Management of colonoscopic perforations: A systematic review

Background

Perforation during colonoscopy is a rare but well recognized complication with significant morbidity and mortality. We aim to systematically review the currently available literature concerning care and outcomes of colonic perforation. An algorithm is created to guide the practitioner in management of this challenging clinical scenario.

Endoscopic and histopathological analysis of incidental focal colorectal 18 F-fluorodeoxyglucose uptake in PET/CT scan: Colonoscopic evaluation is warranted

Background

Unexpected focal colorectal ¹⁸ F-fluorodeoxyglucose uptake has become a common clinical dilemma. The aim of this study was to identify the clinical significance of incidentally detected colorectal lesions on PET/CT scans by comparing positive PET/CT findings with endoscopic and histopathological analysis.

放松音乐对结肠镜检查患者疼痛影响的研究

目的探讨戴耳机听音乐与播放背景音乐对减轻结肠镜检查患者疼痛的效果。方法将180例接受结肠镜检查患者随机分为戴耳机听音乐组、听背景音乐组和对照组各60例。戴耳机听音乐组患者在测量生命体征后即戴上耳机听放松音乐，听背景音乐组患者在测量生命体征后即开始听用CD机播放的放松音乐，对照组患者不听音乐。应用疼痛数字分级法评价3组患者结肠镜检查中的疼痛程度，进镜前、后心率、血压、血氧饱和度变化及前2组对音乐的评价。结果戴耳机听音乐组和听背景音乐组的疼痛评分显著低于对照组，差异有统计学意义（P〈0.05）；戴耳机听音乐组疼痛评分较听背景音乐组低，但差异无统计学意义（P〉0.05）；对照组检查后心率比检查前快，差异有统计学意义（P〈0.05）。结论放松音乐对结肠镜检查患者疼痛具有一定缓解作用，听背景音乐是一种实施方便、经济的缓解结肠镜检查患者疼痛有效方法之一。     

Short flexible fiberoptic colonoscopy in routine office examinations

Through experience with 1,464 examinations using the short flexible fiberoptic colonscope, the author concludes it to be the preferred instrument for endoscopy of the distal bowel. He finds it superior to the rigid instrument in detection of polyps and early malignant disease of the distal descending and sigmoid colons. The flexible instrument is generally less uncomfortable for the patient and is readily accepted as a routine part of a thorough colonic and rectal examination. Read at the meeting of the American Society of Colon and Rectal Surgeons, Hollywood, Florida, May 11 to 16, 1980.     

Multidetector CT colonoscopy: evaluation of the perspective-filet view virtual colon dissection technique for the detection of elevated lesions

Background The purpose of our study was to determine the usefulness of a virtual computed tomography colon dissection visualization technique for the detection of polypoid lesions in comparison with conventional virtual colonoscopy analysis and optical colonoscopy. Methods Twenty-three patients were evaluated with optical colonoscopy and computed tomography colonoscopy using 16-row MDCT on the same day. CT images were analyzed by the colon dissection workup with unfolded haustra visualization and also using the conventional virtual colonoscopy technique (axial images and endoluminal views). The CT analysis was performed by an experienced radiologist using both viewing methods in a randomized order and blinded to optical colonoscopy results. Results Optical colonoscopy revealed 35 colonic lesions; 15 < 5 mm, 18 between 5–9 mm and 2 > 9 mm. For conventional virtual colonoscopy analysis the overall sensitivity was 86.67%; for the colon dissection visualization technique, the overall sensitivity was 82.86%. The average reading time for conventional virtual colonoscopy was 15 ± 3 vs. 8 ± 2 min for the colon dissection visualization technique. Conclusions Our results showed that there is a significant reduction in the reading time using the colon dissection visualization technique without detriment to the detection rate, that is, competitive to conventional virtual colonoscopy interpretation results. There are no conflicts of interest in connection with the submitted article.     

内镜及活检病理对回盲部溃疡的鉴别诊断

目的评价内镜及活检病理对回盲部溃疡性病变病因的诊断价值。方法经内镜检查发现回盲部溃疡，结合临床表现和活检病理对证实的回盲部溃疡改变如肠结核病、克罗恩病、溃疡性结肠炎、恶性淋巴瘤、大肠癌（溃疡型）进行鉴别诊断。结果内镜检查对溃疡性结肠炎、大肠癌较易诊断；对肠结核病、克罗恩病、恶性淋巴瘤诊断率不高。内镜组织活检病理形态学研究表明：异型淋巴细胞、异型上皮、类上皮结节合并干酪样坏死分别相对于恶性淋巴瘤、溃疡型大肠癌和肠结核病均有确诊意义（P〈0．05）；单纯类上皮结节（即结节样肉芽肿）见于克罗恩病和肠结核病，若未发现肠结核干酪样坏死，两者不易鉴别；隐窝脓肿多见于溃疡性结肠炎，但该病理特征诊断意义不强，可见于多种病变。结论回盲部病变以溃疡型病变最为多见。内镜及活检组织病理学检查对回首部溃疡病变的诊断是安全有效的，综合分析其结果可进一步提高诊断准确率。     

Endotics system vs colonoscopy for the detection of polyps

AIM: To compare the endotics system (ES), a set of new medical equipment for diagnostic colonoscopy, with video-colonoscopy in the detection of polyps. METHODS: Patients with clinical or familial risk of colonic polyps/carcinomas were eligible for this study. After a standard colonic cleaning, detection of polyps by the ES and by video-colonoscopy was performed in each patient on the same day. In each single patient, the assessment of the presence of polyps was performed by two independent endoscopists, who were randomly assigned to evaluate, in a blind fashion, the presence of polyps either by ES or by standard colonoscopy. The frequency of successful procedures (i.e. reaching to the cecum), the time for endoscopy, and the need for sedation were recorded. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the ES were also calculated. RESULTS: A total of 71 patients (40 men, mean age51.9 ± 12.0 years) were enrolled. The cecum was reached in 81.6% of ES examinations and in 94.3% of colonoscopies (P = 0.03). The average time of endoscopy was 45.1 ± 18.5 and 23.7 ± 7.2 min for the ES and traditional colonoscopy, respectively (P < 0.0001). No patient required sedation during ES examination, compared with 19.7% of patients undergoing colonoscopy (P < 0.0001). The sensitivity and specificity of ES for detecting polyps were 93.3% (95% CI: 68-98) and 100% (95% CI: 76.8-100), respectively. PPV was 100% (95% CI: 76.8-100) and NPV was 97.7% (95% CI: 88-99.9). CONCLUSION: The ES allows the visualization of the entire colonic mucosa in most patients, with good sensitivity/specificity for the detection of lesions and without requiring sedation.     

西甲硅油乳剂在结肠镜检查中的应用与研究

目的 研究西甲硅油乳剂在结肠镜检查术前肠道准备中的应用价值.方法 将200例接受结肠镜检查的患者随机分为两组,实验组100例,对照组100例.实验组给予聚乙二醇电解质散+西甲硅油乳剂,对照组给予口服聚乙二醇电解质散.观察二组的效果.结果 实验组肠腔内气泡存在量明显少于对照组,术后腹胀程度明显轻于对照组,内镜医师操作满意度优于对照组(P＜0.05),而两组肠道清洁程度无差异(P＞0.05).结论 在结肠镜检查术前肠道准备中应用西甲硅油乳剂能够消除泡沫,提高视野清晰度,减少术后腹胀等不良反应,提高术者操作舒适度,缩短操作时间.     

The impact of patient education on the quality of inpatient bowel preparation for colonoscopy

BACKGROUND:

For patients requiring colonoscopy while admitted to hospital, achieving adequate cleansing of the colon is often difficult.

OBJECTIVES:

To assess the impact of patient education, in the form of both counselling and written instructions, on bowel cleanliness at colonoscopy.

METHODS:

A total of 38 inpatients at a tertiary care hospital in Vancouver, British Columbia, who were referred to the gastroenterology service for colonoscopy were enrolled in the present study. Sixteen patients were randomly assigned to the intervention group, while 22 patients comprised the control group. Both groups received a clear liquid diet and 4 L of a commercially available bowel preparation. The intervention group also received a brief counselling session and written instructions outlining the methods and rationale for bowel preparation before colonoscopy. Bowel cleanliness was assessed by the endoscopist using a five-point rating scale.

RESULTS:

The two groups were similar with respect to demographics, the indication for colonoscopy and findings at colonoscopy. The median bowel cleanliness scores in the control group and the enhanced-instruction group were 3.0 and 2.0, respectively (P=0.001).

CONCLUSION:

Patient counselling and written instructions are inexpensive, safe and simple interventions. Such interventions are an effective means of optimizing colonoscopy preparation in the inpatient setting.