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Colonoscopic snare polypectomy: analysis of 1485 resections comparing two types of current.

The complications related to 1485 colonic snare polypectomies were analyzed according to the type of current which was used for resection. From January 1982 to August 1986 (period 1), blended current was used in 758 snare polypectomies, while continuous coagulation current was applied in 727 polypectomies from September 1986 to October 1989 (period 2). The incidence of complications observed in the entire series was low, consisting of 0.26% perforations and 0.9% major hemorrhages. There were no deaths in this series. Twelve of 14 hemorrhages occurred after resection of polyps larger than 1 cm. Although the incidence of complications was not statistically different in the two groups, there was a significant difference in the timing of hemorrhages. All of the major hemorrhages were immediate (eight) when the blended current was used, but delayed (six; from 2 to 8 days after polyp resection), when pure coagulation current was applied.

Colonic Polyps↗

Culture of colonoscopically obtained biopsy specimens in acute infectious colitis.

To investigate the value of colonoscopy in the diagnosis of acute infectious colitis, we prospectively cultured both feces and biopsy specimens obtained during colonoscopy of patients who, because of clinical features such as the acute onset of abdominal pain and diarrhea, were suspected of having the disease. Of the 20 patients who participated in the study, some causative micro-organism was identified in 13 (Campylobacter in 6 patients, Salmonella in 5 patients, and Yersinia in 2 patients), but not in the remaining 7. In addition, biopsy specimens were more sensitive for culture (positive for Campylobacter in 4 patients, Salmonella in 5 patients, and Yersinia in 1 patient) than were feces samples (positive for Campylobacter in 2 patients and for Yersinia and Salmonella in 1 patient each) (50% versus 20%, p = 0.048). These findings suggest that cultures of biopsy specimens obtained during colonoscopy may be diagnostic in sporadic cases of acute enterocolitis caused by bacteria.

Acute Disease↗

Colonoscopic features of colonic anastomoses.

Colonic anastomoses are frequently encountered, but their endoscopic features have never been adequately characterized. Results of 117 consecutive colonoscopies in patients with colonic anastomoses were prospectively studied during a 12-month period. Anastomoses were photographed, videotaped, and reviewed by the authors. The age range of patients was 18 to 87 years, and interval from surgery extended to 42 years. An equal number of right and left colonic resections were encountered; 9 patients had subtotal colectomies. Ninety-two anastomoses were hand-sewn, and 25 were stapled. Ileal pouch-anal anastomoses were not included. Nine common anastomotic features were identified with the following frequency of occurrence: neovascularity, 105 (89.7%); white anastomotic edge, 64 (54.7%); disruption of haustral pattern, 64 (54.7%); radial suture tracks, 35/92 (38.0%); exposed suture, 11/92 (11.9%); exposed staples, 6/25 (24%); scar tissue adjacent to anastomotic line, 8 (6.8%); nondistensibility of anastomosis, 5 (4.3%); blind colonic pouch, 10 (8.5%). No recurrent carcinomas were noted. The site of seven anastomoses (5.5%) could not be identified. Six of these patients underwent endoscopy more than 8 years postoperatively. Of the remaining 110 patients, 94 (85.5%) had between two and four of the above features identified. In three of four patients who required dilation because of strictures, neovascularity was not seen. We conclude that colonic anastomoses have characteristic endoscopic features. These features can be used as landmarks for definitive identification of anastomotic sites at colonoscopy. The lack of neovascularity at a colonic anastomosis may be an indicator of relative ischemia, predisposing to stricture formation.

Adolescent↗

Results of culture form colonoscopically obtained specimens for bacteria and fungi in HIV-infected patients with diarrhea.

BACKGROUND: The aim of our study was to determine the diagnostic yield of culture for bacteria and fungi from colonic biopsy specimens in 290 consecutive HIV-infected patients with diarrhea. METHODS: During each colonoscopy, three biopsy specimens were homogenized and cultured on media for Salmonella and Shigella and for Campylobacter and Yersinia, on Loewenstein medium and on Sabouraud medium. RESULTS: Cultures were found positive for one (n = 32) or two (n = 5) infectious agents in 37 cases, i.e., in 12.8% of the patients. Bacteria were isolated in 24 cases, and identified as Campylobacter jejunl-coli (n = 14), Salmonella (n = 2), Shigella (n = 1), or Pseudomonas aeruginosa (n = 7). Among the 14 patients with C. jejuni-coli intestinal infection, 11 had normal-appearing mucosa at colonoscopy, and 3 had a concomitant stool culture negative for Campylobacter. Mycobacterial cultures were positive for Mycobacterium avium intracellulare in 6 patients, who were already known as having a disseminated M. avium intracellulare infection from positive blood cultures. Fungal cultures were positive for Candida in 10 cases, without clear clinical significance. CONCLUSIONS: The overall yield of culture for bacterial pathogens from colonic tissue in HIV-infected patients with diarrhea is low, but some individual cases of C. jejuni-coli infections may be detected from colonic tissue culture and not diagnosed by concomitant stool culture.

AIDS-Related Opportunistic Infections↗