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At least 829 records · Page 46Linked to original sources
PubMed2000

Hemorrhoid banding using videoendoscopic anoscopy and a single-handed ligator: an effective, inexpensive alternative to endoscopic band ligation.

OBJECTIVE: We evaluated a technique of hemorrhoid banding using videoscopic anoscopy and a single-handed ligator that offers substantial cost savings over endoscope-mounted devices. METHODS: Patients with rectal bleeding from grade II/III hemorrhoids had videoscopic anoscopy, which provided a magnified view, allowing accurate localization of the hemorrhoids and the dentate line before banding, and a photographic record, if required. Banding was performed using a suction ligator that could be operated by one hand, allowing the other to control the anoscope. RESULTS: Of 39 patients with second- and third-degree hemorrhoids, 34 (87%) had no further bleeding after a single banding session and a further three had no recurrence after a second session. The only complications were pain (one patient) and infection (one patient). CONCLUSIONS: This method is convenient and effective, costing per procedure less than one-tenth of endoscope-mounted band ligators. We recommend its use in preference if magnified views and a photographic record are required. However, its cost and complexity, compared with traditional hemorrhoid banding, may mean that the latter is preferred in the office setting.

Adult↗
PubMed2004

Assessment of clinical impact of endoscopic ultrasound on rectal cancer.

INTRODUCTION: Endoscopic ultrasound (EUS) with fine needle aspiration (FNA) is the most accurate imaging modality for locoregional staging of rectal cancer. It remains unclear whether this technology impacts the clinical outcome of patients with this malignancy. The aim of this study was to assess the impact of EUS FNA by comparing the clinical outcomes of patients with rectal cancer before and after the introduction of EUS in our institution. METHODS: Outcomes of patients with de novo nonmetastatic rectal cancer seen in 1999 without EUS evaluation (non-EUS control group) were compared to patients evaluated in 2000/2001 with EUS FNA (EUS group). RESULTS: Outcomes of 68 (non-EUS control group) and 73 (EUS group) patients with nonmetastatic rectal cancer were compared. Among patients with advanced T or N stage, adjuvant therapy was administered to 45 patients (84.9%; preoperative to 31 (58.5%) patients and postoperative to 14 (26.4%)) in the EUS group; adjuvant therapy was administered to 37 patients (78.7%; preoperative to 7 (14.9%) patients and postoperative to 30 (63.8%)) in the non-EUS group. Cox proportional hazards demonstrated EUS FNA to be associated with reduced tumor recurrence risk, hazard ratio, 0.72 (95% CI: 0.52-0.97, p= 0.03). CONCLUSIONS: EUS staging of rectal cancer appears to facilitate appropriate employment of preoperative neoadjuvant therapy in those patients with advanced disease. EUS use is associated with a recurrence-free survival advantage in patients, supporting its routine use in rectal cancer staging.

Female↗
PubMed2005

Low rate of microsatellite instability in young patients with adenomas: reassessing the Bethesda guidelines.

BACKGROUND AND AIM: Screening adenomas for microsatellite instability (MSI) in patients younger than 40 yr of age has been recommended by the Bethesda Guidelines as a means of identifying patients at risk for hereditary nonpolyposis colorectal cancer (HNPCC). We sought to determine the rate of MSI in adenomas removed from individuals under 40 yr of age over a 5-yr period in a university general gastroenterology practice. METHODS: We identified patients between 18 and 39 yr of age with endoscopically removed adenomatous colorectal polyps. Patients with polyposis syndromes, inflammatory bowel disease, or colorectal carcinoma were excluded. A three-generation family history was obtained via telephone interview. Endoscopic and histology reports were reviewed. Adenomas were tested for MSI using the BAT26 and BAT40 microsatellite markers, and expression of the MSH2 and MLH1 proteins was assessed by immunostaining. RESULTS: A total of 34 patients had 46 adenomas removed endoscopically. Out of 34 patients, 14 (41%) had a family history of colorectal cancer and 3 were from Amsterdam criteria positive families. A total of 28 of 46 adenomas (61%) were distal to the splenic flexure. Polyps ranged in size from 2 to 20 mm and averaged 6.6 mm. Five polyps (11%) were tubulovillous adenomas, and the remainder were tubular adenomas. None of the polyps were serrated adenomas and none demonstrated high-grade dysplasia. Among the 40 adenomas available for testing, none demonstrated MSI using either BAT26 (0/40) or BAT40 (0/21), nor did any of the polyps tested demonstrate loss of either MSH2 or MLH1 expression (0/16). CONCLUSION: Screening adenomas from patients younger than 40 yr of age for MSI was ineffective in identifying potentially new cases of HNPCC. New strategies that improve on the current clinical and molecular screening methods should be developed so that at-risk individuals can be identified and referred for germline testing before developing their first cancer.

Adaptor Proteins, Signal Transducing↗
PubMed1983

Accuracy and value of the Hemoccult test in symptomatic patients.

Hemoccult faecal occult blood testing is widely advocated as a screening test for colorectal cancer but few studies have shown its correlation with conventional methods of investigation for colorectal disease. In a prospective study of 802 symptomatic patients with suspected colorectal disease there was good patient compliance (92.5%) and a high specificity for colorectal cancer (85.4%). The false positive rate was 8.6% (12 of 140 patients with positive results), and while the test result was positive in 22 of 26 colonic cancers the false negative rate for rectal cancer (45.4%) should not detract from its value as a screening test if proper digital anorectal and proctosigmoidoscopic examination are widely practised. A positive Hemoccult test result is a useful indicator for the need to proceed to full colorectal investigation, including colonoscopy.

Adolescent↗
PubMed1985

Sigmoidoscopy/proctoscopy service with open access to general practitioners.

Many hospitals now offer barium enema examinations to general practitioners on an open access basis, so bypassing the traditional sequence of first carrying out a sigmoidoscopy. An open access sigmoidoscopy/proctoscopy service was therefore opened with requests for a barium enema being denied unless preceded by sigmoidoscopy. During the first three and a half years 1458 patients referred direct from their general practitioners were examined using a rigid sigmoidoscope. Patients were also examined with a proctoscope if thought appropriate. After the first year of the service a subsequent examination with a fibreoptic sigmoidoscope was also carried out if the presenting symptom was bleeding for which no cause could be found with the rigid instruments. A total of 516 abnormalities were found to account for symptoms in 506 patients giving a diagnostic rate of 35%. The most common lesion was piles (307 cases). Other relatively common disorders included inflammatory bowel disease (107 cases), benign tumours (44), and malignant tumours (38). Of 41 patients subsequently undergoing fibreoptic sigmoidoscopy a cause for the bleeding was found in 32, the most common being a malignant tumour (16). Most general practitioners in the district used the service and a questionnaire survey indicated that most found it very helpful. Requests from general practitioners for a barium enema fell substantially over the period.

Adolescent↗