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PubMedDate not supplied

[Colonoscopy in hemorrhagic lesions of the colon].

Patients with this pathology represents a difficult problem in differential diagnosis. Clinical findings and radiologic studies could help but endoscopy is now the most precise method in order to determine the site and nature of hemorrhage. We performed 504 colonoscopies in colon hemorrhage finding that our most frequent cause were polyps in both, children and adults in 199 cases (39%); diverticular disease was the second with 131 patients (26%) and third carcinoma with 52 (10%). Other causes were amebic colitis in 47 (8%); inflammatory bowel disease in 28 (6%) and infectious colitis in 13 (3%). Risks, complications and limitations of colonoscopy, as well as its great utility in diagnosis and treatment of colonic hemorrhagic lesions are commented.

Adolescent↗

PubMed1990

A randomized prospective trial comparing oral sodium phosphate with standard polyethylene glycol-based lavage solution (Golytely) in the preparation of patients for colonoscopy.

One hundred and two patients were randomized to receive either oral sodium phosphate or standard polyethylene glycol-based lavage solution (Golytely) prior to colonoscopy in order to establish whether the much smaller volume of the former agent enhanced patient tolerance while maintaining or improving effectiveness and safety. Overall, patients found sodium phosphate preparation much easier to complete. In 37 patients who had had a previous colonoscopy prepared with Golytely, 100% of those now receiving sodium phosphate found it easier to complete and over 90% felt it caused less discomfort, compared with their previous experience with Golytely. Colonoscopists, unaware of the type of lavage solution used, scored the degree of colonic cleansing significantly higher for sodium phosphate-prepared colons compared with colons prepared with Golytely. Serial measurements of blood tests and postural pulse and blood pressure changes did not reveal any clinically significant changes in intravascular volume. Hyperphosphatemia was noted with sodium phosphate, but was transient, and no concomitant decrease in calcium was seen. Histological assessment for possible preparation-induced changes revealed no difference between the two agents. Sodium phosphate is significantly less expensive than Golytely. We conclude that, in the group of patients studied, sodium phosphate is a safe colonic cleansing agent that is better tolerated and more effective than Golytely.

Colonoscopy↗

PubMed1990

Informed consent for colonoscopy. A prospective study.

Central to the nature of the physician-patient relationship is how fully patients are informed about their disease and prognosis and how active a role they take in deciding treatment; the "autonomy" and "paternalistic" models represent current poles of physician behavior. While informed consent has become ubiquitous in medical practice, it is not clear to what extent the value of patient autonomy has entered into everyday medical decisions. To evaluate informed consent, we prospectively surveyed 102 outpatients scheduled to undergo a colonoscopy and 16 of their physicians. The colonoscopy examination is straightforward and offers an optimal opportunity for patient participation in decision making. We found that most patients wanted guidance from their physicians and most physicians did not view the patient as autonomous. The more traditional parentalistic model continues to influence the physician-patient relationship, at least for this technical endeavor.

Attitude of Health Personnel↗

PubMed1990

Prospective and retrospective analysis of colonoscopy findings in patients with a history of colorectal carcinoma in first-degree relatives.

The frequency of colorectal neoplasia was assessed by colonoscopy in 48 patients with a history of colorectal cancer in a first-degree relative. Twelve of these patients were found to have polyps in the colon, including 1 who had invasive cancer. Patients with multiple first-degree relatives who have a history of colorectal cancer were found to be at increased risk, 56% having colonoscopic findings positive for polyps. Of the 12 patients with positive colonoscopic findings, 5 (42%) had multiple lesions. These findings are similar to those reported in recent pedigree studies and further support a genetic basis for common colorectal cancer. First-degree relatives of patients with colorectal cancer should be considered a high-risk group for colorectal neoplasia. Screening with colonoscopy is recommended.

Adenoma↗

PubMed1990

[Preparation for colonoscopy using Golytely--a sure method? Comparative histological and clinical study between lavage and saline laxatives].

UNLABELLED: Looking at clinical side-effects, effectiveness and tolerability, we compared the salinic solution "Golytely" vs. a conventional preparatory procedure (Cascara-Salax) in a prospective study including 28 patients with macroscopic normal mucosa. Mucosal changes in colonic step biopsies were investigated according to prefixed criteria. RESULTS: There was no significant difference concerning weight, blood pressure, pulse rate, body temperature or essential laboratory findings. Whereas preparation using Cascara-Salax was less molesting stated by the patients, there was no difference in the way colonoscopy itself was tolerated in both groups. The performing doctor's evaluation of the colonic cleaning effect and examination conditions showed "Golytely" significantly ahead of Cascara-Salax. Histologically, colonic mucous layers depicted changes in the control groups in 63% vs. 40% in the "Golytely" group. "Golytely" seems to provide a safe and effective method of preparation for colonoscopy.

Colon↗

PubMed1989

Late presentation of splenic trauma after routine colonoscopy.

Splenic trauma is a rare complication of colonoscopy and is often not readily diagnosed. A computerized tomographic scan enabled us to diagnose splenic trauma without hematoperitoneum in a patient presenting with abdominal and left shoulder pain 10 days post-colonoscopy. The scan information and the patient's clinical status allowed for nonoperative treatment of the injury.

Colonoscopy↗

PubMed1989

[Comparison of 2 anesthetic protocols in colonoscopy on a series of 100 patients].

The quality of the anaesthesia and of the recovery (appreciated by Newman's test) of two anesthetic technics for colonoscopies are compared on two homogeneous groups from 50 patients each: propofol alone versus midazolam-alfentanyl association. The differences registered during anaesthesia, particularly concerning the breathing depression might be attributed to alfentanyl which has been used often at important doses. The recovery is delayed in the midazolam + alfentanyl's group in comparison with the propofol's group. The difference is very significant at 15 and 60 minutes. The use's safety and the fast recovery with propofol incite to advocate it as an unique+ anaesthetic agent for colonoscopies.

Alfentanil↗

PubMedDate not supplied

[Usefulness of colonoscopy in the diagnosis of colonic diseases in childhood].

We present here our experience in colonoscopy performed in 93 children between 1984-1988 at hospital J. M. de los Ríos de Caracas. Mean age was 5.44 y/o and the range was 2-13 y/o. Rectal bleeding in 91.36% of the cases was the most common indication of the procedure. Rectal and sigmoid polyps were found in 24.73%. Vascular malformations in 16.13%, studies informs as normal 13.98% and ulcerative colitis in 10.75% No complications were observed so we can suggest colonoscopy as the first tool in diagnosis and treatment of the colonic pathology in children of any age.

Adolescent↗

PubMed1989

Colonoscopy: history and development.

Retrograde colonoscopy of the entire colon, and endoscopic excision of polyps from anywhere in the colon, began in June and September of 1969, respectively. Momentous advances have occurred over the past two decades, and the two procedures are now widely accepted and practiced. Development and perfection of the methodology were, at first, fraught with many difficulties, both procedural and technical, which had to be overcome. Significant opposition was engendered in the early years by some who claimed that the methods were both unnecessary and unduly dangerous. Time has proven otherwise. Progress came about as the result of a steady stream of publications from a number of centers documenting the successful and safe application of the methodology. A recounting is presented of the many contributions that predated development of the colonoscope and colonoscopy, and how the latter came about. For those coming into the art more recently, this review of beginnings is offered to allow a balanced evaluation of their craft.

Colonic Polyps↗

PubMed1989

[Role of colonoscopy in emergency surgery of the colon].

The article analyses the results of using colonoscopy as a method for emergency identification of the causes of acute colonic obstruction and intestinal hemorrhage. The diagnostic informativeness of emergency colonoscopy was 98.7% in colonic obstruction and 97.2% in intestinal hemorrhage. With the use of the results of emergency endoscopy in the choice of the therapeutic tactic for patients with acute colonic obstruction and intestinal bleeding, the percentage of fatal outcomes in the group of patients who underwent operation reduced significantly: to 18.8% in operations for acute colonic obstruction and to 14.8% in operations for intestinal hemorrhage.

Adult↗

PubMed1989

[Is synchronous hemorrhoidectomy with colonoscopy a worthwhile procedure?].

There were 201 patients receiving preoperative colonoscopy prior to hemorrhoidectomy in the meanwhile at MMH from July 1984 to June 1988. Other than rectal bleeding, they had colonic symptoms such as anemia, abdominal pain, familiar history of cancer and change of bowel habit etc. The study included 114 male and 87 female with ages ranging from 15 to 74 years (Median, 42 years). Three patients with colonic cancer and twenty-eight patients with neoplastic polyps were found by colonoscopic examination. Three cancer patients all received cancer surgery instead of hemorrhoidectomy as quickly as possible in a short time. One patient died for advanced stage and the other two patients got good results. The literatures were reviewed and discussed in accordance with the colonoscopic finding, operative time, hospital stay, post-operative morbidity and complication. There were not increase the postoperative morbidity in this series which compare with that of other series. The advantages of this procedure included: 1) Preventing suffer from twice colon preparations. 2) Preventing waiting period for Barium enema. 3) Preventing delay diagnosis of colorectal lesions especially colon cancer or precancer lesions of neoplastic polyps. 4) Performing examination and surgery at the same time-money-saving and time-saving. We thought synchronous hemorrhoidectomy with colonoscopy is a worthwhile clinical procedure.

Adolescent↗

PubMed1987

Escherichia coli peritonitis after left-sided colonoscopy in a patient on continuous ambulatory peritoneal dialysis.

A 69-yr-old man on chronic ambulatory peritoneal dialysis presented with Escherichia coli peritonitis 36 h after left-sided colonoscopy. No evidence for colonic perforation was found and the infection cleared with intravenous and intraperitoneal antibiotics. This case supports the need for further studies evaluating the use of prophylactic antibiotics during colonoscopy of chronic ambulatory peritoneal dialysis patients with diverticula.

Colonoscopy↗

PubMed1988

Age as a risk factor in colonoscopy: fact versus fiction.

Age has been assumed to be an independent risk factor in patients undergoing colonoscopy. However, this has never been specifically studied. We evaluated 302 patients 65 yr old or older, to determine the incidence of complications. We found that the risk is comparable to that of the heterogeneous patient population previously reported, except for a slightly increased incidence of delayed bleeding subsequent to polypectomy. In addition, the presence of cardiac, pulmonary, liver, or kidney disease was not found to be associated with an increased incidence of complications. Neither was there an increased risk of complications in patients undergoing colonoscopy, who had previously undergone abdominal or pelvic surgery. In summary, older patients experience the same risks as younger patients, except for post-polypectomy delayed bleeding, which may be related to atherosclerosis of the blood vessels, and appears to be more common in elderly patients.

Age Factors↗

PubMed1988

Routine double contrast barium enema and fiberoptic colonoscopy in the diagnosis of colorectal carcinoma.

The diagnostic efficacy of routine double-contrast barium enema and fiberoptic coloscopy for detection of cancer was retrospectively studied in 303 patients consecutively operated for colorectal adenocarcinoma in a 52-month period from January 1980. Double-contrast barium enema was performed in 180 patients with 184 carcinomas, 157 (85%) of which were revealed by this examination. The detection rate of carcinoma according to site was 89% between cecum and descending colon, 92% in sigmoid colon and 71% in rectum. Fiberoptic colonoscopy was done in 176 patients with 181 carcinomas, 163 (90%) of which were detected by the endoscopical examination. The detection rate of carcinoma according to site was 86% between cecum and descending colon, 90% in sigmoid colon and 95% in rectum. The two methods were equally effective in detecting carcinoma of the colon. Colonoscopy was superior to barium enema in detection of rectal carcinoma.

Adenocarcinoma↗

PubMed1987

Colonoscopy--a ten year Wellington experience.

Between April 1975 and December 1985, 870 colonoscopies have been performed at Wellington Hospital. A cause of gastrointestinal blood loss was identified in 61% of patients examined for this reason. Ninety-eight percent of patients with longstanding total mucosal ulcerative colitis were able to be managed nonsurgically. The diagnostic problem was resolved colonoscopically in 99% of patients with radiological abnormality. Seven hundred and seventy-six polyps and four polypoid carcinomata were removed endoscopically. A further four patients were referred for surgery following incomplete removal of polypoid carcinomata but no residual tumour was found in the resected bowel. It is suggested that strict criteria be employed in the selection of patients for colonoscopy.

Colonic Diseases↗

PubMed1985

Infusion of propofol ('Diprivan') as sedative technique for colonoscopies.

Sixty male and female patients, scheduled for colonoscopy were premedicated with glycopyrrolate 0.4 mg intramuscularly. Anaesthesia was induced with 2 mg/kg propofol ('Diprivan') and maintained with a continuous infusion of propofol at a rate of 3, 6 or 9 mg/kg/h randomly allocated. Patients lost consciousness within 60.6 +/- 18.7 (s.d.) s. Preservation of the hypnotic effect was infusion-rate dependent as 15, 40 and 85% of the patients were unconscious on infusion rates of 3, 6 or 9 mg/kg/h propofol, respectively. A high degree of sedation was observed in the remaining patients with an incidence of 40, 35 and 0% in the different series. Sedation was light in the remainder of the patients. To increase the acceptability of the procedure, a supplemental bolus of propofol and/or an increase in the infusion rate were required in 40, 15 and 10% of the 3, 6 and 9 mg/kg/h infusion rate groups, respectively. The incidence of amnesia was similar in all three groups (80, 90 and 95%, respectively). Recovery was significantly longer with increasing infusion rate, but remained rapid. The longest time was 7.3 +/- 4.0 min to open eyes on command and 10.6 +/- 4.6 min to answer correctly. The most important side effects were pain on injection (50%) and some restlessness during maintenance (25%). Blood pressure decreased, but heart rate was unaffected. Patients breathed room-air spontaneously. Respiratory rate slowed after induction then increased rapidly above baseline values. The incidence of apnoea was 48% with a mean duration of 51 +/- 22s (s.d.). The technique was evaluated as good or adequate in 95% of the cases. We suggest than an analgesic premedication followed by an average of 6 mg/kg/h propofol by infusion might be a simple and convenient method of achieving good conditions for colonoscopy.

Anesthesia Recovery Period↗

PubMed1985

Intestinal tuberculosis: bacteriological study of tissue obtained by colonoscopy and during surgery.

The biopsy tissue obtained during surgery and colonoscopy from 28 cases of intestinal tuberculosis was utilized for isolation and identification of mycobacteria. The mycobacteria could be isolated in 12 (42%) of 28 patients. Colonoscopy can be a successful method of bacteriological diagnosis of intestinal tuberculosis. Mycobacteria were scarcely ever seen on histological sections. Combined use of guinea pig inoculation and culture was more rewarding than either alone. The yield of positive cultures was greater in tissue with caseation necrosis, though organisms were also recovered from tissues showing non-caseating granuloma and non-specific inflammation. The intestinal tissue gave more positive cultures (41%) than did lymph nodes (14%). The organisms were isolated in patients with or without pulmonary lesions and chemotherapy in the past. All the organisms were isolated as Mycobacterium tuberculosis.

Adolescent↗

PubMed1985

Colonoscopy related endotoxemia.

A pilot study of 20 patients who underwent colonoscopy was performed to investigate the occurrence of endotoxemia related to the procedure and its clinical significance. With the use of the limulus lysate method of assay, endotoxemia was demonstrated in 25 per cent of the patients during colonoscopy and 65 per cent afterwards, but was not associated with either concomitant bacteremia or any ill effects. The appearance of endotoxin in significant concentration in the presence of normal liver function and with no overt focus of infection, suggests that substantial absorption of bacterial products which originate in the intestine occur, but under normal circumstances cause no demonstrable deleterious effects.

Adolescent↗