老年性与非老年性结肠憩室结肠镜资料对比分析

目的通过总结、比较结肠镜诊断的47例非老年性结肠憩室与60例老年性结肠憩室病的特征区别。方法1996年1月至2001年12月6年间,301医院胃镜室经结肠镜检查证实的60岁以下非老年性结肠憩室47例。男38例,女9例。年龄24～59岁,平均43.17±8.22岁。60例老年性结肠憩室,男54例,女16例。年龄60～84岁,平均68.70±5.39岁。结果60岁以下组与60岁以上组相比,结肠憩室总检出率、单发憩室检出率、多发憩室检出率、右半结肠憩室检出率、左半憩室憩室检出率、男性憩室检出率、女性憩室检出率前者均低于后者。结论①结肠憩室的发病率随年龄增长而增高;②非老年人右半结肠发病率相对高于老年人;③非老年人左半结肠憩室及双侧结肠憩室相对低于老年人。     

结肠黑变病对结直肠息肉的影响

目的研究结肠黑变病对结肠息肉发生率、病理类型等的影响。 方法回顾性分析自2012年8月至2015年12月在我院经全结肠镜诊断的结肠黑变病98例,组成黑变病组;随机选取结肠镜诊断无结肠黑变病252例,组成非黑变病组。比较两组一般情况、结肠息肉发病率、息肉病理类型等。 结果结肠黑变病II度、III度累及全结肠的比例分别为71.0%、78.6%,高于黑变病I度的50.9%（P=0.01）。结肠黑变病组结肠息肉发现率达40.8%,远高于非结肠黑变病的23.0%（P=0.001）,而且黑变病组在横结肠、降结肠、盲肠及全结肠≥3个部位发现结肠息肉的比例均高于非黑变病组,P均<0.05,但两组息肉中腺瘤的比例分别为80%、67.9%（P=0.117）,差异无统计学意义。黑变病I、II、III度在息肉检出率、息肉病理类型的比较上,均P>0.05,差异无统计学意义。左半结肠为主型、右半结肠为主型、全结肠型黑变病在息肉检出率、息肉病理类型的比较上,也均P>0.05,差异无统计学意义。 结论结肠黑变病患者结肠息肉发生率高,需加强对结肠黑变病患者肠镜筛查,预防结直肠癌发生。结肠黑变病的病变程度、部位对结肠息肉的检出率、病理类型无影响。     

结肠憩室的内镜特点及其临床分析

目的总结不同时期结肠憩室的内镜下表现及临床特点。方法收集1989年-2004年经结肠镜检查确诊的结肠憩室患者的相关资料,其中1989年-1997组52例,1998年-2004年组113例,观察其临床特点及内镜表现。结果在1989年-1997年组和1998-2004年组中经结肠镜检查确诊的结肠憩室患者占同期结肠镜检查总数的比例从1.47%上升至2.08%,男女之比分别为1.26和1.22,平均发病年龄从61.68岁上升至66.41岁。临床主要表现为腹痛、便秘和腹胀等,1998年-2004年组患者中便秘症状的比例比1989年-1997年组明显增加,差异有显著性（P〈0.05）。1998年-2004年组乙状结肠憩室检出率比1989年-1997年组明显增加,差异有显著性（P〈0.05）。结论近7年结肠镜检出结肠憩室明显增加,其发病例数随发病年龄的增加而增高,好发部位由右半结肠为主转为以左半结肠为主,且乙状结肠发病率明显增加。     

电子肠镜诊治结肠憩室924例分析

目的 研究福建漳州地区人群结肠憩室的患病情况，探讨电子肠镜在结肠憩室诊治中的应用价值。方法 回顾性分析2012年1月至2017年12月在我院行电子肠镜检查并明确诊断为结肠憩室患者的病例资料。结果 共纳入患者924例，男603例，女321例，男性明显多于女性(P<0.0001)。83.7%患者主诉有腹痛、腹胀、排便习惯改变和血便/黑便症状。憩室部位以右半结肠多见(87.6%),单发与多发憩室差异有统计学意义(P<0.0001)。86例(9.3%)患者有憩室相关并发症，>60岁组并发症发生率较高，严重并发症多见。86例中，48例仅粪石嵌顿，20例粪石嵌顿伴憩室炎，15例憩室炎并出血，2例粪石嵌顿伴出血，1例憩室炎伴慢性溃疡并穿孔。47例粪石嵌顿的患者，门诊行肠镜检查时，使用活检钳钳除联合内镜下冲洗解除嵌顿。其余39例患者收入消化内科经内镜联合内科保守治疗，其中1例患者因再出血转外科手术，其余患者疗效确切。结论 本地区憩室检出率呈逐年上升趋势，患者年龄趋于年轻化，男性患者明显多于女性患者，憩室部位以右半结肠多见，并发症的发生率和严重程度与年龄呈正相关。对于>60岁结肠...     

116例结肠气囊肿病临床及内镜特点分析

目的 探讨结肠气囊肿病的临床及内镜特点。方法 回顾性分析2005年1月至2018年6月期间于首都医科大学附属北京友谊医院诊治的116例结肠气囊肿病患者资料,包括患者年龄、性别、临床表现,病变大小、部位、内镜表现等,总结肠道气囊肿病临床和内镜特点。结果 116例患者中男54例、女62例;年龄（59.11±13.13）岁（17~91）岁;单发病变50例（43.10%）,多发66例（56.90%）。病变检出率0.40‰（1/2 524）~2.03‰（8/3 945）。临床表现无症状体检者占24.14%（28/116）,其次为腹痛（18.97%,22/116）、肿瘤标记物升高（17.24%,20/116）。共发现病变168处,结肠镜下表现为黏膜下单发或多发大小不等的半球形或球形囊性隆起,质软,部分黏膜表面充血糜烂。116例患者中66例明确记录气囊肿大小,病变直径（1.61±0.87）cm（0.3~5.0 cm）,其中1.0~<2.0 cm占45.45%（30/66）。病变部位单发者好发于升结肠（38.00%,19/50）和横结肠（28.00%,14/50）,多发者好发于升结肠（28.81%,34/118）、乙状结肠（22.03%,26/118）和降结肠（17.80%,21/118）。结论 结肠气囊肿病临床相对少见,结肠镜检查是诊段的有效手段;其临床表现无特异性,老年患者居多,好发于升结肠。     

普通人群与高危人群结肠息肉检出率的对比研究

目的探讨高危人群与普通人群进行结肠镜常规体检的最佳年龄及结肠镜体检的必要性。 方法收集2015年3月至2019年8月经山西医科大学附属肿瘤医院内镜中心行结肠镜检查的5 213例体检者的内镜诊断报告,回顾性分析不同人群结肠息肉的检出率及其检出率在不同性别和不同年龄段的差异性。 结果5 213例受检者中高危人群772例,普通人群4 441例,其中,男3 469例、女1 744例,发现结肠息肉2 735例(占52.46%)。高危人群中59.33%受检者内镜下诊断为结肠息肉。普通人群中51.27%受检者内镜下诊断为结肠息肉。40岁及以上的普通人群与高危人群的检出率两者比较差异无统计学意义。不论普通人群还是高危人群,男性的结肠息肉检出率高于女性,而且随着年龄的增加,结肠息肉检出率呈上升趋势。 结论40岁及以上要定期做结肠镜常规体检检查,而不是仅限于高危人群才进行常规结肠镜体检,特别是男性。     

单发与多发结肠息肉的临床及病理特征对比分析

目的对比分析单发与多发结肠息肉的临床症状和病理特征。方法选取武汉协和医院2015年1月至2016年12月1 260例经病理诊断明确的结肠息肉切除患者,按照镜下息肉数目分为单发息肉和多发息肉两组,记录患者的一般资料、临床症状、既往史、息肉数目、息肉的病理类型,比较单发与多发结肠息肉临床症状和病理特征。结果 1 260例结肠息肉患者中,单发结肠息肉856例,多发结肠息肉404例。无论是单发还是多发息肉,在男性患者中的检出率均高于女性(P 0. 05);50岁年龄组的单发息肉检出率高于≥50岁年龄组,而在≥50岁年龄组中多发息肉的检出率高于50岁年龄组(P 0. 01);无论是单发息肉还是多发息肉,在有症状患者中的检出率均高于无症状患者(P 0. 01);以腹泻、便血为首要症状的患者中多发息肉的检出率明显高于单发息肉(P 0. 01)。绒毛状腺瘤和增生性息肉在多发息肉中的检出率高于单发息肉,其余病理类型均在单发息肉中的检出率高于多发息肉(P 0. 05)。结论结肠息肉好发于男性,高龄、首发症状为腹泻及便血者有更高的多发息肉检出率,绒毛状腺瘤和增生性息中肉多发息肉的检出率高于单发息肉,临床中对此类患者行内镜检查时,应更为仔细,降低多发息肉的漏诊率。     

结肠憩室的内镜特点及临床分析165例

目的:总结不同时期结肠憩室的临床特点及内镜下表现.方法:收集1989-2004经结肠镜检查确诊结肠憩室患者相关资料,其中1989-1997组52例,1998-2004组113例,观察其临床特点及内镜表现.结果:在1989-1997和1998-2004两组中,经结肠镜检查确诊的结肠憩室患者占同期结肠镜检查总数的比例从1.47%上升至2.08%,男女之比分别为1.26和1.22,平均发病年龄从61.68岁上升至66.41岁.临床主要表现为腹痛、便秘、腹胀等,在1998-2004组中便秘患者比例与1989-1997组相比明显增加,差异具有显著性(30.09%vs 15.38%,P<0.05).1998-2004组乙状结肠憩室检出率比1989-1997组明显增加,差异具有显著性(χ~2=4.303,P<0.05).结论:近7a结肠镜检出结肠憩室明显增加,其发病例数随发病年龄的增加而增高,好发部位由右半结肠为主转为以左半结肠为主,且乙状结肠发病率明显增加.     

结肠镜诊断结肠憩室病

１９７８年１０月～１９９３年１０月１５年间，经结肠镜检出结肠憩室病２９例，检出率０．３１％。结果显示结肠憩室病为我国少见病，其检出率随年龄增加而增高，国人结肠憩室好发于右半结肠，全结肠镜检可提高结肠憩室诊断率，是本病的可靠诊断手段。     

老年结肠憩室患者的临床特点和并发症

目的 探讨老年结肠憩室患者的患病情况、临床特点及并发症。方法 对６２例结肠憩室资料进行回顾性分析。结果 （１）６２例中,老年组和非老年组分别为３５例和２７例,老年患者约占５６％,４０岁以下患者占１０％;（２）老年组憩室在左半结肠的检出率（４５％）显著高于非老年组（２９％）,在右半结肠（２９％）则显著低于非老年组（４５％,均为Ｐ〈０．０５）;（３）老年组单纯憩室炎检出率（１７％）显著低于非老年组（５     

Clinical application of computed tomography virtual colography

OBJECTIVE : To investigate the computed tomography (CT) virtual colographic features of colonic polyps, colorectal cancer, diverticula, ulcerative colitis and other benign colonic lesions. Also, to assess the value of this method in the diagnosis of colorectal lesions. METHODS : Computed tomography colography was performed in 37 patients (26 male, 11 female) suffering from the following conditions: 20 colonic adenomas, six colon cancers, four diverticula, five ulcerative colitis and one each of melanosis coli and amyloidosis. The data from CT scanning were processed by computer with specific software and the colonic lesions were evaluated with 2‐ or 3‐D images, depending on the individual software. RESULTS : Seventeen cases of colonic adenoma, six colon cancers, four diverticula and two cases of ulcerative colitis were detected by using CT colography. However, melanosis coli and amyloidosis of the colon were not detected. CONCLUSION : Computed tomography colography can detect all colonic polyps of 0.5 cm in diameter or larger, colon cancer, diverticula and some ulcerative colitis successfully. It is quick, minimally invasive and able to be tolerated well. It has the potential to become an effective radiological tool in diagnosing colonic lesions.     

Ulcerative colitis and the aging-related development of colonic diverticula

Purpose

Aim of this observational case-control study was to assess the prevalence, features, and risk factors of colonic diverticula in patients with ulcerative colitis (UC).

Methods

The data of 896 UC patients aged ≥?30 years from Brescia IBD database were retrospectively analyzed. Individuals with colonic diverticula were identified and prevalence was compared with that of control patients undergoing screening colonoscopy after gender/age matching. A nested cohort study was then conducted among UC patients in order to define eventual association of diverticula with specific clinico-pathologic parameters.

Results

Prevalence of subjects with diverticula was 11.4% among 465 UC patients aged 49 years and older, significantly lower than 35.1% prevalence in control patients of same age and gender (p?<?0.001). Advancing age was a significant risk factor for diverticula development in both groups. Among UC patients, a short duration and a late onset of UC were both significantly associated to the presence of diverticula. Moreover, UC patients with diverticula had a significantly lower frequency of flares per year, even if maximal flare severity and frequency of hospital admission were similar to those of subjects without diverticula. UC patients with diverticula had a trend toward more frequent extension of UC to the left colon, possibly because of their older age. The majority of those patients had few sigmoid diverticula without symptoms.

Conclusions

Development of colonic diverticula is substantially reduced in patients with UC, markedly among those with an early onset, a long history of inflammatory disease, and a high flare frequency. This study reinforces the hypothesis sustaining a protective role of UC against colonic diverticula.

     

The nature of inflammatory bowel disease in patients with coexistent colonic diverticulosis

GOALS/BACKGROUND: Reports of segmental colitis with diverticula regard this entity as a local disease. Our goal was to reexamine the association of diverticula to colitis and question the relationship of colonic diverticulosis with generalized inflammatory bowel disease (IBD). STUDY: A retrospective database review of more than 1,600 patients matched 100 cases with IBD and colonic diverticulosis with a control group of 100 patients with IBD without diverticulosis. Patients were matched by gender, IBD diagnosis, and date of birth. Variables examined included disease distribution, strictures, fistulae, extraintestinal manifestations (EIMs), family history, and age at IBD diagnosis. RESULTS: For all IBD diagnoses, more sigmoid inflammation occurred in cases with diverticular disease: 82% versus 65% for controls (P = 0.005), and in the rectum: 85% versus 69% for controls (P = 0.005). In the Crohn's disease with diverticulosis subset, sigmoid inflammation was more common: 70% versus 42% for controls (P = 0.007), and in the rectum: 70% versus 46% for controls (P = 0.02). Disease distribution was otherwise similar throughout the colon, ileum, and jejunum. The incidence of strictures (P = 0.99) and fistulae (P = 0.69) was similar. EIMs were more frequent in cases with diverticulosis: 28% versus 16% (P = 0.05). Family history of IBD was similar: 26% for cases and 16% for controls (P = 0.12). Age at IBD diagnosis was significantly greater in diverticulosis cases compared with controls: 51.5 years (+/-17.6) versus 42.8 years (+/- 17.5) (P < 0.001), respectively. CONCLUSIONS: We observed an increased frequency of sigmoid and rectal inflammation, EIMs, and an older age of IBD onset in cases with diverticulosis. This suggests a role for diverticula in IBD beyond that of a mere coincidental finding.     

Prediction and management of recurrent right colon diverticulitis

Purpose

While the incidence of right colonic diverticulitis (RCD) is rare in Western countries, the right colon is the most common site of diverticulitis in Asian countries. However, its recurrent pattern and management were rarely studied. This study was designed to elucidate the pattern of recurrence in RCD.

Methods

Of the 154 patients admitted as right colonic diverticulitis between February 2004 and March 2012, 104 patients were enrolled, prospectively. The recurrence rate, size, multiplicity, location, diagnostic criteria score, and predisposing factors were evaluated based on Hinchey’s classification of diverticulitis.

Results

There were 104 patients with right colonic diverticulitis in this study, and 20 patients (19.2 %) recurred after medical treatment. When the diverticula were not located in the right colon, the recurrence rate was significantly higher than the diverticula located only in the right colon (p?=?0.004). The recurrence rate of diverticulitis for a single diverticulum was significantly lower than that for multiple diverticula (p?=?0.02). Of the 20 patients with recurrence, 1 (5 %) patient underwent laparoscopic diverticulectomy due to a misdiagnosis of diverticulitis as appendicitis. The remaining 19 patients (95 %) received nonoperative management and recovered without any sequelae.

Conclusions

The recurrence rate was 19.2 %, and the predisposing factors were the location of diverticula and the multiplicity of primary diverticula. The re-recurrence rate of recurred patients was 26.3 %. The recurred lesions were controlled simply by nonoperative management. Elective surgery was also a treatment option.     

ENDOSCOPIC BAND LIGATION WITH A WATER‐JET SCOPE FOR THE TREATMENT OF COLONIC DIVERTICULAR HEMORRHAGE

Although lower gastrointestinal bleeding generally has a less severe course and stops spontaneously in most cases without therapeutic intervention, some patients require endoscopic, surgical, or angiographic treatment depending on the nature of the bleeding. We applied endoscopic band ligation (EBL) with a water‐jet scope to bleeding colonic diverticula and evaluated the efficacy and safety of EBL retrospectively. Five consecutive patients were diagnosed as having colonic diverticular hemorrhage, and were treated with EBL at St Luke's International Hospital in Tokyo from June 2009 to August 2009. Comorbid diseases, usage of anti‐platelet agents, hemoglobin level on admission, procedural time, complications such as perforation and abscess formation, and rebleeding after EBL were retrospectively evaluated. In all cases, EBL achieved successful immediate hemostasis without any procedural complications. In four of five cases, bleeding colonic diverticula were everted after EBL. The mean length of hospital stay after EBL was 5 days (range 4–8 days). No patient exhibited clinical evidence of further bleeding during the mean follow‐up period of 3 months (range 2–4 months), and no further intervention was needed after EBL. EBL with a water‐jet scope is considered to be a safe and effective endoscopic treatment for colonic diverticular hemorrhage.     

Therapeutic barium enema for bleeding colonic diverticula： Four case series and review of the literature

The prevalence of diverticular diseases of the colon, including severe and persistent bleeding in Eastern countries, has increased in the last decades. The bleeding from colonic diverticula is the most common cause of acute lower gastrointestinal bleeding. Herein, we report four cases of severe and persistent bleeding of colonic diverticular disease that could be treated with a high concentration barium enema. These four cases showed a similar pattern of bleeding whose source could not be identified. Colonoscopy revealed fresh blood in the entire colon and many diverticula were noted throughout the colon. No active bleeding source was identified, but large adherent clots in some diverticula were noted. After endoscopic and angiographic therapies failed, therapeutic barium enema stopped the severe bleeding. These patients remained free of re-bleeding in the follow-up period （range 17-35 mo） after the therapy. We report the four case series of therapeutic barium enema and reviewed the literature pertinent to this procedure.     

Diverticular disease in the elderly

There are few diseases whose incidence varies as greatly worldwide as that of diverticulosis. Its prevalence is largely age-dependent: the disease is uncommon in those under the age of 40, the prevalence of which is estimated at approximately 5%; this increases to 65% in those > or =65 years of age. Of patients with diverticula, 80-85% remain asymptomatic, while, for unknown reasons, only three-fourths of the remaining 15-20% of patients develop symptomatic diverticular disease. Traditional concepts regarding the causes of colonic diverticula include alterations in colonic wall resistance, disordered colonic motility and dietary fiber deficiency. Currently, inflammation has been proposed to play a role in diverticular disease. Goals of therapy in diverticular disease should include improvement of symptoms and prevention of recurrent attacks in symptomatic, uncomplicated diverticular disease, and prevention of the complications of disease such as diverticulitis. Diverticulitis is the most usual clinical complication of diverticular disease, affecting 10-25% of patients with diverticula. Most patients admitted with acute diverticulitis respond to conservative treatment, but 15-30% require surgery. Predictive factors for severe diverticulitis are sex, obesity, immunodeficiency and old age. Surgery for acute complications of diverticular disease of the sigmoid colon carries significant rates of morbidity and mortality, the latter of which occurs predominantly in cases of severe comorbidity. Postoperative mortality and morbidity are to a large extent driven by patient-related factors.     

Colonoscopy can miss diverticula of the left colon identified by barium enema

AIM: To identify the diagnostic value of colonoscopy for diverticulosis as determined by barium enema. METHODS: A total of 65 patients with hematochezia who underwent colonoscopy and barium enema were analyzed, and the diagnostic value of colonoscopy for diverticula was assessed. The receiver operating characteristic area under the curve was compared in relation to age (< 70 or ≥ 70 years), sex, and colon location. The number of diverticula was counted, and the detection ratio was calculated. RESULTS: Colonic diverticula were observed in 46 patients with barium enema. Colonoscopy had a sensitivity of 91% and specificity of 90%. No significant differences were found in the receiver operating characteristic area under the curve (ROC-AUC) for age group or sex. The ROC-AUC of the left colon was significantly lower than that of the right colon (0.81 vs 0.96, P=0.02). Colonoscopy identified 486 colonic diverticula, while barium enema identified 1186. The detection ratio for the entire colon was therefore 0.41 (486/1186). The detection ratio in the left colon (0.32, 189/588) was significantly lower than that of the right colon (0.50, 297/598) (P < 0.01). CONCLUSION: Compared with barium enema, only half the number of colonic diverticula can be detected by colonoscopy in the entire colon and even less in the left colon.     

Diverticular complications of renal failure

Ten patients with chronic renal failure presented with complications of colonic diverticula. Five had acute diverticulitis, 4 perforated diverticula, and 1 lower gastrointestinal hemorrhage. Symptoms were less severe than expected. In 3 the diagnosis was first suspected when free intra-abdominal air was detected. Seven patients had laparotomy, 5 emergently. Radiologists should be aware of the potential for diverticular complication in patients with renal failure, even with minimal or absent symptoms. Suspicion of colonic pathology either clinically or radiographically should be evaluated promptly so that aggressive therapy can begin.