Common Indication For Colonoscopy Research Articles

Engaging primary care physicians is critical in the screening and diagnosis of colorectal cancer at safety-net hospital systems

BackgroundPrimary care physicians (PCP) play a key role in offering colorectal cancer (CRC) screenings, particularly amongst underserved populations. Given potential delays in or omission of CRC screening in the absence of a PCP, we aimed to determine stage of CRC at diagnosis in an underserved population. MethodsA retrospective chart review was conducted at two Los Angeles County safety-net hospitals. Inclusion criteria were a CRC diagnosis between 2018 and 2021 and age between 50 and 75 years at diagnosis time. The primary outcome was the cancer stage at diagnosis. ResultsA total of 373 patients were included, of those, 52.5 % had a PCP. Compared to others, PCP was similar in age, racial composition, and primary spoken language (Table 1). Of patients with a PCP, 52.0% were diagnosed by screening. After screening, the most common indication for colonoscopy were blood per rectum (24.9 %) and imaging findings (18.0 %). Patients with a PCP had a significantly lower rate of late stage CRC than those without a PCP (42.4 % vs. 68.0 %, p < 0.001). After adjustment, having a PCP was associated with significantly reduced odds of late stage CRC (Adjusted Odds Ratio 0.83, 95 % Confidence Interval [0.68–1.04]). Having a PCP was not associated with any adjusted increase in number of adenomas or tumor size. ConclusionsPatients with a PCP, irrespective of undergoing screening, were diagnosed at earlier CRC stages. This underlines the crucial role of PCPs in CRC and diagnosis, reinforcing the need for their active involvement in these processes.

FIFTEEN YEARS’ EXPERIENCE IN PEDIATRIC ENDOSCOPIC PROCEDURES AT THE ENDOSCOPIC SUITE OF A TERTIARY CARE HOSPITAL

G.I. endoscopy is a highly efficient diagnostic and therapeutic tool now increasingly used in the pediatric population. Our country needs pediatric endoscopic data due to a lack of pediatric gastroenterologists and dedicated pediatric facilities; only a few facilities available in private setups are out of reach of the general population. Hence, this pediatric endoscopic audit was performed to analyze the indications, findings, and complications of all endoscopy procedures in a pediatric population referred to the endoscopy suite of a public sector tertiary care hospital. Data from all pediatric patients who underwent endoscopy from January 2006 to December 2020 was retrospectively reviewed for endoscopy indications, findings, and complications. Three thousand eight hundred seventy pediatric patients (age 0 -18 years) were analyzed. The mean age of the study population was 12.75 years, and the male-to-female ratio was 1.04:1. One thousand seven hundred seventy-nine patients underwent EGD, 1639 had colonoscopy, and 452 had ERCP. The most common indication for EGD was found to be epigastric pain (29.7%), the most common finding was gastritis (21.4%), and the complication rate for all upper G.I. endoscopic procedures was found to be 0.5%. The most common indication for colonoscopy was per rectal bleeding (69%), the most common finding was polyp (29.7%), and the complication rate was 0.9%. The most common indication for ERCP was found to be jaundice secondary to biliary obstruction (57.5%), the most common finding was bile duct stone (30%), and the complication rate was 5.6%. The overall incidence of adverse events was low and was found to be 0.7% in all of the 3870 procedures.

Colon CApsule endoscopy compared to conventional COlonoscopy in patients with colonic DIverticulitis: the study protocol for a randomised controlled superiority trial (CACODI trial)

IntroductionFollow-up after an episode of colonic diverticulitis is a common indication for colonoscopy, even though studies have shown a low risk of positive findings in this population. Our objective is...

877 Utility Value of Colonoscopy in the Over 80's

Abstract Aim To audit the rationale and efficacy of colonoscopy in the over 80’s over a year period at Southport hospital which caters to a geriatrically skewed population. Currently protocol driven diagnostic pathways often lead to direct triaging of patients to endoscopy preventing assessment of biological age of patient, practicalities of the procedure and risk-benefit ratio. Method A retrospective audit with data in 105 patients over the age of 80 who underwent colonoscopy in 2021 January – December 2021 was collated. An audit proforma looking at pre-, during- and post -colonoscopy data was evaluated using the hospital endoscopy records and clinical records. Results Pre-colonoscopy demographics showed that anaemia (31%) and change in bowel habit (26%) were the most common indications for colonoscopy. Completion rates, diagnostic yield and complication rates were evaluated. Completion rate was 73%. Positive findings were diverticulosis (52%), polyps (9%), colitis (3%) and malignancy in 15%. Mitigating factors for non-completion and poor efficacy were discomfort, angulation, poor bowel prep as well as incriminating polypharmacy and comorbidity. Conclusions Based on the audit findings targeted endoscopy in this age group is a better management rather than its usage as first line investigation to achieve maximum efficacy.

The most common gastrointestinal alterations in patients with post-COVID syndrome

Post-COVID syndrome may affect the gastrointestinal tract. However, risk factors of post-COVID syndrome are still unknown. We aimed to identify the most common gastrointestinal symptoms, abnormal laboratory findings and risk factors relevant to post-COVID syndrome. In this retrospective study, we included 79 patients admitted to Semmelweis University Department of Surgery, Transplantation and Gastroenterology between October 2020 and September 2022. We investigated clinical data, laboratory findings and determined the major risk factors. Most of the patients were women (46/79), their mean age was 47.6 years and patients were overweight (BMI: 26.3 kg/m2). The most common comorbidities were cardiovascular diseases (21/79), hypertension (20/79), diabetes (11/79) and malignant diseases (9/79). Typical indications for gastroscopy were dyspepsia (16/79) and epigastric pain (10/79). The most common indications for colonoscopy were diarrhea (29/79) and weight loss (28/79). Among abnormal laboratory findings, liver enzymes levels (GOT: 83.5 U/L, GPT: 85 U/L, GGT: 70 U/L) and ferritin (351.5 ng/mL) were higher in post-COVID patients. Typical conditions diagnosed by gastroscopy, colonoscopy and abdominal ultrasound were gastroesophageal reflux disease (11/26), irritable bowel syndrome (2/19) and diffuse hepatic lesions, respectively. The number of unvaccinated patients was higher compared to those receiving any COVID-19 vaccines (58% vs. 29%). Of the vaccinated patients, 12 patients received mRNA vaccines (10 Pfizer-BioNTech, 2 Moderna) and 6 patients received viral vector vaccines (2 AstraZeneca, 4 Sputnik V). We identified female gender, obesity, cardiovascular diseases, cancer, hypertension and diabetes as major risk factors of post-COVID syndrome. Vaccinated status may prevent post-COVID gastrointestinal symptoms. Orv Hetil. 2023; 164(31): 1206-1212.

Histopathological Outcome of Colonoscopic Biopsies in a Tertiary Hospital in Southwestern Nigeria: A 7-Year Retrospective Study

Background and Aim: Colonoscopy with histopathological analysis of mucosal biopsy samples remains the gold standard procedure for diagnosing lower gastrointestinal disorders. This study aimed to determine the pattern of histopathological findings of mucosal biopsies obtained at colonoscopy over a 7-year period and to correlate the histological findings with the clinical profile of the patients. Methods: This was a retrospective study conducted in a healthcare facility in southwestern Nigeria. The Histology reports from January 1, 2016, to December 31, 2022, were retrieved from the histopathology department of the institution to obtain the following information for analysis: age, gender, year of the test, presenting complaint, provisional clinical diagnosis, colonoscopy diagnosis, and histological diagnosis. Results: The data of a total number of 81 patients were analyzed; 51 males (63.0%) and 30 females (37.0%) with a male-to-female ratio of 1.7–1. The age range of the patients was 30–86 years with a mean (±standard deviations) age of 59.87 ± 14.44. The most common indication for colonoscopy was hematochezia (23 (28.4%)) followed by change in bowel habit (16 [19.8%]), constipation (11 [13.6%]), and tenesmus (10 [12.3%]). Large bowel masses suggestive of cancers were the most common colonoscopy finding in the study subjects (36 [44.4%]). Colorectal cancer was the most common histologic abnormality in the study subjects (26 [32.1%]) followed by chronic nonspecific colitis (8 [9.9%]), polyps (7 [8.6%]), adenomas (5 [6.2%]) and acute on chronic colitis (5 [6.2%]). Twenty-two (27.2%) patients had normal histologic findings. Patients aged between 45 and 64 years had the highest prevalence of colorectal cancer (13 [50.0%]). Conclusion: Colorectal cancer was the most common histopathological finding in this study and the patients were mostly within the middle-age group. Early screening colonoscopy is therefore recommended and histopathological analysis of the mucosal specimens obtained is essential for early detection of premalignant lesions.

THE UTILITY OF BIOPSYING ENDOSCOPICALLY NORMAL APPEARING TERMINAL ILEUM

Abstract INTRODUCTION The terminal ileum is often evaluated during colonoscopy procedures. A common indication for endoscopic examination and biopsy of an endoscopically normal appearing terminal ileum is in patients with inflammatory bowel disease (IBD). 1 In patients without IBD, indications for biopsying an endoscopically normal appearing terminal ileum are less clear and may be associated with increased cost and healthcare utilization, as well as increased levels of anxiety for patients. In this study, we aim to determine the indications for examining and biopsying an endoscopically normal appearing terminal ileum in patients without IBD and if, upon review of these biopsies, there is change in management. METHODS This was a retrospective chart review of patients who underwent colonoscopy with terminal ileum biopsy at Mayo Clinic between 1/1/2021 and 6/30/21. Patients were excluded if they had a history of IBD, prior ileocecal resection, or an endoscopically abnormal terminal ileum. Clinical and laboratory data, as well as outcomes of interest, were obtained from the electronic medical record. Comparisons between patients were performed using Pearson’s chi-square, Student’s and Mann-Whitney tests. RESULTS A total of two hundred consecutive patients were identified as having had biopsies from their endoscopically normal appearing terminal ileum. After reviewing the charts, 69 met inclusion criteria. Of the 69 patients, the majority were female (68.1%) and white (89.9%). Nearly half the patients had a BMI of 30 or above (49.3%). The most common indication for colonoscopy among these patients was chronic diarrhea followed by abdominal pain and hematochezia. Terminal ileum mucosa was histologically abnormal in 6 patients (8.7%): four patients had chronic ileitis, one had acute ileitis, and one had acute and chronic ileitis. All patients with either chronic or acute ileitis had chronic diarrhea listed as an indication for their colonoscopy. The patient with acute and chronic ileitis underwent colonoscopy for suspected Crohn’s disease due to incidental asymptomatic findings of small bowel inflammation on CT enterography. CONCLUSIONS In patients with a normal appearing terminal ileum, clinically significant histologic abnormalities on biopsies were found in a small percentage of patients. Although our sample size is small, there may not be diagnostic and therapeutic utility to routinely biopsy endoscopically normal appearing terminal ileum in patients, even in those with chronic diarrhea. Large prospective studies are needed to further support this observation. REFERENCES 1McHugh, Jonathan B et al. “The diagnostic value of endoscopic terminal ileum biopsies.” The American journal of gastroenterology vol. 102,5 (2007): 1084-9.

Three Years of Colonoscopy Experience in a Tertiary Hospital in Maldives

Background: Colonoscopy is the procedure of choice in investigations of suspected pathologies related to colon and terminal ileum and the standard practice for screening colonic polyps and cancer, especially in the elderly. Adequate bowel preparation is important for the efficacy of the procedure. As there is a lack of published data on colonoscopy preparation and findings in the Maldives, this study was conducted to share the single-center experience.&#x0D; Materials and Methods: This was a retrospective observational preliminary study carried out in the endoscopy center at ADK hospital, Maldives from April 2017 to March 2020. All patients were evaluated as per pre-designed Pro-forma. The procedure was performed after a pre-anesthetic check-up with intravenous sedation after bowel preparation as protocol. Findings were noted and Biopsies were taken as per need and sent for histopathologic examination.&#x0D; Results: Out of 129 patients who underwent lower gastrointestinal endoscopy, only 98 were included for the study analysis. Among them, 44% of patients were male and 56% were female. Young adults were more involved in the procedure. Bowel preparation was poor in the majority (52%). Bleeding per rectum was the most common indication (40%) and hemorrhoids were the most frequent finding (52%). In 86% of patients, colonoscopy was complete up to cecum with the majority of them up to terminal ileum.&#x0D; Conclusion: Per rectal bleeding was the most common indication for colonoscopy and hemorrhoids were the most common findings. Despite poor bowel preparation due to the lack of a standard cleansing regimen, the yield of the procedure was yet satisfactory.

Colonoscopy in Zaria: Indications and findings.

Colonoscopy is an important procedure in the management of colorectal diseases. During a colonoscopy, one can visualize the mucosa of the large bowel and perform therapeutic procedures. The aim of this study is to review the indications and findings of colonoscopy in our center. Data on age, gender, indications, and findings at endoscopy were extracted from the endoscopy unit register. The study is a retrospective descriptive one and included all patients who underwent colonoscopy between June 2017 to December 2019 at the endoscopy unit of Ahmadu Bello University Teaching Hospital (ABUTH), Zaria. Data on age, gender, indications, and findings at endoscopy were extracted from the endoscopy unit register. The data obtained were analyzed using the Statistical Package for the Social Sciences (SPSS) statistical software version 20. One hundred and twenty-five patients had a colonoscopy during the period under review with a male to female ratio of 1.9:1. The age range of the patients was 3 to 85 years and the mean age was 46.7 ± 16.7 The most common indications for colonoscopy in our center were lower gastrointestinal bleeding (40 (32%)), followed by suspected colonic tumors (37 (29.6%)), and hemorrhoids (18 (14.4%)). The commonest findings were hemorrhoids (50 (40%)), colonic tumors (25 (20%)), and colitis (21 (16.8%)). A colonoscopy is an effective tool in the management of colorectal diseases. Lower gastrointestinal bleeding was the commonest indication for colonoscopy in our center and hemorrhoids and colorectal tumors were the commonest findings.

Colorectal Polyps: A Histopathological Study in Tertiary Care Center

Introduction: Gastrointestinal polyps are commonly encountered in the colorectal region. They can be non-neoplastic or neoplastic. Neoplastic polyps include adenomas which are clinically important because of their premalignant nature. The study was carried out to analyze the histomorphological spectrum of polyps; in our institution with special emphasis on adenomatous polyps.Material and methods: This is a retrospective study done from January 2015 to December 2019 in the Department of Pathology, Dhulikhel Hospital - Kathmandu University Hospital (DH - KUH). Relevant clinical data of the patients were obtained from the histopathological records of the patient from the pathology department and biopsies stained with Haematoxylin and Eosin were studied under the light microscope.Results: A total of 168 cases of polyp were studied from 125 patients. The most common indication for colonoscopy in patients with polyp was per rectal bleeding. The age of the patient ranged from 2 to 83 years. The rectum was the commonest location. 106(63.1%) of polyps were non-neoplastic and 6(36.9%) of polyps were neoplastic. Juvenile polyp(71;42.3%) was the commonest polyp. Tubular adenoma(55;32.7%) was the commonest neoplastic polyp. Themaximum number of neoplastic polyps were seen in the age group of 51-60years (11;29.7%). Male predominance was seen in neoplastic as well as a non-neoplastic polyp. High grade adenoma(4;6.7%) was more commonly seen in adenomatous polyp &gt;2cm(3;75%) followed by 1-2cm(1;25%) and none in &lt;1cm.Conclusions: This study gives a fair insight into the distribution of neoplastic and nonneoplastic polyp in the colorectal region. Adenomatous polyps are premalignant.

Demographic Profile of Patients Undergoing Colonoscopy at a Tertiary Care Centre in Central Nepal

Introduction: Colonoscopy is one of the useful diagnostic tool to evaluate lower gastrointestinal tract. Theaim of this study was to evaluate patient characteristics, common symptoms, colonoscopicfindings and histopathology findings by reviewing colonoscopy procedures.&#x0D; Methods: This was a retrospective study conducted at College of Medical Sciences and teaching hospital, Bharatpur, Nepal over a period of three years (1st January 2017 – 31st December 2019). Census sampling method was used to retrieve the data. Patients characteristics, indications, duration of symptoms and findings were retrieved from the endoscopy record register and histopathology finding of those patients whose biopsy were taken were retrieved from the pathology department record file. &#x0D; Results: Over a three years period 324 colonoscopy were reviewed.The mean age of the study populationwas 48.77+/-17.35 years. Male to female ratio was 1.38:1. The most common indication forcolonoscopy was pain abdomen with mucus in stool in 25.3% patients followed by bleedingper rectum in 21.3% patients. Other than normal colonoscopy the most common findings wereHaemorrhoids in 20.1% patients and inflammatory or ulcerative lesions in 17.6% patients.Colorectal malignancy was seen in 6.48% patients. Colonoscopic biopsy was done in 114patients. The common biopsy findings were ulcerative colitis in 12.7%, adenomatous polypin 6.8%, adenocarcinoma in 6.5% of the total study patients.Poorly differentiated carcinomawas found more in the younger age group and males were more commonly affected withcolorectal cancers than females.Conclusions: The most common indication for colonoscopy was pain abdomen with mucus in stool in25.3% patients. The common findings were Haemorrhoids in 20.1% patients and inflammatoryor ulcerative lesions in 17.6% patients. Colorectal malignancy was seen in 6.48% patients.The common biopsy findings were ulcerative colitis in 12.7%, adenomatous polyp in 6.8%,adenocarcinoma in 6.5% of the total study patients. Males were more commonly affected withcolorectal cancers than females.Keywords: Colonoscopy, lower gastrointestinal tract, colorectal cancer, ulcerative colitis,haemorrhoids.

Colonoscopic Evaluation of Lower Gastrointestinal Bleeding (LGIB): Practical Approach.

Background:Haematochesia (Lower Gastrointestinal Bleeding (LGIB) is the most common reason for endoscopic examination. Generaly it is caused by hemorrhoids and diverticular disease, but other anorectal conditions can also lead to LGIB. Recurrent bleeding may result in secondary iron deficiency anemia. Colonoscopy is the primary diagnostic option for establishing a diagnosis of colonic bleeding.Objective:This study aimed to analyze symptoms and endoscopic finding (specialy hemorrhoids) who may be sources of LGIB.Second goal of this study is to estimate time from onset of symptoms to performance of a colonoscopy.Methods:A retrospective study included 603 adult patients who underwent colonoscopy in General Hospital “Sv. Apostol Luka“, Doboj, Bosnia and Herzegovina, between 1.1.2020 and 31.12.2020.Results:Average age of the examined population was 62±13,3years. According to the gender they were mostly men. To be exact,by percentage it was 53.7% of men and 46,3% of women, or by number: 324 men and 279 women. The most common indications for colonoscopy were LGIB (48,8%), abdominal pain and irregular stool. Most frequent endoscopic findings were hemorrhoids 42%. Normal findings had almost one third of all examinated patients. Combined findings-presence of more clinical entities in one patient were presented in 95 cases. In the group with hemorrhoids were almost two thirds of males, but there was no gender difference noted in between group with LGIB and without LGIB. More than half patients were older than 61 years. Anemia was presented in almost 20% of cases. Significantly it is higher frequency of abdominal pain, irregular stool and weight loss observed on the group without LGIB. Also, significantly more frequently patients with LGIB underwent colonoscopy in 0-30 days when compared with patients without LGIB (p=0,016).Conclusion:In patients with haematochezia, taking a careful medical history is mandatory. Hemorrhoids, diverticular disease and colorectal cancers are the most common causes of bleeding. Patients with LGIB and abdominal pain were previously examined with colonoscopy. Completely colonoscopy is advocated to detect probable proximal lesions.

Adenoma detection rate as a quality indicator for colonoscopy: a descriptive cross-sectional study from a tertiary care hospital in Pakistan.

Background and study aims Adenoma detection rate (ADR) is validated for measuring quality of colonoscopy, however there is lack of colorectal cancer (CRC) screening program in South Asia. The purpose of this study is to analyze and review the polyp detection rate (PDR) and ADR and provide insight into the factors that influence them in Pakistan. Patients and methods This retrospective, cross-sectional study was performed at the Aga Khan University Hospital, Karachi, Pakistan, on patients ≥ 18 years, who underwent colonoscopy between January 1, 2017 and June 30, 2018. Results Of 1985 patients, 59 % were male and 41 % female, with mean age of 47.8 ± 16.2 years. The most common indication for colonoscopy was bleeding-per-rectum (28.0 %) and overall PDR and ADR were 17.9 % and 9.9 %, respectively. There was no significant difference between genders for either PDR ( P = 0.378) or ADR ( P = 0.574). Significantly higher PDR and ADR were found for patients ≥ 50 years ( P < 0.001), as well as for suboptimal bowel preparation [PDR (25.7 %; P = 0.007) and ADR (18.6 %; P = 0.014)]. Interestingly, endoscopists with < 500 colonoscopy-procedural-experience reported a higher PDR (21.6 %; P = 0.020) and ADR (14.4 %; P = 0.049), corresponding to a significantly higher PDR (20.6 %; P = 0.005) and ADR (11.7 %; P = 0.02) for endoscopists in practice for ≤ 10 years. Conclusions We have noticed low PDR and ADR, which require further investigation and research. In addition, we believe there should be a different baseline ADR and PDR as a quality indicator for colonoscopy in our region, where no internationally recommended colonoscopic screening programs have been implemented.

COVID-19 and Long-term Planning for Procedure-based Specialties During Extended Mitigation and Suppression Strategies

COVID-19 and Long-term Planning for Procedure-based Specialties During Extended Mitigation and Suppression Strategies

Older Adult Perspectives Toward Surveillance Colonoscopy: A Qualitative Study.

Surveillance colonoscopy is the most common indication for colonoscopy in older adults, yet factors involved in patient decision-making are poorly defined. We sought to understand general perspectives of older adults toward surveillance colonoscopy. We conducted 2 in-person, 90-minute semistructured focus groups at a rural, tertiary care, academic facility with a total of 20 English-speaking participants with a history of colon polyps. We also obtained baseline characteristics including information to calculate life expectancy using the Schonberg Index, a validated measure of 5-year and 9-year mortality. Participant ages ranged from 75 to 89, 67% were female, and 61% had a life expectancy of ≤9 years. Major common themes included reasons for and against getting a surveillance colonoscopy, and preferences and opinions surrounding discontinuing surveillance. Fear of cancer, trust in the colonoscopy procedure, and provider advice played prominent roles in patient decisions to return for surveillance. Most felt they should make screening decisions with input from providers, and that providers should engage them in these decisions and base recommendations on their patients' personal history and health, not on how old they are or on actuarial data. This small, qualitative study suggests that older adults familiar with surveillance colonoscopy prefer patient-centered decision-making on when to discontinue testing and want support and information from providers when making choices. The evidence also suggests that participants value provider communication and trust their advice. Future work will use this information to create a larger patient survey on attitudes and beliefs toward surveillance colonoscopy.

147 Colorectal Mucosal Schwann Cell Hamartomas in a Community Gastroenterology Practice

INTRODUCTION: Mucosal Schwann cell hamartoma (MSCH) is a benign mucosal lesion composed of spindle cells surrounding colonic crypts that can arise anywhere in the colon; usually in the rectosigmoid. Most reports of colonic MSCH are limited to case reports and two case series from tertiary-care academic settings involving 20 and 26 patients. Our retrospective study is the first to describe the characteristics of colorectal MSCH in a community gastroenterology practice. METHODS: We retrospectively identified patients with colorectal MSCH from the pathology database of a large, community gastroenterology practice of 157 physicians in Texas and Louisiana working at 24 outpatient centers. Data were collected from consecutive patients diagnosed with MSCH from 2015–2019. MSCH were confirmed by positive immunohistochemical staining for S-100. Historical data recorded included the endoscopic size and appearance of the polyps, location, indication(s) for colonoscopy, and patient age, sex, and race. RESULTS: 184 colorectal MSCH from 179 patients were identified out of a total of 335,635 colon specimens. The median age of 59 years (range, 40–84). Sixty percent were female, 67% were White, and 25% were Black. The most common indications for colonoscopy were screening (55%), polyp surveillance (35%) and diagnostic (35%), which often overlapped. The polyps were described as sessile (65%), pedunculated (2%), mixed sessile/pedunculated (1.6%), and not specified (32%). The average size was 3.8 mm (range, 1–15 mm), and most were in the distal colon and rectum (77%) followed by transverse (11%) and proximal colon (10%). One MSCH was at an anastomosis and in one, the site was not specified. CONCLUSION: This large retrospective series is the first to describe colorectal MSCH in a community gastroenterology practice. Additionally, the large number of patients provides a better description of MSCH characteristics in comparison to prior small case series. MSCH were most commonly found during screening and surveillance colonoscopies in patients who were older, female and white. Most were located in the distal colon and rectum. Colorectal MSCHs are found infrequently at an approximate rate of 1 every 4 years by a community gastroenterologist, or 0.05% of colonoscopy biopsies.

Correlation between Clinical Symptoms of Various Colorectal Diseases and Colonoscopic Findings

Background: About 30% of patients presenting to surgical outpatient department has lower gastrointestinal (LGI) symptoms. Colonoscopy is a low risk and at the same time investigation of choice in these patients which allows visualization of the entire colon and the terminal portion of ileum. This study was done to find out the diagnostic accuracy of colonoscopy in relation to the clinical symptoms of the disease. &#x0D; Methods: This was a prospective, hospital based study from February 2014 to March 2019 carried out at Nepalgunj Medical College and Teaching Hospital. The colonoscopy diagnosis was compared with the clinical symptoms and further confirmed with histological examination.&#x0D; Results: 341 patients underwent colonoscopy. There were 234 (68.62%) males and 107 (31.37%) females with the male to female ratio of 2.18: 1. The age ranged from 16 to 81 with the mean age of 59.63±10.37. The most common presenting symptom was per rectal bleeding (40.34%) the after were alteration in bowel habit (17.30%), constipation (12.90%), hematochezia (11.43%). The least common indication for colonoscopy was unexplained anemia. Haemorrhoids were the most common findings consisting 32.55%. In 19.94% it was normal. Majority had various inflammatory conditions, among them 10.85% had proctocolitis, 2.34% were suspected to have ulcerative colitis. There were 17(4.98%) patients with colonic and 13(3.18%)with rectal carcinoma. 10.55% had colorectal polyps. Out of 111 patients suspected to have hemorrhoids clinically 102 had same findings on colonoscopy. Similarly 34 patients presenting with chronic diarrhea with bleeding and 59 with alteration in bowel habit where inflammatory conditions were suspected had similar findings on colonoscopy in 29 and 34 patients respectively. Similarly the suspicion of malignancy on clinical basis was also correlated on colonoscopy. The inflammatory conditions diagnosed on colonoscopy were confirmed in 85.04 % by histology. Similarly malignancy and the presence of polyps diagnosed on colonoscopy were confirmed by histology in 97.05% and in 97.22% cases respectively.&#x0D; Conclusion: Colonoscopy is a safe and effective investigation to diagnose various colorectal conditions. There was a correlation between the clinical symptoms and the colonoscopicdiagnosis especially in conditions like inflammatory and neoplastic colorectal diseases. When combined with histology the diagnostic accuracy can be near 100% in conditions like inflammatory and benign or malignant diseases.

Appendix orifice polyps: a study of 691 lesions at a single institution.

Data on the management of appendix orifice lesions are limited. We present our experience on the management of appendix orifice lesions focusing on the range of size, histology, treatment, and outcomes for polyps at the appendix orifice. Retrospective descriptive study at a tertiary referral center. Those having appendix orifice lesion removed and sent for histology between 2000 and 2017. Polypectomy, surgery. Polyp size, shape, histology, treatment. In total, 691 patients matched our inclusion criteria. Screening was the most common indication for colonoscopy (49.1%). Mean size was 10.1mm. The most common excision method was cold biopsy forceps (36.3%), followed by hot snare (9.3%), cold snare (8.5%), jumbo cold forceps (6.7%), hot biopsy (6.8%), and endoscopic mucosal resection (EMR)/endoscopic submucosal dissection (ESD) (4%). Recurrence was seen in 19/184 (10.3%) patients. Index polyps ≥ 10mm had a significantly higher risk of recurrence compared to those ≤ 5mm (odds ratio 3.2 95% CI 1.1-9.2, p = 0.027). None of the patients had complications. Surgery was performed in 45/691 (6.5%). Polyps > 5mm (41/45) were more likely to require surgery than polyps ≤ 5mm (4/45 6.67%), p < 0.001. Retrospective study. Appendix orifice polyps can usually be managed by conventional endoscopic polypectomy methods without the need for ESD.

Clinicopathologic study of colonic polyps in South Western Nigeria

Background and Aim: Colorectal cancer (CRC) is known to be a major cause of morbidity and mortality worldwide. It is believed that CRC develops from adenomas or benign adenomatous polyps. Information concerning this premalignant condition in Nigeria is still relatively scarce. The aim of this study was to describe the clinicopathologic features of colorectal polyps seen in patients who had colonoscopy at the University College Hospital, Ibadan, Nigeria. Patients and Methods: This was a descriptive cross-sectional study carried out at the Endoscopy Unit of the University College Hospital, Ibadan, Nigeria. Colonoscopy was performed on the patients after bowel preparation. Polyps were characterized by their colonic location, size in millimeter, and histopathological diagnosis. The data were analyzed using SPSS version 17.0. Results: The patients comprised 65 (58.0%) males and 47 (42.0%) females. The mean age was 60 ± 12.5 years, with majority being in the age range of 51–60 years. The most common indication for colonoscopy was hematochezia. The location of the polyps was as follows: 41 (36.6%) in the rectum, 30 (26.8%) in the sigmoid colon, and 22 (19.6%) each in the transverse and descending colon. In 51 (45.5%) patients, polyps were 10 mm in 13 (11.6%) patients. The most frequent histological diagnosis was adenomatous polyp. Conclusion: Polyps were found more commonly in males and in individuals aged 50 years and above. The most common location is the rectosigmoid colon, and the polyps are majorly adenomatous. Our findings suggest the need for colonoscopy service to be made more widely available across the country so as to contribute to reduction in CRC incidence among Nigerians.

Underwater Insertion Improves Polyp Detection in Young Adults Undergoing Colonoscopy

Introduction: Rates of colorectal cancer (CRC) in adults under age 50 is increasing, leading the American Cancer Society (ACS) to recommend lowering the initial screening age to 45. Little is known about best screening practices in this population. Underwater insertion (UW) has been shown to improve polyp detection rates among older adults. However, its effect on polyp detection in the young is less well understood. Objective: Assess the effect of underwater insertion on polyp detection among young adults undergoing colonoscopy. Methods: Colonoscopy quality data was prospectively collected at our single, tertiary referral center beginning in June 2012. We analyzed all colonoscopies performed between Aug 2014 and June 2018 in patients age 19-49, inclusive of all indications. Procedures were categorized based on insertion type: air/CO2-insufflated (AI) or underwater (UW). The two groups were compared with respect to polyp detection rates, procedural times, and cecal intubation rates. Significance was determined using chi-square test and unpaired T-test. Results: 583 colonoscopies were included in final analysis, including 168 AI and 415 UW procedures. The most common indications for colonoscopy were personal history, abdominal pain, and bleeding. Bowel prep scores were higher in UW group (7.7 vs. 8.1, p=0.02). UW was associated with a significant increase in ADR over AI (5.2% vs. 16.4%, p<0.0001). Overall PDR also improved with UW, though these results did not reach significance (24.4% vs. 31.0%, p=0.08). Similar significant increases in ADR were seen on subgroup analysis by gender in both females (2.1% vs. 14.6%, p<0.0001) and males (7.5% vs. 18.3%, p=0.01). UW also improved detection of both polyps in the left colon (2.1% vs. 10.5, p=0.0002) and right colon (4.3% vs. 9.8%, p=0.03). Procedural times were marginally longer with UW, though this was not significant (see table 3). Conclusion: The ACS has recommended expanding the target CRC screening population to include younger patients. UW has been shown to significantly improve polyp detection and bowel prep scores, and reduce sedation need in the age 50 and older screening cohort. Our results suggest these benefits extend to younger patients. Our results are limited by the retrospective analysis and non-screening indications for procedures. Further prospective studies are needed to assess the role of UW, as well as other techniques and devices, on polyp detection in younger patients.165_A Figure 1. Baseline characteristics of patient population165_B Figure 2. Polyp detection rates with air-insufflation vs. underwater insertion165_C Figure 3. Procedure times and Boston Bowel Prep Scores with air insufflation vs. underwater insertion