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PubMed2006

The Aer-O-Scope: proof of the concept of a pneumatic, skill-independent, self-propelling, self-navigating colonoscope in a pig model.

BACKGROUND AND STUDY AIMS: Considerable training is needed to enable endoscopists to use the currently available commercial colonoscopes and sigmoidoscopes effectively and safely. The aim of this study was to evaluate the safety and efficacy of the propulsion mechanism incorporated into the Aer-O-Scope (GI View Ltd., Ramat Gan, Israel)--a novel self-propelled, self-navigating colonic endoscope for diagnostic purposes. MATERIALS AND METHODS: Twenty young female pigs underwent complete bowel preparation followed by a sedated examination using the new device. Ten pigs underwent two consecutive procedures, with a wash-out period of 7 days between each procedure. The total number of procedures was 30. Two prototypes of the Aer-O-Scope, with different cable lengths and vehicle balloon sizes (n = 20 and n = 10 for prototypes I and II, respectively) were used. Each examination was followed by a standard colonoscopy for safety evaluation. The insertion length of the Aer-O-Scope was determined by fluoroscopy images. RESULTS: The colon was adequately clean in 25 procedures. Maximum insertion was achieved in 21 procedures (84%)--80% with prototype I (n = 15) and 90% with prototype II (n = 10). The time to maximum insertion averaged 8.9 +/- 4.4 min (10 +/- 4.6 and 6.6 +/- 2.9 min for prototypes I and II; P < 0.05), and the withdrawal time averaged 3.4 +/- 2.1 and 4.2 +/- 3.4 min, respectively. The driving pressures for prototypes I and II averaged 46.3 and 34.5 mbar, respectively. The follow-up conventional colonoscopy identified no mucosal tears or perforations. Minor mucosal petechiae were noted in 43% of the cases. No adverse events were noted up to 7 days after the procedure. CONCLUSIONS: The propulsion mechanism used in this novel self-propelled, self-navigating colonoscope was effective and safe in pigs.

Animals↗
PubMed1987

Balloon probe for the colonoscopic small intestinal enema (CE).

The colonoscopic small intestinal enema (CE) permits the radiological examination of a large portion of the distal small intestine during colonoscopy. The colon (endoscopically) and the small intestine (radiologically) can thus be examined in one session. With a new balloon probe that can be passed through the instrumentation channel of the endoscope, it is no longer necessary to prepare the colonoscope by fitting a circular balloon as previously described, before introducing it into the patient. With the balloon probe, CE can be carried out at any time if an unexpected finding such as inflammation of the ileo-cecal valve makes the examination of the ileum desirable.

Catheterization↗
PubMed2002

Colonoscope length and procedure efficiency.

OBJECTIVE: We set out to compare the success of colonoscopy using long and intermediate length standard adult instruments. METHODS: An intermediate length (133 cm working length) and long (168 cm) videocolonoscope were used on an alternate patient basis during routine endoscopy lists. Completion rates, times, and the need for external abdominal pressure were documented, as were causes of failed cecal intubation. RESULTS: Among patients with no history of colon resection and with satisfactory bowel preparation, 173 procedures were performed with the intermediate and 167 with the long colonoscope. There was no significant difference in completion rates (96% for both, excluding patients with strictures), completion times (intermediate mean = 7.73 min, long = 8.11 min; p = 0.44), or need for external abdominal pressure. Similarly, no difference was observed for male and female patients analyzed separately. Though there was no significant difference in completion rates for males and females overall (99% vs 95% excluding patients with strictures, p = 0.08), the latter had significantly longer completion times (mean = 8.75 vs 6.76 min, p < 0.001) and were more likely to require external abdominal pressure. Intermediate colonoscope length was responsible for failure to reach the cecum in one patient only (0.6%). CONCLUSIONS: Although the length of the intermediate instrument rarely compromises colonoscopy, it offers no significant advantage over the long scope for routine procedures.

Cecum↗
PubMedDate not supplied

Total intraoperative enteroscopy using a colonoscope for detecting the bleeding point.

We report a case of bleeding in the small intestine of a 59-year-old man that was successfully diagnosed and treated by total intraoperative enteroscopy. The patient was admitted to our hospital because of gastrointestinal bleeding. Gastroscopy, colonoscopy and mesenteric arteriography could not identify the bleeding point. Technetium-99m-labeled red blood cell scintigraphy suggested bleeding from the small intestine but could not reveal the precise lesion. As the patient presented melena and went into a state of shock, we performed emergency laparotomy with total intraoperative enteroscopy using a colonoscope. A small ulceration was found at the jejunum, and subsequently partial resection of the jejunum was performed. The lesion was diagnosed histopathologically as angiodysplasia. The patient recovered uneventfully and was discharged on the 24th postoperative day. Bleeding in the small intestine is rare and difficult to diagnose but it sometimes induces a severe condition. Total intraoperative enteroscopy using a colonoscope is effective for detecting the bleeding point in the small intestine and can be performed at most centers without special fiberscopes and techniques.

Angiodysplasia↗
PubMedDate not supplied

[Colonoscopic dilator: a new instrument in the management of benign stenosis of the colon and rectum].

Experience with a colonoscope with a distal segment that allows for the incorporation of dilating olives of the Eder Puestow type is presented. 15 patients with the diagnosis of benign stenosis of the colon or rectum who suffered of abdominal pain and constipation were treated. In 13 patients it was possible to eliminate the patients symptoms. There where no complications. The dilating colonoscope is a valid, alternative in the management of stenosis of the colon and rectum.

Colonic Diseases↗
PubMed1977

Colonoscopic polypectomy in children.

Three children, 30 to 36 months of age, had solitary juvenile polyps in the sigmoid colon and rectal bleeding of varying severity, In all three patients, the polyps were removed without the use of general anesthesia through a standard 100-cm colonoscope used to examine adult patients. No untoward effects were encountered. Colonoscopic polypectomy is an effective therapeutic procedure and obviates the need for either anxious waiting in the mildly symptomatic patient or colotomy and polypectomy in the child with profuse rectal bleeding.

Child, Preschool↗
PubMed1983

Colonoscopic polypectomy in a regional teaching hospital.

Five hundred and thirty-five polyps were found in 200 patients over 6 years at a regional teaching hospital. Eighty-five per cent of the patients were from the hospital area yet the presentation of the patients, the complications of polypectomy, the size, distribution and histological features of the polyps were similar to large series reported from metropolitan specialist centres of referral both in this country and the USA. However, a smaller proportion of our polyps were over 1 cm diameter. Between 25 and 53 per cent of patients had recurrent or residual polyps on the second and third colonoscopy. Patients with two or more polyps at the first endoscopy were significantly more likely (P less than 0.01) to have further polyps at follow-up. We therefore recommend that patients with colonic polyps are colonoscoped annually until free from polyps for 2 years, before being placed on colonoscopic review at 5-year intervals.

Colon↗
PubMed1993

Colonoscopic surveillance after curative resection for colorectal cancer.

Colonoscopic surveillance after resection for colorectal cancer has been advocated to improve detection of anastomotic recurrence, and of synchronous and metachronous tumours. The benefit provided by colonoscopy remains unproven, and the best timing of examination is unclear. To determine the value of colonoscopy after curative resection for large bowel cancer, the efficacy of an endoscopic surveillance programme in the early detection of intraluminal bowel recurrence in a series of patients admitted with colorectal cancer was examined. Between April 1983 and December 1988, 132 patients underwent colonoscopy. Eight (6.1 per cent) were found to have intraluminal recurrence without evidence of extraluminal spread. Six of these recurrences were at the site of anastomosis and two represented metachronous tumour development. All of these patients were symptomatic at the time of diagnosis. In 15 patients (11.4 per cent), adenomatous polyps were discovered during the initial endoscopic examination. These results indicate that colonoscopic surveillance will rarely allow early detection of asymptomatic intraluminal bowel recurrence, but is valuable in the detection of synchronous lesions. Frequent surveillance is not justified in the early postoperative years and colonoscopy should probably be confined to a single procedure to exclude synchronous lesions.

Adenomatous Polyps↗
PubMedDate not supplied

Colonoscopic indirect lymphangiography in a canine model.

Colorectal malignancies metastasize most frequently to mesenteric lymph nodes. Preoperative staging of these nodes by current modalities is problematic. This study evaluates the feasibility of indirect mesenteric lymphangiography as a colonoscopic technique in a canine model. Ten mongrel dogs underwent endoscopic submucosal injection of Ethiodol at various sites in the transverse, descending, and rectosigmoid areas. Serial abdominal roentgenograms were obtained up to 2 weeks postinjection. In seven of the animals, demonstration of mesenteric nodal uptake corresponding to the area(s) of injection was radiographically documented. In the remaining animals (early in the series) nodal opacification was inadequate. This lack of nodal uptake appeared to be due to nonsubmucosal contrast injection. No complications were noted. Colonoscopic indirect lymphangiography appears to be a safe and potentially useful modality in the evaluation of mesocolonic lymph nodes. Further studies to refine this technique and investigate its potential to preoperatively delineate abnormal nodal architecture are warranted.

Animals↗
PubMed1992

Ultrastructural study of M cells from colonic lymphoid nodules obtained by colonoscopic biopsy.

The present study was undertaken to investigate ultrastructurally the epithelium covering lymphoid nodules obtained from colonoscopic biopsies of the human colon and rectum. Colonoscopy using the dye spraying contrast method was performed in nine patients who showed x-ray evidence of lymphonodular hyperplasia. Fifty-two colonoscopical biopsy specimens of lymphoid nodules were obtained from the ascending, transverse, and descending colon and rectosigmoid region. All specimens were observed by light and electron microscopy. Light microscopy disclosed large lymphoid follicles protruding into the lumen with a "dome-type" configuration. These extended to the lamina propria of the mucosa and were associated with a massive lymphoid aggregation extending as far as the muscularis mucosa from the submucosa. The epithelium covering these nodules contained a few goblet cells and many lymphocytes. Observation of the elevated surface at the apex by scanning electron microscopy revealed M cells with sparse microvilli in the dome epithelium surrounded by crypts. Transmission electron microscopy disclosed M cells enfolding many immature or mature lymphocytes and plasmocytes. The M cells had cytoplasmic microvilli (so-called "microfolds") on their surfaces, well-developed tubulovesicular systems, and vacuoles in the cytoplasm. The basic structure of the M cells as observed by scanning and transmission electron microscopy was the same as that of M cells in the Peyer's patches of humans and mice. The apical surface of the colonic lymphoid follicles in Crohn's disease patients was associated with erosions observed by scanning electron microscopy. The erosions proved to be the naked surface of the dome after removal of the epithelium, and many holes from 2.0 to 6.0 microns in diameter were observed on the naked surface. At high magnification, lymphocytes were seen projecting from holes (18%) on the naked surface of the dome. These ultrastructural findings indicate that human colonic lymphoid follicles are very similar to those seen in other species.

Adult↗
PubMed1986

Isolation of intestinal mononuclear cells from colonoscopic biopsies for immunofluorescence analysis by flow cytometry.

A method for isolating and characterizing intestinal lymphoid cells from colonoscopic biopsies is presented. Intraepithelial lymphocytes were separated from the lamina propria by incubation in edetic acid (EDTA) and lamina propria lymphoid cells isolated by incubation in collagenase followed by Ficoll-Hypaque density flotation. Quantitation of T lymphocyte helper (OKT4) and suppressor (OKT8) cells was performed using monoclonal antibodies to cell surface markers and analyzed on a flow cytometer. The isolation procedure yielded approximately 400,000 lamina propria cells and 100,000 intraepithelial cells per sample, with better than 90% viability. Surface marker analysis demonstrated significant differences in the ratios of helper to suppressor cells between the intraepithelial lymphocytes and the lamina propria lymphocytes. These demonstrate the feasibility of lymphoid cell isolation from colonoscopic biopsy specimens for surface marker analysis by flow cytofluorimetry. These techniques could prove important in the study of immune mechanisms in inflammatory bowel diseases.

Antibodies, Monoclonal↗
PubMed1987

Problems in the colonoscopic localization of tumors: continued value of the barium enema.

Six patients in whom errors of diagnosis and therapy occurred because of reliance on colonoscopic tumor localization are presented. Three of the patients required a second laparotomy for surgical resection of a tumor that was missed at the first exploration. While endoscopy is regarded as the diagnostic gold standard, there are problems in its use for colonoscopic localization. Reliance on distance measurements may be misleading. Anatomical variants can be confusing. For this reason, a preoperative barium enema for precise delineation and localization of tumors is recommended. When a barium enema is not feasible, such as when a malignant polyp has been removed endoscopically, preoperative endoscopic localization with injection of India ink or intraoperative colonoscopy must be performed.

Adult↗
PubMed1992

Colonoscopic screening for neoplasms in asymptomatic first-degree relatives of colon cancer patients. A controlled, prospective study.

Individuals with a family history of colorectal cancer are believed to be at an increased risk of developing colorectal neoplasia. To estimate this risk and the potential yield of screening colonoscopy in this population, we recruited and prospectively colonoscoped 181 asymptomatic first-degree relatives (FDR) of colorectal cancer patients and 83 asymptomatic controls (without a family history of colorectal cancer). The mean ages for the FDR and control groups were 48.2 +/- 12.5 and 54.8 +/- 11.0, respectively. Adenomatous polyps were detected in 14.4 percent of FDRs and 8.4 percent of controls. Although 92 percent of our FDRs had only one FDR afflicted with colon cancer, those subjects with two or more afflicted FDRs had an even higher risk of developing colonic adenomas (23.8 percent) than those with only one afflicted FDR (13.1 percent). A greater proportion of adenomas was found to be beyond the reach of flexible sigmoidoscopy in the FDR group than in the controls (48 percent vs. 25 percent, respectively). Logistic regression analysis revealed that age, male sex, and FDR status were independent risk factors for the presence of colonic adenomatous polyps (RR = 2.32, 2.86, and 3.49, respectively; P less than 0.001). Those at greatest risk for harboring an asymptomatic colonic adenoma are male FDRs over the age of 50 (40 percent vs. 20 percent for age-matched male controls). Based on probability curves, males with one FDR afflicted with colon cancer appear to have an increased risk of developing a colonic adenoma beginning at 40 years of age. Our results document, for the first time, an increased prevalence of colonoscopically detectable adenomas in asymptomatic first-degree relatives of colon cancer patients, as compared with asymptomatic controls, and support the use of colonoscopy as a routine screening tool in this high-risk group.

Adenoma↗
PubMed1993

Hemorrhage following colonoscopic polypectomy.

Clinically significant hemorrhage following colonoscopic polypectomy may occur primarily as the polyp is removed or manifest itself days to weeks later secondary to clot dissolution. The rate of hemorrhage following colonoscopic polypectomy ranges widely from 0.3 to 6.1 percent, depending on whether the data are derived from studies using the number of patients or number of polypectomies. A retrospective study was performed in our institution to study 4,721 patients who underwent polypectomy between January 1987 and December 1991. Twenty (0.4 percent) of these patients required hospital admission because of 9 primary and 11 delayed hemorrhages. Fifty-four polyps were removed from these patients: 11 in the right colon, 7 in the transverse colon, 17 in the descending colon, and 19 in the sigmoid colon. Eight polyps were 2 cm or larger, 10 were pedunculated, and 44 were sessile. Six patients underwent cauterization or resnaring of the bleeding polyp site, one patient underwent subtotal colectomy, and the remainder of the patients stopped bleeding spontaneously. Factors that could be associated with the outcome of hemorrhage include patient age, size, location, number and morphology of polyps (i.e., sessile or thick stalk), and use of anticoagulants. An experienced endoscopist with knowledge of electrosurgical and technical principles may be the most important factor for prevention of postpolypectomy bleeding.

Adult↗
PubMed1995

Folate status and adenomatous colonic polyps. A colonoscopically controlled study.

PURPOSE: The aim of our study was to assess any association of folate with development of colonic adenomas. METHODS: Serum and red blood cell folate levels were measured in 62 colonoscopically and histologically evaluated patients with colon adenomas (Group A) and in 50 selected colonoscopically negative controls (Group B). Patients with colon polyps underwent colonoscopy for alterations of bowel habits or abdominal pain, and detected polyps were found coincidentally. Controls underwent colonoscopy for alterations of bowel habits or abdominal pain. There was no difference in hematocrit between the two groups. RESULTS: The mean serum folate level in patients with colonic adenomas was 4.57 ng/ml +/- 2.8 standard deviations (SD), and the mean red blood cells folate levels were 536 ng/ml +/- 273.3 (SD). In controls the mean folate levels in serum and red blood cells were 5.09 ng/ml +/- 2.7 (SD) and 743.8 ng/ml +/- 297.1 (SD), respectively. The red blood cell folate level of colon adenoma patients was statistically lower than the respective level of controls at a highly significant level (P < 0.01). CONCLUSIONS: We suggest that depressed red blood cell folate levels are associated with development of colonic adenomas.

Adenoma↗
PubMed1995

Phenotypic and functional characterization of T-cell lines generated from colonoscopic biopsy specimens in patients with ulcerative colitis.

Intestinal T-cell lines were generated from lamina propria mononuclear cells isolated from colonoscopic biopsies in ulcerative colitis patients and controls. In both ulcerative colitis and controls, expanded cells were constituted largely by T-cell receptor alpha beta+, CD4+, CD45RA- (helper), and CD8+, CD11b- (cytotoxic) phenotypes. T-cell receptor V beta gene usage was not significantly changed after cell expansion and no difference was observed between ulcerative colitis and controls. Ulcerative colitis cells, especially those derived from the patients with long-standing disease, showed significantly higher levels of cytotoxicity against the target cells, including those of colonic epithelial origin, and enhanced production of tumor necrosis factor-alpha and interferon-gamma after short incubation with anti-CD3 antibody. Generation of T-cell lines from colonoscopic biopsy specimens may be useful for detailed functional characterization of locally infiltrating T cells in ulcerative colitis patients.

Adolescent↗
PubMedDate not supplied

Pneumopericardium and subcutaneous emphysema of the neck. An unusual manifestation of colonoscopic perforation.

Subcutaneous neck emphysema has been reported infrequently following colonoscopic perforation and only a single case of pneumopericardium has been previously reported. The successful management of these patients in the literature has largely been non-operative. We report a case of colonoscopic perforation which presented with subcutaneous neck emphysema, pneumopericardium, and pneumoperitoneum that required operative intervention.

Adult↗
PubMed1984

Management of patients with polyps containing malignancy removed by colonoscopic polypectomy.

The management of malignant colonic polyps removed colonoscopically has been a controversial subject. A continuing series is reported of 36 patients with 37 malignant polyps removed by colonoscopic polypectomy (CP) between 1976 and 1982. Fourteen polyps contained carcinoma in situ (CIS); 13 were treated by CP alone; one was treated by CP and colectomy. Nineteen polyps contained invasive carcinoma; 13 were treated by CP alone; six were treated by CP and colectomy. Four patients had sessile polyps resected piecemeal, in which accurate staging was impossible. Two were treated with CP alone, and two had CP plus colectomy. All patients were followed with yearly colonoscopy and/or barium enema. Follow-up has been six to 84 months (mean 36 months). Twenty-seven patients whose polyps were treated by CP alone have had no evidence of recurrent tumor at the polypectomy site. Of the nine patients undergoing colectomy, six had residual tumor at the polypectomy resection site. No patients had involved lymph nodes. Our current approach to this problem is based on the degree of invasion and the status of the resection margins. Polyps containing CIS can safely be treated with CP alone. Polyps with invasive carcinoma and clear resection margins should be treated with CP and either colectomy or frequent repeat colonoscopy. This decision is a clinical one and must involve input from both the clinician and the pathologist. Those polyps whose resection margins are involved or where piecemeal excision precludes accurate pathologic assessment should undergo colectomy.

Adenoma↗