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PubMed1999

Attenuated adenomatous polyposis coli: the role of ascertainment bias through failure to dye-spray at colonoscopy.

PURPOSE: The aim of this study is to show that the diagnosis of attenuated adenomatous polyposis coli must be made with caution and certainly only after adequate colonic examination with dye-spray. METHODS: Four patients thought to have attenuated adenomatous polyposis coli on the basis of family history and the identification of fewer than 100 polyps on simple colonoscopy underwent colonoscopy with dye-spray. RESULTS: All four individuals were found to have more than 100 polyps when dye-spray was used, confirming a diagnosis of classical familial adenomatous polyposis. CONCLUSIONS: The diagnosis of familial adenomatous polyposis may be missed altogether or incorrectly assigned as attenuated adenomatous polyposis coli if dye-spray is not used at colonoscopy. Patients with a family history of familial adenomatous polyposis or colorectal cancer should be considered for dye-spray before the diagnosis of familial adenomatous polyposis is excluded or one of attenuated adenomatous polyposis coli is made.

Adenomatous Polyposis Coli↗

PubMed2000

Oral sodium phosphate solution is a superior colonoscopy preparation to polyethylene glycol with bisacodyl.

PURPOSE: The aim of this study was to compare the efficacy and patient tolerance of two bowel preparations for colonoscopy. METHODS: Three hundred twenty-three consecutive patients undergoing colonoscopy were randomly assigned to receive either oral sodium phosphate, or 2 liters of polyethylene glycol solution preceded by the stimulant laxative bisacodyl. Patients were asked to record the effects of the preparation, noting any vomiting, nausea, or abdominal pain, and to determine a discomfort rating on a scale of 1 to 5. One hundred sixty-nine patients were assigned to the oral sodium phosphate solution, and 154 to polyethylene glycol with bisacodyl. Surgeons were blinded to the preparation used and rated the quality of the bowel preparation on a scale of 1 to 5. RESULTS: Ninety-nine percent of patients in the sodium phosphate group drank all of the solution as opposed to 91 percent of patients in the polyethylene glycol with bisacodyl group. Patients in the sodium phosphate group reported significantly less discomfort (P = 0.002). No significant difference was reported for vomiting, nausea, or abdominal pain associated with the preparations. The quality of bowel cleansing was considered by the colonoscopists significantly better for the sodium phosphate group than the polyethylene glycol with bisacodyl group (P < 0.000001). CONCLUSIONS: Colonoscopy preparation with sodium phosphate solution is better tolerated and more effective than polyethylene glycol with bisacodyl.

Administration, Oral↗

PubMed1989

Management of colonic perforation after colonoscopy. Report of three cases.

In a review of 5424 colonoscopies performed in the last ten years at Bronx-Lebanon Hospital Center, 14 perforations related to the procedure were found. Seven perforations occurred during therapeutic colonoscopies (polypectomies) and seven during diagnostic colonoscopies. Eight patients were treated surgically and six nonsurgically. The decision about whether or not to perform surgery for a colonoscopically induced perforation depends on the clinical condition of the patient. Nonsurgical management is indicated if the patient's general condition remains stable, if the perforation has been diagnosed late, if the pneumoperitoneum that led to the diagnosis does not increase in size, if there are no signs of peritonitis, if the patient does not have a distal obstruction, and if the patient's condition improves in response to conservative treatment.

Aged↗

PubMed1989

Clean sweep of the colon. The use of intraoperative colonoscopy.

Since 1982, intraoperative colonoscopy has been performed on 66 patients. Preoperative intent was to perform a colonoscopic polypectomy during an intra-abdominal procedure in 44 patients, localize lesions that might subsequently lead to either colon resection or colotomy and polyp excision in 13, localize bleeding sites in 4, determine the extent of inflammatory bowel disease in 2, survey the colon in 2 who did not have preoperative colon radiography, and assess bowel viability in 1. Surgery proceeded as planned in 54 patients; however, colonoscopic findings extended the resection to include additional segments of bowel in 4. In four patients, polypectomy or bowel resection was avoided as a result of the colonoscopic findings. Intraoperative colonoscopy was not possible in four patients. No complications were related directly to this procedure. Intraoperative colonoscopy is a useful adjunct for localizing lesions or "clearing" the colon. In some patients, colonoscopic findings may change the extent of resection performed.

Aged↗

PubMed1984

Pneumatic perforation of the colon during colonoscopy. Is the hypermobile right colon a risk factor?

Perforation of the colon by pneumatic injury during colonoscopy is a rare complication. Intraoperative observations of a patient who developed massive cecal distention, pneumatosis coli and severe pneumoperitoneum during colonoscopy suggest that an isolated, air-trapping colonic segment is a factor in the mechanism of such injury. The possibility that a poorly fixed, hypermobile cecum and right colon predispose to such injury by air insufflation during colonoscopy is discussed.

Air↗

PubMed2002

Colonoscopy in asymptomatic individuals with a family history of colorectal cancer.

BACKGROUND: This study was performed to evaluate the use of total colonoscopy as the optimal screening test in asymptomatic individuals with a family history of colorectal cancer (CRC). METHODS: Colonoscopy was performed in 249 asymptomatic individuals who had one or two first-degree relatives (FDRs) with CRC; individuals with three or more FDRs with CRC were excluded. RESULTS: Eighty-six colonic lesions were found in 51 individuals (51 of 249; 20.5%). Among these 51 subjects, 27 had neoplastic polyps (n = 38) and 29 had metaplastic polyps (n = 44). Although no invasive cancer was detected, in 14 individuals the lesions had a high malignancy potential because of their size and histopathology. We did not confirm a statistically significant difference in the incidence of neoplastic polyps according to the number of affected FDRs. Finally, the presence of metaplastic polyps was a very strong indication for the concomitant presence of metaplastic polyps (P <.0001). CONCLUSIONS: Total colonoscopy is the optimal screening procedure for the examination of asymptomatic individuals with a family history of CRC.

Adult↗

PubMed2004

[Irritable bowel syndrome: colonoscopy painful and difficult?].

BACKGROUND AND PURPOSE: Hyperalgesia induced by pelvic colon distension has been demonstrated in patients with irritable bowel syndrome (IBS). In this study the authors analyzed whether colonoscopy of patients with IBS is more painful and technically more demanding as compared to non-IBS patients. PATIENTS AND METHODS: In a prospective study 639 patients (132 with IBS, 507 without IBS) who underwent colonoscopy were evaluated for sex, age, body mass index, administration of sedatives and analgesics, time for cecal intubation, intensity of pain during examination (intensity graduated 1-5), diagnosis and degree of diverticulosis, spasticity, loop formation, elongation and distortion, respectively. A statistical comparison of both patient groups was performed. RESULTS: Patients of the IBS group were significantly younger compared with patients in the control group (p < 0.001). In an age-matched comparison of both groups low pain (intensity 1) was noted in 29 (22%) of IBS patients and 82 patients (31%) in the control group. Severe pain (intensity 4 and 5) occurred in 17 (12.9%) and six (4.5%), respectively, of IBS patients and in 21 (8%) and five patients (2%), respectively, of the control group. The differences were statistically not significant (p = 0.1). Administration of analgesics occurred significantly more frequently in the IBS group (p = 0.01), however, only nine IBS patients (6.8%) and four patients without IBS (1.5%) received analgesics. All other parameters analyzed did not show significant differences between the groups. CONCLUSION: Regarding perception of procedure-related pain and technical problems in colonoscopy, patients with IBS do not show significant differences compared to patients without IBS.

Adult↗

PubMed2003

[The importance of rectoscopy and colonoscopy in Internal Medicine].

The endoscopic examination of the large intestine can be considered today a routine examination in internal medicine. Since the introduction of flexible videoendoscopy, evaluating diseases in the distal colon using rectoscopy has become less important. Anoproctoscopy is an obligatory component for a complete colon diagnostic after a flexible ileo-colonoscopy has been performed. Colonoscopy has improved significantly the diagnosis and therapy of diseases in the large intestine since it has been introduced more than 30 years ago. By introducing modern videocolonoscopy in addition to other instruments, there is today a broad spectrum of diagnostic and therapeutic indications available. Specifically, due to its frequency and prognostic relevance, colonoscopy has become the most powerful and important procedure in the early detection and prevention of colon cancer.

Colonic Diseases↗

PubMedDate not supplied

Virtual colonoscopy and colorectal cancer screening.

Colorectal cancer (CRC) is the leading cause of cancer related death in the United States. Virtual colonoscopy is a new method for imaging the colon and has produced promising early results for polyp and cancer detection. The challenge remains to reproduce these favorable results in clinical practice and to evaluate the use of virtual colonoscopy in a purely screening population. Virtual colonoscopy may dramatically improve population participation in screening programs and play a major role in minimizing the impact of CRC.

Colonic Polyps↗

PubMed2004

Single-stage procedure with intraoperative colonoscopy and colonic irrigation in patients with obstructing left-sided colonic cancer.

BACKGROUND AND AIMS: Recently there has been growing acceptance of the one-stage resection and primary anastomosis with intraoperative antegrade irrigation. This study evaluated the efficacy of a newly developed device for performing a single-stage procedure in patients with obstructing left-sided colon cancer. PATIENTS AND METHODS: A series of 151 consecutive patients with obstructing left-sided colonic cancer underwent on-table irrigation, resection, and primary anastomosis with the use of a newly developed device; 75 patients on-table colonoscopy. The study spanned a 3 years from September 1999 to August 2002. The observed variables were the volume of irrigated saline, time for irrigation and colonoscopic examination, synchronous pathology, operative mortality and morbidity, time to passage of flatus, restarting day of oral intake, and length of hospital stay. RESULTS: The mean volume of irrigated saline was a mean of 12.5 l (range 1-32) over a mean of 14.2 min (range 1-45). Subsequent colonoscopic examination added a mean of 10.7 min (range 3-15). The incidence of synchronous polyps was 47% (35 of 75 cases) in performing the on-table colonoscopic investigations. On-table colonoscopy induced surgeons to extend resection because of synchronous malignancy attested by frozen biopsy specimen in ten patients and because of mucosal necrosis of the proximal colon in three. There were two anastomotic leakages, six wound infections, and one operative mortality. The time to passage of flatus was an average of 3.6 days (range 1.0-7). The time to oral intake was an average of 4.3 days (range 3-8). The length of hospital stay was 11.7 days (range 6-43). CONCLUSION: These findings suggest that our device is an effective tool to facilitate acceptance of the one-stage procedure in patients with obstructing left-sided colonic cancer. Specifically, our device enables quick and easy on-table colonoscopy.

Adult↗

PubMed2005

Screening colonoscopy in 40- to 50-year-old first-degree relatives of patients with colorectal cancer is efficient: a controlled multicentre study.

BACKGROUND AND AIMS: Persons with a familial risk of colorectal cancer (CRC) account for about 25% of all CRC cases. The adenoma prevalence in relatives of CRC patients 50-60 years of age is 17-34%; data on younger individuals are scarce. Our aim was to prospectively define the adenoma prevalence in 40- to 50-year-old first-degree relatives of CRC patients compared to controls. PATIENTS AND METHODS: CRC patients were identified via the regional cancer registry, and their 40- to 50-year-old first-degree relatives (risk group) were invited for screening colonoscopy. Additional probands and controls of the same age were recruited by newspaper articles and radio or television broadcastings. Using high-resolution video colonoscopy, each detected polyp was removed and histopathologically assessed. Each participant completed demographic and epidemiological questionnaires. RESULTS: Of 228 subjects in the risk group 36.4% had polypoid lesions compared to 20.9% of 220 controls (p<0.001). Forty-three (18.9%) subjects in the risk group had adenomas compared to 18 (8.2%) in the control group (p=0.001). High-risk adenomas (>10 mm and/or of villous type) were found in 12 persons in the risk group compared to 5 controls (not significant). In the risk group most lesions (52%) were located proximal to the sigmoid colon compared to 29% in controls. CONCLUSIONS: Subjects between 40-50 years with first-degree relatives with CRC demonstrate a significantly higher prevalence of adenomas than controls, with a tendency towards a more proximal location. These data support a screening colonoscopy in persons with familial risk already between 40 and 50 years.

Adenomatous Polyps↗

PubMed2003

Do distal adenomas mandate total colonoscopy?

BACKGROUND: Distal adenomas have been considered markers of proximal neoplasms. It also has been suggested that patients with small, distal adenomas do not require proximal examination of the colon. This study was conducted to determine the validity of the latter recommendation. METHODS: From a total of 5,132 colonoscopies performed between 1976 and 1999, all patients from whom adenomas were removed were included. Those with previous colon resections or incomplete cecal intubation were excluded. Proximal adenomas were defined as those proximal to the sigmoid colon. Adenomas were considered advanced if they were 1 cm or larger, contained any villous component, or demonstrated severe dysplasia. RESULTS: The study included 226 patients. Overall, 98 patients had distal adenomas, and there was a synchronous proximal adenomas rate of 23.4%. Patients with single, small, rectosigmoid, tubular adenomas had proximal adenomas at a rate of 28.8%, and 9.6% were advanced adenomas. Patients with advanced distal adenomas had synchronous proximal adenomas at a rate of 18.9%, and 10.8% of these were advanced adenomas. According to multiple logistic regression, the strongest predictor of proximal neoplasia was the absence of distal polyps. CONCLUSION: These data confirm the necessity for total colonoscopy in all patients with distal adenomas regardless of size. In addition, the high proportion of proximal neoplasia without distal markers suggests that full colonoscopy may be warranted as a screening tool in all patients.

Adenoma↗

PubMed2001

Decompressive colonoscopy with intracolonic vancomycin administration for the treatment of severe pseudomembranous colitis.

BACKGROUND: We explored the potential of early decompressive colonoscopy with intracolonic vancomycin administration as an adjunctive therapy for severe pseudomembranous Clostridium difficile colitis with ileus and toxic megacolon. METHODS: We reviewed the symptoms, signs, laboratory tests, radiographic findings, and outcomes from the medical records of seven patients who experienced eight episodes of severe pseudomembranous colitis with ileus and toxic megacolon. All seven patients underwent decompressive colonoscopy with intracolonic perfusion of vancomycin. RESULTS: Fever, abdominal pain, diarrhea, abdominal distention, and tenderness were present in all patients. Five of seven patients were comatose, obtunded, or confused, and six of the seven required ventilatory support. The white blood cell count was greater than 16,000 in seven cases (six patients). Colonoscopy showed left-side pseudomembranous colitis in one patient, right-side colitis in one patient, and diffuse pseudomembranous pancolitis in five patients. Two patients were discharged with improvement. Five patients had numerous medical problems leading to their death. Complete resolution of pseudomembranous colitis occurred in four patients. One patient had a partial response, and two patients failed therapy. CONCLUSION: Colonoscopic decompression and intracolonic vancomycin administration in the management of severe, acute, pseudomembranous colitis associated with ileus and toxic megacolon is feasible, safe, and effective in approximately 57% to 71% of cases.

Aged↗

PubMed2001

Colonoscopy in mice.

INTRODUCTION: Current investigational models of murine colitis and colon cancer necessitate sacrifice of animals in order to obtain colonic tissue. The purpose of this study was to develop a safe method of murine colonoscopy that would allow serial evaluation and mucosal biopsies of the same animal. METHODS: Nine mice (two C3H, two C57/BL6, and five IL-10 deficient) were studied a total of four times each over 4 weeks. Three mice [APC (Min +/-)] were examined three times each. Mice were gavaged with 1 cc of a polyethylene glycol solution on the day prior to colonoscopy. Solid chow was withheld and the mice were maintained on Pedialyte. Mice were anesthetized with ketamine and xylazine. A flexible pediatric cystoscope (2.1-mm diameter) with a single biopsy channel was introduced per anum, and the colon was gently insufflated with air to a mean pressure of less than 5 mmHg. Saline irrigation was used when necessary. A single biopsy was obtained from the rectosigmoid colon during each examination. RESULTS: A total of 46 examinations were carried out. One mouse died after being anesthesized for the fourth examination, and two mice [one IL-10 knockout and one APC (Min+/-)] died one day after the 3rd examination. No other complications were noted. The average length of insertion was 3 cm. Transillumination allowed for localization of the endoscope tip. Biopsies, although quite small, were sufficient for pathologic evaluation and diagnosis. CONCLUSIONS: Murine colonoscopy is a safe and feasible technique. It permits consecutive visual and histopathological examinations, and it allows the investigator to monitor the response of the murine colon to experimental interventions.

Animals↗

PubMed2006

Splenic rupture following colonoscopy: two cases with CT findings.

Splenic injury following colonoscopy is extremely rare. We report a 75-year-old woman and a 35-year-old woman who presented to the emergency room with left upper quadrant and left shoulder pain following colonoscopy. Both patients were diagnosed by computed tomography (CT) with splenic injuries and hemoperitoneum. One patient was successfully managed conservatively, and one patient needed emergent open splenectomy. The possibility of splenic injury should be considered in post-colonoscopy patients with left upper quadrant or left shoulder pain.

Abdominal Pain↗

PubMed2005

Interacting effects of preoperative information and patient choice in adaptation to colonoscopy.

PURPOSE: The aim of this study was to match patient information requirements by determining whether giving patients a choice for additional preprocedural audiovisual information modifies the effectiveness of this information on anxiety, worry, knowledge, and patient satisfaction. METHODS: Patients scheduled to undergo colonoscopy were approached one week before their procedure. All patients received an information leaflet during their standard preanesthetic clinic visit. Patients were randomly assigned to a choice or no-choice condition. Patients in the choice condition were free to watch or not watch the video, people in the no-choice condition were further randomized to watch or not watch the video. Measures of anxiety and worry were completed before watching the video. Anxiety, worry, knowledge, and satisfaction were measured one week later just before the colonoscopy. RESULTS: One hundred sixty-six patients completed the study. Of those patients randomized to the choice condition, 69 percent wanted to watch the video. Those who chose not to watch the video were significantly more worried on the day of their procedure. Consistent with current evidence, watching the video was associated with improvements in short-term knowledge (F(1,161) = 4.8, P = 0.03). There was, however, no significant effect of the choice or video conditions on anxiety or patient satisfaction. CONCLUSIONS: There appears to be no additional benefits in terms of patient outcomes by allowing patients to choose whether they want additional audiovisual information. We suggest that all patients undergoing colonoscopy would benefit from watching such an educational video in the week before their procedure.

Adaptation, Psychological↗

PubMed2006

Oral sodium phosphate (Fleet) is a superior colonoscopy preparation to Picopre (sodium picosulfate-based preparation).

PURPOSE: Small-volume bowel preparation is better tolerated than 4-liter polyethylene glycol lavage. However, the efficacy of various small-volume bowel preparation agents for colonoscopy has not been clearly defined. This randomized, controlled trial was designed to compare oral sodium phosphate (Fleet) with Picoprep (sodium picosulfate-based preparation). METHODS: Two hundred twenty-five outpatients, aged 65 years or younger, who would undergo colonoscopy by two endoscopists were randomized to receive two bottles of oral sodium phosphate or three sachets of Picoprep. A standardized questionnaire was completed by all patients and the endoscopists. The endoscopists were blinded to the preparation used. RESULTS: One hundred three patients were randomized to oral sodium phosphate (Fleet) (Group 1) and 122 patients to Picoprep (Group 2). Three patients were excluded because of colonic strictures. The groups were similar in age and gender, indications for colonoscopy, and previous colonic surgery. The quality of bowel cleansing in patients taking oral sodium phosphate (Fleet) was significantly better than Picoprep as assessed by the endoscopists (P = 0.0014). Both types of bowel preparation were associated with similar incidence of nausea (P = 0.4927), dizziness (P= 0.9663), abdominal cramps (P = 0.7157), and patient acceptability (P = 0.0767). Equal majority from either group would use the same bowel preparation again (91 percent of oral sodium phosphate (Fleet) and 93 percent of Picoprep group; P = 0.6172). Although Picoprep was better tasting (P = 0.0273), oral sodium phosphate (Fleet)was perceived to be a good preparation agent by a greater (although not significant) proportion of patients (P = 0.0853). CONCLUSIONS: Oral sodium phosphate (Fleet) is more effective in bowel cleansing than Picoprep as a bowel preparation agent. Both agents have similar side effects and patient acceptance.

Administration, Oral↗

PubMed2005

Measurement of serum electrolytes and phosphate after sodium phosphate colonoscopy bowel preparation: an evaluation.

Our purpose was to observe the effects of sodium phosphate (NaP) colonoscopy preparation on serum electrolytes, phosphate, and calcium and to identify factors associated with any adverse effects. In an unselected group of 100 consecutive patients attending for out patient colonoscopy, 45% of patients had raised serum phosphate, which was positively correlated with creatinine and age. There was a negative association of phosphate with calcium; 16% of patients had hypocalcemia and 26% had hypokalemia. Patients taking ACE inhibitors, AT2 antagonists, or diuretics were associated with hyperphosphatemia. Significant electrolyte and metabolic disturbance from colonoscopy preparation has been shown with NaP preparation, without overt clinical effects. We recommend that elderly patients and those with significant comorbidity have their electrolytes and calcium measured, and diuretics and ACE inhibitors stopped, before NaP administration. Endoscopy units should be alert for patients who might be suffering from electrolyte disturbance postpreparation and be prepared to measure their electrolytes.

Adult↗