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At least 1,315 records · Page 73Linked to original sources

PubMed1987

Is biopsy necessary if colonoscopy is normal?

Multiple endoscopic biopsies were taken from 100 consecutive patients who had a macroscopically normal colon at colonoscopy. Of these, 78 were regarded as histologically normal; 13 cases of melanosis coli, 7 cases of intestinal spirochetosis, and 2 cases of collagenous colitis were identified. In no cases was there histologic evidence of inflammatory bowel disease. Histologic abnormality could not be predicted by retrospective analysis of various clinical, hematologic and biochemical data. In individual subjects the microscopic abnormality was present to a varying degree in all biopsies, except in intestinal spirochetosis where patchy distribution occurred in some subjects. It is therefore concluded that significant pathology may be missed without biopsy of the apparently normal colon, but in order to reduce the workload of pathology departments and shorten the duration of the examination two biopsies from the hepatic flexure and sigmoid colon may be adequate.

Adolescent↗

PubMedDate not supplied

Emergency colonoscopy.

Different diagnostic techniques for massive active lower gastrointestinal hemorrhage are reviewed. According to data in the literature and personal experience in 409 emergency endoscopic examinations of the large bowel, emergency colonoscopy is a valuable diagnostic tool in cases of massive colorectal bleeding.

Colonic Diseases↗

PubMed1988

The lost polyp: a guide to retrieval during colonoscopy.

Polyps resected during colonoscopy should be recovered and sent for pathologic examination. Unfortunately retrieval is incomplete ranging from 85-100% in reported series. There are several specific techniques aimed to increase the retrieval rate which in our experience amounted to 94.5% of a series of 182 polypectomies in 100 consecutive patients. All lost polyps were small and were thought to have been aspirated through the suction channel of the endoscope. In our study 10% of the initially "lost" polyps were within the instrument prior to cleaning. Various forms of polyp retrieval are reviewed with special attention to locating the aspirated polyp.

Colonic Polyps↗

PubMed1995

Angiodysplasia of the lower gastrointestinal tract: an entity readily diagnosed by colonoscopy and primarily managed nonoperatively.

BACKGROUND: The characteristics of patients who develop clinically significant angiodysplasia of the lower gastrointestinal (GI) tract are unknown, and methods of treatment are evolving. PURPOSE: This study was undertaken to identify patient characteristics, methods of diagnosis, and current management of patients who require operation and outcome. METHODS: Patients with the diagnosis of angiodysplasia of the lower GI tract at St. Louis University affiliated hospitals over the past five years were reviewed. RESULTS: Thirty-two consecutive patients were identified. The mean age was 69.8 (range, 29-86) years; 62.5 percent were males. Patient characteristics included: age greater than 65 years, 22 of 32 patients (69 percent); documented coagulopathy, 9 of 32 patients (28 percent); and cardiac valvular disease, 8 of 32 patients (25 percent). Diagnosis was established by colonoscopy in 27 of 32 patients (84 percent), enteroscopy in 3 of 32 patients (9 percent), and angiography in 2 of 32 patients (6 percent). Seventy-eight percent of the angiodysplasias were located in the right colon. Patients were treated by endoscopic coagulation in 16 of 32 patients (50 percent), surgical resection in 9 of 32 (12.5 percent), or observation in 3 of 32 patients (9 percent). Four of 32 patients (12.5 percent) developed recurrent bleeding. Four of 32 patients (12.5 percent) died of various causes. FOLLOW-UP: Follow-up was possible in 25 of 28 surviving patients, and the follow-up period ranged from 3 to 42 months, during which rebleeding occurred in 5 patients who had been previously treated by endoscopic coagulation and in 1 patient who had been treated by transfusion alone. Two patients died of unrelated causes and one from a recurrent lower GI bleed. CONCLUSION: Angiodysplasia is primarily a disease of elderly patients. These patients are frequently anticoagulated and often have co-existing cardiac valvular disease. Endoscopy usually establishes the diagnosis, and endoscopic coagulation is an effective and safe method of treatment. Most patients can be managed without operation.

Adult↗

PubMed1998

Colonoscopy-assisted colostomy--an alternative to laparotomy: report of two cases.

PURPOSE: The objective of this study was to evaluate the feasibility of performing fecal diversion with the help of a colonoscope without a concomitant laparotomy. METHODS: Colostomies were performed on two patients who needed fecal diversion and who would benefit from avoiding the morbidity of laparotomy. A colonoscope was used in each case to guide the surgeon in selecting the appropriate bowel segment. RESULTS: No complications related to the colostomy were noted in either patient. CONCLUSIONS: The technique of colonoscopy-assisted colostomy that we have described offers an acceptable method of creating a stoma without the need for laparotomy.

Aged↗

PubMed1982

Intraoperative colonoscopy for the diagnosis of multiple cancers of the large intestine.

Seventeen patients with multiple simultaneous cancers of the large intestine were investigated. Three out of 4 patients with multiple advanced cancers were correctly diagnosed preoperatively. Multiple cancerous lesions of early and advanced stages coexisted in 13 patients, and it was possible to diagnose the existence of multiple cancers in only 5 preoperatively. A study on the preoperative detectability of coexisting early cancers showed that early lesions located distally to the advanced ones were frequently detected, however, subsidiary lesions located proximally tended to be overlooked. Hence, intraoperative colonoscopy was performed in patients with cancer of the large intestine whenever there was a portion that had not been adequately inspected prior to surgery. Of 31 patients subjected to this examination, 5 had a total of 7 polypoid lesions, in one case we found evidence of a small advanced cancer which was not detected preoperatively.

Adenocarcinoma↗

PubMed1999

Colonoscopy aided by magnetic 3D imaging: assessing the routine use of a stiffening sigmoid overtube to speed up the procedure.

There are not enough trained colonoscopists to cope with the present recommended number of examinations required for diagnostic and surveillance purposes. If colorectal cancer screening is to be introduced, endoscopic examination of the large bowel needs to be easier to learn and significantly quicker to carry out. The 'Bladen system', first described in 1993, is a non-radiological method of visualising the path of the endoscope, using magnetic drive coils under the patient and a chain of sensors along the biopsy channel of the instrument. In 1998, results were published using a novel computer graphics system (the RMR system), in which a much more realistic image of the endoscope could be produced using the stored positional data from the Bladen system. The RMR system has been further refined to allow, for the first time ever, accurate measurement of the effect of the passage of a colonoscope along the bowel on the lengths of different segments of the large intestine. The results obtained in 232 patients undergoing colonoscopy are analysed. In 77 of the patients, a stiffening overtube is used to splint the sigmoid colon once the endoscope is at or beyond the splenic flexure. The mean time taken to pass the colonoscope across the transverse colon is significantly shorter (p < 0.001) when an overtube is used, despite it resulting in significant lengthening of the transverse colon. The routine use of a stiffening overtube can be expected to reduce the total procedure time by between 10 and 20%.

Adult↗

PubMed1983

Management of perforation due to colonoscopy.

Six patients who underwent emergency laparotomy for perforations secondary to colonoscopy or polypectomy are described. Three patients had the laceration closed primarily, two required colostomy, and one needed resection. When contamination is minimal and the colon is mechanically prepared, primary closure without diversion is the treatment of choice. Colostomy is rarely indicated and may lead to increased morbidity, in view of the need for closure. However, resection should be considered if suspicion of carcinoma is great. Factors that contribute to perforation include sedation, forceful introduction of the colonoscope, inadequate equipment for hemorrhage control, and prolonged application of electrocoagulation to the colonic wall.

Colonoscopy↗

PubMed1987

The diagnosis of colorectal cancer with cytologic brushings under direct vision at fiberoptic colonoscopy. A report of 59 cases.

Fifty nine cases of colorectal cancer confirmed postoperatively by histologic examination were correlated with the findings of biopsy specimens and cell brushings. Fifty one cases were positive for malignancy on biopsy (86.4 percent). Brush cytology was positive in 51 cases (86.4 percent). The total preoperative confirmed diagnostic rate of the series was 91.5 percent. Brushing cytology under direct vision at fiberoptic colonoscopy, is a safe, reliable, and quite accurate method for the diagnosis of colorectal cancer. The results from brush cytology did not relate to the configuration and appearance of the tumor. For cell brushing, the fluid in the colonic lumen should be aspirated off as thoroughly as possible. Cell brushings are often positive when colonic stricture and obstruction prevent the colonoscope from reaching the lesion; biopsy, obviously, cannot be done in such a case.

Adolescent↗

PubMed1987

Follow-up colonoscopy in patients with colorectal adenomatous polyps.

Forty-four asymptomatic patients with adenomatous colorectal polyps were followed by repeated colonoscopies and subsequent removal of new polyps. The median follow-up time was 34 months (range, 4 to 131 months). Twenty-six patients (59 percent) developed new adenomatous polyps. The recurrence rate was 69 percent in patients with multiple polyps compared with 54 percent in patients with a single polyp. The location of new polyps was in the same colonic segment in 81 percent of the patients, but not at the same site in the colon where a previous polyp had been removed. The histopathology and size of new polyps compared with the initial polyps showed a significant improvement in histopathology toward more benign polyps (P less than 0.02) and smaller polyps (P less than 0.001). In patients who initially had single adenomatous polyps, new polyp(s) were diagnosed after a mean time of 23 months compared with 13.5 months in patients with two or more adenomatous polyps initially. Patients with atypia in initial polyp(s) developed new polyp(s) after a mean time of 11 months compared with 23 months in patients without atypia. The mean time from a colon with no polyps to the diagnosis of a new adenomatous polyp less than 5 mm in size was 11.5 months, which was a statistically significant shorter time than the 19.4 months observed for the development of polyps 5 mm or larger.

Adult↗

PubMed1985

Colonoscopy in the evaluation of strictures.

This is a review of 181 consecutive colonoscopic procedures performed to resolve the etiology of colonic strictures when the barium enema was inconclusive. In 54 percent, it was possible to intubate the colon above the stricture and thus resolve the problem. In 46 percent, it was impossible to traverse the stricture. In this group, it was nevertheless possible to resolve the problem in another 13 percent using the combined technique of biopsy and cytology. Thus, colonoscopy was helpful and determinate in 67 percent.

Adult↗

PubMed1987

Colonoscopy in ostomy patients. Results at the first postoperative examination.

Patients with a personal history of rectal cancer are considered at high risk for metachronous large-bowel primaries. Since a malignant growth was the main reason for performing a colostomy in patients followed at the centers of the authors' association (AISTOM), a correct follow-up approach for these patients is very important. A multicentric clinical trial was thus carried out to evaluate the efficacy of transstomal endoscopic exploration (TEE) of the residual colon, and data collection began on May 31, 1984. Nine hundred fifty-seven patients were submitted to TEE after curative abdominoperineal resection (Miles) for rectal cancer. The male-female ratio was 1.3; 89.6 percent of the patients were over 50 years of age. A family history of large-bowel cancer was present in 18 percent, and in 23 percent of the patients the cancer was associated with synchronous adenomas. Only 31 percent of the patients had colonoscopy or double-contrast barium enema x-ray beyond the neoplastic area before surgery. TEE was done in 96.8 percent of the patients; in 3.3 percent the examination was not possible, mainly for stenosis of the stoma (in 2.3 percent). In 82 percent of the patients a complete large-bowel exploration was possible: a new large, bowel cancer was found in 22 patients (2.2 percent) and an adenoma in 183 patients (19.1 percent). These results show that, because it is safe, practical, and effective, endoscopy plays an important role in the follow-up of ostomates.

Adenocarcinoma↗

PubMed1983

Fiberoptic colonoscopy. A report of findings in 481 patients from Kuwait.

The authors report 481 colonoscopic examinations, performed in the Amiri Hospital, Kuwait. The objective of this paper is to demonstrate the pattern of colonic diseases in this region and to compare our findings with those reported from elsewhere. Although these are preliminary results, they suggest that colonic diseases, in general, are uncommon in this area. Ulcerative colitis was the most common pathology detected on colonoscopy. Polyps and diverticulosis were less common than those observed in the west. The frequency of Crohn's disease in Indians and Pakistanis in Kuwait was found to be high, although it is reported to be a very rare disease in their native countries.

Adolescent↗

PubMed1990

Colonoscopy for investigation of unexplained rectal bleeding in a tropical country.

One hundred and forty four patients underwent colonoscopy to detect the cause of rectal bleeding. This was successful in either identifying the lesion or excluding the presume of lesions up to the cecum in 88.8% patients. The source of bleeding was diagnosed in 106 (73.61%) patients. Predominant lesions were nonspecific colitis and ulcers (62.26%), polyps (17.92%), cancer (8.49%), rectal varices (3.77%) and tuberculosis (1.88%). The remainder had other colonic conditions such as radiation colitis, ischemic colitis, vascular malformation, diverticulosis, right sided ulcerative colitis and pseudo-pancreatic cyst communicating with the descending colon. The majority (94.33%) of these lesions involved the left colon. Thus colonoscopic examination was useful in localizing the cause of rectal bleeding and the predominant lesions were differed from those reported in the western hemisphere.

Adult↗

PubMed1992

Bowel preparation for the total colonoscopy by 2,000 ml of balanced lavage solution (Golytely) and sennoside.

One of disadvantages of the Golytely preparation is that examinees have to drink as much as 4,000 ml of Golytely. To overcome this disadvantage, we designed a modified preparation regimen in which examinees have to drink only 2,000 ml of Golytely by taking sennoside orally. Bowel preparation was carried out in 297 examinees by this modified method. Examinees ate their usual diet and took 36 mg of sennoside orally on the night before the examination. On the day of the examination, the examinees drank a total of 2,000 ml of Golytely. No severe complications were noted and 97% of the examinees were able to drink the dose of 2,000 ml. Subjects who had also experienced bowel preparation by the modified method of Brown were asked to compare the two regimens, and only 1% preferred Brown's method while 73% preferred bowel preparation by our Golytely method. The result of bowel preparation by this method was excellent or good in 90 to 97% of the subjects at all sites in the colon and rectum. We conclude that bowel preparation for total colonoscopy using 2,000 ml of Golytely and sennoside is superior because it is highly acceptable to the examinees and provides excellent gut irrigation.

Adolescent↗

PubMed1992

A study of intracolonic hydrogen and methane levels during colonoscopy.

Gas samples were obtained during colonoscopy for analysis. Patients were prepared with polyethylene glycol (PEG) (N = 23), phosphate enema (N = 34) and mannitol (N = 4). Air insufflation was used in all procedures. High concentrations of hydrogen were detected in 3 out of 38 gas samples in the PEG group, in 2 of 41 samples in the phosphate enema group and in one of the 8 samples in the mannitol group. All patients had a coexisting intracolonic oxygen concentration > 5%. The results suggest that potentially explosive concentrations of hydrogen may occur after conventional bowel preparations, and that insufflation of carbon dioxide during polypectomy should be a routine.

Colon↗

PubMed1995

Colonic investigations in the elderly: colonoscopy or barium enema?

Colonoscopy (CS) is currently considered the best diagnostic procedure for colonic imaging. The objectives of this multicentric study were to assess whether CS or simple contrast barium enema (SCBE) has the best effectiveness and tolerance in the elderly (over 80 years old). Except in cases of emergency, 67 elderly patients from 3 centers were randomized among three diagnostic strategies: CS, SCBE or barium enema+rectosigmoidoscopy (BERS). CSs were generally carried out after polyethylene-glycol (PEG) cleansing, and barium enemas after enema cleansing. The diagnostic effectiveness of the three strategies was not significantly different: a colonic abnormality was found in CS, SCBE, BERS groups in 65, 56 and 71% of the cases, respectively. No other investigation was needed in 61 to 76% of cases, and, on the basis of the exploration, final therapy was modified in less than 22% of cases. Overall cleansing quality was significantly better with barium enema (84.1%) than with CS (57.0%; p < 0.05). This was explained by a poor tolerance to PEG intake, which led to 28.2% of adverse effects, compared with 7.1% after enema preparation (p < 0.05). This resulted in a significantly higher failure rate of complete colonic exploration with CS (48%) than with barium enema (9%; p < 0.001). In conclusion, the effectiveness of the three diagnostic strategies is similar in the elderly. However, due to a better acceptance of the enema preparation, and to a better success rate of complete exploration, SCBE should be preferred to investigate colonic symptoms when the above preparations are used.

Aged↗

PubMed2003

Gossypiboma treated by colonoscopy.

Gossypibomas are an unusual postoperative complication and are reluctantly reported in the literature. In the past, the patient would require a laparotomy. More recently, they have been treated laparoscopically and percutaneously by interventional radiology. This is the first case report of a gossypiboma treated with colonoscopy. This may represent an addition treatment option for this complication.

Child, Preschool↗