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Prevalence of Colorectal Lesions in Acromegalic Patients
Abstracts
T1419 Evaluation of Colonoscopy Attached Oblique Transparent Cap During Insertion Into the Cecum in Colonoscopy Comparing Inexperienced with Experienced Endoscopists Koichiro Sato, Koichi Hirahata, Sumio Fujinuma, Sayo Itoh, Hiroaki Suda, Tadayoshi Kakemura, Iruru Maetani Background: Total colonoscopy is usually possible but it still remains difficult to acquire the insertion of the colonoscope into the cecum. The oblique transparent cap (OTC, Top, Tokyo, Japan) attaching the tip of colonoscope allows good visualization and makes the procedure easier by keeping the distance between the lens and the lumen. The aim of this study was to assess the OTC during the colonoscope insertion into the cecum between inexperienced and experienced endoscopists. Methods: Consecutive 448 patients were randomized to undergo colonoscopy by four endoscopists with OTC or without. Patients with colonic resections, poor bowel preparation and severe stricture in the colon were excluded. All procedures were performed by two inexperienced endoscopists who had performed less than 500 cases and two experienced who had performed more than 3000 cases. CF260AI was used (Olympus, Tokyo, Japan). Stiffening function was not used. All patients were sedated with pethidine hydrochloride (17.5 mg to 35 mg). The degree of pain and difficulty in insertion of the colonoscope into the cecum was assessed using visual analog scale (VAS 0 Z not at all or very easy 100 Z very severe or difficult). Cecal intubation time, pain and difficulty in insertion of the colonoscope into the cecum were retrospectively analyzed. Result: Inexperienced endoscopists performed 214 patinets, and 110 patients were randomly allocated to OTC-attached colonoscope and 104 patinets to non OTC-attached colonoscope. Experienced endoscopists performed 234 patients, and 119 patients were randomly allocated to OTC-attached colonoscope and 115 patients to non OTC-attached colonoscope. In inexperienced endoscopists the median cecal intubation time was 14.1 minutes with OTC group and 16.1 minutes without OTC group (P ! 0.001). In experienced endoscopists the median cecal intubation time was 5.3 minutes with OTC group and 5.5 minutes without OTC group (P Z 0.569). In inexperienced endoscopists the degree of pain was similar between colonoscope with OTC and without (36.3 mm vs. 39.8 mm; p Z 0.41) but in experienced endoscopists the examination was less painful with OTC than without OTC (18.2 mm vs. 25.6 mm; p ! 0.0046). In the colonoscope with OTC difficulty of cecal intubation was significantly lower than in the colonoscope without OTC in both inexperienced and experienced endoscopist (36.3 mm vs. 46.7 mm; p ! 0.0009, 18.2 mm vs. 25.6 mm; p Z 0.0048). Conclusions: By attaching the OTC to the tip of the colonoscope, endoscopists felt reducing the difficulty in total colonoscopy both endoscopist groups and even in experienced endoscopists less painful examination were achieved compared with conventional colonoscope.
T1420 Pit Pattern Diagnosis of Ulcerative Colitis Associated Dysplasia By Magnifying Colonoscopy Kazuo Ohtsuka, Ken-Ichi Mizuno, Hiroshi Kashida, Ryo Chinzei, Jun-Ichi Ukegawa, Takataro Fukuhara, Keita Sasajima, Yui Kudo, Shigeharu Hamatani, Osamu Ito, Shin-Ei Kudo Backgrounds and Aims: The risk for colorectal cancer increases in patients with long persistent ulcerative colitis (UC). Surveillance colonoscopy with step biopsies for detecting UC associated dysplasia is recommended, despite its huge efforts, because of the difficulties for diagnosing UC associated dysplasia and early stage cancer. Minute surface structures reflect histological findings in sporadic dysplasia and cancer of the colon. Because pit pattern diagnosis has excellent sensitivity and specificity, magnifying colonoscopy enables to detect them without biopsies. Here, we evaluated the magnifying colonoscopic view of the UC associated dysplasia and whether the pit pattern diagnosis improved the diagnosis of the UC associated dysplasia. Patients and Methods: Pit patterns of eleven cases of UC associated dysplasia and cancer were analyzed. Pit pattern was analyzed by Kudo’s classification; type I and II patterns are non neoplastic, type III and IV are dysplasia and type V is cancer. Then, sixty-five UC patients in remission were prospectively examined for surveillance. They were 48 pancolitis and 17 left side type. Suffering duration was more than four years because the shortest periods were four years for development of dysplasia after diagnosing UC. Mean duration time was 9.4 years. Using magnifying colonoscopy with indigo carmine spraying, pictures and specimens were obtained from cecum, ascending colon, transverse colon, descending colon, sigmoid colon, and rectum. Results: Using chromoendoscopy and magnifying colonoscopy, UC associated dysplasia and cancer showed type III, IV, or V pit pattern. Those pit patterns are characterized by irregular pit, varying size, loss of polarity, thin distribution, wide-open or fused type pits. There are some problems with this diagnostic modality, for example, non dysplastic regions sometimes show type III-like or IV-like pit patterns. It is difficult to distinguish between sporadic cancer and UC associated dysplasia. Next, 390 specimens were analyzed for surveilance. Type I or II pit patterns were observed in 386 regions and there was no dysplasia. Type III or IV pit patterns were observed in 4 regions and there were two dysplasias. Conclusion: Type I or II pit pattern lesions will not be dysplasia, hence selected biopsies from type III, IV or V patterns would be sufficient for detecting dysplasia. Magnifying colonoscopy would be useful for diagnosing early colorectal cancer associated with UC and spare the huge efforts of biopsies in surveillance colonoscopy.
AB254 GASTROINTESTINAL ENDOSCOPY Volume 65, No. 5 : 2007
T1421 Safety of Carbon Dioxide Insufflation During Colorectal ESD Tsuyoshi Kikuchi, Yutaka Saito, Takahisa Matsuda, Daizo Saito Introduction: Carbon dioxide (CO2) insufflation is useful during colonoscopy, and especially when Endoscopic Submucosal Dissection (ESD) is perfomed, as patient discomfort is significantly reduced. We have already performed over 150 ESD procedures with CO2 insufflation, with good results. However an increase in the concentration of end-tidal carbon dioxide (ETCO2) during surgical laparoscopy using CO2 insufflation has been reported. Therefore this issue deserves further evaluation. Aims & Methods: The aim was to assess the CO2 body pool during colonoscopy and ESD with CO2 insufflation We employed a percutaneous carbon dioxide (PtcCO2) monitor (TOSCA500 Radiometer, Barsel) and ptcCO2 was measured continuously by non-invasively affixing a sensor to skin. The study population consisted of 37 patients(17 females, mean age :65.4 9.4 years) undergoing colorectal ESD from February to October 2006, and examined about a change of the PtcCO2 density of time. Result: Lesion located at Cecum (6 patients), Right hemicolon(12 patients), Left hemicolon (12 patients), Rectum (7 patients). Operation time was 90 118 min (median SD), average diameter of excised specimen was 44.2 22.6 mm (mean SD). Midazolam average dose: 5.8 mg ( 4.1), average of ptcCO2 before starting insufflation: 40.7 mmHg ( 5.3), average of post procedural ptcCO2 :44.3 mmHg ( 5.7), ptcCO2 peak average 55.6 mmHg ( 8.1) , peak value were measured in any cases by just after the midazolam dosage or physique conversion (abdominal position time). Conclusion: By using PtcCO2 determination, we were able to confirm that the CO2 pool by CO2 insufflation during colonoscopy is low. The mean peak value reached is at a safer level than previously reported in many studies. We consider that ESD performed with CO2 insufflation is safe in terms of risk for CO2 narcosis.
T1422 Prevalence of Colorectal Lesions in Acromegalic Patients Perla O. Schulz, Marcia H. Costa, Hanna Beatriz Thomas De Sa´, Thais G. Andrade, Magali L. Couto, Celeste C. Elia, Marilia S. Andrade, Cyrla Zaltman Introduction: Acromegaly has been associated with an increased prevalence of colorectal lesions (CRL) as hyperplastic and adenomatous polyps and even adenocarcinoma. The mechanisms enrolled although are still unknown, but GH serum levels and longer periods of disease were considered. Aims & Methods: To evaluate the prevalence of colorectal lesions in acromegalic patients. Methods: This is a retrospective study of acromegalic patients, reffered to colonoscopy in the Gastroenterology Unit of HUCFF/UFRJ, between may/2000 and dec/2005. The prevalence of colorectal lesions was correlated with gender, age, duration of disease from the stabilishment of the diagnosis, GH serum levels, location and histological features the lesions observed. The findings were compared with age and sex matching controls. Results: 41 acromegalic patients underwent colonoscopy in the mentioned period. The mean age was 44 (13-72) and 78, 05% were female. The absolute number of polyps found was 25 with a mean number of 1.6 polyps / patient, being found in 39% of patients (16/41). Polyps were observed in more than one colonic segment in 31, 3% of cases and 87, 5% of them were located in the rectosigmoidal region. Polypectomy was performed in all cases and the polyps were captured for histological examination. The histological results showed that 72% (18/25) of polyps were hyperplastic, 20% (5/25) were tubular adenomas, and 4% (2/25) were adenomas from villous type (one HGD and another LGD). No adenocarcinoma was observed. There was no statistical difference between the study and control group when regarding the presence of colorectal lesions. Conclusion: The results suggest that the screening for colorectal cancer in acromegalic patients should be the same applied for the general populations’despite the GH serum levels or the disease duration.
With CRL Without CRL p
Age mean (min-max)
Gender (\-%)
GH (ng/ml)
Disease duration (years)
45 (22-72) 39 (13-67) 0,671
62,5 88 0,063
23,60 24,73 0,371
6 7,5 0,721
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T1419 Evaluation of Colonoscopy Attached Oblique Transparent Cap During Insertion Into the Cecum in Colonoscopy Comparing Inexperienced with Experienced Endoscopists Koichiro Sato, Koichi Hirahata, Sumio Fujinuma, Sayo Itoh, Hiroaki Suda, Tadayoshi Kakemura, Iruru Maetani Background: Total colonoscopy is usually possible but it still remains difficult to acquire the insertion of the colonoscope into the cecum. The oblique transparent cap (OTC, Top, Tokyo, Japan) attaching the tip of colonoscope allows good visualization and makes the procedure easier by keeping the distance between the lens and the lumen. The aim of this study was to assess the OTC during the colonoscope insertion into the cecum between inexperienced and experienced endoscopists. Methods: Consecutive 448 patients were randomized to undergo colonoscopy by four endoscopists with OTC or without. Patients with colonic resections, poor bowel preparation and severe stricture in the colon were excluded. All procedures were performed by two inexperienced endoscopists who had performed less than 500 cases and two experienced who had performed more than 3000 cases. CF260AI was used (Olympus, Tokyo, Japan). Stiffening function was not used. All patients were sedated with pethidine hydrochloride (17.5 mg to 35 mg). The degree of pain and difficulty in insertion of the colonoscope into the cecum was assessed using visual analog scale (VAS 0 Z not at all or very easy 100 Z very severe or difficult). Cecal intubation time, pain and difficulty in insertion of the colonoscope into the cecum were retrospectively analyzed. Result: Inexperienced endoscopists performed 214 patinets, and 110 patients were randomly allocated to OTC-attached colonoscope and 104 patinets to non OTC-attached colonoscope. Experienced endoscopists performed 234 patients, and 119 patients were randomly allocated to OTC-attached colonoscope and 115 patients to non OTC-attached colonoscope. In inexperienced endoscopists the median cecal intubation time was 14.1 minutes with OTC group and 16.1 minutes without OTC group (P ! 0.001). In experienced endoscopists the median cecal intubation time was 5.3 minutes with OTC group and 5.5 minutes without OTC group (P Z 0.569). In inexperienced endoscopists the degree of pain was similar between colonoscope with OTC and without (36.3 mm vs. 39.8 mm; p Z 0.41) but in experienced endoscopists the examination was less painful with OTC than without OTC (18.2 mm vs. 25.6 mm; p ! 0.0046). In the colonoscope with OTC difficulty of cecal intubation was significantly lower than in the colonoscope without OTC in both inexperienced and experienced endoscopist (36.3 mm vs. 46.7 mm; p ! 0.0009, 18.2 mm vs. 25.6 mm; p Z 0.0048). Conclusions: By attaching the OTC to the tip of the colonoscope, endoscopists felt reducing the difficulty in total colonoscopy both endoscopist groups and even in experienced endoscopists less painful examination were achieved compared with conventional colonoscope.
T1420 Pit Pattern Diagnosis of Ulcerative Colitis Associated Dysplasia By Magnifying Colonoscopy Kazuo Ohtsuka, Ken-Ichi Mizuno, Hiroshi Kashida, Ryo Chinzei, Jun-Ichi Ukegawa, Takataro Fukuhara, Keita Sasajima, Yui Kudo, Shigeharu Hamatani, Osamu Ito, Shin-Ei Kudo Backgrounds and Aims: The risk for colorectal cancer increases in patients with long persistent ulcerative colitis (UC). Surveillance colonoscopy with step biopsies for detecting UC associated dysplasia is recommended, despite its huge efforts, because of the difficulties for diagnosing UC associated dysplasia and early stage cancer. Minute surface structures reflect histological findings in sporadic dysplasia and cancer of the colon. Because pit pattern diagnosis has excellent sensitivity and specificity, magnifying colonoscopy enables to detect them without biopsies. Here, we evaluated the magnifying colonoscopic view of the UC associated dysplasia and whether the pit pattern diagnosis improved the diagnosis of the UC associated dysplasia. Patients and Methods: Pit patterns of eleven cases of UC associated dysplasia and cancer were analyzed. Pit pattern was analyzed by Kudo’s classification; type I and II patterns are non neoplastic, type III and IV are dysplasia and type V is cancer. Then, sixty-five UC patients in remission were prospectively examined for surveillance. They were 48 pancolitis and 17 left side type. Suffering duration was more than four years because the shortest periods were four years for development of dysplasia after diagnosing UC. Mean duration time was 9.4 years. Using magnifying colonoscopy with indigo carmine spraying, pictures and specimens were obtained from cecum, ascending colon, transverse colon, descending colon, sigmoid colon, and rectum. Results: Using chromoendoscopy and magnifying colonoscopy, UC associated dysplasia and cancer showed type III, IV, or V pit pattern. Those pit patterns are characterized by irregular pit, varying size, loss of polarity, thin distribution, wide-open or fused type pits. There are some problems with this diagnostic modality, for example, non dysplastic regions sometimes show type III-like or IV-like pit patterns. It is difficult to distinguish between sporadic cancer and UC associated dysplasia. Next, 390 specimens were analyzed for surveilance. Type I or II pit patterns were observed in 386 regions and there was no dysplasia. Type III or IV pit patterns were observed in 4 regions and there were two dysplasias. Conclusion: Type I or II pit pattern lesions will not be dysplasia, hence selected biopsies from type III, IV or V patterns would be sufficient for detecting dysplasia. Magnifying colonoscopy would be useful for diagnosing early colorectal cancer associated with UC and spare the huge efforts of biopsies in surveillance colonoscopy.
AB254 GASTROINTESTINAL ENDOSCOPY Volume 65, No. 5 : 2007
T1421 Safety of Carbon Dioxide Insufflation During Colorectal ESD Tsuyoshi Kikuchi, Yutaka Saito, Takahisa Matsuda, Daizo Saito Introduction: Carbon dioxide (CO2) insufflation is useful during colonoscopy, and especially when Endoscopic Submucosal Dissection (ESD) is perfomed, as patient discomfort is significantly reduced. We have already performed over 150 ESD procedures with CO2 insufflation, with good results. However an increase in the concentration of end-tidal carbon dioxide (ETCO2) during surgical laparoscopy using CO2 insufflation has been reported. Therefore this issue deserves further evaluation. Aims & Methods: The aim was to assess the CO2 body pool during colonoscopy and ESD with CO2 insufflation We employed a percutaneous carbon dioxide (PtcCO2) monitor (TOSCA500 Radiometer, Barsel) and ptcCO2 was measured continuously by non-invasively affixing a sensor to skin. The study population consisted of 37 patients(17 females, mean age :65.4 9.4 years) undergoing colorectal ESD from February to October 2006, and examined about a change of the PtcCO2 density of time. Result: Lesion located at Cecum (6 patients), Right hemicolon(12 patients), Left hemicolon (12 patients), Rectum (7 patients). Operation time was 90 118 min (median SD), average diameter of excised specimen was 44.2 22.6 mm (mean SD). Midazolam average dose: 5.8 mg ( 4.1), average of ptcCO2 before starting insufflation: 40.7 mmHg ( 5.3), average of post procedural ptcCO2 :44.3 mmHg ( 5.7), ptcCO2 peak average 55.6 mmHg ( 8.1) , peak value were measured in any cases by just after the midazolam dosage or physique conversion (abdominal position time). Conclusion: By using PtcCO2 determination, we were able to confirm that the CO2 pool by CO2 insufflation during colonoscopy is low. The mean peak value reached is at a safer level than previously reported in many studies. We consider that ESD performed with CO2 insufflation is safe in terms of risk for CO2 narcosis.
T1422 Prevalence of Colorectal Lesions in Acromegalic Patients Perla O. Schulz, Marcia H. Costa, Hanna Beatriz Thomas De Sa´, Thais G. Andrade, Magali L. Couto, Celeste C. Elia, Marilia S. Andrade, Cyrla Zaltman Introduction: Acromegaly has been associated with an increased prevalence of colorectal lesions (CRL) as hyperplastic and adenomatous polyps and even adenocarcinoma. The mechanisms enrolled although are still unknown, but GH serum levels and longer periods of disease were considered. Aims & Methods: To evaluate the prevalence of colorectal lesions in acromegalic patients. Methods: This is a retrospective study of acromegalic patients, reffered to colonoscopy in the Gastroenterology Unit of HUCFF/UFRJ, between may/2000 and dec/2005. The prevalence of colorectal lesions was correlated with gender, age, duration of disease from the stabilishment of the diagnosis, GH serum levels, location and histological features the lesions observed. The findings were compared with age and sex matching controls. Results: 41 acromegalic patients underwent colonoscopy in the mentioned period. The mean age was 44 (13-72) and 78, 05% were female. The absolute number of polyps found was 25 with a mean number of 1.6 polyps / patient, being found in 39% of patients (16/41). Polyps were observed in more than one colonic segment in 31, 3% of cases and 87, 5% of them were located in the rectosigmoidal region. Polypectomy was performed in all cases and the polyps were captured for histological examination. The histological results showed that 72% (18/25) of polyps were hyperplastic, 20% (5/25) were tubular adenomas, and 4% (2/25) were adenomas from villous type (one HGD and another LGD). No adenocarcinoma was observed. There was no statistical difference between the study and control group when regarding the presence of colorectal lesions. Conclusion: The results suggest that the screening for colorectal cancer in acromegalic patients should be the same applied for the general populations’despite the GH serum levels or the disease duration.
With CRL Without CRL p
Age mean (min-max)
Gender (\-%)
GH (ng/ml)
Disease duration (years)
45 (22-72) 39 (13-67) 0,671
62,5 88 0,063
23,60 24,73 0,371
6 7,5 0,721
www.giejournal.org