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Results of Screening Colonoscopy Among Persons 40 to 49 Years of Age. New England Journal of Medicine. NEJM. 346(23): 1781-1785. June 6, 2002.

The prevalence of colorectal lesions in persons 40 to 49 years of age, as identified on colonoscopy, has not been determined. This article reports on a study that reviewed the procedure and pathology reports for 906 consecutive persons 40 to 49 years of age who voluntarily participated in an employer-based screening-colonoscopy program. Among those who underwent colonoscopic screening, 78.9 percent had no detected lesions, 10.0 percent had hyperplastic polyps, 8.7 percent had tubular adenomas, and 3.5 percent had advanced neoplasms, none of which were cancerous. Eighteen of 33 advanced neoplasms (55 percent) were located distally and were potentially within reach of a sigmoidoscope. If these results are applicable to the general population, at least 250 percents, and perhaps 1000 or more, would need to be screened to detect one cancer in this age group. The authors conclude that colonoscopic detection of colorectal cancer is uncommon in asymptomatic persons 40 to 49 years of age. The noncancerous lesions are equally distributed proximally and distally. The low yield of screening colonoscopy in this age group is consistent with current recommendations about the age at which to begin screening in persons at average risk. 3 tables. 23 references.

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Virtual Colonoscopy Can it Save Lives?. Digestive Health and Nutrition. p. 24. July-August 2002.

This brief article describes a new technique called virtual colonoscopy which involves a computerized scan of the colon. Unlike conventional colonoscopy, air is instilled via a tube. The procedure is less invasive than conventional colonoscopy and requires no sedation. The patient lies on a table while a CT scanner passes over the body, a process that takes about 30 seconds. In the resulting image, the walls of the colon are color coded as to thickness so that growths stand out in a brighter color. However, there are still a number of drawbacks to this procedure that have prevented its introduction to the general public thus far. These drawbacks include the inability to detect all cancerous or precancerous growths, the high incidence of false positive tests, and the need for conventional colonoscopy for patients in whom the virtual colonoscopy demonstrates a problem. The author concludes that eventually virtual colonoscopy may prove to be a cost effective and accurate screening tool for large numbers of patients without symptoms or as a surveillance option for patients with previous adenomas. The article concludes with two web sites that readers can consult for additional information. 1 figure.

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Colon Cleansing Preparation for Gastrointestinal Procedures. Alimentary Pharmacology and Therapeutics. 15(5): 605-611. May 2001.

This article reviews adequate colon cleansing, an essential procedure before reliable diagnostic and surgical colon procedures. Accuracy and safety depend on good preparation. Patient compliance to the colon cleansing procedure is enhanced by simplicity and by well tolerated methods. Several methods are available. Diet and cathartic regimens use clear liquids or diets designed to leave a minimal colonic residue. Laxatives, cathartics, and enemas are employed. Gut lavage solutions are osmotically balanced electrolyte lavage products. Oral sodium phosphate solutions and tablets are available and are attractive because of good efficacy with a small volume of administration. For colonoscopy and colon surgery preparation, these methods have been proven safe and effective. For barium enema X ray, lavage requires an adjunctive agent to enhance barium coating. Overall, all regimens are well tolerated. Efficacy is similar and adequate for most preparations, so choice is based on patient acceptance, cost, and underlying medical conditions. The authors conclude that there has been improvement over the restrictive clear liquid diet, and cathartic and enema methods, but the search for an ideal cleansing method continues. 2 tables. 82 references.

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Colonoscopy and Enteroscopy. Gastrointestinal Endoscopy Clinics of North America. 11(4): 603-639. October 2001.

Pediatric colonoscopy and enteroscopy differ significantly from their adult parallels in nearly every aspect, including patient and parent management and preparation, selection criteria for sedation and general anesthetic, bowel preparation, expected diagnoses, instrument selection, imperative for terminal ileal intubation, and requirement for biopsies from macroscopically normal mucosa. This article focuses on the technique and clinical application of ileocolonoscopy and enteroscopy in childhood. The author discusses the impact of endoscopic investigations and therapies on specific disease processes. The article illustrates the basic technique of colonoscopy in children and the author discusses advanced techniques, such as endosonography, cecostomy, and therapy of lower gastrointestinal (GI) bleeding. The advantages and disadvantages of other noninvasive investigations are compared with colonoscopy and generally are held to be second best. The article highlights those differences and provides a workable guide for those involved or training in the discipline of pediatric colonoscopy and enteroscopy. 14 figures. 3 tables. 184 references.

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Colonoscopy and Sigmoidoscopy: What to Expect. Participate. 9(1): 5-6. Spring 2000.

Colonoscopy is an examination in which a flexible tube like device with a light on the end is inserted through the anus into the intestine. An image of the entire large bowel, or colon, is relayed through the instrument onto a video screen. Sigmoidoscopy is a similar test but only the left side of the colon is visualized. This fact sheet explains what patients can expect when they undergo the diagnostic tests of colonoscopy or sigmoidoscopy (the shorter version). The colonoscopy is performed in a licensed facility with staff specially trained for these tests; sigmoidoscopy may be done in a doctor's office. Colonoscopy is commonly indicated for the diagnosis of diseases that cause acute and chronic diarrhea, intestinal bleeding, and for the detection and management of colon polyps and cancer. For a sigmoidoscopy, preparation entails taking a phosphate enema (Fleet) about 2 hours before the test. For a colonoscopy, it is necessary that the whole bowel be clean. The patient can take only fluids by mouth after noon the day before the test. The preparation includes ingestion of oral laxatives, which cause a profuse diarrhea; these laxatives may be unpleasant, but they are safe when taken with clear fluids, and necessary if the examination is to be optimal. The patient must sign a consent form prior to the procedure. For a sigmoidoscopy, sedation is seldom given; colonoscopy requires sedation, which lessens the anxiety associated with the test and when given with a pain killer, it reduces the pain. Normally, the patient will be on their left side on the examining table and can watch the examination on a video screen if they wish. The nurse will coach the patient on how to breath (regular breathing is relaxing, minimizes the pain, and maintains good oxygen saturation in the blood). If the patient has been sedated, or if the laboratory results of a biopsy are awaited, it may be necessary to speak with the doctor at a later time or schedule a visit for a full explanation of the test results. 1 figure.

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Colonoscopy: Diagnosing Problems of the Lower Digestive Tract. San Bruno, CA: StayWell Company. 2001. 15 p.

This brochure describes colonoscopy, a nonsurgical procedure that allows the health care provider to see directly inside the patient's lower digestive tract (colon and rectum). The brochure describes the use of the colonoscope, an instrument consisting of a thin, flexible tube that is moved through the colon. The tube has several openings through which instruments can be passed (for taking biopsies). The tube also has fiber optics to beam light inside the colon and a camera to pass images to the health care provider's screen. Colonoscopy is used to diagnose colon abnormalities, such as bleeding or an area of inflammation, and to prescribe the best treatment for them. Colonoscopy is also used to screen for colon cancer. Colonoscopy can detect problems in their earliest, most treatable stages. The brochure explains the preprocedure care that patients should follow, including a special diet and the use of colon preparations such as laxatives. The brochure outlines what the patient can expect during the test itself and during recovery. Within a few hours after patients return home, most of them are able to eat normally and resume most normal activities, unless otherwise directed. Results of the colonoscopy are usually given before the patient leaves for home, or within a few days. The brochure is illustrated with black and white line drawings illustrating patients and the colonoscopy procedure, and full color illustrations of the anatomy of the colon and rectum. 9 figures.

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Dysplasia Surveillance in Crohn's Disease. In: Bayless, T.M. and Hanauer, S.B. Advanced Therapy of Inflammatory Bowel Disease. Hamilton, Ontario: B.C. Decker Inc. 2001. p. 263-265.

This chapter on dysplasia (abnormal tissue growth) surveillance in patients with Crohn's disease (CD) is from the second edition of a book devoted to the details of medical, surgical, and supportive management of patients with CD and ulcerative colitis (UC), together known as inflamatory bowel disease (IBD). The author notes that, contrary to traditional thinking, evidence has continued to accumulate suggesting that the risk of colorectal cancer (CRC) is elevated similarly in both UC and CD. Although imperfect, the best tool for screening and surveying these patients is colonoscopy. As has been the practice with UC, the endoscopies for patients with CD probably should commence at 8 years of disease and be repeated every 1 or 2 years. The author answers some questions about dysplasia surveillance, including what patients should have screening and surveillance colonoscopies, the significance of colonic strictures (narrowed areas), the pathologic findings that should mandate surgery, managing dysplasia found in polypoid mucosa, and choice of surgery. For lesions above the rectum, subtotal colectomy (removal of the colon) is the standard surgical procedure, and for rectal lesions, abdominoperineal resection with ileostomy or colostomy. After any of the surgical options, close follow up endoscopic surveillance of remaining colon is essential. 10 references.

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Lower GI Endoscopy: Viewing Your Colon. [Endoscopia de la Parte Baja del Tracto Gastrointestinal: Examen Visual del Colon]. San Bruno, CA: StayWell Company. 2001. [2 p.].

This brochure describes lower gastrointestinal (GI) endoscopy, a special examination that uses a long, narrow, flexible tube called an endoscope. Lower GI endoscopy can examine the entire colon and rectum (colonoscopy) or just the rectum and sigmoid colon (sigmoidoscopy). This instrument contains a strong light and a video camera, allowing the GI tract to be viewed on a video screen. The brochure provides information for patients about what to do before the exam, what to expect during the procedure itself, and what to expect after the procedure. The brochure also briefly describes lower GI anatomy and the types of problems that can be diagnosed with endoscopy, including inflammation of the colon (colitis), growths (polyps), and colon cancer. Patients may be given results of the procedure before they leave the office or hospital; additional results may take several days. The brochure cautions readers to contact their physician if they experience pain in the abdomen, fever, or rectal bleeding during their recovery time. The brochure is illustrated with full color line drawings of the colorectal anatomy and the procedure. The brochure is available in English or Spanish. 4 figures.

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Role of Endoscopy in Inflammatory Bowel Disease. Gastrointestinal Endoscopy Clinics of North America. 11(4): 641-657. October 2001.

Ever since its introduction into clinical use in the 1960s, flexible fiberoptic endoscopy has progressively become an indispensable tool to diagnose and treat gastrointestinal (GI) disorders. In addition to permitting visualization and biopsy sampling of much of the gastrointestinal tract, endoscopy can also be used therapeutically, to localize and treat bleeding, dilate strictures, and remove tumors. Ileal and colonic biopsies are critical to establish the cause of chronic diarrhea, to help distinguish between different forms of colitis, to determine the extent of disease, and to determine if neoplastic changes have arisen in the setting of chronic colitis. This article reviews the expanding use of endoscopy in inflammatory bowel disease (IBD) in the pediatric age group. The author summarizes a practical approach to endoscopic procedures in pediatric patients, including preparation for colonoscopy, sedation, choice of endoscope, and safety concerns. 1 figure. 2 tables. 85 references.

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Colonoscopy Plus Biopsy in the Inflammatory Bowel Diseases. Gastrointestinal Endoscopy Clinics of North America. 10(4): 755-774. October 2000.

Biopsy of the colon is an important diagnostic tool in the investigation of the inflammatory bowel diseases (IBD). Colon biopsies are critical in helping to diagnose diarrhea, to distinguish different forms of colitis, to determine the extent of disease, and to determine if neoplasia (including cancer) has arisen in the setting of chronic colitis. This article reviews a number of scenarios where colon biopsies are of particular importance, such as biopsies in the patient with undiagnosed diarrhea, distinguishing different forms of inflammatory bowel disease (IBD), assessing disease extent and activity, differential diagnosis of and diagnosing other disorders superimposed on inflammatory bowel disease, neoplasia in patients with IBD, and colonic biopsy as a mirror of generalized gastrointestinal or systemic disease. One table summarizes the recommended locations and numbers of biopsies for different scenarios. The author concludes that to use colon biopsies most appropriately in patient management and to get the most mileage from them usually requires frequent clinician-pathologist interaction, often repeat endoscopy with biopsies at a different time, and the assessment of the biopsies in the clinical context. 1 figure. 3 tables. 94 references.

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