This research looks at the feasibility of colonoscopic high frequency ultrasound in the colon using mini probe technology. The objectives are across four different areas with assessment of colonic ...cancer, malignant colorectal polyps, rectal polyps and diverticular disease. High frequency 12 and 20 MHz ultrasound were used to locally stage colonic cancer and compare this to conventional CT in patients undergoing elective colonic resection. In addition, depth of infiltration of rectal polyps was determined by 20 MHz ultrasound and these findings compared with MRI in patients undergoing TEMS procedure. Malignant colorectal polyps were assessed after endoscopic removal to assess for the presence of residual or recurrent disease in the colonic wall and also to stage the local lymph nodes. Finally, the thickness of colonic wall in patients with diverticular disease was measured using 20 MHz ultrasound and this was compared with normal controls. The research has clearly shown that colonoscopic high frequency mini probe ultrasound is feasible in the colon with reproducible results. Overall, 12 and 20 MHz colonoscopic ultrasound are superior to CT for local staging of colonic cancer. 20 MHz ultrasound offers greater accuracy for assessment of depth of infiltration of rectal polyps compared with MRI. This probe may also be utilised to assess the colonic wall for residual disease in the polypectomy scar of malignant polyps but larger numbers are needed with longer follow up in order to draw firm conclusions. Finally, it was feasible to measure the thickness of colonic wall in patients with diverticular disease and this was greater than that seen in normal patients. In conclusion, this research has been promising in that colonoscopic high frequency mini probe ultrasound is feasible in the colon and can be used to assess colorectal polyps and cancer and diverticular disease. In order to draw firm conclusions, this pilot research needs to be taken further with larger scale studies.
This research looks at the feasibility of colonoscopic high frequency ultrasound in the colon using mini probe technology. The objectives are across four different areas with assessment of colonic ...cancer, malignant colorectal polyps, rectal polyps and diverticular disease. High frequency 12 and 20 MHz ultrasound were used to locally stage colonic cancer and compare this to conventional CT in patients undergoing elective colonic resection. In addition, depth of infiltration of rectal polyps was determined by 20 MHz ultrasound and these findings compared with MRI in patients undergoing TEMS procedure. Malignant colorectal polyps were assessed after endoscopic removal to assess for the presence of residual or recurrent disease in the colonic wall and also to stage the local lymph nodes. Finally, the thickness of colonic wall in patients with diverticular disease was measured using 20 MHz ultrasound and this was compared with normal controls. The research has clearly shown that colonoscopic high frequency mini probe ultrasound is feasible in the colon with reproducible results. Overall, 12 and 20 MHz colonoscopic ultrasound are superior to CT for local staging of colonic cancer. 20 MHz ultrasound offers greater accuracy for assessment of depth of infiltration of rectal polyps compared with MRI. This probe may also be utilised to assess the colonic wall for residual disease in the polypectomy scar of malignant polyps but larger numbers are needed with longer follow up in order to draw firm conclusions. Finally, it was feasible to measure the thickness of colonic wall in patients with diverticular disease and this was greater than that seen in normal patients. In conclusion, this research has been promising in that colonoscopic high frequency mini probe ultrasound is feasible in the colon and can be used to assess colorectal polyps and cancer and diverticular disease. In order to draw firm conclusions, this pilot research needs to be taken further with larger scale studies.
Esophageal achalasia is a benign esophageal motility disorder resulting from an impaired relaxation of the lower esophageal sphincter. The principles of treatment involve disruption of the sphincter ...at the esophagogastric junction. Treatment techniques include balloon dilatation, botulinum toxin injection, and surgical myotomy. In 2008, per-oral endoscopic myotomy (POEM) was introduced by Inoue et al. as an endoscopic myotomy with no skin incision. The procedure has been well accepted and widely applied owing to its minimal invasiveness and high cure rates. Moreover, there have been discussions on wider indications for POEM and new technical developments have been reported. The present article reviews the historical background and present status of POEM, as well as future prospects for its application in the treatment of esophageal achalasia.
The objective of this study was to analyse, prospectively, the outcome of a new technique - excision of pilonidal sinus and flattening the natal cleft by division of the coccycutaneous attachments at ...the lower end of the incision.
Sixty-six consecutive patients with chronic pilonidal sinuses were treated between 1995 and 2001. The procedure consisted of an elliptical, wide, local excision, release of the coccycutaneous attachments and primary closure using dermal-subcuticular closure (XRD). Suction drains were used until drainage was minimal. The height of skin level at the lower angle of the wound from the coccyx was measured intra-operatively before and after division of the coccycutaneous attachments. Postoperatively, patients were assessed for hospital stay, return to normal activity, complications and recurrence.
Sixty-four patients (97%) were males, median age 27 years. The height of skin level rose from a mean of 1.8 cm (95% CI, 1.78-1.85) to a mean of 3.8 cm (95% CI, 3.77-3.88; P < 0.001). Morbidity affected 12 patients (18%), epidermal separation of the lower wound angles (6 patients), seromas (5 patients) and 1 wound dehiscence at 2 weeks. All other wounds healed primarily without dehiscence. There were no recurrences after a median follow-up of 22.5 months (range, 12-38 months).
Release of the coccycutaneous attachments is an easy technique to learn, which seems to be an effective way of flattening the natal cleft and may result in lower recurrence rate. This technique should be tried in uncomplicated pilonidal sinus disease before more complex procedures are attempted.
Selection of an appropriate approach to treat full thickness rectal prolapse remains problematic and controversial. We propose that rectal prolapse may be classified as 'low type' (true rectal ...prolapse) or 'high type' (intussusception of the sigmoid with a fixed lower rectum). This assessment can be made via a simple clinical test of digital rectal assessment of lower rectal fixity ('the hook test') based on anatomic changes in rectal prolapse to guide the selection process. In cases with the low-type prolapse, a perineal approach is appropriate (either Delorme's procedure, or rectosigmoidectomy with or without pelvic floor repair). For the high type, an abdominal rectopexy with or without high anterior resection is needed. Retrospective analysis of our cases treated over the last 6 years showed a recurrence rate of 6% in perineal procedures and 0% in abdominal rectopexy combined with resection to date. We believe that employing our simple test and classification can contribute to better patient selection for either approach, minimize anaesthetic and surgical risks and also result in lower recurrence rates.
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