B.H. Sullivan

Surveillance for colonic carcinoma in ulcerative colitis

To evaluate the efficacy of surveillance colonoscopy with biopsy for the detection of high-grade dysplasia (HGD) or colonic carcinoma in patients with chronic ulcerative colitis, we undertook a retrospective review of 248 patients who underwent 370 examinations (mean duration of disease 12 yr). High-grade dysplasia or carcinoma was found in 24 examinations in 16 patients, with a mean duration of disease of 16 yr. There were 15 patients with HGD. Nine patients had HGD alone, 6 had HGD and carcinoma, and 1 had carcinoma without HGD. The overall incidence of HGD was 6%. Dysplasia-associated lesions or mass were the most consistent indicators of carcinoma, the combination being present in four instances. Of the 7 patients with cancer, 6 were recognized by colonoscopy, and 1 patient with negative visual endoscopic findings was discovered using surveillance biopsies. The conclusions of this study are that dysplasia is a reliable histopathologic marker and correlates with the presence of cancer in chronic ulcerative colitis; the absence of dysplasia correlates with the absence of cancer. The presence of dysplasia-associated lesions or mass with HGD is the strongest indication for operation. This study supports the use of surveillance colonoscopy in managing high-risk ulcerative colitis patients.

Endoscopic diagnosis of aortoduodenal fistula.

Intermittent gastrointestinal hemorrhage in a patient having had an aortic graft should suggest an aortoduodenal fistula. Herewith is a description of the first endoscopic diagnosis.

Neurogenic Tumors of the Small Intestine: Review of the literature and report of a case with endoscopic removal

Epigastric pain and melena prompted the study of a woman with cutaneous neurofibromatosis (von Recklinghausens disease). Roentgenographic and endoscopic examination demonstrated an ulcerated polypoid neurilemoma of the duodenum. It was removed by endoscopic electrosurgery. Neurogenic tumors of the intestine are rare, but should be considered in the differential diagnosis when patients with multiple café au lait spots or cutaneous neurofibromatosis manifest epigastric pain, gastrointestinal bleeding, or intestinal obstruction. Endoscopic polypectomy may offer a low risk method of treatment for sutably located bleeding neurogenic tumors of the stomach or duodenum.

Colonoscopy in the diagnosis of unexplained rectal bleeding.

Three hundred six patients with unexplained rectal bleeding were examined by colonoscopy. Significant lesions were found in 30% including polyps having a diameter of 0.5 cm or larger in 14%, carcinoma in 8%, and a small number of patients with inflammatory bowel disease, vascular formations, and radiation colitis. Colonoscopic findings in a large subgroup of patients with diverticulosis established by barium enema did not differ significantly from those of the group as a whole. Significant lesions were also identified in 22% of small subsets of patients with occult bleeding or unexplained melena.

A linkage study of HLA and inherited adenocarcinoma of the colon

A kindred with the familial cancer syndrome is reported in which every confirmed affected member of the pedigree had at least one primary carcinoma of the colon. The average age at which cancer appeared was 38 years, and multiple primary neoplasms occurred in 23% of the cancer patients. Transmission of the cancer trait is consistent with an autosomal dominant mode of inheritance. Colonoscopy eliminated the presence of any unsuspected cancers in family members at risk. HLA typing was done, and by direct typing or inference, data were available on 66 living and deceased individuals. There were four informative matings in the kindred, the offspring of which showed only three crossovers of a possible 17. The lod score totaled 1.06 at a recombination fraction of 0.20. The need for cooperative efforts of many investigators in HLA linkage studies is emphasized, along with the potential value of such an approach.

Colonoscopy: A report of 644 cases and review of the literature

Abstract Direct vision fiberoptic examination of the colon is time-consuming and the technics are not mastered quickly. Nevertheless, colonoscopy is extremely valuable and perhaps at times an indispensable aid in diagnosis. It can provide accurate information critical to the management of many patients with low morbidity and mortality. For patients who have avoided hospitalization and laparotomy as a result of colonoscopy, there is considerable saving not only of medical costs but also of time lost from work and other duties. This is most obvious in the case of polyp excision. Colonoscopic electrosurgery is emerging as the treatment of choice in a variety of clinical problems and will no doubt gain even wider application as technics and instruments become more sophisticated.

Endoscopic pancreatography: Its value in preoperative and postoperative assessment of pancreatic disease

Examples of the use of endoscopic pancreatography in the preoperative evaluation and postoperative follow-up study of patients with pancreatic disease are presented and discussed. Six cases selected from a total experience of forty-eight patients have been summarized. The direct role of pancreatography in the management of these cases is cited. There is a small but definite risk to the procedure. With increased use of endoscopic pancreatography, it is hoped that earlier diagnoses of a variety of pancreatic diseases will be obtained which will permit more accurate medical and surgical therapy.

Endoscopic diagnosis of malignant melanoma metastatic to the duodenum.

intravenous injection through a large-diameter vein or through the intravenous tubing will minimize the hazards from this complication. Analysis of the 5 fatal cases stresses the importance of prompt surgical drainage when ductal obstruction is demonstrated. Because of this and because ERCP is a stressful procedure, it should be performed on only those patients who are acceptable surgical candidates. ERCP has proven to be an exciting new diagnostic procedure in the evaluation of a variety of pancreatic and biliary tract diseases. In properly selected patients, it is capable of providing unique diagnostic information with reasonable risk to the patient. Serious complications following ERCP can be minimized by careful attention to detail, as well as by an appreciation of the hazards associated with ductal obstruction.

Cancer Surveillance in Ulcerative Colitis

The purpose of this study was to determine if colonoscopic surveillance for the detection of dysplasia is an appropriate approach to assess the risk of development of colonic cancer in patients with long-standing ulcerative colitis.