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At least 1,027 records · Page 57Linked to original sources
PubMed2003

Progression of flat low-grade dysplasia to advanced neoplasia in patients with ulcerative colitis.

BACKGROUND & AIMS: Long-standing ulcerative colitis has long been recognized as a risk factor for colorectal cancer, but there is still no universal consensus on the optimal management of ulcerative colitis patients with low-grade dysplasia in flat mucosa. Some authorities favor prompt colectomy, whereas others recommend continued surveillance. The purpose of our study was to determine the frequency with which flat low-grade dysplasia in ulcerative colitis progresses to advanced neoplasia (high-grade dysplasia or colorectal cancer) and whether specific variables could predict such progression. METHODS: We reviewed the medical histories, colonoscopic findings, and surgical and pathology reports of 46 patients with ulcerative colitis diagnosed with flat low-grade dysplasia on a surveillance colonoscopy. The rates of neoplastic progression, as well as the frequency of advanced neoplasia, were tabulated. We correlated progression with several clinical and colonoscopic variables: the number of biopsy samples positive for flat low-grade dysplasia, the duration and anatomic extent of disease, patient age, and medication use. RESULTS: Among these 46 patients, there were 7 cases of colorectal cancer, 5 of which were stage II or higher. Unexpected advanced neoplasia occurred in 4 of 17 (23.5%) patients who underwent colectomy for flat low-grade dysplasia. On an actuarial basis, the rate of neoplastic progression was 53% at 5 years. No clinical features predicted progression to advanced neoplasia. Cancers, including 2 at advanced stages, developed despite frequent follow-up surveillance examinations. CONCLUSIONS: A finding of flat low-grade dysplasia during ulcerative colitis surveillance is a strong predictor of progression to advanced neoplasia. Early colectomy should be recommended for such patients.

Actuarial Analysis↗
PubMed2006

The endoscopic transilluminator: an endoscopic device for identification of the proximal jejunum for transgastric endoscopic gastrojejunostomy.

BACKGROUND: Localization of the proximal jejunum is important for creation of gastrojejunal anastomosis to palliate gastric outlet obstruction or for treatment of obesity with gastric bypass. OBJECTIVE: To facilitate identification of the proximal jejunum during transgastric endoscopic gastrojejunostomy with the use of an endoscopic transilluminator (ET). DESIGN AND SETTING: Acute experiments in a live porcine model. INTERVENTIONS: The ET is a 3500-mm long, 6F radio-opaque tube with a fiberoptic core that lights up at its distal end. When situated in the intestinal lumen, it transilluminates the bowel wall. With the animal under general anesthesia with endotracheal intubation, a colonoscope was advanced to the proximal jejunum. A plastic tube (3500-mm long, 3.5 mm in diameter) was passed through the biopsy channel and placed into the small bowel. The colonoscope was withdrawn, leaving the tube in place. The ET was introduced into the jejunum through the tube. A gastric wall incision was made and the endoscope was advanced to the peritoneal cavity. The transilluminated loop of the proximal jejunum was identified and gastrojejunal anastomosis was made by use of a previously reported endoscopic technique. MAIN OUTCOME MEASUREMENTS: Identification of the proximal jejunum. RESULTS: Eleven pigs (average weight 55 kg) had ET placement. In all of the pigs, placement of the ET was performed easily to the proximal small bowel, and the proximal jejunum was successfully localized by either direct visualization of the transilluminated loop only or with the aid of fluoroscopy. The tip of the ET was usually located about 50 to 70 cm distal to the ligament of Treitz. There were no complications related to the use of ET. LIMITATIONS: The device has not yet been evaluated in humans. CONCLUSIONS: The ET is a safe instrument and can be used to identify the proximal jejunum to facilitate endoscopic gastrojejunostomy.

Animals↗
PubMed2005

Laparoscopic repair of colon perforation after colonoscopy in children: report of 2 cases and review of the literature.

Perforation of the colon is an uncommon complication of colonoscopy in children. In the past, such injuries were treated by laparotomy with primary repair or colostomy. We performed laparoscopic primary repair of the colon in 2 young boys who showed signs of bowel perforation after colonoscopic polypectomy. Both recovered uneventfully and were discharged within several days of admission. In the first patient, the colon had been well prepared, and the perforation was identified almost immediately, resulting in minimal peritoneal contamination. The second patient presented 48 hours after colonoscopy, but there was no gross fecal contamination. In each case, primary repair was felt to be a safe option. Laparoscopic primary repair of colon perforation after colonoscopic polypectomy in children appears to be safe and effective in selected cases. Advantages of the minimally invasive approach include the ability to evaluate the entire colon for injuries, more rapid postoperative recovery, and improved cosmesis.

Child, Preschool↗
PubMed2004

Living related donor liver transplantation for primary sclerosing cholangitis with hepatocellular carcinoma and Crohn's disease: a case report.

INTRODUCTION: Primary sclerosing cholangitis (PSC) is a premalignant condition associated with a risk of developing cholangiocarcinoma in 10% to 20% of patients. However, the prevalence of hepatocellular carcinoma (HCC) in patients with PSC is estimated to be only 2%. In addition, PSC often occurs in association with inflammatory bowel disease. Ulcerative colitis occurs in 60% of PSC patients and Crohn's disease occurs in about 10%. We diagnosed a patient as having PSC with HCC and concomitant Crohn's disease prior to living related donor liver transplantation (LRDLT). PATIENTS AND METHODS: A 63-year-old woman was diagnosed as having PSC with solitary HCC. Preoperative liver condition was Child-Pugh grade C. Colonoscopic findings showed an active longitudinal ulcer in the terminal ileum and clinically diagnosed Crohn's disease. The medical treatment was 5'-aminosalicylates. She received a left lobe graft from her daughter. The immunosuppressants were tacrolimus and azathioprine, which was changed to predonisolone because of leukopenia and moderate acute cellular rejection, after which the postoperative course was uneventful. Colonoscopic findings revealed disappearance of the longitudinal ulcer in the terminal ileum at 15 months after LRDLT. There was no evidence of PSC or HCC recurrence. CONCLUSIONS: Generally, PSC with HCC is rare with a poor prognosis; however, LRDLT may be a treatments option although the patient with PSC had a combined HCC. Moreover, aminosalicylates together with the immunosuppressants may be effective for the clinical management of concomitant Crohn's disease.

Cholangitis, Sclerosing↗
PubMed2001

Which colon cancer screening test? A comparison of costs, effectiveness, and compliance.

PURPOSE: Recent media reports have advocated the use of colonoscopy for colorectal cancer screening. However, colonoscopy is expensive compared with other screening modalities, such as fecal occult blood testing and flexible sigmoidoscopy. We sought to determine the cost effectiveness of different screening strategies for colorectal cancer at levels of compliance likely to be achieved in clinical practice. METHODS: A Markov decision model was used to examine screening strategies, including fecal occult blood testing alone, fecal occult blood testing combined with flexible sigmoidoscopy, flexible sigmoidoscopy alone, and colonoscopy. The timing and frequency of screening was varied to assess optimal screening intervals. Sensitivity analyses were conducted to assess the factors that have the greatest effect on the cost effectiveness of screening. RESULTS: All strategies are cost effective versus no screening, at less than $20,000 per life-year saved. Direct comparison suggests that the most effective strategies are twice-lifetime colonoscopy and flexible sigmoidoscopy combined with fecal occult blood testing. Assuming perfect compliance, flexible sigmoidoscopy combined with fecal occult blood testing is slightly more effective than twice-lifetime colonoscopy (at ages 50 and 60 years) but is substantially more expensive, with an incremental cost effectiveness of $390,000 per additional life-year saved. However, compliance with primary screening tests and colonoscopic follow-up for polyps affect screening decisions. Colonoscopy at ages 50 and 60 years is the preferred test regardless of compliance with the primary screening test. However, if follow-up colonoscopy for polyps is less than 75%, then even once-lifetime colonoscopy is preferred over most combinations of flexible sigmoidoscopy and fecal occult blood testing. Costs of colonoscopy and proportion of cancer arising from polyps also affect cost effectiveness. CONCLUSIONS: Colonoscopic screening for colorectal cancer appears preferable to current screening recommendations. Screening recommendations should be tailored to the compliance levels achievable in different practice settings.

Aged↗
PubMed1999

Pathologic risk factors of occult malignancy in endoscopically unresectable colonic adenomas.

BACKGROUND: With the advent of new endoscopic and laparoscopic techniques, the likelihood of colonoscopically unresectable adenomas harboring occult malignancy influences management. While prior studies have evaluated polyp size and morphology in assessing the risk of malignancy, the relative risk of cancer based on the presence or absence of high-grade dysplasia has not been systematically studied. METHODS: For all lesions preoperatively diagnosed as adenomas without invasive cancer, multivariate logistic regression analysis was performed to elicit independent variables associated with malignancy in the resected specimen. RESULTS: One hundred patients underwent a colectomy for preoperatively diagnosed adenomatous lesions. Multivariate logistic regression analysis revealed size, degree of dysplasia, and left-sided location to be independent predictors of malignancy. CONCLUSIONS: In colonic adenomas which are not amenable to simple colonoscopic resection, the most useful predictors of the lesion harboring a malignancy are polyp size and the presence of high-grade dysplasia, and these factors can help determine management.

Adenoma↗
PubMed1986

Colonic dysfunction during cholera infection.

To study the function of the colon in cholera, 12 patients with acute cholera diarrhea were subjected to measurements of ileocecal flow rates, fecal flow rates, and ionic compositions of stool and ileocecal fluid. Subtraction of fecal flow rates from ileocecal flow rates was taken as a measure of net fluid absorption by the colon. Additionally, these patients underwent colonoscopic perfusion of the colon that measured net colonic absorption rates of water and ions. The mean ileocecal flow rate was 7.9 ml/min compared with a mean fecal flow rate of 7.6 ml/min, indicating a small mean net fluid absorption by the colon of +0.30 ml/min. By colonoscopic perfusion, 6 patients showed net colonic absorption of water and 6 patients net secretion of water with a slight mean net fluid secretion of -0.03 ml/min. The handling of ions by the colon showed mean net absorption of sodium (100 mu Eq/min) and chloride (127 mu Eq/min), and net secretions of potassium (-42 mu Eq/min) and bicarbonate (-112 mu Eq/min). During convalescence, 5 patients who were studied again all showed net colonic absorption of water, and the handling of potassium changed significantly from net secretion in acute disease to net absorption (p less than 0.05). These results showed that the colon contributes to the clinical expression of cholera by failing to absorb water normally, and by secreting potassium at high rates.

Adult↗
PubMed1998

Association between intraepithelial Escherichia coli and colorectal cancer.

BACKGROUND & AIMS: Although multiple studies have focused on Helicobacter pylori, little is known about the mucosa-associated flora of the colon. The aim of this study was to detect bacteria directly in colonic mucosa from patients screened for colorectal cancer. METHODS: Bacteria were quantified with the polymerase chain reaction and identified by comparative sequence analysis in colonoscopic biopsy specimens from 31 asymptomatic and 34 symptomatic controls with normal colonoscopic findings, 29 patients with colonic adenoma, and 31 patients with colorectal carcinoma. In 41 patients, intra- and extracellular location of bacteria was confirmed with the gentamicin protection assay. RESULTS: No bacteria were detected in biopsy specimens from 97% of asymptomatic and 69% of symptomatic controls. In contrast, bacterial concentrations of 10(3)-10(5) colony-forming units per microliter were detected in biopsy specimens from both malignant and macroscopically normal tissue in 90% and 93% of patients with adenoma and carcinoma, respectively. E. coli and coli-like bacteria were shown to colonize the colonic mucosa in 82% of these patients. The gentamicin protection assay indicated that E. coli was partially intracellular in 87% of patients with adenoma and carcinoma and in none of the controls. CONCLUSIONS: The colonic mucosa of patients with colorectal carcinoma but not normal colonic mucosa is colonized by intracellular E. coli.

Adenoma↗
PubMed2004

A prospective evaluation of high-magnification chromoscopic colonoscopy in predicting completeness of EMR.

BACKGROUND: EMR is used to treat flat and sessile lesions in the colon. The aim of this study was to prospectively assess the efficacy of high-magnification chromoscopic colonoscopy in predicting complete resection margins after EMR. METHODS: A total of 1250 patients underwent colonoscopy by using a magnifying colonoscope. Chromoscopy with indigo carmine and crystal violet dye solutions was used to assess mucosal pit patterns. EMR was performed by using the saline solution inject-and-cut technique. After EMR, resection margins were inspected by using high magnification, and completeness of excision was predicted from the surface pit pattern. This was compared with completeness of excision as determined histopathologically. RESULTS: A total of 684 lesions were treated by EMR (62 piecemeal) in 602 patients. The sensitivity of high-magnification chromoscopic colonoscopy for predicting remnant tissue in the lateral margins and the deep margins were, respectively, 79% and 80%. Specificity for both margins was 97%. The overall accuracy of high-magnification chromoscopic colonoscopy in predicting incomplete resection after EMR in the lateral axis and the deep axis was, respectively, 93% and 95%, where the true respective fractions of incomplete resections were 17% and 10%. Of the single en bloc EMRs performed, 77 (12%) had histopathologic evidence of incomplete resection in either axis, compared with 60 (97%) of the 62 piecemeal resections. Piecemeal resection was more likely to result in incomplete resection compared with en bloc EMR (p < 0.001). Complete resection by EMR was more likely if the lesion was sessile instead of flat (p < 0.001). CONCLUSIONS: High-magnification chromoscopic colonoscopy as an in vivo modality for prediction of remnant tissue after EMR has a high overall accuracy, but further studies assessing long-term outcome and cost-effectiveness compared with conventional colonoscopic techniques are required.

Adenoma↗
PubMed2004

Most dysplasia in ulcerative colitis is visible at colonoscopy.

BACKGROUND: Patients with long-standing extensive ulcerative colitis are at increased risk for colorectal carcinoma. Because most dysplasia is believed to be macroscopically invisible, recommended surveillance protocols include multiple non-targeted colonic biopsies. It was hypothesized by us that most dysplasia is actually colonoscopically visible. This study assessed the proportion of dysplasia that has been detected macroscopically in patients who underwent colonoscopy surveillance at our center. METHODS: A retrospective review was conducted of colonoscopically detected neoplasia (dysplasia or cancer) in patients with ulcerative colitis who underwent surveillance from 1988 through 2002. An established surveillance protocol was used in all cases that included random segmental biopsies every 10 cm throughout the length of the colon, in addition to targeted biopsies of macroscopic lesions. Neoplasia detection was categorized as resulting from either targeted or non-targeted ("random") biopsies. Follow-up information was obtained to the study end. RESULTS: A total of 525 patients underwent 2204 surveillance colonoscopies. A total of 110 neoplastic areas were detected in 56 patients: 85 (77.3%) were macroscopically visible at colonoscopy, and 25 (22.7%) were macroscopically invisible. Fifty patients (89.3%) had macroscopically detectable neoplasia, and 6 (10.7%) had macroscopically invisible lesions. The frequency of cancer in patients who had endoscopic resection of neoplasia did not differ from that for the surveillance population as a whole (1/40 vs. 18/525; p=1.0, Fisher exact test), irrespective of whether the lesion was thought to be an adenoma or a dysplasia-associated lesion/mass. Conversely, a high proportion of unresectable lesions harbored cancer. CONCLUSIONS: Most dysplastic lesions in ulcerative colitis are visible at colonoscopy. From a clinical perspective, the endoscopic resectability of a lesion is more important than whether it is thought to be a sporadic adenoma or a dysplasia-associated lesion/mass.

Adenoma, Villous↗
PubMed2004

Safety, efficacy, and patient tolerance of a three-dose regimen of orally administered aqueous sodium phosphate for colonic cleansing before colonoscopy.

BACKGROUND: Sodium phosphate, administered orally, is an effective, well-tolerated colonic cleansing agent. However, colonoscopic visualization is suboptimal in many patients after a conventional 2-dose regimen. This study assessed the safety, the efficacy, and patient tolerance of a 3-dose regimen of sodium phosphate. METHODS: Patients without cardiac, renal, or hepatic insufficiency were randomized to precolonoscopy purgation with 3 (45 mL) doses vs. two doses of aqueous sodium phosphate administered orally. Hemodynamic measurements and serum and urine biochemical tests were obtained at baseline and after purgation. Tolerance of the bowel preparation and colonoscopic visualization were assessed via questionnaires. RESULTS: Quality of colonic cleansing was significantly better with the 3-dose regimen compared with the 2-dose regimen (p < 0.0001). No clinically significant adverse event was detected in either group. Subclinical orthostasis was observed in 5% of patients given the 2-dose regimen vs. 3% of those who took the 3-dose regimen. Post-purgation hyperphosphatemia was greater in the 3-dose group vs. the 2-dose group (p = 0.0003). No other significant differences in biochemistry were noted between the groups. Patient tolerance of the 2-dose regimen was better than the 3-dose regimen (p = 0.0379). CONCLUSIONS: A 3-dose regimen of orally administered sodium phosphate provides superior colonic cleansing without compromising volume status or serum biochemistry but is associated with poorer overall patient tolerance compared with a conventional 2-dose regimen.

Administration, Oral↗
PubMed2004

Safety and efficacy of colonoscopy after myocardial infarction: an analysis of 100 study patients and 100 control patients at two tertiary cardiac referral hospitals.

BACKGROUND: The purpose of this study is to analyze the risks vs. the benefits of colonoscopy soon after myocardial infarction. METHODS: A total of 100 consecutive patients undergoing colonoscopy within 30 days after myocardial infarction at two large tertiary cardiac referral hospitals were studied. The study group was compared with 100 control patients with neither myocardial infarction nor unstable angina during the preceding 6 months (matched for age, colonoscopy indication, and colonoscopist) who underwent colonoscopy. RESULTS: Indications for colonoscopy were bleeding per rectum (37 patients), fecal occult blood (36 patients, hematocrit < 30% in 25), iron deficiency anemia (11 patients, hematocrit < 25% in 9), and other (16 patients). Colonoscopy was performed at a mean of 15.5 (8.3) days after myocardial infarction. Two patients underwent colonoscopic colonic decompression. Colonoscopy was diagnostic in 46 (47%) of the study patients vs. 41% of the control patients ( p = 0.47, chi-square test). The relative rate of ischemic colitis was significantly higher in study vs. control patients (14 vs. 2, p < 0.005). Other diagnoses in study patients were the following: colon cancer (8), bleeding internal hemorrhoids (5), pseudomembranous colitis (5), high-risk adenomatous polyp (large or villous histopathology) (4), and other (10). Urgent colonoscopy was diagnostic in 63% of cases. Twenty-three patients had a major therapeutic benefit consequent to colonoscopy, including colon cancer surgery in 5. Study patients were significantly sicker than control patients (APACHE II score 9.9 [4.3] vs. 7.4 [2.8], p < 0.0001) and suffered significantly more colonoscopic complications compared with control patients (9 vs. 1; OR 5.2: 95% CI [1.2, 9.8], p < 0.03). Minor complications without clinical sequelae occurred in 8 study patients (asymptomatic hypotension or bradycardia). One major complication occurred in this group that was probably not procedure related. CONCLUSIONS: Colonoscopy in patients with a recent myocardial infarction is associated with a higher rate of minor, transient, and primarily cardiovascular complications compared with control patients but is relatively infrequently associated with major complications. Colonoscopy is beneficial and indicated after myocardial infarction, despite a higher risk, in certain circumstances. The relative frequency of ischemic colitis was relatively high in study patients.

APACHE↗
PubMedDate not supplied

Endoscopic resection of large sessile colorectal polyps.

Colonoscopic removal of large, sessile polyps is difficult, but can be successfully carried out by experienced endoscopists. "Piecemeal" resection with an electrocautery snare was performed at our institution in 108 patients with 132 such lesions. The mean size of the unresected polyps was 3.0 cm. Complications occurred in 3.0% of polypectomies (3.8% of patients), with bleeding necessitating transfusion in 2.3% of polypectomies (2.8% of patients), and microperforation (probable) in the remainder. No patient required emergency surgery due to a complication. In 65 patients (60%), colonoscopic resection and follow-up alone was carried out. Of these, adenomas recurred/persisted in 28%, most of which were successfully re-resected. Nearly half of all recurrent polyps occurred after at least one negative intervening examination. Carcinoma later appeared in 17% of the recurrences despite apparent initial complete resection of a previously benign polyp. Cure was ultimately achieved in 88% of endoscopically managed patients. Surgical resection was required in 27% of patients, mostly following the initial polypectomy when invasive carcinoma was found in the specimen. No residual tumor was later found in 41% of the colon specimens from these patients. Ninety-one percent of cancers were favorable stage, whether discovered early or late. Follow-up colonoscopy was achieved in 77% of patients over an average of 3.7 years. Metachronous polyps were excised in 52 patients (63%) and metachronous carcinoma was diagnosed in 3 patients (3.6%). An aggressive regimen of surveillance colonoscopy is warranted in these patients to detect and manage local recurrences and to remove subsequent adenomas. Endoscopic resection of large sessile adenomas can be safe and effective.

Aged↗
PubMedDate not supplied

Endoscopic diagnosis of segmental colonic tuberculosis.

We report colonoscopic findings in 29 proven cases of segmental colonic tuberculosis. The colonoscopic appearances of tuberculosis included: mucosal nodules and ulcers, stricture with nodules and ulcerations, and mucosal nodules with or without pseudopolypoid folds. In 12 (41%) of 29 patients colonoscopy biopsies enabled a histologic diagnosis to be made on the basis of typical granulomas. Culture of biopsy tissue on Lowenstein Jensen media isolated Mycobacterium tuberculosis in six (40%) of 15 patients. Combined histologic and bacteriologic evaluation established the diagnosis in 60% of patients. We conclude that even though target biopsy is an effective method of diagnosis, anti-tuberculous chemotherapy may be started on the basis of the endoscopic appearance if there is a high clinical suspicion of tuberculosis.

Adult↗
PubMed1995

Does routine intravenous glucagon administration facilitate colonoscopy? A randomized trial.

BACKGROUND: Previous studies on the routine use of glucagon in colonoscopy have produced conflicting results. METHODS: Two separate studies were performed. In one study (Study 1), 80 consecutive patients were randomized after cecal intubation to receive 1 mg glucagon (n = 41) or placebo (n = 39), intravenously, in double-blind fashion. In a second study (Study 2) 90 sedated patients undergoing colonoscopy were randomized to receive 1 mg glucagon (n = 46) or placebo (n = 44), intravenously, just before colonoscope insertion. In each study, colonoscope insertion and withdrawal time, therapeutic intervention time, the presence and severity of colonic spasm, colonoscopy yield, and side effects were recorded. RESULTS: Mean withdrawal time in Study 1 was similar in those receiving glucagon (6.85 min) and in those receiving placebo (6.92 min). Mean insertion time in Study 2 (5.07 min) was identical between groups. Spasm scores and colonoscopy yield did not differ between glucagon and placebo in either study. There was a trend toward more side effects (nausea and vomiting) with glucagon in Study 1. Glucagon did not facilitate insertion or withdrawal in the subset of patients with diverticulosis. CONCLUSIONS: Routine use of intravenous glucagon in a dosage of 1 mg does not facilitate colonoscopy by experienced examiners.

Adult↗
PubMed1996

Diagnosis of colorectal tumorous lesions by magnifying endoscopy.

BACKGROUND: The magnifying colonoscope allows 100-fold magnified viewing of the colonic surface. METHODS: We examined 2050 colorectal tumorous lesions by magnifying endoscopy, stereomicroscopy, and histopathology and classified these lesions according to pit pattern. Based on stereomicroscopy, lesions with a type 1 or 2 pit pattern were nontumors, whereas lesions with types 3s, 3L, 4, and/or 5 pit patterns were neoplastic tumors. RESULTS: The pit patterns observed by magnifying endoscopy were fundamentally similar to those demonstrated in stereomicroscopic images. When the diagnosis by magnifying endoscopy was compared with the stereomicroscopic diagnosis, there was agreement in 1130 of 1387 lesions (81.5%). True neoplasms could be differentiated from non-neoplastic lesions. Of lesions with a type 5 pit pattern with a bounded surface, 11 of 22 (50%) were found to be invasive cancers with involvement of the submucosal layer. If this pit pattern is found to involve a relatively broad area of the mucosal surface, extensive malignant invasion (sm-massive) should be strongly suspected. CONCLUSIONS: The magnifying colonoscope provides an accurate instantaneous assessment of the histology of colorectal tumorous lesions. This may help in decision making during colonoscopy.

Adenoma↗
PubMed1999

In vivo identification of colonic dysplasia using fluorescence endoscopic imaging.

BACKGROUND: Previous in vitro studies showed that autofluorescence images of colonic mucosa collected endoscopically can be used to detect dysplasia with high sensitivity. This method is extended to the collection of fluorescence images of adenomatous polyps in vivo. METHODS: Fluorescence images were collected during colonoscopy in 30 patients. A total of 12 adenomatous and 6 hyperplastic polyps were identified. A fiberoptic excitation probe, located in the instrument channel of the colonoscope, delivered 300 mW of near-ultraviolet light at lambdaex = 351 and 364 nm. Mucosal fluorescence in the spectral bandwidth between 400 and 700 nm was imaged, processed, and displayed with various likelihoods of associated dysplasia. RESULTS: Adenomatous polyps exhibited decreased fluorescence intensity compared with adjacent mucosa with normal appearance. With the fluorescence threshold set to 80% of the average intensity of normal mucosa, a sensitivity of 83% for dysplasia identification was achieved. All hyperplastic polyps were correctly identified as being non-dysplastic. Optimal identification of dysplastic regions was obtained with the colonoscope oriented at a near-normal angle of incidence to the polyps. At higher angles of incidence, artifacts caused by illumination shadows were introduced. CONCLUSIONS: The dysplasia associated with adenomatous polyps can be identified in vivo by fluorescence imaging with high sensitivity, thus demonstrating the potential to guide endoscopic procurement of biopsy specimens.

Adenomatous Polyps↗
PubMed1999

Antimicrobial efficacy of endoscopic disinfection procedures: a controlled, multifactorial investigation.

BACKGROUND: Adequate disinfection of endoscopes is essential to prevent environmental and patient-to-patient transmission of infectious agents, but data from controlled studies are limited. Moreover, there is controversy regarding current guidelines for disinfection. We compared the antimicrobial efficacy of several endoscopic disinfection procedures controlling for multiple factors that affect reprocessing. METHODS: A colonoscope was contaminated with 10(8) CFU/mL of Enterococcus faecalis as a standardized inoculum. The colonoscope was passed through 1 of 16 study arms (5 reps/arm for a total of 80 runs) that were controlled for all possible combinations of the following variables: manual precleaning; 10-, 20-, or 45-minute glutaraldehyde exposure; air or ethanol drying; or automated reprocessing with peracetic acid (liquid sterilization system). Suction accessory channels and air-water channels were harvested for microbiologic culture. RESULTS: Control runs (no cleaning or disinfection) recovered more than 5 x 10(7) CFU/mL from each sampling site. When each processing variable was isolated independent of other variables, the benefits of manual precleaning, longer soak times, and ethanol drying were apparent. When factors were combined, manual precleaning followed by 20- and 45-minute glutaraldehyde exposure and ethanol drying removed all test organisms, as did processing with the liquid sterilization system. CONCLUSION: Although the initial cost is higher, the automated liquid sterilization system provides effective sterilization and minimizes worker exposure. In units where chemical disinfection is used, our results suggest that manual precleaning followed by at least 20-minute glutaraldehyde exposure and ethanol rinse drying are sufficient to achieve complete disinfection.

Colony Count, Microbial↗