Colonoscopy: Difference between revisions
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==Adverse effects== | ==Adverse effects== | ||
Colonoscopy has infrequent severe adverse effects.<ref name="pmid18938166">{{cite journal |author=Rabeneck L, Paszat LF, Hilsden RJ, ''et al'' |title=Bleeding and perforation after outpatient colonoscopy and their risk factors in usual clinical practice |journal=Gastroenterology |volume=135 |issue=6 |pages=1899–1906, 1906.e1 |year=2008 |month=December |pmid=18938166 |doi=10.1053/j.gastro.2008.08.058 |url=http://linkinghub.elsevier.com/retrieve/pii/S0016-5085(08)01673-9 |issn=}}</ref> In a study of 2531 volunteers 50 years of age or older undergoing colonoscopy:<ref name="pmid18799557">{{cite journal |author=Johnson CD, Chen MH, Toledano AY, ''et al'' |title=Accuracy of CT colonography for detection of large adenomas and cancers |journal=The New England journal of medicine |volume=359 |issue=12 |pages=1207–17 |year=2008 |month=September |pmid=18799557 |doi=10.1056/NEJMoa0800996 |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=18799557&promo=ONFLNS19 |issn=}}</ref> | Colonoscopy has infrequent severe adverse effects.<ref name="pmid19850154">{{cite journal| author=Ko CW, Riffle S, Michaels L, Morris C, Holub J, Shapiro JA et al.| title=Serious complications within 30 days of screening and surveillance colonoscopy are uncommon. | journal=Clin Gastroenterol Hepatol | year= 2010 | volume= 8 | issue= 2 | pages= 166-73 | pmid=19850154 | ||
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&retmode=ref&cmd=prlinks&id=19850154 | doi=10.1016/j.cgh.2009.10.007 | pmc=PMC2821994 }} </ref><ref name="pmid18938166">{{cite journal |author=Rabeneck L, Paszat LF, Hilsden RJ, ''et al'' |title=Bleeding and perforation after outpatient colonoscopy and their risk factors in usual clinical practice |journal=Gastroenterology |volume=135 |issue=6 |pages=1899–1906, 1906.e1 |year=2008 |month=December |pmid=18938166 |doi=10.1053/j.gastro.2008.08.058 |url=http://linkinghub.elsevier.com/retrieve/pii/S0016-5085(08)01673-9 |issn=}}</ref> In a study of 2531 volunteers 50 years of age or older undergoing colonoscopy:<ref name="pmid18799557">{{cite journal |author=Johnson CD, Chen MH, Toledano AY, ''et al'' |title=Accuracy of CT colonography for detection of large adenomas and cancers |journal=The New England journal of medicine |volume=359 |issue=12 |pages=1207–17 |year=2008 |month=September |pmid=18799557 |doi=10.1056/NEJMoa0800996 |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=18799557&promo=ONFLNS19 |issn=}}</ref> | |||
* [[hematochezia]] occured after snare polypectomy in one patient and required 2 days of hospitalization | * [[hematochezia]] occured after snare polypectomy in one patient and required 2 days of hospitalization | ||
* ''[[Escherichia coli]]'' [[bacteremia]] occur in one patient and required hospitalization | * ''[[Escherichia coli]]'' [[bacteremia]] occur in one patient and required hospitalization | ||
Revision as of 18:07, 13 April 2010
In medicine, colonoscopy is a "endoscopic examination, therapy or surgery of the luminal surface of the colon."[1]
Accuracy
Colonosopy is not perfect and may miss colonic polyps that could lead to colorectal cancer.[2] Several factors affect accuracy and these are part various quality indicators.[3][4]
- Operative experience
Colonoscopies performed by a primary care physician may be less accurate.[5] Colonoscopies performed by examiners who have performed a large volume of procedures are better(at least 200 per year)[6][7], perhaps especially if the prior experience was very recent[8] Non-gastroenterologists do not do as well.[9]
- Bowel cleaning method
Administering the osmotic laxative the morning of the colonoscopy[10], of splitting the administration of the osmotic laxative into a dose the evening before colonoscopy followed by a second dose the morning of the colonoscopy helps[11]. A smaller 960-mL oral sulfate solution split between half the evening before and half the morning of the procedure may be an alternative.[12]
- Cecal intubation rates
Operators should intubate 95% of cecums when screening healthy adults.[3]
- Withdrawal time
Withdrawing the colonoscopy too fast (less than 6 minutes) may cause missing of important abnormalities.[13]
Adverse effects
Colonoscopy has infrequent severe adverse effects.[14][15] In a study of 2531 volunteers 50 years of age or older undergoing colonoscopy:[16]
- hematochezia occured after snare polypectomy in one patient and required 2 days of hospitalization
- Escherichia coli bacteremia occur in one patient and required hospitalization
References
- ↑ Anonymous (2024), Colonoscopy (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ Rex DK, Cutler CS, Lemmel GT, et al (January 1997). "Colonoscopic miss rates of adenomas determined by back-to-back colonoscopies". Gastroenterology 112 (1): 24–8. PMID 8978338. [e]
- ↑ 3.0 3.1 Rex DK, Petrini JL, Baron TH, et al (April 2006). "Quality indicators for colonoscopy". Gastrointest. Endosc. 63 (4 Suppl): S16–28. DOI:10.1016/j.gie.2006.02.021. PMID 16564908. Research Blogging.
- ↑ The Joint Advisory Group on GI Endoscopy. Standards for Training in Endoscopy. http://www.thejag.org.uk. Accessed: March 4, 2009
- ↑ Bressler B, Paszat LF, Chen Z, Rothwell DM, Vinden C, Rabeneck L (January 2007). "Rates of new or missed colorectal cancers after colonoscopy and their risk factors: a population-based analysis". Gastroenterology 132 (1): 96–102. DOI:10.1053/j.gastro.2006.10.027. PMID 17241863. Research Blogging.
- ↑ Harewood GC (January 2005). "Relationship of colonoscopy completion rates and endoscopist features". Dig. Dis. Sci. 50 (1): 47–51. PMID 15712636. [e]
- ↑ Bernstein C, Thorn M, Monsees K, Spell R, O'Connor JB (January 2005). "A prospective study of factors that determine cecal intubation time at colonoscopy". Gastrointest. Endosc. 61 (1): 72–5. PMID 15672059. [e]
- ↑ Dafnis G, Granath F, Påhlman L, Hannuksela H, Ekbom A, Blomqvist P (June 2001). "The impact of endoscopists' experience and learning curves and interendoscopist variation on colonoscopy completion rates". Endoscopy 33 (6): 511–7. PMID 11437045. [e]
- ↑ Rabeneck L, Paszat LF, Saskin R (2010). "Endoscopist specialty is associated with incident colorectal cancer after a negative colonoscopy.". Clin Gastroenterol Hepatol 8 (3): 275-9. DOI:10.1016/j.cgh.2009.10.022. PMID 19879970. Research Blogging.
- ↑ Gupta T, Mandot A, Desai D, Abraham P, Joshi A, Shah S (August 2007). "Comparison of two schedules (previous evening versus same morning) of bowel preparation for colonoscopy". Endoscopy 39 (8): 706–9. DOI:10.1055/s-2007-966375. PMID 17661245. Research Blogging.
- ↑ Park JS, Sohn CI, Hwang SJ, et al (July 2007). "Quality and effect of single dose versus split dose of polyethylene glycol bowel preparation for early-morning colonoscopy". Endoscopy 39 (7): 616–9. DOI:10.1055/s-2007-966434. PMID 17611916. Research Blogging.
- ↑ Di Palma JA, Rodriguez R, McGowan J, Cleveland MB (2009). "A randomized clinical study evaluating the safety and efficacy of a new, reduced-volume, oral sulfate colon-cleansing preparation for colonoscopy.". Am J Gastroenterol 104 (9): 2275-84. DOI:10.1038/ajg.2009.389. PMID 19584830. Research Blogging.
- ↑ Barclay RL, Vicari JJ, Doughty AS, Johanson JF, Greenlaw RL (December 2006). "Colonoscopic withdrawal times and adenoma detection during screening colonoscopy". The New England journal of medicine 355 (24): 2533–41. DOI:10.1056/NEJMoa055498. PMID 17167136. Research Blogging.
- ↑ Ko CW, Riffle S, Michaels L, Morris C, Holub J, Shapiro JA et al. (2010). "Serious complications within 30 days of screening and surveillance colonoscopy are uncommon.". Clin Gastroenterol Hepatol 8 (2): 166-73. DOI:10.1016/j.cgh.2009.10.007. PMID 19850154. PMC PMC2821994. Research Blogging.
- ↑ Rabeneck L, Paszat LF, Hilsden RJ, et al (December 2008). "Bleeding and perforation after outpatient colonoscopy and their risk factors in usual clinical practice". Gastroenterology 135 (6): 1899–1906, 1906.e1. DOI:10.1053/j.gastro.2008.08.058. PMID 18938166. Research Blogging.
- ↑ Johnson CD, Chen MH, Toledano AY, et al (September 2008). "Accuracy of CT colonography for detection of large adenomas and cancers". The New England journal of medicine 359 (12): 1207–17. DOI:10.1056/NEJMoa0800996. PMID 18799557. Research Blogging.