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At least 127 records · Page 7Linked to original sources

PubMed2006

Why wait for a colonoscopy? An easy cure.

OBJECTIVE: Three thousand five hundred and forty-nine patients are waiting for a colonoscopy in the Kent and Medway cancer network. New guidelines identify those who require surveillance for polyp, cancer, IBD and family history. Our hypothesis was that most of the patients on the waiting list would no longer need a colonoscopy if the new guidelines were applied. PATIENTS AND METHODS: We compared the ACPGBI guidelines for screening/surveillance colonoscopy with the indications in 411 notes of one hospital's waiting list and removed patients as appropriate. In the second part of study we analysed 192 patients attending colonoscopy in seven hospitals in the region and calculated the potential impact of the guidelines on our waiting lists. RESULTS: Of 411 patients on the waiting list in one hospital, only 98 (24%) needed to remain on the list. 142 (34%) were cancelled completely. One hundred and seventy-one (42%) were taken off the 'waiting' list and rebooked for a later date since according to the new guidelines the colonoscopy was not due yet. Of 192 colonoscopies actually performed during the study period in 7 hospitals of Kent and Medway cancer network, 72 (38%) were for surveillance. Two thirds of those were not in line with the guidelines. As a result of implementing the guidelines, waiting times for diagnostic colonoscopy fell from 12 to 4 weeks for urgent, and from 40 to 15 weeks for routine referrals. CONCLUSION: A quarter of the 8000 colonoscopies performed annually in our region are unnecessary when compared to the guidelines. More than three quarters of our waiting list could be removed by reviewing the notes. Implementing the guidelines in one cancer network would save pounds 1 million per year even on conservative estimates of pounds 500 per colonoscopy. It would also reduce the waiting times for diagnostic colonoscopy.

Colonoscopy↗

PubMed1999

Is virtual colonoscopy a cost-effective option to screen for colorectal cancer?

OBJECTIVE: Computed tomography (CT) or magnetic resonance (MR) colonography is a new technique that uses data generated from CT or MR imaging to create two- and three-dimensional scans of the colon. It has been advocated to become the new primary technique of screening for colorectal cancer. The economic feasibility of such recommendation, however, has not yet been evaluated. METHODS: The cost-effectiveness of two screening strategies using CT colonography or conventional colonoscopy was compared by computer models based on a Markov process. We supposed that a hypothetical population of 100,000 subjects aged 50 yr undergoes a screening procedure every 10 yr. Suspicious findings of CT colonography are worked-up by colonoscopy. After polypectomy, colonoscopy is repeated every 3 yr until no adenomatous polyps are found. RESULTS: Under baseline conditions, screening by CT colonography costs $24,586 per life-year saved, compared with $20,930 spent on colonoscopy screening. The incremental cost-effectiveness ratios comparing CT colonography to no screening and colonoscopy to CT colonography were $11,484 and $10,408, respectively. Screening by colonoscopy remains more cost-effective even if the sensitivity and specificity of CT colonography both rise to 100%. For the two screening procedures to become similarly cost-effective, CT colonoscopy needs to be associated with an initial compliance rate 15-20% better or procedural costs 54% less than colonoscopy. CONCLUSIONS: To become cost-effective and be able to compete with colonoscopy in screening for colorectal cancer, CT or MR colonography would need be offered at a very low price or result in compliance rates much better than those associated with colonoscopy.

Adult↗

PubMed2002

New occurrence and recurrence of neoplasms within 5 years of a screening colonoscopy.

OBJECTIVE: The fear that colorectal adenomas were missed on initial colonoscopy or that new adenomas have developed is often a rationale for repeating a colonoscopic examination. The aim of this study was to delineate risk factors associated with recurrence of colorectal adenomas after an initial baseline screening colonoscopy. METHODS: The study population comprised 875 subjects who underwent a baseline screening colonoscopy followed by a second examination 1-5 yr later. Multiple logistic regression was used to assess the influence of potential risk factors on the occurrence or recurrence of colorectal adenomas, the strength of the influence being expressed as an OR with a 95% CI. RESULTS: Colorectal adenomas were detected in 484 of all patients (55%) at baseline colonoscopy. Within a 1- to 5-yr time interval, 181 patients (37%) had recurrent adenomas (adenomas were removed during the first colonoscopy) and 73 patients (19%) had newly developed adenomas (adenomas were absent on the first colonoscopy). The occurrence of adenomas at baseline screening colonoscopy was the only factor associated with an increased risk for the recurrence of adenomas at follow-up (OR = 2.51, 95% CI = 1.77-3.55). Recurrence was associated with multiple baseline adenomas (4.45, 2.98-6.64) and baseline adenomas larger than 1 cm (2.62, 1.99-3.11). Recurrence was not associated with histology type or family history of colorectal cancer. There was a significant trend for adenomas to recur in the same proximal or distal segment as the baseline adenomas (p = 0.02). CONCLUSIONS: Colon adenomas tend to recur with greater frequency if the adenomas removed at baseline were either large or multiple. Although patients with large adenomas or multiple adenomas at baseline screening colonoscopy are at a 2.6- to 4.5-fold risk for recurrence of adenomas, the rate of de novo adenoma formation in patients without baseline adenomas may be large enough to warrant repeat colonoscopy at some time in the future. The exact timing of the follow-up colonoscopy needs to be determined.

Adenoma↗

PubMed2003

Volume and yield of screening colonoscopy at a tertiary medical center after change in medicare reimbursement.

OBJECTIVE: Starting July 1, 2001, Medicare began to reimburse for screening colonoscopy in asymptomatic adults older than 50 yr with no risk factors for colorectal cancer. We sought to determine the short-term impact of the change in Medicare reimbursement on the demand for and yield of screening colonoscopy at our tertiary institution. METHODS: Asymptomatic patients older than 50 referred for first screening colonoscopy after the change in Medicare reimbursement from July 1, 2001 to December 31, 2001 were compared with a similar cohort screened before Medicare coverage for a family history of cancer or polyps during the same months the previous year (July 1, 2000 to December 31, 2000). Patient demographics, number, size, location, and histology of polyps/cancers for these screening colonoscopies were collected. RESULTS: A total of 1282 colonoscopies were performed in our institution from July 1, 2001 to December 31, 2001, 257 (20%) for screening. During the same months in the previous year, 121 of 938 colonoscopies (12.9%) were for screening (p < 0.01). This was a 55% increase in the percentage of colonoscopies performed for screening, and a 112% increase in the number of screening colonoscopies. Patients screened after the change in Medicare reimbursement were on average 5 yr older compared with patients of the previous year (62 +/- 10 [mean +/- SD] vs 56 +/- 9 yr; p < 0.01). A total of 61 screening colonoscopies (24%) performed after the change in Medicare reimbursement had adenomatous lesions, compared with 25 (21%) screened for family history (p = ns). The number of adenomas 10 mm or larger or cancers did not differ significantly between the two groups (17 in 2001 vs 12 in 2000; p = ns). Age of 65 or older was associated with detection of adenomatous lesions (OR = 1.7; 95% CI = 1.01-2.9013). CONCLUSIONS: Since the change in Medicare reimbursement, there has been a significant increase in the number and proportion of colonoscopies performed for screening at our institution. Patients screened since this change are older, and the detection rate of neoplastic lesions is similar to those previously screened for a family history of colorectal cancer or polyps.

Academic Medical Centers↗

PubMed2005

Use of colonoscopy for colorectal cancer screening: evidence from the 2000 National Health Interview Survey.

BACKGROUND: The use of colonoscopy as a primary screening tool for colorectal cancer is gaining momentum owing to several studies suggesting superior effectiveness and the recent, favorable decision by Medicare to cover all routine screening colonoscopies. This study documents the use of colonoscopy versus other tests to screen for colorectal cancer. MATERIALS AND METHODS: Data from the 2000 National Health Interview Survey were analyzed. Fecal occult blood test (FOBT), sigmoidoscopy, and colonoscopy done for any reason and for routine screening only were analyzed for those >/=50 years without previously diagnosed colorectal cancer (n = 12,505). RESULTS: The proportion of the total eligible population receiving any of the recommended tests for all possible reasons and for screening purposes only is 34.6% and 25.1%, respectively. For routine screening purposes, the test most commonly utilized was FOBT (55.6%) followed by colonoscopy (29.1%) and sigmoidoscopy (15.3%). When usage was assessed for all reasons, FOBT was still most commonly utilized (45.8%) followed by colonoscopy (38.7%) and sigmoidoscopy (15.5%). The elderly, non-White males and those with private insurance have a higher probability of receiving colonoscopy than FOBT. Several regional differences exist, including higher probability of undergoing sigmoidoscopy versus colonoscopy in the West. CONCLUSIONS: Only one fourth (upper limit one third) of the study population complied with colorectal cancer screening recommendations. Nearly one third of the routine screening tests done in 2000 were colonoscopies. This study provides baseline values that can be used to project future colonoscopy demand and identify potential supply barriers.

Aged↗

PubMed1999

Colorectal cancer after open-access colonoscopy: a community and case survey.

OBJECTIVE: To evaluate whether colonoscopy protects against subsequent colorectal cancer (CRC). DESIGN: Case and population survey. SETTING: Townsville region in northern Queensland, between mid 1985 and January 1998. SUBJECTS: All 8430 patients who underwent 11,148 colonoscopies performed by the author at the Mater Private Hospital (a community-based open-access colonoscopy service) between July 1985 and December 1996; those who were subsequently diagnosed with CRC, to January 1998; and all 476 residents diagnosed with colorectal cancer between 1994 and 1997. MAIN OUTCOME MEASURES: Age-standardised CRC incidence for 1994-1997 for patients who had had a previous colonoscopy and for the remaining community; Dukes' grade of CRCs. RESULTS: For people aged 50 years and over, the incidence of CRC was significantly lower among those who had had a previous colonoscopy than in the remaining community (1.14 versus 2.31 per 1000 patient-years; P = 0.0046). For people aged 35-49 years, the incidence was 0.35 versus 0.31 per 1000 patient-years (P = 0.86). Thirty-one CRCs developed in 29 people who had had previous colonoscopy; only five of these CRCs were graded Dukes C, with none graded Dukes D. In contrast, almost half the CRCs in the rest of the community were graded Dukes C or D (P < 0.001). All but one of those diagnosed with CRC on repeat colonoscopy had risk factors (personal or family history), and 23 of the CRCs were subclinical, with 20 being diagnosed during surveillance colonoscopy. CONCLUSIONS: Patients aged over 50 years who had previously undergone a colonoscopy and ensuing treatment were less likely to be diagnosed with CRC than otherwise expected. Surveillance colonoscopy led to diagnosis of CRCs with lower Dukes grades.

Adult↗

PubMed2004

The current state of colonoscopy training in family medicine residency programs.

BACKGROUND AND OBJECTIVES: The US Preventive Services Task Force has recommended that all adults ages 50 and over be screened for colorectal cancer. Colonoscopy is the most accurate screening procedure, but the feasibility of colonoscopy as a screening tool is limited by the number of physicians trained to perform it. This study determined the current state of colonoscopy training in US family medicine residency programs. METHODS: We surveyed program directors of all Accreditation Council for Graduate Medical Education-approved family medicine residency programs regarding colonoscopy training. RESULTS: The response rate was 94% (426 of 455). Forty-eight percent (n=201) of directors reported that their program offered colonoscopy training, but only 18% (n=75) of all respondents had actually trained one or more residents to do colonoscopies. Nationally, the mean number of colonoscopies performed per resident was 42.6 +/- 3.9. Regional differences were reported; residents trained in the western United States performed a mean of 69.8 +/- 12.8 colonoscopies per resident. Gastroenterologists in hospital-based gastroenterology suites trained approximately 75% of family medicine residents. Fifteen percent (n=64) of directors reported that 133 (4%) of their July 2002 graduates sought credentials to perform colonoscopy. CONCLUSIONS: Only a minority of family medicine graduates seek credentials to perform colonoscopy, and significant regional differences in training exist.

Colonoscopy↗

PubMed2005

[Acceptance of screening colonoscopy in the prevention of colorectal cancer in relation to some demographic factors].

UNLABELLED: Colorectal cancer is a quite common neoplasm. Screening colonoscopies and polypectomies can decrease the incidence of that neoplasm by 75%. Discovering the most frequent reasons and most convincing sources of information about the examinations is important for success of screening programme. OBJECTIVES: The aim of this study was to find the connection between some demographic factors, the source of information about the examination and the consent for colonoscopy. MATERIAL AND METHODS: Two groups of subjects, aged 40-65, were included: 1000 subjects, who gave their consent for colonoscopy and 200 subjects, who refused the examination. The sources of information were two kinds of questionnaires: fulfilled before colonoscopy and in case of lack of consent for the examination, which included demographic data, the reason of undergoing or refusal of colonoscopy and the source of information about the examination. RESULTS: The higher educated were the subjects, the more often they agreed for the examination; among subjects after university 87%, and among subjects with elementary education 71% gave their consent for colonoscopy. The most convincing sources of information were the medial sources; 100% of subjects, who found out about the examination from television and radio, gave their consent for colonoscopy. The most frequent reason of undergoing the examination was prophylaxis (54.6%), and the most frequent reasons of refusal was fear of pain (33.5%). CONCLUSIONS: Educational level and the source of information about the examination are the factors that have an important influence on undergoing screening colonoscopy. Identifying the influence of some demographic factors on the consent for colonoscopy and the efficacy of each source of information seems to be very important for the success of screening colonoscopy programme and therefore for discovering adenomatous polyps and colorectal cancer.

Adult↗

PubMed2005

Computed tomographic virtual colonoscopy computer-aided polyp detection in a screening population.

BACKGROUND & AIMS: The sensitivity of computed tomographic (CT) virtual colonoscopy (CT colonography) for detecting polyps varies widely in recently reported large clinical trials. Our objective was to determine whether a computer program is as sensitive as optical colonoscopy for the detection of adenomatous colonic polyps on CT virtual colonoscopy. METHODS: The data set was a cohort of 1186 screening patients at 3 medical centers. All patients underwent same-day virtual and optical colonoscopy. Our enhanced gold standard combined segmental unblinded optical colonoscopy and retrospective identification of precise polyp locations. The data were randomized into separate training (n = 394) and test (n = 792) sets for analysis by a computer-aided polyp detection (CAD) program. RESULTS: For the test set, per-polyp and per-patient sensitivities for CAD were both 89.3% (25/28; 95% confidence interval, 71.8%-97.7%) for detecting retrospectively identifiable adenomatous polyps at least 1 cm in size. The false-positive rate was 2.1 (95% confidence interval, 2.0-2.2) false polyps per patient. Both carcinomas were detected by CAD at a false-positive rate of 0.7 per patient; only 1 of 2 was detected by optical colonoscopy before segmental unblinding. At both 8-mm and 10-mm adenoma size thresholds, the per-patient sensitivities of CAD were not significantly different from those of optical colonoscopy before segmental unblinding. CONCLUSIONS: The per-patient sensitivity of CT virtual colonoscopy CAD in an asymptomatic screening population is comparable to that of optical colonoscopy for adenomas > or = 8 mm and is generalizable to new CT virtual colonoscopy data.

Adenomatous Polyps↗

PubMed2007

Does colonoscopy cause increased ulcerative colitis symptoms?

BACKGROUND: Ulcerative colitis (UC) patients often report symptom flares after colonoscopy. However, this has not been documented in the literature. OBJECTIVES: 1. Determine whether colonoscopy is associated with increased UC symptoms. 2. Determine whether there is a need for escalation of UC medications after colonoscopy. 3. Identify baseline variables associated with increased symptoms after colonoscopy. METHODS: Fifty-five outpatients with a history of UC, intact colon, and quiescent disease were enrolled in a prospective case-crossover study. Subjects were evaluated with the Simple Clinical Colitis Activity Index (SCCAI) before colonoscopy, 1 week and 4 weeks after colonoscopy. A mixed model analysis was used to accommodate nonindependence of repeated measurements on the same patients. RESULTS: Fifty-one (91%) subjects completed the study. Six subjects had clinical relapse defined by a score of 5 or greater on the SCCAI during the week after colonoscopy. Five subjects increased their 5-aminosalicylic acid (5-ASA) medications immediately postcolonoscopy, two of whom had a SCCAI 5 or greater. Multivariate modeling demonstrated a clear association between the week immediately after colonoscopy preparation and increased disease activity, with the time period being predictive of increased SCCAI (week 1 vs. week 4, P = 0.0127). The baseline SCCAI (P value < 0.0001) and prednisone use (P = 0.0120) were predictive of increased SCCAI postcolonoscopy. Thiopurines (P < 0.001) were protective against increased symptoms. CONCLUSIONS: In our study, 1 in 8 subjects had UC relapse by SCCAI immediately postcolonoscopy, and 1 in 10 subjects required an increase in their 5-ASA medications. Clinicians should be cognizant of this effect of colonoscopy in patients with UC.

Adult↗

PubMed1994

Safety and clinical efficacy of flexible sigmoidoscopy and colonoscopy for gastrointestinal bleeding after myocardial infarction. A six-year study of 18 consecutive lower endoscopies at two university teaching hospitals.

The risks versus benefits of flexible sigmoidoscopy and colonoscopy performed within three weeks of myocardial infarction were studied in nine consecutive patients who underwent sigmoidoscopy and in nine consecutive patients who underwent colonoscopy at two university hospitals. Indications for sigmoidoscopy were red blood per rectum in seven and occult blood in the stools in two. Sigmoidoscopy provided the diagnosis in three, including colon cancer in two and bleeding internal hemorrhoids in one, and provided helpful information in three. Sigmoidoscopy led to colon cancer surgery in two patients, and polypectomy of a 1-cm adenoma in one. Of two highly unstable patients before sigmoidoscopy, one developed second-degree heart block and frequent premature ventricular contractions 3 hr after sigmoidoscopy. No sigmoidoscopic complications occurred in the seven relatively clinically stable patients. Indications for colonoscopy included red blood per rectum in five, occult blood in the stools in three, and melena in one. Colonoscopy provided the diagnosis in five, including one each with colon cancer, internal hemorrhoids, large adenoma, ischemic colitis, and angiodysplasia. Colonoscopy resulted in colon cancer surgery in one patient and endoscopic polypectomies in three patients. Of two moderately unstable patients before colonoscopy, one developed asymptomatic bradycardia during colonoscopy. No colonoscopic complications occurred in the seven clinically stable patients. This study suggests that recent myocardial infarction is not an absolute contraindication to sigmoidoscopy or colonoscopy, that sigmoidoscopy is beneficial in medically stable patients with significant gastrointestinal bleeding, and that colonoscopy may be beneficial in selected, highly stable patients with significant gastrointestinal bleeding.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed2003

A study to validate the colonoscopy simulator.

BACKGROUND: The aim of this study was to investigate the relation between clinical experience and performance with regard to colonoscopic procedures performed on the HT Immersion Medical Colonoscopy Simulator. The hypothesis is that the performance of novice, intermediate, and experienced operators is different on simulators, just as it is on real patients. METHODS: 25 Postgraduate doctors were recruited and divided into three groups according to their level of colonoscopic experience. Candidates were asked at random to perform colonoscopy on module 3 or 4 of the HT Immersion Medical Colonoscopy Simulator. Modules 3 and 4 have built-in complex loops, and can demonstrate the candidate's ability either to avoid or undo the loop. Candidates in the first group, termed "novice," each had performed fewer than 10 colonoscopies and included four preregistration house officers (PRHOs), five specialist trainee resistrars (SpRs) and two consultants. This novice group had completed 80 episodes among them. In the second group, termed "intermediate," each candidate had performed between 11 and 100 colonoscopies, and the candidates included five SpRs and two research fellows. This intermediate group had completed 65 episodes. Members of the third group, termed "experienced" each had performed more than 101 colonoscopies, and included one SpR and six consultants. This experienced group had completed 45 episodes between them. A time result of 3,600 s (1 h) was used to denote perforation. RESULTS: The experienced group were shown to perform better than the intermediate group, which in turn performed better than the novice group. The assessment was based on multiple factors including time taken to complete the test, percentage of the colonic mucosa visualized, incidence of colonic perforations, and path length used. The results were highly significant statistically for all these factors ( p < 0.000) except in path length used. CONCLUSIONS: This study demonstrated that operators who differ in terms of their clinical experience and technical ability also differ in their performance of simulated colonoscopy. Thus, the findings have shown the simulator technology to be a powerful discriminator of manipulative skills in colonoscopy. The clinical differences that exist between novices and experts in terms of experience and technical expertise in endoscopic procedures are reflected by statistically significant differences in performance on the simulator. It is therefore reasonable to argue that improving proficiency on the simulator may translate into improvements in clinical practice. This study has validated the use of the HT Medical Immersion Colonoscopy Simulator to discriminate among subjects with different levels of experience.

Colonoscopy↗

PubMed1997

Relative sensitivity of colonoscopy and barium enema for detection of colorectal cancer in clinical practice.

BACKGROUND & AIMS: The relative sensitivities of barium enema and colonoscopy for colorectal cancer are still debated. The aim of this study was to determine the relative sensitivity of barium enema and colonoscopy in general clinical practice. METHODS: Medical records of 2193 consecutive colorectal cancer cases identified in 20 central Indiana hospitals were reviewed. All procedures performed within 3 years of the diagnosis were identified. RESULTS: The sensitivity of colonoscopy for colorectal cancer (95%) was greater than that for barium enema (82.9%), with an odds ratio of 3.93 for a missed cancer by barium enema compared with colonoscopy. The sensitivity of double-contrast barium enema (85.2%) was not different from that of single-contrast (81.8%). Barium enema performed no better in the right than the left colon. Cancers detected by colonoscopy were more likely to be Dukes' class A (24.9%) than cancers detected by barium enema (9.8%). Colonoscopy performed by gastroenterologists was more sensitive (97.3%) for cancer than colonoscopy by nongastroenterologists (87%), with an odds ratio of 5.36 for a missed cancer by a nongastroenterologist compared with a gastroenterologist. CONCLUSIONS: Hospital quality assurance committees and/or third-party payors should review the sensitivity of barium enema and colonoscopy by practitioners in their institutions. Corrective measures are recommended when sensitivity deviates significantly below the standard set by gastroenterologists performing colonoscopy in this study.

Barium Sulfate↗

PubMed2000

Nitrous oxide for colonoscopy: a randomized controlled study.

BACKGROUND: Intravenous sedation/analgesia for colonoscopy is accompanied with certain risks and postprocedure drowsiness. We sought to determine whether inhaled nitrous oxide (Entonox: 50% nitrous oxide, 50% oxygen) provides adequate analgesia for colonoscopy and the impact of this agent on recovery. METHODS: All patients undergoing outpatient colonoscopy were considered for the study (n = 248) except those with previous colonic resection. Data for patients unsuitable for randomization (n = 58) and those who declined to participate (n = 88) were also analyzed. RESULTS: One hundred two patients were randomized to receive inhaled Entonox alone (n = 56) or intravenous midazolam and meperidine (n = 46). Forty-nine (88%) patients randomized to Entonox underwent complete colonoscopy without conversion to intravenous medications. Entonox patients reported more pain (p < 0.0001), tolerated colonoscopy less well (p < 0.0001), were less satisfied (p = 0.01), and less willing to undergo colonoscopy again under the same circumstances (p = 0.04). Of patients receiving intravenous medication, 91% found colonoscopy less unpleasant and 9% as unpleasant as anticipated; this compares with 52% and 21% Entonox patients, respectively, and an additional 27% Entonox patients who found colonoscopy more unpleasant than anticipated. Recovery was faster among Entonox patients (median 30 versus 60 minutes, p < 0.0001). CONCLUSION: Entonox is less effective than midazolam with meperidine for colonoscopy but is acceptable in many patients and allows faster recovery.

Administration, Inhalation↗

PubMed2004

Prospective evaluation of screening colonoscopy: who is being screened?

BACKGROUND: Universal access to medical procedures is deemed an advantage of the Canadian health care system. The purposes of this prospective study were to determine the degree to which the practice of colon cancer screening by colonoscopy differed among socioeconomic classes and to assess adherence to screening guidelines. METHODS: Consecutive patients scheduled to undergo colonoscopy at a single center between August 2000 and August 2002 completed a questionnaire that determined patient characteristics and indications for the procedure. The patients were divided into two groups: screening patients, defined as individuals who indicated they were undergoing colonoscopy for screening purposes and were asymptomatic, and a control group, which comprised patients undergoing colonoscopy because of symptoms. Statistical analysis was performed to determine if patients in the screening group had different characteristics with respect to socioeconomic class, compared with the control group. RESULTS: A total of 1088 patients completed the questionnaire: 707 (65%) had colonoscopy because of symptoms, compared with 381 (35%) who underwent a screening examination. Mean age and marital status were similar in both groups. Of all colonoscopy procedures, there was a significantly greater proportion of men undergoing colonoscopy for screening purposes: 199 (52.2%) vs. 294 (41.6%) in the symptomatic group ( p = 0.001). Based on the Cochran-Armitage test, patients in the screening group had significantly higher education levels ( p = 0.004) and household incomes ( p = 0.001). CONCLUSIONS: Income and education level, two indices of socioeconomic status, are statistically significantly higher in patients undergoing screening colonoscopy compared with those having colonoscopy for any other reason.

Adenoma, Villous↗

PubMedDate not supplied

[Role of early colonoscopy in severe acute lower gastrointestinal bleeding].

BACKGROUND: Severe acute lower gastrointestinal bleeding (SALGIB) accounts for 15% of cases of acute lower gastrointestinal bleeding (ALGIB). The incidence increases with age and comorbidity. Identification of the origin of bleeding may be difficult. Colonoscopy has been proposed as the primary investigative tool. AIM: To assess the role of early colonoscopy as the primary method of evaluation in patients with SALGIB. PATIENTS AND METHOD: Retrospective study based on a guideline for clinical practice approved in our institution. The study included 50 patients with SALGIB admitted to our gastrointestinal bleeding unit between January 1998 and April 2000. SALGIB was suspected when patients fulfilled two or more of the following criteria: 1) significant hemodynamic compromise, 2) decrease in hemoglobin 2 g/dl, and 3) transfusion requirement >= 2 blood units. Early colonoscopy was performed within 24 hours of onset of bleeding. An accurate endoscopic diagnosis was established if a lesion with active bleeding, visible non-hemorrhagic vessel or adherent red clot was identified. A presumptive diagnosis was made when hematochezia or fresh blood localized in a colonic segment, associated with a single, potentially hemorrhagic lesion, was observed and when the results of esophagogastroduodenoscopy were negative. Colonoscopy, esophagogastroduodenoscopy, barium studies, nuclear scan and angiography were performed. RESULTS: Two hundred twenty-two patients were admitted for ALGIB. Fifty patients(22%) fulfilled the SALGIB criteria. The male/female ratio was 1:1. Definitive diagnosis was accurate in 20 patients. The most frequent cause was angiodysplasia (6 patients) and rectal ulcer (6 patients). Eighteen patients had a presumptive diagnosis; of these 14 had diverticulosis. In 12 patients, no cause was identified. Colonoscopy was performed in 45 patients, of which 32 were performed early and 13 electively. Accurate endoscopic diagnosis was more frequently established with early colonoscopy than with elective colonoscopy (15 [47%] vs 2 [15%], p < 0.05). The results of urgent nuclear scans contributed to accurate diagnosis in 5 out of the 10 patients in whom this technique was performed. Angiography was performed in 2 patients. Endoscopic therapy was attempted in 4 patients, all during early colonoscopy. Ten patients (20%) underwent surgery and 3 patients (6%) died. CONCLUSIONS: In 22% of patients with ALGIB admitted to our hospital bleeding was severe. Colonoscopy is the diagnostic tool of choice. When performed within 24 hours of hospital admission, this technique provides more accurate diagnosis than when performed electively.

Acute Disease↗

PubMed2004

Early colonoscopy in patients with acute diverticulitis: results of a prospective pilot study.

BACKGROUND AND STUDY AIMS: Outcomes following early colonoscopy in patients with acute diverticulitis have not previously been studied. The present study describes the effects of early colonoscopy in patients with acute diverticulitis. PATIENTS AND METHODS: Consecutive patients hospitalized for acute diverticulitis were included in the study. In the first phase, patients with adjacent peridiverticular air or fluid on computed tomography (CT) were excluded. In the second phase of the study, only patients with free intraperitoneal air were excluded. RESULTS: The study population consisted of 107 patients. During the first phase of the study, 49 patients were included; 10 were excluded because of peridiverticular air or fluid. The remaining 39 patients underwent uneventful colonoscopy. During the second phase of the study, 58 patients were included; four were excluded because of free air in the peritoneum. The remaining 54 patients underwent colonoscopy, and perforation of the sigmoid colon occurred in one patient with peridiverticular air. Complete colonoscopy to the cecum or to the obstructing tumor was achieved in 76 patients (81.7 %). A second colonoscopy performed 6 weeks later in 16 of the remaining 17 patients was successfully completed. Findings during the first colonoscopy were polyps in nine cases, polyp with infiltrating adenocarcinoma in one, obstructing adenocarcinoma in one, and a bone trapped in a diverticulum in another one. The latter two patients had a more protracted course and were clearly the ones who benefited most from the colonoscopy. CONCLUSIONS: Early colonoscopy in patients with acute diverticulitis may alter the working diagnosis and be of therapeutic value. The rate of cecal intubation is lower and the perforation rate appears to be higher. A clear-cut indication therefore has to be evident clinically.

Adenocarcinoma↗

PubMed2006

PillCam colon capsule endoscopy compared with colonoscopy for colorectal tumor diagnosis: a prospective pilot study.

BACKGROUND AND AIMS: Colonoscopy is regarded as the gold standard for colorectal cancer (CRC) screening. PillCam capsule endoscopy could be an alternative approach for screening large populations. We report a pilot evaluation in humans of the safety, feasibility, and performance of colon capsule endoscopy compared with colonoscopy. PATIENTS AND METHODS: Patients included in this single-center comparative study had presented for screening colonoscopy or there was suspicion of polyps or CRC. The capsule was ingested in the morning. After excretion, colonoscopy was performed. Significant findings were defined either as polyps > 6 mm, or three or more polyps of any size. Colonoscopy and colon capsule endoscopy (CCE) review were performed by independent physicians. RESULTS: 41 patients (26 women), mean age 56 years (range 26 - 75) were included, and all had complete colonoscopies. Four patients were excluded due to technical problems and one could not swallow the capsule; thus, 36 patients were considered in the analysis. In six the capsule had not been expelled at 10 hours and was retrieved endoscopically. CCE identified 19 of the 25 patients (76 %) with positive findings and 10 of the 13 (77 %) with significant lesions detected by colonoscopy. CCE detected seven lesions not seen at colonoscopy and two tumors were detected by both examinations. Overall sensitivity of CCE to detect significant lesions was 77 %, specificity was 70 %, positive predictive value was 59 %, and negative predictive value was 84 %. No adverse events occurred. CONCLUSION: CCE showed promising accuracy compared with colonoscopy. This new noninvasive technique deserves further evaluation as a potential CRC screening tool.

Adult↗