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 1,513 records · Page 84Linked to original sources
PubMed2007

Assistance of colorectal stent insertion by sphincterotome.

PURPOSE: Palliation of patients with unresectable colorectal carcinoma is an effective treatment and technical failure is undesirable. Insertion of colorectal stent using a combined radiologic and colonoscopic technique may be technically limited by the ability to negotiate tortuous bends, particularly if the bowel is fixed. METHODS: We used a through scope sphincterotome, which improved the ability to traverse difficult strictures. RESULTS: We have used the technique in four cases as a last resort. This resulted in a technical success in all four cases (100 percent). CONCLUSIONS: Sphincterotome is a useful adjunct in stenting difficult colorectal tumor strictures.

Aged↗
PubMed2001

Validation of lymphatic mapping in colorectal cancer: in vivo, ex vivo, and laparoscopic techniques.

BACKGROUND: The use of lymphatic mapping (LM) is being investigated to improve the staging of colorectal cancer (CRC) and thereby identify patients who might benefit from adjuvant chemotherapy. This study evaluated in vivo, laparoscopic, and ex vivo approaches for the ultrastaging of CRC. METHODS: Seventy-five CRC patients were enrolled in a study of LM with peritumoral injection of isosulfan blue dye. LM was undertaken during open colon resection (OCR) in 64 patients, during laparoscopic colon resection (LCR) in 9 patients, and after specimen removal (ex vivo) in 2 patients. Ex vivo LM was also undertaken in 6 patients after unsuccessful in vivo LM. All nodes were examined by hematoxylin and eosin (H&E) staining; in addition, sentinel lymph nodes (SNs) were multisectioned and examined by immunohistochemical staining with cytokeratin (CK-IHC). RESULTS: At least one SN was identified in 72 patients (96%). In vivo LM identified SNs in 56 of 64 (88%) patients undergoing OCR and in 9 of 9 (100%) patients undergoing LCR. Ex vivo LM was undertaken as the initial mapping procedure in 2 cases of intraperitoneal colon cancer and after in vivo LM had failed in 6 cases of extraperitoneal rectal carcinoma; an SN was identified in 7 of the 8 cases. Focused examination of the SN correctly predicted nodal status in 53 of 56 OCR cases, 9 of 9 LCR cases, and 6 of 7 ex vivo cases. Multiple sections and CK-IHC identified occult micrometastases in 13 patients (17%), representing 10 OCR, 1 LCR, and 2 ex vivo cases. CONCLUSIONS: LM of drainage from a primary CRC can be accurately performed in vivo during OCR or LCR. Ex vivo LM can be applied when in vivo techniques are unsuccessful and may be useful for rectal tumors. During LCR, colonoscopic injection can be used to mark the primary tumor and define the lymphatic drainage so that adequate resection margins are obtained. These LM techniques improve staging accuracy in CRC.

Adult↗
PubMedDate not supplied

Abnormality of peptide YY and pancreatic polypeptide immunoreactive cells in colonic mucosa of patients with colonic inertia.

The etiopathology of colonic inertia remains unclear. Current studies show that pancreatic polypeptide-fold family members can serve as regulators of colonic motility and transit. Thus, the cells containing these peptides on colonic mucosa could be abnormal in patients with colonic inertia. We aimed to evaluate the immunocytochemical staining of peptide YY (PYY) and pancreatic polypeptide (PP) immunoreactive cells, and detect if alteration of these cells relates to an increase in enterochromaffin cells (EC) demonstrated by chromogranin A (CgA), in the colonic mucosa of patients with colonic inertia. Nineteen consecutive patients (18 female, 1 male; age, 43.7+/-11.5 years) who underwent subtotal colectomy for colonic inertia were assessed. The control group consisted of 15 patients (all female; age, 50.7+/-12.5 years) who underwent colonoscopic biopsies from the right and left colon for indications other than constipation, inflammatory bowel diseases, diarrhea, or neoplasm. Hollande's-fixed, paraffin-embedded tissues of both right and left colons were collected. Immunocytochemical staining of PYY, PP, or CgA was performed on 4-microm tissue sections with the respective primary rabbit antibody, the biotinylated secondary antibody, and enzyme-labeled streptavidin. The average number of positive cells per microscopic field (200x) was calculated. Positive cells were classified as strongly, moderately, and weakly staining. The proportion of the variously stained cells is expressed as the percentage of the entire positive cell population. On both sides of the colon, the percentages of strongly and moderately stained PYY positive cells were higher in the patient group compared to the controls (right side, 10.6 and 27.3 vs. 6.1 and 18.7%, respectively; left side, 9.4 and 23.9 vs. 6.2 and 23.1%, respectively) (P < 0.01). Furthermore, in the patients with colonic inertia, the percentages of strongly and moderately stained PYY-positive cells were higher in the right-side colon than in the left (P < 0.01). There was no difference in the number of PYY-positive cells between the patients and the controls. PP-positive cells were very rare in all specimens and were found in 7 of 19 cases (36.84%) in the right-side colon and 16 of 19 (84.21%) in the left-side colon in the patient group (P < 0.01, left vs. right). In contrast, the number of EC in the left colon of patients (16.8+/-10.2) was significantly higher than that in the right side (9.4+/-6.0) (P < 0.01) or that in the left side in the control group (10.4+/-6.0) (P < 0.05). We conclude that in the colonic mucosa of patients with colonic inertia, PYY-positive cells present with higher immunoreactivity, indicating that they may contain more hormones, especially on the right side of the colon. However, the PPY- and PP-positive cells did not relate to the increased EC. and It is therefore suggested that the altered PYY in the colonic mucosa may partially contribute to the etiopathology of colonic inertia.

Adult↗
PubMed2006

The association of Streptococcus bovis bacteremia and gastrointestinal diseases: a retrospective analysis.

There is a well-established association between Streptococcus bovis bacteremia (SBB) and colorectal cancer. However, SBB is also frequently associated with chronic liver disease and has been described with other gastrointestinal disorders. The aim of the study was to evaluate the prevalence of gastrointestinal disease in patients with SBB. Retrospective analysis of the microbiology database at Jackson Memorial Medical Center, Miami, Florida, between 1992 and 2002, was performed. Patients' clinical records were reviewed, with special focus on underlying gastrointestinal disease or other major comorbidities. Thirty-eight patients (83%) were adults and eight (17%) were pediatric patients. Nineteen patients presented with gastrointestinal disorders associated with SBB (41%). Nine adult patients (19%) had end-stage liver disease (five female). Six patients had alcohol-induced liver disease (one with concomitant chronic hepatitis C), with the remaining three cases related to autoimmune hepatitis, primary biliary cirrhosis, and nonalcoholic steatohepatitis. Colonic neoplasms (adenocarcinoma in 3 and adenomatous polyps in 3) were found in 6 of 10 adult patients in whom colonoscopic evaluation was performed. Seven adult patients had acquired immunodeficiency syndrome (AIDS) (18%). Mortality in the patients with AIDS and SBB was high (71%). No significant association with gastrointestinal diseases was found in the pediatric population. Bacteremia due to S. bovis in adults is frequently associated with hepatic dysfunction (1:4), colonic neoplasms (1:6), and AIDS (1:6). This association was valid for our adult population only. SBB is an early clue to the likely presence of these serious underlying conditions and warrants rigorous investigation when recognized.

Adolescent↗
PubMed2006

Use of an ultrathin gastroscope to allow endoscopic insertion of enteral wallstents without fluoroscopic monitoring.

Self-expanding metallic stents are useful in relieving tumoral obstruction in the gastrointestinal tract. Endoscopic insertion is usually made through the working channel of a therapeutic endoscope. Fluoroscopy during insertion is thought to be mandatory in most cases. Endoscopists sometimes encounter problems in using or accessing fluoroscopy facilities. This study describes a method to insert, under certain circumstances, enteral Wallstents using only endoscopic control. An ultrathin gastroscope is used to pass severe tumoral strictures and place a guide wire beyond the stenosis. The ultrathin gastroscope is removed leaving the guide wire in place, which is then inserted in a retrograde fashion into a therapeutic colonoscope, allowing insertion of through-the-scope stents. Successful insertion was achieved in 5 malignant gastric outlet obstructions and in 6 rectosigmoid tumoral obstructions. In conclusion, in some cases using an ultrathin endoscope to place a guide wire beyond the stricture can be useful for endoscopic placement of Wallstents without fluoroscopy.

Adenocarcinoma↗
PubMed2005

Long term follow-up of HNPCC gene mutation carriers: compliance with screening and satisfaction with counseling and screening procedures.

Hereditary non polyposis colorectal cancer (HNPCC) is a hereditary predisposition to colorectal and endometrial cancer, caused by mutations of the mismatch repair (MMR) genes MSH2, MLH1 and MSH6. Regular colonoscopy reduces the incidence of colorectal cancer in mutation carriers dramatically. The aim of this study was to evaluate the use of colonoscopy by proven HNPCC mutation carriers. We also evaluated the satisfaction with the counseling and screening procedures at the long term. A questionnaire survey was performed among 94 proven MMR gene mutation carriers. Data were analyzed using univariate and multivariate analysis. The average time of follow-up was 3,5 years (range 0.5-8.5 years). The response rate was 74%. The proportion of unaffected mutation carriers under colonoscopic screening increased from 31 to 88% upon genetic testing, and for gynecological screening from 17 to 69%. However, more than half of the responders experienced colonoscopy as unpleasant or painful. About 97% felt well informed during counseling, and 88% felt sufficiently supported. Ten percent of the responders reported a high cancer worry that was significantly (P = 0.007) associated with a high perceived cancer risk. Six responders (9%) regretted being tested. Remarkably, of 4 of these 6 a close relative died recently of cancer. Problems with obtaining a disability or life insurance or mortgage were experienced by 4 out 10 healthy carriers opting for these services. In conclusion, genetic testing for HNPCC considerably improves compliance for screening, which will result in a reduction of HNPCC-related cancer morbidity and mortality in mutation carriers. Most HNPCC gene mutation carriers cope well with their cancer susceptibility on the long term.

Adult↗
PubMed2007

Familial colorectal cancer referral to regional genetics department--a single centre experience.

Evaluation of familial colorectal cancer referral can assist in the planning of future cancer surveillance. The aim of the study is to assess colorectal cancer referral pattern to our regional genetics service. Hospital computer records and/or department referral books were used to identify cases referred to the regional genetic service during a 10-year period (1992-2001 inclusive). All files were reviewed along with associated demographic data, risk assessments, referral details, results from mutation testing and screening recommendations. In terms of result, a total of 1100 family files were reviewed (Familial Adenomatous Polyposis families were in a separate register). The number of referrals showed a 10-fold increase over the 10 years. 171 (15.6%) of families met the Amsterdam criteria II were classified as high-risk, 589 (53.5%) families were classified as moderate-risk and 337 (31.0%) as average or low risk. 22.9% families were referred with inaccurate cancer history. Sixty-one families have been identified with mismatch repair mutations. 56.8% of referred individuals were recommended to have regular colonoscopy ranging from 18 monthly to 5 yearly depending on their risks. In conclusion, there has been a 10-fold increase in individuals with suspected hereditary bowel cancer referred to the North West Regional Genetics Service in the last ten years. Genetic assessment may reduce the number of low-risk individuals and those who were found not to be mutation carriers from having unnecessary colonoscopic screening. Thus genetic risk assessment should precede the initiation of regular endoscopic screening.

Adult↗
PubMed2001

Update on acute colonic pseudo-obstruction.

Acute colonic pseudo-obstruction is characterized by distention of the colon in the absence of mechanical obstruction. This presentation is typically related to recent surgery, severe illness, or medication. Nasogastric and rectal tube decompression and correction of electrolyte abnormalities are the standard of care. Colonoscopic decompression, performed in a number of these cases, was felt to be unwarranted in many situations and is associated with a high recurrence rate. Medical management beyond conservative measures has been limited. Medical therapy with pharmacologic agents such as erythromycin, metoclopromide, and cisapride was of limited use. Recent findings confirm that an older agent, neostigmine, provides excellent results, including colonic decompression and clinical improvement after administration. This suggests a new standard of care.

Acute Disease↗
PubMed2004

Acute colonic pseudoobstruction.

Acute colonic pseudoobstruction (ACPO) is a clinical condition of acute large bowel obstruction without mechanical blockage. ACPO occurs most often in hospitalized patients with serious underlying medical and surgical conditions. ACPO is an important cause of morbidity and mortality. The pathogenesis of ACPO is not completely understood but likely results from an imbalance in the autonomic regulation of colonic motor function. Metabolic or pharmacologic factors, as well as spinal or retroperitoneal trauma, may alter the autonomic regulation of colonic function, leading to excessive parasympathetic suppression or sympathetic stimulation. This imbalance results in colonic atony and pseudoobstruction. Early recognition and appropriate management are critical to minimizing morbidity and mortality. The mortality rate is estimated at 40% when ischemia or perforation occurs. The best documented treatment of ACPO is intravenous neostigmine, which leads to prompt decompression in the majority of patients after a single infusion. In patients failing or having contraindications to neostigmine, colonoscopic decompression is the active intervention of choice. Surgery is reserved for those with overt peritonitis or perforation.

Acute Disease↗
PubMed2000

Acute Intestinal Pseudo-obstruction.

Acute pseudo-obstruction may manifest clinically in one of three forms--acute gastroparesis, ileus, and acute colonic pseudo-obstruction (Ogilvie's syndrome). Though formerly associated primarily with the postoperative state, these entities are increasingly recognized in association with a wide variety of major medical problems. There are few controlled studies to guide the clinician in the management of these disorders. Treatment remains largely empirical, and time-honored, based primarily on "bowel rest," nasogastric decompression, and supportive care. While a wide variety of pharmacologic approaches have been advocated, few have been subjected to, or survived, the rigors of a properly controlled trial. Neostigmine is a notable exception, and has been shown to be effective in Ogilvie's syndrome. Perforation is a significant threat in megacolon; colonoscopic, or surgical decompression may, therefore, be indicated. Both are associated with significant risks in this context, but may prevent progression to perforation with its attendant mortality. New approaches seek to exploit current concepts in the pathophysiology of ileus and megacolon but have not, as yet, achieved efficacy in human studies.

Journal Article↗
PubMed2002

Cancer in Inflammatory Bowel Disease.

Colorectal cancer (CRC) is a complication in both patients with longstanding ulcerative colitis and those with Crohn's disease. As with sporadic CRC, surgical therapy (with adjuvant chemotherapy in advanced disease) is the only effective treatment. Identifying risk factors for CRC in inflammatory bowel disease (IBD) should allow patients to receive appropriate medical, endoscopic, and surgical care to minimize CRC morbidity and mortality. Total proctocolectomy remains the most effective form of cancer prophylaxis in IBD patients, but because of the impact of this approach and the low absolute risk of cancer, clinicians seldom recommend it. Colonoscopic surveillance with systematic biopsies is used to detect mucosal dysplasia and thus identify those patients at greatest risk for developing CRC. Patients with dysplasia other than that in readily excised polyps should be referred for surgery. Although fraught with limitations, surveillance is the best method currently available for reducing CRC mortality and morbidity short of prophylactic colectomy. It will have to remain the standard of practice until better diagnostic tests are available. Surveillance should be offered and performed in the same manner for patients with Crohn's disease and ulcerative colitis. Chemoprevention may prove effective in the future, but currently used agents have only a modest benefit, if any. Adenocarcinoma of the small intestine occurs at an increased rate in patients with Crohn's disease of the bowel with longstanding small bowel involvement, but there are no current methods of early detection. Treatment is based on disease identified from evaluation of symptoms or incidental finding. Some extraintestinal cancers have been noted to occur at increased rates in series from referral centers but not in population-based studies.

Journal Article↗
PubMed1999

Colon Ischemia.

Colon ischemia is expressed in a broad clinical spectrum, from mild, reversible ischemia to intestinal infarction and gangrene. In most cases, the precipitating cause is unknown, and colonic blood flow usually has normalized by the time the patient seeks medical attention. Satisfactory treatment begins with accurate diagnosis, which depends on serial colonoscopic or roentgenographic studies and the exclusion of other disorders that may mimic colon ischemia. Prognosis typically is good, and most patients require only supportive care with close follow-up. More aggressive therapy, including surgery, is indicated in patients who early in their course develop massive bleeding, perforation, or signs of fulminant colitis or who subsequently develop symptomatic strictures or persistent symptoms of colitis.

Journal Article↗
PubMed1975

Comparison of colonoscopy and the contrast enema in five hundred patients with colorectal disease.

Endoscopic examination of the entire colon (colonoscopy) is an important new method of diagnosis and treatment of diseases of the colon and rectum, particularly cancer. The records of 500 patients who had one or more contrast enemas and subsequent colonoscopy were analyzed in an attempt to evaluate the competitive and complementary features of the two methods. The endoscopists had the advantage of having a radiologic report or radiographs available to them. In general, when the level of abnormality could be reached, colonoscopy had a higher degree of accuracy, particularly since observation could be combined with biopsy. This was particularly true in the case of polyps in which colonoscopy confirmed 166 radiologically described growths plus an additional 118 lesion, twenty-one of which were over 1 cm in diameter. By endoscopic excision of these polyps via the colonoscope, malignant changes can be identified, a conclusion rarely reached by radiographic means alone. With respect to cancer, exclusive of polyps, only twenty-four of thirty-two cases were diagnosed by x-ray study alone. Another nine, interpreted aa demonstrating malignancy from the radiographs, had cancer excluded when subjected to endoscopic confirmation. Colonoscopy has also proved valuable in identifying lesions of the cecum, notoriously a problem for the radiologist, and in identifying milder degrees of inflammatory change which are undetectable by radiographic means. Colonoscopy and the contrast enema are best reported as completmentary rather than competitive approaches, and by their combined use, diagnostic accuracy is greatly enhanced.

Barium Sulfate↗
PubMed1978

Pseudoobstruction of the colon.

Pseudoobstruction of the colon is a specific variety of adynamic ileus. Its characteristic clinical presentation is severe cramping lower abdominal pain, a massively distended abdomen, and a characteristic x-ray picture. Thirty-five patients with this disease complex have been reviewed, and their surgical and medical therapy is discussed. Guidelines for continued medical versus surgical intervention are suggested. Two patients underwent decompression with the colonoscope. Its use and a possible hazard of the procedure are discussed. For those patients who develop pseudoobstruction after trauma or surgery, a pathophysiologic explanation is offered. The possible role of prostaglandin abnormality in the genesis of pseudoobstruction is also discussed.

Adult↗
PubMed1979

Massive cecal dilation: pseudoobstruction versus cecal volvulus?

Seven patients with acute and progressive abdominal distension secondary to massive cecal and right colon ileus are analyzed. Five had pseudoobstruction of the colon and two had cecal volvulus. Two of the patients with pseudoobstruction and one with cecal volvulus died from preexisting diseases. Pseudoobstruction of the colon is not a rare complication of elderly, sick, bedridden patients. Differential diagnoses include cecal and sigmoid volvulus and acute gastric dilation. Initial conservative therapy is warranted if no peritoneal signs are present. If the cecal diameter is more than 12 cm, colonoscopic decompression with a fiberscope should be attempted. If unsuccessful, tube cecostomy will provide curative, life-saving therapy even if taenia splitting is present. Perforation or widely scattered areas of necrosis make resection mandatory.

Aged↗
PubMed1992

Can general surgeons perform colonoscopy safely?

The purpose of the current study was to review the safety of colonoscopy performed by nonfellowship-trained general surgeons. To address this issue, we reviewed more than 1,000 consecutive diagnostic and therapeutic colonoscopies and recorded the complications. This was a multi-institutional study involving seven general surgeons, none of whom had had formal fellowship endoscopic training. Perforation was confirmed by laparotomy, bleeding was defined as that requiring hospitalization and/or transfusion, and cardiopulmonary arrest was self-explanatory. There was one perforation in the diagnostic group and none in the therapeutic group, for a rate of 0.10% overall and 0.12% in diagnostic colonoscopy. There were no instances of bleeding or cardiac arrest. This complication rate of 1 per 1,025 colonoscopic procedures by general surgeons compares favorably with that previously reported by other specialties (p less than 0.001). We conclude that postgraduate endoscopy fellowship is not necessary for general surgeons to become safe colonoscopists.

Clinical Competence↗
PubMed1985

Golytely lavage versus a standard colonoscopy preparation. Effect on normal colonic mucosal histology.

We prospectively studied the changes of colonic mucosa in patients receiving two different preparations for colonoscopic examination. Eighteen consecutive patients undergoing colonoscopy for polyps or mass lesions, properly age- and sex-matched, were randomized to receive Golytely lavage (3-4 L) or a standard preparation (48-h clear liquid diet, 240 ml of magnesium citrate and "X-Prep" senna derivative). Patients with diarrhea or inflammatory bowel disease, or both, were excluded. Biopsy specimens were obtained from normal-appearing mucosa of the right and left side of the colon (none in the distal 10 cm of rectum). Blind review of coded slides was performed with 0-3 scoring for artifact, edema and hemorrhage of the lamina propria, surface epithelial and goblet cells, crypts, and cells in the lamina propria including eosinophils and polymorphonuclear leukocytes. Statistically significant differences were found for preservation of surface epithelial and goblet cells and less edema in favor of patients receiving Golytely. We conclude that the standard form of colon preparation flattens the surface epithelial cells and depletes the goblet cells as well as causes an increase in lamina propria edema, whereas colon lavage preserves normal mucosal histology.

Aged↗
PubMed1986

Pathological findings of lymphangiectasia of the large intestine in a patient with protein-losing enteropathy.

Lymphangiectasia of the large intestine associated with protein-losing enteropathy is reported. A 33-yr-old man suffered from diarrhea, sometimes mixed with blood. Colonoscopic study revealed reddish and edematous mucosa with multiple flat elevated lesions and giant folds in the localized segment of the rectosigmoid. An intestinal clearance test of alpha 1-antitrypsin revealed the association of protein-losing enteropathy. Operation was performed successfully, resulting in a marked improvement of symptoms and laboratory data, especially serum total protein, albumin, IgG, and Leu-2a-positive cells (suppressor/cytotoxic T cells). Giant folds consisted of the submucosal edema and hyperplasia of the epithelial glands with cystic dilatation of glands, and flat elevated lesions consisted of mucosal and submucosal edema associated with intestinal lymphangiectasia, adipose tissue, and blood capillaries. The population of the Leu-2a-positive cells in the lamina propria and intraepithelial layer was decreased and that of the Leu-3a-positive cells (helper/inducer T cells) in the lamina propria was increased.

Adult↗