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PubMed1991

Surgical management of complications of fiberoptic colonoscopy.

A variety of complications are associated with fiberoptic colonoscopy. Life-threatening complications such as perforation and hemorrhage may require surgical intervention. The records of all patients who underwent fiberoptic colonoscopy, with or without biopsy, polypectomy, electrocoagulation, or laser therapy at St. Luke's-Roosevelt Hospital Center were reviewed. Thirteen of 21 perforations occurred during polypectomy, laser therapy, or difficult diagnostic colonoscopy. Eight patients developed a perforation after an uneventful diagnostic colonoscopy. Three patients required operative control of hemorrhage following polypectomy and one after multipolar electrocoagulation (BICAP) therapy for a cecal arteriovenous malformation. Two patients had benign pneumoperitoneum and one a retained polyp snare. Of the 28 patients in this entire series, 26 underwent operative resection or repair. Seventeen (65%) of the latter group underwent primary resection or closure of perforation without protective fecal diversion. Only one (5.9%) septic complication occurred in this group. Twelve patients in the perforation group (57%) underwent primary resection with anastomosis or closure of perforation without fecal diversion. One (8.3%) developed a septic complication. In this entire series, four deaths (14.3%) occurred, all of which were in the perforation group. Delay in diagnosis of perforation was the main factor contributing to death. No patient died of hemorrhage, benign pneumoperitoneum, or retained polyp snare. The key to successful outcome in perforation is early diagnosis and prompt operative intervention.

Aged↗

PubMedDate not supplied

The bowel cleansing for colonoscopy. A randomized trial comparing three methods.

INTRODUCTION: Colonoscopy is the procedure of choice for the detection and ablation of small lesions o the colonic mucosa. A proper bowel cleansing is mandatory. So far several regimens have been proposed but rather none has shown a clear-cut advantage over the others. Aim of this study was to compare cleansing ability and patients' compliance of three oral regimens. PATIENTS AND METHODS: Two-hundred and seventy-three patients were block randomised into three groups. Group A (92 patients) received tablets containing senna 12 mg and Magnesium Sulphate 15 mg the day before colonoscopy. Group B (98 patients) received a Polyethylene Glycol-based solution of two litres plus 4 tablets of Bisacodyl the day before the exam. Group C (83 patients) received Sodium Phosphate 40 milliliters the day before and the day of colonoscopy. Results of 265 patients were available for the analysis. Eight patients were excluded because inability to follow prescription. The lower incidence of constipation in group C was not significant. The other parameters were homogeneously distributed in the three groups. RESULTS: The 79 patients of the group C achieved a better bowel cleansing as compared with the 90 of group A (p = 0.0003) and the 96 of group B (p = 0.034). Constipated patients had a significantly better cleansing with Sodium Phosphate preparation compared with senna plus Magnesium Sulphate (p = 0.017), but not significantly better compared with Golytely solution. Compliance and rate of total colonoscopy performed were not statistically different in the three groups. CONCLUSIONS: Sodium Phosphate solution gave better bowel preparation, with the same compliance, than either senna or Polyethylene solution. In constipated patients Sodium Phosphate showed good efficacy resulting in good cleansing rates similar to that of non-constipated patients. The poor results obtained by Polyethylene were related to the little amount of solution taken even if associated to Bisacodyl.

Aged↗

PubMed1991

An evaluation of multiple clinical variables for hypoxia during colonoscopy.

One hundred consecutive patients undergoing routine colonoscopy were evaluated for changes in arterial oxygen saturation levels. All of the patients were monitored with the Nellcor N-200 pulse oximeter (Nellcor Incorporated) by finger probe and received supplemental oxygen when SaO2 levels decreased below 90 per cent. Forty patients demonstrated a decrease in SaO2 to less than 90 per cent after intravenous sedation but prior to colonoscopy, 14 patients demonstrated a decrease in SaO2 to less than 90 per cent during colonoscopy, and 46 patients maintained SaO2 levels greater than 90 per cent at all times. No statistical differences were found when these three groups were compared for age, body surface area, drug dosage, smoking history and a history of pre-existing hypertension, diabetes, arrhythmias, angina or myocardial infarction and pulmonary disease. These data indicate that all patients undergoing colonoscopy should be placed on supplemental oxygen. We further recommend continuous cardiac and pulse oximetry monitoring when available.

Adolescent↗

PubMed1991

The impact of colonoscopy on colorectal carcinoma.

In an eight-year, ongoing study of 120 patients, 39 with carcinomas and 81 with adenomas, no patient has produced a new carcinoma despite a high incidence of metachronous adenomas. Colonoscopy can identify early carcinomas that can be resected for cure. In addition, colonoscopy can identify the adenomatous polyps and with polypectectomy prevent the progression to carcinoma. Colonoscopy is more accurate than air contrast barium enema, provides a tissue diagnosis, and allows polypectomy. When applied according to risk factors known to be cost effective, colonoscopy leads to earlier diagnosis and thus improved long-term survival.

Adenocarcinoma↗

PubMed1990

[Fiber colonoscopy in children under 18. Our experience with 112 patients studied in the digestive endoscopy section of a general hospital].

The aim of the study was to evaluate the indications of colonoscopy, diagnostic accuracy and efficacy treatment of procedure in young patients aged less than eighteen years using standard forward colonoscopes Olympus CF LB2, CF LBw and CF HL20. Among 5,400 procedures done along eleven years, 112 (2.07 per 100) were performed in patients aged less than eighteen years, 37.6 per 100 of which were performed in children under ten years. In this group general anaesthesia was employed without complications. The most frequent indication of colonoscopy in young patients was rectal bleeding (62.5 per 100). Related to the frequency, in this series, the control of graft versus host disease in patients submitted to bone marrow transplantation was the second indication (11 per 100), followed by the study of chronic anaemia (4.2 per 100) and control of the chronic inflammatory bowel disease (4.2 per 100). Diagnostic accuracy reached 93.75 per 100. In 6 per 100 of the cases the exploration were considered unsatisfactory because inadequate cleaning of the colon. The most frequent diagnostic was "normal colon" (29.6 per 100 of the cases). Polyp was found in 21.2 per 100 of the cases. Polypectomy was performed in all indicated cases. One patient with multiple polyposis were submitted to surgery. Colonoscopy reached the right colon in 25.4 per 100 of the cases. In 54 per 100 of the procedures reached splenic angle and in 83.8 per 100 of the cases, all sigmoid colon was explored. From this experience we suggests that colonoscopy, using standard endoscopes, is a very useful diagnostic and therapeutic technique in child and in young people.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1990

Effect of preoperative colonoscopy on the incidence of synchronous and metachronous neoplasms.

Colonoscopy and air-contrast barium enema performed preoperatively in 389 patients with colorectal cancer revealed synchronous cancer in 4% and polyp in 14%. Nine of the 16 synchronous cancers were located in other surgical segments than the index cancer, and six of the nine were in stage A or B1. Of the 54 synchronous polyps, 28 were located in such other segments. Half of the synchronous cancers and almost half of the synchronous polyps were missed at double-contrast barium enema. All synchronous cancers and three-fourths of the synchronous polyps were detected at colonoscopy. No patient with preoperative colonoscopy presented with metachronous cancer within 3 years from surgery, and only two were subsequently found to have adenocarcinoma arising from an adenomatous polyp. Endoscopic polypectomy was performed in 21 cases during follow-up. Extensive use of preoperative colonoscopy is recommended in the evaluation of colorectal cancer, in order to promote detection of synchronous tumors, reduce the incidence of 'early metachronous' cancer and avoid malignant degeneration of adenomatous polyp.

Adult↗

PubMed1988

Colonoscopy in the follow-up of patients with colorectal carcinoma.

In an effort to determine the value of colonoscopy in the follow-up of patients who have undergone resection for colorectal carcinoma, the authors evaluated prospectively 100 consecutive patients who, during follow-up after resection for colorectal cancer, had normal findings on barium enema examination and also underwent colonoscopy. The follow-up from operation to colonoscopy ranged from 8 months to 15 years (average 2.6 years). Two recurrent and two metachronous carcinomas were detected. In addition, 25 polyps (3 benign) were removed from 22 patients. Twelve of the malignant polyps were less than 1 cm in dimension, the other 10 were larger. Colonoscopy is considered valuable in this setting for earlier detection and removal of recurrent and metachronous carcinomas and potentially premalignant lesions.

Adult↗

PubMed1986

Colonoscopy and bacteraemia: an experience in 50 patients.

There is little consensus concerning the incidence of bacteraemia during colonoscopy and the need for antibiotic prophylaxis in susceptible patients. Hepatic abscesses in one patient which may have been related to prior colonoscopic examinations led the authors to carry out a prospective study of 50 patients undergoing colonoscopy. Multiple blood cultures were carried out to maximise the positive yield of transient bacteraemia and to attempt to determine the time when bacteraemia is most likely to occur. Five patients had positive blood cultures. In two patients S epidermidis was isolated, but only from the precolonoscopic blood sample. In three subjects enteric organisms were cultured from blood samples obtained during the procedure. In one of these three the same organism was cultured from the preendoscopic blood sample so that in only two patients (4%) could the bacteraemia be attributed to the colonoscopy. These results would suggest that the risk of bacteraemia during colonoscopy is low.

Adult↗

PubMed1987

Is preoperative colonoscopy in carcinoma a realistic and valuable proposition?

Colonoscopy was performed preoperatively in 100 consecutive patients as a prospective study to establish the feasibility of the procedure and its value, which was considered "adequate" when the colon remaining after surgical resection had also been examined preoperatively. Colonoscopy was adequate in 35 of 46 patients (76%) with malignant tumour located in the cecum and ascending and transverse colon, but in only 15 of 54 patients (28%) who had a tumour in the left colon or rectum. Synchronous malignant tumours were present in 2 patients, and 54 additional adenomas were discovered in 29 patients. These adenomas could be removed endoscopically in 13 patients and were included in the standard resection in 12. Extension of the planned operation was necessary in only four patients with synchronous adenomas. Routine preoperative colonoscopy to assess the presence of synchronous colonic tumours is more likely to be adequate in proximal or right-sided large-bowel tumours than in left-sided tumours because of the annular configuration of the latter. Because of the high rate (46%) of synchronous adenomas in adequate examinations, inadequate preoperative colonoscopy should be complemented by a repeat examination 3 to 6 months postoperatively in every patient with a malignant tumour of the large bowel.

Adenoma↗

PubMed1983

A randomized blinded clinical trial of a rapid colonic lavage solution (Golytely) compared with standard preparation for colonoscopy and barium enema.

The efficacy and safety of the new colonic lavage solution, Golytely (an electrolyte-polyethylene glycol solution), was compared with standard 2- and 3-day bowel preparations in a randomized blinded study of patients undergoing colonoscopy and barium enema examination. Side effects, patient preference, and quality of examinations were monitored. Colonoscopy was scored by colonic segment for type of residual stool and percentage of bowel wall visualized. Barium enema was graded by stool particle size in the least clean segment. For colonoscopy, preparation with Golytely allowed better visualization of colonic mucosa (p less than 0.002) due to less retained stool (p less than 0.002), produced more optimal exams (p less than 0.002), and required less time to reach the cecum (p less than 0.05). Furthermore, it was preferred by patients, required less than 5 preparation time, and caused no notable side effects. For barium enema, no significant difference existed between preparations. We conclude that Golytely is effective for barium enema examination and is the preparation of choice for colonoscopy.

Adult↗

PubMed1984

Value of colonoscopy after ureterosigmoidostomy.

Ureterosigmoidostomy (US) is an acceptable procedure for urinary diversion. Despite problems with ascending pyelonephritis, anal incontinence, and recently a reported 100- to 500-fold increase in the incidence of colonic carcinoma, the popularity of US is predicted to increase. The records of 110 patients who have undergone US at our institution have been reviewed. Invasive colon cancer developed at the site of ureter implantation in three of these patients. All patients had rectal bleeding and obstipation as initial symptoms. We have located 17 of our US patients and all consented to colonoscopy and urologic follow-up. At colonoscopy 41% of these patients had one to three polyps (0.5 to 6 cm) involving or near the site of the US. No polyps were seen proximal to the US sites. Polyps were histologically defined as tubovillous adenomas or mixed tubovillous-transitional cell adenomas. A single patient with three 4 to 6 cm polyps had superficial adenocarcinoma found in two of the polyps. Recurrent polyps or dysplasia has not been found on follow-up examination. Despite the disadvantages of US, the likely increased popularity of this procedure mandates that all patients be followed regularly for polyps and cancer. Our data support the following recommendations: (1) surveillance colonoscopy should be started soon after US, and (2) conversion to an alternative diversion should be made if recurrent polyps, cancer, or dysplasia is found. Yearly colonoscopy and screening for occult blood must be part of the comprehensive follow-up on all patients after US.

Adenocarcinoma↗

PubMedDate not supplied

[Correlation between colonoscopy and histopathology of the colon in diverticular disease and the irritable colon syndrome].

In this study 29 patients were carriers of diverticular disease of the colons (DDC) and 29 patients with irritable bowel syndrome (IBS). The patients were diagnosed by means of a directed anamnesis standardized by the radiologic study of the colons. The methodology included, radiologic study of the colons, endoscopic examination of the colon (colonoscopy with biopsy) and anatomic pathologic examination of the fragments obtained in the endoscopy. It was tried, by means of colonoscopy with biopsy and anatomic pathological examination, to demonstrate, classify and relate, in agreement with pre-established criterion, the degree of intensity of the inflammatory process in the colic mucosa. According to the results we may conclude that: 1) colonoscopy in the studied inflammatory diseases is important for diagnosis, evaluation of the inflammatory process, identification of associated illness and material obtention for the anatomic pathological examination; 2) there is always a chronic inflammatory process, in variable degrees, of the colic mucosa in DDC and in IBS; 3) colonoscopy with biopsy and the anatomic pathological examination are adequate to diagnose with precision the degree of intensity of the chronic inflammatory process of the colic mucosa and the presence of associated disease in DDC and in IBS.

Adult↗

PubMed1982

Patient acceptance and effectiveness of a balanced lavage solution (Golytely) versus the standard preparation for colonoscopy.

An oral electrolyte solution containing 125 mM/L sodium, 10 mM/L potassium, 80 mM/L sulfate, 20 mM/L bicarbonate, and 80 mM/L of polyethylene glycol, and associated with little water or electrolyte absorption from the gut was recently described in this journal. To determine the efficacy of this solution (Golytely) for colonoscopy, 20 consecutive patients were randomized to either a standard colonoscopy prep or Golytely. Both preps resulted in a feces-free colon, allowing colonoscopy to the cecum in most cases. Although Golytely produced mild cramps (3 of 12) and transient fullness (6 of 12 vs. 0 of 8 with standard prep, p less than 0.02), 11 of 12 were willing to repeat Golytely vs. 3 of 8 with the standard prep (p less than 0.02). It is concluded that Golytely is an effective prep for colonoscopy and well tolerated by patients. It is especially useful for those requiring repeated examinations because of patient acceptance and efficacy.

Adult↗

PubMed1982

Total colonoscopy in children.

One hundred and twenty-three total colonoscopies were performed on 115 children with ages ranging from 3 months to 16 years. The major indications were suspected inflammatory bowel disease and unexplained rectal bleeding. Ninety-seven per cent of all procedures were carried out with sedation only. Adult colonoscopes were used in most of the patients but in babies and small children paediatric instruments were preferable. Total colonoscopy was possible in all patients with a patent colon. The terminal ileum was examined in 63 patients. Endoscopic snare polypectomy was successfully carried out in 8 children and multiple haemangiomas were electrocoagulated in one. Total colonoscopy in this paediatric series proved to be at least as easy, rapid, well-tolerated, and safe as in adults. In selected patients as single colonoscopy can give an accurate diagnosis with biopsy proof and sometimes the opportunity for definitive treatment.

Adolescent↗

PubMed1995

[Effectiveness and costs of screening colonoscopy].

Screening colonoscopy is always indicated when rectosigmoidoscopy reveals an adenoma, since this lesion roughly doubles the patient's risk of contracting colonic cancer. Follow-up should be performed at intervals of about three years after endoscopic removal of all colorectal polyps. Repeated screening examinations are recommended for the following genetic diseases that carry an increased risk of colorectal carcinoma: familial adenomatous polyposis (FAP) and its genetic variant, hereditary non-polyposis colorectal cancer syndrome (HNPCC) and hamartomatous polyposis syndromes (e.g. Peutz-Jeghers). Also in the case of familial "sporadic" carcinoma of the colon, regular screening colonoscopies for first degree relatives are recommended. Although the use of regular screening colonoscopies in patients with a long history of extensive ulcerative colitis is controversial, the recent results support such examinations. While the benefit of screening colonoscopy or sigmoidoscopy of the general population from the age of 50 onward must be affirmed, it should be weighed against the costs involved in such an undertaking. At the present time, the American Cancer Society recommends that from the age of 50 onward, the annual fecal test for occult blood should be supplemented by sigmoidoscopy performed every three to five years.

Adenomatous Polyposis Coli↗

PubMed1994

[Colonoscopy. In investigation, treatment and control of gastrointestinal diseases].

Colonoscopy is the initial examination for patients with manifest or occult rectal bleeding, inflammatory bowel disease and colorectal polyps. In addition to polypectomy, colonoscopy is useful in decompression of adynamic colonileus and laser palliation of intractable tumours. In adenoma patients controls should be limited to high risk patients, i.e. those with large and multiple tubular adenomas, villous adenomas, multiple hyperplastic polyps (> 30), and first degree relatives of patients with colorectal carcinomas. Control after radical surgical treatment of colorectal cancer is offered during the first two years after the operation and to persons younger than 40 years. The efficacy of control programmes for hereditary nonpolyposis colorectal cancer families have to be evaluated in controlled series. Rectosigmoidoscopies could probably replace some total colonoscopies to examine ulcerative colitis patients for cancer, since cancer usually occurs in the distal colon. Complications are rare after diagnostic and therapeutic colonoscopies, but perforation, bleeding and injury to surrounding organs can be experienced.

Colonoscopy↗

PubMed1993

Lack of efficacy of ketorolac tromethamine for analgesia on patients undergoing colonoscopy.

Ketorolac tromethamine (KT) is a new non-narcotic parenteral analgesic which lacks the respiratory depressant and hypotensive side effects of narcotics. Our aim was to determine whether KT can reduce requirements for narcotics and narcotic side effects in colonoscopy. In a randomized, double-blind trial, either intravenous KT (n = 30) or placebo (n = 30) was administered as a preprocedure analgesic to male patients undergoing colonoscopy. Patients who had pain during colonoscopy received supplemental diazepam and meperidine as required to maintain comfort. KT treatment did not affect patient comfort. No significant difference in the dose of diazepam or meperidine required was noted between the study and the placebo group, and there was no difference in the number of patients who required supplemental narcotics. The incidences of hypotension or arterial oxygen desaturation were similar in the KT- and placebo-treated patients. Ten patients in the KT group and four patients in the placebo group reported discomfort at the site of injection. We conclude that intravenous ketorolac tromethamine is no better than placebo as an analgesic premedication in colonoscopy.

Aged↗

PubMed1993

Sedation associated with a more complete colonoscopy.

BACKGROUND: This study examined the effect of sedation on the rate of complete colonoscopic examinations by a family physician performing colonoscopy at an urban family practice residency. The outcomes of biopsies and polypectomies performed during the period of the study were also evaluated. METHODS: Data were prospectively collected on 164 consecutive colonoscopies. Seventy-three percent (124/164) of the examinations were training experiences supervised by the first author. The outcomes of examinations of 126 sedated patients were compared with those of 38 nonsedated patients. Patients were not randomly selected. RESULTS: Examinations of 126 sedated patients were carried out with an 85% reach-the-cecum rate compared with a 31% reach-the-cecum rate for 38 nonsedated patients (P < .05). A higher percentage of examinations done without sedation (16%) were terminated because of pain than were terminated in sedated patients (5%) (P < .05). An electrolyte purge solution was found to be the most effective colonoscopy preparation; only 7% (7/100) of examinations on patients prepared by this method were terminated because of inadequate bowel preparation. Adenomas were found in 11% (14/126) of sedated patients and in 8% (3/38) of nonsedated patients. Cancer was detected in 4 sedated patients. CONCLUSIONS: These findings suggest that sedation in colonoscopy is associated with a higher percentage of complete examinations. Also, patients prepared with an electrolyte purge solution tend to have fewer examinations terminated because of inadequate preparation.

Adenoma↗