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Flexible Sigmoidoscopy in Asymptomatic Patients with Negative Fecal Occult Blood Tests Joy Garrison Cauffman, Phd, Jimmy H
Flexible Sigmoidoscopy in Asymptomatic Patients with Negative Fecal Occult Blood Tests Joy Garrison Cauffman, PhD, Jimmy H. Hara, MD, Irving M. Rasgon, MD, and Virginia A. Clark, PhD Los Angeles, California Background. Although the American Cancer Society and tients with lesions were referred for colonoscopy; addi others haw established guidelines for colorectal cancer tional lesions were found in 14%. A total of 62 lesions screening, questions of who and how to screen still exist. were discovered, including tubular adenomas, villous Methods. A 60-crn flexible sigmoidoscopy was per adenomas, tubular villous adenomas (23 of the adeno formed on 1000 asymptomatic patients, 45 years of mas with atypia), and one adenocarcinoma. The high age or older, with negative fecal occult blood tests, est percentage of lesions discovered were in the sig who presented for routine physical examinations. Pa moid colon and the second highest percentage were in tients with clinically significant lesions were referred for the ascending colon. colonoscopy. The proportion of lesions that would not Conclusions. The 60-cm flexible sigmoidoscope was have been found if the 24-cm rigid or the 30-cm flexi able to detect more lesions than either the 24-cm or ble sigmoidoscope had been used was identified. 30-cm sigmoidoscope when used in asymptomatic pa Results. Using the 60-cm flexible sigmoidoscope, le tients, 45 years of age and over, with negative fecal oc sions were found in 3.6% of the patients. Eighty per cult blood tests. When significant lesions are discovered cent of the significant lesions were beyond the reach of by sigmoidoscopy, colonoscopy should be performed. -
What Is a Rigid Sigmoidoscopy?
Learning about . Rigid Sigmoidoscopy What is a rigid sigmoidoscopy? Rigid sigmoidoscopy is a procedure done to look at the rectum and lower colon. The doctor uses a special tube called a scope. The scope has a light and a small glass window at the end so the doctor can see inside. lower colon rectum anus or opening to rectum This procedure is done for many reasons. Some reasons are: • to look for the cause of rectal bleeding • a tissue sample to test called a biopsy When small growths of tissue called polyps are seen, these are removed. The procedure takes about 5 minutes but plan to be at the hospital for ½ hour. Are there any complications to this procedure? Your doctor will explain the problems that can occur before you sign a consent form. Problems are rare but include: The scope can damage the lining of the colon. The scope can cause severe bleeding by damaging the wall of the colon. You may have blood spotting if a biopsy is done or a polyp is removed. Since the doctor and nurse are with you all of the time, they can manage any problem that may occur. What do I need to do to get ready at home? 4 to 5 days before your procedure: Taking medications: Your doctor may want you to stop taking certain medications 4 to 5 days before the procedure. If you need to stop any medications, your doctor will tell you during the office visit. If you have any questions, call the doctor’s office. Buying a Fleet enema: Your bowel must be clean and empty of waste material before this procedure. -
ACG Clinical Guideline: Diagnosis and Management of Small Bowel Bleeding
nature publishing group PRACTICE GUIDELINES 1265 CME ACG Clinical Guideline: Diagnosis and Management of Small Bowel Bleeding L a u r e n B . G e r s o n , M D , M S c , F A C G1 , J e ff L. Fidler , MD 2 , D a v i d R . C a v e , M D , P h D , F A C G 3 a n d J o n a t h a n A . L e i g h t o n , M D , F A C G 4 Bleeding from the small intestine remains a relatively uncommon event, accounting for ~5–10% of all patients presenting with gastrointestinal (GI) bleeding. Given advances in small bowel imaging with video capsule endoscopy (VCE), deep enteroscopy, and radiographic imaging, the cause of bleeding in the small bowel can now be identifi ed in most patients. The term small bowel bleeding is therefore proposed as a replacement for the previous classifi cation of obscure GI bleeding (OGIB). We recommend that the term OGIB should be reserved for patients in whom a source of bleeding cannot be identifi ed anywhere in the GI tract. A source of small bowel bleeding should be considered in patients with GI bleeding after performance of a normal upper and lower endoscopic examination. Second-look examinations using upper endoscopy, push enteroscopy, and/or colonoscopy can be performed if indicated before small bowel evaluation. VCE should be considered a fi rst-line procedure for small bowel investigation. Any method of deep enteroscopy can be used when endoscopic evaluation and therapy are required. -
04. EDITORIAL 1/2/06 10:34 Página 853
04. EDITORIAL 1/2/06 10:34 Página 853 1130-0108/2005/97/12/853-859 REVISTA ESPAÑOLA DE ENFERMEDADES DIGESTIVAS REV ESP ENFERM DIG (Madrid) Copyright © 2005 ARÁN EDICIONES, S. L. Vol. 97, N.° 12, pp. 853-859, 2005 Cost-effectiveness of abdominal ultrasonography in the diagnosis of colorectal carcinoma Colorectal cancer (CRC) is a most common neoplasm, and the second leading cause of cancer-related death. CRC was responsible for 11% of cancer-related deaths in males, and for 15% of cancer-related deaths in females according to data for year 2000. Most recent data reported in Spain on death causes in 2002 suggest that CRC was responsible for 12,183 deaths (6,896 males with a mean age of 70 years, and 5,287 women with a mean age of 71 years). In these tumors, mortality data do not reflect the true incidence of this disease, since survival has improved in recent years, particularly in younger individuals. In contrast to other European countries, Spain ranks in an intermediate position in terms of CRC-re- lated incidence and mortality. This risk clearly increases with age, with a notori- ous rise in incidence from 50 years of age on. Survival following CRC detection and management greatly depends upon tumor stage at the time of diagnosis; hence the importance of early detection and –because of their malignant poten- tial– of the recognition and excision of colorectal adenomas. Thus, polypectomy and then surveillance are the primary cornerstones in the prevention of CRC (1-4). For primary prevention, fiber-rich diets, physical exercising, and the avoidance of overweight, smoking, and alcohol have been recommended. -
Flexible Sigmoidoscopy with Haemorrhoid Banding
Flexible sigmoidoscopy with haemorrhoid banding You have been referred by your doctor to have a flexible sigmoidoscopy which may also include haemorrhoid banding. If you are unable to keep your appointment, please notify the department as soon as possible. This will allow staff to give your appointment to someone else and they will arrange another date and time for you. This booklet has been written to explain the procedures. This will help you make an informed decision in relation to consenting to the investigation. Please read the booklets and consent form carefully. You will need to complete the enclosed questionnaire. You may be contacted via telephone by a trained endoscopy nurse before the procedure, to go through the admission process and answer any queries you may have. If you are not contacted please come to your appointment at the time stated on your letter. If you have any mobility problems or there is a possibility you could be pregnant please telephone appointments staff on 01284 712748. Please note the appointment time is your arrival time on the unit, and not the time of your procedure. Please remember there will be other patients in the unit who arrive after you, but are taken in for their procedure before you. This is either for medical reasons or they are seeing a different Doctor. Due to the limited space available and to maintain other patients’ privacy and dignity, we only allow patients (and carers) through to the ward area. Relatives/escorts will be contacted once the person is available for collection. The Endoscopy Unit endeavours to offer single sex facilities, and we aim to make your stay as comfortable and stress free as possible. -
Endoscopic Technique for Diag- Nostic Investigations and Therapeutic Interventions of Small Bowel Pathology
ENDOSCOPY: OPENING NEW EYES, SERIES #3 Andrew K. Roorda, M.D., Series Editor The Evolution of Enteroscopy to Spiral Enteroscopy Disaya Chavalitdhamrong Rome Jutabha The diagnosis and treatment of small bowel diseases has historically proven difficult and challenging for gastroenterologists. Although sonde and push enteroscopy were developed first, the former is time-consuming and uncomfortable and the latter limits examination to the proximal jejunum. Intraoperative enteroscopy, which was once con- sidered the gold standard of enteroscopy, has largely been replaced by newer less inva- sive techniques. Capsule endoscopy provides a thorough examination of the small bowel but it does not allow for therapeutic interventions. Balloon-assisted enteroscopy was developed for complete examination of the small bowel and therapeutic interven- tions. Spiral enteroscopy has emerged as a viable alternative to balloon-assisted enteroscopy. It is a safe, effective, and relatively rapid endoscopic technique for diag- nostic investigations and therapeutic interventions of small bowel pathology. This arti- cle reviews the milestone technologies of enteroscopy highlighting the latest developed spiral enteroscopy. INTRODUCTION form endoscopic treatments. With the development of ndoscopic diagnosis and treatment of small bowel balloon-assisted enteroscopy and most recently, spiral conditions is a challenging area for gastroenterol- enteroscopy, endoscopic diagnosis and treatment of Eogists. Until recently, it was not possible to access the entire small intestine are now feasible without most of the small bowel using endoscopic techniques operative intervention. As indications expand and without concomitant surgery. Capsule endoscopy and caseloads grow, it is important for gastroenterologists balloon-assisted enteroscopy thus represent decisive to know how these procedures are done and to be breakthroughs in this field. -
Flexible Sigmoidoscopy – Outpatients
Flexible sigmoidoscopy – Outpatients You have been referred by your doctor to have a flexible sigmoidoscopy. his information booklet has been written to explain the procedure. This will help you to make an informed decision before consenting to the procedure. If you are unable to attend your appointment please inform us as soon as possible. Please ensure you read this booklet and the enclosed consent form thoroughly. Please also complete the enclosed health questionnaire. You may be contacted by an endoscopy trained nurse before your procedure to go through the admission process and answer any queries you may have. If you are not contacted please come to your appointment at the time stated in your letter. Please note your appointment time is your arrival time on the unit and not the time of your procedure. If you have any mobility issues or if there is a possibility you could be pregnant, please contact the appointment staff on 01284 713551 Please remember there will be other patients in the unit who may arrive after you but are taken in for their procedure before you, this is for medical reasons or they are seeing a different doctor. Due to limited space available and to maintain other patients’ privacy and dignity, we only allow patients (and carers) through to the ward area. Relatives/ escorts will be contacted once you are ready for collection. The Endoscopy Unit endeavours to offer single sex facilities, and we aim to make you stay as comfortable and stress free as possible. Source: Endoscopy Reference No: 5035-14 Issue date: 8/1/21 Review date: 8/1/24 Page 1 of 11 Medication If you are taking WARFARIN, CLOPIDOGREL, RIVAROXABAN or any other anticoagulant (blood thinning medication), please contact the appointment staff on 01284 713551, your GP or anticoagulation nurse, as special arrangements may be necessary. -
The Future of Small Bowel Transplantation
Archives ofDisease in Childhood 1995; 72: 447-451 447 CURRENT TOPIC Arch Dis Child: first published as 10.1136/adc.72.5.447 on 1 May 1995. Downloaded from The future of small bowel transplantation Deirdre A Kelly, John A C Buckels Although transplantation of solid organs such Indications for small bowel as kidney and liver have been established since transplantation the 1970s and 1980s, the future of small bowel Small bowel transplantation should be con- transplantation as treatment for intestinal fail- sidered for all children with irreversible ure is only just evolving. Early clinical experi- intestinal failure who are dependent on par- ence was almost universally unsuccessful but enteral nutrition for survival and in whom all recent developments in surgical technique, attempts to improve intestinal adaptation have immunosuppression, and postoperative man- been unsuccessful. Potential candidates may agement have improved outcome with a 50% require small bowel transplantation alone or survival in at least 100 operations.' combined with a liver transplant. Small intestinal transplantation was first The current indications for isolated small demonstrated to be technically feasible in bowel transplantation include: (1) loss of animals in 1902,24 and in humans in the vascular access with normal liver function and 1980s,5-7 but it was not until the Pittsburg histology and (2) intractable gastrointestinal group initiated a programme of small bowel fluid loss. The current indications for com- transplantation using the novel immuno- bined small -
Anesthesiology Services for Gastrointestinal Endoscopy Reference Number: CP.MP.161 Coding Implications Last Review Date: 05/19 Revision Log
Clinical Policy: Anesthesiology Services for Gastrointestinal Endoscopy Reference Number: CP.MP.161 Coding Implications Last Review Date: 05/19 Revision Log See Important Reminder at the end of this policy for important regulatory and legal information. Description Conscious sedation for gastrointestinal (GI) endoscopic procedures is standard of care to relieve patient anxiety and discomfort, improve outcomes of the examination, and decrease the memory of the procedure. A combination of an opioid and benzodiazepine is the recommended regimen for achieving minimal to moderate sedation for upper endoscopy and colonoscopy in people without risk for sedation-related adverse events.5 Generally, the gastroenterologist performing the procedure and/or his/her qualified assistant can adequately manage the administration of conscious sedation and monitoring of the patient. In cases with sedation-related risk factors, additional assistance from an anesthesia team member is required to ensure the safest outcome for the patient. This policy outlines the indications for which anesthesia services are considered medically necessary. Policy/Criteria I. It is the policy of health plans affiliated with Centene Corporation® that anesthesiology services for GI endoscopic procedures is considered medically necessary for the following indications: A. Age < 18 years or ≥ 70 years; B. Pregnancy; C. Increased risk of complications due to physiological status as identified by the American Society of Anesthesiologist (ASA) physical status classification of ASA III or higher; D. Increased risk for airway obstruction because of anatomic variants such as dysmorphic facial features, oral abnormalities, neck abnormalities, or jaw abnormalities; E. History of or anticipated intolerance to conscious sedation (i.e. chronic opioid or benzodiazepine use); F. -
Endoscopic Techniques in Bariatric Patients: Obesity Basics and Normal Postbariatric Surgery Anatomy Dan E
Techniques in Gastrointestinal Endoscopy (2010) 12, 124-129 Techniques in GASTROINTESTINAL ENDOSCOPY www.techgiendoscopy.com Endoscopic techniques in bariatric patients: Obesity basics and normal postbariatric surgery anatomy Dan E. Azagury, MD, David B. Lautz, MD Brigham and Women’s Hospital and Harvard Medical School, Department of Surgery, Boston, Massachusetts. KEYWORDS With the sharp rise in the number of bariatric surgical procedures over the past 15 y, the number and Gastric bypass; array of complications have also risen. Many of these complications are now either diagnosed or Vertical banded managed endoscopically. However, the rising diversity of surgical options requires endoscopists to gastroplasty; have a good working knowledge of normal postoperative anatomy for each procedure. This article Laparoscopic gastric reviews basic obesity epidemiology and describes postsurgical anatomy of the upper gastrointestinal banding; tract, separating the procedures into those with normal small bowel anatomy (restrictive procedures) Biliopancreatic diversion; and procedures resulting in small bowel modifications (procedures with a “malabsorptive” component). Laparoscopic sleeve © 2010 Elsevier Inc. All rights reserved. gastrectomy Many classifications have been used to measure and million potential candidates qualifying for a bariatric surgi- define obesity, of which body mass index (BMI) is the most cal procedure. The often dramatic results of this surgery widely used. BMI is calculated by dividing weight in kilo- have lead to a sharp rise in the interest and number of grams by the square of height in meters. Normal weight bariatric surgical procedures performed over the past 15 y. ranges from 18.5 to 24.9 kg/m2. A BMI between 25 and The number of bariatric procedures performed in the United 29.9 kg/m2 is defined as overweight and an individual is States and Canada was 14,000 in 1998,6 compared with an obese when his or her BMI is Ն30 kg/m2. -
Overview of Deep Small Bowel Enteroscopy 10/7/14, 4:23 PM
Overview of deep small bowel enteroscopy 10/7/14, 4:23 PM Official reprint from UpToDate® www.uptodate.com ©2014 UpToDate® Overview of deep small bowel enteroscopy Author Section Editor Deputy Editor Hiroto Kita, MD, PhD Douglas A Howell, MD, FASGE, FACG Anne C Travis, MD, MSc, FACG, AGAF All topics are updated as new evidence becomes available and our peer review process is complete. Literature review current through: Sep 2014. | This topic last updated: Oct 23, 2013. INTRODUCTION — Evaluation of the small bowel is difficult due to its length, intraperitoneal location, and contractility. Methods used to evaluate the small bowel include push enteroscopy, video capsule endoscopy, and intraoperative enteroscopy. These techniques all have advantages and limitations: ● Push enteroscopy has both diagnostic and therapeutic capabilities, but typically only examines that part of the small bowel that is 50 to 150 cm distal to the ligament of Treitz ● Video capsule endoscopy is capable of examining the entire small bowel, but lacks therapeutic capacity ● Intraoperative enteroscopy permits examination of the entire small bowel and therapeutic interventions, but is much more invasive Alternative endoscopic approaches have been developed to overcome these limitations. Deep small bowel enteroscopy permits visualization and interventional therapy throughout the small bowel by using insertion techniques that pleat the small bowel onto an overtube. The techniques used for deep small bowel enteroscopy limit stretching of the small bowel (as occurs with -
Icd-9-Cm (2010)
ICD-9-CM (2010) PROCEDURE CODE LONG DESCRIPTION SHORT DESCRIPTION 0001 Therapeutic ultrasound of vessels of head and neck Ther ult head & neck ves 0002 Therapeutic ultrasound of heart Ther ultrasound of heart 0003 Therapeutic ultrasound of peripheral vascular vessels Ther ult peripheral ves 0009 Other therapeutic ultrasound Other therapeutic ultsnd 0010 Implantation of chemotherapeutic agent Implant chemothera agent 0011 Infusion of drotrecogin alfa (activated) Infus drotrecogin alfa 0012 Administration of inhaled nitric oxide Adm inhal nitric oxide 0013 Injection or infusion of nesiritide Inject/infus nesiritide 0014 Injection or infusion of oxazolidinone class of antibiotics Injection oxazolidinone 0015 High-dose infusion interleukin-2 [IL-2] High-dose infusion IL-2 0016 Pressurized treatment of venous bypass graft [conduit] with pharmaceutical substance Pressurized treat graft 0017 Infusion of vasopressor agent Infusion of vasopressor 0018 Infusion of immunosuppressive antibody therapy Infus immunosup antibody 0019 Disruption of blood brain barrier via infusion [BBBD] BBBD via infusion 0021 Intravascular imaging of extracranial cerebral vessels IVUS extracran cereb ves 0022 Intravascular imaging of intrathoracic vessels IVUS intrathoracic ves 0023 Intravascular imaging of peripheral vessels IVUS peripheral vessels 0024 Intravascular imaging of coronary vessels IVUS coronary vessels 0025 Intravascular imaging of renal vessels IVUS renal vessels 0028 Intravascular imaging, other specified vessel(s) Intravascul imaging NEC 0029 Intravascular