Clinical usefulness of endoscopic ultrasonography for the evaluation of ulcerative colitis-associated tumors

AIM:To evaluate the clinical usefulness of endoscopic ultrasonography(EUS) for the diagnosis of the invasion depth of ulcerative colitis-associated tumors.METHODS:The study group comprised 13 patients with 16 ulcerative colitis(UC)-associated tumors for which the depth of invasion was preoperatively estimated by EUS.The lesions were then resected endoscopically or by surgical colectomy and were examined histopathologically.The mean age of the subjects was 48.2 ± 17.1 years,and the mean duration of UC was 15.8 ± 8.3 years.Two lesions were treated by endoscopic resection and the other 14 lesions by surgical colectomy.The depth of invasion of UCassociated tumors was estimated by EUS using an ultrasonic probe and was evaluated on the basis of the deepest layer with narrowing or rupture of the colonic wall.RESULTS:The diagnosis of UC-associated tumors by EUS was carcinoma for 13 lesions and dysplasia for 3 lesions.The invasion depth of the carcinomas was intramucosal for 8 lesions,submucosal for 2,the muscularis propria for 2,and subserosal for 1.Eleven(69%) of the 16 lesions arose in the rectum.The macroscopic appearance was the laterally spreading tumor-non-granular type for 4 lesions,sessile type for 4,laterally spreading tumor-granular type for 3,semipedunculated type(Isp) for 2,type 1 for 2,and type 3 for 1.The depth of invasion was correctly estimated by EUS for 15 lesions(94%) but was misdiagnosed as intramucosal for 1 carcinoma with high-grade submucosal invasion.The 2 lesions treated by endoscopic resection were intramucosal carcinoma and dysplasia,and both were diagnosed as intramucosal lesions by EUS.CONCLUSION:EUS provides a good estimation of the invasion depth of UC-associated tumors and may thus facilitate the selection of treatment.

Clinical usefulness of single-balloon endoscopy in patients with previously incomplete colonoscopy

AIM:To evaluate the clinical usefulness of singleballoon endoscopy(SBE) in patients in whom a colonoscope was technically difficult to insert previously.METHODS:The study group comprised 15 patients(8 men and 7 women) who underwent SBE for colonoscopy(30 sessions).The number of SBE sessions was 1 in 7 patients,2 in 5 patients,3 in 1 patient,4 in 1 patient,and 6 in 1 patient.In all patients,total colonoscopy was previously unsuccessful.The reasons for difficulty in scope passage were an elongated colon in 6 patients,severe intestinal adhesions after open surgery in 4,an elongated colon and severe intestinal adhesions in 2,a left inguinal hernia in 2,and multiple diverticulosis of the sigmoid colon in 1.Three endoscopists were responsible for SBE.The technique for inserting SBE in the colon was basically similar to that in the small intestine.The effectiveness of SBE was assessed on the basis of the success rate of total colonoscopy and the presence or absence of complications.We also evaluated the diagnostic and treatment outcomes of colonoscopic examinations with SBE.RESULTS:Total colonoscopy was successfully accomplished in all sessions.The mean insertion time to the cecum was 22.9 ± 8.9 min(range 9 to 40).Abnormalities were found during 21 sessions of SBE.The most common abnormality was colorectal polyps(20 sessions),followed by radiation colitis(3 sessions) and diverticular disease of the colon(3 sessions).Colorectal polyps were resected endoscopically in 15 sessions.A total of 42 polyps were resected endoscopically,using snare polypectomy in 32 lesions,hot biopsy in 7 lesions,and endoscopic mucosal resection in 3 lesions.Fifty-six colorectal polyps were newly diagnosed on colonoscopic examination with SBE.Histopathologically,these lesions included 2 intramucosal cancers,42 tubular adenomas,and 2 tubulovillous adenomas.The mean examination time was 48.2 ± 20.0 min(range 25 to 90).Colonoscopic examination or endoscopic treatment with SBE was not associated with any serious complications.CONCLUSION:SBE is a useful and safe procedure in patients in whom a colonoscope is technically difficult to insert.