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Do I Have IBS?
Published in Melissa G. Hunt, Aaron T. Beck, Reclaim Your Life From IBS, 2022
Melissa G. Hunt, Aaron T. Beck
Another way to get a look at your intestines is for the doctor to do an actual visual exam by performing a sigmoidoscopy, a colonoscopy, or a capsule endoscopy. In both a sigmoidoscopy and a colonoscopy, the doctor inserts a flexible lighted tube into the anus and up through part of the large intestine. Flexible sigmoidoscopy lets the doctor see only the last third of the large intestine (the sigmoid colon). Colonoscopy allows the doctor to see the entire large intestine, and sometimes the terminal ileum (or the last bit of the small intestine) so it’s usually the better procedure, although it does take a bit more time and effort to prepare for it. In both cases, the scope transmits images of the lining of the intestine to a computer or video monitor. The doctor can actually see if there is any inflammation, ulcers, or bleeding. Both procedures also allow the doctor to remove any polyps or other growths and to take very small samples of tissue or biopsies, which can then be looked at carefully under a microscope.
Inflammatory Bowel Disease
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
When a woman presents with symptomatic colitis and relapse is suspected, it is important to rule out infectious causes including Clostridium difficile colitis. Clostridium difficile may have a more fulminant course in patients with IBD [1]. Although imaging and colonoscopy/sigmoidoscopy may be indicated in the initial diagnosis of CD, they are often not necessary for workup of a relapse. If imaging is needed, MRI and ultrasound are preferable to computed tomography to avoid fetal radiation exposure. Gadolinium should be avoided. Flexible sigmoidoscopy without sedation can be safely performed if needed [28, 30]. A full colonoscopy can be performed with anesthesia and fetal monitoring if appropriate and if it will change management [28, 30].
Gastrointestinal diseases and pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Murtaza Arif, Anjana Sathyamurthy, Jessica Winn, Jamal A. Ibdah
The common indications for flexible sigmoidoscopy and/or colonoscopy during pregnancy are rectal bleeding, diarrhea with negative evaluation, and strong indication for a colon mass. Sigmoidoscopy may establish diagnosis in majority of patients and should be considered first. Colonoscopy may be required if refractory lower gastrointestinal symptoms persist and sigmoidoscopy was not diagnostic. The safety and efficacy of flexible sigmoidoscopy and colonoscopy were reported in a study in which 48 sigmoidoscopies (46 patients) and 8 colonoscopies (8 patients) were safely performed during pregnancy (70). There were no adverse fetal outcomes, and no evidence that sigmoidoscopy or colonoscopy precipitated the onset of labor. The safety of polyethylene glycol (PEG) electrolyte solutions has not been studied in pregnancy. PEG solutions are classified as category C. Tap water enemas may be used for bowel preparation for flexible sigmoidoscopy. Removal of majority of colon polyps should be deferred until the postpartum period.
Triumph against cancer: invading colorectal cancer with nanotechnology
Published in Expert Opinion on Drug Delivery, 2021
Preksha Vinchhi, Mayur M. Patel
In this screening method, the endoscopy of descending colon and rectum is done by insertion of a flexible tube into the rectum for the detection of tumors. The procedure requires bowel evacuation before commencing but there is no requirement of sedation. It is a simple procedure imparting the possibility to remove the low-risk polyps during the diagnosis. However, on detection of large or multiple polyps i.e. high-risk conditions, necessitates full colonoscopy for further detection. Preliminary screening with sigmoidoscopy followed by colonoscopy has shown a reduction in incidence and mortality of CRC by 33% and 38–59%, respectively, in a randomized trial [32]. This finding rolled out the trend of performing sigmoidoscopy for primary screening in England and various other countries. This invasive technique is ambiguous for the detection of smaller polyps (6–10 mm). Moreover, it even limits the detection of cancer in the ascending colon, some parts of the transverse colon and cecum [8].
Need For Whole Large Bowel Investigation in Sole Change in Bowel Habit: An Analysis of 719 Patients
Published in Journal of Investigative Surgery, 2021
Krashna Patel, Thomas Athisayaraj, Amitabh Mishra
Recent published data has questioned the need for WLBI in patients referred with particular presenting symptom profiles [4–7]. Right-sided colonic cancer is suspected in those with asymptomatic iron deficiency anemia (IDA) or a palpable right-sided abdominal mass and these patients generally mandate WLBI. Rectal bleeding and/or change in bowel habit (CIBH) suggest more distal disease (beyond splenic flexure). Numerous studies have postulated an initial investigative flexible sigmoidoscopy (FS) would suffice in such presenting symptoms profiles [5,7,8]. CIBH as a sole symptom without IDA and a palpable mass has a less than 1% yield of cancers proximal to the splenic flexure [6]. This previously reported low-risk cohort can contribute to up to a third of suspected cancer referrals made to secondary care specialists [9]. No study in the last decade has evaluated the feasibility of FS-only investigation in this particular select group in the context of colorectal cancer. Symptom profiling and tailoring subsequent investigations is becoming increasingly important within the NHS in light of high demand and economic pressures. However, it remains paramount that patient care and investigation of gastrointestinal symptoms are not compromised.
Estimating the preferences and willingness-to-pay for colorectal cancer screening: an opportunity to incorporate the perspective of population at risk into policy development in Thailand
Published in Journal of Medical Economics, 2021
Pochamana Phisalprapa, Surachat Ngorsuraches, Tanatape Wanishayakorn, Chayanis Kositamongkol, Siripen Supakankunti, Nathorn Chaiyakunapruk
Our findings were similar to literature in the field of acceptability and individual preferences for the colorectal screening25. In the Netherlands, two DCEs were conducted among screening-naive participants and previously screened participants, aged 50–75 years. The results showed that pain, risk of complications, screening location, preparation, duration of procedure, screening interval, and risk reduction of CRC-related death proved to significantly influence the participants’ preferences25. In contrast, another study in the Netherlands showed that the study participants equally preferred 5-yearly flexible sigmoidoscopy and 10-yearly colonoscopy. They favored endoscopic strategies to annual FIT due to the more favorable risk reduction of CRC-related mortality25. In Australia, the study participants preferred colonoscopy over CTC21. In the US, the study participants preferred shorter travel, rewards or small copayments, stool testing, and greater coverage of follow-up costs.23 However, previous DCE studies were conducted in developed countries, which have different economies and healthcare systems from LMICS.