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PubMed2003

Gasless video endoscopic transanal excision of rectal tumors incompletely removed by colonoscopic snare polypectomy.

BACKGROUND: This report describes an experience with gasless video transanal endoscopic microsurgery (VTEM) to excise rectal tumors previously incompletely removed with colonoscopic snare polypectomy. METHODS: Gasless VTEM involves a modification of transanal endoscopic microsurgery (TEM) that incorporates a standard laparoscopic video camera and requires no CO(2) insufflation system. Nineteen patients who had had a rectal tumor removed incompletely by colonoscopic polypectomy with a diathermy snare were enrolled in this prospective study. The patients included 14 men and 5 women whose median age was 63.5 (range, 49-83) years. The rectal tumors included 4 adenomas, 11 adenocarcinomas (Tis, 7; T1, 4), and 4 carcinoid tumors. The median distance from the tumor margin to the dentate line was 5.8 (range, 2.0-13.0) cm. RESULTS: All rectal lesions were successfully removed by gasless VTEM. No intraoperative complication occurred. The median operating time and blood loss were 40 (range, 15-145) minutes and 5 (range, 0-100) mL, respectively. The median maximal tumor diameter in 9 patients with residual tumors was 1.3 (range, 0.5-2.5) cm. There was no operative mortality. A postoperative complication (bleeding from a suture wound and transient incontinence) developed in 1 (5.3%) of the 19 patients. The median postoperative hospital stay was 5 (range, 2-10) days. Postoperative histology revealed a residual tumor in 10 (52.9%) of the 19 specimens. Complete excision of all tumors was confirmed histologically. During a median follow-up period of 59.5 (range, 12.3-94.9) months, no tumor recurred. CONCLUSIONS: Gasless VTEM is useful and minimally invasive for the local removal of rectal tumors incompletely resected by colonoscopic snare polypectomy.

Adenocarcinoma↗
PubMed2003

Variable stiffness colonoscopes: do they offer a better examination?

PURPOSE OF REVIEW: This review evaluates the most recent literature pertaining to variable stiffness colonoscopes in the context of previously published data. A total of 12 papers and abstracts were identified, 5 of which had appeared since April 2002, including 2 in abstract form. RECENT FINDINGS: The data on the impact of variable stiffness colonoscopes has been mixed with regard to cecal intubation rate, cecal insertion time, need for ancillary maneuvers, and patient acceptance. The literature suggests that variable stiffness may improve cecal intubation times among inexperienced examiners and patient acceptance during unsedated or mildly sedated colonoscopy. The only consistent finding appears to be a reduction in the need for ancillary maneuvers. SUMMARY: There is not yet any compelling evidence to support a dramatic improvement in technical performance of colonoscopy using variable stiffness colonoscopes.

Journal Article↗
PubMed1980

Fiberoptic colonoscopic examination in surgical patients with colorectal cancer.

A diagnostic and surveillance program using colonscopy in patients with colorectal cancer was established at North Carolina Memorial Hospital. The records of all patients who had preoperative or postoperative colonoscopic examination between 1976 and 1979 were reviewed. Fifty-five patients had colonscopic examination preoperatively. No additional disease was found in 39. In 15 patients, unsuspected additional disease was detected, and one patient had a suspected polyp ruled out by colonoscopic examination. One of these patients was found to have a synchronous primary cancer, not demonstrated by barium enema. Surgical treatment was modified in nine (16%) of these 55 patients by the preoperative colonoscopic findings. Sixty patients had colonoscopy six months to six years postoperatively. No additional disease was found in 47. Adenomatous polyps were found in eight. Two patients had recurrent cancer proved by colonoscopy, and three had a second primary cancer detected only by colonoscopy. Treatment was directly influenced by colonoscopy in eight (13.3%) of these 60 patients. These studies had a favorable cost/benefit ratio in patients with colorectal cancer and support a program of preoperative colonoscopy in patients with colorectal cancer and reexamination within two to three years after operation.

Colonic Neoplasms↗
PubMed2006

Adequacy of colonoscopic biopsy specimens for molecular analysis: a comparative study with colectomy tissue.

Molecular analyses of tumors are increasingly useful for prognosis and for guiding therapy. Colonoscopic biopsy provides the first source of tissue for most cases of colorectal carcinoma and therefore might become an important source for molecular analyses. We have addressed the question whether molecular analyses of colonoscopic biopsy yield results similar to the findings from the surgical specimen. Further, we analyzed 2 separate areas of the colectomy specimen to assess tumor heterogeneity. We evaluated 3 samples from each of 67 patients for point mutations in the KRAS gene, loss of heterozygosity (LOH) at the Adenomatous Polyposis Coli (APC) and Deleted in Colon Cancer (DCC) genes and for microsatellite instability (MSI) using polymerase chain reaction based techniques. The average time interval between biopsy and surgery was 2.2+/-0.15 weeks. Lesions were from all colon segments and all surgical stages. The degree of agreement between the biopsy and surgical sites was high for APC LOH, MSI, and KRAS mutations (kappa=0.85, 1.00, and 0.93, respectively) but less so for DCC LOH (kappa=0.62). Colonoscopic biopsies are an acceptable source of neoplastic DNA for studies of KRAS, APC LOH, and MSI, but less so for DCC LOH, primarily resulting from technical considerations.

Biopsy↗
PubMed2005

Prevention of colorectal cancer by colonoscopic surveillance in individuals with a family history of colorectal cancer: 16 year, prospective, follow-up study.

OBJECTIVE: To determine to what extent individuals with various family histories of colorectal cancer (from one to three or more affected first degree relatives) benefit from colonoscopic surveillance. DESIGN: Prospective, observational study of high risk families, followed up over 16 years. SETTING: Tertiary referral family cancer clinic in London. PARTICIPANTS: 1678 individuals from families registered with the clinic. Individuals were classified according to the strength of their family history: hereditary non-polyposis colorectal cancer (if they fulfilled the Amsterdam criteria), and one, two, or three affected first degree relatives (moderate risk). INTERVENTIONS: Colonoscopy was initially offered at five year intervals or three year intervals if an adenoma was detected. MAIN OUTCOME MEASURES: The incidence of adenomas with high risk pathological features or cancer. This was analysed by age, the extent of the family history, and findings on previous colonoscopies. The cohort was flagged for cancer and death. Incidence of colorectal cancer and mortality during over 15,000 person years of follow-up were compared with those expected in the absence of surveillance. RESULTS: High risk adenomas and cancer were most common in families with hereditary non-polyposis colorectal cancer (on initial colonoscopy 5.7% and 0.9%, respectively). In the families with moderate risk, these findings were particularly uncommon under age 45 (1.1% and 0%) and on follow-up colonoscopy if advanced neoplasia was absent initially (1.7% and 0.1%). The incidence of colorectal cancer was substantially lower-80% in families with moderate risk (P = 0.00004), and 43% in families with hereditary non-polyposis colorectal cancer (P = 0.06)-than the expected incidence in the absence of surveillance when the family history was taken into account. CONCLUSIONS: Colonoscopic surveillance reduces the risk of colorectal cancer in people with a strong family history. This study confirms that members of families with hereditary non-polyposis colorectal cancer require surveillance with short intervals. Individuals with a lesser family history may not require surveillance under age 45, and if advanced neoplasia is absent on initial colonoscopy, surveillance intervals may be lengthened. This would reduce the demand for colonoscopic surveillance.

Adult↗
PubMed2002

Preoperative colonoscopic derotation is beneficial in acute colonic volvulus.

AIMS: Analysis of preoperative and operative management of acute colonic volvulus and development of treatment guidelines in a region of low incidence. METHODS: A study of 42 consecutive patients operated for acute colonic volvulus between 1970 and 2000. RESULTS: There were 20 patients with sigmoid volvulus, 21 with cecal volvulus and 1 with volvulus of the transverse colon. All patients presented as emergencies. The correct preoperative diagnosis was possible for sigmoid volvulus in 95% (19/20) of cases and for cecal volvulus in 67% (14/21). Preoperative colonoscopic volvulus derotation was attempted in 19 patients and successfully completed in 9 patients (47%). The success rates for preoperative colonoscopic derotation were 58 (7/12) and 33% (2/6) for sigmoid and cecal volvulus, respectively. Thirty-four patients (81%) underwent colon resections, 26 times as a single-stage procedure, and 8 patients (19%) underwent non-resectional operative techniques. Overall surgical morbidity was 24%, the reoperation rate 9.5% and mortality 12% (5/42). The subgroup of 9 patients with successful non-operative volvulus derotation, however, underwent semi-elective single-stage colonic resection without surgical morbidity or mortality. There were no recurrences during a median follow-up period of 9.5 years. CONCLUSION: In the absence of clinical, laboratory or radiological signs of bowel necrosis or perforation, colonoscopic volvulus derotation is recommended in all cases of acute colonic volvulus, followed by semi-elective single-stage colonic resection.

Acute Disease↗
PubMed1981

Colonoscopic polypectomy.

Seven hundred and forty-one colonic polyps have been removed by colonoscopic polypectomy during 300 examinations. Up to 36 polyps were removed at a single examination. Colonoscopic treatment of villous adenomas to 7 cm has been successfully performed in elderly and infirm patients. There were no deaths or incidents of perforation and the only significant complications were two secondary haemorrhages requiring transfusion. The presence of a polyp was not definitely reported in 40% of barium enema X-ray examinations carried out within three months of polypectomy. Double contrast X-ray examinations were significantly more sensitive in the detection of polyps. Colonoscopic polypectomy is a safe and effective technique. All colonic polyps should be removed by this technique after diagnosis.

Adenoma↗
PubMed2005

[Approach to the lower gastrointestinal tract bleeding in patients with normal colonoscopic findings.].

BACKGROUND: Lower gastrointestinal bleeding is a commun clinical entity. Although colonoscopic examination is the first choice for diagnosis, it may not be enough to reveal the cause of bleeding in all subjects. METHODS: Eight patients who had massive lower gastrointestinal bleeding having normal colonoscopic findings were retrospectively evaluated at the Department of Trauma and Emergency Surgery, Istanbul University, Faculty of Medicine RESULTS: There were 5 male and 3 female patients with mean age of 51 (28 to 82). Patients received a mean of 13 U (range 2 to 23) with transfused erythrocyte concentrates. Four patients had found to be normal during angiographic, scintigraphy or enterocylytic examinations. Angiography was diagnostic in 4 patients, and identified bleeding from ileocolic pseudoaneurisms (n= 2) branches of jejunal artery (n=2). Embolization procedure were performed in these 4 patients and 3 of them developed intestinal necrosis and underwent surgery. One did not require further treatment. Two of the patients who underwent surgery expired due to sepsis. Patients were hospitalized for a mean of 17 days (range 5 to 37). CONCLUSION: Despite employment of all diagnostic procedures, the cause of bleeding were not detected in half of patients who had normal colonoscopic findings. If angiographic treatment is necessary, superselective arterial embolization should be performed.

Adult↗
PubMed1991

Management of colonic polyps by colonoscopic polypectomy.

Colonoscopic polypectomy is an important therapeutic advance as it enables most colonic polyps to be removed entirely and studied pathologically and has virtually replaced surgical treatment. The clinical and pathological features of patients with colonic polyps treated by colonoscopic polypectomy over a five-year period are reported. Seventy-four patients (37 men, 37 women) with a mean age of 57 years had 109 polyps removed by snare polypectomy. Rectal bleeding was the predominant symptom and was present in 63.5%. Lower abdominal pain was present in 12%. The majority of polyps were located in the sigmoid (38.5%) and descending (40.3%) colon. Ninety-five polyps were pedunculated and 14 were sessile. Of the neoplastic polyps, 61.6% were pure tubular adenomas, 25.2% were mixed tubulo-villous adenomas and 1% were pure villous adenomas. There were no complications arising from colonoscopy or snare polypectomy. Colonoscopic polypectomy is a safe, reliable and cost-effective therapeutic procedure that has revolutionized the management of pre-cancerous neoplastic colonic polyps.

Adenoma↗
PubMed1987

Change in the extent of colonic involvement in ulcerative colitis: a colonoscopic study.

The change over time in the extent of colonic involvement in ulcerative colitis has, to date, been assessed only by radiological means. To study this issue further, we examined, with repeated colonoscopies, 31 patients with ulcerative colitis. Serial biopsies were taken every 5 cm from the most proximal area reached by the colonoscope down to rectum. The endoscopic and histological extents were evaluated, and the severity of the inflammatory process was graded. Clinical scoring also was performed at the time of both colonoscopies. A change of extent was found in 77% of the patients endoscopically, and in 58% histologically, during a mean follow-up period of 17 months. Extension and regression were demonstrated in the same number of patients. In 61% of 62 procedures, there was complete agreement between colonoscopic and histological extents. The histological extent exceeded the colonoscopic extent in 28% of the procedures. We have the impression that change in the disease extent is a frequent event, and may be a part of the natural history of ulcerative colitis, rather than the exception.

Adult↗
PubMed1987

Colonoscopic therapy of acute pseudoobstruction of the colon.

All patients with the diagnosis of acute colonic pseudoobstruction at the University of California, Davis Medical Center from 1979-1985 were reviewed. These 25 patients were initially treated conservatively (nasogastric tube/rectal tube/enemas) and this was successful in eight of 25 patients (32%). The remaining 17 patients (68%) unresponsive to conservative therapy received endoscopic intervention, either colonoscopic suction decompression (CSD) or colonic suction decompression with proximal colonic tube placement (CDT) for continuous decompression. Of the endoscopic procedures performed, 13/17 (76%) resulted in successful acute decompression. Recurrences occurred in 6/13 (45%) (3/7 in the colonoscopic suction decompression group and three of six in the colonic tube placement group). In the 10 failures, six further procedures were attempted, but only one was successful. These patients were then treated conservatively. There were no instances of colonic perforation. Acute pseudoobstruction in our experience is a benign entity that can be safely and successfully treated nonsurgically. Colonoscopic suction decompression is often initially successful but has a high frequency of recurrence. Newer techniques to prevent recurrence, i.e., colonic tube placement, are of potential benefit but presently have technical problems.

Acute Disease↗
PubMed1980

Colonoscopic polypectomy: the first 200.

Colonoscopic polypectomy is a safe, reliable method of excising most colonic polyps. This paper reports 200 colonoscopic polypectomies performed by one surgeon in a Toronto teaching hospital and reviews results and complications of polyp removal and the treatment of malignant polyps. The relative value of colonoscopic and radiologic detection of polyps is assessed and a plan for follow-up after polypectomy discussed.

Aged↗
PubMed1996

[Diet effect on fiberoptic colonoscopic examination].

In order to study the diet effect on fiber colonoscopic examination, sixty patients were randomly divided into two groups. Thirty patients took food during the period of intesternal preparation, the control group were fasting, then the colonoscopic examination was taken. The result showed that taking food during the period of intesternal preparation not only has no affection on the examination but also enhanced the compliance of colonoscopic examination.

Colonoscopy↗
PubMed1997

Clinical treatment in colonoscopic perforation: a comparison of surgical and conservative management.

BACKGROUND: Successful management of colonoscopic perforation by conservative treatment has been reported, but management remains controversial. Delayed surgery in some situations may lead to an irretrievable result. How to make the best decision? A retrospective study was designed to address this challenge. METHODS: From the period October 1982 and December 1995, 9214 consecutive colonoscopic examinations at Taichung Veterans General Hospital were reviewed. RESULTS: Twenty perforations (0.22%) related to the procedure were found. Of those 16 occurred during diagnostic colonoscopies, and four, during therapeutic colonoscopies. Fifteen perforations caused by diagnostic colonoscopies were treated by surgery, one perforation caused by diagnostic colonoscopy and the four by therapeutic colonoscopies were treated by non-surgical methods. CONCLUSIONS: A standard text on large bowel surgery recommends laparotomy for most cases of colonoscopic perforations. In experience here, however, non-operative management was indicated if the perforation was small with no signs of general peritonitis, and the patient's condition was good. However, if the patients deteriorated with non-operative treatment, immediate laparotomy is indicated.

Adult↗
PubMed1994

Decompression of the large intestine in Ogilvie's syndrome by a colonoscopically placed long intestinal tube.

A technique whereby a long intestinal tube piggy-backed on the colonoscope was placed in the cecum for decompression of the large bowel in Ogilvie's syndrome is described. This technique eliminates the need for fluoroscopy as a KUB can easily confirm the placement of the tube. Although the tube can be potentially dragged back out by the colonoscope, we have not found this to be a problem. This technique appears to be safe and effective in the management of colonic pseudo-obstruction. It can be added to the physicians' armamentarium in managing this clinical entity.

Colonic Pseudo-Obstruction↗
PubMed2006

Colonoscopic polypectomy in retroflexion.

BACKGROUND: Little has been written about the value of retroflexion in the removal of large sessile colon polyps. OBJECTIVE: The objective of the study was to evaluate the utility of retroflexion for removal of large sessile colon polyps. DESIGN: This was a retrospective evaluation of consecutive cases. SETTING: This study was conducted at an academic-hospital-based tertiary-referral colonoscopy practice. PATIENTS: The study comprised consecutive patients with sessile polyps > or = 2 cm who were undergoing endoscopic resection. INTERVENTIONS: The intervention was endoscopic resection of 59 consecutive sessile colon polyps 2 cm or larger in size and located proximal to the rectum by using prototype colonoscopes with short bending sections. MAIN OUTCOME MEASURES: The main outcome measurement was successful endoscopic resection. RESULTS: Fourteen of the polyps were removed either entirely (n = 4) or partially (n = 10) in retroflexion. Patients with polyps that were removed in retroflexion were more likely to have been referred by another colonoscopist than those patients with polyps removed entirely in the forward view (p = 0.05). There were no perforations and no complications related to retroflexion. LIMITATIONS: The study is retrospective, and the practice is a tertiary referral colonoscopy practice. The colonoscopes used are not widely available at this time. CONCLUSIONS: Retroflexion is a useful adjunctive procedure for the removal of some colon polyps proximal to the rectum that are difficult to access endoscopically. The use of retroflexion can increase the fraction of proximal sessile colon polyps amenable to endoscopic resection.

Colonic Polyps↗
PubMed1998

A new method of evaluating hemorrhoids with the retroflexed fiberoptic colonoscope.

BACKGROUND: The conventional classification of the degree of hemorrhoids does not consider the severity of hemorrhage. The purpose of this study was to establish a new objective method for evaluating hemorrhoids in close relation to the main symptoms, hemorrhage and prolapse, as observed through a retroflexed colonoscope in the rectum. METHODS: The subjects were 531 consecutive patients who complained of symptoms related to the rectum or the anus. The degree of mucosal elevation of the rectal columns, changes in color (the existence and degree of red color sign, dilated vein, and white area), and the existence and size of hypertrophied anal papillae were evaluated by colonoscopy. RESULTS: Red color sign was the finding closely related to hemorrhage (p < 0.0001). Dilated vein, white area, and a large hypertrophied anal papilla were related to prolapse (p < 0.0001). The degree of mucosal elevation of the rectal columns was related to both hemorrhage and prolapse (p < 0.0005, p < 0.05). CONCLUSION: Retroflexing the colonoscope intrarectally facilitated identification of findings in the anal canal related to hemorrhage and prolapse, which are the clinical manifestations of hemorrhoids.

Adult↗
PubMed1998

Ineffective use of a detachable snare for colonoscopic polypectomy of large polyps.

BACKGROUND: Colonoscopic polypectomy of large polyps may be associated with complications such as bleeding. Use of a detachable snare may reduce the risk of bleeding. We describe several instances in which the use of such a device proved to be ineffective. METHODS: A detachable snare was used for colonoscopic polypectomy of large polyps in 18 patients (20 polyps), also applied at the residual stalk after conventional polypectomy in 5 patients (5 polyps), and evaluated retrospectively. RESULTS: Sixteen of the 20 polyps were pedunculated, and 4 were semi-pedunculated. In 3 of the 4 semi-pedunculated lesions, the loop slipped off after polypectomy because the lesions were cut close to the site of encirclement. Bleeding occurred in 4 cases because of transection by the loop of a thin stalk (4 mm) before polypectomy (1), slipping of the loop in a semi-pedunculated lesion (1), or insufficient tightening of the loop (2). After conventional polypectomy, we could not effectively snare the residual stalk because of flattening in 3 of the 5 lesions. CONCLUSIONS: Use of the detachable snare for polypectomy of thin stalked or semi-pedunculated lesions may result in technical failure of this technique. The stalk should be fully encircled with the snare before polypectomy. The detachable snare is difficult to apply at the residual stalk after conventional polypectomy.

Aged↗