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PubMed2005

[Clinical investigation of total intravenous anesthesia with remifentanil and propofol for colonoscopy in the elderly].

OBJECTIVE: To evaluate the efficacy and safety of intravenous anesthesia with remifentanil and propofol for colonoscopy in the elderly. METHODS: Thirty old patients scheduled for colonoscopy were randomly allocated into remifentanil group and fentanyl group. Those in group remifentanil received remifentanil at the dose of 0.05 microg/kg.min with micropump, while those in group F were given a bolus injection of fentanyl at 1 microg/kg intravenously. One minute later, all the patients were given a loading dose of propofol of 0.4 mg/kg followed by boluses of propofol (0.2 mg/kg) administered intermittently until Ramsay sedation scale III-IV. The induction time of anesthesia, intubation time of colonoscope, time of recovery from anesthesia and stay in the postanesthesia care unit (PACU) were recorded. The mean arterial pressure (MAP), heart rate (HR), pulse oxygen saturation (SpO(2)) and respiratory rate (RR) were measured and recorded with noninvasive monitoring. The lower limb movement, apnea, dizziness, body weakness, nausea and vomiting, and chest wall rigidity were recorded during operation. All the patients were reviewed for satisfaction after the operation. RESULTS: The time of anesthesia induction, intubation time of colonoscope, time of recovery from anesthesia and stay in PACU in remifentanil group were shorter than those in fentanyl group (P<0.05), and propofol consumption was significantly less in the former group (P<0.05). Greater MAP decrement was observed in remifentanil group (P<0.05). Fewer patients had lower limb movement while more had respiratory depression in remifentanil group than in fentanyl group. The rate of patient-rated satisfaction was significantly higher in remifentanil group (P<0.05). CONCLUSION: Intravenous anesthesia with remifentanil and propofol for colonoscopy is safe and reliable, which can be a good alternative for anesthesia in outpatient operation for the elderly.

Aged↗
PubMed2006

[Current concepts in the genetics of hereditary and sporadic colorectal cancer and the role of genetics in patient management. Hereditary colorectal cancers].

Colorectal cancer (CRC) is the second leading cause of mortality of malignant diseases in Hungary and according to the incidence and prevalence of CRC Hungary is second among European countries. Hence, it is of outstanding interest to know the current concepts on pathogenesis and genetical background of CRC, as well as incorporate this knowledge in the everyday practice. In the first part of the review authors address the genetic background of hereditary colorectal cancer syndromes. In fact, a positive family history may be found in 20-30% and genetically defined trait (e.g. familial adenomatous polyposis (FAP), hereditary nonpolyposis colorectal cancer (HNPCC) and Peutz-Jeghers-syndrome (PJS)) is responsible for 3-5% of all colon cancers. Germline mutations of tumor suppressor gene, APC (5q21) are found in 70-90% of the cases. Until now more than 300 mutations were identified. Though a typical mutation was not found, the location of the mutation is associated to the clinical phenotype and prognosis. Of note, beside APC mutations, biallelic mutations of the MYH gene may be found in a subset of individuals with FAP. The diagnosis of HNPCC is based on family history and the presence of Amsterdam I-Il or Bethesda criteria. The genetic background and clinical phenotype of the syndrome is heterogeneous. Mutations of different mismatch repair genes (mainly hMLH1 or hMSH2) may be identified in most cases. Genetic testing is advised in first degree relatives of FAP patients, if genetic testing is not available colonoscopic surveillance should be done starting at the age of 10-12 years. Due to the high number of mutation genetic testing is difficult in HNPCC families and colonoscopic screening should be advised to affected families.

Adaptor Proteins, Signal Transducing↗
PubMed2006

[Indications for colonoscopy examination and its disease distribution: a report of 5690 cases].

OBJECTIVE: To explore the indications for colonoscopy examination and the distribution of diagnostic diseases. METHOD: From Jan. 2000 to Dec. 2004, 5960 patients received colonoscopy examination in our colorectal center. The indications for colonoscopy examination and the distribution of its diagnostic diseases were analyzed. RESULTS: There were 3096 males and 2594 females,and the mean age was (52+/-15) years. The reasons for colonoscopy included hemafecia (26.9%), atypical abdominal pain (25.8%), diarrhea or increased frequency of stool (11.1%), anal tenesmus or discomfort (7.6%), constipation (7.0%),mucous or bloody purulent stool (3.0%), intra-rectal mass or abdominal mass on physical examination (0.9%), re- examination after colonoscopic polypectomy (10.9%), re-examination after operation for colorectal cancer(1.5%), simple health examination (2.2%). Colonoscope reached the cecum in 97.7% of the cases,and at least one disease was found in 2283 cases (40.1%). Among them,colorectal cancer accounted for 10.3%, colorectal polyps 19.6%, ulcerative colitis 4.3%, and Crohn's disease 0.5% respectively. CONCLUSION: The indications for colonoscopy are too strict to screen the early stage colorectal cancer. Colonoscopy should be performed in the cases with symptoms such as bloody stool, diarrhea, abdominal pain, constipation, or with colorectal polyps, after operation for colorectal cancer,or as members of hereditary colorectal cancer family.

Adolescent↗
PubMed2006

[Acute hemorrhagic colitis induced by the neuraminidase inhibitor oseltamivir].

A 23-year-old woman had lower abdominal pain, diarrhea and bloody stool was admitted and given a diagnosis of influenza B. Her home doctor had started treatment by neuraminidase inhibitor (oseltamivir) the previous day. Colonoscopic examination revealed an area of hemorrhage and erosion in the left transverse colon. After halting oseltamivir treatment these symptoms disappeared and her colonoscopic findings improved. A drug-induced lymphocyte stimulation test was positive for oseltamivir. This case is the first reported case of acute hemorrhagic colitis induced by oseltamivir.

Adult↗
PubMed2006

Endoscopic diagnosis and treatment of severe lower gastrointestinal bleeding.

Severe hematochezia is a common reason for hospitalization but the causes have changed in the last decade. Changes are in part related to the aging population, the evaluation and treatment by colonoscopists rather than surgeons or non-endoscopists, and the changes in colonoscopic practices such as piecemeal polypectomy. A careful history, physical examination, rectal examination, and nasogastric lavage may help localize the bleeding site and focus the differential diagnosis. This should be routine while resuscitating the patient. However, purging the colon for urgent colonoscopy may be the most definitive way to combine diagnosis and treatment of bleeding colonic lesions. Complete colonoscopy with intubation of the terminal ileum is recommended, and also examination of the rectum with a slotted anoscope. If those examinations are negative, a push enteroscopy is recommended for combined diagnosis and treatment. With recent advances in colonoscopic hemostasis, patients will benefit from diagnosis and treatment by experienced colonoscopists. Also, urgent colonoscopy after purge has been reported to be more cost-effective than elective colonoscopy or other strategies for diagnosis of severe hematochezia.

Colitis, Ischemic↗
PubMed2006

[Clinical usefulness of fecal occult blood test as a screening method for asymptomatic patients with colon polyps].

BACKGROUND/AIMS: Detection of asymptomatic benign colon polyp is increasing because colonoscopy is widely used as a screening and diagnostic method. Fecal occult blood test is usually performed for the selection of patients requiring colonoscopy as well as mass screening for colon cancer. The aim of this study was to investigate the usefulness of fecal occult blood test performed prior to colonoscopy as a screening method of benign colon polyps. METHODS: Clinical characteristics of patients with polyps were evaluated according to the fecal occult blood test results in patients who underwent one-day fecal occult blood test and colonoscopic polypectomies from May 2003 to October 2004, retrospectively. RESULTS: A total of 942 colonoscopic polypectomies in 288 patients were evaluated. Fecal occult blood tests were positive only in 32 patients (11.1%). In univariate analysis, there was a significant difference in polyp size (p=0.02) and location (p=0.03) according to the presence of positive fecal occult blood tests. In addition, age of the patient (p=0.046), polyp size (mean, p=0.04; largest, p<0.01) and the number of polyps (p=0.045) were significantly different. However, in multivariate analysis, only polyp size larger than 20 mm was significantly related with positive fecal occult blood test with estimated odds ratio of 4.71. CONCLUSIONS: Fecal occult blood test has limitations as a screening test in asymptomatic patients with colon polyps, except for colon polyps larger than 20 mm in size.

Colonic Neoplasms↗
PubMed1992

Vincristine-induced paralytic ileus: role of fiberoptic colonoscopy and prostaglandin F2 alpha.

Two cases of vincristine-induced paralytic ileus are described, with therapeutic correlation. Both patients had a roentgenographic picture of paralytic ileus showing fecal mass in the ascending colon and dilated bowel loops. One patient was successfully treated with glycerin and saline enema through a fiberoptic colonoscope placed in the ascending colon. The second patient was successfully treated with intravenous prostaglandin F2 alpha (PGF2 alpha). Enema through a fiberoptic colonoscope or the intravenous administration of PGF2 alpha may, therefore, prove useful in the treatment of vincristine-induced gastrointestinal toxicity.

Colonic Pseudo-Obstruction↗
PubMed1991

[Colonoscopy after radical surgery for colorectal cancer. A 10-year prospective study of 309 patients].

Experience from ten year colonoscopic follow-up in patients after radical surgery for colorectal cancer is presented. In all, 309 patients below 76 years were included from 1978 to 1983. All had preoperative proctoscopy and barium enema. Colonoscopy was performed perioperatively, every six months the first three years, four and five years, seven to eight years and ten years after surgery. A minority had double-contrast barium enemas. Synchronous adenomas were removed during surgery and at perioperative colonoscopy and these patients had the same risk of metachronous cancer as those without synchronous adenomas. Five patients with six metachronous cancers, all had new curative surgery. Patients with synchronous adenomas had a higher risk of metachronous adenomas, but had a better prognosis than those without synchronous adenomas. Colonoscopically demonstrated intraluminal local recurrence in the colon could not be treated with new radical surgery in contrast to four out of eight intraluminal recurrences in the rectum. Most local recurrences were extraluminal and were diagnosed by other means.

Adenoma↗
PubMed1990

Peritonitis following colonoscopy in a peritoneal dialysis patient.

A 65-year-old woman on continuous ambulatory peritoneal dialysis (CAPD) developed blood-tinged dialysate and bacterial peritonitis following a colonoscopic polypectomy. She grew multiple anaerobic organisms in her dialysate despite antibiotic prophylaxis with vancomycin and gentamicin prior to the procedure. This case confirms the need for broad spectrum antibiotic prophylaxis prior to colonoscopic procedures, especially if polypectomy is planned. The antibiotic chosen should cover anaerobes as well as gram-positive and gram-negative enteric organisms. We suggest the use of ampicillin, clindamycin, and an aminoglycoside antibiotic for this prophylaxis.

Aged↗
PubMed1990

The elusive colonic malignancy. A need for definitive preoperative localization.

Colonoscopy with biopsy is the standard of practice for the diagnosis of colonic malignancies. Unfortunately, the inability of endoscopy to obtain precise distance measurements from the anal verge can make localization of lesions at operation difficult. For this reason, preoperative barium enema or intraoperative colonoscopy have been advocated to further pinpoint the sites of those lesions not thought to be easily located at operation. Five patients are presented in whom malignant lesions of the colon were diagnosed and verified histologically, but were later undetectable at operation or subsequent colonoscopic examinations. Four of these patients underwent laparotomy and three received colon resections. None of these patients' tumors were identified during intraoperative colonoscopy, in the resected bowel on pathologic examination, or on follow-up colonoscopy. A fifth patient is presented who spontaneously passed a polyp containing invasive adenocarcinoma, but multiple colonoscopic examinations have failed to identify the site of the lesion. To date, none of these tumors have recurred with periods of follow-up ranging from 6 months to 2 years. These patients demonstrate a poorly documented and little understood aspect of the behavior of colonic malignancies, i.e., the ability to spontaneously regress or slough from the bowel wall. Based on these instances, localization of potentially malignant colon lesions is recommended with submucosal dye injections at initial endoscopy or with colonoscopy in the operating room immediately prior to operation.

Aged↗
PubMed1990

[Endocarditis caused by Streptococcus bovis and colorectal neoplasms].

PURPOSE: To evaluate the association of Streptococcus bovis endocarditis with large bowel neoplasms. PATIENTS AND METHOD: Twenty episodes (19 patients) of Streptococcus bovis endocarditis (5.05%) selected from 396 episodes of endocarditis followed up from 1978 to 1990. The mean age was 57.68 years, 16 (84.21%) were males. Previous heart disease was not known in nine (45%). Previous manipulation that might induce bacteremia was identified in three patients. Symptoms related to neoplasia of the digestive system were not informed. The mean time of follow up (17 cases) was 33.76 months, standard deviation 27.37 months. Sixteen patients were submitted to colonic evaluation (barium enema in 11, colonoscopy in 5 patients, and both were performed in 5 patients). RESULTS: Bowel neoplasias were diagnosed in 12 (75%) of 16 patients submitted to colonic evaluation, one colonic adenocarcinoma in one (8.33%), patient, histologic benign polyps in eight (66.6%). Two patients are waiting for colonoscopic resection. In one patient the polyp was lost after colonoscopic resection. CONCLUSION: The high incidence of large bowel neoplasia in patients with Streptococcus bovis endocarditis indicates that evaluation of the large bowel must be performed on in patients with S. bovis endocarditis in order to diagnose neoplasias, even in the absence of symptoms of bowel disease.

Adenocarcinoma↗
PubMed1990

Prospective and retrospective analysis of colonoscopy findings in patients with a history of colorectal carcinoma in first-degree relatives.

The frequency of colorectal neoplasia was assessed by colonoscopy in 48 patients with a history of colorectal cancer in a first-degree relative. Twelve of these patients were found to have polyps in the colon, including 1 who had invasive cancer. Patients with multiple first-degree relatives who have a history of colorectal cancer were found to be at increased risk, 56% having colonoscopic findings positive for polyps. Of the 12 patients with positive colonoscopic findings, 5 (42%) had multiple lesions. These findings are similar to those reported in recent pedigree studies and further support a genetic basis for common colorectal cancer. First-degree relatives of patients with colorectal cancer should be considered a high-risk group for colorectal neoplasia. Screening with colonoscopy is recommended.

Adenoma↗
PubMed1989

[Preoperative diagnosis of carcinoid of the terminal ileum in the absence of carcinoid syndrome].

Carcinoid of the small intestine, usually found in the terminal ileum, presents a diagnostic challenge when the classic clinical and laboratory findings are absent. The commonest symptom, marked abdominal pain due to intussusception, may arouse suspicion of carcinoid. The precise preoperative diagnosis in the absence of the classic syndrome is impossible and the only way to diagnose it is by colonoscopic biopsy of the terminal ileum. The case described illustrates such a preoperative diagnosis in a 59-year-old woman with severe abdominal pain, nausea, vomiting and weight loss. X-ray studies aroused suspicion of tumor intussusception as the cause of the intestinal obstruction. Colonoscopic biopsy revealed the presence of a carcinoid tumor. However, there had been no symptoms of the carcinoid syndrome, nor was there increased urinary 5-hydroxy indoleacetic acid. On operation the tumor was found to be disseminated and unresectable, so surgical intervention was limited to palliative ileo-transversostomy.

Biopsy↗
PubMed1989

[Is synchronous hemorrhoidectomy with colonoscopy a worthwhile procedure?].

There were 201 patients receiving preoperative colonoscopy prior to hemorrhoidectomy in the meanwhile at MMH from July 1984 to June 1988. Other than rectal bleeding, they had colonic symptoms such as anemia, abdominal pain, familiar history of cancer and change of bowel habit etc. The study included 114 male and 87 female with ages ranging from 15 to 74 years (Median, 42 years). Three patients with colonic cancer and twenty-eight patients with neoplastic polyps were found by colonoscopic examination. Three cancer patients all received cancer surgery instead of hemorrhoidectomy as quickly as possible in a short time. One patient died for advanced stage and the other two patients got good results. The literatures were reviewed and discussed in accordance with the colonoscopic finding, operative time, hospital stay, post-operative morbidity and complication. There were not increase the postoperative morbidity in this series which compare with that of other series. The advantages of this procedure included: 1) Preventing suffer from twice colon preparations. 2) Preventing waiting period for Barium enema. 3) Preventing delay diagnosis of colorectal lesions especially colon cancer or precancer lesions of neoplastic polyps. 4) Performing examination and surgery at the same time-money-saving and time-saving. We thought synchronous hemorrhoidectomy with colonoscopy is a worthwhile clinical procedure.

Adolescent↗
PubMed1988

Acute colonic ileus (pseudo-obstruction) in renal transplant recipients.

Colon complications are a potential source of serious morbidity to the immunosuppressed patient. Because of multiple predisposing factors, renal transplant patients are a high-risk group for the development of acute colonic pseudo-obstruction. During a recent 18-month period, 290 renal transplants (79 living, 211 cadaveric donors) were performed and prospectively analyzed for colonic dysmotility. A total of 34 episodes of acute colonic ileus (30 primary, 4 recurrent) occurred in 30 (10.3%) renal transplant recipients. Acute colonic ileus was more frequent after living-donor transplantation (19.0% vs. 7.1%, p = 0.006). Analysis of multiple variables revealed that the incidence of acute colonic ileus was directly related to mean cumulative prednisone dosage (p less than 0.05). Medical therapy (rapid steroid reduction, bowel rest) resulted in a 76.7% response, whereas 8 patients underwent colonoscopy because of progression to acute pseudo-obstruction. The success rate for colonoscopic decompression was 87.5%; in 1 patient cecal perforation developed after unsuccessful decompression. Overall, 33 of 34 (97.1%) episodes of acute colonic ileus were successfully treated. Steroid-induced ileus (pseudo-obstruction) is a potentially malignant early form of colonic dysmotility infrequently reported in transplant recipients. Successful management requires early clinical recognition, reduction in steroid dosage, bowel rest, and urgent colonoscopic decompression in select cases.

Adult↗
PubMed1988

[Colorectal carcinoma following radiotherapy of gynecological carcinoma].

To assess the risk of radiation-induced cancer of the colon we studied 196 patients with a history of radiation treatment for cancer of the female genital system. After a median follow-up of 12.4 years (range 10-15 years) corresponding to 1172 patient-years, 94 (48%) patients were still alive. 84 (89%) of these patients were evaluated for a second primary cancer to the colon. In 38 (45%) colonoscopic examination was performed. 3 patients were found to have a second primary cancer to the colon compared with 0.32 expected (relative risk 9.3) on the basis of rates from the Zürich Tumor Registry. Due to partial long-term survival, patient non-compliance and non-feasibility of colonoscopic examination, only one fourth of all patients initially treated by radiotherapy for cancers of the female genital system were suitable for colon screening. For these high risk women, colorectal tumor screening should be integrated into a gynecologic tumor follow-up.

Adult↗
PubMed1986

[Personal experiences with endoscopic polypectomies of the gastrointestinal tract].

The authors performed from 1983 86 gastrofiberoscopic diathermocoagulations and 132 colonoscopic polypectomies. The finding of the high number of adenomas in the stomach - 22.35%/63.15% in diameter to 10 mm/-is surprising. As to complications they recorded in one case mucosal bleeding after gastrofiberoptic polypectomy and in one case a covered perforation of the sigmoid at the site of colonoscopic polypectomy. The discussion is devoted to the present views of the importance of the endoscopic polypectomy in the diagnosis and treatment of polyps in the gastrointestinal tract with the accentuation of the problems of the endoscopic polypectomy from the proximal part of the digestive tube. The authors state the necessity to keep this method for removal of the gastric hyperplasiogenous polyps and the polyps to 10 mm in diameter. Finally, the advantages of the endoscopic polypectomy: unpretentiousness, no risk for patient, high diagnostic and therapeutic value and the economy, as compared with transabdominal surgical approach, are stressed.

Adenocarcinoma↗
PubMed1986

[Endoscopic diagnosis and management of colonic polyps].

Colonoscopic diagnosis of colonic polyps is a rather easy task, although some small polyps might be missed when they are situated around the steep angulation or behind the fold. A correct diagnosis of mucosal carcinoma is difficult not only by colonoscopy but also by biopsy because the cancer focus may be small or not exposed on the polyp surface. Therefore, colonoscopic polypectomy is the best procedure of choice for correct histologic diagnosis of mucosal and invasive carcinoma. Only by polypectomy can correct diagnosis of invasive carcinoma be made, although there are various endoscopic signs such as irregularity of the surface configuration and white spots on the surrounding mucosa suggesting invasive carcinoma. Over the course of several years experience of colonoscopy we have encountered small flat elevations under 1 cm in diameter of which 58% were benign adenomas and 42% contained minute foci of carcinoma. These small flat lesions might have been missed quite easily during routine examination in the past and they might play an important role in the pathogenesis of colonic carcinoma. Benign polyp and mucosal carcinoma can be adequately treated by polypectomy only, whereas invasive carcinoma needs further treatment as it has a risk of node metastasis. Risk factors influencing metastasis are lymphatic permeation, poorly differentiated carcinoma, massive invasion close to the cut end. Only when one of these findings is seen in the removed polyp, further surgical treatment must be considered. However, the patient's general condition, age and site of the polyp should be carefully taken into account in order to choose the appropriate treatment in each individual case as the risk of metastasis under such situations mentioned above is not so high. Management of invasive carcinoma is still a controversial issue and a long-term, clinicopathologic study will be needed to solve this question.

Biopsy↗