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PubMed1981

Colonoscopic diagnosis of angiodysplasias of the gastrointestinal tract.

We have reviewed our experience with colonoscopy in the diagnosis of angiodysplastic lesions of the colon. In 14 of the patients in our series, the lesions in the colon were diagnosed colonoscopically, confirming arteriographic findings in many but being the only diagnostic modality facilitating the diagnosis in three of the patients. Results of our experience indicate that colonoscopy is an effective means of diagnosing or confirming the diagnosis of angiodysplastic lesions of the right colon. It should be part of the evaluation along with superior and inferior mesenteric angiography of every patient with occult gastrointestinal tract bleeding or iron deficiency anemia, or both, for whom no diagnosis can be made with standard barium contrast techniques.

Adolescent↗
PubMed1995

Colonoscopic diagnosis and treatment of acute appendicitis.

An atypical case of acute appendicitis is reported, in which the initial presentation was not suggestive of this diagnosis. A routine work-up revealed elevated levels of inflammatory markers, an ultrasonographically normal abdomen and normal endoscopic findings in the upper gastrointestinal tract. During colonoscopy, performed 3 days after admission, the inflamed appendiceal orifice was localized and intubated using an endoscopic retrograde cholangio-pancreatography (ERCP) catheter; pus was aspirated. Elective appendectomy was carried out 5 months later on the asymptomatic patient. Histological analysis revealed fibrous thickening of the appendiceal wall, correlating with an old inflammatory process, along with changes typical for acute ulcerophlegmonous appendicitis. To the best of our knowledge, this is the first case of an endoscopically diagnosed and treated acute ulcero-phlegmonous appendicitis. We draw the following conclusions: (1) Acute appendicitis may present atypically, leading to an extensive clinical work-up including gastroscopy and colonoscopy. (2) This condition may be effectively treated, at least temporarily, by colonoscopic suction of appendiceal pus, provided that clinical urgency for laparotomy is absent. (3) Histological changes typically associated with acute ulcero-phlegmonous appendicitis may be present in asymptomatic patients and in patients without fever and with normal erythrocyte sedimentation rates and blood leucocyte counts. (4) Elective appendectomy should be considered in patients with conservatively healed acute appendicitis or periappendiceal abscess.

Acute Disease↗
PubMed1995

Laparoscopy-assisted colonoscopic polypectomy.

One of the most feared complications in the removal of moderate-sized or large sessile polyps is colonic perforation. Complete colonoscopic total excision of these kinds of polyps can be safely undertaken using laparoscopic assistance, which enables prompt diagnosis and treatment of perforation. Laparoscopy-assisted endoscopic polyp excision can be safely performed, avoiding critical septic complications and can also help in the selection of patients to appropriate colonic resection without increasing morbidity or mortality.

Colon↗
PubMed1994

Colonoscopic screening for first degree relatives of patients with colorectal cancer.

BACKGROUND: In addition to identifying and eradicating premalignant lesions, and detecting early cancer before the development of life-threatening consequences, new concepts and technological advances have stimulated a hightened interest in the secondary prevention of colorectal cancer. METHODS: People whose first degree relatives have had colorectal cancer are considered to run a higher risk of developing colorectal carcinoma. A screening program was carried out for 358 first degree relatives of colorectal cancer patients using colonoscopic screening. RESULTS: The mean age of these first degree relatives was 44 years, ranging from 13 to 78 years. Two hundred and eleven (58.9%) of them were asymptomatic. Totally 73 polyps were detected in 53 subjects (14.9%). Two cancer lesions were identified. Thirty polyps (41.1%) measured between 0.5 cm and 2.0 cm. The polyps were mostly located in the rectum and sigmoid colon (63%). One polyp was found in a subject below 30 years of age. Over the age of 30, the incidence of polyp increased dramatically. CONCLUSIONS: Our results confirmed that the screening program for the first degree relatives of patients with colorectal cancer is worthwhile. The program would have a more significant impact if the screening could start from subjects around the age of 30.

Adult↗
PubMed1994

Colonoscopic evaluation of rectal bleeding in young adults.

The role of colonoscopy in the evaluation of blood loss per rectum has been studied extensively in older patients but not in the younger adult population. The objective of this study was to review the diagnostic yield of colonoscopy in patients 40 years of age or younger with passage of minimal amounts of bright red blood per rectum or occult blood positive stools. Retrospectively, 5924 colonoscopic examinations were reviewed. All patients, 40 years of age or younger, with rectal bleeding as the only indication for colonoscopy were selected. A total of 280 patients met these criteria and 59 (21%) had significant findings. Polyps were present in 25 (8.9%) of patients. Other findings included colitis, diverticular disease, and angiodysplastic lesions present in 8.6 per cent, 2.1 per cent, and 1.1 per cent, respectively. Adenocarcinoma was present in one patient (0.03%). These results suggest that colonoscopy in patients 40 years of age or younger with rectal bleeding may be justified because significant findings may be present in up to 21 per cent of patients.

Adenocarcinoma↗
PubMed1994

Selective management of colonoscopic perforations.

BACKGROUND: Colonoscopy is a safe procedure if performed properly. Perforations from such procedures are rare, but not entirely avoidable. Usually perforations from diagnostic colonoscopy result in large defects requiring surgical management. Perforations from therapeutic colonoscopy occur by a different mechanism and frequently result in a smaller perforation. STUDY DESIGN: This is a retrospective review of 26,708 consecutive colonoscopic procedures performed from January 1986 to June 1992. RESULTS: There were 12 perforations, five from diagnostic colonoscopy and seven from therapeutic colonoscopy. All patients with perforation from diagnostic colonoscopy were treated operatively, while six of the seven perforations from therapeutic colonoscopy were managed nonoperatively. The type of operation depended upon the intraoperative findings. CONCLUSIONS: Perforations from therapeutic colonoscopy occur by a different mechanism than from diagnostic colonoscopy and may be selectively managed without an operation and with a low mortality and morbidity rate, provided proper guidelines are adhered to.

Aged↗
PubMed1996

Colonoscopic findings in patients with lower gastrointestinal bleeding send to a hospital for their study. Value of clinical data in predicting normal or pathological findings.

BACKGROUND: Lower gastrointestinal bleeding is a highly frequent clinical problem that may reflect serious pathology in the colon. Colonoscopy is generally accepted as the diagnostic procedure of choice. Decisions as to whether to carry out colonoscopy or not, are not well defined. METHODS: 536 colonoscopies, made to discover the cause of lower gastrointestinal bleeding were analyzed and a final 457 included in the study. All of these patients came to the hospital because they had presented at least in one occasion, one episode of rectal bleeding, and were send by the specialist of the zone, in order to achieve a correct diagnosis of its process. In all cases the following associated symptoms were analyzed: the presence of diarrhea, constipation, abdominal pain and rectal mass on examination. The characteristics of lower gastrointestinal bleeding were analyzed in a subset of 150 consecutive patients. RESULTS: Mean age was 59 +/- 16.9 years. 54.5% were male and 45.5% female. The exploration was normal until the cecum in 146 patients (32%). In the remaining 311, the findings were: polyps (25.1%), diverticular disease (24%), neoplasia (12.6%), inflammatory bowel disease (9.4%), unspecific proctitis (2.4%), ischemic colitis (2.4%), angiodysplasia (1.9%), infectious colitis (1.1%), and miscellaneous (0.7%). An age of less than 40 years and the existence of anal pathology were significantly more frequent among patients with a normal examination (p < 0.001), but with a sensitivity of only 66%. No differences were found among patients with disordered bowel frequency or abdominal pain in relation to the colonoscopic findings. Previous presence of a rectal mass when the examination proved abnormal (p=0.06). Intermittent bleeding and the presence of blood in the stools were more frequent in patients with normal examination (p= 0.07 and p< 0.05, respectively). No significant differences in relation to colour, duration of bleeding, or to whether toilet paper was stained with blood were found. CONCLUSIONS: 1) The more frequent endoscopic findings were polyps and diverticular disease. 2) Clinical data are of little value in predicting a normal examination. 3) Total colonoscopy appears to be the first procedure of choice in all patients with lower gastrointestinal bleeding, irrespective of the clinical data and the presence of anal pathology.

Adolescent↗
PubMed1996

[Tumor staging and follow-up care in rectosigmoid carcinoma: colonoscopic endosonography compared to CT, MRI and endorectal MRI].

BACKGROUND AND STUDY AIMS: Endosonography has become the best available method for local staging of primary rectal cancer and diagnosing recurrent local tumor. The aim of this prospective study is to compare the accuracy of endoscopic ultrasound (EUS), using an echo colonoscope (CF-UM 3, CF-UM 20, Olympus optical) to computed tomography (CT), body coil magnetic resonance imaging (MRI) and endorectal coil magnetic resonance imaging (EMRI). PATIENTS AND METHODS: From February 1991 to July 1993 90 patients with primary rectosigmoidal tumors (n = 32: 9 women, 23 men, mean age 68 years [range 37 to 84]) or follow-up examinations for recurrent local cancer (patients: n = 58, examinations: n = 93; 41 women, 52 men, mean age 61 years [range 31 to 84]) were investigated. The results of preoperative examinations were compared to histopathological findings regarding T and N stages. RESULTS: In T staging, accuracy of EUS (78%) was superior to CT (50%) and equivalent to both MRI (75%) and EMRI (80%). The accuracy of EUS (84%) in assessing transmural tumor infiltration was superior to CT, MRT and EMRT (50%, 75% and 80%, resp.); however, CT (77%) and MRI (86%) were more accurate than EUS (64%) and EMRI (33%) in assessing N stages. Recurrent local cancer was found in 22 patients. All but one were detected by EUS. Sensitivity, specificity and accuracy in follow-up examinations for recurrent disease for EUS were 95%, 94% and 95%, for CT 75%, 73% and 74%, for MRI 57%, 100% and 70%, and for EMRI 83%, 100% and 90% resp. CONCLUSIONS: Endoscopic ultrasound proved to be a safe and accurate method of preoperative staging and early diagnosis of recurrent rectal cancer and was superior or at least equivalent to CT, MRI and EMRI.

Adult↗
PubMed1996

Colonoscopic screening for families of patients with colorectal cancer.

We conducted a prospective study using primary colonoscopy in the families of patients with surgically treated colorectal cancer (CRC) to evaluate its feasibility as a screening method for CRC. The presumed detection sensitivity of sigmoidoscopy in this group was also evaluated. Over a 3-year period, 142 first-degree relatives (73 men and 69 women) of 117 patients with CRC participated in this colonoscopic screening study. The average age at presentation for examination was 49.1 years (range, 31-79 yr). Forty-nine patients had adenomatous polyps (AP) and four patients had cancer, yielding a frequency of 37% (53/142). Thirty-six family members were under 40 years of age, eight of whom had AP. In total, there were 111 AP and four invasive cancers; 42% (48/111) of AP and 75% (3/4) of cancers were beyond the reach of conventional flexible sigmoidoscope. Of 53 patients with AP or cancer in the large bowel, 36 had AP or cancer in the distal colon (rectosigmoid region and descending colon), 15 (42%) of whom were found to have at least one AP or cancer in the proximal colon (proximal to the descending colon). The remaining 17 patients' lesions were confined to the proximal colon, and would not have been detected with a flexible sigmoidoscope. Sigmoidoscopy in high-risk patients with neoplasm in the large bowel has a sensitivity of 68%. We conclude that a vigorous surveillance program using primary colonoscopy should be set up for those who are first-degree relatives of patients with CRC. Routine examination should start at the age of 40, and the entire colon should be evaluated.

Adult↗
PubMed1997

A community hospital experience with colonoscopic polypectomies.

This study analyzed 432 consecutive polypectomies performed in 279 patients in the gastroenterology unit of a community hospital. The patients were separated into 2 groups; group I--symptomatic patients considered suitable for colonoscopic examination, and group II--asymptomatic high-risk patients. The mean number of detected polyps was similar in both groups, the vast majority of the polyps in both groups were small (< 5 mm), and were mainly of tubular histology. Polyps in the rectosigmoid area were more common (56.6%) in the symptomatic patients than in the asymptomatic patients (44.1%). Fourteen percent of patients in group I and 33% in group II had no polyps within 60 cm from the anal verge. Carcinoma in situ was found in large polyps mainly in group I. Flat adenomas were not found in the studied population. The incidence of hyperplastic polyps was similar in both groups and did not predict the concomitant existence of adenomatous polyps. The male:female ratio was the same in both groups. The percent of detected polyps increased with age. A strong right shift in the location of the polyps was evident with increasing age. Multiple polyps were a common event in this Israeli population of symptomatic and high-risk asymptomatic patients. More than 30% of the polyps were found outside the reach of the sigmoidoscope, with this proportion increasing with age. These data provide further support to the claim that colonoscopy should therefore serve as the choice diagnostic tool in these high-risk populations.

Age Distribution↗
PubMed1976

Anatomic localization and step by step advancement of the fiberoptic colonoscope.

Anatomic localization of the tip of a colonoscope without the aid of fluoroscopy is adequate in a majority of patients. External check points of transilluminated light within the colon on the abdominal wall, characteristic internal appearance of the colon and gross anatomic landmarks have been used. An improved technique for advancement results if a routine sequence of maneuvers is used in a similar manner in all patients.

Colon↗
PubMed1998

Colonoscope flexural rigidity measurement.

A testing device is developed that determines the stiffness, or flexural rigidity, of an endoscope at specific locations down its length by subjecting it to a compressive axial force, a situation similar to the actual forces applied to the endoscope during a clinical procedure. The endoscope is made to deform in a similar fashion to a slender buckled column and the force causing this deformation is related to the flexural rigidity using column buckling theory. A direct relationship between the critical load needed to cause buckling and the square of column length L is demonstrated experimentally and is expected theoretically, giving confidence in the application of column buckling theory to endoscope testing. Additional confidence in the validity of the column buckling test results is obtained by their similarity to data obtained by subjecting the endoscope to a transverse load, determining deflection, and modelling the endoscope as a bent elastic beam. Several makes and models of endoscopes were tested, with flexural rigidity values typically ranging between 160 to 240 Ncm2. The effect of a metal stiffener inserted in an endoscope's accessory channel is quantified, as is the change in flexural rigidity down the insertion shaft of a graded-stiffness endoscope. Significant differences in flexural rigidity were obtained between identical endoscopes, each sharing similar usage histories, indicating the need for flexural rigidity measurements for each individual endoscope of a particular model line, though a more extensive study is required to reliably determine scope-to-scope stiffness variations for a particular model line.

Colonoscopes↗
PubMed1983

Experience with routine office sigmoidoscopy using the 60-cm flexible colonoscope in private practice.

Based on reported success and safety, 1121 sigmoidoscopies were performed in 964 patients seen privately by one surgeon, as a routine office screening procedure, using the flexible 60-cm sigmoidoscope instead of the rigid 25-cm instrument. The doubling of the distance that was examined doubled the diagnostic yield for neoplasia and inflammatory bowel disease, specific or nonspecific. As compared with barium-enema examinations, the yield was even greater: 5:1 for neoplasia, 7:1 for inflammation, 3:1 for polyps greater than 1 cm, and 5:1 for false-negative, false-positive, or equivocal x-ray findings. No serious complications were encountered in any of the examinations including 72 polypectomies performed in the office. The study supports flexible fiberoptic sigmoidoscopy as a major screening tool for individuals in private practice in truly evaluating the interior of the lower 60-cm of the colorectum for neoplasia and for the diagnosis and monitoring of bowel disease or neoplasia confined to that area.

Adolescent↗
PubMed2006

Use of a double balloon enteroscope facilitates caecal intubation after incomplete colonoscopy with a standard colonoscope.

BACKGROUND: Caecal intubation is a necessary step in the complete endoscopic evaluation of the colon. Studies have estimated that experienced colonoscopists may fail to reach the caecum in up to 10% of cases. AIMS: To evaluate the utility of the double balloon enteroscope used for complete examination of the colon in patients with incomplete standard colonoscopy. PATIENTS: Twenty consecutive patients with incomplete colonoscopies within the Veterans Affairs Palo Alto Health Care System. Mean age of 66 years (S.D.+/-12 years, range 46-84), 16 men. METHODS: Prospective single-centre case series on the caecal intubation rate using standard double balloon enteroscope technique in patients with previous incomplete conventional colonoscopy. RESULTS: Use of the standard double balloon enteroscope technique permitted complete colonoscopy to be achieved in 95% of the patients (19/20). Seven patients (35%) had significant pathology beyond the extent of the prior incomplete colonoscopy. We performed endoscopic mucosal resection, polypectomy or biopsy. The mean time to reach the caecum was 28 min (S.D.+/-20 min, range 6-90 min). The sedation was similar to conventional colonoscopy. No complications occurred. CONCLUSIONS: The double balloon enteroscope technology and technique can be used to complete examination of the colon in patients who were referred because of incomplete standard colonoscopy.

Aged↗