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PubMed1999

Procedure-specific outcomes assessment for colonoscopy.

Since its origin, much of the improvement in colonoscopy has been related to technologic advancements in the endoscope itself. The pace of technologic improvement, however, has slowed and improvements affecting colonoscopy are occurring in new areas; one of which is patient outcomes. Using this analogy of macro and micro outcomes research (quality assessment), this article highlights key outcomes research and quality assessment issues as they apply to colonoscopy.

Colonic Diseases↗

PubMed2000

Colonoscopy.

Colonoscopy and polypectomy are the most effective tools available to prevent colorectal cancer. The technical performance of colonoscopy can be improved by methods that make polyp detection easier and more reliable, facilitate cecal intubation, and reduce recurrence and complication rates after polypectomy. The state-of-the-art and possible future trends in patient preparation, indications, screening and surveillance intervals, sedation issues, and virtual colonoscopy are reviewed in this article.

Cecum↗

PubMed2000

[Patient opinions after colonoscopy. Results of a cross sectional, multicenter ANGH study (2)].

OBJECTIVES: The aims of this study were to evaluate patient opinions following colonoscopy and to analyze the role of conditions of practice on patients' opinions. METHODS: A study was suggested to all members of the ANGH. During one week of practice, a questionnaire was filled out by the gastroenterologist and a second one by the patient, alone, one day after colonoscopy. RESULTS: Eighty six hospitals (229 gastroenterologists) took part in the study which included 815 patients; 752 of them (92%) filled out the satisfaction questionnaire. Five hundred and eighty four patients (78%) would accept a new endoscopy in the same conditions; 168 patients (22%) would accept if the conditions were different or would refuse a new endoscopy. The main factors associated with acceptance under the same conditions were: good tolerance (odds-ratio (OR): 5.08), old age (OR: 5), anesthesia (OR: 2.67) or conscious sedation (OR: 2.29), male gender (OR: 2.39) and ambulatory care (OR: 2). CONCLUSION: This study of clinical practice underscored the different factors associated with better acceptance of colonoscopy. Individual gastroenterologists could use these data to guide practice.

Age Factors↗

PubMed2000

Prospective randomized trial comparing bowel cleaning preparations for colonoscopy.

Colonoscopy is commonly accepted as the procedure of choice for the detection and treatment of colonic lesions. The current study was undertaken to compare effectiveness and tolerance of different bowel preparations. Three hundred patients were randomized into three groups, to be administered either a senna compound, a polyethylene glycol lavage, or an oral sodium phosphate (NaP) solution. Tolerance of the preparation was considered. After each colonoscopy, the endoscopist blindly scored cleansing for each bowel segment and defined the quality of the examination as "optimal," "acceptable," or to be repeated. Significantly more patients in Group C (68%) achieved a "good" cleansing compared with Group B (50%; P < 0.0001) and with Group A (38%; P < 0.005). Sixty-three percent of constipated patients obtained a "good" preparation in Group C, which was significantly higher than in Group A (28%; P < 0.05) and than in Group B (42%; P < 0.02). Feasibility of the examination was considered "optimal" in 80% of procedures in Group C, which was higher than in Group A (59%; P < 0.005) and in Group B (62%; P < 0.005). The tolerance of preparation was "good" in 93% of the examinations for Group C. This prospective randomized trial showed good effectiveness of NaP solutions, with an optimal tolerance. Results of use of the NaP solution showed a clear advantage for constipated patients, with similar results for nonconstipated patients. The author believes that the NaP solution should be the standard preparation for elective colonoscopy.

Aged↗

PubMedDate not supplied

[Written information: evaluation of an informative leaflet for patients undergoing colonoscopy].

Client teaching and information on medical procedures and care organisation is recognised as one of the most important tasks for the nurse. The information must be complete, detailed, and personalized according to the client culture and learning capacity. To address these points, an information booklet has been designed to inform clients undergoing colonoscopy in the gastroenterology unit of Azienda Ospedaliera Careggi, Florence. The booklet, together with a multiple choice questionnaire aimed at evaluating clients' satisfaction with the information provided, was distributed to 100 clients undergoing a colonoscopy over a two-month period in 1998. The results of the survey suggest that the booklet has been instrumental in client learning about the procedure, as shown by the high positive satisfaction response provided to the questionnaire. Moreover, contents provided are clear and easy to understand. Clients would like to have specifically detailed information on the way the exam is performed, on its duration (22%) and on the disinfection procedures (21%). At present, all the patients booked for colonoscopy receive the booklet in their homes.

Adult↗

PubMedDate not supplied

Diagnosis of gastrojejunocolic fistula by chromo-colonoscopy.

The role of colonoscopy has not been adequately evaluated in the diagnosis of gastrojejunocolic fistula. We report the findings and complications of routine colonoscopy in four patients and a novel technique 'Chromo-colonoscopy' in the diagnosis of this entity.

Adult↗

PubMed2002

Colonoscopy.

Colonoscopy is now the gold standard method for investigating most colonic symptoms. However, it is a demanding procedure that can be associated with low completion rates and significant complications, and it requires considerable skill to perform colonoscopy consistently well and safely. In this article, the key steps in performing colonoscopy are described with a view to providing the trainee with a logical sequence of manoeuvres on which to base a sound technique.

Colonoscopes↗

PubMed2003

[Splenic rupture following colonoscopy: report of an unusual case in the absence of underlying splenic disease].

Splenic injury following colonoscopy is rare and, to our knowledge, 18 cases only have been reported so far in the literature. The presumed mechanisms for splenic injury during colonoscopy are direct trauma to the spleen or excessive traction of the splenocolic ligament this latter mechanism being due to decreased mobility between the spleen and the colon secondary to adhesions. Splenomegaly or underlying splenic disease are two conditions which are considered to be predisposing factors to splenic injury. We report one case of splenic rupture which was due to colonoscopy in the absence of any underlying splenic disease. This case was diagnosed and monitored by computed tomography, thus avoiding unnecessary splenectomy.

Aged↗

PubMedDate not supplied

[Cytopathological test performed during colonoscopy in the diagnosis of colorectal stenosis].

The etiological diagnosis for the colorectal strictures can be very difficult. With the colonoscopy, it was possible to obtain samples with direct vision of the lesion. Consequently, the cytologic efficiency improved, with similar or even better results than histopathology. In the present study (107 patients) it was used the cytopathology performed during colonoscopy. After a specimen was obtained, it was smeared on glass slide, fixed in 95% alcohol, stained by HE, and examined microscopically, with conclusions during the procedure. The results were compared and further correlated to the histopathology of surgical specimen or based on clinical follow-up in those case not submitted to operation. The results showed a striking degree of correlation between both exams. For the cytopathology there were no inconclusive results, false-negative were less frequent than with histopathology, and only one case of false-positive (rectal villus adenoma) was observed. Considering the type, localization and perviousness of the lesion, similar conclusions were drawn, and did not affect the results, except that there were more false-negatives in both exams when the lesions were impervious. The cytopathological and histopathological studies were both highly sensitive and specific for the diagnosis of carcinoma. In conclusion, cytopathology performed during colonoscopy is safe and efficient in the study of colorectal strictures, which contributes to improve the orientation of these patients.

Adult↗

PubMed1992

Postoperative follow-up of patients with colorectal carcinoma by colonoscopy.

OBJECTIVE: To find out if colonoscopy is of use in the follow-up of patients who have been operated on for colorectal carcinoma. DESIGN: Retrospective study. SETTING: Department of diagnostic radiology, university hospital. SUBJECTS: 390 consecutive patients operated on for colorectal carcinoma during the 10-year period 1981 to 1990. MAIN OUTCOME MEASURES: Number of recurrences, synchronous of metachronous tumours, and number and size of adenomas found on colonoscopy. RESULTS: Neoplastic lesions were found in 175 (45%) of the 390 patients studied. There were 14 anastomotic recurrences and 12 new primary carcinomas. At operation for recurrent tumours Dukes' A or B lesions were found in half of the 14 patients who had no symptoms, and a quarter of the 12 who had had symptoms. Those with recurrent carcinoma were younger than those without. Adenomas 1 cm in diameter or more were found in 44 patients and 104 had adenomas less than 1 cm. In addition one carcinoid was found. CONCLUSION: Colonoscopy gave a high yield of neoplastic lesions when used to follow-up patients after resection of colorectal carcinoma, particularly at six months, and resulted in half the recurrent carcinomas being diagnosed before the patients had symptoms. We recommend its use for follow-up of high risk patients, but further studies are needed to establish the optimum time intervals.

Adenoma↗

PubMed2003

Oral sodium phosphate compared with water enemas combined with bisacodyl as bowel preparation for elective colonoscopy.

BACKGROUND: Colonoscopy with high diagnostic accuracy requires a high quality of bowel preparation using a method that is well accepted. The aim of this study was to compare oral intake of sodium phosphate solution (SP) with a conventional method of bowel preparation using Bisacodyl combined with repeated water enemas until the appearance of clear return fluid (BE) on bowel preparation and to compare patient compliance in a randomized-investigator blinded trial. METHODS: During a 3-months period, 253 consecutive patients referred for elective colonoscopy in the outpatient clinic were evaluated. After application of the exclusion criteria, 201 patients fulfilled the criteria for the trial; 119 were randomized to SP and 82 to BE. RESULTS: The endoscopist reported a significantly (P = 0.001) improved overall bowel preparation after SP compared with BE. Emptying was significantly better in all segments of the colon except the caecum. Colonoscopy was incomplete in 9 patients (7.6%) in the SP group and in 3 patients (3.7%) in the BE group, but this difference was not significant. The number of patients with colon pathology was similar in both groups. Only 10% in the SP group would have preferred another preparation had this been possible, compared with 89% in the BE group (P < 0.0001). Only the SP preparation emerged as a negative independent predictor of poor bowel preparation after multivariate logistic regression modelling. CONCLUSION: Patient compliance and quality of bowel preparation were better after SP than after BE.

Aged↗

PubMed2004

[Colonic lavage prior to colonoscopy: comparable outcomes of two polyethylene-glycol preparations and a sodium-phosphate solution].

OBJECTIVE: Comparison of three cleansing solutions for bowel preparation prior to colonoscopy. DESIGN: Prospective, randomized. METHOD: 140 outpatients referred for colonoscopy were randomized into three groups for cleansing with 4 litres PEG 4000, 4 litres PEG 3350 or with 90 ml sodium phosphate with an additional 2.5 litres of fluid. Between cleansing and colonoscopy, patients filled in a questionnaire concerning taste, abdominal cramps and tolerance to the procedure. Blinded to the type of cleansing the endoscopist scored the effects on the colon and rectosigmoid, and made the endoscopic diagnosis. RESULTS: All data were available for 127 of the 140 patients (50 men, 77 women), mean age 51 years (range 18-96). Comparison between the three groups showed no statistically significant difference in the opinion of the patients concerning taste, abdominal cramps and tolerance of lavage. The endoscopist's scoring of total colon cleansing showed a small reduction in colon cleanliness when using sodium phosphate compared to PEG 3350 (p = 0.03). No differences were found between the two PEG solutions. Combining both PEG solutions and comparing them with the sodium-phosphate solution showed fewer abdominal cramps (p = 0.07) with sodium phosphate and a cleaner colon with PEG (p = 0.07). Women complained slightly more of abdominal cramps and were slightly less tolerant of the procedure than men. Previous colonic surgery did not influence the results. Patients with diverticula were older, but no other effect of cleansing was found. CONCLUSION: The three preparations are comparable in their cleansing effect and tolerance by the patient.

Adolescent↗

PubMed2004

[The recurrence rate of colon polyp after polypectomy and the interval of surveillance colonoscopy: predictors of early development of advanced polyp].

BACKGROUND/AIMS: Surveillance of individuals with colon polyps is important for the prevention of colon cancer, and its interval is based on the clinical status. Our aims were to determine the recurrence rate of advanced polyp after polypectomy and estimate the adequate interval of surveillance colonoscopy as well as the risk factors of recurrence in Korea. METHODS: Ninety-seven patients who underwent follow-up colonoscopy after initial colonoscopic polypectomy were retrospectively studied. All polyps were endoscopically removed with electrocautery. RESULTS: Mean number of initial polyps were 2.2 and advanced polyps were observed in 40% of the patients. The cumulative recurrence rate of colon polyp was 13.8% within 1 year, and 60% within 3 years, while that of advanced polyps was 2.5% and 31% within 1 and 3 years, respectively. The significant difference was noted according to the initial polyp number in both overall and advanced polyp recurrence rate. The age at the diagnosis of colon polyps was a significant factor only in overall polyp recurrence rate. Patients who initially had one polyp showed 15% of advanced polyp recurrence within 3 years. CONCLUSIONS: Recurrence of advanced polyp is very rare within one year after polypectomy. Patients with single polyp have low risk and thus, their surveillance may be delayed beyond the standard 3 years. When surveillance colonoscopy is to be performed for the patients with 2 or more polyps, initial polyp number and age should be considered.

Aged↗

PubMed1992

Colonoscopy in unexplained lower gastrointestinal bleeding.

Two hundred and forty patient with unexplained gastrointestinal blood loss underwent colonoscopy. Significant lesions which were thought to be likely causes of bleeding were identified in 98 patients, ie, 41% of total, which included active colitis in 9%, large polyps in 10% and colorectal cancer in 12% of patients. Of the cancers found at colonoscopy, 64% were Dukes A or B. This study confirms the role of colonoscopy in the investigation of unexplained chronic lower gastrointestinal bleeding.

Adult↗

PubMed2004

Consider colonoscopy for young patients with hematochezia.

BACKGROUND: Hematochezia is a common complaint in adult patients aged <50 years. Most studies of lower endoscopy for rectal bleeding have concentrated on older patients or have failed to mention the location of lesions. OBJECTIVE: To determine the findings of complete colonoscopy in adults younger than 50 years with rectal bleeding. METHODS: Data were retrieved from medical records and included demographics, indications, endoscopic findings, and histology. Lesions were labeled according to location: proximal to the splenic flexure or distal to (and including) the splenic flexure. Excluded were those with a history of colitis, colorectal cancer, polyps, anemia, significant weight loss, severe bleeding, or strong family history of colorectal cancer. RESULTS: The study included 223 patients with rectal bleeding aged <50 years who had undergone a colonoscopy. Normal findings were recorded for 48 (21.5%). Four (1.8%) were diagnosed with cancer in the distal colon, and 22 (9.9%) were found to have colon adenomas, 6 of whom had proximal adenomas only. Hemorrhoids were present in 135 patients (60.5%). Other findings included colitis, angiodysplasia, diverticulosis, anal fissures, and rectal ulcers. CONCLUSIONS: Colon neoplasms may be present even in younger adults with nonurgent rectal bleeding. Though most findings were benign and located in the distal colon, colonoscopy should be strongly considered for this patient group.

Adenoma↗

PubMed2005

Virtual colonoscopy.

Virtual colonoscopy (VC) is less invasive than optical colonoscopy in screening for colorectal cancer, although it does require exposure to radiation. Patient sedation is not required, but bowel preparation and air insufflation are. Studies of VC have shown rising detection rates, especially for lesions >or=10mm. Traditional colonoscopy is still required for polyp removal and to confirm cancer.

Clinical Trials as Topic↗

PubMed2005

Haptic device for colonoscopy training simulator.

A new 2-DOF haptic device for colonoscopy training simulator employing flexible endoscopes, is developed. The user operates the device in translational and roll directions. The developed folding guides of the device keep the endoscope tube straight. This helps transmit large decoupled forces of the colonoscopy simulation to the user. The device also includes a mechanism to detect jiggling motion of the scopes to allow users to practice this important skill of the colonoscopy. The device includes PD controller to compensate the inertia and friction effects. This provides the users with better transparent sensation of the simulation.

Clinical Competence↗

PubMed2005

[Carcinogenesis in ulcerative colitis-associated colon cancer and surveillance colonoscopy].

It has been widely accepted that long-standing cases with ulcerative colitis, especially pancolitis have higher risk of complicating colitic cancer. Colitic cancer often appears as multi-focal invasive features with un-differentiated histology. Therefore, endoscopic diagnosis of precancerous or cancer associated dysplastic lesions. Surveillance colonoscopy has preventing effects for developing colitic cancer. In western world, annual surveillance colonoscopy with multiple stepwise has been adopted. In Japan, surveillance colonoscopy with targeted biopsies assisted by chromoendoscopy and/or magnifying endoscopy has proven to be efficacious in finding such lesions.

Colitis, Ulcerative↗