Double-Balloon Endoscopy after Incomplete Colonoscopy and Its Comparison with Computed Tomography Colonography

BACKGROUND/AIMS: Because of the national screening program for colorectal carcinoma in The Netherlands, the number of colonoscopies has increased. In case of incomplete colonoscopy, computed tomography colonography (CTC) and double-balloon colonoscopy (DBc) are alternative options. This study evaluated cecal intubation rate and pathology detection rate in the previously unexplored part of the colon, complication rate of DBc, and CTC results after incomplete colonoscopy. METHODS: Retrospective observational study in a tertiary referral hospital regarding DBc and CTC reports from cases with incomplete colonoscopy. RESULTS: Sixty-three DBcs were performed after incomplete colonoscopy. Cecal intubation rate was 95%. Detection rate was 58% (5% carcinoma and 3% high-grade dysplastic adenoma). CTC preceded 54% of DBcs and 62% of CTC findings were confirmed. In 16%, a biopsy was taken, and in 60%, an intervention (mostly polypectomy) was performed. One major complication (1.5%) occurred, i.e., arterial bleeding due to polypectomy necessitating right hemicolectomy. CTC (n=213) showed a possible lesion in 35%, and could be confirmed by follow-up endoscopy or surgery in 65%. CONCLUSIONS: DBc is effective and safe for completion of colon inspection in incomplete colonoscopy. In patients with a high likelihood of pathology, DBc is preferred over CTC.

Effect of Reducing Abdominal Compression during Prone CT Colonography on Ascending Colonic Rotation during Supine-to-Prone Positional Change

OBJECTIVE: To determine the effect of reduced abdominal compression in prone position on ascending colonic movement during supine-to-prone positional change during CT colonography (CTC). MATERIALS AND METHODS: Eighteen consecutive patients who had undergone prone CTC scanning with cushion blocks placed under the chest and hip/thigh to reduce abdominal compression and had confirmed sessile polyps > or = 6 mm in the well-distended, straight, mid-ascending colon, were included. Radial location along the ascending colonic luminal circumference (degrees) was measured for 24 polyps and 54 colonic teniae on supine and prone CTC images. The supine-to-prone change ranging between -180degrees and +180degrees (- and + for internal and external colonic rotations, respectively), was determined. In addition, possible causes of any ascending colonic rotations were explored. RESULTS: Abdominal compression during prone CTC scanning completely disappeared with the use of cushion blocks in 17 of 18 patients. However, some degrees of ascending colonic rotation were still observed, with the radial location changes of -22degrees to 61degrees (median, 13.9degrees) for the polyps and similar degrees for teniae. Fifty-four percent and 56% of polyps and teniae, respectively, showed changes > 10degrees. The radial location change of the polyps was significantly associated with the degree of anterior shift of the small bowel and mesentery (r = 0.722, p < 0.001) and the degree of posterior displacement of the ascending colon (r = 0.566, p = 0.004) during supine-to-prone positional change. CONCLUSION: Ascending colonic rotation upon supine-to-prone positional change during CTC, mostly in the form of external rotation, is not eliminated by removing abdominal compression in prone position.

Colon Capsule Endoscopy: Where Are We and Where Are We Going

Colon capsule endoscopy (CCE) is a noninvasive technique for diagnostic imaging of the colon. It does not require air inflation or sedation and allows minimally invasive and painless colonic evaluation. The role of CCE is rapidly evolving; for example, for colorectal screening (colorectal cancer [CRC]) in average-risk patients, in patients with an incomplete colonoscopy, in patients refusing a conventional colonoscopy, and in patients with contraindications for conventional colonoscopy. In this paper, we comprehensively review the technical characteristics and procedure of CCE and compare CCE with conventional methods such as conventional colonoscopy or computed tomographic colonography. Future expansion of CCE in the area of CRC screening for the surveillance of polyps and adenomatous lesions and for assessment of inflammatory bowel disease is also discussed.

Diagnóstico de neoplasia colorrectal: descripción de hallazgos en colonoscopia virtual y convencional / Diagnosis of Colorectal Neoplasia: Description of Findings On Virtual Colonoscopy And Conventional Colonoscopy

Introducción: La colonoscopia virtual surge como método diagnóstico en las diferentes patologías del colon. Objetivos: Describir y comparar los hallazgos de la colonoscopia convencional y la virtual relacionados con la presencia de neoplasias y sus características morfológicas de tamaño y localización, en pacientes con sospecha de patología de colon. Métodos: Estudio descriptivo de registro de casos clínicos. Se incluyeron 23 pacientes remitidos al servicio de gastroenterología para realización de colonoscopia, durante septiembre de 2007 y mayo de 2008. Los pacientes fueron llevados a colonoscopia virtual y, posteriormente, a colonoscopia óptica; los hallazgos fueron clasificados por un radiólogo y un gastroenterólogo, respectivamente, según su localización en los diferentes segmentos del colon, así como el tamaño, el tipo de lesión en mucosa, submucosa, carcinomas y lesiones extrínsecas. Resultados: El grado de concordancia de los dos procedimientos para el diagnóstico de pólipos fue de 76 %. Se encontró que la colonoscopia virtual tiene una sensibilidad para el diagnóstico de pólipos de 85,7 % IC (52,6-100) y un valor predictivo negativo de 92,9 % IC (75,8-100), valores considerados importantes, pero con amplios intervalos de confianza atribuidos a la poca cantidad de pacientes. Conclusiones: En el presente estudio se encontró un alto valor predictivo negativo, lo que hace que la colonoscopia virtual pueda ser el método diagnóstico inicial de elección en el tamizaje de las patologías colorrectales. En caso de ser negativa, se descarta patología; si es positiva, el método diagnóstico a seguir para confirmar los hallazgos sería la colonoscopia directa.

Introduction: Virtual colonoscopy emerges as a new diagnostic method to study the pathology that affects the colon. Objectives: To describe and compare the findings of conventional colonoscopy and virtual colonoscopy related to the presence of a neoplasia according to its morphology, size and location in patients suspected of having colonic pathology. Material and Methods: Descriptive study of the review of clinical cases. 23 patients submitted to the gastroenterology service between September 2007 and May 2008 for a conventional colonoscopy were included. The patients were taken to virtual colonoscopy and, subsequently, to optical colonoscopy; the findings were classified by a radiologist and a gastroenterologist, respectively, according to its location in the different segments of the colon, as well as size, the type of lesion in the mucous and submucous membrane, carcinomas and extrinsic lesions. Results: The degree of concordance between the two procedures on the diagnosis of polyps was 76%. Virtual colonoscopy had 85.7% sensibility (IC 52.6-100) and a negative predictive value of 92.9% (IC 75.8-100) for the diagnosis of polyps. These are considered important findings, but with wide intervals of confidence due to the small quantity of patients. Conclusion: In this study we found a high negative predictive value, which means that virtual colonoscopy could be the initial diagnostic method of choice in the screening of colorectal pathologies. In case it is negative, pathology is ruled out. If it is positive, the diagnosis method to follow in order to confirm the findings would be direct colonoscopy.

Korean Guidelines for Colorectal Cancer Screening and Polyp Detection

Colorectal cancer is the second most common cancer in males and the fourth most common in females in Korea. Since the most of colorectal cancer occur through the prolonged transformation of adenomas into carcinomas, early detection and removal of colorectal adenomas are one of the most effective methods to prevent colorectal cancer. Considering the increasing incidence of colorectal cancer and polyps in Korea, it is very important to establish Korean guideline for colorectal cancer screening and polyp detection. Korean Multi-Society Take Force developed the guidelines with evidence-based methods. Parts of the statements drawn by systematic reviews and meta-analyses. Herein we discussed the epidemiology of colorectal cancers and adenomas in Korea, optimal screening methods for colorectal cancer, and detection for adenomas including fecal occult blood tests, radiologic tests, and endoscopic examinations.

Korean Guidelines for Colorectal Cancer Screening and Polyp Detection

Colorectal cancer is the second most common cancer in males and the fourth most common in females in Korea. Since the most of colorectal cancer occur through the prolonged transformation of adenomas into carcinomas, early detection and removal of colorectal adenomas are one of the most effective methods to prevent colorectal cancer. Considering the increasing incidence of colorectal cancer and polyps in Korea, it is very important to establish Korean guideline for colorectal cancer screening and polyp detection. Korean Multi-Society Take Force developed the guidelines with evidence-based methods. Parts of the statements drawn by systematic reviews and meta-analyses. Herein we discussed the epidemiology of colorectal cancers and adenomas in Korea, optimal screening methods for colorectal cancer, and detection for adenomas including fecal occult blood tests, radiologic tests, and endoscopic examinations.

Value of CT virtual colonoscopy in the diagnosis of colorectal diseases / 中国医师进修杂志

ObjectiveTo estimate the value of CT virtual colonoscopy (CTVC) and its image postprocessing techniques in the diagnosis of colorectal diseases.MethodsCTVC images of 84 patients with suspected colorectal diseases were retrospectively analyzed combined with multiple planar reconstruction (MPR),shaded surface display(SSD) and transparent image reconstruction.The location,size,shape and type of the lesions were analyzed and the images were compared with electronic colonoscopy and pathologic specimen finding.ResulltsFify-nine of 84 patients were diagnosed as coloretal cancer (23 cases with cancer in sigmoid colon,22 cases in rectum,11 cases in ascending colon and 3 cases in appendix),8 cases were porctopolypus,3 cases were multiple colonic diverticula,1 case was hemorrhoids,13 cases were normal.All the diagnosis was confirmed correct by operation pathology or clinic.ConclusionCTVC can show the shape and other features of colorectal diseases,and has important significance for clinical staging and surgical planning of colorectal cancer.

Korean Guidelines for Colorectal Cancer Screening and Polyp Detection / 대한소화기학회지

Colorectal cancer is the second most common cancer in males and the fourth most common in females in Korea. Since the most of colorectal cancer occur through the prolonged transformation of adenomas into carcinomas, early detection and removal of colorectal adenomas are one of the most effective methods to prevent colorectal cancer. Considering the increasing incidence of colorectal cancer and polyps in Korea, it is very important to establish Korean guideline for colorectal cancer screening and polyp detection. Korean Multi-Society Take Force developed the guidelines with evidence-based methods. Parts of the statements drawn by systematic reviews and meta-analyses. Herein we discussed the epidemiology of colorectal cancers and adenomas in Korea, optimal screening methods for colorectal cancer, and detection for adenomas including fecal occult blood tests, radiologic tests, and endoscopic examinations.

Performance of computed tomographic colonography for the screening of colorectal polyp in acromegalic patients: a prospective study / Desempenho da colonografia tomográfica computadorizada para o rastreamento de pólipo colorretal em pacientes acromegálicos: um estudo prospectivo

CONTEXT: Acromegalic patients have better chances to develop colorectal polyps and cancer and, considered a high-risk group, need to undergo frequent screening examinations. Moreover, in acromegalia, the increased bowel length and the intestinal loop complexity can lead to higher levels of technical difficulties and increase the risks of complications at conventional colonoscopy. Computed tomographic colonography, also known as virtual colonoscopy, is an innovative and secure technology which is revolutionizing the diagnosis of colon and rectum neoplasias. OBJECTIVE: To analyze computed tomographic colonography performance for the screening of colorectal polyps in acromegalic patients. METHODS: A prospective study of 21 asymptomatic acromegalic patients, 12 male and 9 female, average age 49, who underwent computed tomographic colonography and conventional colonoscopy. Computed tomographic colonography was performed with a GE Helical Multislice Computed Tomography Apparatus. Conventional colonoscopy was performed in the same day, without previous knowledge of the computed tomographic colonography diagnostics. The study evaluated the capacity of computed tomographic colonography to detect patients with colorectal polyps and identify each colorectal lesion described by the colonoscopy. RESULTS: In two patients (2/21), conventional colonoscopy was incomplete. However, in all patients computed tomographic colonography was complete. In Phase I ("per patient"), computed tomographic colonography diagnosed eight of the nine patients with colorectal polyps and showed 88 percent sensitivity, 75 percent specificity and 81 percent accuracy. In Phase II ("per polyp"), out of the 21 acromegalic patients included in this study, 12 presented normal findings at conventional colonoscopy. A total of 19 polyps were identified in 9 patients. Ten of the 19 polyps were smaller than 10 mm, and 9 were equal to or larger than 10 mm. Computed tomographic colonography...

CONTEXTO: Pacientes com acromegalia apresentam maiores chances de desenvolver pólipo e câncer colorretal e, sendo considerados integrantes do grupo de risco, necessitam serem submetidos aos exames de rastreamento. Por sua vez, na acromegalia, o maior comprimento do cólon e a formação de alças intestinais complexas podem prever maiores dificuldades técnicas e aumentar o risco em potencial de complicações durante o exame de colonoscopia convencional. A colonografia tomográfica computadorizada, também denominada colonoscopia virtual, é uma tecnologia inovadora e segura, que está revolucionando o diagnóstico das neoplasias do cólon e do reto. OBJETIVO: Analisar o desempenho da colonografia tomográfica computadorizada no rastreamento de pólipos colorretais em pacientes com acromegalia. Métodos - Estudo prospectivo com 21 pacientes acromegálicos, 12 do sexo masculino e 9 do sexo feminino, idade média de 49 anos, assintomáticos, submetidos a colonografia tomográfica computadorizada e colonoscopia convencional. A colonografia tomográfica computadorizada foi realizada com aparelho de tomografia computadorizada helicoidal multislice da marca GE. A colonoscopia convencional foi realizada, no mesmo dia, sem prévio conhecimento do diagnóstico da colonografia tomográfica computadorizada. O estudo avaliou a capacidade da colonografia tomográfica computadorizada para detectar pacientes acromegálicos com pólipos colorretais e a identificação de cada lesão colorretal descrita pela colonoscopia. RESULTADOS: Em dois pacientes (2/21) a colonoscopia convencional foi incompleta. Entretanto, em todos os pacientes a colonografia tomográfica computadorizada foi completa na avaliação colorretal. Na primeira fase ("por paciente"), a colonografia tomográfica computadorizada diagnosticou oito de nove pacientes com pólipos colorretais e mostrou 88 por cento de sensibilidade, 75 por cento de especificidade e 81 por cento de precisão. Na segunda fase ("por pólipo")...

Avaliação do desempenho da colonografia tomográfica computadorizada (colonoscopia virtual) no diagnóstico de pólipos colorretais / Evaluation of computed tomographic colonography for detection of colorectal polyps

RACIONAL: A colonografia tomográfica computadorizada tem sido proposta como teste substituto da colonoscopia para o diagnóstico de pólipos colorretais em programas de rastreamento de câncer de intestino grosso. OBJETIVO: Avaliar o desempenho da colonografia tomográfica computadorizada na detecção de pólipos colorretais, considerando a colonoscopia como padrão-ouro. MÉTODOS: Foram estudados 20 pacientes com alto risco para neoplasia colorretal (14 homens e 6 mulheres com idades médias de 55 e 59 anos, respectivamente). A colonografia tomográfica computadorizada foi realizada até 3 horas antes da colonoscopia. Um cateter com balão foi introduzido no reto com insuflação dos cólons e do reto com ar ambiente até que fosse obtida distensão satisfatória dos mesmos. Para otimizar a distensão colônica, minimizar artefatos decorrentes da peristalse e diminuir o espasmo, foram administrados 20 mg de hioscina intravenosa imediatamente antes do exame radiológico. RESULTADOS: A imagem radiológica do cólon foi considerada de qualidade satisfatória em todos os casos. A colonoscopia detectou o total de 85 pólipos em 19 dos 20 pacientes (95 por cento). Todos os pólipos observados foram removidos e encaminhados para exame anatomopatológico. A colonografia tomográfica computadorizada identificou 8 dos 10 pólipos com diâmetros > 10 mm (80 por cento), 2 dos 19 com diâmetro entre 5 e 9 mm (18,2 por cento), e apenas 1 dos 53 <5 mm (9,1 por cento). Dos 43 pólipos adenomatosos, 17 eram > 5 mm. Destes, 8 (47 por cento) foram corretamente identificados pela colonografia tomográfica computadorizada. Nenhuma das neoplasias com diâmetros <5mm foi observada no exame radiológico. Dezenove dos 20 pacientes (95 por cento) submetidos a ambos os testes prefeririam submeter-se a nova colonoscopia, ao invés de uma colonografia tomográfica computadorizada, na eventualidade hipotética de ser necessário repetir um dos dois testes. CONCLUSÃO: Para pacientes com risco aumentado...

BACKGROUND: Computed tomographic colonography has been proposed for detection of colorectal polyps instead of colonoscopy in colorectal cancer screening programs. AIM: To evaluate the performance of computed tomographic colonography in the detection of colorectal polyps with colonoscopy used as the gold standard. METHODS: We prospectively studied 20 patients at high risk for colorectal neoplasia (14 men and 6 women; mean age, 55 years and 59 years). Computed tomographic colonography was performed immediately before colonoscopy. We inserted a rectal balloon catheter and insufflated the colon with room air to the level that a good distension was observed. Twenty milligrams of hioscin was given immediately before computed tomographic imaging of the abdomen and pelvis in order to minimize the degree of smooth-muscle spasm and peristalsis and to reduce the patient's discomfort. RESULTS: Computed tomographic colonography images were considered satisfactory in all cases. Colonoscopy detected 85 polyps in 19 of 20 patients (95 percent). All the observed polyps were successfully removed and examined histologically. The radiological examination correctly identified 8 of 10 polyps 10 mm or more in diameter, 2 of 19 (18,2 percent) with 5-9 mm, and just 1 of 53 <5mm (9,1 percent). Seventeen of the 43 adenomatous polyps were > 5 mm. Eight (47 percent) were correctly identified on computed tomographic colonography. None of the neoplasias <5 mm were identified on colonography. Nineteen patients preferred colonoscopy in the event of having to repeat on of the two examinations. CONCLUSION: For the detection of colorectal polyps, computed tomographic colonography seems to be useful only when the result is positive, as the negative results of this examination cannot eliminate the presence of these lesions.

Extracolonic Findings of CT Colonography: Frequency Analysis between Symptomatic and Asymptomatic Patients

PURPOSE: To perform a frequency analysis of the extracolonic findings (ECF) of the CT colonography between symptomatic and asymptomatic patients. MATERIALS AND METHODS: Seventy-two consecutive symptomatic patients and sixty-three consecutive asymptomatic patients who underwent CT colonography were enrolled in this study. Non-contrast enhanced axial images were reviewed retrospectively to identify the ECF and classified them as major, moderate or minor important findings according to their potential clinical importance. The frequencies of each classification and ECF were analyzed and compared between two groups (symptomatic and asymptomatic). RESULTS: Eighty-two ECF were identified in 49 (68.1%) of the 72 symptomatic patients. The findings were classified as follows: major (8/49, 11.1%), moderate (17/49, 23.6%), minor (39/49, 54.2%). Sixty ECF were detected in 38 (60.3%) of the 63 asymptomatic patients. The findings were classified as follows: major (2/38, 3.2%), moderate (7/38, 11.1%), minor finding (35/63, 55.6%). No statistically significant differences were found between the two groups (p > 0.05) for the overall ECF frequency. However, a significantly higher frequency of major or moderate ECF was observed in symptomatic patients (30.6%) compared to asymptomatic patients (12.7%) (p < 0.05). CONCLUSION: The overall ECF frequency was similar between symptomatic and asymptomatic patients; however, the frequency of clinically important ECF (major or moderate) was higher in symptomatic patients, compared to asymptomatic patients. This result suggests that the major or moderate ECF required a further work up or treatment in symptomatic patients.