Evolving issues in colon endoscopy:
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia [u.a.]
Saunders
1997
|
| Schriftenreihe: | Gastrointestinal endoscopy clinics of North America
7,3 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XIV S., S. 345 - 544 Ill., graph. Darst. |
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| 245 | 1 | 0 | |a Evolving issues in colon endoscopy |c Douglas K. Rex, guest. ed. |
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Datensatz im Suchindex
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| adam_text | EVOLVING ISSUES IN COLON ENDOSCOPY
CONTENTS
Preface xiii
Douglas K. Rex
Growth Rate of Colon Polyps and Cancer 345
Bjorn Hofstad and Morten Vatn
Malignancy potential of colorectal polyps increases with size. The
growth rate and destiny of each polyp is virtually unknown. It
was recently shown that polyps smaller than 10 mm left in situ
may partly regress or partly increase in size, whereas one quarter
of polyps are unchanged after 3 years. Polyps smaller than 5 mm
show a mean increase in size, whereas polyps measuring 5 to
9 mm show a mean decrease in size. Methodologic problems with
the measurement of polyps and cancer are discussed. More studies
of polyp growth related to risk factors are warranted.
Colon Cancer Screening: Sigmoidoscopy or Colonoscopy 365
Sanjiv K. Khullar and James A. DiSario
Colorectal cancer is a common neoplasia with high morbidity and
mortality. With endoscopy it is possible to identify its precursor
lesion, the adenoma, and early localized cancer. Early detection
and removal of adenomas can reduce the incidence and mortality
of this disease. Studies using fecal occult blood testing (FOBT) and
sigmoidoscopy for screening asymptomatic patients demonstrate
a reduction in mortality from colorectal cancer. Colonoscopy, how¬
ever, has the highest yield for detecting polyps. Most authorities
and organizations now recommend screening the asymptomatic
population over age 50 for colorectal neoplasia. The estimated cost
of colon cancer screening is well within the benchmark figure of
,000 per year of life saved, which is considered by the govern¬
ment to be cost effective. Controversies still exist regarding which
GASTROINTESTINAL ENDOSCOPY
CLINICS OF NORTH AMERICA
VOLUME 7 • NUMBER 3 • JULY 1997 vii
colon cancer screening strategy is the most sensitive, specific, ac¬
ceptable to the population, and cost effective. The American Cancer
Society recommends a combination of FOBT and flexible sigmoid
oscopy, but some experts believe that a one time colonoscopy at
age 60 may be a more cost effective method. If the costs of colonos¬
copy are reduced, it is more cost effective than other techniques.
Colonoscopy also may help to stratify at risk patients, and those
with negative initial colonoscopy may not need further screening.
Advances in molecular biology may provide markers for screening
or identifying people who are at high risk for colorectal neoplasia.
This development may allow screening to be directed at high
risk groups.
Prevalence and Incidence of Colorectal Adenomas and Cancer
in Asymptomatic Persons 387
Alfred I. Neugut, Judith S. Jacobson, and Vincent A. Rella
The prevalence of colorectal adenomatous polyps varies widely
from country to country and is highly correlated with colorectal
cancer incidence rates in each country. The prevalence of adenomas
reported in older studies was based on autopsy findings and is
higher than that in more recent studies based on endoscopy find¬
ings. Among asymptomatic, average risk patients, adenoma preva¬
lence averages approximately 10% in sigmoidoscopy studies and
more than 25% in colonoscopy studies, whereas the prevalence
of colorectal cancer among these patients is less than 1%. The
cumulative incidence of new adenomas within 3 years after normal
endoscopy averages about 7% by flexible sigmoidoscopy and 27%
by colonoscopy.
Marking and Identifying Colon Lesions: Tattoos, Clips, and
Radiology in Imaging the Colon 401
Kenneth K. Ellis and M. Brian Fennerty
Precise knowledge of a lesion s location in the colon is infrequently
required. Occasionally, however, this information can be of critical
clinical importance. A variety of endoscopic and radiologic tech¬
niques have been described to localize an area or site within the
colon. Tissue staining or tattooing is the most reliable endoscopic
method of colon lesion localization, and India ink provides a long
lasting and probably permanent tattoo of the site. Endoscopic clips
are less reliable and remain cumbersome to use. Electronic imaging
is an intriguing approach but remains experimental. Sites and le¬
sions also can be identified by barium radiography or fluoroscopy,
but these techniques involve added expenses and are not as reliable
as tattooing with India ink.
New Methods of Polypectomy 413
Jerome D. Waye
The three most prominent advances in colonoscopic polypectomy
are the submucosal injection of saline to ensure safety of polypec
viii contents
tomy, the use of the small, or mini, snare for removal of most colon
polyps, and the introduction of the argon plasma coagulator for
the treatment of vascular abnormalities of the colon and the fulgu
ration of residual adenoma at the base of sessile polyps with a
noncontact technique. The role of Endoloop, endoscopic clips, and
rubber band ligation for polypectomy is discussed.
Colonic Chromoscopy: A New Perspective on Polyps and
Flat Adenomas 423
Christopher Y. Kim and David E. Fleischer
A recent innovation in colonoscopy has been the use of chromos¬
copy. This technique allows better visualization of mucosal lesions
by applying dyes to the mucosal surface. This article focuses on
the principles and techniques of chromoscopy and magnification
in the colon. The authors also describe the use of chromoscopy for
differentiating polyps and detecting flat adenomas. The clinical
significance of flat adenomas is reviewed.
Computed Tomographic Colography and Virtual Colonoscopy 439
David A. Ahlquist, Amy K. Hara, and C. Daniel Johnson
CT colography (CTC) is a powerful new approach to imaging the
colorectum and a promising screening tool for the detection of
colorectal neoplasia. From data generated by a helical CT scan,
CTC uses virtual reality technology to produce highly discriminant
two and three dimensional images that permit a thorough and
minimally invasive evaluation of the entire colorectum. A dynamic
CTC display technique from the endoluminal perspective, called
virtual colonoscopy, simulates colonoscopy by flying through the
three dimensional colon image. CTC offers potential advantages in
diagnostic performance, safety, and patient acceptance over current
screening approaches. Although early data suggest excellent colo¬
rectal polyp detection rates, this nascent technology will require
rigorous clinical investigation and further refinements to assess
adequately its place in the endoscopist s armamentarium.
Cancer Biology in Ulcerative Colitis and Potential Use in
Endoscopic Surveillance 453
Bradley D. Shapiro and Bret A. Lashner
Because patients with longstanding ulcerative colitis are at an in¬
creased risk for developing colorectal cancer, surveillance colonos¬
copy and colectomy for dysplasia or asympomatic cancer is advised
as a method of reducing cancer related mortality. Generally, the
use of dysplasia as a criterion for a positive test in cancer surveil¬
lance has performed poorly. The emerging field of colon cancer
genetics has identified several important tumor markers that have
the potential to improve sensitivity for the detection of early neo¬
plasia. Specifically, p53 tumor suppressor gene mutations, aneu
ploidy, and mucin associated sialosyl Tn expression appear most
promising for future use in surveillance programs.
CONTENTS ix
Real Time Magnetic Three Dimensional Imaging of
Flexible Endoscopy 469
Christopher B. Williams, Brian P. Saunders, G. Duncan Bell,
John S. Bladen, Duncan F. Gillies, and Christopher M. Guy
Because of the variability of the colonic anatomy from patient
to patient, colonoscopy may be technically difficult to perform
and teach, and lesions may be localized inaccurately by the
endoscopist. Endoscopists understandably have abandoned fluo
roscopy as an adjunct because of its expense, complexity, and
potential hazard. The authors have developed a novel method
of magnetic imaging that gives real time views in simulated
three dimensions of the endoscope configuration and the location
of its tip in the abdomen. The system is inherently safe and
easy to use, although it currently requires a catheter to be
inserted into the instrumentation channel. Preliminary experience
suggests that this approach will be a significant help to endoscop¬
ists performing colonoscopy, particularly to those who are cur¬
rently learning or less experienced.
Colonoscopy for Diagnosis and Treatment of Severe
Lower Gastrointestinal Bleeding: Routine Outcomes
and Cost Analysis 477
Dennis M. Jensen and Gustavo A. Machicado
Approximately 10% to 15% of patients seen by gastroenterologists
have severe, ongoing hematochezia, which most physicians as¬
sume is from a lower gastrointestinal (LGI) source. This article
discusses current colonoscopic diagnosis and treatment of patients
with severe LGI bleeding. The authors present their approach to
the diagnosis and treatment of patients with severe hematochezia.
They also discuss the specific lesions that cause this condition
and the cost assessment of emergency colonoscopy compared
to other approaches for diagnosis and treatment of severe hemato¬
chezia.
Colonoscopy and Acute Colonic Pseudo Obstruction 499
Douglas K. Rex
There is no well defined standard of care for the use of colonoscopy
in the treatment of acute colonic pseudo obstruction (ACPO). Co¬
lonoscopy can be helpful for ACPO, but it can be accompanied by
complications, is not completely effective, and can be followed by
recurrence. These possibilities must be weighed against the overall
risk of spontaneous perforation, which is low but real. The use
of colonoscopy therefore should be selective, and it should be
performed by experts and accompanied generally by tube
placement.
X CONTENTS
Detection and Treatment of Angiodysplasia 509
Benjamin Krevsky
Angiodysplasias of the colon are difficult to detect but usually easy
to treat. Colonoscopy is the most sensitive and specific method for
detection, but angiography, endoscopic ultrasound, and nuclear
medicine techniques are also useful. Emerging optical analysis
techniques, such as remote endoscopic digital spectroscopy and
enhancement with opioid antagonists, may improve detection
rates. Treatment is performed conventionally with contact probes.
Other methods of treatment include lasers, injection therapy, angio
graphic techniques, rubber band ligation, hormonal therapy, and
surgical resection.
Laparoscopic Colectomy: Prospects and Problems 525
Michael D. Holzman and Steve Eubanks
This article provides a fundamental review of laparoscopic colecto
mies. An overview of the physiology of laparascopic procedures
is given as an introduction to the rationale of laparoscopic colecto
mies. A review of the current published literature including indica¬
tions and an overview of laparoscopic bowel procedures for malig¬
nant diseases are presented.
Index 541
Subscription Information Inside back cover
CONTENTS xi
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| spelling | Evolving issues in colon endoscopy Douglas K. Rex, guest. ed. Philadelphia [u.a.] Saunders 1997 XIV S., S. 345 - 544 Ill., graph. Darst. txt rdacontent n rdamedia nc rdacarrier Gastrointestinal endoscopy clinics of North America 7,3 Colon - Radiographie Endoscopie digestive Coloskopie (DE-588)4207836-2 gnd rswk-swf (DE-588)4143413-4 Aufsatzsammlung gnd-content Coloskopie (DE-588)4207836-2 s DE-604 Rex, Douglas K. Sonstige (DE-588)156248514 oth Gastrointestinal endoscopy clinics of North America 7,3 (DE-604)BV005455484 7,3 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=007716663&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
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| title | Evolving issues in colon endoscopy |
| title_auth | Evolving issues in colon endoscopy |
| title_exact_search | Evolving issues in colon endoscopy |
| title_full | Evolving issues in colon endoscopy Douglas K. Rex, guest. ed. |
| title_fullStr | Evolving issues in colon endoscopy Douglas K. Rex, guest. ed. |
| title_full_unstemmed | Evolving issues in colon endoscopy Douglas K. Rex, guest. ed. |
| title_short | Evolving issues in colon endoscopy |
| title_sort | evolving issues in colon endoscopy |
| topic | Colon - Radiographie Endoscopie digestive Coloskopie (DE-588)4207836-2 gnd |
| topic_facet | Colon - Radiographie Endoscopie digestive Coloskopie Aufsatzsammlung |
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