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At least 865 records · Page 48Linked to original sources

PubMed2006

Sedation-free colonoscopy using an upper endoscope is tolerable and effective in patients with low body mass index: a prospective randomized study.

OBJECTIVE: Small-caliber upper endoscopes can be used safely and effectively for sedation-free colonoscopy. The objective of the study is to assess the efficacy of a small-caliber upper endoscope (9.2 mm) comparing with a standard colonoscope (12.2 mm). METHODS: In a prospective trial, patients undergoing sedation-free colonoscopy were randomly assigned to the upper endoscope (E) or the standard colonoscope (C). Outcome measures included patient self-assessed pain score (4-point scale), endoscopist-assessed pain score (4-point scale), cecal intubation rate, difficult cecal intubation rate (>900 s), number of polyps detected, and complication rates. RESULTS: A total of 244 patients were entered. Clinical characteristics were not different between the two groups. Cecal intubation was achieved in 91.0% of the patients in each group. The mean patient self-assessed pain score (SD) was significantly lower in the E group compared with the C group: 1.44 (0.81) versus 2.08 (1.10), p < 0.001. The mean endoscopist assessment of patient pain score (SD) was significantly lower in the E group compared with the C group as well: 1.27 (0.67) versus 1.58 (0.90), p= 0.003. In patients with low body mass index (BMI < 22 kg/m(2)), the cecal intubation rate was significantly higher in the E group (97.7%vs 79.4%, p= 0.026) and the difficult cecal intubation rate was significantly lower in the E group (9.3%vs 32.4%, p= 0.011). There were no significant differences in the number of polyps detected and complication rates between the two groups. CONCLUSION: A small-caliber upper endoscope is tolerable and effective for sedation-free colonoscopy, especially in patients with low BMI.

Body Mass Index↗

PubMed2006

Comparative study of conventional colonoscopy, chromoendoscopy, and narrow-band imaging systems in differential diagnosis of neoplastic and nonneoplastic colonic polyps.

AIM: To identify the feasibility of the narrow-band imaging (NBI) method compared with that of conventional colonoscopy and chromoendoscopy for distinguishing neoplastic and nonneoplastic colonic polyps. METHOD: This study enrolled consecutive patients who underwent colonoscopy using a conventional colonoscope between January and February 2006 at Chang-Gung Memorial Hospital, Linkou Medical Center, Taiwan. These 78 patients had 110 colorectal polyps. During the procedure, conventional colonoscopy first detected lesions, and then the NBI system was used to examine the capillary networks. Thereafter indigo carmine (0.2%) was sprayed directly on the mucosa surface prior to evaluating the crypts using a conventional colonoscope. The pit patterns were characterized using the classification system proposed by Kudo. Finally, a polypectomy or biopsy was performed for histological diagnosis. RESULTS: Of the 110 colorectal polyps, 65 were adenomas, 40 were hyperplastic polyps, and five were adenocarcinomas. The NBI system and pit patterns for all lesions were analyzed. For differential diagnosis of neoplastic (adenoma and adenocarcinoma) and nonneoplastic (hyperplastic) polyps, the sensitivity of the conventional colonoscope for detecting neoplastic polyps was 82.9%, specificity was 80.0% and diagnostic accuracy was 81.8%, significantly lower than those achieved with the NBI system (sensitivity 95.7%, specificity 87.5%, accuracy 92.7%) and chromoendoscopy (sensitivity 95.7%, specificity 87.5%, accuracy 92.7%). Therefore, no significant difference existed between the NBI system and chromoendoscopy during differential diagnosis of neoplastic and nonneoplastic polyps. CONCLUSION: The NBI system identified morphological details that correlate well with polyp histology by chromoendoscopy.

Adult↗

PubMed2006

Evaluation and analysis of colonoscopy in the diagnosis of 186 cases of ulcerative colitis patients.

The objective of this study was to evaluate the diagnostic value of colonoscopy plus biopsy in patients with ulcerative colitis (UC). Retrospective analysis was performed on clinical data in 186 cases. Erosions, or ulcers, together with mucosal hyperemia and oedema were the most common manifestations of colonoscopy in 87% of patients. In about 56.4% of 186 cases, such manifestations occurred in the rectum and the sigmoid colon. Nearly 65.6% of the patients had a chronic intermittent clinical course. One case developed colon cancer, and another case had toxic megacolon; each case represents 0.05% of the total 186 patients. Therefore, prevalence of both malignancy and complication is low. Colonoscopy plus biopsy is considered to be the major means of the diagnosis of UC, demonstrating its value in differential diagnosis.

Adolescent↗

PubMed1996

Investigating inflammatory bowel disease--white cell scanning, radiology, and colonoscopy.

OBJECTIVE: To evaluate different methods of examination of the bowel in suspected inflammatory bowel disease. DESIGN: Prospective investigation of all children over a three year period with suspected inflammatory bowel disease. A technetium-99m-HMPAO labelled white cell scan (Tc-WCS), barium follow through examination (Ba-FT), and colonoscopy plus biopsy were undertaken. SETTING: Great Ormond Street Hospital for Children, London. SUBJECTS: 39 children (20 male and 19 female), median age 12.1 years (range 3.9-15.1 years). MAIN OUTCOME MEASURES: There was total agreement in 21/39 cases, positive in 16, and negative in five. Of 31 histologically proved cases, positive results were obtained in 28 Tc-WCSs (sensitivity 90%), 10 of 24 Ba-FTs (sensitivity 42%), and 27 colonoscopies (sensitivity 87%). CONCLUSION: The Tc-WCS is sensitive, specific, and non-invasive and should be a first line investigation. Ba-FT with a high radiation burden and relatively low sensitivity requires its role to be redefined. Colonoscopy, with endoscopic biopsy, has a high pick-up rate where facilities and expertise exist.

Adolescent↗

PubMed2004

Detecting diminutive colorectal lesions at colonoscopy: a randomised controlled trial of pan-colonic versus targeted chromoscopy.

BACKGROUND: Diminutive and flat colorectal lesions can be difficult to detect using conventional colonoscopic techniques. Previous data have suggested that pan-chromoscopy may improve detection rates. No randomised control trial has been performed examining detection rates of such lesions while controlling for extubation time and lavage effect. AIM: We conducted a randomised controlled trial of pan-colonic chromoscopic colonoscopy for the detection of diminutive and flat colorectal lesions while controlling for extubation time and lavage effect. METHODS: Consecutive patients attending for routine colonoscopy were randomised to either pan-chromoscopy using 0.5% indigo carmine (IC) or targeted chromoscopy (control group). A minimum diagnostic extubation time was set at eight minutes with controls undergoing a matched volume of saline wash. RESULTS: A total of 260 patients were randomised; 132 controls and 128 to pan-colonic chromoscopy. Extubation times did not differ significantly between the control (median 15 minutes (range 8-41)) and chromoscopy (median 17 minutes (range 8-39)) groups. The volume of IC used in the pan-chromoscopy group (median 68 ml (range 65-90)) and normal saline used in the control group (69 ml (range 60-93)) did not differ significantly. There was a statistically significant difference between the groups regarding the total number of adenomas detected (p<0.05) with significantly more diminutive (<4 mm) adenomas detected in the pan-chromoscopy group (p = 0.03). Pan-chromoscopy diagnosed more diminutive and flat lesions in the right colon compared with controls (p<0.05), with more patients with multiple adenomas (>3) detected using pan-chromoscopy (p<0.01). Hyperplastic lesions were more commonly detected in the pan-chromoscopy group compared with controls (p<0.001). More hyperplastic polyps were detected in the left colon (86% rectosigmoid) using chromoscopy compared with controls. CONCLUSION: Chromoscopy improves the total number of adenomas detected and enhances the detection of diminutive and flat lesions. Importantly, eight diminutive lesions had foci of high grade dysplasia. Chromoscopy may benefit patients, assuming a high risk of colorectal cancer, and help in risk stratification and planning follow up colonoscopy intervals.

Adenoma↗

PubMed1987

Future requirements for colonoscopy in Britain. Report by the Endoscopy Section Committee of the British Society of Gastroenterology.

Current gastroenterological opinion is that colonoscopy provides the most accurate technique for diagnosing structural colonic disease, especially neoplasia. A strong case has been made for continuing colonoscopic surveillance of patients with neoplastic polyps, chronic ulcerative colitis, and after resection of carcinomas. The incidence of these diseases is known, and calculations can be made of the desirable frequency of colonoscopy. These indicate that about 160 colonoscopies per 100,000 population per year are required. At present facilities in the United Kingdom fall well below that figure.

Colitis, Ulcerative↗

PubMed1988

Open access colonoscopy for suspected colonic neoplasia.

An open access endoscopy service for direct referral of patients suspected to have colonic neoplasia has been analysed. In the first year of the service 137 patients were referred by 52 general practitioners. The most common reason for referral was rectal bleeding (58%). Colonoscopy was done without outpatient consultation or barium enema examination in 130 patients: there were no complications. The diagnostic yield was 57%: 34 patients (25%) had neoplasia (cancer 14, adenoma 20), which was higher than the yield of neoplasia in patients referred for open access double contrast barium enema during the same period. Only nine patients (7%) needed further investigation because colonoscopy was incomplete and 21 (16%) were treated by polypectomy at the diagnostic colonoscopy.

Aged↗

PubMed1993

Haemoccult does not reduce the need for colonoscopy in surveillance after curative resection for colorectal cancer.

Patients who had undergone curative resection for colorectal cancer were studied to compare the efficacy of faecal occult blood detection (Haemoccult test) with colonoscopy in the detection of metachronous tumours. Fifty nine patients were studied and both Haemoccult testing and colonoscopy were successfully completed in 54 patients. In 37 patients, both tests were negative. One patient with a positive Haemoccult test had no colonoscopic abnormality and remains alive and well two years later. There were, however, 16 patients with negative Haemoccult tests in whom an abnormality was found on colonoscopy. In four patients, one Dukes's A cancer and seven tubulovillous adenomas were found--all neoplastic lesions that would have been missed if surveillance had been by Haemoccult alone.

Aged↗

PubMed2000

A prospective single centre study comparing computed tomography pneumocolon against colonoscopy in the detection of colorectal neoplasms.

BACKGROUND AND AIMS: To determine the sensitivity and specificity of computed tomography (CT) pneumocolon in the detection of colorectal neoplasms. METHODS: A total of 201 consecutive patients with colorectal symptoms or requiring surveillance for colorectal neoplasms underwent both conventional colonoscopy and CT pneumocolon. RESULTS: On conventional colonoscopy 13 invasive colorectal carcinomas were detected in 13 patients, and 118 polyps in 63 patients (14 polyps were > or =1 cm in diameter, 25 were 6-9 mm, and 79 were < or =5 mm). CT pneumocolon detected all 13 cancers, two false positive cancers, but only 20 polyps (seven were > or =1 cm). This resulted in a sensitivity of 100% (95% confidence interval (CI) 87-100%) and specificity of 99% (95% CI 97-100%) for detection of invasive carcinoma, and a sensitivity of 73% (95% CI 56-90%) and specificity of 94% (95% CI 91-98%) for detection of invasive carcinoma and/or > or =1 cm polyps. CT pneumocolon also identified invasive carcinoma not seen at colonoscopy because of incomplete examination in three patients, and detected metastases in six colorectal carcinoma patients and extracolonic carcinoma in a further seven patients. CONCLUSIONS: CT pneumocolon had a high sensitivity and specificity for detection of invasive colorectal carcinoma but not colorectal polyps. CT pneumocolon may be suitable for initial investigation of patients with symptoms of colorectal malignancy.

Aged↗

PubMed2004

Infective endocarditis from Enterococcus faecalis complicating colonoscopy in Heyde's syndrome.

A case of infective endocarditis from Enterococcus faecalis after colonoscopy in a patient with aortic stenoinsufficiency and bleeding intestinal angiodysplasia (Heyde's syndrome) is reported.A 77 year old man with aortic stenoinsufficiency presented with enterorrhagia and underwent a colonoscopy, which showed normal findings. Fifteen days later he developed a moderate degree of fever. Blood cultures were positive for E faecalis. An echocardiogram showed aortic valve vegetations, and infective endocarditis was diagnosed and successfully treated by antibiotics. Some months later, intestinal bleeding recurred and intestinal resection was performed. Histopathology showed angiodysplasia. In patients with Heyde's syndrome antibiotic prophylaxis should be considered before colonoscopy.

Aged↗

PubMed1988

Oral bowel lavage preparation for colonoscopy.

Colonoscopy is a commonly performed diagnostic and therapeutic procedure in most general hospitals, which requires effective bowel preparation to be worthwhile. We report the effect of replacing a diet, laxative and bowel washout preparation with oral bowel lavage using a balanced electrolyte formulation, in our unit. The preparation was acceptable to patients, medical and nursing staff, generally preferred to previous preparations by those who had experienced them, allowed a more complete colonoscopy with an excellent quality of view, and was less expensive in nursing time. We regard oral bowel lavage as currently the method of choice for bowel preparation prior to colonoscopy in the majority of patients.

Administration, Oral↗

PubMed2001

Is transcutaneous electrical nerve stimulation an effective analgesia during colonoscopy?

OBJECTIVES: To evaluate the efficacy of transcutaneous electrical nerve stimulation (TENS) as analgesia during colonoscopy. DESIGN: In a randomised controlled trial, patients undergoing diagnostic colonoscopy were assigned to one of three groups: standard medication only (midazolam); active TENS plus standard medication; or non-functioning TENS and standard medication. Efficacy of TENS was determined using numerical rating scores for pain and the post-procedural evaluation questionnaire. SETTING: Patients undergoing diagnostic colonoscopy in a teaching hospital. MAIN OUTCOME: There was no statistically significant differences between the three groups. However in the active TENS group there was a greater variation in "physical discomfort" and "psychological distress", suggesting TENS may be effective in subgroup of patients.

Adult↗

PubMed2002

Colorectal neoplasms: prospective comparison of thin-section low-dose multi-detector row CT colonography and conventional colonoscopy for detection.

PURPOSE: To prospectively compare thin-section low-dose multi-detector row computed tomographic (CT) colonography with conventional colonoscopy for the detection of colorectal neoplasms. MATERIALS AND METHODS: One hundred five patients underwent CT colonography immediately before colonoscopy. Supine and prone CT colonographic acquisitions to image the region during a 30-second breath hold were performed. CT colonographic images were prospectively interpreted for the presence, location, size, and morphologic features of polyps. The time of image interpretation was noted. Sensitivity, specificity, and positive and negative predictive values of CT colonography were calculated, with 95% CIs, by using colonoscopic findings as the reference standard. The weighted CT dose index was calculated on the basis of measurements in a standard body phantom. Effective dose was calculated by using commercially available software. RESULTS: Median CT data interpretation time was 12 minutes. One hundred thirty-two polyps in 59 patients were identified at colonoscopy; no polyps were detected in 46 patients. Sensitivities for detection of polyps smaller than 5 mm, 6-9 mm, and larger than 10 mm in diameter were 12% (11 of 91 polyps), 70% (19 of 27 polyps), and 93% (13 of 14 polyps), respectively. Estimated overall specificity was 97.7% (515 of 527 imaging results). The total weighted CT dose index for combined supine and prone CT colonography was 11.4 mGy. The effective doses for combined CT colonography were 5.0 mSv and 7.8 mSv for men and women, respectively. CONCLUSION: Low-dose multi-detector row CT colonography has excellent sensitivity and specificity for detection of colorectal neoplasms 10 mm and larger.

Aged↗

PubMed2003

Detection of colorectal lesions: lower-dose multi-detector row helical CT colonography compared with conventional colonoscopy.

PURPOSE: To compare the performance of lower-dose multi-detector row helical computed tomographic (CT) colonography with that of conventional colonoscopy in the detection of colorectal lesions. MATERIALS AND METHODS: One hundred fifty-eight patients underwent multi-detector row helical CT colonography (beam collimation, 4 x 2.5 mm; table feed, 17.5 mm/sec; voltage, 140 kV; and effective dose, 10 mAs) followed by conventional colonoscopy. Conventional colonoscopy served as the reference standard. Two radiologists interpreted CT colonographic images to assess the presence of polyps or carcinomas. Sensitivity was calculated on both a per-polyp and a per-patient basis. In the latter, specificity and positive and negative predictive values were also calculated. Weighted CT dose index was calculated on the basis of measurements obtained in a standard body phantom. Effective dose was estimated by using commercially available software. RESULTS: CT colonography correctly depicted all 22 carcinomas (sensitivity, 100%) and 52 of 74 polyps (sensitivity, 70.3%). Sensitivity for detection was 100% in all 13 polyps 10 mm or larger in diameter, 83.3% in 20 of 24 polyps 6-9 mm, and 51.3% in 19 of 37 lesions 5 mm or smaller. With regard to the per-patient analysis, CT colonography had a sensitivity of 96.0%, a specificity of 96.6%, a positive predictive value of 94.1%, and a negative predictive value of 97.7%. The total weighted CT dose index for combined prone and supine acquisitions was 2.74 mGy. The simulated effective doses for complete CT colonography were 1.8 mSv in men and 2.4 mSv in women. CONCLUSION: Lower-dose multi-detector row helical CT colonography ensures substantial dose reduction while maintaining excellent sensitivity for detection of colorectal carcinomas and polyps larger than 6 mm in diameter.

Aged↗

PubMed1994

Which hurts the most? A comparison of pain rating during double-contrast barium enema examination and colonoscopy.

PURPOSE: To study the degree of pain caused by double-contrast barium enema examination and colonoscopy and to compare pain ratings by patients and medical personnel. MATERIALS AND METHODS: In a random sample, 190 patients (aged 45-79 years) (mean, 63.1 years) recorded their experiences of pain during each procedure and the medical staff recorded their impressions of the patients' pain, on a 10-point progressive scale. The data were analyzed with the Wilcoxon rank test, Spearman rank correlation, and generalized kappa value. RESULTS: Patients' pain ratings were significantly higher during colonoscopy than during double-contrast barium enema examination (P < .0001). Pain was rated significantly higher by patients than by personnel for both procedures (P < .0001). CONCLUSION: In the choice of procedure, patients' high level of pain during colonoscopy should be remembered. The medical staff frequently underestimated patients' pain during both procedures, and this study documents a need for more extensive pain relief measures during potentially painful examinations of the large bowel.

Aged↗

PubMed1994

Colorectal cancer overlooked at barium enema examination and colonoscopy: a continuing perceptual problem.

PURPOSE: To evaluate reasons for missed diagnosis of colorectal carcinoma at barium enema (BE) examination and colonoscopy and determine if standards have improved since a similar study in 1981. MATERIALS AND METHODS: Relevant studies obtained within 3 years of diagnosis in 161 patients with colorectal carcinoma treated in 1990 were reviewed. RESULTS: Twenty-seven carcinomas were overlooked at BE examination and seven at colonoscopy. Fifteen percent of BE examination errors were purely perceptive (ie, the tumor was visible in retrospect). Another 15% were purely technical. Combined perceptive and technical errors occurred in 45% of cases. Interpretive errors (ie, the lesion was misinterpreted as benign) occurred in 25% of cases. CONCLUSION: Similar reasons for missing diagnoses of colorectal cancer at BE examination were seen in 1990 and 1981, with a high rate of perceptive errors. Double reading BE studies may reduce this rate, and readiness to perform BE examination after an incomplete colonoscopy may reduce colonoscopic "misses."

Barium Sulfate↗

PubMed1994

Colonic submucosal tumors: comparison of endoscopic US and target air-enema CT with barium enema study and colonoscopy.

PURPOSE: To compare the imaging characteristics of colonic submucosal tumors at endoscopic ultrasound (US) and target air-enema computed tomography (TACT) with those at conventional double-contrast barium enema study and colonoscopy. MATERIALS AND METHODS: Twenty consecutive patients with suspected colonic submucosal tumors at barium enema study and colonoscopy underwent endoscopic US, TACT, or both. Morphologic features and posture-related change in shape of tumor were evaluated with barium enema study, color and consistency of tumor with colonoscopy, internal echogenicity of tumor and layer of origin in normal colonic wall with endoscopic US, and CT attenuation number with TACT. RESULTS: Eight lipomas, seven carcinoids, three leiomyomas, four lymphangiomas, and one hemangioma were found at histologic examination. Lipomas and lymphangiomas had characteristic findings at endoscopic US and TACT. The differential diagnosis of the other submucosal tumors was facilitated by using endoscopic US. CONCLUSION: Endoscopic US and TACT may play a valuable role in the evaluation of colonic submucosal tumors.

Adult↗

PubMedDate not supplied

Colonoscopy 'my way': preparation, anticoagulants, antibiotics and sedation.

Colonoscopy was introduced in the 1960s. The facility with which this technique is performed has been enhanced by vast improvements in instrumentation. In spite of this, physician attitudes concerning colonoscopy have changed little over the past several decades. The diet for precolonoscopic preparation has not been altered for 30 years. Colonoscopists have a great reluctance to use a new preparation instead of the 4 L electrolyte solution, perhaps because this was such a significant advance in colonoscopic cleansing, its predecessor being castor oil and enemas. Physicians continue to be wary of the patient who is taking acetylsalicylic acid in the absence of any studies that show that this is detrimental for polypectomy. The management of the patient on warfarin anticoagulation remains a subject for debate. As for antibiotic prophylaxis, most endoscopy units do not have a standardized approach, although there are good guidelines that, if followed, should decrease the risk of infective endocarditis. Sedation for the endoscopic examination is usually administered by the colonoscopist, although anesthesiologists may, in some countries (and in some defined areas of the United States) be the primary administrators of sedation and analgesia. The present article is a personal approach to the following issues: the preparation of the colon for an examination, current thoughts about anticoagulation and acetylsalicylic acid, antibiotic prophylaxis for colonoscopy and the technique for sedation out of the hospital.

Analgesia↗