Colonoscopic Diagnosis Research Articles

Frustration still exists.

See Article on Page 222-227 The history of colonoscopy could be the history of bowel preparation. In fact, the evolution of bowel preparation is much longer than the history of colonoscopy. Bowel preparation was also inevitable in the era of radiological colon study. Along with the progress in colonoscopy, various studies of bowel preparation have been done. The main emphases of those bowel-cleansing studies were drugs or regimens and administration methods. A single agent or combined regimens have been tried in various ways. In fact, the agents are not as diverse as the colonoscopic procedures. An unavoidable limitation of drugs or agents is that must they do no harm to the human body and be sufficiently effective [1]. This article addresses the single and the combined use of a polyethylene glycol solution and a sodium picosulfate with magnesium citrate solution. The authors reported good results for the sodium picosulfate/magnesium citrate solution, even for its single use [2]. Sodium picosulfate with magnesium citrate is not a novel agent and has already been reported to be an efficient precolonoscopy bowel-preparation agent [3]. However, the study is still worthwhile because the importance of bowel preparation cannot be underestimated in any practical colonoscopies. In other words, bowel cleansing is the basic procedure for successful colonoscopic diagnosis and treatment. Many patients used to say that the colonoscopy itself was bearable, but the process of bowel preparation was a real pain. That was reality! Bowel cleansing is time consuming, uncomfortable and stressful. As a matter of fact, despite the existence of various bowel-cleansing methods, we still experience frustrating situations for patients and even for doctors. Accordingly studies should be continued. Although the efficacies of the drugs and of the administration methods are the key points, practical points, such as the planned timetable and schedules, could be obstacles to bowel cleansing. In short, frustration still exists in bowel preparation. A tailored approach could be helpful. Patience and sincerity are needed for colonoscopists, assisting staff members and patients themselves. The basic principle is important and still remains as an issue.

Funktionelle Magen-Darm-Erkrankungen

Functional dyspepsia (FD) and irritable bowel syndrome (IBS) are the most important functional gastrointestinal diseases (FGID), and both affect about 5-15 % of the German population. The patients' symptoms are caused by disturbances of gastrointestinal (GI) motility, secretion and sensitivity. Central processing of visceral afferences is disturbed, and the course of the disease and individual symptom perception are influenced by psychosocial factors. Diagnosis of FD and IBS is based on a compatible symptom pattern, absence of alarm symptoms and exclusion of relevant differential diagnoses. The diagnosis of FD requires a normal upper GI endoscopy. Current German guidelines also demand a normal colonoscopy for diagnosis of IBS. Basic therapeutic measures include explanation of the nature of the disease and its harmlessness quo ad vitam . Individual trigger factors should be identified and eliminated if possible. Drug therapy of persisting complaints is guided by the dominant symptom.

Lower GI Bleeding: Epidemiology and Management

Gastrointestinal (GI) bleeding from the colon is a common reason for hospitalization and is becoming more common in the elderly. While most cases will cease spontaneously, patients with ongoing bleeding or major stigmata of hemorrhage require urgent diagnosis and intervention to achieve definitive hemostasis. Colonoscopy is the primary modality for establishing a diagnosis, risk stratification, and treating some of the most common causes of colonic bleeding, including diverticular hemorrhage which is the etiology in 30% of cases. Other interventions, including angiography and surgery, are usually reserved for instances of bleeding that cannot be stabilized or allow for adequate bowel preparation for colonoscopy. We discuss the colonoscopic diagnosis, risk stratification, and definitive treatment of colonic hemorrhage in patients presenting with severe hematochezia.

Tu1484 Colonoscopic Diagnosis and Therapeutic Strategy of Colorectal Serrated Lesions

Based on the clinical presentation and the lavage diagnosis 60% of patients were diagnosed with intestinal food allergy. High-definition imaging with i-scan visualized lymphoid hyperplasia, slight mucosal edema and blurred mucosal vascular pattern. Based on these findings i-scan could predict food allergy with a sensitivity, specificity and accuracy of 85%, 89%, and 86%, respectively. Positive and negative predictive value for i-scan to predict food allergy were 92% and 80%, respectively. Conclusion: High-definition endoscopy with virtual chromoendoscopy could mimic slight mucosal changes in patients with intestinal food allergy which were highly predictive for the disease.

Role of CT Virtual Colonoscopy in Diagnosis of Colo-Rectal Neoplasms

Purpose: to assess the role of CT colonography (virtual colonoscopy) as a non-invasive imaging technique in detection and diagnosis of colorectal neoplasia using conventional colonoscopy and/or operative findings as a reference standard, as well as highlighting its advantages and possible pitfalls. Methods: sixty patients were examined by CT after standard bowel preparation, rectal insufflation and IV contrast injection. Imaging was performed in both supine and prone positions. Evaluation consisted of review of the transverse CT images, sagittal and coronal reformations and 3D endoluminal lmages. CT colonographic findings were correlated with standard conventional colonoscopic and/or operative findings. Results: Virtual colonoscopy correctly identified all 6 carcinomas (100%), 12 out of the 13 polyps that measured 10mm or more (92.3%), 19 of the 23 polyps that measured 6 - 9 mm (82.6%) and 28 out of 48 polyps that measured 5mm or less (58.3%). There were 11 false positive findings of polyps by virtual colonoscopy and no false positive findings of cancer. Virtual colonoscopy also detected 35 incidental extracolonic findings in 25 patients while non were detected by conventional colonoscopy. 17 of the 24 patients who had no lesions during conventional colonoscopy were considered free of lesions by CT colonography yielding a per-patient specificity of 70.8% Conclusion: CT colonography has high sensitivity for the detection of clinically important polyps and cancer as well as multiple advantages over conventional colonoscopy in imaging of colorectal neoplasms

Trichuriasis diagnosed by colonoscopy: case report and review of the literature spanning 22 years in mainland China

Trichuriasis is soil-source parasitic disease, usually endemic in warm, humid, tropical and subtropical countries. We report a case of trichuriasis diagnosed by colonoscopy performed in a non-endemic area and review the literature on the colonoscopic diagnosis of Trichuris trichiura spanning 22 years (1989-2011) in mainland China. A total of 4382 trichuriasis cases were diagnosed by colonoscopy out of 41,337 patients who underwent colonoscopy. Most of the patients were cured by unloading the whipworms using colonoscopy pincers. We strongly suggest colonoscopy as a useful diagnostic and treatment tool, especially when the patient is lightly infected or is infected by only a few male worms with no eggs in the stool. The geographical distribution, parasite burden, and the parasitizing locations of T. trichiura in the intestine of the human body were analyzed, and the clinical signs and symptoms, as well as the utility of colonoscopy in the diagnosis and treatment of trichuriasis are discussed.

Always a Suspect: CMV in Ulcerative Colitis

In June 2011, a 60-year-old white woman with history of ulcerative colitis presented with severe bloody diarrhea, reporting up to 12 bowel movements per day, vomiting and fatigue. She had initially presented with painless diarrhea and urgency 14 years ago. After the initial colonoscopic and histologic diagnosis of ulcerative colitis, she was placed on tapering doses of steroids and eventually on 100 mg of 6-mercaptopurine (6-MP). Over the next 5 years, she was treated for intermittent flares of ulcerative colitis with oral steroids in addition to 6-MP. Colonoscopy performed for a flare 6 years ago revealed viral inclusions in the cecal and rectal biopsies, consistent with cytomegalovirus (CMV). Serum IgG and IgM levels were elevated at 50.1 and 3.1, respectively. She was treated with ganciclovir 900 mg for 6 weeks in addition to 6-MP and prednisone, with subsequent clearance of histologic CMV inclusions. Over the next 5 years, she had a total of six colitis flares which were treated with short courses of steroids. However, because of an episode of pancreatitis in October 2006, 6-MP was discontinued in favor of methotrexate 12.5 mg weekly. Infliximab infusions were included in her regimen in March 2011 and were continued every 8 weeks thereafter. Her past medical history was otherwise significant for hepatitis A, hypothyroidism, hyperlipidemia, sclerosing cholangitis (for which she was treated with ursodeoxycholic acid 900 mg orally daily) and Sjogren’s syndrome. She was a non-smoker and non-drinker and worked as a librarian. Upon presentation in June 2011, her physical examination revealed a pale woman with a soft, non-distended, non-tender abdomen with positive bowel sounds. She was re-started on 40 mg of prednisone with continuation of methotrexate and infliximab; severe diarrhea persisted. Colonoscopy revealed severe ulcerative colitis with several large nodules suggestive of ‘‘dysplasia-associated lesion or mass’’ (DALM) (Fig. 1). Biopsies revealed high-grade dysplastic epithelium in the sigmoid and rectal nodules (Fig. 2). Viral inclusion bodies specific to CMV were observed with conventional histology and with immunohistochemal stains (Fig. 3). Infliximab infusions were stopped in favor of ganciclovir 900 mg given orally twice daily for 6 weeks. After one week of therapy, bowel movements decreased to 5–6 per day, her fatigue improved, but her hematocrit decreased by 4 points to 28.8 %. Intravenous iron was initiated to treat iron deficiency. Ten days after stopping ganciclovir, her hematocrit normalized. Upon follow-up colonoscopy 4 months later, severe ulcerative colitis with more dysplastic nodular lesions in several locations were identified. Because of this, she underwent a laparascopically-assisted total proctocolectomy with an end-ileostomy. The specimen revealed welldifferentiated adenocarcinoma in the cecum and sigmoid colon. Sixty-two lymph nodes identified were negative. When seen at follow up 2 months post colectomy, she felt more energetic and had discontinued prednisone, infliximab and methotrexate. Ursodeoxycholic acid was continued as the treatment for her primary sclerosing cholangitis. S. Kommareddy C. L. Chun W. Rogers G. Triadafilopoulos El Camino Hospital, Mountain View, CA, USA

Colo-cutaneous fistula formation due to delayed mesh migration following lumbar hernia repair : Colonoscopic diagnosis

Colo-cutaneous fistula formation due to delayed mesh migration following lumbar hernia repair : Colonoscopic diagnosis

Incidental drainage of a periappendicular abscess during colonoscopy

A 50-year-old man was referred to the outpatient colonoscopy clinic after a positive fecal occult blood test during screening for colorectal cancer. Colonoscopy, which was performed with the patient sedated, revealed a 12-mm tumor covered by normal, smooth mucosa at the site of the appendicular orifice. A biopsy was taken, but this led to an immediate purulent discharge occurring from the lesion (● Video 1). Therefore, a diagnosis of a periappendicular abscess was incidentally established. After the patient had recovered from the sedation, he was specifically questioned about recent abdominal symptoms and recalled a transient self-limiting episode of abdominal pain and mild fever 2 weeks previously. Because of the abscess drainage, the patient was treated with a course of oral metronidazole and ciprofloxacin. A computed tomography (CT) scan 1 week after the procedure revealed no abnormal findings and the patient remained asymptomatic. Acute appendicitis is the most frequent acute abdominal emergency seen in developed countries. Its most common complication is perforation and this may be followed by abscess formation [1]. Colonoscopic diagnosis and treatment of a periappendicular abscess is rare [2]. In this case a periappendicular abscess was incidentally discovered and drained during a colonoscopy. Although controversial, some authors suggest that abscesses such as this should be treated with broad-spectrum intravenous antibiotics and percutaneous drainage. Interval appendectomy should be considered in patients with a low operative risk [3]. These options have been declined by the patient, who remains asymptomatic after 10 months of follow-up.

The Clinical Utility of Positron Emission Tomography-computed Tomography in the Evaluation of Inflammatory Bowel Diseases

Background/Aims: Positron emission tomography-computed tomography (PET-CT) is a nuclear imaging technique that provides noninvasive, three dimensional, quantitative images. Recently, PET-CT has been shown to be valuable in assessing patients with inflammatory diseases; however, the clinical utility of PET-CT in the evaluation of inflammatory bowel disease (IBD) has not been defined. Thus, the aim of this study was to determine the clinical utility of PET-CT in the evaluation of IBD. Methods: Between November 2006 and September 2010, clinical, endoscopic, and radiological data on 14 patients (6 males and 8 females: age range, 33-79 years) with suspected IBD were collected. The standard work-up method for a definite diagnosis of IBD included ileocolonoscopy. Results: The 14 patients were divided into the following five groups: ulcerative colitis (n=4, 29%), intestinal Behcet’s disease (n=3, 21%), intestinal tuberculosis (n=2, 14%), malignancy (n=2, 14%), and no abnormal findings with colonoscopy (n=3, 21%). A PET-CT based-diagnosis of IBD correlated with a colonoscopic diagnosis in nine cases (64.3%), but the matching ratio of the distribution of lesions between PET-CT findings and colonoscopic findings was only 18.1% (2/11). Conclusions: The utility of PET-CT in the diagnosis of IBD requires further evaluation. (Intest Res 2011;9:97-104) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Caeco-colic intussusception in an adult: a rare case report

Intussusception is common in children but rare in adults. Caeco-colic intussusception is an uncommon cause of intestinal obstruction in adults. Very limited information is available about the role of colonoscopy in diagnosis of intussusception in the literature. We present a case of caeco-colic intussusception in a 50-year-old male who presented with the complaints of pain in abdomen and a lump in the right hypochondrium. Colonoscopy and contrast studies revealed the diagnosis of intussusception. Abdominal computed tomography (CT scan) is considered as the most sensitive investigation to diagnose intussusception at present, whereas colonoscopy is sparingly used to diagnose intussusception. In this patient, colonoscopy not only established the diagnosis and malignant nature of the lead point, but also guided the definitive extent of surgical resection. CT scan offers a presumptive diagnosis as compared to the definitive diagnosis of intussusception by colonoscopy. In adult intussusception, colonoscopy can be considered as a complimentary investigation to other diagnostic modalities. Hence regular use of colonoscopy in adult intussusception should be encouraged where presentation is either subacute or chronic.

A Case of Successful Colonoscopic Treatment of Acute Appendiceal Bleeding by Endoclips

Lower gastrointestinal bleeding is a common disease among elderly patients. The common sources of lower gastrointestinal bleeding include vascular disease, Crohn's disease, neoplasm, inflammatory bowel disease, hemorrhoid, and ischemic colitis. However, bleeding from the appendix has been reported very rarely in patients with lower gastrointestinal tract bleeding. In general, after a colonoscopic diagnosis of appendiceal bleeding, a laparoscopic or surgical appendectomy would be recommended. We report a case of successful colonoscopic treatment of appendiceal bleeding without complications by endoclips. This report suggests that colonoscopic clipping is a safe and effective means to treat bleeding from appendiceal lesions. Further study is needed to evaluate procedure-related complications and to confirm the procedure's safety and efficacy.

Colonoscopic Diagnosis of Trichuris trichiura (Whipworm)

Purpose:Trichuris trichiura is the third most common roundworm worldwide, with more than one fourth of the world's population carrying this parasite. The diagnosis is made primarily by stool examination for eggs. Colonoscopic diagnosis is rare, with less than 20 cases reported in the literature. Case: A 73 year Nepalese male presented to the outpatient endoscopy unit for evaluation of nonspecific generalized abdominal pain and normocytic anemia. He had no associated nausea, vomiting, weight loss or change in bowel pattern. The patient had immigrated to the United States about one year earlier. His laboratory data was significant for normocytic anemia without eosinophilia. Upper endoscopy revealed chronic gastritis but was otherwise unremarkable. Colonoscopy revealed a solitary worm, found in the cecum, with ova characteristic of Trichuris trichiura. The patient was treated with albendazole 400mg daily for three days. Follow-up two months after treatment revealed improvement in symptoms. Discussion:Trichuris trichiura affects more than 800 million people worldwide. The majority of cases in the United States are found within the immigrant population. The mode of transmission is primarily fecal-oral or accidental ingestion of eggs, which are usually found on dry goods such as beans, rice or grains. Upon ingestion of eggs, larvae hatch and develop in the small intestine and then migrate into the right colon. Adult worms live in the cecum and ascending colon. The anterior portion of the adult worm embeds in the mucosa, whilst the posterior portion hangs in the lumen and mates with neighboring worms. It takes approximately 60 days for a gravid female worm to shed eggs. Female worms in the cecum shed between 3,000 and 20,000 eggs per day. The lifespan of adult worms is between 1-3 years. Diagnosis is primarily by stool examination; however it is important to note that stool analysis can be negative if examined within 2-3 months of acquiring infection. Clinical presentations can include non-specific abdominal pain, colonic obstruction, perforation, gastrointestinal hemorrhage or rectal prolapse, with laboratory findings of anemia or eosinophilia. Patients with light infestation can be asymptomatic. Colonoscopic findings of worms in the right colon (cecum and ascending colon) generally reflect a light burden, while worms found in the left colon (descending, sigmoid colon and rectum) reflect heavy burden. Irrespective of infection burden, treatment is recommended. The treatment options are albendazole 400mg once daily for 3 days, or mebendazole 100mg twice daily for 3 days.

Colonoscopic Diagnosis of Polypoid Endometriosis in the Sigmoid Colon

Purpose: Gastrointestinal (GI) tract is the most common site for extra pelvic endometriosis. Endometriotic deposits are rarely mucosal and even if present, endoscopic biopsies are usually non-diagnostic due to secondary mucosal changes. Methods: 30-year-old female with c-section 9 years ago complained of abdominal cramps, bloating, constipation and rectal bleeding during menstruation for 3 years with recently increasing severity. She was diagnozed with pelvic endometriosis and had partial relief despite multiple medical treatments. Her physical exam is unremarkable except for moderate tenderness to palpation in left lower quadrant. Results: She had normocytic anemia with hemoglobin of 9.8 gm/dl and all other labs were unremarkable. CT of the abdomen revealed thickening of the sigmoid colon and mildly distended proximal colon. Colonoscopy immediately after menstruation revealed an almost completely obstructing polypoid sigmoid mass and adherent blood clots. Mucosal biopsies revealed endometrial glands which confirmed the diagnosis. Sigmoid resection, total abdominal hysterectomy and bilateral salpingo-oopherectomy were subsequently performed. Conclusion: Endometriosis occurs in about 10% of all women and colorectal endometriosis (CRE) accounts for 5-12% of all cases. Rectum and sigmoid colon are the most common GI sites with a combined estimate of 70-90%. Although numerous case reports of CRE exists, mucosal involvement is rare and endoscopic diagnosis usually has low yield even in cases with visible lesions. Mucosal changes can mimic IBD or even neoplasm. Our case adds to the growing body of polypoid endometriosis which was confirmed on endoscopic biopsies. Future studies are needed to elucidate if the diagnostic yield is increased by biopsying in the immediate post menstrual period as in our case, when the endometrial glands are more superficial.Figure: Colonoscopic view.Figure: Endometrial glands.

Colonoscopic Clipping as a Treatment for Appendiceal Bleeding

Bleeding from the appendix has been reported very rarely in patients with lower-gastrointestinal-tract bleeding. In general, after a colonoscopic diagnosis of appendiceal bleeding, laparoscopic or surgical appendectomy would be recommended. Two patients with continuous bleeding from the appendix were treated with partial occlusion of the appendiceal orifice by colonoscopic clipping. In neither case was there evidence of further active bleeding over the following 12 months. This is the first report of such a treatment in the English literature.

Colonoscopic Findings in Appendiceal Intussusception in Cystic Fibrosis: A Tubular Cecal Structure Containing Impacted Luminal Secretions

Colonoscopic diagnosis of appendiceal intussusception with cystic fibrosis is important to avoid colonoscopic “polypectomy” of an inverted appendix causing inadvertent cecal perforation.1Fazio R.A. Wickremesinghe P.C. Arsura E.L. et al.Endoscopic removal of an intussuscepted appendix mimicking a polyp: an endoscopic hazard.Am J Gastroenterol. 1982; 77: 556-558PubMed Google Scholar Yet little is known about the colonoscopic findings.2Bradly D.P. Gallegos M. Jakate S. Appendiceal mass in an adolescent with cystic fibrosis.Clin Gastroenterol Hepatol. 2009; (A24): 7Google Scholar We report a striking colonoscopic appearance of this intussusception. A 19-year-old woman with cystic fibrosis, complicated by pulmonary bronchiectasis, chronic pancreatic insufficiency, and 2 admissions for right lower quadrant (RLQ) pain attributed to distal intestinal obstruction syndrome (DIOS), presented with increasingly severe RLQ pain and vomiting for 2 weeks. The abdomen was soft, but was mildly tender in the RLQ. Routine blood test results and esophagogastroduodenoscopy were within normal limits. Abdominopelvic computed tomography revealed a tubular structure (extracolonic appendix, black arrows) extending 8 cm outside cecum, penetrating through the cecal wall (white arrow), to become a multiwalled structure within the cecum (intracecal, inverted appendix), and containing a 1.3-cm–wide lumen, findings consistent with appendiceal intussusception (Figure A, sagittal view). Colonoscopy, performed to exclude cecal cancer, revealed a 5-cm long, smooth, tubular structure covered by normal-appearing mucosa, arising perpendicularly from cecal caput, and containing a central 1.3-cm–wide lumen filled beyond the brim with impacted, inspissated secretions (Figure B, colonoscopic videophotograph at ileocecal valve level). This structure was identified as a partly inverted appendix by its attachment to cecal caput and absence of an alternative appendiceal orifice. Cautious colonoscopic irrigation with water, serial luminal biopsies, and suctioning removed only 10% of impacted secretions, in an unsuccessful attempt at disimpaction to reduce the intussusception. Colonoscopic biopsies of intussuscepted appendiceal mucosa were safely performed, revealing nonneoplastic, colonic-type mucosa with infiltration of eosinophils, findings associated with chronic appendicitis/appendiceal intussusception. The patient underwent laparoscopic appendectomy. Gross examination of resected specimen revealed a distended appendix with a dilated, 1.3-cm–wide lumen, filled with inspissated mucous. Microscopic examination in cross-section revealed thinned appendiceal mucosa from compression by a greatly expanded central lumen, filled with impacted, inspissated, eosinophilic secretions (Figure C, low-power photomicrograph, H&E, 20×). High-power photomicrograph revealed inspissated secretions arising from a crypt (arrows) and flowing, similar to lava, into the appendiceal lumen, which are characteristic appendiceal findings with cystic fibrosis (Figure C, inset, 400×). Patients with cystic fibrosis can develop appendiceal intussusception from impacted appendiceal secretions that provide a lead point for intussusception.3Chaar C.I.O. Wexelman B. Zuckerman K. et al.Intussusception of the appendix: comprehensive review of the literature.Am J Surg. 2009; 198: 122-128Abstract Full Text Full Text PDF PubMed Scopus (59) Google Scholar They also develop other obstructed ducts/lumens from inspissated secretions, including DIOS, pancreatic obstruction with pancreatic insufficiency, and biliary obstruction. The following, currently reported, colonoscopic and colonoscopic biopsy findings may be diagnostic of appendiceal intussusception with cystic fibrosis: a tubular structure within cecum, containing impacted, inspissated secretions within its lumen, arising from the cecal caput, and without an alternative appendiceal orifice, with colonoscopic biopsies showing an eosinophilic mucosal inflammatory infiltrate without neoplasia. Endoscopic therapy to relieve obstruction currently is performed for esophageal food impaction. As a speculation, gentle colonoscopic appendiceal luminal irrigation, perhaps using N-acetylcysteine, might disimpact and potentially reduce the intussusception, just as colonic irrigation at colonoscopy with N-acetylcysteine may relieve DIOS.4Shah U. Shafiq Y. Khan M.A. Gastrograffin use in distal intestinal obstruction syndrome of cystic fibrosis.J Ayub Med Coll Abbottabad. 2007; 19: 58-60PubMed Google Scholar

Surgical gastrointestinal endoscopy in Ibadan, Nigeria

Introduction Fiberoptic colonoscoscopy is about 43 years old now. Improvement in instruments led rapidly to wide acceptance of colonoscopy in diagnosis and therapy of colorectal diseases. The diagnosis of benign and malignant neoplasms was revolutionized by colonoscopy. Flexible fiberoptic endoscopes have now replaced rigid endoscopes because of the enhanced safety, ease of application and ability to link to a monitor (videoscopes) so that the patient may even follow the procedure. The use of these flexible fiberoptic endoscopes for both upper and lower gastrointestinal tract examinations started in the University College Hospital Ibadan as far back as 1986; however most of these examinations were carried out by the physicians of the gastroenterology unit. From 1989 to 1990 some sporadic endoscopic examinations were done by one surgeon, but when he left the service surgical endoscopy was done by the medical gastroenterologists. Recently, the hospital acquired new scopes available for gastrointestinal surgeons, medical gastroenterologists, pulmonologists, otorhinolaryngologists and thoracic surgeons. Surgical endoscopy is now done in the Division of Surgical Gastroenterology routinely . This is a preliminary report of our experience with surgical upper and lower gastrointestinal endoscopies in the University College Hospital Ibadan, Nigeria.

The Impact of Advances in Instrumentation and Techniques of Colonoscopy from 1988 to 2008 on Inpatient Colonoscopy Performance at a High Volume Endoscopy Unit in the United States: Significantly Shorter Procedure Time, Higher Completion Rate, Performance on Sicker Inpatients, and Near Disappearance of Flexible Sigmoidoscopy

Colonoscopy instrumentation and technique have improved from 1988 to 2008. We analyze whether these improvements have resulted in improved colonoscopy performance. This was a retrospective study of 50 consecutive inpatients in 1988 vs. 1998 vs. 2008 undergoing intended colonoscopy at a teaching hospital. Patient APACHE score, cecal and terminal ileal intubation rates, procedure time, and colonoscopic diagnoses were compared for the three different years. Changes in practice of inpatient colonoscopy in 2008 from 1988 include (1) remarkably sicker inpatients undergoing colonoscopy in 2008, as indicated by: significantly higher mean APACHE II score (11.0 ± 6.6 vs. 5.9 ± 4.1, P < 0.00001), significantly more frequent monitored bed status (58% vs. 10%, OR = 12.4; 95%-ORCI: 4.31-35.4, P < 0.00001), and significantly higher rates of several chronic diseases (e.g. CHF, 24% vs. 6%, P = 0.02); (2) significantly higher colonoscopy completion rate in 2008 (88% vs. 64%; OR = 4.13, 95%-ORCI: 1.51-11.2, P = 0.009); (3) significantly higher terminal ileum intubation rate in 2008 (44% vs. 14%, OR = 4.83, 95%-ORCI: 1.85-12.5, P = 0.002); and (4) significantly shorter mean procedure time in 2008 (26.3 ± 7.9 min vs. 48.0 ± 20.3 min, P < 0.00001). The ratio of intended colonoscopy/flexible sigmoidoscopy was significantly higher in 2008 vs. 1988 (OR = 7.50, 95%-ORCI: 2.56-21.8, P < 0.00001). Internal hemorrhoids were significantly more frequently diagnosed by colonoscopy in 2008 (44% vs. 12%, OR = 5.76, 95%-ORCI: 2.12-15.5, P = 0.001), attributed to increased rectal retroflexion. Due to improved instrumentation and technique, colonoscopy has dramatically changed from 1988 to become a clinically more valuable test in 2008 as manifested by a higher completion rate, greater clinical applicability, and shorter procedure time. Colonoscopy is supplanting flexible sigmoidoscopy.

PTH-010 Comparison of colorectal cancer diagnoses in bowel cancer screening and 2-week rule patients: Abstract PTH-010

Introduction The two most common pathways through which colorectal cancer (CRC) is diagnosed in 60–69-year-olds are the 2-week wait pathway or bowel cancer screenng. The 2-week wait system involves fast tracking patients with worrying symptoms such as rectal bleeding, change of bowel habit to loose stools or iron deficiency anaemia to colonoscopy. Bowel cancer screening patients are offered faecal occult blood (FOB) testing and then colonoscopy if they prove positive. We have compared the CRC diagnoses made via each pathway. Methods We identified all 60–69-year-olds who underwent colonoscopy between 1.4.08 and 31.3.09 in the Newcastle Hospitals as part of the Bowel Cancer Screening Programme or via the 2-week wait system from the endoscopy IT system. All patients with a colonoscopic diagnosis of CRC or of a polyp had their histology reviewed. All patients with confirmed CRC, after multidisciplinary team review and treatment were categorised as to the site and staging of the cancer and the two groups were compared. Results See Abstract 010. Conclusion Patients with bowel cancer diagnosed by bowel cancer screening are more likely to have their CRC in the sigmoid colon and to be diagnosed at an earlier stage than those referred through the 2-week pathway. There is a strong trend towards patients being diagnosed by BCS being male.

The role of colonoscapy and squash preparations in diagnosis and follow-up of stool negative enteric schistosomiasis: A case report of double infection with S. mansoni and S. intercalatum

Background: To present a case of simultaneous infection with two types of schistosoma. To underline the role of colonoscopy in diagnosis. Methods: A 30 year old Mauritian male was admitted to the Nephrology department as he had been recently diagnosed with hypertension due to chronic renal failure. Basic laboratory tests revealed leucocytosis (13,100 WBC/μL), eosinophilia (5,100/μL), elevated IgE 1050 UI/ml. The patient mentioned having constipation and periodic diffuse abdominal pain. The upper abdominal ultrasound showed increased echogenicity of both kidneys. C/T scan demonstrated bilateral nodular lesions <1 cm. Bone marrow aspiration was non diagnostic. The patient finally underwent urinary bladder cystoscopy that was normal and 24 hour urine collection showing no ova. Renal biopsy was not performed due to increased risk of complications. Inspite of these results, it was decided that a total colonoscopy with squash preparations and biopsies was needed. Results: Colonoscopy showed terminal eileum having normal appearence, transverse colon having 2-3 mucosal folds with whitish nodules interlaping with normal mucosa and finally rectosigmoid being erythematous, with small ulcers which were friable and again whitish nodules surrounded by normal mucosa. Biopsy was performed the result of which showed schistosomal ova in different phases of necrosis (rectosigmoid), chronic eosinophilia and inflammation (right and transverse colon). Squash preparations taken during colonoscopy were examined under the microscope: the samples from rectum and sigmoid showed multiple granulomas around S. intercalatum ova and the samples from transverse colon showed a few granulomas around S. intercalatum ova. The patient received 2 courses of treatment with praziquantel. Because his symptoms as well eosinophilia were still present after the treatment, it was decided to give a a 3rd course. Follow-up colonoscopy 10 days later showed normal colonic mucosa. Eosinophilia and symptoms regressed. Conclusion: Diagnosing enteric Schistosomiasis is difficult because stool samples are often negative. At times were parasitic infection is strongly suspected, total colonoscopy and squash preparations may be needed to establish the diagnosis. Abstracts for SupplementInternational Journal of Infectious DiseasesVol. 14Preview Full-Text PDF Open Archive