Colonoscopy For Various Indications Research Articles

Endoscopic features of lymphoid follicles in the colonic mucosa using the image enhanced endoscopy and its association with colorectal adenoma.

Lymphoid follicles hyperplasia (LH) is sometimes observed in the normal colon as small, round, yellowish-white nodules. LH is associated with food hypersensitivity and bowel symptoms and histologically characterized as intense infiltration of lymphocytes or plasmacytes. It is suggested that LH represents inflammatory immune response in the colonic mucosa. We investigated the presence of LH in the normal colonic mucosa and its association with incidence of colorectal lesions including colorectal cancer, adenoma and hyperplastic polyp. 605 participants undergoing colonoscopy for various indications were enrolled. Presence of LH in the proximal colon (appendix, cecum and the ascending colon) was observed using the blue laser imaging (BLI) endoscopy, a new generation image enhanced endoscopy (IEE) system. LH was defined as well demarcated white nodules. Elevated LH with erythema was distinguished as LH severe. Association between presence of LH and occurrence of colorectal lesions was investigated. Prevalence of all colorectal lesions and adenoma were significantly lower in LH severe group compared to the LH negative group (P = 0.0008, 0.0009, respectively). Mean number of all colorectal lesions and adenoma were also lower in LH severe group compared to the LH negative group (P = 0.005, 0.003 respectively). The logistic regression with adjustment for gender and age demonstrated that presence of LH severe held significantly lower risk of all colorectal lesions (OR = 0.48, 95%CI = 0.27-0.86) and adenoma (OR = 0.47, 95%CI = 0.26-0.86). LH in the colonic mucosa visualized by IEE is useful endoscopic finding to predict risk of colorectal adenoma.

Current trend of colonic diverticulosis in patients undergoing colonoscopy in a tertiary care hospital in Northern India

Background: Diverticular disease of the colon has a wide geographic variation and is a very common cause of hospital visits and admissions in the west. Contrary to this there is scarce data on colonoscopic prevalence of diverticular disease from our country.
 Aims and Objectives: To determine the prevalence of colonic diverticulosis and concomitant colonoscopic pathologies among patients undergoing colonoscopy in a tertiary care gastrointestinal endoscopy setting in Northern India.
 Materials and Methods: All adult patients who underwent colonoscopy for various indications and were diagnosed to have colonic diverticulosis from August 2016 to December 2019 in the Department of Gastroenterology, Shifa Medical centre, Srinagar, Kashmir, India were included in the study.
 Results: Out of a total of 4500 colonoscopic procedures, diverticulosis was seen in 190 cases with an overall prevalence of 4.2%. Fifty-six percent of these were males and 44% were females. In 77 (40.52%) patients diverticulosis was seen in left colon, in 72 (37.89 %) in right colon and in 41 (21.57 %) diverticulosis was noted in pancolonic distribution. Adenomatous polyps were seen in 27 % of the cases.
 Conclusion: Colonic diverticulosis has very low prevalence in this northern Indian state. Adenomatous polyps are commonly associated with this condition.

The Efficacy and Safety of Combined Senna and Probiotic-Based Bowel Preparation for Colonoscopy in Children.

Background and objectiveBowel preparation (BP) is a major determinant of accurate and successful colonoscopy and its outcomes in children and adults. The present study aimed to evaluate the effectiveness and safety of a senna alkaloid and probiotic-based BP in children undergoing elective colonoscopy.MethodsChildren aged 2-15 years who underwent esophagogastroduodenoscopy (OGD) and colonoscopy for various indications from December 2018 to May 2019 at the Apollo Children’s Hospital who were prescribed a senna and probiotic-based [Bacillus coagulans (B. coagulans)] preparation before the procedure were included in the study. The effectiveness of the bowel preparation was assessed using the Boston Bowel Preparation Scale (BBPS). Safety assessment was performed by recording adverse events in the study.ResultsSuccessful bowel preparation was observed in all patients according to BBPS, and the mean BBPS score was 2.93 ±0.25, indicating good bowel clearance. About 29 (96.67%) patients showed accessible terminal ileum. There were no major side effects reported in the study. The formulation was found to be palatable and acceptable by 100% of patients.ConclusionThe study revealed the administration of the novel BP to be effective and safe in children undergoing elective colonoscopy for various indications.

Diagnostic Value of Pyruvate Kinase Isoenzyme Type M2 in Colon Cancer Proven with Colonoscopy.

Background:Colonoscopy is the gold standard for colon cancer screening; it is also associated with a high cost and complication. Proliferating cells, in particular tumor cells, express a dimeric isoenzyme of pyruvate kinase, termed M2 pyruvate kinase (M2-PK). The aim of this study was to determine the diagnostic accuracy of fecal M2-PK for colon cancer.Materials and Methods:Forty-nine patients with colon cancers and 49 healthy controls were selected consecutively among individuals undergoing screening colonoscopy for various indications. The diagnosis was confirmed by histology. M2-PK measurements were done by enzyme-linked immunosorbent assay of fecal occult blood test (FOBT) and immunological FOBT (IFOBT) according to the manufacturer's instructions.Results:M2-PK > 9 (U/mL) was the best cutoff point in the detection of colon cancers. In this cutoff point, sensitivity and specificity were 87.8% and 91.8%, respectively, and accuracy was 89.8%. The sensitivity and specificity of IFOBT were 93.9% and 100%, respectively, and accuracy was 96.9%. The sensitivity and specificity of FOBT were 65.3% and 100%, respectively, and accuracy was 82.6%.Conclusion:IFOBT with high sensitivity and specificity and accuracy and low cost is the best fecal screening test. The current study suggests that fecal M2-PK can be used for high-risk colon cancer patients and negative IFOBT that refused colonoscopy as a precolonoscopy screening test.

Evaluation of a fecal immunochemistry test prior to colonoscopy for outpatients with various indications.

BackgroundStool tests can predict advanced neoplasms prior to colonoscopy. Results of immunochemical stool tests to predict findings at colonoscopy for various indications are less often reported. We compared pre-colonoscopy stool tests with findings in patients undergoing colonoscopy for different indications.Patients and methodsCharts of patients undergoing elective or semi-urgent colonoscopy were reviewed. Comparison of adenoma detection rates and pathological findings was made between prescreened and non-prescreened, and between stool-positive and stool-negative cases. Demographics, quality of colonoscopy, and pathological findings were recorded. Odds ratios (ORs) and 95% confidence intervals (CIs) were assessed. Statistical significance was accepted at p≤0.05.ResultsCharts of 325 patients were reviewed. Among them, stool tests were done on 144 patients: 114 were negative and 30 were positive. Findings were similar in the pretest and non-pretest groups. Detection of advanced adenomas per patient was higher in the stool-positive group compared to the stool-negative group (23.4% vs 3.5%, p=0.0016, OR =7.6 [95% CI: 2–29.3]). Five advanced adenomas (without high-grade dysplasia or adenocarcinoma) and several cases of multiple adenomas were missed in the negative group. Sensitivity and specificity for advanced polyps was 63.6% and 82.7%, respectively. The negative predictive value was 96.5%. Male gender was independently predictive of any adenoma.ConclusionThe stool immunochemical test best predicted advanced neoplasms and had a high negative predictive value in this small cohort. Whether this test can be applied to determine the need for colonoscopy in groups other than average risk would require more studies.

Endoscopic features of lymphoid follicles using blue laser imaging (BLI) endoscopy in the colorectum and its association with chronic bowel symptoms.

Background/AimIn the colorectum, lymphoid follicles hyperplasia (LH) is sometimes observed as small, round, yellowish-white nodules. The novel image-enhanced endoscopy system named blue laser imaging (BLI) provides enhanced the contrast of surface vessels using lasers for light illumination. We investigated the endoscopic features of LH observed by using BLI endoscopy and its association with chronic bowel symptoms.Patients/Methods300 participants undergoing colonoscopy for various indications were enrolled. Entire colorectum was observed by using BLI-bright mode with non-magnification view. LH was defined as well demarcated white nodules. Elevated LH with erythema was distinguished as LH severe.ResultsLHs were observed more clearly by using BLI-bright mode compared to conventional white light colonoscopy and were also histologically confirmed as intense infiltration of lymphocytes or plasmacytes. LH was observed in 134 subjects (44.6%) and 67 (22.3%) were LH severe. LH was associated younger age (Odds ratio (OR) = 1.05, 95%Confidence Interval (95%CI) = 1.03–1.07, P<0.0001) and chronic bowel symptoms including constipation, hard stools, diarrhea and loose stools (all LH: OR = 4.03, 95%CI = 2.36–6.89, P<0.0001, LH severe: OR = 5.31, 95%CI = 2.64–10.71, P<0.0001). LH severe was closely associated with both constipation associated symptoms (OR = 3.94, 95%CI = 1.79–8.66, P = 0.0007) and diarrhea associated symptoms (OR = 5.22, 95%CI = 2.09–13.05, P = 0.0004). In particular, LH severe in the ascending colon was strongly associated with bowel symptoms (P<0.0001).ConclusionLH, visualized by using BLI endoscopy was associated with bowel symptom, raising the possibility of pathogenic role of this endoscopic finding in the functional lower gastrointestinal disorders.

Blastocystis sp. in Irritable Bowel Syndrome (IBS)--Detection in Stool Aspirates during Colonoscopy.

Blastocystis is one of the most common gut parasites found in the intestinal tract of humans and animals. Its' association with IBS is controversial, possibly as a result of irregular shedding of parasites in stool and variation in stool detection. We aimed to screen for Blastocystis in colonic stool aspirate samples in adult patients with and without IBS undergoing colonoscopy for various indications and measure the interleukin levels (IL-8, IL-3 and IL-5). In addition to standard stool culture techniques, polymerase chain reaction (PCR) techniques were employed to detect and subtype Blastocystis. All the serum samples collected were subjected for ELISA studies to measure the interleukin levels (IL-8, IL-3 and IL-5). Among 109 (IBS n = 35 and non-IBS n = 74) adults, direct stool examination and culture of colonic aspirates were initially negative for Blastocystis. However, PCR analysis detected Blastocystis in 6 (17%) IBS and 4 (5.5%) non-IBS patients. In the six positive IBS patients by PCR method, subtype 3 was shown to be the most predominant (3/6: 50%) followed by subtype 4 (2/6; 33.3%) and subtype 5 (1/6; 16.6%). IL-8 levels were significantly elevated in the IBS Blasto group and IBS group (p<0.05) compared to non-IBS and non-IBS Blasto group. The level of IL-3 in were seen to be significantly higher in than IBS Blasto group and IBS group (p<0.05) compared to non-IBS. Meanwhile, the IL-5 levels were significantly higher in IBS Blasto group (p<0.05) compared to non-IBS and non-IBS Blasto group. This study implicates that detecting Blastosystis by PCR method using colonic aspirate samples during colonoscopy, suggests that this may be a better method for sample collection due to the parasite’s irregular shedding in Blastocystis-infected stools. Patients with IBS infected with parasite showed an increase in the interleukin levels demonstrate that Blastocystis does have an effect in the immune system.

Randomized, double-blind trial of CO2 versus air insufflation in children undergoing colonoscopy

Studies in adults have shown that postprocedural abdominal pain is reduced with the use of carbon dioxide (CO(2)) instead of air for insufflation during colonoscopy. The aim of our study was to compare postprocedural abdominal pain and girth in children undergoing colonoscopy using CO(2) or air for insufflation. This was a prospective, randomized, double-blind study that included 76 consecutive pediatric patients undergoing colonoscopy for various indications. Patients were randomly assigned to either CO(2) or air insufflation. At 2, 4, and 24 hours after the examination, the patients' pain was assessed by using the 11-point numerical rating scale. The waist circumference was measured 10 minutes and 2 and 4 hours after colonoscopy. A significantly higher proportion of patients had no pain after colonoscopy in the CO(2) group compared with the air group (82 vs 37% at 2 hours and 95% vs. 63% at 4 hours, P < .001). Mean abdominal pain scores 2 and 4 hours after the procedure were statistically significantly lower in the CO(2) group compared with the control air group (0.5 vs 2.6 at 2 hours and 0.1 vs 1.2 at 4 hours, P < .001). There was no difference in waist circumference between the 2 groups at all time intervals. The results of this randomized trial show clear benefits of CO(2) insufflation for colonoscopy in reducing postprocedural discomfort. ( NCT02407639.).

Safety and Efficacy of Colonoscopy in Patients 85 Years and Older: Retrospective Review

Introduction: To determine the safety and complication rate of colonoscopy in the population over 85 years and older in a single center outpatient ambulatory surgical unit. Methods: We under took a retrospective review of 410 patients ages 85 years and older from 2006 through 2012 in a single center outpatient ambulatory surgical center. We reviewed the charts of these patients to find indication for colonoscopy, comorbidities, whether sedation was given, the quality of the bowel preparation, whether cecal intubation or ileal visualization was accomplished, and any complications. Results: We reviewed 410 patients charts aged 85 years and older between 2006 and 2012. Mean age was 87.3 years, of which 228 (52.5%) of the patients were males. The leading indications for colonoscopy were: screening in 100 (38.2%), history of a polyp or cancer in 90 (34.4%), and history of bleeding and anemia in 38 (14.5%) patients. Heart disease was seen in 172(42.0%), lung disease in 52 (12.7%), and renal disease in 40 (9.8%) patients. One hundred eighty-nine (46.1%) patients did not receive any form of sedation during colonoscopy. Excellent to good quality bowel preparation was documented in 146 (59.6%), fair to adequate in 82 (39.6%) and poor in 2 (0.8%) patients. Polyps were detected in 122 patients with 87 (21.2%) having pre-cancerous polyps (tubular, tubulovillous, or villous) and 7 (1.7%) having colon cancer. Cecal intubation or ileal visualization was accomplished in all of the patients. Bleeding after the procedure was seen in 7 (1.7%) patients, but in no case was hospitalization or further intervention required. There were no perforations, cardiovascular complications, or pulmonary complications observed. Sixty-five patients were deceased at the time of chart review. We were able to find the cause of death only in 3 of these patients, which were unrelated to the procedure. Conclusion: The United States Preventive Services Task Force (USPSTF) recommends against colon cancer screening in the elderly population due to concerns over procedure-related complications. Over 70% of the population in this review underwent colonoscopy because there was a history of polyps or cancer or for screening. The complication rate in this review was negligible. With the increasing life span of people and reduced complications from colonoscopy, healthy elderly patients can consider colonoscopy for various indications. Further prospective study is needed to determine whether screening colonoscopies in the elderly can prolong life.

The Effect of Polyp Location and Patient Gender on the Presence of Dysplasia in Colonic Polyps

OBJECTIVE:There is increasing evidence of significant clinical and biological differences between proximal and distal colorectal polyps, as well as possible differences based on patient gender. There is a need to optimize and individualize screening strategies. We studied the potential influence of gender and of polyp location on the presence of dysplasia in colon polyps.METHODS:We used a prospective database on adenoma detection to identify patients. The primary outcome was the presence of dysplasia in colonic polyps. Covariates include age, gender, race, lesion size and site, and use of aspirin. Multivariate logistic regression analysis was used to analyze the relationship between the primary outcome and covariates. Results were reported as odds ratios (ORs), 95% confidence intervals (CIs), and P-values.RESULTS:A total of 2,400 patients (50.5% females and 49.5% males) completed colonoscopy for various indications. A total of 3,045 polyps were removed in 1,237 patients. Of those polyps, 54% (n=1,636) were on the right compared with 46% (n=1,409) in the left colon. The proportion of adenomas was significantly greater on the right colon when compared with the left: 69.4% vs. 39.3% (P=<0.0001). Multivariate logistic regression analysis showed that the right colon did have a significant association with dysplasia when controlling for age, gender, polyp size, and use of aspirin (OR=3.1 (95% CI: 2.3–4), P=<0.0001). Female gender was associated with decreased odds of finding dysplasia (OR=0.6 (95% CI: 0.46–0.78), P=0.03).CONCLUSION:Patient characteristics (male gender) as well procedure findings (increase polyp size and right-sided lesions) are associated with increased odds of dysplasia.

Colonic diverticulosis is associated with an increased adenoma detection rate in patients undergoing first-time screening colonoscopy

Diverticulosis is a common finding in patients undergoing colonoscopy. The effect of colonic diverticulosis on the colorectal adenoma detection rate (ADR) and other colonoscopy quality indicators remains unclear. To determine if colonic diverticulosis is associated with differences in (1) colorectal ADR and (2) other quality indicators and operating characteristics in patients undergoing first-time screening colonoscopy. Retrospective cohort study conducted at an outpatient surgical center affiliated with an academic medical center. 300 consecutive patients (190 women) with a median age of 57 years (range: 23-70 years) who underwent colonoscopy for various indications were included. 108 (36%) of these 300 patients had diverticulosis found on colonoscopy. 142 (47.3%) of these patients (88 women, median age of 52 years) underwent their first screening colonoscopy. In this population, the frequency of colonic diverticula was 39.2%, and the ADR was 47.5% for patients with diverticulosis and 27.4% for patients without diverticulosis. Multivariate analysis revealed that the presence of diverticulosis had an associated odds ratio of 2.3 (p=0.04) in favor of finding at least one adenoma. No statistically significant differences were found among the rates of total colonoscopy, median scope insertion and withdrawal times, and the amounts of midazolam and fentanyl required for sedation when patients with diverticulosis were compared to those without diverticulosis. Colonic diverticulosis was associated with an increased ADR in patients undergoing first-time screening colonoscopy. The presence of colonic diverticulosis did not adversely affect the cecal intubation rate, scope insertion or withdrawal times, or sedation requirements.

Diverticulosis Does Not Adversely Affect Cecal Intubation Rates, Procedure Times, or Sedation Requirements During Colonoscopy

Purpose: Diverticulosis is a commonly diagnosed condition in patients undergoing colonoscopy. The presence of colonic diverticula can make performing colonoscopy more challenging. However, it is unclear if diverticulosis adversely affects cecal intubation rates, scope insertion times, withdrawal times, or sedation requirements in patients undergoing total colonoscopy. Our aim was to determine if the presence of colonic diverticulosis is associated with differences in cecal intubation rates, scope insertion times, withdrawal times, or sedation requirements during colonoscopy. Methods: A retrospective, single-center, cohort study was conducted that included patients who underwent colonoscopy by one of five experienced attending gastroenterologists (without the assistance of trainees) at an outpatient surgical center. Patients were identified using a hospital database and electronic medical records were reviewed. Univariate and multivariate analyses (adjusted for colorectal preparation quality) were conducted. Results: 300 consecutive patients (190 women) with a median age of 57 years (range: 23-70 years) who underwent colonoscopy for various indications were reviewed. 108 (36%) of these patients had diverticulosis (in any colonic segment) found on colonoscopy. The rate of total colonoscopy (successful cecal intubation) was 99.1% in patients with colonic diverticula and 97.4% in patients without colonic diverticula (P=0.42). Median scope insertion time was 6 min (range: 2-37 min) in patients with diverticulosis and also 6 min (range: 2-34 min) in patients without diverticulosis (P=0.34). Median scope withdrawal time was 11 min (range: 4-24 min) in patients with diverticulosis and also 11 min (range: 5-43 min) in patients without diverticulosis (P=0.50). Table 1 shows no statistically significant difference in scope insertion or withdrawal times in either group. Analysis of the amount of midazolam and fentanyl administered to perform colonoscopy showed no statistically significant difference in the amount of medication required in patients with or without diverticulosis (Table 2). We also analyzed the amount of drug administered using “dose equivalents” with 1 dose equivalent = 1 mg of midazolam = 25 mcg of fentanyl = 25 mg of diphenhydramine. Using this method, there was also no statistically significant difference in the amount of drugs administered to patients with or without diverticulosis (Table 2).Table 1: Colonoscopy insertion and withdrawal times stratified by diverticulosis statusTable 2: Amounts of sedative medications required to provide adequate conscious sedation in patients undergoing colonoscopyConclusion: The presence of colonic diverticulosis did not adversely affect cecal intubation rates, scope insertion times, scope withdrawal times, or sedation requirements in patients undergoing total colonoscopy. A large prospective study is warranted to confirm these findings.

Rectal perforation during colonoscopic retroflexion: a large, prospective experience in an academic center

Retroflexion in the rectum is performed routinely during colonoscopy in an attempt to detect lesions that could be missed by forward viewing alone. Case reports of rectal perforation caused by this procedure have been published, but the frequency of this serious complication in large series is unknown. In addition, there are few reports regarding the management of colonoscopic rectal perforations. To determine the colonic perforation rate of rectal retroflexion and the management of this complication at 3 affiliated academic hospitals from July 1, 2001, to June 30, 2008. Multicenter case series. A university hospital, a Department of Veterans Affairs hospital, and an urban safety-net hospital. A diverse population of patients who underwent colonoscopy for various indications. Four cases of rectal perforation occurred during rectal retroflexion in a total of 39,054 consecutive colonoscopies (0.10 per 1000). One of these complications occurred in a colonoscopy performed by a supervised trainee; the other 3 occurred during colonoscopy performed by experienced faculty endoscopists alone. Three of the 4 perforations were managed successfully without surgical intervention. The complication rate relies on physician self-reporting. Rectal retroflexion during colonoscopy is associated with a low rate of perforation, yet this serious complication can occur even in the hands of experienced endoscopists. Most cases of rectal perforation during retroflexion can be managed nonoperatively.

Comparison of an Established Simple Office-Based Immunological FOBT With Fecal Tumor Pyruvate Kinase Type M2 (M2-PK) for Colorectal Cancer Screening: Prospective Multicenter Study

The immunological fecal occult blood test (IFOBT) has established itself as a more precise marker for colorectal cancer (CRC) screening than traditional guaiac-based FOBT. The simpler, cheaper, and more convenient newer office-based IFOBTs have been validated for diagnosing CRC. Dimeric isoenzyme of pyruvate kinase, M2-PK, expressed by tumor cells, has as well been proposed as a screening tool for CRC. This is the first study comparing fecal M2-PK as a screening biomarker for CRC against previously evaluated office-based IFOBT and colonoscopy. Six hundred forty consecutive subjects (symptomatic, as well as for CRC screening) referred for colonoscopy for various indications across five centers in Germany provided the stool samples for performing M2-PK and an immunochemical FOB strip test. The IFOBT used was a rapid immunochromatographic assay for detection of fecal hemoglobin. For M2-PK, a commercially available sandwich enzyme-linked immunosorbent assay (ELISA) was used. The M2-PK test needs 6 h, while the office-based test can be read in just 10 min and is five times cheaper. Office-based IFOBT had sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and positive and negative likelihood ratios (LR) of 64.5, 96.3, 72.0, 94.9, 17.5, and 0.4 for diagnosing colorectal neoplasia (CRN), while the above performance characteristics for M2-PK at a cutoff value of 4 U/mL were 72.4, 73.8, 29.0, 94.8, 2.8, and 0.8 respectively. This office-based IFOBT was found to have significantly higher specificity, PPV, and positive LR as compared with M2-PK. IFOBT proved to be a convenient, noncumbersome, quick, and cheap tool in patients with above-average risk for detection of CRN.

MR-Kolonografie bei stationären Patienten: Durchführbarkeit und Sensitivität

Besides conventional colonoscopy, CT and MR colonography offer alternate virtual imaging modalities of the colon. The sensitivity of CT colonography, which is associated with radiation exposure, has been published in prior, large studies. Regarding MR colonography, in particular dark lumen MR colonography with the rectal administration of a water enema as a contrast agent, only limited published data exist. The goal of this study was to compare MR colonography with conventional colonoscopy in the detection of colorectal polyps. In addition the feasibility and image quality in unselected hospitalised patients were assessed. Included were 103 hospitalised patients who had to undergo colonoscopy for various indications. Immediately prior to conventional colonoscopy, MR colonography with rectal water enema and additional intravenous administration of contrast material was performed. Detection rates for polyps and adenomas were documented with both imaging modalities. Image quality and completion rates (practicability) and other (incidental) findings were also recorded. In 15 of 103 patients the MR examination could not be done or was only partially completed. The detection rate of MR colonography for polyps (adenomas) was 2% (4%) for polyps (adenomas) up to 5 mm in diameter, 38% (56%) for polyps (adenomas) 6-10 mm in diameter and 89% (89%) for polyps (adenomas) up to 11 mm in diameter. One flat carcinoma seen with conventional coloscopy was missed on MR colonography. MR colonography offers the possibility of imaging the colon without exposure to radiation. Polyps and adenomas are detected, similar to the detection rate of CT colonography, with adequate sensitivity only if they are larger than 10 mm in diameter. Therefore this imaging technique is not (yet) suitable as a screening test. Additional limitations are the necessary cooperation of the patient which can reduce the practicability and image quality in selected patients. Further studies like the just started German multicentre trial are needed to assess the position of MR colonography.