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PubMedDate not supplied

[Oncological supervision of patients after colonoscopic polypectomy].

The high frequency of development of new adenomas in patients after colonoscopic polypectomy (30-50%) suggests the need for periodic control examinations of the whole large bowel. The diagnostic value of rectoscopy and routine diagnostic enema is limited and these methods are not suitable for periodic control of the bowel. An important method is fiberoptic sigmoidoscopy (FSS), but it is also insufficient because neoplasms are present frequently in proximal parts of the colon. The best method for evaluation of the whole colon is coloscopy, moreover, this method makes possible removal of the found polyps. In particular cases an alternative of coloscopy may be a combination of FSS and double contrast radiological examination of the colon. The frequency of control examinations of the large bowel depends primarily on the number of removed polyps. The patients after removal of a single polyp should undergo control examinations at intervals of 4-5 years. In cases with multiple adenomas removed during the first procedure or with one large adenoma (over 2 cm in diameter) should have control examinations repeated every 2-3 years.

Colonic Polyps↗
PubMed1990

[Colonoscopic approach in the therapy of sigmoid volvulus].

We present 13 patients with 15 episodes of colonic volvulus, who underwent colonoscopy to decompress and/or devolvulate. Colonoscopic exploration demonstrated a non obstructive dilatation in three cases. In the remaining 10 patients, with 12 episodes of volvulus, decompression was obtained in 83.3% and devoluvulation in 41.6%. There were two failures, due to peritoneal metastases and adhesions which fixed the volvulus. In 40% of the cases there were mild ischemic signs. Forty per cent of the patients were submitted to elective surgery and the two failures (20%) were operated in emergency. The remaining 4 patients declined surgical treatment. At is allows differential diagnosis, we think that, for these patients, colonoscopy should be the first therapeutic approach; it also allows decompression and/or devolvulation and an early diagnosis of the associated ischemia.

Adult↗
PubMed1990

[Clinical experiences with early colonoscopic decompression in acute pseudo-obstruction of the colon].

The prognosis of an acute colonic pseudoobstruction has improved significantly since the introduction of colonoscopic decompression. Our experience confirms this technique as a safe and effective therapy even for critically ill patients. In most of our cases several endoscopic decompressions were necessary before a lasting improvement of the clinical symptoms could be achieved. The additional use of new procinetic substances and the endoscopic placement of thick decompression tubes may reduce the number of endoscopic procedures necessary for each patient.

Acute Disease↗
PubMed1990

A clinico-pathological profile of colonic polyps in Brunei Darussalam--a study of 25 cases treated by colonoscopic polypectomy.

Colonic polyps are not rare in Brunei Darussalam with an incidence of 13% in 193 colonoscopies performed over the last two years. Majority of the polyps were adenomatous. Incidence was higher in the Malays and had a male preponderance. Commonest age of presentation was above the age of 40 years and the pattern is comparable to the Western pattern. All the polyps were removed by colonoscopic polypectomy.

Adenocarcinoma↗
PubMed1989

Colonoscopic surveillance after diagnosis of carcinoma of the colon and rectum.

Routine colonoscopic surveillance was undertaken in 63 patients after resection of colonic cancer. Recurrence at the anastomotic site was never shown visually or histologically. Despite this, local or metastatic progression occurred in 8 patients; thus, the stade of the mucosa is no guide to the progression of the disease. However, colonoscopy was useful in detecting polyps and second carcinomas. A plan of follow-up is advocated, based on the likelihood of development of further tumours.

Colectomy↗
PubMed1989

[Colonoscopic surveillance of patients operated on in colorectal cancer. Retrospective evaluation of 269 tests in 125 patients].

The ideal frequency of endoscopic surveillance of patients operated on for colorectal cancer is not known. We report our experience of colonoscopic follow up of 125 patients after excision of a colorectal cancer. The median interval between resection and the first check colonoscopy was 12 months. The median duration of follow-up was 28 months (range: 3 months to 10 years). 269 colonoscopies allowed diagnosis of 8 anastomotic recurrences within a median delay of 21 months after surgery (range: 3 months to 5 years). In 6 of these patients, the recurrence was clinically suspected. In 2 patients, it was asymptomatic and was discovered on systematic colonoscopy. Potentially curative surgery was only possible in 1 case. Follow up colonoscopies also allowed excision of 113 adenomatous polyps in 39 patients and the discovery of 4 new invasive cancers within a median delay of 7.4 years after excision of the first cancer. Due to the disappointing value of colonoscopy in the detection of anastomotic recurrences and the propensity of the remaining colon to develop new polyps, in the absence of a comparative trial, we arbitrarily adopted a follow up rhythm based on early post-operative colonoscopy (3 months post-surgery) and then yearly for the first 2 years. Further follow-up was similar to that adopted for patients with a past history of endoscopic polypectomy.

Aged↗
PubMed1988

In situ DNA hybridization for cytomegalovirus in colonoscopic biopsies.

We reviewed colonoscopic biopsies of the lower gastrointestinal tract performed during a two-year period. Those representing neoplasia were excluded. Formalin-fixed paraffin-embedded biopsy specimens from 53 patients were studied by in situ DNA hybridization for cytomegalovirus (CMV) using commercially available biotinylated DNA probes detected by an avidin-biotin peroxidase technique. Nine of the patients were severely immunocompromised: four had acquired immunodeficiency syndrome, three had ulcerative colitis and were receiving high-dose steroid therapy, one was a bone marrow transplant recipient, and one had idiopathic pulmonary fibrosis and was receiving therapy with prednisone and cyclophosphamide. Four of these had evidence of CMV infection by routine histology and DNA hybridization. Three additional immunocompromised patients had evidence of CMV infection by DNA hybridization alone. Forty-four patients had inflammatory conditions or ulcerations of the lower gastrointestinal tract. Six of these had evidence of CMV by DNA hybridization alone. Histologically normal as well as enlarged and cytomegalic cells were probe positive, and the cells were sparse to numerous in number. They were found in the epithelium and/or lamina propria. This technique was demonstrated to be applicable to routinely processed colonic biopsy specimens.

Adult↗
PubMed1988

Colonoscopic polypectomy.

Since the advent of fiberoptic endoscopy and the introduction of colonoscopic polypectomy, a simple and cost-effective procedure has been available to deal with an exceedingly common problem, the colonic polyp. Although polyps in the gastrointestinal tract have a varied natural history, there is strong evidence that adenomatous colonic polyps have a potential for malignant degeneration and that virtually all colorectal cancers arise from adenomatous polyps. This article will review some basic features of the endoscopic approaches and problems associated with polypectomy.

Colonic Polyps↗
PubMed1988

Selenium status and the polyp-cancer sequence: a colonoscopically controlled study.

Diminished blood selenium levels have been associated with increased risk of gastrointestinal cancers in man, while dietary selenium supplementation reduces the incidence of experimental colon cancer in rats. However, no previously published data are available concerning selenium and the evolution of colon cancer from benign neoplastic colonic polyps through localized and metastatic cancer. To assess any influence of selenium on this polyp to cancer sequence, we measured plasma and erythrocyte selenium levels in colonoscopically and histologically evaluated patients with adenomatous polyps (group I), locally resectable colon cancer (group II), metastatic colon cancer (group III), and selected colonoscopy negative controls (group IV). We found no difference in selenium levels between groups IV versus groups I or II. Likewise, within group I, no difference in selenium was present for different polyp histologies or numbers of polyps. However, selenium levels did drop progressively (p = 0.028, ANOVA) from polyp (group I) to local cancer (group II, p = NS vs group I) to metastatic cancer (group III, p less than 0.05 vs group I or group II). Parallel changes were seen in both plasma and erythrocyte levels, suggesting that these selenium abnormalities are of long duration, reflecting tissue stores, and therefore capable of influencing cancer risk. We conclude that selenium stores may not be an important factor in the de novo formation of benign neoplastic colonic polyps. Although these data suggest that selenium does not affect the polyp-cancer sequence, it is possible that a subset of patients with polyps and the lowest selenium levels are at higher risk for malignant transformation. However, these human data do not support a significant role for selenium in colon carcinogenesis.

Aged↗
PubMed1986

Colonoscopic polypectomy.

Colonoscopic polypectomy is well established as an outpatient procedure. In skilled hands it is essentially safe. The components of a satisfactory therapeutic outcome are good bowel preparation, adequate sedation analgesia, an experienced operator and the proper range of equipment. In this two year series of 71 patients (176 polyps) there were no fatalities, no perforations and only two minor bleeds. Eighty percent of the polyps were of the tubuloadenomatous or tubulovillus type. Carcinoma was present in 6% and their outcome is described in detail. The commonest presentation of colonic polyps was rectal bleeding or occult blood in the stools (56%). Two or more polyps were present in 60% of patients. Seventy percent were located distal to the splenic flexure and the rest proximally. Fifteen percent were over 2 cm in maximum diameter. Policies for the type and frequency of follow-up are a matter for ongoing discussion.

Adult↗
PubMed1979

The endoscopy corner: reversible ischemic colitis--correlation of colonoscopic and pathologic changes.

Ischemic colitis is a well described complication following distal aortic replacement. The diagnosis is typically made by correlating clinical signs such as the occurrence of abdominal pain and bloody diarrhea with supporting radiographic changes. In this report, the diagnosis of ischemic colitis was confirmed on the basis of colonoscopic and associated histopathological findings. Colonoscopy is a useful technic in establishing the diagnosis of ischemic colitis, especially in patients whose clinical condition makes barium enema not feasible.

Aged↗
PubMed1979

[Colonoscopic polypectomy. Histopathological features and course (author's transl)].

A study of 424 colonic polyps resected electrically via colonic fibroscopy in 343 patients, in several Parisian centers between september 1972 and august 1976. The topography, shape, diameter and histological type of the polyps were analysed, and 14.3% were malignant. Study of the prevalence of the different histological types in subjects of the both sexes, by ten year age groups, revealed the large number of villous and adenocarcinomatous forms in the young woman. The preponderance and increase with age of villous forms in the male explain the marked shift in histological forms towards malignancy seen after the age of 60. The average time taken for transformation of a benign polyp already accessible to endoscopic resection into a killing recto-colic carcinoma may be 13 years. Initial results of the follow-up, of 83 patients undergoing 101 colonoscopic polypectomies, and despite inadequate follow-up, indicated that 9% of polyps recurred (above all, villous and adenovillous polyps), and the absence of local recurrence or metastases detectable after electrical resection of 17 colonic polyps with invasive adenocarcinoma must be taken with great reserve.

Adenocarcinoma↗
PubMed1979

Fatal colonic explosion during colonoscopic polypectomy.

A patient is described who sustained the first reported colonic explosion during colonoscopic polypectomy. Mannitol solution was used for bowel preparation, and the colon was completely clean. During snare removal of a cecal polyp using high-frequency current a loud explosion occurred. In spite of emergency surgery with transfusion of 45 units of blood, uncontrollable hemorrhage persisted from multiple bleeding points, and the patient died. This occurrence seems to us to justify the routine use of carbon dioxide insufflation during polypectomy and the avoidance of mannitol for bowel preparation.

Aged↗
PubMed1977

Colonoscopic polypectomy.

A total of 87 polyps were treated during 62 colonoscopic examinations on 60 patients; 69 polyps were resected and 18 were fulgurated with the hot-biopsy forceps. Fifteen patients were under 13 years old, and the average age was 38 years. Twelve patients had more than one polyp. There were no complications and the method could be carried out in all patients, whenever it was indicated. Sixteen polyps were hamartomas, 13 shistosomatic, six hyperplastic, two lymphoid and 36 adenomas. Among these adenomas, six showed evidence of foci carcinoma, one in situ and five, invasive. Surgical resection was indicated in only one patient with sessile polyp with invasive focus of carcinoma. No metastasis was detected whatsoever.

Adenoma↗
PubMed1983

Dysplasia and ulcerative colitis--a colonoscopic study.

Cancer will be found on colonoscopic biopsy in 11% of patients with chronic ulcerative colitis for over eight years' duration. Sixteen percent of patients with dysplasia will subsequently be found to have carcinoma of the colon. A total of 3% of patients in the high-risk group will have cancer of the colon. Endoscopic biopsies should be separated into those performed for diagnostic or surveillance purposes, so that meaningful and reproducible results will be obtained. Annual total colonoscopy and biopsies are recommended for surveillance purposes.

Biopsy↗