Painless Colonoscopy

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Painless Colonoscopy

• Nov.30,2006

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Introduction

• Cancer has been the leading cause of death since
  1981 in Taiwan
• About 94 cancer deaths every day in 2005
• One cancer death every 15.19 minutes

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Cancer Death in 2002
Case Incidence
Liver 6943 30.83
Lung 6846 30.40
Colorectal 3649 16.20
Female breast 1203 10.90
Stomach 2433 10.80
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Cancer incidence in 2002
Case number incidence
Cervix 5725 51.88
Female breast 5339 48.38
liver 8860 39.34
Colorectal 7895 35.06
lung 7094 31.50
prostate 2189 19.06
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Colorectal cancer incidence trend
Year Case number Incidence
1995 4217 19.83
1996 5252 24.49
1997 5472 25.29
1998 6298 28.84
1999 6681 30.24
2000 7213 32.38
2001 7366 32.88
2002 7895 35.06
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Hong Kong Trend
Years Case Number Incidence
1991 2100 35
2002 3500 52
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England Trend
Years Sample Case number Incidence
1991 1290 55.5
2000 1536 63.9
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New York State Trend
Years White Male incidence White female incidence
1976 82.5 59.0
2003 68.4 50.4
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Possible cause of decreasing incidence of
colorectal cancer in USA

• Life style change.
• Colonoscopic polypectomy

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Colon polyp and Cancer (I)

• Family adenomatous polyposis and colon cancer
• Tumor in a big polyp
• Cancer, neighbored by multiple polyps
• Colon polyp to cancer ?

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Colon polyp and cancer ( II )
Polyp Size High grade dysplasia
0.5 cm 3
1cm 5
1.5 10
2.0 15
2.5 24
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Colon polyp type, Dysplasia
Type Severe Dysplasia
Tubular adenoma 2.2
Tubuvillous adenoma 14.9
Villous adenoma 32
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Carcinoma percentage
Type 1cm 1-2 cm Over 2 cm
Tubular adenoma 1 10.2 34.7
Tubovillous adenoma 3.9 7.4 45.8
Villous adenoma 9.5 10.3 52.9
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Polyp-carcinoma Sequence

• Normal colon mucosa
• Small polyps
• Large polyps
• Carcinoma
• Infiltrating carcinoma
• metastasis

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Vogelstein Hypothesis (Cell 61759-767)

• FAP gene mutation ( 5q )
• DNA hypomethylation
• K-ras gene mutation ( 12p)
• Loss DCC gene ( 18 q )
• Loss p53 gene ( 17p )

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Colon polyp to Cancer

• 90 colon cancers derived from colon polyps.
• No polyps, No cancer!
• Colonscopic polypectomy may prevent from colon
  cancer ?

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Painless colonoscopy

• IVG colonoscopy ( intravenous general Anesthesia)
• Medication Propafol, Dormicum
• Associated with O2 mask
• Patient feel satisfactory

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Colonoscopy indication ( I )

• Asymptomatic patient
• Colon cancer history
• Colon polyp history
• Family history, 40 Y/O
• 60 Y/O
• Colitis history

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Colonoscopy indication ( II )

• Bloody stool
• Bowel habit change
• Stool OB positive
• Abdominal pain
• Unexplained anemia
• Body weight loss.
• Abdominal mass.

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Colonoscopy indication ( III )

• Barium enema abnomality
• X-ray abnormality.
• Colonoscopic polypectomy
• Removal of foreign body by colonoscope.

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Contra-indication of colonoscopy

• Acute toxic megacolon
• Acute diverticulitis
• Hemodymanic unstable
• MI in recent 3 months
• Un-cooperative patient

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Complication of colonoscopy

• Perforation 0.12 (59/51196)
• Bleeding 0.014 (7/51196)
• Death 0.01

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Result

• From 2005-10 to 2006-11
• 99 patient underwent painless colonoscopy
  examination or colonoscopic polypectomy
• All tolerated procedure.
• No complication

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Indication

• Colon cancer follow up 24
• Colon polyps follow up 21
• Bowel habit change19
• Bloody stool, bleeding 20
• Stool OB positive 7
• Abdominal pain 3
• Colitis follow up 2
• Age gt60 1

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Colonoscopy complete Rate

• Up to cecum or ileum 95
• Up To A-colon 3
• Up to T-colon1
• Complete rate4/99 95.9

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Finding

• Hemorrhoids 47
• Colon polyps 31
• Colon diverticula 11
• Tumor 7
• Colitis 7

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Thank You for Your Attension