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PubMed1987

[Colonoscopy in advanced age: cardiac arrhythmias].

62 in- and outpatients (65-89 years) with an average age of 76 +/- 5.6 years were investigated with Holter-ECG during colonoscopy to find out whether an endoscopy increases the tendency for cardiac arrhythmias. 50 per cent of the inpatients had a compensated cardiac insufficiency and 57.9 per cent had a coronary heart disease. Cascara-Salax and gut lavage were used for cleansing of the gut. 15 patients with a premedication of 5 mg Diazemuls an 50 mg Dolantin got an analysis of the blood gas before and after the premedication from a hyperaemic lobe of the ear. During endoscopy the number of patients with arrhythmias of a high degree was lower compared to the control period. With regard to the ventricular premature beats there was the following observation: (Table: see text). During the control period 6 patients had some supraventricular premature beats, during colonoscopy there were 14 patients with such arrhythmias. One female patient had a transitory atrial fibrillation. Before premedication the pO2 is 76.9 +/- 9 mmHg, afterwards 68.4 +/- 12.0 mmHg. Three patients showed a decrease of the pO2 down to 55 mmHg, three other patients down to 65 mmHg. The colonoscopy in the elderly does not essentially increase the cardiac arrhythmias, the severe premature beats do not increase. It is concluded that the cardiac risk is not increased by the endoscopy. The importance of the preparation for cleansing and the premedication is discussed.

Aged↗

PubMed1986

Perforations from colonoscopy during diagnosis and treatment of polyps.

Within a department specialized in surgical gastroenterology 11 perforations of the large bowel occurred over a 10 year period as complication of diagnosis and treatment of polyps by colonoscopy. The incidence by diagnostic colonoscopy was 0.6% (95% confidence interval 0.2-1.3%) and by polypectomy 0.7% (95% confidence interval 0.2-1.8%). Nine of the perforations were located in the sigmoid colon; one occurred retroperitonally in the descending colon. The lesions were from 1-8 cm long and were located in normal bowelsegments. The most important cause of perforation was forceful introduction of the scope and the use of electrocoagulation. The patients were treated by laparotomy and antibiotics. In six cases the operation was initiated within one hour after the perforation had occurred, the remaining 5 were operated on when they developed symptoms 1/2-3 days after the colonoscopy. One patient, a 84-year-old man, died of acute myocardial infarction 4 weeks after the operation.

Adult↗

PubMed1987

Colonoscopy in inflammatory bowel disease. Diagnostic accuracy and proposal of an endoscopic score.

Colonoscopy is used in the differential diagnosis of inflammatory bowel disease but its accuracy and the "weight" of the various endoscopic signs have not been assessed. In a prospective study 357 patients with 606 colonoscopies, in whom the endoscopic appearances were those of ulcerative colitis, Crohn's colitis, or indeterminate colitis, were followed-up for an average period of 22 mo. A final, definite, endoscopy-independent diagnosis was reached by means of autopsy, surgery, or histology on biopsy in 71% of patients. Accuracy of colonoscopy was 89%, with 4% errors and 7% indeterminate diagnoses. Errors were more frequent in severe inflammatory activity (9%). The most useful endoscopic features in this differential diagnosis were discontinuous involvement, anal lesions, and cobblestoning of mucosa for Crohn's disease, and erosions or microulcers and granularity for ulcerative colitis. After selecting the endoscopic features with best predictive value, an "endoscopic score" was calculated by means of "likelihood ratios."

Colitis, Ulcerative↗

PubMed1985

Colonoscopy and the followup of colorectal carcinoma.

The colonoscopy findings in 100 patients who had had a previous resection for colorectal carcinoma are reviewed. This postoperative surveillance was aimed at discovering benign or malignant neoplastic growth within the remaining large bowel. Six patients had further carcinoma discovered at colonoscopy followup, five of these were symptomless. Twenty-eight patients had one or more adenomas. A special risk group was confirmed: patients with multiple neoplasia in the original resected specimen have over a 50% chance of further adenomas being present. This represents a worthwhile yield and colonoscopy surveillance of the remaining colon should be part of the followup programme in these patients.

Carcinoma↗

PubMed1985

Colonoscopy following intraoperative lavage in the management of severe colonic bleeding.

Intraoperative lavage of the colon through a catheter inserted into the caecum provides a rapid means of cleansing the bowel of blood and clots to enable thorough colonoscopy in cases of severe colonic bleeding. This permits diagnosis of the site and cause of haemorrhage in those cases in which neither arteriography, conventional colonoscopy, nor laparotomy alone are helpful. Four cases are presented in which the technique of colonoscopy following intraoperative lavage allowed diagnosis and treatment in massive large bowel bleeding.

Adult↗

PubMed1984

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

A prevalence screening program with colonoscopy was undertaken in four kindreds manifesting the cancer family syndrome. Forty-five percent of counseled patients underwent colonoscopy, providing 42 asymptomatic individuals. Seven patients (17%) were found to have adenomatous or villous polyps; two of these were malignant and one showed epithelial atypia. Three of the seven patients with polyps had multiple lesions. Only two patients had rectosigmoid polyps. From these limited data, colonoscopy is recommended as a useful screening procedure in individuals at high risk for colorectal cancer.

Adenoma↗

PubMed1982

[Colonoscopy and "hot" biopsy. Its value in vascular ectasias of the colon].

According to Gerald Rogers et. al., we believe about the usefulness of colonoscopy and endoscopic biopsy using Williams' forcep (hot biopsy forcep) for the diagnosis and final treatment of colon vascular ectasias. This method should be used immediately after the hemorrhage has finished. Angiography is prescribed when: 1) endoscopy suggests or confirm the presence of vascular ectasias in order to establish the degree of lesions and the therapeutic management. 2) When the caecum cannot be reached by the colonoscope. 3) When endoscopy is negative and there is firm clinic assumption of ectasias but the colonoscopic study has been done to much later after the bleeding stopped. Selective angiography would be the first prescription in case of bleeding which doesn't stop quickly with the necessity of immediate therapeutic measures taking into account the difficulties of intrahemorrhagic colonoscopy. Five cases are presented to support this point of view concerning the diagnosis of vascular ectasias of the right colon and considerations are made about local treatment by mean of colonoscopy and hot biopsy forcep which, when it's possible, has less morbidity and mortality than surgery, specially in attention than this is an entity concerning elderly patients.

Aged↗

PubMed1982

[Experiences with intraoperative colonoscopy in patient protocols in 2,547 cases].

Technique and indications for intraoperative colonoscopy are reviewed. A total retrograde fiberoptic colonoscopy was performed on the unopened bowel at laparotomy in 1135 patients, and a partial colonoscopy (70 to 90 cm) in 1412 patients. Additional polyps were found in 24% of patients with carcinoma of the rectum and colon (n = 1023), in 26% of patients with diverticulitis (n = 112), and 8.3% of patients with proctological diseases (n = 1412). A second carcinoma was found in 3.1% of cases with colonic carcinoma, in 1.8% of cases with diverticulitis, and 0.35% of cases with proctological diseases.

Colonic Neoplasms↗

PubMed1994

A normal initial colonoscopy after age 50 does not predict a polyp-free status for life.

OBJECTIVES: The prevalence of colon polyps increases with age in the general population. It is unknown whether a lack of adenomatous polyps determined at one time point after the age of 50 is predictive of a subsequent low risk of polyp development. METHODS: Twenty-nine patients between ages 50 and 70 who had no prior history of polyps and had a normal colonoscopy at least 5 yr previously were recruited for follow-up colonoscopy to evaluate the incidence of neoplastic disease in this presumably low-risk group. RESULTS: The incidence of adenomatous polyps after a mean of 5.74 yr was 41.4% (95% confidence interval: 23.5-61.1%). A total of 20 adenomatous polyps were found in 12 patients. Seven polyps were 5 mm or more in size. CONCLUSIONS: We conclude that in patients with no history of colonic neoplasia who are 50 yr old, or older, the finding of a normal colonoscopy does not predict diminished risk of neoplasia.

Adenomatous Polyps↗

PubMedDate not supplied

[Intraoperative colonoscopy: current indications].

From January 1987 to December 1991, 37 patients underwent intraoperative colonoscopy for several indications; these latter can be summarized in the need to define the site or extension of the lesions treated or detected by endoscopy before surgery. This procedure is therefore necessary in those cases in whom intraoperative endoscopy is likely to be useful in planning the surgical treatment. The use of intraoperative colonoscopy should be however considered complementary, but not substitutive, of the preoperative colonoscopy.

Adult↗

PubMed1994

[Findings in 1000 colonoscopies at a county hospital. A prospective study].

1,000 colonoscopies were registered in a specially designed database. The database software secured complete registrations. We present the diagnostic results according to symptoms and pattern of bleeding. One third of the colonoscopies were routine examinations of malignant or benign neoplasms and ulcerative colitis. We found malignancy to be much more frequent in newly referred patients than in the routine control group. Pathology was found in particular in patients with overt or occult lower gastrointestinal bleeding. Colonoscopy should be a primary diagnostic procedure in the event of lower gastrointestinal tract bleeding. The authors discuss the benefit of routine colonoscopic follow-up of neoplasms and ulcerative colitis.

Adult↗

PubMed1993

Is there a role for upper gastrointestinal endoscopy in the evaluation of patients with occult blood-positive stool and negative colonoscopy?

OBJECTIVE: To determine the role of upper gastrointestinal endoscopy in the clinical investigation of patients with occult blood-positive and negative colonoscopy. METHODS: This is a retrospective study of 211 consecutive patients who were investigated by upper gastrointestinal endoscopy for occult blood-positive stool and negative colonoscopy. Patients were categorized into four groups: asymptomatic (n = 117), symptomatic (n = 37), severe anemia (hemoglobin < 10 g/dl) (n = 33), and incomplete (CBC not obtained or insufficient documentation regarding the presence or absence of symptoms) (n = 24). RESULTS: Eighty-eight of the 211 patients (42%) had abnormal upper gastrointestinal endoscopic findings: 43% of the "asymptomatic" group, 35% of the "symptomatic" group, 45% of the "severe anemia" group, and 42% of the "incomplete" group. The number of patients with abnormal upper gastrointestinal findings increased with age (p = 0.0002). Furthermore, there was a significant difference in upper gastrointestinal lesions between the patients who were 60 yr of age or older, and the patients less than 60 yr of age: 51% compared to 22% (p = 0.00003). All upper gastrointestinal endoscopic findings were benign, with 53 of the 88 patients (60%) having erosive gastritis. However, only 25 of those 88 patients (28%) had a lesion for which a specific treatment was available. CONCLUSIONS: Upper gastrointestinal endoscopy in patients with occult blood-positive stool and negative colonoscopy has a very low yield for significant lesions, not only from a therapeutic standpoint, but also for detection of malignant lesions. Prospective studies are needed to determine which specific groups of patients deserve further investigation.

Aged↗

PubMed1993

Indications for colonoscopy. An analysis based on indications and diagnostic yield.

Open access colonoscopy for patients with suspected colonic disease is often not practical and some form of patient selection may be necessary. One year's colonoscopic data from our unit were analysed to determine the major indications for the procedure and the diagnostic yield, and to evaluate the suitability of colonoscopy for each indication. The seven major indications were rectal bleeding, iron deficiency anaemia, cancer follow-up, polyp follow-up, abdominal pain, abnormal bowel habit and 'other'. Four hundred and forty-eight procedures were included in the analysis, with rectal bleeding, polyp follow-up and iron deficiency anaemia producing the highest diagnostic yields of 69.1%, 53.3% and 47.7% respectively. Lower yields were obtained for cancer follow-up (21%), abdominal pain (38.2%) and abnormal bowel habit (46.8%). The indication, 'other', produced a combined yield of 66.7%; the majority of patients in this group were known to have colitis. On the basis of these findings we propose that where facilities and expertise do not allow for routine colonoscopy, some form of patient selection should be employed and we believe this selection should take place according to the diagnostic yield for each indication.

Abdominal Pain↗

PubMed1993

Diagnostic yield of colorectal neoplasia with colonoscopy for abdominal pain, change in bowel habits, and rectal bleeding.

OBJECTIVES: To assess the clinical yield of colonoscoping in patients who present with rectal bleeding, persistent abdominal pain, or change in bowel habits in the absence of bleeding. DESIGN: A prospective study of colonoscopy patients. SETTING: Three colonoscopy practices in New York City between April 1986 and November 1989. PATIENTS: Eight hundred sixty-one patients with rectal bleeding, 113 patients with abdominal pain, 154 with change in bowel habits, and 44 patients with both abdominal pain and bowel change. MAIN RESULTS: Of 861 patients with rectal bleeding, 293 (33.6%) had colonic neoplasia (8.6% cancer and 25% adenomatous polyps). In patients who had colonoscopy because of abdominal pain (n = 113), change in bowel habits (n = 154), or both abdominal pain and bowel change (n = 44), respectively 25 (22.1%), 42 (27.3%), and 10 (22.7%) had colonic neoplasms. If one looks at significant neoplasia (cancer or adenomas > 1 cm), then the findings in rectal bleeders were 14.5%, whereas the abdominal pain, change in bowel habits, and both groups had 7.1%, 7.1%, and 13.6%, respectively. Patients with rectal bleeding were more likely to have multiple adenomas than those with nonbleeding symptoms (p < 0.05). CONCLUSIONS: Patients with persistent nonbleeding GI symptoms, including abdominal pain and change in bowel habits, have almost as high a yield of colorectal neoplasia as those with rectal bleeding.

Abdominal Pain↗

PubMed1993

[Colonoscopy without the aid of fluoroscopy. Results from a gastroenterological practice].

In Switzerland colonoscopy is usually performed with the aid of fluoroscopy. However, the advantages of fluoroscopy are uncertain and it involves much equipment. Accordingly, in 200 consecutive colonoscopies we attempted to work without reliance on fluoroscopy. In this way the cecum was reached in 92.5% of cases. Addition of the fluoroscope made it possible to reach it in a further 1.5%. It is concluded that in gastroenterologic practice colonoscopy can be performed without fluoroscopy since the success rate is essentially the same.

Adolescent↗

PubMed1993

Management of suspected perforation following colonoscopy: a case report.

Early detection of colon cancer is imperative for a good prognosis. Family physicians are therefore becoming the front line of defense in the fight against colorectal malignancy. Many family physicians are incorporating colonoscopy into their practices in an attempt to avoid costly referrals and loss of continuity of care. While the complication rate for colonoscopy is extremely low, any physician who performs colonoscopy must be fully aware of all possible complications and their management.

Abdominal Pain↗

PubMed1993

Evolving colonoscopy skills in a rural family practice: the first 293 cases.

During the 1980s, many family physicians acquired flexible sigmoidoscopy skills for the early detection and secondary prevention of colorectal cancer. As these skills have matured, some family physicians have advanced from flexible sigmoidoscopy to the performance of colonoscopy. This is a descriptive report of this phenomenon from the private practice of one family physician. The first five years of total colonoscopy experience (293 procedures) were analyzed. No complications were encountered. A learning effect (measured in terms of scope depth and anatomical depth) was present during the first 50 procedures; an improvement in examination depth between the 25th and 50th procedure was present. Previous abdominal surgery had an effect on limiting scope-insertion depths. There were no complications, and among sedated patients, 137/253 (54%) of procedures reached the cecum. Important findings included cancer, polyps, and colitis. Twenty-seven percent (9/34) of important pathological findings were located beyond the reach of the 60 cm sigmoidoscope. This study of full colonoscopy in private family practice suggests it is safe, and the diagnostic yield is substantial. Additional studies by family physicians are needed regarding technique, quality assurance, and patient satisfaction.

Adolescent↗

PubMed1995

Physicians' perceptions of dysplasia and approaches to surveillance colonoscopy in ulcerative colitis.

OBJECTIVE: Colonoscopic biopsy surveillance to detect dysplasia, defined as a neoplastic change of the epithelium without invasion into the lamina propria, in patients with ulcerative colitis has become a widespread practice. We undertook a survey study to determine physicians' perceptions of, and approaches to, dysplasia surveillance colonoscopy in ulcerative colitis. METHODS: Members of two regional gastroenterology associations in the United States, including both academic and private practice-based gastroenterologists, and a group of senior gastroenterology trainees were surveyed by means of a written questionnaire. The questionnaires were distributed at three separate meetings of practicing gastroenterologists or trainees: 1) a Gastrointestinal pathology course for second-year gastroenterology fellows from training programs around the United States (February 1993, Los Angeles, CA); 2) a meeting of the Southern California Gastroenterology Society (March 1993, Los Angeles, CA); and 3) a meeting of the Pacific Northwest Gastroenterology Society (June 1993, Seattle, Washington). The percentages of all responses were tallied and analyzed for the group as a whole as well as by subgroup analysis. Understanding of the definition of dysplasia and specific practice techniques and approaches were the main outcomes sought. RESULTS: Only 19% of respondents correctly identified the definition of dysplasia. More respondents (48%) correctly defined high grade dysplasia specifically compared with only 16% who correctly defined low grade dysplasia. The majority of respondents (69%) recommended colectomy when high grade dysplasia was diagnosed, yet nearly one-third of respondents pursued continued surveillance in this setting. Almost uniformly, respondents pursued continued surveillance and not colectomy when low grade dysplasia was diagnosed. Nearly one-half of the respondents thought that there was only < 20% chance of finding invasive cancer in patients with preoperative diagnoses of high grade dysplasia. On average, respondents performed surveillance colonoscopy every 1-2 yr and took an average of three biopsies per site, at approximately eight sites in the colon, and most respondents confidently relied on their local pathologist at making the diagnosis. There were, however, wide variations in the practice of dysplasia surveillance. CONCLUSIONS: The majority of respondents did not know the definition of dysplasia, and most viewed it as a preneoplastic lesion. Furthermore, there was a lack of appreciation that the difference between low grade and high grade dysplasia is one of degree or severity of neoplastic change and for the likelihood of finding invasive cancer at surgery if there is only a diagnosis of dysplasia preoperatively. Dysplasia surveillance colonoscopy in ulcerative colitis is not a well standardized, clearly understood screening tool, and continued education of the gastroenterology community regarding its outcomes and pitfalls is needed.

Colectomy↗