Die Koloskopie ist eine der wichtigsten apparativen Untersuchungsmethoden der heutigen Medizin. Sie dient nicht nur der Diagnostik, sondern kann auch therapeutische Verwendung finden. Bei der vorliegenden Arbeit handelt es sich um eine randomisierte kontrollierte doppelblinde Studie. Das Hauptziel bestand in dem Vergleich der etablierten Methode, bei der Raumluft als Insufflationsgas verwendet wird, mit einer Methode, bei welcher stattdessen Kohlenstoffdioxid benutzt wird. Insgesamt wurden 150 Patienten in die prospektive Studie aufgenommen. Diese wurden gebeten, zu festgelegten Zeitpunkten nach der Untersuchung, Angaben zu Ihrem Beschwerdebild anzufertigen. Zusätzlich wurde nach der Arbeitsfähigkeit und der Zufriedenheit gefragt. Abschließend wurden noch verschiedene Faktoren während der Koloskopie geprüft, die der untersuchende Arzt am Ende der Prozedur notierte. Zu diesen gehörten die Allgemeine Einschätzung, die Untersuchungsdauer, etwaig auftretende Komplikationen und der Sedierungsbedarf.

Although intestinal involvement occurs in more than half of the cases with KS that are HIV positive, it is uncommon in the classical form, as it occurs in approximately 10% of the patients. We present the case of a 60-year-old male patient with a one-year disease time characterized by having violaceous lesions on the feet and the hands, slightly pruritic and 2 months of epigastralgia and constipation with weight loss of approximately 12 percent of his total body weight. In the physical examination multiple violaceous papule-like lesions are shown on the hands and the feet, some coalescing to form plaques. Laboratory tests revealed a mild normocytic normocytic anemia, the serology for viral hepatitis B and C was negative, HIV negative and ELISA test too. An upper endoscopy was performed and multiple maculopapular and erythematous-violaceous lesions were observed in the esoph-agus, the stomach and the duodenum. In the colonoscopy, multiple lesions with similar characteristics in the ileum, throughout the colon and in the rectum were recognized. The biopsy result was compatible with the KS in all lesions and it was confirmed with the positive HVV-8 immunohis-tochemistry. This case highlights the likelihood of presenting GI SK in elderly patients with gastrointestinal compromise and cutaneous findings, HIV negatives as well as the need to realize an adequate discarding by performing endoscopic studies with the biopsies to optimize treatment. / Revisión por pares

Koloskopi är en vanlig undersökning som utförs för att utreda symtom och eventuella sjukdomstillstånd i ändtarm, tjocktarm samt sista delen av tunntarmen. Undersökningen kan upplevas obehaglig och smärtsam samt kräver flera dagars förberedelser. Inför undersökningen ska patienten genomgå laxering för att rengöra sin tarm så att slemhinnan noggrant kan inspekteras. Information om förberedelser och undersökning är en viktig del för att förbereda patienten, både mentalt och fysiskt. En väl rengjord tarm bidrar till att undersökningskvaliteten ökar samt risken för vårdskador minskar. Syftet var att beskriva patienters upplevelser av information och förberedelser inför koloskopi samt att beskriva deras reflektioner inför undersökningen. Kvalitativ metod användes i studien och baseras på åtta intervjuer med patienter som skulle genomgå en planerad koloskopiundersökning. Intervjuerna genomfördes utifrån en intervjuguide med semistrukturerade intervjufrågor. Genom kvalitativ innehållsanalys bearbetades och analyserades det insamlade materialet. I resultatet framkom att patienters reflektioner och upplevelser kunde indelas i tre kategorier och åtta underkategorier. Huvudkategorierna var: Reflektioner inför koloskopi, upplevelser och reflektioner gällande laxering samt upplevelse av informationen inför laxering och koloskopi. Slutsatsen tyder på att koloskopi är en undersökning som framkallar många tankar och känslor hos den som ska undersökas. Förberedelserna inför undersökningen upplevs krävande och påverkar det vardagliga livet i varierande omfattning. Informationen som patienterna erhöll från endoskopimottagningen har upplevts som klar och tydlig, men samtidigt har det i studieresultatet framkommit synpunkter på att informationen från inremittenten är bristfällig. / Colonoscopy is a common examination conducted to investigate symptoms and possible diseases of the rectum, colon and the last part of the small intestine. The examination can be inconvenient and painful and requires several days of preparation. Prior to the examination, the patient should undergo purgation to cleanse the bowel so that the mucosa can be accurately inspected. Information on preparation and examination is an important part of preparing the patient, both mentally and physically. A well-cleaned intestine contributes to increase the quality of the examination and the risk of health damage is reduced. The aim was to describe patients' experiences of information and preparation for colonoscopy and to describe their reflections before the examination. Qualitative method was used in the study and based on eight interviews with patients who would undergo a scheduled colonoscopy. The interviews were conducted on the basis of an interview guide with semi-structured interview questions. Through qualitative content analysis the collected material were processed and analyzed. The result showed that the patients' reflections and experiences could be divided into three categories and eight subcategories. The main categories were: Reflections before the colonoscopy, experiences and reflections regarding purgative experience and the information for the purgation and colonoscopy. The conclusion indicates that colonoscopy is an examination that evokes many thoughts and feelings of the person to be examined. Preparations for the examination perceive demanding and affects everyday life in varying degrees. The information that patients received from endoscopy clinic has been perceived as clear, but at the same time the study results has revealed views that the information from the house doctor is flawed.

A Cochrane review conducted a meta-analysis looking only at FOBT for colorectal cancer screening. This review, based on published and unpublished data from 5 controlled trials, demonstrated that 3-card home FOBT conferred a reduction in colorectal cancer mortality of 16% (relative risk [RR]=0.84; 95% confidence interval [CI], 0.77-0.92) and a number needed to screen of 1173 (95% CI, 741-2807) to prevent 1 death from colon cancer over a 10-year period. If adjusted for adherence to screening, the reduction in mortality increased to 23% (RR=0.77; 95% CI, 0.57-0.89). In addition, long-term follow up of one of the RCTs in the review showed a continued reduction in colorectal cancer mortality of 34% (RR=0.66; 95% CI, 0.54-0.81) in subjects adhering to the FOBT screening protocol over a 13-year interval. Overall mortality did not differ between the screened and unscreened groups. A systematic review performed for the US Preventive Services Task Force (USPSTF) incorporated more recent data on colorectal cancer screening including colonoscopy. This review reached similar conclusions as above. This review also looked at office FOBT performed after digital rectal exam. It is important to note that a single office FOBT has a lower sensitivity than 3-card home FOBT and its effectiveness for reducing colorectal cancer mortality was unknown at the time of the systematic review. A subsequent 2005 Veterans Affairs prospective cohort study found that the sensitivity for detecting advanced neoplasia was only 4.9% for digital FOBT, and negative results did not decrease the likelihood of advanced neoplasia. The USPSTF review did not find any screening trials of colonoscopy but analyzed data from the National Polyp Study and a case-control study to draw its conclusions. The review reported an odds ratio for colorectal cancer mortality for patients who had colonoscopy to be 0.43 (95% CI, 0.30-63). The USPSTF review also looked at the sensitivity and adverse effects of FOBT compared to colonoscopy. One-time 3-card home FOBT had a sensitivity of 30% to 40% for detecting cancer. The sensitivity of one-time colonoscopy was difficult to determine since it was the criterion standard examination, but it was estimated to be greater than 90%, with a risk of perforation of 1/2000. The USPSTF review found both screening strategies cost-effective (<$30,000 per additional life-year gained) compared to no screening. FOBT had a cost per life-year saved of $5691 to $17,805 compared with $9038 to $22,012 for colonoscopy performed every 10 years.

BACKGROUND: Colonoscopy performance by gastroenterologists has been shown to be associated with lower rates of developing interval colorectal cancer. However, it is unclear if this difference among specialists stems from a difference in meeting colonoscopy quality indicators. OBJECTIVE: The purpose of this study is to determine and compare the rates of colonoscopy quality indicators between different specialties. DESIGN: This is a cohort study of patients undergoing screening colonoscopy investigating quality metrics as compared by the proceduralist specialty. SETTING: All screening colonoscopies performed at the Cleveland Clinic between 2012 and 2014 were followed by manual chart review. PATIENTS: Average-risk patients, ≥50 years of age, who had a complete screening colonoscopy were included. MAIN OUTCOME MEASURES: Adenoma detection rate, cecal intubation rate, withdrawal time, and other nonestablished overall and segment-specific rates were calculated and compared using t tests. RESULTS: A total of 4151 patients were included in the analysis. Colonoscopies were performed by 54 (64.3%) gastroenterologists, 21 (25%) colorectal surgeons, and 9 (10.7%) general surgeons. Gastroenterologists had the highest overall adenoma detection rate (28.6 ± 1.2; p < 0.001), followed by colorectal surgeons (24.3 ± 1.5) and general surgeons (18.4 ± 2.3), as well as the highest adenoma detection rate in men (34.7 ± 1.3; p < 0.001), followed by colorectal surgeons (28.2 ± 1.6) and general surgeons (23.7 ± 2.6). Similarly, gastroenterologists had the highest adenoma detection rate in women (24.3 ± 1.1; p < 0.001), followed by colorectal surgeons (21.6 ± 1.4) and general surgeons (12.9 ± 2.0). Withdrawal time was the longest among general surgeons (11.1 ± 5.5; p = 0.041), followed by colorectal surgeons (10.94 ± 5.2) and gastroenterologists (10.16 ± 1.26). LIMITATIONS: We could not adjust for some procedure-related details such as retroflexion in the right colon and the use of end-of-scope devices. CONCLUSIONS: In this study, only gastroenterologists met the currently accepted overall and sex-specific adenoma detection rate benchmarks. They also outperformed nongastroenterologists in many other nonestablished quality metrics. See Video Abstract at http://links.lww.com/DCR/B232.

Colonoscopy is essential for colorectal cancer screening and disease surveillance. It can remove pre-cancerous colon polyps to reduce a patient’s cancer risk. This thesis aims to improve colonoscopy’s localization using motion tracking and colonoscopy’s coverage using surface mapping. Chapter 4 describes an endoscope motion tracker that records the scope’s insertion length, rotation, and speed during a colonoscopy. The endoscope tracker’s motion record can be combined with the endoscope’s video to localize colon polyps or cancers. In the future, the device could record highly skilled manoeuvres performed by endoscopists to help train medical residents. It is difficult to image the colon’s mucosa because the colonoscope’s camera has a limited field of view. Chapter 3 uses a 180° fisheye camera to unwrap high resolution panoramas of a colon phantom. The panoramas are then combined into a mosaic map of the colon phantom’s surface. The colon’s surface is approximated as a cylinder. Follow up experiments could test our mapping algorithm using imagery from a wide-angle, high-definition colonoscope. Chapter 2 describes another technique to localize locations where polyps have been removed—blood vessel landmarks. Colonic blood vessels from a pig were imaged to determine if they could be used to fingerprint locations on the colon’s wall. Blood vessels are also useful image features for surface mapping. The proof-of-concept experiments successfully imaged large arteries but further work is needed to image the small capillaries in the colonic mucosa and to image the veins. In summary, we have visualized colonic blood vessels to test if they could be useful landmarks, tested using an extended field of view camera to create an unwrapped map of the colon wall, and designed an endoscope tracker to help localize abnormal tissue. Combining the endoscope tracker with the other two techniques should make is possible to accurately map the colon. / Thesis / Doctor of Philosophy (PhD) / Colonoscopy is a powerful tool for colon cancer screening. A colonoscopy can decrease the chance of developing advanced cancers by removing pre-cancerous polyps before they grow. This research works to improve colonoscopy’s localization using motion tracking and its coverage using surface mapping. We have developed an endoscope motion tracker that records the scope’s insertion length, rotation, and speed during a colonoscopy. It is In described in Chapter 4. The recorded motion can be combined with the endoscope’s video to improve colon cancer localization. Next, it is difficult to image the colon’s mucosa because the colonoscope’s camera has a limited field of view. Chapter 3 uses a 180° fisheye camera to unwrap high resolution panoramas of a colon phantom. The panoramas are then combined into a cylindrical surface map. Finally, Chapter 2 images the colon’s blood vessels to determine if they can fingerprint locations on the colon’s wall.

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