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Your search term(s) "colonoscopy" returned 35 results.

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Colonoscopy. Gastrointestinal Endoscopy Clinics of North America. 10(1): 135-160. January 2000.

This article on colonoscopy is from a special millennium issue of Gastrointestinal Endoscopy Clinics of North America that offers an overview of the past, highlights the present, and focuses on the future of gastrointestinal endoscopy. The author notes that colonoscopy and polypectomy (removal of colonic polyps) are the most effective tools available to prevent colorectal cancer. The technical performance of colonoscopy can be improved by methods that make polyp detection easier and more reliable, facilitate cecal intubation, and reduce recurrence and complication rates after polypectomy. The author reviews the state of the art and possible future trends in patient preparation, indications, screening and surveillance intervals, sedation issues, and virtual colonoscopy. The author notes that a central goal of research in gastrointestinal disease is one whose fulfillment can already be imagined: the virtual obliteration of death from colorectal cancer. Colonoscopy already has the potential to play the central role in fulfilling this goal, but its full potential will only be reached with further improvements in acceptability, comfort, and safety for patients, with reduction of costs and improved detection of neoplasia. 1 figure. 6 tables. 198 references.

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Comparison of Colonoscopy and Double-Contrast Barium Enema for Surveillance After Polypectomy. New England Journal of Medicine. 342(24): 1766-1772. June 15, 2000.

After patients have undergone colonoscopic polypectomy, it is uncertain whether colonoscopic examination or a barium enema is the better method of surveillance. This article reports on a study undertaken as part of the National Polyp Study, in which the authors offered colonoscopic examination and double contrast barium enema for surveillance to patients with newly diagnosed adenomatous polyps. A total of 973 patients underwent one or more colonoscopic examinations for surveillance. In the case of 580 of these patients, the authors performed 862 paired colonoscopic examinations and barium enema examinations that met the requirements of the protocol. The findings on barium enema were positive in 222 (26 percent) of the paired examinations, including 94 of the 242 colonoscopic examinations in which one or more adenomas were detected (rate of detection, 39 percent). The proportion of examinations in which adenomatous polyps were detected by barium enema was significantly related to the size of the adenomas; the rate was 32 percent for colonoscopic examinations in which the largest adenomas detected were 0.5 cm or less, 53 percent for those in which the largest adenomas detected were 0.6 to 1.0 cm, and 48 percent for those in which the largest adenomas detected exceeded 1.0 cm. Among the 139 paired examinations with positive results on barium enema and negative results on colonoscopic examination in the same location, 19 additional polyps, 12 of which were adenomas, were detected on colonoscopic reexamination. The authors conclude that, in patients who have undergone colonoscopic polypectomy, colonoscopic examination is a more effective method of surveillance than double contrast barium enema. 5 tables. 23 references.

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Controversies in the Investigation and Treatment of Lower Gastrointestinal Bleeding. Practical Gastroenterology. 24(1): 42, 52, 54, 58. January 2000.

Lower gastrointestinal (GI) bleeding may be intermittent, self limited, or produce a life threatening emergency. There are several options for diagnostic evaluation, but the location and etiology of the bleeding source may remain elusive. In this article, the authors review the diagnostic and treatment options and provide recommendations for developing an organized patient algorithm. The majority of patients with lower GI hemorrhage will stop bleeding during resuscitation. Once the bleeding has stopped, investigation of the source of the bleed usually proceeds with routine endoscopic and radiological studies, followed by elective segmental resection, if indicated. In patients where it is impossible to determine the precise location and etiology, both patient and physician must await the next bleeding episode. Patients who present with lower GI bleeding are usually adults older than 50 years. The most common etiologies of lower GI bleeding include diverticulosis, vascular ectasia, ischemic colitis, inflammatory bowel disease (IBD), and neoplasm (cancer). Diagnostic options include colonoscopy, traditional imaging techniques (CT scan or contrast studies), nuclear scintigraphy, or mesenteric angiography. Colonoscopy and mesenteric angiography both offer the means for potentially controlling the hemorrhage whereas scintigraphy does not. Colonoscopy can provide the means to treat bleeding lesions through electrocautery, epinephrine injection, or sclerotherapy. Angiography can provide access for vasopressin infusion or embolization. The unstable patient without a determined site of bleeding represents the most challenging dilemma, as blind total abdominal colectomy is associated with potential rebleeding from the small intestine and significant morbidity and mortality. 26 references.

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End of Barium Enemas? (editorial). New England Journal of Medicine. 342(24): 1823-1824. June 15, 2000.

This editorial comments on an article published in the same journal describing the use of barium enema versus colonoscopy for diagnostic uses. The editorial author notes that whether or not colonoscopy is a better way to examine the colon, it has been replacing barium enemas in recent years. The appeal of endoscopic technology, the ability to detect and remove lesions during a single procedure, and the influence of the gastroenterology community have been persuasive. In the research article on the accuracy of barium enema versus colonoscopy, barium enema did not fare well, especially in the identification of small polyps. The commentary author discusses the generalization of results, the problem of translating the procedures to typical clinical practice (rather than the research procedures, which were performed by a hand picked group of top technicians), and the recent finding that some colorectal cancers may arise from flat adenomas. The author concludes that the ability of barium enema to detect clinically important polyps is not good enough to use this method for the surveillance of patients who are increased risk for polyps or for a diagnostic evaluation of the colon. Barium enema may still have a role in screening (where expectations regarding the accuracy of findings are not as high) but it is unclear exactly what this role should be. 9 references.

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Virtual Colonoscopy: A Review. Practical Gastroenterology. 24(2): 38, 40-42, 50, 57-58. February 2000.

Virtual colonoscopy (computed tomography or CT colonoscopy) is a new imaging technique with the potential to alter current diagnostic approaches to colonic diseases, particularly colon cancer screening. This article describes the technique, clinical status, limitations and other potential indications of this new technology. Although colonoscopy remains the gold standard test, public acceptance for cancer screening remains poor. Virtual colonoscopy can detect colonic lesions greater than 1cm with an accuracy comparable to colonoscopy and is superior to barium enema for the detection of medium sized polyps. Because it offers the patient a relatively quick, minimally invasive, more comfortable and safer procedure, it may have greater patient acceptance than current recommended screening strategies. Similar to colonoscopy and barium enema, bowel cleansing prior to CT colonoscopy is essential to avoid stool or fluid artifacts. The cleansed colon is first distended throughout its length with either room air or carbon dioxide. The CT scan is then performed on a CT table. From the patients' perspective, the data acquisition phase typically takes no more than 10 minutes. However, significant limitations include the need for bowel preparation, a significant miss rate for flat or subcentimetric lesions, the inability to biopsy or remove these lesions once detected as well as cost issues. 2 figures. 4 tables. 27 references.

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