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PubMed2001

Surveillance colonoscopy following resection of colorectal polyps and cancer.

Patients undergoing clearing colonoscopy with resection of adenomas should generally have their next examination at three years. Exceptions include large sessile adenomas removed piecemeal (re-examine at two to six months until no evidence of recurrent polyp, then at one year), average risk patients with a single tubular adenoma (next examination at five years) and patients with 'numerous' adenomas (next examination at one or two years). Patients with surgically resected colorectal cancer should have a clearing colonoscopy preoperatively or within two to three months of surgery in obstructed patients, even if the preoperative barium enema is negative for proximal lesions. After the clearing colonoscopy, subsequent examinations can be performed based on the associated adenoma findings.

Colonic Polyps↗

PubMed2006

Commonly used preparations for colonoscopy: efficacy, tolerability, and safety--a Canadian Association of Gastroenterology position paper.

INTRODUCTION: The increased demand for colonoscopy, coupled with the introduction of new bowel cleansing preparations and recent caution advisories in Canada, has prompted a review of bowel preparations by the Canadian Association of Gastroenterology. METHODS: The present review was conducted by the Clinical Affairs group of committees including the endoscopy, hepatobiliary/transplant, liaison, pediatrics, practice affairs and regional representation committees, along with the assistance of Canadian experts in the field. An effort was made to systematically assess randomized prospective trials evaluating commonly used bowel cleansing preparations in Canada. RESULTS: Polyethylene glycol (PEG)-; sodium phosphate (NaP)-; magnesium citrate (Mg-citrate)-; and sodium picosulphate, citric acid and magnesium oxide (PSMC)-containing preparations were reviewed. Regimens of PEG 2 L with bisacodyl (10 mg to 20 mg) or Mg-citrate (296 mL) are as effective as standard PEG 4 L regimens, but are better tolerated. NaP preparations appear more effective and better tolerated than standard PEG solutions. PSMC has good efficacy and tolerability but head-to-head trials with NaP solutions remain few, and conclusions equivocal. Adequate hydration during preparation and up to the time of colonoscopy is critical in minimizing side effects and improving bowel cleansing in patients receiving NaP and PSMC preparations. All preparations may cause adverse events, including rare, serious outcomes. NaP should not be used in patients with cardiac or renal dysfunction (PEG solution is preferable in these patients), bowel obstruction or ascites, and caution should be exercised when used in patients with pre-existing electrolyte disturbances, those taking medications that may affect electrolyte levels and elderly or debilitated patients. Health Canada's recommended NaP dosing for most patients is two 45 mL doses 24 h apart. However, both safety and efficacy data on this dosing schedule are lacking. Many members of the Canadian Association of Gastroenterology expert panel administer both doses within 24 h, as studied in clinical trials, after careful one-on-one discussion of risks and benefits in carefully selected patients. Safety data on PSMC and combination preparations in North America are limited and clinicians are encouraged to keep abreast of developments in this area. CONCLUSIONS: All four preparations reviewed provided effective bowel cleansing for colonoscopy in the majority of patients, with varying tolerability. Adequate hydration is essential in patients receiving the preparations.

Colonoscopy↗

PubMed1998

Impact of sedation and resident teaching on complications of colonoscopy.

There is controversy regarding the frequency of sedation-related complications of colonoscopies and whether these procedures are safely performed by physicians-in-training. We retrospectively reviewed the safety of 1,004 consecutive outpatient colonoscopies. No perforations occurred. No patients were hospitalized for sedation-related complications. Seventeen percent of patients had significant changes in vital signs that lasted less than 5 min. These changes were less common in patients receiving </=3 mg midazolam intravenously without meperidine (p < 0.005). Complications were slightly more frequent in procedures performed by trainees (23%) than by gastroenterologists (12%) and by surgeons (18%) (p = 0.01). These data support the safety of colonoscopy under intravenous sedation, even when performed by trainees.

Adolescent↗

PubMed2005

The EPAGE internet guideline as a decision support tool for determining the appropriateness of colonoscopy.

BACKGROUND: Few studies have examined how physicians perceive guidelines, much less their perceptions of an Internet presentation of such guidelines. This study assessed physicians' acceptance ofan Internet-based guideline on the appropriateness of colonoscopy. METHODS: Gastroenterologists participating in an international observational study consulted an Internet-based guideline for consecutive patients referred for colonoscopy. The guideline was produced by the European Panel on the Appropriateness of Gastrointestinal Endoscopy (EPAGE), using a validated method (RAND). Through the use of questionnaires, physicians were asked their opinions and perspectives of the guideline and website. RESULTS: There were 289 patients included in the study. The mean time for consulting the website was 1.8 min, and it was considered easy to use by 86% of physicians. The recommendations were easily located for 82% of patients and physicians agreed with the appropriateness in 86% of cases. According to the EPAGE criteria, colonoscopy was appropriate, uncertain, and inappropriate in 59, 28, and 13% of patients, respectively. CONCLUSIONS: The EPAGE guideline was considered acceptable and user-friendly and the use, usefulness and relevance of the website were considered acceptable. However, its actual use will depend on the removal of certain organizational and cultural obstacles.

Adolescent↗

PubMed2003

Surgical implications of colonoscopy.

Colonoscopy, although increasingly used as a screening tool, has many surgical applications. As a tool for the abdominal surgeon, colonoscopy may be used not only to diagnose neoplasia, but also hemorrhage, and inflammatory and obstructive disorders. Therapeutically, endoscopic polypectomy has impacted the incidence of colorectal cancer, and further visualization techniques have augmented the ability of the endoscopist to discriminate between benign and neoplastic lesions. Colonoscopy remains a necessary implement to facilitate the diagnosis and therapy of those patients with disorders of the colon and rectum.

Colonoscopy↗

PubMed2004

Individuals with an increased risk of colorectal cancer: perceived benefits and psychological aspects of surveillance by means of regular colonoscopies.

PURPOSE: To evaluate the psychological consequences of genetic counseling followed by a surveillance program using colonoscopy among individuals with increased risk of colorectal cancer. PATIENTS AND METHODS: Two hundred sixty-five individuals, participating in a surveillance program with colonoscopy, were mailed a survey questionnaire that assessed their experience of the surveillance program and their perception of the risk of colorectal cancer. The Hospital Anxiety and Depression scale and the Swedish Short Form-36 Health Survey was also included. RESULTS: Two hundred forty individuals completed the questionnaire and were divided into the following risk groups: risk group 1, an individual with a mutation in hMLH1 or hMSH2 and a lifetime colorectal cancer risk of 80% (n = 28); risk group 2, a lifetime colorectal cancer risk of 40% (n = 129); and risk group 3, a lifetime colorectal cancer risk of 20% (n = 83). Among all individuals, the mean for perceived benefit was 8.0, and the perception of discomfort was 3.3 on the visual analog scale (1-10). In risk group 1, 61% underestimated personal risks as being 40% or less. Approximately 50% of the subjects in risk groups 2 and 3 either under- or overestimated their lifetime risk. According to the Swedish Short Form-36 Health Survey and the Hospital Anxiety and Depression scale, the study sample resembled the reference population. CONCLUSION: A majority of the study sample understood why they were under surveillance, and regular colonoscopies were well-tolerated. The wide range of risk perception as well as low-risk perception in mutation positive subjects is acceptable, as long as these individuals adhere to surveillance programs and do not demonstrate increased levels of anxiety or depression.

Adaptor Proteins, Signal Transducing↗

PubMed2003

Three-dimensional endoluminal CT colonography (virtual colonoscopy): comparison of three commercially available systems.

OBJECTIVE: The purposes of this study were to directly compare 3D endoluminal volume rendering and navigational capabilities of three different CT colonography systems and to assess feasibility of 3D evaluation for primary polyp detection. MATERIALS AND METHODS: Closely matched endoluminal images from three CT colonography software systems (Navigator, Vitrea 2, and V3D-Colon) and optical colonoscopy were obtained of eight pathologically proven colorectal polyps. All images were then reviewed by 25 physicians (12 radiologists and 13 gastroenterologists) who were not familiar with the three systems. For each polyp, the images yielded by the three systems were rated according to polyp conspicuity, 3D effect (depth), subjective quality, and likeness to optical colonoscopy. For comparison of endoluminal navigation capability, automated or semiautomated flight from rectum to cecum and cecum to rectum was attempted in 10 cases (20 flights) in which a continuous colonic air column could be identified on the 2D images. Additional 3D features were also compared. RESULTS: For polyp conspicuity, 3D effect, and likeness to optical colonoscopy, the V3D-Colon system was favored in 92.0% (184/200), 92.5% (185/200), and 92.5% (185/200) of responses, respectively (p < 0.001). For the same categories, the Navigator system ranked second in 73.0%, 74.0%, and 75.0% of cases, and the Vitrea 2 system ranked last in 79.0%, 77.5%, and 76.0% of cases, respectively. Automated or semiautomated navigation was successful in eight (40%) of 20 flights with Vitrea 2, in nine (45%) of 20 flights with Navigator, and in 20 (100%) of 20 flights with V3D-Colon (p < 0.001). The V3D-Colon system also had more navigational features than the other two systems. CONCLUSION: Pronounced subjective and objective differences in 3D endoluminal rendering and navigational capabilities exist among the systems evaluated. Of the three, effective time-efficient primary 3D evaluation appears to be feasible only with the V3D-Colon system.

Adenoma↗

PubMed2004

Feasibility of MDCT Colonography in ultra-low-dose technique in the detection of colorectal lesions: comparison with high-resolution video colonoscopy.

OBJECTIVE: The purpose of this study was to assess the feasibility of MDCT colonography in an ultra-low-dose technique in the detection of endoluminal colonic lesions compared with high-resolution video colonoscopy. SUBJECTS AND METHODS: After standard bowel cleansing, 137 patients (77 men, 60 women; mean [+/- SD] age, 57.1 +/- 11.3 years) underwent high-resolution video colonoscopy within 2 hr after ultra-low-dose MDCT colonography had been performed. Ultra-low-dose MDCT colonography was performed with patients in the supine position only using 10 mAs (effective weighted CT dose index, 0.94 mGy). After mathematic noise reduction by nonlinear gaussian filter chains, using dedicated software (ECCET), images were analyzed by two blinded observers in simultaneously displayed interactive 2D and 3D modes. Findings of ultra-low-dose MDCT colonography were compared with the results obtained with high-resolution video colonoscopy. RESULTS: Calculated effective doses were 0.7 and 1.2 mSv for men and women, respectively. Ultra-low-dose MDCT colonography detected 84 (62%) of 135 lesions: 11 (78.6%) of 14 large polyps (> 10 mm), 12 (85.7%) of 14 medium polyps (9.9-5 mm), and 61 (57%) of 107 small polyps (< 5 mm). On a patient-by-patient basis, an overall sensitivity of 70.3% with a specificity of 80.8% was calculated. False-positive findings were seen mostly for small lesions (eight medium and 29 small lesions). Two of the three false-negative lesions were retrospectively detected in contrast-enhanced cleansing fluid; one was a flat lipoma not detectable on ultra-low-dose MDCT colonography. CONCLUSION: Despite an effective dose of approximately 1 mSv, MDCT colonography using an ultra-low-dose technique performs as well as MDCT colonography with a standard dose, according to published data. After mathematic noise reduction, 82% of polyps larger than 5 mm can be detected.

Colon↗

PubMed1981

Colonoscopy in the diagnosis of antibiotic-associated colitis. A prospective study.

Colonoscopic findings among 16 patients with histologically proved antibiotic-associated pseudomembranous colitis (PMC) were analyzed. The characteristic endoscopic changes of PMC with pseudomembranes were observed in only 5 (31%) out of 16 patients by sigmoidoscopy but in 11 (85%) out of 13 patients in whom colonoscopy was also performed. The findings suggest the importance of colonoscopy in the early diagnosis of PMC and indicate that the typical endoscopic changes of PMC are limited to the colon above the rectosigmoid area in most patients with antibiotic-associated colitis. It is emphasized that colonoscopy should be performed at least in clinically suspected PMC cases, in which the early diagnosis of PMC might be missed if sigmoidoscopy alone is performed.

Adult↗

PubMed1996

Reevaluation of clinical features of ischemic colitis. Analysis of 68 consecutive cases diagnosed by early colonoscopy.

BACKGROUND: Ischemic colitis (IC) is generally considered a disease of elderly patients who have associated diseases. The aim of the present study was to reevaluate the clinical features of IC. METHODS: We retrospectively analyzed the clinical characteristics, background, and endoscopic and histologic changes in 68 consecutive patients (16 men and 52 women) with this disease diagnosed by early colonoscopy. RESULTS: The patients' age ranged from 22 to 98 years (mean, 55 years). Twenty-three patients (34%, including 19 women) were less than 50 years of age. The classical predisposing factors were not discernible in patients younger than 50. Chronic constipation and prior history of abdominal surgery were common in both young and old patients. Early colonoscopy (especially by the 3rd day from onset) showed endoscopic and histologic findings consistent with the characteristics of IC. CONCLUSIONS: IC is not limited only to the elderly, and it should be considered in the differential diagnosis of colitis with melena in younger patients, especially females, who do not have any predisposing factors. Chronic constipation and prior history of abdominal surgery were commonly associated in both young and old patients. Early colonoscopy, especially by the 3rd day from the clinical onset, is essential for the accurate diagnosis of IC.

Abdomen↗

PubMed2005

Prospective randomized comparison of oral sodium phosphate and polyethylene glycol lavage for colonoscopy preparation.

AIM: To compare the effectiveness, patient acceptability, and physical tolerability of two oral lavage solutions prior to colonoscopy in a Taiwanese population. METHODS: Eighty consecutive patients were randomized to receive either standard 4 L of polyethylene glycol (PEG) or 90 mL of sodium phosphate (NaP) in a split regimen of two 45 mL doses separated by 12 h, prior to colonoscopic evaluation. The primary endpoint was the percent of subjects who had completed the preparation. Secondary endpoints included colonic cleansing evaluated with an overall assessment and segmental evaluation, the tolerance and acceptability assessed by a self-administered structured questionnaire, and a safety profile such as any unexpected adverse events, electrolyte tests, physical exams, vital signs, and body weights. RESULTS: A significantly higher completion rate was found in the NaP group compared to the PEG group (84.2% vs 27.5%, P<0.001). The amount of fluid suctioned was significantly less in patients taking NaP vs PEG (50.13+/-54.8 cc vs 121.13+/-115.4 cc, P<0.001), even after controlling for completion of the oral solution (P = 0.031). The two groups showed a comparable overall assessment of bowel preparation with a rate of "good" or "excellent" in 78.9% of patients in the NaP group and 82.5% in PEG group (P = 0.778). Patients taking NaP tended to have significantly better colonic segmental cleansing relative to stool amount observed in the descending (94.7% vs 70%, P = 0.007) and transverse (94.6% vs 74.4%, P = 0.025) colon. Slightly more patients graded the taste of NaP as "good" or "very good" compared to the PEG patients (32.5% vs 12.5%; P = 0.059). Patients' willingness to take the same preparation in the future was 68.4% in the NaP compared to 75% in the PEG group (P = 0.617). There was a significant increase in serum sodium and a significant decrease in phosphate and chloride levels in NaP group on the day following the colonoscopy without any clinical sequelae. Prolonged (>24 h) hemodynamic changes were also observed in 20-35% subjects of either group. CONCLUSION: Both bowel cleansing agents proved to be similar in safety and effectiveness, while NaP appeared to be more cost-effective. After identifying and excluding patients with potential risk factors, sodium phosphate should become an alternative preparation for patients undergoing elective colonoscopy in the Taiwanese population.

Administration, Oral↗

PubMed2006

Conventional colonoscopy and magnified chromoendoscopy for the endoscopic histological prediction of diminutive colorectal polyps: a single operator study.

AIM: To accurately differentiate the adenomatous from the non-adenomatous polyps by colonoscopy. METHODS: All lesions detected by colonoscopy were first diagnosed using the conventional view followed by chromoendoscopy with magnification. The diagnosis at each step was recorded consecutively. All polyps were completely removed endoscopically for histological evaluation. The accuracy rate of each type of endoscopic diagnosis was evaluated, using histological findings as gold standard. RESULTS: A total of 240 lesions were identified, of which 158 (65.8%) were non-neoplastic and 82 (34.2%) were adenomatous. The overall diagnostic accuracy of conventional view, and chromoendoscopy with magnification was 76.3% (183/240) and 95.4% (229/240), respectively (P<0.001). CONCLUSION: The combination of colonoscopy and magnified chromoendoscopy is the most reliable non-biopsy method for distinguishing the non-neoplastic from the neoplastic lesions.

Adenomatous Polyps↗

PubMed2006

The timing of bowel preparation before colonoscopy determines the quality of cleansing, and is a significant factor contributing to the detection of flat lesions: a randomized study.

AIM: To compare the cleansing quality of polyethylene glycol electrolyte solution and sodium phosphate with different schedules of administration, and to evaluate whether the timing of the administration of bowel preparation affects the detection of polyps. METHODS: One hundred and seventy-seven consecutive outpatients scheduled for colonoscopy were randomized in one of four groups to receive polyethylene glycol electrolyte solution or oral sodium phosphate with two different timing schedules. Quality of cleansing, polyp detection, and tolerance were evaluated. RESULTS: Patients receiving polyethylene glycol or sodium phosphate on the same day as the colonoscopy, obtained good to excellent global cleansing scores more frequently than patients who received polyethylene glycol or sodium phosphate on the day prior to the procedure (P < 0.001). Flat lesions, but not flat adenomas, were more frequent in patients prepared on the same day (P = 0.02). CONCLUSION: The quality of colonic cleansing and the detection of flat lesions are significantly improved when the preparation is taken on the day of the colonoscopy.

Adult↗

PubMed2006

Objective assessment of the antispasmodic effect of shakuyaku-kanzo-to (TJ-68), a Chinese herbal medicine, on the colonic wall by direct spraying during colonoscopy.

AIM: To objectively evaluate the effect of TJ-68 on colonic spasms during colonoscopy. METHODS: One hundred and one patients subjected to screening colonoscopy were randomly assigned to two groups: TJ-68 in 51 subjects and saline as the control in 50. The endoscope was inserted into the sigmoid colon, then a spastic region was identified and the tip of the colonoscope was positioned at a distance of about 10 mm from the spastic region. The endoscopic view was recorded before and after direct spraying of the TJ-68 solution or warm saline. The intraluminal area of the spastic region was serially measured using a computer image analyzer and expressed as pixel counts. The area under the curve (AUC) was calculated from the pixel curve. Statistical significance was assessed by Wilcoxon's test and Mann-Whitney U test. RESULTS: The mean AUC of the spastic region before and after TJ-68 spraying was 29,128 and 121,943 pixels, respectively, while with saline, it was 31,635 pixels and 48,617 pixels, respectively. Thus, the AUC significantly increased after TJ-68 spraying compared with the spraying of saline (P<0.001). CONCLUSION: Direct spraying of TJ-68 on the colonic mucosa suppressed colonic spasm and it may be useful during colonoscopy when anticholinergic agents are contraindicated.

Aged↗

PubMed2006

[Prospective evaluation of the safety and tolerance of colonoscopy in children].

BACKGROUND: Colonoscopy is a well established diagnostic and therapeutic procedure in pediatrics. AIM: To evaluate colon preparation alternatives for colonoscopy or sigmoidoscopy, type of sedation, clinical indications and findings. PATIENTS AND METHODS: Prospective study of 123 children referred for colonoscopy. Demographic data, type of colon preparation, sedation, type of endoscope and endoscopic results were obtained. The following day, a phone interview was carried out inquiring about duration, quality and adverse effects of the sedation and procedure. RESULTS: Seventy one boys (58%) and 52 girls (42%) with a mean age of 6.7+/-4.4 years, were recruited. The main indication was lower gastrointestinal bleeding (71%). The different colon preparations produced elimination of clear liquid stools in 50%, non transparent liquid in 23%, semi liquid in 22% and solid in 6% of the patients. Most common side effects were abdominal distension (20%) and nausea (16.8%). The most commonly used drugs were midazolam (76%) and demerol (43%). The average duration of the procedure was 18.3 minutes (range: 4-50). The most common findings were rectal polyps (18.7%) and hemorrhagic colitis (14.6%). In 77% of cases, the sedation was considered very good or good. Colon visualization was described as very good (51%) or good (36%). Seventy three percent of children had complete amnesia. The most common adverse effect was vomiting (7.5%). CONCLUSION: Lower endoscopies are feasible procedures to carry out in children, in an ambulatory basis, with intravenous sedation and minimum adverse effects.

Administration, Oral↗

PubMed2005

The value of colonoscopy to assess rectal bleeding in patients referred from Primary Care Units.

OBJECTIVES: Rectal bleeding is very common in the general population. It is produced mainly because of benign disease originating in the anus and the rectum. Our aim was to evaluate the need for colonoscopy in patients presenting with rectal bleeding. PATIENTS AND METHODS: Patients referred from Primary Care Units and complaining of rectal bleeding were included prospectively in a three-month study. All patients underwent a careful medical history along with physical examination, laboratory tests, and colonoscopy. RESULTS: 126 patients with a mean age of 49.2 years (range: 19-80) were studied. Rectal digital examination was abnormal in 75 cases (59.5%). Severe disease was encountered in 22 patients (neoplasm, angiodysplasia, and inflammatory bowel disease); 10 patients had polyps, 6 had colorectal cancer, and 6 had inflammatory bowel disease. Out of 63 patients younger than 50 years, 5 had severe disease, all of them in the form of inflammatory bowel disease. CONCLUSIONS: A neoplasm of the rectum and colon in patients younger than 50 years is a rare event. A colonoscopy must be performed in this group of patients to rule out inflammatory bowel disease.

Adult↗

PubMed1999

[Utility of COPA (cuffed oropharyngeal airway) in anesthesia for colonoscopies].

OBJECTIVE: To assess the usefulness of the cuffed oropharyngeal airway (COPA), a new device for airway control, in 45 patients scheduled for colonoscopy. PATIENTS AND METHODS: The patients were anesthetized with propofol and the COPA was applied following the manufacturer's recommendations. Positive pressure ventilation was provided at first, and later the patients were allowed to breathe spontaneously. RESULTS: The mean dose of propofol needed to place the COPA correctly was 2.3 +/- 0.3 mg.kg-1. "Free hands" anesthesia was possible in 43 procedures (96%). Placement had to be attempted several times in five patients (11%) before adequate ventilation was achieved. Two patients (4%) had to be switched to a smaller or larger size COPA. In two others (4%), the technique was abandoned because of inadequate ventilation. No hemodynamic changes were observed after placement, although systolic blood pressure tended to increase slightly during colonoscopy, while heart rate decreased. Spontaneous ventilation was possible in all cases and respiratory frequency and end-tidal CO2 increased significantly during colonoscopy. No cases of laryngospasm or sore throat were observed, although 10 patients (22%) coughed upon emergence from anesthesia. CONCLUSIONS: The COPA is a new alternative to intubation or other methods for controlling the airway during short procedures, making "free hands" anesthesia possible in most cases. Provided contraindications are respected, the number and seriousness of complications seems to be minimal.

Adult↗

PubMed1999

Pilot evaluation of a nurse-administered carepath for successful colonoscopy for persons with spinal cord injury.

Due to ongoing improvements in medical care, the life expectancy of persons with spinal cord injury (SCI) continues to improve and approach that of the able-bodied population. As the SCI population ages, cancer would be expected to increase as a cause of death. When a patient presents with occult fecal blood and anemia, colonscopy to the cecum is often pursued. It has been our experience that 80 percent of patients are found to have inadequate bowel preps resulting in suboptimal colonoscopy when the prep is attempted at home. Because of this, we developed a nurse-administered carepath necessitating a 48-hour admission for bowel prep and colonoscopy. The bowel prep consists of magnesium citrate, polyethylene glycol-electrolyte solution, and sodium phosphate/biphosphate enemas. Throughout hospitalization, the patient receives a clear liquid diet. Eighteen patients have been placed on the carepath. At the time of colonoscopy, all 18 were noted to have received an acceptable bowel prep allowing vizualization to the cecum. A description of the carepath and its benefits is presented.

Cathartics↗