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PubMed2002

Primary CD56+ T/NK cell lymphoma of the colon.

Primary T/natural killer (NK) cell lymphoma of the colon is extremely rare. Despite the advances in histological and immunophenotypic studies, the diagnosis of primary T/NK cell lymphoma of the colon can be delayed because the early symptoms and colonoscopic findings may be very similar to those of inflammatory bowel diseases such an Crohn's colitis, and most physicians have little available information on this group of neoplasms. Moreover, florid nonspecific inflammatory infiltrates would not allow characterization of the tumor cells in such an inflammatory background. Herein, we describe a patient who initially presented with features that were clinically and colonoscopically similar to Crohn's colitis. Three months later, he had cecal bleeding and perforation, and primary T/NK cell lymphoma of the colon was diagnosed through immunophenotypic and genotypic studies of surgical specimens.

Adult↗
PubMed2004

Minilaparotomy approach for the resection of laterally spreading tumors of the colon.

PURPOSE: We report our experience of using the minimally invasive minilaparotomy approach to resect colonic laterally spreading tumors (LSTs) that could not be removed by colonoscopic snare polypectomy. METHODS: We prospectively examined 17 patients who underwent a minilaparotomy, defined as an incision less than 7 cm long, between 1997 and 2001, for a collective 19 colonic LSTs. RESULTS: Complete en bloc resection of the LSTs was successfully performed in all 17 patients. The resections included colotomy and polypectomy in four patients (four LSTs), limited colectomy in seven patients (nine LSTs), and colectomy with regional lymph node dissection in six patients (six LSTs). There was no mortality or morbidity. The mean +/- standard deviation (SD) length of the minilaparotomy was 6.7 (+/-0.8) cm, and the mean (+/-SD) operating time and blood loss were 139 (+/-39) min and 27 (+/-15) ml, respectively. Histology revealed 2 adenomas, 16 Tis carcinomas, and 1 T1 carcinoma. None of the patients had lymph node metastasis or positive resection margins. There have been no signs of tumor recurrence after a median follow-up period of 30.4 months. CONCLUSIONS: The minilaparotomy approach is appropriate for resecting LSTs that cannot be removed by colonoscopic snare polypectomy, and provides a minimally invasive alternative to conventional laparotomy.

Adenoma↗
PubMed2004

Advanced diagnostic tools: virtual colonoscopy and magnifying chromoendoscopy.

Early endoscopic diagnosis of colorectal cancers (CRCs) represents the best tool for the reduction of CRC mortality, but the conventional colonoscopic view seems unable to clarify faint changes of colorectal mucosa. For these reasons, during the last few decades, two new techniques have been developed in order to better define, diagnose and treat colorectal lesions: chromoendoscopy (CE) and magnifying chromoendoscopy (MC). The authors herein highlight the benefits of both and compare the results of conventional endoscopy and CE with 0.2% indigo carmine solution, evaluating 995 consecutive selected patients referred for colonoscopy between January 1999 and March 2003 at the International Health Union of Rome. CE showed new neoplastic patterns not detectable with conventional endoscopy in 102 patients (10.2%). The incidence of high-grade dysplasia and early carcinomas was 9.9% for protruded, 13.1% for flat and 60% for depressed lesions. Our comparative study on 995 consecutive selected patients confirmed the existence of flat and depressed neoplasms in Italy and shows the high accuracy rate of CE over conventional endoscopy for the detection of non-polypoid lesions. CE should be used routinely in order to enhance the early diagnosis of CRCs, while MC in experienced hands represents a significant advance in colonoscopic practice improving the diagnosis of every single lesion, enhancing therapeutic efficacy of colorectal tumours.

Colonography, Computed Tomographic↗
PubMed2005

Using the gastroscope for incomplete colonoscopy.

PURPOSE: Reports of virtual colonoscopy demonstrate sensitivity similar to that of conventional colonoscopy for polyps 5 mm or larger, suggesting the validity of its use for colorectal cancer screening. Critical to the success of either procedure is the ability to evaluate the entire colon. Cecal intubation rates during diagnostic or screening colonoscopies vary from 53 to 99 percent. We describe the added value of using a gastroscope to perform a colonoscopic examination that would otherwise result in an incomplete colonoscopy. METHODS: From January 1, 2002 to December 31, 2002 a total of 1,979 colonoscopies were performed. A gastroscope was used in 1.3 percent (n = 26) of these colonoscopies in an effort to complete the index examination initially started with a standard or pediatric colonoscope. The success rate was defined as intubating proximal to the initial area of impasse and entering the cecum. RESULTS: Cecal intubation was achieved in 62 percent of patients. CONCLUSIONS: In patients with incomplete conventional colonoscopy, the gastroscope can usually advance through the initial area of impasse with a cecal intubation rate of 62 percent.

Aged↗
PubMed2005

Failure of conservative management after the passage of a distal colonic "cast": report of a case.

PURPOSE: The spontaneous passage per rectum of a full-thickness colon "cast" is a rare consequence of acute colonic ischemia. Previous cases have undergone surgery soon afterward because of intractable symptoms. We report a patient who was managed conservatively for 11 months but ultimately required definitive surgery. METHODS: The clinical, radiographic, pathologic, and endoscopic findings were obtained from the case notes and compared with previously reported cases. RESULTS: A 67-year-old obese patient underwent a Hartmann's procedure for a perforated diverticular abscess, which was reversed six months later. On the first postoperative night after the reversal, she had a brief hypotensive episode, and three weeks later passed a 21-cm, full-thickness infarcted piece of colon. She did not develop peritonitis and for 11 months experienced only mild symptoms. Under colonoscopic surveillance, the granulation tissue conduit connecting the remaining viable bowel became increasingly stenosed proximally and difficult to dilate. After three rapidly consecutive episodes of large-bowel obstruction, she required a laparotomy to resect the stricture and restore bowel continuity. From a literature review, this is the eighth case of its kind and the first in which such prolonged conservative management has been possible. CONCLUSIONS: When symptoms permit, it is feasible to manage patients conservatively in the short-term after this unusual event to allow recovery from the initial insult and planning of future surgery. However, definitive treatment is surgical and colonoscopic management should not delay this once the patient is fit for surgery.

Aged↗
PubMed2005

Recurrent sigmoid volvulus in pregnancy: report of a case and review of the literature.

Intestinal obstruction caused by sigmoid volvulus is extremely rare during pregnancy; only 73 cases have been reported worldwide. A case report of recurrent sigmoid volvulus in a 22-year-old pregnant Saudi female and a review of the literature are presented. Despite a previous sigmoidopexy in another institution, colonoscopic detortion and rectal tube decompression was successful until after delivery when sigmoid colectomy was performed. From this case, we propose a treatment option based on the absence or presence of peritonitis and gestational age is suggested. In the first trimester, nonoperative procedure using colonoscopic detorsion and rectal tube decompression is recommended until the second trimester when sigmoid colectomy is performed for recurrent cases. In the third trimester, the treatment is nonoperative until fetal maturity and delivery when sigmoid colectomy is performed. Sigmoid volvulus complicating pregnancy is an uncommon and potentially serious condition and should be recognized as a surgical emergency. Prompt surgical intervention is necessary to minimize maternal and fetal morbidity and mortality.

Diagnosis, Differential↗
PubMed2006

Intangible costs and benefits of ulcerative colitis surveillance: a patient survey.

PURPOSE: Colonoscopic surveillance in ulcerative colitis has costs and benefits beyond cancer prevention, which might influence program efficacy. This study assesses the more intangible aspects of surveillance. METHOD: A questionnaire was sent to all patients on the St. Mark's colitis surveillance program. Data on quality of life (Euroqol-5D and Hospital Anxiety and Depression Scale), complications, and preferences for surveillance and information (Kranz Health Opinion Survey) were collated with demographics and surveillance history. RESULTS: Two hundred eighty-one of 329 patients (85.4 percent) responded. Median Euroqol score was 80. There were no perforations. Bleeding rate was 0.11 percent. No transfusions, endoscopic intervention, or surgeries were required. 24.0 percent were frightened before colonoscopies, correlating with anxiety (r = 0.25, P < 0.0001). 60.2 percent patients found colonoscopies comfortable; experienced colonoscopists caused less discomfort (r = 0.20, P = 0.0007). 83.8 percent patients thought they had received appropriate amounts of information. 97.8 percent patients believed surveillance important, 96.4 percent thought surveillance gave them reassurance, and 67.9 percent believed surveillance greatly reduced their cancer risk. Regarding cancer risk management, one-third of patients indicated they might not necessarily opt for surveillance in its current form. CONCLUSION: Colonoscopic surveillance is well tolerated with an extremely low complication rate. Patients have a good quality of life (although lower than the general population) and believe surveillance is important and reassuring. However, many are anxious before their colonoscopy. The majority are happy with information quantity and quality, although none thought they received too much. Not all patients would necessarily opt for surveillance in its current form, and we must be willing to individualize cancer risk management to comply with patient preferences.

Adult↗
PubMedDate not supplied

Economic comparison of current endoscopic practices: Barrett's surveillance vs. ulcerative colitis surveillance vs. biopsy for sprue vs. biopsy for microscopic colitis.

Health care costs are an increasingly important study outcome. Endoscopic practice consumes a large proportion of gastroenterology-related health expenses. An economic comparison of several currently accepted endoscopic practices was performed, ranking them according their cost-effectiveness, as viewed from the payer perspective. The cost-effectiveness of four currently accepted standard endoscopic practices was examined: small bowel biopsy to assess for celiac sprue, colonoscopic biopsy to assess for microscopic colitis, surveillance of Barrett's esophagus, and surveillance of chronic ulcerative colitis (CUC). Parameter estimates were obtained from the published literature. Charges were based on Medicare professional plus facility/technical fees. Performing colonoscopic biopsies for microscopic colitis in the setting of chronic nonbloody diarrhea was the most cost-effective practice ($2447/case detected), while small bowel biopsy for sprue in the setting of a patient with a first-degree relative with sprue ($3042/case detected) or with anemia ($2982/case detected) was also a cost-effective approach. Small bowel biopsy in the setting of diarrhea ($3900/case detected) was less cost-effective, while CUC surveillance ($14,119/detection of dysplasia) and performance of small bowel biopsy in an asymptomatic patient ($15,209/case detected) were clearly the least economical. As efforts are made to reduce the costs of health care, more attention will be focused on the cost-effectiveness of routine endoscopic practices. Although, our findings put endoscopic practices into economic perspective, future perspective, future prospective trials are required to confirm the validity of these findings.

Barrett Esophagus↗
PubMed1999

Malignant Colorectal Polyps.

When a patient undergoes colonoscopic resection of a colorectal polyp found to contain invasive cancer, I carefully analyze a number of pathologic and clinical features of the case to formulate an effective management plan. I usually consider colonoscopic treatment alone to be definitive therapy when the malignant polyp has favorable prognostic features. I find that the risk of residual colonic cancer or lymph node metastases usually is less than the risk of further cancer surgery when the polyp is considered to be completely resected by the endoscopist; and on pathologic examination, the resection margins are negative; and no evidence of vascular invasion, lymphatic invasion, or high-grade cancer exists. When unfavorable criteria are found and the patient is a good risk for surgery, I find that surgical resection of the involved colonic segment and draining lymphatic system usually is indicated. When formulating a management plan, I individualize treatment according to the location of the malignant polyp, risk of surgery, and wishes of an informed patient. I urge patients to adopt a healthy diet and lifestyle to reduce the risk of colorectal neoplasia. I cannot make specific recommendations for preventive dietary supplements such as vitamins, minerals, or drugs such as aspirin because efficacy and risk-benefit chemopreventive trials are ongoing.

Journal Article↗
PubMed1983

Colonoscopy: an essential monitoring technique after resection of colorectal cancer.

A pilot study was undertaken to determine the usefulness of colonoscopy in the postoperative follow-up of patients with colorectal cancer. Of 56 patients, 9 (17 percent) had positive intraluminal examinations, including one recurrent cancer and three large polyps (greater than 1 cm) despite normal barium enema films. Twenty percent had negative colonoscopic findings which ruled out suspicious lesions on roentgenograms. More than one third had alterations in therapy as a result of colonoscopic examination. Colonoscopy is a useful and fruitful diagnostic aid in the follow-up of colon cancer. It should be used early in the postoperative period and added at rational intervals in long-term surveillance. It appears to complement other accepted methods of detecting recurrence.

Adenoma↗
PubMed1988

Cholangiopancreatography, sphincterotomy, and common duct stone removal via Roux-en-Y limb enteroscopy.

An enteroscopic method that uses a pediatric colonoscope provides an alternative approach to the diagnostic and management problems arising in the setting of a Roux-en-Y limb hepaticojejunostomy or biliary diversion. Three patients with Roux-en-Y limb reconstructions who experienced recurrent cholangitis, recurrent pancreatitis, or choledocholithiasis in whom the technique was used are presented. The technique, which uses colonoscopic principles, is discussed along with the combined use of percutaneous transhepatic assistance. Enteroscopy of a Roux-en-Y limb is technically feasible and expands the diagnostic and management approach to biliary and pancreatic disease involving this postoperative anatomic condition.

Adult↗
PubMed1990

Clinical, biological, and endoscopic picture of attacks of Crohn's disease. Evolution on prednisolone. Groupe d'Etude Thérapeutique des Affections Inflammatoires Digestives.

One hundred forty-two patients with active colonic or ileocolonic Crohn's disease were included in a multicenter prospective study. Data collection included 28 clinical, biological, and endoscopic items; the latter were recorded according to a standardized colonoscopic protocol; a previously validated endoscopic index of severity was calculated. Oral prednisolone (1 mg/kg body wt per day) was started and maintained until clinical remission and for at least 3 and at most 7 wk. A second clinical biological and endoscopic evaluation was then performed. At initial colonoscopy, mucosal lesions were, by decreasing order of frequency, superficial ulcerations, deep ulcerations, mucosal edema, erythema, pseudopolyps, aphthoid ulcers, ulcerated stenosis, and nonulcerated stenosis (93%, 74%, 48%, 44%, 41%, 35%, 10%, 8%, and 2% of cases, respectively). No correlation was found between the clinical activity index and any of the endoscopical data (lesion frequency and surface, endoscopic severity index). Ninety-two percent of patients underwent clinical remission within 7 wk of treatment. None of the 28 clinical biological and endoscopical items collected just before treatment could predict clinical response to steroids. Only 38 of the 131 patients in clinical remission were also in endoscopic remission. In conclusion, (a) the description and severity of colonoscopic lesions in active Crohn's disease have been quantified; (b) no correlation exists between clinical severity and nature, surface, or severity of endoscopic lesions; (c) Oral prednisolone (1 mg/kg body wt per day) induces a clinical remission in 92% of patients within 7 wk; (d) resistance to steroids cannot be predicted from the data collected before treatment onset; and (e) only 29% of patients in clinical remission also achieve endoscopic remission.

Adult↗
PubMed1991

Portal colopathy: prospective study of colonoscopy in patients with portal hypertension.

Twenty patients with portal hypertension related to a variety of causes prospectively underwent colonoscopy for hematochezia (n = 10), hemoccult positive stool and anemia (n = 9), or polyp found with screening flexible sigmoidoscopy (n = 2) (includes 1 patient with anemia/heme-positive stool). Twelve patients (60%) had previously undergone a course of sclerotherapy, and 10 (50%) had endoscopic evidence of congestive gastropathy. Colonoscopic findings included mucosal abnormalities resembling multiple vascular ectasias in 14 (70%), 4 of whom also had endoscopic features suggesting a mild, chronic colitis. Neither signs of chronic liver disease nor stigmata suggestive of more severe portal hypertension correlated with the colonoscopic findings. Two patients required heater probe therapy for actively oozing lesions resembling vascular ectasias and an additional two patients sclerotherapy for bleeding midrectal varices. Although likely an overestimate of the frequency, this study suggests that portal colopathy can occur in portal hypertension. Vascular ectasialike lesions in such settings may be associated with acute as well as chronic gastrointestinal bleeding and may require pharmacological, directed endoscopic, or portal decompressive therapy. Additional studies are required to determine not only the pathophysiology but also the true frequency of this entity.

Capillaries↗
PubMed1984

Cancer surveillance after ureterosigmoidostomy: colonic microscopic changes.

Ureterosigmoidostomy (U-S) is a procedure for diversion of the urinary stream. U-S is associated with a manyfold-increased risk for subsequent development of colonic carcinoma close to the sites of ureteral entry into the sigmoid colon. A surveillance program for colonic carcinomas in U-S patients includes colonoscopic examination of the colon to at least 60 cm and random biopsies of the sigmoid colon distal to the ureteral orifices. In eight patients, a change from sulphomucin to a variable admixture with sialomucin was found in the histologically unremarkable colonic mucosae. When the urinary stream was shunted away from the U-S site in two patients, the mucosal mucin was composed of sulphomucin which is present in normal sigmoid colons. The effect of urine admixed with feces in the sigmoid colon is nonspecific as judged by alterations of the mucosal mucin composition. The U-S patient deserves periodic examinations to detect colonic carcinoma but the histological examination of colonoscopically unremarkable mucosae is not currently contributory toward this surveillance effort.

Adult↗
PubMed1995

Levels of p53 antigen in the plasma of patients with adenomas and carcinomas of the colon.

Plasma levels of p53 protein were examined by an enzyme linked immunosorbent assay in 184 patients enrolled in a colonoscopy study. The mean levels among 47 individuals with normal colonoscopic examinations and no prior history of colonic neoplasia (0.12 ng/ml) and among 61 individuals with normal colonoscopic examinations and a prior history of colonic neoplasia (0.09 ng/ml) were similar. However, the mean levels among 54 individuals with newly diagnosed colonic adenomas (0.44 ng/ml) and 22 individuals with newly diagnosed colonic carcinomas (0.55 ng/ml) were statistically significantly elevated compared to the normal controls (P < 0.02). Among these tumor patients, the plasma levels tended to increase with increasing adenoma size and with increasing carcinoma stage, although these trends were not statistically significant. Defining a significant positive plasma level as any value greater than ten times background, the percentage of positive samples increased from 4% in the controls to 20% in the adenoma cases to 32% in the carcinoma cases. These results demonstrate that plasma p53 protein levels are elevated in a subgroup of individuals with colonic neoplasia.

Adenoma↗
PubMed2006

Aberrant crypt foci in patients with a positive family history of sporadic colorectal cancer.

Early detection is crucial in the prevention of colorectal cancer (CRC) deaths. The earliest detectable neoplastic lesion in the colon is the aberrant crypt foci (ACF). A major question is whether ACF are precursors of CRC, and thus, early biomarkers for CRC risk. If so, we hypothesized that the number of ACF would be higher in patients who had a family history of CRC compared to patients without. We counted ACF in the distal 20cm of colon/rectum during 103 colonoscopic examinations using a prototype Close Focus Colonoscope (Olympus Corp.) with methylene blue chromendoscopy. Each patient was asked whether they had a family history of CRC in a first degree relative, or a personal history of CRC or adenoma. Patients answering 'no' to these questions (n=17) had a mean number of ACF of 4.4; the mean was significantly higher in the patients with a positive family history of CRC (9.0, p<0.01; n=43) or a personal history of advanced adenoma (7.5, p<0.05; n=34).

Adenocarcinoma↗
PubMedDate not supplied

Bowel wall enhancement in magnetic resonance colonography for assessing activity in Crohn's disease.

BACKGROUND: This study focuses on the correlation of the signal intensity (SI) of the bowel wall in magnetic resonance (MR) colonography with the inflammation activity in Crohn's disease. MATERIAL AND METHODS: We performed MR colonography in 42 patients and compared the change of the SI of the bowel wall (T1-weighted/paramagnetic contrast medium) with colonoscopic findings. RESULTS: Change of the SI and colonoscopically assessed inflammatory activity are significantly correlated (r=.676, P<or=.01). CONCLUSION: The degree of the contrast enhancement of the bowel wall may be a criterion for the degree of inflammation in Crohn's disease.

Adult↗
PubMed2007

CT colonography: automatic measurement of polyp diameter compared with manual assessment - an in-vivo study.

AIM: To investigate whether automated diameter assessment was feasible for CT colonography. MATERIALS AND METHODS: Two experienced observers independently measured the maximum diameter of 50 polyps (colonoscopic reference size range 5-12 mm) from colonography datasets using conventionally placed software callipers and a variety of two-dimensional (2D) computed tomography (CT) window settings (colon, abdominal, bone, lung), and also three-dimensional (3D) perspective rendering. Polyps were also measured using automated polyp-segmentation software. Agreement between observers and with the colonoscopic reference measurement was determined using Bland-Altman, Wilcoxon, and Mann-Whitney U analyses. RESULTS: Inter-observer agreement was similar for all window displays: mean difference in millimetres (SD difference; 95% limits of agreement) ranged from 0 (1.7, -3.3, 3.3) for 2D colon to -1.1mm (1.6, -4.3, 2.0) for 3D, compared with -0.5 (2.09, -4.6, 3.6) for automated measurement. When compared to colonoscopy, the largest discrepancy occurred using the 3D display (mean difference 1.3mm, 2.5mm for each observer). There was also a significant difference between estimates and reference size when using the 2D abdominal and 3D displays (p=0.03, <0.001). CONCLUSION: Automated polyp measurement is possible in vivo. Automated and conventional methods have comparable inter-observer agreement. The greatest measurement error is encountered when using a 3D display for estimates of diameter.

Colon↗