COLONOSCOPY Edited by Paul Miskovitz Colonoscopy Edited by Paul Miskovitz Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2011 InTech All chapters are Open Access articles distributed under the Creative Commons Non Commercial Share Alike Attribution 3.0 license, which permits to copy, distribute, transmit, and adapt the work in any medium, so long as the original work is properly cited. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published articles. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. Publishing Process Manager Igor Babic Technical Editor Teodora Smiljanic Cover Designer Jan Hyrat Image Copyright Gunnar Pippel, 2010. Used under license from Shutterstock.com First published August, 2011 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechweb.org Colonoscopy, Edited by Paul Miskovitz p. cm. ISBN 978-953-307-568-6 free online editions of InTech Books and Journals can be found at www.intechopen.com Contents Preface IX A Brief Overview of Selected Aspects of Colonoscopy: Past, Present and Future XI Part 1 The Technique 1 Chapter 1 Preparing for Colonoscopy 3 Rosalinda S. Hulse Chapter 2 Sedation and General Anaesthesia for Colonoscopy in Childhood 25 Alicja Bartkowska-Śniatkowska, Jowita Rosada-Kurasińska and Małgorzata Grześkowiak Chapter 3 Quality of Screening Colonoscopy: Learning Technical Skills and Evaluating Competence 47 Marco Bustamante Chapter 4 Maintaining Quality in Endoscopy 61 Anita Balakrishnan, Stephen Lewis and Kenneth B Hosie Part 2 Applications 77 Chapter 5 The Impact of Colonoscopy on Colorectal Cancer Incidence and Mortality 79 Minhhuyen T. Nguyen and David S. Weinberg Chapter 6 Post-Polypectomy Colonoscopy Surveillance 97 Sung Noh Hong Chapter 7 Endoscopic Manifestations and Mucosal Patterns Associated to Collagenous Colitis 121 Daniel Gustavo Cimmino and José Manuel Mella VI Contents Chapter 8 Endoscopic Approach in Ulcerative Colitis 129 Rogério Saad-Hossne and Fábio V. Teixeira Chapter 9 Pathological Issues of Ulcerative Colitis/Dysplasia 139 Tomita S., Fujii S. and Fujimori T Chapter 10 Pathology of Staging of Early Colorectal Lesions During Surveillance Programmes 153 Emil Salmo and Najib Haboubi Chapter 11 Endoscopic Submucosal Dissection for Colorectal Lesions 167 Takashi Shida Chapter 12 Portal Hypertensive Colopathy 171 Vatsala Misra, Vishal Dhingra, S P Misra and Manisha Dwivedi Part 3 The Future? 177 Chapter 13 Research and Therapeutic Innovation: Tissue Resonance InterferoMeter Probe in Early Detection-Screening for Rectal Cancer 179 Alberto Vannelli and Luigi Battaglia Chapter 14 Autofluorescence Imaging for Diagnosing Intestinal Disorders 205 Mikihiro Fujiya, Kentaro Moriichi, Nobuhiro Ueno, Yusuke Saitoh and Yutaka Kohgo Chapter 15 Intestinal Dynamic Color Doppler Sonographic Tissue Perfusion Measurement 221 Thomas Scholbach, Jörg Hofmann and Jakob Scholbach Chapter 16 Towards Intelligent Systems for Colonoscopy 245 Jorge Bernal, Fernando Vilariño and Javier Sánchez Chapter 17 Virtual Colonoscopy - Technical Aspects 271 Andrzej Skalski, Mirosław Socha, Tomasz Zieliński and Mariusz Duplaga Chapter 18 Robotic Colonoscopy 291 Felice Cosentino, Emanuele Tumino, Giovanni Rubis Passoni, Antonella Rigante, Roberta Barbera, Antonella Tauro and Philipp Emanuel Cosentino Chapter 19 Experimental Small Animal Colonoscopy 309 Terrah J. Paul Olson and Richard B. Halberg Preface To publish a book on colonoscopy suitable for an international medical audience, drawing upon the expertise and talents of many outstanding world-wide clinicians, is a daunting task. To edit such a book is a comparable challenge. The use of the Internet for both medical research and communication greatly helps with this international endeavor. The field of colonoscopy within the larger realm of gastrointestinal endoscopy is, so to speak, a moving target. New developments in videocolonoscope instruments and ancillary equipment, infection risk and control, the use of patient antibiotic prophylaxis, the doctrine of informed consent, procedural technique, the need for terminal ileal intubation, documentation including the use of the electronic health record, patient selection for the procedure, patient preparation, and moderate sedation and monitoring are being made and reported daily in both the medical and the lay press. The rigors developed from the discipline of medical outcomes research are rapidly being applied to the field, hand in hand with questions about procedural reimbursement issues being raised by government and private insurers as well as by patients themselves. Just as over the last several decades colonoscopy has largely supplanted the use of barium enema x-ray study of the colon, new developments in gastrointestinal imaging such as computerized tomographic colonography (CT colonography, “virtual” colonoscopy) and video transmitted capsule study of the colonic lumen and new discoveries in cellular and molecular biology that may facilitate the early detection of colon cancer, colon polyps and other gastrointestinal pathology threaten to relegate the role of colonoscopy as a diagnostic screening technique to the side lines of medical practice. The field has certainly come a long way since the winter of 1974 when as a fourth year medical student at Cornell University Medical College doing a gastroenterology elective rotation at the then New York Hospital in New York City I was given the opportunity (courtesy of my mentors) to look down the “teaching head” of the colonoscope and actually see pathology within the lumen of the large bowel of a patient I was following on the wards! I trust you will find the efforts of the talented and renowned physicians who have contributed to this endeavor to convey a sense of X Preface the history, the present state-of-the art and ongoing confronting issues, and the predicted future of this discipline both rewarding and worthy of your time and consideration. July 2011 Paul Miskovitz MD, AGAF Clinical Professor of Medicine Division of Gastroenterology and Hepatology Department of Medicine Weill Cornell Medical College New York, New York, U.S.A. Faculty Lecturer in Gastroenterology and Hepatology Weill Cornell Medical College-Qatar Doha, Qatar Faculty Lecturer in Gastroenterology and Hepatology The American Austrian Foundation Salzburg-Weill Cornell Seminars Salzburg, Austria Attending Physician New York-Presbyterian Hospital Weill Cornell Campus New York, New York, U.S.A. Consulting Gastroenterologist Hospital for Special Surgery New York, New York, U.S.A. [...]... http://blogs.wsj.com/health/2009/08/06/the-other-propofol-issue-when-insuranceshould-pay-for-it/ (The other propofol issue: when insurance should pay for it-Accessed 4/17 /2011) http://promotions.mardenkane.com/cbs/cbscares/rules.cfm (Accessed 1/10 /2011) http://thehappyhospitalist.blogspot.com/2009_08_01_archive.html (Propofol during colonoscopy anesthesia by gastroenterologists and general practitionersAccessed 4/17 /2011) http://www.asge.org/PublicationsProductsIndex.aspx?id=352... intubation skills in trainees Gastrointest Endosc Vol.44, No.1, (July 1996) pp 5 4-7 ISSN 001 6-5 107 Chiu, H-M., Wang, H -P., Wu M-S., Lin, J-T (2011) The clinical efficacy and future perspective of narrow band imaging for the diagnosis of colorectal neoplasm Dig Endosc Vol.23, Suppl.1, (May 2011) pp 11 6-9 ISSN 144 3-1 661 Choudari, C .P., Rajgopal, C., Palmer, K.R (1994) Acute gastrointestinal haemorrhage in... (February 2006) p 24 1-4 ISSN 016 3-2 116 Jemal, A., Bray, F., Center, M.M., Ferlay, J., Ward, E., Forman, D (2011) Global cancer statistics CA: Cancer J Clin Vol61, No.2, (March-April 2011) pp 6 9-9 0 ISSN 000 7-9 235 Kahi, C.J., Anderson, J.C., Waxman, I., Kessler, W.R., Imperiale, T.F., Li, X., Rex, D.K (2010) High-definition chromocolonoscopy vs high-definition white light colonoscopy for average-risk colorectal... Gastroenterol Vol.45, No.1, (January 2011) pp 6-1 5 ISSN 019 2-0 790 Feld, A.D (12/201 0-1 /2011) Open access Risky business AGA Perspectives Vol.6, No.6, (December 2010-January 2011) pp 5,7 ISSN 155 4-3 366 Filip, M., Iordache, S., Säftoiu, A., Ciurea, T (2011) Autofluorescence imaging and magnification endoscopy World J Gastroenterol Vol.17, No.1, (January 2011) pp 9-1 4 ISSN 100 7-9 327 Fredette, M.E., Lightdale, J.R... Gastroenterology (2011) Gut (May 2011) [Epub ahead of print] pp 1-8 ISSN 146 8-3 288 Goh, K-L (2011) Development of gastrointestinal endoscopy in Malaysia: A historical perspective with special reference to the experience at the University of Malaya Medical Centre Dig Endosc Vol.23, Suppl.1, (May 2011) pp 15 0-3 ISSN 144 3-1 661 Goodwin, J.S., Singh, A., Reddy, N., Riall, T.S., Kuo, Y.F (2011) Overuse of screening colonoscopy. .. (http://blogs.wsj.com/health/2009/08/06/ the-other-propofol-issue-when-insuranceshould-pay-for-it/, http://thehappyhospitalist.blogspot.com/2009_08_01_archive.html, Coté, 2011)) As a counterpoint, the need for conscious sedation in routine adult cases has recently been challenged (Khalid et al., 2011) The means for sedation of pediatric patients undergoing colonoscopy has also received attention (Fredette... screening colonoscopy J Gen Intern Med Vol.20, No.11, (November 2005) pp 98 9-9 5 ISSN 088 4-8 734 DiSario, J.A., Fennerty, M.B., Tietze, C.C., Hutson, W.R., Burt, R.W (1994) Endoscopic balloon dilation for ulcer-induced gastric outlet obstruction Am J Gastroenterol Vol.89, No.6, (June 1994) pp 86 8-7 1 ISSN 000 2-9 270 Dobie, K.A., Burke, C (2011) Colonoscopy for Dummies pp 1-6 4, Wiley Publishing Inc., ISBN 97 8-0 -4 706166 1-1 ,... (September 2007) pp 134 4-5 1 ISSN 044 6-6 586 McHugh, M., Osei-Anto, A., Klabunde, C.N., Galen, B.A (2011) Adoption of CT colonography by US hospitals J Amer Coll Radiol Vol.8, No.3 (March 2011) pp 16 9-7 4 ISSN 15461440 Miskovitz, P Gibofsky, A (1995) Risk management in endoscopic practice Gastrointest Endosc Clin North Am Vol.5, No.2, (April 1995) pp 39 1-4 01 ISSN 105 2-5 157 Miskovitz, P., Gordon, B., Yurt,... (November 2009) pp 518 6-9 2 ISSN 100 7-9 327 Van den Broek, F.J., Fockens, P., van Eeden, S., Stokkers, P.C., Ponsioen, C.Y., Reitsma, J.B., Dekker, E (2011) Narrow-band imaging versus high-definition endoscopy for the diagnosis of neoplasia in ulcerative colitis Endoscopy Vol.43, No.2, (February 2011) pp 10 8-1 5 ISSN 0013726X Wada, Y., Kudo, S-E., Misawa, M., Ikehara, N., Hamatani, S (2011) Vascular pattern... Keswani, R.N (2011) Single-balloon colonoscopy versus repeat standard colonoscopy for previous incomplete colonoscopy: a randomized, controlled trial Gastrointest Endosc Vol.73, No.3, (March 2011) pp 50 7-1 2 ISSN 001 6-5 107 Khalid, A.B., Majid, S., Salih, M., Hashmat, F., Jafri, W (2011) Is full colonoscopic examination necessary in young patients with fresh bleeding per rectum? Endoscopy (March 2011) [Epub . insurance companies and regulatory agencies has been recently addressed (http://blogs.wsj.com/health/2009/08/06/ the-other-propofol-issue-when-insurance- should-pay-for-it/, http://thehappyhospitalist.blogspot.com/2009_08_01_archive.html,. Bowel preparation for colonoscopy Proper and safe patient bowel preparation for colonoscopy is essential (Beck, 2010). It is generally accepted that inadequate bowel preparation for colonoscopy. training programs (Sedlack, 2010) and for application and re-application for hospital colonoscopy privileges (Wexner et al., 2002, Obstein et al., 2011). Polypectomy rate has been proposed as