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At least 703 records · Page 39Linked to original sources
PubMed2004

A novel shape-locking guide for prevention of sigmoid looping during colonoscopy.

BACKGROUND: Looping of the endoscope in the sigmoid colon and other colonic segments often represents a significant challenge to the performance of comfortable, complete, and swift colonoscopy. This report describes the design and operation of a new device that addresses this problem, together with preliminary preclinical experience with this use of this shape-locking guide (SG-1). METHODS: The shape-locking guide is an overtube that can be converted from a flexible to a rigid configuration on demand. When in the rigid configuration, the shape-locking guide is designed to protect the colon wall from lateral forces exerted by the colonoscope. The shape-locking guide was evaluated in vitro by using an artificial colon model to learn how to operate it, and to assess feasibility for prevention of colon looping. In addition, safety was assessed in vivo in a pig model. RESULTS: In vitro, the shape-locking guide prevented colonic looping and, thereby, aided completion of "colonoscopy" in the artificial colon model. Subsequent in vivo studies demonstrated that use of the shape-locking guide is safe and feasible; it performed well with respect to ease of insertion and avoidance of sigmoid looping. There was no evidence of significant injury to the colon or adjacent abdominal viscera. CONCLUSIONS: This preliminary study shows that use of the shape-locking guide is safe and that it has performance characteristics that may assist the performance of colonoscopy. Human trials are being undertaken.

Animals↗
PubMedDate not supplied

Eradication of diminutive polyps: a prospective evaluation of bipolar coagulation versus conventional biopsy removal.

Bipolar probe coagulation (BICAP) was evaluated and compared with conventional cold biopsy (CBx) as a potential therapeutic modality for eradication of diminutive colonic polyps (DPs). Seventy-seven and 79 DPs were treated with BICAP and CBx, respectively. Twenty-one percent of the BICAP and 29% of the CBx (p greater than 0.05) group had residual polypoid tissue detected at flexible sigmoidoscopy 3 weeks after treatment. Because of incomplete polyp removal, CBx and BICAP coagulation cannot be recommended as definitive therapies for DPs. Neoplasia was present in 22% of DPs located less than 60 cm from the anus, 73% of proximally located small polyps, and 32% of all DPs. Despite apparent eradication at the time of treatment, the incidence of residual polypoid tissue would suggest the need for critical evaluation of other modalities used to eradicate or remove DPs.

Adult↗
PubMedDate not supplied

Barium enema versus colonoscopy for patients with polyps found during flexible sigmoidoscopy.

This prospective study compares the accuracy of barium enema examination performed by experienced radiologists to colonoscopy performed by experienced gastroenterologists blinded to the radiographic findings to detect proximal, synchronous lesions in patients with polyps detected during fiberoptic sigmoidoscopy. Three thousand six patients were examined, of whom 147 (5%) had polyps larger than 0.5 cm in diameter. Of 114 patients who completed the protocol, 46 patients (40%) had synchronous, proximal colonic lesions. There were no radiographic false positives, but the single-contrast barium enema missed polyps in 13 while detecting polyps in 2 patients (sensitivity = 13%). The double-contrast barium enema missed proximal polyps in 23 patients while detecting them in 8 (sensitivity = 26%). We conclude that patients with neoplastic polyps found during fiberoptic sigmoidoscopy should have colonoscopy without barium enema. If the entire colon cannot be examined at colonoscopy, we advise double-contrast barium enema.

Adenocarcinoma↗
PubMed1996

Use of a pediatric colonoscope improves the success of total colonoscopy in selected adult patients.

BACKGROUND: Colonoscopy using a standard adult colonoscope can be difficult or impossible when there is a fixed, angulated sigmoid colon or stricture. It is sometimes possible to traverse such segments using a smaller-diameter, more flexible pediatric colonoscope. METHODS: For this prospective study, one endoscopist started 645 consecutive, elective colonoscopies with a standard adult Olympus CF-100L colonoscope (52% women, 48% men). There were 36 examinations (5.6%) in which the adult colonoscope could not be passed through a fixed, angulated sigmoid colon (n = 34) or a sigmoid colonic stricture (n = 2). In such instances (33 women and 3 men), the endoscopist switched to a pediatric colonoscope. RESULTS: The pediatric colonoscope successfully reached the cecum in 21 of the 36 cases (58.3%). The figure was 38.5% for the older Olympus CF-P20L fiberoptic colonoscope (n = 13) and 69.6% for the newer Olympus PCF-100 videocolonoscope (n = 23). Concomitant conditions in the 34 patients in whom the pediatric colonoscope was used because of a fixed, angulated sigmoid included previous pelvic surgery in 22, pelvic radiation therapy in 2, pelvic endometriosis in 3, and two with previous sigmoid diverticulitis. CONCLUSIONS: The pediatric colonoscope, and particularly the newer Olympus PCF-100 colonoscope, is very useful in adult patients in whom it is not possible to traverse a fixed, angulated sigmoid colon or stricture using the standard adult colonoscope. This is predominantly a problem of female patients. Previous pelvic surgery may be an important causative factor in this regard.

Colon↗
PubMed1996

Absence of bacteremia after gastrointestinal procedures in children.

BACKGROUND: Transient bacteremia after certain gastrointestinal endoscopies is well documented in adult patients; however, experience in pediatric patients is very limited. We conducted a prospective study to determine the frequency of bacteremia after common endoscopic procedures in children. METHODS: A total of 108 endoscopies were performed in 95 patients (age range 8 months to 17 years; mean age 10.2 years). Procedures included 68 esophagogastroduodenoscopies (EGDs), 29 colonoscopies, and 11 flexible sigmoidoscopies. Most procedures (88) were performed with patients under conscious sedation; 20 were under general anesthesia with endotracheal intubation. Biopsy specimens were obtained from all patients. Blood samples for aerobic and anaerobic cultures were obtained prior to, and within 5 minutes of, completion of the procedure. In patients who underwent general anesthesia, a third sample was obtained 5 minutes after endotracheal intubation and before endoscopy. RESULTS: Four of the pre-endoscopic blood cultures were positive. Two cultures were positive after endotracheal intubation, but were negative after endoscopy. Four cultures were positive after endoscopy. All organisms were skin or environmental flora and were considered contaminants. All patients with positive cultures remained asymptomatic during the 72 hours after the procedure. CONCLUSION: We conclude that clinically relevant bacteremia is very infrequent following routine endoscopic procedures with biopsies in immunocompetent children.

Adolescent↗
PubMed1999

Argon plasma coagulation therapy for hemorrhagic radiation proctosigmoiditis.

BACKGROUND: Radiation-induced proctosigmoiditis is a serious complication of pelvic radiation therapy. Rectal bleeding occurs among 6% to 8% of these patients and is extremely difficult to manage. Pharmacotherapy is generally ineffective, whereas surgical treatment is associated with high morbidity and mortality. Argon plasma coagulation is a new method of noncontact electrocoagulation well suited for hemostasis of large bleeding areas. METHODS: From December 1996 through March 1998, we used argon plasma coagulation to treat 28 patients with hemorrhagic radiation-induced proctosigmoiditis. Indications for treatment were anemia (n = 18) and persistent bleeding despite pharmacotherapy (n = 10). Argon flow and electrical power were set at 1.5 L/min and 50 W. The severity of rectal bleeding was graded from 0 to 4 (highest), and hemoglobin levels were recorded before and after treatment. RESULTS: Eighty-two therapeutic sessions were performed (median 2.9 sessions per patient). The severity score for rectal bleeding dropped at least 1 point for all but 2 patients, and the mean value decreased from 2.96 to 0.68. Average hemoglobin level increased 1.2 gm/dL (1.9 gm/dL among anemic patients). No serious complications were observed. CONCLUSIONS: Argon plasma coagulation appears to be a simple, safe, and effective technique in the management of hemorrhagic radiation-induced proctosigmoiditis.

Adult↗
PubMed1999

Licensure, use, and training of paramedical personnel to perform screening flexible sigmoidoscopy.

BACKGROUND: The purpose of this study was to assess the state board of nursing guidelines about the performance of flexible sigmoidoscopy by nurses and to determine the current use and training of paramedical personnel in flexible sigmoidoscopy at gastroenterology fellowship programs in the United States. METHODS: Separate one-page questionnaires were sent to state boards of nursing and directors of endoscopy at gastroenterology fellowship programs in the United States. RESULTS: Twenty percent (10 of 50) of state boards of nursing explicitly approve the performance of sigmoidoscopy by registered nurses, and 50% (25 of 50) explicitly approve the practice by nurse practitioners. Forty-six percent (23 of 50) of state boards of nursing have no written policy but allow nurses to use a "decision making model" to determine whether the performance of sigmoidoscopy is allowed. Fifteen percent (24 of 164) of gastroenterology fellowship programs in the United States use paramedical personnel to perform flexible sigmoidoscopy. Sixty-three percent (15 of 24) of these programs started since 1995, and 67% (16 of 24) require that the paramedical personnel perform 50 or more supervised sigmoidoscopies during their training. Forty-five percent (5 of 11) of programs with physician assistants/nurse practitioners use these personnel to perform colonoscopy or endoscopy. CONCLUSIONS: Nurses are allowed to perform flexible sigmoidoscopy in most states based on current state board of nursing guidelines. The use of paramedical personnel to perform endoscopic procedures is increasing rapidly.

Adult↗
PubMed1976

Proctosigmoidoscopy and rectal biopsy in infants and children.

The medical records of all patients ages 0 to 21 years who underwent proctosigmoidoscopy and/or rectal biopsy over a 27 month period of time were reviewed to determine the efficacy and safety of these procedures in pediatric patients. One hundred twenty-one patients underwent proctosigmoidoscopy; 91 of these also had rectal biopsies. Median age was two years; 21% were less than six months and 8% less than one month of age. Depth of examination was 10 to 15 cm in most patients greater than 10 years of age. Induced friability was the most frequently observed mucosal abnormality. Abnormal findings were almost always present in patients with bloody diarrhea and were quite common in those with rectal bleeding, but less common in those with chronic diarrhea and abdominal pain. Colitis of various causes was the most common cause of blood in the stool; anal fissures were found in only four of 23 patients with rectal bleeding. Both proctosigmoidoscopy and rectal biopsy were needed to exclude the presence of colitis. Mobidity was 0% with proctosigmoidoscopy and 0.34% with rectal suction biopsy.

Abdomen↗