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Colonoscopy
Kinds of Colonoscopy Selected AbstractsSPLENIC RUPTURE FOLLOWING ROUTINE COLONOSCOPYDIGESTIVE ENDOSCOPY, Issue 4 2010Tabraze Rasul Splenic rupture is a life-threatening condition characterized by internal hemorrhage, often difficult to diagnose. Colonoscopy is a gold standard routine diagnostic test to investigate patients with gastrointestinal symptoms as well as to those on the screening program for colorectal cancer. Splenic injury is seldomly discussed during consent for colonoscopy, as opposed to colonic perforation, as its prevalence accounts for less than 0.1%. A 66-year-old Caucasian woman with no history of collagen disorder was electively admitted for routine colonoscopy for surveillance of adenoma. She was admitted following the procedure for re-dosing of warfarin, which was stopped prior to the colonoscopy. The patient was found collapsed on the ward the following day with clinical shock and anemia. Computed tomography demonstrated grade 4 splenic rupture. Immediate blood transfusion and splenectomy was required. Splenic rupture following routine colonoscopy is extremely rare. Awareness of it on this occasion saved the patient's life. Despite it being a rare association, the seriousness warrants inclusion in all information leaflets concerning colonoscopy and during its consent. [source] SECOND LOOK COLONOSCOPY: INDICATION AND REQUIREMENTSDIGESTIVE ENDOSCOPY, Issue 2009Jean-Francois Rey Background:, There are circumstances when a colonoscopy should be repeated after a short interval following the first endoscopic procedure which has not completely fulfilled its objective. Review of the literature:, A second look colonoscopy is proposed when there remains a doubt about missed neoplastic lesions, either because the intestinal preparation was poor or because the video-endoscope did not achieved a complete course in the colon. The second look colonoscopy is also proposed at a short interval when it is suspected that the endoscopic removal of a single or of multiple neoplastic lesions was incomplete and that a complement of treatment is required. When the initial endoscopic procedure has completely fulfilled its objective, a second look colonoscopy can be proposed at longer intervals in surveillance programs. The intervals in surveillance after polypectomy are now adapted to the initial findings according to established guidelines. This also applies to the surveillance of incident focal cancer in patients suffering from a chronic inflammatory bowel disease. Conclusion:, Finally, in most developed countries, a priority is attributed to screening of colorectal cancer and focus is given on quality assurance of colonoscopy which is considered as the gold standard procedure in the secondary prevention of colorectal cancer. [source] MAGNIFYING COLONOSCOPY FOR THE DIAGNOSIS OF INFLAMMATORY CHANGES IN ULCERATIVE COLITISDIGESTIVE ENDOSCOPY, Issue 3 2006Satoshi Sugano Background:, Endoscopic observation is the most effective method for the evaluation of staging in ulcerative colitis (UC). However, in cases with very mild inflammatory activity, histopathological diagnosis may also be required. Unfortunately, biopsy-related accidents are not uncommon. As an alternative, we have used a magnifying colonoscope commonly used for tumor diagnosis to examine in detail the colon mucosa of UC patients in clinical remission, and then compared these findings relative to conventional endoscopy using histopathological diagnosis. Subjects and Methods:, Among UC cases examined by colonoscopy between April 2000 and April 2005, 27 cases without hematochezia for at least 1 month were enrolled in this study. Following observations of inflammatory changes using conventional colonoscopy, magnifying observation and biopsies at a total of 144 sites were evaluated. Using histopathological standards, acute-phase inflammation was indicated by the presence of neutrophil infiltration, whereas chronic-phase inflammation was indicated by infiltration of lymphocytes, plasma cells and eosinophils. Results:, Indicators of significant inflammation by conventional observation was erosion. Under magnification, inflammation appears as superficial defects in mucosa and small whitish spots. When the presence of infiltrating neutrophils was used as a positive histological marker for inflammation, there was no difference in the accuracy of diagnosis by conventional observation (95.1%) versus magnifying observation (97.2%). In contrast, when lymphocyte infiltration was used as a marker, the accuracy of diagnosis increased significantly (88.2%) using magnifying observation relative to conventional observation (61.1%). Conclusions:, Magnifying endoscopy can be used effectively in the evaluation of minute mucosal changes in cases of UC remission. [source] OPTICAL/DIGITAL CHROMOENDOSCOPY DURING COLONOSCOPY USING NARROW-BAND IMAGING SYSTEMDIGESTIVE ENDOSCOPY, Issue 2005Yasushi Sano This review is regarding the narrow-band imaging (NBI) system which has been developed at National Cancer Center Hospital East, Japan. The technology of the NBI system is based on modifying the spectral features by narrowing the bandwidth of spectral transmittance using various optical filters. The NBI system consists of three filters, 415,30 nm, 445,30 nm, and 500,30 nm, which are used as observing the fine capillaries in the superficial mucosa is essential to identify gastrointestinal neoplasms. The NBI system has been in development since 1999 and the first report of it's efficacy for gastrointestinal tract use was reported in 2001. In our pilot study, the NBI system may be sufficient to differentiate hyperplastic polyp from adenomatous polyp, and to visualize neoplasia with image processing in real-time during colonoscopy without the need for dye spraying. Herein, we propose the term ,optical/digital chromoendoscopy' using the NBI system and hope that this instrument will become standard endoscopy for in the 21st century. To estimate the feasibility and efficacy of using the NBI system for surveillance or screening examination, randomized control trials should be conducted in the future. [source] CR11 PATIENT RECALL OF INFORMED CONSENT INFORMATION PRIOR TO COLONOSCOPYANZ JOURNAL OF SURGERY, Issue 2007I. G. Thomson Purpose To determine if patients presenting for colonoscopy can remember information discussed in the informed consent process. Focusing on whether patients know of the possible risks. Methodology A prospective study of patients presenting for elective colonoscopy through the Colorectal Unit. Patients were consented in outpatient clinics prior to the procedure using the colonoscopy consent form supplied by Queensland Health. On the day of the procedure a 2 page questionnaire with 13 questions was completed by the patient prior to their colonoscopy. Indications for colonoscopy date of consent & procedure and seniority of consenting doctor were obtained from medical records. Results 100 patients completed the questionnaire. 94% of patients could correctly identify colonoscopy as the procedure being undertaken. 45% of patients were able to identify that there were any risks involved with the procedure. Only 28% of patients could name perforation as a possible risk. h regard to other investigative options 83% could not identify any from a list of three. Despite this 92% felt they were given enough information and were happy to proceed. Conclusion This study highlights room for improvement in the current informed consent process. The current process falls short in educating patients of the possible serious risks involved. Patients do not recall other therapeutic options given. The consent process does convey basic information allowing the patient to identify the name of the investigation and anatomical area investigated. Despite these shortcomings most patients felt they were given enough information to proceed. [source] SPLENIC RUPTURE FOLLOWING ROUTINE COLONOSCOPYDIGESTIVE ENDOSCOPY, Issue 4 2010Tabraze Rasul Splenic rupture is a life-threatening condition characterized by internal hemorrhage, often difficult to diagnose. Colonoscopy is a gold standard routine diagnostic test to investigate patients with gastrointestinal symptoms as well as to those on the screening program for colorectal cancer. Splenic injury is seldomly discussed during consent for colonoscopy, as opposed to colonic perforation, as its prevalence accounts for less than 0.1%. A 66-year-old Caucasian woman with no history of collagen disorder was electively admitted for routine colonoscopy for surveillance of adenoma. She was admitted following the procedure for re-dosing of warfarin, which was stopped prior to the colonoscopy. The patient was found collapsed on the ward the following day with clinical shock and anemia. Computed tomography demonstrated grade 4 splenic rupture. Immediate blood transfusion and splenectomy was required. Splenic rupture following routine colonoscopy is extremely rare. Awareness of it on this occasion saved the patient's life. Despite it being a rare association, the seriousness warrants inclusion in all information leaflets concerning colonoscopy and during its consent. [source] REFRACTORY DIVERTICULAR COLITIS WITH PROGRESSIVE ULCERATIVE COLITIS-LIKE CHANGES EXTENDING TO THE RECTUMDIGESTIVE ENDOSCOPY, Issue 3 2009Tateki Yamane A 68-year-old man visited our department because of diarrhea and bloody stools. Colonoscopy revealed diverticula scattered in the sigmoid colon with localized mucosal edema and reddening. The mucosa became somewhat rough 9 months later, and had an erosive, ulcerative colitis (UC)-like appearance after a further 6 months, with these changes extending to the rectum. These findings led to a diagnosis of diverticular colitis (DC) with UC-like changes. The condition was refractory to treatment including drug therapy and was thus surgically treated. No cases of DC have been reported in Japan, and a refractory case of DC with progressive UC-like changes extending to the rectum is rare even in Europe and the USA. [source] COLLAPSE-SUBMERGENCE METHOD: SIMPLE COLONOSCOPIC TECHNIQUE COMBINING WATER INFUSION WITH COMPLETE AIR REMOVAL FROM THE RECTOSIGMOID COLONDIGESTIVE ENDOSCOPY, Issue 1 2007Takeshi Mizukami Colonoscopy is a difficult examination to conduct for inexperienced examiners. In an attempt to improve the view, there is often a tendency to overinsufflate air, which causes elongation or acute angulations of the colon and makes passage of the scope difficult. Sakai et al. were the first to describe a simple colonoscopic technique using water infusion instead of air insufflation. We have modified this technique to simplify the procedure further by combining water infusion using disposable syringes with complete air suction from the rectum to the descending colon. With the resultant elimination of the boundary lines between water and air, a good view of the lumen is obtained though the transparent water. With the patient in the left lateral position, this procedure allows the water to flow straight down into the descending colon through the ,collapsed' lumen, and the scope to be easily negotiated through the straightened recto-sigmoid colon and sigmoid-descending colon junction with minimum discomfort. Measurements of the patients' abdominal circumference during colonoscopy showed that colonic distension hardly occurred. Under supervision by the author, six complete novices were allowed to insert the colonoscope within 10 min by this method for one patient per week, as long as the patients did not complain of pain. The average trial number for the first cecal intubation within 10 min was 3.3, and the average success rate during the first 3 months was 58.6%. We believe that this ,collapse-submergence method' is easy to master, even for inexperienced examiners. [source] WEGENER'S GRANULOMATOSIS COMPLICATED WITH APHTHOID COLITISDIGESTIVE ENDOSCOPY, Issue 3 2006Yasushi Umehara A 58-year-old man was admitted with upper abdominal pain and high fever. There was no abnormality on chest X-ray, abdominal ultrasonography, abdominal CT and upper gastrointestinal endoscopy. Antineutrophil cytoplasmic antibodies (C-ANCA) titers were high and a chest CT scan depicted multiple nodules in the bilateral lungs. A diagnosis of Wegener's granulomatosis was therefore made. Three weeks after admission, diarrhea and bloody stool developed. Colonoscopy revealed many aphthoid lesions surrounded by redness in the entire colon. Although the biopsy from aphtha did not show vasculitis or granuloma, the aphthoid lesions were suspected as a complication of Wegener's granulomatosis. As a result of predonisolone medication (60 mg/day), the plasma C-reactive protein (CRP) and high fever improved promptly. In conclusion, although colonic involvement in a patient with Wegener's granulomatosis is extremely rare, it is important to keep in mind that colonic lesions might be due to vasculitis in ANCA-positive disease, such as Wegener's granulomatosis. [source] Colonic perforation after endoscopic biopsy of a submucosal tumor: successful conservative treatmentDIGESTIVE ENDOSCOPY, Issue 4 2002Kuang-I. Colonoscopy is a powerful diagnostic and therapeutic procedure with a recognized risk of complications ranging from perforation to hemorrhage and septicemia. Perhaps the most dangerous complication associated with this procedure is bowel perforation. Although some colonic perforations can be treated medically, prompt surgery is generally preferred to minimize morbidity and mortality. We present a case of colonic perforation resulting from bite biopsy followed by mucosal resection of a submucosal tumor. Perforation occurred in a delayed manner despite prophylactic closure of the mucosal defect by the replacement of endoclips. The patient recovered spontaneously after antibiotic treatment and reduction of oral intake. We carried out successful conservative medical treatment of a minor iatrogenically induced bowel perforation without operation. [source] Large mucosa-associated lymphoid tissue lymphoma simulating multiple polypoid lesions at the cecum and rectumDIGESTIVE ENDOSCOPY, Issue 4 2001Yutaka Onishi Herein we describe a case of mucosa-associated lymphoid tissue (MALT) lymphoma of the cecum and rectum with the Leser,Trélat sign. A 76-year-old Japanese woman was admitted to the Harima Hospital of Ishikawajima-harima Heavy Industries, Health Insurance Society for hematochezia. Colonoscopy showed two large elevated tumors, one in the cecum and the other in the rectum. Biopsy was not diagnostic. Endoscopic snare loop biopsy specimens from both tumors were diagnosed as MALT lymphoma. After staging to IIE, the patient underwent surgery. Macroscopically, the cecal tumor was elevated with a large and deep depressed region, measuring 40 × 35 mm. The rectal lesion was a large elevated tumor, measuring 80 × 70 mm. Histologically, both tumors were diagnosed as MALT lymphoma and there was no lymph node metastasis. The patient received chemotherapy and there is no evidence of recurrence 1 year after surgery. We present this case to show that colorectal MALT lymphoma can present as a large tumor, even in early clinical stages, that multiple lesions should be anticipated and that surgical treatment is needed in these cases. [source] Nodule-aggregating lesion of the ileum: Report of a case and a review of the literatureDIGESTIVE ENDOSCOPY, Issue 3 2001Norikazu Sakamoto We describe here a rare case of nodule-aggregating lesion of the terminal ileum detected by colonoscopy. An 82-year-old Japanese woman was admitted to our hospital with diarrhea. Colonoscopy revealed a flat elevated tumor with conglomerated nodular surface involving the entire circumference of the terminal ileum, suggesting a nodule-aggregating lesion. Magnifying the colonoscopic view showed the branch-like or gyrus-like pits. On biopsy, the tumor was diagnosed as a tubulovillous adenoma. Retrograde ileogram using a colonoscope revealed an elevated tumor with nodular irregularity, measuring 5 cm in length. Ileocecal resection was performed. Macroscopically, the tumor in the terminal ileum, 8 cm distant from the ileocecal valve, showed a nodule-aggregating lesion, measuring 44 × 60 × 6 mm in size. Histologically, the tumor showed a focal carcinoma in tubulovillous adenoma. To our knowledge, this is the fifth case of early cancer of the ileum in Japan, and the first case of nodule-aggregating lesion of the ileum detected by colonoscopy in the world. [source] VASCULAR ECTASIA OF THE COLON TREATED BY ARGON PLASMA COAGULATION: REPORT OF A CASEDIGESTIVE ENDOSCOPY, Issue 1 2001Yoshie Tada A 72-year-old woman presented with hematochezia. Colonoscopy revealed branch-like vasodilation in the ascending colon and chronic hemorrhage from vascular ectasia of the colon was suspected. Argon plasma coagulation was performed. After treatment, epithelialization of the lesion site was noted and her anemia improved. Vascular ectasia of the colon is recognized as the etiology of lower gastrointestinal bleeding with increasing frequency. Infrared ray electronic endoscopy is useful for determining the extent of disease and argon plasma coagulation, a new hemostatic technique, is suitable for treatment of this condition. [source] Case Report: Atresia coli in a foal: Diagnosis made with colonoscopy aided by N-butylscopolammonium bromideEQUINE VETERINARY EDUCATION, Issue 9 2010B. Hunter Summary Atresia coli, a rare congenital defect, was diagnosed in a foal via colonoscopy after N-butylscopolammonium bromide was used to aid visualisation of the intestinal defect. Colonoscopy is a cost effective tool for diagnosing atresia of the terminal colon. N-butylscopolammonium bromide aided colonoscopy has not been previously reported in horses. [source] Oral mesalamine and clinical remission are associated with a decrease in the extent of long-standing ulcerative colitisINFLAMMATORY BOWEL DISEASES, Issue 7 2006Michael F. Picco MD Abstract Objective: To compare colonoscopy alone with surveillance biopsy for the determination of anatomic extent in long-standing ulcerative colitis (UC). To assess the influences of mesalamine use and clinical disease activity on the change of histologic extent with time. Materials and Methods: Disease extent (proctosigmoiditis, left-sided colitis, or pancolitis) measured by colonoscopy and surveillance biopsy was compared among 212 consecutive patients with long-standing UC. Among the 102 patients who had 2 consecutive colonoscopies with surveillance biopsies, the following influences on change in histologic extent were determined: disease activity, mesalamine use, age at disease onset, folic acid, corticosteroid and azathioprine/6-mercaptopurine use, and time between colonoscopies. Results: Agreement between gross and microscopic findings was poor (, = 0.39). Colonoscopy underestimated and overestimated extent in 25.9% and 8.5%, respectively. Microscopic distribution between consecutive colonoscopies remained the same in 60.8%. Where distribution changed, an increase was twice as common as a decrease in extent. There was no difference in age at onset, time between colonoscopies, or disease duration among those with an increase, decrease, or no change in extent. Clinical remission and oral mesalamine were independently associated with 10.7 and 5.8 times the odds of a decrease in disease extent, respectively. Folic acid, topical mesalamine, corticosteroids, and immunomodulators did not influence change in extent. Conclusions: UC extent is best determined by surveillance biopsy. Among patients with long-standing UC, histologic extent fluctuates with time. Disease remission and oral mesalamine were independently associated with decreases in disease extent. [source] Microscopic colitis: an underdiagnosed cause of chronic diarrhoea , the clue is in the biopsiesINTERNAL MEDICINE JOURNAL, Issue 7 2003C. S. Pokorny Abstract Microscopic forms of colitis (collagenous colitis and lymphocytic colitis) are uncommon but important causes of chronic diarrhoea that are often overlooked. The clinical features of these disorders are similar, and they are more common in middle-aged females, although the female predominance is greater in collagenous colitis. Although their cause is unclear, both are associated with a variety of autoimmune diseases. Colonoscopy and barium enema are typically normal, so that the diagnosis depends on the demonstration of characteristic changes on histopathological examination of colorectal biopsies. These should be taken in all patients undergoing colonoscopy for the investigation of chronic diarrhoea. There are no large controlled trials of therapy available. Treatment is empirical, generally using the same agents as for inflammatory bowel disease. Assessment of therapy is also difficult as spontaneous remissions occur often. (Intern Med J 2003; 33: 305,309) [source] Splenic Hematoma as a Complication of ColonoscopyJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 2 2004Bryan J. Lekas MD No abstract is available for this article. [source] Are repeat upper gastrointestinal endoscopy and colonoscopy necessary within six months of capsule endoscopy in patients with obscure gastrointestinal bleeding?JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 12 2008David Gilbert Abstract Background and Aim:, Medicare reimbursement for capsule endoscopy for the investigation of obscure gastrointestinal bleeding in Australia requires endoscopy and colonoscopy to have been performed within 6 months. This study aims to determine the diagnostic yield of repeating these procedures when they had been non-diagnostic more than 6 months earlier. Methods:, Of 198 consecutive patients who were referred for the investigation of obscure gastrointestinal bleeding, 50 underwent repeat endoscopy and colonoscopy solely to enable reimbursement (35 females and 15 males; mean age 59.4 [range: 21,82] years). The average duration of obscure bleeding was 50.16 (range: 9,214) months. The mean number of prior endoscopies was 3 (median: 2) and 2.8 colonoscopies (median: 2). The most recent endoscopy had been performed 18.9 (median: 14; range: 7,56) months, and for colonoscopy, 19.1 (median 14; range 8-51) months earlier. Results:, A probable cause of bleeding was found at endoscopy in two patients: gastric antral vascular ectasia (1) and benign gastric ulcer (1). Colonoscopy did not reveal a source of bleeding in any patient. Capsule endoscopy was performed in 47 patients. Twenty four (51%) had a probable bleeding source identified, and another five (11%) a possible source. These included angioectasia (17 patients), mass lesion (2), non-steroidal anti-inflammatory drug enteropathy (2), Cameron's erosions (2), and Crohn's disease (1). Four patients undergoing repeat capsule endoscopy had a probable bleeding source detected. Conclusion:, The yield of repeat endoscopy and colonoscopy immediately prior to capsule endoscopy is low when these procedures have previously been non-diagnostic. Such an approach is also not cost-effective. [source] Informed consent in direct access colonoscopyJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 12 2007Dev S Segarajasingam Abstract Background and Aim:, Although direct access colonoscopy is a common practice, some consider the level of informed consent as inadequate, and therefore a medico-legal concern. The aim of this study was to assess the adequacy of informed consent from a patient perspective in a direct access colonoscopy service. Methods:, All patients having outpatient colonoscopy from May 2003 to February 2004 at a direct access colonoscopy service were considered for inclusion into the study. Information was obtained from patients by structured questionnaire administered either at the time of discharge from the day ward or mailed to their homes. Results:, Information was obtained from 346 direct access colonoscopy patients (172 male, 159 female; 226 , 50 years, 103 < 50 years), 80% of whom were referred by their family doctor. Colonoscopy was done for investigation of symptoms in 220 patients, and for screening and surveillance in 115 patients, with an indication not specified in 11 patients. The majority of patients were either very satisfied (70.5%) or satisfied (25.1%) with the consent process, with no demographic characteristics found to predict dissatisfaction. Thirty-seven patients expressed a preference to have seen a gastroenterologist prior to colonoscopy, and four of these patients reported the consent process to be unsatisfactory. Seventy (20.2%) patients reported that the most useful information about colonoscopy was received after they had completed bowel preparation. Conclusion:, No demographic characteristics were found to predict the small fraction of patients dissatisfied with the informed consent process. Further medico-legal risk reduction may be facilitated by enhancing the provision of information prior to bowel preparation. [source] Usefulness of virtual colonoscopy in the diagnosis of symptomatic large colonic lipomasJOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 2007A Koktener SUMMARY Lipomas of the colon are uncommon tumour of the gastrointestinal tract, but cause diagnostic difficulty when they are symptomatic. We reported two cases of symptomatic, large colonic lipoma. Colonoscopy was incomplete because of the narrowing lumen caused by lipomas. By the help of computed tomography colonography/virtual colonoscopy, colonic lipomas were diagnosed correctly, but also proximal colon was examined. [source] A comparison of the acceptance of immunochemical faecal occult blood test and colonoscopy in colorectal cancer screening: a prospective study among ChineseALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 1 2010M. C. S. Wong Aliment Pharmacol Ther 2010; 32: 74,82 Summary Background, Preferences to choose immunochemical faecal occult blood test (FIT) and colonoscopy as colorectal cancer (CRC) screening modalities among asymptomatic Chinese subjects remain unknown. Aim, To evaluate the preference of choosing colonoscopy vs. FIT among CRC screening participants. Methods, From a community-based CRC screening programme for asymptomatic Hong Kong Chinese aged 50,70 years, participants attended standardized educational sessions and chose the options of annual FIT for 5 years or direct colonoscopy once. Factors associated with choosing colonoscopy were evaluated by multivariate regression analysis. Results, Among 3430 participants [mean age 56.8 years (s.d. 5.0); female 55.1%, male 44.9%], 51.3% chose colonoscopy and 48.7% chose FIT. Older participants (65,70 years) were less likely to choose colonoscopy [adjusted odds ratio (aOR) 0.731, P = 0.041]. Subjects who chose colonoscopy were those disagreed screening would lead to discomfort (aOR 1.356, P < 0.001), had relatives or friends who had CRC (first degree relatives aOR 1.679, P < 0.001; second degree relatives aOR 1.304, P = 0.019; friends or others aOR 1.252, P = 0.026) and those who self-perceived their health as poor (aOR 1.529, P = 0.025). Conclusions, Faecal occult blood test and direct colonoscopy were equally preferable to Chinese. Colonoscopy was preferred among the younger subjects, those with positive family history of CRC and self-perceived poor health status. [source] Colonic left-side increase of eosinophils: a clue to drug-related colitis in adultsALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 5 2009G. CASELLA Summary Background, The colon shows frequent eosinophilic infiltration in allergic proctocolitis of infants, whereas in adults, eosinophilic infiltration of the colon is less defined and may be found in different conditions including drug-induced colitis, even though the pathological findings are often inconsistent. Aim, To quantify eosinophils in the mucosa of normal controls and to compare them with those of patients with abdominal symptoms related to ,drug colitis'. Methods, Mucosal biopsies were obtained during colonoscopy in 15 controls and in 27 patients with abdominal symptoms, a history of probable ,drug-related colitis' and without obvious causes of eosinophilia. Results, The drugs related to the patient symptoms were nonsteroidal anti-inflammatory drugs (70%), antiplatelet agents (19%) and oestroprogestinic agents (11%). Colonoscopy was normal in 30% of patients and abnormal in 70%. Histology showed low content of inflammatory cells and normal crypt architecture in-patients with endoscopy similar to inflammatory bowel diseases. The eosinophil score was significantly higher in the left side of the colon in the patient group compared with controls. Conclusions, The finding of an increased eosinophil count limited to the left (descending and sigmoid) colon is an important clue towards a diagnosis of drug-related colitis [source] Quantitative colonoscopic evaluation of relative efficiencies of an immunochemical faecal occult blood test and a sensitive guaiac test for detecting significant colorectal neoplasmsALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 4 2009P. ROZEN Summary Background, The guaiac faecal occult blood test (G-FOBT), HemoccultSENSA, is sensitive for significant neoplasms [colorectal cancer (CRC), advanced adenomatous polyps (AAP)], but faulted by non-specificity for human haemoglobin (Hb). Quantified, Hb- specific, immunochemical faecal occult blood tests (I-FOBT) are now used. Aims, To (i) compare I-FOBT and G-FOBT efficacy in identifying significant neoplasms and colonoscopy needs for positive tests and (ii) examine number of I-FOBTs needed and test threshold to use for equivalent or better sensitivity than G-FOBT and fewest colonoscopies for positive tests. Methods, Three daily G-FOBTs and I-FOBTs were collected and analysed in 330 patients scheduled for colonoscopy. Results, Colonoscopy found significant neoplasms in 32 patients, 6 CRC, 26 AAP. G-FOBT, sensitivity and specificity were 53.1% (17 neoplasms) and 59.4%, resulting in 8.1 colonoscopies/neoplasm. One I-FOBT having ,50 ngHb/mL of buffer provided equivalent sensitivity but 94.0% specificity, resulting in 2.1 colonoscopies/neoplasm. By analysing the higher of two I-FOBTs at 50 ngHb/mL threshold, sensitivity increased to 68.8% (22 neoplasms, P = 0.063), specificity fell to 91.9% (P < 0.001), but still required 2.1 colonoscopies/neoplasm. Conclusions, In this population, quantified I-FOBT had significantly better specificity than G-FOBT for significant neoplasms, reducing the number of colonoscopies needed/neoplasm detected. Results depend on the number of I-FOBTs performed and the chosen development threshold. [source] Phlebosclerotic colitis coincident with carcinoma in adenomaPATHOLOGY INTERNATIONAL, Issue 10 2003Yasuhiko Kimura Phlebosclerosis of the colon is a rare disease characterized by a thickening of the wall of the colon with fibrosis, hy-alinization and calcification to the affected veins. These symptoms result in a type of ischemic colitis known as phlebosclerotic colitis. A case of phlebosclerotic colitis coincident with carcinoma in adenoma is reported. A 74-year-old Japanese woman was admitted to hospital because of a mass in her right lower abdomen. Abdominal computed tomography examination revealed linear calcifications in the wall of the cecum and the ascending colon. Colonoscopy revealed dark purple mucosa with multiple ulcers in the cecum and the ascending colon. Biopsy specimens showed a marked hyalinous thickening of the wall of small blood vessels in the mucosa. Phlebosclerotic colitis was suspected because of negative results with amyloid stain. Alternative ileocolic angiography showed the serpentine of the peripheral nature blood vessels and pooling at the late venous phase. Microscopic examination of the surgically resected colon revealed mucosal and submucosal fibrosis, and a thickening of the venous wall with fibrosis, hyalinization and calcification from the mucosa to the serosa, which caused a marked luminal narrowing. A small polypoid lesion was also found in the affected region and was diagnosed histologically as carcinoma in adenoma. To our knowledge, this is the first reported case of phlebosclerotic colitis complicated by carcinoma. [source] Urinary and rectal complications of contemporary permanent transperineal brachytherapy for prostate carcinoma with or without external beam radiation therapy,CANCER, Issue 4 2004Michael F. Sarosdy M.D. Abstract BACKGROUND Prostate brachytherapy is increasingly used to treat prostate carcinoma, alone or combined (combination therapy) with external beam radiation therapy (EBRT). This report cites the frequency and nature of urinary and rectal complications requiring unplanned interventions after contemporary brachytherapy with or without EBRT. METHODS A total of 177 consecutive patients underwent either brachytherapy (100 patients [56.5%]) or combination therapy (77 patients [43.5%]) for clinical T1-2 prostate carcinoma between July 1998 and July 2000. All the patients were analyzed with regard to disease characteristics, treatment details, and complications requiring unplanned interventions in up to 48 months of follow-up. RESULTS Catheter drainage for urinary retention was required for a median of 55 days (range, 3,330 days) in 36 patients (20%), including 24% after brachytherapy and 16% after combination therapy. Transurethral resection of the prostate (TURP) was performed at a median of 12 months (range, 8,18 months) after implantation in 5% of patients after brachytherapy and 14.5% of patients after combination therapy (P = 0.029). Colonoscopy with or without fulguration for rectal bleeding was performed in 37 of 158 patients (97 in the brachytherapy group and 61 in the combination therapy group) (23.4%) at a median of 17 months (range, 4,45 months), including 15 patients (15.5%) after brachytherapy and 22 patients (36%) after combination therapy (P = 0.002). Combination therapy resulted in fecal diversion in 6.6% of patients (P = 0.021), urinary diversion in 3.2% of patients (P = 0.148), and clean intermittent self-catheterization for recurrent stricture after multiple TURPs in 4.9% of patients (P = 0.055), none of which occurred after brachytherapy. Overall, 20.6% of patients underwent TURP or colonoscopy after brachytherapy, whereas 44.2% underwent those or more extensive unplanned procedures after combination therapy (P = 0.001). CONCLUSIONS Complications requiring unplanned procedures may occur after brachytherapy, and may be increased significantly after brachytherapy combined with EBRT. These data reinforce the concept that quality assurance and technique are important in prostate brachytherapy, but, even when these are in place, complications can occur, especially when EBRT is added to brachytherapy. Cancer 2004. © 2004 American Cancer Society. [source] Review of the Lynch syndrome: history, molecular genetics, screening, differential diagnosis, and medicolegal ramificationsCLINICAL GENETICS, Issue 1 2009HT Lynch More than one million patients will manifest colorectal cancer (CRC) this year of which, conservatively, approximately 3% (,30,700 cases) will have Lynch syndrome (LS), the most common hereditary CRC predisposing syndrome. Each case belongs to a family with clinical needs that require genetic counseling, DNA testing for mismatch repair genes (most frequently MLH1 or MSH2) and screening for CRC. Colonoscopy is mandated, given CRC's proximal occurrence (70,80% proximal to the splenic flexure). Due to its early age of onset (average 45 years of age), colonoscopy needs to start by age 25, and because of its accelerated carcinogenesis, it should be repeated every 1 to 2 years through age 40 and then annually thereafter. Should CRC occur, subtotal colectomy may be necessary, given the marked frequency of synchronous and metachronous CRC. Because 40,60% of female patients will manifest endometrial cancer, tailored management is essential. Additional extracolonic cancers include ovary, stomach, small bowel, pancreas, hepatobiliary tract, upper uroepithelial tract, brain (Turcot variant) and sebaceous adenomas/carcinomas (Muir-Torre variant). LS explains only 10,25% of familial CRC. [source] Colonoscopy: the polyp surveillance/treatment pathway.COLORECTAL DISEASE, Issue 3 2007Is it efficient? No abstract is available for this article. [source] Incidence and Prognosis of Colorectal Dysplasia in Inflammatory Bowel Disease: A Population-based Study from Olmsted County, Minnesota,INFLAMMATORY BOWEL DISEASES, Issue 8 2006Tine Jess MD Abstract Background and Aims: The risk, fate, and ideal management of colorectal dysplasia in inflammatory bowel disease (IBD) remain debated. We estimated the incidence, long-term outcome, and risk factors for progression of colorectal dysplasia (adenomas [adenoma-associated lesions or masses (ALMs)], flat dysplasia, and dysplasia-associated lesions or masses [DALMs]) in a population-based IBD cohort from Olmsted County, Minnesota. Materials and Methods: The Rochester Epidemiology Project was used to identify cohort patients with colorectal dysplasia. Medical records were reviewed for demographic and clinical characteristics. Histology slides were reviewed by a pathologist blinded to previous pathology reports. The cumulative incidence of dysplasia was estimated, and the association between patient characteristics and recurrence/progression of dysplasia was assessed using proportional hazards regression. Results: Twenty-nine (4%) IBD patients developed flat dysplasia (n = 8), DALMs (n = 1), ALMs in areas of IBD (n = 18), or ALMs outside areas of IBD (n = 2). Among 6 patients with flat low-grade dysplasia (fLGD) who did not undergo colectomy, none progressed during a median of 17.8 (range 6,21) years of observation with a median of 3 (range 0,12) surveillance colonoscopies. Four (22%) patients with ALMs in areas of IBD who did not undergo surgery developed LGD or DALMs. Primary sclerosing cholangitis and dysplasia located proximal to the splenic flexure were significantly associated with risk for recurrence/progression of dysplasia. Conclusions: This population-based cohort study from Olmsted County, Minnesota did not confirm an increased risk of cancer related to fLGD, whereas 22% of patients with ALMs in areas of IBD developed fLGD or DALMs. [source] Oral mesalamine and clinical remission are associated with a decrease in the extent of long-standing ulcerative colitisINFLAMMATORY BOWEL DISEASES, Issue 7 2006Michael F. Picco MD Abstract Objective: To compare colonoscopy alone with surveillance biopsy for the determination of anatomic extent in long-standing ulcerative colitis (UC). To assess the influences of mesalamine use and clinical disease activity on the change of histologic extent with time. Materials and Methods: Disease extent (proctosigmoiditis, left-sided colitis, or pancolitis) measured by colonoscopy and surveillance biopsy was compared among 212 consecutive patients with long-standing UC. Among the 102 patients who had 2 consecutive colonoscopies with surveillance biopsies, the following influences on change in histologic extent were determined: disease activity, mesalamine use, age at disease onset, folic acid, corticosteroid and azathioprine/6-mercaptopurine use, and time between colonoscopies. Results: Agreement between gross and microscopic findings was poor (, = 0.39). Colonoscopy underestimated and overestimated extent in 25.9% and 8.5%, respectively. Microscopic distribution between consecutive colonoscopies remained the same in 60.8%. Where distribution changed, an increase was twice as common as a decrease in extent. There was no difference in age at onset, time between colonoscopies, or disease duration among those with an increase, decrease, or no change in extent. Clinical remission and oral mesalamine were independently associated with 10.7 and 5.8 times the odds of a decrease in disease extent, respectively. Folic acid, topical mesalamine, corticosteroids, and immunomodulators did not influence change in extent. Conclusions: UC extent is best determined by surveillance biopsy. Among patients with long-standing UC, histologic extent fluctuates with time. Disease remission and oral mesalamine were independently associated with decreases in disease extent. [source] Low-molecular-weight heparin as bridging therapy during interruption of oral anticoagulation in patients undergoing colonoscopy or gastroscopyINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 2 2007M. Constans Summary Nowadays, most patients under oral anticoagulant therapy (OAT) require invasive procedures such as colonoscopy (CC) or gastroscopy (GC). The goals of the management of OAT are to minimise the risk of thromboembolism and bleeding. We have performed the first prospective, observational study to evaluate these parameters using fixed-dose high-risk thromboprophylactic therapy with sodic bemiparin (Hibor®) as bridging therapy. From January 2004 to January 2005, patients under OAT were included. Periprocedure prophylaxis consisted of: Acenocumarol patients: Day ,3: withdrawal acenocumarol. Days ,2,,1,0: Hibor ®3500 UI/d sc and days +1,+2,+3: Hibor® 3500 U/I + acenocumarol. And day +5: acenocumarol only. Warfarin patients: Days ,5,,4: withdrawal warfarin, ,3,,2,,1, 0; Hibor® 3500 UI/day sc, days +1,+2,+3,+4: Hibor® 3500 UI/day sc and warfarin and day +5; warfarin only. Thromboembolic complications and bleeding were recorded in a 3 month follow-up. We included 100 consecutive patients in the intention-to-treat group. The remaining 98 patients were 50 women and 48 men. Mean age of women was 71.1 (range: 46,87) years and 70.7 (range: 39,86) years in men. Eighty-three took acenocumarol, and 15 warfarin. Thirty-two gastroscopies and 61 colonoscopies were performed and in five patients both were performed. No thromboembolic and bleeding complications related to bemiparin were observed in the 103 endoscopies. Two patients developed pruritus at the punction site. Fixed-dose high-risk thromboprophilactic therapy with bemiparin (Hibor®) is safe and effective as a bridging therapy in patients under OAT who require GC or CC. [source] | |||||||||||||||||||||||||||||||||||||