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PubMed2004

Acute hemorrhagic rectal ulcer syndrome: a new clinical entity? Report of 19 cases and review of the literature.

PURPOSE: Acute hemorrhagic rectal ulcer syndrome is characterized by sudden onset, painless, and massive hemorrhage from rectal ulcer(s) in patients with serious underlying illnesses. It is a matter of controversy whether acute hemorrhagic rectal ulcer syndrome is a distinct clinical entity. This is the first Asian report on acute hemorrhagic rectal ulcer syndrome to be made outside Japan. METHODS: From January 1989 to December 1999, 8085 patients underwent total colonoscopy at our institution. We retrospectively analyzed the medical records and colonoscopic files. The diagnosis of acute hemorrhagic rectal ulcer syndrome was made by means of the clinical, histologic, and colonoscopic findings. RESULTS: Among the 8085 patients, 19 patients (11 males; mean age, 71.2 +/- 10.1 years) were diagnosed with acute hemorrhagic rectal ulcer syndrome, which accounted for 2.8 percent of the patients with massive lower gastrointestinal bleeding. The duration from hospitalization to the onset of massive bleeding ranged from 3 to 14 (mean, 9 +/- 3.3) days. Characteristics of colonoscopic appearance were solitary or multiple rectal ulcer(s), with round, circumferential, geographical, or Dieulafoy-like lesions located within a mean of 4.7 cm +/- 1.5 cm from the dentate line. Histopathologically, the lesions appeared as necrosis with denudation of covering epithelium, hemorrhage, and multiple thrombi in the vessels of the mucosa and underlying stroma, which is considered to be similar to stress-related mucosa injury. Successful hemostasis was obtained in 74 percent (14/19) of patients with direct therapeutic maneuvers. Prognosis was largely dependent on accurate diagnosis and management of the underlying disorders. CONCLUSIONS: We assert that acute hemorrhagic rectal ulcer syndrome is a rare but important entity and stress that awareness of this clinical entity should lead to a high index of suspicion resulting in early detection, diagnosis, and appropriate therapy.

Acute Disease↗
PubMed2006

Compliance and Satisfaction with Long-Term Surveillance in Finnish HNPCC Families.

OBJECTIVE: Nation-wide preventative colonoscopic surveillance for mutation carriers in HNPCC families has been organized since the early 1980 by the Finnish HNPCC registry. After characterization of MMR genes, a predisposing mutation has been verified in 111 HNPCC families and over 1500 family members at risk have been tested. The aim of this study was to evaluate the compliance and satisfaction of mutation carriers during life-long colonoscopic surveillance. MATERIALS AND METHODS: Hospital records of long-term surveillance were obtained for all mutation carriers (n=664). A questionnaire assessing overall experience, willingness to continue the surveillance, painfulness (a three-rank scale), possible interruption of endoscopy and the need for pain relief medication during colonoscopy, was sent to all living mutation carriers (n=587). The questionnaire was returned by 441 persons (75%) of whom 415 persons under colonoscopic surveillance were included in the study and 26 young mutation carriers excluded as they were still pending their first endoscopy. RESULTS: Out of 664 mutation carriers, surveillance had been interrupted in 8 cases (1.2%). Colonoscopies were described as painful by 151 (36%), uncomfortable by 161 (39%) and easy by 103 (25%) patients. Endoscopy was more often rated as painful by females (1.36, SD 0.71) than by males (0.86, SD 0.75), P<0.001. Medication for pain during colonoscopies was administered more often to females (32%) than males (15%), P<0.001. Colonoscopy had to be discontinued because of pain at least once in 10% of the patients. CONCLUSION: Patient compliance under life-long surveillance was excellent, but painfulness, especially in females, must be seen as a risk for compliance and the quality of endoscopies.

Adult↗
PubMed1976

Colonic polypoid disease: need for total colonoscopy.

Colonoscopic examination of the entire colon was performed on 146 patients for radiographically suspected benign polypoid disease. Of thirty-six patients who did not have a neoplastic lesion at the suspected site, seven (19 per cent) had unsuspected small benign polypoid adenomas elsewhere in the colon. Of the remaining 110 patients who had a neoplastic lesion at the radiographically suspected site, 17 lesions (15 per cent) were either adenocarcinomas or neoplastic polyps with invasive carcinoma. One hundred twenty-eight additional unsuspected neoplastic polyps were found in 62 of the 110 patients (56 per cent). Six of the additional neoplastic lesions were either adenocarcinomas or polyps with invasive carcinoma. Four of these malignant lesions were in patients who had a benign polyp at the radiographically suspected site. Suspected colonic polypoid disease should be evaluated colonoscopically despite radiographic evidence of benignity. Colonoscopic evaluation in colonic polypoid disease should include examination of the entire colon with pathologic documentation of all polypoid lesions encountered.

Colonic Neoplasms↗
PubMedDate not supplied

Colonic cancer surveillance in ulcerative colitis is not essential for every patient.

It is generally recognised that there is an increased risk of colonic cancer in patients with long-standing extensive colitis, and regular annual or biennial colonoscopic surveillance protocols have been recommended in order to detect early cancer. There is, however, little evidence to suggest that these protocols are of value. There have been no properly conducted controlled trials in this area, and the studies that have been reported are flawed by selection bias, the inclusion of patients with "pseudo disease" and protocol violators. Many studies have not distinguished between "screening colonoscopy" and "colonoscopic surveillance". Some have not drawn attention to the failures in the surveillance, i.e. patients with Dukes' grade C or worse, and overall the conclusions drawn have been unrealistically optimistic. The diagnosis of low grade dysplasia which has been accorded importance is insensitive, non-specific and is subject to gross interobserver error. It is of little clinical value. Colonoscopic surveillance using currently available techniques is of only marginal benefit to patients included within the protocol. It is not cost-effective and cannot be made to be so.

Colitis, Ulcerative↗
PubMed2004

Do aspirin and nonsteroidal anti-inflammatory drugs cause false-positive fecal occult blood test results? A prospective study in a cohort of veterans.

PURPOSE: To determine whether use of regular aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) is a risk factor for a false-positive fecal occult blood test result. METHODS: Consecutive patients referred for colonoscopy for a positive fecal occult blood test result at a Veterans Affairs hospital were eligible. Patients with hematochezia, peptic ulcer disease, or unevaluated dyspepsia requiring antacids, or who used warfarin, were excluded. Regular aspirin and NSAID use was defined as at least one daily dose for at least 3 days per week. Colonoscopic findings unlikely to explain a positive test result alone were defined a priori as diverticulosis, hemorrhoids, or polyps <1.0 cm with no villous histology. Findings likely to explain a positive test result included cancer and advanced polyps. RESULTS: The sample comprised 193 veterans with a mean (+/- SD) age of 66 +/- 10 years; 98% were male and 86% were white. No colonoscopic findings explained the positive fecal occult blood test result in 153 patients (79%). One hundred and thirty-five patients (70%) were regular aspirin or NSAID users, of whom 21% (n = 29) had findings to explain the positive test results, compared with 19% (11/58) of nonusers (P = 0.7). There was no relation between aspirin dose and colonoscopic findings unlikely to explain a positive test result. Multivariate analysis found no association between regular aspirin or NSAID use and a false-positive test result (odds ratio = 0.85; 95% confidence interval: 0.39 to 1.84). CONCLUSION: Aspirin and NSAID use were not risk factors for a false-positive fecal occult blood test result in this study.

Aged↗
PubMedDate not supplied

Per-rectal pulsed irrigation versus per-oral colonic lavage for colonoscopy preparation: a randomized, controlled trial.

The aim of this study was to compare the efficacy and patient tolerance of a new pulsed irrigation system to colonic lavage for colonoscopic preparation. Thirty-four prospective patients scheduled for routine colonoscopy were randomized to one of two preparations: a per-rectal pulsed irrigation device (18 patients) versus per-oral colonic lavage (15 patients). Colonoscopic preparation was assessed on a 0 to 4 plus scale by region and overall. This was done live and by video tape by two independent endoscopists who were blinded to the patient's preparation. There was no significant difference with respect to cleanliness of the colon with pulsed irrigation patients having an average overall preparation score of 3.00 +/- 0.19 (SEM) versus colonic lavage patients with a score of 3.14 +/- 0.19. There was also no statistically significant difference between the two groups with respect to demographics, time to reach the cecum, time for entire procedure, volume of aspiration or wash, or sedation given. We conclude that the new pulsed irrigation device provides an alternative to the standard per-oral lavage solution for colonoscopic preparation.

Administration, Oral↗
PubMedDate not supplied

Accuracy of assessment of the extent of examination by experienced colonoscopists.

One hundred colonoscopies were done. The colonoscopist noted whether the cecum had been intubated as well as the markers used to make this determination. With the colonoscope in position at maximum penetration, a radiologist independently determined its position using fluoroscopy, with a contrast agent delivered through the colonoscope. The cecum was entered in 86 of 100 cases. The tip of the colonoscope was at the level of the ileocecal valve in nine additional cases; the colonoscopist judged that the cecum was well seen in five of these nine. In one case, the colonoscopist overestimated the extent of the examination when transillumination in the right lower quadrant was the only confirming marker. When the more reliable markers (ileocecal valve, appendiceal orifice, converging indentations of the taenia coli in the cecal pole) were seen, no errors were made. Experienced colonoscopists are accurate in assessing the extent of colonoscopy and fluoroscopic confirmation is not routinely needed. When reliable markers are not seen during the examination, a barium enema, preferably with air contrast, should be done.

Cecum↗
PubMed1998

Invasion depth diagnosis of depressed type early colorectal cancers by combined use of videoendoscopy and chromoendoscopy.

BACKGROUND: Depressed type early colorectal cancers are found less frequently than other polypoid cancers although they have a higher submucosal invasion rate. Recently videocolonoscopy and chromoendoscopy have become available and precise descriptions of these lesions are now routine. Because endoscopic mucosal resection is designated for intramucosal and focally extended submucosal (m-sm1) cancers, an evaluation of the characteristic findings indicating invasion depth with these modalities is important. METHODS: Between January 1991 and March 1996, 64 depressed type early colorectal cancers were detected and treated. When a faint abnormality of the mucosa was suspected by routine videocolonoscopy, 0.1% of indigo carmine solution was sprayed on the mucosal surface (chromoendoscopy). Colonoscopic findings of m-sm1 cancers and moderately and massively extended submucosal (sm2-3) cancers were retrospectively reviewed and compared with confirmed histologic findings. RESULTS: Characteristic colonoscopic findings needed for surgical operation were as follows: (1) expansion appearance, (2) deep depression surface, (3) irregular bottom of depression surface, and (4) folds converging toward the tumor. By using these findings, the invasion depth of depressed type early colorectal cancers could be correctly determined in 58 of 64 lesions (91%). CONCLUSIONS: Characteristic colonoscopic findings obtained by a combination of videocolonoscopy and chromoendoscopy are useful for determination of the invasion depth of depressed type colorectal cancers, an essential factor in choosing a treatment modality.

Colon↗
PubMed1998

Risk of contamination of sterile biopsy forceps in disinfected endoscopes.

BACKGROUND: Previous studies have shown that pathogens may persist within bacterial biofilms in endoscope accessory channels despite high-level disinfection. Breaching the gastrointestinal mucosa with biopsy forceps contaminated at time of passage has the potential to cause cross-infection between patients. METHODS: We studied contamination risk of sterilized biopsy forceps passed through endoscopes after high-level disinfection. For each trial, five video colonoscopes, duodenoscopes, and gastroscopes were used. All endoscopes had been previously processed and stored for 10 or more hours. Sterile biopsy forceps were inserted and retrieved followed by vortexing the tips in 15 mL of soy broth. Under a laminar flow hood, the broth was filtered through a 0.2 microm millipore membrane and plated. Because of minimal bacterial growth resulting from the above, soy broth (> 20 mL) was flushed through two video colonoscopes, duodenoscopes, and gastroscopes on two occasions and collected. The effluent was plated using a sample of 0.1 mL dilution. The remaining suspension was passed through a millipore filter, and the filter was cultured. All cultures were incubated more than 48 hours. RESULTS: Biopsy forceps underwent a total of 24 anaerobic and 75 aerobic cultures. Microbacterial growth occurred on 17 plates: 7 from gastroscopes, 5 from colonoscopes, and 5 from duodenoscopes. Fifteen plates grew staphylococcus for a total of 21 colonies, 1 plate grew 1 colony of propionibacter, 2 plates grew diphtheroids for a total of 4 colonies, and 1 plate grew a single colony of lactobacillus. Cultures from soy broth flushed through the various endoscopes grew on 5 plates: 3 from gastroscopes and 2 from duodenoscopes grew a total of 8 colonies of staphylococcus. CONCLUSIONS: With proper cleaning technique, a 20-minute soak in 2% glutaraldehyde is effective in disinfecting endoscopes. Although current procedures for endoscope disinfection remain imperfect, we found that in this clinical setting, infection of pathogenic gastrointestinal flora is unlikely when using sterile biopsy forceps.

Bacterial Infections↗
PubMed1997

Does non-dysenteric intestinal amoebiasis exist?

BACKGROUND: Chronic abdominal pain and frequent bowel disturbance are common symptoms experienced by more than 15% of apparently healthy people. In areas endemic for Entamoeba histolytica infection, these symptoms are often diagnosed as non-dysenteric intestinal amoebiasis even though no causal relation between such symptoms and E histolytica has been established and clinical presentation of non-dysenteric intestinal amoebiasis and irritable bowel syndrome (IBS) is not distinct. This study was done to assess the clinical significance of E histolytica infection in causation of such symptoms. METHODS: Patients with symptoms suggestive of non-dysenteric intestinal amoebiasis were recruited from a survey to assess the prevalence of abdominal symptoms in the general population (group A; n = 78) and from medical outpatient clinics (group B; n = 66). Participants who had symptoms as well as symptom-free controls (group C; n = 100) were clinically examined and underwent stool examination, amoebic serology, colonoscopic examination, histopathological examination of colonoscopic biopsy samples, and a trial of antiamoebic therapy (only for participants with symptoms) with metronidazole and mebendazole. FINDINGS: There were no significant differences between the 144 patients with symptoms and the 100 symptom-free controls in the proportion with E histolytica in stools (26 [18%] vs 18 [18%]), serological evidence of E histolytica infection (61 [42%] vs 41 [41%]), colonoscopic abnormalities (five of 66 vs one of 33), or histopathological abnormalities (36 [49%] of 73 vs ten [30%] of 33). Cyst-positive and cyst-negative individuals showed no significant difference in serological evidence of E histolytic infection, histological abnormalities, or response to therapeutic trial with metronidazole. A diagnosis of IBS was suggested on the basis of consensus criteria and Kruis diagnostic index in 127 of 144 patients with symptoms. The diagnosis of non-dysenteric intestinal amoebiasis could be made in only one patient, who had relapse of symptoms within 6 weeks of antiamoebic therapy and therefore the relapse did not meet criteria for the diagnosis of non-dysenteric intestinal amoebiasis. More than 60% of cyst-positive as well as cyst-negative patients with symptoms showed either complete or partial response to treatment strategy for IBS. INTERPRETATION: Chronic bowel symptoms, such as pain in abdomen and frequent bowel disturbance, have no association with either past or present infection with E histolytica. Most patients with such symptoms are likely to have IBS. The clinical entity of non-dysenteric intestinal amoebiasis, if it exists, must be extremely rare.

Abdominal Pain↗
PubMed2006

Surveillance colonoscopy in patients with colorectal cancer: how often should we be doing it?

BACKGROUND: The optimum protocol for colonoscopic surveillance following curative resection for colorectal cancer has not been established. The aim was to assess the incidence of recurrence and metachronous tumours in our less intensive colonoscopic surveillance programme and compare our results with those reported from intensive surveillance programmes. METHODS: Colonoscopic records of patients who had surveillance colonoscopy following curative resection from April 1998 to March 2003 for cancer were available from the endoscopy department computer database. The variables studied included the tumour site, Duke's stage, number of recurrences, number of metachronous tumours, size and number of polyps and their biopsy results. RESULTS: There were a total of 105 patients. Two patients were diagnosed with metachronous tumours and three with recurrence. Adenomatous polyps were identified in 24 patients of which nine had multiple/advanced adenomas (equal to or more than 1cm adenomatous polyps, or with severe dysplasia). CONCLUSION: The risk of development of colonic pathology following curative resection for colorectal cancer is low. More intensive follow-up should be reserved for patients with additional risk of developing further cancers.

Adenoma↗
PubMed1999

Colonic tuberculosis: clinical features, endoscopic appearance and management.

BACKGROUND: Although rare in the West, colonic tuberculosis is not an uncommon disease in developing countries. However, the clinical manifestations and radiological appearance of the disease are non-specific. In recent years, colonoscopy has been found to be very useful in diagnosing patients with colonic tuberculosis. METHODS: Clinical features, colonoscopic findings, histology and response to treatment were recorded in 50 patients with colonic tuberculosis. RESULTS: Abdominal pain, fever, anorexia, weight loss and diarrhoea were the common symptoms. The colonoscopic features consisted of ulcers (92%), nodules (88%), deformed caecum and ileocecal valve (42%), strictures (25%), multiple fibrous bands (8%) and polypoid lesions (6%). Segmental tuberculosis and lesions simulating carcinoma were seen in 22 and 16% of patients, respectively. Histological examination of the colonic biopsy specimens showed well-formed, non-caseating granulomas in 18%, collection of loosely arranged epithelioid cells in 40% and chronic non-specific inflammatory changes in 42% of the patients. Six patients needed surgical intervention. The other 44 patients responded well to anti-tuberculous therapy and became asymptomatic. CONCLUSIONS: It is concluded that colonoscopy is a useful method for diagnosing colonic tuberculosis. It is suggested that if the clinical picture and colonoscopic appearance are suggestive of tuberculosis and target biopsies reveal non-caseating granulomas, a collection of loosely arranged epithelioid cells, or even non-specific changes, then a therapeutic trial of anti-tuberculous drugs should be given and continued if there is clinical improvement.

Adult↗
PubMed2003

A novel indicator for surveillance colonoscopy following colorectal cancer resection.

INTRODUCTION: Current surveillance for recurrent intraluminal or metachronous colorectal cancer following resection is largely undertaken by colonoscopic examination of the remaining colon. The burden on colonoscopic services is high and the procedure is expensive. Immunological faecal occult blood testing (FOBT) is a sensitive and specific test for detecting colorectal cancer, and may fine tune the need for timely surveillance colonoscopy. METHODS: Consecutive patients due for surveillance colonoscopy following colonic resection for cancer were prospectively studied. Each patient had a single faecal sample obtained at per rectal examination on a gloved examining finger. This was subjected to immunological FOBT in the clinic, and patients were categorized as FOBT positive or negative, according to the result. Colonoscopy as well as ultrasound or CT of the liver were performed within eight weeks of FOBT. RESULTS: Six hundred and eleven patients had both FOBT and colonoscopy. Fifty-nine (13.6%) were categorized as FOBT-positive. Of these, nine had biopsy-proven recurrent or metachronous cancer, 12 patients had one, or more adenomatous polyps, one patient had radiation proctitis and two patients had pan-colonic mucositis following chemotherapy. In the remaining 552 FOBT-negative patients, no cancers were found. Thirty-eight patients had polyps that were removed. The sensitivity and specificity for detecting cancer by immunological FOBT was 100% sensitivity for detecting adenomatous polyps was 24% but specificity was 93%. CONCLUSION: The immunological faecal occult blood test provides sensitive detection of metachronous and recurrent cancer in postoperative surveillance. Routine application may be used to reduce the frequency of colonoscopic surveillance, as a negative FOBT may be taken as a sign that colonoscopy may be deferred safely.

Adult↗
PubMed2001

Screening and surveillance colonoscopy in chronic Crohn's colitis.

BACKGROUND & AIMS: Unlike ulcerative colitis, there are few reports on the efficacy of surveillance colonoscopy in patients with chronic Crohn's colitis and therefore little agreement as to whether routine surveillance is indicated. We report on 259 patients with chronic Crohn's colitis who underwent screening and subsequent surveillance colonoscopy and biopsy since 1980. METHODS: Biopsies were performed at 10-cm intervals and from strictures and polypoid masses. Pathology was classified as normal, dysplasia (indefinite, low-grade, high-grade), or carcinoma. RESULTS: A total of 663 examinations were performed on 259 patients. The median interval between examinations was 24 months; examinations were performed more frequently (1-6 months) in patients with dysplasia on biopsy. A thinner-caliber colonoscope was required to complete 12% of screening examinations and 23% of surveillance examinations. The pediatric colonoscope helped increase our yield of neoplasia by 19%. The screening and surveillance program detected dysplasia or cancer in 16% (10 indefinite, 23 low-grade, and 4 high-grade dysplasias and 5 cancers). A finding of definite dysplasia or cancer was associated with age >45 years and increased symptoms. By life table analysis, the probability of detecting dysplasia or cancer after a negative screening colonoscopy was 22% by the fourth surveillance examination. CONCLUSIONS: Colonoscopic surveillance should be strongly considered in chronic extensive Crohn's colitis.

Adolescent↗
PubMed2000

Endoscope washers--a protocol for their use.

A protocol for the disinfection of gastroduodenoscopes, retrograde cholangiopancreatography endoscopes and colonoscopes using endoscope washers is described. The process recommends initial manual washing with a disinfectant containing didecyldimethylammonium chloride, surfactants and enzymes, a second washing in the endoscope washer using a detergent associated with a bacteriostatic, fungistatic substance (benzoisothiazolone) and finally the use of a 2% glutaraldehyde product buffered at pH6. After treatment with 2% Steranios added to the washer, less than 1 micro-organism/ml liquid was found in the following units: 83% of the colonoscopes, 83% of the oesophagogastroduodenoscopes, 83% of the main channels of the retrograde cholangiopancreatography endoscopes and 75% of the auxiliary channels of the latter instruments. In 14% of the colonoscopes, 42% of the gastroduodenoscopes, 42% of the main and 50% of auxiliary channels in the retrograde cholangiopancreatography endoscopes there were no signs of microbial growth in the wash liquid. The results obtained indicated that this protocol allowed adequate disinfection of the endoscope channels, structurally the most difficult part of the instrument to disinfect. Emphasis is given to the degree by which instrument contamination can increase during overnight storage, suggesting that endoscopes need to be submitted to further disinfection after overnight storage. Moreover, the water flowing into the washers can also cause instrument recontamination, particularly during the final rinses. Therefore, to better safeguard the health of patients undergoing endoscopy, special care must be taken to maintain the filters and disinfect the washers themselves, no matter how effective the disinfection protocol used may be.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed2002

Magnetic endoscope imaging: a new technique for localizing colonic lesions.

BACKGROUND AND STUDY AIMS: The precise localization of advanced colorectal lesions preoperatively directs the appropriate surgical management. The use of internal landmarks at colonoscopy can be inaccurate, and other methods are therefore necessary to localize lesions precisely. Magnetic endoscope imaging (MEI), a real-time, nonradiographic technique for imaging of the colonoscope, may assist in determining the location of lesions found at colonoscopy. PATIENTS AND METHODS: A prospective study was carried out to determine the accuracy of MEI for localizing the colonoscope tip anatomically. The MEI system was used to identify one of four predetermined locations within the colon. Once identified, two endoscopic marking clips were attached to the colonic mucosa, and 400 - 500 ml of Urografin radiographic contrast medium was injected to produce an air-contrast "enema." The clips were subsequently localized using plain abdominal radiography, assessed by a single experienced radiologist who was blinded to the colonoscopic findings. RESULTS: Twenty-nine consecutive patients were enrolled in the study. The overall accuracy of MEI in comparison with the air-contrast "enema" was 90 % (26 of 29 cases). There were three slight errors of localization - clips localized to the descending rather than the sigmoid-descending colon junction (n = 1), or to either side of the mid-transverse (n = 1) and hepatic flexure (n = 1) - but these were not considered to be of surgical or clinical importance. CONCLUSIONS: MEI is a reliable and accurate method for determining the anatomical position of the endoscope tip during colonoscopy. When it becomes commercially available, we believe the use of MEI will avoid the need for unnecessary barium enemas for localization of lesions prior to definitive surgery.

Colonic Neoplasms↗
PubMed2006

Characterization of colonic polyps at conventional (nonmagnifying) colonoscopy after spraying with 0.2 % indigo carmine dye.

BACKGROUND AND STUDY AIMS: Japanese endoscopists have devised a classification system based on mucosal crypt patterns which is helpful for distinguishing between hyperplastic polyps, adenomas, and invasive cancers at colonoscopy. The aim of this study was to assess how well the various types of colonic polyp could be distinguished using conventional colonoscopes after spraying with 0.2 % indigo carmine dye. PATIENTS AND METHODS: The endoscopic appearances of all colonic lesions were assessed in 476 unselected patients using normal-resolution, nonmagnifying colonoscopes after spraying with 0.2 % indigo carmine dye. RESULTS: A total of 709 lesions were found in the 476 patients, and histology was available for 673 of these lesions: 187 lesions were found to be non-neoplastic (128 hyperplastic, 2 juvenile, 30 inflammatory, and 27 classified as "others"); 467 lesions were adenomatous; and 19 lesions were carcinomas. Of the 467 adenomas, 377 were tubular, 77 were tubulovillous, 8 were villous and 5 were serrated; 423/467 were correctly identified (sensitivity 91 %). Of the 187 non-neoplastic lesions, 153 were correctly classified (specificity 82 %). A total of 343 of the 377 tubular lesions were correctly identified as tubular adenomas (sensitivity 90 %), and 46 of the 77 tubulovillous lesions were correctly identified. CONCLUSIONS: Standard colonoscopy with dye spraying can be used to differentiate colonic polyps. Magnification is not always necessary to distinguish neoplastic from nonneoplastic colonic lesions. This finding could result in resource savings in colonoscopic screening.

Adult↗
PubMed1995

The role of colonoscopy in the differential diagnosis of acute, severe hemorrhagic colitis.

BACKGROUND AND STUDY AIMS: This study assesses the diagnostic value of colonoscopy performed at an early stage of a first attack of acute, severe hemorrhagic colitis. PATIENTS AND METHODS: One hundred fourteen consecutive patients were prospectively studied. The colonoscopic diagnosis was compared with the final diagnosis of the colitis, which was based on clinical, microbiological, endoscopic, and histological criteria during the acute illness, but also on the results of a thirty-month follow-up of the patients aiming to confirm whether the colitis was relapsing or nonrelapsing in nature. RESULTS: The colonoscopic diagnosis was ulcerative colitis (UC) in 40, Crohn's disease in four, and infective colitis (IC) in 70 patients. The endoscopic diagnosis was finally confirmed in all 40 UC patients and in 68 of 70 (97.1%) IC patients. Two patients with an initial endoscopic and histological diagnosis of IC presented with typical attacks of UC 28 and 30 months later, respectively. Prominent endoscopic appearances in IC were mucosal edema, erythematous areas, hemorrhagic spots, bleeding, microaphthoid ulcers, and luminal exudate. Although rectal sparing was occasionally seen, endoscopic lesions were continuous and severe in the distal colon, but were patchily and unevenly distributed in other parts of the colon in IC. In UC, prominent colonoscopic findings were bleeding, mucosal friability, granularity, and ulceration; lesions were continuously distributed in the involved area. CONCLUSIONS: Colonoscopy is a useful procedure in the differential diagnosis of severe bloody diarrhea of unknown cause.

Acute Disease↗