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PubMedDate not supplied

Ancillary colonoscope insertion techniques. An evaluation.

Colonoscope insertion from anus to cecum requires a sound basic technique that minimizes looping and maintains a straight scope. Four adjunct techniques may help advance insertion but none has been carefully evaluated. Accordingly, data were collected prospectively from 417 patients undergoing colonoscopy by the author. There were 223 males and 194 females with a median age of 60 years (range 12-94 years). Colonoscopy was complete in 405 cases (97.1%). The incidence and effectiveness of the four maneuvers were: hold breath (63%, 32%), abdominal pressure (65%, 60%), turn on left side (36%, 42%), turn on right side (19%, 77%). All 4 techniques were used in 54 patients (13%); 3 were used in 98 (24%); 2 in 98 (24%); 1 in 53 (13%); and none in 114 (27%). These ancillary techniques were more often used in females than males (P = 0.01); in intact colons more often than those after left colectomy (P = 0.001); and in patients of slim build than those of normal build (P = 0.04). Of the four techniques, abdominal pressure was most often used and turning on the right side was most often effective.

Colonic Diseases↗
PubMed1984

Angiodysplasia. Clinical presentation and colonoscopic diagnosis.

Angiodysplasia is a recently recognized important cause of lower intestinal bleeding in older patients. Although angiography is an established procedure for the diagnosis of angiodysplasia, colonoscopy is being used increasingly for evaluation of lower intestinal bleeding. In order to define the nature of bleeding due to angiodysplasia and the appropriate role of colonoscopy, 80 patients diagnosed by angiography, pathology, or colonoscopy were reviewed. Bleeding attributable to angiodysplasia varied from acute life-threatening hemorrhage to occult blood in stools. Thirteen patients with angiodysplasia had no bleeding and were identified incidentally by colonoscopy performed for other indications. Eighty-nine percent of the lesions were located in the right colon and there was a mean of 1.5 angiodysplastic lesions per patient. The sensitivity of colonoscopy compared to angiography and pathology was 68% overall and 81% when the colon was completely examined and lesions were located in the colon. The predictive value of a positive colonoscopic diagnosis was 90% in this population. Colonoscopy should be employed as an initial study in patients with chronic or mild acute rectal bleeding.

Acute Disease↗
PubMed1987

Angiodysplasia--an uncommon cause of colonic bleeding: colonoscopic evaluation of 1,050 patients with rectal bleeding and anaemia.

Angiodysplasia of the colon was diagnosed in 31 out of 1,050 patients (3%) presenting with rectal bleeding or anaemia, among 10,000 colonoscoped at St. Mark's Hospital. The lesions were identified in 16 out of 879 (2%) patients with rectal bleeding, in 15 out of 171 (9%) patients with anaemia, and in a further three patients without features of blood loss. The angiodysplasia lesions were predominantly in the right colon (76%) and occurred with a similar frequency (12%) in the transverse and the left colon. Affected patients (59% male and 41% female) were in the older age group (53-89 years; mean age 69.5 years) but only one patient had known aortic valve disease. Angiodysplasia is an important diagnosis to consider in patients presenting with colonic bleeding or anaemia because it can be treated in the majority of cases by endoscopic electrocoagulation. However in our experience it is less common (3%) than previously suggested by other authors (40-67%). Endoscopic over-diagnosis is possible when intramucosal capillaries with no bleeding tendency on local traumatisation or biopsy are included in the diagnosis but these lesions are not true angiodysplasia.

Aged↗
PubMed1991

Colonoscopic appendectomy: report of a case.

A persistent appendix occurred after inversion appendectomy. Colonoscopic removal was straightforward and would appear to be the treatment of choice in this unusual circumstance.

Adult↗
PubMed1991

Colonoscopically guided tube decompression in Ogilvie's syndrome.

Ogilvie's syndrome (pseudo-obstruction of the colon) may result in gangrene and perforation of the colon if not effectively treated. Colonoscopic decompression and endoscopically guided rectal tube placement were employed to treat five patients with this syndrome who had failed medical therapy. All patients tolerated the procedure well and required no further treatment.

Adult↗
PubMedDate not supplied

Colonoscopic impaction in left colon strictures resulting in right colon pneumatic perforation.

Colonic perforation during flexible colonoscopy is a rare but recognized complication. We reviewed 4,593 colonoscopies performed from 1984 to 1989. The perforation rate for diagnostic colonoscopy was 0.17% (6/3,538) and for therapeutic colonoscopy it was 2% (21/1,055). Four perforations of the right colon occurred at a site proximal to the level of the impacted colonoscope. The lesions being evaluated were obstructive in nature: two diverticular strictures (sigmoid colon), one ischemic stricture (descending colon), and one annular carcinoma (descending colon). The four perforations occurred in the right colon and manifested as distension with pneumoperitoneum or retroperitoneal emphysema. Operative management included total abdominal colectomy in two patients (ileoproctostomy in one and ileostomy in one) and right colectomy in two. Outcome was favorable in all cases.

Aged↗
PubMed1989

Management of patients with invasive carcinoma removed by colonoscopic polypectomy.

The management of patients with invasive carcinoma removed by colonoscopic polypectomy remains controversial. In order to assess the criteria for subsequent surgery after polypectomy, the histologic findings and outcome of 25 patients with invasive carcinomas treated by polypectomy were analyzed. Subsequent surgery was indicated when removed invasive carcinoma showed at least one of the following findings: 1) carcinoma near the surgical margin, 2) vessel invasion, 3) massive invasion, and 4) poorly differentiated adenocarcinoma. The authors considered those findings to be a risk factor for local residual carcinoma or lymph-node metastases, or both. Of 25 patients, 18 showed risk factors, with 16 receiving surgery. Only one had residual carcinoma in the lymphatic vessel of the surgical specimen. The remaining 15 had no carcinoma in the surgical specimens, however, one died of recurrent disease 55 months later. Two patients with risk factors received no surgery for various reasons. Local recurrent carcinoma developed in one 39 months later and the other had no recurrent carcinoma at autopsy. Seven patients without risk factors were adequately treated by polypectomy without recurrent disease 34 to 96 months later (average, 69 months). Consequently, of 18 patients with risk factors, 3 showed either residual carcinoma in the surgical specimens or recurrent carcinoma was found later. None of 7 patients without risk factors developed recurrent disease. We recommend that patients with risk factors be followed by surgery; however, patients without risk factors can be adequately treated by polypectomy alone.

Adenoma↗
PubMed1986

Complications in colonoscopic polypectomy. An experience with 1,555 polypectomies.

One thousand five-hundred fifty-five polyps were removed from 1172 patients; the sizes ranged from 5 mm to 6 cm. Nineteen complications accounted for 1.2 percent. Bleeding was the most common complication, followed by transmural burn. Other complications included a silent free perforation, a snare-wire entrapment, and an ensnared bowel wall. The complications in colonoscopic polypectomy are low. With proper technique, better selection of patients, and a broad knowledge of the causes and mechanisms, however, the complication rate can be reduced even more.

Adult↗
PubMedDate not supplied

The colonoscope in cecal volvulus: report of three cases.

Colonoscopy was employed to attempt detorsion of volvulus of the right colon in four patients considered to be high-risk surgical patients. In one patient detorsion was accomplished, so that emergency laparotomy became unneccesary. The site of torsion was reached in every patient. When detorsion does not occur reasonably soon after the colonoscope enters the right colon, persistent efforts are more likely to be harmful than helpful. Abdominal symptoms in a patient who has been ill or injured for some time should suggest the possibility of volvulus of the right colon. Early diagnosis and earlier employment of colonoscopy would almost surely result in an increased rate of success in accomplishing detorsion. When detorsion is accomplished, subsequent resection of the right colon should be seriously considered as, without it, volvulus is said to recur frequently.

Adult↗
PubMedDate not supplied

Colonoscopic features of eosinophilic gastroenteritis.

This report describes the colonoscopic findings in a patient with eosinophilic gastroenteritis and the effect of treatment upon the course of the disease. Clinical manifestations and treatment depend upon the site of bowel involvement. The patient had mucosal involvement of stomach and small intestine, but colonoscopy demonstrated extensive colorectal involvment, most severe distally. We suggest fiberoptic sigmoidoscopy as an alternative diagnostic modality.

Colon↗
PubMedDate not supplied

The colonoscope in volvulus of the transverse colon.

A case of volvulus of the transverse colon in a patient with dystrophia myotonica is reported in which the volvulus was reduced during colonoscopy. Indications for colonoscopy in patients with volvulus of the transverse colon are discussed, and it is suggested that colonoscopic reduction of volvulus of the transverse colon might have a place as emergency treatment in patients with other severe complications.

Adult↗
PubMed1991

Aggressive colonoscopic approaches to lower intestinal bleeding.

The most obvious advantage of colonoscopy is to establish the diagnosis at any level of the colon by direct observation of the mucosal surface and identification of any active bleeding and or responsible lesions. It also enables therapeutic intervention. In a period of 18 years from 1973 to 1990, 230 emergency colonoscopic examinations were performed in 205 cases for evaluation of acute and severe bleeding from the lower intestinal tract. There were 108 men and 97 women. They appeared quite serious and needed constant medical supervision including shock treatment and blood transfusion. The ages of the patients varied from 5 months to 90 years old. There were 24 children in this series. Colonoscopy was performed within 48 hours after onset of anal bleeding. All examinations were done without fluoroscopy. It was necessary to reach the cecum in 66% of cases to determine the responsible lesions. Bleeding was identified in all except 11 cases (94.7%). Bleeding and the responsible lesions were both visualized in 147 cases (71.7%). The source of bleeding was located proximal to the ileocecal valve in 37 cases (18%). Much blood was found in the bowel which interfered observation in 14 cases. No bleeding nor lesions could be identified in 8 cases (3.9%). Most common causes of bleeding in adults were cancer, inflammatory lesions, ischemic colitis and vascular ectasia, while the most common cause of bleeding in children was juvenile polyp.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2000

Colonoscopic diagnosis and management of nonpolypoid early colorectal cancer.

Nonpolypoid colorectal neoplasms are grossly classified into three groups: slightly elevated (small flat adenomas), laterally spreading, and depressed. Flat adenomas are not invasive until they are rather large, whereas depressed lesions can invade the submucosa even when they are extremely small. Nonpolypoid lesions are difficult to detect and are often overlooked. Keys to detect them are their slight color change, interruption of the capillary network pattern, slight deformation of the colonic wall, spontaneously bleeding spots, shape change of the lesion with insufflation and deflation of air, and interruption of the innominate grooves. Spraying of indigo carmine dye helps to clarify the lesions. A pit pattern analysis with a zoom colonoscope is useful for the diagnosis and staging of early colorectal cancer. Small flat adenomas are thought to be precursors of protruded polyps and lateral spreading tumors, whereas depressed lesions are thought to grow endophytically and become advanced cancers. Small depressed lesions are treated with an endoscopic mucosal resection (EMR) technique; but when they massively invade the submucosa, surgical resection is indicated. Laterally spreading tumors are not as invasive despite their large size and therefore are good indications for the EMR or piecemeal EMR method. Small flat adenomas need not be treated urgently, as almost none is invasive. Accurate diagnosis with dye-spraying and zoom colonoscopy is vital for deciding the treatment strategy.

Adenoma↗
PubMed2006

Retroperitoneal gas gangrene after colonoscopic polypectomy without bowel perforation in an otherwise healthy individual: report of a case.

BACKGROUND: Abdominal gas gangrene caused by clostridia species is rare and usually associated with organ perforation, immune suppression, or advanced malignoma. CASE REPORT: A 61-year-old man was admitted with severe back pain 1 day after uncomplicated colonoscopic polypectomy. With the exception of preexisting minor depression, the patient had been previously in excellent health. The computed tomography scan showed retroperitoneal emphysema in the left psoas muscle. During exploratory laparotomy, a spreading retroperitoneal phlegmon with pneumoretroperitoneum and a secondary peritonitis were found. A macroscopic perforation of the gut, particularly at the polypectomy sites was excluded. After the operation, the patient evolved in a septic shock condition and had pulmonary failure. Before hyperbaric oxygen therapy could be employed, the patient died. The autopsy showed a massive gas gangrene of the retroperitoneum caused by Clostridium perfringens, but no macroscopic bowel perforation was detected. RESULTS: This is the first report of a case of gas gangrene after uncomplicated polypectomy without macroscopic perforation in an otherwise healthy individual. A microperforation due to mucosal defect after polypectomy was most likely the entry point for the bacteria. CONCLUSION: We conclude that clostridial myonecrosis should be considered in unclear abdominal infections, even if the patient's history is not typical as in the present case.

Clostridium perfringens↗
PubMed2002

Laparoscopic-assisted resection of giant sigmoid lipoma under colonoscopic guidance.

Colonic lipomata are rare and mostly asymptomatic lesions; but as they become larger they may produce abdominal pain, constipation, diarrhea, hemorrhage, and intussusception. We report the case of a 75-year-old man who suffered from nonspecific recurrent abdominal pain in the left upper and lower quadrants and had variable episodes of diarrhea and constipation of 4 weeks' duration. During colonoscopy, a giant intraluminal polyp was diagnosed at 35 cm. Abdominal helical computed tomography (CT) revealed a constipating colonic tumor with a diameter of >or=50 mm and density values equal to fat. During laparoscopic surgery in the lithotomy position, the sigmoid and the descending colon were mobilized using a Harmonic scalpel. The origin of the polyp was localized precisely under colonoscopic guidance. The former 12-mm incision in the left lower quadrant was expanded to approximately 70 mm for extracorporal tumor resection. The left and sigmoid colon resections were carried out, and the polyp was removed by full-wall excision. After closure with a single-layer suture, the colon was pushed back into the peritoneal cavity. The patient had an uneventful recovery and was discharged 10 days postoperatively. Histology confirmed a benign lipoma of the descending colon. Laparoscopic-assisted resection under endoscopic guidance proved to be suitable for the removal of large colonic polyps without complications.

Aged↗
PubMed2002

Colonoscopic retrieval of an appendiceal foreign body: prophylaxis for appendicitis?

Management of orally ingested foreign bodies usually consists of endoscopic retrieval while the objects reside within the esophagus or stomach. Although most foreign bodies that pass through the pylorus will be excreted without incident, some may become impacted distally, resulting in obstruction or perforation. Appendiceal foreign bodies have been reported rarely, yet have resulted in the development of acute appendicitis. We report the case of a young male who swallowed a nail that became impacted in the appendiceal lumen and was retrieved colonoscopically before the development of acute appendicitis.

Adult↗
PubMed2006

Colonoscopic screening for colon cancer.

Colonoscopic screening for colon cancer was suggested in 1988 [17], but it has only recently received significant acceptance. It is a topic of much current discussion among both health care providers and the general public, especially since the nationally broadcasted colonoscopy of a well-known television anchor person [8]. This brief discussion presents the role of colonoscopy in colon cancer screening. It sets forth the rationale for endoscopic screening, evaluates it using World Health Organization guidelines, and briefly considers the timing and termination of screening. By screening is meant the testing of asymptomatic individuals in a large population. This is to be distinguished from surveillance, which involves ongoing follow-up testing of individuals at known risk. The former is the subject of this discussion.

Adenocarcinoma↗