Download PDF
Clin Colon Rectal Surg 2003; 16(3): 163-172
DOI: 10.1055/s-2003-42899
Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

New Techniques in Colonoscopy

Charles B. Whitlow, Alan E. Timmcke
  • Department of Colon and Rectal Surgery, Ochsner Clinic Foundation, New Orleans, Louisiana
Further Information

Publication History

Publication Date:
10 October 2003 (online)

Also available at
    Permissions and Reprints

ABSTRACT

Colonoscopy is the best method for diagnosing neoplastic processes affecting the colon and is frequently the modality by which definitive treatment of these diseases is provided. Surgery has been the mainstay of treatment of colonic obstruction. In the past 15 years, laser, balloon, and stenting technology has provided alternatives to surgery in colonic obstruction from malignant or benign causes. Colonic stents safely treat colonic obstruction either as a bridge to surgery or as palliation. The most common complications are perforation, stent migration, and stent reocclusion. The neodymium:yttrium-aluminum-garnet (Nd:YAG) is the most widely used laser for treating colorectal disease. Its use is described in treating colonic obstruction, bleeding, and staged destruction of villous adenomas. Balloon dilatation has been used to treat benign strictures. Perforation and the need for repeated treatment are the most common complications from its use. A combined approach with laser or balloon dilatation and stenting has also been successfully used. Preoperative marking of small colonic neoplasms aids in localization of the tumor, especially in laparoscopic procedures. Tattooing and metallic clips are the most common methods for marking, are more accurate than preoperative colonoscopic localization, and are less time consuming than intraoperative colonoscopy.

KEYWORDS

Large bowel obstruction - colonic stenting - balloon dilatation - colonic marking

REFERENCES

  • 1 Deans G T, Krukowski Z H, Irwin S T. Malignant obstruction of the left colon.  Br J Surg . 1994;  81 1270-1276
    CrossrefPubMedSearch in Google Scholar
  • 2 Carter J, Valmadre S, Dalrymple C. et al . Mangement of large bowel obstruction in advanced ovarian cancer with intraluminal stents.  Gynecol Oncol . 2002;  84 176-179
    CrossrefPubMedSearch in Google Scholar
  • 3 Friedland S, Hallenbeck J, Soetikno R M. Stenting the sigmoid colon in a terminally ill patient with prostate cancer.  J Pall Med . 2001;  4 153-156
    PubMedSearch in Google Scholar
  • 4 Dauphine C E, Tan P, Beart R W. et al . Placement of self-expanding metal stents for acute malignant large-bowel obstruction: a collective review.  Ann Surg Oncol . 2002;  9 574-579
    CrossrefPubMedSearch in Google Scholar
  • 5 Law W L, Chu K W, Ho J WC. 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
  • 6 Binkert C A, Ledermann H, Jost R. Acute colonic obstruction: clinical aspects and cost-effectiveness of preoperative and palliative treatment with self-expanding metallic stents: a preliminary report.  Radiology . 1998;  206 199-204
    PubMedSearch in Google Scholar
  • 7 Itabashi M, Hamano K, Kameoka S, Asahina K. Self-expanding stainless steel stent application in rectosigmoid stricture.  Dis Colon Rectum . 1993;  36 508-511
    PubMedSearch in Google Scholar
  • 8 Adamsen S, Holm J, Meisner S. et al . Endoscopic placement of self-expanding metal stents for treatment of colorectal obstruction with long-term follow-up.  Dan Med Bull . 2000;  47 225-227
    PubMedSearch in Google Scholar
  • 9 Mainar A, Ariza M, Tejero E. et al . Acute colorectal obstruction: treatment with self-expandable metallic stents before scheduled surgery: results of a multicenter study.  Radiol . 1999;  210 65-69
    PubMedSearch in Google Scholar
  • 10 Aviv R I, Shyamalan G, Watkinson A. et al . Radiological palliation of malignant colonic obstruction.  Clin Radiol . 2002;  57 347-351
    CrossrefPubMedSearch in Google Scholar
  • 11 Camunez F, Echenagusia A, Simo G. et al . Malignant colorectal obstruction treated by means of self-expanding metallic stents: effectiveness before surgery and in palliaton.  Radiology . 2000;  216 492-497
    CrossrefPubMedSearch in Google Scholar
  • 12 Miyayama S, Matsu O, Kifune K. et al . Malignant colonic obstruction due to extrinsic tumor: palliative treatment with a self-expanding nitinol stent.  AJR Am J Roentgenol . 2000;  175 1631-1637
    PubMedSearch in Google Scholar
  • 13 Tamim W Z, Ghellai A, Counihan T C. et al . Experience with endoluminal colonic wall stents for the management of large bowel obstruction for benign and malignant disease.  Arch Surg . 2000;  135 434-438
    PubMedSearch in Google Scholar
  • 14 Baron T H, Dean P A, Yates M R. et al . Expandable metal stents for the treatment of colonic obstruction: techniques and outcomes.  Gastrointest Endosc . 1998;  47 277-286
    CrossrefPubMedSearch in Google Scholar
  • 15 Spinelli P, Mancini A. Use of self-expanding metal stents for palliation of rectosigmoid cancer.  Gastrointest Endosc . 2001;  53 203-206
    CrossrefPubMedSearch in Google Scholar
  • 16 Martinez-Santos C, Lobato R, Fradejas J M. et al . Self-expandable stent before elective surgery versus emergency surgery for the treatment of malignant colorectal obstructions: comparison of primary anastomosis and morbidity rates.  Dis Colon Rectum . 2002;  45 401-406
    CrossrefPubMedSearch in Google Scholar
  • 17 Canon C L, Baron T H, Morgan D E. Treatment of colonic obstruction with expandable metal stents: radiologic features.  AJR Am J Roentgenol . 1997;  168 199-205
    PubMedSearch in Google Scholar
  • 18 Han Y M, Lee J M, Lee T H. Delayed colon perforation after palliative treatment for rectal carcinoma with bare rectal stent: a case report.  Korean J Radiol . 2000;  1 169-171
    PubMedSearch in Google Scholar
  • 19 Stone C D, Lichtenstein D R. A novel technique for endoscopic removal of a migrated colonic stent.  Gastrointest Endosc . 2001;  54 522-524
    CrossrefPubMedSearch in Google Scholar
  • 20 Repici A, Reggio D, De Angelis. et al . Covered metal stents for management of inoperable malignant colorectal strictures.  Gastrointest Endosc . 2000;  52 735-740
    CrossrefPubMedSearch in Google Scholar
  • 21 DeGregorio M A, Mainar A, Tejero E. et al . Acute colorectal obstruction: stent placement for palliative treatment: results of a multicenter study.  Radiology . 1998;  209 117-120
    PubMedSearch in Google Scholar
  • 22 Odurny A. Colonic anastomosis stenoses and Memotherm stent fracture: a report of three cases.  Cardiovasc Intervent Radiol . 2001;  24 336-339
    CrossrefPubMedSearch in Google Scholar
  • 23 Paul L, Pinto I, Gomez H. et al . Metallic stents in the treatment of benign diseases of the colon: preliminary experience in 10 cases.  Radiology . 2002;  223 715-722
    PubMedSearch in Google Scholar
  • 24 Jeyarajah A R, Shepherd J H, Fairclough P D, Pathcett S E. Effective palliation of a colovaginal fistula using a self-expanding metal stent.  Gastrointest Endosc . 1997;  46 367-369
    PubMedSearch in Google Scholar
  • 25 Ball K A. LASERS: The Perioperative Challenge.  St. Louis: CV Mosby 1990
    Search in Google Scholar
  • 26 Nishioka N S. Applications of LASERS in gastroenterology. In: Puliafito CA, ed. LASER Surgery and Medicine: Principals and Practice New York: Wiley-Liss 1996: 83-92
    Search in Google Scholar
  • 27 Naveau S, Aubert A, Poynard T, Chaput J C. Long-term results of treatment of vascular malformations of the gastrointestinal tract by neodymium YAG laser photocoagulation.  Dig Dis Sci . 1990;  35 821-826
    CrossrefPubMedSearch in Google Scholar
  • 28 Mathus-Vliegen E M, Tytgat G N. The potential and limitations of laser photoablation of colorectal adenomas.  Gastrointest Endosc . 1991;  37 9-17
    PubMedSearch in Google Scholar
  • 29 Hyser M J, Gau F C. Endoscopic Nd:YAG laser therapy for villous adenomas of the colon and rectum.  Am Surg . 1996;  62 577-580
    PubMedSearch in Google Scholar
  • 30 Conio M, Caroli-Bosc F X, Filiberti R. et al . Endoscopic Nd:YAG laser therapy for villous adenomas of the right colon.  Gastrointest Endosc . 1999;  49(4 pt 1) 504-508
    PubMedSearch in Google Scholar
  • 31 Tranberg K G, Moller P H. Palliation of colorectal carcinoma with the Nd:YAG laser.  Eur J Surg . 1991;  157 57-60
    PubMedSearch in Google Scholar
  • 32 Daneker G W, Carlson G W, Hohn D C, Lynch P, Roubein L, Levin B. Endoscopic laser recanalization is effective for prevention and treatment of obstruction in sigmoid and rectal cancer.  Arch Surg . 1991;  126 1348-1352
    PubMedSearch in Google Scholar
  • 33 Tan C C, Iftikhar S Y, Allan A, Freeman J G. Local effects of colorectal cancer are well palliated by endoscopic laser therapy.  Eur J Surg Oncol . 1995;  21 648-652
    PubMedSearch in Google Scholar
  • 34 Eckhauser M L. Laser therapy of gastrointestinal tumors.  World J Surg . 1992;  16 1054-1059
    PubMedSearch in Google Scholar
  • 35 Schulze S, Lyng K M. Palliation of rectosigmoid neoplasms with Nd:YAG laser treatments.  Dis Colon Rectum . 1994;  37 882-884
    PubMedSearch in Google Scholar
  • 36 Viggiano T R, Zighelbolm J, Alquist D A, Gostout C J, Wang K K, Larson M V. Endoscopic Nd:YAG laser coagulation of bleeding from radiation proctopathy.  Gastrointest Endosc . 1993;  39 513-517
    CrossrefPubMedSearch in Google Scholar
  • 37 Kaassis M, Oberti E, Burtin P, Boyer J. Argon plasma coagulation for the treatment of hemorrhagic radiation proctitis.  Endoscopy . 2000;  32 673-676
    Thieme ConnectPubMedSearch in Google Scholar
  • 38 Cothren R M, Sivak Jr V M, Van Dam J. et al . Detection of dysplasia at colonoscopy using laser-induced fluorescence: a blinded study.  Gastrointest Endosc . 1996;  44 168-176
    PubMedSearch in Google Scholar
  • 39 Mycek M A, Schomacker K T, Nishioka N S. Colonic polyp differentiation using time-resolved autofluorescence spectroscopy.  Gastrointest Endosc . 1998;  48 390-394
    PubMedSearch in Google Scholar
  • 40 Aston N O, Owen W J, Irving J D. Endoscopic balloon dilatation of colonic anastomotic strictures.  Br J Surg . 1989;  76 780-782
    PubMedSearch in Google Scholar
  • 41 Stone J M, Bloom R J. Transendoscopic balloon dilatation of complete colonic obstruction: an adjunct in the treatment of colorectal cancer: report of three cases.  Dis Colon Rectum . 1989;  32 429-431
    CrossrefPubMedSearch in Google Scholar
  • 42 Williams A J, Palmer K R. Endoscopic balloon dilatation as a therapeutic option in the management of intestinal strictures resulting from Crohn's disease.  Br J Surg . 1991;  78 453-454
    CrossrefPubMedSearch in Google Scholar
  • 43 Dear K L, Hunter J O. Colonoscopic hydroststic balloon dilatation of Crohn's strictures.  J Clin Gastroenterol . 2001;  33 315-318
    CrossrefPubMedSearch in Google Scholar
  • 44 Miller E S, Barnett R M, Williams R B. Sigmoid endometriotic stricture treated with endoscopic balloon dilatation: report of a case and literature review.  Md Med J . 1990;  39 1081-1084
    PubMedSearch in Google Scholar
  • 45 Askin M P, Waye J D, Fiedler L, Harpaz N. Tattoo of colonic neoplasms in 113 patients with a new sterile carbon compound.  Gastrointest Endosc . 2002;  56 339-342
    CrossrefPubMedSearch in Google Scholar
  • 46 Vinati P, Welch J P, Cohen J L. Endoscopic localization of colon cancers.  Surg Endosc . 1994;  8 1085-1087
    CrossrefPubMedSearch in Google Scholar
  • 47 Dunaway M T, Webb W R, Rodning C B. Intraluminal measurement of distance in the colorectal region employing rigid and flexible endoscopes.  Surg Endosc . 1988;  2 81-83
    CrossrefPubMedSearch in Google Scholar
  • 48 Fennerty M B, Sampliner R E, Hixson L J, Garewal H S. Effectiveness of India ink as a long-term colonic mucosal marker.  Am J Gastroenterol . 1992;  87 79-81
    PubMedSearch in Google Scholar
  • 49 Bottoman V A, Peitro M, Thirlby R C. Localization of colonic lesions with endoscopic tattoo.  Dis Colon Rectum . 1994;  37 775-776
    PubMedSearch in Google Scholar
  • 50 Dell'Abbate P, Iosca A, Galimberti A. et al . Endoscopic preoperative colonic tattoing: a clinical and surgical complication.  Endoscopy . 1999;  31 271-273
    Thieme ConnectPubMedSearch in Google Scholar
  • 51 Ellis K K, Fennerty M B. Marking and identifying colon lesions: tattoos, clips, and radiology in imaging the colon.  Gastrointest Endosc Clin N Am . 1997;  7 401-411
    PubMedSearch in Google Scholar
  • 52 Kim S H, Milsom J W, Church J M. et al . Perioperative tumor localization for laparoscopic colorectal surgery.  Surg Endosc . 1997;  11 1013-1016
    CrossrefPubMedSearch in Google Scholar
  • 53 Fu K, Fuji T, Kato Y. et al . A new endoscopic tattoing technique for identifying the location of colonic lesions during laparoscopic surgery: a comparison with the conventional technique.  Endoscopy . 2001;  33 687-691
    Thieme ConnectPubMedSearch in Google Scholar
  • 54 Montorsi M, Opocher E, Santambrogio R. Original technique for small colorectal tumor localization during laparoscopic surgery.  Dis Colon Rectum . 1999;  42 819-822
    CrossrefPubMedSearch in Google Scholar
  • 55 Ohdaira T, Konishi F, Nagai H. et al . Intraoperative localization of colorectal tumors in the early stages using a marking clip detector system.  Dis Colon Rectum . 1999;  42 1353-1355
    CrossrefPubMedSearch in Google Scholar
  • 56 Iida Y, Miura S, Munemoto Y. et al . Endoscopic resection of large colorectal polyps using a clipping method.  Dis Colon Rectum . 1994;  37 179-180
    CrossrefPubMedSearch in Google Scholar
  • 57 Sobrino-Faya M, Martinez S, Gomez Balado M. et al . Clips for the prevention and treatment of postpolypectomy bleeding (hemoclips in polypectomy).  Rev Esp Enferm Dig . 2002;  94 457-462
    PubMedSearch in Google Scholar
  • 58 Rezzo R, Scopinaro G, Gambaro M. Radioguided occult colonic lesion identification (ROCLI) during open and laparoscopic surgery.  Tumor . 2002;  88 S19-S22
    PubMedSearch in Google Scholar