Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Colonoscopes”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,081 records · Page 60Linked to original sources
PubMed2002

Results of screening colonoscopy among persons 40 to 49 years of age.

BACKGROUND: The prevalence of colorectal lesions in persons 40 to 49 years of age, as identified on colonoscopy, has not been determined. METHODS: We reviewed the procedure and pathology reports for 906 consecutive persons 40 to 49 years of age who voluntarily participated in an employer-based screening-colonoscopy program. The histologic features of lesions that were identified and removed on endoscopy were categorized according to those of the most advanced lesion removed proximally (up to the junction of the splenic flexure and the descending colon) and the most advanced lesion removed distally. An advanced lesion was defined as an adenoma at least 1 cm in diameter, a polyp with villous histologic features or severe dysplasia, or a cancer. RESULTS: Among those who underwent colonoscopic screening, 78.9 percent had no detected lesions, 10.0 percent had hyperplastic polyps, 8.7 percent had tubular adenomas, and 3.5 percent had advanced neoplasms, none of which were cancerous (95 percent confidence interval for cancer, 0 to 0.4 percent). Eighteen of 33 advanced neoplasms (55 percent) were located distally and were potentially within reach of a sigmoidoscope. If these results are applicable to the general population, at least 250 persons, and perhaps 1000 or more, would need to be screened to detect one cancer in this age group. CONCLUSIONS: Colonoscopic detection of colorectal cancer is uncommon in asymptomatic persons 40 to 49 years of age. The noncancerous lesions are equally distributed proximally and distally. The low yield of screening colonoscopy in this age group is consistent with current recommendations about the age at which to begin screening in persons at average risk.

Adenoma↗
PubMed2001

Endoscopic diagnosis of colonic tuberculosis.

BACKGROUND: GI tuberculosis is a diagnostic challenge, particularly in the absence of evidence of pulmonary infection. It may mimic many other abdominal diseases such as other infectious processes, tumors, and Crohn's disease. In the absence of positive laboratory and radiologic tests, the diagnosis is often established definitively by obtaining a surgical specimen. Colonoscopy, however, has been used successfully to diagnose the disease and thus avoid the morbidity and mortality associated with exploratory laparotomy. METHODS: An evaluation was conducted of colonoscopic features in 10 patients with colonic tuberculosis. OBSERVATIONS: In all cases there was ileocecal involvement; total colonic involvement was found in only 1 case. The colonoscopic appearance included the following: ulcerated lesions, sessile firm polyps, masses, and small diverticula, ranging from 3 to 5 mm in diameter. In 5 of our patients the diagnosis was confirmed bacteriologically, in 3 with endoscopic biopsy material, and in 2 by sputum examination. In all cases antituberculous therapy produced remarkable symptom and endoscopic improvement. CONCLUSION: This report highlights the importance of colonoscopy in the diagnosis of tuberculous involvement of the GI tract.

Adult↗
PubMed2002

Warm water irrigation for dealing with spasm during colonoscopy: simple, inexpensive, and effective.

BACKGROUND: Colonic spasm can interfere with colonoscopy by hindering insertion of the colonoscope and by making polypectomy difficult, painful, and dangerous. Methods for dealing with colonic spasm include waiting for it to subside and administration of antispasmodic agents such as glucagon or hyoscyamine. Glucagon is expensive and hyoscyamine has side effects. This study evaluated an inexpensive technique, warm water irrigation, for overcoming colonic spasm during colonoscopy. METHODS: A prospective, randomized, controlled trial in a consecutive series of patients was conducted to compare warm water irrigation for relaxation of spasm with standard examination techniques. Patients in whom the sigmoid colon had been resected were excluded. In the test group, water from the hot water tap at approximately body temperature was instilled into the colon by means of the accessory channel of the colonoscope with a 30 mL syringe. Any irrigation, either for removal of stool or control of spasm, was performed with warm water in the test group and water at room temperature in the control group. After each colonoscopy, the level of pain experienced by the patient was recorded with a linear analog scale. RESULTS: Sixty-nine patients were randomized. The groups were similar with respect to gender distribution, age, and degree of spasm. There was no difference between groups for insertion time, total duration of colonoscopy, dose of midazolam administered, or frequency of severe spasm. Patients who had warm water irrigation had significantly less discomfort than control patients (median 2.0, interquartile range: 1-4 on a 10 point linear analog scale, vs. 4.0, interquartile range: 2-5). CONCLUSIONS: Although glucagon and hyoscyamine remain options for treatment of colonic spasm, the results of this study suggest that warm water is also effective. It has no side effects and costs practically nothing.

Aged↗
PubMed2002

Carbohydrate-electrolyte rehydration protects against intravascular volume contraction during colonic cleansing with orally administered sodium phosphate.

BACKGROUND: Colonic cleansing with sodium phosphate causes intravascular volume contraction in some patients. This study tested the hypothesis that carbohydrate-electrolyte oral rehydration would attenuate the hypovolemic changes associated with administration of sodium phosphate. METHODS: Adult outpatients were randomized to ingest either regular clear fluids or a carbohydrate-electrolyte rehydration solution during precolonoscopy purgation by ingestion of aqueous sodium phosphate. Investigators were blinded to the treatment assignment of patients. Clinical hemodynamic measurements and biochemical tests were obtained at baseline and after bowel preparation. Tolerability and colonoscopic visualization were assessed with questionnaires. RESULTS: One hundred sixty-eight patients completed the study (81 clear fluids, 87 rehydration). By comparison with clear fluids, rehydration resulted in significantly less intravascular volume contraction. Changes in estimated central venous pressure and orthostatic pulse were significantly greater in the clear fluid group versus the rehydration group (p < 0.03). Changes in biochemical parameters after purgation also suggested a greater degree of volume contraction in the clear fluid versus rehydration group. Colonoscopic visualization was superior in the rehydration versus clear fluid group (p < 0.01); tolerability of the preparations was similar between groups (p = 0.2). CONCLUSIONS: Carbohydrate-electrolyte rehydration protects against intravascular volume contraction during preparation for colonoscopy by ingestion of sodium phosphate. This approach is well tolerated by patients and improves colonic cleansing.

Administration, Oral↗
PubMed2003

A comparison of magnifying and nonmagnifying colonoscopy for diagnosis of colorectal polyps: A prospective study.

BACKGROUND: Discrimination between neoplastic and non-neoplastic colorectal polyps is essential for determining appropriate treatment. The mucosal crypt pattern of polyps can be observed with a nonmagnifying colonoscope; however, mucosal crypt patterns are better seen by magnifying colonoscopy, which can also be a noninvasive means for predicting histopathology. This study prospectively compared the ability to distinguish between neoplastic and non-neoplastic lesions by magnifying and nonmagnifying colonoscopy. METHODS: Six hundred sixty patients were randomly assigned to undergo magnifying or nonmagnifying colonoscopy (2 groups each of 330 patients). The mucosal crypt pattern of colorectal lesions was classified into types I through V after spraying with 0.2% Indigo carmine dye. The histopathology of all lesions was confirmed by evaluation of endoscopic resection specimens or biopsy specimens. Only lesions 10 mm or less in diameter were included in the study. RESULTS: The accuracy of magnifying colonoscopy in distinguishing neoplastic from non-neoplastic lesions (92%, 372/405) was significantly higher than for nonmagnifying colonoscopy (68%, 278/407). Insertion of magnifying and nonmagnifying colonoscopes to the cecum was successful in, respectively, 321 patients (97%) and 317 patients (96%), with no significant differences in the average time to reach the cecum or average total procedure time. No serious complication was observed during or immediately after the examinations. CONCLUSIONS: Observation of mucosal crypt pattern with magnifying colonoscopy is superior to nonmagnifying colonoscopy for distinguishing between neoplastic and non-neoplastic colorectal lesions.

Colonic Polyps↗
PubMed2003

Validation of a computer-based colonoscopy simulator.

BACKGROUND: The computer-based colonoscopy simulator is intended to provide a realistic colonoscopic experience and feedback to operators regarding procedure skills. Advocates hope that computer-based colonoscopy simulators will enhance the mastery of colonoscopy by trainees. Before this hypothesis can be tested, the claims made for a simulator must be validated. The aims of this study were to answer the following: Does a computer-based colonoscopy simulator provide a "realistic" experience? Do computer-based colonoscopy simulators' performance parameters differentiate varying levels of experience? METHODS: Ten staff gastroenterologists, 6 gastroenterology fellows, and 6 residents each performed 2 computer-based colonoscopy simulator colonoscopies and performance parameters were recorded. Staff colonoscopists then completed a 6-item survey grading the "realism" of the simulation and procedure difficulty. Survey responses and performance scores were compared with the Wilcoxon rank-sum test. RESULTS: Faculty found the computer-based colonoscopy simulator experience to be realistic despite the "cases" being markedly easier than actual colonoscopy. The computer-based colonoscopy simulator distinguishes subjects according to endoscopic experience with 3 of its measured parameters (total procedure time, insertion time, time in "red-out"). No significant difference in the ability to distinguish among user types was found for the other 10 computer-based colonoscopy simulator measurements for which data were analyzable. CONCLUSION: The computer-based colonoscopy simulator provides a favorable degree of virtual realism with regard to visual simulation and colonoscope mechanics, although the "cases" were regarded as considerably easier than actual colonoscopy. The computer-based colonoscopy simulator has only limited capability for distinguishing varying levels of competence at actual colonoscopy. These findings suggest that a study to determine the role of computer-based colonoscopy simulators in the curriculum of trainees is warranted.

Clinical Competence↗
PubMed2001

A new hydrogen peroxide--based medical-device detergent with germicidal properties: comparison with enzymatic cleaners.

BACKGROUND: The objective of this study was to evaluate the efficacy of the cleaning and bacterial killing ability of a new non-enzyme-based formulation (killing detergent solution [KDS]) compared with commercially available enzymatic detergents that included Metrizyme (Metrex Research Division of Sybron Canada Ltd. Morrisburg, Ontario) and Gzyme (Germiphene Corp, Brantford, Ontario). KDS is a hydrogen peroxide-based detergent formulation that combines cleaning efficacy with the ability to kill microorganisms. The KDS formulation helps ensure the protection of the health care worker from infectious risk during the soaking and cleaning stages of medical device reprocessing and reduces the bioburden on devices before sterilization/disinfection. METHODS: Test organisms that included Enterococcus faecalis, Salmonella choleraesuis, Staphylococcus aureus, and Pseudomonas aeruginosa were suspended in artificial test soil (ATS-B; patent submitted), inoculated at 10(6) colonyforming units per carrier and dried overnight before detergent exposure. The ATS-B mimics the blood, protein, carbohydrate, and endotoxin levels of patient-used medical devices. Plastic lumen carriers and a flexible colonoscope were used for surface and simulated-use testing, respectively. RESULTS: The results for the microbial challenge dried onto polyvinyl chloride (PVC) carriers demonstrated that the ability of KDS to remove protein, blood, carbohydrate, and endotoxin from surface test carriers was as effective as the enzyme detergents that were evaluated. Furthermore, KDS was able to effect approximately a 5-Log(10) reduction in microbial loads with a 3-minute exposure at room temperature, whereas none of the other detergents were as effective. In simulated-use testing of a soiled colonoscope, KDS was significantly better at ensuring microbial killing compared with Gzyme and Metrizyme and was equivalent to the enzymatic detergents in cleaning ability. CONCLUSIONS: In summary the KDS has excellent microbial-killing ability in 3-minute exposures at room temperature and cleans as well as the existing enzymatic detergent formulations that were tested.

Detergents↗
PubMed2000

Effect of conscious sedation on cardiac autonomic regulation during colonoscopy.

BACKGROUND: Colonoscopy is associated with cardiovascular events including hypotension, hypertension, and myocardial ischemia. The pathogenetic mechanisms of these cardiovascular events are unknown, but there is evidence that the autonomic nervous system may play a role. Conscious sedation is often used to relieve the inconvenience caused by the procedure. In this study, we evaluated the effects of sedation on cardiac autonomic regulation during colonoscopy. METHODS: One hundred and eighty patients undergoing elective colonoscopy were prospectively randomized into three groups: (i) sedation with intravenous midazolam (midazolam group); (ii) sedation with intravenous saline (placebo group); and (iii) no intravenous cannula (control group). Continuous electrocardiogram was recorded prior to, during, and after the colonoscopic procedure. Heart rate variability (HRV) was assessed by means of the power spectral analysis; the powers of low-frequency (LF 0.04-0.15 Hz) and high-frequency (HF 0.15-0.40 Hz) components were calculated. RESULTS: Intubation of the colonoscope increased the LF component of HRV and decreased HF power in all study groups compared to baseline recording. Furthermore, compared to baseline, the LF/HF ratio--a marker of cardiac sympathetic regulation--increased during intubation in the midazolam (P < 0.001) and placebo (P < 0.05) groups, with no change in the control group. During intubation the midazolam group presented with higher LF and lower HF power than placebo (P < 0.001) and control groups (P < 0.01). Accordingly, the LF/HF ratio was higher in the midazolam group than in the placebo (P < 0.05) or control groups (P < 0.05). CONCLUSIONS: Midazolam potentiates the dominance of the sympathetic nervous system induced by colonoscopy. Therefore, conscious sedation with midazolam may contribute to the occurrence of cardiovascular events during colonoscopy.

Colonoscopy↗
PubMed2000

Diversion colitis in patients with myelopathy: clinical, endoscopic, and histopathological findings.

OBJECTIVE: One of the problems with a diverting colostomy, applied in patients with myelopathy for complications of the neuropathic large bowel, is diversion colitis. A clinical, endoscopic, and histological survey was conducted to describe the problem in these patients. METHODS: 19 patients with myelopathy who have had colostomies (68% of those available) participated in the survey. History of rectal discharge and perineal ulceration plus colonoscopic and biopsy observations were recorded. 20 patients with myelopathy who have not had colostomies, with clinically indicated colonoscopic examinations, were compared for skin breakdown and endoscopic appearance. RESULTS: 15 patients who had colostomies (79%) reported rectal discharge, and 9 (47%) sustained perineal ulceration, 2 being recurrent and refractory. None of the 20 patients who had not had colostomies had perineal ulceration (p = 0.04). Colonoscopy revealed mucosal erythema and friability in 18 patients (94%) with a predominance in the rectosigmoid colon. 1 of 20 without colostomy presented with this picture (p < 0.001). Mucosal biopsies of diverted colon revealed chronic inflammation in all patients, severe inflammation in 13 of 19 subjects at < or = 20 cm from the anus, and in 3 of 10 at > 20 cm (p = 0.06). No difference in the severity of inflammation with time, 0 to 2 years versus > 2 to 18 years post colostomy, could be demonstrated. CONCLUSIONS: Diversion colitis is a frequent, persistent, and sometimes problematic complication in patients with myelopathy who have also had colostomies.

Adult↗
PubMed1998

Growth patterns and genetic changes of colorectal carcinoma.

BACKGROUND: Recent Japanese studies have shown that histogenesis of small colorectal carcinomas can be divided into two groups: polypoid growth arising from polypoid neoplasia, and nonpolypoid growth arising from flat or depressed neoplasia. This classification should be verified with genetic as well as morphologic characteristics. SUBJECTS AND METHODS: In order to classify our subject into polypoid growth and nonpolypoid growth types both histologically and endoscopically, we selected 42 colorectal carcinomas < 2 cm in size (35 submucosal and seven more advanced). Clinicopathological findings, presence or absence of Ki-ras gene mutation and overexpression of p53 protein were compared between the two types. RESULTS: Histologically, the cases were divided into 27 of the polypoid growth type and 15 of the nonpolypoid growth type. None of the nonpolypoid growth cases contained adenomatous remnant, wheras this was found in 75% of the polypoid growth cases. No Ki-ras mutation was observed in any of the nonpolypoid growth cases, although it appeared in 44% of the polypoid growth cases. Regarding the overexpression of p53 protein, no significant difference was observed between the two types. The histological and the colonoscopic polypoid growth-nonpolypoid growth classifications correlated well with each other (agreement rate 98%), except for one lesion, which was classified as polypoid growth type endoscopically but as nonpolypoid growth type histologically. CONCLUSIONS: The histologically defined polypoid growth-nonpolypoid growth classification may indicate a difference in pathway of colorectal carcinogenesis. Also, colonoscopic polypoid growth-nonpolypoid growth classification is available for preoperative estimation of the genetic characteristics of small carcinomas.

Adenoma↗
PubMed1994

Detection of K-ras mutation in colonic effluent samples from patients without evidence of colorectal carcinoma.

BACKGROUND: K-ras gene mutation appears in more than 50% of patients with colon tumors. Both its frequency and early appearance may qualify this mutation as a potential biomarker. To enable early detection of mutant K-ras alleles, we had previously developed a sensitive polymerase chain reaction (PCR)-based assay, i.e., enriched PCR, which enables detection of one mutant K-ras allele present within 10,000 normal alleles. Using the enriched PCR, we were able to detect mutant K-ras alleles in "normal-appearing" colonic mucosa in patients with colorectal cancer. PURPOSE: A study was initiated to determine whether mutant K-ras alleles could be identified in colonic effluent samples of patients who may be at risk to develop colorectal cancer. METHODS: Over 9 years, colonic effluent samples were collected prior to routine colonoscopy from 39 patients who were apparently free of colorectal cancer. These samples were collected from patients with a family history of colorectal cancer (n = 7), adenomatous polyps (n = 7), previously resected colorectal cancer (n = 5), inflammatory bowel disorders (n = 13), normal colonoscopic examination (n = 6), and familial adenomatous polyposis (n = 1). All of the samples were double coded and analyzed for K-ras gene mutation. RESULTS: Of the 39 patients, seven were found to harbor mutant K-ras codon 12 alleles. Mutations were found in patients with a family history of colorectal cancer (three of seven), adenomatous polyps (one of seven), previously resected colorectal carcinoma (two of five), and familial adenomatous polyposis (one of one). In one case, effluent was found to harbor a mutant K-ras allele 4 years before the patient was diagnosed with colorectal cancer. CONCLUSIONS: (a) Effluent samples contain enough DNA to be detected with enriched PCR. Such samples may well be representative of the entire colon in general as opposed to a localized area such as that usually analyzed during colonoscopy. (b) K-ras gene mutation can be identified in routinely obtained colonic washings of patients who are at risk of developing colorectal cancer. Such mutations were absent in patients with inflammatory bowel disorders and in those who had undergone normal colonoscopic examinations. Detection of K-ras mutation in colonic washings may assist in identifying patients who may be at high risk for developing adenocarcinoma of the colon. IMPLICATIONS: The ability to examine colonic effluents provides a powerful and convenient source of sampling and may be adapted for future large-scale screening.

Adult↗
PubMed1979

Initial treatment of sigmoid volvulous by colonoscopy.

The initial management of acute, nonstrangulated sigmoid volvulous is to attempt proctosigmoidoscopic, rectal tube, or barium enema reduction and evacuation. If unsuccessful emergency surgery is necessary. The flexible colonoscope offers an additional therapeutic modality to effectuate preoperative reduction of the twisted sigmoid colon if attempts with conventional methods fail. Three cases of acute sigmoid volvulous are presented which illustrate for the first time successful reduction of acute sigmoid volvulous by colonoscopy after failure of the usual methods of treatment. Instead of emergency surgery all of these patients had elective resection with primary colocolostomy. Patients with acute sigmoid volvulous refractile to reduction by conventional modalities should have an attempt at flexible colonoscopic reduction.

Acute Disease↗
PubMed1983

Therapeutic and diagnostic colonoscopy in nonobstructive colonic dilatation.

Cecal perforation has been well established as a consequence of mechanical obstruction of the distal colon and has been estimated to occur in 1.5% to 7% of patients with colon obstruction. Perforation of the cecum also occurs in cases of nonobstructive colonic dilatation (NCD). Although the incidence is unknown, the mortality rate is nearly 50%. Over an eight-year period, 44 patients (mean age 59 years) underwent 52 colonoscopic examinations for presumed NCD. Twelve patients (27%) developed NCD while convalescing from a recent operation and 29 patients (66%) had major systemic disorders that preceded the development of NCD. Medical treatment for an average of 2.6 days was uniformly unsuccessful. Mean cecal diameter prior to colonoscopy was 12.8 cm (range 9.5 to 17 cm). Based on radiographic or clinical criteria, 38 patients (86%) were successfully decompressed on the initial colonoscopic examination; mean cecal diameter decreased to 8.7 cm (p less than 0.01). Perforation of the cecum during colonsocopy occurred in one patient (2%) who survived. Fourteen patients died; six deaths were attributed solely to the patient's who underwent operation. In summary, colonoscopy is a safe and effective therapeutic and diagnostic tool in cases of massive cecal dilatation. It should be considered before cecostomy in patients without radiographic evidence of pneumoperitoneum or clinical signs of peritoneal irritation.

Adult↗
PubMed1987

Patient management after endoscopic removal of the cancerous colon adenoma.

The subject of management of patients after endoscopic removal of cancerous adenomas is controversial. A retrospective review of 126 lesions in 121 patients who had had colonoscopic polypectomy of malignant lesions between 1971 and 1985 was used to determine the criteria for colon resection. Invasive cancer was identified in 80 patients, while 41 patients had carcinoma in situ. A synchronous colon cancer was found in five of the 121 patients. The patients who had carcinoma in situ had no evidence of residual tumor or metastatic disease on subsequent follow-up (colon resection in three patients and endoscopic surveillance in 38 patients). Of the 80 patients with invasive cancer, 44 had subsequent colon resection, and 34 of these had no evidence of tumor in the resected bowel or mesenteric lymph nodes. Ten patients had residual tumor, metastatic cancer to regional lymph nodes, or both. Each of the 10 had at least one of the following indications of inadequate resection or dissemination of disease to local lymph nodes (the first indication is a macroscopic evaluation, while the remaining four are all microscopic): incomplete excision, poorly differentiated tumor, invasion of the line of resection, invasion of the polyp stalk, and invasion of venous or lymphatic channels. Present recommendations for patient management after endoscopic removal of an invasive malignant adenoma should include colon resection with regional lymphadenectomy for patients with one or more of these five criteria. Patients without any of these risk factors should have early repeat endoscopic examination 3 months after initial polypectomy to evaluate the polypectomy site. Total colonoscopic examination is repeated at 1 year to ensure the surveillance program is begun with a colon without neoplasms.

Adenoma↗
PubMed2004

Endoscopic diagnosis and management of hereditary nonpolyposis colorectal cancer.

PURPOSE OF REVIEW: Hereditary nonpolyposis colorectal cancer (HNPCC) is an autosomal dominant condition that accounts for 2 to 7% of all colorectal malignancies diagnosed annually. Endoscopic surveillance affords a rational strategy for reducing HNPCC-associated colorectal cancer incidence and mortality. The primary objective of this review is to highlight evidence supporting the role of endoscopy, particularly colonoscopy, in the preventive management of HNPCC. Clinical features, diagnostic criteria, and use of genetic testing to identify high-risk patients who warrant surveillance will also be discussed. RECENT FINDINGS: Colonoscopic surveillance has been shown to be an effective strategy for reducing HNPCC-associated colorectal cancer incidence and mortality. Current recommendations for the appropriate use of colonoscopic surveillance are based on an understanding of the natural history of the disease and the ability to identify high-risk individuals using both clinical criteria and genetic testing. High-risk individuals should undergo surveillance every 1 to 2 years beginning at age 20 years and then annually after age 40. Endoscopic surveillance is also recommended every 1 to 2 years following surgical resection of an HNPCC-associated cancer or adenoma because of the high rate of metachronous tumors. SUMMARY: Endoscopic surveillance remains the mainstay of preventive management of HNPCC. Appropriate use of genetic testing can aid in the identification of high-risk individuals and thereby optimize cost-effectiveness of this approach.

Journal Article↗
PubMed1986

Sigmoidoscopy and biopsy in surveillance for cancer in ulcerative colitis.

Surveillance has become an established concept to find dysplasia as a premalignant lesion in ulcerative colitis. Since the advent of colonoscopy and the access of the entire colon to biopsy, utilization of the rigid sigmoidoscope and rectal biopsies has been markedly reduced. We have reviewed 940 rectal biopsies obtained from 360 patients with ulcerative colitis of various extent and duration to determine the yield of dysplasia and assess the value of this procedure. The rectal biopsies had been performed for a variety of reasons in the course of clinical management of ulcerative colitis in addition to surveillance. Dysplasia was found in 10.8% of the patients--higher than has been demonstrated by colonoscopy. In four of the 39 patients with dysplasia a carcinoma coexisted (2) or developed subsequently (2). In no instance did dysplasia serve to warrant the colectomy that disclosed the carcinoma, but earlier discovery of the dysplasia or more intense surveillance once it had been found might have led to earlier discovery of the carcinoma. The yield of dysplasia was greater in those with onset of ulcerative colitis in childhood. In more than half, including 71% of patients with onset in childhood, the dysplasia was found before they had the disease for 9 years. Surveillance, therefore, should begin earlier in young patients with ulcerative colitis. Sigmoidoscopic biopsies do not substitute for colonoscopic biopsies in a surveillance program. Nevertheless, the ease of obtaining rectal biopsies, the relatively large yield of dysplasia, and the need for frequent sigmoidoscopy in the clinical management of ulcerative colitis all warrant a high priority role for rectal biopsies to supplement that of colonoscopic biopsies.

Adolescent↗
PubMed1992

Hidden colonic adenomas in a patient with a family history of polyposis.

We describe an asymptomatic patient with a strong family history of polyposis who was found to have flat and depressed adenomas that were not visible on colonoscopy. The diagnosis required assessment of multiple, randomly obtained biopsy specimens. Partial deflation of the colon during colonoscopy may allow hidden lesions to be seen. Biopsies should be performed in all patients with a family history of polyposis who are examined colonoscopically, even if they are asymptomatic and no lesions are visible through the colonoscope.

Adenoma↗
PubMed2003

Treatment of ulcerative colitis using fecal bacteriotherapy.

BACKGROUND: Although the etiology of idiopathic ulcerative colitis (UC) remains poorly understood, the intestinal flora is suspected to play an important role. Specific, consistent abnormalities in flora composition peculiar to UC have not yet been described, however Clostridium difficile colitis has been cured by the infusion of human fecal flora into the colon. This approach may also be applicable to the treatment of UC on the basis of restoration of flora imbalances. GOAL: To observe the clinical, colonoscopic and histologic effects of human probiotic infusions (HPI) in 6 selected patients with UC. CASE REPORTS: Six patients (3 men and 3 women aged 25-53 years) with UC for less than 5 years were treated with HPI. All patients had suffered severe, recurrent symptoms and UC had been confirmed on colonoscopy and histology. Fecal flora donors were healthy adults who were extensively screened for parasites and bacterial pathogens. Patients were prepared with antibiotics and oral polyethylene glycol lavage. Fecal suspensions were administered as retention enemas within 10 minutes of preparation and the process repeated daily for 5 days. By 1 week post-HPI some symptoms of UC had improved. Complete reversal of symptoms was achieved in all patients by 4 months post-HPI, by which time all other UC medications had been ceased. At 1 to 13 years post-HPI and without any UC medication, there was no clinical, colonoscopic, or histologic evidence of UC in any patient. CONCLUSIONS: Colonic infusion of donor human intestinal flora can reverse UC in selected patients. These anecdotal results support the concept of abnormal bowel flora or even a specific, albeit unidentified, bacterial pathogen causing UC.

Administration, Rectal↗