Un nuevo método sencillo y exacto para medir el tamaño de los pólipos durante la colonoscopia / A simple new method to accurately measure the size of polyps during colonoscopy

Resumen Introducción: tradicionalmente, los pólipos colónicos se miden empíricamente por estimación visual y con las pinzas de biopsia, aunque dichos métodos son inexactos. Diferentes métodos han sido investigados, pero no tienen la exactitud esperada. Por lo anterior, se realizó este trabajo para construir un algoritmo que permitiera medir los pólipos a partir de fotografías tomadas con el colonoscopio. Materiales y métodos: el trabajo se realizó en tres fases. En la primera, se construyó un algoritmo en el programa MATLAB. Se capturaron fotos en formato JPG con el colonoscopio. En la segunda fase, con el algoritmo se midieron imágenes de objetos con tamaños conocidos para verificar la exactitud del algoritmo. Después de verificar la exactitud, fue sometida al algoritmo la fotografía de los pólipos del colon. En la tercera fase, se utilizaron imágenes de pólipos previamente enviadas a tres expertos. Todas las fotografías fueron tomadas con el colonoscopio Olympus Exera II. Resultados: en los objetos menores de 5 mm, el algoritmo sobreestimó el tamaño entre 0,11 y 0,08 mm; en los mayores de 5 mm, sobreestimó el tamaño entre 0,25 mm y 1,76 mm en los de 22 mm. Los expertos sobrestimaron los tamaños de manera importante. En los pólipos de 7, 8 y 9 mm, los expertos dijeron que medían 12, 15 y 18 mm, respectivamente. Conclusión: el algoritmo desarrollado tiene adecuada exactitud para medir pólipos colónicos. Por su fácil consecución y utilización, podría ser una herramienta para solucionar la dificultad de medir pólipos durante una colonoscopia.

Abstract Introduction: Traditionally, colon polyps' measurements have been empirically estimated visually and with biopsy forceps, but neither method is inaccurate. Other methods have been studied but have not had the accuracy expected. The research reported here was undertaken to address this issue by building an algorithm for measure polyps from photographs taken through a colonoscope. Materials and methods: The study was done in three phases. First, an algorithm was built in MATLAB, and photos taken with a colonoscope were stored in the JPG format. In the second phase, images of objects with known sizes were checked against the algorithm to verify its accuracy. After verification of the algorithm's accuracy, photographs of colon polyps were measured using the algorithm. In phase 3, images of polyps previously sent to three experts were measured with the algorithm. All photographs were taken with an Olympus Exera II Colonoscope. Results: For objects smaller than 5 mm, the algorithm overestimated sizes by 0.11 to 0.08 mm. For those greater than 5 mm, it overestimated sizes by 0.25 mm to 1.76 mm in those of 22 mm. The experts seriously overestimated sizes. They estimated that 7 mm polyps measured 12 mm, 8 mm polyps measured 15 mm, and 9 mm polyps measured 18mm. Conclusion: The algorithm developed is sufficiently accurate for measuring colon polyps and is easy to obtain and relatively easy to use. It could become a tool for overcoming the difficulty of measuring polyps during a colonoscopy.

Efficacy of Peracetic Acid (EndoPA®) for Disinfection of Endoscopes / 대한소화기학회지

BACKGROUND/AIMS: We aimed to investigate the efficacy of peracetic acid (EndoPA®; Firson Co., Ltd., Cheonan, Korea) in disinfecting endoscopes. METHODS: We prospectively investigated the gastroscopes (Part I) utilized in 100 gastroscopic examinations and colonoscopes (Part II) utilized in 30 colonoscopic examinations after disinfecting them with 0.2% peracetic acid (EndoPA®; Firson Co., Ltd.). These instruments had been collected consecutively throughout the study period. We reprocessed and disinfected the endoscopes according to the guidelines for cleaning and disinfecting gastrointestinal endoscopes laid down by the Korean Society of Gastrointestinal Endoscopy in 2017. Three culture samples were obtained from each examination, based on different sampling methods. The primary outcome was a positive culture rate. RESULTS: In Part I of our study, two of 300 samples were positive. The culture positive rate after disinfection was 0.7% (2/300). The culture positive rate was not significantly different based on the exposure time to EndoPA® or the age of the scopes (p=0.7 or 0.2, respectively). In Part II of our study, all samples (n=90) were negative. CONCLUSIONS: We conclude that 0.2% peracetic acid (EndoPA®) appears to be a good disinfectant for both gastroscopes and colonoscopes.

Can water insufflation and carbon dioxide overcome the difficulties of colonoscope insertion?

No abstract available.

Intussusception after Colonoscopy: A Case Report and Review of Literature

Intussusception after colonoscopy is an unusual complication. A MEDLINE search revealed only 7 reported cases. We present a report of a 28-year-old man who developed abdominal pain several hours after routine colonoscopy and in whom computed tomography (CT) revealed colocolic intussusception. We postulate that this condition is iatrogenic and induced by suctioning of gas on withdrawal of the colonoscope. A common observation among the reported cases was abdominal pain several hours after colonoscopy and right-sided intussusception. All cases had colonoscopy reaching the right side of the colon. Treatment for adult intussusception remains controversial with regard to reduction versus resection, especially given the high association with a pathological cause and malignancy. Among the 8 reported cases, only the current case did not require surgery. A combination of benign colonoscopy, CT, and the clinical picture should provide sufficient information to initially choose a more conservative treatment approach.

Current status of endoscopic balloon dilation for Crohn's disease

The therapeutic target in Crohn's disease (CD) has been raised to the achievement of mucosal healing. Although effective treatments that target cytokines and other molecules has been widely used for CD, intestinal strictures are still a major cause of surgery. Endoscopic balloon dilation (EBD) is known to be an effective and safe intervention for intestinal strictures in CD. Since frequent intestinal resection often results in short bowel syndrome and can decrease the quality of life, EBD can help avoid surgery. EBD with a conventional colonoscope for Crohn's strictures of the colon and ileo-colonic anastomosis has established efficacy and safety. In addition, EBD using balloon-assisted enteroscopy has recently been applied for small bowel Crohn's strictures. Although the evidence is not strong, EBD may become an alternative to surgery in small bowel strictures in CD. EBD and other new methods such as self-expanding stent implantation for Crohn's strictures may be useful and safe; however, it is important to address several issues regarding these interventions and to establish a protocol for combined therapies.

Clinical Significance of Preoperative Virtual Colonoscopy for Evaluation of the Proximal Colon in Patient With Obstructive Colorectal Cancer

PURPOSE: Virtual colonoscopy is the most recently developed tool for detecting colorectal cancers and polyps, but its effectiveness is limited. In our study, we compared the result of preoperative virtual colonoscopy to result of preoperative and postoperative colonoscopy. We evaluated also the accuracy of preoperative virtual colonoscopy in patients who had obstructive colorectal cancer that did not allow passage of a colonoscope. METHODS: A total of 164 patients who had undergone preoperative virtual colonoscopy and curative surgery after the diagnosis of a colorectal adenocarcinoma between November 2008 and August 2013 were pooled. We compared the result of conventional colonoscopy with that of virtual colonoscopy in the nonobstructive group and the results of preoperative virtual colonoscopy with that of postoperative colonoscopy performed at 6 months after surgery in the obstructive group. RESULTS: Of the 164 patients, 108 were male and 56 were female patients. The mean age was 62.7 years. The average sensitivity, specificity, and accuracy of virtual colonoscopy for all patients were 31.0%, 67.2%, and 43.8%, respectively. In the nonobstructive group, the average sensitivity, specificity, and accuracy were 36.6%, 66.2%, and 48.0%, respectively, whereas in the obstructive group, they were 2%, 72.4%, and 25.4%. Synchronous cancer was detected via virtual colonoscopy in 4 of the 164 patients. CONCLUSION: Virtual colonoscopy may not be an effective method for the detection of proximal colon polyps, but it can be helpful in determining the therapeutic plan when its results are correlated with the results of other studies.

Development of a Robotic Colonoscopic Manipulation System, Using Haptic Feedback Algorithm

PURPOSE: Colonoscopy is one of the most effective diagnostic and therapeutic tools for colorectal diseases. We aim to propose a master-slave robotic colonoscopy that is controllable in remote site using conventional colonoscopy. MATERIALS AND METHODS: The master and slave robot were developed to use conventional flexible colonoscopy. The robotic colonoscopic procedure was performed using a colonoscope training model by one expert endoscopist and two unexperienced engineers. To provide the haptic sensation, the insertion force and the rotating torque were measured and sent to the master robot. RESULTS: A slave robot was developed to hold the colonoscopy and its knob, and perform insertion, rotation, and two tilting motions of colonoscope. A master robot was designed to teach motions of the slave robot. These measured force and torque were scaled down by one tenth to provide the operator with some reflection force and torque at the haptic device. The haptic sensation and feedback system was successful and helpful to feel the constrained force or torque in colon. The insertion time using robotic system decreased with repeated procedures. CONCLUSION: This work proposed a robotic approach for colonoscopy using haptic feedback algorithm, and this robotic device would effectively perform colonoscopy with reduced burden and comparable safety for patients in remote site.

Refractory pseudomembranous colitis that was treated successfully with colonoscopic fecal microbial transplantation

Pseudomembranous colitis (PMC) is a nosocomial and opportunistic infection caused by Clostridium difficile. PMC is related to the use of antibiotics leading to intestinal dysbiosis and an overgrowth of C. difficile. Metronidazole or vancomycin is considered to be the standard therapy for the management of PMC. However, PMC has a 15%-30% recurrence rate and can be refractory to standard treatments, resulting in morbidity and mortality. Here we describe a patient who experienced refractory PMC who was treated with fecal microbiota transplantation. A 69-year-old woman was admitted to the hospital with consistent abdominal pain and diarrhea, which had been present for 5 months. She was diagnosed with PMC by colonoscopy and tested positive for C. difficile toxin. Even though she took metronidazole for 10 days, followed by vancomycin for 4 weeks, her symptoms did not improve. Because of her recurrent and refractory symptoms, we decided to perform fecal microbiota transplantation. Fifty grams of fresh feces from a donor were obtained on the day of the procedure, mixed with 500 mL of normal saline, and then filtered. The filtered solution was administered to the patient's colon using a colonoscope. After the procedure, her symptoms rapidly improved and a follow-up colonoscopy showed that the PMC had resolved without recurrence.

Comparison of the efficacy of disinfectants in automated endoscope reprocessors for colonoscopes: tertiary amine compound (Sencron2®) versus ortho-phthalaldehyde (Cidex®OPA)

BACKGROUND/AIMS: To prevent the transmission of pathogens by endoscopes, following established reprocessing guidelines is critical. An ideal reprocessing step is simple, fast, and inexpensive. Here, we evaluated and compared the efficacy and safety of two disinfectants, a tertiary amine compound (TAC) and ortho-phthalaldehyde (OPA). METHODS: A total of 100 colonoscopes were randomly reprocessed using two same automated endoscope reprocessors, according to disinfectant. The exposure time was 10 minutes for 0.55% OPA (Cidex® OPA, Johnson & Johnson) and 5 minutes for 4% TAC (Sencron2®, Bab Gencel Pharma & Chemical Ind. Co.). Three culture samples were obtained from each colonoscope after reprocessing. RESULTS: A total of nine samples were positive among the 300 culture samples. The positive culture rate was not statistically different between the two groups (4% for OPA and 2% for TAC, P=0.501). There were no incidents related to safety during the study period. CONCLUSIONS: TAC was non-inferior in terms of reprocessing efficacy to OPA and was safe to use. Therefore, TAC seems to be a good alternative disinfectant with a relatively short exposure time and is also less expensive than OPA.

Endocuff-Assisted Colonoscopy—A Novel Accessory in Improving Adenoma Detection Rate: A Review of the Literature

Endocuff (Arc Medical Design) is a U.S. Food and Drug Administration-approved device that is attached like a cap to the distal tip of the colonoscope; it is used to improve adenoma detection rates during colonoscopy. The aim of this review was to summarize and evaluate the clinical and technical efficacy of Endocuff in improving adenoma detection rate. A comprehensive literature review was performed to identify studies describing this technique. In this review article, we have summarized case series and reports describing Endocuff use and results. The reported indications, results, limitations, and complications are discussed.

Fecal Microbiota Transplantation: Current Applications, Effectiveness, and Future Perspectives

Fecal microbiota transplantation (FMT) is the infusion of liquid filtrate feces from a healthy donor into the gut of a recipient to cure a specific disease. A fecal suspension can be administered by nasogastric or nasoduodenal tube, colonoscope, enema, or capsule. The high success rate and safety in the short term reported for recurrent Clostridium difficile infection has elevated FMT as an emerging treatment for a wide range of disorders, including Parkinson's disease, fibromyalgia, chronic fatigue syndrome, myoclonus dystopia, multiple sclerosis, obesity, insulin resistance, metabolic syndrome, and autism. There are many unanswered questions regarding FMT, including donor selection and screening, standardized protocols, long-term safety, and regulatory issues. This article reviews the efficacy and safety of FMT used in treating a variety of diseases, methodology, criteria for donor selection and screening, and various concerns regarding FMT.

Use of a Double-Channel Gastroscope Reduces Procedural Time in Large Left-Sided Colonic Endoscopic Mucosal Resections

BACKGROUND/AIMS: Endoscopic mucosal resection (EMR) of large colorectal lesions is associated with increased procedural time. The objective of this study was to evaluate the effect of double-channel gastroscope (DCG) use on the procedural time of EMRs in the rectosigmoid area. METHODS: All EMRs for sessile or flat rectosigmoid lesions > or =2 cm performed between July 2011 and September 2012 were retrospectively analyzed. RESULTS: There were 55 lesions > or =2 cm in the rectosigmoid area in 55 patients, of which 26 were removed by EMR using a DCG (DC group) and 29 by using an ordinary colonoscope or gastroscope (OS group). The mean size of the removed polyps, morphology, adverse effects, and other parameters were similar between the two groups. The mean procedural time was significantly lower in the DC group than in the OS group (24.4+/-18.3 minutes vs. 36.3+/-24.4 minutes, p=0.015). Moreover, in a subgroup of patients with polyps >40 mm, the statistical difference in the mean procedural time between the DC and OS groups was even more pronounced (33+/-21 minutes vs. 58.7+/-20.6 minutes, p=0.004). CONCLUSIONS: Our data suggest that the use of a DCG in the resection of large nonpedunculated rectosigmoid lesions significantly reduces the procedural time.

Is Retroflexion Helpful in Detecting Adenomas in the Right Colon?: A Single Center Interim Analysis

BACKGROUND/AIMS: Colonoscopy is less effective at screening for colorectal cancer in the right side of the colon. Retroflexion during colonoscopy is expected to improve the detection rate of colorectal adenomas. The aim of the present study was to evaluate the usefulness of retroflexion in the right-sided colon. METHODS: From April to November 2013, a total of 398 patients were enrolled in this study. For each patient, a cap-assisted colonoscopic examination was performed. After cecal intubation, a forward view examination from the cecum up to the hepatic flexure was performed and all identified polyps were removed. The colonoscope was reinserted to the cecum, and a careful second forward view examination of the cecum to the hepatic flexure was performed, with removal of additionally identified polyps. The colonoscope was then reinserted to the cecum and retroflexed; a third colonoscopic examination was then performed to the hepatic flexure in retroflexion with removal of additional polyps. Total polyp numbers and characteristics were compared between the two forward view examinations and the retroflexion examination. RESULTS: A successful retroflexion was performed in 90.2% of patients. A total of 213 polyps and 143 adenomas were detected in the right-sided colon using the routine method of examining the right colon twice in forward view. An additional 35 polyps and 24 adenomas were detected on retroflexion. Of these 35 polyps, 27 (77.1%) were small-sized polyps (< or =5 mm) and 24 (71.4%) were adenomas. Finding additional adenomas using the retroflexion technique was associated with older age. CONCLUSIONS: Colonoscopic retroflexion is helpful in the detection of cecum and ascending colon adenomas, especially small-sized adenomas (< or =5 mm). It is particularly useful in older patients.

Metachronous schwannoma in the colon with vestibular schwannoma

We experienced a case of vestibular schwannoma and metachronous schwannoma in the colon. A 59-year-old female presented with a 1-month history of hematochezia. She had undergone suboccipital craniectomy resulting in radical subtotal resection, followed by gamma knife radiosurgery for a large left vestibular schwannoma 4 years prior to admission. On preoperative colonoscopy, a huge mass through which the colonoscope could not be passed was detected. CT scans showed colo-colonic intussusception with a 4.8-cm-sized mass in the descending colon. PET/CT revealed hypermetabolism of the descending colon tumor and pericolic lymph nodes. We performed left hemicolectomy under the preoperative impression of colon cancer with intussusception. A pathological diagnosis of benign schwannoma of the colon was made in this patient.

A Randomized Controlled Trial of Comparison on Time and Rate of Cecal and Termianl Ileal Intubation according to Adult-Colonoscope Length: Intermediate versus Long

For a complete colonoscopic examination, a high intubation rate and a short intubation time have been demanded to colonoscopists, if possible. The aim of the present study was to compare these examination parameters, intubation time and rate, according to the length of colonoscope. A total of 507 healthy Korean subjects were randomly assigned into two groups: intermediate length adult-colonoscope (n=254) and long length adult-colonoscope (n=253). There were significant differences in cecal intubation time and in terminal ileal intubation rate according to the length of the colonoscope. Time-to-cecal intubation was shorter for the intermediate-scope group than for the long-scope group (234.2 +/- 115.0 sec vs 280.7 +/- 135.0 sec, P < 0.001). However, the success rate of terminal ileal intubation was higher in the long-scope group than in the intermediate-scope group (95.3% vs 84.3%, P < 0.001). There were no significant differences in other colonoscopic parameters between the two groups. The intermediate length adult-colonoscope decreased the time to reach the cecum, whereas the long-scope showed a success rate of terminal ileal intubation. These findings suggest that it is reasonable to prepare and use these two types of colonoscope appropriate to the needs of the patient and examination, instead of employing only one type of colonoscope.

Comparison on colonoscopic parameters according to length of adult-colonoscope / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>High success rate of intubation and short intubation time have been needed to endoscopists for a complete and comfortable colonoscopy, if possible. The purpose of present study was to compare procedure efficiencies according to adult-colonoscope length.</p><p><b>METHODS</b>This was a prospective, randomized, single-blinded controlled trial. A total of 239 healthy Korean subjects were randomly assigned to two groups: one group receiving intermediate-length adult-colonoscope (n = 119), and the other group receiving long-length adult-colonoscope (n = 120). Cecal intubation time and rate, and terminal ileal intubation time and rate as well as other procedure-related outcomes (adenoma detection rate, withdrawal time, and total procedure time) were evaluated.</p><p><b>RESULTS</b>There were significant differences in cecal intubation time and terminal ileal intubation rate according to colonoscope length. The time of cecal intubation was shorter in the intermediate-scope group than that in the long-scope group ((222.13 ± 101.67) s vs. (253.85 ± 109.40) s, P = 0.014). However, the rate of terminal ileal intubation was higher in the long-scope group than that in the intermediate-scope group (94.2% vs. 83.2%, P = 0.007). In addition, terminal ileal intubation time was also shorter in the long-scope group than that in the intermediate-scope group ((35.21 ± 38.89) s vs. (44.09 ± 33.87) s, P < 0.001). There were no significant differences in other procedure-related outcomes between the two groups.</p><p><b>CONCLUSIONS</b>The intermediate-length adult-colonoscope had an advantage over the long-length adult-colonoscope regarding cecal intubation time, whereas the long-scope had an advantage over the intermediate-scope regarding the rate and time of terminal ileal intubation. These results suggest that it is rational to prepare and use these two types of colonoscope properly, instead of employing only one type of colonoscope.</p>

La vigilancia colonoscópica previa a lo estipulado en las normativas actuales / Colonoscopic surveillance performed earlier than in current practice

Se demostró que aquellos pacientes con un primer estudio con preparación regular presentaron una incidencia significativamente mayor de pólipos perdidos.

How Do I Overcome Difficulties in Insertion?

Demand for colonoscopy is increasing because it is an important tool not only for screening of colorectal neoplasm but also for resection of such lesions in early stage. Cecal intubation requires expertise on shortening of the examination time and improvement of the cecal intubation rate without causing pain to the patients. About 5% to 10% of patients still experience difficulties or failure of the cecal intubation. There are number of factors that affect the difficulty of the colonoscopy such as technical skill of the endoscopist, angulated sigmoid, redundant colon, advanced age, female gender, diverticular disease, and inadequate bowel preparation. In an effort to overcome these situations and to and aiding colonoscope insertion with reducing pain, various methods have introduced. Like this review discusses ways to approach patients with technically difficult colons for achieving the successful cecal intubation.

A New Technique Using Ultra-slim Endoscopy for High-Grade Crohn's Stricture

Crohn's disease (CD) is a chronic inflammatory bowel disease of unknown etiology. Most patients with CD will eventually develop a stricturing or penetrating complication. Colonoscopic findings may predict the clinical course in patients with CD. Moreover, since CD patients are at increased risk for developing dysplasia and colorectal cancer, surveillance colonoscopy is necessary for the detection of malignancies. We describe here a CD patient with a high-grade anorectal stricture who successfully underwent a total colon examination with an ultra-slim upper endoscope after an insertion failure with a standard colonoscope and gastroscope.

Effect of Previous Abdominal or Pelvic Surgery on Colonoscopy / 대한소화기내시경학회지

BACKGROUND/AIMS: A number of studies have reported wide variability in the colonoscope insertion time among patients who had prior abdominal surgery. The aim of this study was to investigate the effect of abdominal surgery on colonoscope insertion time. METHODS: The subjects were 192 patients with prior abdominal surgery, among 3,600 patients who underwent a colonoscopy at Samsung Changwon Hospital from May 2008 to May 2010. We collected the following data: insertion time, age, gender, height, weight, BMI, waist circumference, method of abdominal surgery, and the degree of bowel cleanliness. Previous abdominal operations were divided into colectomy, non-colectomy abdominal surgery, pelvic surgery, and laparoscopic surgery groups. RESULTS: The average colonoscope insertion time in patients with prior abdominal surgery (7.73+/-5.95 min) was longer than that of the non-surgery group (6.4+/-3.88 min). Patients in the colectomy groups were older and had a shorter insertion time (5.11+/-3.32 min) than patients in the other groups. CONCLUSIONS: Insertion of a colonoscope in patients with previous abdominal surgery was more difficult than that in the control group, except the colectomy group.