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PubMed1986

The value of colonoscopy in schistosomal, tuberculous, and amebic colitis. Two-year experience.

Forty-six patients were diagnosed as having schistosomal, tuberculous, or amebic colitis over a two-year period using colonoscopy and biopsy. Both schistosomal and tuberculous colitis could be diagnosed by characteristic endoscopic and histologic features in the majority of cases. Colonoscopy provided the added advantage of endoscopic polypectomy at the diagnostic session itself. The yield of granulomas in tuberculous lesions was 100 percent, although acid-fast bacilli could not be recovered from any. The endoscopic picture of amebic colitis often resembles that of inflammatory bowel disease; hence endoscopic biopsies are of paramount importance in establishing a correct diagnosis, especially in developing countries where both diseases exist with considerable frequency.

Adult↗

PubMed1986

Subcutaneous emphysema and pneumothorax complicating diagnostic colonoscopy.

A case of subcutaneous emphysema and pneumothorax secondary to a diagnostic colonoscopy is presented. While 11 cases of retroperitoneal emphysema due to colonoscopy were identified in the literature, there are only two further reports of pneumothorax. Possible etiologic and therapeutic aspects are discussed.

Colonoscopy↗

PubMed1987

Screening asymptomatic patients at high risk for colon cancer with full colonoscopy.

To evaluate the reliability of screening only the distal colon in patients at high risk for colonic cancer, the endoscopic findings of 49 completely asymptomatic patients who underwent colonoscopy based solely on a positive family history of colonic cancer (average age, 54.5 years) were reviewed. Polypoid lesions were present in 31 (63.3 percent). Thirty-three polyps in 13 patients were larger than 1 cm, including two invasive cancers. Eleven patients (22.4 percent) had polyps proximal to 40 cm only and would not have been identified on examination of the distal bowel alone. The predictive accuracy of rectosigmoid screening in this population is 78 percent. Initial screening of patients at high risk for colonic cancer should include full colonoscopy. The extent of follow-up examinations is then based on endoscopic findings.

Adult↗

PubMed1991

Emergency colonoscopy for the diagnosis of lower intestinal bleeding.

During the past 8 years, we performed emergency colonoscopy in 206 patients in whom severe bloody stools suggested bleeding of the lower digestive tract. The site of hemorrhage could be determined in 184 patients (89.3%). In cases with severe hemorrhage, the causes were stercoral rectal ulcer and bleeding from the small intestine or the upper GI tract. The bleeding tended to be mild in patients with other colon diseases. Determination of the bleeding site was impossible or difficult when a large amount of blood was present in the intestinal lumen or the blood was completely discharged. These observations suggest that emergency colonoscopy is effective for determination of the site of GI bleeding, but improvements are considered to be needed especially in the preparation for the examination in patients in critical condition.

Adult↗

PubMed2003

Is colonoscopy alone sufficient to screen for ulcerative colitis-associated colorectal carcinoma?

Patients with ulcerative colitis (UC) are at increased risk for colorectal carcinoma (CAC). Despite the fact that patients at risk are followed closely by colonoscopy to screen for dysplasia, the prevalence of CAC is still unacceptably high. The aim of this study was to evaluate the prevalence of risk factors for CAC, such as dysplasia, and to determine the relevance of colonoscopic surveillance in the group who went on to develop cancer. A series of 24 patients with UC were diagnosed with CAC. The patients' records were analyzed retrospectively for duration of UC, prevalence of preoperative dysplasia, and other cancer risk factors (CRFs) (e.g., pancolitis, primary sclerosing cholangitis, early onset of UC, and backwash ileitis). The mean age of the patients at the time of cancer diagnosis was 43 years with an average UC duration of 15 years (6 patients had had UC less than 8 years). CAC was identified preoperatively by colonoscopy in 15 of 24 patients, with an additional 7 of 15 showing flat dysplasia. Five of nine patients without preoperatively diagnosed CAC had flat dysplasia. Overall, 19 patients had additional CRFs, most of them with at least two more CRFs. Despite a regular colonoscopic follow-up for most patients with UC, flat dysplasia was missed in 12 patients preoperatively. Therefore we suggest that patient information should also always include surgical options in each case where significant cancer risk factors are found.

Aged↗

PubMed2002

Metachronous colon tumors: risk factors and rationale for the surveillance colonoscopy after initial polypectomy.

PURPOSE: We analyzed the possible risk factors for metachronous colon tumors after endoscopic resection of initial tumors. METHODS: Three hundred and twenty-one patients entered the surveillance study after colonoscopic resection of initial tumors between 1985 and 1999. Histology of initial tumors was adenoma in 214 patients and carcinoma in 107 patients. Solitary tumor was observed in 196 patients and multiple tumors in 125 at initial endoscopy. The median surveillance period was 39 (range, 12-112) months, and the median frequency of surveillance colonoscopy was three (range, 2-10) times. RESULTS: Metachronous neoplasms were identified in 114 of 321 surveillance cases (36%). In the 114 cases, the number of patients with metachronous adenoma was 103 (90%) and that of carcinoma was 11 (10%). Clinical characteristics at entry - including age, gender, multiplicity of polyp, histology of polyp, and site of polyp - were not different between patients with metachronous tumors and those without metachronous tumors. Kaplan-Meier analysis revealed that patients with a histology of carcinoma and those with multiple polyps at entry developed metachronous tumors significantly earlier than did patients with initial adenomas and initial solitary polyp, respectively ( P<0.001, P<0.001). However, other characteristics at entry did not produce significant differences in the rate of the development of metachronous tumors using Kaplan-Meier analysis. Proportional hazards model analysis revealed that histology of the initial tumor as carcinoma (relative risk, 1.690, 95% confidence interval, 1.118-2.555) and multiplicity (1.472, 1011-2.143) were significant risk factors for metachronous colon tumors. The 75%, 50%, and 25% metachronous tumor-free periods after initial polypectomy were 14, 21, and 39 months, respectively. CONCLUSIONS: These results may help optimizing surveillance strategies for metachronous colon tumors and raising the economic benefit of colonoscopy.

Adenocarcinoma↗

PubMed2003

Mechanical small bowel obstruction precipitated by colonoscopy.

Mechanical small bowel obstruction (SBO) is rare complication of colonoscopy. We present a patient who developed SBO 24 h after surveillance colonoscopy. Four years prior to this procedure, he had undergone augmentation cecocystoplasty with continent ileal conduit. He subsequently underwent laparotomy and lysis of a band adhesion that caused extrinsic compression of the ileum proximal to ileotransverse colostomy. We further review the literature, describe the salient features of colononoscopy-induced bowel obstruction, and identify the risk factors for this unusual complication.

Abdominal Pain↗

PubMed2005

A preliminary prospective study of the usefulness of a magnetic endoscope locating device during colonoscopy.

BACKGROUND: Although magnetic endoscope imaging of the colonoscope via the Endoscope Positioning Detecting Unit (EPDU) has been studied to some extent in Europe, its application in the United States has been limited. The purposes of this study were to determine whether the technique enabled for accurate localization of the lesion and to determine if and how the device facilitated scope insertion and completion of the colonoscopic exam. METHODS: Outpatient colonoscopies using the EPDU were performed by three experienced surgical endoscopists over a 5-month period. A specialized scope with electromagnetic coils or a regular scope with a magnetic probe insert in the instrument channel was used for the duration of the examination to identify loops and localize pathology. RESULTS: A total of 80 colonoscopies were performed with the device. In two patients, the probe insert was removed prior to completion of the procedure; thus, the total number of examinations included in the study was 78. The EPDU was used in conjunction with transillumination to estimate the location of polyps or cancers in the 33 patients (42%) in whom such lesions were found. In the four patients who subsequently underwent operation, the lesion's location as estimated by EPDU was verified. In regard to the usefulness of the device during insertion, the EPDU led to the discovery of loops and to the application of pressure that resulted in prompt completion of the examination in 28% of cases (deemed most useful). In 33% of cases, the device identified loops and led to the application of abdominal wall pressure and early position changes, thus facilitating the examination; however it did not lead to its immediate or rapid completion. In 39% of cases, the device was not required or used for insertion due to the simple nature of the examination. CONCLUSIONS: The EPDU was accurate in estimating lesion location. The device also holds promise as an aid in the completion of difficult exams (about 30% of cases in this study).

Adenocarcinoma↗

PubMed1997

Splenic rupture from colonoscopy. A report of two cases and review of the literature.

Splenic injury after colonoscopy is rare. Only 15 cases previously have been reported in the English literature. Partial capsular avulsion is the proposed mechanism of injury. Any condition causing increased splenocolic adhesions may be a predisposing factor to splenic injury. Two cases of splenic injury following colonoscopy are reported in addition to a complete review of the literature.

Colonoscopy↗

PubMed1998

Splenic hematoma. A rare complication of colonoscopy.

An extremely rare yet potentially fatal complication of colonoscopy is reported. A 52-year-old female developed a splenic subcapsular hematoma following routine colonoscopy. Conservative treatment was successful. In the English literature, only 14 similar cases have been reported. Treatment of a splenic flexure lesion, previous surgery with splenocolic adhesions, and inflammatory bowel disease increase the risk of such a complication. Increased awareness by surgeons and gastroenterologists should lead to prompt treatment and favorable outcome.

Colonoscopy↗

PubMed1998

How useful is colonoscopy in locating colorectal lesions?

BACKGROUND: It is important to establish the precise location of a colorectal lesion preoperatively. We used a model based on colorectal cancer to assess the efficacy of colonoscopy in locating these lesions. METHODS: We retrospectively analyzed all consecutive new colorectal cancer cases at the Department of Surgery, United Christian Hospital, Hong Kong, in 1995. RESULTS: Of the 123 cases reviewed by us, 84 cases satisfied the analysis criteria. The overall accuracy was 81%. It was especially high in the rectosigmoid region (93%) and descending colon (100%). The overall predictive power was 83%. It was especially high in the right-sided colon (100%) and the rectosigmoid region (93%). CONCLUSIONS: We conclude that colonoscopy is an accurate means for locating lesions in the upper rectum and sigmoid colon. It is also very predictive of lesions in the upper rectum, sigmoid colon, and right-sided colon.

Adult↗

PubMed1999

Laparoscopic treatment of colonic perforations related to colonoscopy.

BACKGROUND: Colonic perforations associated with colonoscopy are rare but major complications. Conservative treatment is less invasive than major surgery, but any case of failure leads to more extensive surgical procedures with a higher morbidity and mortality than the immediate operative repair. To reduce the invasiveness of major surgery and avoid the risk of failure, we introduced laparoscopic techniques to deal with iatrogenic colonic perforations. METHODS: Each colonic perforation was identified by diagnostic laparoscopy. The perforation was then characterized by size and extent of thermal damage into one of three types, followed by type-dependent treatment (suture, tangential resection, segmental resection, or open procedure). Operative time, complications, clinical outcome, and patient satisfaction were recorded. RESULTS: Seven patients underwent diagnostic laparoscopy for colonic perforations. Laparoscopic treatment was performed on five patients (one simple closure by suture, three tangential resections, and one segmental resection). Two cases required open procedures. There was one intraoperative complication that necessitated conversion. There were no postoperative complications. All laparoscopically treated patients were satisfied with their clinical outcome and cosmetic results. CONCLUSIONS: Laparoscopic treatment seems to reduce the invasiveness and morbidity of major surgery. At the same time, it is more definitive than conservative treatment, so that we now prefer to use laparoscopic techniques to treat colonic perforations related to colonoscopy.

Adult↗

PubMed2006

Splenic rupture after diagnostic colonoscopy: a case report.

Colonoscopy is a commonly used diagnostic and therapeutic procedure. Splenic injury or rupture after this procedure is rare. We report a case of splenic rupture and hematoma in a middle-aged man who presented with symptoms of worsened anemia after diagnostic colonoscopy.

Colonoscopy↗

PubMed2004

Actual colonic perforation in virtual colonoscopy: report of a case.

Computed tomography colonography, also termed virtual colonoscopy, is a new imaging method to investigate the colon, which may be a potential alternative to the conventional endoscopic colonoscopy in some cases. The high safety profile of this imaging method was considered as an additional advantage of this procedure. A case of colonic perforation in computed tomography colonography is presented, highlighting a potential risk related to this procedure. It is assumed that perforation was the result of overinflation of air into an obstructed colon caused by a lesion at the rectosigmoid junction. Thus, it is suggested that in such cases, air insufflation should be gradual, thereby minimizing the risk of perforation.

Adenocarcinoma↗

PubMed2003

Internal hernia as a complication of colonoscopy: report of a case.

After screening colonoscopy, a 65-year-old female developed small-bowel obstruction as demonstrated on abdominal CT scan. The obstruction was caused by a large herniation of the small intestine seemingly caused by the colonoscopic procedure. This is only the second report in the literature of incarcerated intestinal hernia as a complication of colonoscopy.

Aged↗

PubMed2003

Vertebral venous air embolism: an unusual complication following colonoscopy: report of a case.

Although fiberoptic colonoscopy has gained wide popularity as a diagnostic and therapeutic tool, there remains an inherent complication rate following colonoscopic evaluation. Endoscopically induced bowel perforation and uncontrolled bleeding often necessitate immediate surgical intervention. Another often-unrecognized complication is the introduction of air into the vertebral venous system. A case of vertebral venous air embolism after routine diagnostic colonoscopy is reported with a review of current literature.

Colonoscopy↗

PubMed2006

Microscopic colitis in routine colonoscopies.

Lymphocytic colitis (LC) and collagenous colitis (CC), both known as microscopic colitis (MC), are uncommon entities with increasing incidence as more clinicians take biopsies from macroscopically normal colons and as pathologists use more rigorous diagnostic criteria to be confident of the diagnosis. Information on the incidence of this type of colitis is limited and based on reported cases. The purpose of this work is to estimate the incidence of LC and CC in reviewed routine colonoscopies. We reviewed 2815 colonoscopies performed at a tertiary referral center with an open-access service using restricted histological criteria in order to establish the frequency rate of LC and CC in routine colonoscopic biopsy material. Cases suspicious for MC were stained with Masson's trichrome or Congo red stain and immunohistochemically for lymphocytes, where appropriate. Review of routine colonoscopic biopsies showed that MC is underreported in our colonoscopic material. Incidence rates of LC and CC (0.9 and 0.4, respectively) were based on morphological assessment of colonoscopic biopsies using stringent criteria together with clinical data and after differentiation with other lesions which can mimic MC. The 10.2% rate of this type of colitis in patients with chronic watery diarrhea indicates the necessity to consider these lesions in older individuals with diarrhea and normal endoscopical colonic mucosa.

Adult↗

PubMed2006

Fentanyl or tramadol, with midazolam, for outpatient colonoscopy: analgesia, sedation, and safety.

The present study determined the acceptability of colonoscopy in outpatients treated with tramadol or fentanyl for analgesia and sedation. One hundred fifty patients were randomly assigned to receive midazolam, 0.05 mg/kg, and fentanyl, 2 microg/kg, intravenously (group 1), midazolam, 0.05 mg/kg, and tramadol, 1 mg/kg, per os (group 2), or midazolam, 0.05 mg/kg, and tramadol, 2 mg/kg, per os (group 3). Pain severity, level of sedation, cardiorespiratory parameters, and procedure-related side effects and complications were registered and analyzed. No significant cardiorespiratory disturbances were observed. Sedation level during the procedure was similar in all groups. Pain severity values measured during the procedure was significantly higher in groups 2 and 3 than in group 1 (P < 0.001). Both hospital and home adverse events occurred more frequently in groups 2 and 3 compared to group 1 (P < 0.03). The patients receiving fentanyl-based analgesia tolerated colonoscopy better than patients treated with tramadol.

Adult↗