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At least 1,243 records · Page 69Linked to original sources
PubMed1999

Use of the enteroscope for colo-ileoscopy: low yield in unexplained lower gastrointestinal bleeding.

BACKGROUND AND STUDY AIMS: The small intestine is a potential origin of bleeding in patients with unexplained gastrointestinal tract hemorrhage or iron-deficiency anemia. Most reports on the investigation of these patients describe the use of upper tract enteroscopy. The diagnostic yield of combined upper and lower enteroscopy has not been widely assessed and remains to be clarified. The aim of this study was to assess the benefit of lower gastrointestinal tract enteroscopy in occult digestive bleeding. PATIENTS AND METHODS: Between 1 December 1995 and 15 January 1998, 54 patients with gastrointestinal bleeding of unknown origin were prospectively studied using upper and lower video push enteroscopy (44 for chronic iron-deficiency anemia and 10 for unexplained gastrointestinal tract hemorrhage with no potential site having been identified by other investigations). Examinations were done using a Olympus video enteroscope (SIF-100) under general anesthesia in a one-day clinic. An upper tract examination was done first, directly followed by the lower tract investigation. RESULTS: The upper tract enteroscopy was successful in 53 patients (98%) and retrograde ileoscopy in 21 patients (39%). In 18 (38%) cases the technical failure resulted from the impossibility of intubating the ileocecal valve. A potential source of upper gastrointestinal bleeding was detected in 35% of patients with chronic iron-deficiency anemia and in 20% of those with unexplained gastrointestinal tract hemorrhage. The most common lesion in the small bowel was angiodysplasia (25%). The lower tract video push enteroscopy disclosed 11 lesions in patients with chronic anemia. However the lesions, including two ileocecal valve cancers, were mainly located in the colon and had been missed by previous colonoscopy. No case of ileal lesion was detected in this group of patients. In patients with unexplained gastrointestinal tract hemorrhage, three lesions were detected but only one of these was in the ileum. Associated colonic and jejunal lesions were observed in three patients (5.5%). Overall, the diagnostic yield of lower video push enteroscopy was less than 2%. CONCLUSION: This prospective study has shown that using an enteroscope as a colonoscope in the management of patients with gastrointestinal bleeding of unknown origin is of little help. It might actually be more appropriate to perform a second colonoscopy. This however remains controversial and a prospective study is needed to answer that question.

Adult↗
PubMed2001

A novel approach to endoscopic colorectal mucosal resection using a three-channel outer tube and multiple forceps: an experimental assessment.

BACKGROUND AND STUDY AIMS: Colorectal endoscopic mucosal resection (EMR) has limitations both anatomically and technically when it is done using the conventional snare wire method. The aim of this study was to develop a new method and instrument for colorectal EMR. METHODS: A total of 21 EMR procedures were done using ten surgical specimens. Saline was injected into the normal submucosa of freshly resected colorectal specimens to prepare a pseudotumor. EMR was performed experimentally by employing a three-channel outer tube with three forceps and a colonoscope with a needle-type precutting knife. This method was assessed in terms of safety and the size of the resected specimens. RESULTS: Perforation occurred only twice in the initial stage of this study. The size of the specimens resected by EMR was 28-39 mm (long diameter 34.8+/-3.11), by 22-28 mm (short diameter 25.8+/-2.07). CONCLUSION: This method can achieve safety and en bloc mucosal resection to the submucosal layer. This novel approach may be promising for clinical application as a new form of endoscopic surgery.

Colonoscopes↗
PubMed2001

Endoscopic snare excision of large pedunculated colorectal polyps: a new, safe, and effective technique.

BACKGROUND AND STUDY AIMS: The endoscopic polypectomy of large pedunculated polyps can have serious complications, such as hemorrhage, which has an incidence of about 2 %. We describe here a new, safe, and effective technique of endoscopic polypectomy for the treatment of large pedunculated colorectal polyps using a standard detachable diathermic snare. PATIENTS AND METHODS: 35 patients (18 men, 12 women; mean age 67.3, range 35 - 82), with 43 pedunculated colorectal polyps, of benign appearance and of size 3 cm or larger (range 3 - 5 cm) on colonoscopy, were included in our study. The polypectomy was performed in two steps: a) we first placed a polypectomy snare round the middle of the stalk, as a prophylactic measure to prevent postpolypectomy bleeding, and we then took out the colonoscope without removing the snare after dismantling it and blocking with a clip; b) endoscopic polypectomy was done using a second polypectomy snare, and transecting the stalk of the polyps at 2 mm above the first snare. The first polypectomy snare was left in place, and the patients were discharged within 3 hours of endoscopic polypectomy. The first polypectomy snare sloughed off spontaneously and slipped down the anus, being evacuated within 4 days following the endoscopic polypectomy. RESULTS: The ensnared polyps were located in the rectosigmoid region (n = 27), and the descending (n = 13) and transverse colon (n = 3). Complete ensnarement of the head of the polyp with a single endoscopic treatment was obtained in all cases. In addition, no procedural or delayed bleeding was noted during a 6-month follow-up. CONCLUSIONS: Our technique allows us to overcome the risk of bleeding, since the use of a standard diathermic snare makes it easier to obtain optimal tightness. Moreover, this technique is cheaper than the use of the standard detachable snare currently available (the cost of the snares being $50.52 compared with $189.47).

Adult↗
PubMed2006

Improved colonoscopy success rate with a distally attached mucosectomy cap.

BACKGROUND AND STUDY AIMS: Although colonoscopy is a well-established procedure, various technical difficulties may cause failure. This report describes experience with cap-assisted colonoscopy (CAC), a technique in which a mucosectomy cap is attached to the end of colonoscope in order to improve the success rate. PATIENTS AND METHODS: From January 2003 to May 2005, CAC was used in consecutive patients with difficult colonoscopy procedures, which were defined firstly as failure to pass through the sigmoid colon after 20 min of examination, or secondly as failure to reach the cecum at the end of the procedure. Patients with prior colonic surgery, poor bowel preparation, distal colonic stricture, or obstructing tumors were excluded. The results with the CAC method were reviewed retrospectively. RESULTS: A total of 100 patients met the criteria for difficult colonoscopy during the study period. When CAC was used to repeat the procedure, cecal and terminal ileal intubation could then be achieved in 94 and 70 patients, respectively. In the remaining six patients in whom cecal intubation failed, one failure was due to a tumor obstruction at the splenic flexure. CONCLUSIONS: CAC can be used as a rescue method to improve the success rate of colonoscopy when failure is encountered.

Adolescent↗
PubMed1984

Electronic endoscopy of the gastrointestinal tract. Initial experience with a new type of endoscope that has no fiberoptic bundle for imaging.

We report on 31 endoscopic investigations using a new type of electronic endoscope which has no fiberoptic bundle for imaging. The device carries on its tip a light-sensitive CCD chip which functions as a TV camera. The signals received are transformed by a processor and displayed on a TV monitor. The upper digestive tract was inspected in 23 patients with the electronic endoscope and in the same session, a fiberoptic-endoscopic esophagogastroduodenoscopy was carried out on 16 of them. The information obtained using the 2 systems differed neither quantitatively nor qualitatively. Because of its external diameter, it was not possible to introduce the electronic endoscope past esophageal stenoses in 2 patients. Preliminary experience with 2 types of colonoscopes in 8 patients strongly indicates that these devices are equivalent, in respect of optical quality, to the fiberoptic endoscopes. The quality and color reproduction of the TV image of the upper and lower digestive tract are excellent. Electronic endoscopy offers great potential for consultation, training and documentation. The patients tolerated the procedure very well.

Adult↗
PubMed1984

Initial experience with the new electronic endoscope.

With the introduction of an electronic sensor attached to the tip of a flexible endoscope, which functions in the manner of a television camera, new dimensions have been opened up for endoscopy. First reports on the clinical application of this new method have been presented at congresses held recently. We, too, were given the opportunity of trying out the prototype of an electronic colonoscope in four patients. This is a brief report of our findings.

Colonic Polyps↗
PubMed1981

Colonoscopy in infancy and childhood with special regard to patient preparation and examination technique.

Only long colonoscopes, Olympus CF-LB2 or TCF-2L, were used for the 76 pediatric colonoscopies. A combination of a thin-liquid diet and laxatives was employed for 1-2 days before all the examinations. Physiological saline enemas on the eve and the morning of the day of examination were employed as supplementary colon-cleansing measures only in larger children. A mixture consisting of chlorpromazine, promethazine and pethidine chloride supplemented with atropine sulfate was used for premedication. Diazepam and ketamine chloride given i.v., or inhalation of halothane +N2O+O2 were employed for general anesthesia. Diazepam and phentanyl citrate given intravenously were used for the sedation of older children. The "classical" and Gaisford's modification of the procedure were found to be the most suitable examination techniques in infants and children. The coecum was reached in 75% of all examinations, and we had no complications with pediatric colonoscopy.

Adolescent↗
PubMed2001

An easy method for the intraluminal administration of peppermint oil before colonoscopy and its effectiveness in reducing colonic spasm.

BACKGROUND: Systemic administration of a cholinergic blocking agent or glucagon is used to reduce spasms, but it is inconvenient and sometimes causes side effects. This study is an evaluation of the intracolonic administration of peppermint oil during colonoscopy for the control of colonic spasm. METHODS: Each patient in the treated group (n = 409) was given approximately 200 mL of the solution (a mixture of 8 mL of peppermint oil and 0.2 mL of Tween 80 per 1 L of water with 0.04% indigo carmine) by using a hand pump attached to the accessory channel of the colonoscope. Changes in patient posture were made to distribute the solution. The patients in the control group (n = 36) were given the solution without peppermint oil. RESULTS: A satisfactory spasmolytic effect was seen in 88.5% of the treated patients and in 33.3% of those in the control group (p<0.0001). No adverse effect was observed. The mean time to onset was 21.6 +/- 15.0 seconds, and the effect continued for at least 20 minutes. In patients with irritable bowel syndrome, efficacy was significantly lower (p < 0.0001). CONCLUSIONS: The intraluminal administration of peppermint oil by using a hand pump is a simple, safe, and convenient alternative to the systemic injection of a cholinergic blocking agent or glucagon during colonoscopy.

Adult↗
PubMed2001

Efficacy of high-level disinfectants for reprocessing GI endoscopes in simulated-use testing.

BACKGROUND: There has been recent public concern regarding the adequacy of current practices for flexible endoscope reprocessing. High-level disinfection is defined by the Food and Drug Administration (FDA) as a minimum of 6-log reduction of mycobacteria under a worst-case scenario. Several agents are currently approved by the FDA, but published data on their relative efficacies against mycobacteria are lacking. The objective of this study was to determine the efficacy of these agents for high-level disinfection. METHODS: In simulated-use testing, video endoscopes (5 colonoscopes and 5 duodenoscopes) were each inoculated with 9.0 x 10(7) colony-forming units of Mycobacterium chelonae. Cleaning was performed by using a standardized protocol. Each endoscope was then subjected to chemical disinfection with Cidex (2.0% glutaraldehyde) at 20 degrees C for 20 minutes, Sporox (7.5% hydrogen peroxide) at 20 degrees for 30 minutes, and Steris 20 (0.2% peracetic acid) at 50 degrees C to 56 degrees C for 12 minutes using the Steris System 1 processor. Although not FDA-approved, tests were also conducted by using 70% isopropyl alcohol at 20 degrees C for 20 minutes. These results were compared with disinfection with ethylene oxide gas. All channels were sampled for M chelonae before and after manual cleaning and after disinfection. RESULTS: Cleaning alone resulted in an average log reduction of 3. Cidex, Sporox, Steris 20, ethylene oxide gas, and isopropyl alcohol, in combination with manual cleaning, each achieved a 6-log or greater reduction of the mycobacterial inoculum. No organisms were recovered from any channel after reprocessing with ethylene oxide and Steris 20. CONCLUSIONS: Commercially available high-level disinfectants are equally efficacious for reprocessing flexible GI endoscopes when used in conjunction with cleaning and in accordance with recommended guidelines.

2-Propanol↗
PubMed2001

Usefulness of Dennis Colorectal Tube in endoscopic decompression of acute, malignant colonic obstruction.

BACKGROUND: Colonoscopic decompression has been attempted in patients with acute colonic obstruction caused by colon cancer to avoid emergency surgery and multiple subsequent operations but has usually been unsuccessful. This is an evaluation of the usefulness of a new device for endoscopic decompression in these patients. METHODS: Nine consecutive patients (6 men, 3 women; 65 to 89 years of age) with acute colonic obstruction resulting from colon cancer underwent endoscopic decompression with a Dennis Colorectal Tube. RESULTS: In all 9 patients (1 with carcinoma of the sigmoid colon, 3 with carcinoma of descending colon, 2 with carcinoma of the transverse colon, 2 with carcinoma of the ascending colon, and 1 with carcinoma of the cecum), endoscopic decompression was successful. After decompressing and cleansing the colon for several days, a one-stage operation was possible in all patients. CONCLUSION: Dennis Colorectal Tube is an excellent device for endoscopic decompression of acute, malignant colonic obstruction.

Acute Disease↗
PubMed1993

A prospective randomized trial comparing manual and automated endoscope disinfection methods.

OBJECTIVE: To compare the efficacy of endoscope disinfection using automated and manual systems. DESIGN: Prospective randomized trial. SETTING: A 1,000-bed tertiary care referral center. METHODS: All endoscopes underwent a three-stage decontamination process including brushing and cleaning with water and detergent, manual or automated disinfection with 2% glutaraldehyde, and 70% alcohol rinse with forced air drying. Cultures were obtained from endoscopes from both groups before and after alcohol rinse and then after overnight storage. RESULTS: Cultures from 8/30 (27%) automated and 11/30 (37%) manually disinfected (P = 0.58) endoscopes grew gram-negative bacteria and/or nontuberculous mycobacteria before the alcohol rinse. After alcohol rinse, 3 (10%) of 30 automated and 8 (27%) of 30 manually disinfected endoscopes remained contaminated (P = 0.28). Manually disinfected endoscopes were contaminated more frequently with coliform bacteria, whereas endoscopes undergoing automated disinfection were more frequently contaminated with nontuberculous mycobacteria, but the differences were not statistically significant. After alcohol rinse and forced air drying, there was no difference in contamination rates between freshly disinfected endoscopes and those stored overnight (7/30 (23%) versus 4/30 (13%), P = 0.50). Colonoscopes and duodenoscopes were contaminated more often than gastroscopes (P = 0.00001). CONCLUSION: The persistent endoscope contamination after manual and automated disinfection indicates the importance of developing more reliable and effective disinfection methods.

Automation↗
PubMed1995

First clinical results with a real time, electronic imager as an aid to colonoscopy.

The early clinical results are described of a real time, electromagnetic imaging system as an aid to colonoscopy. After gaining experience with the use of the system, one experienced endoscopist was randomised to perform consecutive colonoscopies either with (n = 29) or without (n = 26) the imager view. All procedures were recorded on computer disk and replayed for retrospective analysis. Total colonoscopy was achieved in all patients except one (imager view not available). Comparing intubation time and duration of loop formation per patient, there was no significant difference between the two study groups. The number of attempts taken to straighten the colonoscope pre patient, however, was less when the endoscopist was able to see the imager view, p = 0.03. Hand pressure was also more effective when the endoscopist and endoscopy assistant could see the imager display, p = 0.02. Preliminary experience suggests that real time, electronic imaging of colonoscopy is safe, effective, and will improve the accuracy of the procedure.

Abdomen↗
PubMedDate not supplied

Hemostasis of colonic diverticular bleeding with hemoclips under endoscopic control: report of a case.

This paper reports a case in which endoscopic hemostasis of a bleeding colonic diverticula was successful with endoscopic hemoclip. The patient, a 53 year-old man with painless hematochezia, was urgently admitted to our institute. After colonic cleaning preparation, colonoscopic examination was performed. At the bottom of the diverticulum of the ascending colon, a vessel with oozing blood was endoscopically noted. Hemoclips were placed on and around the visible vessel and immediate hemostasis was completed. Endoscopic clipping method for management of bleeding diverticular vessel is an effective, simple, and safe procedure.

Colonoscopes↗
PubMed2002

Efficiency of the glutaraldehyde test strip for monitoring the concentration of glutaraldehyde in reused solutions for disinfecting endoscopes.

BACKGROUND: Glutaraldehyde has been widely used for low-temperature disinfection of endoscopes. The current practice at Siriraj Hospital is to change the glutaraldehyde solution every 21 days or when the solution appears turbid. The disadvantages of this practice include inadequate disinfection of endoscopes if the concentration of glutaraldehyde in a reused solution is insufficient or wasted if the discarded solution is still active. OBJECTIVE: To determine the efficiency of a glutaraldehyde test strip (GTS) in monitoring the amount of glutaraldehyde in a reused solution for disinfecting endoscopes. METHOD: Reused glutaraldehyde solutions for disinfecting bronchoscopes, gastroscopes and colonoscopes were tested for the concentration of glutaraldehyde with a GTS thrice weekly for the first week and then every working day up to 56 days. If the GTS indicated a concentration of glutaraldehyde > or = 1.8 per cent after 21 days, 5 ml of the solution was taken to the laboratory to determine its mycobactericidal activity. RESULTS: All samples of the reused glutaraldehyde solution up to 56 days with a concentration of > or = 1.8 per cent glutaraldehyde on GTS from testings showed mycobactericidal activity. If the glutaraldehyde solution was reused for up to 28, 42 or 56 days, it could save 9,603; 22,813 and 29,415 baht per year respectively for the gastroscopy and colonoscopy units. The corresponding figures were -949; 2,726 and 4,564 baht per year for the bronchoscopy unit. It is estimated that up to 400,000 baht per year could be saved by adopting the strategy of GTS monitoring in all endoscopy units at Siriraj Hospital. CONCLUSION: The current strategy of discarding reused glutaraldehyde solution in the gastroscopy, colonoscopy and bronchoscopy units at Siriraj Hospital may be inappropriate since the reused solution is still mycobactericidal for up to 56 days.

Bronchoscopes↗
PubMed2003

Combined endoluminal and endocavitary approaches to colonic lesions.

Colonic lesions of benign or early malignant origin may be difficult to remove by colonoscopy. However, conventional surgical resection is considered as too invasive for these types of lesions suitable for local excision. The combined laparoscopic-colonoscopic excision was performed in 75 patients (males, 42; females, 33) with benign or early malignant lesions of the colorectum. Three different variations were used: laparoscopy-assisted endoscopic resection (LAER), endoscopy-assisted laparoscopic wedge resection (EAWR), and endoscopy-assisted laparoscopic transluminal resection (EATR). If these techniques were not applicable, an endoscopy-assisted laparoscopic segment resection (EASR) was performed. Conversion rate was 5.0%. Although the expenditure of combined endoscopic/laparoscopic approaches is higher, they are attractive alternatives to either laparoscopic tubular resection or open surgery.

Colectomy↗
PubMed1990

[Fiber colonoscopy in children under 18. Our experience with 112 patients studied in the digestive endoscopy section of a general hospital].

The aim of the study was to evaluate the indications of colonoscopy, diagnostic accuracy and efficacy treatment of procedure in young patients aged less than eighteen years using standard forward colonoscopes Olympus CF LB2, CF LBw and CF HL20. Among 5,400 procedures done along eleven years, 112 (2.07 per 100) were performed in patients aged less than eighteen years, 37.6 per 100 of which were performed in children under ten years. In this group general anaesthesia was employed without complications. The most frequent indication of colonoscopy in young patients was rectal bleeding (62.5 per 100). Related to the frequency, in this series, the control of graft versus host disease in patients submitted to bone marrow transplantation was the second indication (11 per 100), followed by the study of chronic anaemia (4.2 per 100) and control of the chronic inflammatory bowel disease (4.2 per 100). Diagnostic accuracy reached 93.75 per 100. In 6 per 100 of the cases the exploration were considered unsatisfactory because inadequate cleaning of the colon. The most frequent diagnostic was "normal colon" (29.6 per 100 of the cases). Polyp was found in 21.2 per 100 of the cases. Polypectomy was performed in all indicated cases. One patient with multiple polyposis were submitted to surgery. Colonoscopy reached the right colon in 25.4 per 100 of the cases. In 54 per 100 of the procedures reached splenic angle and in 83.8 per 100 of the cases, all sigmoid colon was explored. From this experience we suggests that colonoscopy, using standard endoscopes, is a very useful diagnostic and therapeutic technique in child and in young people.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

[The role of colonoscopy in screening for tumors of the large intestine].

In 1986-1988, 6434 patients underwent colonoscopy in general hospital: 2076 were at risk for large bowel cancer whereas in 4358 the procedure was used for prophylaxis. Benign polyps or polyposis were detected in a total of 1699 (26.4%) patients: 856 (41.2%) in the risk group and 843 (19.3%) in the prophylactic one. Malignancy was diagnosed in 248 (11.9%) and 41 (0.9%) patients, respectively. It was found that small and early tumors made up 22% of the total number of cancers in the prophylactic group and 16.9% in the high risk group only. Colonoscopic screening carried out under general hospital condition is psychologically and economically justified since it allows to form a risk group and diagnose early cancer whereas timely removal of polyps assures secondary prophylaxis of large bowel cancer.

Adult↗
PubMed1990

[Retrograde ileography. Contrast imaging of the terminal ileum by colonoscopy].

The distal ileum, the segment most frequently affected by small intestinal disease, may be difficult to visualize by conventional x-ray techniques. In recent years various methods have been described for retrograde ileography during or after colonoscopy. However, these methods require special equipment and may be difficult to perform in practice. We have therefore tried out a somewhat modified technique. Patients with suspected distal ileal disease are examined on a fluoroscopy table at the x-ray department. When necessary, biopsies are taken during the introduction of the scope. With the tip of the colonoscope in the terminal ileum (or coecum) a catheter is introduced through the biopsy channel into the distal ileum. Water-soluble contrast (Mixobar) is then instilled under fluoroscopic control and films are taken in the supine, oblique and prone positions. Owing to gas already present in the ileum a double contrast effect is obtained. The ileography is completed in 5-10 minutes and entails no additional discomfort for the patient. The technique is easy to learn and requires no special equipment. It does not obviate the need for conventional small bowel enema, but may be a valuable supplement to this examination when distal ileal pathology is suspected.

Colonoscopes↗