonic neoplasia. Of these, 258 underwent a second examination after 1 year and 143 underwent a third examination after another year. Of 60 patients in whom polyps were found on one of the three examinations, 58 underwent colonoscopy and polypectomy; 77 adenomatous polyps were present in 39 of these patients. The incidence of adenomatous polyps was 7.9% for the first examination, 3.9% for the second, and 2.1% for the third. Of patients with an index polyp found by sigmoidoscopy, 57.5% had synchronous polyps discovered by colonoscopy. Thirty-six of 77 polyps in 24 patients showed dysplasia; 9 were less than 0.5 cm, 14 were 0.5 cm to 0.9 cm, and 13 were 1 cm or larger. Forty-four surveillance colonoscopies (done after initial colonoscopy and polypectomy) have been performed in 28 patients. Eighteen examinations resulted in finding 30 adenomatous polyps, of which 10 showed dysplasia. This study 1) is the first report of flexible sigmoidoscopy data to support the American Cancer Society recommendation of two serial screening sigmoidoscopies a year apart, 2) reinforces the concept that an index polyp indicates a need for a complete colonoscopy, 3) reinforces the need for ongoing surveillance by colonoscopy after detection of adenomas, and 4) adds to reports of dysplasia in diminutive polyps.

Aged↗

PubMed2000

The yield for colorectal cancer and adenoma by indication at colonoscopy.

Colonoscopy is an integral part of the clinician armamentarium in the diagnosis of colorectal cancer and its precursor, the adenoma. Polypoid lesions when identified can be excised at colonoscopy and in turn reduce the risk of colorectal cancer. We prospectively evaluated the yield of colorectal cancer and adenomatous polyps by indication for colonoscopy over a one-year period. A total of 375 colonoscopies were carried out. The more common indications of colonoscopy were rectal bleeding, abdominal pain, surveillance of colorectal cancer and altered bowel habit. The highest yield for cancer was for rectal bleeding with 12.5% while surveillance of patients with a history of polyps yielded the highest percentage of new polyps. We conclude that rectal bleeding as an indication for colonoscopy yielded the highest number of cancers.

Adenoma↗

PubMed2001

[Quality of colonoscopy and surgical treatment of perforations].

INTRODUCTION: Perforation during colonoscopy is a well-known complication. The purpose of our study was to evaluate the incidence of acute surgical intervention due to colonic perforations during endoscopy at our department, and evaluate the rate of incomplete examinations. METHODS: The latest 4000 colonoscopies performed at Hvidovre Hospital were examined for possible complications and success rate. RESULTS: Seventeen percent of the colonoscopies were incomplete, mostly due to anatomical difficulties, incomplete bowel preparation, and pain. Twelve (0.3%) of the 4000 patients were operated on due to perforation which occurred during the examination. The mortality rate in these 12 patients was 17% and the survivors had a median hospital stay of eight days. DISCUSSION: Future strategy should focus on improving the quality of colonoscopy, thereby increasing the success rate and lowering patient discomfort. Furthermore, the new non-invasive modalities virtual colonoscopy (CT or MRI) should be developed further so that they might substitute all the diagnostic colonoscopies.

Aged↗

PubMedDate not supplied

Value and limits of emergency colonoscopy in cases of severe lower gastrointestinal haemorrhage.

Acute bleeding of the lower gastrointestinal tract causes complex diagnostic problems. Colonoscopy is subject to discussion as the first method of diagnosing lower digestive tract bleeding. From June 1998 to September 2001 we observed 80 patients with acute bleeding (45 males and 35 females; mean age: 65.5 years). All patients underwent an emergency colonoscopy. In 15 cases we carried out an angiography and in 9 a scintigraphy (always after colonoscopy). Colonoscopy detected the cause of the bleeding in 69 patients (86.2%) during the first examination. Angiography and scintigraphy revealed the haemorrhage in 8 (53%) and 7 (77.7%) cases, respectively. Ten cases were treated during colonoscopy; 31 underwent surgery. We consider an emergency colonoscopy as the first method for diagnosing the causes of bleeding. If this examination fails we consider arteriography and scintigraphy as second-line approaches for obtaining a diagnosis.

Adult↗

PubMed2002

Colorectal cancer screening in asymptomaic adults: comparison of colonoscopy, sigmoidoscopy and fecal occult blood tests.

BACKGROUND AND PURPOSE: Fecal occult blood tests (FOBT) and flexible sigmoidoscopy have previously been recommended for colon cancer screening. More recently, studies have recommended colonoscopy due to the high rates of advanced neoplasm not detected by FOBT and sigmoidoscopy. Previous studies of the effectiveness of colonoscopic screening in Taiwan were limited to families of patients with colorectal cancer. This study compared colonoscopy, sigmoidoscopy and FOBT for colorectal cancer screening in asymptomatic adults. METHODS: Screening colonoscopies and FOBT were performed in asymptomatic adults enrolled in our health-screening program between January 1997 and December 2000. Advanced neoplasm was defined as the presence of a polyp larger than 1 cm, polyps with villous or severe dysplastic features, or cancer. The junction of the splenic flexure and descending colon was defined as the boundary of the proximal and distal colon, and it was presumed that the distal colon would be examined using sigmoidoscopy in all patients. Data on the prevalence of polyps, advanced neoplasm, and cancer among different age groups were obtained. The results of chemical and immunologic FOBT were compared. The anatomic distributions of advanced neoplasm and cancer were analyzed. RESULTS: A total of 7,411 colonoscopic examinations were included in the analysis. Advanced neoplasms were present in 93 examinations (1.3%), including 16 cancers (0.2%). Chemical FOBT detected 20.2% of advanced neoplasms and 37.5% of cancers. Immunologic FOBT detected 48.3% of advanced neoplasms and 87.5% of cancers. If sigmoidoscopy had been performed in place of colonoscopy, 26.9% of advanced neoplasms and 12.5% of cancers would not have been detected. CONCLUSIONS: Colonoscopy can detect neoplastic lesions undetectable by FOBT and sigmoidoscopy in asymptomatic subjects. These results suggest that colonoscopy should be the method of choice in colon cancer screening.

Adult↗

PubMed2006

[Indications for colonoscopy examination and its disease distribution: a report of 5690 cases].

OBJECTIVE: To explore the indications for colonoscopy examination and the distribution of diagnostic diseases. METHOD: From Jan. 2000 to Dec. 2004, 5960 patients received colonoscopy examination in our colorectal center. The indications for colonoscopy examination and the distribution of its diagnostic diseases were analyzed. RESULTS: There were 3096 males and 2594 females,and the mean age was (52+/-15) years. The reasons for colonoscopy included hemafecia (26.9%), atypical abdominal pain (25.8%), diarrhea or increased frequency of stool (11.1%), anal tenesmus or discomfort (7.6%), constipation (7.0%),mucous or bloody purulent stool (3.0%), intra-rectal mass or abdominal mass on physical examination (0.9%), re- examination after colonoscopic polypectomy (10.9%), re-examination after operation for colorectal cancer(1.5%), simple health examination (2.2%). Colonoscope reached the cecum in 97.7% of the cases,and at least one disease was found in 2283 cases (40.1%). Among them,colorectal cancer accounted for 10.3%, colorectal polyps 19.6%, ulcerative colitis 4.3%, and Crohn's disease 0.5% respectively. CONCLUSION: The indications for colonoscopy are too strict to screen the early stage colorectal cancer. Colonoscopy should be performed in the cases with symptoms such as bloody stool, diarrhea, abdominal pain, constipation, or with colorectal polyps, after operation for colorectal cancer,or as members of hereditary colorectal cancer family.

Adolescent↗

PubMed1989

[Value of preoperative colonoscopy in colon-rectal neoplasms].

The surgical approach to treat colo-rectal carcinoma is usually based on the findings of barium enema. In 102 patients we reviewed the yield of pre-operative colonoscopy. Barium enema revealed the cancer in 76 of 84 patients (91%), whereas colonoscopy did so in 96 of 102 subjects (94%). In addition, 5 associated cancerous lesions were demonstrated by colonoscopy and none by barium enema. Associated benign lesions were seen in 14 patients. In 5 patients the surgical plan based on the barium enema was modified by the findings at colonoscopy. Eight false negatives to barium enema were correctly diagnosed by colonoscopy. We conclude that colonoscopy yields valuable information, beyond that of barium enema, in patients with colo-rectal cancer.

Adult↗

PubMed1988

Colonoscopy in the diagnosis and management of colorectal neoplasia in a DGH.

Patients presenting to a district general hospital (DGH) with colorectal neoplasms have been studied before and after the introduction of a colonoscopy service, in order to investigate the diagnostic, therapeutic and economic benefits of performing colonoscopy in preference to sigmoidoscopy and double contrast barium enema (DCBE). Colonoscopy led to a 3-fold increase in the incidence of colonic polyps, and 22% of all adenomas showed worrying features. Severe dysplasia and malignancy was seen most frequently in large adenomas (greater than 2 cm), and in those with a villous component. Laparotomy was avoided in 31 patients with proximal polyps, giving colonoscopy an added therapeutic and economic advantage over sigmoidoscopy and DCBE. Colonoscopy was used less frequently to detect colonic carcinomas, as over half of these were rectal, or presented as emergencies. These findings confirm the value of performing colonoscopy in patients who present with colorectal symptoms.

Adenoma↗

PubMed1985

A comparison of colonoscopy and selective visceral angiography in the diagnosis of colonic angiodysplasia.

The results of selective visceral angiography and colonoscopy were compared in the diagnosis of angiodysplasia of the large bowel. Fifty six patients were diagnosed as having angiodysplasia on angiography and 34 of these patients also underwent colonoscopy. Twenty three of the colonoscopies were positive giving a diagnostic yield of 68%. Three colonoscopies were negative and eight were incomplete. Colonoscopy was useful in the diagnosis of concomitant disease and also provided the clinician with the therapeutic possibility of electrocoagulation. Colonoscopy at operation proved to be a valuable technique in assessing the extent of angiodysplasia prior to resection.

Adolescent↗

PubMedDate not supplied

Selective sedation for colonoscopy.

A study of selective sedation for colonoscopy was conducted in two parts. All procedures were performed by one experienced colonoscopist. In the first phase, 41 patients received intravenous sedation before colonoscopy and were then prospectively randomized to either a "not-reversed" group, which did not receive flumazenil before withdrawal of the colonoscope, or to a "reversed" group, which received flumazenil before colonoscope withdrawal. None of the 20 patients reversed and 1 of the 21 patients not reversed experienced pain during the withdrawal phase of colonoscopy. Sixty percent of patients in the reversed group and 10% in the not-reversed group remembered the colonoscopic findings being explained during the procedure. Ninety percent and 81% of patients in the reversed and not-reversed groups, respectively, expressed a preference to be awake to watch the withdrawal of the colonoscope. In the second phase of this study, 40 patients underwent colonoscopy without prior intravenous sedation. Sedation was given only if pain was experienced during the procedure. Thirty percent had no pain at all, 55% minimal pain, 8% moderate pain, and 3% severe pain. Twenty-three percent required intravenous sedation, whereas 78% did not receive any sedation. Ninety-three percent were willing to undergo another colonoscopy without prior sedation. Only 8% preferred prior intravenous sedation before any future colonoscopy.

Adult↗

PubMed1994

Low-cost, office-based, screening colonoscopy.

OBJECTIVES: Performing full colonoscopy at regular intervals and removing lesions at an early stage might significantly lower the incidence and mortality of colorectal cancer. Such a program must be inexpensive, safe, and time-efficient. METHODS: Screening colonoscopy was performed on 639 patients. For a normal examination, the physician's time is limited to giving the medication for conscious sedation, performing the colonoscopy, and completing a written report form. The total charge for a normal screening colonoscopy is $150. RESULTS: Adenomatous and/or hyperplastic polyps were detected in 218 patients (34.1%). One hundred sixty adenomatous and 134 hyperplastic polyps were removed. Forty-eight percent (48.1%) of the adenomatous and 21.6% of the hyperplastic polyps were above the sigmoid colon. Six adenocarcinomas were detected in five patients. One patient had a delayed bleeding episode requiring no transfusion or therapeutic intervention, and one patient had a "post-polypectomy syndrome" requiring no therapeutic intervention. The average physician time in the endoscopy room for normal examinations was 18 min. CONCLUSIONS: Screening colonoscopy can be safely performed in an office facility. Physician time with the patient should be limited to allow a low cost that compares favorably with screening costs for other malignancies. Long-term studies to assess the capability of screening colonoscopy to lower mortality from colorectal cancer should continue.

Adenocarcinoma↗

PubMed1996

Colonoscopy evaluations: justification by cost?

The type of colonic imaging (radiological vs colonoscopic) for evaluating symptomatic patients without evidence of bleeding in both an efficacious and cost-conserving manner has become a very debated issue. In a randomized, controlled clinical trial, the authors hoped to examine the prevalence of neoplasm and the effectiveness and cost-effectiveness of initial diagnostic strategies of colonoscopy versus flexible sigmoidoscopy and air contrast barium enema in patients without evidence of intestinal bleeding. One hundred forty-nine patients over the age of 40 with symptoms suggestive a colonic disease without evidence of bleeding (no hematechezia, negative test for fecal occult blood, and normal serum hemoglobin) were randomized to undergo either initial colonoscopy or flexible sigmoidoscopy plus barium enema. Patients with incomplete lower GI tests were referred for the corresponding alternative imaging modality. Cost analyses using sensitivity analysis were performed. Baseline information with respect to age, race, sex, inpatient status, reason for referral, mean weight loss, hemoglobin, blood urea nitrogen, and albumin were similar in both groups. Eighteen patients (24%) who initially received air contrast barium enema and flexible sigmoidoscopy then required colonoscopy, whereas only five patients (6%) who initially underwent colonoscopy first required air contrast barium enema plus flexible sigmoidoscopy. The study found that: a) The prevalence of cancer in the study was low (one of 149 patients); b) initial colonoscopy detected more persons with adenomas than that of air contrast barium enema plus flexible sigmoidoscopy (23 of 75 patients vs 13 of 74 patients, odds radio, 2.07, CI,0.90-4.92; this approached significance); and c) air contrast barium enema plus flexible sigmoidoscopy detected more diverticulosis (46 of 74 patients vs 31 of 75 patients, odds ratio, 0.41, 95% CI, 0.21-0.87). The significant conclusions were that patients undergoing flexible sigmoidoscopy plus air contrast barium enema were more likely to undergo alternative procedures and that sensitivity analysis suggested that, for most areas in the United States, initial colonoscopy would be more cost-effective for the outcome of detection of adenomas (1).

Barium Sulfate↗

PubMedDate not supplied

A comparative study of double contrast barium enema and colonoscopy for evaluation of rectal bleeding in children.

In pediatric age group, rectal bleeding is both common and distressing. Unlike in adults, very few studies comparing diagnostic efficacy of double contrast barium enema (DCBE) and Colonoscopy are available in children. A prospective study was performed to compare the diagnostic accuracy of high quality DCBE against colonoscopy in children with overt rectal bleeding. Fourty four children underwent flexible colonoscopy and DCBE independently. The final diagnosis was made after considering all investigations. Against this gold standard, the sensitivity and specificity of DCBE were 66.66% and 100% while that of colonoscopy 74.35% and 100% respectively. When assessing polypoidal lesions of colon, diagnostic yield of enema study was 86.20% as compared to 72.41% with colonoscopy. In colitis cases, the similar figures for enema and endoscopy were 53.84% and 76.92% respectively. The observed differences were statistically insignificant. No significant preparation, premedication or procedure related complications were encountered. The study thus highlights the utility and complementary role of DCBE and colonoscopy for evaluation of children with rectal bleeding.

Barium Sulfate↗

PubMed1997

Colonoscopy performed by a family physician. A case series of 751 procedures.

BACKGROUND: Colonoscopy, including biopsy and polypectomy, is a procedure not commonly performed by primary care physicians. The purpose of this research was to present a large case series of colonoscopic procedures performed by a family physician in a rural practice. METHODS: A chart review of every colonoscopy procedure performed by a family physician over a 7-year period determined the demographic characteristics, indications, findings, and complications for each procedure. RESULTS: A total of 751 colonoscopies were performed on 555 patients (347 women and 208 men), with a mean age of 53.8 years. In 91.5% of procedures, the cecum was intubated. The most common indications for colonoscopy were bleeding (49.9%), polyp follow-up (20.9%) abdominal pain (11.7%), diarrhea (11.6%), and abnormal findings on flexible sigmoidoscopy (8.4%). Three hundred sixteen benign polyps were discovered and removed by either biopsy or polypectomy. There were 184 adenomatous colorectal polyps found in 134 (17.8%) colonoscopies. Of these 184 adenomatous polyps, 106 (58%) were potentially within reach of the flexible sigmoidoscope. Only three adenocarcinomas were discovered during the entire study period. There was only one major procedural complication: a patient experienced blood oozing from a polypectomy stump; cautery stopped the bleeding, and the patient was hospitalized overnight, with no further intervention or transfusion required. There were five other self-limited complications, including adverse reactions to sedation and infiltration at the intravenous site. CONCLUSIONS: Colonoscopy with polypectomy that was safely and competently performed in a solo rural practice adds to the evidence that experienced family physicians can provide this important service to their community.

Adenocarcinoma↗

PubMed1975

Comparison of colonoscopy and the contrast enema in five hundred patients with colorectal disease.

Endoscopic examination of the entire colon (colonoscopy) is an important new method of diagnosis and treatment of diseases of the colon and rectum, particularly cancer. The records of 500 patients who had one or more contrast enemas and subsequent colonoscopy were analyzed in an attempt to evaluate the competitive and complementary features of the two methods. The endoscopists had the advantage of having a radiologic report or radiographs available to them. In general, when the level of abnormality could be reached, colonoscopy had a higher degree of accuracy, particularly since observation could be combined with biopsy. This was particularly true in the case of polyps in which colonoscopy confirmed 166 radiologically described growths plus an additional 118 lesion, twenty-one of which were over 1 cm in diameter. By endoscopic excision of these polyps via the colonoscope, malignant changes can be identified, a conclusion rarely reached by radiographic means alone. With respect to cancer, exclusive of polyps, only twenty-four of thirty-two cases were diagnosed by x-ray study alone. Another nine, interpreted aa demonstrating malignancy from the radiographs, had cancer excluded when subjected to endoscopic confirmation. Colonoscopy has also proved valuable in identifying lesions of the cecum, notoriously a problem for the radiologist, and in identifying milder degrees of inflammatory change which are undetectable by radiographic means. Colonoscopy and the contrast enema are best reported as completmentary rather than competitive approaches, and by their combined use, diagnostic accuracy is greatly enhanced.

Barium Sulfate↗

PubMed2001

Risk factors predictive of positive findings at colonoscopy(1).

PURPOSE:The surgery department at our institution has become the primary provider of colonoscopy. We sought to determine which risk factors, if any, were most predictive of positive findings on colonoscopy.Between March and December 1999, 202 consecutive patients referred for colonoscopy were identified. Each patient was interviewed and a standard questionnaire completed before colonoscopy to establish possible risk factors for the presence of colorectal cancer or polyps. The colonoscopy findings, including pathology reports, were correlated with the questionnaire and subjected to chi-square analysis to determine statistical significance.The risk factors most likely to be associated with a finding of colorectal cancer or polyp were family history of colorectal cancer (65%), bleeding (65%), fecal occult blood positive (64%), abdominal pain (60%), and alteration of bowel habits (53%).No risk factor by history or presenting symptoms reached statistical significance as an independent predictor of a positive colonoscopy finding. However, most frequently associated with positive colonoscopy findings were a family history of colorectal cancer, bleeding, positive fecal occult blood test, presence of abdominal pain, and alteration of bowel habits. A history to include these risk factors can serve to prioritize the need for a colonoscopic examination.

Journal Article↗

PubMed2002

[Virtual colonoscopy].

Colorectal cancer is a leading cause of cancer death in the western world. Virtual colonoscopy is a new method for 2-D and 3-D imaging of the colon, using a multislice helical CT technology. This method has already demonstrated excellent results in polyp and cancer detection, having similar accuracy to endoscopic colonoscopy in the detection of polyps above 6 mm in size. The major application of this novel technique is in diagnosing cases where conventional colonoscopy fails to demonstrate the entire colon due to technical problems. The second important application is to investigate the colon proximal to an obstructing tumor, where both barium enema and colonoscopy cannot overcome the obstruction. The possibility of widespread application remains in evaluating the use of virtual colonoscopy in a purely screening population. Further developments, including stool tagging, computer aided detection of polyps and faster scanners will contribute to accuracy and patient compliance with widespread use of virtual colonoscopy. This examination may dramatically improve population participation in screening programs and play a major role in minimizing the impact of colorectal cancer.

Colonic Polyps↗