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PubMed1976

Pneumatic ileal perforation: an unusual complication of colonoscopy.

Pneumatic perforation of the bowel is a rare complication of colonoscopy. Pneumatic ileal perforation complicating this procedure has not been reported. We describe a case of pneumatic ileal perforation during colonoscopy in an elderly lady who also had adhesions from previous abdominal surgery. A relative lack of symptomatology, the finding of a clean ileal perforation at surgery, and a benign postoperative period characterized her course. Possible etiological factors are discussed with reference to the literature dealing with intraluminal pressures in the bowel. Pressure much higher than the physiological pressure is likely to be reached during colonoscopy, with reflux of air across the ileocecal sphincter acting as a safety mechanism. Bursting pressures differ for different layers of the bowel and from segment to segment. This report calls attention to certain risk factors which might lead to a remote perforation during colonoscopy.

Aged↗

PubMed1979

Colonoscopy in lower gastro-intestinal haemorrhage.

The value of colonoscopy in the diagnosis and management of lower gastro-intestinal haemorrhage was assessed in 107 patients who were examined during a 2-year period. The main indications were to define uncertain radiological findings, to further investigate the cause of bleeding in patients with normal barium studies and to carry out polypectomy. Radiological lesions were confirmed in 27, defined in 12, and refuted in 14 patients. Twenty-eight lesions were demonstrated on colonoscopy which were not diagnosed by barium enema or sigmoidoscopy. A diagnosis was made by colonoscopy in more than two-thirds of the patients with frank blood loss and normal radiographs. In cases of occult bleeding it was farless helpful. Colonoscopy significantly improved diagnosis and management of gastro-intestinal bleeding when the cause was in doubt after standard investigations. In addition, 37 polyps were removed through the colonoscope from 30 patients.

Gastrointestinal Hemorrhage↗

PubMed1994

A comparative study of eight fecal occult blood tests and HemoQuant in patients in whom colonoscopy is indicated.

BACKGROUND AND OBJECTIVE: Some studies suggest that immunochemical fecal occult blood tests (FOBTs) and HemoQuant are more efficient at detecting fecal occult blood than the commonly employed Hemoccult II (guaiac) test. We undertook this study to determine whether an immunochemical test either alone or in combination with a guaiac test gives efficiency superior to the Hemoccult II test in predicting significant gastrointestinal tract disease. DESIGN: Criterion standard, prospective, blinded. SETTING: Referral population of ambulatory patients at an institutional and a private hospital. PATIENTS: Eight-one patients referred to a gastroenterologist and in whom colonoscopy was indicated. INTERVENTIONS: While on a restricted diet, patients made preparations for FOBTs from three consecutive bowel movements. Patients then underwent colonoscopy. Polyps larger than 1 cm in size, carcinoma of the colon, peptic ulcers, gastric erosions, and angiodysplasia were considered to be likely causes of occult gastrointestinal tract bleeding. MAIN OUTCOME MEASURES: Using colonoscopy results as the reference standard, sensitivity, specificity, and positive and negative predictive values for each of eight tests or pair of tests were compared with those of Hemoccult II. RESULTS: Of 81 patients, 10 had significant lower gastrointestinal tract lesions and six had significant upper gastrointestinal tract lesions. Hemoccult SENSA, Heme-Select, and FECA-EIA were shown to be more sensitive than Hemoccult II but slightly less specific. Paired tests showed less efficiency than Hemoccult II alone. CONCLUSIONS: We did not find an ideal test or pair of tests; however, Hemoccult SENSA exhibited higher sensitivity than Hemoccult II and many other tests. The sensitivity, specificity, and positive predictive values of many of the FOBTs were believed to be low. We recommend that physicians consider FOBTs only as adjuncts to history and physical examination findings in deciding how to proceed in diagnosing gastrointestinal tract disease.

Colonoscopy↗

PubMed2005

Localizing colorectal cancer by colonoscopy.

HYPOTHESIS: Colonoscopic localization of colorectal carcinoma is frequently inaccurate and unreliable. DESIGN: Consecutive case series. SETTING: Tertiary care teaching hospital. PATIENTS: Three hundred fourteen consecutive patients undergoing surgical resection for colorectal cancer from January 1, 2000, to December 31, 2003. INTERVENTION: Surgical resection for colorectal cancer. MAIN OUTCOME MEASURE: Incidence of erroneous site localization. RESULTS: Two hundred thirty-six patients had complete endoscopic, pathologic, and operative records. Colonoscopy was inaccurate for tumor localization in 49 cases (21%). In 27 (11%) of these cases, a different procedure was required than initially planned; in an additional 10 cases (4%), the surgical approach required modification. Inaccurate localization was associated with previous colorectal procedures on both univariate analysis (odds ratio, 3.94; 95% confidence interval, 1.50-10.32; P<.005) and multivariate analysis (odds ratio, 4.47; 95% confidence interval, 1.64-12.08; P = .003). Having the colonoscopy performed by a surgeon trended toward protection from error on multivariate analysis (odds ratio, 0.47; 95% confidence interval, 0.20-1.08; P = .07). Age, sex, diverticular disease, endoscopist volume and years of training, and bowel preparation had no significant effect. CONCLUSIONS: Colonoscopy has a considerable error rate for localization of colorectal cancer, especially when previous colorectal procedures have been performed. Adjunctive localizing techniques, such as endoscopic tattooing, should be strongly considered.

Adult↗

PubMed1992

Intraoperative colonoscopy in patients with colorectal cancer.

Sixty-seven patients underwent intraoperative colonoscopy during elective surgery for colorectal cancer. Complete examination of the colon was achieved in 65 patients (97 per cent), albeit with insertion through a colotomy in three (4 per cent). A synchronous carcinoma was found in six patients (9 per cent), which necessitated a change of planned surgical procedure. Synchronous polyps were detected and removed in 24 patients (36 per cent); two had polyps with carcinoma in situ. The mean age of patients with synchronous carcinoma was significantly higher than that of those without (74.1 versus 61.2 years, P = 0.02). Intraoperative colonoscopy took a mean of 15 min surgical time and only two minor complications (serosal lacerations) were encountered. In patients with colorectal cancer, intraoperative colonoscopy allows complete assessment of the colon and identifies synchronous lesions.

Aged↗

PubMed1984

Diverticular rupture during colonoscopy. Fact or fancy?

Uncomplicated colonic diverticula have been regarded as weak points in the bowel wall which have a predisposition to rupture during colonoscopy. We attempted to prove or disprove this assumption. Eleven segments of diverticula-containing sigmoid colon were insufflated via a colonoscope and the rupture pressure manometrically recorded. The mean +/- SEM pressure causing serosal tear was 202 +/- 15 mm Hg and mucosal rupture 226 +/- 14 mm Hg. No diverticular blowouts occurred. Intraluminal sigmoid pressures were measured manometrically in 15 patients with and 15 patients without colonic diverticula during routine colonoscopy. The pressure recordings were read in a blinded fashion, and the values were then grouped and analyzed in those patients with and without sigmoid colon diverticula. Intrarectal, sigmoid, peak sigmoid, peak sigmoid with cough, and peak sigmoid with Valsalva pressures were similar in both groups. Furthermore, the pressure levels generated during colonoscopy were much lower than those required for colonic rupture in the cadaver colons. We conclude that the reason most colonic perforations occur in the sigmoid area is not due to diverticular blowout. Rather, excluding instances where electrocautery is used, we feel it is due to instrument trauma. Less commonly, excessive air insufflation can result in serosal laceration and mucosal rupture, whereas diverticular blowout is probably limited to the setting of acute diverticulitis.

Colon↗

PubMed1984

Survey of the use of colonoscopy in inflammatory bowel disease.

In a survey of patients with inflammatory bowel disease (IBD), colonoscopy with multiple biopsies has been shown to be superior to either colonoscopy alone or barium studies in assessing disease extent. Thus, of a total of 149 patients, 23 (15%) were considered to have total colitis on barium enema, 51 (34%) on macroscopic colonoscopy appearance compared to 92 (62%) on biopsy. Furthermore, radiological assessment of "skip lesions" was shown to be unreliable. Although it remains to be seen whether the more accurate delineation of disease extent achieved by endoscopy is advantageous in terms of clinical management, it may have implications for our understanding of the disease.

Biopsy↗

PubMed1992

Comparison between double-contrast barium enema and colonoscopy to investigate lower gastrointestinal bleeding.

A retrospective study was performed to compare the diagnostic accuracy of high-quality double-contrast barium enema (DCBE) against gold standard colonoscopy in 288 patients with suspected lower gastrointestinal bleeding who went through both examinations. Colonoscopy detected the potential cause of bleeding in 99 patients (100%); in order of frequency: polyps greater than or equal to 1 cm (N = 47; 48%), carcinoma (N = 21; 21%), inflammatory bowel disease (IBD) (N = 15; 15%), solitary ulcers (N = 6; 6%), other types of colitis (N = 5; 5%), angiodysplasia (N = 3; 3%), and stenosis (N = 2; 2%). DCBE diagnosed 88 cases (89%) and missed 11 consisting of IBD (N = 4), angiodysplasia (N = 3), solitary ulcers (N = 3), and polyps (N = 1). The overall sensitivity and specificity of DCBE was 0.89 and 0.97, respectively. The sensitivity for carcinoma, polyps, and IBD was 1.00, 0.98, and 0.73, respectively. We conclude that DCBE is very effective to diagnose carcinoma and polyps greater than or equal to 1 cm, the most frequent causes of bleeding, but less effective to diagnose IBD and other nonfrequent causes. If a high-quality DCBE does not reveal the cause of bleeding, the contribution of a following colonoscopy will be to diagnose causes of bleeding other than carcinoma and polyps less than 1 cm and to offer therapeutic possibilities.

Adolescent↗

PubMed1992

Benign colorectal neoplasms undetected by colonoscopy.

This retrospective investigation assessed the sensitivity of colonoscopy for the detection of colonic polyps seen previously at barium enema examination. Included in the study were 77 patients with 106 polypoid lesions. Films showing lesions not subsequently seen at colonoscopy were reviewed and only those lesions with a visible point of attachment, exhibiting no movement in response to filling or change in position of the patient, and confidently diagnosed as a polyp by both reviewing radiologists were included among the 106 lesions. Sixteen lesions (15%) seen radiologically were not located colonoscopically, indicating an endoscopic sensitivity of 85%. Contrary to previous reports, most of the lesions missed endoscopically were in the left colon in regions thought to have been traversed by the instrument. The 15% false-negative rate found for colonoscopy is consistent with existing reports on colonoscopic errors and is approximately the same as the false-negative error rate for radiologic detection of colonic polyps.

Adult↗

PubMed1985

Randomized single-blind clinical trial of a rapid colonic lavage solution (Golytely) vs. standard preparation for barium enema and colonoscopy.

A randomized single-blind clinical trial was conducted to compare the effectiveness and acceptance by patients of a new oral balanced lavage solution with those of a standard preparation for cleansing the colon for barium enema (50 patients) and colonoscopy (20 patients). The quality of preparation was comparable for the 2 preparations. For colonoscopy, Golytely preparation resulted in slightly better results than standard preparation. Patient acceptance was comparable for the 2 preparations. We conclude that Golytely can be used as an alternative to standard preparation for barium enema. For colonoscopy, it is slightly superior to standard preparation.

Adult↗

PubMed1986

Cecal volvulus: a complication of colonoscopy.

Colonoscopy is a widely used procedure with low morbidity and mortality. A case of cecal volvulus following colonoscopy is presented. This potentially lethal complication should be considered in patients with persistent abdominal pain following colonoscopy because it is easily diagnosed radiographically and requires emergency surgical intervention.

Cecal Diseases↗

PubMed1992

Colonoscopy in patients with a family history of colorectal cancer.

Since 1982 it has been the second author's policy to advise all patients who have presented with a positive family history of bowel cancer and who are over the age of 30 years to undergo colonoscopy. In the period to August 1990, 600 such patients had at least one colonoscopy. Colorectal polyps or cancer were detected in 270 patients (45 percent). The incidence was essentially the same for the 171 patients with only second-degree relatives affected (43 percent), for the 194 patients with more than one affected relative (45 percent), and for the 429 patients with an affected first-degree relative (46 percent). Only the 55 patients with more than one affected first-degree relative had a higher incidence (67 percent). The incidence in the 136 totally asymptomatic patients was 36 percent but was 48 percent in the 464 with symptoms. In 37 patients carcinoma was diagnosed. Even in the 30- to 39-year age group there was a 29 percent incidence of polyps or carcinoma. Colonoscopic screening of patients with a family history of bowel cancer compares favorably with mass screening for breast cancer. It is currently advised that all patients over 30 years of age with a family history of colorectal cancer undergo colonoscopy on presentation and, if clear, every four years thereafter unless two first-degree relatives are affected, when it should be every two years.

Adult↗

PubMed1990

Colonoscopy in patients with a primary family history of colon cancer.

Patients with a primary family history of colon cancer were recommended to have full colonoscopy for screening. The results of 125 such patients who also were asymptomatic, had no prior history of neoplasms, and had negative fecal occult blood, showed 15 patients (12 percent) with neoplasms. Only 6 (5.2 percent) had neoplasms that were detectable only by colonoscopy (i.e., above 55 cm). These results suggest that colonoscopy may not be necessary to screen patients with a primary history of colon cancer.

Adult↗

PubMed1997

Clinical investigation of colorectal cancer detected by follow-up colonoscopy after endoscopic polypectomy.

PURPOSE: We analyzed the results of a long-term follow-up surveillance of patients with colorectal polyps after endoscopic polypectomy in terms of the cumulative incidence of subsequent colorectal cancer and the clinicopathologic characteristics of carcinomas detected by colonoscopy. METHOD: The study cohort consisted of 6,715 patients who had received endoscopic resection of single or multiple colorectal polyps and then underwent periodic colonoscopy (or a combination of sigmoidoscopy and barium x-ray examination in some cases) during an average follow-up of six years (40,622 person-years in total). RESULTS: During the follow-up, 31 cases of colorectal cancer containing 15 submucosal invasive carcinomas (T1,N0,M0) and 16 advanced carcinomas were detected. The cumulative incidence of colorectal cancer was analyzed for four subgroups of the 6,715 patients classified according to the diameter, grade of dysplasia, and histologic features of polyps. Furthermore, the depth of invasion, macroscopic configuration of submucosal invasive cancer, and site of colorectal cancer observed in the 31 cases were compared with those of a reference group of 1,497 patients with colorectal cancer treated at Takano Hospital during the same period. Submucosal invasive cancer was the most common type among the colorectal carcinomas detected during follow-up. In terms of macroscopic configuration of submucosal cancer, the superficial type was significantly more common than the protruded type. The superficial submucosal cancer showed a significantly longer interval to detection than the protruded submucosal cancer. By site of lesion, proximal colon cancer was significantly more common. CONCLUSION: Follow-up colonoscopy appears to be useful in patients with larger polyps (>5 mm). Patients with severe dysplasia and those with malignant polyps should be followed-up carefully. Because submucosal cancer detected by follow-up examination after polypectomy showed higher rates of superficial-type cancer and proximal colon cancer, careful endoscopic examination of the entire colon is important.

Adenomatous Polyps↗

PubMedDate not supplied

Therapeutic colonoscopy.

Therapeutic colonoscopy has replaced or lessened to a significant degree the need or extent of traditional open surgical procedures. The common uses of therapeutic colonoscopy are hemostasis, resection and ablation of benign and malignant disease, decompression and recanalization of obstructed or dilated bowel, as well as foreign body extraction. Bleeding from arteriovenous and other vascular abnormalities can be controlled with 40% to 80% success rates using endoscopically delivered, monopolar, bipolar, or laser coagulation. The palliation of bleeding recurrent or inoperable colorectal cancer is achieved in up to 90% of patients. Virtually all pedunculated adenomas and most sessile adenomas are regularly removed colonoscopically, while large and recurrent villous adenomas in high risk individuals can be successfully managed by endoscopically delivered laser ablation techniques. Emergency colonoscopic reduction of sigmoid volvulus is performed pre-operatively and decompression of the dilated colon of non-obstructive colonic ileus is now regularly achieved. Colonic strictures have been dilated with a variety of techniques ranging from divulsion with through-the-scope balloon dilators to laser recanalization. Pre-operative endoscopic laser relief of tumor obstruction is employed to avoid preliminary or decompressing colostomy. Endoscopic laser debulking and recanalization of recurrent or inoperable cancer has been achieved with up to 80% success and various foreign bodies may be extracted from the colon with a number of endoscopic techniques. The morbidity of therapeutic colonoscopy has ranged from 1% to 2% for polypectomy to 11% for laser palliation of bleeding from advanced cancer, often with obstruction.

Adenoma↗

PubMed1996

Instant technetium 99m hexamethyl propylenamine oxime-labeled leukocyte scan compared with colonoscopy in early assessment of disease extent and activity in acute colitis.

AIM: This study was undertaken to evaluate technetium 99m (Tc 99m) hexamethyl propylenamine oxime (HMPAO)-labeled leukocyte scintigraphy for assessment of disease extent and activity in acute colitis. PATIENTS AND METHODS: Twenty-seven patients, hospitalized because of acute watery and/or bloody diarrhea, were investigated using both total colonoscopy and Tc 99m HMPAO-labeled leukocyte scintigraphy within 48 hours after admittance. RESULTS: Final diagnoses were ulcerative colitis in 14 patients, Crohn's disease in 7 patients, and infectious colitis in 6 patients. Using colonoscopy as the reference method, the maximum extent of colitis was correctly assessed by the leukocyte scan in 18 patients (67 percent), although rectal engagement was not visualized in 5 (19 percent). In six additional patients, there was almost complete agreement between the two methods. One other patient, with leftsided ulcerative colitis, was erroneously assessed as having total extent. Two other patients (one with Crohn's colitis and one with infectious colitis) had different segments incorrectly assessed. Sensitivity, specificity, and diagnostic accuracy of scintigraphy in detecting active inflammatory segments were 0.85, 0.83, and 0.85, respectively. Intensity of inflammatory activity assessed by the leukocyte scan correlated significantly with colonoscopic assessment (r = 0.719; P < 0.0001). CONCLUSION: Information regarding extent, localization, and disease activity in patients with acute colitis of inflammatory or infectious origin may be satisfactorily obtained using Tc 99m HMPAO-labeled leukocyte scanning. The noninvasive nature of the method makes it an attractive early alternative to other investigational procedures such as total colonoscopy or barium examination, particularly in cases with an established diagnosis of inflammatory bowel disease.

Acute Disease↗

PubMed1995

Surgical management of ileosigmoid fistulas in Crohn's disease: role of preoperative colonoscopy.

PURPOSE: Surgical treatment of ileosigmoid fistulas in Crohn's disease remains controversial and can be radical (resection of both segments) or conservative (ileal resection with suture or wedge resection of the sigmoid). At our institution, the sigmoid defect is sutured if the sigmoid is not affected by primary Crohn's disease or by important stricture; otherwise, the sigmoid is resected. We reviewed our experience to evaluate our results with this procedure. METHODS: Thirty patients with ileosigmoid fistulas underwent operation. Among them, 15 had a preoperative colonoscopy, whereas others had no endoscopic work-up. In nine patients, the sigmoid was thought to be affected by Crohn's disease (n = 7) or stricture (n = 2) and was resected. In 21 patients, the sigmoid was thought to be affected by proximity, and a simple suture (n = 15) or wedge resection (n = 6) was performed. Eleven patients had a temporary stoma (37 percent). One had coloprotectomy. RESULTS: One patient died postoperatively. One patient had postoperative sigmoidocutaneous fistula after conservative treatment. Histology of the sigmoid specimen showed Crohn's disease in 8 patients (27 percent), including 5 of 9 resected specimens, and 3 of 21 conservative procedures. All patients with Crohn's misdiagnosis did not have preoperative colonoscopy. Nine of 11 stomas were closed in a median delay of four months. With a median delay of nine years, four patients have again undergone surgery for recurrent colonic Crohn's disease, all of whom underwent surgery initially without preoperative colonoscopy. CONCLUSION: Preoperative endoscopic assessment of the colon is a reliable guide to use when choosing between sigmoid resection or a conservative approach and can result in reduced morbidity and improved long-term results.

Adolescent↗

PubMed1990

Usefulness of performing colonoscopy one year after endoscopic polypectomy.

This retrospective study defines a population with neoplastic colonic polyps who have had colonoscopic polypectomy and, in follow-up within one year, a repeat colonoscopic evaluation. The population was broken down into two groups, one group that had polyps at the second examination and one group that did not. This study determined which factor(s) were significant among this population in distinguishing whether new polyps would be found at one year follow-up. The authors found that among the many variables studied, only polyp multiplicity was significant in predicting polyp recurrence. More than one polyp found at index colonoscopy led to a significant chance of having a new polyp after only one year. Also, it was demonstrated that these "new" polyps were unlikely to have been "missed" polyps from the initial colonoscopy. Because of the shifting location, smaller size, and fewer instances of histologic atypia in these polyps compared with those at index examination, the authors believe that polyps found after one year may be assumed to have arisen de novo. Finally, the authors show that a significant number of polyps occur beyond the reach of the flexible sigmoidoscope (approximately 60 cm). The authors recommend that patients who have polyps undergo a colonoscopic examination. When patients are re-evaluated after having colonoscopic neoplastic polypectomy, they should undergo repeat colonoscopy.

Adenoma↗