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PubMedDate not supplied

Multicenter evaluation of training of non-endoscopists in 30-cm flexible sigmoidoscopy.

An estimated 145,000 patients will be diagnosed with colorectal cancer in the United States in 1987. Although half of these cancers are potentially detectable by sigmoidoscopy, rigid sigmoidoscopy is not widely used for early detection, largely because of discomfort it causes patients. Flexible sigmoidoscopy has been shown to be more acceptable and more efficient in detecting cancers. In order for flexible sigmoidoscopy to be of more value in cancer control, however, primary care physicians must learn the technique and incorporate it into their complete physical examinations. This paper reports the results of a multicenter trial that evaluated the training required for non-endoscopists to learn how to use the 30-cm flexible sigmoidoscope. Instructions with plastic models, followed by an average of six supervised patient examinations, proved sufficient for them to learn the necessary skills.

Colonic Neoplasms↗
PubMed2005

Prevalence of advanced colonic polyps in asymptomatic Chinese.

AIM: To investigate the prevalence of advanced polyps in asymptomatic Chinese and to determine the risk of proximal advanced colonic polyps in subjects with and without polyps in the distal colon. METHODS: Data were collected prospectively during colonoscopic examinations performed in 5 973 subjects as part of health evaluation at our unit from December 1997 to December 2003. Polyps were considered advanced, if they were larger than 10 mm or were tubovillous, villous or malignant. Proximal colon was defined as the splenic flexure and more proximal portions of the colon. RESULTS: Colon polyps were detected in 971 (16.3%) subjects (613 males and 358 females) with their mean age being 56.6+/-10.7 years. Advanced polyps were noted in 199 (3.3%) individuals. Subjects were sub-classified according to the location of polyps into three groups: distal (569, 58.6%), proximal (284, 29.2%), and combined proximal and distal (118, 12.2%) groups. Subjects with advanced polyps in these three groups were 95 (9.8%), 56 (5.8%), and 48 (4.9%) respectively. In the 48 subjects with advanced combined polyps, 13 advanced polyps were distributed at the distal colon, 17 at the proximal colon, and 18 at both. Eighteen colon cancers including 12 at sigmoid and 6 at ascending colon were confirmed by final pathology. The relative risk for advanced proximal polyp according to distal findings was 3.1 (95%CI: 1.3-7.4) for hyperplastic polyp, 2.7 (95%CI: 1.4-5.3) for tubular polyp and 13.5 (95%CI: 5.1-35.4) for advanced polyp as compared to that for no polyp. However, 56 (28.2%) of 199 subjects with advanced polyps had no index polyps at the distal colon and might go undetected under sigmoidoscopic screening. CONCLUSION: Although distal lesions can predict the risk of advanced proximal polyps, a substantial portion of Chinese with advanced proximal polyps is not associated with any distal sentinel lesions. These data have implications for screening policy of colon cancers in Taiwanese Chinese.

Adult↗
PubMed2004

A case of pseudomembranous colitis associated with rifampin.

Pseudomembranous colitis is known to develop with long-term antibiotic administration, but antitubercular agents are rarely reported as a cause of this disease. We experienced a case of pseudomembranous colitis associated with rifampin. The patient was twice admitted to our hospital for the management of frequent bloody, mucoid, jelly-like diarrhea and lower abdominal pain that developed after antituberculosis therapy that included rifampin. Sigmoidoscopic appearance of the rectum and sigmoid colon and mucosal biopsy were compatible with pseudomembranous colitis. The antitubercular agents were discontinued and metronidazole was administered orally. The patient's symptoms were resolved within several days. The antituberculosis therapy was changed to isoniazid, ethambutol and pyrazinamide after a second bout of colitis. The patient had no further recurrence of diarrhea and abdominal pain. We report here on a case of pseudomembranous colitis associated with rifampin.

Aged↗
PubMed1978

Treatment of complicated schistosomiasis mansoni with oxamniquine.

Twenty male patients (mean age 23 years) with Schistosoma mansoni infections (mean egg count 429 +/- 311/g feces) were each treated with oxamniquine orally in a single daily dose of 20 mg/kg for 3 consecutive days. Seventeen patients had hepatosplenomegaly, two of these had ascites. Three patients had diffuse colonic polyposis, one of these had ascites. Except for one who developed mild hematemesis 3 days after treatment, all patients tolerated the drug very well. However, 11 patients developed a fever 24 to 48 hours after completing treatment, which lasted for 2-3 days and coincided with increased excretion of schistosomal antigens in urine. Three months after completing therapy, all except one young patient ceased to have live egge in the stools or rectal tissue. Six months after treatment, three patients with colonic polyposis showed marked clinical improvement and sigmoidoscopic and barium enema examination demonstrated almost complete disappearance of all polyps.

Adult↗
PubMed1976

Lincomycin-clindamycin-associated psuedomembranous colitis.

Five cases of lincomycin-clindamycin-associated acute pseudomembranous colitis, demonstrating a spectrum of clinical, histological and radiological severity, were encountered over a five-months period. All patients presented with watery diarrhoea without the passage of macroscopic blood or pus. Two patients were seriously ill with fulminant colitis, but responded rapidly to corticosteroids given parenterally and supportive therapy. The diagnosis of acute colitis should be considered in all patients developing diarrhoea during or up to three weeks after beginning therapy with lincomycin or clindamycin and can be confirmed by sigmoidoscopic examination. Withdrawal of the antibiotic and symptomatic treatment is appropriate for mild cases of colitis, but our experience suggests that corticosteroid therapy is safe and effective in severe cases. Indiscriminate use of these antibiotics should be avoided.

Acute Disease↗
PubMed1983

Abdominal blood pool scintigraphy in the management of acute or intermittent gastrointestinal bleeding.

Gastrointestinal blood pool scintigraphy, using a modified in-vivo red blood cell labelling technique with technetium-99, is a new, easily performed, non-invasive procedure. It is valuable in screening patients with acute or intermittent gastrointestinal blood loss in whom duodenoscopic and sigmoidoscopic findings are unhelpful. This paper reviews the value of this scintigraphic technique over the first eight months of its use in a major teaching hospital, and compares the results with other published data. The high sensitivity of this procedure, and its ability to demonstrate gastrointestinal bleeding very strikingly, are illustrated with several examples. If used and interpreted appropriately, scintigraphy is sensitive in detecting and localizing the bleeding site, and is very helpful in indicating the optimal timing of emergency contrast angiography. The study further supports the view that scintigraphy should be the initial diagnostic imaging procedure in this group of patients, and that emergency angiography should be reserved primarily for patients in whom there is scintigraphic evidence of continuing blood loss.

Abdomen↗
PubMed2000

Distribution of colorectal adenomas: implications for bowel cancer screening.

OBJECTIVE: To determine the distribution of colorectal adenomas relative to the splenic flexure in an asymptomatic population undergoing colonoscopy, as an indicator of the number of patients with adenomas who would be missed by screening with flexible sigmoidoscopy. DESIGN: Retrospective survey of medical records. SETTING: Private endoscopy centres in Melbourne, Victoria. SUBJECTS: All 1131 asymptomatic individuals who underwent full colonoscopy between 1 January 1995 and 31 December 1997 after referral from a bowel cancer prevention program organised by the endoscopy centres. People referred were aged either 40 years or over with a first-degree relative with bowel cancer, or 50 years or over with marked anxiety about bowel cancer. MAIN OUTCOME MEASURES: Presence and distribution of colorectal adenomas. RESULTS: Polyps were found in 270 individuals (24%) and were confirmed to be adenomas in 138 (12%). These 138 comprised 106 men and 32 women, with mean age 54 years (range, 40-78 years). Most (86%) had a single adenoma. Position of adenomas in relation to the splenic flexure was: distal only in 85 of the 138 people (62%), proximal only in 34 (25%), and both distal and proximal in 19 (14%). CONCLUSIONS: In 25% of asymptomatic people found to have adenomas by this bowel cancer prevention program, the adenomas were found only in the proximal colon, well beyond the reach of the flexible sigmoidoscope. This distribution of adenomas suggests that screening programs cannot rely solely on flexible sigmoidoscopy.

Adenoma↗
PubMed1988

Small polyps found during fiberoptic sigmoidoscopy in asymptomatic patients.

STUDY OBJECTIVE: To determine the prevalence of small polyps in the rectosigmoid in an asymptomatic group and the likelihood of finding synchronous neoplastic polyps proximally at colonoscopy. DESIGN: Asymptomatic patients with polyps 9 mm or less found at screening fiberoptic sigmoidoscopy were referred for colonoscopy, at which time all polyps were removed. SETTING: Screening fiberoptic sigmoidoscopy unit. PATIENTS: Referral from Executive Health Wellness Clinic and large multispeciality clinic. RESULTS: From 3923 sigmoidoscopic examinations, 258 asymptomatic subjects (7%) were identified who had polyps 9 mm or smaller. One hundred and eighty-nine patients (73%) had colonoscopy. In 179 patients, the target lesion noted at sigmoidoscopy was identified at colonoscopy. Based on histology of the target lesion, patients were divided into three groups: Group 1 (72 patients) had only hyperplastic polyps; Group 2 (69 patients) had at least one neoplastic polyp; and Group 3 (31 patients) had polyps with normal histology. Seven patients were not classified. Neoplastic polyps were found proximally in 21 patients in Group 1 (29%; 95% CI, 19 to 39), 23 patients in Group 2 (33%; 95% CI, 22 to 44), and 4 patients in Group 3 (13%; 95% CI, 4 to 30). There was no difference in mean age between groups. The results were similar when only polyps 5 mm or smaller were analyzed. CONCLUSION: Because small polyps of any histologic type in the rectosigmoid indicate a high risk for having neoplastic polyps proximally, the guidelines of both the American College of Physicians and the American Society of Gastrointestinal Endoscopy may need to be revised. Colonoscopy seems justified in any patient in whom a small polyp is discovered at sigmoidoscopy.

Adult↗
PubMed1991

Oral mesalamine (Asacol) for mildly to moderately active ulcerative colitis. A multicenter study.

OBJECTIVE: To evaluate the efficacy and safety of a pH-sensitive, polymer-coated oral preparation of mesalamine in patients with mildly to moderately active ulcerative colitis. DESIGN: A multicenter, double-blind, placebo-controlled randomized trial. SETTING: Five university-based medical centers, one inflammatory bowel disease center, and three private practice sites. PATIENTS: A total of 158 patients with newly or previously diagnosed active ulcerative colitis. INTERVENTION: A pH-sensitive, polymer-coated oral preparation of mesalamine (5-aminosalicylic acid) was used at 1.6 and 2.4 g/d for 6 weeks. MEASUREMENTS: Efficacy was measured by scores for stool frequency, rectal bleeding, patient's functional assessment, sigmoidoscopic findings, and physician's global assessment. Stringent criteria for disease activity were established prospectively. RESULTS: The analysis of protocol-compliant patients showed a significant improvement at 3 weeks in patients taking 2.4 g/d of mesalamine compared with patients taking placebo (32% versus 9%; P = 0.003). At 6 weeks, both the 1.6 g/d (43%) and 2.4 g/d (49%) doses were significantly superior to placebo (23%) (P = 0.03 and P = 0.003, respectively). In addition, more patients worsened in the placebo group compared with the 2.4 g/d group (50% versus 19%; P = 0.003); however, there was no statistically significant difference in worsening between the 1.6 g/d mesalamine group and the placebo group. The oral mesalamine tablet was well tolerated, and no clinically significant changes were observed in hematologic, hepatic, or renal laboratory profiles. CONCLUSION: Colon-targeted oral mesalamine at 2.4 g/d is effective therapy for mildly to moderately active ulcerative colitis. It is well tolerated and should provide a viable therapeutic alternative to sulfasalazine.

Administration, Oral↗
PubMedDate not supplied

[Use of proteic metabolism (15N-glycine) in the early detection of disease exacerbation in patients with non-specific ulcerative colitis].

Disease activity was assessed in 10 (five males and five females) ulcerative colitis patients through the following parameters: clinical, laboratory, sigmoidoscopic and histological. Protein metabolism was also assessed with 15N-glycine and urinary ammonia as end product. Only one patient had exacerbation of the disease two months after the study started. This patient presented in the beginning of the study protein synthesis and breakdown of 4.51 and 3.47 g protein/kg/day, respectively, values higher than all other patients, showing an hypermetabolic state, suggesting an increase of the disease activity. However, this increase was not detected by others indicators and indexes utilized. These data allow to suggest the hypothesis that protein metabolism predicts precociously the exacerbation of disease activity in ulcerative colitis patients.

Colitis, Ulcerative↗
PubMedDate not supplied

How to do it in surgery: transanal endoscopic microsurgery.

Transanal endoscopic microsurgery has been performed in our institution since 1993 (Curran et al, 1994). It involves the use of a specially designed operating sigmoidoscope to excise benign and early invasive tumours from the rectum. It allows for accurate dissection of these lesions ensuring safe and complete excision with histological confirmation of this.

Anus Neoplasms↗
PubMed1987

Flexible fiberoptic sigmoidoscopy. Logistics and economics of office use.

Early detection of colorectal cancer, followed by surgical excision, can effect a cure in 50% of patients. The flexible fiberoptic sigmoidoscope enables identification of lesions in the premalignant or early malignant stages. Its use is cost-effective in any practice that includes more than 200 to 300 patients over age 50, and the procedure is well accepted by patients. Available options for learning the technique are listed, along with their approximate fees. The author explores all considerations pertinent to instituting this screening procedure and suggests the best way to introduce sigmoidoscopy into the established office routine.

Adult↗
PubMedDate not supplied

Investigation of children with chronic diarrhoea.

OBJECTIVE: To study the lower G.I. endoscopic and histopathological findings in children with chronic diarrhoea. DESIGN: Prospective analysis. SETTING: Hospital based. SUBJECT: 83 children with age up to 14 years admitted in Umaid Hospital, Jodhpur including 33 subjects with chronic diarrhoea and 50 normal children in control group. METHODS: All 83 children including study (33) and control group (50) underwent lower G.I. Endoscopy using FUJINON-SIG-ET sigmoidoscope in older children and PENTAX FG-23H gastroscope in younger children after proper preparation. Rectal biopsies were taken in all the subjects except one and was sent for histopathological examination. RESULTS: Majority (90.8%) were in 0-5 year age group with median age of 3.8 years. We could finally reach to definitive diagnosis in 13% patients with chronic diarrhoea. Over all, colitis was the most common cause. CONCLUSION: Both, endoscopy and biopsy are needed to reach final diagnosis.

Adolescent↗
PubMedDate not supplied

Practicality of 5-aminosalicylic suppositories for long-term treatment of inactive distal ulcerative colitis.

BACKGROUND/AIMS: Topical 5-aminosalicylic acid (5-ASA) is regarded as an effective form of therapy for distal ulcerative colitis. Unfortunately, experience about acceptability and tolerance of long-term treatment with 5-ASA suppositories is still meager. METHODOLOGY: We have evaluated the performance of 5-ASA suppositories as maintenance treatment in 34 patients with inactive distal colitis. Prior to entering the study, all patients were in clinical remission for 1-12 months. A single 500 mg 5-ASA suppository was administered nightly for 12 months in every patient and all other treatments were discontinued. Clinical evaluation was performed at 3, 6 and 12 months. RESULTS: Four patients withdrew from the study within the first 3 months because of local intolerance to the suppositories. Score of both comfort and tolerance was significantly higher in patients who continued treatment than in those who withdrew. Two patients who stayed in remission withdrew, one at 7 months because of thrombocytopenia and the other at 9 months for personal reasons. Of the 28 remaining patients, 7 relapsed and 21 remained in clinical remission at the end of the 12-month study period. Eleven of the 21 responder patients agreed to a sigmoidoscopic examination, that confirmed remission in all of them. Eight out of the 9 patients who had previously received 5-ASA enemas preferred suppositories to enemas. Apart from the 4 patients who did not tolerate suppositories, 26 patients considered this form of therapy quite comfortable. CONCLUSIONS: 5-ASA suppositories are generally well tolerated and considered comfortable for treatments of at least one year.

Adolescent↗
PubMed2000

Inflammatory bowel disease up to 1932.

Inflammatory bowel diseases have been a major interest of generations of Mount Sinai Hospital gastroenterologists. Although clinical descriptions of diarrhea with or without blood go back thousands of years, clear distinctions between enteritis and ulcerative colitis were possible only in the 19th century. At that time, many case reports were published of, in retrospect, classical regional enteritis. The term "ulcerative colitis" dates from 1888; the introduction of the electric sigmoidoscope soon after made it possible to make proper diagnosis of ulcerative colitis and distinguish it from infective dysentery, membranous mucous or catarrhal colitis, and nervous diarrhea. Doctors at The Mount Sinai Hospital adopted this diagnostic approach in the 1870s and 1880s, and were particularly interested in patients with tuberculosis-like ileocecal disease without tubercle bacilli. Articles were written by Weiner in 1914, Moschcowitz and Wilensky in 1923 and 1927, and Goldfarb and Suissman in 1931. Dr. A.A. Berg, in 1925, encouraged his assistant Leon Ginzburg to conduct a study of the inflammatory granulomatous diseases of the bowel, when Ginzburg and Gordon Oppenheimer were working in Dr. Paul Klemperer's laboratory. Initial reports came in 1927 and 1928, but Ginzburg and Oppenheimer "in conjunction with Dr. Burrill B. Crohn" presented a definitive paper, "Non-specific Granulomata of the Intestine," on May 2, 1932, to the American Gastro-Enterological Association. On May 13, 1932, Dr. Crohn presented a paper on "Terminal Ileitis" to the American Medical Association; this was published later that year with the title "Regional Ileitis: A Pathologic and Chronic Entity," under the authorship of Crohn, Ginzburg and Oppenheimer.

Europe↗
PubMed2001

Feasibility study of colonoscopy as the primary screening investigation in relatives of patients with colorectal cancer.

AIM: Relatives of patients with colorectal cancer are thought to be at a higher risk for this disease than the average population. We aimed to determine whether colonoscopy is a feasible primary screening investigation for this group to identify premalignant and malignant lesions. METHODS: A total of 449 people underwent colonoscopy and all had one or more relatives with colorectal cancer, of these, 212 were classified as 'asymptomatic' and 237 as being 'symptomatic'. Colonoscopy commenced at 40 years of age or 10 years younger than the youngest affected relative. RESULTS: Neoplastic change, benign and malignant, was found in 25.5% of the 'asymptomatic' group and 24% of the 'symptomatic' group; in 26% of those with one first degree relative, 39% with two or more first degree relatives and only 19% with second degree relatives. 38% of lesions were out of reach of a flexible sigmoidoscope. No known complications occurred. CONCLUSIONS: It is feasible to perform colonoscopy as the primary investigation for the first degree relatives of patients with colorectal cancer. The yield of neoplastic lesions is sufficient to make this appropriate.

Adenoma↗
PubMed2000

Screening sigmoidoscopy: a randomised trial of invitation style.

OBJECTIVES: To examine uptake rates for screening sigmoidoscopy and whether offering prior consultation about sigmoidoscopic screening improves the uptake rate. DESIGN: Patients between 50.5-60.5 years of age registered with one practice were identified and offered screening sigmoidoscopy. Patients were randomly allocated to one of two groups. The first group was sent an invitation to have screening sigmoidoscopy along with an explanatory leaflet. The second group was sent the same invitation and leaflet but with an added option to discuss the test in the first instance with their general practitioner. Response rates (regarding reply to initial invitation and subsequent attendance for screening) in the two groups were measured. SETTING: Urban General Practice, Dundee, Scotland, UK. RESULTS: The overall uptake rate was low at 24%. Significantly fewer people in the second group (i.e. those with the option to discuss first) replied to the initial invitation. Assessing those who did reply, there was no difference between the two groups in numbers who thereafter went on to attend for screening. Only two percent of people took up the offer to find out more about the test from their general practitioner. CONCLUSIONS: The offer of flexible sigmoidoscopy as a screening test for colorectal cancer generates little interest in this population at present and compliance rates are low. The offer of prior consultation about the procedure with a patient's own general practitioner is not sufficient to generate interest. These results highlight potential difficulties with the introduction of a mass screening program.

Family Practice↗
PubMed2003

Correlation of the morphology and size of colonic polyps with their histology.

BACKGROUND: Colonic adenomatous polyps are premalignant lesions; early recognition and use of a polypectomy for these polyps can reduce the occurrence of colorectal cancer. The purposes of this study were to evaluate the complications of polypectomy and the relationship between the morphology and size of colonic polyps and their histology. METHODS: Data on colonic polyps from 324 patients who received a polypectomy between April 1998 and December 2001 were collected. These included 207 men and 117 women, ranging in age between 17 and 86 years old, and who had had a colonoscopy or sigmoidoscopic examination. A polypectomy was performed on those colonic polyps discovered, and their morphology, size, and histology were analyzed. RESULTS: The histological findings of these polyps included adenoma, carcinoma, hyperplastic, and inflammatory polyps. One and a half percent (n = 6) were carcinomas, all of which belonged to the Yamada III or IV polyp group and were more than 1 cm in size, except for 1 polyp which was 0.7 cm. One case was complicated by colon perforation, and 2 cases experienced mild bleeding with no need for a blood transfusion or hospitalization. CONCLUSIONS: Morphology and size are closely related to the malignant change in colonic polyps. Colonic polyps with a size greater than 1 cm and classified as Yamada type III or IV have a higher potential for malignant change, and a polypectomy should be considered when they are discovered. A polypectomy is a safe procedure with only minor complications.

Adenomatous Polyps↗