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PubMed2001

Clinical results of CT colonoscopy.

With increasing emphasis among the medical community on the early diagnosis and staging of colorectal cancer, interest has grown in CT colonography as a developing technique to challenge existing methods such as the barium enema and conventional colonoscopy. First introduced in 1994, CT colonography has experienced dramatic improvements in both hardware and software capabilities, resulting in shorter scanning times, greater user-friendliness and promising performance statistics. The recent development in multi-slice CT scanners has meant the ability to scan patients in a single breath hold, while innovations in image reconstruction and manipulation have optimised and yet greatly simplified study interpretation. Recent imaging protocols that use IV contrast to stage known or suspected colorectal cancer have been described. Current interest has focused on improving patient acceptance of the technique through the development of faecal tagging agents to avoid full bowel catharsis. This review summarises the development of CT colonography to date, evaluates its applications and performance in the detection and screening of colorectal polyps and looks at future directions of this exciting technique.

Colonic Neoplasms↗
PubMed1992

Distal colonic hyperplastic polyps do not predict proximal adenomas in asymptomatic average-risk subjects.

The significance of distal colonic hyperplastic polyps was investigated in 482 asymptomatic average-risk subjects, aged 50-75 years, in whom fecal occult blood test results were negative and who underwent screening colonoscopy. The incidence of adenomas in the colon proximal to the sigmoid-descending colon junction in subjects with hyperplastic polyps distal to that point was 18% and was similar to the incidence of proximal colonic adenomas in subjects with no distal colonic polyps (15%). The incidence of proximal colonic adenomas in subjects with no distal colonic adenomas was 38% and was significantly greater than the incidence found in individuals with no distal colonic polyps or only hyperplastic polyps. Our data do not support distal colonic hyperplastic polyps as markers for proximal colonic adenomas in asymptomatic average-risk subjects.

Adenoma↗
PubMed2002

Colonoscopy and polypectomy.

Colonoscopy and polypectomy, when performed by adequately trained physicians, is a safe and effective procedure that can decrease deaths resulting from colorectal cancer.

Colonic Neoplasms↗
PubMed1992

Diagnosis and staging of colonic tumors by conventional abdominal sonography as compared with hydrocolonic sonography.

BACKGROUND: Ultrasonic examination has become increasingly important in the diagnosis of diseases of the gastrointestinal tract. In neoplastic diseases of the large intestine, however, the diagnostic value of conventional transabdominal sonography is limited. The purpose of this investigation was to determine whether the evaluation and staging of colonic tumors would be improved by the retrograde instillation of water into the colon in a procedure called hydrocolonic sonography. METHODS: Three hundred patients were examined in a prospective study in which both conventional transabdominal sonography and transabdominal hydrocolonic sonography were performed before the diagnosis was verified by colonoscopy. The indication for the examinations was abdominal pain, diarrhea, weight loss, or the presence of occult blood in a stool specimen. RESULTS: With the instillation of water into the colon, it was possible to display the colon sonographically from the rectosigmoid transition to the cecum in 97 percent of the patients examined. In addition to permitting the evaluation of the colonic lumen, the procedure allowed the five layers of the colonic wall and the connective tissue surrounding the colon to be examined in detail. Only 9 of 29 carcinomas were diagnosed by conventional abdominal sonography (31 percent), whereas hydrocolonic sonography permitted the diagnosis of 28 (97 percent). No polyps could be detected by conventional abdominal sonography, whereas hydrocolonic sonography permitted the diagnosis of 38 of 42 polyps greater than or equal to 7 mm (91 percent) and 3 of 12 polyps less than 7 mm (25 percent). In addition, detailed evaluation of the structure of the bowel wall with hydrocolonic sonography permitted a more precise staging of colonic tumors. CONCLUSIONS: Hydrocolonic sonography, a new diagnostic procedure, can facilitate the diagnosis and staging of colonic tumors.

Abdomen↗
PubMed1992

Endoscopic removal of colonic leiomyoma.

Most gastrointestinal leiomyomas are found in the stomach, only 3% of them arising in the colon. Surgical resection of the leiomyoma is usually necessary owing to its submucosal location. We describe a patient with a 1.5 cm pedunculated leiomyoma of the colon successfully removed by colonoscopic snare electrocauterization. We believe this to be the first report of a colonic leiomyoma of this size removed endoscopically without complication. We review the literature regarding gastrointestinal leiomyomas with special attention to pedunculated leiomyomas and their endoscopic management.

Aged↗
PubMed2002

[Flat neoplasia of the colon and rectum: definitions and illustrations].

Thanks to recent progresses in colonoscopy non-polypoid lesions, even very small, can be detected and removed per endoscopy. They are defined endoscopically as flat polyps or flat lesions and correspond microscopically to neoplasia in more than 30% cases. This review presents the definitions and different types of flat adenomas and flat early adenocarcinomas as established by Japanese authors. The use of appropriate definitions and classifications and the need of a perfect method in preparing the samples before microscopic examination are underlined. Flat adenocarcinomas tend to invade the submucosa at a smaller size than carcinomas arising in polypoid adenomas. They result either of the malignant transformation of flat adenomas or of a de novo type histogenesis. Flat early adenocarcinomas invading the submucosa and measuring less than 1 cm belong to the latter category.

Adenocarcinoma↗
PubMed2002

[Colorectal polyps].

The polyp is a focal mass that projects from the wall into the lumen. The term polyp is appropriate for gross, radiologic, and endoscopic usage and should be further modified to indicate topographic site, size, number and shape. Strictly spoken, a polyp consists of a head and a stalk, but also the lesions without a clear stalk, but still protruding into the lumen, are called (sessile) polyps. In this view, "polyp" means any lesion, which is circumscribed and raised above normal surrounding mucous membrane so that it is visible to the naked eye. Clinicians sometimes even use "polyp" to refer to any tumor detected in the large intestine. The term polyp does not hold any information about the pathological nature of the lesions. Some polyps (benign, non-neoplastic polyps) do not have an increased potential for becoming malignant, while other polyps (adenomas, neoplastic polyps) are precancerous, which may progress to malignant lesions (carcinomas). Thus polyps must be biopsied or resected to determine their histological type and establish a complete diagnosis.

Colonic Neoplasms↗
PubMedDate not supplied

Possible mechanism pertinent to mucosal invasion in sporadic colonic adenomas.

Colorectal adenomas are foci of dysplastic mucosa that may antedate the development of a colorectal cancer. In this work we investigated 62 colonic polyps. A close examination revealed that in some adenomatous glands facing the muscularis mucosa a group of dysplastic cells were missing. Those glandular defects were connoted as glandular pores. Many glands with pores were dilated and had retained mucin, inflammatory cells and/or necrotic material. Those products were often released through the pores into the surrounding lamina propria. Glandular pores were recorded in 25% (3/12) of the tubular adenomas, in 33% (2/6) of the serrated adenomas, in 50% (4/8) of the tubulo-villous adenomas and in 67% (14/21) of the villous adenomas. None of the 14 hyperplastic polyps had glandular pores. While cell locomotion is considered to be the most important parameter accountable for the local progression of tumors, the present results may offer an alternative view to the cell-migration theory (as the sole pathway of invasion). The release of proteolytic secretions through glandular pores in some colonic adenomas disrupt the surrounding matrix, a mechanism that would facilitate neoplastic cell penetration into the lamina propria.

Adenoma↗
PubMed1992

[Multiple colorectal cancers. A population based study].

Data from the Registry of Digestive Cancers in the Côte-d'Or (France) concerning 2,174 colorectal cancers diagnosed between January 1, 1976 and December 31, 1985, and followed through December 31, 1987 enabled us to study the risk of a second synchronous or metachronous intestinal cancer occurring in a given population. Several simultaneous cancers were seen in 59 patients i.e. 2.8 per cent of cases. Diagnosis was made during the initial diagnostic phase in only 32 per cent of cases. Simultaneous cancers occurred preferably on the same colonic segment (kappa = 0.4) and the distribution of the principal tumour did not differ from that of the cancers occurring alone. When polyps were associated with the cancer, the risk of discovering a second synchronous lesion was multiplied by 3.8. Survival in single or multiple synchronous lesions was identical for the same cancer stage. Twenty cases of second metachronous cancers occurred during follow-up of a first colorectal cancer, the relative risk (RR) compared to the Côte-d'Or population was 1.4 (NS). The risk was significantly high for Dukes' stage A tumours (RR = 2.9; P less than 0.01), with an exophytic appearance (RR = 2.1; P less than 0.05) or with adenomatous remnants (RR = 3.4; P less than 0.01). These data suggest that complete examination of the colon should be performed when the diagnostic of colorectal cancer is made to look for an associated cancer or polyps. Follow-up surveillance should address mainly patients with Dukes' stage A or Dukes' stage B carcinoma with an exophytic appearance or adenomatous remnants.

Actuarial Analysis↗