Endoscopic ultrasound-guided colo-colostomy for the treatment of benign complete occlusion of colonic anastomosis: a case series and description of technique.

AIM: The incidence of benign colonic anastomotic stricture is approximately 2% in patients undergoing left hemicolectomy or anterior resection and as high as 16% in patients undergoing low anterior or intersphincteric resection. In the majority, rather than complete occlusion, a stenosis forms, which can be managed with endoscopic balloon dilatation, a self-expanding metallic stent or endoscopic electroincision. In the less common scenario of a completely occluded colonic anastomosis, surgery is often required. In this study, we aim to describe the technique we used to treat this condition non-operatively METHOD: We describe a case series of three patients with benign complete occlusion of their colorectal anastomosis and how we managed them nonoperatively with a colonic/rectal endoscopic ultrasound (EUS) anastomosis technique and a Hot lumen-apposing metallic stent. RESULTS: We demonstrate that the technical and clinical success for this technique is 100%. CONCLUSIONS: We believe that the technique we describe is effective and safe. It should be widely reproducible in centres with expertise in interventional EUS, given the similarity to well-established procedures such as EUS-guided gastroenterostomy. Patient selection and timing of reversal of ileostomy need careful consideration, especially in patients with a history of keloid formation. Given the shorter hospital stay and reduced invasiveness of this technique, we believe it should be considered for all patients who have complete benign occlusion of a colonic anastomosis. However, given the small number of cases and short period of follow-up, the long-term outcome of this technique is not known. More studies with higher power and a longer period of follow-up should be conducted to further ascertain the effectiveness of this technique.

Safety of the colonoscope magnetic imaging device (ScopeGuide) in patients with implantable cardiac devices.

BACKGROUND AND STUDY AIMS: Use of the colonoscope magnetic imaging device (ScopeGuide, Olympus Medical Systems, Tokyo, Japan) is currently contraindicated by the manufacturer for patients with implantable cardiac devices, a group of patients that is increasing annually along with the number of colonoscopies performed in the era of colorectal cancer screening. This is the first study to examine the safety of ScopeGuide in patients with permanent pacemakers, implantable cardioverter defibrillators, and cardiac resynchronization therapy. PATIENTS AND METHODS: Nonimplanted cardiac devices were exposed to the electromagnetic field of ScopeGuide ex vivo and assessed for evidence of interference or change in device settings. Following this, consecutive patients attending device check clinics were prospectively recruited and exposed to the ScopeGuide electromagnetic field. After an initial device check, patients underwent continuous external cardiac monitoring and device interrogation while a colonoscope was placed on the abdomen over clothing and connected to ScopeGuide to simulate colonoscopy. Patients were monitored for 2 minutes to assess for any interference. ScopeGuide was then disconnected and devices were checked for any change in settings. RESULTS: A total of 230 patients were invited to participate and 100 were recruited to the study. There was no evidence of interference on device leads or change in programming following exposure to the electromagnetic field generated by ScopeGuide. CONCLUSION: ScopeGuide does not appear to cause interference or change in settings and is therefore likely to be safe for use in patients with implantable cardiac devices.

Comparison of Pentax HiLine and Olympus Lucera systems at screening colonoscopy.

AIM: To compare the performance characteristics of Pentax HiLine (PHL) (with i-scan) and Olympus Lucera (OL) systems in a screening population. METHODS: Screening colonoscopies in asymptomatic guaiac faecal occult blood test-positive patients with PHL (n = 58) and OL (n = 425) colonoscopes were analysed. All procedures were performed by a single colonoscopist. PHL used white-light endoscopy (WLE) on scope insertion and contrast/surface enhancement (i-scan 1) on withdrawal, and OL utilised WLE both on insertion and withdrawal. Patient age, sex, instrument insertion and withdrawal times, nurse assessed patient comfort scores, midazolam and fentanyl doses, procedure completion and rates of lesion detection were recorded separately for each group. Comparisons between the groups were made using either Fisher's exact test (for dichotomous variables) or Mann-Whitney U test (for ordinal and continuous variables). RESULTS: Colonoscopy completion rates were similar in both groups: 413/425 (97.2%) for OL and 55/58 (94.9%) for PHL (P = 0.24). For complete colonoscopies, the two groups were well matched for age, sex, colonoscope insertion times (mean 11.1 min in OL vs 11.6 min in PHL, P = 0.93) and normal colonoscopy withdrawal times (mean 15.6 min in OL vs 14.7 min in PHL, P = 0.2). Patients in the PHL group experienced a small increase in discomfort (mean patient comfort scores were 0.49 in the OL and 0.95 in the PHL group, P < 0.0001). While Fentanyl doses required were similar between groups (mean 57.5 µg in OL vs 61.4 µg in PHL, P = 0.13), slightly more Midazolam was required in the PHL group (mean 2.1 mg in OL vs 2.4 mg in PHL, P = 0.035). There was no difference in polyp (58% in OL vs 67% in PHL) or adenoma (49% in OL vs 56% in PHL) detection rates between the groups. Neither the total number of polyps and adenomas, nor the characteristics of these (including size, location or presence of advanced features) were different between the two systems. CONCLUSION: This study suggests that there is no advantage of either colonoscope system in lesion detection.