ABSTRACT
BACKGROUND/AIMS: The successful colonoscopic insertion has been predicted by several clinical factors including female gender, obesity, poor bowel preparation, and a history of surgery. In addition, anatomical differences, such as Kudo's pattern (B, C of the sigmoid colon), rotation of the hepatic and splenic flexure, and the diameter of the sigmoid colon have also been considered to affect the success of colonoscopic insertion. The aim of this study was to evaluate the anatomical factors using virtual CT colonscopy in the case where the colonoscopic insertion is difficult. METHODS: From April 2005 to June 2005, 32 patients who experienced a delayed insertion time > or =10 minutes during colonoscopy (Group I) and other 34 patients whose insertion time was <10 minutes (Group II) were examined by virtual CT colonoscopy. The shape of the sigmoid colon was compared with Kudo's pattern, rotation of hepatic (HFR) and splenic flexure (SFR), and the diameter of the most distended sigmoid colon at the supine position (SCD) in both groups. Excessive SFR or HFR was defined if the splenic flexure or hepatic flexure was rotated by more than 360 degrees from the natural course of the colon. RESULTS: There were significant differences between group I (M : F=16 : 16, mean age: 61.7+/-13.8, SCD: 40.9+/-7.4 mm) and group II (M : F=25 : 9, mean age: 46.9+/-11.4, SCD: 39.7+/-7.2 mm) in terms of gender, age, BMI (24.1+/-3.5 kg/m2 in group I, 23.5+/-2.1 kg/m2 in group II), and the colonoscopic insertion time (18.1 minutes in group I, 6.3 minutes in group II). The Kudo's pattern was as follows: pattern A : B : C=23.3% : 36.7% : 40.0% in group I, and pattern A : B : C=50.0% : 37.5% : 12.5% in group II. Excessive rotation of the splenic flexure was 50% in group I, and 21.9% in group II. However, there were no clinical significant difference in bowel preparation, sedation, previous bowel operation, the type of cathartics and SCD. CONCLUSIONS: Anatomical differences can affect a difficult colonoscopic insertion, which includes shape of the sigmoid colon, excessive rotation of the splenic flexure. However a further large randomized trial study will be needed.
Subject(s)
Female , Humans , Cathartics , Colon , Colon, Sigmoid , Colon, Transverse , Colonoscopy , Obesity , Supine PositionABSTRACT
BACKGROUND/AIMS: The successful colonoscopic insertion has been predicted by several clinical factors including female gender, obesity, poor bowel preparation, and a history of surgery. In addition, anatomical differences, such as Kudo's pattern (B, C of the sigmoid colon), rotation of the hepatic and splenic flexure, and the diameter of the sigmoid colon have also been considered to affect the success of colonoscopic insertion. The aim of this study was to evaluate the anatomical factors using virtual CT colonscopy in the case where the colonoscopic insertion is difficult. METHODS: From April 2005 to June 2005, 32 patients who experienced a delayed insertion time > or =10 minutes during colonoscopy (Group I) and other 34 patients whose insertion time was <10 minutes (Group II) were examined by virtual CT colonoscopy. The shape of the sigmoid colon was compared with Kudo's pattern, rotation of hepatic (HFR) and splenic flexure (SFR), and the diameter of the most distended sigmoid colon at the supine position (SCD) in both groups. Excessive SFR or HFR was defined if the splenic flexure or hepatic flexure was rotated by more than 360 degrees from the natural course of the colon. RESULTS: There were significant differences between group I (M : F=16 : 16, mean age: 61.7+/-13.8, SCD: 40.9+/-7.4 mm) and group II (M : F=25 : 9, mean age: 46.9+/-11.4, SCD: 39.7+/-7.2 mm) in terms of gender, age, BMI (24.1+/-3.5 kg/m2 in group I, 23.5+/-2.1 kg/m2 in group II), and the colonoscopic insertion time (18.1 minutes in group I, 6.3 minutes in group II). The Kudo's pattern was as follows: pattern A : B : C=23.3% : 36.7% : 40.0% in group I, and pattern A : B : C=50.0% : 37.5% : 12.5% in group II. Excessive rotation of the splenic flexure was 50% in group I, and 21.9% in group II. However, there were no clinical significant difference in bowel preparation, sedation, previous bowel operation, the type of cathartics and SCD. CONCLUSIONS: Anatomical differences can affect a difficult colonoscopic insertion, which includes shape of the sigmoid colon, excessive rotation of the splenic flexure. However a further large randomized trial study will be needed.
Subject(s)
Female , Humans , Cathartics , Colon , Colon, Sigmoid , Colon, Transverse , Colonoscopy , Obesity , Supine PositionABSTRACT
Objective To evaluate the ability of virtual CT colonoscopy to detect colorectal proliferative lesions in endoscopically proven patients and its clinical application prospects. Methods Virtual colonoscopy was performed using thin section helical computed tomography of the abdomen and pelvis in 23 patients with conventional colonoscopic findings suggestive of abnormalities within 1 hour. The data from CT scanning was processed by computer with specific commercial software, two and three dimensional reconstruction was subsequently made. Results The diagnosis of colorectal carcinomas was made on virtual colonoscopy in 21 cases, among which 20 cases were endoscopically diagnosed as cancers and 1 case was found sigmoid stricture of unknown causes, that was finally confirmed surgically and pathologically. All polyps greater than 11 mm were identified both by conventional endoscopy and virtual colonoscopy. 19 polyps with size of 6～10 mm were detected on virtual colonoscopy, the location and size of 13 polyps were in accordance with those of endoscopic findings, 2 false positive polyps were reported in 6 newly detected polyps. Virtual colonoscopy correctly localized all 21 cancers, compared with 18 using conventional colonoscopy. Conclusion Virtual colonoscopy is a valuable clinical method in diagnosis of colorectal cancers and polyps with size larger than 6 mm, and it is a good indication for colonic stricture and colonoscopy intolerable patients.