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PubMed1979

Colonic tuberculosis diagnosed by colonoscopic biopsy.

A patient with pulmonary tuberculosis and a constricting transverse colon lesion on barium enema was found at colonoscopy to have a 1.5 X 3.0 cm ulcer with irregular, edematous borders. Multiple colonoscopic biopsies of the ulcer revealed acid-fast bacilli with absence of granulomas. Previously, the diagnosis of colonic tuberculosis had been thought to require laparotomy for confirmation. The authors now suggest that colonoscopic biopsy may be a desirable alternative in selected cases.

Biopsy↗
PubMed1979

Colonoscopic polypectomies.

One hundred ninety-three consecutive colonoscopic procedures were carried out over a recent 1-year period. An overall success rate of 92.7% was achieved for 178 attempted polypectomies. Bleeding was a complication in two patients. No colonic perforations resulted from the procedures. The results represent experience gained with 1,450 colonoscopic polypectomies.

Adult↗
PubMed1994

Septicemia occurring after colonoscopic polypectomy in a splenectomized patient taking corticosteroids.

Although a transient bacteremia may occur in approximately 4% of patients after colonoscopic procedures, clinically significant bacteremia or endocarditis is exceedingly rare. To our knowledge, the case we describe herein is the first reported case of septicemia due to Flavobacterium meningosepticum and Escherichia coli after colonoscopic polypectomy. Our patient was probably immunocompromised and, therefore, predisposed to bacteremia after the procedure, because she was asplenic, diabetic, and receiving long-term steroid therapy for her chronic autoimmune disorders. Several recent reports have suggested that immunocompromised patients are more likely to develop septicemia after endoscopic procedures.

Bacteremia↗
PubMed1993

Management of complications of colonoscopic polypectomy.

Complications can occur following therapeutic endoscopy. The most serious complication is bleeding, which occurs in 1.4% of all colonoscopic polypectomies. Perforation occurs in 0.3% of patients and postpolypectomy coagulation syndrome is seen in 1% of all patients following polypectomy. Bleeding is a dramatic complication, but most cases can be handled colonoscopically without the need for surgery or angiography. For patients who present with delayed bleeding (2% of all patients), emergency colonoscopy should be performed if the patient has active ongoing bleeding. Once a patient stops bleeding, rebleeding is not commonly seen. A schema is given for polypectomy when the patient is on anticoagulants. Other postpolypectomy syndromes discussed include pain, a contrecoup burn of the wall, and the transmural burn. Most of these resolve without any therapy. A review of the literature and personal comments are included in this article, which provides practical guidelines for postpolypectomy complications.

Acute Disease↗
PubMed1995

Colonoscopic diagnosis of dysplasia and early cancer in longstanding colitis.

Five colitic cancers were detected among 40 patients with longstanding total colitis. The colitic cancers did not show the common polypoid or ulcerated appearance in the early stage, often being flat or plaque-like. It was not easy to detect these lesions endoscopically, and it was often impossible to do so radiologically. The flat or plaque-like early cancers were often surrounded by granular and/or red mucosa. We believed that the colonoscopic detection of this colitic cancer and dysplasia was difficult because: (1) the morphology of the lesions was difficult to determine, (2) the background mucosa was not normal. When the lesions were small, it was more difficult to detect them on the colitic mucosa than on the normal mucosa. The contrast between the lesion and the background mucosa was not clear in the latter condition. In surveillance colonoscopy (using a TV colonoscope) for longstanding ulcerative colitis, careful scrutiny throughout the large intestine is required to detect colitic cancers and dysplasia at an early state.

Adult↗
PubMed1976

Colonoscopic polypectomy.

The colonoscopic management of 86 patients with polypoid lesions of bleeding from the colon of intermittent nature is discussed. There were 145 polyps found in 85 of these patients. Adenomatous polyps occurring in the sigmoid colon above the reach of the standard sigmoidoscope was the most common finding and pathological diagnosis. Adenocarcinoma of the colon occurred in two patients and invasive carcinoma of a polyp was found in three other patients. Five other patients had polyps that demonstrated a carcinoma in situ. The definitive treatment of these complicated polyps is outlined. The importance of barium enema examination on follow-up of polyp and carcinoma patients and on patients with polyps found at standard sigmoidoscopy is stressed. The possibility of colonoscopic follow-up in lieu of colectomy and ileoproctostomy is suggested for patients with multiple polyps of the colon who do not belong to the familial polyposis group.

Adenocarcinoma↗
PubMed1991

Incarceration of colonoscope in an inguinal hernia. "Pulley" technique of removal.

Because of its relative safety, colonoscopy has become an accepted diagnostic and therapeutic procedure in the evaluation of patients with colorectal disorders. Many unusual complications of colonoscopy have been described, but only anecdotal reports of hernial incarceration have been published. We present a case of a right-sided hernial incarceration of the colonoscope that would not permit reduction of the hernia nor removal of the instrument by conventional means. The mechanism of incarceration, which dictates the size of hernia at risk for incarceration, is explained. The "pulley" technique, which was used to remove the instrument without surgical intervention, is described.

Aged↗
PubMed1987

A new colonoscope holder.

A new, simple, stable instrument for holding the colonoscope during procedures requiring the use of both hands is described.

Colonoscopes↗
PubMed2002

Adenocarcinoma in solitary large hyperplastic polyp diagnosed by magnifying colonoscope: report of a case.

We report a case of carcinoma in a hyperplastic polyp in a 78-year-old female that was diagnosed before resection using a magnifying colonoscope. The patient presented with fecal occult blood and underwent total colonoscopy, which revealed a 12-mm sessile polyp in the cecum. When seen in magnified view, an irregularly shaped pit was evident at the center of the polyp that was distinct from the asteroid-type pits observed over most of the lesion. We diagnosed this lesion as a hyperplastic polyp with a carcinoma component. The patient underwent endoscopic mucosal resection, and histologic section revealed a well-differentiated intramucosal adenocarcinoma in the hyperplastic polyp. Hyperplastic polyps of the colon are regarded as benign, nonneoplastic lesions. Few have reported carcinomas in or with hyperplastic polyps, and most of those were diagnosed after resection and histologic investigation. The literature suggests a precise observation and consideration of resection for large solitary hyperplastic polyps in the right side of the colon, because the risk of malignancy is high. Magnifying colonoscopy is helpful for observing the surface in detail and for correctly diagnosing and managing the lesion.

Adenocarcinoma↗
PubMed1986

Growth characteristics of autochthonous experimental colonic tumors as assessed by serial colonoscopic measurement in rats.

We report the growth characteristics of autochthonous experimental colonic tumors as assessed by serial measurements at colonoscopy. Male Fischer 344 rats were given 10 weekly subcutaneous injections of the bowel carcinogen azoxymethane, 10 mg/kg (weeks 1-10). Beginning in week 15, colonoscopy to the splenic flexure was performed weekly with a pediatric fiberoptic bronchoscope. Width of identified tumors was measured in photographs that included a scale passed through the biopsy channel, and tumor volume was calculated using computerized image analysis. Sensitivity, specificity, predictive values, and efficiency of colonoscopy for identification of tumors were 85%-100%. Cumulative tumor incidence in the descending colon increased in a relatively linear fashion from 3% at week 15 to 68% at week 30. Tumor width by colonoscopy correlated well with width at necropsy (r = 0.951). Growth curves of individual tumors were highly variable; however, tumor width showed stable mean weekly growth rates. By contrast, mean calculated tumor volume rose exponentially, with deviation from the fitted curve in the sixth week. All tumors greater than 3 mm in width or greater than 10 mm3 in volume showed invasion. Final tumor width and volume, and growth of tumor volume during the initial week but not the later weeks of observation, correlated with depth of invasion. Our findings suggest that colonoscopic measurement was useful to study the growth characteristics of autochthonous experimental colonic tumors; azoxymethane administration produced persistently altered colonic epithelium that had variable latent periods until development of visible tumors in individual rats; the growth curves of individual colonic tumors were exponential, although variable, during the initial weeks; invasion was found in small tumors and depth of invasion correlated with growth rate during the initial week but not the later weeks. This aggressive behavior of the tumors early in their course contrasts with colorectal adenomas in humans and argues against the routine occurrence of an adenoma-carcinoma sequence in the model we used.

Animals↗
PubMedDate not supplied

Performing screening flexible sigmoidoscopy using colonoscopes: experience in 500 subjects.

There is still controversy regarding the optimal length of flexible sigmoidoscopes. We performed screening distal colon examinations using 168-cm colonoscopes in 500 asymptomatic subjects who were unsedated and had sigmoidoscopy cleansing preparation. The mean depth of penetration was 66 cm and was similar in persons in whom the examination was discontinued because of poor preparation versus those with discomfort. Polyps were detected in 87 patients, but only 5 subjects had polyps detected above 60 cm. We conclude that in a group of unsedated subjects scheduled for flexible sigmoidoscopy after a sigmoidoscopy prep, the use of instruments longer than 60 cm gives very little additional yield.

Colonic Neoplasms↗
PubMed2006

A randomized controlled trial evaluating the usefulness of a transparent hood attached to the tip of the colonoscope.

OBJECTIVES: Considering the increasing demand for colonoscopy, auxiliary devices that could facilitate the examination would be useful. A hood attached to the tip of the colonoscope has been reported to be helpful in detecting and removing colorectal polyps. However, its usefulness in aiding scope intubation has not been fully evaluated. METHODS: Patients for colonoscopy between July 2004 and May 2005 in Tokyo University Hospital were enrolled to this randomized controlled trial, and assigned to colonoscopy with a transparent hood, a short hood, or no hood. Colonoscopies were conducted by trainees without sedation. The evaluated outcomes were cecal intubation rate, trainee intubation rate (cecal intubation within 15 min), cecal intubation time, and polyp detection rate. RESULTS: Enrolled 684 patients were randomly assigned to transparent hood (N = 221), short hood (N = 228), and no hood (N = 235) groups. The overall cecal intubation rate was 95.3% (652/684) and did not differ among the groups. The overall trainee intubation rate was 55.1% (377/684) and significantly higher in the transparent hood group than in the no hood group for female patients (60.7%vs 37.4%, P = 0.003). Cecal intubation time was 11.5, 13.5, and 14.0 min in the transparent, short, and no hood groups, respectively, and significantly shorter in the transparent hood group than in the no hood group among overall (P = 0.008), female (P = 0.001), and old (P = 0.04) patients. Polyp detection rate was higher in the transparent hood group than in the no hood group (49.3%vs 39.1%, P = 0.04). CONCLUSIONS: The transparent hood was useful in shortening the cecal intubation time especially in difficult cases.

Clinical Competence↗
PubMed1990

Colonoscopic polypectomy. North Indian experience.

Colonoscopic snare polypectomy was carried out in 70 patients (40 children, 30 adults). There was a male preponderance in both the groups with a combined male: female ratio of 4.4:1. The majority of patients (85%) were aged 20 years or below. All patients presented with intermittent bleeding per rectum, ranging from 2 months - 6 years (mean 1.2 +/- 1.1 years) in children and 1-14 years (1.9 +/- 2.3) in adults. The majority of patients polyps were located in the rectum (73%) or in the rectosigmoid region (21%). Polyps were significantly more common in the rectum (80% vs 63%; P less than 0.01) and less frequent in the rectosigmoid (15% vs 30%; p less than 0.01) in children as compared to adults. A single polyp was present in 49 (70%) patients; 17 (24%) had 2-10 polyps, while 4 patients (2 children, 2 adults) had more than ten polyps. Most patients (94%) had polyps of less than 2 cm size. Histologically, the most polyps (91.5%) were of the juvenile variety; 39 (97.5%) children and 25 (83%) adults had this variety of polyp. The remaining 5 (17%) adults and one (2.5%) child had adenomatous polyps. The difference in the polyp histology between the two age groups was statistically significant (p less than 0.05). Only one patient (1.4%) had excessive bleeding following polypectomy. The present study suggests two important differences in the nature of polyps as compared to the West: 1) our patients were much younger, and polyps were rare after 40 years; and (2) histologically, the commonest polyps were of the juvenile variety (91.5%) while adenomatous polyps were rare (8.5%).

Adolescent↗
PubMed1977

Colonoscopic decompression of massive nonobstructive cecal dilation.

During the past three years, six patients with massive nonobstructive cecal dilation were treated by the surgical endoscopy service at the University of Michigan Medical Center. Case reports are presented on the five patients for whom decompression of the colon distention using the flexible fiberoptic colonoscope was successful. The sixth patient for whom nonoperative decompression was unsuccessful died following tube cecostomy. Colonoscopy, in our hands, has been a safe and effective method of nonoperatively decompressing the dilated cecum in seriously ill patients with a variety of severe associated conditions.

Aged↗
PubMed1994

Colonoscopic-assisted laparoscopic colectomy.

One of the technical difficulties during laparoscopic and laparoscopic-assisted resection of the right, transverse, and left colon is the mobilization of the splenic and hepatic flexures. We present a simple technique of colonoscopic traction of the splenic or hepatic flexure. This technique enables good exposure and facilitates dissection while laparoscopic mobilization of these segments of the colon is performed.

Colectomy↗
PubMed1996

Colorectal neoplasms detected colonoscopically in at-risk members of colorectal cancer families stratified by the demonstration of DNA microsatellite instability.

This study compared colonoscopic findings in families meeting the Amsterdam criteria (A) for hereditary non-polyposis colorectal cancer (HNPCC) but stratified according to whether the familial cancers showed DNA microsatellite instability. DNA was extracted from paired samples of normal and cancer, and microsatellite instability was analysed at up to six loci. Families were termed replication error positive (RER+) when at least 50% of tumours tested per family were positive. Of 26 families studied 17 were RER+ and 9 were RER-. Cancers in the A/RER- families showed no right-sided predilection (P < 0.001). Colonoscopies have been performed on 182 at-risk members of A/RER+ families and 60 members of A/RER- families. More of the at-risk members of A/RER-families were found to have adenomas at colonoscopy (P = 0.095), but these were smaller than those of A/RER+ families (P = 0.19). The adenoma:carcinoma ratio was twice as high in A/RER- families (13:1) as in A/RER+ families (7:1). One of the A/RER- families had hyperplastic polyposis. The others do not appear to have attenuated familial adenomatous polyposis and are similar to the adenoma families or late-onset colorectal cancer families described by others. This study illustrates the importance of molecular technology in separating HNPCC from syndromes with overlapping phenotypes.

Adenoma↗
PubMedDate not supplied

Comparative surgical and colonoscopic appearance of colon anastomoses constructed with sutures, staples, and the biofragmentable anastomotic ring.

UNLABELLED: The following animal study was undertaken to compare and assess the endoscopic gross appearance and histology of colonic anastomoses constructed with sutures, staples, and the biofragmentable anastomotic ring (BAR). METHODS: Three anastomoses--1 BAR, 1 stapled, and 1 sutured--were placed in each of 48 dogs and colonoscopy and anastomotic evaluation were done. RESULTS: No leaks were found by air insufflation at surgery. Grossly, the BAR had serosal hematomas in 27/48 anastomoses vs 7/48 for stapled and 1/48 for sutured (BAR vs stapled P < 0.0005 and sutured vs stapled P = 0.07). Adhesions were significantly greater for BAR (35/36) and sutured (34/36) compared to stapled (26/36) (BAR vs stapled P = 0.01 and sutured vs. stapled P = 0.04). Colonoscopic exams at days 3, 7, and 28 showed no significant difference among groups with respect to bleeding, ulceration, necrosis, granulation, or contour. Sutured anastomoses were more stenotic (24/31) than stapled (4/31) or BAR (3/31) ones (BAR vs sutured and sutured vs stapled P < 0.005). At 28 days, 10/10 sutured vs 2/10 stapled vs 3/10 BAR were stenotic (BAR vs sutured P = 0.02, sutured vs stapled P = 0.01). Inflammation on histologic exam at 28 days was not significantly different: sutured (12/12), stapled (12/12), or BAR (9/12). Fibrosis was more prominent in sutured (12/12) than in stapled (5/12) or BAR (4/12) anastomoses (BAR vs sutured P = 0.001, sutured vs stapled P = 0.004, and BAR vs stapled P = 1.00). All anastomoses healed primarily without necrosis or obstruction. CONCLUSIONS: (1) Colonoscopy to evaluate anastomoses can be done safely even in the early post-operative period. (2) The BAR anastomoses had the most serosal hematomas; BAR and sutured had more adhesions than stapled anastomoses; and sutured anastomoses had the most stenosis and fibrosis. None of these differences was of clinical significance.

Anastomosis, Surgical↗