SEARCH · PubMed Health

Results for “Colonoscopy”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 523 records · Page 29Linked to original sources

PubMed1994

Complete colonoscopy: how often? And if not, why not?

OBJECTIVE: Colonoscopy completion rate is an easily measurable criterion of technical competency. Reporting of completion rates lacks uniformity, however, and few studies focus on colonoscopy completion alone. The purpose of this study is to establish criteria for consistency in the reporting of completion rates, so that colonoscopists are better able to use such reports to evaluate their own experience. METHODS: A prospective study of colonoscopy completion rate and reasons for incompletion was carried out for 2907 patients. Completion was defined as the colonoscope touching the end of the colon. Rates are reported as crude (all cases) and adjusted (excluding incompletions due to stool and disease). RESULTS: The crude completion rate was 93.6% and the adjusted rate was 98.8%. Reasons for incompletion were stool (n = 47), colonic disease (n = 97), and pain or tortuosity (n = 34). The crude completion rate was lower in women than in men (92.4% vs. 94.8%), lower in the very young (< 20 yr, 85.7%) and very old (> 80 yr, 88.9%), was < 90% in patients presenting with altered bowel habit, diarrhea, constipation, hemorrhage, inflammatory bowel disease, abdominal pain, or cancer, was only 53.8% in patients in intensive care units, was 84.1% in the author's first 127 cases, was lower in women post hysterectomy (92.8% vs. 98.3%), and was higher in patients who had had a colon resection [98.4% (right colectomy), 99.2% (left colectomy), 95.8% (intact colon)]. When adjusted rates were compared, most of those differences disappeared (except male vs. female, hysterectomy vs. no hysterectomy). CONCLUSIONS: Crude colonoscopy completion rates are affected by a number of factors that may make comparisons between colonoscopists difficult. The use of adjusted completion rates minimizes the effect of disease-related factors, allows completion rate to be a better reflection of technical ability, and may facilitate more uniform reporting of colonoscopy results.

Colonic Diseases↗

PubMed1993

[Midazolam and Meperidine for colonoscopy].

We studied the sedative, analgesic and amnesic effects of intravenous midazolam and meperidine for colonoscopy, and also compared patient's satisfaction, changes of vital signs, safety and complications with intramuscular meperidine during the colonoscopy. Two hundred and ninety-nine patients undergoing physical check-up were randomized to receive intramuscular meperidine 50 mg and Hyoscine-N-Butylbromide (buscopan) 20 mg (Group IM-MB, n = 57) or intravenous midazolam 0.05 mg/kg, meperidine 1 mg/kg and buscopan 20 mg (Group IV-MMB, n = 242) before colonoscopy. All patients were closely observed and arterial oxygen saturations (SaO2) were monitored with pulse oximeter in Group IV-MMB. The demographic data of both groups were similar. There were significantly more severe pain responses (grimacing, moaning, shouting for pain, abdominal rigidity and body moving during colonoscopy) in Group IM-MB (51%) than in Group IV-MMB (13%) (p < 0.01). In immediate procedure recall after recovery from medications, 39% of Group IM-MB remembered severe pain during colonoscopy and only 3% of Group IV-MMB did (p < 0.01). 92% of Group IV-MMB who felt satisfactory with the medications were significantly higher than 21% in Group IM-MB (p < 0.01). Both groups significantly increased in heart rate after the injection of medications (p < 0.01). Group IM-MB increased 15 +/- 18% and Group IV-MMB 61 +/- 28% with significant difference between groups (p < 0.01). This might be caused by meperidine, buscopan, and relative hypovolemia of patients. There were significant decreases in SaO2 in Group IV-MMB, mean 4.5 +/- 1.7% (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1996

[Complications of diagnostic and interventional colonoscopy].

The Wels General Hospital is a large teaching hospital where all endoscopies are performed by the staff of the First Department of Internal Medicine. The reports of 10,000 colonoscopies between January 1st, 1986 and February 15th, 1994 were scrutinized by the authors, 15 complications of diagnostic and therapeutic colonoscopies were identified. There were seven perforations and one ileus associated with diagnostic colonoscopy (8989 patients) and five bleeding episodes and two perforations after polypectomy (1609 polyps removed; 1011 patients). Four bleeding episodes after polypectomy were controlled endoscopically with circumlesional injection of adrenaline. One patient required emergency surgical treatment. All perforations were treated surgically. Two elderly patients with multimorbidity died after perforation and emergency surgery (peritonitis and pulmonary embolism being the respective causes of death). The frequency of perforation was 0.09% (9 of 10,000), the mortality rate was 0.02% (2 of 10,000), and the bleeding rate after polypectomy was 0.05% (5 of 10,000). The frequency of complications in relation to the experience of the physicians revealed that five of seven perforations associated with diagnostic colonoscopy occurred in the hands of less experienced endoscopists (doctors in training with less than 400 completed endoscopies). Life-threatening complications related to the performance of flexible fiberoptic colonoscopies are rare, especially during diagnostic procedures. As reported in the literature, our results show that the risks are greatest with relatively inexperienced physicians but are not entirely avoidable even with the most experienced endoscopists.

Aged↗

PubMed1997

[Emptying of colon prior to colonoscopy. A comparison between emptying using peroral polyethylene glycol-electrolyte and conventional emptying with dietary restrictions, laxatives and water lavage].

The purpose of the study was to compare the degree of bowel emptying at colonoscopy after preparation with either traditional water enema, dietary restrictions and laxatives or after oral lavage solution (Klean-Prep). Colonoscopy was performed in 104 patients over a two month period, 56 patients being allocated to the conventional preparation and 48 to Klean-Prep. The quality of bowel emptying was evaluated visually during endoscopy and by the proportion of incomplete colonoscopies. Bowel emptying was less satisfactory after Klean-Prep (p = 0.018) and seven incomplete colonoscopies resulted in contrast to two after conventional preparation. The results were obtained from a surgical department with a permanent small staff of motivated nurses preparing a huge number of patients for colonoscopy. No economic advantages could be demonstrated by the use of Klean-Prep.

Administration, Oral↗

PubMed1997

Colon cancer screening. Sigmoidoscopy or colonoscopy.

Colorectal cancer is a common neoplasia with high morbidity and mortality. With endoscopy it is possible to identify its precursor lesion, the adenoma, and early localized cancer. Early detection and removal of adenomas can reduce the incidence and mortality of this disease. Studies using fecal occult blood testing (FOBT) and sigmoidoscopy for screening asymptomatic patients demonstrate a reduction in mortality from colorectal cancer. Colonoscopy, however, has the highest yield for detecting polyps. Most authorities and organizations now recommend screening the asymptomatic population over age 50 for colorectal neoplasia. The estimated cost of colon cancer screening is well within the benchmark figure of $40,000 per year of life saved, which is considered by the government to be cost effective. Controversies still exist regarding which colon cancer screening strategy is the most sensitive, specific, acceptable to the population, and cost effective. The American Cancer Society recommends a combination of FOBT and flexible sigmoidoscopy, but some experts believe that a one-time colonoscopy at age 60 may be a more cost-effective method. If the costs of colonoscopy are reduced, it is more cost effective than other techniques. Colonoscopy also may help to stratify at-risk patients, and those with negative initial colonoscopy may not need further screening. Advances in molecular biology may provide markers for screening or identifying people who are at high risk for colorectal neoplasia. This development may allow screening to be directed at high-risk groups.

Colonic Neoplasms↗

PubMed1998

Advancing from flexible sigmoidoscopy to colonoscopy in rural family practice.

This paper describes the background, experience, training, and preceptorship of a rural family physician that culminated in provision of diagnostic and therapeutic colonoscopy to his patients. Initial training took place in a two-day continuing medical education course. Subsequent training consisted of one-on-one training in 11 colonoscopies and five polypectomies, correspondence, recommended readings, a one-on-one preceptorship, and telephone consultation. Training was provided by University of Tennessee faculty who were experts in the area of colonoscopy and polypectomy procedures. The outcomes of 250 consecutive colonoscopies performed by the rural family physician are documented here. Training requirements vary widely by professional organization and subspecialty. Some subspecialists have recommended as many as 100 supervised colonoscopies and 25 polypectomies as a minimum training requirement for hospital privileges. It is our contention that unnecessarily high training requirements add to educational costs and may restrict qualified rural physicians from providing these services.

Adolescent↗

PubMed1977

A comparison of colonoscopy and roentgenography for detecting polypoid lesions of the colon.

This study compares the effectiveness of the roentgen and colonoscopic examination of the colon for detecting polypoid lesions. We evaluated the findings in 64 patients with suspected or known polypoid lesions who received the same colon cleansing regimen for both examinations, and were studied by examiners of similar expertise. As in other studies, the endoscopist had the advantage of knowing the roentgen findings, and the colonoscopic findings were often taken to indicate whether or not a lesion was present. In about half the patients, however, a second roentgen examination, repeat colonoscopy, or surgical specimen provided additional information for scoring. For example, a filling defect of the same size and location on two roentgen examinations, but not demonstrated at colonoscopy was scored as a false negative colonoscopic finding. The study results indicate that 54% of small polyps less than or equal to 0.9 cm in size were missed on roentgen examination, whereas no proven misses for lesions of this size were shown for colonoscopy. This absence of colonoscopic false-negative findings for small polyps, however, may be partially explained by a relative insensitivity of the roentgen method. For larger lesions greater than or equal to 1.0 cm in size the miss-rate for the two examinations was similar: 15% for roentgen examination and 12% for colonoscopy. We conclude: (1) Colonoscopy is a more sensitive method than roentgen examination for detecting small polyps of the colon, and (2) Performance of the two examinations may be comparable for demonstrating lesions 1.0 cm or larger in size.

Colonic Neoplasms↗

PubMed1998

Device for measuring the forces exerted on the shaft of an endoscope during colonoscopy.

Colonoscopy involves advancing a flexible endoscope into and along the entire length of the colon. The procedure can be painful and carries the risk of perforating the organ, yet very little is known of the forces involved. A device to measure the forces exerted on the endoscope during colonoscopy is described. The device features a handle designed in the shape of a hinged split cylinder that locks around the endoscope, gripping it tightly. The handle has two parts, an inner part that grips the endoscope, and an outer part that is gripped by the endoscopist. The two parts are joined together by members that transmit the forces through to the endoscope. One of the members incorporates strain gauges that measure the torque applied to the endoscope, as well as the push and pull forces. The handle can easily be unlocked and moved along the endoscope as the colonoscopy proceeds. The device is used to measure the forces applied to the endoscope during 11 routine colonoscopies, and summary results are presented. These are believed to be the first accurate measurements of the forces exerted during colonoscopy.

Colonoscopes↗

PubMed2002

Colorectal cancer screening: the potential role of virtual colonoscopy.

Virtual colonoscopy is a promising new technique that combines rapid spiral CT scanning of the abdomen with advanced computer programs capable of re-creating two- and three-dimensional views of the colon and rectum. Recent studies comparing this method with conventional colonoscopy show that virtual colonoscopy already is more accurate than barium enema X-ray studies for the detection of colorectal polyps, and that it approaches the accuracy of colonoscopy for diagnosing advanced lesions. Before virtual colonoscopy can be promoted for population-based screening for colorectal cancer, a number of issues discussed in this review need to be addressed. These include questions of accuracy, availability, acceptability, and cost-effectiveness.

Colonography, Computed Tomographic↗

PubMed2005

Virtual colonoscopy: clinical application.

Virtual colonoscopy (VC), also known as computed tomography Colonography (CTC), is a non-invasive test for the examination of the colon based on volumetric, thin-collimation CT acquisition of a cleansed and air-distended colon. The technique is easy, less labour-intensive than barium enema and conventional colonoscopy, and is inherently safer. Several studies demonstrate the ability of VC in the detection of colonic neoplastic lesions, not only large carcinomas, but also polyps. Currently, the most widely accepted clinical indication is incomplete or unsuccessful colonoscopy, which may be the result of redundant colon, patient intolerance to the procedure, spasm not resolving even with the use of spasmolytics, obstructing colo-rectal cancer. VC is also used to detect cancer in frail and immobile patients to avoid sedation during colonoscopy or the turning required during barium enema. The use of VC in patients under surveillance following colo-rectal cancer surgery is under investigation. Further studies are necessary in order to assess the cost-effectiveness of this approach. For colo-rectal cancer screening, a practical approach is to consider VC as a currently credible alternative screening method and as a reasonable alternative to the other colo-rectal cancer screening tests when a patient is unable or unwilling to undergo conventional colonoscopy.

Clinical Trials as Topic↗

PubMed1995

Does routine intravenous glucagon administration facilitate colonoscopy? A randomized trial.

BACKGROUND: Previous studies on the routine use of glucagon in colonoscopy have produced conflicting results. METHODS: Two separate studies were performed. In one study (Study 1), 80 consecutive patients were randomized after cecal intubation to receive 1 mg glucagon (n = 41) or placebo (n = 39), intravenously, in double-blind fashion. In a second study (Study 2) 90 sedated patients undergoing colonoscopy were randomized to receive 1 mg glucagon (n = 46) or placebo (n = 44), intravenously, just before colonoscope insertion. In each study, colonoscope insertion and withdrawal time, therapeutic intervention time, the presence and severity of colonic spasm, colonoscopy yield, and side effects were recorded. RESULTS: Mean withdrawal time in Study 1 was similar in those receiving glucagon (6.85 min) and in those receiving placebo (6.92 min). Mean insertion time in Study 2 (5.07 min) was identical between groups. Spasm scores and colonoscopy yield did not differ between glucagon and placebo in either study. There was a trend toward more side effects (nausea and vomiting) with glucagon in Study 1. Glucagon did not facilitate insertion or withdrawal in the subset of patients with diverticulosis. CONCLUSIONS: Routine use of intravenous glucagon in a dosage of 1 mg does not facilitate colonoscopy by experienced examiners.

Adult↗

PubMed2005

Virtual reality colonoscopy simulation: a compulsory practice for the future colonoscopist?

BACKGROUND AND STUDY AIM: As for any manual procedure, the learning curves for medical interventions can have undesirable phases, occurring mostly in the early experience of applying a technique. There have been impressive advances in endoscopic procedures during recent years, and there is an emerging trend that the number of procedures is increasing in parallel with these. In addition, the introduction of screening programs for colorectal cancer will also increase the numbers of procedures needed. Recent developments in medical simulation seem promising with regard to the possibility of "training out" undesirable parts of the learning curve outside the operating room. The aim of this study was to investigate whether the use of the AccuTouch flexible endoscopy simulator improves the early part of the learning curve in colonoscopy training. METHOD: 12 endoscopy trainees, 10 surgeons and two medical gastroenterologists, all with experience in gastroscopy but with no specific colonoscopy experience, were randomly assigned to either simulator training or to a control group. They all received the same theoretical study package and the training group practiced with the AccuTouch colonoscopy simulator until a predefined expert level of performance was reached. All trainees performed their first ten individual colonoscopies described in detail in a separate protocol. RESULTS: Trainees in the simulator-trained group performed significantly better (P=0.0011) and managed to reach the cecum in 52% of their cases (vs. 19% in the control group), and were 4.53 times more likely to succeed compared with the controls. Additionally, there was a significantly shorter procedure time and less patient discomfort in the hands of the simulator-trained group. CONCLUSION: Skills acquired using the AccuTouch simulator transfer well into the clinical colonoscopy environment. The results of this trial clearly support the plan to integrate simulator training into endoscopic education curricula.

Adult↗

PubMed1975

The results of diagnostic colonoscopy in the management of unexplained bleeding from the rectum.

A consecutive series of 71 colonoscopies performed for unexplained bleeding per rectum is reported. All patients had had previous barium enema examinations reported as normal. In 26 colonoscopies lesions were detected; there were 12 cancers and 11 polyps. Twenty-five of these lesions were in the left colon. These findings illustrate the value of colonoscopy in supplementing the available radiological findings. The sighting of blood at sigmoidoscopy was associated with a lesion found on colonoscopy in most instances, whereas the presence of occult blood was associated with a lesion in very few. Colonoscopy should be considered prior to laparotomy in every case of unexplained blood in the stools.

Adenocarcinoma↗

PubMed2001

Colon cancer screening with virtual colonoscopy: promise, polyps, politics.

Virtual colonoscopy (CT colonography) promises to become a primary method for colorectal cancer screening and return radiologists to a major role in colon cancer prevention. Results from major centers in the United States show accuracy to be comparable to conventional colonoscopy for detection of polyps of significant size--that is, greater than 10 mm--with few false-positives. The advent of virtual colonoscopy has also heightened awareness of the natural history of colonic polyps, particularly in terms of identifying an appropriate target size for detection in colorectal screening programs. Small polyps (<10 mm) are often either hyperplastic on histology or are unlikely to progress to frank cancer in the patient's lifetime and are therefore of little clinical significance for the average adult. Thus, the rationale for detecting and removing each and every colonic polyp regardless of size has come under increasing scrutiny in the context of cost-benefit analysis of various test strategies for colorectal cancer screening. Virtual colonoscopy may allow patients to obtain reliable information about the status of their colonic mucosa noninvasively and thus make a more informed decision as to whether to proceed to conventional colonoscopy for polypectomy.

Colonic Polyps↗

PubMed2003

Detection of proximal adenomatous polyps with screening sigmoidoscopy: a systematic review and meta-analysis of screening colonoscopy.

BACKGROUND: The relative effectiveness of flexible sigmoidoscopy compared with colonoscopy to screen for colorectal cancer depends on the magnitude of the association between findings in the proximal and distal colon and the false-negative rate of screening sigmoidoscopy for proximal neoplasia. To address this, we performed a systematic review and meta-analysis of screening colonoscopy studies. METHODS: Published studies through July 31, 2000, of asymptomatic patients undergoing screening colonoscopy were identified from the MEDLINE database. We generated pooled estimates of the odds ratio for the association between findings in the distal and proximal colon and the prevalence of isolated proximal adenomatous neoplasia. RESULTS: Using the sigmoid-descending colon junction to identify the beginning of the distal colon, the pooled odds ratio for the association between distal adenomatous polyps and any proximal neoplasia was 2.40 (95% confidence interval [CI], 1.42-4.05). Diminutive distal adenomatous polyps were also associated with proximal neoplasia (odds ratio, 2.36; 95% CI, 1.30-4.29). Distal hyperplastic polyps were not associated with proximal neoplasia (odds ratio, 1.44; 95% CI, 0.79-2.62). The prevalence of isolated advanced proximal neoplasia in the 3 studies was 2%, 3%, and 5%. Using the sigmoid-descending colon junction to identify the beginning of the distal colon yields a pooled estimate of isolated proximal neoplasia of 16.3% (95% CI, 13.6%-19.1%). CONCLUSIONS: Distal adenomatous polyps, including diminutive distal adenomatous polyps, are associated with an increased prevalence of synchronous proximal neoplasia. Two percent to 5% of patients undergoing screening colonoscopy may have isolated advanced proximal neoplasia. Even more patients may have isolated nonadvanced proximal neoplasia.

Adenomatous Polyps↗

PubMed1999

Development and in vitro testing of a miniature robotic system for computer-assisted colonoscopy.

In this article we present a new concept for computer-assisted colonoscopy based on a miniature robot capable of propelling itself semiautonomously along the colon. The miniature robot is designed to perform the same functions as current colonoscopy systems-i.e., visualization and tissue sampling for biopsy-and exploits an innovative inchworm-like locomotion principle based on adhering to the colon wall by vacuum suction. The miniature robot is connected by a thin and flexible umbilical cable to an external control unit; this unit provides pneumatic actuation signals in the appropriate sequence to the miniature robot, and information on the robot's functioning to the endoscopist, who can either teleoperate or directly supervise its operation. A prototype colonoscopy system using this robot has been fabricated and tested in vitro, with promising results. The proposed concept has strong potential for further development, since miniaturization and functional integration of instrumentation and tools, together with computer assistance, not only make colonoscopy more acceptable, but can also open up a wide range of new applications in endoluminal diagnosis, therapy, and surgery.

Animals↗

PubMed1984

The use of colonoscopy in the study of synchronous colorectal neoplasms.

Over a 5-year period, 185 patients with primary colorectal carcinoma were studied by colonoscopy for synchronous neoplasms. Twenty-eight patients had incomplete examinations due to obstructing tumors, and 157 had total colonoscopy. Sixty patients (35.9%) had synchronous neoplasms, of which 43 (25.7%) were adenomatous polyps, 5 (3%) were villous polyps, and 12 (7.2%) were carcinomas. The planned surgical procedure was altered on 7 of 12 synchronous cancers (58.3%), 10 of 38 adenomatous polyps, and 17 of 157 (10.8%) patients who underwent total colonoscopy. Preoperative colonoscopy is deemed essential for the optimal management of the patient with colorectal carcinoma.

Aged↗

PubMed1995

Faecal occult blood testing and colonoscopy in the surveillance of subjects at high risk of colorectal neoplasia.

Colonoscopy is the established method of surveillance of subjects at high risk of developing colorectal neoplasia but the procedure is expensive, time consuming and occasionally hazardous. Faecal occult blood tests can be prepared at home and are cheap, simple and safe. Hemeselect is an immunological faecal occult blood test that is more sensitive for colorectal cancer than Haemoccult. The aim of this study was to determine the sensitivity of the Hemeselect test for asymptomatic colorectal neoplasia in subjects at high risk of the disease who were undergoing colonoscopy, thus assessing its suitability as an alternative means of screening high-risk groups. A total of 919 asymptomatic subjects were asked to complete Hemeselect tests. These were completed satisfactorily by 808 individuals (compliance rate 88 per cent) and were positive in 164 patients (20 per cent). At colonoscopy 11 cancers were detected in ten patients (seven Hemeselect positive) and 36 (16 Hemeselect positive) had at least one adenoma 1 cm or more in diameter. The test sensitivites of Hemeselect for carcinoma and large (1 cm or more) adenomas were 70 and 44 per cent respectively. In a subset of 417 subjects who also completed Haemoccult tests, the sensitivities were 33 and 18 per cent. Hemeselect specificity is 88 per cent compared with 98 per cent for Haemoccult. While the sensitivity of Hemeselect is higher than that of Haemoccult, it is still insufficient to replace colonoscopy in high-risk groups.

Colonoscopy↗