Download PDF
Clin Colon Rectal Surg 2001; 14(4): 347-358
DOI: 10.1055/s-2001-18514
Copyright © 2001 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Therapeutic Colonoscopy

Patrick H. D. Colquhoun, Anthony M. Vernava III
  • Department of Colorectal Surgery, Cleveland Clinic Florida Naples, Naples, FL
Further Information

Publication History

Publication Date:
19 November 2001 (online)

Also available at
    Permissions and Reprints

ABSTRACT

Colonoscopy provides a limited-access approach to colonic pathologies that would otherwise require surgical intervention. These therapies are proving safe and effective in a segment of the population prone to significant surgical morbidity and mortality. Colonic obstruction secondary to neoplasia, volvulus, anastomotic stricture, and colonic pseudo-obstruction are being treated via the colonoscope with reported success rates in excess of 90%. Lower gastrointestinal bleeding appears best localized via the colonoscope, and new experience suggests common pathologies such as angiodysplasia and diverticulosis are amenable to colonoscopic treatment in the majority of cases. The literature suggests these interventions to be safe, with complication and mortality rates below 5%.

KEYWORD

Colonoscopy - colonic obstruction - colonic pseudo-obstruction - lower gastrointestinal hemorrhage

REFERENCES

  • 1 Gordon P H, Nivatvongs S. Principles and Practice of Surgery for the Colon and Rectum, 1st ed.  St. Louis: Quality Medical Publishing; 1992
    Search in Google Scholar
  • 2 Lo S K. Metallic stenting for colorectal obstruction.  Gatrointest Endosc Clin NA . 1999;  9 459-477
    PubMedSearch in Google Scholar
  • 3 Keighley M RB, Williams N. Surgery of the anus, rectum and colon.  Philadelphia: WB Saunders; 1993
    Search in Google Scholar
  • 4 Corman M L. Colon and Rectal Surgery. Philadelphia: Lippincott-Raven; 2000
  • 5 . Single-stage treatment for malignant left-sided colonic obstruction: a prospective randomized clinical trial comparing subtotal colectomy with segmental resection following intraoperative irrigation. The SCOTIA Study Group. Subtotal Colectomy versus On-table Irrigation and Anastomosis.  Br J Surg . 1995;  82 1622-1627
    PubMedSearch in Google Scholar
  • 6 Nugent K P, Daniels P, Stewart B, Pantakar R, Johnson C D. Quality of life in stoma patients.  Dis Colon Rectum . 1999;  42 1569-1574
    CrossrefPubMedSearch in Google Scholar
  • 7 Wedell J, Banzhaf G, Chaoui R, Fischer R, Reichmann J. Surgical management of complicated colonic diverticulitis.  Br J Surg . 1997;  84 380-383
    CrossrefPubMedSearch in Google Scholar
  • 8 Chau C L. Surgical considerations in the Hartman's procedure.  Aust NZ J Surg . 1996;  66 676-679
    PubMedSearch in Google Scholar
  • 9 Keck J O, Collopy B T, Ryan P J, Fink R, Mackay R J, Woods J R. Reversal of Hartmann's procedure: effect of timing and technique on safety and ease.  Dis Colon Rectum . 1994;  37 243-248
    CrossrefPubMedSearch in Google Scholar
  • 10 Khory D, Beck D E, Opelka F G, Hicks T C, Timmcke A E, Gathright J B. Colostomy closure: Ochsner Clinic experience.  Dis Colon Rectum . 1996;  39 605-609
    PubMedSearch in Google Scholar
  • 11 Stone J M, Bloom R J. Transendoscopic balloon dilation of complete colonic obstruction.  Dis Colon Rectum . 1989;  32 429-431
    CrossrefPubMedSearch in Google Scholar
  • 12 Hoekstra H J, Verschueren R C, Oldhoff J, Van der Ploeg E. Palliative and curative electrocoagulation for rectal cancer. Experience and results.  Cancer. 1985;  55 210-213
    PubMedSearch in Google Scholar
  • 13 Gevers A M, Macken E, Hiele M, Rutgeerts P. Endoscopic laser therapy for palliation of patients with distal colorectal carcinoma: analysis of factors influencing long-term outcome.  Gastointest Endosc . 2000;  51 580-585
    PubMedSearch in Google Scholar
  • 14 Dohmoto M. New method endoscopic implantation of rectal stent in palliative treatment of malignant stenosis.  Endoscopia Digestiva . 1991;  3 1507-1512
    PubMedSearch in Google Scholar
  • 15 Camunez F, Echenagusia A, Simo G, Turegano F, Vasquez J, Barreiro-Meiro I. Malignant colorectal obstruction treated by means of self expanding stents: effectiveness before surgery and in palliation.  Radiology . 2000;  216 492-497
    CrossrefPubMedSearch in Google Scholar
  • 16 De Gregorio A M, Mainar A, Tejero E. Acute colorectal obstruction: stent placement for palliative treatment-results of a multicenter study.  Radiology . 1998;  209 117-120
    PubMedSearch in Google Scholar
  • 17 Binkert C A, Ledermann H, Jost R, Sauerenmann P, Decurtins M, Zollikofer C L. Acute colonic obstructions: clinical aspects and cost-effectiveness of preoperative and palliative treatment with self-expanding metallic stents-a preliminary report.  Radiology . 1998;  206 204-499
    PubMedSearch in Google Scholar
  • 18 Mainar A, De Gregorio Ariza A M, Tejero E. Acute colorectaol obstruction: treatment with self expandable mettalic stents before scheduled surgery-results of a multicenter study.  Radiology . 1999;  210 65-69
    PubMedSearch in Google Scholar
  • 19 Saida Y, Sumiyama Y, Nagao J, Takase M. Stent endoprosthesis for obstructing colorectal cancers.  Dis Colon Rectum . 1996;  39 552-555
    PubMedSearch in Google Scholar
  • 20 Law W L, Chu K W, Ho J W, Tung H M, Law S Y, Chu K M. Self expanding metallic stent in the treatment of colonic obstruction caused by advanced malignancies.  Dis Colon Rectum . 2000;  43 1522-1527
    CrossrefPubMedSearch in Google Scholar
  • 21 Orchard J L, Rekha M, Khan H. The use of colonoscopy in the treatment of colonic volvulus: three cases and review of the literature.  Am J Gastroenterol . 1984;  79 864-867
    PubMedSearch in Google Scholar
  • 22 Ballantyne G H. Review of sigmoid volvulus: history and results of treatment.  Dis Colon Rectum . 1982;  25 494-501
    CrossrefPubMedSearch in Google Scholar
  • 23 Dineen M D, Motson R W. Treatment of colonic anastomotic strictures with through the scope balloon dilators.  J R Soc Med . 1991;  84 264-266
    PubMedSearch in Google Scholar
  • 24 Virgilio C, Cosentino S, Favara C, Russo V, Russo A. Endoscopic treatment of postoperative colonic strictures using an achalsia dilator: short-term and long-term results.  Endoscopy . 1995;  27 219-222
    PubMedSearch in Google Scholar
  • 25 Johansson C. Endoscopic dilation of rectal strictures: a prospective study of 18 cases.  Dis Colon Rectum . 1996;  39 423-428
    PubMedSearch in Google Scholar
  • 26 Aston N O, Owen W J, Irving J D. Endoscopic balloon dilation of colonic anastomotic strictures.  Br J Surg . 1989;  76 7810-782
    PubMedSearch in Google Scholar
  • 27 Ogilvie H. Large intestine colic due to sympathetic deprivation.  Br Med J . 1948;  2 671-672
    CrossrefPubMedSearch in Google Scholar
  • 28 Strodel W E, Brothers T. Colonoscopic decompression of pseudo-obstruction and volvulus.  Surg Clin North Am . 1989;  69 1327-1335
    PubMedSearch in Google Scholar
  • 29 Rex D K. Colonoscopy and acute colonic pseudo-obstruction.  Gastrointest Endo Clin North Am. 1997;  7 499-507
    PubMedSearch in Google Scholar
  • 30 Starling J R. Treatment of nontoxic megacolon by colonscopy.  Surgery . 1983;  94 677-681
    PubMedSearch in Google Scholar
  • 31 Lowman R M, Davis L. An evaluation of cecal size in impending perforation of the cecum.  Surg Gyncol Obstet . 1956;  102 711-716
    PubMedSearch in Google Scholar
  • 32 Ponec R J, Saunders M D, Kimmey M B. Neostigmine for the treatment of acute colonic pseudo-obstruction.  N Engl J Med . 1999;  341 137-141
    CrossrefPubMedSearch in Google Scholar
  • 33 Kukora J S, Dent T L. Colonoscopic decompression of massive nonobstructive cecal dilation.  Arch Surg . 1977;  112 512-517
    PubMedSearch in Google Scholar
  • 34 Geller A, Petersen B T, Gostout C J. Endoscopic decompression for acute psudo-obstruction.  Gastrointest Endosc . 1996;  44 144-150
    CrossrefPubMedSearch in Google Scholar
  • 35 Harig J M, Fumo D E, Loo F D, Parker H J, Soergel K H, Helm J F, Hogan W J. Treatment of acute nontoxic megacolon during colonscopy: tube placement versus simple decompression.  Gastrointest Endosc . 1988;  34 23-27
    CrossrefPubMedSearch in Google Scholar
  • 36 Gosche J R, Sharpe J N, Larson G M. Colonoscopic decompression for pseudoobstruction of the colon.  Am Surg . 1989;  55 111-115
    PubMedSearch in Google Scholar
  • 37 Schrock T R. Colonoscopic diagnosis and treatment of lower gastrointestinal bleeding.  Surg Clin North Am . 1989;  69 1309-1325
    PubMedSearch in Google Scholar
  • 38 Eaton A C. Emergency surgery for acute colonic hemorrhage-a retrospective study.  Br J Surg . 1981;  68 109-112
    CrossrefPubMedSearch in Google Scholar
  • 39 Parkes B M, Obeid F N, Sorensen V J, Horst H M, Faith J J. The management of lower gastrointestinal bleeding.  Am Surg . 1993;  59 676-678
    PubMedSearch in Google Scholar
  • 40 Drapanas T, Pennington D G, Kappelman M, Lindsey E S. Emergency subtotal colectomy: preferred management of massively bleeding diverticular disease.  Am Surg . 1973;  177 519-526
    PubMedSearch in Google Scholar
  • 41 Farner R, Lichliter W, Kuhn J, Fisher T. Total colectomy versus limited colonic resections for acute lower gastrointestinal bleeding.  Am J Surg . 1999;  178 587-591
    CrossrefPubMedSearch in Google Scholar
  • 42 McGuire H H. Bleeding colonic diverticula. A reappraisal of natural history and management.  Ann Surg . 1994;  200 653-656
    PubMedSearch in Google Scholar
  • 43 Ng D A, Opelka F G, Beck D E, Hicks T C, Timmcke A E, Gathright J B. Predictive value of Tc99m labeled red blood cell scintigraphy for positive angiogram in massive lower gastrointestinal hemorrhage.  Dis Colon Rectum . 1997;  40 471-477
    CrossrefPubMedSearch in Google Scholar
  • 44 Vernava A M, Moore B A, Longo W E, Johnson F E. Lower gastrointestinal bleeding.  Dis Colon Rectum . 1997;  40 858-886
    PubMedSearch in Google Scholar
  • 45 Jensen D M, Machicado G A. Colonoscopy for diagnosis and treatment of severe lower gastrointestinal bleeding.  Gastrointest Endo Clin North Am . 1997;  7 477-498
    PubMedSearch in Google Scholar
  • 46 Cohn S M, Moller B A, Zieg P M, Milner K A, Angood P B. Angiography for preoperative evaluation in patients with lower gastrointestinal bleeding-are the benefits worth the risks?.  Arch Surg . 1998;  133 50-55
    PubMedSearch in Google Scholar
  • 47 Ohyama T, Sakurai Y, Masayoshi I, Daito K, Sezai S, Sato Y. Analysis of urgent colonoscopy for lower gastrointestinal tract bleeding.  Digestion . 2000;  61 189-192
    CrossrefPubMedSearch in Google Scholar
  • 48 Caos A, Benner K G, Manier J, McCarthy D M, Blessing L D, Katon R M, Gogel H K. Colonoscopy after golytely preparation in acute rectal bleeding.  J Clin Gastroenterol . 1986;  8 46-49
    CrossrefPubMedSearch in Google Scholar
  • 49 Rossini F P, Ferrari A, Soandre M. Emergency colonoscopy.  World J Surg . 1989;  13 190-192
    CrossrefPubMedSearch in Google Scholar
  • 50 Johnston J, Sones J. Endoscopic heater probe coagulation of the bleeding colonic diverticulum.  Gastointest Endosc . 1986;  32 160
    PubMedSearch in Google Scholar
  • 51 Ramirez F C, Johnson D A, Zierer S T, Walker G J, Sanowski R A. Successful endoscopic hemostasis of bleeding diverticula with epinephrine injection.  Gastointest Endosc . 1986;  43 160-170
    PubMedSearch in Google Scholar
  • 52 Kim Y I, Marcon N E. Injection therapy for colonic diverticular bleeding: a case study.  J Clin Gastroenterol . 1993;  17 46-48
    PubMedSearch in Google Scholar
  • 53 Andress H J, Mewes A, Lange V. Endoscopic hemostasis of a bleeding diverticulum of the sigma with fibrin sealant.  Endoscopy . 1993;  25 193
    PubMedSearch in Google Scholar
  • 54 Savides T, Jensen D M. Colonoscopic hemostasis of recurrent diverticular hemorrhage associated with a visible vessel: a report of three cases.  Gastointest Endosc . 1994;  40 70-73
    PubMedSearch in Google Scholar
  • 55 Jensen D M, Machicado G A, Jutabha R, Kovacs T O. Urgent colonoscopy for the diagnosis and treatment of severe divertiuclar hemorrhage.  N Engl J Med . 2000;  342 78-82
    CrossrefPubMedSearch in Google Scholar
  • 56 Santos J C, Aprilli F, Guimaraes A S, Rocha J J. Angiodysplasia of the colon: endoscopic diagnosis and treatment.  Br J Surg . 1988;  75 256-258
    PubMedSearch in Google Scholar
  • 57 Kantarian J C, Riether R D, Sheets J A, Stasik J J, Rosen L, Khubchandani I T. Endoscopic retrieval of foreign bodies from the rectum.  Dis Colon Rectum . 1987;  30 902-904
    PubMedSearch in Google Scholar
  • 58 Obrador A, Gaya J, Pueyo J, Dolz C. Colonoscopic removal of a long piece of lawn hose.  Gastrointest Endosc . 1988;  34 286-287
    PubMedSearch in Google Scholar
  • 59 Norfleet R G, Skerven G, Chatterton H T. Colonoscopic removal of a ``pop-up meat thermometer'' from the sigmoid colon.  J Clin Gastroenterol . 1984;  6 477-478
    PubMedSearch in Google Scholar
  • 60 Segall M M, Klein S N, Bradley G T. Colonoscopic extraction of dentures.  Gastrointest Endosc . 1983;  29 142-143
    PubMedSearch in Google Scholar
  • 61 Melzter S J, Goldberg M D, Meltzer R M, Claps F. Appendiceal obstruction by a toothpick removed at colonoscopy.  Am J Gastoenterol . 1986;  81 1107-1108
    PubMedSearch in Google Scholar
  • 62 Monkemuller K E, Patil R, Marino C R. Endoscopic removal of a toothpick from the transverse colon.  Am J Gastroentetol . 1996;  91 2438-2439
    PubMedSearch in Google Scholar
  • 63 Tarnasky P R, Newcomer M K, Branch M S. Colonoscopic diagnosis and treatment of chronic chicken bone perforation of the sigmoid colon.  Gastrointest Endosc . 1994;  40 373-375
    CrossrefPubMedSearch in Google Scholar
  • 64 Matsushita M, Hajiro K, Takakuwa H, Nishio A. Colonoscopic clipping closure of a divot after removal of an impacted chicken bone.  Gastrointest Endosc . 1998;  48 337-338
    PubMedSearch in Google Scholar
  • 65 Strodel W E, Nostrant T T, Eckhauser F E, Dent T L. Therapeutic and diagnostic colonscopy in nonobstructive colonic dilatation.  Ann Surg . 1983;  197 416-421
    PubMedSearch in Google Scholar
  • 66 Nivatvongs S, Vermeulen F D, Fang D T. Colonoscopic decompression of acute pseudo-obstruction of the colon.  Ann Surg . 1982;  196 598-600
    PubMedSearch in Google Scholar
  • 67 Bode W E, Beart Jr W R, Spencer R J, Culp C E, Wolff B G, Taylor B M. Colonoscopic decompression for acute pseudoobstruction of the colon (Olgilvie's syndrome). Report of 22 cases and review of the literature.  Am J Surg . 1984;  147 243-245
    CrossrefPubMedSearch in Google Scholar
  • 68 Vanek V W, Al-Saiti M. Acute pseudo-obstruction of the colon (Ogilvie's syndrome). An analysis of 400 cases.  Dis Colon Rectum . 1986;  29 203-210
    CrossrefPubMedSearch in Google Scholar
  • 69 Jetmore A B, Timmcke A E, Gathright Jr B J, Hicks T C, Ray J E, Baker J W. Ogilvie's syndrome: colonoscopic decompression and analysis of predisposing factors.  Dis Colon Rectum . 1992;  35 1135-1142
    CrossrefPubMedSearch in Google Scholar
  • 70 Krige J E, Hudson D A, Kottler R E. Acute colonic pseudo-obstruction. Current diagnosis and management.  S Afr Med J . 1989;  75 271-274
    PubMedSearch in Google Scholar