Colonoscopy: Difference between revisions
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==Accuracy== | ==Accuracy== | ||
Colonosopy is not perfect and may miss [[colonic polyp]]s that could lead to [[colorectal cancer]].<ref name="pmid8978338">{{cite journal |author=Rex DK, Cutler CS, Lemmel GT, ''et al'' |title=Colonoscopic miss rates of adenomas determined by back-to-back colonoscopies |journal=Gastroenterology |volume=112 |issue=1 |pages=24–8 |year=1997 |month=January |pmid=8978338 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0016508597000152 |issn=}}</ref> Withdrawing the colonoscopy too fast may cause missing of important abnormalities.<ref name="pmid17167136">{{cite journal |author=Barclay RL, Vicari JJ, Doughty AS, Johanson JF, Greenlaw RL |title=Colonoscopic withdrawal times and adenoma detection during screening colonoscopy |journal=The New England journal of medicine |volume=355 |issue=24 |pages=2533–41 |year=2006 |month=December |pmid=17167136 |doi=10.1056/NEJMoa055498 |url=http://content.nejm.org/cgi/ | Colonosopy is not perfect and may miss [[colonic polyp]]s that could lead to [[colorectal cancer]].<ref name="pmid8978338">{{cite journal |author=Rex DK, Cutler CS, Lemmel GT, ''et al'' |title=Colonoscopic miss rates of adenomas determined by back-to-back colonoscopies |journal=Gastroenterology |volume=112 |issue=1 |pages=24–8 |year=1997 |month=January |pmid=8978338 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0016508597000152 |issn=}}</ref> Several factors affect accuracy. | ||
;Operative experience | |||
Colonoscopies performed by a [[primary care physician]] may be less accurate.<ref name="pmid17241863">{{cite journal |author=Bressler B, Paszat LF, Chen Z, Rothwell DM, Vinden C, Rabeneck L |title=Rates of new or missed colorectal cancers after colonoscopy and their risk factors: a population-based analysis |journal=Gastroenterology |volume=132 |issue=1 |pages=96–102 |year=2007 |month=January |pmid=17241863 |doi=10.1053/j.gastro.2006.10.027 |url=http://linkinghub.elsevier.com/retrieve/pii/S0016-5085(06)02261-X |issn=}}</ref> Colonoscopies performed by examiners who have performed a large volume of procedures are better(at least 200 per year)<ref name="pmid15712636">{{cite journal |author=Harewood GC |title=Relationship of colonoscopy completion rates and endoscopist features |journal=Dig. Dis. Sci. |volume=50 |issue=1 |pages=47–51 |year=2005 |month=January |pmid=15712636 |doi= |url=http://www.springerlink.com/openurl.asp?genre=article&issn=0163-2116&volume=50&issue=1&spage=47 |issn=}}</ref><ref name="pmid15672059">{{cite journal |author=Bernstein C, Thorn M, Monsees K, Spell R, O'Connor JB |title=A prospective study of factors that determine cecal intubation time at colonoscopy |journal=Gastrointest. Endosc. |volume=61 |issue=1 |pages=72–5 |year=2005 |month=January |pmid=15672059 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0016510704024617 |issn=}}</ref>, perhaps especially if the prior experience was very recent<ref name="pmid11437045">{{cite journal |author=Dafnis G, Granath F, Påhlman L, Hannuksela H, Ekbom A, Blomqvist P |title=The impact of endoscopists' experience and learning curves and interendoscopist variation on colonoscopy completion rates |journal=Endoscopy |volume=33 |issue=6 |pages=511–7 |year=2001 |month=June |pmid=11437045 |doi= |url= |issn=}}</ref> | |||
;Bowel cleaning method | |||
Administering the osmotic laxative the morning of the colonoscopy<ref name="pmid17661245">{{cite journal |author=Gupta T, Mandot A, Desai D, Abraham P, Joshi A, Shah S |title=Comparison of two schedules (previous evening versus same morning) of bowel preparation for colonoscopy |journal=Endoscopy |volume=39 |issue=8 |pages=706–9 |year=2007 |month=August |pmid=17661245 |doi=10.1055/s-2007-966375 |url=http://www.thieme-connect.com/DOI/DOI?10.1055/s-2007-966375 |issn=}}</ref>, 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<ref name="pmid17611916">{{cite journal |author=Park JS, Sohn CI, Hwang SJ, ''et al'' |title=Quality and effect of single dose versus split dose of polyethylene glycol bowel preparation for early-morning colonoscopy |journal=Endoscopy |volume=39 |issue=7 |pages=616–9 |year=2007 |month=July |pmid=17611916 |doi=10.1055/s-2007-966434 |url=http://www.thieme-connect.com/DOI/DOI?10.1055/s-2007-966434 |issn=}}</ref>. | |||
;Withdrawal time | |||
Withdrawing the colonoscopy too fast (less than 6 minutes) may cause missing of important abnormalities.<ref name="pmid17167136">{{cite journal |author=Barclay RL, Vicari JJ, Doughty AS, Johanson JF, Greenlaw RL |title=Colonoscopic withdrawal times and adenoma detection during screening colonoscopy |journal=The New England journal of medicine |volume=355 |issue=24 |pages=2533–41 |year=2006 |month=December |pmid=17167136 |doi=10.1056/NEJMoa055498 |url=http://content.nejm.org/cgi/content/full/355/24/2533 |issn=}}</ref> | |||
==Adverse effects== | ==Adverse effects== | ||
Revision as of 10:54, 4 March 2009
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.
- Operative experience
Colonoscopies performed by a primary care physician may be less accurate.[3] Colonoscopies performed by examiners who have performed a large volume of procedures are better(at least 200 per year)[4][5], perhaps especially if the prior experience was very recent[6]
- Bowel cleaning method
Administering the osmotic laxative the morning of the colonoscopy[7], 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[8].
- Withdrawal time
Withdrawing the colonoscopy too fast (less than 6 minutes) may cause missing of important abnormalities.[9]
Adverse effects
In a study of 2531 volunteers 50 years of age or older undergoing colonoscopy:[10]
- 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]
- ↑ 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]
- ↑ 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.
- ↑ 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.
- ↑ 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.