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At least 991 records · Page 55Linked to original sources

PubMed1990

Whole gut irrigation and Prepacol laxative preparation for colonoscopy: a comparison.

Two techniques for preparation of the colon for colonoscopy were compared in a controlled trial. Fifty patients given a low residue diet and the laxative Prepacol were compared with 50 patients given whole gut irrigation. Significantly more patients suffered from vomiting (P = 0.0005), shivering (P = 0.0062) and nausea (P = 0.031) following irrigation; in two cases the procedure had to be abandoned because of profuse vomiting. Irrigation was less well tolerated by the patients (P = 0.00002) than preparation with Prepacol. On the other hand, the quality of bowel preparation was found to be better (P = 0.0005) after irrigation. On two occasions colonoscopy was not possible following Prepacol preparation because of faecal residue. Patients with a previous colorectal resection showed a similar quality of cleansing to those patients prepared with irrigation. We conclude that Prepacol is as efficient as irrigation for patients who have had a previous colorectal resection because the quality of bowel preparation is as good and the associated patient discomfort is small.

Adolescent↗

PubMed1991

Colon perforation during colonoscopy: surgical versus conservative management.

A survey of endoscopy units in the West Midlands, UK, was undertaken to ascertain the management of colonic perforation during colonoscopy. Fifteen perforations were reported from a total of 17,500 colonoscopies performed in 14 units (a rate of 0.09 per cent). In seven patients the diagnosis was suspected or diagnosed immediately and in the remaining eight 2-72 h later. Four patients with associated pathology (carcinoma, Crohn's disease, ulcerative colitis and a polyp) had resection and primary anastomosis. Seven patients had a simple oversew, four of these having had a delayed diagnosis. In four cases the site of perforation was not identified, but only one patient had conservative treatment. Three patients had drainage and a defunctioning colostomy. There was no significant morbidity following treatment. It is recommended that patients who have had a good bowel preparation should be treated conservatively unless there is a large perforation or an underlying carcinoma.

Adult↗

PubMed1995

Intraoperative measurement of colonic anatomy and attachments with relevance to colonoscopy.

This study examined the variations in colonic length and mesenteric attachments in 118 patients undergoing laparotomy. Measurements were taken according to a set protocol with the bowel pulled medially, or towards the pubic symphysis or the xiphisternum, mimicking the possible displacements that may occur during colonoscopy. A free sigmoid loop was not present in 20 patients (17 percent) because of adhesions. A descending mesocolon of 10 cm or more in length was recorded in ten patients (8 percent) and an ascending mesocolon 10 cm or greater in 11 (9 percent). Some 24 patients (20 percent) had mobile splenic flexures and in 34 (29 percent) the mid-transverse colon reached the symphysis pubis or lower when pulled downwards. Mean (range) total colonic length was 114.1 (68-159) cm. This study helps define anatomical variations that may affect the facility, or otherwise, of colonoscopy.

Adult↗

PubMed2005

Helicobacter pylori infection is associated with colon adenomatous polyps detected by high-resolution colonoscopy.

Helicobacter pylori (H. pylori) is associated with the development of cancer in the stomach, but both positive and negative associations were reported with colorectal neoplasia. We sought to determine whether H. pylori is associated with colon neoplasia in Japanese population. We examined 332 patients who underwent routine high-resolution total colonoscopy and serologic testing for IgG antibodies agonist H. pylori. Subjects who received cyclooxygenase-2 inhibitors or previous eradication therapy and those with borderline titer levels were excluded from data analysis (n = 27). Seronegative control subjects were from the same study population to maximize the representativeness. There were no significant differences in age and gender between the 2 patient groups. A significant increase in the incidence of adenomatous polyps (p < 0.0001) and decrease in normal colonoscopic findings (p < 0.0005) were observed in seropositive patients than those seronegative. Our study indicates an etiological link of H. pylori infection to colorectal neoplasia and the need of routine colonoscopy in seropositive patients.

Adenomatous Polyps↗

PubMed1995

A study of a new osmotic purgative for colonoscopy. Is Golytely worth its salt?

An osmotic laxative containing polyethylene glycol and sodium sulfate (Golytely Braintree Laboratories, Inc., Braintree, MA) is widely used to clean the colon for colonoscopy. However, its salty taste makes the mixture unpalatable. We therefore tested the claim that a similar solution but without sodium sulfate (Golytely-RSS Braintree Laboratories, Inc., Braintree, MA) makes preparation of the colon more acceptable to patients in a double-blinded randomized controlled trial. Colonic preparation using polyethylene glycol with or without sodium sulfate was randomized in 100 patients due to undergo colonoscopy. The overall acceptability of the regimen was measured on a linear analogue scale and an estimate of symptoms was obtained. Body weight and serum electrolytes, urea, creatinine, hemoglobin and hematocrit were determined before and after preparation in order to assess fluid absorption. The efficacy of colonic cleansing was graded by the colonoscopist. Four patients did not complete the protocol, 47 received the regimen containing sodium sulfate and 49 received the regimen without it. The two groups did not differ in age or body mass. There was no statistical difference in the overall acceptability of the two regimens to the patients (median acceptability rating 74 for regimen with sodium sulfate, range 4-100 compared with 77 for regimen without, range 3-100, p = 0.32, Mann-Whitney test). Nor was there any difference in taste, nausea, vomiting, cramping or perianal discomfort or in the endoscopists' rating of the cleanliness of the colon. The serum sodium concentration rose slightly (mean 1.6 mmol/L) when the regimen with sodium sulfate was used.(ABSTRACT TRUNCATED AT 250 WORDS)

Cathartics↗

PubMed1995

Accuracy of colonoscopy in localisation of colorectal cancer.

An audit was performed of 77 patients with a single colorectal cancer visualised and sited before surgery by colonoscopic examination. The site of the cancer described at colonoscopy was compared with the actual site found at laparotomy. Six significant errors in preoperative localisation were encountered, when a change from the preoperatively planned resection to an alternative resection was found necessary. In two of these cases, extra morbidity was encountered as a result of these siting errors. Inaccurate localisation is a potential hazard of colonoscopy, especially when the examination is incomplete.

Colonoscopy↗

PubMed1987

Splenic pseudoaneurysm rupture into the colon: colonoscopy before and after successful arterial embolization.

We report a case of splenic pseudoaneurysm rupture into the colon in chronic pancreatitis. At the time of bleeding, pancreatitis was undiagnosed and the colonic lesion was misinterpreted at colonoscopy. The lesion was also misinterpreted at laparotomy, because it simulated intra-abdominal carcinomatosis. The diagnosis was made by CT examination which showed an eccentric enhancing region within a hypodense mass in the region of the splenic hilum. Definitive control of bleeding was achieved by splenic arterial embolization. Splenic infarction and an intrasplenic abscess complicated the embolization, but they did not require surgical intervention. Healing of the colonic wall and of the colonic mucosa was observed at colonoscopy 3 weeks after the embolization.

Aneurysm↗

PubMed1988

Intraoperative colonoscopy in the detection of nonpalpable colonic lesions--how to identify the affected bowel segment.

The development and widespread use of the colonic fiberscope has led to the identification of early colonic cancers which, being small and flat, are not palpable by intraoperative examination of the exterior of the intestine. Standard operation for cancer is required when snare polypectomy is insufficient, or when it is considered that the lesions would be resected incompletely by electrocautery. We report on the use of intraoperative colonoscopy in 11 patients to identify small lesions and to maintain an adequate distance from the lesions. Intraoperative colonoscopy allows lesions to be detected rapidly, safe operations, and a decrease in operation time.

Adenoma↗

PubMed1992

Diminutive colonic polyps: an indication for colonoscopy.

A prospective study investigated the significance of solitary diminutive colonic polyps discovered during screening flexible sigmoidoscopy. Eighty-two patients with a solitary diminutive polyp (less than or equal to 5 mm) underwent colonoscopy after cold biopsy of the index polyp. Of the patients with adenomatous index polyps, 42.5 percent had proximal neoplastic polyps. Of the patients with hyperplastic index polyps, proximal neoplastic polyps were found in 38.9 percent. These data suggest that diminutive polyps identified during flexible sigmoidoscopy, whether adenomatous or hyperplastic, place the patient in the intermediate risk group for colorectal neoplasia. We recommend that any patient with polyps seen during screening sigmoidoscopy, regardless of histopathology, should undergo colonoscopy.

Biopsy↗

PubMed1993

Colonoscopy in patients with benign anorectal disease.

A prospective study was performed to determine the incidence of colorectal neoplasia and inflammatory bowel disease in patients with benign anorectal disease. Over a three-year period, 102 consecutive patients who presented with hemorrhoids, fissure, fistula-in-ano, anorectal abscess, and anal condylomata and who did not have gastrointestinal symptoms underwent colonoscopy. The mean age of all patients was 53.5 years; males out-numbered females 1.6:1. No patient was found to have inflammatory bowel disease. Ten of 102 (9.8 percent) were found to have a neoplastic lesion (nine adenomas and one adenocarcinoma). Patients found to have a neoplastic lesion tended to be older (61 years vs. 52.7 years; P = 0.06). Neoplasia was found in 4 of 21 (19 percent) with a family history of colorectal cancer and in 6 of 81 (7.4 percent) without a family history (P = 0.24). Patients presenting with outlet-type bleeding were not found to have a higher detection of neoplasia. The specific type of anorectal disease present was not associated with an increased risk for colorectal neoplasia. Our study suggests that benign anorectal disease and colorectal neoplasia may coexist. Anorectal disease is not predictive of neoplasia. The decision to perform colonoscopy should be based on age, gastrointestinal symptoms, and other risk factors.

Adult↗

PubMed1997

Cleansing ability and tolerance of three bowel preparations for colonoscopy.

PURPOSE: This study was undertaken to determine whether different regimens using sodium phosphate (NaPh) solutions resulted in better bowel cleansing than polyethylene glycol-salt (PEG) solutions and, if so, why. Side-effects and patient acceptability of the different regimens were also investigated. METHODS: A total of 486 patients requiring colonoscopy were randomly assigned to one of three preparations in a single-blind prospective study. The preparations were as follows: Group A, 3 liters of PEG solution taken at 2 p.m. the day before examination; Group B, 45 ml of NaPh solutions taken at 7 a.m. and 7 p.m. the day before examination; or Group C, 45 ml of NaPh taken at 6 p.m. the day before and at 6 a.m. on the morning of, examination. Cleanliness of the bowel was assessed blindly, and patients were questioned about side-effects and preferences for NaPh vs. PEG. RESULTS: Numbers, ages, and gender distribution of patients in the three groups did not differ significantly from each other. Cleanliness scores for the three groups were 3.34 +/- 0.97, 3.22 +/- 0.85, and 4.11 +/- 0.67 (Group C vs. Groups A and B, P < 0.0005; Group A vs. Group B, P > 0.30). Predominance of material in the right side of the colon was found in 13.7, 29.8, and 4.2 percent of Groups A, B, and C, respectively. In the three groups, nausea alone occurred in 3.8, 13.7, and 16.3 percent of patients; vomiting occurred in 0.6, 7.4, and 5.4 percent of patients; and dryness/thirst occurred in 1.9, 17.4, and 20.4 percent of patients, respectively. A total of 80.6 and 82.6 percent of those in Groups B and C who had previously had PEG expressed a preference for taking NaPh (P < 0.001). CONCLUSIONS: The regimen of Group C is significantly better than the regimens of Groups A or B in bowel cleansing. Regimens of Groups A and B did not differ in efficacy of cleansing. It is the timing of taking NaPh in the regimen of Group C rather than its composition that is responsible for its superior cleansing ability compared with PEG. Overnight deposition of small intestinal material in the right colon is partly responsible for the inferior cleansing ability of regimens that involve taking the solution on the day before colonoscopy. Despite a higher incidence of minor side-effects from NaPh than from PEG, a significantly higher proportion of patients preferred NaPh.

Aged↗

PubMed1997

Tumor cell implantation after colonoscopy with biopsies in a patient with rectal cancer: report of a case.

PURPOSE: Colonoscopy with biopsy(ies) is performed in patients with colorectal cancer for diagnosis and screening of synchronous lesions. There is some fear of spreading the disease related to implantation of tumor cells at sites of mucosal damage or to hematogenous or lymphatic spread as a result of tumor manipulation. METHODS: A total colonoscopy including biopsies, performed in a patient because of anal blood loss and tenesmus, revealed a circular, polypoid, ulcerated mass from 1.5 to 12 cm above the anal verge. After preoperative radiotherapy, the patient was subjected to surgical intervention. RESULTS: Histopathology revealed a poorly differentiated rectum adenocarcinoma, staged pT4N1Mx. At approximately 12 cm proximally from the tumor, a biopsy taken through a minute irregularity of the mucosa revealed some granulation tissue with adjacent normal colon mucosa. The basis of this granulation tissue, corresponding to submucosa, contained poorly differentiated tumor elements. CONCLUSIONS: This tiny lesion might have been caused by implantation of exfoliated cancer cells in a biopsy site. It may not be without risk to create excessive biopsy lesions in the presence of a manifestly malignant tumor because of the possibility of tumor cell implantation.

Adenocarcinoma↗

PubMed1999

Prospective observation of small "flat" tumors in the colon through colonoscopy.

PURPOSE: No prospective observations of "flat" tumors of the colon have yet been reported. The purpose of this study was to investigate the progression of small flat tumors by prospective observations using colonoscopy. METHODS: The shapes of flat tumors were classified into three types, including slightly elevated lesions with a flat top (flat-top type), slightly elevated lesions with a wide depression in the center (wide-depressed type), and slightly elevated lesions with a slit-like depression in the center (slit-depressed type). A total of 14 flat tumors of the colon in 13 patients (2 women; median age, 58; range, 46-72 years) were examined in this project. All cases were followed up prospectively using colonoscopy, and all underwent a resection using the submucosal saline injection and snaring technique. RESULTS: Because two patients were eventually dropped from the follow-up, only 12 lesions were studied. The observation period ranged from 11 to 26 (median, 19) months. At the time the observations started, the diameter of the tumors varied from 2 to 6 (median, 4) mm, and the shapes were flat-top type in five lesions, wide-depressed type in three lesions, and slit-depressed type in four lesions. Of the 12 flat tumors, 8 showed various changes in their shape. However, only two lesions demonstrated an increase in diameter of the tumor from 2 to 4 mm. In the other ten tumors any change in size was less than 2 mm. No lesions were carcinomas according to the final histologic diagnosis, but all were adenomas. CONCLUSIONS: Flat tumors of the colon did not rapidly progress when they measured approximately 5 mm in diameter. Such flat tumors did tend to change their shapes; however, such changes did not indicate invasion to the submucosal layer.

Adenoma↗

PubMed1999

Colonoscopy aided by magnetic 3D imaging: is the technique sufficiently sensitive to detect differences between men and women?

Colonoscopy tends to be more difficult to perform in women. Women also experience more pain during flexible sigmoidoscopy, and the mean insertion distance of the instrument is less than in men. The 'Bladen system', first described in 1993, is a non-radiological method of continuously visualising the path of the endoscope using magnetic drive coils under the patient and a chain of sensors up the biopsy channel of the instrument. In 1998, results were published that used a novel computer graphics system (the 'RMR system'), in which a much more realistic endoscope could be produced using the stored positional data from the Bladen system. The RMR computer graphics system has been further refined to enable measurement of the anatomical lengths of different parts of the large intestine to an accuracy of greater than 5 mm. The system is used to analyse the results obtained in 232 patients undergoing a total colonoscopy. In women, the colonoscope tends to form loops in the sigmoid colon more readily than in men (p < 0.05). When the first 50 cm of the endoscope are inserted for the first time, the tip passes either up to or beyond the splenic flexure in 40/116, or 34.5%, of males, compared with 24/117, or 20.5%, of females (p = 0.0137). It is demonstrated that women have longer transverse colons than men, and the differences are especially apparent when a stiffening tube is used to splint the left side of the colon (p < 0.0001). The possible relevance of these observations to biomedical engineers and those manufacturing and assessing prototype endoscopes is discussed.

Adult↗

PubMed1982

Bacteremia associated with lower gastrointestinal endoscopy, fact or fiction? I. Colonoscopy.

A survey of the medical literature reveals conflicting data as to whether bacteremia occurs during endoscopic examination of the lower gastrointestinal tract. In an attempt to study this problem a prospective study was undertaken, and the first arm of the study included patients undergoing colonoscopy. The second arm of the study, comprising patients undergoing proctosigmoidoscopy, will be presented subsequently. Fifty-one patients undergoing colonoscopy were studied. Excluded from the study were patients with elevation of temperature above 101 degrees F, inflammatory bowel disease, diarrhea, valvular heart disease, vascular prosthesis, chemotherapy, or immunosuppression. Aerobic and anaerobic culture were done before and after the procedure, as well as at timed intervals during the procedure. Whenever biopsy or polypectomy were carried out, further cultures were done. Skin cultures were done from venipuncture sites. In one patient (2 per cent) Staphylococcus epidermidis was found in more than one set of cultures. Polypectomy or biopsy were not associated with bacteremia.

Colonoscopy↗

PubMed1982

Retroperitoneal and mediastinal emphysema as a complication of colonoscopy.

Retroperitoneal and mediastinal emphysema as a complication of colonoscopy, though infrequent, may occur. It is important to realize that this can be a benign clinical condition that will resolve with conservative management. A case of retroperitoneal emphysema after routine colonoscopy is reported with a review of literature and a brief discussion.

Adult↗

PubMed1986

The role of colonoscopy in the assessment of patients with colorectal cancer.

A retrospective review of 176 patients with adenocarcinoma of the colon who underwent total colonoscopy preoperatively demonstrated synchronous carcinomas in 3.4 percent and synchronous polyps in 55.1 percent. Full-column barium enemas (68 patients) failed to identify cancer in 22 percent of patients and synchronous polyps in 58 percent of patients, a statistically significant (P less than 0.001) number of false-negative examinations. Double-contrast barium enemas (30 patients) failed to identify cancer in 27 percent of patients and synchronous polyps in 42 percent of patients, also a statistically significant (P less than 0.007) number of false-negative examinations. Full column and air contrast barium enemas identified all index cancers with distant metastases. Air-contrast barium enemas failed to identify 40 percent of "early" index cancers (confined to the bowel wall, negative nodes), and full-column barium enemas failed to identify 32 percent. The incidence of synchronous carcinoma and polyps underscores the need for total colon evaluation when a primary carcinoma is detected. Because of the poor accuracy of barium studies, total colonoscopy is the method of choice for this evaluation.

Adenocarcinoma↗

PubMed1987

Splenic injury as a complication of colonoscopy and polypectomy. Report of a case and review of the literature.

Injury to the spleen is a rare complication of colonoscopy and polypectomy. The danger of this unusual complication is real and its early recognition and proper management are essential to a favorable outcome. A case of injury to the spleen requiring splenectomy following colonoscopy and polypectomy is reported and discussed. Review of the literature by the authors revealed only six similar cases.

Aged↗