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PubMed1984

The role of colonoscopy in the diagnosis and management of lower intestinal bleeding.

Colonoscopy and roentgenographic studies are complementary techniques in the evaluation of disorders involving the large bowel. The exact roles of these methods in the diagnosis and management of lower intestinal bleeding, however, remain to be established. In this paper, we have formulated various roles for colonoscopy in lower intestinal hemorrhage depending upon the rate and activity of the bleeding according to whether the episode is: 1) recent minor bleeding or recurrent minor or occult bleeding; 2) severe bleeding which has stopped; 3) severe and active bleeding. In addition, we discuss colonoscopic therapy of bleeding lesions and intraoperative endoscopy of the small and large bowel.

Adolescent↗

PubMed1984

[Emergency colonoscopy in lower intestinal occlusion].

From March 1980 to June 1983, 23 patients presenting with clinical and or radiological manifestations of colonic obstruction and with uncertainty as to medical/surgical possibilities of management, underwent emergency colonoscopy in the intensive care unit of our Digestive Disease Department. The investigations were conducted without preparation (enema) or premedication, using an ordinary colonoscope. The endoscopic examination led to correct diagnosis in 21 patients out of 23 (91.3 p. 100). The main causes of occlusion were: colonic or rectal cancer (11 cases), Ogilvie's syndrome (6 cases), volvulus of the sigmoid colon (3 cases). Endoscopy contributed to treatment in eight patients with good results in six. It was unsatisfactory in two cases of volvulus of the sigmoid colon which recurred. In two instances complications occurred which were attributable to the method: one pneumoperitoneum without frank perforation and a transtumoral perforation in a case of sigmoid cancer, discovered at laparotomy. No septic complication or mortality resulted from endoscopy. Colonoscopy under normal conditions should not be advocated systematically, but can be used as a method of investigation and possibly of therapy in selected cases of colonic obstruction admitted into intensive care units.

Adult↗

PubMed1984

Occult faecal blood loss determined by a 51Cr method and chemical tests in patients referred for colonoscopy.

In 67 patients referred for colonoscopy the faecal blood loss was determined by a 51Cr method and 7 chemical tests. For patients with negative colonoscopy (no. = 10), colorectal polyps (no. = 24), rectal cancer (no. = 8), or colonic cancer (no. = 12), the median 51Cr-determined faecal blood loss was 0.67, 0.74, 1.26, and 2.18 ml/24 h, respectively. For all chemical tests the results were highly influenced by the upper time limit for a positive reaction. Mixing of faecal specimens before testing proved unimportant. Fecatwin sensitive showed more positive tests in delayed compared with immediate analyses (p less than 0.01). Of cases of colorectal polyps, tetramethylbenzidine (TMB) tests including Hemo-Fec Test could detect half, the benzidine test 2 of 5. Fecatwin sensitive and Hemoccult II 1 of 4, and Fecatwin 1 of 24. Of cases of colorectal cancer, TMB tests, the benzidine test, Fecatwin sensitive, Hemoccult, and Fecatwin could detect about 85%, 85%, 85%, 80%, and 45%, respectively. All chemical tests detected faecal blood loss from colorectal lesions more easily than from gastric lesions.

Adult↗

PubMed1983

Treatment of nontoxic megacolon by colonoscopy.

The indications for colonoscopy in a recent consecutive series of 232 examinations were analyzed. Of these examinations, 30 (13%) were performed for nontoxic megacolon. Nontoxic megacolon is defined as severe dilatation of a segment or the entire colon unaccompanied by signs or symptoms of colon toxicity. Mechanical factors (volvulus, anastomosis, diverticulosis, carcinoma) were responsible for the nontoxic megacolon in 13 of these patients. Nontoxic megacolon was classified as secondary to acute pseudoobstruction (Ogilvie's syndrome, pancolonic megacolon, acute myxedema ileus) in 17 patients. All patients were being evaluated for possible exploratory celiotomy to prevent perforation of the colon because of the massive colonic distention. Colonoscopic examination was performed at the bedside or in the intensive care unit for 11 of 30 patients. No bowel preparation was used. Evacuation of air and fecal material was more efficiently accomplished by use of an external suction device attached to the biopsy part of the endoscope. For 12 of the 13 patients who had a mechanical basis for their nontoxic megacolon the colon was successfully decompressed. All 17 patients with acute pseudoobstruction were successfully treated. There were no iatrogenic perforations. Possible emergency operation was avoided for all patients except one who had a cecal volvulus. Colonoscopy should be considered as the initial treatment for nontoxic megacolon prior to surgical intervention.

Colonoscopy↗

PubMed1983

[Surveillance colonoscopy after ureterosigmoidostomy].

Twenty-two patients underwent surveillance colonoscopy for 2 to 54 months (average, 22 months) after ureterosigmoidostomy. The distance between site of ureterocolonic anastomosis and anal verge ranged from 13 to 30 cm (average, 18.3 cm) in right side and from 20 to 37 cm (average, 29.5 cm) in left side. The form of implanted site could be classified into 3 types which were flat, sessile and pedunculated types. Endoscopic biopsies performed on eleven polyp-like regions of ureterocolonic anastomosis revealed inflammation in 10 cases (90%) and adenoma without malignancy in one case (10%). The mucosa more than 5 cm away from implanted site showed findings of inflammation without constitutional abnormality in more than 60% of all patients. The periodical surveillance colonoscopy at intervals of approximately one year seemed to be useful for early detection of the tumors of the colon after ureterosigmoidostomy.

Adult↗

PubMed1984

Comparison of colon cleansing methods in preparation for colonoscopy.

Colonoscopy cleansing regimens were evaluated in 197 patients randomized in two study phases to one of four methods: group 1 (64 patients), 3-day clear liquid diet; group 2 (40 patients), 3-day minimum-residue diet; group 3 (44 patients), 1-day minimum-residue diet; group 4 (49 patients), Golytely. Groups 1-3 also received laxatives and enemas before colonoscopy. Physician assessment by endoscopists unaware of the method of colon cleansing favored group 4 (p less than 0.001), with good to excellent preparations achieved in 69% of group 1, 80% of groups 2 and 3, and 92% of group 4. Group 4 patients also experienced less abdominal distress (p less than 0.01). Breath hydrogen and methane levels were measured in groups 3 and 4 both before and after preparation. The decrease in pre- to postprep levels of hydrogen and methane were not significantly different between the groups and postprep gas concentrations were below combustible levels in both groups. There were no clinically significant differences between the four groups for any of the other measured hematologic or biochemical parameters. It is concluded that Golytely is a safe, effective method of colon cleansing, well tolerated by patients.

Adult↗

PubMed1984

Malignant colon polyps--cure by colonoscopy or colectomy?

Although malignant sessile colon polyps usually require colectomy for proper treatment, the vast majority of malignant pedunculated polyps can be removed colonoscopically for cure. The author's experience with 83 consecutively encountered malignant polypoid lesions is reviewed and is the basis for the discussion herein. All 49 malignant pedunculated polyps were removed colonoscopically. Eight of these patients also underwent colectomy because of questionable or definite presence of cancer cells within the stalk portion of the polyp; no residual cancer was identified at the polypectomy site, and all lymph nodes were negative in these patients. Of 34 patients with malignant sessile polypoid lesions, 13 underwent colectomy because of obvious malignancy at colonoscopy. Twenty-one sessile lesions were removed colonoscopically; with malignancy documented, nine of the 21 patients underwent colectomy. Positive findings (either cancer at the polypectomy site or in lymph nodes) at surgery were identified in two of these nine patients. Colonoscopic polypectomy can be considered curative for malignant pedunculated polyps provided the stalk portion of the lesion is totally uninvolved with the malignant process, provided there is no lymphatic or vascular invasion, the malignancy is well differentiated, and follow-up endoscopic examination of the polypectomy site reveals no residual or recurrence. These four criteria must be satisfied in order to consider a malignant pedunculated polyp curatively removed by colonoscopic polypectomy alone. The risk of colectomy in patients satisfying these four criteria is believed to be greater than the risk of metastatic disease and death from this lesion. Colectomy is recommended for all patients with malignant sessile polypoid lesions, provided their general medical condition provides an acceptable operative risk. Although colonoscopic polypectomy is not recommended for obviously malignant sessile polyps, there are instances where sessile lesions are removed colonoscopically and found microscopically to contain focal or minute areas of invasive cancer. In certain of these patients, the risk of colectomy may exceed the risk of recurrence or metastasis, if the polypoid lesion has been totally removed colonoscopically and completeness of the polypectomy has been documented by follow-up colonoscopy. Each patient's clinical history, general condition, and histopathology must be reviewed individually by a clinician experienced in this field in order to reach a wise and proper decision regarding the potential need for colectomy, and limit colectomy to those patients in whom it is absolutely necessary.

Adenoma↗

PubMed1981

[Yersinia enterocolitica septicaemia associated with Yersinia intestinal lesions detected by colonoscopy (author's transl)].

A 78-year-old patient previously operated upon for rectal carcinoma and who had no sign of immune system deficiency developed septicaemia. Blood cultures were positive for Yersinia enterocolitica (chemotype 4, serotype 0 : 3, lysotype VIII) and the histocompatibility antigen HLA B 27 was present. The disease responded to gentamicin and doxycycline. Colonoscopy was performed on the 8th day through the permanent colostomy opening and showed lesions of the ascending colon typical of Yersinia enterocolitis : whitish, oval ulcerations on an erythematous background. This appears to be the first published case of Yersinia septicaemia where lesions of intestinal Yersinia infection were found on colonoscopy.

Aged↗

PubMed1981

Segmental tuberculosis of the colon diagnosed by colonoscopy.

Segmental tuberculosis of the colon is a rare clinical entity. In the absence of pulmonary or ileocecal involvement, colonic tuberculosis may be difficult to differentiate from neoplasm or Crohn's disease by symptomatic and radiological means. Colonoscopy and biopsy can, however, establish the diagnosis and prevent operative intervention, as indicated in the present report. A patient with a radiologically demonstrated strictured lesion of the sigmoid colon was found at colonoscopy to have several hemorrhagic transverse ulcers ranging in diameter between 1-4.5 cm. Multiple target colonoscopic biopsies, specifically from the ulcer beds, revealed necrotizing granulomas and acid-fast bacilli. Antituberculous chemotherapy produced remarkable symptomatic, radiographic and endoscopic improvements and averted exploratory laparotomy for the establishment of the diagnosis. This case report points out the importance of colonoscopic biopsy as a useful diagnostic modality in this disease.

Biopsy↗

PubMed1980

[Prophylaxis and therapy of colon perforation in diagnostic fiber colonoscopy (author's transl)].

Three cases of colonic perforation which we could observe in 622 own colonoscopies and two which have been referred to us for surgical repair, are reported. On behalf of these cases the cause of such a perforation as a complication of colonoscopy is pointed out. The symptoms of colonic perforation are not very impressive and somewhat incharacteristic. The treatment of choice is immediate laparotomy, whereby the decision whether simply suture of the defect or resection with or without colostomy remains to be made intraoperatively. In case of massive pneumoperitoneum the puncture of the lower abdomen can be made as an emergency operation.

Adult↗

PubMed1995

Colonoscopy.

Colonoscopy is a procedure that more primary care physicians are performing. This article has attempted to provide such physicians the basic information needed regarding the indications, contraindications, and complications associated with colonoscopy. Patient issues such as preparation, education, and consent were also discussed.

Anemia↗

PubMed1995

Drugs and sedation for colonoscopy.

Sedation, with or without analgesia, is commonly used for colonoscopy procedures in the United States. Prudent drug product selection, careful titration of drug dosage to ensure use of the lowest effective dose (Table 1), and vigilant monitoring of medicated patients will optimize the value of conscious sedation in colonoscopy. When a close patient-physician relationship exists in the primary care setting, use of medications only "if needed" during the procedure may be a reasonable alternative that can minimize the exposure of patients to sedation-related side effects. Patient-controlled medication delivery may be one method used to address patient variability in the need for sedation.

Adult↗

PubMed1995

Psychological considerations in colonoscopy.

In summary, psychological issues around the colonoscopy procedure have not yet been fully studied or even formulated. The framework taken here is to consider psychological preconditions to disease, psychological barriers to screening, and ways to maximize the psychological strength of patients when presenting serious diagnoses. Two common themes are present in this review. First, the idea of hopelessness and loss of personal control is present throughout the research in terms of personality predispositions, decisions to seek care, and outcome of disease when present. Physicians need to address the question, what can I do to maximize the hopefulness of this person before, during, and after screening? Are we encouraging an optimistic perspective in the lives of others? The second theme is closely related and that is the critical nature of the patient/physician relationship in all stages of health/illness behavior. It is often the positive, empathic strength of this relationship that affects patient behavior and ultimately the patient's medical outcome. Future research as well as physician self-examination and increased knowledge in this area are truly important. It is in this way that the procedure of colonoscopy truly becomes part of the total patient care.

Colonoscopy↗

PubMedDate not supplied

[The importance of colonoscopy in the early detection of colorectal cancer].

The rates of surveillance for patients with colorectal cancer have been steady in the decades. Aspects regarding the importance of the early detection of the colorectal cancer were focussed, as well as the outstanding difference observed in relation to the surveillance of patients when the detection of the disease is achieved early. It was emphasized the use of colonoscopy as a diagnostic and therapeutic method which brings beneficial results to an effective raising in the rates of detection of patients with colorectal cancer. It was also demonstrated that colonoscopy having a higher accuracy in the diagnosis of the large bowel polyps and in the performance of polypectomies, has much contributed to put to an end to the cycle described by Morson: the evolution of adenomatous polyp to cancer.

Colonoscopy↗

PubMedDate not supplied

Jejunal perforation: a complication of colonoscopy.

Perforation of a hollow viscus following fibreoptic endoscopy is rare. Perforation following colonoscopy has been reported to occur in the large intestine. We report a case. Small bowel perforation subsequent to colonoscopy.

Colonoscopy↗

PubMed1994

[Orthograde intestinal lavage in the preparation for colonoscopy].

Thirty-eight proctological patients were prepared for colonoscopy by drinking 2l of aqueous solution of polyethylene glycol-4000 and electrolytes, so that additional purgatives, cleansing enemas, and waste-free diet are not needed. Control of hemodynamics, clinical and biochemical blood tests, and plasma electrolyte content revealed no significant changes in these parameters after preparation for the examination. Colonoscopy was conducted to a full measure in 94% of cases. This method was preferred rather than the use of purgatives and enemas by 82% of patients. Intestinal lavage with polyethylene glycol and electrolyte solution is a simple and effective method, it is convenient for the patient and does not cause marked side effects.

Administration, Oral↗

PubMed1995

Safety profile of 5-h oral sodium phosphate regimen for colonoscopy cleansing: lack of clinically significant hypocalcemia or hypovolemia.

OBJECTIVES: Oral sodium phosphate (NaP), a colonic cleansing agent for colonoscopy that is superior to standard polyethylene glycol-based lavage solutions because of greater patient acceptance, effectiveness, and significantly less cost, causes intravascular volume depletion and hyperphosphatemia. To determine whether these changes may be near the threshold for inducing clinically serious side effects, these parameters were studied in patients receiving two doses of NaP over 5 h rather than the conventional 12-h duration. METHODS: 50 patients (27 outpatients, 23 inpatients) drank 45 ml of NaP at 1700 and 2200 h the night before colonoscopy. Patients with renal failure, active heart disease, ileus, or gross ascites were excluded. RESULTS: Serial blood tests and hemodynamic measurements demonstrated signs of intravascular volume depletion in less than 10% of outpatients but up to 40% of inpatients. None of the patients complained of postural dizziness or presyncope. All patients became hyperphosphatemic (maximum 3.72; normal < 1.30 mmol/L). Measurements of ionized calcium were significantly lower compared with baseline values (mean values 1.19 vs 1.23 mmol/L, respectively). In 44% of patients, these values were below the lower limits of normal (1.19 mmol/L) but these changes were minor (lowest value 1.07 mmol/L) and none of the patients were symptomatic. CONCLUSIONS: This study suggests that oral NaP is a safe agent in most patients for colonic cleansing, even when given using a 5-h regimen.

Blood Volume↗

PubMed1995

Chronic, unexplained diarrhea: are biopsies necessary if colonoscopy is normal?

OBJECTIVE: We sought to determine the frequency of clinically important histological abnormalities in patients with chronic, unexplained diarrhea who had macroscopically normal colonic endoscopies. METHODS: Of 855 consecutive patients undergoing colonoscopy (595 cases) or flexible proctosigmoidoscopy (260 cases) by one endoscopist, biopsies were taken in 111 cases of unexplained diarrhea of at least 4-6 weeks duration in which the colorectal mucosa appeared grossly normal. All biopsies were blindly reviewed by one pathologist. RESULTS: In this group of patients with macroscopically normal colons, we identified no cases of Crohn's disease or ulcerative colitis or any definite cases of collagenous colitis (CC) or lymphocytic colitis (LC). There was one case classified as "possible CC" and 13 cases classified as "some features of LC". There were five cases of melanosis coli, one case of cytomegalovirus colitis (in an immunosuppressed patient), and one case of radiation injury. Ninety-one cases were classified as no pathological diagnosis or minimal histological change. Patients with abnormal histology were contacted to see if they had persistence or resolution of diarrhea. For the cases of "possible CC" and "some features of LC," diarrhea had resolved spontaneously in the majority. Interesting to note, only one of the five melanosis coli patients admitted to laxative use, raising the question of surreptitious abuse. CONCLUSIONS: We conclude that the yield of biopsies in diarrhea patients with macroscopically normal colons at endoscopy is low. It may be reasonable to obtain biopsies in patients with relatively severe or debilitating symptoms, with diarrhea that sounds "organic" (e.g., nocturnal stools, frequent watery stools, weight loss, elevated sedimentation rate), or in patients who are immunosuppressed. When biopsies are taken at colonoscopy, we suggest taking about six from throughout the colon and placing them into just one specimen container to help minimize costs.

Adult↗