Preoperative Colonoscopy In Patients Research Articles

Mo1683 QUALITY OF PREOPERATIVE COLONOSCOPY IN PATIENTS UNDERGOING SURGERY FOR COLORECTAL CANCER

Colonoscopy provides important information that impacts the outcomes of subsequent surgical interventions for colorectal cancer. This includes description of the tumor, anatomical location, size and presence of synchronous polyps/tumors. Marking of lesions with tattoo can assist surgical localization and decrease surgical errors. In this study we aimed to evaluate the documentation and performance preoperative colonoscopy in patients with lesions suspicious for colorectal cancer. We conducted a retrospective chart audit of 198 patients who underwent colonoscopy prior to colectomy for colorectal cancer at our institution between January 2013 and January 2018. Data reviewed included the indication for the procedure, duration, completion of procedure (if not at index procedure, within 6m after surgery), quality of bowel preparation, tumor location and size, performance of endoscopic tattooing, subsequent surgical interventions and pathology reports. Findings: Consistently documented variables included the procedure date, indication for the procedure, extent reached and type of sedation (100%). Tumor size was documented in 43% of cases. The distribution of lesions in the colon was the following: cecum 18%, ascending colon 19%, transverse colon 8%, descending colon 3%, sigmoid colon 29% and rectum 23%. Complete examination of the colon was performed in 80% of the cases. In patients who did not undergo complete examination perioperatively, (15/40) 35% had a repeat colonoscopy and (25/40) 65% of patients with incomplete examination did not undergo repeat testing due to progressive disease, death and loss to follow up. Endoscopic tattooing was performed in (57/117) 29% of the cases with lesions in non-fixed location (excluding rectum and cecum) and localization measuring the distance from the anal canal was performed in 48% of the cases. The endoscopic estimation of tumor size did not correlate with pathologic specimen. We found significant room for improvement in the quality of endoscopic reporting and performance in patients with colorectal cancer. The data will provide feedback to physicians on performance and help implementing systemic quality improvement interventions.Endoscopic estimation of size compared to pathologic measurementView Large Image Figure ViewerDownload Hi-res image Download (PPT)

P049 Correlation of Surgical Pathology With Preoperative Colonoscopy in Patients With IBD

BACKGROUND: Previous studies have shown a very high rate of advanced neoplasia including cancer among patients referred for colectomy for dysplasia detected during surveillance colonoscopy. Our goal was to re-evaluate this correlation using a more recent cohort of patients from a single IBD center. METHODS: This is a single center, retrospective study of IBD patients who underwent colectomy for any indication from 1998 to 2017. Patients who underwent colonoscopy before colectomy were included. Demographic and clinical variables as well as the colonoscopy to surgery interval were collected from medical records. Pathological findings including location, lesion type and grade were compared between surgery and colonoscopy using the Spearman correlation index. Variables associated with discordant findings were also determined using regression analysis. RESULTS: A total of 192 patients with IBD (31.8% CD, 68.2% UC) underwent colectomy and all but 2 preceding colonoscopies were performed with white light (median interval t months, range s-z). All but 2 colonoscopies were performed with white light only. 52 patients had neoplasia in the resected specimen: 10 adenocarcinoma (Ca), 7 HGD, 30 LGD, 3 indefinite and 2 were sessile serrated lesion (SSL). Colonoscopy identified 4 patients with Ca, 4 with HGD, 1 LGD, and 1 SSL. The correlation between surgical and endoscopic pathological findings was modest (r = X, P = z). The following variables were associated with a missed diagnosis of advanced neoplasia during colonoscopy in univariate and multivariate analysis (a, b, c, d, e.g. male sex, moderate-severely active disease, standard vs. HD imaging and length of time between colonoscopy and surgery). CONCLUSION(S): These findings confirm a poor correlation between pre- and postoperative findings when using white light colonoscopy in patients with IBD. Image enhanced colonoscopy may reduce the rate of discordant results but this needs to be addressed in a prospective fashion.

Preoperative colonoscopy in patients with a supposed primary ovarian cancer.

The final diagnosis of ovarian cancer is based on surgery and pathological verification. Therefore patients who are presented to surgery may be described only as supposed ovarian cancer. According to the literature the diagnosis of ovarian cancer is confirmed only in 2/3 of them. The rest are that which mimic ovarian cancer. One of them is colorectal cancer. Colonoscopy is a gold standard in its diagnostics. On the other hand, ovarian cancer may disturb the bowel patency and makes the bowel resection or stoma necessary.The main aim was to find out the distribution of bowel patency disturbances in ovarian cancer patients during preoperative colonoscopy and to assess their predictive value with respect to the bowel resection or stoma and the additional aim to identify the pathologies which mimic the ovarian cancer.In a prospective study among 104 patients with supposed ovarian cancer, primary ovarian cancer was diagnosed in 68 patients. The rest of them suffered from colorectal cancer found at colonoscopy (N = 6), ovarian benign pathology (N = 8), ovarian borderline tumor (N = 5), and other nonandexal malignant diseases (N = 17). In ovarian cancer group dominated serous carcinoma and fedération international de gynécologie et d’obstétrique stage 3 (N = 33).During preoperative colonoscopy in ovarian cancer patients, the complete obstruction was found in 27.9%, and relative risk of bowel resection or stoma was in them 4.29 and 4.38, respectively. Another colonoscopic finding was limited patency caused by extrinsic compression (29%) which is connected with relative risk of bowel resection or stoma 3.16 and 3.21 accordingly. The last colonoscopy finding was described as moderate limited patency of unknown origin (20.6%) and the relative risk of bowel resection or stoma was 5.14 and 4.17, respectively.Colonoscopy enables the diagnoses of colorectal cancer one of the diseases which mimic ovarian cancer in patients supposed to have this diseases.Bowel patency disturbances found at colonoscopy are a potential risk factor to intestine resection or ostomy.Colonoscopy is not fully noninvasive procedure and its obligatory use in patients supposed to have ovarian cancer should be limited to the cases with specific symptoms, and tumor marker pattern. Preoperative computed tomography, dedicated to bowel examination, candidates as an alternative to colonoscopy, but not completely.

Synchronous Colorectal Neoplasias : A Single Hospital Study

Background and the aim of the study: The presence of more than one primary tumor in the colon at time of presentation is diagnosed as colorectal synchronous neoplasias (SN) and the largest one is considered the index tumor. The aim of this study is to identify the magnitude of synchronous colorectal neoplasias and its relation to different variables as pattern of presentation, age, gender and histopathology in addition to evaluation of different methods of diagnosis in patients presented to King Abdul Aziz Specialist Hospital, Taif, Saudi Arabia. Patients and methods: This is a retrospective chart review study. The hospital records and the files of all patients diagnosed to have colonic neoplasms were reviewed from January 2008 to August 2014. Results: The study involved 87 patients, 53 males and 34 females. Ten of the 87 patients (6 males and 4 females) had synchronous colonic neoplasms (11.5%). Intestinal obstruction was the presenting symptom in 4/10 patients (40%, Vs 35.6% in patient with single lesion), rectal bleeding in 4/10 patients (40%) and in 20% mass in right lower quadrant was the presenting symptom. In obstructed patients, SN was diagnosed after examination of the operative specimen, however; intra-operative palpation detected multiple colonic polypi in one patient and intra-operative colonoscopy detected SN in another 2 patients. In the non obstructed patients preoperative colonoscopy and biopsy diagnosed multiple lesions in 5/6 of the patients (83.3%). Pre and intra- operative colonoscopy helped to guide accurately the extent of resection in 83.3% of non obstructed patients and in 75% of obstructed patients respectively. Mean period of follow up was 3. 4±0.8 years. Conclusion: The incidence of SN is significantly higher in this study than that recorded in English literature, so a larger study involving all regions of Saudi Arabia is strongly recommended as the presence of SN worsens the prognosis entailing modification of the treatment options. Thorough pathological examination is mandatory of any doubtful colonic lesions, and the study verified the effectiveness of preoperative colonoscopy in patients with non obstructed colorectal cancer and intra-operative colonoscopy in obstructed patients for visualization and biopsy of these lesions.

Role of Preoperative Colonoscopy in Patients with Gastric Cancer: A Case Control Study of the Prevalence of Coexisting Colorectal Neoplasms

We evaluated the prevalence of coexisting asymptomatic colorectal neoplasm (CRN) in patients with gastric cancer (GC). Preoperative colonoscopic examinations were performed in 495 patients with GC who underwent gastrectomy between January 2009 and December 2010. To compare the prevalence of CRN in these patients with that in a normal population, we selected 495 sex- and age-matched persons who underwent colonoscopies for health screening. Risk factors for CRN were evaluated by univariate and multivariate analyses. The overall incidence of CRN was 41.8 % (414/990). The prevalence of overall CRN, high-risk CRN, and colorectal carcinoma (CRC) were significantly higher in the GC group than in the control group (overall CRN: 48.9 % vs. 34.7 %; high-risk CRN: 28.3 % vs. 13.5 %; CRC: 2.6 % vs. 0.2 %; all P < 0.001). The presence of GC [odds ratio (OR), 1.82; 95 % confidence interval (CI), 1.4-2.38; P < 0.001], age ≥50 years (OR, 2.58; 95 % CI, 1.75-3.81; P < 0.001), and male sex (OR, 2.28; 95 % CI, 1.72-3.02; P < 0.001) were risk factors for overall CRN. In patients with GC, age ≥40 years (OR, 3.22; 95 % CI, 1.24-8.37; P = 0.016) and male sex (OR, 3.21; 95 % CI, 2.17-4.76; P < 0.001) were risk factors for overall CRN. The prevalence of coexisting CRN, including CRC, was higher in patients with GC than in the normal population. Preoperative colonoscopy is strongly indicated in patients with GC who are male and/or ≥40 years of age.

Preoperative Colonoscopy in Patients with Gastric Cancer

Preoperative Colonoscopy in Patients with Gastric Cancer

W1459: The Role of Preoperative Colonoscopy in Patients With Suspected Bowel Infiltrating Endometriosis

W1459: The Role of Preoperative Colonoscopy in Patients With Suspected Bowel Infiltrating Endometriosis

Preoperative colonoscopy for patients with gastric adenocarcinoma

In patients with gastric adenocarcinoma (GA), the most common double primary cancer is colorectal cancer. The aim of the present study was to evaluate the necessity of preoperative colonoscopy in patients with GA who have no symptoms of colorectal disease or any past/family history of colorectal cancer. Colonoscopy was carried out in 205 patients before gastric surgery for treatment of GA. The prevalence of colorectal neoplasms (CRN, adenoma and adenocarcinoma) was evaluated according to age, sex, body mass index (BMI) and stage, location and differentiation of GA. The median age and BMI were 59 years (range 32-81) and 22.9 (range 17.0-42.3), respectively. There were 135 male patients (65.9%). Synchronous adenoma and adenocarcinoma were detected in 68 (33.2%) and four (2.0%) patients, respectively. Univariate analysis showed that patients 50 years and older, male or with multiple GA had a significantly higher incidence of CRN (P = 0.005, 0.019, and 0.023, respectively). All of the GA patients with synchronous colorectal adenocarcinoma were older than 50 years. The stage, location and differentiation of GA and BMI did not show a significant difference in the incidence of CRN. Multivariate analysis showed that age (50 years and older) was the only risk factor of CRN in GA patients (odds ratio 2.470; 95% confidence interval 1.058-5.767). Preoperative colonoscopy for screening of CRN should be considered in GA patients > or = 50 years because of a relatively high prevalence of CRN and the possibility of synchronous CRC.

Preoperative Colonoscopy Decreases the Need for Laparoscopic Management of Colonic Polyps

Patients are commonly referred to surgeons for surgical resection of polyps that cannot be excised colonoscopically. Repeating the colonoscopy may be met with resistance by both the patient and the referring endoscopist. However, there are two distinct benefits. First, if the lesion was not marked, tattooing facilitates laparoscopic resection. Second, and more importantly, many of these polyps can be removed endoscopically by an experienced colorectal surgeon, avoiding unnecessary colon resection. Over a period of five years, we have reviewed preoperative colonoscopy in patients who were referred for surgical treatment of benign polyps. From January 1999 through September 2003 all patients referred for surgical resection of a benign polyp were consecutively entered into a database by a single group of colorectal surgeons. All patients underwent preoperative colonoscopy on the day before the planned colon resection. Patient charts were reviewed, and demographics were recorded. The referral and preoperative colonoscopy reports and all pathology results were reviewed to record the polyp size, location, histology, and subsequent treatment. Altogether, 71 patients were included in this study. The average size of the polyps was 24 mm (range, 10-60 mm). The location of the polyp as determined by preoperative colonoscopy differed from the location noted on referral colonoscopy in nine patients (13 percent). Surgery was canceled in 23 patients (32 percent), primarily because of complete polypectomy at preoperative colonoscopy. Of the 48 who underwent surgery, 23 (47 percent) had a colonic tattoo placed, at the discretion of the surgeon. Lesions clearly located in the cecum were not tattooed routinely. Of the 48 patients who underwent surgery, 45 (94 percent) underwent laparoscopic colon resection. We concluded that patients referred for surgical resection of a polyp should undergo repeat colonoscopy preoperatively, given that in our study one-third of patients were spared unnecessary colectomy. In addition, repeat endoscopy by the operating surgeon offers an opportunity to confirm the location of the lesion and place a colonic tattoo to facilitate laparoscopic resection.

Preoperative colonoscopy in patients over age 50 with confirmed gynecologic malignancy

The use of mechanical circulatory support (MCS) devices has increased sixfold since 2006. Although there is an established legal and ethical consensus that patients have the right to withdraw and withhold life-sustaining interventions when burdens exceed benefits, this consensus arose prior to the widespread use of MCS technology and is not uniformly accepted in these cases. There are unique ethical and clinical considerations regarding MCS deactivation. Our center recently encountered the challenge of an awake and functionally improving patient with a total artificial heart (TAH) who requested its deactivation. We present a narrative description of this case with discussion of the following questions: (1) Is it ethically permissible to deactivate this particular device, the TAH? (2) Are there any particular factors in this case that are ethical contraindications to proceeding with deactivation? (3) What are the specific processes necessary to ensure a compassionate and respectful deactivation? (4) What proactive practices could have been implemented to lessen the intensity of this case's challenges? We close with a list of recommendations for managing similar cases.

Preoperative colonoscopy in patients with gynecologic tumors

Preoperative colonoscopy in patients with gynecologic tumors

Fiberoptic colonoscopic examination in surgical patients with colorectal cancer.

A diagnostic and surveillance program using colonscopy in patients with colorectal cancer was established at North Carolina Memorial Hospital. The records of all patients who had preoperative or postoperative colonoscopic examination between 1976 and 1979 were reviewed. Fifty-five patients had colonscopic examination preoperatively. No additional disease was found in 39. In 15 patients, unsuspected additional disease was detected, and one patient had a suspected polyp ruled out by colonoscopic examination. One of these patients was found to have a synchronous primary cancer, not demonstrated by barium enema. Surgical treatment was modified in nine (16%) of these 55 patients by the preoperative colonoscopic findings. Sixty patients had colonoscopy six months to six years postoperatively. No additional disease was found in 47. Adenomatous polyps were found in eight. Two patients had recurrent cancer proved by colonoscopy, and three had a second primary cancer detected only by colonoscopy. Treatment was directly influenced by colonoscopy in eight (13.3%) of these 60 patients. These studies had a favorable cost/benefit ratio in patients with colorectal cancer and support a program of preoperative colonoscopy in patients with colorectal cancer and reexamination within two to three years after operation.