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At least 955 records · Page 53Linked to original sources

PubMed1995

Role of oral sodium phosphate and its effectiveness in large bowel preparation for out-patient colonoscopy.

The aim of our study was to determine the tolerance and efficacy of oral sodium phosphate compared with polyethylene glycol electrolyte (PEG) solution on out-patient colonoscopy. Seventy-nine patients (35 male, 44 female) for elective out-patient colonoscopy were randomized to receive either PEG (GoLYTELY) solution or oral sodium phosphate (Fleet PhosphoSoda) before the procedure. Patients subsequently completed a questionnaire to assess tolerance to either regimen. The endoscopists, who were blinded to the type of bowel preparation, assessed the results in terms of residual faecal content and percentage of bowel wall visualized. Sixty-seven per cent (26) of 39 patients found Phospho-Soda easy to complete, compared with 53% (21) of 40 patients with PEG (P = 0.06). There was no statistical significance between the two groups in terms of symptomatology. Colonoscopic assessment of the Phospho-Soda group showed better cleansing compared to the PEG group at all levels of the colon (P = 0.02-0.002). Phospho-Soda is just as well tolerated as a standard PEG regimen and provides better cleansing of the bowel for colonoscopy.

Administration, Oral↗

PubMed1995

[Acceptability of high colonoscopy using different premedication--a comparison of the effect of midazolam versus midazolam and pethidine from the viewpoint of the patient and the physician].

Invasive endoscopic procedures such as total colonoscopy result in a better patient acceptance, the less discomfort they cause. Therefore a premedication for total colonoscopy is often required. In a prospective, double-blind, placebo-controlled clinical study of 132 patients examined by one experienced endoscopist we compared two premedication schedules: midazolam (mean 5.2 mg i.v.) versus midazolam (mean 4.8 mg) plus pethidin (50 mg). We found that the combination midazolam plus pethidin provides a deeper and more reliable sedation and analgesia than midazolam alone. The combination of both drugs caused also more anterograde amnesia. It was also shown, that the endoscopist scored a higher degree of patient's pain during the examination than the patient did himself. No more negative side-effects such as decrease of arterial partial pressure of oxygen or cardiopulmonary complications were found using the combination of both drugs; they provided to be safe without added risk of hypoxia. Thus, the combination of both drugs can be given as premedication for total colonoscopy.

Adolescent↗

PubMed1996

Acute appendicitis immediately after colonoscopy.

In a 69-yr-old man we treated, acute appendicitis occurred immediately after colonoscopy was performed. There were no signs or symptoms of appendicitis before colonoscopy, including in the colonoscopic findings around the cecal end and appendicular orifice. Because appendicitis is a rare complication of colonoscopy, prompt recognition should lead to early and effective treatment.

Acute Disease↗

PubMed1997

Virtual colonoscopy.

A new method for colon examination, virtual colonoscopy, has been created by combining spiral computed tomography and virtual reality computer technology. If virtual colonoscopy proves equal to or superior to traditional colonoscopy in sensitivity and specificity for cancer screening, it would yield significant clinical and public health benefits because of its potential for increased acceptance among patients as well as its considerably lower cost and risks.

Colon↗

PubMed1997

Colonoscopy and acute colonic pseudo-obstruction.

There is no well-defined standard of care for the use of colonoscopy in the treatment of acute colonic pseudo-obstruction (ACPO). Colonoscopy can be helpful for ACPO, but it can be accompanied by complications, is not completely effective, and can be followed by recurrence. These possibilities must be weighed against the overall risk of spontaneous perforation, which is low but real. The use of colonoscopy therefore should be selective, and it should be performed by experts and accompanied generally by tube placement.

Acute Disease↗

PubMedDate not supplied

[Colonoscopy: indications, contraindications and complications].

The bioengeneering technological development associated with new medical information transformed colonscopy today in one of the most complete method of investigation on colorrectal diseases. The authors aim to describe the use of colonoscopy as a diagnostic and therapeutic method, its main indications and limitations. The wide utilization of colonoscopy as therapy is emphasized in the polipectomy, the identification of bleeding areas and the hemostasy. Some intervening facts are discussed as copious bleeding, perfuration and post polipectomy syndrome. Finally, the authors report the low morbidity and mortality rates in their personal experience with colonoscopy during the last decade.

Colonoscopy↗

PubMed1976

Flexible colonoscopy.

Colonoscopy with fiberoptic instruments has opened new vistas in diagnosis and treatment of colonic disease. Such endoscopy requires skill, experience, and judgment to be accomplished readily and safely but permits visual examination of the entire colon and, frequently, the terminal ileum as well. Although in experienced hands colonoscopy may have greater diagnostic accuracy than the barium enema, particularly with respect to colorectal cancer and polyps, the two are complementary modalities and with their combined use an extremely high rate of detection and confirmed diagnosis can be expected. The Beth Israel group introduced the technique of snare-cautery removal of colonic polyps via the colonoscope and has now successfully resected over 2500 such polyps without a single death. This is the largest world experience. Selected polyps can be removed endoscopically as an ambulatory procedure, reducing costs and incapacitation time. Neoplastic polyps often harbor invasive cancer and their extirpation is expected to reduce the incidence of overt colorectal cancer. Colonoscopy and endoscopic polypectomy offers the opportunity to check the rising incidence, morbidity, and mortality related to colorectal cancer.

Adenoma↗

PubMed1980

Idiopathic cecal ulcer. Diagnosis by colonoscopy followed by nonoperative management.

Idiopathic ulcer of the cecum has been considered a rare condition requiring surgical treatment because of a high incidence of complications, including bowel perforation. Cecal ulcerations are usually diagnosed at the time of surgery for presumed appendicitis or peritonitis of unknown origin. Preoperative diagnosis of cecal ulcer by barium enema has been unreliable and previous literature cites only one case diagnosed by colonoscopy. We describe four cases in which the diagnosis was made at colonoscopy. Three of our four patients were treated conservatively and did not require laparotomy. Idiopathic cecal ulcer should be considered in the differential diagnosis of lower gastrointestinal hemorrhage as well as atypical appendicitis. If the diagnosis of cecal ulcer is made by colonoscopy in a patient without evidence of an acute abdomen, conservative management may be followed by complete healing, avoiding unnecessary surgery.

Adult↗

PubMed1989

Midazolam versus diazepam for combined esophogastroduodenoscopy and colonoscopy.

This study compares the effects of two different benzodiazepines used for conscious sedation during combined upper gastrointestinal endoscopy (EGD) and colonoscopy. Subjects were assessed for their degree of analgesia and amnesia for the procedure, prior experience with endoscopy, and willingness to undergo another similar procedure should such be necessary. The patients were randomized single blind to receive either midazolam or diazepam for their preprocedure sedation. The amount of preprocedure sedation utilized was determined by titration of the dose to achieve slurring of speech. Prior to receiving either agent, the subjects were shown a standard card containing pictures of 10 common objects, were asked to name and remember them, and were told they would be "quizzed" (at 30 min and 24 hr) after being sedated for their recollection as to the objects pictured on the card. Each subject filled out a questionnaire addressing their perceived discomfort during the endoscopic procedure and their memory of the procedure 24 hr after the procedure. Sixty-three percent of the midazolam-sedated subjects reported total amnesia for their colonoscopy vs 20% of diazepam-sedated patients (P less than 0.001). Fifty-three percent of midazolam-sedated patients reported total amnesia of their upper gastrointestinal endoscopy vs only 23% of diazepam-sedated subjects (P less than 0.05). The midazolam-sedated subjects reported experiencing less pain with both upper gastrointestinal endoscopy (P less than 0.05) and colonoscopy (P less than 0.001) than did the diazepam-sedated group. Most importantly, the midazolam group was more willing to undergo another similar endoscopic procedure should they be asked to do so by their physician (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1979

Extent of inflammatory lesions in ulcerative colitis assessed by radiology, colonoscopy, and endoscopic biopsies.

Radiography of the colon with double-contrast technique was performed directly after total colonoscopy with multiple biopsies in 50 patients with ulcerative colitis. In two-thirds of the series the inflammatory lesions were found to be more widespread at colonoscopy than on radiography. Signs of colitis in an even larger part of the bowel were found on examination of the biopsies in half of the cases. The distribution of characteristic inflammatory changes seen at colonoscopy was also studied. The frequency of the lesions was found to be relatively low in the rectum and highest in the descending and sigmoid parts of the colon.

Adult↗

PubMed2005

Virtual colonoscopy: current status and future directions.

Virtual colonoscopy (CT colonography) is a technique whereby CT images of the cleansed and distended colon are acquired, ostensibly for detecting colonic neoplasia, although also providing additional diagnostic information from extracolonic organs. This article examines the current status of virtual colonoscopy, reviewing the technical parameters, performance characteristics, and issues surrounding implementation in routine clinical practice. Future directions for virtual colonoscopy are explored, including advances toward prepless examinations and automated interpretation.

Cathartics↗

PubMed2004

Polyethylene glycol 3350 without electrolytes: a new safe, effective, and palatable bowel preparation for colonoscopy in children.

OBJECTIVE: To assess safety, efficacy, and acceptance of polyethylene glycol 3350 without electrolytes (PEG) for bowel preparation for colonoscopy in children. Study design In a prospective study, 46 children (mean age, 11.2 years; range, 2.8-17.8) were given PEG at a dose of 1.5 g/kg/day for 4 days before colonoscopy. Patients were allowed to mix PEG in the beverage of their choice. Stool frequency and adverse effects were monitored during PEG therapy. Compliance, tolerance, and quality of colonic preparation were assessed. Serum electrolytes were measured before and after PEG therapy in 29 children. RESULTS: Daily stool frequency increased with PEG therapy from baseline of 2.6+/-0.3 to 3.0+/-0.5 on day 1, 4.6+/-0.4 on day 2, 5.5+/-0.7 on day 3, and 6.0+/-0.6 on day 4 (days 2, 3, and 4, P<.001 for difference vs baseline). The colonic preparations were rated as excellent or good in 91% and 95% in the right and left colon, respectively, at endoscopy. Adverse effects were mild nausea (13%), abdominal pain (11 %), and vomiting (11%). Electrolyte profile revealed small, clinically insignificant changes with PEG therapy. Compliance and tolerance were rated as excellent by 89% and 85% of patients, respectively. CONCLUSIONS: Electrolyte-free PEG 3350 can be used as an effective and safe bowel preparation that is well accepted by children for colonoscopy.

Adolescent↗

PubMed2003

A prospective trial of variable stiffness pediatric vs. standard instrument colonoscopy.

BACKGROUND: The pediatric variable stiffness colonoscope is believed to have theoretical advantages over the standard colonoscope, however a systematic evaluation of this instrument in routine clinical practice involving adult patients is lacking. METHODS: Consecutive patients (blinded) undergoing colonoscopy in an outpatient endoscopy center by one of 4 experienced colonoscopists had the procedure performed with a standard colonoscope (n=384) or pediatric variable stiffness colonoscope (n=413). Failure to negotiate the sigmoid colon within 10 minutes was regarded as a failure and, if suitable, the patient was crossed over to colonoscopy with the alternative instrument. RESULTS: Median (95% CI) time to the cecum was significantly faster in the pediatric variable stiffness colonoscope group (odds ratio 5.0: 95% CI[4.7,5.3] minutes) compared with the standard colonoscope group (odds ratio 5.5: 95% CI[5.2,5.8] minutes, p=0.01). There were 22 failures overall (2.8%), 14 in the standard colonoscope group (3.6%) and 8 in the pediatric variable stiffness colonoscope group (1.9%; p=0.1). With regard to the 14 failures in the standard colonoscope group, colonoscopy was attempted with the pediatric variable stiffness colonoscope in 13 and completed successfully in 12 (92%). The pediatric variable stiffness colonoscope was superior in cases of severe stenosing diverticular disease; two of 27 examinations with the pediatric variable stiffness colonoscope were rated as failed vs. 12 of 18 with the standard colonoscope (p<0.001). CONCLUSIONS: Intubation time was faster with the pediatric variable stiffness colonoscope, but use of this instrument was not associated with a superior cecal intubation rate compared with the standard colonoscope. However, in patients with severe stenosing diverticular disease, the intubation rate with the pediatric variable stiffness colonoscope was superior.

Cecal Diseases↗

PubMed2003

Virtual colonoscopy: past, present, and future.

Virtual colonoscopy is developing into a practical clinical technique. The issues of the steep learning curve and accuracy of the technique are undergoing advances related to patient preparation, scanning technique, reading methods, and CAD. It is probably the best test for patients with an incomplete colonoscopy or for those patients who cannot undergo colonoscopy. Its precise role in screening average-risk patients for colon cancer remains to be defined by ongoing research and clinical trials.

Colonography, Computed Tomographic↗

PubMed2002

Virtual colonoscopy. Potential clinical applications of a new technique.

The potential role of virtual colonoscopy is not limited to colorectal cancer screening, although that is its greatest potential. Same-day VC should be offered for patients undergoing an incomplete colonoscopy. Conversely, faster, more accurate interpretation by the radiologist on the same day as a VC should lead to the consideration by the gastroenterologist of same-day colonoscopy for patients with a suspicious, significantly sized polyp.

Cohort Studies↗

PubMed1979

Complications of diagnostic and therapeutic colonoscopy in the Federal Republic of Germany. Results of an inquiry.

In April, 1978, we carried out a survey covering 27 hospitals, in which colonoscopy is performed on a routine basis. With respect to the size of the hospital, the equipment available and the level of training of the examiner, this selection may be regarded as representative. A total of 35,892 colonoscopies, 7,365 polypectomies, 58 electrocoagulations and 14 rugectomies were analysed with respect to the nature, localization and treatment of any complications that arose. The rate of complications seen in diagnostic colonoscopy was 0.008% for bleeding and 0.14% for perforation, the mortality rate being 0.02%. As expected, the complication rate for colonoscopic polypectomy was higher. Bleedings were reported in 2.24%, perforations in 0.34% and deaths in 0.1% of the examinations. Of particular importance would seem to be the possibilities of preventing complications. It was shown on the basis of the survey that a good, standardized training of the endoscopist, the strict observance of the contraindications, the non-use of analgesics and general anaesthesia, fluoroscopic control of "difficult" colons and the use of the best instruments and aids presently available, reduce the complication rate to a minimum.

Colon↗

PubMed2005

Insertability and safety of a shape-locking device for colonoscopy.

BACKGROUND: Loop formation during colonoscopy insertion results in patient pain and delays in advancement of the colonoscope tip. AIM: To assess the insertability and safety of a novel shape-locking guide (ShapeLock, USGI, San Clemente, CA) that resists looping during colonoscopy. RESULTS: In 54 patients, both a disposable and a partly reusable version of the ShapeLock received high scores (mean scores >9.0 on 1-10 scale) for ease of insertion, and ability to maneuver the colonoscope through the shape locked device. No significant trauma resulted from use of the device. CONCLUSION: A novel shape-locking device for colonoscopy can be readily and safely inserted into the colon and locked. The device warrants controlled evaluation to determine in which, if any cases, it may be useful for either experienced colonoscopists and/or those with less or minimal experience.

Adult↗

PubMed2006

Barrett's esophagus is common in older men and women undergoing screening colonoscopy regardless of reflux symptoms.

BACKGROUND: Although Barrett's esophagus (BE) is the precursor of esophageal adenocarcinoma (ACA), most patients with ACA present outside of a BE surveillance program. This could be due to undiagnosed symptomatic GER and BE or BE/ACA occurring in patients without reflux symptoms. We have, therefore, studied the prevalence of BE and symptom status in older patients referred for colonoscopy. METHODS: All patients referred for outpatient colonoscopy were eligible if they were at least 65 yr old and had not previously undergone esophagoscopy. After informed consent, the patients completed detailed GER questionnaires. During the research endoscopy, the endoscopist recorded the squamocolumnar junction (SCJ) as either long-segment BE (LSBE), short-segment BE (SSBE), or normal. If the SCJ was felt to be "irregular" the endoscopist was asked to predict, in their judgment, if BE was present. All patients had biopsies below the SCJ, which were examined by a gastrointestinal pathologist who was blinded to the endoscopic findings. RESULTS: BE esophagus was present in 50 of the 300 patients studied (16.7%). BE was more common in men (35 of 161, 21.7%) than in women (15 of 139, 10.8%) (p < 0.025). GERD symptoms were reported in 106 patients (35%) and BE was present in 19.8% of symptomatic and 14.9% of asymptomatic cases (NS). The majority of the BE in this study was less than 3 cm in length (92%). The questionnaires did not predict the presence of BE. CONCLUSIONS: BE is common in unscreened male and female patients at least 65 yr of age who are referred for colonoscopy. Men were more likely than women to have BE although it occurred in both sexes. Reflux symptoms were fairly common but a poor predictor of BE.

Adenocarcinoma↗