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PubMed1997

Feasibility of the transparent cap-fitted colonoscope for screening and mucosal resection.

PURPOSE: A transparent plastic cap of 17 mm in outer diameter, 15 mm in inner diameter, and 10 mm in length can be easily attached to the tip of a colonoscope. By using the cap, a better view of the lesions hiding at the opposite side of the fold can be obtained. When a flat colonic lesion is found, a submucosal injection of saline solution is performed, the target mucosa is sucked inside the cap, snared under a full endoscopic suction, and resected by an electrical current. This procedure is called endoscopic mucosal resection using transparent cap-fitted endoscope (EMRC). Feasibility of the cap-fitted colonoscope for screening colonoscopic examination and mucosal resection was evaluated. MATERIALS AND METHODS: One hundred forty patients were randomly allocated for screening with a normal colonoscope (NCF) or that with the cap-fitted colonoscope (CCF). Average time for insertion up to the cecum, patients' discomfort during insertion expressed in 4 degrees, and average number of lesions found in one patient were compared. Thirty lesions randomly allocated for mucosal resection with conventional strip biopsy or EMRC were also evaluated. RESULTS: Time consumed for insertion up to the cecum with the CCF (12.4 +/- 6.6 minutes) was the same as that with the NCF (12.3 +/- 5.2 minutes), and there was no significant difference in patients' discomfort; however, the average number of lesions found in one patient was larger when using the CCF (0.86 +/- 0.96) than when using the NCF (0.58 +/- 0.81). For mucosal resection, 40 flat or wide-based lesions including 6 mucosal carcinomas were resected with EMRC. We experienced only one pinhole perforation of the ascending colon by heat damage, which was treated successfully by surgery. There was no other major complication or recurrence. CONCLUSION: The cap-fitted endoscope was equal in maneuverability, was excellent in sensitivity in comparison with the regular colonoscope, and was thought to be feasible both in screening and mucosal resection.

Aged↗
PubMed2005

Handcrafted two-channel colonoscope for grasping-forceps-assisted resection of giant pedunculated polyps.

BACKGROUND: Colonoscopic polypectomy of giant pedunculated polyps has an increased risk of bleeding and is technically difficult. To facilitate the removal of the polyps, we handcrafted a two-channel colonoscope and applied it for grasping-forceps-assisted resection. METHODS: We easily handcrafted a two-channel colonoscope by taping a plastic tube along the shaft of a standard colonoscope and used it for the technique in 10 patients with 12 giant pedunculated polyps. OBSERVATIONS: The colonoscope with forceps assistance proved to be satisfactory for handling detachable and polypectomy snares. Immediate bleeding occurred in one patient because the detachable snare could not be maneuvered over the polyp. In 3 patients, the plastic tube became mobile during the procedure because the tape that attached the tube became loose. No other complications occurred. CONCLUSIONS: A handcrafted two-channel colonoscope for grasping-forceps-assisted resection of giant pedunculated polyps is effective for the prevention of postpolypectomy bleeding and the reduction of technical difficulties.

Adult↗
PubMedDate not supplied

Usefulness of pediatric colonoscopes in adult colonoscopy.

Use of small diameter, extraflexible pediatric colonoscopes has proved to be valuable in adult endoscopy practice, not only for passing strictures and stomas but also where either fixation due to diverticular disease or postoperative adhesions, or unavoidably painful looping made passage of adult colonoscopes impossible. In 70 of 78 (92%) of the cases where the adult colonoscope could not be passed through the sigmoid colon by an expert endoscopist, the pediatric colonoscope passed through, often very easily. Fifteen of these patients were considered to have been saved surgery by successful passage. The "failure" rate for all colonoscopy examinations was only 2%; this low failure rate was attributable to the use of pediatric instruments whenever passage through the sigmoid colon proved to be impossible with standard colonoscopes. In our opinion every unit performing frequent colonoscopies should have a pediatric colonoscope available for selected adult patients as well as for use in children.

Biopsy↗
PubMed2004

Colonoscopic manifestations of typhoid fever with lower gastrointestinal bleeding.

BACKGROUND: Intestinal bleeding in patients with typhoid fever usually occurs in the ileum. However, endoscopic findings in such patients are not well established. We examined the colonoscopic manifestations of intestinal lesions with bleeding in patients with typhoid fever. PATIENTS AND METHODS: The colonoscopic findings of seven patients who presented with haematochezia due to typhoid fever were reviewed retrospectively. Typhoid fever was diagnosed when the Salmonella typhi was isolated or when the Widal test showed strongly positive reactions. RESULTS: Clinical data and colonoscopic findings were reviewed in seven patients (four men and three women with an average age of 42 years). The most commonly involved area was the terminal ileum (100%), followed by the ileocecal valve (57%), the ascending colon (43%), and the transverse colon (29%). Left colon was intact in all cases. The most common colonoscopic finding was multiple variable-sized punched-out ulcers with slightly elevated margin, as found in five patients. In two patients, only several oedematous hyperaemic mucosal patches with haemorrhagic spots or shallow erosions were seen. Active bleeding was noticed only in one patient, who received endoscopic haemostasis twice. The remaining six patients were treated by conservative treatment including antibiotic therapy. There was no complication during or after the colonoscopic examination. CONCLUSIONS: Intestinal bleeding in typhoid fever usually occurs from the ulcers in the ileum or proximal colon, and the most common colonoscopic manifestations are multiple variable-sized punched-out ulcerations.

Adult↗
PubMed2003

Colonoscopic surveillance after curative colorectal resection: results of an empirical surveillance programme.

INTRODUCTION: Colonoscopic surveillance after colorectal cancer resection is widely practised despite little evidence that it improves survival. The optimum protocol for colonoscopic follow-up after colorectal cancer resection has not yet been elucidated. We audited the outcome of an empirical colonoscopic follow-up programme in a cohort of patients who underwent colorectal resection with a minimum of five years follow-up to establish patterns of metachronous neoplasia and suitable surveillance intervals. METHODS: The colonoscopic records, biopsy results and follow-up details of patients diagnosed with colorectal cancer between June 1990 and June 1996 were reviewed. The number and type of metachronous neoplastic lesions diagnosed was recorded. Rates of development of new neoplasms were estimated by calculating the time from operation to their first discovery. Factors predictive of further development of polyps or cancer were sought. Results were compared to published reports of intensive follow-up programmes. RESULTS: Seven hundred and ninety-eight patients underwent colorectal resection with curative intent during the study period. 226 patients had one or more follow-up colonoscopies (mean time post resection 48.8 months). In total 352 colonoscopies, encompassing 1437 patient years of surveillance, were performed. Nine metachronous cancers in eight patients, five of which were asymptomatic were diagnosed by colonoscopy at a mean of 63 months. Three asymptomatic recurrences were diagnosed but all were inoperable. 70 (31%) patients had adenomatous polyps diagnosed after a mean time from operation of 34 months for simple adenomatous polyps and 21 months for those with advanced features. Patients with multiple polyps or advanced polyps at the initial colonoscopy were more likely to form subsequent polyps. Only 5.8% of patients with a single adenoma or a normal colon formed an advanced adenoma over the next 36 months of surveillance. CONCLUSION: The results of an empirical colonoscopic follow-up programme compared favourably to the results of the intensive programmes reported in the literature. Most patients are at very low risk of developing significant colonic pathology over the first five years after resection. Colonoscopic surveillance intervals need not be less than five years unless the patient has multiple adenomas or advanced adenomas at the first colonoscopy. Three yearly surveillance intervals are most probably adequate in these individuals.

Aged↗
PubMed2006

Colonoscopic withdrawal times and adenoma detection during screening colonoscopy.

BACKGROUND: Colonoscopy is commonly used to screen for neoplasia. To assess the performance of screening colonoscopy in everyday practice, we conducted a study of the rates of detection of adenomas and the amount of time taken to withdraw the colonoscope among endoscopists in a large community-based practice. METHODS: During a 15-month period, 12 experienced gastroenterologists performed 7882 colonoscopies, of which 2053 were screening examinations in subjects who had not previously undergone colonoscopy. We recorded the numbers, sizes, and histologic features of the neoplastic lesions detected during screening, as well as the duration of insertion and of withdrawal of the colonoscope during the procedure. We compared rates of detection of neoplastic lesions among gastroenterologists who had mean colonoscopic withdrawal times of less than 6 minutes with the rates of those who had mean withdrawal times of 6 minutes or more. According to experts, 6 minutes is the minimum length of time to allow adequate inspection during instrument withdrawal. RESULTS: Neoplastic lesions (mostly adenomatous polyps) were detected in 23.5% of screened subjects. There were large differences among gastroenterologists in the rates of detection of adenomas (range of the mean number of lesions per subject screened, 0.10 to 1.05; range of the percentage of subjects with adenomas, 9.4 to 32.7%) and in their times of withdrawal of the colonoscope from the cecum to the anus (range, 3.1 to 16.8 minutes for procedures during which no polyps were removed). As compared with colonoscopists with mean withdrawal times of less than 6 minutes, those with mean withdrawal times of 6 minutes or more had higher rates of detection of any neoplasia (28.3% vs. 11.8%, P<0.001) and of advanced neoplasia (6.4% vs. 2.6%, P=0.005). CONCLUSIONS: In this large community-based gastroenterology practice, we observed greater rates of detection of adenomas among endoscopists who had longer mean times for withdrawal of the colonoscope. The effect of variation in withdrawal times on lesion detection and the prevention of colorectal cancer in the context of widespread colonoscopic screening is not known. Ours was a preliminary study, so the generalizability and implications for clinical practice need to be determined by future studies.

Adenoma↗
PubMed2004

Magnifying colonoscopic features of ulcerative colitis reflect histologic inflammation.

BACKGROUND: Colonoscopy plays an important role in the diagnosis of ulcerative colitis and the determination of disease activity. Standard colonoscopic findings, however, do not often agree with histologic findings. The aim of this study was to clarify the relation between magnifying colonoscopic features and histologic inflammation in the course of ulcerative colitis. METHODS: We performed magnifying colonoscopy examinations in 60 patients with ulcerative colitis. We classified the features into six types and analyzed the relations among these features, standard colonoscopic features (Matts grades), and pathohistological findings. RESULTS: It was difficult to distinguish the remission stage from the active stage by standard colonoscopy in cases of Matts grade 2 disease. There was a relation, however, between the magnifying colonoscopic types and the degrees of histologic inflammation. The magnifying colonoscopic types reflected histologic inflammation status more accurately than did standard colonoscopic findings. CONCLUSION: Magnifying colonoscopy is useful for determining the degree of histologic change without biopsy in patients with ulcerative colitis.

Adult↗
PubMed1994

Does colonoscopic polypectomy reduce the incidence of colorectal carcinoma?

The study's objective was to examine whether there is evidence that colonoscopic polypectomy reduces the incidence of colorectal cancer. The records of all patients who underwent colonoscopic polypectomy by a single surgeon between 1974 and 1991 were reviewed. Patients with colorectal cancer diagnosed at the initial colonoscopy, with a history of colorectal cancer, inflammatory bowel disease or familial adenomatous polyposis or with only hyperplastic polyps were excluded. There were 1008 remaining patients, of whom 645 have attended at least one follow-up colonoscopic examination, and these 645 patients from the basis of the study, because the incidence of cancer is known exactly in this group. The mean period of follow up was 4.4 years and the mean number of follow-up colonoscopic examinations was 2.2. There was a total of 2847 person-years of colonoscopic follow up. The expected incidence of cancer, age and sex adjusted, is calculated using Australian epidemiological figures. The observed incidence of cancer was 3 cases (all asymptomatic) per 2847 person-years, which is indistinguishable from the general population's risk of 3.75 cases per 2847 person-years. Analysis of previous publications suggests that patients with adenomas are at an increased risk of developing colorectal cancer of about 2.5 times the general population's risk. If correct, then the observed incidence of 3 cases per 2847 person-years is less than the expected incidence of 9.4 cases per 2847 person-years. This analysis suggests colonoscopic polypectomy does reduce the incidence of colorectal cancer.

Adenoma↗
PubMed2004

Colonoscopic perforation and bleeding of the colon can be treated safely without surgery.

The incidence of colonoscopic perforation of colon is about 0.3 per cent. The incidence of colonoscopic bleeding is about 0.6 per cent. Many of those patients undergo unnecessary operations. In order to assess the outcome of nonoperative management of those patients with postcolonoscopic perforation and bleeding, the records of 5120 patients who underwent colonoscopies from September 1, 1988 to June 30, 2003 were retrospectively reviewed with attention paid to colonoscopic perforation and bleeding. Their symptoms, management, and outcome were reviewed. There were 2765 male and 2355 female patients. Ages ranged from 9 to 91 years. A total of 1902 patients (37.1%) had polyps removed. Six patients (0.1%) had colonoscopic perforation. All of them presented with abdominal pain 1 to 4 days after colonoscopic polypectomy. All had subphrenic free air or subcutaneous emphysema on the radiogram. All were treated nonoperatively with nothing by mouth and intravenous fluids and antibiotics in the hospital and recovered uneventfully. Six patients (0.1%) had colonic bleeding that occurred 1 to 14 days after colonoscopic polypectomy. All of them were managed by repeat colonoscopy with injection of epinephrine. All recovered without further bleeding. Therefore, postcolonoscopic perforation and bleeding can be treated nonoperatively. It is safe and cost effective. The mortality and morbidity are very low.

Adolescent↗
PubMed2005

Evaluation of a novel colonoscope designed for easier passage through flexures: a randomized study.

BACKGROUND AND STUDY AIMS: A new colonoscope (XCF-Q160AW prototype, Olympus, Tokyo, Japan) has been developed, designed with an additional passive bending function to ease intubation through the left colonic flexure. In this study we investigated whether this function could be included in a standard colonoscope without jeopardizing general performance, particularly passage through the sigmoid colon. PATIENTS AND METHODS: 280 outpatients referred for routine colonoscopy at Telemark Hospital were randomly allocated to colonoscopy with a standard colonoscope (Olympus 140 series) or the XCF-Q160AW prototype. Sedation was given on demand. End points were cecal intubation and the patients' grading of pain in a questionnaire. RESULTS: Cecal intubation rates were 85% and 87% for standard and prototype endoscopes, respectively (P = 0.57). On-demand sedation was given to nine (7%) and 15 (11%) of the patients, respectively (P = 0.17). Of the patients, 256 (85%) returned their questionnaire, with 87 (63%) in the standard group and 109 (77%) in the prototype group reporting that they had experienced 'no pain/slight pain' (P < 0.001). In a multiple logistic regression analysis, this difference in experienced pain remained statistically significant after adjustment for interendoscopist variation and the use of the endoscope-stiffening function. Two patients in the study, in whom there had previously been several unsuccessful attempts at negotiating the splenic flexure, were successfully examined with the prototype colonoscope. CONCLUSION: Examination with the Olympus XCF-Q160AW prototype with a passive bending function caused less pain than use of a standard Olympus 140 series colonoscope, without compromising other endoscope functions for colonic intubation.

Colon↗
PubMed2001

Clinical application of a new colonoscope with variable insertion tube rigidity: a pilot study.

BACKGROUND: Colonic loop formation can prolong colonoscopy, increase patient discomfort, and preclude complete examination. A colonoscope with variable insertion tube rigidity may facilitate colonoscopy. Our aim was to determine whether the use of a colonoscope with variable insertion tube rigidity reduces insertion time and improves patient acceptance of colonoscopy. METHODS: Fifty patients were randomly assigned to undergo colonoscopy with a conventional colonoscope or a variable rigidity colonoscope (VRC). Patient acceptance, dosage of medication, use of abdominal pressure, and patient repositioning were assessed. Statistical analysis was performed by the 2-sample Wilcoxon rank sum test and an extension of Fisher exact test. RESULTS: The groups were comparable with respect to age, gender, and medications required during colonoscopy. The cecum was reached in all 25 patients who underwent colonoscopy with the VRC, including 1 patient in whom the cecum was not reached at a previous colonoscopy with a conventional instrument. In the conventional colonoscopy group, the cecum was not reached in 4 patients (2 poor preparation, 2 loop formation). There was no significant difference between the 2 groups with respect to insertion time. In the group that underwent colonoscopy with the variable rigidity instrument, less abdominal pressure was required (p = 0.05), and nursing assessment of patient discomfort was more favorable (p = 0.05). There were no complications and no significant differences in the intubation time to cecum or in repositioning, patient acceptance, or patient assessment of abdominal pain. CONCLUSION: The use of a variable rigidity colonoscope reduced the frequency of abdominal pressure but did not affect intubation time to cecum, repositioning, patient acceptance, or patient assessment of abdominal pain.

Adult↗
PubMed1996

Colonoscopic perforations. Etiology, diagnosis, and management.

Since its introduction into clinical medicine, flexible fiberoptic colonoscopy has had a great impact on diagnosis and management of diseases of the colon and rectum. There are three mechanisms responsible for colonoscopic perforation: specifically, mechanical perforation directly from the colonoscope or a biopsy forceps, barotrauma from overzealous air insufflation, and, finally, perforations that occur during therapeutic procedures. Perforation of the colon, which requires surgical intervention more frequently than bleeding, occurs in less than 1 percent of patients undergoing diagnostic colonoscopy and may be seen in up to 3 percent of patients undergoing therapeutic procedures such as polyp removal, dilation of strictures, or laser ablative procedures. Management of colonic perforation secondary to colonoscopy remains a controversial issue in that it can be effectively managed by operative and nonoperative measures. If a perforation does occur, signs and symptoms that the patient will experience will be related to both the size and site of the perforation, adequacy of the bowel preparation, amount of peritoneal soilage, underlying colonic pathology (where a thin walled colon from colitis or ischemia, for example, may result in a larger perforation than a healthy colon), and, finally, overall clinical condition of the patient. Radiology often establishes diagnosis. Plain films of the abdomen and an upright chest x-ray may reveal extravasated air confined to the bowel wall, free intraperitoneal air, retroperitoneal air, subcutaneous emphysema, or even a pneumothorax. A localized perforation may demonstrate lack of pneumoperitoneum. Some surgeons recommend surgery for all colonoscopic perforations; however, there does appear to be a role for conservative management in a select group of patients such as those with silent asymptomatic perforations and those with localized peritonitis without signs of sepsis that continue to improve clinically with conservative management. Finally, conservative management works well in those patients with postpolypectomy coagulation syndrome. Surgery is most definitely indicated in the presence of a large perforation demonstrated either colonoscopically or radiographically and in the setting of generalized peritonitis or ongoing sepsis. The presence of concomitant pathology at time of colonoscopic perforation such as a large sessile polyp likely to be a carcinoma, unremitting colitis, or perforation proximal to a nearly obstructing distal colonic lesion may force immediate surgery. Finally, in the patient who deteriorates with conservative management, one should proceed to surgery.

Algorithms↗
PubMed1992

Ogilvie's syndrome: colonoscopic decompression and analysis of predisposing factors.

Forty-eight cases of Ogilvie's syndrome, colonic pseudo-obstruction, presenting between 1983 and 1989 were retrospectively reviewed to assess the results of colonoscopic decompression and to identify potential etiologic factors. Three patients had spontaneous resolution with medical treatment. Forty-five patients required 60 colonoscopic decompressions: 38 (84 percent) were successfully treated using colonoscopy; five (11 percent) required an operation; and two died within 48 hours of colonoscopy from medical causes. No complications or deaths were the result of colonoscopy. Twenty-nine patients (64 percent) were successfully treated with a single colonoscopy. One-third of patients required serial decompressions. Average cecal diameter in patients with successful colonoscopic decompression was 12.4 cm but was larger for patients requiring more than one colonoscopy (13.3 cm) and for those who failed colonoscopic therapy (13.4 cm). The spine or retroperitoneum had been traumatized or manipulated in 52 percent of patients. Patients with Ogilvie's syndrome were being treated with narcotics (56 percent), H-2 blockers (52 percent), phenothiazines (42 percent), calcium-channel blockers (27 percent), steroids (23 percent), tricyclic antidepressants (15 percent), and epidural analgesics (6 percent) at diagnosis. Electrolyte abnormalities included hypocalcemia (63 percent), hyponatremia (38 percent), hypokalemia (29 percent), hypomagnesemia (21 percent), and hypophosphatemia (19 percent). Colonoscopic decompression in Ogilvie's syndrome is safe and effective management. Multiple pharmacologic and metabolic factors, as well as spinal and retroperitoneal trauma, appear to alter autonomic regulation of colonic function, resulting in colonic pseudo-obstruction.

Adult↗
PubMed2003

Use of a colonoscope instead of a sigmoidoscope to screen asymptomatic adults for colorectal cancer.

BACKGROUND: Colonoscopic screening can detect neoplasms in asymptomatic adults, many of which would not be detected by sigmoidoscopy. However, because of cost and resource factors, many adults still undergo flexible sigmoidoscopy for colorectal cancer screening. In asymptomatic adults over age 50 undergoing unsedated flexible sigmoidoscopy screening, use of a colonoscope instead of a sigmoidoscope was studied to determine the feasibility, safety, tolerability, and yield. METHODS: Over an 18-month period, asymptomatic adults referred for colorectal cancer screening by sigmoidoscopy were enrolled. Two experienced nurses attempted to reach the cecum by using a pediatric colonoscope but stopped if significant discomfort was experienced, if the preparation was suboptimal, or if polyps were found. RESULTS: A total of 672 adults (652 men, 20 women) underwent screening. The colonoscope was advanced beyond the level attainable with a sigmoidoscope (70-cm mark) in 240 cases. The cecum was reached in 110 (16.4%) of these patients, with a mean pain intensity for patients of 2.6 (scale 1-10) and a mean time for completion of the procedure of 17 minutes. Colonoscopy to the cecum was not feasible because of patient discomfort in 280 patients (41.7%), poor preparation in 179 (26.7%), left-sided polyps or cancer in 69, and/or severe diverticulosis and tortuosity in 34 cases. Twenty patients had polyps proximal to the 70-cm mark (65% adenomas, no cancer). There was no complication. CONCLUSIONS: The use of a colonoscope instead of a sigmoidoscope by nurses performing unsedated screening sigmoidoscopy is feasible, safe, and well-tolerated, and may improve the yield for screening by at least 16.4% in patients who would otherwise have had only the left colon examined.

Aged↗
PubMed2004

Quality assurance and gastrointestinal endoscopy: an audit of 500 colonoscopic procedures.

UNLABELLED: The aim of this study was to assess the quality of colonoscopic procedures in our endoscopy unit with the goal of improving performance. METHODS: We prospectively audited 500 consecutive colonoscopic procedures and assessed sixty-two process or outcome indicators for each procedure. RESULTS: Most of the measured indicators were within standard limits: cecal intubation rate (92%), inadequate bowel preparations (24%), inappropriate procedures (9.7%), normal procedures (54%), yield for neoplasia (32%), morbidity (0.4%), and overall patient satisfaction (95.8%). Some indicators were outside standard limits suggesting our practices should be modified: endoscopy withdrawal time less than 6 minutes (78%), forceps removal of polyps (31%), resected polyps not recovered for pathological examination (12%), adenomas with villous elements (22%), patients unsatisfied because of time spent waiting for the procedure (19%), patients unsatisfied because of inadequate explanations (10%). There was no standard for a few indicators: patient discomfort (6.9%), diagnostic success (89%), therapeutic success (92%). Three new indicators were proposed: proportion of patients aged<50 years, number of normal colonoscopic procedures to perform to detect one advanced adenoma or cancer, and proportion of colonoscopic procedures causing discomfort. The diagnostic yield of colonoscopy was dependent on age, gender, indication and appropriateness of indication but not on the prescriber. CONCLUSION: This audit allowed us to evaluate our endoscopic practices and to detect certain shortcomings and deviations from standards. It enabled us to change some of our practices with the goal of improving the quality of our colonoscopic procedures.

Adolescent↗
PubMed2000

Band ligation for colonic bleeding: modification of multiband ligating devices for use with a colonoscope.

BACKGROUND: Current multiband ligating devices can be useful in the treatment of colorectal hemorrhage but are not designed to be used with a colonoscope. This restricts the ability to treat more proximal sites of colonic bleeding with this type of device. This study describes methods of modifying multiband ligating devices for use with a colonoscope, and the application of both single band and modified multiband ligating devices in the treatment of colonic bleeding. METHODS: Five consecutive patients with colorectal hemorrhage were treated endoscopically with a single-band ligating device or a modified multiband ligating device. The lesions treated included two postpolypectomy ulcers, one arteriovenous malformation, one post-coagulation ulcer after ablation of an arteriovenous malformation, and one diverticulum. RESULTS: Colonoscopic band ligation using either device was successful in all five patients with follow-up ranging from 2 to 5 months. CONCLUSIONS: Colonoscopic band ligation appears to be a safe and effective treatment for various types of colorectal hemorrhage. Currently available multiband ligating devices can be easily modified for use with a colonoscope. Endoscopic band ligation of colonic bleeding may be particularly useful in patients with coagulopathies and those cases in which bleeding is uncontrollable with other therapeutic modalities.

Adult↗
PubMed1998

Is colonoscopic surveillance reducing colorectal cancer mortality in ulcerative colitis? A population based case control study.

BACKGROUND: Colonoscopic surveillance is a standard procedure in many patients with long standing, extensive ulcerative colitis (UC), in order to avoid death from colorectal cancer. No conclusive proof of its benefits has been presented however. AIMS: To evaluate the association between colonoscopic surveillance and colorectal cancer mortality in patients with UC. PATIENTS: A population based, nested case control study comprising 142 patients with a definite UC diagnosis, derived from a study population of 4664 patients with UC, was conducted. METHODS: Colonoscopic surveillance in all patients with UC who had died from colorectal cancer after 1975 was compared with that in controls matched for age, sex, extent, and duration of the disease. Information on colonoscopic surveillance was obtained from the medical records. RESULTS: Two of 40 patients with UC and 18 of 102 controls had undergone at least one surveillance colonoscopy (relative risk (RR) 0.29, 95% confidence interval 0.06 to 1.31). Twelve controls but only one patient with UC had undergone two or more surveillance colonoscopies (RR 0.22, 95% confidence interval 0.03 to 1.74), indicating a protective dose response relation. CONCLUSION: Colonoscopic surveillance may be associated with a decreased risk of death from colorectal cancer in patients with long standing UC.

Adolescent↗
PubMed1991

Colonoscopic surveillance after polypectomy: considerations of cost effectiveness.

OBJECTIVE: To assess the cost effectiveness of the current recommendation that persons who have had an adenomatous colon polyp removed have periodic colonoscopic surveillance at fixed and regular intervals. DESIGN: Cost-effectiveness analysis using data from the medical literature in a simulation model to estimate the costs of and the risk for perforation associated with periodic colonoscopic surveillance for a 50-year-old man followed for 30 years. MAIN RESULTS: A program of colonoscopy every 3 years would incur cumulatively a 1.4% risk for colon perforation, a 0.11% risk for perforation-related death, and direct physician costs of $2071 for colonoscopy (discounted at 5%). If a 50-year-old man's cumulative remaining risk for death from cancer is 2.5% after the removal of a single small adenoma and if effectiveness of colonoscopic surveillance every 3 years is 100%, then one death from cancer could be prevented by doing 283 colonoscopies, incurring 0.6 perforations, 0.04 perforation-related deaths, and direct physician costs of $82,000. If surveillance were 50% effective and the cumulative remaining risk for death from cancer were 1.25%--a plausible scenario--1131 colonoscopies would be required to prevent one death from cancer, incurring 2.3 perforations, 0.17 perforation-related deaths, and physician costs of $331,000. CONCLUSIONS: The cost effectiveness of colonoscopic surveillance is very sensitive to estimates of the cumulative remaining risk for death from cancer after polypectomy as well as to surveillance efficacy. For persons whose remaining risk for death from cancer may be low, such as persons with a single small adenoma, recommendations for colonoscopic surveillance at fixed and regular intervals may be excessively costly.

Aged↗