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Approach To The Patient With Rectal Bleeding
Published in John P. Papp, Endoscopie Control of Gastrointestinal Hemorrhage, 2019
Additional procedures—barium enema—if negative, colonoscopy. This is a significant symptom that requires exploration. Every effort must be made to explain the symptom satisfactorily. Whenever this complaint is obtained, careful attention must be given to the strong possibility that a lesion exists in the area of the rectosigmoid colon. Although a hemorrhoid or fissure may cause this symptom, a cancer or polyp in the left colon may deposit a linear streak of blood on the surface of a formed stool as it passes the lesion. This type of bleeding does not occur as a result of diverticulosis. If a lesion is seen on double-contrast barium enema, a decision must be made concerning proper therapy. If no lesion is identified, colonoscopic examination must be performed. The sigmoid colon is a difficult area for the radiologist to adequately visualize. It is in this area that hidden lesions may be expected. The X-ray-negative patient with a significant history will have a 15% incidence of polyps and a 10% incidence of carcinoma. A significant history means: Blood streaking or spotting the stoolA positive test for occult bloodUnexplained iron deficiency anemia
Radiation Injury
Published in Han C. Kuijpers, Colorectal Physiology: Fecal Incontinence, 2019
Chronic ulcerative proctitis is diagnosed by sigmoidoscopy. The findings may range from erythema and telangiectasia to ulceration and necrosis. Double-contrast barium enema helps to confirm these findings and demonstrate loss of distensibility of the rectum and colon. Mucosal irregularities, ulcers, and ragged margins may be seen, often with abrupt termination at the rectosigmoid or descending colon-sigmoid junctions. Multiple lesions are not infrequent and unsuspected fistulas may be revealed. Rectal biopsy is seldom helpful and may precipitate bleeding. The main symptoms are frequent bleeding, diarrhea, tenesmus, frequency, and fecal incontinence. These symptoms are often extremely distressing and disabling. Up to 75% of these patients may be manageable by conservative medical measures with rectal steroids, low-residue diets, antidiarrheal medication, and blood transfusions. Approximately 20% of patients may require surgery for proctitis unresponsive to these measures.4,5
Colon, rectum and anus
Published in Michael Gaunt, Tjun Tang, Stewart Walsh, General Surgery Outpatient Decisions, 2018
Gross structural abnormalities and colonic strictures can be excluded using a double contrast barium enema. Colonoscopy should be reserved for those in whom colorectal cancer or inflammatory bowel disease need exclusion (alarm symptoms are sudden onset after 50 years of age or a significant family history of colorectal neoplasia or inflammatory bowel disease).
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
Table 3 shows the characteristics of participants. The average age of participants was 62.4 ± 6.4 years. Two hundred and forty-six (61.5%) were female. The common comorbidities were hypertension, dyslipidemia, diabetes mellitus, and cardiovascular disease (51.0%, 31.0%, 24.0%, and 6.0%, respectively). More than half of the participants were retirees. The average monthly income was US$495 (US$217–929) (16,000 THB [7,000–30,000 THB]). More than half (53.5%) of the participants were aware of CRC. Approximately, one-fourth (23.5%) of the participants were aware of CRC screening. One hundred and sixty-two (40.5%) participants were not apprehensive about CRC. When the participants were directly asked, 47.0%, 11.0%, and 42.0% of them mentioned that they preferred colonoscopy, double-contrast barium enema (DCBE), and FIT, respectively, if these screening programs were free of charge. On the other hand, 25.5%, 12.5%, and 62.0% of the participants would prefer colonoscopy, DCBE, and FIT, respectively, if they had to pay out of their own pockets. The acceptable copayment amounts from their own pockets were US$93, US$46, and US$3 (3,000, 1,500, and 100 THB) from the full costs of US$186, US$93, and US$3 (6,000, 3,000, and 100 THB) for colonoscopy, DCBE, and FIT, respectively (Supplementary Table 7E). However, 71 participants (17.8%) refused to undergo any CRC screening with various reasons, such as no symptom, busy, and afraid to know the results.
Colorectal carcinoma screening: Established methods and emerging technology
Published in Critical Reviews in Clinical Laboratory Sciences, 2020
Erika Hissong, Meredith E. Pittman
CT colonography has recently emerged as a noninvasive screening modality for patients who opt out of colonoscopy, and it has largely replaced double contrast barium enema as the imaging study of choice for most indications. Estimated sensitivity rates for CT colonography are between 88% and 98% for high risk adenomas (greater than 10 mm) and around 87% for adenomas between 6–9 mm in size [85–90]. A meta-analysis of 49 studies estimate the pooled sensitivity for detection of colorectal carcinoma to be 96.1% for CT colonography, which is at least as good as invasive colonoscopy [73]. Screening with CT colonography every 5 years is now a recommended screening strategy by both the United States Preventive Services Task Force and the American Cancer Society [91,92].
Feasibility of salvage colonoscopy by water exchange for failed air-insufflated patients: a prospective, randomized, controlled trial
Published in Scandinavian Journal of Gastroenterology, 2022
Mo Wang, Hai-Tao Shi, Xin-Xing Tantai, Lei Dong, Shi-Yang Ma
Other options aiming to reduce the pain caused by colonoscopy have also been reported. Some researchers chose CO2 to replace air for its advantage in reduction of postprocedural pain. It is known that CO2 could be relatively rapidly absorbed through the intestinal mucosa into the blood and then being eliminated through respiration [22–24]. However, it contributes little to pain reduction during the procedure. As its principle remains the same as the conventional AI, CO2 colonoscopy is inappropriate for complicated intestines or conditions, thus is not considered as an effective salvage measure. Anesthesia or sedation colonoscopy is another alternative method to reduce pain. However, colonoscopy with sedation is associated with an increased risk of complications, such as respiratory depression, hypotension and cardiac arrhythmia [9]. Other drawbacks of sedation colonoscopy include longer postprocedural recovery time, postprocedural monitoring and additional cost and space [25]. In addition, failed cases are always associated with complex intestine, which requires the change of position and abdominal compression. Sedation will bring difficulties to these operations. New technologies have also occasionally been used as a rescue measure, such as balloon-assisted colonoscopy, CT or MR colonoscopy, double-contrast barium enema, colon capsule and check-cap [3]. However, none of these methods have the conditions for large-scale clinical application. Although acquiring new skills of WEC is required, it is relatively easy to master. Unlike other methods, WEC does not require additional human power, equipment or costs, and thus seems to be the best colonoscopy salvage technique.