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PubMed2006

Guidelines for colonoscopy surveillance after cancer resection: a consensus update by the American Cancer Society and the US Multi-Society Task Force on Colorectal Cancer.

Patients with resected colorectal cancer are at risk for recurrent cancer and metachronous neoplasms in the colon. This joint update of guidelines by the American Cancer Society and the US Multi-Society Task Force on Colorectal Cancer addresses only the use of endoscopy in the surveillance of these patients. Patients with endoscopically resected Stage I colorectal cancer, surgically resected Stages II and III cancers, and Stage IV cancer resected for cure (isolated hepatic or pulmonary metastasis) are candidates for endoscopic surveillance. The colorectum should be carefully cleared of synchronous neoplasia in the perioperative period. In nonobstructed colons, colonoscopy should be performed preoperatively. In obstructed colons, double-contrast barium enema or computed tomography colonography should be performed preoperatively, and colonoscopy should be performed 3 to 6 months after surgery. These steps complete the process of clearing synchronous disease. After clearing for synchronous disease, another colonoscopy should be performed in 1 year to look for metachronous lesions. This recommendation is based on reports of a high incidence of apparently metachronous second cancers in the first 2 years after resection. If the examination at 1 year is normal, then the interval before the next subsequent examination should be 3 years. If that examination is normal, then the interval before the next subsequent examination should be 5 years. Shorter intervals may be indicated by associated adenoma findings (see "Guidelines for Colonoscopy Surveillance After Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society"). Shorter intervals also are indicated if the patient's age, family history, or tumor testing indicate definite or probable hereditary nonpolyposis colorectal cancer. Patients undergoing low anterior resection of rectal cancer generally have higher rates of local cancer recurrence compared with those with colon cancer. Although effectiveness is not proven, performance of endoscopic ultrasound or flexible sigmoidoscopy at 3- to 6-month intervals for the first 2 years after resection can be considered for the purpose of detecting a surgically curable recurrence of the original rectal cancer.

Colectomy↗

PubMed2001

[Preparation for colonoscopy: A comparison between 3 commercially available Golytely solutions].

The preparation for colonoscopy is essential for the results of the examination. The effectiveness of 3 commercially available Golytely solutions for colonoscopy (Original-Golytely-salt, Oralav and Delcoprep) were compared in a randomized prospective study. 310 outpatients were randomized into 3 groups. One of the above-mentioned solutions were used in these patients. Before the examination the patients were asked to drink 3 l of the given solution within 2 h. The colonoscopy was realized within 3-5 h after the end of preparation. Outcome criteria were the subjective acceptability of the solution for the patient, cleanness of the bowel and the formation of foam. In all 3 groups sufficient up to very good results could be achieved. There were no significant differences in the 3 groups. We conclude that the used procedure is absolutely sufficient to prepare for colonoscopy and that administration of liquids of more than 3 l or the use of enema or laxans on the previous day, are unnecessary. The suggested procedure can be used for children, too.

Adult↗

PubMed2002

Two liters of polyethylene glycol-electrolyte lavage solution versus sodium phosphate as bowel cleansing regimen for colonoscopy: a prospective randomized controlled trial.

BACKGROUND AND STUDY AIMS: As a bowel cleansing agent for colonoscopy, sodium phosphate (NaP) has been reported to have equal effectiveness and better patient tolerance in comparison with 4 l polyethylene glycol-electrolyte lavage (PEG-EL) solution. Poor patient tolerance is frequently associated with a large amount of fluid consumed, and better patient tolerance might therefore be expected if the volume of PEG-EL solution could be reduced. This study aimed to compare 2 l PEG-EL solution with NaP in relation to patients' tolerance and its effectiveness as a bowel cleansing agent. PATIENTS AND METHODS: Two hundred consecutive patients admitted to the day-procedure ward for elective colonoscopy were prospectively randomized to receive either a 2-l PEG-EL solution or a 90-ml oral NaP regimen. Patients with a history of congestive heart failure, impaired renal function (creatinine > 1.5 mg/dl), or previous colectomy were excluded from the study. The patients completed a questionnaire to assess their tolerance of bowel preparation before the colonoscopy. Endoscopists, who were blinded to the type of regimen that had been used, scored the adequacy of bowel preparation from the rectum to cecum using a defined endoscopic score. RESULTS: Two hundred patients were included in this randomized trial. Nine patients were excluded, due to either an incomplete questionnaire (two in the PEG-EL group, one in the NaP group) or inability to complete the bowel preparation regimen (four in the PEG-EL group and two in the NaP group). The demographic data were comparable in the two groups. There were no differences between the two groups with regard to willingness to repeat the regimen, ease of consumption, acceptability of the bowel preparation regimen, or the endoscopists' satisfaction with the quality of bowel preparation. The NaP group had a better mean endoscopic score at the cecum compared with the PEG-EL group (1.47 +/- 1.15 vs. 1.05 +/- 0.76; P = 0.007). CONCLUSIONS: The effectiveness and patient tolerance of the 2-l PEG-EL solution is comparable with that of oral NaP. The 2-l PEG-EL solution is therefore an effective alternative as a bowel-cleansing agent for colonoscopy.

Adult↗

PubMed2002

Evaluation of a new three-dimensional magnetic imaging system for use during colonoscopy.

BACKGROUND AND STUDY AIMS: A prototype magnetic imaging system (Scope Guide, Olympus Optical Co., Ltd.) provides a new facility for continuous viewing on a monitor of the position of the colonoscope during examination, without exposing patients or medical staff to radiation. The aim of this prospective study was to compare this magnetic imaging system with routine colonoscopy, including fluoroscopy. The study parameters were the detection of loops, the location of the endoscope tip at defined positions, the insertion time, and the premedication rate. MATERIALS AND METHODS: In the first part of the study, 133 consecutive patients were examined - 64 using an integrated three-dimensional colonoscope and 69 with the three-dimensional probe inserted into the biopsy channel of a routine video colonoscope. Fluoroscopy was used in all investigations for comparison at defined anatomical points and loops, and pathological findings and defined anatomic structures were documented using a laser printer both for three-dimensional colonoscopy and fluoroscopy. In the second part of the study, 25 further patients underwent colonoscopy with a modified prototype, now exclusively using the integrated three-dimensional colonoscope. RESULTS: The total time for insertion and the premedication rate did not differ from those of routine colonoscopies with fluoroscopy available. Precise detection of loops was observed in the first study in 79 - 100 % of cases in comparison with fluoroscopy. Precise localization of the endoscopic tip improved from 30 % in the first part of the study to 80 % in part 2. CONCLUSION: Using magnetic three-dimensional imaging systems, the position of the colonoscope, the detection and observation of loops during straightening, and localization of pathological findings can be accurately achieved. Modification of the prototype led to satisfactory improvement in all parameters tested.

Colonoscopy↗

PubMed2002

[Colonoscopy and sigmoidoscopy in patients aged eighty years or older].

BACKGROUND: The demographic development will lead to an increase in endoscopic examinations in elderly patients. Indications, feasibility and therapeutic consequences following detection of pathologic findings are important assessing the relevance of endoscopy in geriatric patients. METHODS: We analyzed all colonoscopies and sigmoidoscopies which were performed between January 1995 and December 2000 in patients older than 80 years. The parameters indication, sedation, colonoscopy completion rate, endoscopic findings, therapeutic consequences and complications were evaluated. RESULTS: A total of 951 endoscopies in patients older than 80 years (781 colonoscopies, 170 sigmoidoscopies; mean age 84.3 years) were performed. The most frequent indications were: abdominal pain (n = 144; 15 %), bleeding (n = 115; 12 %), constipation (n = 97; 10 %), anemia (n = 85; 9 %), and history of polyps (n = 78; 8 %). Sedation was used in 183 examinations (19 %), mostly with midazolam (n = 179). Colonoscopy was completed successfully to the coecum in 71 %. 214 examinations were unremarkable (23 %). Frequent pathologic findings were: diverticular disease (n = 396; 42 %), polyps (n = 256; 27 %), and colorectal carcinoma (n = 75; 8 %). Curative surgery was possible in 55 % and palliative surgery in 9 % of patients with colorectal carcinoma, respectively. A complication was observed in six patients (0.6 %), four bleedings following polypectomy, one perforation after dilatation of a stenotic tumor, and one transient neurologic deficit. CONCLUSIONS: Endoscopy of the lower gastrointestinal tract is feasible in geriatric patients with a low rate of complications. The low number of normal findings and the frequent diagnosis of colorectal carcinoma were remarkable. In spite of old age more than half of the patients with carcinoma could be operated curatively emphasizing the importance of endoscopic investigations in this age group.

Age Factors↗

PubMed2003

Effect of real-time magnetic endoscope imaging on the teaching and acquisition of colonoscopy skills: results from a single trainee.

BACKGROUND AND STUDY AIMS: Most trainees have little concept of the loops that occur during colonoscopy, and have difficulty in appreciating the combination of withdrawal and torquing manoeuvres that are essential to achieving complete colonoscopy. Real-time magnetic endoscope imaging (MEI) allows visualization of shaft looping, and so makes intuitive the manoeuvres necessary to straighten the colonoscope shaft. PATIENTS AND METHODS: Consecutive routine colonoscopies were performed by a single trainee (with previous experience of 15 colonoscopies). Procedures were randomly assigned to be carried out either with the trainee viewing the MEI display, or without the MEI view, which was recorded throughout all examinations. RESULTS: In total, 71 procedures were performed. To assess the trend for learning, procedures were analysed in blocks of 24 consecutive examinations (periods 1 to 3). In the first 24 procedures (period 1), the number of attempts at straightening the colonoscope and duration of looping were significantly less, and the intubation time was shorter, for examinations performed with the MEI view. In periods 2 to 3, there was a continued trend towards improved performance, but without a significant difference between procedures performed with or without MEI. CONCLUSIONS: During training, real-time colonoscope imaging using MEI appears to enhance the endoscopist's appreciation of looping and improves the learning of the manoeuvres required to straighten the colonoscope shaft. A prospective, multicentre study assessing a larger number of trainees is needed to clarify these findings.

Adult↗

PubMed2003

Invasive colorectal cancer detected up to 3 years after a colonoscopy negative for cancer.

BACKGROUND AND STUDY AIMS: Colonoscopy has replaced barium enema as the primary method for direct diagnosis of colorectal cancer, but detection may fail, and the reasons for this are not completely understood. PATIENTS AND METHODS: In order to analyze the accuracy of colonoscopy for detecting invasive colorectal cancer, 7365 colonoscopic examinations were matched with the most accurate local government population-based cancer registry in Japan. RESULTS: In 15 colonoscopic examinations, patients were not diagnosed as having invasive colorectal cancer, but disease of this type was detected within 3 years of the examinations (false-negative examinations). During the same period, 233 colonoscopies were identified as true-positive examinations. The false-negative rate for detecting invasive colorectal cancer with colonoscopy was 6% at 3 years. The false-negative rate was significantly higher in individuals between 60 and 69 years of age and in invasive cancers located to the right of the splenic flexure. CONCLUSIONS: Colonoscopists should receive adequate training in achieving easy cecal intubation, detecting small or flat lesions, and carrying out adequate biopsies.

Colonoscopy↗

PubMed2003

[Acute appendicitis after colonoscopy: causality or coincidence?].

Complications due to diagnostic colonoscopy are very rare. Perforation is the most frequent colon-related event. So far only ten cases of acute appendicitis after colonoscopy have been reported in the literature. We present the case of a 79-year-old man who developed acute appendicitis after diagnostic colonoscopy. Diagnosis was aggravated by the fact that in the patient's history an appendectomy had been performed 65 years earlier. Because of the rarity of this event it is doubtful whether the endoscopic examination was causal or coincidental. However, in cases of pain after colonoscopy, appendicitis has to be included in the differential diagnosis.

Abdomen, Acute↗

PubMed2004

Can visual distraction decrease the dose of patient-controlled sedation required during colonoscopy? A prospective randomized controlled trial.

BACKGROUND AND STUDY AIMS: We previously demonstrated that audio distraction using relaxation music could lead to a decrease in the dose of sedative medication required and improve patient satisfaction during colonoscopy. This prospective randomized controlled trial was designed to test the hypotheses that visual distraction may also decrease the requirement for sedatives and that audio and visual distraction may have additive beneficial effects when used in combination. PATIENTS AND METHODS: 165 consecutive patients who underwent elective colonoscopy were randomly allocated into three groups to receive different modes of sedation: group 1 received visual distraction and patient-controlled sedation (PCS); group 2 received audiovisual distraction and PCS; group 3 received PCS alone. A mixture of propofol and alfentanil, delivered by a Graseby 3300 PCA pump, was used for PCS in these groups. Each bolus of PCS delivered 4.8 mg propofol and 12 micro g alfentanil. Measured outcomes included the dose of PCS used, complications, recovery time, pain score, satisfaction score, and willingness to use the same mode of sedation if the procedure were to be repeated. RESULTS: Eight patients were excluded after randomization. The mean+/-SD dose of propofol used in group 2 (0.81 mg/kg +/- 0.49) was significantly less than the dose used in group 1 (1.17 mg/kg +/- 0.81) and that used in group 3 (1.18 mg/kg +/- 0.60) ( P < 0.01, one-way analysis of variance). The mean +/- SD pain score was also lower in group 2 (5.1 +/- 2.5), compared with the pain scores in group 1 (6.2 +/- 2.2) and group 3 (7.0 +/- 2.4) ( P < 0.01, one-way analysis of variance). The mean +/- SD satisfaction score was higher in groups 1 (8.2 +/- 2.4)) and 2 (8.4 +/- 2.4), compared with the score in group 3 (6.1 +/- 2.9) ( P < 0.01, one-way analysis of variance). A majority of patients in groups 1 (73 %) and 2 (85 %) said that they would be willing to use the same mode of sedation again, compared with only 53 % in group 3 ( P < 0.01, chi-squared test). CONCLUSIONS: Visual distraction alone did not decrease the dose of sedative medication required for colonoscopy. When audio distraction was added, both the dose of sedative medication required and the pain score decreased significantly. Both visual and audiovisual distraction might improve patients' acceptance of colonoscopy.

Acoustic Stimulation↗

PubMed2004

Sympathovagal balance fluctuates during colonoscopy.

BACKGROUND AND STUDY AIM: Colonoscopy is a common gastroenterological procedure for investigation of the bowel. The main side effects of colonoscopy are pain during investigation, cardiovascular complications and very rarely even death. The aim of this study was to compare the continuous fluctuation of heart rate variability (HRV) components during colonoscopy under normal conditions, analgesia/sedation, and total intravenous anesthesia. PATIENTS AND METHODS: 37 consecutive patients (aged 35 - 65), were randomly allocated to three groups: no sedation (control group 1); analgesia/sedation (group 2); and total intravenous anesthesia (group 3). Holter electrocardiography and subsequent frequency domain analysis were undertaken. The low-frequency (LF, 0.04 - 0.15 Hz) and the high-frequency (HF, 0.15 - 0.40 Hz) components were estimated using spectral analysis in the usual way. Normalized units (nu) were calculated from the following equations: LFnu = LF/(LF + HF), and HFnu = HF/(LF + HF). RESULTS: Groups 2 and 3 were found to have a significantly lower HFnu and higher LFnu than group 1 essentially throughout the procedure. A one-way analysis of variance and t-test confirmed that the differences were significant when the colonoscope reached the splenic flexure as were the LF/HF balances at the splenic and hepatic flexures and the cecum. The percentage change in LF/HF was also analyzed, and it was found that in group 3 the mean change was over 136 % when the colonoscope reached the sigmoid flexure, which was significantly higher than in the other two groups. CONCLUSION: Most changes in HRV components occurred during colonoscopy of the left side of the bowel. Analgesia/sedation and total intravenous anesthesia increased HRV by increasing the LF component.

Adult↗

PubMed2004

Intravenous hyoscine as a premedication for colonoscopy: a randomized double-blind controlled trial.

BACKGROUND AND STUDY AIMS: There is wide variation in the use of antispasmodics to facilitate colonoscopy, both within and between countries, and its use before such procedures remains controversial. The aim of this study was to determine whether there was any objective benefit in using hyoscine as a premedication for colonoscopy in a district general hospital. PATIENTS AND METHODS: Consecutive day-case patients undergoing colonoscopy were included in the study. They were prospectively randomly allocated to receive either intravenous hyoscine (n = 61) or intravenous placebo (n = 56) as part of their premedication. RESULTS: Our analysis demonstrated no statistically significant difference between the two groups with respect to the median time from colonoscope insertion to caecal intubation (9.7 minutes in the hyoscine group vs. 8.3 minutes in the placebo group) or the median total procedure time (14.8 minutes in the hyoscine group vs. 13.8 minutes in the placebo group). There was also no statistically significant difference in success rates for caecal intubation between the two groups ( P < 0.06). However a type II error cannot be excluded because of the small sample size. CONCLUSION: This study demonstrated no obvious benefit in the routine use of hyoscine as a premedication for colonoscopy in a district general hospital setting.

Adult↗

PubMed2005

Prospective comparison of cardiopulmonary events during minilaparoscopy and colonoscopy under conscious sedation.

BACKGROUND AND STUDY AIMS: Cardiorespiratory parameters were examined throughout diagnostic minilaparoscopy procedures. The same parameters were analyzed during colonoscopy, and the data were compared. PATIENTS AND METHODS: Sixty-five consecutive unselected patients undergoing minilaparoscopy (group 1: ASA I, n = 34; group 2: ASA II/III, n = 31) and 61 consecutive unselected patients undergoing colonoscopy (group 3: ASA I, n = 31; group 4: ASA II/III, n = 30) were included. Oxygen saturation (Sao (2)), heart rate (HR) and mean arterial pressure (RRm) were measured continuously, and 12-lead electrocardiography (ECG) recordings were made at specific times during each procedure. RESULTS: Minor differences were observed, particularly after premedication, probably due to different dosage regimens and timing in the two examination techniques. After premedication, testing for differences from baseline values showed a minor decrease in Sao (2) and RRm in the minilaparoscopy groups in comparison with the colonoscopy groups (median Sao (2), group 1: 99.9 % +/- 0 vs. group 3 : 100 % -1, P = 0.0078; median RRm, group 1: 99.5 - 4 mm Hg vs. group 3 : 96 -16 mm Hg, P = 0.046, and median RRm, group 2 : 110 + 1 mm Hg vs. group 4 : 101 -13.5 mm Hg, P = 0.0007). HR increased in minilaparoscopy in comparison with colonoscopy (median HR: group 2 : 77 + 4 beats/min vs. group 4 : 75.5 +/- 0 beats/min; P = 0.01). Comparison of defined relevant pathological changes in Sao (2), RRm, HR, and ECG showed no significant differences. DISCUSSION: These data indicate that diagnostic minilaparoscopy under conscious sedation is only associated with limited risk in patients with compensated cardiopulmonary diseases. This is probably due to the low insufflation pressure used.

Blood Pressure↗

PubMed2005

Combining physostigmine with meperidine for sedation and analgesia during colonoscopy.

BACKGROUND AND STUDY AIM: Opiate or benzodiazepine drugs are often used during colonoscopy, but they are associated with respiratory depression and prolonged recovery. Physostigmine, a tertiary anticholinesterase agent, is known to enhance analgesia and to reverse the central nervous system depressant effects of these drugs. This study compared the effect of giving meperidine alone with the effect of giving meperidine in combination with physostigmine in patients who were undergoing complete colonoscopy. PATIENTS AND METHODS: A total of 44 outpatients undergoing elective colonoscopy were randomly assigned to receive analgesia with either meperidine 0.5 mg/kg intravenously (group 1, n=24) or physostigmine 10 micrograms/kg intravenously, followed 5 minutes later by meperidine 0.5 mg/kg intravenously (group 2; n=20). The patients were assessed with regard to oxygen saturation, hemodynamic changes, pain perception and sedation scores, readiness to go home, and adverse effects. RESULTS: The group 1 patients' oxygen saturations consistently fell, both during the procedure and in the recovery period; in group 2, oxygen saturations remained stable throughout the procedure and recovery period (95.88%+/-0.99 vs. 98.15+/-0.99, P<0.001). Patients in group 2 reported lower pain perception scores during the procedure (measured using a visual analog scale) than patients in group 1 (1.46+/-0.31 vs. 1.75+/-0.41; F1,42=6.484, P<0.015) and were less sedated during recovery (F1,41=6.56, P<0.015). No significant differences were found between the two groups with regard to heart rate or arterial blood pressure. All patients in group 2 were ready to go home after 25 minutes in the recovery area; three patients in group 1 were not ready to leave at 25 minutes and left the facility after 60 minutes. Four patients suffered from minor side effects of physostigmine (sweating and nausea). CONCLUSIONS: Combining physostigmine with meperidine as preparatory treatment for patients undergoing colonoscopy prevents respiratory depression, improves analgesia, and shortens recovery time, with only mild side effects.

Adult↗

PubMed2005

Indigo carmine-assisted high-magnification chromoscopic colonoscopy for the detection and characterisation of intraepithelial neoplasia in ulcerative colitis: a prospective evaluation.

BACKGROUND AND STUDY AIMS: Recent data suggest that panchromoscopy using methylene blue can improve the detection of intraepithelial neoplastic lesions in the context of surveillance colonoscopy for patients with chronic ulcerative colitis. This method has also been shown to provide a more accurate diagnosis of the extent of disease and inflammatory activity. Interval cancers are known to occur in patients with chronic ulcerative colitis despite the adoption of currently accepted surveillance biopsy protocols. We hypothesised that targeted chromoscopy alone, with high-magnification imaging, may increase the total number of intraepithelial neoplastic lesions detected, compared with conventional colonoscopy and biopsy surveillance according to current protocols. PATIENTS AND METHODS: A total of 350 patients with long-standing ulcerative colitis (>or=8 years) underwent surveillance colonoscopy using high-magnification chromoscopic colonoscopy (HMCC). Quadrantic biopsies at 10-cm intervals were taken on extubation in addition to targeted biopsies of abnormal mucosal areas. Defined lesions were further evaluated using modified Kudo crypt pattern analysis. These data were compared with data from 350 disease duration- and disease extent-matched control patients who had undergone conventional colonoscopic surveillance between January 2001 and April 2005. RESULTS: Significantly more intraepithelial neoplastic lesions were detected in the magnification chromoscopy group compared with controls (69 vs. 24, P<0.0001). Intraepithelial neoplasia was observed in 67 lesions, of which 53 (79%) were detected using magnification chromoscopy alone. Chromoscopy increased the number of flat lesions with intraepithelial neoplasia detected compared with controls (P<0.001). Twenty intraepithelial neoplastic lesions were detected from 12,850 non-targeted biopsies in the HMCC group (0.16%), while 49 intraepithelial neoplastic lesions were detected from the 644 targeted biopsies in the HMCC group (8%). From 12,482 non-targeted biopsies taken in the control group patients, 18 (0.14%) showed intraepithelial neoplasia. The yield of intraepithelial neoplastic lesions from targeted biopsies in the control group (i. e. without HMCC imaging), however, was only modestly improved at 1.6% (6/369). Using modified Kudo criteria, the sensitivity and specificity for differentiating neoplastic from non-neoplastic lesions using HMCC were 93% and 88% respectively. The total procedure time was significantly longer in the HMCC group compared with controls (P<0.02). CONCLUSIONS: Magnification chromoscopy improves the detection of intraepithelial neoplasia in the endoscopic screening of patients with chronic ulcerative colitis. Neoplastic and non-neoplastic mucosal change can be predicted with a high overall accuracy using magnification techniques. These adjunctive endoscopic techniques have important clinical implications and may lead to changes in current practice guidelines.

Biopsy, Needle↗

PubMed2006

High-magnification chromoscopic colonoscopy in ulcerative colitis: a valid tool for in vivo optical biopsy and assessment of disease extent.

BACKGROUND AND STUDY AIMS: Colonoscopy with mucosal biopsy is currently considered to be the "gold standard" investigation for the evaluation of disease activity and disease extent in ulcerative colitis. Conventional colonoscopic criteria are inadequate for assessing disease extent and for predicting clinical relapse, however. Histopathological markers of relapse, such as microscopic crypt abscess formation and mucin depletion cannot be identified using conventional endoscopy. The aim of this study was to evaluate the efficacy of high-magnification chromoscopic colonoscopy for the in vivo assessment of histopathological inflammation and disease extent using standardised endoscopic and histopathological criteria. PATIENTS AND METHODS: Total colonoscopy using the Olympus CF240Z magnifying colonoscope was performed prospectively in 325 consecutive patients with a known diagnosis of ulcerative colitis. A "biphasic" examination of all five colonic segments and the rectum was performed with conventional endoscopy followed by magnification imaging and biopsy. Disease activity was documented using Baron's classification, modified Saitoh criteria for magnification imaging, and Matts' histopathological grading. RESULTS: A total of 1800 images from 300 patients were analyzed (25 patients were excluded). The kappa coefficients of agreement between Saitoh's magnification criteria grades 1/2, 3/4, and 5/6 and Matts' histopathological grades 1/2, 3a/b, and 4/5 were 0.96, 0.62, and 0.51, respectively. Mild, moderate, and severe histopathological disease (Matts' grades 1/2, 3a - 4, and 5) were represented more accurately using Saitoh's criteria than by conventional Baron scores for all clinical parameters ( R = 0.976; P < 0.001). Magnification imaging was significantly better than conventional colonoscopy for predicting disease extent in vivo ( P < 0.0001). CONCLUSIONS: This is the largest prospective study and the only Western group to report on this application of magnification imaging. High-magnification imaging provides a sensitive and specific in vivo "virtual biopsy" in ulcerative colitis and so an instant biomarker for disease relapse, while accurately predicting disease extent. High-accuracy optical biopsy can limit the number of biopsies required, with significant cost savings for pathology services.

Adolescent↗

PubMed2006

Colonoscopic withdrawal times and adenoma detection during screening colonoscopy.

BACKGROUND: Colonoscopy is commonly used to screen for neoplasia. To assess the performance of screening colonoscopy in everyday practice, we conducted a study of the rates of detection of adenomas and the amount of time taken to withdraw the colonoscope among endoscopists in a large community-based practice. METHODS: During a 15-month period, 12 experienced gastroenterologists performed 7882 colonoscopies, of which 2053 were screening examinations in subjects who had not previously undergone colonoscopy. We recorded the numbers, sizes, and histologic features of the neoplastic lesions detected during screening, as well as the duration of insertion and of withdrawal of the colonoscope during the procedure. We compared rates of detection of neoplastic lesions among gastroenterologists who had mean colonoscopic withdrawal times of less than 6 minutes with the rates of those who had mean withdrawal times of 6 minutes or more. According to experts, 6 minutes is the minimum length of time to allow adequate inspection during instrument withdrawal. RESULTS: Neoplastic lesions (mostly adenomatous polyps) were detected in 23.5% of screened subjects. There were large differences among gastroenterologists in the rates of detection of adenomas (range of the mean number of lesions per subject screened, 0.10 to 1.05; range of the percentage of subjects with adenomas, 9.4 to 32.7%) and in their times of withdrawal of the colonoscope from the cecum to the anus (range, 3.1 to 16.8 minutes for procedures during which no polyps were removed). As compared with colonoscopists with mean withdrawal times of less than 6 minutes, those with mean withdrawal times of 6 minutes or more had higher rates of detection of any neoplasia (28.3% vs. 11.8%, P<0.001) and of advanced neoplasia (6.4% vs. 2.6%, P=0.005). CONCLUSIONS: In this large community-based gastroenterology practice, we observed greater rates of detection of adenomas among endoscopists who had longer mean times for withdrawal of the colonoscope. The effect of variation in withdrawal times on lesion detection and the prevention of colorectal cancer in the context of widespread colonoscopic screening is not known. Ours was a preliminary study, so the generalizability and implications for clinical practice need to be determined by future studies.

Adenoma↗

PubMed2000

Patient tolerance of colonoscopy without sedation during screening examination for colorectal polyps.

BACKGROUND: The administration of sedative drugs at colonoscopy has its drawbacks such as increases in the rate of complications and cost. Our aim was to study how individuals, drawn from a population registry and invited to undergo screening colonoscopy for colorectal polyps, experienced the procedure without conscious sedation. METHODS: Four hundred fifty-one individuals underwent the screening examination (median age 67 years, range 63 to 72). The cecum was intubated in 369 (82%). Fourteen days after the examination, 429 of the attendees received a questionnaire designed to evaluate their tolerance of the procedure. RESULTS: Four hundred nine participants (95%) replied.Twenty-one (5%) of these individuals found the examination very uncomfortable, 184 (45%) found it moderately uncomfortable, and 204 (50%) did not find it uncomfortable. A larger proportion of women than men, 110 (63%) versus 79 (41%), found the procedure very or moderately uncomfortable (p<0.001). Three hundred sixty-eight (90%) individuals stated that they would undergo repeat colonoscopy in 5 years. CONCLUSION: In this screening setting, routine use of conscious sedation did not seem to be necessary, as most participants found the examination to be only moderately uncomfortable or not at all uncomfortable. Colonoscopy without conscious sedation may, however, reduce the rate of intubation of the cecum and increase the risk of missing adenomas and cancers.

Aged↗

PubMed2001

Routine versus "on demand" sedation and analgesia for colonoscopy: a prospective randomized controlled trial.

BACKGROUND: The safety and tolerance of routine sedation and analgesia versus "on demand" sedation were compared in patients undergoing colonoscopy. METHODS: Two hundred forty-nine outpatients were randomly assigned to one of two groups. Group A (n = 125) received midazolam, 0.07 mg/kg intravenously plus meperidine, 0.77 mg/kg intravenously immediately preceding the colonoscope insertion. Group B (n = 124) received the same medication upon request during the procedure. Tolerance was assessed 24 hours later by phone interview performed by a nurse blinded to the medication regimen administered. RESULTS: Eighty-three patients (66%) in Group B required sedation during colonoscopy. Among men in Group B more than 60 years of age, only 23% required sedation. The proportion of patients reporting moderate or severe pain (34% vs. 12.1%, p < 0.001) and of those stating they would not be willing to undergo colonoscopy again in the future (22% vs. 9.7%, p < 0.005) was significantly higher in the "on demand" sedation group. By multivariate analysis the randomization group was the single variable independently associated with both such outcomes. The frequency of side effects was similar in the two groups. CONCLUSIONS: Administration of sedative and analgesic drugs routinely before colonoscopy is superior to "on demand" sedation in terms of tolerance and is not associated with an increase in side effects.

Analgesia↗