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PubMed1976

Serosal tears following colonoscopy.

After colonoscopic perforation, laparotomy was performed in a 28-year-old woman. Seromuscular tears and lacerations were found in an adjacent loop of sigmoid colon that appeared normal through the colonoscope. At laparotomy, the mucosa of that loop was entirely intact. Six weeks later, a laparotomy was again performed, revealing well-healed lacerations with extensive adhesion formation. The incidence of this complication in patients undergoing colonoscopy is unknown.

Adult↗
PubMed1999

Carcinoma in situ of the colorectum: SEER trends by race, gender, and total colorectal cancer.

BACKGROUND AND OBJECTIVES: To determine if Americans of African origin (blacks) have less access to colonoscopic polypectomy than Americans of European origin (whites), the rate of carcinoma in situ of the colorectum (CIS), a disease more similar to benign adenoma of the colorectum than invasive cancer in its symptomatology, discovery, and treatment, was determined in the United States from 1973 to 1994. The hypothesis being tested is that CIS will be far less common in blacks than in whites and that rates of CIS should be increasing in whites from 1973 to 1994. METHODS: CIS and invasive carcinoma of the colorectum incidence data were obtained from Surveillance, Epidemiology, and End Results (SEER) Public Use Files from 1973 through 1994. Rates were age adjusted and proportions determined by division of CIS rates for each subsite by total carcinoma rates, for each year, race, and gender. The colorectum was divided anatomically in this analysis at the junction of the descending and sigmoid colon. RESULTS: The relationships between male/female and black/white CIS incidence rates were broadly similar to invasive cancer rates over the 21 years of SEER, demonstrating a white male predominance for distal disease, a black male predominance for proximal disease, and a decline in incidence since 1988. CIS as a proportion of total colorectal cancer increased in all races and genders from 1973 to 1987, but then declined in all groups. CONCLUSIONS: The majority of CIS is excised by endoscopic resection. Therefore, this might be considered a surrogate population for those individuals who have colonoscopic resection of benign adenomas. It is this latter treatment that has been hypothesized to be the cause for the declining incidence of invasive colorectal cancer. However, data presented herein do not support this hypothesis.

Black People↗
PubMed1986

Early invasive carcinoma in colonic polyps. A review of the literature with emphasis on the assessment of the risk of metastasis.

The proper treatment of adenomatous colonic polyps containing small foci of invasive cancer is controversial because the metastatic potential of these lesions is not precisely known. This article critically reviews all known English language studies of this lesion. Before the introduction of colonoscopic polypectomy, the estimated incidence of metastasis from this lesion was 10.4% (based on 12 studies containing 347 polyps), with a confidence interval (95% level) of 7.4 to 14.1. The incidence of metastasis estimated from lesions removed via colonoscopic polypectomy was 10.1% (based on 13 studies containing 188 polyps), with a confidence interval of 5.9 to 14.8. Differences in the definitions of the involved lesions, study designs, and indications for resection cause problems with case selection bias and make comparison of studies difficult. These problems are discussed in detail. Most studies had broad confidence intervals for the estimated incidence of metastasis because of small sample size. The histopathologic criteria, as reflected in the literature, for considering polypectomy alone as adequate treatment for this lesion are summarized and discussed.

Carcinoma↗
PubMed1987

Dysplasia of the colon after jejuno-ileal bypass.

Colonoscopic biopsies were performed on 38 patients, 10-13 years after jejuno-ileal bypass. No significant dysplasia or premalignant change was seen in 371 biopsies. In one patient two tubulovillous adenomata were found in an otherwise normal colon, which is likely to be a chance finding. Although it will take another 10-20 years to establish whether jejuno-ileal bypass is associated with an increased risk of large bowel cancer in humans, there is at present no indication for regular colonoscopic surveillance.

Colon↗
PubMed1996

Multicentre study of surgical complications of colonoscopy.

A total of 196 records of colonoscopic surgical complications were reviewed during a 12-year period. Perforation (183 patients) and haemorrhage (11) were the two main complications. Diagnosis of perforation was delayed in 58 per cent of patients. The sigmoid colon was the site of perforation in 72 per cent with evidence of peritoneal contamination in 59 per cent. Postoperative mortality rate of perforation was 12 per cent and was significantly related to a past history of medical disease and size of perforation. Postoperative morbidity rate was 43 per cent. There were two deaths after colostomy closure. The overall mortality rate of colonoscopic perforation requiring an emergency surgical procedure reached 14 per cent. Haemorrhage always occurred after endoscopic polypectomy; the postoperative course was uneventful in these patients.

Adult↗
PubMed2005

Lower gastrointestinal symptoms are not predictive of colorectal neoplasia in a faecal occult blood screen-positive population.

BACKGROUND: The aim of this study was to evaluate the incidence of lower gastrointestinal symptoms in faecal occult blood (FOB) test-positive participants in a colorectal screening programme, and to compare the colonoscopic findings in symptomatic and asymptomatic individuals. METHODS: Five hundred and sixty-three consecutive individuals with a positive FOB test in the Scottish arm of the national colorectal cancer screening pilot were studied. All were aged between 50 and 69 years and underwent colonoscopy. Before the procedure the participants were given a standard questionnaire to elicit gastrointestinal symptoms; these were correlated with the colonoscopic findings. RESULTS: Of the 563 participants, 439 (78.0 per cent) had one or more lower gastrointestinal symptoms and 124 (22.0 per cent) were symptom free. Taking adenoma and carcinoma together, 322 (57.2 per cent) of the subjects were found to have colorectal neoplasia, and 128 (22.7 per cent) had a completely normal colon. Rectal bleeding was the most common symptom, followed by change in bowel habit, abdominal pain, tenesmus, unexplained weight loss, rectal pain and unexplained anaemia. No significant associations were found between any of these symptoms and the findings at colonoscopy. CONCLUSION: In a FOB test-positive screened population, lower gastrointestinal symptoms are common, but are not predictive of colorectal neoplasia.

Abdominal Pain↗
PubMed2005

Prevalence of family history of colorectal cancer in the general population.

BACKGROUND: Robust estimates of the prevalence of a family history of colorectal cancer in the general population are essential to inform planning of provision for colonoscopic surveillance and for clinical genetics services. However, there is a paucity of high-quality data. METHODS: Computerized record linkage was used to assess systematically the family history of 160 cancer-free community subjects and thereby provide prevalence data that are independent of participant recall. The data set comprised 2664 first- and second-degree relatives of study subjects, with 148 068 years at risk. RESULTS: Of people in the 30-70 years age range, 9.4 (95 per cent confidence interval (c.i.) 5.8 to 14.9) per cent had a first-degree relative affected by colorectal cancer, and 28.8 (95 per cent c.i. 22.3 to 36.2) per cent had an affected first- or second-degree relative. Between 0 and 3.1 per cent of study subjects merited colonic surveillance, depending on the stringency of the guidelines used. CONCLUSION: An appreciable proportion of the general population has a relative affected by colorectal cancer, sufficient to merit screening under certain criteria. In the absence of good-quality evidence supporting colonoscopic surveillance in groups at moderate risk, these data directly inform the planning of services for people with a family history of colorectal cancer. However, the clinical risk and financial implications of screening should be taken into account.

Adult↗
PubMed1990

Sigmoid stricture at colonoscopy--an indication for surgery.

Strictures of the sigmoid colon continue to pose a diagnostic dilemma. They commonly appear to be due to diverticular disease but carcinoma must always be excluded. In some cases diverticula may be present but in others there is no obvious cause for the stricture. In a series of 1039 consecutive colonoscopies performed between 1984 and 1986, 19 cases of sigmoid stricture that could not be negotiated with the colonoscope were encountered. In each case the cause of the stricture could not be demonstrated. Fifteen patients (79%) underwent laparotomy primarily on clinical grounds or with barium enema findings suggestive of carcinoma. A final diagnosis of diverticular disease was made in nine cases and adenocarcinoma is six cases. Barium enema was a poor predictor of malignancy in a stricture. Four patients were treated conservatively and two of these patients continued to have significant symptoms due to diverticular disease. This experience suggests that sigmoid strictures that prevent the passage of a colonoscope should be resected when the cause of the stricture is not apparent.

Adenocarcinoma↗
PubMed1993

Quality control in colonoscopy: a Singapore perspective.

For quality control purposes, a computer based auditing system for colonoscopy has been developed in the Department of Colorectal Surgery, Singapore General Hospital, Singapore. The first year's experience was reviewed to determine both workload patterns and the individual operators' performances. Colonoscopic completion rates, both as raw data and cusum transformations, were used as indices of quality control. The mean colonoscopic completion rate for the Unit was 97.0% and, when temporal trends were analysed by cusum, all operators consistently met or exceeded the minimum target completion rate of 90%.

Colonoscopy↗
PubMed1987

Acute colonic pseudo-obstruction (Ogilvie's syndrome). Presentation of 14 of our own cases and analysis of 1027 cases reported in the literature.

In addition to the presentation of 14 of our own patients, this study analyzes 1027 cases with acute colonic pseudo-obstruction reported in the literature from 1948 to 1987. Principal associated diseases are cardiopulmonary insufficiencies, postoperative conditions, and systemic disorders. The syndrome is related to a disturbance of colonic autonomic innervation resulting in gross dilatation of the cecum and the right hemicolon. Therapeutic measures include conservative management, colonoscopic decompression, and surgical procedures. The latter have been associated with high morbidity and mortality. Our data support a nonoperative approach to this condition, including conservative measures and colonoscopic decompression as the initial therapy of choice with few complications and high efficacy.

Aged↗
PubMedDate not supplied

The reliability of cecal landmarks during colonoscopy.

Confirming colonoscopic intubation of the cecum can be a laborious, time-consuming, and often frustrating endeavor. Anatomic landmarks may offer visual clues of cecal intubation, but the predictability of this evidence is unclear. The presence of three cecal landmarks, alone and in combination, were evaluated to precisely define their reliability. Between February and October of 1991, 601 of 708 (85%) consecutive colonoscopic examinations were able to be completed to the cecum as confirmed by fluoroscopy. All three cecal landmarks studied were present in 64% (386/601), two cecal landmarks in 32% (189/601), and one cecal landmark in 4% (26/601) of the patients. Therefore, at least two cecal landmarks were identified in 96% (575/601) of the patients. The ileocecal sphincter was identified in 98% (591/601) of patients overall, in 98% (185/189) of patients and 2 cecal landmarks, and in 77% (20/26) of patients with 1 cecal landmark. The appendiceal orifice was seen in 87% (524/601) of patients overall and in 72% (137/189) of patients with 2 cecal landmarks. Transillumination through the abdominal wall was possible in 74% (447/601) of patients overall and in 30% (56/189) of patients with 2 cecal landmarks. In summary, the ileocecal sphincter is the most reliable cecal landmark and is invariably visualized, even when all other landmarks are obscure. While other cecal landmarks, such as the appendiceal orifice and transillumination, are consistently identified, they are most valuable when found in association with the ileocecal sphincter.

Cecum↗
PubMed1988

Conceptual developments through colonoscopy.

Fiberoptic colonoscopy is 25 years old this year. Improvement in instruments led rapidly to wide acceptance of colonoscopy in diagnosis and therapy of colorectal diseases. The diagnosis of benign and malignant neoplasms was revolutionized by colonoscopy. The differential diagnosis of inflammatory bowel disease, assessment of its extent and severity, response to treatment, and potential for development of cancer are all made easier by colonoscopy. Colonoscopy has improved the diagnosis of diverticular disease, rectal bleeding, identification of ischemia, and other problems. Therapeutic colonoscopy has radically changed the management of colonic polyps, and colonoscopic polypectomy is now the standard form of treatment for most of these lesions. Treatment of bleeding lesions, decompression of obstruction, and removal of foreign bodies are other examples of therapeutic colonoscopic procedures.

Colonic Diseases↗
PubMed1976

[Epithelial dysplasia in ulcerative colitis. Histological possibility for the early diagnosis of "colitis"-carcinoma (author's transl)].

From 249 histologically examined cases with ulcerative colitis (within the years 1967 to 1974) 20 cases were selected, which had an onset of the disease before the 20th year of age and/or a duration of more than 10 years. These cases were checked-up for "prae-cancerous" epithelial dysplasia. Four of these 20 cases showed medium to severe epithelial dysplasia together with carcinoma (= 1.61% of the entire collective). In 2 cases low grade to severe dysplasia occurred in different parts of the colon without demonstrable carcinoma. In 1 case epidermoid epithelial metaplasia were found in the splenic flexure and in the rectum. The biological significance of these metaplasia remains unclear. With reference to the formal pathogenesis these lesions are probably "indirect" metaplasia. The early diagnosis of "colitis"-carcinoma can be improved by systematic colonoscopic examinations resp. by colonoscopic biopsies. "Prae-cancerous" epithelial dysplasias, which occur in a high rate together with carcinoma, are found not only in the rectum but also in other parts of the colon. Multiple biopsies from different parts of the colon as well as the rectum would thus seem to be desirable if mucosal sampling is to be employed as a screening test.

Adult↗
PubMedDate not supplied

Suppression of the human mucosal-related colonic microflora with prophylactic parenteral and/or oral antibiotics.

The purpose of this investigation was to assess the effects of preoperative administration of parenteral antibiotics with or without concomitant preoperative administration of oral antibiotics on the colonic mucosal-related microflora. Thirty-one patients were studied in a prospective fashion. Group A patients (n = 8) had colonoscopic mucosal biopsies performed after mechanical bowel preparation. Group B patients (n = 5) received neomycin and erythromycin (NE), 1 g each following mechanical bowel preparation, at 1, 2, and 11 p.m. the evening prior to either elective colon resection (n = 2) or prior to colonoscopic biopsy (n = 3). Emergent trauma patients who had left colon or sigmoid perforations due to gunshot wounds requiring segmental resection comprised group C (n = 7). These patients received cefoxitin or cefotetan 2 g intravenously preoperatively. Individuals in group D (n = 11) all had elective left hemicolectomies or sigmoid resections due to nonobstructing malignancies. These patients underwent the same regimen as group B patients in addition to receiving intravenous cefoxitin perioperatively. Quantitative and qualitative bacterial cultures as well as scanning electron microscopy (SEM) were used to study the mucosa-associated flora. Tissue for culture and SEM were obtained from the pathologic specimen immediately after removal. The interval between the dosage of parenteral antibiotics to tissue removal was 3 hours in both groups. Anaerobic and aerobic counts were suppressed the greatest in patients receiving both oral and parenteral antibiotics (p = 0.0001). Mean anaerobic counts decreased from 3.4 X 10(7) in group A to 1.8 X 10(2) (mean cfu/g) in group D patients. Mean aerobic counts in group A decreased from 3.7 X 10(6) to 64 (mean cfu/g) in group D.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMed1992

Benign colorectal neoplasms undetected by colonoscopy.

This retrospective investigation assessed the sensitivity of colonoscopy for the detection of colonic polyps seen previously at barium enema examination. Included in the study were 77 patients with 106 polypoid lesions. Films showing lesions not subsequently seen at colonoscopy were reviewed and only those lesions with a visible point of attachment, exhibiting no movement in response to filling or change in position of the patient, and confidently diagnosed as a polyp by both reviewing radiologists were included among the 106 lesions. Sixteen lesions (15%) seen radiologically were not located colonoscopically, indicating an endoscopic sensitivity of 85%. Contrary to previous reports, most of the lesions missed endoscopically were in the left colon in regions thought to have been traversed by the instrument. The 15% false-negative rate found for colonoscopy is consistent with existing reports on colonoscopic errors and is approximately the same as the false-negative error rate for radiologic detection of colonic polyps.

Adult↗
PubMed1994

Endoscopic resection of large colorectal polyps using a clipping method.

PURPOSE: In conventional endoscopic snare polypectomy, bleeding and perforation are the principal concerns. To prevent these complications, we employ an endoscopic clipping technique using the HX-3L clipping apparatus. METHODS: With this method, clips are used to clamp the base of a polyp. A snare is hung peripheral to the clips. The polyp is then resected by coagulating and cutting with an electric current. RESULTS: Neither bleeding nor perforation during or after polypectomy has occurred, nor have complications related to the use of clips developed. Gigantic polyps were not resected piecemeal, but rather were resected en bloc facilitating a clear determination of cancer on the surface of the resected site. Endoscopic clipping permitted site marking for colonoscopic surveillance. CONCLUSION: We conclude that the clipping method has many advantages and is a useful technique in colonoscopic polypectomy.

Adult↗
PubMed1991

"Mini-perforation" of the colon--not all postpolypectomy perforations require laparotomy.

In a 10-year experience with 4,784 consecutive colonoscopic polypectomies, the need for operative intervention in just two of seven perforations indicates that patients with specially defined, limited perforations can usually be treated nonoperatively. This specific complication, which has been termed "mini-perforation," is generally detected within 6-24 hours of polypectomy, and is characterized by local pain and tenderness, without signs of diffuse or spreading peritoneal irritation. Free intra-abdominal or retroperitoneal air on x-ray documents the actual perforation. Complete resolution of symptoms within 24-48 hours confirms the diagnosis of "mini-perforation." Success depends on good bowel preparation for colonoscopy, and early recognition of perforation, with institution of bowel rest and intravenous antibiotics. The "mini-perforation" spontaneously closes, probably by omental adherence. Frequent serial clinical examinations are mandatory so that frank perforation with advancing peritonitis will be promptly recognized and treated surgically. An understanding of the three levels of cautery injury to the colon wall--"serosal burn," "mini-perforation," and "frank perforation" are essential in managing the complications of colonoscopic polypectomy.

Anti-Bacterial Agents↗
PubMed1997

What is the risk factor for metachronous colorectal carcinoma?

PURPOSE: The purpose of this study was to determine the risk factors for developing metachronous colorectal carcinoma and to determine an adequate postoperative colonoscopic surveillance. METHODS: Two hundred eighty-four patients, examined by routine colonoscopy after resection for colorectal carcinoma, were reviewed. Clinical and pathologic factors were assessed by multiple logistic regression analysis. RESULTS: One hundred eighty-three patients with synchronous adenoma or carcinoma at the initial operation had a significantly higher incidence of both metachronous adenoma and carcinoma than the 101 patients without a synchronous lesion. Other clinical factors including age, gender, tumor stage, tumor site, and tumor grade were not significant for an increased incidence of metachronous carcinoma. The presence of synchronous lesions proved to be the only risk factor (relative risk, 3.293; P = 0.0155) for developing metachronous carcinoma. Metachronous carcinoma was detected in 30 patients (10.6 percent) and completely removed from all patients. Mucosal carcinoma was found in 25 patients (8.8 percent) and invasive carcinoma in 5 patients (1.8 percent). All five invasive carcinomas were detected in asymptomatic patients having synchronous lesion. Four patients required a second operation for metachronous carcinoma more than 13 months following the first. CONCLUSION: The risk factor for developing metachronous carcinoma is the presence of synchronous adenoma or carcinoma at the initial operation. To detect metachronous carcinoma at a curable stage, annual colonoscopic surveillance should be performed for high-risk patients.

Adenoma↗