Colonoscopy
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]
- Bowel cleaning method
Administering the osmotic laxative the morning of the colonoscopy[9], 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[10]. A smaller 960-mL oral sulfate solution split between half the evening before and half the morning of the procedure may be an alternative.[11]
- 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.[12]
Adverse effects
Colonoscopy has infrequent severe adverse effects.[13] In a study of 2531 volunteers 50 years of age or older undergoing colonoscopy:[14]
- 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]
- ↑ 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.