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PubMed2001

The effect of stimulant laxatives and polyethylene glycol-electrolyte lavage solution for colonoscopy preparation on serum electrolytes and hemodynamics.

We have previously shown that magnesium citrate or bisacodyl before polyethylene glycol electrolyte lavage solution (PEG-ELS) improves colonoscopy preparation. Patients prefer this to preparation with full-volume PEG-ELS alone. However, such combinations might cause undesirable changes in hemodynamics or serum electrolytes. This study examined the effects of these combinations on heart rate, blood pressure, and serum electrolytes. We randomized 68 consecutive patients undergoing colonoscopy to one of three preparations. Group 1 received 4 L of PEG-ELS, group 2 received 2 L of PEG-ELS with 20 mg bisacodyl, and group 3 received 2 L of PEG-ELS preceded by 296 mL of magnesium citrate. Heart rate, blood pressure, and serum electrolytes were measured before starting the preparation and immediately before colonoscopy. Mean serum magnesium fell by 0.01 mg/dL and 0.11 mg/dL in groups 1 and 2, respectively, and rose by 0.06 mg/dL in group 3 (p = 0.044). There were no other significant changes. Statistically significant changes in serum magnesium after preparation with PEG-ELS and a stimulant laxative are minor and probably of no clinical relevance. Two liters of PEG-ELS with a stimulant laxative is safe and effective for colonoscopy.

Cathartics↗

PubMed2003

Risk of colorectal adenoma in liver transplant recipients compared to immunocompetent control population undergoing routine screening colonoscopy.

BACKGROUND: Immunosuppression following solid organ transplantation has been associated with a higher prevalence of cancers including colon cancer. However, the risk of colorectal adenoma following liver transplantation is unknown. The objective of this pilot study is to determine whether the prevalence of colorectal adenoma is increased in liver transplant recipients. METHODS: In this retrospective study, 25 patients who had liver transplantation at our institution between 1994 to 1997 and who underwent routine posttransplantation colonoscopy were compared with 50 controls who were undergoing routine screening colonoscopy. Transplant recipients who were younger than 45 years, survived less than 3 years following liver transplant, with history of inflammatory bowel disease, or prior history of colonic adenoma or cancer were excluded from the study. In both groups, colonoscopic diagnosis of polyp was confirmed by pathologic diagnosis of adenoma on biopsy. RESULTS: 25 (12M/13F, mean age 53 +/- 7 years) liver transplant recipients were compared with 50 controls (19M/31F, mean age of 59 +/- 7 years). In transplant recipients, colonoscopy was performed 41 +/- 19 months after liver transplantation. Seven (28%) liver transplant recipients (5M, 2F) and 4 (8%) controls (3F, 1M) were found to have adenomatous polyp (OR 4.5, 95% CI 1-21.2, P = 0.049). Malignant polyps were not detected in both groups. CONCLUSION: Liver transplant recipients appear to have an increased risk for developing colorectal adenoma. Early screening colonoscopy is warranted for this group of patients.

Adenoma↗

PubMed1982

Bacteremia in children following upper gastrointestinal endoscopy or colonoscopy.

Fifty children undergoing upper gastrointestinal endoscopy and 25 undergoing colonoscopy were studied prospectively with aerobic and anaerobic blood cultures for the development of bacteremia. Twenty-six of the endoscopies and all the colonoscopies were done under general anesthesia. Cultures were obtained before, at 5 min, and at 30 min after the procedure. Only a single positive blood culture was obtained in an upper endoscopy patient. All cultures from the colonoscopy patients were negative. Biopsy or polypectomy were not important variables in the development of bacteremia. It is concluded that the risk of bacteremia in children following upper endoscopy or colonoscopy is minimal and should not be considered a contraindication to their performance.

Adolescent↗

PubMed1983

Sigmoidoscopy, colonoscopy, and radiology in the evaluation of children with rectal bleeding.

The authors evaluated the diagnostic role of sigmoidoscopy, colonoscopy, and double contrast radiology in 103 children with rectal bleeding, with or without other gastrointestinal symptoms. The children's mean age was 44 months, with a range from 1 month to 12 years. In 74.5% of the subjects investigated, visual inspection of the anus and sigmoidoscopy with rectal biopsy disclosed a positive diagnosis. Of the remaining patients, a conclusive diagnosis was reached by either colonoscopy or double contrast radiology in all but six patients. These six, with mild painless hematochezia, remained without a diagnosis. The diagnostic procedure in pediatric patients with rectal bleeding should include an initial visual inspection of the anus, and sigmoidoscopy; air contrast enema and colonoscopy should be performed only in children whose sigmoidoscopy is negative, in diagnostic assessment of inflammatory bowel disease, and in cases of recurrent bleeding after removal of rectal polyps. Colonoscopy is important also in the follow-up examination of children with inflammatory bowel disease and allows the removal of polyps located in the proximal colon.

Barium Sulfate↗

PubMed1991

Comparison of indium-111 scintigraphy and colonoscopy with histologic study in children for evaluation of colonic chronic inflammatory bowel disease.

Indium-111 leukocyte scanning and colonoscopy were performed in 19 children and adolescents with chronic inflammatory bowel disease to study the correlation of evaluation between these two diagnostic modalities in comparison to histologic study for colonic disease. Seven patients had ulcerative colitis, 10 had Crohn's disease, and two patients had no specific diagnosis after evaluation. The sensitivity of indium-111 scan was 18%, specificity was 62.5%, and accuracy for diagnosing colonic disease was only 37%. In comparison, sensitivity and specificity for colonoscopy were 100 and 57%, respectively. Furthermore, accuracy with colonoscopy was 84%. Our data suggest that the usefulness of scans is limited to patients in whom standard diagnostic procedures are contraindicated. In addition, it is essential to confirm the visual diagnostic impression on colonoscopy with histologic study.

Adolescent↗

PubMed2004

Does fluoroscopic imaging still have a role in colonoscopy?

GOAL: To assess the use and value of fluoroscopic imaging in difficult colonoscopy. BACKGROUND: Few endoscopy centers have easy access to fluoroscopy to facilitate difficult colonoscopy. Its benefits are therefore unclear. Although interest in colonoscope imaging has recently been stimulated by magnetic imaging techniques, these are expensive and unlikely to be widely available for some time. STUDY: During routine colonoscopy lists, a mobile fluoroscopy unit was used when colonoscopy could not be completed in the absence of stricturing despite changes in patient position and application of external pressure. This retrospective review assesses the percentage of procedures completed with and without fluoroscopy. RESULTS: A series of 1551 procedures in adult patients without colon resection and with satisfactory bowel preparation was analyzed. The cecal intubation rate was 95.1% (1475/1551), rising to 96.5% (1475/1528) when impassable strictures were excluded. Fluoroscopy was used in 61 (4%) of the 1528 procedures without stricture, but allowed completion in only 13% (8/61). In the absence of stricture, fluoroscopy improved completion rate by only 0.5% (from 96.0% to 96.5%). CONCLUSIONS: Fluoroscopy is seldom required and even then contributes little to success. Magnetic imaging, which provides continuous 3-dimensional images, may be more likely to speed and facilitate completion.

Adolescent↗

PubMed1994

Addition of cisapride shortens colonoscopy preparation with lavage in elderly patients.

METHODS: The effect of pre-treatment with cisapride on colonoscopy preparation with lavage solution was compared in 120 out-patients less than 60 years and 73 out-patients 60 years or older, who were scheduled for total colonoscopy. By random allocation, patients were assigned to receive cisapride 10 mg or placebo 30 minutes before ingesting the magnesium citrate lavage solution. RESULTS: The cleansing results and patients' acceptance did not differ significantly in the two treatment groups in either age group. The time from the start of ingesting magnesium citrate until the rectal effluent became clear was significantly shorter in cisapride-treated patients of 60 years or more. Moreover, the residual fluid volume removed by suction during colonoscopy was significantly less in the patients above aged 60 years who received cisapride. CONCLUSION: These findings indicate that the combination of cisapride and magnesium citrate is more effective than magnesium citrate alone in cleansing the colon for colonoscopy in elderly patients.

Adult↗

PubMed2006

Prospective assessment of the impact of feedback on colonoscopy performance.

BACKGROUND: Colonoscopy is an operator-dependent procedure. The medical literature describes disparity in colonoscopy performance with respect to polyp detection, caecal intubation rates and procedural times. AIM: To assess prospectively the impact of feedback among a large cohort of colonoscopists on three performance parameters: caecal intubation rate, insertion time and withdrawal time. METHOD: In a prospective clinical study, procedural data from all out-patient colonoscopies performed by attending gastroenterologists at our institution were recorded routinely in a computerized database. Enhanced serial feedback was provided on a quarterly basis for three procedure parameters: intubation to caecum, insertion time and withdrawal time. Feedback (absolute value, % rank and group distribution) was sent by email every 3 months beginning with January 2005 feedback for all of 2004, and subsequently quarterly in April 2005 (for January-March 2005), July 2005 (for April-June 2005) and October 2005 (for July-September 2005). RESULTS: Feedback was provided to 58 endoscopists with a median experience level of 8 years. There was a relative decline of 19% in incomplete procedures, with median caecal non-intubation rates decreasing from 4.7% to 3.8% following the introduction of feedback while median insertion times declined from 10.6 to 9.5 mins, P = 0.02. Median withdrawal times did not change significantly, 9.1-8.9 mins, P = 0.6. CONCLUSIONS: Feedback by email appears to improve colonoscopy performance, enhancing completion rates and shortening insertion times without compromising withdrawal times.

Clinical Competence↗

PubMed2006

Risk factors for cardiopulmonary events during propofol-mediated upper endoscopy and colonoscopy.

BACKGROUND: Propofol-mediated sedation for endoscopy is popular because of its rapid onset and recovery profile. AIM: To examine procedure-specific occurrence and risk factors for cardiopulmonary events during propofol-mediated upper endoscopy (EGD) and colonoscopy. DESIGN: A cohort study using the Clinical Outcomes Research Initiative database was used to determine the frequency of cardiopulmonary events. Clinical Outcomes Research Initiative consisted of 69 practice sites comprising 593 US endoscopists. Multivariate logistic regression analysis used variables, such as age, ASA classification and propofol administration by monitored anaesthesia care or gastroenterologist-administered propofol to determine the risk of cardiopulmonary events. RESULTS: The overall cardiopulmonary event rate for 5928 EGDs and 11 683 colonoscopies was 11.7/1000 cases. For colonoscopy, ascending ASA classification was associated with an increased risk. Monitored anaesthesia care was associated with a decreased adjusted relative risk (0.5, 95% CI: 0.36-0.72). ASA I and II patients receiving monitored anaesthesia care for EGD exhibited a significantly lower relative risk (ARR 0.29, 95% CI: 0.14-0.64). For subjects with ASA class III or greater, there was no difference in the risk between monitored anaesthesia care and gastroenterologist-administered propofol. CONCLUSIONS: There are procedure-specific risk factors for cardiopulmonary events during propofol-mediated EGD and colonoscopy. These should be taken into account during future prospective comparative trials.

Adult↗

PubMed2005

Determination of large bowel length and loop complexity in patients with acromegaly undergoing screening colonoscopy.

BACKGROUND: Patients with acromegaly are at moderately increased risk of developing colorectal cancer and may be considered for screening colonoscopy. In turn, large bowel dimensions may be increased in these patients, factors that predict for increased risk of serious complications such as perforation. OBJECTIVE: To evaluate this risk potential, we measured large bowel length and loop complexity using magnetic endoscopic imaging (MEI). DESIGN: Case-control study in 25 unselected patients with acromegaly (mean age 56 years) vs. 41 nonacromegalic controls (mean age 60 years) undergoing screening colonoscopy. MEASUREMENTS: MEI parameters were determined and age- and sex-adjusted mean differences calculated. The dependency of total large bowel length on various demographic and disease-related factors (e.g. GH exposure, IGF-I and IGFBP-3 concentrations) was assessed using regression techniques. RESULTS: Total large bowel length was increased by 20%[95% confidence interval (CI) 9-31%] in patients with acromegaly compared with controls (unadjusted and adjusted; P-values < 0.001). Acromegaly was also associated with increased time taken to reach the caecum (P = 0.01) and increased pelvic loop complexities (5/25 vs. 1/41, Fisher's exact test: P = 0.03). Total large bowel length was predicted by age at colonoscopy (P = 0.003) and patient height (P = 0.03), but not by surrogate biochemical markers of disease activity. CONCLUSIONS: Acromegaly is associated with increased large bowel length and loop complexity making colonoscopy technically challenging, and theoretically increasing the risk of serious complications. Patients need to be counselled accordingly, and appropriate resources with experienced staff allocated.

Acromegaly↗

PubMed2006

Audit of bowel preparation with Picolax (sodium picosulfate plus magnesium citrate) for colonoscopy.

The aim of this study was to assess the quality of bowel preparation for colonoscopy with standard dose Picolax (two sachets administered on the day prior to the procedure, as per the manufacturer's instructions) in a large cohort of patients. A retrospective audit was performed of colonoscopies performed at our institution over a 1-year period. Patients were excluded if standard dose Picolax was not used, if the quality of the bowel preparation was not recorded or if completion of the procedure was not recorded. Of the 619 fully evaluable cases, the quality of the bowel preparation was assessed by the colonoscopist performing the procedure as good in 263 (42.5%), satisfactory in 242 (39.1%) and poor in 114 (18.4%) of the cases. In only 28 (4.5%) cases, poor bowel preparation was the reason cited for an incomplete colonoscopy. There was no difference in the quality of bowel preparation between inpatients and outpatients. In clinical practice, Picolax is an effective bowel preparation for colonoscopy in the vast majority of cases.

Cathartics↗

PubMed2006

Less patient discomfort by one-man colonoscopy examination.

A randomised prospective trial compared safety and patient tolerance for one-man method with two-man method undergoing colonoscopy. Eighty patients were randomized to 1 of 2 groups: the two-man method group (n = 40); or the one-man method group (n = 40). All colonoscopic examinations were performed by the same endoscopist to reduce skill-based variation. Patient tolerance for colonoscopy was evaluated with a numerical rating scale ranging from 0 for painless to 5 for maximal pain. Cardiopulmonary parameters were recorded during the procedure. Patients receiving one-man method had lower pain score than two-man method. The length of the scope reach to the cecum was shorter in the one-man group than the two-man group. The patients underwent two-man colonoscopy had higher maximum increase in heart rate during the procedure compared with one-man group. One-man colonoscopy can improve patient tolerance and reduces patient pain by decreasing the redundancy of colonoscope during the procedure.

Adolescent↗

PubMedDate not supplied

The role of colonoscopy in screening persons with family history of colorectal cancer.

First-degree relatives of colorectal cancer patients are at increased risk for developing colorectal neoplasms. In order to assess the potentiality of colonoscopy screening in this high-risk population, 213 asymptomatic family members (age range 30-69 years, mean 42.8 years) of those patients with colorectal cancer received colonoscopic examination at Chang-Gung Memorial Hospital from April 1992 to May 1994. Twenty-eight persons with 42 lesions (polyps or cancer) were identified, including 28 adenomas, nine hyperplastic polyps and five adenocarcinomas. The positive detection rate was 9.9% for adenoma and 2.3% for cancer. Colorectal neoplasms afflicted males more frequently than females (16.7 vs 5.7%, P < 0.05) and occurred less frequently in those < 40 years of age (5.5 vs 17.2%, P < 0.05). Forty-two per cent of the detected neoplastic lesions were beyond the reach of 60 cm flexible sigmoidoscopy and 36% of adenomas were < 0.5 cm in size and would be missed if patients were screened by air contrast barium enema. Cost analysis revealed that the charges of both screening colonoscopy and screening flexible sigmoidoscopy/air contrast barium enema were approximate. Colonoscopy also has a high acceptability and safety. It appears appropriate to use colonoscopy, rather than flexible sigmoidoscopy or air contrast barium enema, as an initial screening procedure for persons with a family history of colorectal cancer, especially those > 40 years of age.

Adenoma↗

PubMed1991

Peri-operative colonoscopy detects synchronous tumours in patients with colorectal cancers.

The aim of this study was to assess the value of colonoscopy as a peri-operative investigation in patients treated for colorectal cancer by surgical excision. Patients (134 male, 83 female) undergoing curative resection for colorectal carcinoma between August 1984 and January 1989 had colonoscopy within 3 months of surgery. Eleven patients (5%) had a synchronous cancer, which was diagnosed by colonoscopy in eight. In six of these eight, the diagnosis was made after surgery and 3 patients needed a second colectomy. However, in 3 patients the synchronous cancer was removed endoscopically without the need for further surgical resection. Most synchronous cancers had an earlier pathological stage than the index tumour. The rate of synchronous cancers was higher in patients with synchronous benign polyps (16%) than in those without polyps (3%). Colonoscopy is clearly justified as a peri-operative investigation in all patients undergoing potentially curative resection of colorectal cancer. If possible, the examination should be carried out prior to surgery, to guide the extent of resection.

Adult↗

PubMed2005

Performing a colonoscopy 12 months after surgery for colorectal neoplasia.

BACKGROUND: There appears to be acceptance that following up patients after surgery for colorectal neoplasia is of value. However, specific issues relating to which investigations to perform and how often remain unresolved. The aim of this project was to evaluate the clinical utility of performing a colonoscopy 12 months after curative surgery for colorectal neoplasia. METHODS: Patients were selected if they had undergone a curative resection for colorectal neoplasia, and if they had had a completed colonoscopy prior to surgery. Study endpoints included: (i) compliance with follow up; (ii) the prevalence, total number, size, and histology of polyps; and (iii) identification of recurrent or metachronous cancer. RESULTS: The study group included 253 patients of mean age 69.7 years (SD 11.6) and a male : female ratio of 1.4:1.0. Colonoscopies were completed on 90% of patients at a mean of 1.1 years following surgery. A total of 149 polyps were identified in 30% of patients. On histology, 42% were tubular adenomas, 6% tubulo-villous adenomas, 7% were villous adenomas, and 37% were hyperplastic. Advanced adenomas were identified in 7.9% of patients (95% CI 4.8-12.1%). No recurrent or metachronous cancers were identified. CONCLUSION: We have observed a high prevalence of advanced adenomas in patients undergoing a 12-month, follow-up colonoscopy after curative surgery for colorectal neoplasia. The significance of these observations requires further evaluation.

Adenoma↗

PubMed2006

Magnification chromo-colonoscopy.

Chromoscopic colonoscopy using indigo carmine is indispensable for the accurate detection of flat neoplastic lesions. In particular, the dye spray technique facilitates the detection of both flat hyperplastic polyps and highly dysplastic lesions. However, magnification chromo-colonoscopy discriminates adenomas from hyperplastic polyps with greater accuracy than conventional methods by showing distinct and visible pit patterns. A pit pattern represents crypt orifices, which reflect the underlying histological structures and colonoscopists can make histological predictions by observing the pit patterns without obtaining biopsy specimens. The pit patterns are classified as types I, II, IIIL, IIIs, IV and V based on histological characterization of normal mucosa, hyperplastic polyp, polypoid adenoma, flat adenoma, tubulo-villous adenoma and cancerous tissue, respectively. In previous reports, overall accuracy ranged from 80 to 95%. In addition, magnification chromo-colonoscopy is useful for the diagnosis of early cancer associated with substantial invasion of the submucosa, in which type V pits are subclassified as types V-I and V-N. The presence of type V-N pits is significant in correlation to cancer with substantial invasion of the submucosa. Magnification chromo-colonoscopy is useful in clinical decision-making when deciding whether endoscopic resection or bowel resection is the appropriate initial procedure to treat lesions.

Colonic Neoplasms↗

PubMed2002

Yield of colonoscopy in patients with nonacute rectal bleeding: a multicenter database study of 1766 patients.

OBJECTIVE: There are few data to guide the choice between colonoscopy and flexible sigmoidoscopy in patients with nonacute rectal bleeding, especially in younger age groups. Our aim was to determine the yield of colonoscopy for significant proximal large bowel disease in the absence of significant distal disease, with special reference to young patients. METHODS: This was a retrospective study of data collected prospectively in 1766 patients (median age 57 yr, 711 women). The endoscopic database (GI-Trac) contained 152 discrete fields for data input. Multiple logistic regression analysis was performed to identify variables independently associated with the presence of isolated significant proximal disease. RESULTS: Young patients had a higher percentage of normal examinations than did older patients. The incidence of diverticular disease, small polyps, large polyps, and cancer rose with increasing age. No patient aged <40 yr had an isolated proximal cancer, but 7% had other significant isolated proximal disease. There was no overall association between age and significant proximal disease in the absence of significant distal disease (p = 0.66). The only variable associated with isolated proximal disease was anemia (odds ratio = 1.81; 95% CI = 1.11-2.93; p = 0.02). CONCLUSION: The yield of colonoscopy (beyond the range of sigmoidoscopy) for neoplasia is low in patients aged <40 yr, but other significant disease may be missed if age is the only criterion determining colonoscopy use.

Adult↗

PubMed2002

Variable stiffness colonoscopes are associated with less pain during colonoscopy in unsedated patients.

OBJECTIVES: Application of a new variable stiffness colonoscope (VSC) is expected to control loop formation and to lessen patient discomfort. The aim of this prospective study was to compare the efficacy of VSC with a conventional colonoscope (CC) in unsedated colonoscopy, based on the experience of examiners. METHODS: Four-hundred sixty-seven patients were randomly assigned to undergo colonoscopy with either VSC or CC by an endoscopist, including experienced and less-experienced examiners. The percentages of completed procedure and time to cecal intubation were recorded. Patients were asked to rate pain on a 5-point pain score. RESULTS: The percentages of completed procedure with VSC and CC were 98% and 95%, respectively, by less-experienced hands, and 99% and 98%, respectively, by experienced hands. Time for cecal intubation with VSC and CC was 15.7 and 18.5 min, respectively, by less-experienced hands, and 9.8 and 10.6 min, respectively, by experienced hands. A significantly lower mean pain score was noted in VSC patients compared with CC patients, irrespective of experience of the examiner. The percent of patients rating the procedure as moderately or severely painful was significantly lower with VSC than with CC, both in less-experienced (19% vs 40%; p < 0.01) and experienced hands (15% vs 26%; p < 0.05). CONCLUSIONS: Our results indicated that VSC allows favorable examination compared with CC regarding completeness, time to cecal intubation, and comfort of patients undergoing unsedated colonoscopy, irrespective of the examiner's experience. These features suggest VSC as the preferred colonoscope for patients undergoing unsedated colonoscopy.

Aged↗