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

Displaying all search results.


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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Biomarkers for IBD-Related Colon Cancer: CCFA Researchers Seek Better Ways to Detect Risk and Prevent Disease. Take Charge. p. 32-35. Winter 2006.

One of the complications of inflammatory bowel disease (IBD, including Crohn's disease and ulcerative colitis) is an increased risk for colon cancer, a risk that rises even more after people have had colitis or Crohn's of the colon for more than 8 to 10 years. This article discusses the biomarkers used to detect IBD-related colon cancer. Gastroenterologists urge people with IBD to have a colonoscopy every one to two years after they have had IBD for more than 8 years. The author considers the increased cancer risk (which actually applies to a minority of IBD patients, approximately 10 percent) and diagnostic or screening strategies that can distinguish between inflammatory changes in the colon and precancerous ones. The author outlines the problems with colonoscopy in this patient population and makes the case for a quick, non-invasive test for colon cancer based on a biomarker, comparable to the Prostate Specific Antigen (PSA) which is used to screen for prostate cancer. The Crohn's and Colitis Foundation of America (CCFA) is currently supporting three research projects concerning the identification and testing of genetic markers for colon cancer. The author concludes that soon some of the genetic and other tests under study will be moved from the lab to clinical use, where they will complement colonoscopy in screening people with IBD for colon cancer. The article includes quotes from and photographs from three researchers in the area of biomarkers. 3 figures.

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Cancer: New Colonoscopic Techniques. IN: Jewell, D.P., et al, eds. Challenges in Inflammatory Bowel Disease: Management of Crohn's Disease. Malden, MA: Blackwell Publishing Inc. pp. 293-302.

Patients with longstanding, extensive ulcerative colitis (UC) are at increased risk of developing colorectal cancer. Colonoscopic surveillance is recommended to reduce associated mortality. This chapter on new colonoscopic techniques is from a textbook that addresses some of the challenges in the understanding of UC and Crohn’s disease (CD), collectively known as inflammatory bowel disease (IBD). In this chapter, the authors discuss detection of premalignant lesions in UC, chromoendoscopy, the efficiency of chromoendoscopy, and future trends, including confocal laser endomicroscopy. The authors conclude that the newly developed high-resolution and magnification endoscopes offer features that allow more and new mucosal details to be seen. These techniques are commonly used in conjunction with chromoendoscopy. Endoscopic prediction of neoplastic and non-neoplastic tissue is possible by analysis of the surface architecture of the mucosa, which influences the endoscopic management. 5 figures. 1 table. 19 references.

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Colonoscopies 101: Everything You've Always Wanted to Know But Were Afraid to Ask. Digestive Health and Nutrition. 8(1): 18-20. March- April 2006.

Colorectal cancer is the third most common cancer in both men and women in the United States. A colonoscopy is used to find and remove fleshy growths in the colon (polyps) before they become cancerous. This article answers common questions about colonoscopy, including the procedure itself, why it may be used, and alternatives. The author notes that, in order for the gastroenterologist to complete the test, the patient’s colon must be entirely empty of stool. Emptying the bowel requires fasting, laxatives, and increased drinking the day before the test. A colonoscopy is typically an outpatient procedure performed under sedation. Patients must arrange transportation after the procedure. The author walks patients through each step of the procedure. A final section describes some alternative screening methods, including virtual colonoscopy, digital rectal exam (DRE), stool blood test, flexible sigmoidoscopy, and barium enema with contrast. One sidebar outlines six steps to colorectal cancer prevention; another summarizes the guidelines for colon cancer screening using colonoscopy. 3 references.

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Straight Talk on Colorectal Cancer. Digestive Health and Nutrition. 7(2): 16-18. March-April 2005.

This article discusses colorectal cancer, emphasizing the importance of early detection for best treatment results. The author cautions that because colorectal cancer does not often have symptoms in its earlier stages, screening and removal of polyps (growths on the inner wall of the large intestine) are vital. Removing a polyp eliminates the chance of it changing to a cancerous growth. The author considers some of the reasons why there are low screening rates, including people being unaware of the need for or the benefits of screening, and clinicians not recommending screening. The author also discusses the colonoscopy procedure, preparation for colonoscopy, fecal occult blood testing, recommendations for how often to have these screening tests, new testing methods that are under development (including virtual colonoscopy), risk factors for colorectal cancer, lifestyle factors that may play a role in the development of colorectal cancer, and the role of genetics in colorectal cancer. One sidebar summarizes colorectal cancer screening guidelines; another sidebar lists the different methods currently available to screen for colorectal cancer. 1 figure. 6 references.

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Colon Cancer: The Power of Prevention. Princeton, NJ: Films for the Humanities and Sciences. 2002. (videorecording).

One of the most deadly forms of cancer is also one of the most preventable. In this program, doctors from the University of Pennsylvania School of Medicine, Vanderbilt-Ingram Cancer Center, Memorial Sloan-Kettering Cancer Center, and elsewhere focus on three case studies of senior citizens with colon cancer to explore the etiology and pathology of colon cancer, risk factors, and screening options. Prevention through colonoscopic examinations is emphasized, and treatments such as surgery with adjuvant therapy and combination chemotherapy involving 5-FU, Camptosar, and oxaliplatin are described.

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Facing Reality: The Facts About 'Virtual' Colonoscopy. Arlington, VA: American College of Gastroenterology. 2003. 2 p.

This brochure describes virtual colonoscopy, also called CT colonography, an x-ray test that looks for cancer and precancerous growths (polyps) in the colon (large bowel). Virtual colonoscopy is based on a CT scan of the abdomen and pelvis. During the examination, a tube is placed in the rectum and the colon is filled with air, followed by an abdominal-pelvic CT scan, which is then repeated with the patient lying in a different position. Because air is pumped into the colon, cramping may result. By contrast, in a conventional colonoscopy most patients receive sedative drugs that alleviate discomfort. Written in question and answer format, the brochure discusses how the test is performed, what the patient may experience, the expected results of the test, the role of conventional colonoscopy, and the guidelines of professional organizations regarding virtual colonoscopy. The brochure stresses that there has been no definitive demonstration to support either the overall effectiveness or cost-effectiveness of virtual colonoscopy. The brochure includes the contact information for the American College of Gastroenterology (www.acg.gi.org).

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Virtual Colonoscopy. Bethesda, MD: National Digestive Diseases Information Clearinghouse. 2003. 2 p.

Virtual colonoscopy (VC) uses x rays and computers to produce two- and three-dimensional images of the colon (large intestine). The procedure is used to diagnose colon and bowel disease, including polyps, diverticulosis, and cancer. VC can be performed with computed tomography (CT) or with magnetic resonance imaging (MRI) scans. This fact sheet describes virtual colonoscopy, including the preprocedure activities, and the advantages and disadvantages of VC. One sidebar briefly describes conventional colonoscopy. A final section describes the goals and work of the National Digestive Diseases Information Clearinghouse.

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Colonoscopy. Ostomy Quarterly. 40(3): 58-60. Spring 2002.

This newsletter article describes colonoscopy, a common and relatively routine procedure that allows the physician to visualize the colon and rectal lining by looking through a long flexible scope or using a video monitor attached to the scope. The author covers history, indications, patient preparation, sedation, the procedure itself, and possible complications. Colonoscopy is used to diagnose and monitor many colorectal diseases and to screen for colorectal cancer (particularly in patients over age 50). Major complications can include bleeding or perforation; minor complications include the effects of bowel preparation, low blood pressure, low oxygenation, bacteria in the bloodstream, bloating, and abdominal cramping. The article concludes with a list of five web sites for additional information. 8 figures. 10 references.

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Complications of Gastrointestinal Endoscopy. In: Feldman, M.; Friedman, L.S.; Sleisenger, M.H. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 7th ed. [2-volume set]. St. Louis, MO: Saunders. 2002. p. 539-548.

Complications of gastrointestinal (GI) endoscopy are remarkably uncommon, in spite of the striking increase in the number and diversity of procedures performed since the 1970s. This chapter on complications of GI endoscopy is from a comprehensive and authoritative textbook that covers disorders of the gastrointestinal tract, biliary tree, pancreas, and liver, as well as the related topics of nutrition and peritoneal disorders. Topics include general complications, such as adverse effects of medications, cardiopulmonary problems, infectious complications, electrosurgical hazards, and abdominal distension; complications of upper endoscopy, including perforation, bleeding, and miscellaneous complications; and complications of sigmoidoscopy and colonoscopy, including perforation, bleeding, and miscellaneous complications. The authors stress that adherence to all safety issues, particularly sedation and monitoring, and the standardization of endoscopic training and practice may lower the complication rate of endoscopy and improve the already good safety record. The chapter includes a mini-outline with page citations, full-color illustrations, and extensive references. 1 figure. 6 tables. 124 references.

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Low-Salt Bowel Cleansing Preparation (LoSo Prep) as Preparation for Colonoscopy: A Pilot Study. Alimentary Pharmacology and Therapeutics. 16(7):1327-1331. July 2002.

Currently available colon cleansing preparations are often poorly tolerated. This article reports on a study undertaken to evaluate the efficacy of a low-volume, low-salt preparation for colonoscopy. This was a pilot study in patients scheduled for colonoscopy. The preparation consisted of 34 grams of magnesium citrate and four bisacodyl tablets the day before the procedure, and one bisacodyl suppository on the morning of the procedure. The study included 20 patients (age range 49 to 81 years, all male). There were no significant side effects associated with the preparation. All rated the taste as 'tolerable or better.' The examination was considered to be adequate, with no limitations, in 17 patients (85 percent) and was scored as good to excellent (no solid stool) in 11 patients (55 percent), acceptable (small amounts of solid stool) in six patients (30 percent) and poor in three patients (15 percent). Importantly, two of the failures then received a standard polyethylene glycol preparation and again failed to show adequate colon preparation. The authors conclude that the low-salt colon cleansing preparation was an effective alternative preparation for colonoscopy. 2 tables. 34 references.

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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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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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