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PubMed2003

[State of the art of MR colonoscopy].

MR colonoscopy is suitable for colorectal cancer screening. This imaging modality is non-invasive, has no harmful side effects and provides a high diagnostic accuracy. MR colonoscopy has been found to be highly sensitive and specific in detecting colorectal lesions > 10 mm in size. Since colonic polyps are difficult to differentiate from residual stool, colonic cleansing has been unavoidable but reduces patient acceptance. Cleansing of the bowel can be avoided if the signal of stool is rendered different from its surrounding. This can be achieved by adding an agent to the food that tags the feces (fecal tagging). This article describes current techniques of MR colonoscopy as well as first results with fecal tagging.

Aged↗

PubMed2003

Patient-controlled sedation for colonoscopy: a randomized trial comparing patient-controlled administration of propofol and alfentanil with physician-administered midazolam and pethidine.

BACKGROUND AND STUDY AIMS: Patient-controlled sedation (PCS) using propofol and alfentanil provides effective sedation for colonoscopy, with the advantage of a shorter recovery time in comparison with diazepam and pethidine. However, most endoscopy units in the United Kingdom are currently using midazolam (a shorter-acting benzodiazepine) as a sedative agent. This study compares the efficacy of sedation and recovery times between PCS and a combination of midazolam and pethidine. PATIENTS AND METHODS: Sixty-seven patients undergoing colonoscopy were randomly assigned prospectively to receive sedation with either PCS, using propofol and alfentanil, or a bolus of midazolam and pethidine. Sedation and pain scores were recorded during the procedure by one specialist nurse. Patients' recollection of pain was recorded after the procedure. Recovery was assessed using number connection tests. The impact on subsequent activities and the level of amnesia, as well as overall satisfaction, were established by telephone call after 24 h. RESULTS: The sedation method had no impact on the success, difficulty, or duration of the colonoscopy. PCS could be set up by the specialist nurse without affecting the time between cases. Patients in the PCS group recovered significantly faster (median 5 min vs 35 min; P < 0.0001) and left the department more quickly (median 40 min vs 75 min; P < 0.0001). Patients in the PCS group had significantly higher pain scores and significantly more recall than those in the midazolam and pethidine group. All patients were satisfied with the sedation they received. CONCLUSIONS: PCS provides an acceptable alternative to sedation with midazolam and pethidine with the advantage of significantly faster recovery times, which are of relevance in the outpatient setting.

Adjuvants, Anesthesia↗

PubMed2004

[Volvulus of the small intestine, a rare complication during laxative period before colonoscopy].

HISTORY AND CLINICAL FINDINGS: A 69-year-old patient was hospitalized 16 h after investigation of the colon (screening colonoscopy), suffering from abdominal pain, which had started during the laxative period the day before colonoscopy. INVESTIGATIONS: Clinical and technical investigations showed signs of a peritonitis. TREATMENT AND COURSE: By laparotomy a volvulus of the small intestine was found, caused by adhesions after appendectomy years before. A resection of a part of the small intestine got necessary, there were no problems during the postoperative course. CONCLUSIONS: If pain appears during the laxative period before colonoscopy, rare complications like volvulus of the small intestine should be considered.

Aged↗

PubMed2005

Significance of colonoscopy in patients with intestinal graft-versus-host disease after hematopoietic stem cell transplantation.

BACKGROUND AND STUDY AIMS: Patients with intestinal graft-versus-host disease (GVHD) are generally in poor clinical condition. In this study we aimed to establish the clinical significance of endoscopic diagnosis of this condition, observing only the distal section of the large intestine. PATIENTS AND METHODS: Endoscopic and pathological findings at colonoscopy were evaluated retrospectively in 12 patients who were diagnosed with intestinal GVHD after undergoing hematopoietic stem cell transplantation. RESULTS: The main mucosal changes observed at endoscopy were granular change, edema, "spotty redness", and sloughing. These were clearly displayed after enhancement with Indigo carmine staining, and with insertion of the colonoscope only as far as the distal section of the large intestine. A histological diagnosis of intestinal GVHD was made in 50 % of the patients, whose intestinal epithelium specimens showed numerous apoptotic bodies. It was possible to perform total colonoscopy in two patients who were in relatively good condition clinically, but there were no remarkable differences in the endoscopic findings throughout the large intestine, from the terminal ileum to the rectum. In terms of clinical outcomes of the 12 patients, their prognosis was poor in that they all either went on to suffer from chronic GVHD or died. CONCLUSIONS: Endoscopic and histological findings on distal colonoscopy are clinically significant in the diagnosis of intestinal GVHD, and limiting this examination to the distal section of the large intestine avoids causing further clinical deterioration in patients who are already in very poor general condition and the possibility of causing endoscopy-related complications.

Adolescent↗

PubMed2005

Carbon dioxide insufflation in colonoscopy: safe and effective in sedated patients.

BACKGROUND AND STUDY AIMS: Several studies have shown that insufflation of carbon dioxide (CO2) instead of air during colonoscopy can reduce postprocedural pain. However, CO2 insufflation might also lead to CO2 retention in the human body. It was recently shown that this side effect does not occur in unsedated patients, but that sedation leads to impaired respiration. Sedated patients may therefore be more prone to CO2 retention. This randomized, double-blinded study was designed to investigate whether CO2 insufflation leads to CO2 retention in sedated patients. PATIENTS AND METHODS: A total of 103 consecutive patients undergoing colonoscopy were randomly assigned to the use of either CO2 or air insufflation. End-tidal carbon dioxide (ETCO2), a noninvasive parameter for arterial P CO2, was recorded before the examination, twice during it, and 10 min after it. Midazolam or pethidine, or both, were used for sedation. The patient's pain during the examination and 1, 3, 6, and 24 h afterwards was registered using a questionnaire. RESULTS: CO2 was used in 52 patients and air insufflation in 51. A total of 52 patients (51 %) received sedation. There were no differences in ETCO2 between the CO2 and air group. A slight increase in ETCO2 was observed in sedated patients, while there was no increase in unsedated patients. CO2 insufflation significantly reduced pain after the procedure at all time points. CONCLUSIONS: This study indicates that CO2 insufflation reduces pain and is safe to use in colonoscopy for sedated patients.

Aged↗

PubMed2006

Colonoscopy, tumors, and inflammatory bowel disease - new diagnostic methods.

Accurate detection of premalignant lesions and early cancers in the colon is essential for curative endoscopic or surgical therapy, since the prognosis for the affected patients is closely related to the size and stage of the neoplastic lesion. Total colonoscopy is the accepted gold standard for screening and surveillance of colorectal cancer. This review summarizes recently published diagnostic developments and key findings in the areas of colonoscopy, colonic tumors, and inflammatory bowel diseases. Relevant findings have been reported for chromo-endoscopy in the diagnosis of colitis-associated neoplasia, as well as flat and depressed adenomas. Real-time Doppler capabilities have now been added to endoscopic optical coherence tomography; the results of large-scale testing of narrow-band imaging endoscopy in the colon are being awaited; and fluorescence imaging has recently been added to the facilities available in video endoscopy. Most importantly, endomicroscopy now for the first time allows single-cell subsurface imaging during ongoing colonoscopy procedures, opening the way to in-vivo molecular and functional imaging.

Colitis↗

PubMed1998

Patient-controlled sedation with propofol and alfentanil during colonoscopy: a pilot study.

BACKGROUND AND STUDY AIMS: Patient controlled sedation (PCS) is becoming increasingly popular in day-case surgery and has the potential for use during endoscopy. We aimed to examine its safety and acceptability during colonoscopy in a pilot study using alfentanil and propofol and assess its influence on the patient's recovery time. PATIENTS AND METHODS: Sixteen otherwise healthy patients undergoing colonoscopy were attached to a Graseby 3300 PCA pump containing propofol 400 mg and alfentanil 1 mg (total volume 42 ml) and gave themselves bolus of 0.5 ml whenever they became uncomfortable. RESULTS: All patients tolerated the procedure well and found the PCS easy to use. There were no serious haemodynamic or respiratory complications and patients recovered quickly after the procedure, irrespective of the dose of drug given. CONCLUSIONS: PCS with propofol and alfentanil is an effective, short-acting form of sedation for patients undergoing colonoscopy and may be an alternative to benzodiazepines.

Aged↗

PubMed1995

Effect of colonoscopy premedication containing diazepam and pethidine on the release of mast cell mediators in gut mucosal samples.

BACKGROUND AND STUDY AIMS: To date there is no information available on whether drugs that are commonly used in premedication for colonoscopy procedures, such as diazepam and pethidine, may activate intestinal mast cells and thereby give rise to adverse effects. Since opioids such as pethidine are well-known for their ability to induce histamine release from several mast cell subtypes, the present study investigated the effect of diazepam and pethidine, intravenously administered as premedication for colonoscopy, on mast cell mediator secretion from colonic and rectal mucosa. PATIENTS AND METHODS: The secretion of the mast cell mediators histamine and tryptase was followed from biopsies of patients with and without premedication for 30 minutes in an air-bubbled incubation medium (mucosa oxygenation). The mediator release and tissue histamine content were studied prospectively in 17 control persons (histologically normal mucosa) as well as in 71 patients with inflammatory bowel disease (IBD) (histologically uninvolved and involved tissue). RESULTS: Although a significant accumulation of histamine was found in inflamed IBD-tissue, the results indicate, however, that this premedication does not enhance the release of histamine or tryptase from gut mucosal samples, neither in the histologically normal mucosa of control persons nor in tissue unaffected or affected by inflammatory bowel disease. CONCLUSION: This study demonstrates that colonoscopy premedication with diazepam and pethidine is safe in terms of gut mucosal mast cell activation.

Adult↗

PubMed1995

Endotoxemia and mediator release during colonoscopy.

BACKGROUND AND STUDY AIMS: Previous clinical and experimental studies have shown evidence of a leakage of whole bacteria and bacterial products after major trauma through the gut barrier. By determining plasma endotoxin levels, products of the arachidonic pathway, interleukin-6, and the endotoxin-neutralizing capacity (ENC) of plasma during colonoscopy, we studied the gut barrier function and the pathogenetic sequelae of mediator release during a minimally invasive procedure. PATIENTS AND METHODS: Thirty-two patients were enrolled in a controlled prospective study. Endotoxin and ENC were determined by a chromogenic modification of the limulus amebocyte lysate test. Prostanoids and interleukin-6 were measured using commercially available ELISA tests. C-reactive protein levels were checked by nephelometry. RESULTS: Twenty-one of the 32 patients had elevated endotoxin plasma levels during colonoscopy. In one patient, gut-derived bacteria were detected in plasma. ENC decreased after 5 min, and thromboxane B2 levels also started to increase at that time. No acute-phase response took place after 24 h. CONCLUSION: During colonoscopy, endotoxin can be detected in blood. ENC measurement was shown to be even more sensitive. The pathogenetic sequelae leading to gut barrier failure remain unclear, because mediator release and endotoxemia, as checked by ENC, took place simultaneously.

Adult↗

PubMed1994

The costs of colonoscopy in patients with ulcerative pan-colitis in Sweden.

The costs of colonoscopy examinations at a hospital in Sweden were calculated in ten consecutive patients with ulcerative pan-colitis. Since colonoscopy in such patients is incomplete if not followed by microscopic study of the state of the colon mucosa, the costs of both the endoscopic and histological examinations were calculated together. The costs of the material used (disposable items, recycled items and durable items) and the wages for personnel involved (endoscopists, pathologists, nurses, laboratory technicians, secretaries and clerks) were calculated for each colonoscopic and histological examination. The mean cost per complete examination was US$223, which is moderate despite the high personnel costs in Sweden. Since the biopsy material obtained in an endoscopic examination is of value not only for conventional histological study but also for DNA analysis, periodic colonoscopy is still to be recommended in patients with long-standing ulcerative pan-colitis until new methods of cancer detection and prevention become available.

Adult↗

PubMed1994

Evaluating customer satisfaction with colonoscopy.

Twenty patients were interviewed shortly after colonoscopy, and the adjectives and phrases they used to describe the experience were formed into a 31-item questionnaire, on which each item was rated using a seven-point scale. This questionnaire was completed by 110 similar patients. Principal components analysis of these responses yielded three components: satisfaction, physical discomfort, and emotional distress. This demonstrates that patients' experience of colonoscopy is multi-dimensional; whether or not a patient feels satisfied is unrelated to how distressing or uncomfortable it is. Component-based scale scores were calculated so as to quantify every patient's experience on each dimension. Procedures performed by the most experienced endoscopist were no less uncomfortable than others, but they were less distressing. Female patients experienced more discomfort than males, but were no more distressed or less satisfied. This questionnaire could be useful in any future audit of colonoscopy from the patients' point of view.

Analysis of Variance↗

PubMed1991

A randomised controlled trial to evaluate the effects of flumazenil after midazolam premedication in outpatients undergoing colonoscopy.

The degree of sedation and amnesia, subjective assessment of awakening and side effects after intravenous injection of 3-4 mg midazolam and 1 mg flumazenil or placebo were studied directly after colonoscopy, and on the first and the eight day. A total of 91 patients were studied; 45 patients were given flumazenil and 46 patients a placebo. Five minutes after injection of the test drugs all 45 patients given flumazenil but only 38 patients given the placebo were alert (p = 0.006). All three response criteria (for sedation, amnesia and subjective assessment of awakening) were fulfilled by 84.4% of the patients given flumazenil and 45.7% of the patients given the placebo (p = 0.0002). Thirty minutes after injection of the test drugs dizziness, nausea, and fatigue were found in 3 patients given flumazenil and in 10 patients given placebo. One day after colonoscopy 9 of 45 patients (20%) given midazolam and flumazenil complained of fatigue and 9 of 46 patients (19.5%) given midazolam and placebo. Eight days (+/- 1 day) later two patients in each group complained of headache, nausea and fatigue. No patient developed phlebitis at the injection site. Flumazenil seems to be a safe and efficient drug for reversing the sedative effect of midazolam, premedication after colonoscopy. However, resedation due to the effects of midazolam may occur. Flumazenil thus permits administration of a higher dose of midazolam without prolongation of the surveillance time. Improved exploitation of time, space and nursing resources is thus possible without jeopardizing patient safety, although caution is necessary since patients may not be fit to resume all normal activities.

Adolescent↗

PubMed1989

Negative Haemoccult test in malignant and premalignant lesions of the colon. Validation of the Haemoccult test with total colonoscopy.

To date, no published report on a trial has provided sufficiently strong evidence of the accuracy of the Haemoccult Test assessed by false-negative error, and validated on the basis of a complete colonoscopy of all patients. Total colonoscopy (up to the cecum) was performed on 534 patients whose stools had been tested for occult blood. The results of the colonoscopy were classified as follows: --expected continual bleeding (target lesions: carcinoma, polyps greater than or equal to 10 mm) --intermittant bleeding (polyps less than 10 mm, colitis, etc.), and --no source of bleeding. Results were regarded as false-negative in patients who were found to have a target lesion (carcinoma, polyp greater than or equal to 10 mm) following a negative Haemoccult test. Apart from positive and negative prognostic values, sensitivity and specificity were taken into account as characteristics for the quality of the test. Following a positive Haemoccult test result 46 of the 534 patients were found to have polyps greater than or equal to 10 mm and 22 carcinomas; following negative Haemoccult test results 31 patients were found to have polyps measuring greater than or equal to 10 mm in diameter and 2 carcinomas. On the basis of the chosen classification a false-negative Haemoccult result was established in 8.6% and a false-positive result in 4.3%. The Haemoccult test showed a sensitivity of 67% and a specificity of 93% in patients with target lesions or patients without a source of bleeding.

Colonoscopy↗

PubMed1984

Septicaemia after colonoscopy due to an iliac artery aneurysm.

Transient bacteraemia following colonoscopy is very rare after colonoscopy though endotoxaemia without clinical consequences may occur in about 9% of patients (1, 2). An unusual case of septicaemia after colonoscopy associated with an iliac artery aneurysm is reported.

Aged↗

PubMed1983

Pneumatosis cystoides coli: a rare complication of colonoscopy.

A case of colonic pneumatosis cystoides intestinales (PCI) which occurred three days after a routine colonoscopy is presented. A review of the literature revealed only two other cases of PCI following colonoscopy. The close temporal association to the colonoscopy supports the mechanical hypothesis as the probably mechanism leading to intramural PCI.

Aged↗

PubMed2000

Urgent colonoscopy for the diagnosis and treatment of severe diverticular hemorrhage.

BACKGROUND: Although endoscopy is often used to diagnose and treat acute upper gastrointestinal bleeding, its role in the management of diverticulosis and lower gastrointestinal bleeding is uncertain. METHODS: We studied the role of urgent colonoscopy in the diagnosis and treatment of 121 patients with severe hematochezia and diverticulosis. All patients were hospitalized, received blood transfusions as needed, and received a purge to rid the colon of clots, stool, and blood. Colonoscopy was performed within 6 to 12 hours after hospitalization or the diagnosis of hematochezia. Among the first 73 patients, those with continued diverticular bleeding underwent hemicolectomy. For the subsequent 48 patients, those requiring treatment received therapy, such as epinephrine injections or bipolar coagulation, through the colonoscope. RESULTS: Of the first 73 patients, 17 (23 percent) had definite signs of diverticular hemorrhage (active bleeding in 6, nonbleeding visible vessels in 4, and adherent clots in 7). Nine of the 17 had additional bleeding after colonoscopy, and 6 of these required hemicolectomy. Of the subsequent 48 patients, 10 (21 percent) had definite signs of diverticular hemorrhage (active bleeding in 5, nonbleeding visible vessels in 2, and adherent clots in 3). An additional 14 patients in this group (29 percent) were presumed to have diverticular bleeding because although they had no stigmata of diverticular hemorrhage, no other source of bleeding was identified. The other 24 patients (50 percent) had other identified sources of bleeding. All 10 patients with definite diverticular hemorrhage were treated endoscopically; none had recurrent bleeding or required surgery. CONCLUSIONS: Among patients with severe hematochezia and diverticulosis, at least one fifth have definite diverticular hemorrhage. Colonoscopic treatment of such patients with epinephrine injections, bipolar coagulation, or both may prevent recurrent bleeding and decrease the need for surgery.

Acute Disease↗

PubMed2002

Results of screening colonoscopy among persons 40 to 49 years of age.

BACKGROUND: The prevalence of colorectal lesions in persons 40 to 49 years of age, as identified on colonoscopy, has not been determined. METHODS: We reviewed the procedure and pathology reports for 906 consecutive persons 40 to 49 years of age who voluntarily participated in an employer-based screening-colonoscopy program. The histologic features of lesions that were identified and removed on endoscopy were categorized according to those of the most advanced lesion removed proximally (up to the junction of the splenic flexure and the descending colon) and the most advanced lesion removed distally. An advanced lesion was defined as an adenoma at least 1 cm in diameter, a polyp with villous histologic features or severe dysplasia, or a cancer. RESULTS: Among those who underwent colonoscopic screening, 78.9 percent had no detected lesions, 10.0 percent had hyperplastic polyps, 8.7 percent had tubular adenomas, and 3.5 percent had advanced neoplasms, none of which were cancerous (95 percent confidence interval for cancer, 0 to 0.4 percent). Eighteen of 33 advanced neoplasms (55 percent) were located distally and were potentially within reach of a sigmoidoscope. If these results are applicable to the general population, at least 250 persons, and perhaps 1000 or more, would need to be screened to detect one cancer in this age group. CONCLUSIONS: Colonoscopic detection of colorectal cancer is uncommon in asymptomatic persons 40 to 49 years of age. The noncancerous lesions are equally distributed proximally and distally. The low yield of screening colonoscopy in this age group is consistent with current recommendations about the age at which to begin screening in persons at average risk.

Adenoma↗

PubMed2002

Effect of magnetic endoscope imaging on patient tolerance and sedation requirements during colonoscopy: a randomized controlled trial.

BACKGROUND: Pain during colonoscopy is primarily related to mesenteric stretching from looping of the colonoscope insertion tube. Prompt recognition and removal of loops reduces patient discomfort and may lessen sedation requirements. Magnetic endoscope imaging allows real-time visualization of the colonoscope during insertion. The effect of magnetic endoscope imaging on patient pain and sedation requirements was assessed in a prospective randomized controlled trial. METHODS: A total of 122 consecutive patients undergoing routine colonoscopy by a single experienced endoscopist were randomized to have the procedure performed either with the endoscopist viewing the imager display (n = 62), or without the imager view (n = 60). Procedures began with administration of hyoscine-N-butylbromide alone, and sedative medications (midazolam and meperidine) were self-administered by the patient with a patient-controlled analgesia pump. Cardiorespiratory parameters were recorded and patient pain was assessed with a 100-mm visual analogue scale. RESULTS: The number of attempts at straightening the colonoscope was fewer (median 8 [0-66] vs. 15 [0-87], p = 0.0076) and the duration of looping less (median 4.5 min [0-27.3 min] vs. 6.4 min [0-29.4 min]), when the endoscopist was able to see the imager view. The total number of patient demands (by patient-controlled analgesia) for medication (median 1 vs. 2.5) and total doses of midazolam (median 0.44 mg vs. 0.88 mg) and meperidine (median 16.75 mg vs. 32.5 mg) administered did not significantly differ between patients examined with or without the imager. Patient pain scores were also similar. CONCLUSIONS: Magnetic endoscope imaging allows accurate assessment and straightening of loops during colonoscopy, but without a significant reduction in patient requirements for sedative medication or improvement in patient tolerance. However, the dosages of sedation drugs used were small.

Adult↗