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Chromoendoscopy-Targeted Biopsies Are Superior to Standard Colonoscopic Surveillance for Detecting Dysplasia in Inflammatory Bowel Disease Patients: A Prospective Endoscopic Trial

Quality in the technical performance of colonoscopy and the continuous quality improvement process for colonoscopy: recommendations of the U.S. Multi-Society Task Force on Colorectal Cancer

Patients (N = 2,097) undergoing ambulatory office colonoscopy were followed to determine the incidence of endoscopic complications. In this group, 1,320 patients had diagnostic colonoscopy with or without biopsy; 777 patients had 2,019 polyps removed. Three of 2,097 patients (0.1%) had transient hyp

Sixty-four patients took part in a cohort study measuring the efficacy of daily hormonal therapy in diminishing intestinal bleeding from small bowel angiodysplasia. Thirty patients received 5-10 mg norethynodrel either with mestranol, 0.075-0.15 mg (24 patients) or with conjugated estrogens, 0.625 mg (six patients). The cohort group consisted of 34 patients who either refused hormonal therapy (six patients) or were diagnosed early in our experience, before the resurgence of hormonal therapy (28 patients). Mean follow-up was 15.6 months (range 2-31 months) for the treated group and 13.4 months (range 1-23 months) for the untreated group. In addition, the change in monthly transfusion requirement with therapy was analyzed ("within group" analysis). Fifty percent (15 of 30) of the treated group required no further transfusion during therapy, while 44% (15 of 34) of the untreated group required no further therapy (not significant). During therapy, the mean monthly transfusion requirement of packed red blood cells in the treated group was not significantly different from that found before therapy (1.5 vs. 2.2 units, NS) or from that of the control group (1.5 vs. 1.6 units, NS). The findings do not support the use of hormonal therapy for bleeding from small intestinal angiodysplasia.

In the past few years, several groups of investigators have developed colonoscopic instruments or accessories to speed up the examination and make it more tolerable for patients. The NeoGuide Endoscopy System has the computer processing ability to direct each 8-cm segment of its colonoscope to bend at the exact place where the leading segment turned around a corner. This follow-the-leader system is intended to reduce loops and ensure comfort through preventing excess pressure on the colon wall by making a turn without the usual maneuver of pushing on the wall to advance the scope.

TO THE EDITOR: Thank you for your comment on the article "The most important technique in colonoscopy." Surely, abdominal pressure provides a great assistance to the performance of colonoscopy, and low abdominal pressure does indeed help in preventing the formation of a sigmoid loop. In fact, low abdominal pressure in the low suprapubic area, or in the left or right low abdomen will assist in keeping the scope straight while intubating the sigmoid curves. However, the role of abdominal pressure during colonoscopy is the subject of another article, "The second most important technique during colonoscopy."