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World Journal of Gastroenterology Dec 2014The incidence of colorectal cancer has been increasing in the developed world including South Korea and China. Colonoscopy allows for greater diagnostic specificity and... (Review)
Review
The incidence of colorectal cancer has been increasing in the developed world including South Korea and China. Colonoscopy allows for greater diagnostic specificity and sensitivity compared with other types of examinations, such as the stool occult blood test, barium enema, and computed tomography colonography. Therefore, in recent years, the demand for colonoscopies has grown rapidly. New beginners including primary care physicians may help meet the increasing demand by performing colonoscopies. However, it is a challenge to learn the procedure due to the long learning-curve and the high rate of complications, such as perforation and bleeding, as compared to gastroscopy. Thus, considerable training and experience are required for optimal performance of colonoscopies. In order to perform a complete colonoscopic examination, there were a few important things to learn and remember, such as the position of examinee (e.g., left and right decubitus, supine, and prone) and examiner (two-man method vs one-man standing method vs one-man sitting method), basic skills (e.g., tip deflection , push forward and pull back, torque, air suction and insufflation), advanced skills (e.g., jiggling and shaking, right and left turn shortening, hooking, and slide-by technique), assisting skills (e.g., position change of examinee, abdominal compression, breathing-holding, and liquid-infusion technique), and intubation techniques along the lower gastrointestinal tract. In this article, we attempt to describe the methods of insertion and advancement of the colonoscope to the new beginners including primary care physician. We believe that this article may be helpful to the new beginners who wish to learn the procedure.
Topics: Clinical Competence; Colon; Colonic Diseases; Colonoscopy; Education, Medical, Graduate; Equipment Design; Humans; Learning Curve; Patient Positioning; Prognosis
PubMed: 25493011
DOI: 10.3748/wjg.v20.i45.16984 -
Hong Kong Medical Journal = Xianggang... Feb 2016Colorectal cancer is one of the top three cancers in the world in terms of incidence. Colonoscopy, which many regard as the gold standard in diagnosis of colonic polyps... (Review)
Review
Colorectal cancer is one of the top three cancers in the world in terms of incidence. Colonoscopy, which many regard as the gold standard in diagnosis of colonic polyps and neoplasm, is costly, invasive and labour-intensive, and deemed an unsuitable population-wide index screening tool. Alternative modalities, including guaiac and immunohistochemical faecal occult blood tests, computed tomographic colonography, colon capsule endoscopy, flexible sigmoidoscopy, and double-contrast barium enema are available. The procedures, test characteristics, and their implications are reviewed. Immunohistochemical faecal occult blood testing appears to be the most suitable population-wide screening test for an average-risk population, with flexible sigmoidoscopy as an alternative. More evidence is needed to determine the role of computed tomographic colonography and colon capsule endoscopy in colorectal cancer screening.
Topics: Colonography, Computed Tomographic; Colonoscopy; Colorectal Neoplasms; Early Detection of Cancer; Humans; Immunohistochemistry; Occult Blood; Sigmoidoscopy
PubMed: 26744124
DOI: 10.12809/hkmj154685 -
Journal of the National Medical... Apr 1986Peptic ulcer disease is a less common cause of gastrocolic fistula than either carcinoma of the stomach or colon. However, use of steroids or aspirin appear to make this...
Peptic ulcer disease is a less common cause of gastrocolic fistula than either carcinoma of the stomach or colon. However, use of steroids or aspirin appear to make this a more common complication of benign disease. The typical symptoms are pain, diarrhea, weight loss, foul eructation, and feculent vomiting. The most accurate method of diagnosis is with barium enema. The treatment is surgical.
Topics: Adult; Aspirin; Colonic Diseases; Female; Gastric Fistula; Humans; Intestinal Fistula; Stomach Ulcer
PubMed: 3712471
DOI: No ID Found -
BMJ Clinical Evidence Jun 2007Nearly two thirds of colorectal cancers occur in the rectum or sigmoid colon. It is the third most common cancer in resource-rich countries, accounting for about 20,000... (Review)
Review
INTRODUCTION
Nearly two thirds of colorectal cancers occur in the rectum or sigmoid colon. It is the third most common cancer in resource-rich countries, accounting for about 20,000 deaths each year in the UK, and 60,000 each year in the USA.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical question: What are the effects of screening for colorectal cancer? We searched: Medline, Embase, The Cochrane Library and other important databases up to November 2006 (BMJ Clinical evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 19 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review we present information relating to the effectiveness and safety of the following interventions: colonoscopy, computed tomography colography, double contrast barium enema, faecal occult blood testing, flexible sigmoidoscopy.
Topics: Colonoscopy; Colorectal Neoplasms; Evidence-Based Medicine; Humans; Incidence; Mass Screening; Occult Blood; Sigmoidoscopy
PubMed: 19454089
DOI: No ID Found -
Journal of the Anus, Rectum and Colon 2018Anal fistulas usually result from an anal gland infection in the intersphincteric space, which is caused by bacteria entering through the anal crypt (cryoptglandular... (Review)
Review
Anal fistulas usually result from an anal gland infection in the intersphincteric space, which is caused by bacteria entering through the anal crypt (cryoptglandular infection). Reports of anal fistulas have been as high as 21 people in 100,000. Anal fistulas are 2-6 times more prevalent in males than females, with the condition occurring most frequently in patients in their 30s and 40s. Anal abscess symptoms include sudden onset of anal pain, swelling, redness, and fever. Purulent discharge or intermittent perianal swelling and pain are most often consistent with anal fistula symptoms. Methods for diagnosing anal fistulas include visual inspection, palpation, digital examination, anoscopic examination, barium enema, fistulography, as well as imaging, such as ultrasound, CT, and MRI. Parks classification is widely adapted in the West; however, Japan usually employs Sumikoshi classification. Antibiotics should be administered in cases of perianal abscess with surrounding cellulitis, or concomitant systemic disease, or those not alleviated by incision and drainage. The site and size of incision and drainage depend upon the abscess type and location. Incisions should be performed taking care not to damage the sphincter muscles and with possible future fistula surgery in mind. As spontaneous recovery is rare, except in the case of children, surgery is the principle approach to anal fistulas. Several approaches are utilized for anal fistulas. A specific procedure may be chosen depending upon curability and anal function. Postsurgical outcomes vary from study to study. Fecal incontinence may occur after fistula surgery, but reports vary.
PubMed: 31559351
DOI: 10.23922/jarc.2018-009 -
Surgery Today Nov 2014Local excision is increasingly performed for "early stage" rectal cancer in the US; however, local recurrence after local excision has become a controversial issue in... (Review)
Review
Local excision is increasingly performed for "early stage" rectal cancer in the US; however, local recurrence after local excision has become a controversial issue in Western countries. Local recurrence is considered to originate based on the type of tumor and procedure performed, and in surgical margin-positive cases. This review focuses on the inclusion criteria of "early" rectal cancers for local excision from the Western and Japanese points of view. "Early" rectal cancer is defined as T1 cancer in the rectum. Only the tumor grade and depth of invasion are the "high risk" factors which can be evaluated before treatment. T1 cancers with sm1 or submucosal invasion <1,000 μm are considered to be "low risk" tumors with less than 3.2 % nodal involvement, and are considered to be candidates for local excision as the sole curative surgery. Tumors with a poor tumor grade should be excluded from local excision. Digital examination, endoscopy or proctoscopy with biopsy, a barium enema study and endorectal ultrasonography are useful for identifying "low risk" or excluding "high risk" factors preoperatively for a comprehensive diagnosis. The selection of an initial local treatment modality is also considered to be important according to the analysis of the nodal involvement rate after initial local treatment and after radical surgery.
Topics: Diagnostic Imaging; Digestive System Surgical Procedures; Digital Rectal Examination; Early Diagnosis; Endoscopy, Gastrointestinal; Female; Humans; Lymphatic Metastasis; Male; Neoplasm Grading; Neoplasm Invasiveness; Rectal Neoplasms; Risk Factors
PubMed: 24254058
DOI: 10.1007/s00595-013-0766-3 -
World Journal of Gastroenterology May 2015To evaluate the effectiveness of barium impaction therapy for patients with colonic diverticular bleeding.
AIM
To evaluate the effectiveness of barium impaction therapy for patients with colonic diverticular bleeding.
METHODS
We reviewed the clinical charts of patients in whom therapeutic barium enema was performed for the control of diverticular bleeding between August 2010 and March 2012 at Yokohama Rosai Hospital. Twenty patients were included in the review, consisting of 14 men and 6 women. The median age of the patients was 73.5 years. The duration of the follow-up period ranged from 1 to 19 mo (median: 9.8 mo). Among the 20 patients were 11 patients who required the procedure for re-bleeding during hospitalization, 6 patients who required it for re-bleeding that developed after the patient left the hospital, and 3 patients who required the procedure for the prevention of re-bleeding. Barium (concentration: 150 w%/v%) was administered per the rectum, and the leading edge of the contrast medium was followed up to the cecum by fluoroscopy. After confirmation that the ascending colon and cecum were filled with barium, the enema tube was withdrawn, and the patient's position was changed every 20 min for 3 h.
RESULTS
Twelve patients remained free of re-bleeding during the follow-up period (range: 1-19 mo) after the therapeutic barium enema, including 9 men and 3 women with a median age of 72.0 years. Re-bleeding occurred in 8 patients including 5 men and 3 women with a median age of 68.5 years: 4 developed early re-bleeding, defined as re-bleeding that occurs within one week after the procedure, and the remaining 4 developed late re-bleeding. The DFI (disease-free interval) decreased 0.4 for 12 mo. Only one patient developed a complication from therapeutic barium enema (colonic perforation).
CONCLUSION
Therapeutic barium enema is effective for the control of diverticular hemorrhage in cases where the active bleeding site cannot be identified by colonoscopy.
Topics: Administration, Rectal; Adult; Aged; Aged, 80 and over; Barium Sulfate; Contrast Media; Diverticulum, Colon; Enema; Female; Gastrointestinal Hemorrhage; Humans; Japan; Male; Middle Aged; Patient Positioning; Radiography; Recurrence; Retreatment; Retrospective Studies; Time Factors; Treatment Outcome
PubMed: 25987779
DOI: 10.3748/wjg.v21.i18.5555 -
Annals of the Royal College of Surgeons... May 2018Introduction Intussuception remains one of the most common surgical abdominal emergencies in the paediatric population. The aim of this study was first to re-evaluate...
Introduction Intussuception remains one of the most common surgical abdominal emergencies in the paediatric population. The aim of this study was first to re-evaluate our non-operative reduction rate of intussusception using multiple interval barium enemas and second to investigate or discuss an audit cycle, providing evidence and validating the modification of clinical practice. Materials and methods This five-year retrospective study performed at one of two institutions at which a paediatric surgical service is offered. Individuals included were all patients under 12-years of age who were diagnosed with intussusception. Factors considered to be influential in the reduction of the intussusception were collected. End points were defined as successful barium enema reduction or surgical intervention. Results were compared with similar research published in 2010. Results Overall prevalence was found to be 12 cases/year, with a sample size of 60 patients, the mean age at presentation of 13.6 months. Barium enema reduction was attempted in 56/60 patients, while 4/60 patients had operative management as a first intervention. Overall reduction rate was 66% (37/56), 78% occurring on first attempt and 22% on the second attempt. There was no evidence of intussusception in 3/19 patients who had operative management as a second intervention. Delayed interval barium enema reduction demonstrated an improved reduction rate of 66% compared with single-use barium enema reduction of 41% (chi square 0.02). Conclusion A significant benefit was achieved by performing delayed interval enema reduction, which contributed to a 61% increased reduction rate, the actual reduction rate approaches 71%. The audit cycle remains of paramount importance to ensure optimum patient care.
Topics: Barium Enema; Child, Preschool; Clinical Audit; Female; Humans; Infant; Intussusception; Male; Retrospective Studies; Treatment Outcome
PubMed: 29543052
DOI: 10.1308/rcsann.2018.0023 -
Diseases of the Colon and Rectum Jul 1990Hirschsprung's disease in the adolescent and adult is a rare and often misdiagnosed cause of lifelong refractory constipation. Two adolescent and three adult patients... (Review)
Review
Hirschsprung's disease in the adolescent and adult is a rare and often misdiagnosed cause of lifelong refractory constipation. Two adolescent and three adult patients with Hirschsprung's disease treated between 1973 and 1987 at the University of Michigan Medical Center are reported. Each patient presented with chronic constipation requiring enemas, cathartics, and multiple hospital admissions for management. Diagnosis in each case was made with barium enema and full-thickness rectal biopsy. Four patients underwent endorectal pull-through procedures, all with good long-term results. The fifth patient, initially treated with a Duhamel retrorectal pull-through procedure, required reoperation for constipation secondary to a retained rectal septum. Review of 199 cases of adult Hirschsprung's disease enables comparison of the various operative procedures for this disorder with respect to postoperative complications and functional outcomes. Anorectal myectomy with low anterior resection, the Duhamel-Martin procedure, and the Soave endorectal pull-through procedure are the most acceptable methods for surgical management.
Topics: Adolescent; Adult; Anal Canal; Biopsy; Constipation; Enema; Hirschsprung Disease; Humans; Methods; Muscles; Postoperative Complications; Rectum
PubMed: 2193786
DOI: 10.1007/BF02052222 -
Annals of the Royal College of Surgeons... Jul 1987The experience of 66 cases of colovesical fistula is reported. The most common cause was diverticular disease (71%), the remainder being due to malignancy, Crohn's...
The experience of 66 cases of colovesical fistula is reported. The most common cause was diverticular disease (71%), the remainder being due to malignancy, Crohn's disease, radiotherapy, appendicitis and trauma. The most sensitive investigation was barium enema, which was abnormal in 98% and actually showed the fistula in 57%. In 32 patients a single stage resection was performed, without mortality or significant morbidity and we would advocate this form of treatment for fistulae which are not complicated by gross sepsis or obstruction.
Topics: Colon; Colonic Diseases; Female; Humans; Intestinal Fistula; Male; Urinary Bladder; Urinary Bladder Fistula
PubMed: 3631873
DOI: No ID Found