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Preparing for a Colonoscopy. Baltimore, MD: AGA Institute. 2007. 4 p.

This brochure from the American Gastroenterological Association (AGA) familiarizes readers with colonoscopy, a procedure in which a long flexible tube is used to check for colon cancer and to treat colon polyps. The brochure outlines the reasons for having a colonoscopy and helps readers know what to expect before, during, and after the colonoscopy. Topics include preparing the colon for the test, the equipment used, and possible complications. In addition to its role as a screening tool, colonoscopy can be used to evaluate blood loss, abdominal or rectal pain, changes in bowel habits, abnormalities that may have first been detected by other diagnostic studies, and active bleeding from the large bowel. Colonoscopy may be performed in a hospital, special outpatient surgical center, or a physician’s office. The brochure emphasizes that colorectal cancer can be cured, especially when detected early through tests such as the colonoscopy. A final section reiterates the basic information presented in the brochure. One illustration presents the organs of the digestive system labeled in a simple line drawing. Readers are referred to the AGA website at www.gastro.org/patient for more information about digestive health and to find a local AGA member physician. 4 figures.

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Suspected Asymptomatic Large Colon Lipoma: Biopsy?. Practical Gastroenterology. 32(3): 35-40. March 2008.

This article presents a case report of a suspected large colon lipoma. The authors note that lipomas are the second most common benign tumors of the colon, after adenomatous polyps. When symptomatic, colon lipomas present with abdominal pain, rectal bleeding, and changes in bowel habits. The authors report the case of a 59-year-old female with a history of hypertension and hyperlipidemia who underwent a routine colonoscopy that showed a 3.5-centimeter lipomatous-appearing polyp in the sigmoid colon. Referral to the gastroenterology clinic resulted in no further treatment until 1 year later when repeat colonoscopy showed the same sized mass. The mass was biopsied and histopathology revealed smooth muscle prominence and fibrovascular tissue. One week later, the patient presented with bright red blood per rectal and mild, crampy abdominal pain; flexible sigmoidoscopy showed a completely obstructing purplish mass in the sigmoid colon with an overlying clot. A computerized tomography (CT) scan of the abdomen showed a pendunculated soft tissue density consistent with lipoma and a 2.9-centimeter mass in the lumen of the sigmoid colon consistent with hematoma. Conservative management resulted in spontaneous resolution of the bleeding and no symptoms at 1-year follow-up. The authors conclude by reminding readers of the characteristic features of lipoma and by cautioning that biopsy can result in no additional diagnostic hints and may even cause complications such as bleeding or obstruction. 5 figures. 14 references.

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Understanding Colonoscopy. Oak Brook, IL: American Society for Gastrointestinal Endoscopy. 2008. 2 p.

This brochure from the American Society for Gastrointestinal Endoscopy (ASGE) familiarizes readers with colonoscopy, a diagnostic test that examines the lining of the colon for abnormalities. After defining the test, the brochure reviews the preparations that a person should undergo before the test, whether current medications can be continued, what to expect during the test, how long the test will last, what to expect after the test, the possible complications, and the use of biopsy in conjunction with colonoscopy. An additional section describes colonic polyps, why they need to be removed, and how they are usually removed. The brochure reminds readers of the importance of colonoscopy and the fact that most people tolerate colonoscopy without pain or complications. The brochure concludes with a brief description of the work of and contact information for the ASGE.

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Colonoscopy Withdrawal Times and Adenoma Detection Rates. Gastroenterology and Hepatology. 3(8): 609-610. August 2007.

This article from a series on advances in endoscopy answers common clinical questions about colonoscopy withdrawal times and adenoma detection rates. The author discusses the main quality indicators for colonoscopy, recommendations for adenoma detection rates, the relationship between withdrawal times and adenoma detection rates, the role of other factors such as bowel preparation or the presence of advanced neoplasia in this context, and areas needing additional research. Research studies have shown that adenoma detection was strongly associated with longer withdrawal times: Endoscopists whose withdrawal times were more than 6 minutes detected more than twice as many patients with adenomas that were 1 centimeter or larger in size. The author reminds readers that withdrawal time is not the only factor involved, and improved research on other aspects, such as how well endoscopists are looking behind folds, how well they clean up, and the general quality of their bowel preparations, is needed. 5 references.

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Colonoscopy. IN: Wexner, S.; Stollman, N., eds. Diseases of the Colon. . New York, NY: Informa Healthcare USA. 2007. pp 137-162.

This chapter about colonoscopy is from a comprehensive text that offers chapters about each of the major colonic disorders. Each chapter is coauthored by at least one surgeon and one gastroenterologist to reflect the in-depth collaboration between these fields that is required for managing diseases of the colon. In this chapter, the authors describe the diagnostics, imaging, and therapeutic techniques for colonic evaluation and intervention. They note that the development of a means to accurately and safely visualize the entire colon endoscopically has revolutionized the diagnosis and management of colonic diseases and the clinical practice of gastroenterologists and colorectal surgeons. The authors discuss colon embryology and endoscopic anatomy, the role of sigmoidoscopy, professional training and competence in colonoscopy, patient preparation, bowel preparation, antibiotic prophylaxis, anticoagulant and antiplatelet medication use, the equipment used for colonoscopy, the role of the colonoscopy assistant, sedation and analgesia during colonoscopy, infection control and colonoscope disinfection, contraindications and limitations of colonoscopy, and the use of air-contrast barium enema and virtual colonoscopy. The chapter includes black-and-white photographs and illustrations and concludes with an extensive list of references. 7 figures. 2 tables. 154 references.

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Gourmet Colon Prep. Practical Gastroenterology. 31(11): 41-42, 47-57. November 2007.

This article reviews the current diet regimens used during bowel preparation for colonoscopy and offers suggestions for dietary measures that may make the bowel preparation more tolerable and thus ultimately more successful. The authors summarize selected commercially available colonoscopy preparations and their accompanying manufacturer diet and liquid recommendations. The authors review clinical trials addressing some alternative regimens for bowel preparation. Specific topics include the clear liquid diet, the use of lactose-free, fiber-free nutritional supplements, low-residue diet options, sample menus, preparations for patients who have an ileostomy or jejunostomy, and tips for improving acceptability. The authors conclude that liberalizing the preprocedure diet may not only decrease hunger during the preparation period but can also decrease the patient’s dread of such a long period without food. Emphasizing the importance of adequate fluid intake to prevent dehydration is valuable, and providing a variety of options for the liquid diet may be helpful. 11 tables. 13 references.

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New Post-Polypectomy Surveillance Guidelines. Practical Gastroenterology. 31(8): 30, 35-42. August 2007.

People found to have adenomatous polyps usually undergo polypectomy and then are placed into a surveillance program of periodic colonoscopy to remove missed synchronous and new metachronous adenomas and cancers. This article reviews new postpolypectomy surveillance guidelines issued by the United States Multi-Society Task Force on Colorectal Cancer and the American Cancer Society (USM-STF/ACS). The author outlines how this set of guidelines differs from earlier guidelines: They offer a consensus statement that strengthens the guidelines, they specifically examine predictors of advanced adenomas and incorporate them into the guidelines, and they emphasize the quality of baseline colonoscopy and its impact on detection of postpolypectomy colorectal cancer. The author maintains that risk stratification can reduce the intensity of follow-up evaluation in a substantial proportion of these patients, so limited colonoscopy resources could be shifted from surveillance to screening and diagnosis. The article includes the recommendations, addition surveillance considerations, and a discussion of their implications for clinical practice. 8 tables. 67 references.

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Post-Polypectomy Surveillance: Who and How. Practical Gastroenterology. 31(7): 19-25. July 2007.

The most common neoplastic lesions found during screening tests are colorectal adenomas; their presence indicates a possible increased risk for future colorectal neoplasia. This article considers the guidelines for postpolypectomy surveillance of these patients. The author notes that high-quality baseline colonoscopy with excellent preparation, adequate examination, and complete polypectomy will reduce miss rates and should be the basis of any program of follow-up. Findings at baseline colonoscopy can be used to predict future risk and thus recommended surveillance intervals. High-risk adenomas justify a surveillance interval of 3 years; for those with one or two tubular adenomas, an interval of 5 to 10 years is adequate. Hyperplastic polyps warrant only an average-risk screening program. The author concludes that the implementation of these guidelines could free up procedures to support screening programs. 1 figure. 1 table. 11 references.

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Recto-Sigmoid Perforation During Retroflexion: Is There a Relationship to Rectal Prolapse?. Practical Gastroenterology. 31(7): 37-38, 43. July 2007.

Although colonic perforation is a known complication of colonoscopy, the rectum is generally considered to be an area of low risk for perforation. This article presents the case of a 70-year-old man with rectosigmoid colon perforation occurring upon retroflexion in the rectum during colonoscopy. This patient had prolapse of the rectal mucosa identified on digital rectal examination (DRE) prior to insertion of the colonoscopy. The authors present the case details, including confirmation of the perforation and the laparotomy repair of the 1 to 2 centimeter colon perforation just above the peritoneal reflexion. The patient was discharged from the hospital 2 days later with no further complications. The authors conclude that rectal prolapse may increase the risk of perforation during retroflexion. Thus, endoscopists should use caution when performing this maneuver in patients with rectal prolapse. 17 references.

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Standards for Gastroenterologists for Performing And Interpreting Diagnostic Computed Tomographic Colonography. Gastroenterology. 133(3): 1005-1024. 2007.

This article provides standards for gastroenterologists for performing and interpreting diagnostic computed tomography (CT) colonography, a relatively new technique used to image the colon. The article provides a brief background section and an executive summary of the recommendations before presenting the full task force review and recommendations. Topics include the current status of CT colonography; current indications for CT colonography, including failed colonoscopy, evaluation of the colon proximal to an obstructing lesion, evaluation of patients with contraindications to colonoscopy, and as screening for asymptomatic normal-risk adults; qualifications and training of personnel; examination and equipment specifications, including colonic preparation, the CT acquisition technique, and CT interpretation; reading and reporting the results; quality control and safety; and regulatory issues, including the implications of the Stark laws, referrals, split interpretation and billing for services, oversight, and risk management issues. In each topic area, the authors provide specific task force recommendations. 1 figure. 2 tables. 115 references.

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