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The Correlation Study Among Total Colonoscopic Findings, Clinical Symptoms and Laboratory Markers in Ulcerative Colitis
Abstracts
T1445 The Role of Retroflexion in the Detection of Rectal Disease During Routine Colonoscopy Abdo Saad, Douglas K. Rex Introduction: Whether routine performance of retroflexion in the rectum during colonoscopy is necessary remains controversial. Methods: A prospective study of consecutive colonoscopies was performed from 6/20/2005 to 8/15/2006. Endoscopies were performed by a single physician using colonoscopes with two different angles of view: 140 or 170 . The rectum was initially examined on forward view from the rectosigmoid junction to the dentate line, followed by retroflexion. All identified pathologies in the distal rectum were submitted separately for histology. Results: One thousand five hundred two patients were included: 767 (51%) were female, mean age 58.8 12.5 years. Retroflexion was successful in 1411 (94.0%) patients, and was unsuccessful or not performed because the rectum appeared narrow in 91 (6.1%). One thousand seventy six (72%) procedures were performed with a 140 view colonoscope while the rest 170 (28%) were performed with 170 angle of view colonoscopes. Forty two patients had lesions in the distal rectal mucosa. In 36 the lesions were identified in both the forward and retroflexed views (25 patients with hyperplastic polyps, 7 with tubular adenomas, 1 with tubulovillous adenomas, 2 with an ulcer and 1 with a fistula). Seven polyps in the distal rectum were visualized only by retroflexion (6 hyperplastic polyps and one 4 mm sessile tubular adenoma). There was no difference in information added by retroflexion with 140 vs. 170 angle of view instruments. Conclusion: To our knowledge, this is the largest reported prospective evaluation of the value of retroflexion in the rectum. Routine rectal retroflexion did not add clinically important information after a careful forward examination of the rectum to the dentate line.
T1446 The Correlation Study Among Total Colonoscopic Findings, Clinical Symptoms and Laboratory Markers in Ulcerative Colitis Taro Osada, Toshifumi Ohkusa, Isao Okayasu, Tsutomu Yoshida, Shu Hirai, Kazuko Beppu, Naoto Sakamoto, Tomoyoshi Shibuya, Akihito Nagahara, Sumio Watanabe Background and Aim: Total colonoscopy plays a crucial role in the diagnosis of ulcerative colitis (UC) by defining the pattern, extent and activity of inflammation, as well as by providing a way to obtain mucosal tissue for histological evaluation. In this study, we divided colon into seven segments(periappendicial lesion, cecum, ascending colon, transverse colon, descending colon, sigmoid colon and rectum) for endoscopic and histological findings, and assessed the relationship among these findings, clinical symptoms and laboratory data. Method: We performed total colonoscopy examinations consecutively in 56 patients with UC. To score each patient for degree of disease activity, the large intestine was divided into seven segments. Each segment was scored endoscopically, and biopsy specimens from each segment were scored for histological activity. These seven scores were summed up respectively. The patients were also evaluated using a symptom-activity index and laboratory markers, WBC count, platelet count, CRP and ESR prior to colonoscopic examination. Results: There was a significant positive correlation between symptomatic-activity scores, endoscopic (r Z 0.452), and histological (r Z 0.563) scores. Histological scores correlated more closely with symptomaticactivity scores than did endoscopic scores. Although the endoscopic and histological scores of the rectosigmoid colon (rectum:r Z 0.608, r Z 0.547. sigmoid colon:r Z 0.401, r Z 0.557) and descending colon(r Z 0.369, r Z 0.403) correlated well with clinical symptoms, there was no similar correlation for the proximal colon. WBC count, CRP and ESR were also significantly correlated with sum of endoscopic and histological scores (WBC:r Z 0.338, r Z 0.330. CRP:r Z 0.447, r Z 0.369 ESR:r Z 0.483, r Z 0.589), platelet count was not. Especially, CRP and ESR were well correlated with proximal (periappendicialwdescending) colon lesion (CRP: r Z 0.474, r Z 0.480. ESR:r Z 0.423, r Z 0.529). Conclusions: Clinical symptoms were reflected distal-colon lesions, on the other hand, CRP and ESR were reflected proximal-lesions. It was indicated when clinical symptoms were improved and CRP and ESR were not improved, proximal-lesions might be remained. Because especially laboratory markers were relatively less association with colon lesions, total colonoscopy should be done when clinical symptoms improve, in order to evaluate the proximal colon.
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T1447 Colonoscopy Delay in Lower Gastrointestinal Bleeding: Influence On Diagnostic Accuracy, Endoscopic Therapy and Hospital Stay Francisco Rodriguez-Moranta, Ana Berrozpe, Josep M. Botargues, Antonio Soriano-Izquierdo, Nadia Chahri, Sebastiano Biondo, Jordi Guardiola Introduction: Lower gastrointestinal bleeding (LGB) is a common and potentially life-threatening disorder that often requires hospitalization. Colonoscopy is considered as the diagnostic procedure of choice in LGB but the best moment to perform it remains controversial. Aims & Methods: To determine whether delay in performing colonoscopy to patients with LGB influences diagnostic accuracy, the chance of offering endoscopic therapy, and the hospital stay. Design: prospective cohort study. Setting: tertiary teaching hospital. Patients: all consecutive patients admitted from January 2005 and May 2006. Analysis: The effect of colonoscopy delay on diagnostic accuracy, the chance of offering endoscopic therapy and the hospital stay were assessed by univariate and multivariate analysis adjusting for age, comorbidity, and severity of the bleeding episode. Results: A total of 212 patients with LGB were admitted during the period of study. Colonoscopy was performed to 84.4% (180/212) of patients and some kind of endoscopic therapy was given to the 18% (32/180) of them. A definitive source of bleeding was found in 56.7% (102/180) and a presumptive cause in 33.9% (61/180). Diverticular bleeding was the most common cause of LGB (25%, 45/180). Other causes were ischemic colitis in 17.2% (31/180) of patients, colonic neoplasm in 14.4% (26/180), haemorrhoids or fissures in 13.9% (25/180), angiodysplasia in 6.1% (11/180), other diagnoses in 14% (20/180). The cause remained unknown in 9.4% of patients (17/140). Colonoscopy was performed during the first 24 hours after admission in 51.1% of patients (92/180), between 24 and 48 hours in 20% (36/180), between 48 and 72 hours in 20% (36/180) and later than 72 hours in 8.8% (16/180). A definite source of bleeding was identified in 67% (62/92) of patients when colonoscopy was performed within the first of 24 hours but in only 45% (40/88) if it was performed later (p ! 0.01). Colonoscopy within the first 24 hours was associated to early discharge (3.3 3.5 days vs. 5.9 4.7 days; p ! 0.001) and with a better chance to receive endoscopic therapy (23% (21/92) vs. 12% (11/88), p Z 0.07). In the multivariate analysis achieving a colonoscopy during the first 24 hours was independently associated with a better chance of identifying a definitive source of bleeding and receive endoscopic therapy, and with shorter hospital stay (hazard ratio 0.42; 95% CI, 0.21-0.81; p Z 0.004; hazard ratio 0.38; 95% CI, 0.16-0.91; p Z 0.03 and hazard ratio 0.69; 95% CI, 0.59-0.79; p ! 0.001, respectively). Conclusion: Early colonoscopy can improve the management of the LGB with regard to its greater diagnostic accuracy and reduction of hospital stay.
T1448 A Randomized Blind Prospective Comparative Study Between Bipolar Eletrocoagulation and Argon Plasma Coagulation for Chronic Radiation Coloproctopathy Luciano Lenz, Fernanda P. Thuler, Marcus Dos Santos, Frank Nakao, Gustavo A. De Paulo, Ermelindo D. Libera, S. Rohr Maria Rachel, Angelo P. Ferrari Background: Chronic radiation coloproctopathy (CRCP) is a recognized late complication of radiation therapy for pelvic cancer. A variety of endoscopic therapeutic options have been used to treat CRCP such as bipolar eletrocoagulation (BEC) and argon plasma coagulation (APC). Because there is no consensus and comparative studies, the aim of this study is to compare the efficacy, safety and number of sessions of BEC and APC in the management of the bleeding telangiectasias from CRCP. Methods: Patients with active bleeding from telangiectasias were enrolled in two groups (13 BEC and 13 APC) and classified according of Saunders score. BEC settings were 50 W and APC settings were 40 W and 1.0 l/min. Colonoscopy was performed to rule out synchronous lesions and follow-up was performed with flexible sigmoidoscopies. Clinical cure was defined as cessation of bleeding and endoscopic cure was determined by absence of telangiectasias. Failure was defined whenever more than 7 sessions or other therapy was necessary. Results: 26 patients were included. The mean age was 67 years (range 33-82 years). Eight patients were clinically cured on the APC group (mean 2.87 sessions, range 1-5) and 7 showed endoscopic cure (mean 3.28, range 17). Eight patients on the BEC group presented clinical (mean 1.87, range 1-3) and endoscopic cure (mean 2, range 1-4). Three patients of each group are still in treatment. There was no significant difference regarding the number of sessions for clinical (p Z 0,033) and endoscopic cure (p Z 0,133). One patient of each group died because of pneumonia (during the treatment-APC group) and coronary disease (after cure-BEC group), respectively. The complications were: bleeding from ulcers (2 patients in BEC group), fever (2 patients) and anal pain (7 patients). There was no significant difference regarding complications between both groups (p Z 0, 22). Conclusions: BEC and APC are safe, effective and well-tolerated in the treatment of patients with bleeding telangiectasias from CRCP. There was no significant difference between these groups. The choice of treatment must be based on the experience of each endoscopic group.
Volume 65, No. 5 : 2007 GASTROINTESTINAL ENDOSCOPY AB261
T1445 The Role of Retroflexion in the Detection of Rectal Disease During Routine Colonoscopy Abdo Saad, Douglas K. Rex Introduction: Whether routine performance of retroflexion in the rectum during colonoscopy is necessary remains controversial. Methods: A prospective study of consecutive colonoscopies was performed from 6/20/2005 to 8/15/2006. Endoscopies were performed by a single physician using colonoscopes with two different angles of view: 140 or 170 . The rectum was initially examined on forward view from the rectosigmoid junction to the dentate line, followed by retroflexion. All identified pathologies in the distal rectum were submitted separately for histology. Results: One thousand five hundred two patients were included: 767 (51%) were female, mean age 58.8 12.5 years. Retroflexion was successful in 1411 (94.0%) patients, and was unsuccessful or not performed because the rectum appeared narrow in 91 (6.1%). One thousand seventy six (72%) procedures were performed with a 140 view colonoscope while the rest 170 (28%) were performed with 170 angle of view colonoscopes. Forty two patients had lesions in the distal rectal mucosa. In 36 the lesions were identified in both the forward and retroflexed views (25 patients with hyperplastic polyps, 7 with tubular adenomas, 1 with tubulovillous adenomas, 2 with an ulcer and 1 with a fistula). Seven polyps in the distal rectum were visualized only by retroflexion (6 hyperplastic polyps and one 4 mm sessile tubular adenoma). There was no difference in information added by retroflexion with 140 vs. 170 angle of view instruments. Conclusion: To our knowledge, this is the largest reported prospective evaluation of the value of retroflexion in the rectum. Routine rectal retroflexion did not add clinically important information after a careful forward examination of the rectum to the dentate line.
T1446 The Correlation Study Among Total Colonoscopic Findings, Clinical Symptoms and Laboratory Markers in Ulcerative Colitis Taro Osada, Toshifumi Ohkusa, Isao Okayasu, Tsutomu Yoshida, Shu Hirai, Kazuko Beppu, Naoto Sakamoto, Tomoyoshi Shibuya, Akihito Nagahara, Sumio Watanabe Background and Aim: Total colonoscopy plays a crucial role in the diagnosis of ulcerative colitis (UC) by defining the pattern, extent and activity of inflammation, as well as by providing a way to obtain mucosal tissue for histological evaluation. In this study, we divided colon into seven segments(periappendicial lesion, cecum, ascending colon, transverse colon, descending colon, sigmoid colon and rectum) for endoscopic and histological findings, and assessed the relationship among these findings, clinical symptoms and laboratory data. Method: We performed total colonoscopy examinations consecutively in 56 patients with UC. To score each patient for degree of disease activity, the large intestine was divided into seven segments. Each segment was scored endoscopically, and biopsy specimens from each segment were scored for histological activity. These seven scores were summed up respectively. The patients were also evaluated using a symptom-activity index and laboratory markers, WBC count, platelet count, CRP and ESR prior to colonoscopic examination. Results: There was a significant positive correlation between symptomatic-activity scores, endoscopic (r Z 0.452), and histological (r Z 0.563) scores. Histological scores correlated more closely with symptomaticactivity scores than did endoscopic scores. Although the endoscopic and histological scores of the rectosigmoid colon (rectum:r Z 0.608, r Z 0.547. sigmoid colon:r Z 0.401, r Z 0.557) and descending colon(r Z 0.369, r Z 0.403) correlated well with clinical symptoms, there was no similar correlation for the proximal colon. WBC count, CRP and ESR were also significantly correlated with sum of endoscopic and histological scores (WBC:r Z 0.338, r Z 0.330. CRP:r Z 0.447, r Z 0.369 ESR:r Z 0.483, r Z 0.589), platelet count was not. Especially, CRP and ESR were well correlated with proximal (periappendicialwdescending) colon lesion (CRP: r Z 0.474, r Z 0.480. ESR:r Z 0.423, r Z 0.529). Conclusions: Clinical symptoms were reflected distal-colon lesions, on the other hand, CRP and ESR were reflected proximal-lesions. It was indicated when clinical symptoms were improved and CRP and ESR were not improved, proximal-lesions might be remained. Because especially laboratory markers were relatively less association with colon lesions, total colonoscopy should be done when clinical symptoms improve, in order to evaluate the proximal colon.
www.giejournal.org
T1447 Colonoscopy Delay in Lower Gastrointestinal Bleeding: Influence On Diagnostic Accuracy, Endoscopic Therapy and Hospital Stay Francisco Rodriguez-Moranta, Ana Berrozpe, Josep M. Botargues, Antonio Soriano-Izquierdo, Nadia Chahri, Sebastiano Biondo, Jordi Guardiola Introduction: Lower gastrointestinal bleeding (LGB) is a common and potentially life-threatening disorder that often requires hospitalization. Colonoscopy is considered as the diagnostic procedure of choice in LGB but the best moment to perform it remains controversial. Aims & Methods: To determine whether delay in performing colonoscopy to patients with LGB influences diagnostic accuracy, the chance of offering endoscopic therapy, and the hospital stay. Design: prospective cohort study. Setting: tertiary teaching hospital. Patients: all consecutive patients admitted from January 2005 and May 2006. Analysis: The effect of colonoscopy delay on diagnostic accuracy, the chance of offering endoscopic therapy and the hospital stay were assessed by univariate and multivariate analysis adjusting for age, comorbidity, and severity of the bleeding episode. Results: A total of 212 patients with LGB were admitted during the period of study. Colonoscopy was performed to 84.4% (180/212) of patients and some kind of endoscopic therapy was given to the 18% (32/180) of them. A definitive source of bleeding was found in 56.7% (102/180) and a presumptive cause in 33.9% (61/180). Diverticular bleeding was the most common cause of LGB (25%, 45/180). Other causes were ischemic colitis in 17.2% (31/180) of patients, colonic neoplasm in 14.4% (26/180), haemorrhoids or fissures in 13.9% (25/180), angiodysplasia in 6.1% (11/180), other diagnoses in 14% (20/180). The cause remained unknown in 9.4% of patients (17/140). Colonoscopy was performed during the first 24 hours after admission in 51.1% of patients (92/180), between 24 and 48 hours in 20% (36/180), between 48 and 72 hours in 20% (36/180) and later than 72 hours in 8.8% (16/180). A definite source of bleeding was identified in 67% (62/92) of patients when colonoscopy was performed within the first of 24 hours but in only 45% (40/88) if it was performed later (p ! 0.01). Colonoscopy within the first 24 hours was associated to early discharge (3.3 3.5 days vs. 5.9 4.7 days; p ! 0.001) and with a better chance to receive endoscopic therapy (23% (21/92) vs. 12% (11/88), p Z 0.07). In the multivariate analysis achieving a colonoscopy during the first 24 hours was independently associated with a better chance of identifying a definitive source of bleeding and receive endoscopic therapy, and with shorter hospital stay (hazard ratio 0.42; 95% CI, 0.21-0.81; p Z 0.004; hazard ratio 0.38; 95% CI, 0.16-0.91; p Z 0.03 and hazard ratio 0.69; 95% CI, 0.59-0.79; p ! 0.001, respectively). Conclusion: Early colonoscopy can improve the management of the LGB with regard to its greater diagnostic accuracy and reduction of hospital stay.
T1448 A Randomized Blind Prospective Comparative Study Between Bipolar Eletrocoagulation and Argon Plasma Coagulation for Chronic Radiation Coloproctopathy Luciano Lenz, Fernanda P. Thuler, Marcus Dos Santos, Frank Nakao, Gustavo A. De Paulo, Ermelindo D. Libera, S. Rohr Maria Rachel, Angelo P. Ferrari Background: Chronic radiation coloproctopathy (CRCP) is a recognized late complication of radiation therapy for pelvic cancer. A variety of endoscopic therapeutic options have been used to treat CRCP such as bipolar eletrocoagulation (BEC) and argon plasma coagulation (APC). Because there is no consensus and comparative studies, the aim of this study is to compare the efficacy, safety and number of sessions of BEC and APC in the management of the bleeding telangiectasias from CRCP. Methods: Patients with active bleeding from telangiectasias were enrolled in two groups (13 BEC and 13 APC) and classified according of Saunders score. BEC settings were 50 W and APC settings were 40 W and 1.0 l/min. Colonoscopy was performed to rule out synchronous lesions and follow-up was performed with flexible sigmoidoscopies. Clinical cure was defined as cessation of bleeding and endoscopic cure was determined by absence of telangiectasias. Failure was defined whenever more than 7 sessions or other therapy was necessary. Results: 26 patients were included. The mean age was 67 years (range 33-82 years). Eight patients were clinically cured on the APC group (mean 2.87 sessions, range 1-5) and 7 showed endoscopic cure (mean 3.28, range 17). Eight patients on the BEC group presented clinical (mean 1.87, range 1-3) and endoscopic cure (mean 2, range 1-4). Three patients of each group are still in treatment. There was no significant difference regarding the number of sessions for clinical (p Z 0,033) and endoscopic cure (p Z 0,133). One patient of each group died because of pneumonia (during the treatment-APC group) and coronary disease (after cure-BEC group), respectively. The complications were: bleeding from ulcers (2 patients in BEC group), fever (2 patients) and anal pain (7 patients). There was no significant difference regarding complications between both groups (p Z 0, 22). Conclusions: BEC and APC are safe, effective and well-tolerated in the treatment of patients with bleeding telangiectasias from CRCP. There was no significant difference between these groups. The choice of treatment must be based on the experience of each endoscopic group.
Volume 65, No. 5 : 2007 GASTROINTESTINAL ENDOSCOPY AB261