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PubMed1977

Colonoscopy in surgical practice.

Colonoscopy is a rewarding new technique with a potential for early and more accurate diagnosis. One hundred and seventy colonoscopies carried out over the past three years showed or confirmed colonic cancer in 14 patients, and solitary or multiple colonic polyps were found in 28 cases, of which 18 were excised endoscopically. A large villous adenoma was diagnosed in one patient, and the absence of a suspected sinister lesion was shown by direct examination and biopsy in 110 cases. There were 17 examination failures, including two perforations of the bowel. Colonoscopy complements rather than supplants barium enema examination and will make diagnostic laparotomy for colonic lesions unnecessary. The use of the diathermy snare allows endoscopic removal of colonic polyps and should greatly reduce the need for formal surgery in these cases. The financial saving to the Health Service will greatly outweigh the expense of the procedure, but it should be undertaken only in well organised centres as a specialist service for selected patients. In skilled hands it is safe, but potential hazards exist for the inexperienced endoscopist.

Colon↗

PubMed2003

Wireless capsule endoscopy: a comparison with push enteroscopy in patients with gastroscopy and colonoscopy negative gastrointestinal bleeding.

BACKGROUND: The development of wireless capsule endoscopy allows painless imaging of the small intestine. Its clinical use is not yet defined. The aim of this study was to compare the clinical efficacy and technical performance of capsule endoscopy and push enteroscopy in a series of 50 patients with colonoscopy and gastroscopy negative gastrointestinal bleeding. METHODS: A wireless capsule endoscope was used containing a CMOS colour video imager, transmitter, and batteries. Approximately 50,000 transmitted images are received by eight abdominal aerials and stored on a portable solid state recorder, which is carried on a belt. Push enteroscopy was performed using a 240 cm Olympus video enteroscope. RESULTS: Studies in 14 healthy volunteers gave information on normal anatomical appearances and preparation. In 50 patients with gastrointestinal bleeding and negative colonoscopy and gastroscopy, push enteroscopy was compared with capsule endoscopy. A bleeding source was discovered in the small intestine in 34 of 50 patients (68%). These included angiodysplasia (16), focal fresh bleeding (eight), apthous ulceration suggestive of Crohn's disease (three), tumour (two), Meckel's diverticulum (two), ileal ulcer (one), jejunitis (one), and ulcer due to intussusception (one). One additional intestinal diagnosis was made by enteroscopy. The yield of push enteroscopy in evaluating obscure bleeding was 32% (16/50). The capsule identified significantly more small intestinal bleeding sources than push enteroscopy (p<0.05). Patients preferred capsule endoscopy to push enteroscopy (p<0.001). CONCLUSIONS: In this study capsule endoscopy was superior to push enteroscopy in the diagnosis of recurrent bleeding in patients who had a negative gastroscopy and colonoscopy. It was safe and well tolerated.

Adolescent↗

PubMed2006

Virtual colonoscopy--an overview.

Virtual colonoscopy is emerging as a technique for the detection of tumor lesions in the colon. Being a patient-friendly examination, virtual colonoscopy could play an important role in colorectal cancer screening. This article reviews the current state of the art of virtual colonoscopy with future developments and issues to be resolved.

Colonic Neoplasms↗

PubMed2002

Quality of virtual colonoscopy in patients who have undergone radiation therapy or surgery: how successful are we?

OBJECTIVE: In patients who have a history of abdominopelvic radiation, surgery, or both, conventional colonoscopy may fail to examine the entire colon. The purpose of this study is to assess whether high-quality virtual colonoscopy can be achieved in this patient population. MATERIALS AND METHODS: After colonic cleansing, 61 patients (16 men and 45 women; mean age, 64 years; age range, 27-81 years) underwent 63 virtual colonoscopy examinations after using either single- or multidetector CT (slice thickness, 3.75-5.0 mm; table speed, 1.7-11.25 cm/sec; pitch, 1.5-3.0; and overlapped reconstructions, 1.95-2.5 cm) in supine and prone positions after IV administration of 1 mg of glucagon and rectal air insufflation. Conventional two-dimensional axial images were analyzed on a PACS (picture archiving and communication system) workstation. Two radiologists, who were unaware of patient history, independently evaluated the colonic distention on a 4-point scale (4 = optimal distention) and fluid retention on a 3-point scale (3 = no fluid) for all segments of the colon in patients who were imaged in both the supine and prone positions. Segmental and total average colon scores were calculated. RESULTS: Forty-one patients (65%; 43 examinations, 67%) underwent prior surgery, radiation, or both (surgery, n = 29; radiation, n = 3; both, n = 11). The average overall colonic distention and fluid retention for this group was 3.13 and 2.38, respectively, versus 3.24 and 2.3 in the control group (p = not significant). CONCLUSION: High-quality examinations were achieved in patients who had previously undergone radiation, surgery, or both with no clinically significant difference in distention or fluid retention compared with the controls.

Abdomen↗

PubMed1979

Fibreoptic colonoscopy. Indications, results and complications.

Fibreoptic colonoscopy was commenced in the Edward Wilson Colon and Rectum Unit at Sydney Hospital in June, 1973. The experience of the first five years of its use is reported. Six hundred and twenty-six examinations have been performed in 568 patients. Fibreoptic colonoscopy has been of particular value in the diagnosis and treatment of colonic polyps. A total of 318 polyps were removed from 184 patients. Their distribution, size and histological features are recorded. Eight complications occurred in the 628 examinations (1.6%). There were six colonic perforations (1.2%) with one death, and two significant haemorrhages (0.4%). This incidence of complications is acceptably low, especially in view of the great benefits obtained by the patient from fibreoptic colonoscopy. The newer instruments, especially the medium length Olympus MB3 colonoscope, have greatly facilitated the examination and, combined with increasing experience, may significantly lower the incidence of complications in the future.

Adolescent↗

PubMed1976

Colonoscopy and polypectomy.

Experience with 100 colonoscopies in 88 patients in a community hospital is presented. The instrument used was the F09000PL 165 cm ACMI colonoscope for the first 88 cases, and the F9A 160 cm ACMI colonoscope for the last 12. There were no complications. The preparation of the patient and the technique of colonoscopy and polypectomy are detailed. Indications and contraindications are outlined and discussed. Colonoscopy in this series has definitely saved 16 patients and possibly another 20 patients from laparotomy.

Adult↗

PubMedDate not supplied

Clinical significance of virtual colonoscopy (CT colonography) with special reference to polyp morphology.

BACKGROUND/AIMS: Computed tomographic colonography [virtual colonoscopy (VC)] is a new imaging method that may contribute to the detection of colorectal neoplasms. The aim of this study was to investigate the clinical significance of VC for the diagnosis of colorectal tumors with special reference to their morphology. METHODOLOGY: Sixteen patients with colorectal tumors were enrolled in this study. Colonic preparation was performed using magnesium sulfate, and scopolamine butylbromide was injected before air insufflation from the anus. VC was performed with an Aquilion multislice CT system (Toshiba) and Workstation M900 maximum (ZIO). The results were compared with those of conventional colonoscopy (CC). In six cases, total colonoscopy was not possible due to tumor stricture. RESULTS: The number of lesions detected by CC was 58; 48 early carcinomas/adenomas (group A) and 10 advanced carcinomas (group B). All group B lesions and 43.8% (21 lesions) of group A lesions were identified by VC. The specificity of VC for group A and B lesions was 45.8% and 100%, respectively. There was no significant difference in detection rate for group A lesions by subclassification according to their morphology: pedunculated; 22% (2/9), semipedunculated; 50% (6/12), sessile; 29% (4/14), superficially elevated; 56% (5/9), and superficially elevated morphology with central depression; 100% (4/4). The mean diameter of the lesions that were detected and not detected by VC was 7+/-8.0 mm (range: 3-30 mm) and 8+/-5.8 mm (range: 2-20 mm), respectively (P=0.90). CONCLUSIONS: Polyps with superficial morphology could be detected by VC as well as those with protuberant morphology. According to evidence that neither the morphology nor the size of a lesion was a significant factor for detection by VC, the authors consider that the diagnostic ability of VC may be improved by better preparation.

Colonic Polyps↗

PubMed2002

Virtual colonoscopy.

Computed axial colonography, usually called virtual colonoscopy, is a new diagnostic method potentially useful for investigating polyps and tumors of the colon and rectum. It uses spiral axial tomography data to build up images similar to those given by conventional colonoscopy, offering advantages in that it causes no adverse reactions, and is accepted well by patients, who do not need to be sedated. Reports to date show its sensitivity and specificity vary in identifying polyps in the colon, and there are still many problems with the new method, such as its cost, its learning curve, the identification of flat lesions, and detection of extracolonic abnormalities. There is a pressing need to establish the accuracy and cost-effectiveness of virtual colonoscopy as a screening method for colorectal tumors, and for post-polypectomy surveillance.

Journal Article↗

PubMed2006

[Virtual CT colonoscopy and virtual CT barium enema using multidetector-row CT].

CT colonography is a promising technique that provides both multiplanar and endoluminal perspective of the air-filled, distended, cleaned colon. "Virtual colonoscopy" refers to computer-simulated 3D endoscopic visualization of the colonic mucosal surface. Unlike barium enema and conventional colonoscopy, CT colonography can give cross- sectional and endoluminal images of the colon and enables to image extracolic abnormality. CT colonography offers potential advantages over colonoscopy in that it causes little discomfort to the patient, and does not need sedation. It is more accurate in spatial location of lesions and creates no complication. To date, most studies assessing CT colonography have focused in technical development, less aggressive bowel preparation, and computer-aided diagnosis of polyp detection. In the future, CT colonography would be a diagnostic and screening tool for the colorectal polyp and cancer.

Barium Sulfate↗

PubMed1979

Complications in colonoscopy.

Colonoscopy, when performed for appropriate indications and by experienced, competent personnel, is a remarkably safe procedure. The occasional complications which occur may be the result of pneumatic, mechanical or electrical injuries to the colon or may develop as secondary disorders involving other organ systems. Most complications can be successfully prevented by adequately preparing both the endoscopist and the patient and by avoiding colonoscopy when specific contraindications are present. Should complications occur, their management generally follows established surgical principles. Even though colonoscopy has made a dramatic impact upon the diagnosis of and therapy for disease of the large intestines, it is important for practitioners to be mindful of its limitations. Future developments, applied rationally, can be expected to extend its usefulness and further improve its safety.

Burns, Electric↗

PubMedDate not supplied

The role of colonoscopy in complicated diverticular disease. A review.

Colonoscopy in complicated diverticular disease may assist the clinician in establishing the diagnosis of associated strictures. A review of the literature shows that carcinoma was identified in 21 (17%) of 125 patients and that an additional diagnosis was made in 40 (32%) patients. Although colonoscopy may be a difficult procedure in patients with diverticular disease the caecum was reached in 27 (61%) of 44 patients and took no longer than routine colonoscopic orpcedures. Further analysis of these results confirms that the barium enema frequently produces both false positive and false negative diagnoses of carcinoma and polyps. The presence of bleeding strongly suggests the presence of a concomitant lesion. Fifteen (11%) carcinomas were identified in a group of 135 patients with persistent rectal bleeding whose barium enema showed only diverticular disease and an additional diagnosis was made in 50 (37%) of these patients. Colonoscopy is an important investigation in patients with complicated diverticular disease.

Aged↗

PubMedDate not supplied

Value of colonoscopy in the detection of sigmoid malignancy in patients with diverticular disease.

Sixty patients with diverticular disease, referred because a barium enema examination could not exclude a co-existing malignanty, were studied in a retrospective manner, to find out the contribution of colonoscopy in the diagnosis of sigmoid carcinoma in such patients. All X-ray studies were blindly reviewed and divided in two categories: a) diverticular disease with malignancy or strong suspicion for malignancy and b) diverticular disease without suspicion for malignancy. The accuracy of the endoscopical examination was evaluated by a follow-up study with a range of 3 months-3 years. Colonoscopy appeared to be accurate in more than 3/4 of the referred patients but was not helpful when there was a severe stenoisis and/or the diseases segment could not be reached for biopsy. The incidence diminished when a small calibre fiberendoscope was used, practically always allowing to reach or to pass the stenotic segment. There were no false positive nor false negative endoscopical results in our study. In a substantial number of patients major surgical exploration could be prevented. We consider colonoscopy therefore a valuable adjunct in detecting or eliminating cancer in colonic diverticular disease. The availability of various fiberendoscopic instruments is a prerequisite for reaching an acceptable success rate and diagnostic accuracy.

Colon↗

PubMed1977

Fiberoptic endoscopy of the gastrointestinal tract in infants and children. II. Fiberoptic colonoscopy and polypectomy in 15 children.

Fiberoptic colonoscopy was performed on 15 patients between the ages of 1 1/2 years and 16 years. Ten patients were hospitalized and five were outpatients. Of 12 with frank or microscopic blood in stools, fiberoptic colonoscopy revealed single polyps in six patients, ulcerative colitis in two and negative results in four with prior nondiagnostic radiographic studies, colonoscopy revealed ulcerative colitis in one, granulomatous colitis in one and negative findings in one. Polypectomy through the colonoscope was accomplished in all six patients with polyps. Perforation of the sigmoid colon during polypectomy with the snare loop was the single complication encountered. Lower intestinal endoscopy should be selectively considered for diagnosis and therapy of unexplained bleeding or recurrent lower abdominal pain in children in whom proctosigmoidoscopic laboratory and radiographic examinations do not achieve a diagnosis.

Abdomen↗

PubMed1977

Benign pneumoperitoneum after fiberoptic colonoscopy. A prospective study of 100 patients.

A prospective study of 100 consecutive unselected patients undergoing both diagnostic and therapeutic firoptic colonoscopy was undertaken. Our incidence of colonic perforation is 1%, which is similar to the incidence reported in the literature. This study suggests that even when immediate postcolonoscopic supine and erect abdominal radiographs as well as pre- and postcolonoscopic total blood counts and enzyme levels to supplement clinical impressions are obtained, the incidence of perforation of the colon after fiberoptic colonoscopy is low and not any higher than that reported in the literature. Pneumoperitoneum may occur after fiberoptic colonoscopy with minimal or no clinical evidence suggesting perforation. Perforation in some patients may be treated conservatively without the need of emergency laparotomy.

Adult↗

PubMed1982

A second look at colonoscopy: indications, failures, and costs.

Results of colonoscopy and colonoscopic polypectomy in 599 patients have been reviewed. Added experience has not decreased the number of failures--failure to examine the entire colon, polyps not retrieved for histological examination ("lost polyps"), undetected ("missed") lesions, and false-negative biopsy specimens. The incidence of invasive carcinoma in polyps measuring under 1 cm is less than 1%; polypectomy should be reserved for larger lesions or demonstrated growth of small polyps. Diagnostic colonoscopy in selected patients (those with persistent gross or occult rectal bleeding but normal results from sigmoidoscopic and barium enema studies) demonstrates a causative lesion in greater than 25% and detects a cancer in 5% to 10% of patients.

Biopsy↗

PubMed1989

Splenic injury during colonoscopy.

Splenic injury was associated with a flexible fiberoptic colonoscopy and required an urgent splenectomy. Injuries to viscera other than the colon during colonoscopy are rare, and the diagnosis is frequently delayed. Excessive traction on the splenocolic ligament or on preexisting adhesions, resulting in capsular tears, is the presumed mechanism of injury. Although computed tomography may be helpful, the greatest aid to an early diagnosis is the knowledge that this complication may occur.

Colonoscopes↗

PubMed1981

A comparison of two methods of whole gut lavage for colonoscopy.

Two forms of bowel preparation for colonoscopy were compared--19 patients were given 5 per cent mannitol solution orally while a further 19 were infused with isotonic saline via a nasogastric tube. Both methods proved equally acceptable to the patients and endoscopists. Saline led to a rise in body weight (+0.75 +/- 0.35 kg) and blood pressure (+7.5 +/- 2.8 mmHg) while mannitol caused a significant fall in both body weight (-0.74 +/- 0.28 kg) and blood pressure (-3.8 +/- 2.9 mmHg). Plasma volume measurements were carried out on 17 patients; 8 receiving saline showed a rise (+0.22 +/- 0.08 l) while 9 taking mannitol experienced a fall (-0.17 +/- 0.08 l). Twelve further subjects prepared with a combination 10 per cent mannitol and isotonic saline showed a small fall in plasma volume (-0.08 +/- 0.05 l). Mannitol proved an acceptable preparation for colonoscopies but a fall in body weight, blood pressure and plasma volume posed a small risk to the elderly subject and in view of the known risks of mannitol during diathermy this form of preparation was not considered a suitable alternative to isotonic saline.

Administration, Oral↗

PubMed1984

Direct vision brush cytology with colonoscopy: an aid to the accurate diagnosis of colonic strictures.

The accuracy of direct vision brush cytology at colonoscopy was compared with colonoscopic biopsies, colonoscopy alone and radiology in the diagnosis of colonic strictures. There were 82 brushings in 79 patients; 55 had malignant and 24 had benign lesions. Cytology was correct in 66 (81 per cent), and biopsy was less accurate with 53 (68 per cent) correct reports. The combined accuracy of cytology and biopsy was 88 per cent. Whilst an endoscopic diagnosis was usually correct (96 per cent), direct vision brush cytology had an important place in the accurate tissue diagnosis of colonic strictures, particularly those in the rectosigmoid.

Barium Sulfate↗