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At least 1,027 records · Page 57Linked to original sources

PubMed2000

Colorectal cancer screening 2000: the role of colonoscopy in average-risk individuals.

Colorectal cancer fulfills all of the criteria of a disease process that is suitable for a screening program. Several screening tests are effective in preventing mortality from colorectal cancer and are widely recommended. Despite the lack of direct comparisons, there is compelling indirect evidence that programs using colonoscopy as the primary tool are likely to be more effective than programs using fecal occult blood testing or flexible sigmoidoscopy as initial strategies. Colonoscopy-first programs are more expensive initially, but their cost effectiveness may prove to be comparable with the currently recommended programs in certain settings.

Colonoscopy↗

PubMed2006

Recent advances in chromoscopic colonoscopy and endomicroscopy.

The basic rationale for secondary prevention of colorectal carcinoma is by endoscopic polypectomy. New technologies in the form of high-magnification or "zoom" colonoscopy complemented by chromoscopic agents permit early detection of neoplastic colorectal lesions, particularly flat and depressed types. Detailed morphologic characteristics of the surface crypt or "pit pattern" can be obtained with these techniques, enabling an in vivo "optical biopsy" and staging tool. Establishing suitability for endoscopic resection or surgical excision can be enhanced using these techniques. Furthermore, chromoscopic colonoscopy may have a role in routine endoscopic colorectal cancer surveillance programs in patients at high risk for colorectal neoplasia, such as those with long-standing ulcerative colitis and familial colorectal cancer syndromes. This review summarizes recent data regarding the prevalence and histopathologic characteristics of flat and depressed colorectal lesions in Western cohorts and describes how their detection and management can be improved by chromoscopy and magnification technology. We outline these techniques from a clinical perspective and describe the basic principles of endoscopic mucosal resection.

Colonic Polyps↗

PubMed1981

Colonoscopy in children.

The flexible 65 cm endoscope, while introduced for use in the diagnosis of colonic disease in adults, has proven valuable for diagnosis and treatment in children. The diameter of the American Cystoscope Company's instrument makes it ideal for children. The spectrum of colonic disease in children parallels that in adults. Although carcinoma is rare, polypoid disease, colitis, enterocolitis and lymphoid hyperplasia are sufficiently common to warrant consideration of colonoscopy. The present study, while small, suggests the usefulness of this procedure. With the use of the easily maneuvered, short instrument, a surgeon experienced in colonoscopy can reduce the need for laparotomy in many children.

Adolescent↗

PubMed1983

Colonoscopy: an essential monitoring technique after resection of colorectal cancer.

A pilot study was undertaken to determine the usefulness of colonoscopy in the postoperative follow-up of patients with colorectal cancer. Of 56 patients, 9 (17 percent) had positive intraluminal examinations, including one recurrent cancer and three large polyps (greater than 1 cm) despite normal barium enema films. Twenty percent had negative colonoscopic findings which ruled out suspicious lesions on roentgenograms. More than one third had alterations in therapy as a result of colonoscopic examination. Colonoscopy is a useful and fruitful diagnostic aid in the follow-up of colon cancer. It should be used early in the postoperative period and added at rational intervals in long-term surveillance. It appears to complement other accepted methods of detecting recurrence.

Adenoma↗

PubMed1990

Colorectal adenomas in the Lynch syndromes. Results of a colonoscopy screening program.

Forty-four asymptomatic putative Lynch syndrome patients participated in a colonoscopy screening program. There were 18 men and 26 women; mean age was 44 yr. Thirty percent of Lynch syndrome patients had at least one adenoma; 20% had multiple adenomas. In 18% of the patients, adenomas were discovered proximal to the splenic flexure. In a reference group of 88 age- and sex-matched patients, 11% had adenomas, 4% had multiple adenomas, and 1% had right-sided adenomas. Twenty-one Lynch syndrome patients had follow-up colonoscopies. Of 7 patients with adenomas on initial examinations, 6 had adenomas at follow-up. Of 14 patients with negative initial examination results, 3 had adenomas at follow-up. The prevalence of adenomas in the Lynch syndromes is greater than in an unselected reference group. The adenomas are more proximally located, corresponding to the site of cancer distribution in the Lynch syndromes. A high rate of synchronous and metachronous lesions is found. Our findings support the hypothesis that adenomatous changes are the premalignant lesion in the Lynch syndromes. We also found evidence of heterogeneity among Lynch syndrome families in adenoma incidence.

Adenoma↗

PubMed2005

A prospective study of a new immunochemical fecal occult blood test in Korean patients referred for colonoscopy.

OBJECTIVES: The exquisite performance characteristics of an immunochemical fecal occult blood test (IFOBT) are well understood. We evaluated the diagnostic validity of a new IFOBT for colorectal neoplasia in patients undergoing colonoscopy and compared its results with two other commercially available IFOBTs. DESIGN AND METHODS: Eighty-five consecutive patients referred for colonoscopy were studied. We performed three different IFOBTs, namely, HM-Jack, Instant-View, and a newly developed OcculTech on each fecal specimen. RESULTS: OcculTech was easy to perform and had a sensitivity, specificity, and positive predictive value of 58.3%, 76.3%, and 27.9%, respectively, for the detection of colorectal cancers and >or=1 cm adenomas. OcculTech showed higher sensitivity than the automatic analyzer, HM-Jack. No improvement was obtained by combining tests. CONCLUSIONS: The OcculTech test had performance characteristics comparable to the two other IFOBTs. This study confirms the usefulness of the OcculTech test for colorectal neoplasia screening.

Adenoma↗

PubMed2006

Routine ileoscopy at colonoscopy: a prospective evaluation of learning curve and skill-keeping line.

BACKGROUND: Ileoscopy is the criterion standard for mucosal lesions of terminal ileum but is performed in 5% of colonoscopy activity, and the need for training is undefined. OBJECTIVE: To assess the learning curve and skill-keeping line of ileoscopy. DESIGN: Prospective randomized study. SETTING: Single GI endoscopy unit. PATIENTS: Adult outpatients referred for colonoscopy. INTERVENTIONS: Patient randomization to ileocolonoscopy by trainees and seniors. MAIN OUTCOME MEASUREMENTS: Ileoscopy skill was divided into the following: ileocecal valve (ICV) intubation (success rate, time) and ileal exploration (length, time). Consecutive blocks of 10 procedures were used to calculate the learning curve and the skill-keeping line. Variables considered to influence ICV intubation were the following: endoscopist experience, ICV morphology, patient age, gender, body mass index, diverticular disease, and preceding abdominal/pelvic surgery. RESULTS: Learning curve showed that competency in ICV intubation (80% success rate) and ileal exploration (16 cm) was achieved after 50 procedures. The skill-keeping line showed that ileoscopy was easy (97% success rate), fast (1 minute), and well accepted up to 45 cm of the ileum. Thin-lipped and volcanic ICV are the most difficult and easiest to intubate, respectively. Crohn's disease and adenomas of the proximal edge of ICV were diagnosed in 2.2%. CONCLUSIONS: Training in ileoscopy is recommended to achieve competency, and endoscopists should consider practicing ICV intubation to maintain and increase their skill. Ileoscopy can be difficult when the ICV is thin lipped or single bulged, and easy when it has a volcanic morphology.

Aged↗

PubMed2006

The Cath-Cam: a new concept in colonoscopy.

BACKGROUND: Guidewires and catheters exert less force on the gut wall than an endoscope. OBJECTIVE: To develop a guidewire-assisted device for colonoscopy. METHODS: A light-weight flexible catheter illuminated with light-emitting diodes was designed to carry an ultraslim high-resolution videoendoscope of 3 mm. Tip bend stiffness was 5 times less than a colonoscope. Hinged guidewires were passed, folded, through the accessory channel. A loop could be rapidly formed to explore the lumen. RESULTS: The catheter followed curves of excised pig colon and exerted significantly less force on the colon wall than a colonoscope (mean 1.6 +/- 0.23 N vs 3.0 +/- 0.37 N, P < .05; bend-radius, 80 mm). Survival studies in pigs showed that the guidewire loop could be advanced under visual control and the Cath-Cam could be advanced by using much less force than the colonoscope. CONCLUSIONS: A catheter-based colonoscope with a miniature video imager reduced the force required for successful colonoscopy in pigs.

Animals↗

PubMed2005

New imaging techniques at colonoscopy: tissue spectroscopy and narrow band imaging.

Although colonoscopy has undergone impressive development in recent decades, there remains a need for better endoscopic visualization in specific circumstances (eg, dysplasia screening in ulcerative colitis and detection of flat colorectal lesions). Many techniques are under investigation; this article discusses different forms of spectroscopy and narrow band imaging. Ideal colonoscopy should have high diagnostic accuracy and the ability to screen large mucosal areas. The most successful clinical method probably will be a combination of techniques, providing wide-area surveillance (such as fluorescence endoscopy or immunoscopy) and point detection methods, such as narrow band imaging or confocal microendoscopy, that can be used to identify the lesion further.

Animals↗

PubMed2006

Flexible sigmoidoscopy and colonoscopy during pregnancy.

More than 6000 pregnant women each year have an indication that warrants a flexible sigmoidoscopy or colonoscopy. In addition to the potential complications inherent in the risk of sedation and the procedures themselves, the endoscopist who performs these procedures in pregnant women must be aware of the potential to do harm to the fetus. This article reviews the existing literature as it pertains to flexible sigmoidoscopies and colonoscopies performed during pregnancy, including indications and diagnostic usefulness, safety, use of medications, and therapeutic interventions.

Colonoscopy↗

PubMed2006

Rational colonoscopy, realistic simulation, and accelerated teaching.

The authors hope that the combination of ScopeGuide imager (to make sense of colon looping) and the new-generation Colonoscopy Simulator (allowing structured teaching and repetitive practice) will make it possible to accelerate colonoscopy training and perhaps also will provide an acceptable way of re-honing the skills of existing endoscopists.

Clinical Competence↗

PubMed2005

Laparoscopic repair of colon perforation after colonoscopy in children: report of 2 cases and review of the literature.

Perforation of the colon is an uncommon complication of colonoscopy in children. In the past, such injuries were treated by laparotomy with primary repair or colostomy. We performed laparoscopic primary repair of the colon in 2 young boys who showed signs of bowel perforation after colonoscopic polypectomy. Both recovered uneventfully and were discharged within several days of admission. In the first patient, the colon had been well prepared, and the perforation was identified almost immediately, resulting in minimal peritoneal contamination. The second patient presented 48 hours after colonoscopy, but there was no gross fecal contamination. In each case, primary repair was felt to be a safe option. Laparoscopic primary repair of colon perforation after colonoscopic polypectomy in children appears to be safe and effective in selected cases. Advantages of the minimally invasive approach include the ability to evaluate the entire colon for injuries, more rapid postoperative recovery, and improved cosmesis.

Child, Preschool↗

PubMed1995

Can barium enema indicate when colonoscopy will be difficult?

The barium enemas of 48 consecutive patients, who were technically difficult to intubate at colonoscopy, were compared to those of 46 patients who were not. Measurements were taken of colonic length and mobility, and an assessment made of diverticular disease. Rectosigmoid length (mean difficult group = 61 cm, mean control = 54 cm, P = 0.01) and total colonic length (mean difficult group = 157 cm, mean control = 140 cm, P < 0.0001) were greater in the difficult colonoscopy group as were transverse colon mobility (mean difficult group = 10 cm, mean control = 7 cm, P = 0.003) or redundancy (transverse colon reaching the true pelvis on the erect film); 65% difficult group vs 17% control group, P < 0.0001. The presence of moderate or severe diverticular disease was also greater in the difficult (23%) compared to the control (4%) group, P = 0.02. When available, assessment of a previous barium enema is a useful guide to probable technical difficulty of colonscopy. It may allow appropriate allocation of potentially difficult cases to specialist endoscopy lists.

Adolescent↗

PubMed2000

Patient-controlled analgesia for conscious sedation during colonoscopy: a randomized controlled study.

BACKGROUND: The aim of this study was to assess whether patient-controlled anesthesia (PCA) can improve patient tolerance for colonoscopy. We compared baseline sedation and analgesia with baseline sedation and PCA. METHODS: Fifty-six consecutive patients were alternatively allocated to 1 of 2 groups: either to control group (n = 28) to receive standard sedation (meperidine and midazolam as baseline and additional doses of meperidine administered by the anesthesiologist) or to a PCA group (n = 28) to receive the same baseline premedication but additional analgesia with meperidine being self-administered. Cardiopulmonary parameters were recorded and tolerance for the examination was evaluated by a numeric rating scale, 0 meaning "no pain" and 10 meaning "maximal pain." RESULTS: Patients' mean pain score (on a scale of 0 to 10) was 4.85 +/- 3.74 for the PCA group and 5.30 +/- 3.53 (not significant) for the control group. Physicians' assessment of patient tolerance registered a lower numeric rating score than patients' assessment. The duration of the procedure was slightly longer in the PCA group. None of the patients experienced a decline in oxygen saturation below 90%; a decrease in expiratory carbon dioxide during the examination was noted in both groups of patients, particularly during the first minutes of the examination. Mean additional sedation per patient in the PCA group was slightly higher, but not significantly different. CONCLUSIONS: Our results suggest that patient-controlled analgesia during colonoscopy is as effective as standard sedation with respect to patient tolerance and safety of the examination.

Aged↗

PubMed2004

Colonoscopy in the diagnosis of intestinal tuberculosis in asymptomatic patients.

BACKGROUND: Colonoscopy with terminal ileoscopy is crucial for the diagnosis of intestinal tuberculosis. This report describes characteristic endoscopic findings in patients with intestinal tuberculosis with few or no clinical symptoms. METHODS: Data for 11 consecutive patients in whom a diagnosis of intestinal tuberculosis was made during the last 15 years in one facility were reviewed. Clinical findings and the frequency of endoscopic findings were evaluated. Mucosal lesions were classified into 4 types: type 1, circumferential ulceration with nodules; type 2, round or irregularly shaped small ulcers, arranged circumferentially, without nodules; type 3, multiple erosions restricted to the large intestine; and type 4, small ulcers or erosions restricted to the ileum. The gross endoscopic appearance of healed lesions included patulous ileocecal valve, pseudodiverticular deformity, and atrophic mucosal areas with aggregated ulcer scars. RESULTS: Only one patient had remarkable clinical symptoms (anorexia and weight loss), whereas, the other 10 had few or no symptoms. The frequency of type 1, 2, 3, and 4 endoscopic findings was, respectively, 36%, 36%, 9%, and 18%. The frequencies for patulous ileocecal valve, pseudodiverticular deformity, and atrophic mucosal area were, respectively, 45%, 45%, and 91%. CONCLUSIONS: When colonoscopy is performed in asymptomatic patients, it is important to be aware of subtle endoscopic findings that are characteristic for intestinal tuberculosis. Recognition of such findings may lead to a correct diagnosis of early stage intestinal tuberculosis.

Adult↗

PubMed2004

A prospective, observational study of colonic mucosal abnormalities associated with orally administered sodium phosphate for colon cleansing before colonoscopy.

BACKGROUND: Colonic mucosal abnormalities associated with sodium phosphate colonic preparations have been described. The aim of this prospective study was to determine the frequency at which these occur and to define the endoscopic and histopathologic patterns of these changes. METHODS: Within a 16-month period, 730 of patients referred for elective colonoscopy entered the study. Patients with known inflammatory bowel disease and those taking non-steroidal anti-inflammatory drugs were excluded. A sodium phosphate solution was ingested orally 14 and 8 hours before endoscopy. After standard colonoscopy, a 3-year clinical follow-up program was conducted. RESULTS: Endoscopically, mucosal lesions, possibly associated with sodium phosphate ingestion, were visible in 24 patients (3.3%). Erosions were found in 3 patients, aphthoid lesions in 21 patients, and an ulcer in one patient. Lesions often were multiple. Histopathologically, findings included focal active inflammation in 14 of 24 patients, mucosal disruption and erosion (7/24), edema of the lamina propria (5/24), mucosal hyperemia or focal hemorrhage (5/24), lymphoid nodules (5/24), and ulceration (1/24). CONCLUSIONS: Orally administered sodium phosphate-associated colonic mucosal abnormalities are infrequent but can mimic an non-steroidal anti-inflammatory drug-induced injury or inflammatory bowel disease, and in particular must be differentiated from Crohn's disease.

Cathartics↗

PubMed1981

Prophylaxis of infective endocarditis during colonoscopy: report of a survey.

Ninety-eight directors of infectious disease training programs responded to a questionnaire about bacterial endocarditis prophylaxis for susceptible patients during colonoscopy. Although 54% recommended a penicillin and an aminoglycoside, antibiotics commonly used to protect against the enterococcus, there are no published data to support the use of prophylaxis. Most directors of gastrointestinal training programs do not routinely use antibiotic prophylaxis during colonoscopy. If antibiotics are chosen, they should include a penicillin and an aminoglycoside or vancomycin (alone or with aminoglycoside) at the dosage schedule suggested by the American Heart Association Committee.

Anti-Bacterial Agents↗

PubMed1981

Colonoscopy in ischemic colitis.

Fifteen patients with ischemia of the colon are presented. The majority showed a similar clinical presentation with hematochezia, abdominal pain, and diarrhea in an elderly patient population having associated disease. Colonoscopy was abnormal in all patients studied. Three endoscopic stages were recognized; (1) acute stage characterized by petechiae, pallor, and hyperemia; (2) subacute stage consisting of ulceration and exudation; and (3) chronic stage characterized by stricture, decrease in haustrations, and mucosal granularity. Conventional barium enemas were abnormal and suggested ischemic colitis in six of 15 patients. Rigid proctoscopy was normal or demonstrated nonspecific proctitis in 12 of 15 patients studied. Colonoscopic biopsies demonstrated superficial inflammatory changes in all patients. Thirteen patients had complete mucosal healing endoscopically in 2 weeks to 3 months with stricture developing in four patients. Because ischemic colitis is a distinct subtype of ischemic bowel disease most often limited to the superficial mucosa, colonoscopy is an alternative and usually safe modality in the diagnosis of this entity and proved more accurate that conventional x-ray and proctoscopy.

Aged↗