Colonoscopy: Difference between revisions
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;Operative experience | ;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> | 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> Non-gastroenterologists do not do as well.<ref name="pmid19879970">{{cite journal| author=Rabeneck L, Paszat LF, Saskin R| title=Endoscopist specialty is associated with incident colorectal cancer after a negative colonoscopy. | journal=Clin Gastroenterol Hepatol | year= 2010 | volume= 8 | issue= 3 | pages= 275-9 | pmid=19879970 | ||
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&retmode=ref&cmd=prlinks&id=19879970 | doi=10.1016/j.cgh.2009.10.022 }} </ref> | |||
;Bowel cleaning method | ;Bowel cleaning method | ||
Revision as of 18:06, 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] In a study of 2531 volunteers 50 years of age or older undergoing colonoscopy:[15]
- 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.
- ↑ 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.