Intussusception of the vermiform appendix: preoperative colonoscopic diagnosis of two cases and review of the literature

Intussusception of the appendix is an uncommon condition, and the diagnosis is rarely made preoperatively. Making an accurate diagnosis before laparotomy is important in providing the optimal treatment for the patient. We present the clinical and endoscopic features of two cases of intussusception of the appendix and review the literature. Diagnosis was made preoperatively by colonoscopy in these cases and an elective appendectomy was performed. Appendiceal intussusception should be considered in the differential diagnosis of abdominal pain. Colonoscopy can be a valuable tool in establishing this diagnosis and in selecting the appropriate management Accepted: 18 April 2000     

常规电子结肠镜检查中结肠息肉漏诊分析

目的探讨常规电子结肠镜检查中结肠息肉的漏诊情况，包括漏诊率、漏诊息肉大小、分型、部位和病理状况。方法回顾3年间在120d内接受多次结肠镜检查的结肠息肉患者的病例资料，记录患者前2次肠镜检查的息肉数，漏诊息肉数，计算漏诊率。结果符合要求的患者共143例，男92例，女51例，年龄23～82岁；漏诊息肉数共126枚，漏诊率22．5％；在漏诊的息肉中，〈5mm、5～9mm和≥10mm息肉分别占80．2％、18．3％和1．6％，各项间比较差异有统计学意义（P〈0．01）；山田Ⅰ、Ⅱ、Ⅲ和Ⅳ型息肉分别占87．3％、8．7％、3．2％和0．8％，各项间比较差异有统计学意义（P〈0．01）；直肠、乙状结肠、降结肠、横结肠、肝曲、升结肠和盲肠分别占11．1％、27．0％、12．7％、19．1％、10．3％、15．1％和4．8％，各项间比较差异有统计学意义（P〈0．01）；漏诊的晚期腺瘤在漏诊的腺瘤性息肉中占14．8％；漏诊息肉数与基础息肉数间相关分析显示有显著的相关性（r=0．674，P〈0．01）。结论常规电子结肠镜检查中结肠息肉有较高的漏诊率，各段结肠间漏诊率不同，且漏诊息肉绝大多数为〈5mm的Ⅰ型息肉。患者罹患息肉越多，漏诊越多。     

克罗恩病的内镜及临床特点

目的总结克罗恩病（CD）的内镜及临床特点。方法收集1975年6月至2005年6月经结肠镜及病理学检查确诊的155例CD患者的相关资料，分析其内镜下表现及临床病理特点。结果1975—1990年和1991—2005年两组中，经结肠镜及病理学检查确诊的CD患者占同期镜检总数的比例从0．45％升至0．53％。患者男女之比为1．21：1；平均发病年龄42．6岁，高峰年龄段男为20～39岁及50～59岁，女为50～59岁；病程大于10年者占80％；临床主要表现为腹痛、腹泻、血便等肠道症状，以及贫血、发热、消瘦等全身症状；病变部位小肠为主者占43．87％、结肠为主者占23．23％、回结肠为主者占32．90％。结论CD的发病率有上升趋势，临床表现多样化，结肠镜结合病理学检查是目前诊断CD的主要方法。     

Risk of proximal colorectal neoplasia among asymptomatic patients with distal hyperplastic polyps

PURPOSE: Many guidelines on colorectal cancer screening do not consider distal hyperplastic polyps to be a marker for proximal neoplasia. However, 11 of 17 published studies have shown an increased risk of proximal neoplasia in patients with distal hyperplastic polyps. Our goal is to assess the risk of proximal neoplasia in asymptomatic patients with distal hyperplastic polyps, compared to those with distal tubular adenomas or no distal polyps. METHODS: We assessed proximal (cecum, ascending, transverse colon and splenic flexure) and distal polyps in patients undergoing screening colonoscopy, classifying them into 3 groups: distal hyperplastic polyps only; distal adenomas with or without hyperplastic polyps; no distal polyps. The prevalence of proximal neoplasia and advanced neoplasia (polyps > or =1 cm, villous adenomas, or cancer) was compared among these groups. RESULTS: Of 2357 patients, 427 (18%) had neoplasia, including 103 (4%) with advanced neoplasia. Proximal neoplasia occurred in 175 (9%) of 1896 patients with no distal polyps, compared with 28 (12%) of 237 with distal hyperplastic polyps (P = 0.20) and 64 (29%) of 224 with distal adenomas (P <0.0001). Proximal advanced neoplasia occurred in 39 (2%) patients with no distal polyps, compared with 4 (2%) with distal hyperplastic polyps (P = 0.70) and 9 (4%) with distal adenomas (P = 0.13). CONCLUSIONS: Patients with distal hyperplastic polyps, unlike those with distal adenomas, do not exhibit an increased risk for proximal neoplasia or proximal advanced neoplasia compared to those with no distal polyps. The discovery of hyperplastic polyps on screening sigmoidoscopy should not prompt colonoscopy.     

Retrieval of colorectal polyps following snare polypectomy: experience of the multiple-suction technique in 602 cases

Background Retrieving colorectal polyp after endoscopic snare polypectomy is time consuming and possibly incurs a failure. The aim of the study was to assess the effectiveness of the multiple-suction (M-S) technique for retrieving a variety of polyps. Materials and methods Four hundred and nine cases received endoscopic snare polypectomy from January 2003 to January 2007 were reviewed. The resected polyps were retrieved by M-S technique, in which suction regarded as the leading technique, was taken in combination with channel occlusion, trap, snare, and grasping forcep. Time of cecal intubation and of polypectomy, total examination time, shape, size, location, and number of polyp(s) were recorded. Retrieval time and polyp lost rate were also noted. Results A total of 602 polyps more than 3 mm in diameter underwent snare polypectomy. There were 96.7% (582/602) of polyps retrieved by the M-S technique. The mean retrieval time was 1.5 ± 0.6 min. Time of polypectomy, retrieval time, and total examination time were significantly positive correlative with the number of polyps (P < 0.05). In a univariate analysis, longer retrieval time was significantly associated with larger polyps, more distant polyps from the anus, and a greater number of polyps, while higher polyp lost rate was significantly associated with sessile polyp, smaller polyps, and a greater number of polyps. In a multivariate analysis, retrieval time level (≤2.0 or >2.0 min) was linked to the number of polyps. Conclusions The M-S technique is proved to be reliable when used in the majority cases of colorectal polyp retrieval. In retrieving too many polyps, the M-S technique is time consuming, and hence, additional methods should be applied to improve its retrieval effectiveness.     

Colonoscopic Stigmata of 1 mm or Deeper Submucosal Invasion in Colorectal Cancer

Purpose  This study was designed to identify colonoscopic stigmata, indicating substantial invasion into the submucosa by T1 colorectal cancer with sessile morphology, including both flat and protruded types. Methods  A total of 111 Tis or T1 colorectal cancers were studied retrospectively. The lesions were divided into two groups: Group A (n = 83), Tis or T1 cancers with <1 mm submucosal invasion; and Group B (n = 28), T1 cancers with a ≥1 mm submucosal invasion. Printed photographs of the lesions were reviewed by five experienced colonoscopists who were blinded to histology. Deep depression, irregular surface, ulceration or erosion, fold convergence, and spontaneous bleeding were independently evaluated. Findings considered present by three or more reviewers were defined as positive. Kappa analysis was used to measure inter/intraobserver variability. Results  Positive rates of four findings but not fold convergence were significantly higher in Group B than in Group A. Irregular surface and spontaneous bleeding were significant independent predictors of ≥1 mm submucosal invasion, with diagnostic accuracies of 85.6 and 76.6 percent, respectively. Kappa analysis demonstrated fair-to-good inter/intraobserver agreement for spontaneous bleeding and fair-to-good intraobserver agreement for irregular surface. Conclusions  Irregular surface and spontaneous bleeding were colonoscopic stigmata, indicating ≥1 mm submucosal invasion in T1 colorectal cancer.     

Radiology in investigation of rectal bleeding

Although most causes of chronic anorectal bleeding are diagnosed from clinical or sigmoidoscopic examination, there are a number of conditions not detectable from barium enema studies. Results of colonoscopy are compared to those for single- and double-contrast barium enema examinations, and recommendations are made for increasing diagnostic accuracy. Read at the meeting of the American Society of Colon and Rectal Surgeons, Atlanta, Georgia, June 10 to 14, 1979.     

Narrow-band imaging optical chromocolonoscopy： Advantages and limitations

Narrow-band imaging （NBI） is an innovative optical technology that modifies the center wavelength and bandwidth of an endoscope＇s light into narrow-band illumination of 415 ：1： 30 nm. NBI markedly improves capillary pattern contrast and is an in vivo method for visualizing microvessel morphological changes in superficial neoplastic lesions. The scientific basis for NBI is that short wavelength light falls within the hemoglobin absorption band, thereby facilitating clearer visualization of vascular structures. Several studies have reported advantages and limitations of NBI colonoscopy in the colorectum. One difficulty in evaluating results, however, has been nonstandardization of NBI systems （Sequential and nonsequential）. Utilization of NBI technology has been increasing worldwide, but accurate pit pattern analysis and sufficient skill in magnifying colonoscopy are basic fundamentals required for proficiency in NBI diagnosis of colorectal lesions. Modern optical technology without proper image interpretation wastes resources, confuses untrained endoscopists and delays interinstitutional validation studies. Training in the principles of ＂optical image-enhanced endoscopy＂ is needed to close the gap between technological advancements and their clinical usefulness. Currently available evidence indicates that NBI constitutes an effective and reliable alternative to chromocolonoscopy for in vivo visualization of vascular structures, but further study assessing reproducibility and effectiveness in the colorectum is ongoing at various medical centers.