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Results for “Colonoscopy”

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At least 1,099 records · Page 61Linked to original sources

PubMed2003

Hydrogen breath test as an indicator of the quality of colonic preparation for colonoscopy.

BACKGROUND: Breath hydrogen levels after ingestion of polyethylene glycol were evaluated as a method of predicting the quality of colonic preparation. METHODS: One hundred patients undergoing nonemergency colonoscopy were recruited for this study. After fasting overnight, they were instructed to ingest a polyethylene glycol solution containing 12 g lactulose at a rate of 50 mL every 5 minutes for 2 hours. During ingestion of the polyethylene glycol solution, breath samples were taken at 15-minute intervals for 240 minutes and breath hydrogen concentration was measured. RESULTS: The preparation for colonoscopy was judged to be poor in 18% and adequate in 82%. The breath hydrogen levels over 90 minutes were significantly higher in the poor group than in the adequate group. In all patients with a breath hydrogen level less than 10 parts per million at 240 minutes, the preparation was adequate. Conversely, all patients with a poor preparation had a breath hydrogen level of more than 10 ppm at 240 minutes. CONCLUSIONS: The hydrogen breath test effectively predicts adequacy of colonic preparation.

Adult↗

PubMed1999

Population-based surveillance by colonoscopy: effect on the incidence of colorectal cancer. Telemark Polyp Study I.

BACKGROUND: Most cases of colorectal cancer (CRC) develop from adenomas. Polypectomy is believed to reduce the incidence of CRC, but this effect has never been explored in prospective controlled studies. The aim of the present study was to evaluate the effect of polypectomy on colorectal cancer incidence in a population-based screening program. METHODS: In 1983, 400 men and women aged 50-59 years were randomly drawn from the population registry of Telemark, Norway. They were offered a flexible sigmoidoscopy and, if polyps were found, a full colonoscopy with polypectomy and follow-up colonoscopies in 1985 and 1989. A control group of 399 individuals was drawn from the same registry. In 1996 both groups (age, 63-72 years) were invited to have a colonoscopic examination. Hospital files and the files of The Norwegian Cancer Registry were searched to register any cases of CRC in the period 1983-96. RESULTS: At screening endoscopy 324 (81%) individuals attended in 1983 and 451 (71%) in 1996. From 1983 to 1996, altogether 10 individuals in the control group and 2 in the screening group were registered to have developed CRC (relative risk, 0.2; 95% confidence interval (CI), 0.03-0.95; P = 0.02). A higher overall mortality was observed in the screening group, with 55 (14%) deaths, compared with 35 (9%) in the control group (relative risk, 1.57; 95% CI, 1.03-2.4; P = 0.03). CONCLUSION: Endoscopic screening examination with polypectomy and follow-up was shown to reduce the incidence of CRC in a Norwegian normal population. The possible effect of screening on overall mortality should be addressed in larger studies.

Aged↗

PubMed2005

Assessment of the cough reflex after propofol anaesthesia for colonoscopy.

BACKGROUND: Dysfunction of the cough reflex as a result of the lingering effects of anaesthetics may lead to aspiration pneumonia or retained secretions after general anaesthesia. It is unknown whether low concentrations of propofol alter the cough reflex in the early period after anaesthesia. The objective of this study was to investigate the effect of low concentrations of propofol on the cough reflex sensitivity as assessed by the cough reflex threshold to an inhaled irritant. METHODS: Fifteen, ASA I-II, non-smoking patients undergoing elective colonoscopy were studied. Anaesthesia was induced and maintained with a blood target-controlled propofol infusion. Cough reflex threshold was measured with citric acid. Increasing concentrations of nebulized citric acid (2.5, 5, 10, 20, 40, 80, 160, 320, and 640 mg ml(-1)) were delivered during inspiration until a cough was evoked. The citric acid concentration eliciting one cough (C1) was defined as the cough reflex threshold. C1 was log transformed for statistical analysis (Log C1). Log C1 was measured before anaesthesia and during the recovery period with estimated decreasing propofol concentrations of 1.2, 0.9, 0.6, and 0.3 microg ml(-1). RESULTS: Log C1 (median; interquartile range) measured with propofol concentrations of 1.2, 0.9, 0.6, 0.3, and 0 microg ml(-1) were 1.9 (0.6), 1.9 (1.0), 1.9 (1.1), 1.9 (0.6), and 1.9 (0.7) mg ml(-1) (NS), respectively. However, light sedation was observed with propofol concentrations of 1.2 and 0.9 microg ml(-1). CONCLUSION: This study indicates that residual sedation after propofol anaesthesia for colonoscopy does not adversely affect the cough reflex.

Adult↗

PubMed1993

Colonoscopy-associated listeriosis: report of a case.

We report a case of meningitis due to Listeria monocytogenes that occurred following colonoscopy. The patient had cirrhosis, a portosystemic shunt, and diarrhea for which she was being evaluated. Only one previous report has linked colonoscopy to listeriosis. We review the pathogenesis of listeriosis and, in particular, the evidence that prior fecal colonization is followed by bacteremia in a susceptible host. The findings in this case are consistent with this pathogenetic sequence.

Adult↗

PubMed2005

Sole use of dexmedetomidine has limited utility for conscious sedation during outpatient colonoscopy.

BACKGROUND: This study evaluated the ability of dexmedetomidine to provide analgesia and sedation for outpatient colonoscopy, examining outcomes including cardiorespiratory variables, side effects, and discharge readiness. METHODS: Sixty-four patients were randomly assigned to one of three treatment regimens. In group D, patients received 1 microg/kg dexmedetomidine over 15 min followed by an infusion of 0.2 microg x kg x h. Group P received meperidine (1 mg/kg) with midazolam (0.05 mg/kg), and group F received fentanyl (0.1-0.2 mg intravenous) on demand. The assessment included measurements of heart rate, blood pressure, oxygen saturation, respiratory rate, quality of sedation/analgesia, and an evaluation of the recovery time. RESULTS: The study was terminated before the planned 90 patients had been recruited because of adverse events in group D. In all groups, negligible hemoglobin oxygen saturation and respiratory rate variations were observed. In group D, there was a significantly larger decrease in heart rate (to approximately 40 beats/min in 2 of 19 cases) and blood pressure (to less than 50% of the initial value in 4 of 19 patients). Supplemental fentanyl was required in 47% of patients receiving dexmedetomidine to achieve a satisfactory level of analgesia (vs. 42.8% of patients in group P and 79.2% of patients in group F). Vertigo (5 patients), nausea/vomiting (5 patients), and ventricular bigeminy (1 patient) were observed only in group D. Time to home readiness was longest in group D (85 +/- 74, 39 +/- 21, and 32 +/- 13 min in groups D, P and F, respectively; P = 0.007). CONCLUSIONS: The use of dexmedetomidine to provide analgesia/sedation for colonoscopy is limited by distressing side effects, pronounced hemodynamic instability, prolonged recovery, and a complicated administration regimen.

Adult↗

PubMed1983

Therapeutic and diagnostic colonoscopy in nonobstructive colonic dilatation.

Cecal perforation has been well established as a consequence of mechanical obstruction of the distal colon and has been estimated to occur in 1.5% to 7% of patients with colon obstruction. Perforation of the cecum also occurs in cases of nonobstructive colonic dilatation (NCD). Although the incidence is unknown, the mortality rate is nearly 50%. Over an eight-year period, 44 patients (mean age 59 years) underwent 52 colonoscopic examinations for presumed NCD. Twelve patients (27%) developed NCD while convalescing from a recent operation and 29 patients (66%) had major systemic disorders that preceded the development of NCD. Medical treatment for an average of 2.6 days was uniformly unsuccessful. Mean cecal diameter prior to colonoscopy was 12.8 cm (range 9.5 to 17 cm). Based on radiographic or clinical criteria, 38 patients (86%) were successfully decompressed on the initial colonoscopic examination; mean cecal diameter decreased to 8.7 cm (p less than 0.01). Perforation of the cecum during colonsocopy occurred in one patient (2%) who survived. Fourteen patients died; six deaths were attributed solely to the patient's who underwent operation. In summary, colonoscopy is a safe and effective therapeutic and diagnostic tool in cases of massive cecal dilatation. It should be considered before cecostomy in patients without radiographic evidence of pneumoperitoneum or clinical signs of peritoneal irritation.

Adult↗

PubMed1992

Colonoscopy and the pediatric patient.

Recent advances in the field of flexible fiberoptic technology have facilitated the diagnosis and treatment of a wide variety of gastrointestinal diseases in children. As a result, pediatric patients are becoming more common in the endoscopy suite. Although many technical aspects of colonoscopy are the same whether applied to adult or pediatric patients, subtle differences do exist. Recognition of these differences will lead to a safer and more successful procedure for the pediatric patient. This article addresses the application of colonoscopy to pediatric populations based on review of current literature and personal experience of the author.

Child↗

PubMedDate not supplied

Patient satisfaction with conscious sedation for ambulatory colonoscopy in a community hospital.

Patient acceptance of ambulatory colonoscopy is important for colon cancer screening programs to be successful. The goal of this study was to assess patient satisfaction with the method of conscious sedation that is standard in most endoscopy units. The authors also attempted to identify patient characteristics associated with a poor sedation experience. The findings suggest that 90% of ambulatory patients undergoing colonoscopy are adequately sedated with the standard meperidine midazolam regimen. The only patient characteristic found to predict poor sedation response was the preceding use of a prescription narcotic as an outpatient.

Adult↗

PubMedDate not supplied

Health belief assessment regarding screening colonoscopy.

The purpose of this study was to assess (by questionnaire) health beliefs related to colorectal cancer screening via colonoscopy in a population 50 years of age and older. The Health Belief Model provided the theoretical framework for data collection. The study design was a nonexperimental exploratory survey. A total of 42 subjects (31% male, 69% female) completed a 14-item questionnaire that addressed psychological factors including health beliefs. Descriptive statistics were used for data analysis. Results of this study show there is a need for appropriate health education to trigger people to take preventive action such as colonoscopy. Community based health education programs should be designed to induce behavioral change by teaching the client the benefits of prevention and early detection of colorectal cancer, to which the client is susceptible. Future health education programs guided by this research will contribute to the reduction of highly preventable deaths from colorectal cancer while lowering the enormous cost of treating this condition.

Aged↗

PubMedDate not supplied

The importance of abdominal pressure during colonoscopy: techniques to assist the physician and to minimize injury to the patient and assistant.

This article outlines techniques that can be used to assist the physician's ability during colonoscopy to achieve cecal intubation in both standard situations and in specific conditions such as the obese patient. When applied properly, abdominal pressure can help shorten the length of the procedure, minimize the angle of turns in the colon, and minimize discomfort to the patient. A Mayo physician survey unanimously concluded that abdominal pressure is beneficial during colonoscopy. This article addresses the ergonomics of applying pressure and suggests techniques that minimize risk of injury to both the patient and the assistant. In addition, questions that new assistants may ask are addressed.

Abdomen↗

PubMedDate not supplied

A prospective study to assess the efficacy and patient tolerance of three bowel preparations for colonoscopy.

The adherence to the required clear liquid diet and a high-volume bowel cleansing solution prior to colonoscopy often leads to poor patient compliance and inadequate exams. This study evaluated the efficacy and patient tolerance of three bowel preparation regimens prior to colonoscopy. One hundred fourteen patients were randomized to one of three preparations. Group 1 was assigned a clear liquid diet/magnesium citrate and bisacodyl prep; group 2 was assigned to receive a diet kit/magnesium citrate and bisacodyl prep; and group 3 received a diet kit/polyethylene glycol electrolyte prep. The adequacy of bowel preparation was graded by the endoscopists performing the procedures. The preparations were rated by patients for tolerance, compliance, and side effects. The three methods of preparation did not prove to be significantly different in regards to efficacy of colon cleansing or patient tolerability. There was also no difference in compliance between the three regimens. There were no reported side effects in any of the study groups. This study suggests that a low-residue diet kit, given in conjunction with polyethylene glycol electrolyte or magnesium citrate and bisacodyl, produces adequate colon cleansing and patient tolerability.

Administration, Oral↗

PubMed2000

Magnetic resonance colonography and virtual magnetic resonance colonoscopy with the 1.0-T system: a feasibility study.

RATIONALE AND OBJECTIVES: An ex vivo study and a clinical, prospective, patient study were undertaken to evaluate the feasibility of magnetic resonance (MR) colonography with a 1.0-T system. METHODS: An ex vivo colon model was scanned. A cleaned pig colon was prepared with six simulated sessile polyps (diameters of 4-12 mm) and one simulated pedunculated polyp (diameter of 5 mm). Subsequently, five patients (aged 39-81 years; four women, one man) were examined with MR colonography, immediately followed by endoscopic colonoscopy. After preparation for colonoscopy, the colon was filled with a Gd-DTPA/water solution (1:100). A breath-hold 3D gradient-echo sequence was acquired in both the prone and supine positions and after intravenous Gd-DTPA administration. Images were analyzed interactively by using multiplanar projections, maximum-intensity projection, and a virtual endoscopic view. The MR results were compared with the findings of the fiberoptic endoscopy. RESULTS: All seven simulated lesions of the colon model could be detected by MR imaging. In one patient, an advanced colon cancer as well as an additional small polyp was depicted. In the other four patients, single polyps with a diameter of 1 to 2.5 cm and a large adenoma were visualized by MR colonography. Contrast enhancement of the polyps was noted only after subtraction. CONCLUSIONS: The 1.0-T system is feasible for MR colonography. Reduced requirements for hardware could contribute to establish the novel technique as a screening method for colorectal polyps.

Adenoma↗

PubMedDate not supplied

Detection of colonic polyps in a phantom model: implications for virtual colonoscopy data acquisition.

PURPOSE: Virtual colonoscopy is a new method of colon examination in which computer-aided 3D visualization of spiral CT simulates fiberoptic colonoscopy. We used a colon phantom containing various-sized spheres to determine the influence of CT acquisition parameters on lesion detectability and sizing. METHOD: Spherical plastic beads with diameters of 2.5, 4, 6, 8 and 10 mm were randomly attached to the inner wall of segments of plastic tubing. Groups of three sealed tubes were scanned at 3/1, 3/2, 5/1 collimation (mm)/pitch settings in orientations perpendicular and parallel to the scanner gantry. For each acquisition, image sets were reconstructed at intervals from 0.5 to 5.0 mm. Two blinded reviewers assessed transverse cross-sections of the phantoms for bead detection, using source CT images for images for acquisitions obtained with the tubes oriented perpendicular to the gantry and using orthogonal reformatted images for scans oriented parallel to the gantry. RESULTS: Detection of beads of > or = 4 mm was 100% for both tube orientations and for all collimator/pitch settings and reconstruction intervals. For the 2.5 mm beads, detection decreased to 78-94% for 5 mm collimation/pitch 2 scans when the phantom sections were oriented parallel to the gantry (p = 0.01). Apparent elongation of beads in the slice direction occurred as the collimation and pitch increased. The majority of the elongation (approximately 75%) was attributable to changing the collimator from 3 to 5 mm, with the remainder of the elongation due to doubling the pitch from 1 to 2. CONCLUSION: CT scanning at 5 mm collimation and up to pitch 2 is adequate for detection of high contrast lesions as small as 4 mm in this model. However, lesion size and geometry are less accurately depicted than at narrower collimation and lower pitch settings.

Colon↗

PubMed1987

Splenic rupture at colonoscopy.

We report splenic rupture a few hours after a colonoscopy. Even though the patient had no previous history of splenic injury or symptoms attributable to splenocolonic adhesions, exploration revealed adhesions between the spleen and the colon at the level of the splenic flexure. Pathological examination revealed capsular thickening and fibrosis. Splenocolonic adhesions may lead to potentially lethal rupture of the spleen. A careful history prior to endoscopy should rule out pathological conditions that may lead to formation of adhesions between the spleen and the colon. In addition, the endoscopist should consider splenic rupture after colonoscopy in the patient who develops abdominal pain and acute anemia without evidence of intestinal perforation or external bleeding.

Colonoscopy↗

PubMed1988

The role of colonoscopy in the diagnosis of tuberculosis.

The value of colonoscopy in the diagnosis of ileocolonic tuberculosis at Groote Schuur Hospital was assessed and the published world experience reviewed. During a 4-year period, abdominal tuberculosis was diagnosed in 94 patients, of whom 18 manifested involvement of the ileocecal area and/or colon. Colonoscopy, performed in 10 of these, provided diagnostic information in 7. Since the endoscopic appearance of diseased mucosa is nonspecific, adequate bacteriological and histological assessment of biopsied tissue is essential to differentiate tuberculosis from other disorders that may simulate it. We stress the importance of microscopy and culture for Mycobacterium tuberculosis.

Adult↗

PubMed1991

Colonoscopy without prior preparation in mild to moderate active ulcerative colitis.

We evaluated the effect of different types of preparations on the diagnostic yield of colonoscopy (total or limited) in mild to moderate active ulcerative colitis. Our ability to determine the extent of disease and see the mucosa beyond the inflamed areas was assessed in patients receiving no preparation (group A, 72 examinations) and those receiving diphosphosoda enemas (group B, 181 examinations). There were three failures in group A and 11 in group B. In the majority of patients (71% of group A, 83% of group B) the scope could be passed under optimal viewing conditions at least one segment beyond the involved area. In group A the cecum was reached in 16% of the procedures and in group B in 18%. We conclude that in mild to moderate active ulcerative colitis, colonoscopy can be performed without preparation, and still achieve the same results as with preparatory enemas.

Cecum↗

PubMed2004

Fractured colon: an endoscopically distinctive lesion associated with colonic perforation following colonoscopy in patients with collagenous colitis.

BACKGROUND: Collagenous colitis is characterized by collagen deposition in the superficial colonic mucosa, beneath the surface epithelium, resulting in chronic nonbloody diarrhea of variable severity. The mucosa generally appears endoscopically normal. METHODS: We report the occurrence of distinctive linear mucosal tears, unassociated with trauma, in 4 patients during diagnostic colonoscopy. The patients' tissue specimens were examined histologically, and clinical courses were recorded. OBSERVATIONS: Recognition of linear "fractures" was followed in 3 patients by colonic perforation. One patient required colectomy. Severe collagenous colitis was present in all. The resection specimen contained shallow linear ulcers overlying fibrotic submucosa, with pneumatosis and acute peritonitis. CONCLUSIONS: We theorize that the stiffness of the colon in areas of collagenous colitis with submucosal fibrosis makes it susceptible to linear "fractures" during colonoscopic air insufflation with subsequent transmural air dissection. We urge extreme caution if this lesion is recognized at colonoscopy and recommend aborting the examination and obtaining plain radiographs to detect free intraperitoneal air.

Aged↗

PubMed1997

Colonoscopy preparation in children: safety, efficacy, and tolerance of high- versus low-volume cleansing methods.

BACKGROUND: The use of large-volume electrolyte balanced solutions as preparation for colonoscopy often results in poor patient compliance and acceptance. The tolerance, safety, and efficacy of high-versus low-volume colon-cleansing methods as preparation for colonoscopy in children were compared by randomized operator-blinded trial. METHODS: Twenty-nine children ages 3.6-14.6 years had either high-volume nasogastric balanced polyethylene glycol electrolyte lavage (20 ml/kg/ h) until the effluent was clear (n = 15), or two oral doses of sodium phosphate solution (22.5-45 ml) separated by oral fluid intake (n = 14). RESULTS: Both preparations were equally effective. The low-volume preparation was better tolerated and caused less discomfort that the high-volume preparation, judging by serial nurse observations. The incidence of abdominal symptoms, diarrhea, sleep disturbance, and vomiting was not significantly different between the two groups. Both groups had a small reduction in mean hematocrit and serum calcium levels. The sodium phosphate preparation caused increases in mean serum sodium concentrations from 140 to 145 mmol/L and serum phosphate concentrations from 1.41 to 2.53 mmol/L. Ten hours after the commencement of the preanesthetic fast, these concentrations had returned to normal. CONCLUSIONS: There are advantages in terms of tolerance, discomfort, and case of administration with acceptable colonic cleansing with the use of the less-invasive oral sodium phosphate low-volume colon-cleansing preparation in children. Safe use requires ensuring an adequate oral fluid intake during the preparation time and avoidance of use in patients with renal insufficiency.

Adolescent↗