PubMed Health⌕ Search

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 55 records · Page 3Linked to original sources
PubMed2006

Complications of colonoscopy in an integrated health care delivery system.

BACKGROUND: Information about colonoscopy complications, particularly postpolypectomy bleeding, is limited. OBJECTIVE: To quantify the magnitude and severity of colonoscopy complications. DESIGN: Retrospective cohort. SETTING: Kaiser Permanente of Northern California. PATIENTS: 16, 318 members 40 years of age or older undergoing colonoscopy between January 1994 and July 2002. MEASUREMENTS: Electronic records reviewed for serious complications, including hospital admission within 30 days of colonoscopy for colonic perforation, colonic bleeding, diverticulitis, the postpolypectomy syndrome, or other serious illnesses directly related to colonoscopy. RESULTS: 82 serious complications occurred (5.0 per 1000 colonoscopies [95% CI, 4.0 to 6.2 per 1000 colonoscopies]). Serious complications occurred in 0.8 per 1000 colonoscopies without biopsy or polypectomy and in 7.0 per 1000 colonoscopies with biopsy or polypectomy. Perforations occurred in 0.9 per 1000 colonoscopies (CI, 0.5 to 1.5 per 1000 colonoscopies) (0.6 per 1000 without biopsy or polypectomy and 1.1 per 1000 with biopsy or polypectomy). Postbiopsy or postpolypectomy bleeding occurred in 4.8 per 1000 colonoscopies with biopsy (CI, 3.6 to 6.2 per 1000 colonoscopies). Biopsy or polypectomy was associated with an increased risk for any serious complication (rate ratio, 9.2 [CI, 2.9 to 29.0] vs. colonoscopy without biopsy). Ten deaths (1 attributable to colonoscopy) occurred within 30 days of the colonoscopy. LIMITATIONS: 99.3% (16 204) of colonoscopies were nonscreening examinations. The rate of complications may be lower in a primary screening sample. The small number of observed adverse events limited power to detect risk factors for complications. CONCLUSIONS: Colonoscopy with biopsy or polypectomy is associated with increased risk for complications. Perforation may also occur during colonoscopies without biopsies.

Adult↗
PubMed1995

Colonoscopy: a review of its yield for cancers and adenomas by indication.

Colonoscopy for bleeding indications (positive fecal occult blood test, emergent or nonemergent rectal bleeding, melena with a negative upper endoscopy and iron deficiency anemia) has a substantial yield for cancers (1 per 9 to 13 colonoscopies), although slide rehydration of fecal occult blood tests decreases the yield (1 per 45 colonoscopies). Prospective studies indicate that nonbleeding colonic symptoms have a substantially lower yield for cancer than bleeding symptoms (1 per 109 colonoscopies). Patients with indications for screening colonoscopy with a relatively high yield of cancer are those with Lynch syndrome (1 per 39 colonoscopies) and males more than 60 yr old (1 per 64 colonoscopies). Perioperative colonoscopy in persons undergoing colorectal cancer resection has a high yield for synchronous cancer (2-3%). An initial examination in persons with long-standing ulcerative colitis has a high yield for cancer (12%). Surveillance colonoscopy after cancer resection has an intermediate yield for anastomotic cancer (1 per 74 procedures) and metachronous cancers (1 per 82 colonoscopies), although this number may overestimate the yield of metachronous cancer. Postpolypectomy surveillance and ulcerative colitis surveillance colonoscopy have relatively low yields for cancer (1 per 317 and 360 colonoscopies, respectively). However, postpolypectomy surveillance colonoscopy, in combination with initial clearing colonoscopy, has been proven to be almost entirely effective in preventing colorectal cancer death. Further, cancer yields for postpolypectomy surveillance should improve with implementation of new surveillance guidelines, with little or no impact on mortality. The effectiveness of ulcerative colitis surveillance is less certain. Referral of patients with low-grade dysplasia for colectomy would improve the value and effectiveness of surveillance colonoscopy in ulcerative colitis. Adenoma yields at colonoscopy are relatively independent of indication, as evidenced by the high yield of adenomas in screening colonoscopy studies. Demographic factors, including increasing age and male gender, are important predictors of adenomas at initial colonoscopy. Age, male gender, and multiple and large adenomas at initial examination are predictors of adenomas at subsequent postpolypectomy surveillance. Persons with ureterosigmoidostomies can be screened by interval flexible sigmoidoscopy and do not require screening colonoscopy. A history of breast cancer does not predict an improved yield of colonoscopic screening compared to average-risk persons.

Adenoma↗
PubMed2000

Significance of a normal surveillance colonoscopy in patients with a history of adenomatous polyps.

PURPOSE: The aim of this study was to determine the appropriate surveillance for patients with a history of adenomatous polyps whose last colonoscopic examination was normal. METHODS: This was a retrospective review of a database of 7,677 colonoscopies (1990 to 1996). In patients under colonoscopic surveillance, we reviewed cases of patients who had received three colonoscopies (an index (initial) colonoscopy positive for adenomas and 2 follow-up colonoscopies (interim and final)). The risk of adenomas and cancers at final follow-up colonoscopy was compared between patients having a normal interim colonoscopy and those with a positive interim colonoscopy. The risk at final colonoscopy was also stratified by time interval and the size and number of adenomas at the initial index colonoscopy. RESULTS: Two hundred four patients undergoing surveillance for adenomas met inclusion criteria. At index colonoscopy the median polyp size was 1 cm and median frequency was three polyps. At all follow-up colonoscopies, we detected 493 adenomas and one cancer (median follow-up, 55 months). At 36 months patients with a normal interim colonoscopy (n = 91) had significantly fewer polyps than patients with a positive interim colonoscopy (n = 113; 15 vs. 40 percent; P = 0.0001). By 40 months, adenomas were detected in more than 40 percent of patients in both groups. The risk after a normal interim colonoscopy was not affected by time interval or number or size of polyps. Adenomas found subsequent to a normal interim colonoscopy were dispersed throughout the colon in 28 patients and isolated to the rectosigmoid in 6 patients. CONCLUSIONS: In patients with a history of adenomas, a normal follow-up colonoscopy is associated with a statistically but not clinically significant reduction in the risk of subsequent colonic neoplasms. These patients require follow-up surveillance colonoscopy at a four-year to five-year interval.

Adenomatous Polyposis Coli↗
PubMed2006

Incidence of advanced adenomas at surveillance colonoscopy in patients with a personal history of colon adenomas: a meta-analysis and systematic review.

BACKGROUND: Current guidelines stratify patients with a personal history of adenomas as low risk (ie, 1-2 small [<10 mm] adenomas at index colonoscopy) or high risk (> or =3 small adenomas or advanced adenoma at index colonoscopy) for recurrent advanced adenomas. Guidelines recommend longer intervals between surveillance colonoscopies for low-risk patients, but physicians frequently perform surveillance colonoscopy at shorter intervals for these patients. OBJECTIVE: Our purpose was to perform a meta-analysis about the incidence of advanced adenomas at 3-year surveillance colonoscopy among high- and low-risk patients. METHODS: Computer searches of MEDLINE, PREMEDLINE, and EMBASE were performed to identify appropriate studies. Study selection criteria were (1) study design--prospective or registry-based study, (2) study population--patients with a personal history of adenomas, and (3) intervention--completion of surveillance colonoscopy at an interval of > or =2 years. Data were extracted on (1) incidence of advanced adenomas at surveillance colonoscopy, (2) interval between colonoscopies, and (3) risk factors associated with recurrent adenomas. After the validity of study design was assessed and independent, duplicate data extraction was performed from selected trials, summary relative risks (RR) for the incidence of advanced adenomas at 3-year colonoscopy were calculated. RESULTS: Fifteen studies met study selection criteria, but only 5 studies stratified surveillance colonoscopy results according to findings at the index colonoscopy. Patients with > or =3 adenomas at index colonoscopy were more likely to have recurrent advanced adenomas than were patients with 1 to 2 adenomas: RR 2.52, 95% CI 1.07-5.97. Patients with adenomas with high-grade dysplasia at index colonoscopy were also at increased risk for recurrent advanced adenomas: RR 1.84, 95% CI 1.06-3.19. In the individual studies, increasing size of adenomas and increasing number of adenomas at index colonoscopy were the most commonly reported risk factors associated with recurrent advanced adenomas. No studies stratified surveillance colonoscopy results according to the definitions of low risk and high risk used in current guidelines. CONCLUSION: Few published studies stratify the incidence of advanced adenomas at surveillance colonoscopy according to index colonoscopy findings. In the future, large prospective studies or studies using pooled data from existing randomized controlled trial databases or polyp registries should be used to better define which patients are at low risk for advanced adenoma recurrence.

Adenoma↗