New Techniques in Colonoscopy

Abstract

Colonoscopy is the best method for diagnosing neoplastic processes affecting the colon and is frequently the modality by which definitive treatment of these diseases is provided. Surgery has been the mainstay of treatment of colonic obstruction. In the past 15 years, laser, balloon, and stenting technology has provided alternatives to surgery in colonic obstruction from malignant or benign causes. Colonic stents safely treat colonic obstruction either as a bridge to surgery or as palliation. The most common complications are perforation, stent migration, and stent reocclusion. The neodymium:yttrium-aluminum-garnet (Nd:YAG) is the most widely used laser for treating colorectal disease. Its use is described in treating colonic obstruction, bleeding, and staged destruction of villous adenomas. Balloon dilatation has been used to treat benign strictures. Perforation and the need for repeated treatment are the most common complications from its use. A combined approach with laser or balloon dilatation and stenting has also been successfully used. Preoperative marking of small colonic neoplasms aids in localization of the tumor, especially in laparoscopic procedures. Tattooing and metallic clips are the most common methods for marking, are more accurate than preoperative colonoscopic localization, and are less time consuming than intraoperative colonoscopy.