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PubMed1996

Incidence and causes of rectal bleeding in general practice as detected by colonoscopy.

BACKGROUND: Rectal bleeding is common, but it is still unclear which patients require investigation to exclude serious pathology, although it is known that colectoral cancer is very rare under the age of 40 years. Few studies have examined all patients presenting to their primary health physician rather than screening whole populations. AIM: The aim of this study was to investigate the view that all patients over the age of 40 who present to their general practitioner with rectal bleeding should undergo investigation by colonoscopy to rule out serious pathology, regardless of symptomatology. METHOD: A prospective study was carried out of 99 consecutive patients over 40 years presenting with rectal bleeding to 17 general practices in Newcastle upon Tyne. RESULTS: Serious pathology was detected by colonoscopy in 44.4% of patients. The diagnoses were: colorectal carcinoma, eight cases (two Dukes' grade A, two Dukes' grade B, four Dukes' grade C); one or more polyps, 25 cases (in 17 cases at least one polyp was 5 mm or greater in diameter); inflammatory bowel disease, 11 cases. In the remaining 55 patients, bleeding was associated with diverticular disease (16 cases) and haemorrhoids (28 cases). No cause was found in 11 patients. This high rate of pathology may be partly caused by selection of cases for referral by the general practitioner, despite efforts to minimize this. Three symptoms as elicited by the colonoscopist were found to be significantly associated with serious disease: blood mixed with stool (P < 0.001); change in bowel habit (P < 0.005); and the presence of abdominal pain (P < 0.025). However, symptoms elicited on primary presentation were less helpful and symptoms changed significantly between consultation with the general practitioner and colonoscopy. CONCLUSION: All patients over the age of 40 years presenting with rectal bleeding should be referred for flexible sigmoidoscopy or colonoscopy. Symptoms are unhelpful in deciding who requires investigation.

Adult↗

PubMedDate not supplied

Safety of colonoscopy.

The deterioration of three patients with ulcerative colitis shortly following colonoscopy made us question whether this was related to the colonoscopy or bowel preparation, this trial was set up to answer this question. A total of 105 patients were recruited and underwent full bowel preparation and colonoscopy. Results showed that there was no statistically significant difference between patients with ulcerative colitis and controls with non-inflammatory disease in increase in bowel frequency, general well being or pain. In summary we conclude that full bowel preparation and colonoscopy in patients with ulcerative colitis managed as outpatients do not lead to a deterioration in their symptoms.

Adolescent↗

PubMed1996

Colonoscopy in the investigation of colonic diseases.

A retrospective analysis of 640 patients who underwent 681 colonoscopic examinations between March 1984 and April 1996 was undertaken. The major indications were rectal bleeding (32.8%), change in bowel habit (24.7%), abdominal pain (20.1%), abnormal barium enema (9.8%) and iron deficiency anaemia (4.8%). Total colonoscopy was performed in 79.3% of cases. The colonoscopic finding was normal in 49.8% of patients. Most of the lesions were benign. Polyps and carcinoma were found in 9.2% and 7% of patients respectively. 91.3% of the lesions were located distal to the splenic flexure and of the remaining proximal lesions, polyps and carcinoma accounted for only 2.2%. Rectal bleeding produced the highest diagnostic yield (70%) followed by iron deficiency anaemia (61.3%), change in bowel habit (48.1%) and abnormal barium enema (47.6%). Lower yields were found in patients with abdominal mass (33.3%), follow up colonoscopy (28.6%) and abdominal pain (26.9%). However, the diagnostic yield of clinically significant pathology varied widely among the different indications. Therefore, selection of patients for colonoscopy based on the diagnostic yield of each indication may not be practical. Sigmoidoscopy is suggested as the first line of investigation for patients suspected to have colonic diseases, particularly where there is limited trained manpower and facility. Total colonoscopy should be reserved for sigmoidoscopy negative patients with persistent symptoms and high risk cases for malignancy.

Adolescent↗

PubMed1997

Colonoscopy experience at a family practice residency: a comparison to gastroenterology and general surgery services.

BACKGROUND AND OBJECTIVES: Colonoscopy training is receiving greater emphasis in family practice residencies. However, no standards have been established to measure the adequacy of this training. This study assessed the colonoscopy experience of family practice residents at Louisiana State University Medical Center at Shreveport (LSUMC-S). METHODS: We included all colonoscopies performed by the family practice service between August 1992 and December 1994 and matched them by gender and age with cases from the gastroenterology (GI) and general surgery (GS) services performed during the same time period. Family practice and GI were compared using 143 cases from each service; 166 cases were used to compare family practice to GS. RESULTS: The cecum was intubated in 87% of patients on all services. The average time to complete the procedure was 35 minutes by the family practice service, 44 minutes by GI, and 25 minutes by GS. No significant differences were found between family practice and GI in the number of patients with polyp, normal colon, or biopsy performed. In comparison to GS, there were significantly fewer patients on the family practice service with normal colon and more with multiple polyps and biopsy performed. Significantly more cancers were found by the family practice service than by either GI or GS. There were no complications reported for any of the services. Results compared favorably with data in the current literature. CONCLUSIONS: The colonoscopy experience available to family practice residents at LSUMC-S is acceptable within the parameters studied.

Biopsy↗

PubMed1997

The effect of colonoscopy on tumor markers.

As preoperative elevated serum levels of carcinoembryonic antigen (CEA) and CA19.9 are markers for bad prognosis in colorectal cancer patients, it is important to decide whether preoperative total colonoscopy would make a significant change in their serum levels. CEA and CA 19.9 were evaluated in three groups of patients before and after colonoscopy. The groups comprised the following: Group A, 20 patients with colorectal cancer; Group B, 17 patients with colorectal polyp of > or = 1-cm diameter; Group C, 16 patients with no colorectal pathology. CEA serum levels were found to be significantly lower after colonoscopy in all groups. CA19.9 was found to be significantly lower after colonoscopy only in Group B; it did not reach significance in Group A and was found not to be significantly higher in Group C.

Adult↗

PubMed1998

[Value of colonoscopy in tumor after-care after colorectal carcinoma].

The significance of colonoscopic follow up is discussed controversially. Colonoscopy after resection of colorectal cancer offers the possibility of direct inspection and to take biopsies for the early detection of local recurrence or additional neoplasms. In a retrospective study we examined the benefit of regular colonoscopies. Between 1/1995 and 4/1996 237 colonoscopies were performed on 164 patients after resection of colorectal cancer. The evaluation was done due to the stage of the primary tumor, the age of the patients, the time after operation and the number of previous colonoscopies. 54 adenomas were found in 35 of 164 patients. 32% of the adenomas were diagnosed in the ascending colon or colon transversum. Additionally three carcinomas were found. There were two local recurrences and one metachronous neoplasm. Two patients were diagnosed without clinical symptoms and were able to undergo potential curative resection again. Because of the number and the localisation of diagnosed neoplasms colonoscopic surveillance should be performed every six months in the first two years after resection of colorectal cancer.

Adenomatous Polyposis Coli↗

PubMed1998

[Pediatric colonoscopy].

The procedure and results of 50 colonoscopies performed over a three-year period on a group of 43 children (range: 0.3-16 yr; median: 9 yr) are described. The main indications were evaluation for, or control of already known, chronic inflammatory bowel disease (n = 38) and rectal bleeding (n = 8). Following verbal and written information the children were admitted one to two days before the procedure for bowel preparation. Children < 10 years old received general anaesthesia during the colonoscopy (n = 25) and most children > or = 10 years old received an intravenous sedation with pethidine and midazolam (n = 25). In only one case was intravenous sedation not successful. The coecum was visualised in 96% and the terminal ileum intubated in 77% (when intended) of the endoscopies. The most important results obtained were establishment of the diagnosis of inflammatory bowel disease in 21 of 30 suspected cases and the removal of a polyp in two cases. At the time of colonoscopy a "best guess" diagnosis of either ulcerative colitis or Crohn's disease often predicted the histological diagnosis, but endoscopy tended to underestimate the severity and extent of the inflammation as compared to microscopy. There were no complications. We conclude that colonoscopy performed according to our recommendations is a safe and informative procedure for evaluation of the large bowel and terminal ileum in children with intestinal disease.

Adolescent↗

PubMed1977

Hereditary polyposis coli I: the diagnostic value of colonoscopy, barium enema, and fecal occult blood.

In families with one of the Mendelian hereditary polyposes, one can predict the proportion of patients at risk and thus obtain a denominator against which colonoscopy, barium enema, and fecal occult blood can be validated. Colonoscopy is more sensitive than barium enema. There were 42 positive colonoscopies, 12 positive barium enemas, both being positive in 10 of these. There were 141 negative enemas, 133 negative colonscopies, and 118 negative for both. Occult blood was positive in 30% of patients with polyposis, five to seven times more frequently than in those without evident polyposis. Colonoscopy detected polyposis in 30% of the progeny of affected people. The shortfall, compared with the 50% expected under the Mendelian hypothesis, is readily explained by removal of affected cases from the study by surgery or death from cancer.

Barium Sulfate↗

PubMedDate not supplied

Guidelines for use of flexible fiberoptic colonoscopy in management of patients with colorectal neoplasia.

Flexible fiberoptic colonoscopy, to have the maximum effect upon the management of patients having, suspected of, or at risk of having colorectal neoplastic disease, must be applied in accordance with substantial guidelines. Schemes for the application of colonoscopy have been designed for the early and accurate diagnosis of benign and malignant polypoid lesions. Colonoscopy has proven effective in confirming radiographic findings and the removal of pre-malignant and superficially malignant lesions. When applied in accordance with appropriate guidelines, flexible fiberoptic colonoscopy should provide not only secure surveillance in those individuals at high risk, but also should reduce appreciably the morbidity and mortality of colorectal neoplasia.

Colonic Neoplasms↗

PubMedDate not supplied

Diagnostic performance of virtual colonoscopy.

The most important diagnostic performance of virtual colonoscopy is the ability to detect colorectal polyps. However, its diagnostic value for evaluation of patients undergoing incomplete colonoscopy and the ability to detect unsuspected extracolonic findings are also important diagnostic features. Because of important differences between published patient populations, a meta-analysis combining data from different studies would not provide a reliable statistic. The by-patient sensitivity for patients with polyps 10 mm and larger ranges from 75% to 100% in most series and was 100% in the two largest series published to date. By-polyp sensitivity for polyps 10 mm and larger ranges from 50% to 100% and was 89-90% in the two largest series. Detailed data on smaller polyps are summarized. Virtual colonoscopy is an excellent test for evaluation of patients with incomplete colonoscopies. The incidence of significant extracolonic findings is 7-13%.

Colon↗

PubMed2000

Colonoscopy technique with an external straightener.

BACKGROUND: An external straightener for colonoscopy which enables proper compression of the abdomen during the entire examination has been developed. METHODS: Beginning January 1, 1997, patients undergoing outpatient colonoscopy were subjected to either manual abdominal compression or compression with an external straightener. Two hundred patients were divided into two groups of 100 patients each: group A (colonoscopy using traditional methods; 38 men, 62 women, mean age 59.6 years, range 18 to 80) and group B (colonoscopy with the help of the external straightener; 40 men, 60 women, mean age 59.8 years, range 16 to 75). Fifteen minutes after the examination, each patient completed a form that assessed the degree of pain during the procedure (no pain, mild, moderate, severe). RESULTS: The ileocecal valve was reached in 89 cases in group A and 94 cases in group B. The average time required to reach the valve was 9.34+/-4 minutes (range 4 to 25) in group A and 6.97+/-3.37 minutes (range 2 to 21) in group B (p<0.001). With regard to the degree of pain, the results for groups A and B were, respectively: no pain = 25% and 40%, mild = 29% and 34%, moderate = 30% and 20%, severe = 16% and 6% (p< 0.001). CONCLUSIONS: The external straightener reduced examination time and decreased the degree of patient pain compared with traditional methods.

Adolescent↗

PubMedDate not supplied

Prospective evaluation of a small caliber upper endoscope for colonoscopy after unsuccessful standard examination.

Colonoscopy is unsuccessful in some patients because of a fixed sigmoid loop or anatomical stenoses. We prospectively evaluated 1600 patients undergoing colonoscopy at Virginia Mason Medical Center from December 1, 1986 to November 31, 1987. Thirty-one procedures (1.9%) failed to reach the splenic flexure because of functional or anatomic stenoses. Attempt at pancolonoscopy with a 9.8-mm diameter, 102-cm length endoscope (Olympus XQ) was successful to the right colon in 73% and cecum in 60% of these patients. Two thirds of the successfully intubated patients had clarification of radiographic abnormalities or delineation of additional colon pathology. There were no complications or instrument damages, but limitations included short scope length and small suction channel. We conclude that small diameter upper endoscopes can be used safely and effectively for colonoscopy in a subset of patients in whom conventional colonoscopy is unsuccessful.

Colonic Diseases↗

PubMed1977

Recurrent carcinoma of the colon in the anastomosis diagnosed by roentgen examination and colonoscopy.

After resection for cancer of the large bowel recurrence at the anastomosis occurs in about 10%. In 30 operated cases roentgenography and colonoscopy were performed. In 18 cases roentgen examination gave rise to suspicion of recurrence at the anastomosis but this was confirmed by colonoscopy and surgery only in 6 cases. In two additional cases with normal roentgenographic findings recurrence at the anastomosis and a second primary cancer were diagnosed by colonoscopy in one case each. The clinical symptoms provided no guidance in the diagnosis of recurrence. Roentgen examination is admittedly less conclusive than colonoscopy for discovery of recurrent and metachronous carcinoma. The methods are, however, complementary and both examinations should be regularly carried out in order to establish an early diagnosis.

Adenocarcinoma↗

PubMed2003

Standardized reprocessing of reusable colonoscopy biopsy forceps is effective: results of a German multicenter study.

BACKGROUND AND STUDY AIMS: National and international guidelines recommend that a standardized protocol consisting of cleaning, ultrasound cleaning, and sterilization should be used for the reprocessing of endoscopic accessories in order to reduce the risk of transmission of microorganisms. This German multicenter study investigated the efficacy of standardized reprocessing of reusable biopsy forceps used during colonoscopy. MATERIALS AND METHODS: Ten endoscopy centers (eight hospitals and two private practices) used 330 biopsy forceps during routine colonoscopy. The forceps were used once, five times, or 20 times for colonoscopy, based on a randomization plan. The reprocessing protocol consisted of manual cleaning with an enzymatic agent, ultrasound cleaning with an enzymatic agent (30 min, 40 degrees C, 47 Hz), neutralization, drying, and sterilization (5 min, 134 degrees C). Aldehydes were not used, and the protocol did not include a disinfection step. The biopsy forceps were sent to three microbiological institutes, based on a randomization plan, to have them tested for the presence of organisms, including identification of bacteria. RESULTS: A total of 318 of the 330 forceps were evaluable; 314 forceps (98.74 %) were sterile after use once, five times, or 20 times. Four forceps were contaminated with Staphylococcus epidermidis (n = 2), Bacillus licheniformis (n = 1) and Corynebacterium aquaticum (n = 2). All of 25 forceps were sterile after being used 20 times. CONCLUSION: Colonoscopy biopsy forceps can be reliably reprocessed following this standardized protocol, even without aldehydes.

Bacteria↗

PubMed2001

Virtual colonoscopy: a new tool for colorectal cancer screening.

Virtual colonoscopy or computed-tomography colonography is a promising new method for colorectal cancer screening. Helical computed tomography is used to generate high-resolution, two-dimensional axial images of the abdomen and pelvis. Three-dimensional images of the colon simulating those obtained with conventional colonoscopy can be reconstructed from the data obtained. Favorable attributes of virtual colonoscopy include its safety, high patient acceptance, and ability to provide a full structural evaluation of the entire colon. Multiple studies of virtual colonoscopy have been published in the literature in the past year regarding technique, image display, image reconstruction, clinical trial results, and feasibility as a screening tool. This manuscript will review the various studies in each of these areas.

Journal Article↗

PubMed1977

Colonoscopy in clinical practice.

Colonoscopy is a relatively new and important diagnostic modality for evaluation colonic disease. In order to assess its value in the community hospital, all colonoscopies done by me (250 examinations in two hospitals) were reviewed. Colonoscopy was sometimes easy and sometimes long and tedious. It was difficult to reach the cecum consistently, but success improved with experience. Many neoplasma not seen on barium enema were found, including three carcinomas. Twenty-seven polyps were removed with the aid of the colonoscopic snare. No complications occurred. Colonoscopy should probably be restricted to those physicians who have a large enough case load and who can spend enough time learning the procedure to develop expertise.

Adolescent↗

PubMed1995

First clinical results with a real time, electronic imager as an aid to colonoscopy.

The early clinical results are described of a real time, electromagnetic imaging system as an aid to colonoscopy. After gaining experience with the use of the system, one experienced endoscopist was randomised to perform consecutive colonoscopies either with (n = 29) or without (n = 26) the imager view. All procedures were recorded on computer disk and replayed for retrospective analysis. Total colonoscopy was achieved in all patients except one (imager view not available). Comparing intubation time and duration of loop formation per patient, there was no significant difference between the two study groups. The number of attempts taken to straighten the colonoscope pre patient, however, was less when the endoscopist was able to see the imager view, p = 0.03. Hand pressure was also more effective when the endoscopist and endoscopy assistant could see the imager display, p = 0.02. Preliminary experience suggests that real time, electronic imaging of colonoscopy is safe, effective, and will improve the accuracy of the procedure.

Abdomen↗

PubMedDate not supplied

[DIAGNOSTIC AND THERAPEUTIC COLONOSCOPY IN PEDIATRICS]

Gastrointestinal bleeding in childhood is an uncommon problem, althought when it happens it maybe an emergency. Upper bleeding predominates, and when we consider lower bleeding, the principal cause are polyps. Recent evidence points out that polyps are responsible for bleeding in 77% of cases.We decided to study the clinical course, histologic characteristics and treatment in children with lower gastrointestinal bleeding. This investigation was held at Edgardo Rebagliati National Hospital during 1990 to 1996. Inclusion criteria were: younger than 14 years, gastrointestinal bleeding, and colonoscopy exam.100 colonoscopies were done in 74 children. Polyps were the cause for gastrointestinal bleeding in 71.6% of cases. In 14 children more than one colonoscopy was done. More than one polyp in 16 children were found. Ulcerative colitis was diagnosed in two cases, and intestinal tuberculosis in other two cases. Average age was 8.8 years, and 100% presented rectorragia and anemia.Polyps were located principally in rectum and sigmoid. Polipectomy was done in 94.34% of the cases, and it was technically succesful. We had only one complication (snare wire was trapped) but with no morbidity.Histological examination demonstrated that juvenile polyp was the most frequent type (56.66%), followed by tubular adenoma (11.32%), and Peutz-Jegher polyp in 3.77%. Treatment was polipectomy in all cases. Eleven procedures were done in the surgical room, and 19 in the endoscopy unit, with no complications in any of the cases.CONCLUSION: In children the main cause for lower gastrointestinal bleeding are polyps. All cases present with rectorragia or anemia, and juvenile polyps are the most frequent type. Colonoscopy is a safe method for diagnosis and treatment, which can be done in the endoscopy unit with mild sedation and with an anesthesist or pediatrician as assistants.

Journal Article↗