Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Colonoscopy”

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 19 recordsLinked to original sources
PubMed2001

Patient experience and preferences toward colon cancer screening: a comparison of virtual colonoscopy and conventional colonoscopy.

BACKGROUND: Virtual colonoscopy has excellent sensitivity for the detection of cancer and polyps greater than 1 cm in diameter. For virtual colonoscopy to succeed as a screening test for colorectal neoplasia, it must be well tolerated and accepted by patients. Patients' experiences with virtual colonoscopy and conventional colonoscopy were assessed and compared. METHODS: Patients referred to the GI clinic for colonoscopy for any indication were recruited to undergo virtual colonoscopy before conventional colonoscopy. Patients were asked to complete a questionnaire twice: after virtual colonoscopy and after completing both tests. Three variables, overall pain, discomfort, and lack of respect, were assessed by using a 7-point Liken scale with higher scores denoting a worse experience. Patients' preferences for virtual colonoscopy versus conventional colonoscopy were determined with a time tradeoff technique. To verify response stability, patients were asked to return an additional questionnaire by mail at 24 hours. RESULTS: Two hundred ninety-five patients completed the questionnaire immediately after the procedures, and 83 patients completed the questionnaire at 24 hours. At both 0 and 24 hours, patients reported more pain, discomfort, and less respect after virtual colonoscopy than conventional colonoscopy (p < 0.01). The overall agreement (Kappa statistic) between times 0 and 24 hours was fair. Patients reported that they preferred conventional colonoscopy and would wait longer for conventional colonoscopy (mean = 4.9 weeks) than undergo a virtual colonoscopy (p < 0.01). CONCLUSIONS: Patients tolerate both virtual colonoscopy and conventional colonoscopy, although they report more pain, discomfort, and less respect undergoing virtual colonoscopy. Efforts to improve patient experience during virtual colonoscopy need to be investigated.

Abdominal Pain↗
PubMed2006

Afternoon colonoscopies have higher failure rates than morning colonoscopies.

BACKGROUND: There are several known predictors of an incomplete colonoscopy or difficult colonoscopy. In addition, inadequate bowel preparation has been reported in procedures scheduled later in the day. Operator fatigue, which tends to be higher as the day passes on, may also impact colonoscopy completion rate. AIMS: To determine the influence of performing outpatient colonoscopies in the afternoon versus morning on the completion rates of colonoscopy and adequacy of bowel preparation. METHODS: Retrospective chart review of all outpatient colonoscopies performed between November 2003 and October 2004 in the Division of Gastroenterology at MetroHealth Medical Center in Cleveland, Ohio. Patient demographics, indications for procedure, and colonoscopic findings were reviewed. Patients received polyethylene glycol electrolyte-based bowel preparation in the evening prior to the day of the scheduled colonoscopy. RESULTS: A total of 2,087 colonoscopies was performed, of which 1,084 were in the morning and 999 were in the afternoon. Patients in the morning and afternoon were similar in regards to the known risk factors predictive of an incomplete colonoscopy. The incompletion rate was significantly higher in the afternoon compared to the morning (6.5% vs 4.1%, P= 0.013, OR for incompletion was 1.64, CI 1.11-2.44). Inadequate bowel preparation was found in 167 out of 1,084 (15.4%) colonoscopies in the morning and 197 out of 999 (19.7%) colonoscopies in the afternoon (P= 0.011). Even after excluding incomplete colonoscopies due to poor bowel preparation precluding examination, the incompletion rate was still higher in the afternoon (5% vs 3.2%, P= 0.043, OR 1.60, CI 1.03-2.51). CONCLUSIONS: Scheduling of colonoscopies in the afternoon compared to the morning may be an independent predictor of an incomplete colonoscopy and inadequate bowel preparation. According to our study findings, scheduling of all outpatient colonoscopies preferentially in the morning would avoid suboptimal procedures in 5% of patients and the need for unnecessary repeat colonoscopy or an alternative imaging study in 2.4% of patients.

Aged↗
PubMed2003

Virtual colonoscopy using oral contrast compared with colonoscopy for the detection of patients with colorectal polyps.

BACKGROUND & AIMS: Virtual colonoscopy using abdominal spiral computed tomography scanning allows total colonic evaluation with minimal invasiveness. Two-dimensional images and selective 3-dimensional images of the colon are used to detect colorectal lesions. This trial used conventional colonoscopy with segmental unblinding to determine the ability of virtual colonoscopy to identify patients with colorectal lesions who need conventional colonoscopy. METHODS: We studied 205 patients with virtual colonoscopy using oral iodinated contrast preceding conventional colonoscopy. Colonic lavage was achieved with an oral sodium phosphosoda preparation and colonic distention with a carbon dioxide electronic insufflator. RESULTS: The overall sensitivity and specificity of virtual colonoscopy in identifying patients with colorectal lesions was 61.8% and 70.7%, respectively. Virtual colonoscopy was more accurate in identifying patients with lesions >/=6 mm (sensitivity 84.4% and specificity 83.1%) and those with lesions >/=10 mm (sensitivity 90% and specificity 94.6%). The negative predictive value of virtual colonoscopy was 95% for a 6-mm cutoff size and 98.9% for a 10-mm cutoff. Using a 10-mm cutoff, virtual colonoscopy precludes the need for conventional colonoscopy in 86% of patients with a 1% false-negative rate (68% with a 3.4% false-negative rate when using a 6-mm cutoff). CONCLUSIONS: Virtual colonoscopy has a high sensitivity and specificity for detecting patients with significant colorectal lesions. Its high negative predictive value may help reduce the number of negative screening colonoscopies. Further studies are needed to determine what lesion cutoff size is clinically acceptable and the appropriate interval time for repeat virtual colonoscopy when it detects lesions below this cutoff size.

Administration, Oral↗
PubMed2000

Virtual colonoscopy compared with conventional colonoscopy: a developing technology.

AIM: To determine the accuracy of computed tomography colography (virtual colonoscopy) in detecting colorectal polyps and colorectal cancer. DESIGN: Blinded comparison of virtual colonoscopy (initially supine-only scans and later supine plus prone scans) with the criterion standard of conventional colonoscopy. SUBJECTS AND SETTING: 100 patients aged 55 years or over referred to a public teaching hospital for colonoscopy, July 1997 to January 2000, because of colonic symptoms or a family history of bowel cancer. MAIN OUTCOME MEASURES: Presence and size of polyps and other lesions; certainty of polyp identification on virtual colonoscopy (on 100-point visual analogue scale); sensitivity and predictive values of virtual colonoscopy. RESULTS: Conventional colonoscopy identifed 121 polyps in 47 patients; 28 of these polyps, in 19 patients, were identified by virtual colonoscopy. Sensitivity of virtual colonoscopy for detecting polyps (using supine plus prone scans) was 73% for polyps with diameter > or = 10 mm (95% CI, 39%-94%) and 19% for smaller polyps (95% CI, 10%-31%) (P < 0.001); corresponding figures for supine-only scans were 57% (95% CI, 18%-90%) and 11% (95% CI, 4%-24%), respectively. Ten polyps identified at virtual colonoscopy were considered false-positive findings (8%). The value of finding a polyp on virtual colonoscopy (with thresholds of 5 mm for diameter and 30 points for certainty score) was assessed as a predictor of finding a polyp (diameter > 5 mm) on conventional colonoscopy. Positive and negative predictive values were 88% and 89%, respectively, for supine plus prone scans. CONCLUSION: Although virtual colonoscopy shows potential as a diagnostic tool for colorectal neoplasia, it is currently not sufficiently sensitive for widespread use.

Colon↗
PubMed1999

Use of a push enteroscope improves ability to perform total colonoscopy in previously unsuccessful attempts at colonoscopy in adult patients.

OBJECTIVE: Total colonoscopy with use of a standard adult colonoscope can be difficult in the presence of a redundant or angulated colon. It is often possible to traverse these areas with the use of a thinner, more flexible endoscope. The objective of this study was to evaluate the efficacy of completing total colonoscopy using a push enteroscope when a standard colonoscope was unsuccessful. METHODS: A prospective analysis was performed for 721 consecutive colonoscopies attempted by two gastroenterologists. Those patients in whom complete colonoscopy was unsuccessful using the standard colonoscope (Olympus CF-100L) had attempts to complete colonoscopy using the enteroscope (Olympus SIF-100). The extent of each exam was recorded. Additional pathologic findings discovered by the use of the enteroscope and therapeutic interventions performed were additionally noted. RESULTS: Colonoscopy using an enteroscope was performed in 32 patients with successful total colonoscopy in 22 patients (68.7%). Additional pathology was noted in nine patients who had successful complete colonoscopy using the enteroscope; adenomatous polyp (n = 5), adenocarcinoma (n = 1), bleeding source (n = 2), and extent of colitis (n = 1). Total colonoscopy rate using standard adult colonoscope was 93.2% (630 of 676) when cases with poor bowel preparation (n = 23) and obstructing lesions (n = 14) were excluded. When the results of successful colonoscopies with the enteroscope were included, the overall completion rate of total colonoscopy improved to 96.4% (652 of 676). CONCLUSION: The use of the enteroscope to help evaluate patients who have had incomplete colonoscopies with the standard colonoscope increases the diagnostic yield of colonic examination.

Adult↗
PubMed2006

Comparison of virtual colonoscopy with conventional colonoscopy in detection of colorectal polyps.

BACKGROUND/AIMS: To determine the sensitivity and specificity of multidetector computed tomography-based virtual colonoscopy for colorectal polyp detection by using conventional colonoscopy as the reference standard. METHODS: 48 patients with high risk for colorectal cancer underwent virtual colonoscopy followed by conventional colonoscopy. Examination results were compared with conventional colonoscopy, which served as the gold standard. RESULTS: Virtual colonoscopy correctly depicted 19 of 22 polyps (sensitivity, 86%) that were detected in conventional colonoscopy. All 4 polyps that were greater than 10 mm in size (100%), 6 of 7 polyps 6-9 mm in size (85%), and 9 of 11 polyps 5 mm in size or smaller (81%) were correctly depicted with virtual colonoscopy. Virtual colonoscopy had an overall sensitivity of 86% and specificity of 98%. CONCLUSION: Multidetector computed tomography-based virtual colonoscopy has excellent sensitivity for the detection of clinically important colorectal polyps.

Adenoma↗
PubMed2006

Risk of developing colorectal cancer following a negative colonoscopy examination: evidence for a 10-year interval between colonoscopies.

CONTEXT: Limited evidence exists to guide the optimal frequency of repeat endoscopic examination for colorectal cancer screening after a negative colonoscopy. OBJECTIVE: To determine the duration and magnitude of the risk of developing colorectal cancer following performance of a negative colonoscopy. DESIGN, SETTING, AND PATIENTS: Population-based retrospective analysis of individuals whose colonoscopy evaluations did not result in a diagnosis of colorectal neoplasia. Patients who had been evaluated between April 1, 1989, and December 31, 2003, were identified using Manitoba Health's physician billing claims database (N = 35 975). Standardized incidence ratios (SIRs) were calculated to compare colorectal cancer incidence in our cohort with colorectal cancer incidence in the provincial population. Stratified analysis was performed to determine the duration of the reduced risk. Patients with a history of colorectal cancer prior to the index colonoscopy, inflammatory bowel disease, resective colorectal surgery, and lower gastrointestinal endoscopy within the 5 years before the index colonoscopy were excluded. Cohort members were followed up from the time of the index colonoscopy until diagnosis of colorectal cancer, death, out-migration from Manitoba, or end of the study period on December 31, 2003. MAIN OUTCOME MEASURE: Incidence of colorectal cancer. RESULTS: A negative colonoscopy was associated with SIRs of 0.69 (95% confidence interval [CI], 0.59-0.81) at 6 months, 0.66 (95% CI, 0.56-0.78) at 1 year, 0.59 (95% CI, 0.48-0.72) at 2 years, 0.55 (95% CI, 0.41-0.73) at 5 years, and 0.28 (95% CI, 0.09-0.65) at 10 years. The proportion of colorectal cancer located in the right side of the colon was significantly higher in the colonoscopy cohort than the rate in the Manitoba population (47% vs 28%; P<.001). CONCLUSIONS: The risk of developing colorectal cancer remains decreased for more than 10 years following the performance of a negative colonoscopy. There is a need to improve the early detection rate of right-sided colorectal neoplasia in usual clinical practice.

Adult↗
PubMed2000

A randomized, controlled trial to assess a novel colorectal cancer screening strategy: the conversion strategy--a comparison of sequential sigmoidoscopy and colonoscopy with immediate conversion from sigmoidoscopy to colonoscopy in patients with an abnormal screening sigmoidoscopy.

OBJECTIVE: Our study was a randomized, controlled trial to assess a novel strategy that provides comprehensive colorectal cancer screening in a single visit versus traditional sigmoidoscopy and, where appropriate, colonoscopy on a subsequent day. METHODS: Consecutive patients referred for screening were randomized to control or so-called "conversion" groups. Patients in the control group were prepared for sigmoidoscopy with oral phospho-soda. Those with an abnormal sigmoidoscopy were scheduled for colonoscopy on a future day after oral polyethylene glycol preparation. In the conversion group, patients were prepared with oral phosphosoda. Patients with a polyp >5 mm or multiple diminutive polyps were converted from sigmoidoscopy to colonoscopy, allowing comprehensive screening in a single visit. Clinical outcomes were assessed by postprocedure physician and patient questionnaires. RESULTS: Two hundred thirty-five patients were randomized (control = 121, conversion = 114). In the control group, 28% had an indication for colonoscopy. Three of 33 (9%) with an abnormal sigmoidoscopy did not return for colonoscopy. At colonoscopy, 27% had a proximal adenoma. In the conversion group, 28% had an abnormal sigmoidoscopy and underwent conversion to colonoscopy. Forty-one percent undergoing colonoscopy in the conversion group had a proximal adenoma. Physicians reported no differences in preparation or procedure difficulty, whereas patients reported no differences in the level of comfort or overall satisfaction between groups. When queried regarding preferences for future screening, 96% chose the conversion strategy. CONCLUSIONS: The conversion strategy led to similar outcomes compared to traditional screening while improving compliance with colonoscopy in patients with an abnormal sigmoidoscopy.

Adenoma↗
PubMed2004

Computed tomographic colonography (virtual colonoscopy): a multicenter comparison with standard colonoscopy for detection of colorectal neoplasia.

CONTEXT: Conventional colonoscopy is the best available method for detection of colorectal cancer; however, it is invasive and not without risk. Computed tomographic colonography (CTC), also known as virtual colonoscopy, has been reported to be reasonably accurate in the diagnosis of colorectal neoplasia in studies performed at expert centers. OBJECTIVE: To assess the accuracy of CTC in a large number of participants across multiple centers. DESIGN, SETTING, AND PARTICIPANTS: A nonrandomized, evaluator-blinded, noninferiority study design of 615 participants aged 50 years or older who were referred for routine, clinically indicated colonoscopy in 9 major hospital centers between April 17, 2000, and October 3, 2001. The CTC was performed by using multislice scanners immediately before standard colonoscopy; findings at colonoscopy were reported before and after segmental unblinding to the CTC results. MAIN OUTCOME MEASURES: The sensitivity and specificity of CTC and conventional colonoscopy in detecting participants with lesions sized at least 6 mm. Secondary outcomes included detection of all lesions, detection of advanced lesions, possible technical confounders, participant preferences, and evidence for increasing accuracy with experience. RESULTS: A total of 827 lesions were detected in 308 of 600 participants who underwent both procedures; 104 participants had lesions sized at least 6 mm. The sensitivity of CTC for detecting participants with 1 or more lesions sized at least 6 mm was 39.0% (95% confidence interval [CI], 29.6%-48.4%) and for lesions sized at least 10 mm, it was 55.0% (95% CI, 39.9%-70.0%). These results were significantly lower than those for conventional colonoscopy, with sensitivities of 99.0% (95% CI, 97.1%->99.9%) and 100%, respectively. A total of 496 participants were without any lesion sized at least 6 mm. The specificity of CTC and conventional colonoscopy for detecting participants without any lesion sized at least 6 mm was 90.5% (95% CI, 87.9%-93.1%) and 100%, respectively, and without lesions sized at least 10 mm, 96.0% (95% CI, 94.3%-97.6%) and 100%, respectively. Computed tomographic colonography missed 2 of 8 cancers. The accuracy of CTC varied considerably between centers and did not improve as the study progressed. Participants expressed no clear preference for either technique. CONCLUSIONS: Computed tomographic colonography by these methods is not yet ready for widespread clinical application. Techniques and training need to be improved.

Colonography, Computed Tomographic↗
PubMed2004

An analysis of the potential impact of computed tomographic colonography (virtual colonoscopy) on colonoscopy demand.

BACKGROUND AND AIMS: There has been much speculation about the potential impact on the use of conventional colonoscopy if "virtual" computed tomographic colonography (CTC) became a widely accepted modality for colorectal cancer (CRC) screening. However, no formal analysis of the impact of CTC on colonoscopy demand has been reported. METHODS: A mathematical model to predict colonoscopy demand based on several relevant input parameters was constructed. Current national colonoscopy practice, estimated using various published reports, was used as the foundation to project colonoscopy demand if CTC were implemented as the primary CRC screening modality. RESULTS: In the base-case analysis, if CTC were used as the primary modality for CRC screening, 1.78 million colonoscopies could be eliminated from the total 6.47 million in 2003. Depending on the polyp size threshold used to define a CTC study as positive (6 or 10 mm), this loss would be partially offset by 1.21 million (6 mm) or .34 million (10 mm) follow-up colonoscopies for CTC examinations with positive findings, resulting in a net loss of .57 million (8.8% decrease) (6 mm) or 1.44 million (22.3% decrease) (10 mm). Extensive sensitivity analyses showed that the findings of this model were robust and insensitive to most parameters tested but were sensitive to a few parameters, including the percentage of CTC examinations with positive findings. CONCLUSIONS: Wide-scale implementation of CTC for CRC screening would likely lead to a decrease in use of conventional colonoscopy. The percentage of CTC studies with positive findings seemed to be a pivotal variable, which would be determined in large part by the polyp size ultimately established to define a positive finding.

Colonography, Computed Tomographic↗
PubMed2003

Colonoscopic surveillance of patients with a family history of colon cancer and a history of normal colonoscopy: is a five-year interval between colonoscopies appropriate?

BACKGROUND & AIMS: Patients with a family history of colon cancer are advised to undergo surveillance colonoscopy 5 years after a normal screening colonoscopy. No prospective study has evaluated the prevalence of adenomas found at surveillance colonoscopy in these patients. The aims of this trial were (1) to determine the percentage of these patients with adenomas; (2) to determine the percentage of these patients with advanced adenomas (i.e., villous adenomas, adenomas > or = 10 mm, adenomas with high grade dysplasia); and (3) to assess risk factors for adenomas in these patients. METHODS: Consecutive patients with a family history of colorectal cancer and a normal screening colonoscopy 5 years earlier were offered a surveillance colonoscopy. Patients also completed a questionnaire about potential risk factors for adenomas. Multiple logistic regression analysis assessed associations between risk factors and adenomas. RESULTS: One hundred patients completed the trial. The male/female ratio was 54/46, the mean age was 56.2 +/- 8.8 years, and 91% were white. Eight percent (8 of 100) of patients had advanced adenomas at surveillance colonoscopy, and 33% (33 of 100) had adenomas. Among patients with adenomas, 39% (13 of 33) had no adenomas in the left side of the colon (i.e., distal to the splenic flexure). Among patients with advanced adenomas, 25% (2 of 8) had no adenomas in the left side of the colon. Multiple logistic regression analysis showed a significant negative association between adenomas and NSAID use (odds ratio, 0.26 [95% confidence interval, 0.09-0.79]), and male gender had a positive association with adenomas (odds ratio, 2.79 [95% confidence interval, 1.01-7.74]). CONCLUSIONS: These data support a 5-year interval between screening and surveillance colonoscopy for patients with a family history of colorectal cancer and a normal screening colonoscopy.

Adenoma↗
PubMed2004

Prospective comparison of contrast enhanced CT colonography and conventional colonoscopy for detection of colorectal neoplasms in a single institutional study using second-look colonoscopy with discrepant results.

BACKGROUND: Colorectal cancer is the second leading cause of death from cancer in Western countries. Early detection by colorectal cancer screening can effectively cut its mortality rate. CT colonography represents a promising, minimally invasive alternative to conventional methods of colorectal carcinoma screening. AIMS: The purpose of this prospective single institutional study was to compare the abilities of routine clinical CT colonography and conventional colonoscopy to detect colorectal neoplasms using second-look colonoscopy to clarify discrepant results. PATIENTS AND METHODS: CT colonography was performed in 100 symptomatic patients using contrast enhanced multidetector CT followed by conventional colonoscopy on the same day. If results were discrepant, a second-look colonoscopy was performed after unblinding. CT colonographic findings were compared with those of conventional colonoscopy. RESULTS: Conventional colonoscopy found 122 colorectal neoplasms in 49 patients. The overall sensitivity of CT colonography at detecting patients with at least one polyp 6 mm or larger was 76% and its specificity was 88%. Its by-patient sensitivity for polyps 10 mm or larger was 95% and its specificity was 98%. By-polyp sensitivities were 71% for polyps 10 mm or larger, and 61% for polyps 6 mm or larger. A second-look colonoscopy was performed in 19 patients and two initial false-positive findings of CT colonography were reclassified as true-positive. For conventional colonoscopy, this produced a by-polyp sensitivity of 94% for detection of lesions 6 mm and larger. CONCLUSIONS: CT colonography had both a high by-patient sensitivity and specificity for detection of clinically important colorectal neoplasms 10 mm or larger. This suggests that CT colonography has the potential to become a valuable clinical screening method for colorectal neoplasms.

Adult↗
PubMed2002

Method of colonoscopy in 42 consecutive patients presenting after prior incomplete colonoscopy.

OBJECTIVES: Cecal intubation is one of the goals of colonoscopy. We sought to describe the methodology used by a single experienced examiner to perform colonoscopy in a consecutive group of patients with challenging colons. METHODS: Records of 42 consecutive patients with one or more prior unsuccessful attempts at colonoscopy by a gastroenterologist or surgeon and referred for a repeat attempt at colonoscopy were reviewed. RESULTS: Colonoscopy was complete to the cecum in 40 of the 42 patients (95%). An array of methods was employed, including propofol sedation (n = 2), pediatric colonoscope (n = 8), an external straightener (n = 9), external straightener with pediatric colonoscope (n = 2), upper endoscope (n = 8), guidewire exchange (n = 3), and enteroscope with a colon straightener (n = 1) or an enteroscope straightener (n = 1). CONCLUSIONS: A variety of methods and instruments were employed to achieve a high cecal intubation rate during colonoscopy in a group of patients with prior incomplete colonoscopies. Others may find one or more of these methods useful in patients with challenging colons.

Adult↗
PubMed2006

Air-inflated magnetic resonance colonography in patients with incomplete conventional colonoscopy: Comparison with intraoperative findings, pathology specimens, and follow-up conventional colonoscopy.

BACKGROUND: To assess the usefulness of air-inflated magnetic resonance colonography (MRC) in patients with incomplete conventional colonoscopy (CC). METHODS: From September 2001 to December 2004, 51 patients (25 male and 26 female, age range 32 to 85 years) with incomplete colonoscopy were recruited to have MRC performed. Half-fourier single short turbo spin echo (HASTE) axial, coronal, and three dimensional fat suppressed gradient echo sequence (VIBE) coronal images in both the prone and supine positions were performed for each patient. MRC was reviewed by two radiologists for detection of synchronous colonic lesion. The location and size of lesions were recorded and were compared with the findings of CC. Patients were managed according to the clinical situation and intraoperative findings were compared with MRC findings. Follow-up colonoscopy was performed in 29 patients. The follow-up colonoscopy findings were then compared with the MRC findings. RESULTS: Forty-four patients had incomplete colonoscopy because of an obstructing tumor. The other seven patients had incomplete colonoscopy because of excessive bowel looping. Apart from one patient suffering from chronic obstructive airway disease with resulting nondiagnostic MRC, all other patients had MRC successfully performed. Each colon was divided into six bowel segments for analysis. All 300 segments were of diagnostic quality and were assessed by the MRC. MRC correctly identified all 44 obstructing tumors demonstrated by initial CC. Synchronous tumors in proximal colonic segments were identified in two patients by MRC. In addition, MRC identified two colonic tumors located in bowel segments inaccessible by CC because of excessive looping. CONCLUSIONS: MRC is useful for detection of colonic pathology and assessment of proximal colon in patients with colonic cancer after incomplete colonoscopy.

Adult↗
PubMed1998

Efficacy of total colonoscopy with a transparent cap in comparison with colonoscopy without the cap.

BACKGROUND AND STUDY AIMS: In spite of scrupulous inspection during routine colonoscopy, small lesions behind the semilunar folds can be situated in blind spots, where they are easily overlooked. The aim of this study was to evaluate the efficacy of total colonoscopy with a transparent cap in identifying such lesions, in comparison with colonoscopy without the cap. PATIENTS AND METHODS: In 24 patients with colorectal polyps, tandem colonoscopic procedures were carried out on the same day in random order, first without a transparent cap and then with the cap (without-to-with), or first with the cap and then without the cap (with-to-without). The time required for intubation as far as the cecum, the number of polyps detected, and procedure-related complications were recorded. The frequencies of terminal ileal intubation and retroflexion within the rectum were also recorded. RESULTS: Total colonoscopy was carried out in all of the patients without any complications. Colonoscopy with a transparent cap ensured good visual fields during insertion and withdrawal of the colonoscope. There were no significant differences in the intubation time to the cecum or in the frequency of terminal ileal intubation between the two procedures. The miss rate for polyps was 15% in without-to-with tandem colonoscopies, and zero in with-to-without procedures (P = 0.0125). The diameter of all the missed polyps except for one lesion (8 mm) was less than 5 mm. Retroflexion within the rectum was more difficult using the colonoscope with the cap (P < 0.0001), and was successful in only one case using the cap. CONCLUSIONS: Total colonoscopy with a transparent cap allows inspection of the blind area of the colonic mucosa behind the semilunar folds, with good visual fields. This method is potentially useful for both screening and diagnostic purposes.

Adult↗
PubMed2006

CathCam guide wire-directed colonoscopy: first pilot study in patients with a previous incomplete colonoscopy.

BACKGROUND AND STUDY AIMS: Conventional colonoscopy as the gold standard for large-bowel diagnostics and therapy may fail in 5 %-20 % of cases, depending on the experience of the examiner. Colonoscopy is regarded as difficult and painful by many patients. In an attempt to overcome the limitations of conventional colonoscopes, a guide wire-directed, thin, flexible diagnostic colonoscope, the CathCam was developed. In this prospective pilot study, we report its use in patients in whom conventional colonoscopy had failed. PATIENTS AND METHODS: 49 patients with a previous or current failure of complete colonoscopy were invited to participate in a trial using the new CathCam system, and 14 (nine men; mean age 59 years) accepted. The CathCam is an 11-mm diameter disposable, multilumen catheter, with visualization by a 3-mm camera with six light-emitting diodes. In the first five patients, the CathCam was inserted over a newly developed 0.024-inch, hinged, lumen-seeking guide wire. Subsequently, a modified combined approach was used: a conventional colonoscope was introduced into the sigmoid or left colon, then the guide wire was advanced as far as possible, followed by CathCam insertion over it. Caecal intubation rate, insertion times and patient discomfort were recorded; patients received low-dose midazolam sedation (2-5 mg). RESULTS: One patient was excluded during colonoscopy. The caecum could be eventually reached in 12 of 13 patients; in the remaining patient a significant sigmoid stricture could be passed, but further advancement appeared too risky. The mean caecal intubation time was 24 minutes (range 3-105 min). Only two patients experienced pain and discomfort during the procedure (one immediate assessment and one case reported at later telephone interview). No complications occurred, and previously undiagnosed important findings were obtained in 9 cases. CONCLUSIONS: A combined approach, consisting of guide wire insertion via a partially introduced colonoscope followed by CathCam or colonoscope insertion into the caecum was successful in over 90 % of patients with previous failure of complete colonoscopy. Further improvements may make this system suitable for use as a standard diagnostic colonoscope, either as a single unit (CathCam plus guide wire) or using the guide wire alone with a standard colonoscope in difficult cases.

Adult↗
PubMed1986

Anaesthesia for colonoscopy. An examination of the anaesthesia as an element of risk at colonoscopy.

The importance of anaesthesia as an element of risk at colonoscopy has been examined retrospectively over a 10-year period from 1975 to 1984. The colonoscopic examinations were made by surgical gastroenterologists and anaesthesiologists working in cooperation. In 1242 cases the patients received diazepam/fentanyl anaesthesia during the colonoscopy (Group I) and in 126 cases they received general anaesthesia (Group II). The incidence of perforations of the large bowel in Group I was 0.8% (95% confidence limits: 0.4-1.5%) and in Group II 0.0% (95% confidence limits: 0.0-2.9%). Statistically the difference is not significant (P = 0.38). The groups were comparable with a view to the patients' age, weight, the duration of the colonoscopy and the number of times that polypectomy had been performed. All anaesthesia was administered by staff qualified by training and experience to administer anaesthesia, and did not cause any complications. However, four patients had vasovagal reflexes due to manipulation of the colonoscope. The dosing in the patients in Group I averaged: diazepam as premedication 9.2 mg, intravenous diazepam 12.4 mg, intravenous fentanyl 0.14 mg, and the duration of the colonoscopy was 36.5 min. The medication and the duration of the colonoscopy did not vary significantly in the patients with perforation of the large bowel. Our conclusion is that diazepam/fentanyl anaesthesia, administered by experienced staff, is harmless, and that general anaesthesia for colonoscopy did not involve an increased risk of perforation of the large bowel.

Aged↗
PubMed1988

Prospective comparison of double contrast barium enema plus flexible sigmoidoscopy v colonoscopy in rectal bleeding: barium enema v colonoscopy in rectal bleeding.

Rectal bleeding often heralds serious colonic disease. The literature suggests that colonoscopy is superior to barium enema plus sigmoidoscopy, although no good comparative studies exist. Seventy one patients with overt rectal bleeding had prospectively flexible sigmoidoscopy, double contrast barium enema and colonoscopy completed independently. Against the gold standard, the sensitivity and specificity of colonoscopy were 0.69 and 0.78 respectively for a spectrum of colonic lesions, while for combined flexible sigmoidoscopy and double contrast barium enema these values were 0.80 and 0.56, respectively. When assessing adenoma or carcinoma, colonoscopy was more sensitive at 0.82 v 0.73, while flexible sigmoidoscopy plus double contrast barium enema was superior for detecting diverticular disease. The positive predictive value for colonoscopy was 0.87 against 0.81 for flexible sigmoidoscopy and double contrast barium enema. This study confirms that colonoscopy should be a first line investigation in subjects likely to require biopsy or therapeutic intervention.

Barium Sulfate↗