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PubMedDate not supplied

Colonoscopy.

Colonoscopy is an accepted technique for investigation of the colon. No portion of the large bowel is inaccessible to the diagnostic and therapeutic approach by flexible colonoscopy. The technical aspects of instrumentation have yielded to progress, with a small television chip currently incorporated into the tip of endoscopes transmitting an excellent image of the colon. Primary colonoscopy is being performed for selected indications, and, as facility with the technique increases, there will be a greater tendency for the performance of primary colonoscopy. Interruption of the adenoma-carcinoma sequence by techniques of snare-polypectomy may serve to markedly decrease the incidence of colon cancer over the next generation.

Barium Sulfate↗

PubMedDate not supplied

Guidelines for colonoscopy surveillance after cancer resection: a consensus update by the American Cancer Society and 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 (ACS) and 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 Stage 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 done 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 colonoscopy is normal, then the interval before the next subsequent examination should be 5 years. Shorter intervals may be indicated by associated adenoma findings (see Postpolypectomy Surveillance Guideline). Shorter intervals are also 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.

American Cancer Society↗

PubMed2005

Ischemic enterocolitis examined by colonoscopy and selective angiography.

AIM: To study the value of colonoscopy and selective angiography in diagnosing ischemic enterocolitis. METHODS: Among the 16 cases under study, 10 cases had hypertension and a history of coronary artery disease (one was hospitalized for sub-ventricular-wall infarction). The blood pressure of 10 of the 16 cases ranged from 13.9-23.8 to 13.3-14.6 kPa (170-180/100-110 mmHg). Two cases had chronic auricular fibrillation, and in four cases, a cardiogram showed left-front branch conduction block. Sixteen patients were examined by colonoscopy. Among them, 14 cases had a long course of angiocardiac disease, and were further examined by selective mesenteric inferior angiography. RESULTS: The colonoscopy revealed local mucous hyperemia edema and blood on contact. Lesions were found in the sigmoid colon in four cases, in the descending colon in eight cases and in splenic flexure in four cases, which suggests that the lesion always appeared in the left part of colon. There were different degrees of inflammatory cell infiltration, submucous bleeding, edema, fibro-embolism and hemosiderosis by biopsy in the 16 patients whose membranes affect part of the enteral wall. Of the 14 patients examined by mesenteric inferior angiography, 3 cases showed mesenteric amphraxis inferior and formation of collateral circulation. There were different degrees of stenosis in the other 11 subjects' mesenteric inferior cavities which grew slim and their branches were stenotic, so the radiographic image was not complete and the ends of some branches even cannot be seen. CONCLUSION: The colonoscopy and the selective mesenteric inferior angiography are both helpful in the diagnosis of ischemic enterocolitis.

Aged↗

PubMed2006

Comparative study of two bowel preparation regimens for colonoscopy: senna tablets vs sodium phosphate solution.

AIM: To compare the efficacy and acceptance of senna tablet and sodium phosphate solution for bowel preparation before colonoscopy. METHODS: One hundred and thirty four patients, who needed elective colonoscopy, were randomly allocated to take 180 mg senna tablet or 95 mL sodium phosphate solution on the day before colonoscopy. The efficacies of both laxatives were compared using the mean difference of colon-cleanliness score of the rectum, sigmoid segments, descending colon, transverse colon and cecum. The scores were rated by two observers who were blinded to the laxatives administered. The higher score means that the colon is cleaner. The efficacy of both laxatives were equivalent if the 95% confidence interval of the mean difference of the score of colon lie within -1 to +1. RESULTS: On intention-to-treat analysis, the mean cleanliness scores in the four segments of colon except the cecum were higher in the sodium phosphate group than those in senna group (7.9 +/- 1.7 vs 8.3 +/- 1.5, 8.0 +/- 1.8 vs 8.5 +/- 1.4, 7.9 +/- 2.0 vs 8.5 +/- 1.3, 7.9 +/- 2.0 vs 8.2 +/- 1.4 and 7.2 +/- 1.7 vs 6.9 +/- 1.4, respectively). The 95% confidence intervals (95% CI) of mean difference in each segment of colon were not found to lie within 1 point which indicated that their efficacies were not equivalent. The taste of senna was better than sodium phosphate solution. Also, senna had fewer side effects. CONCLUSION: The efficacy of senna is not equivalent to sodium phosphate solution in bowel preparation for colonoscopy, but senna may be considered an alternative laxative.

Adult↗

PubMed2006

Listening to Turkish classical music decreases patients' anxiety, pain, dissatisfaction and the dose of sedative and analgesic drugs during colonoscopy: a prospective randomized controlled trial.

AIM: To determine whether listening to music decreases the requirement for dosages of sedative drugs, patients' anxiety, pain and dissatisfaction feelings during colonoscopy and makes the procedure more comfortable and acceptable. METHODS: Patients undergoing elective colonoscopy between October 2005 and February 2006 were randomized into either listening to music (Group 1, n = 30) or not listening to music (Group 2, n = 30). Anxiolytic and analgesic drugs (intravenous midazolam and meperidine) were given according to the patients' demand. Administered medications were monitored. We determined their levels of anxiety using the State-Trait Anxiety Inventory Test form. Patients' satisfaction, pain, and willingness to undergo a repeated procedure were self-assessed using a visual analog scale. RESULTS: The mean dose of sedative and analgesic drugs used in group 1 (midazolam: 2.1 +/- 1.4, meperidine: 18.1 +/- 11.7) was smaller than group 2 (midazolam: 2.4 +/- 1.0, meperidine: 20.6 +/- 11.5), but without a significant difference (P > 0.05). The mean anxiety level in group 1 was lower than group 2 (36.7 +/- 2.2 vs 251.0 +/- 1.9, P < 0.001). The mean satisfaction score was higher in group 1 compared to group 2 (87.8 +/- 3.1 vs 58.1 +/- 3.4, P < 0.001). The mean pain score in group 1 was lower than group 2 (74.1 +/- 4.7 vs 39.0 +/- 3.9, P < 0.001). CONCLUSION: Listening to music during colonoscopy helps reduce the dose of sedative medications, as well as patients' anxiety, pain, dissatisfaction during the procedure. Therefore, we believe that listening to music can play an adjunctive role to sedation in colonoscopy. It is a simple, inexpensive way to improve patients' comfort during the procedure.

Adult↗

PubMed1998

Is colonoscopy indicated for small adenomas found by screening flexible sigmoidoscopy?

BACKGROUND: There is controversy over whether patients who have a small tubular adenoma on screening flexible sigmoidoscopy should undergo colonoscopic examination of the proximal colon. OBJECTIVE: To prospectively determine the prevalence of advanced polyps in the proximal colon among patients who have small adenomas on screening sigmoidoscopy. DESIGN: Prospective cohort study. SETTING: A health maintenance organization and a Veterans Affairs medical center. PATIENTS: Asymptomatic patients older than 50 years of age who had no risk factors for colon cancer and underwent sigmoidoscopy. INTERVENTION: At the time of sigmoidoscopy, all polyps were biopsied and characterized. All patients with distal adenomas were offered colonoscopy. MEASUREMENTS: The size and histology of polyps identified by sigmoidoscopy and colonoscopy were noted. Polyps were considered advanced if they were larger than 10 mm or were tubulovillous, villous, or malignant. The prevalence of advanced proximal polyps was determined, and patients were stratified by the size and number of distal polyps found by sigmoidoscopy. RESULTS: Among 4490 patients who underwent sigmoidoscopy, a neoplastic lesion was detected in 401 (8.9%) and colonoscopy was done in 301 (75%). Of 90 patients with a single tubular adenoma 1 to 5 mm in diameter in the distal colon, 0% (95% CI, 0.0% to 4.0%) had an advanced proximal polyp compared with 5.4% (CI, 2.4% to 10.4%) of those who had multiple distal polyps 1 to 5 mm or 6 to 10 mm in diameter and 7.9% (CI, 2.6% to 17.6%) of those who had advanced distal polyps (P = 0.013 for trend). The low-risk group with a single tubular adenoma 1 to 5 mm in diameter represented 44% of all patients with distal adenomas or cancers found at flexible sigmoidoscopy. CONCLUSIONS: Among patients undergoing screening sigmoidoscopy, those with single tubular adenomas of 5 mm or less had a low prevalence of advanced proximal polyps. These patients may not benefit from colonoscopy.

Adenoma↗

PubMedDate not supplied

Diagnostic colonoscopy.

Colonoscopy is employed in prevention, diagnosis, follow-up and treatment of colorectal diseases. The technological advancement of colonoscopes and supplementary equipment, has broadened indications for colonoscopy. However, since it is an invasive method with potential complications and hazards it should be performed by specialists capable of preventing, recognizing and treating them. The authors report their personal experience with 1,234 colonoscopies. The most frequent indications were changes in bowel habits and rectal bleeding in 35.1% and 30.5% cases respectively. The patients were given 10% mannitol for bowel cleansing and inadequate bowel cleansing in only 15 (1.2%) so that the colonoscopy could not be completed. The overall incidence of perforation was 0.16%. Three hundred and one polypectomies were performed and two cases (0.75%) of bleeding were noted.

Adolescent↗

PubMed2000

[Virtual colonoscopy].

Virtual colonoscopy is a fundamentally new imaging technique, in which volumetric CT or MRI data are processed to virtual endoscopic images of the colon. The main application is early detection of colorectal cancer. To date, no data of studies on screening for colorectal cancer are available. The results of clinical studies show comparable results for endoscopy and virtual colonoscopy for the detection of clinically relevant polyps (> or = 1 cm) and better results of virtual colonoscopy than of conventional barium studies. Whether virtual colonoscopy as a minimally invasive technique will gain a place in screening for colorectal cancer depends on several issues such as costs, effectiveness and acceptance by patients.

Colonic Polyps↗

PubMed1999

Common anxieties of patients undergoing oesophago-gastro-duodenoscopy, colonoscopy and endoscopic retrograde cholangio-pancreatography.

AIMS & METHODS: To investigate the anxieties of patients undergoing oesophago-gastro-duodenoscopy (OGD), colonoscopy and endoscopic retrograde cholangio-pancreatography (ERCP) in relation to their demographic features, their knowledge and understanding of the procedure, its indication, and their doctors' explanation. A standard questionnaire was filled in consecutively for 280 OGD patients, 64 colonoscopy patients and 50 ERCP patients. RESULTS & CONCLUSIONS: Majority of the anxious patients were afraid of pain. There was no difference between the "fearless" and "fearful" groups in terms of source of referral and inpatient/outpatient status. However for all 3 procedures, anxious patients were significantly younger by a mean of 10 years. Females, better educated and OGD patients undergoing the procedure for the first time were more anxious but this difference was not seen with the more complex colonoscopy and ERCP. The more sophisticated ERCP seemed to instill greater anxiety amongst Malay patients. Doctors were significantly more likely to explain the indication for OGD and colonoscopy than how it would be done. This discrepancy was not seen with ERCP where the endoscopists tend to adopt a more personal approach. Most patients prefer to be sedated.

Adolescent↗

PubMed2000

[Optimization of the technique of virtual colonoscopy using a multislice spiral computerized tomography].

PURPOSE: To optimize scanning parameters for virtual colonoscopy utilizing a multislice Helical CT scanner in an in vitro study (using a homemade colonic phantom) and in a preliminary clinical study. MATERIAL AND METHODS: A colonic phantom was built using a plastic tube and 12 plastiline polyps were placed inside. The colonic phantom was studied with a multislice Helical CT scanner. Axial images were obtained with the phantom parallel to the long axis of the moving table (in order to simulate the evaluation of ascending and descending colon): oblique images were acquired with the phantom at 45 degrees relative to the long axis of the moving table (in order to simulate the evaluation of sigmoid colon and colonic flexures). Four different scanning protocols were tested: 1) slice collimation, 5 mm; slice width, 7 mm; table speed, 25 mm; reconstruction index, 5 mm; 2) slice collimation, 2.5 mm; slice width, 3 mm; table speed, 15 mm; reconstruction index, 3 mm; 3) slice collimation, 1 mm; slice width, 1.25 mm; table speed, 5 mm; reconstruction index, 1 mm; 4) slice collimation, 1 mm; slice width, 1.25 mm; table speed, 4 mm; reconstruction index, 1 mm. Quantitative analysis consisted in evaluation of the number of identified polyps and polyp size along the longitudinal axis. Qualitative analysis consisted in the evaluation of image artifacts and quality of 3D reconstructed images (step artifacts and polyp geometry distortion). This preliminary clinical study was performed in 12 patients (7 men and 5 women) who underwent multislice Helical CT colonography. We selected patients with clinical indications for conventional colonoscopy or after unsuccessful conventional colonoscopy. RESULTS: Multislice Helical CT colonography was 100% sensitive in the detection of all polyps and in all scanning protocols. With oblique scans, only a 3-mm polyp was missed during protocol 1 (sensitivity: 92%). Polyp geometry distortion was observed on longitudinal reconstructions, whereas no distortion was seen on axial images. Image quality was graded as optimal for protocols 2, 3, and 4; protocol 1 was graded as good on transverse scans and as poor on oblique scans. In our preliminary clinical study, two colonic carcinomas and three polyps were identified. CONCLUSIONS: At present, the introduction of multislice technology in virtual colonoscopy permits to improve spatial resolution and image definition. The actual clinical advantage, in terms of increased diagnostic accuracy, needs further investigation in larger clinical studies.

Artifacts↗

PubMed2001

Feasibility study of colonoscopy as the primary screening investigation in relatives of patients with colorectal cancer.

AIM: Relatives of patients with colorectal cancer are thought to be at a higher risk for this disease than the average population. We aimed to determine whether colonoscopy is a feasible primary screening investigation for this group to identify premalignant and malignant lesions. METHODS: A total of 449 people underwent colonoscopy and all had one or more relatives with colorectal cancer, of these, 212 were classified as 'asymptomatic' and 237 as being 'symptomatic'. Colonoscopy commenced at 40 years of age or 10 years younger than the youngest affected relative. RESULTS: Neoplastic change, benign and malignant, was found in 25.5% of the 'asymptomatic' group and 24% of the 'symptomatic' group; in 26% of those with one first degree relative, 39% with two or more first degree relatives and only 19% with second degree relatives. 38% of lesions were out of reach of a flexible sigmoidoscope. No known complications occurred. CONCLUSIONS: It is feasible to perform colonoscopy as the primary investigation for the first degree relatives of patients with colorectal cancer. The yield of neoplastic lesions is sufficient to make this appropriate.

Adenoma↗

PubMed2003

A randomized prospective trial of bowel preparation for colonoscopy with Fortrans compared with bisacodyl.

BACKGROUND: An empty and adequate clean colon is a prerequisite of diagnostic or therapeutic colonoscopy. Our aim is to assess the efficacy and tolerance of bowel preparation for colonoscopy with Fortrans (polyethylene glycols) versus oral bisacodyl. METHODS: One hundred and four consecutive patients scheduled for colonoscopy were prospectively enrolled and allocated to Fortrans group or bisacodyl group by block randomization. RESULTS: Ninety-four patients were included for final analysis. Forty-five patients underwent preparation with Fortrans. The efficacy and tolerance of colon preparation were similar with both methods (p = 0.102, p = 0.202). The latency before the first bowel movement and total preparation time were shorter with Fortrans than with bisacodyl (p = 0.0001 and 0.001, respectively). Statistically significant differences were noted in changes of body weight, serum levels of sodium and calcium in patients taking bisacodyl (p = 0.049, 0.015, and 0.038, respectively). The taste of Fortrans was rated significantly better than that of bisacodyl (p = 0.002). Patients experienced more abdominal discomfort completing preparation with bisacodyl (p = 0.002). CONCLUSIONS: Fortrans and bisacodyl are equally effective and well tolerated in preparation for colonoscopy. However, Fortrans preparation takes less time and provides a better taste with less abdominal discomfort and less change in body weight as well as serum levels of sodium and calcium than bisacodyl preparation.

Bisacodyl↗

PubMed2003

[Virtual colonoscopy in real life--is it that good?].

BACKGROUND: Colon cancer is the main cause of mortality among the gastrointestinal cancers in Israel. Early detection of the average risk population is recommended from the age of 50 to 75 years. Private departments of radiology aggressively advertise virtual colonoscopy for the early detection of colon cancer, although it is not recognised as such in any country. METHODS: We collected all cases in which virtual colonoscopy was followed by endoscopic colonoscopy in the same patient from four medical centers in Israel. RESULTS: Total discrepancy between the results of the two examinations was found in 2/3 of the patients. In some cases colon cancer was missed. CONCLUSIONS: The results presented herein, raise many questions and "red lights" as to the use of virtual colonoscopy in its present form for screening purposes in Israel unless it is in the setting of clinical research.

Advertising↗

PubMed2004

[Comparison of midazolam versus midazolam/meperidine during colonoscopy in a prospective, randomized, double-blind study].

BACKGROUND/AIMS: Colonoscopy is a painful procedure. Therefore conscious sedation is often used. However, the value of adding analgesics to sedatives has not been well evaluated. METHODS: The double blind, randomized controlled trial was carried out to compare patients' and endoscopist' assessments in both groups of patients: MP (Midazolam/Placebo) group (n=49) received midazolam plus placebo and MM (Midazolam/Meperidine) group (n=51) received midazolam plus meperidine. RESULTS: There was no significant difference of baseline characteristics except previous operation history. There were no significant difference of grade of tolerance, pain and willingness to another colonoscopy between the two groups. In endoscopist' satisfaction, the degree of difficulty was higher in MP group than in MM group (39.0 vs. 31.7,p<0.05). After the colonoscopy, systolic blood pressure, oxygen saturation, and pulse rate were significantly decreased (p<0.05) in both groups. However, there was no difference in the degree of decrease between the two groups. The incidence of adverse effect was not different in the two groups. However, one case of orthostatic hypotension with presyncope was noted in MM group. CONCLUSIONS: Adding meperidine to the midazolam before the colonoscopy does not seem to bring more beneficial effect to patients, whereas endoscopist favored the use of both medications.

Adult↗

PubMed2004

[Systematic quality control programme for colonoscopy in an endoscopy centre in Norway].

BACKGROUND: Colonoscopy is regarded as the gold standard for diagnosis of colorectal disease, and increasingly considered a primary screening approach for colorectal cancer. The quality of the procedure varies between centres and endoscopists. The aim of the present study was to describe a quality control programme for colonoscopy performance in a secondary care centre. MATERIAL AND METHODS: Starting in 2001, we established a systematic quality control programme. All patients received a questionnaire on their satisfaction with and pain during and after examination. The questionnaire was to be filled in the next day and mailed back to the centre. Pain and discomfort during and after colonoscopy and caecum intubation rate were registered as indicators of quality. RESULTS: During the study period of 15 month, 1354 colonoscopies were performed by 16 endoscopists. 94% of examinations were performed without any sedation. 1054 (78%) of patients responded to the questionnaire, 99% of whom were generally satisfied. The caecum intubation rate was 82%. While 23% of patients scored for moderate pain during the examination and 16% complained of severe pain, 61% had no or only light pain. Significant differences between endoscopists regarding pain and caecum intubation rate were found in a multiple logistic regression model. INTERPRETATION: A satisfactory feedback from patients was observed, with a high response rate to the questionnaire survey and high overall satisfaction, in spite of the fact that about one third of patients experienced moderate or severe pain. There were significant variations in performance between endoscopists.

Adolescent↗

PubMed2004

[Estimation of appropriateness of colonoscopy using RAND/UCLA method].

Multicenter European trials estimating appropriateness of colonoscopy are one of the hot topics in gastroenterology. The aim of the study was the estimation of appropriateness of colonoscopy and usefulness of panel experts criteria (elaborated according to RAND/UCLA method) in Department of Gastroenterology of Medical University of Silesia in Katowice and other gastroenterology centers throughout Europe. The trial was conducted between January 1st 2001 and May 30th 2001 in 18 centers in 9 European countries. 307 patients, who signed informed consent, were recruited in Katowice, while 5697 patients were enrolled in the other centers. The data have been collected in a prospective manner on a dedicated sheet, prepared in the coordinating centre in Lausanne (Switzerland). The part of the sheet with evaluation of appropriateness of colonoscopy was filled in before the procedure. The endoscopic (and histopathologic if necessary) diagnosis was collected after the procedure. The data from all centers were analyzed in Lausanne and the results were sent to the participants. The comparison of results from Katowice and of all the other centers was performed in Katowice. We found out, that self-estimation (made by colonoscopist), but also what is much more important the estimation done according to objective criteria of the panel of experts were significantly higher in our department, than in the other participating centers. The overestimation of self-judgment has been significantly higher in the other centers, than in our department. The higher percentage of therapeutic colonoscopies in our department can be responsible for such results.

Adult↗

PubMed2005

[Virtual colonoscopy is now reality].

Virtual colonoscopy involves a helical CT or MR scan of the abdomen and pelvis to detect colorectal polyps and cancer. Both modalities have shown promising sensitivity in revealing larger polyps, in comparison with colonoscopy. Caution should be exercised in its clinical implementation due to significant interobserver variation and individual learning curves. A Danish study indicates that CT colonography (CTC) can be performed cost-effectively compared to colonoscopy. CTC is recommended in preference to double-contrast barium enema after incomplete colonoscopy.

Clinical Competence↗

PubMed2006

[A case of iatrogenic tension pneumoperitoneum following colonoscopy in a patient with cytomegalovirus colitis].

Perforation of the colon occurs in 0.2 to 2% of all colonoscopic examinations. The most common sites of perforation are rectosigmoid junction and cecal area. Colonic perforation, leading to tension pneumoperitoneum in most cases, may be caused by direct trauma or pressurized air. It should be suspected in patients with hypotension, tachycardia and tachypnea during or after the colonoscopy. An 83-year-old woman was admitted due to pulmonary embolism and left cerebellar infarction. Colonoscopy was performed due to bloody diarrhea. She was diagnosed as cytomegalovirus (CMV) colitis. One week after the colonoscopy, colon perforation was incidentally found on ascending colon, and tension pneumoperitoneum occurred immediately after the procedure. The perforated site was primarily closed and the patient discharged 20 days later. Herein, we report a case of tension pneumoperitoneum following colonoscopy in a patient with CMV colitis.

Aged, 80 and over↗