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PubMedDate not supplied

Efficacy and safety of oral sodium phosphate versus polyethylene glycol solution for bowel preparation for colonoscopy.

OBJECTIVE: To assess the acceptability, safety and effectiveness of an oral sodium phosphate solution (Exelyte) for colon preparation prior to colonoscopy, compared with a polyethylene glycol solution (Peglec). METHOD: A colonoscopist-blinded, prospective, randomized, observational clinical study. PATIENTS: One hundred patients undergoing colonoscopy for various indications were randomized (n = 50 each) to receive either 90 mL of oral sodium phosphate mixed with 300 mL clear liquid and then consume about 4-5 glasses of water, or 2 liters of polyethylene glycol solution. RESULT: Sodium phosphate showed a safety profile similar to that of polyethylene glycol. However, patients tolerated it better. The colonoscopist reported similar cleansing of bowel in both groups. CONCLUSION: Oral sodium phosphate is well tolerated, is safe and provides bowel cleansing similar to that with a polyethylene glycol solution.

Administration, Oral↗

PubMedDate not supplied

[The complications of diagnostic colonoscopy].

Major complications of diagnostic colonoscopy based on a series of 17.583 procedures performed from 1980 throughout 1991 are reported. No higher risk of colon perforation was registered either performing total or partial colonoscopy, for the site of perforation was in most cases the sigmoid colon.

Colon↗

PubMedDate not supplied

[Colonic perforation after colonoscopy: our experience].

The authors describe 6 cases of perforation during colonoscopy, occurring over the period from 1981 to 2001, out of a total of 7358 endoscopic examinations performed. Five of these perforations were found as complications of operative colonoscopy. In one case the endoscopic view of the omentum immediately revealed the perforation. Four patients underwent surgical treatment and in two cases medical therapy was implemented. In agreement with the literature, the authors stress that the management of iatrogenic colon perforations is quite difficult and depends upon the clinical features. While conservative treatment is indicated in minimal perforations in patients in good general condition with no signs of peritoneal irritation, surgery must be performed in all uncertain situations. A delay in performing surgical treatment may sometimes prove fatal.

Colon↗

PubMedDate not supplied

[Conventional colonoscopy versus chromoendoscopy and magnifying endoscopy for the diagnosis of colorectal lesions: a comparative prospective study in 995 patients].

Early endoscopic diagnosis of colorectal cancers is the best tool for the reduction of colorectal cancer mortality, but conventional colonoscopy seems unable to detect minor changes in the colorectal mucosa. The authors compare the results of conventional colonoscopy and chromoendoscopy plus magnifying endoscopy for the detection of colorectal lesions. This prospective study evaluated 995 consecutive selected patients. All patients with a previous diagnosis of colorectal polyps, inflammatory bowel disease, history of colorectal surgery, high coagulative risk or poor bowel preparation were excluded from the study. All examinations were performed by a single endoscopist. The authors compared the results of conventional endoscopy and chromoendoscopy with a 0.4% indigo carmine solution and magnifying endoscopy. At the end of each examination, data from ordinary and dye-spraying views were carefully recorded. A total of 202 protruding, 99 flat and 5 depressed lesions were detected. The incidence of high-grade dysplasia and early carcinoma was 9.9% for protruding lesions, 13.1% for flat lesions and 60% for depressed lesions. Chromoendoscopy revealed new neoplastic patterns not detectable at conventional endoscopy in 127 patients. This prospective study shows the high accuracy rate of chromoendoscopy for the detection of non-polypoid lesions. Chromoendoscopy could be used as a routine procedure in order to enhance the early diagnosis of colorectal cancers.

Adenocarcinoma↗

PubMedDate not supplied

[Surveillance and cost-effectiveness of colonoscopy in asymptomatic increased risk subjects of colorectal cancer: Ferrara experience].

Colorectal cancer represents the second leading cause of cancer deaths in western countries with elevated costs for health service. It's very important to develop screening and surveillance programs for cancer prevention with "cost-effective" means. We present a surveillance program with colonoscopy focused on first degree relatives of CRC patients. Colonoscopy is a "cost-effective" mean of screening for high risk subjects.

Adult↗

PubMed1992

[Splenic rupture following colonoscopy: an unusual complication].

A case of splenic rupture after an uneventful diagnostic colonoscopy in a 68-year old man is reported. Conservative management of this complication was successful. Splenic rupture is a unique and severe complication of colonoscopy, which can rarely be managed conservatively.

Aged↗

PubMed1992

Senna vs. bisacodyl in addition to Golytely lavage for colonoscopy preparation--a prospective randomized trial.

Colonoscopy preparation with lavage is a clinically accepted procedure. After having shown that its results can be improved by the additional intake of Senna this randomized prospective trial was designed to evaluate the effects of different laxatives in a combined preparation regimen. The day before endoscopy either Bisacodyl or extractum Sennae was given to 120 patients. Immediately before examination all patients underwent whole gut irrigation with Golytely solution. Patient acceptance and effectiveness of the two procedures were excellent and no relevant intolerance was observed. Satisfactory cleansing results were achieved with Bisacodyl as well as with Senna (98.3 vs. 95%). There was no significant difference between the laxatives used. We conclude that both regimens are safe, generally well tolerated and effective ways of preparation for colonoscopy.

Adult↗

PubMed2005

Real-time haptic interface for VR colonoscopy simulation.

Colonoscopy is an endoscopic medical procedure where the colon of the patient is examined. This minimally invasive technique is performed with a colonoscope, a long tube with an integrated imaging device at its tip. The doctors performing these procedures require high skills in multiple domains such as hand-eye coordination, visualization, safety and ease at guiding flexible endoscopes. The importance of training colonoscopy procedures rises with the growth of variety of colon diseases. In order to safely train surgeons to these procedures, a computer-assisted haptic simulator is proposed. This paper describes both the haptic hardware interface and virtual reality software that compose the training system. A high friction belt is used to render the required forces and to insure the absence of slippage. A differential drive actuated with two DC motors enables to set the system into translation and rotation. A virtual reality environment has been developed to provide real-time visualisation and force feedback.

Colonoscopy↗

PubMed2004

[A laparoscopic management of an iatrogenic lesion of the colon during a colonoscopy].

The colon injury during a colonoscopy is a rare, however a serious complication, requiring, mostly, a surgical management. Only few patients may undergo a conservative treatment. The authors discuss the problem of the iatrogenic colon perforation during the colonoscopy and they assess a benefit of the miniinvasive surgery in the diagnostics and treatment algorithm. The main benefit is seen in the reduction of the surgical intervention risks, in the surgical trauma minimalisation, in more favourable postoperative status and in the possibility of the definitive injury management.

Aged↗

PubMed2005

IUD removal with colonoscopy: a case report.

BACKGROUND: Intrauterine device (IUD) perforation of the bowel is uncommon. Although IUD perforation may be asymptomatic, the most common complaint is unexplained abdominal pain. CASE: A case of IUD perforation of the large bowel was diagnosed 7 years after insertion. The patient presented with unexplained lower abdominal pain diagnosed initially as pelvic inflammatory disease. Laparoscopy revealed that the IUD was embedded deeply in the rectum. Bowel preparation and intravenous antibiotics followed by colonoscopy using a grasping snare resulted in successful IUD removal. CONCLUSION: Patients presenting with IUDs embedded in the large bowel may benefit from attempted removal using colonoscopy rather than laparotomy. Bowel preparation, intravenous antibiotics and pos-textraction evaluation to rule out perforation may be prudent.

Adult↗

PubMed2005

[Importance of colonoscopy combined with biopsy in the diagnosis of colonic Crohn's disease].

OBJECTIVE: An attempt was made to provide a better insight into endoscopic and histological features and/or problems encountered when establishing a diagnosis of colonic Crohn's disease (Crohn's colitis). METHODS: As presented in our 27 cases with Crohn's colitis, the endoscopic findings and histological changes of biopsy specimens were summarized. As collated with correspondent results of biopsy and surgical specimens, the diagnostic accuracy of endoscopy was evaluated. RESULTS: twenty-six involvements of the large intestine (combined with other sites of the intestine) was found (96.3%). However, involvement limited to the colon alone was seen in only 4 cases (14.8%). Endoscopically, overlapped lesions with multistaged-segmental distributed and multi-sited diverse patterns (destructive and proliferative/regenerative) of inflammatory changes were observed. Endoscopic accuracy was 66.7%. The characteristic features of mucosal biopsy include focal distribution of the lesions, a thickened and edematous submucosa, deep fissuring ulcers, lymphoid aggregate, and hyperplasia, fibrosis and granulomas (detected in 30% of the group), etc. CONCLUSIONS: Colonic involvement of Crohn's disease is common. Colonoscopy may be valuable in establishing the diagnosis and in assessing the extent and severity of colonic involvement, and CDEIS was value in the follow up of patients. Colonoscopic biopsies are helpful for verification of the diagnosis in difficult cases. Colonoscopy has replaced radiology as the initial test of choice in many clinical situations.

Biopsy↗

PubMedDate not supplied

Splenic rupture as a complication of colonoscopy.

Splenic rupture is a rare but potentially lethal complication of colonoscopy. We report a 66-year-old man who developed abdominal pain 6 hours after diagnostic colonoscopy. His clinical status deteriorated rapidly. Splenic rupture was identified at laparotomy. He recovered after surgery.

Aged↗

PubMed1991

[Subcutaneous emphysema as a complication of colonoscopy].

A 71-year-old man underwent colonoscopy and multiple poly-pectomy. A few hours after the procedure he developed massive subcutaneous emphysema of the abdomen, chest, mediastinum, scrotum and both legs. Treatment was by conservative measures only. The emphysema gradually disappeared and he was discharged within a few days without sequelae. Subcutaneous emphysema is a rare complication of colonoscopy which has also been described after other endoscopic and radiological investigations of the gastrointestinal tract. It is due to a tiny laceration of the mucosal wall of the colon incurred during aggressive instrumentation, through which pass large quantities of air. The laceration is located underneath the peritoneal sac and the air flows into the retroperitoneum (closed or extraperitoneal perforation). The appearance of subcutaneous emphysema a few hours later, usually after leaving the hospital, is characteristic. In contrast to intraperitoneal perforation (open perforation), surgical intervention is not indicated and treatment is usually conservative. It includes complete cessation of oral alimentation, insertion of a nasogastric tube, IV drip, and correction of hydro-electrolytic or acid-base imbalances. The overall prognosis following such measures is excellent.

Aged↗

PubMed1991

Diagnostic and therapeutic colonoscopy in children: experience from a pediatric gastroenterology centre in India.

Eighty colonoscopies were performed in 72 children suffering from various colonic disorders. The indications for colonoscopic examination were bleeding per rectum (83.3%), prolonged colitis (14.0%) and colonic obstruction (2.7%). Total bowel wash with normal saline was very good for colonic preparation in majority of the cases. Pediatric colonoscope (PCF-Olympus) was used and the procedure performed under sedation with intravenous diazepam and pentazocine. Juvenile polyps were the commonest lesions (69.4%). Diagnosis of idiopathic ulcerative colitis, acute colitis, tuberculous colitis, amebic colitis and allergic colitis was made in 5.5, 4.2, 2.7, 1.3 and 1.3% cases, respectively. Tuberculous hypertrophic lesion and tuberculous stricture was seen in one case each. The commonest site of juvenile polyps was rectosigmoid region. Ninety per cent of them were single, 8% had polyps ranging from 2-4 in number and one (2%) child had juvenile polyposis coli. Successful colonoscopic removal of polyps with polypectomy snare was possible in 96% cases. No complications were observed. Colonoscopy is a safe and useful mode of investigation of colonic disorders in expert hands. It has a great therapeutic value in childhood.

Adolescent↗

PubMed1991

[Dysplasia in ulcerative colitis detected by surveillance colonoscopy].

A total of 222 surveillance colonoscopies were performed in 84 patients with ulcerative colitis between 1979-1989. In 60 patients with total colitis, 3 carcinomas, 2 high-grade, 4 low-grade and 8 indefinite for dysplasia were found. In 24 with left-sided colitis, 1 low-grade and 1 indefinite for dysplasia were found. The overall incidence of dysplasia in patients with total colitis was 28%, similar to the reported incidence from the Western countries. A sequence of dysplasia development was recorded in 14 cases. Progression of dysplasia was found in some of the low-grade or indefinite cases, however regression was also recorded in another cases. These results suggest the usefulness of surveillance colonoscopy for early detection of carcinoma in long-standing ulcerative colitis.

Adult↗

PubMed1991

Screening for colon malignancy with colonoscopy.

Screening of asymptomatic individuals for colon malignancy has been advocated for the past 20 yr in the hopes of reducing colon cancer mortality. Although sigmoidoscopy is an important element of current screening recommendations, the sensitivity of this test in asymptomatic subjects has never been studied. The purpose of this study was to determine the prevalence and location of polyps and cancers in an asymptomatic population by performing full colonoscopy. We wished to assess the sensitivity of screening flexible sigmoidoscopy to 60 cm by determining how many patients with adenomas or cancer had "index" adenomatous polyps in the distal 60 cm. One hundred five healthy male outpatients, over 50 yr old, with negative examinations for occult blood in stools and no prior history of colon pathology, had full colonoscopy. Careful examination of the distal 60 cm was performed, followed by a full colon examination to the cecum. Forty-three patients (41%) had adenomatous polyps, and only 19 of these patients had an index adenomatous polyp in the distal 60 cm. Therefore, the sensitivity of sigmoidoscopy was 44%. The prevalence of adenomas increased with age. Patients were assigned to one of three groups based on the findings in the distal 60 cm. Group 1 (n = 65) had no polyps in the distal 60 cm, but 18 of these patients (28%) had adenomatous polyps in the proximal colon. Among 21 patients with only hyperplastic polyps in the distal 60 cm (group 2), six patients (29%) had proximal adenomas. In group 3, eight of 19 patients (42%) with adenomas in the distal 60 cm also had proximal adenomatous polyps. We conclude that adenomatous polyps are common in asymptomatic men who have negative tests for fecal occult blood. Sigmoidoscopy to 60 cm had a sensitivity of only 44% in this patient population, suggesting that this is an insensitive test for the detection of patients with adenomatous polyps.

Aged↗

PubMed1991

[Colonoscopy after radical surgery for colorectal cancer. A 10-year prospective study of 309 patients].

Experience from ten year colonoscopic follow-up in patients after radical surgery for colorectal cancer is presented. In all, 309 patients below 76 years were included from 1978 to 1983. All had preoperative proctoscopy and barium enema. Colonoscopy was performed perioperatively, every six months the first three years, four and five years, seven to eight years and ten years after surgery. A minority had double-contrast barium enemas. Synchronous adenomas were removed during surgery and at perioperative colonoscopy and these patients had the same risk of metachronous cancer as those without synchronous adenomas. Five patients with six metachronous cancers, all had new curative surgery. Patients with synchronous adenomas had a higher risk of metachronous adenomas, but had a better prognosis than those without synchronous adenomas. Colonoscopically demonstrated intraluminal local recurrence in the colon could not be treated with new radical surgery in contrast to four out of eight intraluminal recurrences in the rectum. Most local recurrences were extraluminal and were diagnosed by other means.

Adenoma↗

PubMedDate not supplied

[Colonoscopy in Crohn's disease of the colon].

The author's experience with 42 colonoscopies in 41 patients with barium enema diagnosis of Crohn's disease is presented. The radiologic, endoscopic, histologic and surgical results are compared. According to radiological localization, the patients were classified in these groups: anorectal (9.7%), colic (51.2%) and ileocolic (39.1%). In 34 patients (80.9%) the endoscopic appearance was compatible with Crohn's disease, and in 24 (70.5%) the histologic examination confirmed the diagnosis. Endoscopic findings were as follows: segmental lesions in 34 (100%), aphthous ulcers in 18 (52.9%), cleft-like ulceration in 24 (70.5%) and cobblestone mucosa in 28 (82.3%). In 8 patients where endoscopy was not suggestive of Crohn's disease, the histologic examination was also negative, showing that colonoscopy was better than barium enema. Twenty patients with endoscopic diagnosis of Crohn's disease were operated and the diagnosis was confirmed in all. Endoscopic biopsies were positive in 12 (60%) of these operated patients. The author concludes that the endoscopic diagnosis of Crohn's disease can be made regardless of biopsy results.

Adolescent↗