Review article
The role of sigmoidoscopy and colonoscopy in the diagnosis and management of lower gastrointestinal disorders: endoscopic findings, therapy, and complications

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Hemorrhoids

Hemorrhoidal bleeding is typically bright red, occurs at the end of defecation, and coats the stool. Other symptoms of hemorrhoids include anorectal discomfort, pruritis ani, fecal soiling, and prolapse [5]. Hemorrhoids appear as bulging, red, bluish, or gray lumps in the anorectum. External hemorrhoids arise below the dentate line, whereas internal hemorrhoids arise above the dentate line. Internal hemorrhoids are best appreciated at FS by rectal retroflexion [6]. Internal hemorrhoids are

Ulcerative colitis

Symptoms of ulcerative colitis include diarrhea, rectal bleeding, abdominal pain, and pyrexia. Colonoscopic findings with mild, acute ulcerative colitis include replacement of the smooth and glistening, or “wet,” appearance of normal healthy colonic mucosa by granular mucosa caused by disruption of normal light reflection; blunting of the normal finely branching mucosal vascular pattern so that vessel branches become fewer and more tortuous; blunting of intrahaustral folds caused by mucosal

Hemostasis

Colonoscopic therapy is being applied more frequently to arrest acute or chronic colonic bleeding, in lieu of surgery (see elsewhere in this volume). Colonic bleeding from focal colonic lesions such as angiodysplasia or a Dieulafoy lesion can be treated by electrocoagulation, thermocoagulation, laser, or injection therapy [125].

Immediate postpolypectomy bleeding is usually initially managed by resnaring and tightly closing the snare about the residual stalk base, without applying

Procedure complications

Diagnostic and therapeutic colonoscopy can cause complications (Box 3, Box 4). The complication rate of diagnostic and therapeutic colonoscopy is about 0.4% and 1.4%, respectively [144]. Patients occasionally do not tolerate bowel preparation regimens. Stimulant laxatives may cause abdominal cramps and pain. Colonic lavage with polyethylene glycol solution rarely causes cardiac arrhythmias, nausea, vomiting, or Mallory-Weiss tears [145]. The combination of a narcotic and benzodiazepine can

Colonoscope cleansing and disinfection

The endoscope and endoscopic channels should be thoroughly cleaned by scrubbing the outside, and brushing the channels after use [171]. The instrument is then disinfected, usually by rinsing with Cidex (2% glutaraldehyde, Johnson and Johnson, New Brunswick, New Jersey) for at least 20 minutes, and thoroughly rinsed to completely remove the disinfecting solution [171]. Glutaraldehyde has caused colitis in patients exposed to inadequately rinsed colonoscopes during colonoscopy [167]. Endoscopic

Alternatives to colonoscopy

Colonoscopy is more costly and cumbersome than air-contrast barium enema (ACBE) because of the need for parenteral sedation, intraprocedural monitoring, and patient escorting postprocedure, and entails greater patient risk than ACBE. Colonoscopy is preferred for cancer screening because of higher diagnostic sensitivity and the ability to sample or remove polyps. Air-contrast barium enema and colonoscopy are equally sensitive at detecting large polyps, but ACBE often misses small polyps [173],

Improvements in colon cancer screening

Colon cancer incidence and survival in the United States have improved only slightly during the past decade despite the demonstrable efficacy of colonoscopic polypectomy at cancer prevention [1], [180], [181], [182]. This failure is caused largely by the ineffective screening of the vast population at risk for this exceedingly common malignancy. Multiple, not mutually exclusive approaches, are attempting to address this deficiency. Colonoscopy is being applied more liberally to screen the

Summary

Flexible sigmoidoscopy and colonoscopy have revolutionized the clinical management of colonic diseases. Colonoscopy is a highly sensitive and specific test. Colonic diseases often produce characteristic colonoscopic findings, as well as characteristic histologic findings, as identified in colonoscopic biopsy or polypectomy specimens. Colonoscopy is relatively safe, with a low incidence of serious complications, such as colonic perforation, hemorrhage, cardiopulmonary arrest, or sepsis.

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