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PubMed2004

Colonoscopic screening and follow-up in patients with acromegaly: a multicenter study in Italy.

Acromegaly is an infrequent disease attributable to endogenous excess of GH and IGF-I. Human studies have associated the GH-IGF-I axis with the development of colorectal cancer; however, the question of whether colorectal cancer is a problem in acromegaly is currently unresolved. We performed a cross-sectional study to assess the risk of colonic neoplasia in patients with acromegaly. Colonoscopic screening was performed in 235 patients with acromegaly at five tertiary care hospitals in Italy between January 1, 1996, and December 31, 2001. A repeat colonoscopy was performed in 121 patients after a mean interval of 32.1 months. Colonoscopic findings in patients with acromegaly were compared with those of 233 patients with nonspecific abdominal complaints who were referred for endoscopy during the study period. A total of 65 patients (27.7%) and 36 controls (15.5%) had colonic neoplasia. In 55 patients (23.4%) and 34 control subjects (14.6%), the most important findings were adenomas (odds ratio, 1.7; range, 1.1-2.5), whereas 10 patients (4.3%) and two control subjects (0.9%) had carcinoma (odds ratio, 4.9; range, 1.1-22.4). The risk of colonic neoplasia was higher for younger patients with acromegaly compared with age-matched controls. Patients with acromegaly with or without colonic neoplasia did not differ significantly for IGF-I levels or duration of disease. A neoplastic recurrence was found in 16.5% of patients who underwent follow-up; 90% of them had had a neoplasm removed at the first colonoscopy. Acromegaly carries with it a moderate, but definitive, increase in the risk of colonic neoplasia that occurs at a younger age than in the general population. Patients who are found to harbor a colonic neoplasia are at risk for recurrence.

Acromegaly↗
PubMed2000

Color image segmentation based on fuzzy rule-based reasoning applied to colonoscopic images.

A fuzzy color segmentation approach is developed for the analysis of colonoscopic images. The segmentation is made up of two phases: segmentation through histogram space filtering and region merging using fuzzy rule-base reasoning. The first phase involves using a scale-space filter to analyze the hue, saturation, and intensity (HSI) histograms to determine the number of classes and construct a 3-D class grid. The color image is then segmented based on the class grid. In the second phase, region merging based on applying the fuzzy rule-base is employed to guide the combining process of the segmented regions. For fuzzy reasoning, three criteria are evaluated, namely, the edge strength along the boundary, color similarity, and spatial connectivity of adjoining regions. Experimental testing of the proposed method applied on colonoscopic images was conducted, and the results are encouraging.

Colonoscopy↗
PubMed1987

Histologic and colonoscopic assessment of disease extension in ulcerative colitis.

A comparison between histologic and colonoscopic extension of ulcerative colitis was made in 107 examinations (83 patients). During colonoscopy signs of inflammation were registered, and biopsy specimens were taken from the following gut segments: rectum, left colon, transverse colon, and right colon. Inflammatory activity in the specimens was graded in accordance with severity in a scale from one to five. Endoscopically, total colitis was seen in 40 examinations but was present in 70 examinations histologically. In 34 of 107 examinations the extension of disease was underestimated at colonoscopy. A slight inflammation existed in those segments that appeared normal colonoscopically. Our conclusion is that the extension of ulcerative colitis often is underestimated endoscopically and that inflammatory activity can be present in mucosa assessed as normal on colonoscopy.

Colitis, Ulcerative↗
PubMed2006

Incidence and management of colonoscopic perforations: 8 years' experience.

AIM: To review the experience of a major medical teaching center with diagnostic and therapeutic colonoscopies and to assess the incidence and management of related colonic perforations. METHODS: All colonoscopies performed between January 1994 and December 2001 were studied. Data on patients, colonoscopic reports and procedure-related complications were collected from the departmental computerized database. The medical records of the patients with post procedural colonic perforation were reviewed. RESULTS: A total of 120067 colonoscopies were performed during the 8 years of the study. Seven colonoscopic perforations (4 females, 3 males) were diagnosed (0.058%). Five occurred during diagnostic and two during therapeutic colonoscopy. Six were suspected during or immediately after colonoscopy. All except one had signs of diffuse tenderness and underwent immediate operation with primary repair done in 4 patients. No deaths were reported. CONCLUSION: Perforation rate during colonoscopy is low. Nevertheless, it is a serious complication and its early recognition and treatment are essential to optimize outcome. In patients with diffuse peritonitis early operative intervention makes primary repair a safe option.

Adult↗
PubMed2004

Our sigmoid colon volvulus experience and benefits of colonoscope in detortion process.

BACKGROUND/AIMS: The sigmoid colon is the most frequent site for a volvulus. In this report, we review our experience with sigmoid colon volvulus. METHODOLOGY: We present our experience of 81 cases of sigmoid volvulus admitted to our department. RESULTS: Preoperative endoscopic volvulus detortion was attempted in all patients, and in 39 of them the procedure was successful. The success rate of endoscopic detortion for sigmoid colon volvulus with a flexible colonoscope (60%) was higher than with a rigid rectosigmoidoscope (42%). In 19 of these 39 non-operatively devolvulated patients, sigmoid resection with primary anastomosis was performed within 7-10 days after reduction, but 20 patients did not accept the elective operation after a non-operative treatment. Among the 61 patients undergoing urgent or elective operation for sigmoid volvulus, there were 17 laparotomies with only detortion, 19 resections with elective anastomosis, 6 resections with primary anastomosis, and 19 resections with a Hartmann's pouch. There were 9 deaths (21%) among 42 patients who underwent an emergency operation, and one (5.2%) among the 19 patients who had elective surgery died because of a cerebral embolus. CONCLUSIONS: Initial therapy with endoscopy affords decompression and an adequate preparation of patients for surgical resection, and a flexible colonoscope has notable advantages over rigid instruments for the detortion process.

Adult↗
PubMedDate not supplied

[Colonoscopic screening in first-degree relatives of patients with sporadic colorectal cancer].

UNLABELLED: Colonoscopic screening has been recommended in asymptomatic first-degree relatives of patients with colorectal cancer. In fact this population is believed to have an increased risk in developing colorectal neoplasia. The purpose of this study is to report the impact of colonoscopy in a series of completely asymptomatic first-degree relatives of patients operated on for colorectal cancer at our institution. A total of 480 individuals was requested to participate in a screening program based on faecal occult blood testing (FOBT) and colonoscopy in those with positive FOBT. Colonoscopy was also suggested to persons with negative FOBT. After the first 195 examined relatives, FOBT was abandoned because of continuously increasing acceptance of colonoscopy. RESULTS: Two hundred fifty four subjects (52.4%) accepted to participate at the screening program. After the first 195 examined relatives, FOBT was abandoned because of continuously increasing acceptance of colonoscopy. A total of 142 colonoscopies was performed. Colonoscopy was completed in 112 relatives (78.9%). Thirty-three subjects (23.2%) had a positive colonoscopy: one had invasive adenocarcinoma, one had large villous adenoma and 31 had 54 polyps. Twenty-three lesions (40.3%) were located proximal to the splenic flexure. Of the 54 polyps, 45 (83.3%) were less than 1 cm in size. These findings confirm the utility of colonoscopic screening in asymptomatic first-degree relatives of patients with colorectal cancer. However, its feasibility with the current endoscopic facilities remains an unsolved question.

Adenocarcinoma↗
PubMedDate not supplied

Histological appraisal of ulcerative colitis fibreoptic colonoscope biopsy specimens.

The availability of the fibreoptic colonoscope with biopsy facilities has created new opportunities for the investigation of ulcerative colitis. Morphological assessment of the disease, which has hitherto been limited to observing changes in the mucosa of the sigmoid colon and rectum, can now be made on biopsy material obtained under direct vision from the large bowel above the level of the sigmoid. On the basis of 157 colonoscopic biopsies taken from 38 patients with endoscopic appearances of the disease is proposed. The classification is as follows: (i) active chronic phase without ulceration; (ii) active chronic phase with ulceration; (iii) quiescent chronic phase; (iv) healed chronic phase; (v) precancerous phase. Three degrees of severity (mild, moderate and severe) for each phase are recognized.

Biopsy↗
PubMed2003

A potential alternative treatment of uncomplicated painful diverticular disease by trans-colonoscopic irrigation technique: a preliminary report.

BACKGROUND: Colonic diverticular disease is a common disorder in elder patients. Medical treatment was usually recommended as the first line management for this disease. However, the recurrence rate of such disorder is still high. In patients with severe complications such as abscess or fulminant inflammation, non-invasive diagnostic examination, abdominal CT scan for example, is recommended. Its most common symptom is repeated abdominal pain with disturbance of bowel habit. Many patients are found to be with diverticular disease only after colonoscopic examination. The aim of this study is to introduce a new irrigation-draining method and to evaluate its efficacy in treatment of uncomplicated painful colonic diverticular disease. METHODS: To reduce the risk of recurrence of acute diverticulitis and other severe complications, we introduce a transcolonoscopic irrigation technique for patients of uncomplicated diverticular disease by flushing out the obstructed fecalith from the diverticular sac in order to improve the drainage from the obstructed diverticular sac. RESULTS: Thirty-two patients of uncomplicated painful diverticular disease with obstructed fecalith impacted were treated by this technique. Clinical symptom improved in all of them and no complications developed during the mean follow-up period of 46 months. CONCLUSION: The results of this preliminary study suggest that this technique accomplished in the colonoscopic examination without additional therapeutic procedures. It provides another potential alternative to the conventional medical treatment for patients with uncomplicated diverticular disease.

Abdominal Pain↗
PubMed2004

[A case of pedunculated leiomyoma found during colonoscopic examination for anal bleeding].

Gastrointestinal leiomyomas are commonly found in the stomach, and but 3% of them arises from the colon. Colonic leiomyomas are often found incidentally during colonoscopic examination. Most of patients with colonic leiomyoma are asymptomatic, but patients with large size leiomyoma occasionally have abdominal mass, hemorrhage, intestinal obstruction or perforation. Pedunculated leiomyomatous polyp is rare. Leiomyomatous polyps are occasionally misjudged as adenomatous polyps by endoscopist. We report a case of pedunculated leiomyomatous colonic polyp in 65 year-old female patient. She has complained of intermittent hematochezia and lower abdominal discomfort for 5 months. During colonoscopy, an 1 cm sized long pedunculated polyp at the splenic flexure was detected. It was removed by colonoscopic snare polypectomy. Leiomyomatous polyp was confirmed by microscopic and immunohistochemical findings.

Aged↗
PubMed2004

[The usefulness of colonoscopic biopsy in the diagnosis of intestinal tuberculosis and pattern of concomitant extra-intestinal tuberculosis].

BACKGROUND/AIMS: Intestinal tuberculosis can be difficult to diagnose because it may mimic many other intestinal diseases. The aim of this study was to evaluate the diagnostic yield of colonoscopic biopsy and frequency of concomittent extra-intestinal tuberculosis in intestinal tuberculosis. METHODS: The medical records of 225 consecutive patients with intestinal tuberculosis (81 men, 144 women; mean age 40.6 yrs) were analyzed retrospectively. RESULTS: Histological examination of colonoscopic biopsy specimens revealed granulomas in 163 (72.4%) of the 225 patients. However, caseous necrosis was found in only 25 (11.1%) patients, and acid-fast bacilli (AFB) were noted in 39 (17.3%) of the 225 patients. Mycobacterium tuberculosis was isolated from the culture of biopsy specimens in 52 (29.3%) of 177 patients. Eighty-four patients (37.3%) had concomitant extra-intestinal tuberculosis and 67 (29.8%) showed active pulmonary tuberculosis. Histological examination of the biopsy specimens enabled the diagnosis of intestinal tuberculosis by the presence of either caseating granulomas or AFB in 52 (23.1%) patients. Combination of histological examination and Mycobacterium culture established the diagnosis in 87 (38.7%) patients. Before getting the result of Mycobacterium culture, the diagnosis could be made, by either histological examination or the presence of extra-intestinal tuberculosis in 107 (47.6%) patients. Combination of caseating granulomas, AFB staining, Mycobacterium culture, and the presence of extra-intestinal tuberculosis resulted in the diagnosis in 126 (56.0%) patients. CONCLUSIONS: To increase the diagnostic yield, AFB staining and Mycobacterium culture should be routinely performed on biopsy specimens in addition to routine histological examination for caseating granulomas.

Adolescent↗
PubMed2004

Colonoscopic perforations: incidence, management, and outcomes.

Fiberoptic colonoscopy provides superior diagnostic and therapeutic capabilities in the treatment of lower gastrointestinal disease processes. A well-recognized, but uncommon, complication during the procedure is perforation. The purpose of this study was to determine the incidence of colonoscopic perforation, define risk factors, assess the management of these complications, and evaluate outcomes. From January 1997 through December 2003, 43,609 colonoscopies were performed in our medical center. There were 14 (0.032%) perforations (1 in 3115 procedures); 7 from diagnostic and 7 from therapeutic procedures. General surgeons performed 1243 procedures (2.9%), and their rate of perforation was 0.080 per cent compared with 0.031 per cent for gastroenterologists during the same period. Half of the perforations occurred in the rectosigmoid, and the most common mechanism was mechanical (n = 6). Perforation was identified immediately during endoscopy in 50 per cent of the patients. Thirteen of 14 perforations were treated within 24 hours; 1 was delayed 48 hours. Initial surgical management was undertaken in 11/14 patients. Initial nonoperative treatment was attempted in three and was successful in only one patient. The mean length of stay following perforation was 11.2 days (range, 4-36 days). Three patients (21.4%) had 7 postoperative complications. Colonoscopic perforations are uncommon but can be recognized early and managed surgically with acceptable morbidity and postoperative length of stay.

Adult↗
PubMed2005

[Treatment of ulcerative colitis by combined therapy of retention enema and per-colonoscopic spraying with zhikang capsule compound liquid].

OBJECTIVE: To explore the therapeutic efficacy of patients with ulcerative colitis (UC) treated by retention enema and per-colonoscopic spraying of Zhikang Compound Liquid (ZKCL). METHODS: Eighty-six patients with UC were divided into two groups. The 52 patients in the treated group were treated for 4 courses of retention enema, the drug for enema used in the 1st course was ZKCL-A (consisted of normal saline, Zhikang capsule, gentamycin and dexamethasone) and smecta, in the 2nd course ZKCL-A alone, in the 3rd and 4th course, ZKCL-B (with the same contents of ZKCL-A but without dexamethasone), the enema was carried out once a day in the evening, 15 days as one course. Besides, local spraying of ZKCL-A and smecta were given once by colonoscopy before the 1st and 3rd course. The 34 patients in the control group were treated by salicylazosulfapyridine orally. RESULTS: In the treated group, 32 patients got complete remitted, 15 were treated effectively, 5 ineffectively, the total effective rate being 90.38% while the corresponding number in the control group were 8, 14, 12, and 64.71%, respectively. Significant difference was seen when compared with the therapeutic effects of the two groups. CONCLUSION Good efficacy was got in treating patients with UC by retention enema and per-colonoscopic spraying with ZKCL.

Administration, Rectal↗
PubMed1991

The value of colonoscopic surveillance following a diagnosis of colorectal cancer or adenomatous polyp.

Conventional follow-up of patients with colonic neoplasia will at best only identify symptomatic lesions and those visible with a sigmoidoscope, and will therefore fail to identify new malignant lesions in time for effective treatment. In 1980 we began a prospective study of the efficacy and feasibility of replacing conventional outpatient follow-up with annual colonoscopic surveillance. One hundred and fifty-eight patients, attending one surgeon, have been entered: 74 patients who had a curative resection for colorectal carcinoma and 84 patients who had endoscopic or local resection of an adenoma. In the carcinoma group (mean follow-up 4.3 years, range 1-21), 40 of 237 colonoscopies were positive (17%) in 27 patients (36%). Forty-eight polyps were removed endoscopically and two asymptomatic recurrent carcinomas identified. In the adenomatous polyp group (mean follow-up 4 years, range 1-11), 40 of 252 colonoscopies were positive (16%) in 29 patients (34%). Fifty polyps were removed endoscopically, including two which had become malignant. All patients were also screened by Haemoccult stool testing, in the hope that it would identify these lesions and allow the frequency of colonoscopy to be reduced. Unfortunately, Haemoccult testing failed to identify many lesions, including one carcinoma and one malignant polyp. Our experience suggests that colonoscopic follow-up of all patients with colonic neoplasia attending one surgeon is a feasible exercise which can and should replace outpatient appointments for clinical examination.

Aged↗
PubMed1987

Chronic nonspecific inflammatory bowel disease of the cecum and proximal colon in children with grossly normal-appearing colonic mucosa: diagnosis by colonoscopic biopsies.

The diagnosis of inflammatory bowel disease rests on radiologic, endoscopic, and histologic criteria. Five patients, 2 to 17 years of age, sought medical attention because of chronic abdominal pain, diarrhea, and heme-positive stools. Rectal biopsies, visual inspection of colonic mucosa through the colonoscope, and contrast radiographs of the large and small intestine yielded nonspecific results. Serial endoscopic biopsies demonstrated a gradient of inflammatory changes diminishing in severity distally from the ileocecal valve and cecum. The disease process was most evident in specimens from the cecum, whereas biopsies distal to the transverse colon had a normal histologic appearance in all five patients. Biopsies from the proximal colon may provide evidence of inflammatory bowel disease not detectable using standard techniques. The combination of chronic abdominal pain, diarrhea, and heme-positive stools associated with inflammatory changes in biopsy specimens obtained from the proximal colon, but normal findings on radiologic, colonoscopic, and rectal biopsy examinations, may represent an early stage in the evolution of chronic nonspecific inflammatory bowel disease, including ulcerative colitis or regional enteritis (Crohn disease).

Adolescent↗
PubMedDate not supplied

[Colonoscopic follow up of rectocolonic cancer surgeries. Assessment of 64 examinations].

A collation of 64 colonoscopic examinations performed on 41 patients operated on for cancer of the colon or rectum is reported. Eleven patients (26.8 percent) had positive follow-up endoscopic findings. In 13 enumerated tumoral proliferations. 8 benign polyps and 5 malignant growths were found, one of the latter on the anastomosis, and the other 4 on the remaining colon. 80 percent of these tumoral growths and all malignant tumors were discovered in the two years following surgery. When colonic strictures present before operation prevent total colonoscopic exploration, such an endoscopic examination of the colon in its entirety must be made immediately following passage of three post-operative months. It is prudent not to wait for attendant alarming signs but rather to integrate total colonoscopy including excision of "overlooked" or newly-formed polyps into the follow-up protocol of all colon surgery cancer patients who have become high-risks for either a relapse or recurrence of polyps. In the initial two post-operative years, when there is a maximal risk. Colonoscopy should be performed every six months and thereafter at longer but regular intervals throughout survival.

Adenocarcinoma↗
PubMed1974

Non-invasive colonoscopic polypectomy. Review of 100 cases.

Colonoscopic polypectomy was done in one hundred patients. One hundred eighty-three polyps were removed from these patients during 111 colonoscopies and eight malignant polyps were found. The material suggests that pedunculated malignant polyps, when the stalk is clear of carcinoma, can be cured through colonoscopic polypectomy, thus obviating the need for laparotomy. At present, however, more cases and a longer follow-up are needed before this can be established. There were no deaths and no perforations. There were two cases of bleeding, only one requiring transfusion. The procedure costs less and entails less time in hospital than laparotomy, colotomy and polypectomy.

Adult↗
PubMed1984

Non-obstructive colonic dilation: radiologic findings in 50 patients following colonoscopic treatment.

Fifty patients with acute onset of colonic dilatation without mechanical obstruction were evaluated before and after colonoscopic decompression. Colonic dilatation, as demonstrated radiographically, was segmental or consistent with mechanical obstruction in 33 (66%). Signs of impending cecal perforation were seen in five (10%) and these patients had colonoscopic decompression, tube cecostomy, or both. Following colonic decompression, cecal diameter may remain unchanged for two to four days, despite decreased abdominal girth and even shortening of the colon radiographically. Improvement in pain, distention, tenderness, fever and leukocytosis may precede radiographic improvement. The radiologist must recognize this entity, look for signs of impending perforation and signs of bowel shortening, with or without decompression after treatment. Barium studies of the colon should be avoided since they can hamper the endoscopic diagnosis and treatment of colonic dilatation.

Adult↗
PubMed1981

Bowel preparation and the safety of colonoscopic polypectomy.

A fatal colonic explosion has been recorded during colonoscopic polypectomy after oral mannitol bowel preparation. It has been suggested that bacterial degradation of oral mannitol allows the production of hydrogen and methane which are potentially explosive. We have analyzed the gas composition of colonic aspirates in unprepared patients (n = 11), after orthograde saline lavage (n = 11), after oral mannitol alone (n = 11), and when oral mannitol was given with oral antibiotics (n = 11). After oral mannitol bowel preparation 7 patients had potentially explosive gas mixtures compared with 4 in the unprepared group, 1 after orthograde saline lavage, and none when oral antibiotics were used before mannitol. We believe, therefore, that if oral mannitol is used for bowel preparation before colonoscopic polypectomy oral antibiotics should also be administered or insufflation should be with carbon dioxide.

Administration, Oral↗