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At least 1,171 records · Page 65Linked to original sources
PubMed2006

Magnifying colonoscopy as a non-biopsy technique for differential diagnosis of non-neoplastic and neoplastic lesions.

AIM: To clarify whether mucosal crypt patterns observed with magnifying colonoscopy are feasible to distinguish non-neoplastic polyps from neoplastic polyps. METHODS: From June 1999 through March 2000, 180 consecutive patients with 210 lesions diagnosed with a magnifying colonoscope (CF-200Z, Olympus Optical Co., Ltd., Tokyo, Japan) were enrolled. Magnification and chromoendoscopy with 0.2% indigo-carmine dye was applied to each lesion for mucosal crypt observation. Lesions showing types I and II crypt patterns were considered non-neoplastic and examined histologically by biopsy,whereas lesions showing types III to V crypt patterns were removed endoscopically or surgically. The correlation of endoscopic diagnosis and histologic diagnosis was then investigated. RESULTS: At endoscopy, 24 lesions showed a type I or II pit pattern, and 186 lesions showed type III to V pit patterns. With histologic examination, 26 lesions were diagnosed as non-neoplastic polyps, and 184 lesions were diagnosed as neoplastic polyps. The overall diagnostic accuracy was 99.1% (208/210). The sensitivity and specificity were 92.3% (24/26) and 99.8% (184/186), respectively. CONCLUSION: Magnifying colonoscopy could be used as a non-biopsy technique for differentiating neoplastic and non-neoplastic polyps.

Adenoma↗
PubMed2002

Colonoscopy as a screening test for colorectal cancer in average-risk individuals.

Screening for colorectal cancer has become the standard of care and is currently recommended by most major health organizations, including the American Cancer Society. Randomized controlled trials using fecal occult blood testing as the screening strategy have shown a reduction in mortality due to colorectal cancer. However, colorectal cancer differs from other cancers in that a variety of screening tests have been approved and recommended by experts. The advantages and disadvantages of different screening tests have been the subject of intense debate. Colonoscopy has theoretical advantages over other screening tests, including direct visualization of the entire colon and, more importantly, removal of precancerous adenomatous lesions. This review discusses the advantages and disadvantages of colonoscopy as a screening test for colorectal cancer with regard to efficacy, cost-effectiveness, and patient compliance.

Barium Sulfate↗
PubMed1986

The influence of colonoscopy on the operative management of colorectal cancer.

Total colonoscopy was used in the evaluation of 85 patients with colorectal cancer, either preoperatively or within six months of surgery. Synchronous lesions (six carcinomas, 22 adenomatous polyps, one villous adenoma and nine cases of severe diverticular disease) were detected in 38 (44.7%) patients. The planned surgical procedure was altered in 10 patients (11.8%)--a more extensive resection being performed in each case. In particular, five of the six cases of synchronous cancers were located in different surgical segments. Colonoscopy is a necessary prerequisite in the evaluation of patients with colorectal cancer.

Aged↗
PubMed2001

The histopathology of 103 consecutive colonoscopy biopsies from 82 symptomatic patients with acquired immunodeficiency syndrome: original and look-back diagnoses.

OBJECTIVE: To compare the primary diagnoses assigned by general surgical pathologists on a series of 103 consecutive colon biopsies from individuals infected with human immunodeficiency virus (HIV) with diagnoses rendered by a pathologist with extensive experience in gastrointestinal pathology in HIV/acquired immunodeficiency syndrome. DESIGN: New sections were cut from paraffin blocks of 103 consecutive colon biopsies taken during colonoscopies of 82 different HIV-infected patients; all new sections were stained with hematoxylin-eosin. These individuals either had negative stool studies or had failed to respond to therapy and had chronic large bowel symptoms, such as frequent small volume-type diarrhea, tenesmus, and/or bright red blood per rectum. Immunohistochemistry for cytomegalovirus (CMV) was performed on 18 of 22 specimens originally diagnosed with CMV colitis. RESULTS: The initial study yielded 70 (68%) negative or nonspecific diagnoses, 22 (21%) cases of CMV colitis, 5 (5%) Cryptosporidium diagnoses, 2 cases each of adenomatous polyps and Kaposi sarcoma, and 1 case each of spirochetosis and squamous cell carcinoma of the anorectum. Review of the recuts yielded 64 (62%) negative or nonspecific diagnoses, 12 (12%) new adenovirus infections (3 combined with CMV), and 11 (11%) lone CMV infections. Three attaching and effacing bacterial infections were diagnosed, 1 with adenovirus coinfection. A total of 4 spirochetosis cases were found on review. Seven (7%) of the biopsies showed at least 1 coinfection. Nine biopsies had features suggestive of inflammatory bowel disease. CONCLUSIONS: Colonoscopy with biopsy after negative stool studies or failure to respond to therapy yielded a high proportion of negative or nonspecific diagnoses. Adenovirus and enteropathogenic bacterial infections had been totally overlooked on initial examination. It takes particular experience to evaluate gastrointestinal biopsies from HIV-infected patients.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Optimal timing of colonoscopy to screen for cancer in ulcerative colitis.

Patients with ulcerative colitis have a high risk of colon cancer that increases with duration of disease. Annual colonoscopy with biopsies for 99 patients with pancolitis and a mean duration of disease at entry of 17 years was evaluated. The outcomes of mucosal dysplasia or cancer were analyzed to determine the annual risk (hazard rate) of high-grade dysplasia or colon cancer. The hazard rates were used to recommend screening intervals. The delay in the diagnosis of cancer is minimized for any given number of tests when the time between tests is inversely proportional to the square root of the hazard rate. Since the hazard rate for cancer increases with duration of disease, intervals for screening tests should not be uniform. For a range of reasonable marginal benefits from additional testing, the number of tests recommended is less than the number of tests done in fixed-interval screening programs. Scheduling screening tests using patient-specific hazard rates to minimize the delay in the diagnosis of cancer reduces the number of colonoscopies, associated cost, and morbidity.

Adolescent↗
PubMed2004

Location of adenomas missed by optical colonoscopy.

BACKGROUND: Previous estimates of the adenoma miss rate with optical colonoscopy (OC) are hindered by the use of OC as its own reference standard. OBJECTIVE: To evaluate the frequency and characteristics of colorectal neoplasms that are missed prospectively on OC by using virtual colonoscopy (VC) as a separate reference standard. DESIGN: Prospective, multicenter screening trial. SETTING: 3 medical centers. PARTICIPANTS: 1233 asymptomatic adults who underwent same-day VC and OC. MEASUREMENTS: Colorectal neoplasms (adenomatous polyps) missed at OC before VC results were unblinded. RESULTS: Fourteen (93.3%) of 15 nonrectal neoplasms were located on a fold; 10 (71.4%) of these were located on the backside of a fold. Five (83.3%) of 6 rectal lesions were located within 10 cm of the anal verge. LIMITATIONS: Estimation of the OC miss rate depended on polyp detection on both VC and second-look OC and therefore underestimates the true OC miss rate, particularly for smaller polyps. CONCLUSIONS: Most clinically significant adenomas missed prospectively on OC are located behind a fold or near the anal verge. The 12% OC miss rate for large adenomas (>or=10 mm) when state-of-the-art 3-dimensional VC is used as a separate reference standard is increased from the previous 0% to 6% estimates derived by using OC as its own reference standard.

Adenoma↗
PubMedDate not supplied

[The assessment of colonic polyps found via colonoscopy].

AIM: To evaluate the histopathological characteristics of colonic polyps, found during colonoscopy examination and endoscopic polypectomy, and their relation to age, tumor location, sex, histological type and degree of epithelial dysplasia. MATERIAL AND METHODS: Between 1996 and 1997, 2,465 total colonoscopies were performed at the Gastroenterology Department of the Virgin Macarena University Hospital in Seville. Different size polyps were found in 318 patients who had been referred because of several symptoms/by several centers. The mean age was 59.2 years in men and 61.5 years in women. RESULTS: 446 polyps were removed by endoscopic polypectomy, 32 (7.2%) were hyperplastic polyps, 402 were adenomas (90.2%) and 12 (2.6%) were adenomas with adenocarcinoma. Seventy-five percent of adenomas were located in the left colon and rectum and 25% in right colon. Hyperplastic polyps were found in left colon. Of the polyps removed, 55.1% were smaller than 1 cm, 26.5% were between 1 and 2 cm and 18.4% were between 2 and 7 cm. Histopathologic study of adenomas revealed that 17% were villous adenoma, 80% were tubular adenomas and 3% were tubulovillous adenomas. Adenocarcinomas were found in 12 (2.8%) adenomas. Of the adenomatous polyps, 87.4% had low-grade dysplasia and 12.6% high-grade dysplasia. Statistical analysis showed a strong correlation between size of adenoma and degree of dysplasia (p < 0.05). Similar significant relation was found between histological type and size (p < 0.05) but there were no statistically significant differences between location, sex or age, and degree of dysplasia (p < 0.05). CONCLUSIONS: Size of colonic polyps is related to epithelial dysplasia and histological type (p < 0.05). No correlation was found between location, sex or age and degree of dysplasia.

Adenocarcinoma↗
PubMed1999

[Comparative study of histopathological effects of preoperative chemotherapy using UFT and in vitro MTT assay of colonoscopy specimens from patients with colorectal cancer].

In previous studies, we demonstrated that the histopathological effects of 5-FU on colorectal cancer corresponded with the clinical effects. We measured the chemosensitivity of colorectal cancer to 5-FU by MTT assay using specimens from colonoscopy, and compared this with the histopathological effects. Forty-five patients with histologically proven colorectal cancer were enlisted for this study. Patients first underwent colonoscopy, and MTT assays were performed. Afterwards, preoperative UFT chemotherapy at a dose of 600 mg/day was given over 10 days before the operation. The histopathological effects of the resected tumors in response to 5-FU were estimated. Seven of 37 patients were judged sensitive to 5-FU by MTT assay. The response rate was 18.9%. On the other hand, 30 of 37 were evaluated as insensitive. Five of 7 patients with sensitivity to 5-FU were also evaluated as sensitive according to the histopathological effects. The sensitivity true positive rate was 71.4%. Twenty-nine patients without sensitivity to 5-FU were also evaluated as insensitive according to the histopathological effects. The specificity true negative rate was 96.7%, and the accuracy rate was 91.9%. The chemosensitivity of colorectal cancer to 5-FU, determined by MTT assay, was nearly consistent with the histopathological effects, so it may also be expected to correspond with the clinical effects.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1999

A prospective randomised study comparing polyethylene glycol and sodium phosphate bowel cleansing solutions for colonoscopy.

Polyethylene glycol (Klean-Prep, Norgine) is widely used for bowel cleansing in the United Kingdom. This study compares the efficacy, acceptability and adverse effects of a polyethylene glycol (PEG) solution with sodium phosphate (Fleet Phospho-soda, De Witt) for bowel preparation prior to colonoscopy. Two hundred and nine consecutive patients were prospectively randomised to either PEG or sodium phosphate (SP) preparation. The endoscopist was blinded to the randomisation process. Fifty patients were excluded from the study because of previous colectomies or incomplete data. Of the remaining 159 patients, 88 had been randomised to the PEG group and 71 to the SP group. There was no difference in sex distribution between the groups. There were no significant differences between groups in terms of patient acceptability, side effects (nausea/vomiting and abdominal cramps), adequacy of bowel preparation and colonoscopy completion rates. 74% of the PEG and 70.4% of the SP group were rated by the endoscopist as having good or excellent bowel preparation. Sodium phosphate is well tolerated without additional side effects when compared with PEG solution. Both solutions were found to be equally effective in bowel cleansing.

Cathartics↗
PubMed2000

Detailed colonoscopy for detecting early superficial carcinoma: recent developments.

Early superficial colorectal carcinoma (CRC) has been commonly detected by routine colonoscopic examination in Japan. A series of 769 early CRCs and 4821 adenomas were diagnosed by colonoscopy at Hiroshima University Medical Hospital between 1991 and 1998. Of early CRCs, macroscopically superficial early CRCs accounted for 209 lesions (28%). Among 5590 lesions of adenomas and carcinomas, depressed-type lesions showed a significantly higher malignant potential for cancerous and submucosal invasion than elevated lesions (polypoid, IIa-type lesions, and G-LST). As one of the quantitative examinations for early CRC, pit pattern observed by magnifying video-colonoscopy was useful. We performed magnifying observations for 265 lesions of colorectal neoplasias using Kudo's pit pattern classification for 2 years. Depressed-type lesions characterized the Ills and V pit patterns, and elevated lesions characterized the III(L) pit pattern. The incidence of cancer was significantly higher in lesions with IIIs and V pit patterns. Furthermore, the V(N) pit pattern was considered a significant indicator of submucosal invasion. These results indicated that superficial early CRC could be considered to constitute about one-third of all early CRCs. Of them, the depressed-type lesions showed a significantly higher malignant potential than elevated lesions. Pit pattern observation by magnifying videocolonoscopy is useful for predicting the histology/invasion depth of early CRC.

Adenomatous Polyps↗
PubMed1997

[Laparoscopy-assisted colonic polypectomy or how to be helped by laparoscopy to prevent colectomy in benign colonic polyps considered to be unresectable by colonoscopy].

The aim of this study was to prospectively evaluate the role of laparoscopic surgery in all patients presenting with colonic polyps. From April 1994 to April 1996, 16 consecutive patients were treated. The laparoscopy starts the procedure, then a colonoscopy easily and rapidly locates the colonic lesion. Under laparoscopic supervision a new snare polypectomy is often possible. If polypectomy remains impossible, a mini-laparotomy is performed above the polyp and allows polypectomy by extra-peritoneal colotomy. In one case, the polyp was not found on colonoscopy. Colonoscopic polypectomy was possible in 6 cases (40%), and 9 mini-laparotomies were necessary (60%). No colectomy was performed. The final histologic result showed two Dukes A carcinomas justifying secondary wide colectomy. Laparoscopy-assisted polypectomy is a safe and efficient procedure, allows complete excision of polyps and may avoid a colonic resection.

Aged↗
PubMedDate not supplied

Colonoscopy in symptomatic patients with positive family history of colorectal cancer.

BACKGROUND: Most patients with colorectal cancer (CRC) develop clinical signs and symptoms which are not specific for CRC, and usually at a late stage of the disease, resulting in a considerable delay of the diagnosis. In our study we examined patients with bowel symptoms which were at increased risk for developing CRC, because of their family history. METHODS: Over the last 6 years, colonoscopy was performed in 203 patients with colorectal symptoms, who had at least one Ist degree relative with CRC, at the Colorectal Surgery Unit of St George's Hospital. Five hundred ninety two individuals without CRC family history and with either rectal bleeding (n = 479), or with change of bowel habits (n = 113) were used as control group. RESULTS: In the group of patients with family history of CRC 81 colonic lesions were found in 53 patients (53/203, 26%). Patients with family history of CRC were grouped in three categories according to their main symptom. In the subgroup of patients with bleeding (n = 129) there were found 46 colonic lesions in 33 patients. In the subgroup of patients with change of bowel habits (n = 45) we were able to detect 39 colonic lesions. In the group of patients with abdominal pain (n = 29) 4 patients had a metaplastic polyp and one patient had a neoplastic polyp. With regard to the number of 1st degree relatives with CRC, we found that 16/172 (9%) patients with one such relative and 4/31 (13%) of the patients with two relatives were diagnosed with neoplastic polyps. CONCLUSIONS: Total colonoscopy (TC) is an excellent diagnostic procedure for the examination of symptomatic patients with positive family history of colorectal cancer. TC has a diagnostic role detecting the cause of symptoms or excluding the presence of malignancy. Simultaneous resection of the neoplastic and metaplastic polyps, provides an additional, secondary prevention of CRC.

Abdominal Pain↗
PubMed2000

["Virtual colonoscopy": back to the future?].

"Virtual colonoscopy" is a new method of producing an endoscopic view of the colon without endoscopy. The images are derived from the data of conventional abdominal computer-tomography or magnetic resonance tomography, using modern computer programmes. The method makes it possible to detect colonic polyps or carcinomas with a sensitivity and specificity of 80%. The most interesting application of "virtual colonoscopy" may be as a screening method for colorectal polyps in preventing the development of colorectal cancer. This may improve patient acceptance for colorectal cancer screening programmes.

Colonic Neoplasms↗
PubMed2002

[Colonoscopy in preoperative staging and treatment of colorectal cancer].

OBJECTIVES: To investigate the value of colonoscopy for the diagnosis and preoperative staging of colorectal cancer, and evaluate the significance of correct preoperative staging in guiding treatment. METHODS: 28 patients with colorectal cancer were examined by general colonoscopy, magnifying endoscopy and endoscopic ultrasonography before operation. Preoperative staging, and proper treatment protocols were made. RESULTS: Endoscopy revealed that 15 of the 28 patients had early colorectal cancer and 13 advanced colorectal cancer. The correct diagnosis rate for preoperative staging was 100%; the accuracy of penetrating depth was 89% (25/28). In the early cases, tumour invasion was confined to mucosal layer in 11 patients and submucosal layer in 4. Six patients with early cancers 6 cm from the anus were treated by endoscopic mucosa resection (EMR) or EMR combined with open surgery. No postoperative recurrence was found by endoscopy during the period of follow-up for 12 - 40 months. CONCLUSION: Correct preoperative staging for colorectal cancer is of important significance in guiding treatment, especially in early staging cases. In order to improve the quality of life for colorectal cancer patients, we should treat them with individualized operation based on curative resection.

Adult↗
PubMedDate not supplied

Subjects older than 60 years with negative findings on sigmoidoscopy should still undergo colonoscopy.

BACKGROUND/AIMS: The objective of this study was to evaluate the impact of age on the prevalence of proximal clinically important lesions in subjects without any rectosigmoid neoplasm. METHODOLOGY: The present study involved 497 patients (aged > or = 50 years old) who underwent a colonoscopy because of abdominal symptoms or positive fecal occult blood test. A proximal colon was defined as one proximal to a sigmoid colon. Clinically important lesions were defined as adenocarcinoma, tubular adenoma > or = 1 cm in diameter, or adenoma with villous histology or high-grade dysplasia. RESULTS: Of the 497 patients, 83 had clinically important lesions in the proximal colon. Of those 83, 53 patients had no neoplasm in the distal colon or rectum. In patients with no distal neoplasm, the prevalence of proximal clinically important lesions in subjects over 60 years old significantly exceeded that in patients aged 50-60 (39/105 vs. 14/125; P < 0.0001). In patients with distal neoplasm, the prevalence of proximal clinically important lesions in subjects over 60 was similar to that in 50 to 60-year-old subjects (16/119 vs. 14/148; P = 0.406). CONCLUSIONS: Results suggest that subjects older than 60 years old should still undergo a colonoscopy even if they have no neoplasm on sigmoidoscopy.

Adenoma↗
PubMed2002

Colonoscopy for colorectal cancer screening in African Americans.

BACKGROUND: Studies show an increase in right-sided adenomas and cancers. In African Americans, a near equal distribution of right- and left-sided colorectal adenomas and cancers or even a predominance of right-sided adenomas and cancers has been shown. This study evaluated the location of both colorectal polyps and cancers in self-identified African Americans evaluated at Howard University Hospital. METHODS: A retrospective chart review of endoscopic records and the computerized tumor registry at Howard University Hospital for self-identified African Americans with polyps on colonoscopy and colorectal cancer diagnosed and/or treated between January 1, 1993 and December 31, 1999 was carried out. Polyps and cancers were documented as being right sided, left sided, both right and left sided, and unspecified when the location of the lesion was not documented. RESULTS: Eight hundred and thirty-seven patients had adenomas removed from 1993 to 1999, of which 36.3% had right-sided and 42% had left-sided adenomas. Three hundred and twenty patients were diagnosed and/or treated for colorectal cancer from 1993 to 1999, of whom 44.2% had right-sided and 46.7% had left-sided cancers. CONCLUSION: Our study revealed near equal distribution of right- and left-sided colorectal adenomas and cancers in African Americans. Colonoscopy as opposed to sigmoidoscopy appears to be the appropriate modality for screening African Americans at average risk for colorectal cancer.

Adenoma↗
PubMedDate not supplied

[Role of colonoscopy in the diagnosis and management of lower gastrointestinal hemorrhage].

The purpose of he study was to analyze the role of the Colonoscopy in the diagnosis and treatment of low intestinal hemorrhages. We studied retrospectively all patients with Hematochezia, seen by the author, from april 1984 to december 1997. We studied the clinical symptoms, causes, localizations of the bleeding and the treatment applied, either endoscopic or surgical. We also reviewed the security and tolerance of the procedure. We could detect without doubt the cause in 74 patients (51.7%), including patients with multiple colon diverticulum, where the bleeding is sometimes very difficult to detect. We concluded that the Colonoscopy is the best method to find the source of bleeding in the lower portion of the colon. The procedure is well tolerated and safe in elderly patients.

Adolescent↗