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PubMed2002

Colorectal cancer risk: the impact of evidence of a field effect of carcinogenesis on blinded diagnosis using an anti-adenoma antibody test performed on colonoscopic effluent.

To better define high-risk populations for colorectal cancer screening, we used anti-adenoma antibody Adnab-9, comparing colonic effluent and tissue field effects from 45 high-risk and 11 control patients. We included Adnab-9 binding at the tissue level to elucidate the impact of a field effect of carcinogenesis contributing to the outcome of the effluent binding test. In high-risk patients, 64% of the left-sided effluent samples were positive (P < 0.002); 67% showed a field effect (P < 0.006); 82% of combined tests were positive (P < 0.001), as compared to 9%, 18%, and 27% respectively, of controls. Adnab-9 binding correlates with increased colorectal cancer risk associated with a field effect of carcinogenesis.

Adenoma↗
PubMed2004

Colonoscopic miss rates for right-sided colon cancer: a population-based analysis.

BACKGROUND & AIMS: Colonoscopy contains an inherent miss rate for colorectal cancer. Although miss rates from academic centers or units known for their endoscopic expertise have been previously reported, the colorectal cancer miss rate of colonoscopy performed in usual clinical practice is unknown. We conducted a population-based study to estimate the proportion of right-sided colon cancers missed during colonoscopy in Ontario. METHODS: All persons > or =20 years old with a new diagnosis of right-sided colon cancer admitted to the hospital for surgical resection in Ontario from April 1, 1997, to March 31, 2001, were identified. Patients who had a colonoscopy within 3 years of their diagnosis were divided into 2 groups: detected cancers (those who had a colonoscopy up to 6 months before the diagnosis) and missed cancers (those who had a colonoscopy between 6 and 36 months before the diagnosis). Data were obtained from the Canadian Institute for Health Information Discharge Abstract Database, the Ontario Health Insurance Plan database, and the Registered Persons Database. RESULTS: Between April 1, 1997, and March 31, 2001, we identified 4920 persons with a new diagnosis of right-sided colon cancer, of whom 2654 (53.9%) had had at least 1 colonoscopy within 3 years of their admission for surgical resection. Most (96.0%) had had their most recent colonoscopy up to 6 months before admission (detected cancers). However, 105 patients (4.0%) had their most recent colonoscopy between 6 and 36 months before admission to the hospital (missed cancers). CONCLUSIONS: Among persons undergoing resection for right-sided colon cancer, the miss rate of colonoscopy for detecting cancer in usual clinical practice was 4.0%.

Aged↗
PubMed2003

Colonoscopic surveillance of patients with a family history of colon cancer and a history of normal colonoscopy: is a five-year interval between colonoscopies appropriate?

BACKGROUND & AIMS: Patients with a family history of colon cancer are advised to undergo surveillance colonoscopy 5 years after a normal screening colonoscopy. No prospective study has evaluated the prevalence of adenomas found at surveillance colonoscopy in these patients. The aims of this trial were (1) to determine the percentage of these patients with adenomas; (2) to determine the percentage of these patients with advanced adenomas (i.e., villous adenomas, adenomas > or = 10 mm, adenomas with high grade dysplasia); and (3) to assess risk factors for adenomas in these patients. METHODS: Consecutive patients with a family history of colorectal cancer and a normal screening colonoscopy 5 years earlier were offered a surveillance colonoscopy. Patients also completed a questionnaire about potential risk factors for adenomas. Multiple logistic regression analysis assessed associations between risk factors and adenomas. RESULTS: One hundred patients completed the trial. The male/female ratio was 54/46, the mean age was 56.2 +/- 8.8 years, and 91% were white. Eight percent (8 of 100) of patients had advanced adenomas at surveillance colonoscopy, and 33% (33 of 100) had adenomas. Among patients with adenomas, 39% (13 of 33) had no adenomas in the left side of the colon (i.e., distal to the splenic flexure). Among patients with advanced adenomas, 25% (2 of 8) had no adenomas in the left side of the colon. Multiple logistic regression analysis showed a significant negative association between adenomas and NSAID use (odds ratio, 0.26 [95% confidence interval, 0.09-0.79]), and male gender had a positive association with adenomas (odds ratio, 2.79 [95% confidence interval, 1.01-7.74]). CONCLUSIONS: These data support a 5-year interval between screening and surveillance colonoscopy for patients with a family history of colorectal cancer and a normal screening colonoscopy.

Adenoma↗
PubMed1976

Colonoscopic perforation: its emergency treatment.

One of the accepted complications of colonoscopy is perforation. This is known to occur in greater frequency in patients having undergone previous pelvic or colonic surgery, as well as patients suffering from diverticulosis. A case is presented of colonic perforation during diagnostic examination in an area of adhesions secondary to pelvic surgery. Immediately after the perforation, the patient entered into vascular collapse and respiratory distress, with a distended abdomen. The introduction of a large bore intravenous catheter into the abdominal cavity with the release of the pneumoperitoneum resulted in an instantaneous return of vital signs and the patient subsequently underwent surgery and recovered. It is felt that this method of emergency treatment can be life-saving in a patient perforating during colonoscopy.

Catheterization↗
PubMed2002

Colonoscopic barotrauma treated by conservative management: role of high-flow oxygen inhalation.

Most patients with colonoscopy-induced colonic perforation require urgent surgical intervention. Certain patients may, however, recover with conservative management. If the colonic perforation has been induced by barotrauma, there may be an extravasation of air which may lead to collection and tracking of air along the tissue planes, involving the retroperitoneum, peritoneal cavity, mediastinum, pleura, pericardium, or even the scrotum. The conservative treatment of colonic perforation includes bowel rest and antibiotics. Absorption of air collected in different body cavities may take some time, and inhalation of high-concentration oxygen may enhance the rate of gaseous absorption. We describe here a patient with colonic perforation induced by barotrauma, who recovered fully on conservative management with inhalation of high-concentration oxygen. We recommend that this approach should be used more frequently in such a situation.

Adult↗
PubMed2006

Does chromoendoscopy with structure enhancement improve the colonoscopic adenoma detection rate?

BACKGROUND AND STUDY AIMS: Colonoscopy is still considered the standard investigation for the detection of colorectal adenomas, but the miss rate, especially for small and flat lesions, remains unacceptably high. Chromoscopy has been shown to increase the yield for lesion detection in inflammatory bowel disease. The aim of this randomized prospective study was to determine whether a combination of chromoscopy and structure enhancement could increase the adenoma detection rate in high-risk patients. PATIENTS AND METHODS: All patients included in the trial had a personal history of colorectal adenomas and/or a family history of colorectal cancer (but excluding genetic syndromes). They were randomized to one of two tandem colonoscopy groups, with the first pass consisting of conventional colonoscopy for both groups, followed by either chromoscopy and structure enhancement (the "study" group) or a second conventional colonoscopy (the control group) for the second-pass colonoscopy. All detected lesions was examined histopathologically after endoscopic resection or biopsy. The principal outcome parameter was the adenoma detection rate; the number, histopathology, and location of lesions was also recorded. RESULTS: A total of 292 patients were included in the study (146 patients in each group). The patients' demographic characteristics, the indications for colonoscopy, and the quality of bowel preparation were similar in the two groups. There was a significant difference between the two groups with respect to the median duration of the examination (18.9 minutes in the control group vs. 27.1 minutes for the study group, P < 0.001). Although more hyperplastic lesions were detected throughout the colon in the study group ( P = 0.033), there was no difference between the two groups in either the proportion of patients with at least one adenoma or in the total number of adenomas detected. Chromoscopy and structure enhancement diagnosed significantly more diminutive adenomas (< 5mm) in the right colon, compared with controls ( P = 0.039). CONCLUSIONS: On the basis of our results we cannot generally recommend the systematic use of chromoscopy and structure enhancement in a high-risk patient population, although the detection of small adenomas in the proximal colon was improved.

Adenoma↗