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PubMedDate not supplied

Colonic preparation correlates with fasting breath hydrogen in patients undergoing colonoscopy.

BACKGROUND/AIMS: Fasting breath hydrogen has been reported to be low after fasting and polyethylene glycol ingestion. However, the relationship between fasting breath hydrogen and colonic preparation for colonoscopy has not been studied before. We evaluated fasting breath hydrogen in patients undergoing colonoscopy and correlated it with the quality of colonic preparation. METHODOLOGY: One day before colonoscopy, the patients ingested clear liquid diet and starting in the afternoon the day before colonoscopy they drank polyethylene glycol 8oz every 10 minutes for 3 hours. They fasted overnight. Fasting breath hydrogen was measured using an EC 60 gastrolyzer. Colonic preparation was rated as excellent, fair or poor. The colonoscopic findings were noted. RESULTS: There were 69 male patients. 89% had excellent or fair colonic preparation (Group A) 11% had poor preparation (Group B). Fasting breath hydrogen in Group B patients 14.5 +/- 1.5 ppm was significantly higher compared to that in Group A patients 2.2 +/- 0.2 ppm (p < 0.005 t-test). In other respects the two groups were similar. CONCLUSIONS: Patients undergoing colonoscopy after polyethylene glycol ingestion who have poor colonic preparation have higher fasting breath hydrogen compared to those who have excellent/fair colonic preparation. The clinical implication of this observation is discussed.

Aged↗

PubMed2003

[The value of using fluoroscopy during colonoscopy. A prospective randomized study].

INTRODUCTION: No randomised trials have estimated the value of using fluoroscopy for colonoscopy. The aim of our study was to estimate the rate of success using this method. MATERIAL AND METHODS: In a prospective trial 264 patients were included, 139 were examined without fluoroscopy-equipment (Group A), and 125 with fluoroscopy-equipment (Group B). We registered: Indication for colonoscopy, duration of the colonoscopy, medication, time in which X-ray was being used, whether coecum was reached or not, clinical results of the examinations and complications. In cases where coecum was not intubated the cause was registered. RESULTS: We found a significantly higher rate of success of the colonoscopy in Group B (84%) than in group A (74%) (p = 0.045). Pain and looping of the scope were the main reasons for insufficient examination. DISCUSSION: In a modern endoscopic ward fluoroscopy must be available, but it seems reasonable to start uncomplicated colonoscopies without the use of fluoroscopy. In cases where coecal intubation is not obtained, conversion to examination with fluoroscopy should be possible.

Adult↗

PubMed1992

Colonoscopy: a prospective report of complications.

Patients (N = 2,097) undergoing ambulatory office colonoscopy were followed to determine the incidence of endoscopic complications. In this group, 1,320 patients had diagnostic colonoscopy with or without biopsy; 777 patients had 2,019 polyps removed. Three of 2,097 patients (0.1%) had transient hypotension requiring i.v. fluid resuscitation and oxygen administration. All patients went home without sequelae. Acute postpolypectomy bleeding occurred in 11 of 777 patients (1%) requiring acute management; bleeding was controlled during colonoscopy in all. Postpolypectomy syndrome occurred in 9 of 777 patients (1%). All patients were treated medically. Late postpolypectomy bleeding occurred in 15 of 777 patients (2%). Perforation occurred in two of 777 patients (0.3%), at 1 and 9 days postpolypectomy. Both patients underwent surgery with uneventful recoveries. We conclude that office colonoscopy including polypectomy is safe. The overall complication rate for therapeutic ambulatory colonoscopy was 5%, with major events requiring hospitalization in 2% of patients.

Adolescent↗

PubMed2004

[Comparison of technical aspects of colonoscopy in various gastroenterologic centres].

There are ongoing multicenter European trials analyzing, among other factors, technical aspects of colonoscopy in various countries. The aim of the study was to compare the techniques of preparation and performance of colonoscopy in the Department of Gastroenterology at Medical University of Silesia in Katowice and other gastroenterology centers throughout Europe. The trial was conducted between January 1st 2001 and May 30th 2001 in 18 centers in 9 European countries. 307 consecutive patients, who signed consent forms, were recruited in Katowice, while 5697 patients were enrolled in other centers. The data were collected in a dedicated sheet, prepared in the coordinating center in Lausanne (Switzerland). The part concerning methods of bowel preparation was filled in before colonoscopy and the remaining questions (sedation, number of persons involved, duration, completeness, diagnosis, complications) were answered after the procedure. The data from all centers were analyzed in Lausanne and the results were sent back to the participants. The comparison of results from Katowice and other centers was performed in Katowice. We found out, that the type of cleansing the gut did not influence the quality of bowel preparation. Colonoscopy was performed under deep sedation (in the presence of anesthesiologist and anesthesiology nurse) more frequently in Katowice than in other centers. Differences between Katowice and the rest of centers in the other technical aspects of colonoscopy were of minor importance.

Adult↗

PubMed2004

Yield of colonoscopy in children with rectal bleeding.

OBJECTIVE: Rectal bleeding is a common complaint in children and is the most common indication for colonoscopy. The aim of this study is to report the yield of this procedure in children. METHODS: Analysis of the medical records of all children below 18 years of age, who underwent colonoscopy from 1993 to 2002, in King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia for the evaluation of rectal bleeding. RESULTS: Eighty-nine children presented with bleeding per rectum, accounting for 49% of the indications for colonoscopy. The majority (92%) was Saudi nationals, the age range was from 5 months to 18 years, and the male to female ratio was 1.1: 0.9. There were 22 children between 0-12 years and 35 between 13-18 years. The overall yield of colonoscopy was 57/89 (64%); however, the yield was slightly better 22/32 (69%) for children 0-12 years. In a subset of children (22 patients, 21 of them were in the age group 0-12 years) where rectal bleeding was associated with diarrhea, the yield was 22/23 (97%). The causes of bleeding per rectum are presented in the table indicating that colitis was the most common cause 30/57 (36%), followed by polyps in 15 (27%); whereas rectal ulcers, chronic anal fissures and hemorrhoids accounted for 5% each. However, age-related analysis shows that colitis occurred more commonly in older children and polyps were found almost with equal frequency in both age groups. CONCLUSION: The diagnostic yield of colonoscopy is very high especially in children presenting with bloody diarrhea.

Adolescent↗

PubMedDate not supplied

Colonoscopy as a screening test for colorectal cancer.

Colonoscopy is the current gold standard for the diagnosis and treatment of colorectal neoplasms. Several gastroenterological and/or endoscopical societies recommend screening by colonoscopy in high risk patients for colorectal cancer whilst for average risk patients colonoscopy remains a valid option. In some countries screening colonoscopy is now covered by medical insurance. It is also the final common pathway of all colorectal cancer screening methods. This paper addresses the advantages and also limitations of colonoscopy as the first procedure for colorectal screening and emphasizes the importance of organized training and continuous assessment of competence of gastroenterologists and the necessity to have quality control audits of the endoscopy units.

Age Factors↗

PubMed2005

[Localization of colonic tumor in laparoscopic surgery. Intraoperative colonoscopy or preoperative tattoo].

INTRODUCTION: Tumor localization may be critical in laparoscopic surgery because manual palpation may not be possible. This study focused on the need for intraoperative colonoscopy to identify the tumor site. We also present our preliminary experiences with preoperative tattoo of the resection site. MATERIALS AND METHODS: A prospective, consecutive, consecutive study of 61 patients operated on laparoscopically for colonic tumor together with 9 patients with preoperative tattoo of the resection site (5 laparoscopic and 4 open operations) was done. RESULTS: Intraoperative colonoscopy was necessary to identify the tumor site in 23% of the 61 patients without preoperative tattoo. Tumor grading and localization in this group did not differ from that in the group where colonoscopy was not needed (p>0.05). The median operation time was significantly longer in the group in which intraoperative endoscopy was performed (p<0.05). The preoperative tattoo caused no complications, and the tattoo was visible in all 9 patients intraoperatively. DISCUSSION: Almost one fourth of the patients operated on laparoscopically for colonic tumor needed intraoperative colonoscopy to identify the tumor site. This impeded the laparoscopic operation, prolonged the operation time and increased the potential risk for infectious complications. Preoperative tattoo, which renders intraoperative colonoscopy superfluous, should therefore be considered for all patients operated on laparoscopically for colonic tumor, as it is difficult to determine in advance the patients in whom the tumor site will be hard to identify intraoperatively.

Adenocarcinoma↗

PubMed2005

Assessment of the quality of colonoscopy in Romania.

We performed a national prospective multicentric study in order to assess the quality of colonoscopies performed in Romania. Between the 1st and 30th of November 2004, we performed a questionnaire-type study with regard to the practice of colonoscopy, addressed to all the centers in Romania known to perform digestive endoscopy. Thirty centers responded to our questionnaire, resulting in a number of 2,559 colonoscopies that were performed in Romania during the month of November (a mean of 85 colonoscopies/center/month). The percentage of cecal intubations performed nationwide was 70.5%, 74.1% in university hospitals, as compared to nonuniversity ones (64.6%) (p=0.000027). Regarding sedation during colonoscopy, in 46% of the cases the colonoscopy was performed without sedation and in 54% of the cases with sedation (or sedo-analgesia).

Colonic Neoplasms↗

PubMed2006

[Is gastric cancer a new indication for surveillance colonoscopy? Colon cancer is increased in gastric cancer patients].

BACKGROUND/AIMS: It has been reported that the risk of gastric polyp is increased in various colonic polyposis syndromes or in series of patients with sporadic colonic polyps. However, there are only a few large case controlled studies of colon cancer incidence in gastric cancer patients who underwent colonoscopy. The aims of this study were to determine the incidence of colorectal neoplasm and to evaluate the necessity of colonoscopic surveillance in patients with gastric cancer. METHODS: We performed colonoscopy in 105 patients with gastric cancer who agreed to undergo colonoscopy before or after 6 months from gastric resection between January 2002 and December 2004 in Kangbuk Samsung hospital. As a control group, 269 consecutive, age and sex matched patients without gastric neoplasm on gastroscopy who underwent colonoscopy within 6 months for the evaluation of various gastrointestinal symptoms during the year 2004 were included. Endoscopic reports and pathological results were reviewed retrospectively. RESULTS: In the patient group, adenomatous polyps were diagnosed in 24/105 patients (22.9%) and colorectal adenocarcinoma in 10/105 patients (9.5%). In the control group, adenomatous polyps were diagnosed in 78/269 patients (29.0%) and colorectal adenocarcinoma in 2/269 patients (0.7%). The incidence of colorectal adenocarcinoma between the patient group and control group showed significant differences (odds ratio 11.04, p=0.003). CONCLUSIONS: The risk of colorectal adenocarcinoma increases significantly in patients with gastric cancer. We suggest that the patients with gastric cancer might carry a high risk for colorectal cancer whom require surveillance colonoscopy.

Adenocarcinoma↗

PubMed1992

A prospective study of bidirectional endoscopy (colonoscopy and upper endoscopy) in the evaluation of patients with occult gastrointestinal bleeding.

UNLABELLED: One hundred patients with occult gastrointestinal bleeding (OGIB) (i.e., guaiac-positive stools and/or iron deficiency anemia) were prospectively evaluated with bidirectional endoscopy [upper endoscopy (EGD) and colonoscopy] to determine the origin of occult bleeding. Predetermined criteria were used to prospectively define gastrointestinal bleeding sources. Among the 58 males and 42 females, the median age was 65 yr. Thirty-one percent of the group had gastrointestinal symptoms. Sixty-six percent of the study group were inpatients. Bidirectional endoscopy detected the source of OGIB in 53% of patients, with a positive finding on EGD of 36%, and with colonoscopy, of 26%. In only 9% of patients was a source of OGIB detected on both EGD and colonoscopy. Acid peptic disease accounted for the source of OGIB in 27%, colonic adenomas 14%, angiodysplasia 13%, colorectal carcinoma 6%, and gastric cancer in 1% of patients. The diagnostic yield was significantly higher with EGD than with colonoscopy in patients with anemia and guaiac-positive stools (45% vs. 26%, p less than 0.01). Upper endoscopy directed a change in patient management in 29 patients. IN CONCLUSION: for the patient population described in this study, bidirectional endoscopy determined the source of OGIB in 50%. As expected, colonoscopy resulted in a higher cancer detection rate than EGD--yet EGD detected the origin of OGIB in 68% (36/53) of patients found to have an occult bleeding source, and resulted in a therapeutic initiation or a change in therapy for 30% of all patients.

Aged↗

PubMed1990

[The effect of various cleansing methods for total fiber optic colonoscopy].

It is a fact that there are recent increasing trends of incidence of the colorectal carcinoma among other colorectal diseases. In such trend, the early detection remain to be most important by the air contrast barium enema and total fiber optic colonoscopy There are several ways to prepare the colon for barium enema and fiber optic colonoscopy which include several agents. The mechanical cleansing have been used most frequently since Brown's method was adapted to be most perfect for colon cleansing. The ideal laxatives and enema solutions were limited to adequate dose, it's effectiveness, patient's diet and bowel habit, minimal side effect, low cost and simple to perform. In order to compare the effectiveness of various cleansing solutions, six experimental methods were formed as shown; 1. normal saline enema, 2. castor oil with normal saline enema, 3. castor oil with soapsuds enema, 4. magnesium citrate with normal saline, 5. magnesium citrate with soapsuds enema and 6. ingestion of Golyetly solution. The authors have compared and determined the degree of cleanliness by an experienced endoscopist The total number of patients was 247, age distribution was 43 +/- 15 years old, and sex distribution was 133 males and 114 females. The grade I and II represented no difficulties at performing the fiber optic colonoscopy+, but grade III and IV had some difficulties, even unable to perform the fiber optic colonoscopy. The effectiveness the cleansing agents, represented with grade I and II was 95.9% (47/49) in method 6, 93.2% (54/58) in method 2, 83.3% (30/33) in method 3, 70.0% (28/40) in method 5, 66.7% (16/24) in method 1, and 45.7% (18/40) in method 4. Method 2 and 6 were the most effective in normal bowel habit patients. In constipated patients, method 6 was the most effective and all method except method 4 were effective in diarrhea patients. The degrees of less mucosal irritation by various bowel cleansing method were in the order of method 6(100%), 1(100%), 5(74%), 2(69%). In subjective symptoms and cleansing groups, abdominal distension, pain, nausea and vomiting were complained, and that's subject symptoms were in the order of method 3(88.9%), 6(79.6%), 1(75%), 5(72.5%), 2(72.4%), 4(67.5%). In conclusion, we believe that the Golytely of the mechanical cleansing solution for fiber optic colonoscopy was the most effective, but others depended on the patient's condition and bowel habit.

Adult↗

PubMedDate not supplied

[The role of emergency colonoscopy in colorectal hemorrhage].

The diagnosis of lower intestinal hemorrhage usually follows the successive sequence: a) digital rectal examination, b) rectosigmoidoscopy, c) barium enema, d) colonoscopy. This latter method has proven to be the most sensitive. This study is a retrospective examination of the results obtained by emergency colonoscopy on the diagnosis and treatment of lower intestinal hemorrhage. Out of 1258 colonoscopy procedures performed between January 1983 and June 1988 in the Digestive Endoscopy Unit of our Institute, 44 (3.5%) were emergency procedures (within 48 hrs. after recovery) due to lower intestinal hemorrhage. The most frequent causes of hemorrhage found were the following: 1) hemorrhagic colitis (20.5%), 2) polyps (13.6%), 3) hemorrhoids (13.6%), 4) carcinoma (9.0%). The hemorrhagic source was not established in 9 cases (20.5%). The sensitivity of this method was therefore 97.2%. In 6 cases of hemorrhagic polyps treatment to stop bleeding was also possible by means of the colonoscopy (endoscopic polypectomy). In our experience, the emergency colonoscopy was found to be a highly sensitive diagnostic procedure for lower intestinal hemorrhages, permitting even definitive treatment of the lesion in 13.6% of cases with no complications associated with the technique. We feel therefore that, when available, it should be considered the first and foremost exam to be performed for emergency diagnosis of colo-rectal hemorrhages.

Adolescent↗

PubMed1989

Comparison of an orally administered gastrointestinal lavage solution with traditional enema administration as preparation for colonoscopy in dogs.

Forty dogs were randomly assigned to be given either multiple enemas (group A) or orally administered lavage solution (group B) before colonoscopy. Dogs of group A (n = 20) were given 3 large-volume warm-water enemas 6 hours apart, with the last enema given 9 to 15 hours before colonoscopy. Dogs of group B (n = 20) were given a total dose of 50 ml of the lavage solution/kg of body weight through an orogastric tube. The lavage solution was administered in 2 doses of 25 ml/kg given 1 hour apart, 12 to 18 hours before colonoscopy. Dogs were monitored for changes in body weight and in serum sodium, potassium, chloride, calcium, phosphate, urea nitrogen, creatinine, and total CO2 concentrations. Colonoscopy was performed on dogs under general anesthesia by an investigator blinded as to the method of preparation, and the quality of preparation was subjectively evaluated. The quality of colon preparation was significantly (P less than 0.005) better after administration of oral lavage solution, compared with that after multiple enemas. There were minimal changes in laboratory values, side-effects were minimal, and biopsy specimen artifacts were not seen. Because proper patient preparation is necessary for complete colonoscopic examination, results suggested that an orally administered polyethylene glycol-containing electrolyte solution is preferable to administration of multiple enemas in preparing dogs for colonoscopy.

Administration, Oral↗

PubMed1989

[Arrhythmia during endoscopic retrograde cholangiopancreatography (ERCP) and colonoscopy].

A group of 51 patients undergoing ERCP and 33 patients undergoing colonoscopy underwent additionally electrocardiography (ekg) by Holter method so as to define the frequency and character of rhythm disorders during the above examinations and the correlation between those disorders and coexisting circulatory system diseases. Besides, the author compared the percentage of ckg changes observed during ERCP and colonoscopy with the changes found during panendoscopy (described in the previous paper). Ekg monitoring by means of Oxford Medilog System apparatus started half an hour before fibroscopy and continued up to half an hour after the examination. In the ERCP premedication, just before endoscopy, the author made 2-3 spraying of 10% of lignocaine solution on the pharynx mucosa and half an hour earlier s.c. 10 mg of morphine with 1 mg of atropin sulphate. Patients undergoing colonoscopy were given (half an hour before the examination) 10 mg of diazepam with 20 mg noramidopyrin. The percentage of patients with circulatory system diseases was in the two groups similar and amounted to 31.4% (ERCP) and 33.3% (colonoscopy). In the statistical analysis the author used chi-square test, difference test, analysis of variances and standardization of the results by means of the direct method. The examinations made showed a significant increase in cardiac rhythm disorders during ERCP (in 70% of patients) and colonoscopy (in 70.9% of patients). During the examinations, the most frequent disorders were sinus tachycardia above 120/min., ventricular and supraventricular extrasystoles.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1989

Fluoroscopy in colonoscopy. Who is using it and why?

Use of fluoroscopy during colonoscopy has never been broadly assessed. A survey of 1,864 members of the Society of American Gastrointestinal Endoscopic Surgeons and the American Society of Colon and Rectal Surgeons was carried out to quantify the use of fluoroscopy and to elicit impressions regarding its capabilities, indications, and usefulness. After the establishment of the responding colonoscopist's training, experience, and other background data, impressions of fluoroscopy's role in many issues were obtained using a graded response system. Concluding the two-page survey were open-ended questions addressing the respondent's indications, contraindications, and rationale for using or not using fluoroscopy. Six hundred thirty-one colonoscopists responded. Seventy-five per cent never use fluoroscopy; the most frequently cited reasons were lack of need and inaccessibility of fluoroscopy. For many colonoscopists, fluoroscopy is unavailable (22%) or available outside of the usual endoscopy setting (44%). Fluoroscopy is used by 25 per cent of colonoscopists. Almost three quarters of this group have the capability of performing fluoroscopy in their colonoscopy unit. The indications for fluoroscopy varied with the frequency of its use; frequent users employ fluoroscopy to treat loops, to confirm cecal intubation, and to locate the instrument tip precisely. Infrequent users employ fluoroscopy to apply the sigmoid straightening overtube or because of prior failed colonoscopy. Impressions regarding the impact of fluoroscopy on learning, completing, and safeguarding colonoscopy were obtained. Most colonoscopists are satisfied without using fluoroscopy, although 65 per cent of nonusers believe it would improve colonoscopy performance if it were used. Ninety-two per cent of frequent users of fluoroscopy reported that they would feel significantly impaired without having the capability to perform fluoroscopy.(ABSTRACT TRUNCATED AT 250 WORDS)

Colonoscopy↗

PubMed1988

Therapeutic colonoscopy in the treatment of colonic pseudo-obstruction.

Colonic pseudo-obstruction has been recognized since Ogilvie described this disease in 1948. Metabolic, surgical, and medical causes have been implicated at various times. Treatment has included surgical decompression by cecostomy and colectomy. Successful nonoperative decompression by colonoscopy was first reported by Kukora and Dent in 1977. Since that report several authors have reported their results using this technique. Presented here is a series of nine patients with colonic pseudo-obstruction treated initially with colonoscopy. Patients presented with a variety of associated conditions, including post operative patients, orthopedic injuries, metastatic carcinoma, and an unusual case after a normal vaginal delivery. Eight patients responded well to colonoscopic decompression. One patient, the second in the series, was unable to be decompressed with colonoscopy and underwent a cecostomy under local anesthesia. Successive colonoscopy may be required to allow restoration of normal colonic function, as was the case in seven of our patients. One death occurred, due to unrelated causes. The authors have found colonoscopy to be a safe and reliable therapy for colonic pseudo-obstruction.

Adult↗

PubMed1995

Sensitivity, specificity, and predictive value of fecal occult blood testing (Hemoccult II) for colorectal neoplasia in symptomatic patients: a prospective study with total colonoscopy.

OBJECTIVES: To evaluate the specificity, sensitivity, and positive predictive value of fecal occult blood testing (FOBT) in symptomatic patients, with colonoscopy as the gold standard, and to assess the usefulness of FOBT as an ancillary examination in symptomatic patients for whom total colonoscopy is indicated. METHODS: We studied 439 consecutive patients who underwent Hemoccult II testing before total colonoscopy. RESULTS: The sensitivity, specificity, and positive predictive value for colorectal neoplasia (cancer and adenomatous polyps) was 76.5%, 56.7%, and 27.6%, respectively. The sensitivity, specificity, and positive predictive value for colorectal cancer were 69.2%, 73.2%, and 7.3%, respectively. CONCLUSIONS: The sensitivity, specificity, and positive predictive value of FOBT are difficult to estimate from screening programs, because Hemoccult-negative individuals do not undergo examination of the colon, and many of the Hemoccult-positive cases do not undergo total colonoscopy. With total colonoscopy serving as the gold standard, FOBT does not appear to be of much value as an ancillary examination in patients with symptoms potentially attributable to the lower gastrointestinal tract.

Adenomatous Polyps↗

PubMed1995

Flexible sigmoidoscopy or colonoscopy for colorectal screening: a randomized trial of performance and acceptability.

In a randomized clinical trail to assess acceptability, yields, costs, and unwanted effects of screening procedures, 232 subjects (137 with family history of colorectal carcinoma or adenoma, 95 without) were offered either flexible sigmoidoscopy or colonoscopy. Subjects with polyps found on sigmoidoscopy were followed up by colonoscopy. The two procedures were similar in compliance (65%) and yield (19% adenoma, 15% hyperplastic polyps). Polyps of either type were more common in those with a family history (prevalence: 41% compared with 24% without family history, p = 0.04). Costs per procedure were 60% lower for sigmoidoscopy, but follow-up colonoscopy reduced this cost advantage to 20% per subject. The subjects found the preparation for sigmoidoscopy easier, but the procedure more uncomfortable and embarrassing, as colonoscopy was performed under sedation. In this hospital-based study, colonoscopy was as acceptable to subjects, and only slightly more costly than sigmoidoscopy. Advantages of sigmoidoscopy would be greater for use outside hospitals and with less intensive follow up.

Aged↗