Abstract

The index of hemoglobin (IHb) has not been applied in colonoscopy to correlate the histological features of colon polyps. This study tested whether the net change of IHb values between polyp and normal mucosa correlates with the pathological features of colon polyps. This study consecutively enrolled patients who underwent colonoscopy during September 2011–August 2012 in a single tertiary referral colorectal unit. Endoscopic pictures and IHb values of each part of the colon were taken at the levels of cecum, ascending colon, transverse colon, sigmoid colon, and rectum. The net change of IHb values was calculated as follows: IHb value of colon polyp minus that of the surrounding mucosa. A total of 117 patients (32 with hyperplastic polyp, 5 with sessile serrated adenoma, 53 with tubular adenoma, 10 with villotubular adenoma, and 3 with adenocarcinoma) were recruited. The net change of IHb values increased in following order: hyperplastic polyp, tubular adenoma, sessile serrated adenoma, villotubular adenoma, and adenocarcinoma (−3.8 ± 6.3, −1.2 ± 1.7, −1.2 ± 5.7, 2.9 ± 8.1, and 12.7 ± 9.3, respectively, p < 0.001). Alcohol drinking and serum hemoglobin level were two independent factors related to the IHb values of non-polyp colon mucosa. Using a cutoff value of 2.4 for the net change of IHb values, selected based on the receiver operating characteristic curve analysis, the optimal sensitivity (52.9%) and specificity (75.6%) could be achieved for defining the polyp histology as an advanced colon lesion. The net change of IHb values between colon polyp and nonpolyp mucosa can correlate with the pathological features of colon polyps. A positive net change of IHb values may indicate a more adverse histological pattern with a higher malignant potential.

Abstract

In Taiwan, the prevalence of colorectal cancer has been increasing in recent decades. As a result, the fecal occult blood test (FOBT) has been advocated and widely used for colorectal cancer screening in areas with limited colonoscopy capacity. The goal of this study was to analyze the sensitivity of a single immunochemical FOBT (I-FOBT) and correlate it with the results of colonoscopy for detecting colorectal neoplasia in the asymptomatic Taiwanese population. Data were collected from the results of health examinations conducted on asymptomatic adults older than 40 years and who simultaneously underwent one-time I-FOBT and colonoscopy examinations between January 01, 2008 and June 30, 2009. The sensitivity and specificity of the I-FOBT were calculated in correlation to age, size, and pathologic result. A total of 6096 patients were analyzed, including 3418 men and 2678 women, aged 40–87 years. I-FOBT result was positive in 229 patients (3.8%), the sensitivity of detection of total colorectal neoplasia and advanced neoplasia were 6.98% and 22.1%, respectively. A total of 13 participants were found to have invasive cancer in this study, and the sensitivity and specificity of the I-FOBT in this group were 69.2% and 96.4%, respectively. Besides, the positive rate of I-FOBT increased with age, with 40–49 years (2.89%), 50–75 years (4.21%), and >75 years (5.68%). In addition, the sensitivity for detecting total neoplasia and advanced neoplasia was similar in patients ≥50 years and ≥40 years of age. The I-FOBT has better sensitivity for detecting invasive cancer and advanced neoplasia than for detecting nonadvanced neoplasia. Repeated I-FOBT examinations with good adherence to the screening program may improve the detection rate and sensitivity of the I-FOBT.

Abstract

Adequate colonic cleansing is essential for a high quality colonoscopy. Few studies have investigated the association between patient education and quality of bowel preparation. The control group comprised 165 participants who underwent colonoscopy after a standard bowel preparation protocol during the period September–October 2013 and the study group comprised 251 individuals who underwent colonoscopy after a modified bowel preparation protocol during the period January–February 2014. The modified bowel preparation protocol included an instructional video and leaflet, a dietician-designed 2-day low fiber diet, a follow-up phone message, and information to confirm stool characteristics. The Aronchick Bowel Preparation Scale was used to define the quality of bowel preparation. The endoscopists who performed the procedures were blinded to the preparation protocols. The percentage of participants with excellent bowel preparation quality was significantly higher in the study group than in the control group (35.9% vs. 21.8%, p = 0.002). Also, the percentage of participants with poorly prepared bowels was significantly higher in the control group than in the study group (3% vs. 0.8%, p = 0.042). Moreover, the adenoma detection rate was significantly higher in the study group (35.1% vs. 24.8%, p = 0.028). The results show that the quality of bowel cleansing can be improved by providing patients with a modified bowel preparation protocol.

Abstract

Adequate bowel preparation is an important quality indicator of colonoscopy. This study validated whether the bowel cleansing quality and adenoma detection rate (ADR) could be different between two bowel preparation schedules in individuals receiving health examinations. We enrolled individuals who had received a colonoscopy as part of the regimen for their health checkup program with split-dose phosphosoda for bowel preparation. Prior to December 31, 2012, the second dose of phosphosoda was administered at 10:00 pm before the day of the colonoscopy and the individuals were defined as the 10-pm group. After January 1, 2013, the schedule was changed to 4:00 am the same day as the colonoscopy and was defined as the 4-am group. The bowel cleansing quality was assessed using the Aronchick scale. A total of 431 individuals were included, 259 in the 10-pm group and 172 in the 4-am group. The 4-am group individuals had a higher rate of excellent or good bowel cleansing quality as compared with the 10-PM group (77.3% vs. 22%, respectively, p < 0.001). The ADR was also higher in the 4-am group than in the 10-pm group (36% vs. 25.5%, respectively, p = 0.019). Modifying the time schedule of bowel preparation could improve bowel cleansing quality and increase the colonic ADR in a health management center.

Abstract

A Dieulafoy lesion is an uncommon and sometimes life-threatening cause of gastrointestinal hemorrhage. Typically, it presents as a tiny mucosal defect with an exposed protruding artery with normal surrounding mucosa. An 84-year-old woman developed sudden massive hematochezia and had an unstable hemodynamic status. The source of bleeding was found to be an exposed vessel in the rectum without surrounding ulceration. The patient was treated successfully with an epinephrine injection given endoscopically, followed by hemostatic clipping.

Abstract

Colonoscopy is a standard and useful examination in the diagnosis of colorectal diseases, however, it usually causes pain to patients. Some patients receive narcotic drugs, e.g., meperidine, for pain relief if a colonoscopy is carried out without sedation. Whether the administration of such analgesic drugs to patients without sedation facilitates the performance of the colonoscopy or reduces pain remains to be elucidated. The aim of this study was to evaluate the analgesic effect of meperidine as premedication for patients undergoing a colonoscopy without sedation. A total of 217 patients (109 men, 108 women) undergoing a diagnostic colonoscopy without sedation were analyzed prospectively. The procedures were carried out by three experienced endoscopists in a medical center. The patients could opt to receive analgesic drugs, with 25 mg of meperidine being given intramuscularly prior to the procedure if requested by either the doctor or patient. The colonoscopic examination was performed by one person using the short-axis method. Questionnaires to evaluate abdominal pain during or after colonoscopy without sedation were collected and analyzed for patients who used meperidine as premedication (Group A) and for those who did not receive meperidine (Group B). Abdominal pain was evaluated using a visual analog scale from 0 to 10. The cecal intubation rate, total insertion time, and the patients willingness to receive another colonoscopy in the future if needed were also analyzed. In both groups, the cecal intubation rate was more than 99% with no significant difference between groups. The mean ± standard deviation insertion time was 7.14 ± 5.45 minutes in Group A and 6.24 ± 4.24 minutes in Group B (p = 0.309). The visual analog pain score was 3.54 ± 3.13 in Group A and 2.46 ± 2.75 in Group B (p = 0.009). After adjusting for age and sex, the pain score was 3.51 ± 3.21 in Group A (p = 0.055). Multivariate analysis showed that female sex and the individual endoscopist performing the colonoscopy were associated with abdominal pain during the examination. In our study, premedication with meperidine or no premedication was not associated with a reduction in abdominal pain during colonoscopy without sedation. The insertion time and cecal intubation rate showed no difference between patients with or without additional analgesic drugs prior to the procedure. However, as self-selection bias could not be ruled out, further randomized, placebo-controlled trials are needed to confirm our findings.

Abstract

Colonoscopic polypectomy is a common procedure for removing colonic polyps to prevent subsequent development of colon cancer. Hemorrhage is the most common complication following polypectomy, with a reported rate of 0.3% to 6.0%. The risk increases to 12.5% when the size of the polyp stalk exceeds 1 cm. The most commonly used endoscopic preventive techniques, such as injection therapy, prophylactic use of endoclip, or endoloop, were found to decrease the rate of post-polypectomy hemorrhage, and repeated use of these techniques is useful for controlling bleeding. Here, we reported a case of a 65-year-old man with refractory post-polypectomy hemorrhage for a 2-cm adenomatous polyp. Application of an endoloop using the tulip-bundle technique achieved successful hemostasis. To our knowledge, this is the first report of this technique being used to treat refractory acute post-polypectomy hemorrhage.