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PubMed1999

[Perforation of the colon during colonoscopy].

Perforation of the colon during colonoscopy for diagnostic or therapeutic purposes is an important but not a frequent complication. Bibliographic controversies exist upon the type of treatment either conservative or surgical. In the late years reported cases favorise a trial for conservative treatment under optimal clinical conditions. We report our late experience with 3 cases of iatrogenic colonic perforation treated laparoscopically. Direct visualisation of the local status, the possibility of simple colonic oversew, abdominal toilette and drainage are the advantages of the method on which it should be added the psychological comfort for the surgeon and his gastroenterologist.

Adult↗
PubMed2002

Early detection of colorectal cancer using high-magnification chromoscopic colonoscopy.

BACKGROUND: Endoscopic techniques aimed at early detection of colorectal cancer (CRC) and its precursors, permitting targeted in vivo luminal treatments, have been developed by the Japanese since the early 1990s. The introduction of this new technology to the UK (i.e. magnification endoscopes) may permit earlier and more accurate diagnosis. According to Japanese data, magnification chromoscopy can be used to predict histology and invasive depth of cancer, and help in the detection of flat and depressed colonic lesions. Flat and depressed lesions are not purely Japanese phenomena: they exist with a similar incidence in the UK. METHODS: A Medline search was performed for the years 1955-2001 using the following medical subject headings and search methodology: colorectal cancer and colonoscopy or aberrant crypt foci or molecular kinetics or flat/depressed lesions or chromoscopy. RESULTS AND CONCLUSION: Early CRC, in the form of flat or depressed lesions, can be difficult to detect using conventional colonoscopic techniques and penetrate the colonic mucosa deeply. The implications of detecting these lesions in relation to current approaches to the prevention of CRC are profound.

Adenoma↗
PubMed2003

The role of flat and depressed colorectal lesions in colorectal carcinogenesis: new insights from clinicopathological findings in high-magnification chromoscopic colonoscopy.

High-magnification chromoscopic endoscopy is a new technique which has been recently introduced to the UK. This technology, initially pioneered by the Japanese in the 1980s, has changed our understanding of the pathogenesis of colorectal cancer and our subsequent therapeutic strategies aimed at the secondary prevention of cancer. Magnification colonoscopic techniques when combined with colonic chromoscopy (dye spraying of the colon) permit in vivo assessments of lesions at a magnification and resolution similar to a stereomicroscope. Furthermore, flat/depressed adenomas and cancers can be diagnosed with increasing frequency and new resection practices performed. This technique is known as endoscopic mucosal resection. As gastrointestinal endoscopists adopt these new techniques, close liaison with histopathologists is essential to provide the highest standards of diagnostic accuracy. The histopathologist also needs to be aware of the endoscopic findings when interpreting specimens and hence must understand new endoscopic terminologies and classification systems that accompany the introduction of new technologies and therapeutic techniques. This article describes the controversies relating to the flat and depressed colorectal lesion, where these new endoscopic technologies are ideally suited. It then provides a working description of high-magnification chromoscopic colonoscopy including the Japanese 'pit pattern' and morphological classification system-information which will be provided to histopathologists with specimens obtained by these new techniques. Finally, we describe the procedure of endoscopic mucosal resection, as the type and quality of specimens received for histopathological analysis will be highly influenced by these techniques.

Colonoscopy↗
PubMed2003

Ulcerative ileitis encountered at ileo-colonoscopy: likely role of nonsteroidal agents.

BACKGROUND & AIMS: Ileoscopy is increasingly practiced, but it is unclear what diagnostic and management decisions should ensue if ulcerations are encountered. METHODS: The lead author identified 40 patients with ulcerative ileitis during 1900 consecutive ileoscopies in a community practice. We analyzed the clinical, endoscopic, and histopathologic findings in these patients and related them to drug usage. RESULTS: Although most patients were asymptomatic, ileitis likely contributed to blood loss in 14 and to right lower quadrant pain in one. Endoscopy revealed multiple, discrete, fibrin-covered ulcerations in the prevalvular segment with patches of erythematous stippling, normal intervening mucosa, and occasional mucosal scars or webs. Histologic findings included focal superficial neutrophilic infiltrates, edema, mucosal hemorrhage, lymphatic dilatation, fibromuscular hyperplasia, prominence of the muscularis mucosae, and antral and Paneth cell metaplasia. Granulomas, fissure ulcers, and apoptosis were notably absent. No specific disease process developed in a median follow-up of 3.2 years. Thirty-three patients admitted recently taking nonsteroidal anti-inflammatory drugs (NSAIDs), notably: enteric-coated aspirin at 325 mg/day or less (19), selective cyclooxygenase-2 inhibitors (5), and nonacetylated salicylates (3). Three fourths of nonsteroidal users were taking agents with low or intermediate gastroduodenal toxicity. Lesions disappeared after drug withdrawal, and reappeared on resumption. CONCLUSIONS: Ileoscopy during colonoscopy may identify an ulcerative ileitis. This lesion likely contributes to gastrointestinal blood loss and other clinical manifestations, and likely is caused by NSAID use, including those usually associated with low toxicity or at low doses. Features of NSAID-ileitis overlap with Crohn's ileitis, but differentiation of the 2 entities is critical for appropriate management.

Adult↗
PubMed2000

Magnetic resonance colonography versus conventional colonoscopy for the detection of colonic endoluminal lesions.

BACKGROUND & AIMS: The most effective prophylaxis for colorectal cancer is endoscopic polypectomy. Prompted by the disadvantages of conventional colonoscopy (CC), we assessed the diagnostic ability of a promising alternative technique for detecting endoluminal masses: magnetic resonance colonography (MRC). METHODS: Seventy consecutive patients referred for CC underwent preliminary MRC. The diagnostic ability of this technique in detecting colonic endoluminal lesions was determined, compared with that of CC, and related to the findings from histologic examination. RESULTS: In detecting endoluminal lesions, MRC achieved a diagnostic accuracy similar to CC (sensitivity, 96%; specificity, 93%; positive predictive value, 98%; and negative predictive value, 87.5%). CONCLUSIONS: MRC could be useful in screening programs of patients at high risk for colon cancer. Patients with MRC-detected endoluminal lesions must undergo CC for histologic diagnosis.

Adenocarcinoma↗
PubMed2006

High prevalence of sessile serrated adenomas with BRAF mutations: a prospective study of patients undergoing colonoscopy.

BACKGROUND & AIMS: Sporadic colorectal cancers with a high degree of microsatellite instability are a clinically distinct subgroup with a high incidence of BRAF mutation and are widely considered to develop from serrated polyps. Previous studies of serrated polyps have been highly selected and largely retrospective. This prospective study examined the prevalence of sessile serrated adenomas and determined the incidence of BRAF and K-ras mutations in different types of polyps. METHODS: An unselected consecutive series of 190 patients underwent magnifying chromoendoscopy. Polyp location, size, and histologic classification were recorded. All polyps were screened for BRAF V600E and K-ras codon 12 and 13 mutations. RESULTS: Polyps were detected in 72% of patients. Most (60%) were adenomas (tubular adenomas, tubulovillous adenomas), followed by hyperplastic polyps (29%), sessile serrated adenomas (SSAs; 9%), traditional serrated adenomas (0.7%), and mixed polyps (1.7%). Adenomas were more prevalent in the proximal colon (73%), as were SSAs (75%), which tended to be large (64% >5 mm). The presence of at least one SSA was associated with increased polyp burden (5.0 vs 2.5; P < .0001) and female sex (P < .05). BRAF mutation was rare in adenomas (1/248 [0.4%]) but common in SSAs (78%), traditional serrated adenomas (66%), mixed polyps (57%), and microvesicular hyperplastic polyps (70%). K-ras mutations were significantly associated with goblet cell hyperplastic polyps and tubulovillous adenomas (P < .001). CONCLUSIONS: The prevalence of SSAs is approximately 9% in patients undergoing colonoscopy. They are associated with BRAF mutation, proximal location, female sex, and presence of multiple polyps. These findings emphasize the importance of identifying and removing these lesions for endoscopic prevention of colorectal cancer.

Adenoma↗
PubMed2001

Lactobacillus rhamnosus endocarditis complicating colonoscopy.

We report the first case of endocarditis caused by Lactobacillus after an uneventful colonoscopy. The initial empiric treatment with the standard regimen of penicillin-aminoglycoside failed; subsequent treatment with a combination of antibiotics, selected according to the in vitro studies, was successful.

Aged↗
PubMed2006

Urinary excretion of polyethylene glycol 3350 during colonoscopy preparation.

BACKGROUND: Whole gut lavage with a polyethylene glycol electrolyte solution (PEG) is a common bowel cleansing method for diagnostic and therapeutic colon interventions. Absorption of orally administered PEG from the gastrointestinal tract in healthy human beings is generally considered to be poor. In patients with inflammatory bowel disease (IBD), intestinal permeability and PEG absorption were previously reported to be higher than in normal subjects. In the current study, we investigated the absorption of PEG 3350 in patients undergoing routine gut lavage. METHODS AND RESULTS: Urine specimens were collected for 8 hours in 24 patients undergoing bowel cleansing with PEG 3350 for colonoscopy. The urinary excretion of PEG 3350, measured by size exclusion chromatography, ranged between 0.01 and 0.51 % of the ingested amount, corresponding to 5.8 and 896 mg in absolute amounts, respectively. Mean PEG excretion in patients with impaired mucosa such as inflammation or ulceration of the intestine (0.24 % +/- 0.19, n = 11) was not significantly higher (p = 0.173) compared to that in subjects with macroscopically normal intestinal mucosa (0.13 % +/- 0.13, n = 13). CONCLUSION: The results indicate that intestinal absorption of PEG 3350 is higher than previously assumed and underlies a strong inter-individual variation. Inflammatory changes of the intestine do not necessarily lead to a significantly higher permeability of PEG.

Administration, Oral↗
PubMed1991

Splenic trauma during colonoscopy.

A case of splenic rupture following therapeutic colonoscopy is described, and previously reported cases are reviewed. The occurrence of this event and the associated circumstances are often unpredictable. A high index of suspicion is the key to the diagnosis of this rare but potentially lethal complication.

Aged↗
PubMed1991

Anisakiasis of the colon: report of two cases with emphasis on the diagnostic and therapeutic value of colonoscopy.

Anisakiasis of the colon is a rare entity as compared with gastric anisakiasis, and its diagnosis is very difficult. We present here two cases--a 42-year-old woman and a 30-year-old woman--of anisakiasis of the colon treated by colonoscopic removal of the worm without surgery. The importance of colonoscopy for the diagnosis and treatment of this disease is briefly discussed.

Adult↗
PubMed1990

Golytely preparation for colonoscopy: 1.5 liters is enough for outpatients.

In a prospective double-blind study of the effectiveness and patient acceptance of Golytely whole-gut preparation for colonoscopy, 50 consecutive patients were randomly allocated to drink either 1.5 l (Group I) or 3 l (Group II). The patients had some slight dietary restrictions, and received mild laxatives on the preceding day. The cleansing result did not differ significantly in the two groups. The result was assessed as "good" in 76% of cases in Group I (95% confidence limits 55-91%) and in 83% of cases in Group II (95% confidence limits 63-95%). In half of the remaining cases in both groups the result was "acceptable" and in the other half "poor". Patient acceptance did not differ significantly in the two groups. After completion of the randomized study, oral cleansing with 1.5 l Golytely has been our daily routine. In 42 patients so treated quality of cleansing was good in 81% (95% confidence limits 66-91%), acceptable in 12%, and poor in 7%.

Adult↗
PubMed1989

Role of colonoscopy in gallstone ileus:--a case report.

This paper reviews the role of colonoscopy in large-bowel obstruction by a gallstone. We report the case of an elderly female with a cholecystocolonic fistula who had a large-bowel obstruction caused by a gallstone that migrated to the level of narrowing in the large bowel. After multiple attempts at removal of the stone with a snare and basket retriever, the patient was taken to the operating room and the stone was removed. Colonscopy in these circumstances can be diagnostic and possibly therapeutic.

Aged↗
PubMed1987

Surveillance colonoscopy and biopsy in patients with ureterosigmoidostomy.

Colonoscopy with biopsy was included in the surveillance of 19 patients with ureterosigmoidostomy, because of the high incidence of colonic carcinoma reported in such cases. The patients were examined 1-6 times, at intervals of 1-2 years, 4-36 years after the urinary diversion. Random biopsies from the distal colon and rectum showed only discrete changes, and no dysplasia. Polyps with dysplastic changes were found close to ureteral anastomoses in three patients. For routine check-up of the rectosigmoid region and the ureteral implantation sites, examination with a flexible sigmoidoscope seems to be adequate and preferable, giving easy access to the risk zone for the development of cancer. Caution should be exercised, however, when performing biopsy close to the ureteral orifices.

Adult↗
PubMed1984

Massive subcutaneous emphysema following colonoscopy.

A case of massive subcutaneous emphysema following colonoscopic polypectomy is reported. The incidence of colonic perforation following colonoscopy is 0.1% and may be intraperitoneal or retroperitoneal. Intraperitoneal perforation is usually immediately apparent and likely to require urgent surgical exploration. The development of subcutaneous emphysema or a pneumoscrotum suggests a retroperitoneal perforation and in the majority of cases management is conservative. Contrast studies are often unhelpful but plain x-rays may help to distinguish between intraperitoneal and retroperitoneal perforations.

Aged↗
PubMed1982

Left-sided colonoscopy in screening programs. What preparation?

In order to limit patients' refusal to undergoing colorectal cancer endoscopic screening procedures, traditional cleansing enemas were compared with a new simpler oral cleansing preparation by means of a randomized controlled trial. Ninety-three patients were evaluated both for compliance and effectiveness of the two modalities tested. No difference in acceptability or effectiveness was detected. The authors discuss more rigorous cleansing techniques routinely used in diagnostic schedules which cannot be considered for preparation for colonoscopy in screening programs.

Administration, Oral↗
PubMed1981

Ten years of colonoscopy.

Over the last 10 years, 6170 colonoscopies have been performed at the Medical Department of the University of Erlangen. On the basis of these examinations, an overview, largely tabular in form, of the developments in the endoscopy of the lower gastrointestinal tract is presented. An assessment of the individual results obtained has intentionally not been undertaken. Present possibilities and requirements are presented by the diagnostic and therapeutic tasks and the solutions thus far employed.

Adult↗