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PubMed1994

[Quality control and use of resources in colonoscopy. A prospective evaluation of 1000 colonoscopies].

In a prospective study 1,000 consecutive colonoscopies were registered in a specially designed database. Mean time spent on colonoscopy was 26.3 minutes. 419 colonoscopies were technically difficult. The desired level in the gut was reached in 747 examinations. There were two non-fatal complications. Both were haemorrhages following snare polypectomies. One third of the colonoscopies were control examinations. If we followed the commonly accepted policy for control of colitis and neoplasms, in a few years time, all our capacity would be used for routine examinations. A consensus for selection of patients for colonoscopy is needed. We found 107 of 230 double-contrast barium enema examinations to be false negative or false positive. This is a higher figure than obtained with colonoscopy.

Adult↗
PubMed2006

Factors determining post-colonoscopy abdominal pain: prospective study of screening colonoscopy in 1000 subjects.

BACKGROUND: Factors determining post-colonoscopy abdominal pain remain poorly understood. Accordingly, a prospective study was conducted to reveal the key determinants. METHODS: One thousand consecutive and asymptomatic patients (569 men, 431 women; mean age 51 years, range 19-84 years) undergoing total colonoscopy were evaluated to assess their abdominal pain. Their demographic data, psychological profiles (determined on the Brief Symptom Rating Scale and Maudsley Personality Inventory), and endoscopic findings were treated as independent variables in polytomous logistic regression in which pain severities were treated as outcome variables. Factors affecting the duration of pain were evaluated on multivariate linear regression. RESULTS: Colonoscopy duration (s; odds ratio [OR]: 1.001, 95% confidence interval [CI]: 1-1.002, P<0.01) and female sex (OR: 1.368, 95%CI: 1.02-1.853, P=0.03) were significantly associated with abdominal pain, but age, body mass index, psychological traits, conscious sedation, use of i.v. hyoscine butylbromide, and colonic preparation were not. Duration of the colonoscopy was longer in female than male subjects (P=0.04). On stepwise linear regression, irritable bowel syndrome (regression coefficient: 27.47, 95%CI: 6.99-47.67, P<0.01) and conscious sedation (regression coefficient: -22.17, 95%CI: -42.52 to -1.42, P = 0.036) were the best predictors of prolonged pain in 485 patients who had pain. CONCLUSIONS: Female sex and duration of colonoscopy increased the likelihood of post-procedural abdominal pain. Conscious sedation temporarily suppressed the pain but had no effect on its occurrence. Irritable bowel syndrome may have prolonged the discomfort.

Abdominal Pain↗
PubMedDate not supplied

Fiberoptic colonoscopy: complications of colonoscopy and polypectomy.

Members of the American Society of Colon and Rectal Surgeons were polled regarding complications of colonoscopy and polypectomy. Sixty per cent of the members responded. One hundred sixty-two surgeons were found to be performing colonoscopy, and this paper presents the accumulated data on complications. A total of 20,139 colonoscopies were performed, with 12,746 diagnostic procedures and 7,393 polypectomies. The overall complication rate was 0.4 per cent with diagnostic colonoscopy and 1.8 per cent with polypectomy. Based upon these complications, guidelines in regard to history, preparation, and technique of colonoscopy and polypectomy are discussed.

Colonic Diseases↗
PubMed2002

Computed tomographic colonography (virtual colonoscopy): blinded prospective comparison with conventional colonoscopy for the detection of colorectal neoplasia.

BACKGROUND AND STUDY AIMS: Computed tomographic colonography (CTC), also known as virtual colonoscopy, is a recently introduced imaging modality for the detection of colorectal neoplasia. The aim of our study was to evaluate the performance of CTC in a blinded comparison with conventional colonoscopy. PATIENTS AND METHODS: A total of 66 consecutive, symptomatic patients underwent spiral computed tomography (CT) examination after standard bowel preparation. CT images were analyzed and subsequently compared with conventional colonoscopy findings. RESULTS: Conventional colonoscopy detected 15 colorectal carcinomas and 52 polyps. CTC correctly identified all carcinomas, 13 of 14 polyps greater than 10.0 mm (sensitivity 92.8 %; 95 % confidence interval (95 % CI); 77 - 100), 11 of 13 polyps between 6.0 and 9.0 mm (sensitivity 84.6 %; 95 % CI; 62 - 100), and six of 25 polyps smaller than 5.0 mm (sensitivity 24 %; 95 % CI; 6 - 42). The per-patient sensitivity and specificity were 93.7 % and 94.1 %, respectively. CONCLUSIONS: Computed tomographic colonography is an accurate imaging modality for the detection of colorectal neoplasia, especially for lesions larger than 6.0 mm in diameter.

Adult↗
PubMed2003

Wide angle colonoscopy with a prototype instrument: impact on miss rates and efficiency as determined by back-to-back colonoscopies.

OBJECTIVE: Polyps are missed during conventional colonoscopy, even with meticulous technique. The aim of this study was to investigate whether a prototype wide angle colonoscope is associated with a reduced miss rate for polyps. METHODS: Two studies were performed. In study 1, a total of 50 patients underwent back-to-back, same-day colonoscopy by a single examiner with the prototype wide angle colonoscope and with a standard colonoscope, with the order of scopes randomized. In study 1, an attempt was made to keep examination time with the two colonoscopes equal. In study 2, a total of 20 patients were examined, 10 by the same colonoscopist who performed study 1 and 10 by a second colonoscopist. In study 2, examiners tried to perform the examinations as quickly as accuracy would allow. RESULTS: In study 1, the miss rate for all polyps was lower with the wide angle colonoscope (20% vs 31%; p = 0.046), although the mean examination time with the wide angle instrument was shorter (6.75 min vs 7.64 min; p = 0.0005). There was no significant difference in detection of adenomas. Polyps, including adenomas, were missed in the peripheral endoscopic field more frequently with the standard colonoscope. In study 2, wide angle colonoscopy was associated with reductions in examination time of 25% and 30% for the two examiners, respectively. Miss rates were the same for one colonoscopist but were higher for the other colonoscopist when the wide angle instrument was used. CONCLUSION: A prototype wide angle colonoscope did not eliminate polyp miss rates. Wide angle colonoscopy has the potential to reduce examination time and improve visualization of the periphery of the endoscopic field of view, but improvements in resolution are needed.

Adult↗
PubMed2004

An evaluation of colorectal endoscopic mucosal resection using high-magnification chromoscopic colonoscopy: a prospective study of 1000 colonoscopies.

BACKGROUND AND STUDY AIMS: Endoscopic mucosal resection provides an alternative to surgery for resection of sessile and flat colorectal lesions. High-magnification chromoscopic colonoscopy may allow early detection and anticipate histological diagnosis by identifying colonic crypt patterns. The aim of the present study was to assess the efficacy and safety of en-bloc endoscopic mucosal resection with high-magnification chromoendoscopy in the management of sessile and flat colorectal lesions </= 20 mm. PATIENTS AND METHODS: A single endoscopist using high-magnification chromoendoscopy prospectively examined 1000 patients attending for routine colonoscopy. Patients were selected for inclusion in the study if they were considered to be at high risk for underlying colorectal neoplasia or polyps. Within the study period, 1000 patients (29 %) qualified for entry from a total of 3480 colonoscopies conducted in our institution. Endoscopic mucosal resection was carried out in appropriate flat and sessile lesions. RESULTS: Endoscopic mucosal resection was carried out in 599 lesions. Complete histological resection was confirmed in 576 (96 %). Perforation occurred in one patient (0.2 %) and bleeding in 12 (2 %). A total of 254 lesions (40 %; excluding hyperplasia/metaplasia) were flat or depressed, and 374 (60 %) were sessile. Fifty-eight flat lesions (23 %) contained high-grade dysplasia or beyond, compared to 33 sessile lesions (9.0 %; P = 0.001). After resection, 21 lesions were upgraded histologically, with 17 being defined as adenoma with high-grade dysplasia or beyond. CONCLUSIONS: This study confirms that flat adenomas and carcinomas occur in the West and demonstrates the malignant potential of such lesions, which can be managed successfully using endoscopic techniques. Endoscopic mucosal resection with high-magnification chromoscopy is a safe and effective form of treatment for sessile or flat colorectal lesions. Complete resection can improve the accuracy of histopathological diagnosis. However, colonoscopists require training in these procedures in order to improve the rate of colorectal cancer detection.

Adenoma↗
PubMed2005

A retrospective evaluation of patient acceptance of computed tomography colonography ("virtual colonoscopy") in comparison with conventional colonoscopy in an average risk screening population.

PURPOSE: To evaluate patient acceptance of computed tomography (CT) colonography compared with conventional colonoscopy by means of a self-assessed questionnaire. MATERIAL AND METHODS: Four-hundred-and-one patients with valid address information from our patient collective were preselected. Patient acceptance was evaluated retrospectively using a self-assessed questionnaire. The patients underwent CT colonography in our institution using 4x or 16x multi-detector row (MDR) CT. Two-hundred-and-forty-six patients returned a completed questionnaire, 157 of these indicating that they had undergone both virtual and conventional colonoscopy. RESULTS: One-hundred-and-twenty (76.4%) of the 157 patients would undergo another CT colonography if necessary, while only 14 patients would not. One-hundred-and-sixteen (73.9%) patients favored the actual examination procedure of CT colonography (P<0.0001), while only 6.4% preferred the conventional method. Preparation prior to CT colonography was experienced as more convenient than preparation prior to conventional colonoscopy (52.2% versus 14%). CONCLUSION: CT colonography was preferred in terms of both preparation and the actual procedure itself.

Adult↗
PubMed1983

Towards safer colonoscopy: a report on the complications of 5000 diagnostic or therapeutic colonoscopies.

The diagnostic and therapeutic benefits of colonoscopy are well known but most large-scale surveys, especially those involving multiple centres, may underestimate the range and incidence of complications. The detailed records of 5000 colonoscopies in a specialist unit have been analysed and conclusions drawn which may help to make the procedure safer. The incidence of haemorrhage was 1% and bowel perforation 0.1%. All the major haemorrhages occurred during polypectomies over 2 cm in size. Secondary haemorrhage was an unpredictable occurrence, one to 14 days later. Three deaths followed colonoscopy: one cardiorespiratory death was related to oversedation; a second was due to mismanaged ischaemic colitis developing two days after traumatic instrumentation, and the third was due to peritonitis. Minor complications included thrombophlebitis, abdominal distension, and vasovagal episodes. Because of experience during the first half of the series and also due to improvements in instrumentation, the complication rate of the later part of the series was halved. Recommendations include the avoidance of oversedation, review of previous barium enema films so as to be aware of large polyps which are more likely to bleed, and the recognition of situations where perforation or septicaemia is likely to occur.

Adult↗
PubMed2006

High resolution colonoscopy with chromoscopy versus standard colonoscopy for the detection of colonic neoplasia: a randomized study.

BACKGROUND & AIMS: High-resolution colonoscopy with chromoscopy (HRC) is a technique designed to improve the detection of colonic neoplasias. We prospectively compared standard colonoscopy (SC) and HRC in a randomized multicenter trial. METHODS: Patients (n = 203; age, 58 +/- 10 years; sex ratio, 1) were recruited according to the following criteria: (1) a history of either familial or personal colonic neoplasia or (2) alarm symptoms after the age of 60 years. After randomization, an SC was performed in 100 patients (resolution, < or = 410,000 pixels) and a HRC in 103 patients (Fujinon EC485ZW, 850,000 pixels). In the HRC group, each colonic segment was examined before and after spraying with indigo carmine 0.4%. RESULTS: Two hundred seventy-six polyps were detected in 198 patients. One hundred sixty of them were hyperplastic polyps, 116 were adenomas, and 2 were carcinomas. The numbers of hyperplastic polyps and purely flat adenomas were significantly higher in the HRC group than in the SC group (1.1 +/- 1.6 vs 0.5 +/- 1.4 and 0.22 +/- 0.68 vs 0.07 +/- 0.29, respectively; P = .01 and P = .04), but there was no significant difference in the total number of adenomas per patient (primary end point) detected between the HRC and the SC groups (0.6 +/- 1.0 vs 0.5 +/- 0.9, respectively). CONCLUSIONS: Although HRC improves detection of purely flat adenomas and hyperplastic polyps, the overall detection of colonic adenomas in a population at increased risk of neoplasia is not significantly improved. These findings do not support the routine use of HRC in clinical practice.

Adenoma↗
PubMed2003

Virtual colonoscopy compared with conventional colonoscopy for stricturing postoperative recurrence in Crohn's disease.

BACKGROUND: The place of virtual colonoscopy (VC) in patients with Crohn's disease (CD) requiring endoscopic follow-up after surgery is unknown. The authors compared findings from VC versus conventional colonoscopy (CC) for assessing the postoperative recurrence of CD. METHODS: Sixteen patients with ileocolonic anastomosis for CD were prospectively enrolled from January 2001 to January 2002. Recurrence was assessed by CC according to Rutgeerts et al. VC was performed with a computed tomography scanner, with images examined by three radiologists who were unaware of the endoscopic findings. RESULTS: CC showed perianastomotic recurrence in 15 of 16 patients. Perianastomotic narrowing or stenosis was detected by VC in 11 of these 15 patients. There were 11 true positive, 1 true negative, 0 false-positive, and 4 false-negative findings (73% sensitivity, 100% specificity, 100% positive predictive value, 20% negative predictive value, 75% accuracy). Among the eight patients showing a rigid stenosis of the anastomosis not allowing passage of the colonoscope, VC detected narrowing or stenosis in seven patients. CONCLUSIONS: The current findings suggest that although the widespread use of VC in CD is currently not indicated because of possible false-negative findings, this technique may represent an alternative to CC in noncompliant postsurgical patients with a rigid stenosis not allowing passage of the endoscope.

Adult↗
PubMed2002

CT virtual colonoscopy in patients with incomplete conventional colonoscopy.

OBJECTIVES: To study the usefulness of CT virtual colonoscopy (CTVC) in patients with incomplete conventional colonoscopy (CC) and assess the statistical differences between two methods of colorectal segment examination. METHODS: Sixty patients with incomplete CC underwent volume scanning using spiral CT. CT VC images were obtained using a navigator software in workstation. All patients were confirmed by surgical or CC biopsy histology. Statistical analysis was done using t test comparing two sample percentages. RESULTS: CTVC succeeded in 55/60 patients (91.7%) who had incomplete CC. Additional lesions were identified in the proximal colon in 15/55 patients (27.3%), including 1 primary carcinoma, 16 polyps in 13 patients and 1 ulcerative colonitis. The main cause of incomplete CC was occlusive mass; others were redundant, tortuous colon loops, and excessive colonic spasm. There was a statistically significant difference between the two methods in colorectal segment examination. CONCLUSION: CTVC is a feasible and effective adjunctive method for evaluating the entire colorectal segment following an incomplete CC procedure. It offers a new approach for colorectal examination.

Adult↗
PubMedDate not supplied

Virtual CT colonoscopy versus conventional colonoscopy: a prospective study.

BACKGROUND/AIMS: Diagnosis of colorectal diseases might be a challenge. This prospective study aimed to evaluate virtual CT colonoscopy (CT colonography) as a new diagnostic modality in colorectal diseases. METHODOLOGY: Thirty-two patients (22 males and 10 females, mean age 47 years) with different colorectal complaints were investigated by CT colonography. Scanning parameters were collimation of 5mm, table speed of 6.25mm/s and pitch of 1.25. All images were evaluated in axial slices, reformatted images with endoluminal and extraluminal views. All patients were re-examined by the conventional colonoscope. The CT colonography and the colonoscopy findings were correlated. RESULTS: CT colonography suspected colorectal malignancy in 14 patients, diagnosed colorectal polyps in 4 (out of 6), suspected inflammatory bowel diseases in 5 (out of 6), showed colonic diverticulae in 3 (out of 4), and found no abnormality in 2 patients. CT colonography displayed the proximal colon above the obstructing lesion in extraluminal views, fungating mass in endoluminal view and accurately localized the lesion. In inflammatory bowel diseases, segmental (in 4 patients) or skipped (one patient) wall thickening, loss of colonic haustration (3 patients) and pseudopolyps (one patient) were detected. Superficial ulcers were missed. Endoluminal images displayed the orifices of the diverticulae in 3 patients. The CT colonography sensitivity was 86.7% and its specificity was 100%. CONCLUSIONS: The high resolution and multiple image display of CT colonography allow detection of many colorectal lesions. CT colonography is also a noninvasive imaging modality that is particularly valuable in poor risk patients and for colorectal examination proximal to an obstructing lesion.

Adult↗
PubMed2003

Clinical indications of patients with colorectal neoplasm who underwent colonoscopy at King Chulalongkorn Memorial Hospital (presentations of colorectal neoplasm from colonoscopy database).

Even though colorectal cancer in Thailand is not the number one leading cause of death, the incidence of this malignancy is not ignorable. Unfortunately, the majority of patients are diagnosed at a very late stage because of no screening protocol for a high risk group. The authors retrospectively reviewed clinical presentations of patients with colorectal neoplasm who underwent colonoscopy at King Chulalongkorn Memorial Hospital during the two-year period from September 2000 to December 2002. There were 107 patients with colorectal polyps and 48 patients with colorectal cancer. According to frequency of indications: anemia, bowel habit change, and abnormal radiography were presented in patients with colorectal polyps and cancers. There were more right sided colorectal polyps than rectosigmoid polyps. In addition, rectosigmoid cancer was detected less often than right sided colonic cancer. Half of the patients with rectosigmoid cancer presented with hematochezia compared to right sided colonic cancer. Total colonic examination is required if a colonic neoplasm is suspected.

Adult↗
PubMed2001

Efficacy of use of colonoscopy in dextran sulfate sodium induced ulcerative colitis in rats: the evaluation of the effects of antioxidant by colonoscopy.

The goals in developing animal models of inflammatory bowel disease (IBD) are to determine the underlying mechanisms and the action of currently available drugs and to evaluate the value of new therapeutic approaches. Because of the difficulty in determining the severity of colitis in living animals, it has been necessary to kill the experimental animals at varying stages in the studies. If colonoscopic evaluation or endoscopic biopsy is feasible in these experimental animals, continuous observations could be possible, thus avoiding the need to kill them. The aims of the current study were to assess the efficacy of endoscopic examination as a monitoring tool for the severity of colitis in rats and to the efficacy of DA-9601, an extract from Artemisia asiatica which has both antioxidative and cytoprotective actions, on dextran sulfate sodium induced ulcerative colitis in rats endoscopically. Sprague-Dawley rats received 4% DSS in drinking water for 5 consecutive days. Either DA-9601 or sulfasalazine was administered twice a day for 8 days, starting 3 days before DSS administration. After the colonoscopic evaluations on days 2, 4, and 5 after DSS administration the rats were also killed for gross and histopathological evaluations. Simultaneous measurements of malondialdehyde (MDA) and myeloperoxidase (MPO) activities were performed. There was a statistically significant correlation between the scores evaluated by the gross examination and colonoscopic scores, between the colonoscopic scores and the levels of MDA or mucosal MPO activities, and between colonoscopic scores and histopathological activity index. DA-9601 showed excellent improvement in gross lesion scores, decreased MDA amounts and MPO activities compared to sulfasalazine. In conclusion, the introduction of appropriate colonoscopic examination in animal models of IBD could avoid the sacrifice of experimental animals for interim evaluation and provide the valuable information on the course and efficacy of treatment. The potential usefulness of antioxidants in treating IBD is very promising based on the colonoscopic intervention of IBD.

Animals↗