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At least 19 recordsLinked to original sources
PubMed1976

Routine and blind histological diagnoses on colonoscopic biopsies compared to clinical-colonoscopic observations in patients without and with colitis.

Of the 110 patients examined, complete agreement was found between the blind and routine histological studies in the sections from 69 patients (63%), between the blind histological study and that of colonoscopy in 66 patients (60%), and between the routine histological diagnoses and those of colonoscopy in 73 patients (66%). The diagnosis of a normal colonic mucosa was made by blind study on colonoscopic biopsies in 32 patients, by the routine one in 36 patients, and by clinical-colonoscopic examination in 40 cases, the percentage of agreement with the colonoscopic diagnosis being 68 and 72, respectively. The diagnosis of unspecific non-ulcerative colitis was made by the blind histological study in 43 patients, by the routine histological examination in 58 cases, and by colonoscopy in 41 patients. The percentage of agreement between the histological studies and the clinical-colonoscopic diagnoses was 61 and 78, respectively. A diagnosis of ulcerative colitis was made by the blind histological study in 35 patients, by the routine histological examination in 16, and by colonoscopy in 27 cases. The percentages of agreement between the histological studies and the diagnoses by clinical-colonoscopic examination were 82 and 59, respectively. The differences in symptomatology between groups were small, except for a high occurrence of diarrhoea and blood in stool in ceses with ulcerative colitis, as evaluated by blind histological study. The findings stress the importance of following defined criteria for histological examination.

Biopsy↗
PubMed1991

Documenting the use of fluoroscopy during colonoscopic examination: a prospective study.

To determine the patterns of fluoroscopy use during colonoscopy, 500 consecutive patients undergoing colonoscopic examination were studied over a 6-month period. The procedures were performed on 195 patients by three gastroenterologists and on 305 patients by three colon and rectal surgeons. The study group comprised 237 women and 263 men aged an average of 62 years (range, 12-90 years). The results revealed that fluoroscopy was used during 37% of colonoscopic examinations. The most common indications for fluoroscopy were the treatment of sigmoid loops (42%) and the localization of the colonoscope tip (51%), totaling 93% of 312 fluoroscopic checks. The suspected position of the colonoscope tip was inaccurate in 15% (47/312) of fluoroscopic checks. The most common bowel location of the colonoscope tip during the fluoroscopic checks was the hepatic flexure (24%), followed by the cecum (21%). In all, 53% (166/312) of fluoroscopic checks involved the right colon. The selective use of fluoroscopy during more difficult cases was emphasized by the significantly longer time required for the procedure (36 vs 26 min) and the significantly lower cecal intubation rate (79% vs 99%). In summary, fluoroscopy is deemed to be a safe, reliable technique that facilitates the completion of difficult colonoscopic examinations. It is especially helpful in the treatment of sigmoid loops and in the precise localization of the position of the colonoscope tip, especially during negotiation of the right colon.

Adolescent↗
PubMedDate not supplied

Usefulness of pediatric colonoscopes in adult colonoscopy.

Use of small diameter, extraflexible pediatric colonoscopes has proved to be valuable in adult endoscopy practice, not only for passing strictures and stomas but also where either fixation due to diverticular disease or postoperative adhesions, or unavoidably painful looping made passage of adult colonoscopes impossible. In 70 of 78 (92%) of the cases where the adult colonoscope could not be passed through the sigmoid colon by an expert endoscopist, the pediatric colonoscope passed through, often very easily. Fifteen of these patients were considered to have been saved surgery by successful passage. The "failure" rate for all colonoscopy examinations was only 2%; this low failure rate was attributable to the use of pediatric instruments whenever passage through the sigmoid colon proved to be impossible with standard colonoscopes. In our opinion every unit performing frequent colonoscopies should have a pediatric colonoscope available for selected adult patients as well as for use in children.

Biopsy↗
PubMed1992

Ogilvie's syndrome: colonoscopic decompression and analysis of predisposing factors.

Forty-eight cases of Ogilvie's syndrome, colonic pseudo-obstruction, presenting between 1983 and 1989 were retrospectively reviewed to assess the results of colonoscopic decompression and to identify potential etiologic factors. Three patients had spontaneous resolution with medical treatment. Forty-five patients required 60 colonoscopic decompressions: 38 (84 percent) were successfully treated using colonoscopy; five (11 percent) required an operation; and two died within 48 hours of colonoscopy from medical causes. No complications or deaths were the result of colonoscopy. Twenty-nine patients (64 percent) were successfully treated with a single colonoscopy. One-third of patients required serial decompressions. Average cecal diameter in patients with successful colonoscopic decompression was 12.4 cm but was larger for patients requiring more than one colonoscopy (13.3 cm) and for those who failed colonoscopic therapy (13.4 cm). The spine or retroperitoneum had been traumatized or manipulated in 52 percent of patients. Patients with Ogilvie's syndrome were being treated with narcotics (56 percent), H-2 blockers (52 percent), phenothiazines (42 percent), calcium-channel blockers (27 percent), steroids (23 percent), tricyclic antidepressants (15 percent), and epidural analgesics (6 percent) at diagnosis. Electrolyte abnormalities included hypocalcemia (63 percent), hyponatremia (38 percent), hypokalemia (29 percent), hypomagnesemia (21 percent), and hypophosphatemia (19 percent). Colonoscopic decompression in Ogilvie's syndrome is safe and effective management. Multiple pharmacologic and metabolic factors, as well as spinal and retroperitoneal trauma, appear to alter autonomic regulation of colonic function, resulting in colonic pseudo-obstruction.

Adult↗
PubMed1991

Colonoscopic surveillance after polypectomy: considerations of cost effectiveness.

OBJECTIVE: To assess the cost effectiveness of the current recommendation that persons who have had an adenomatous colon polyp removed have periodic colonoscopic surveillance at fixed and regular intervals. DESIGN: Cost-effectiveness analysis using data from the medical literature in a simulation model to estimate the costs of and the risk for perforation associated with periodic colonoscopic surveillance for a 50-year-old man followed for 30 years. MAIN RESULTS: A program of colonoscopy every 3 years would incur cumulatively a 1.4% risk for colon perforation, a 0.11% risk for perforation-related death, and direct physician costs of $2071 for colonoscopy (discounted at 5%). If a 50-year-old man's cumulative remaining risk for death from cancer is 2.5% after the removal of a single small adenoma and if effectiveness of colonoscopic surveillance every 3 years is 100%, then one death from cancer could be prevented by doing 283 colonoscopies, incurring 0.6 perforations, 0.04 perforation-related deaths, and direct physician costs of $82,000. If surveillance were 50% effective and the cumulative remaining risk for death from cancer were 1.25%--a plausible scenario--1131 colonoscopies would be required to prevent one death from cancer, incurring 2.3 perforations, 0.17 perforation-related deaths, and physician costs of $331,000. CONCLUSIONS: The cost effectiveness of colonoscopic surveillance is very sensitive to estimates of the cumulative remaining risk for death from cancer after polypectomy as well as to surveillance efficacy. For persons whose remaining risk for death from cancer may be low, such as persons with a single small adenoma, recommendations for colonoscopic surveillance at fixed and regular intervals may be excessively costly.

Aged↗
PubMedDate not supplied

Peroral enteroscopic removal of a retained percutaneous transhepatic guidewire from the jejunum using a colonoscope.

Several authors have described the ability to perform small-intestine endoscopy with long, flexible fiberscopes. A peroral colonoscope has been used for small-bowel enteroscopy and biopsy. A pediatric colonoscope for jejunoscopy has been described. Herein we report a patient undergoing percutaneous transhepatic decompression for the extrahepatic biliary obstruction in whom the guidewire broke and was lost in the liver. The proximal end of the wire was within the liver, while the distal end exited the ampulla and lay within the upper jejunum. Utilizing a peroral approach with the flexible pediatric colonoscope, we recovered the guidewire without advancing it further into the jejunum, where it may have been lost and have necessitated a celiotomy.

Aged↗
PubMed1990

Invasive colorectal adenomas: surgery versus colonoscopic polypectomy.

Of 6,426 colonoscopies performed in 1978-1987, 66 invasive colorectal adenomatous polyps were removed in 58 examinations. The study group included 36 (62%) men and 22 (38%) women with an age range of 42-96 years. Forty-three patients had invasive pedunculated polyps and 15 had invasive sessile polyps. Following the colonoscopic polypectomy, secondary surgical resection was done in 19 patients with pedunculated polyps and in 13 patients with sessile polyps. The operative specimens showed that the colonoscopic polypectomy removed the entire cancerous focus in all patients with pedunculated polyps, including those with stalk invasion. In contrast, most cases with sessile polyps turned out on operation to be Dukes' B or C carcinoma. Follow-up (mean 4.4 years) was available for 53 (93%) patients: none of 24 unoperated patients with pedunculated polyps suffered from local recurrence. We conclude that colonoscopic polypectomy is sufficient for invasive pedunculated polyps, provided that histology shows that the resection margins are free of tumoral cells. Surgery is recommended for all invasive sessile polyps.

Adult↗
PubMed1992

Dysplasia in chronic ulcerative colitis: implications for colonoscopic surveillance.

Mucosal dysplasia has been used as a marker for patients with chronic ulcerative colitis considered to be most at risk of developing cancer, and its identification is the basis for colonoscopic surveillance programs. To evaluate the reliability of this premise, colectomy specimens from two groups of patients who had undergone surgery for chronic ulcerative colitis (50 with cancer and 50 without) were retrieved. The groups were matched by age, sex, duration of disease, disease extent, and symptoms at the time of surgery. Using a standard technique of multiple random biopsies, we utilized the standard colonoscopic biopsy forceps to obtain four biopsies from mucosa that was not macroscopically suspicious for dysplasia or cancer in eight defined regions in each of the 100 colon specimens. This technique mimicked exactly the methods used in our clinical surveillance program. All 3,200 biopsies were evaluated blindly by one pathologist for presence and grade of dysplasia. Twenty-six percent of colons with an established cancer harbored no dysplasia in any biopsy from any region in the colon. While an overall association between the presence of cancer and high-grade dysplasia was detected (relative risk = 9.00; 95 percent CI of 2.73-29.67), the sensitivity and specificity of random colonic biopsies to detect concomitant carcinoma were 0.74 and 0.74, respectively. These findings prompt concern that reliance on random biopsies, obtained during colonoscopic surveillance, may be misplaced.

Adult↗
PubMed1977

A new technique for insertion of the colonoscope through the ileocaecal valve.

At colonoscopy it is important to examine the distal part of ileum in inflammatory diseases particularly. Different techniques for insertion of the colonoscope into the ileum have been described. In our experience these methods require considerable skill and practice. We have therefore worked out a technique for easier access to the ileum with a colonoscope. A closed biopsy forceps is used for identification of the ileocaecal valve by dislodging the upper lip. The forceps is manoeuvred through the ostium and then the colonoscope can be inserted into the ileum with the forceps as a guide.

Biopsy↗
PubMed1990

The colon in shigellosis: serial colonoscopic appearances in Shigella dysenteriae I.

Twenty-five patients (16 males and 9 females; mean age 24.7 +/- 8.4 years) with acute colitis caused by Shigella dysenteriae I were studied, a total of 115 colonoscopic examinations being performed. Twenty-two patients had weekly colonoscopic examinations until the last procedure revealed normal colonic mucosa. Six abnormal colonoscopic appearances were documented, namely mucosal edema, ulcers, friability, punctate spots, erythematous areas and luminal exudate. Mucosal edema was the dominant finding in the first week of the disease. Star-shaped mucosal ulcers and friability were observed in the 2nd and 3rd weeks of the disease. Punctate hemorrhagic spots with normal intervening mucosa in patients with minimal constitutional and colonic symptoms were the hallmark of the disease from the 4th week onwards. None of the patients revealed granularity, cobblestoning, linear fissures, pseudopolyps, pseudomembrane or anal lesions. The colonic involvement was subtotal in 20 patients and total in 5 patients. The mucosal disease was continuous in the initial stage and became patchy during the later stage of recovery. The mucosal disease lasted for 38.8 +/- 12.1 (10-65 days). All the patients followed-up by serial colonoscopy examinations eventually had normal colonic mucosa.

Adult↗
PubMed1991

Management of colonic polyps by colonoscopic polypectomy.

Colonoscopic polypectomy is an important therapeutic advance as it enables most colonic polyps to be removed entirely and studied pathologically and has virtually replaced surgical treatment. The clinical and pathological features of patients with colonic polyps treated by colonoscopic polypectomy over a five-year period are reported. Seventy-four patients (37 men, 37 women) with a mean age of 57 years had 109 polyps removed by snare polypectomy. Rectal bleeding was the predominant symptom and was present in 63.5%. Lower abdominal pain was present in 12%. The majority of polyps were located in the sigmoid (38.5%) and descending (40.3%) colon. Ninety-five polyps were pedunculated and 14 were sessile. Of the neoplastic polyps, 61.6% were pure tubular adenomas, 25.2% were mixed tubulo-villous adenomas and 1% were pure villous adenomas. There were no complications arising from colonoscopy or snare polypectomy. Colonoscopic polypectomy is a safe, reliable and cost-effective therapeutic procedure that has revolutionized the management of pre-cancerous neoplastic colonic polyps.

Adenoma↗
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↗
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↗
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↗
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↗
PubMedDate not supplied

Fiberoptic colonoscopy: the fate of colonoscopic polypectomy sites.

Nine cases of colonoscopic polypectomy followed by colonic resection are reviewed. A properly performed colonoscopic polypectomy produces a mucosal defect resembling a superficial ulceration. Granulation tissue rapidly covers the area, and this, in turn, is eventually covered by normal colonic mucosal epithelium. Mural inflammation is mild and limited to the submucosa, and no demonstrable change occurs in the muscular layers.

Colonic Diseases↗
PubMed1992

Colonoscopic polypectomy in children.

Between January 1984 and July 1990, a total of 129 colonoscopic snare polypectomies were performed during 77 sessions on 74 patients aged 2 to 12 years. Bleeding per rectum (mean duration, 10 months) was the chief presenting symptom and was present in all of these patients. In 89% of patients polypectomy was carried out without using general anesthesia. Ninety-six percent of patients had juvenile polyps. Two patients had familial polyposis coli and one patient had a solitary adenomatous polyp. The majority (98; 80%) of the polyps were located in the rectosigmoid region. Four patients developed complications, one needing emergency operation. There were no deaths in the series. It is concluded that colonoscopic snare polypectomy is a simple, effective, and safe procedure for treating colorectal polyps in children.

Child↗