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Oxford Textbook of Medicine (5 ed.)

Edited by David A. Warrell, Timothy M. Cox, John D. Firth

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Latest update

The November 2012 update sees updates to over 70 chapters, focusing on Neurology and Gastroenterology. This update also incorporates a selection of 29 Case Histories taken from related titles in the Oxford Case Histories series, linked to from related chapters. Each case includes several questions followed by detailed answers and discussion to enhance diagnostic and clinical understanding.

Neurology updates include substantial updates to key chapters and new material on a wide range of topics including spinal cord injury, autonomic nervous system disorders, and inherited neurodegenerative diseases. 

Gastroenterology updates include extensive revisions of key chapters on liver failure and acute pancreatitis and new material on a wide range of matters, ranging from the common to the rare: including surgical treatments for colonic diverticular disease, antibody tests for immune disorders, and a revised treatment algorithm for small bowel bacterial overgrowth.

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Publisher:
Oxford University Press
Print Publication Date:
May 2010
Print ISBN-13:
9780199204854
Published to Oxford Medicine:
May 2012
DOI:
10.1093/med/9780199204854.001.1

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Disclaimer

Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check the product information and clinical procedures with the most up to date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work. Except where otherwise stated, drug dosages and recommendations are for the non-pregnant adult who is not breastfeeding.

Contents

Colonoscopy and flexible sigmoidoscopy

Chapter:
Colonoscopy and flexible sigmoidoscopy
Author(s):

James E. East,

Brian P. Saunders

DOI:
10.1093/med/9780199204854.003.150301_update_001

Update:

Preparation of instruments—modified to include discussion of prion disease.

Prophylaxis against endocarditis—modified to reflect updated guidelines.

Flexible sigmoidoscopy—discussion of findings of recent population-based screening studies.

Cost-effectiveness—discussion of importance of quality assurance of endoscopists.

Images—videos of diagnostic colonoscopy and resection of a colonic polyp.

Updated on 28 November 2012. The previous version of this content can be found here.

Colonoscopy and flexible sigmoidoscopy are techniques for visualizing the lumen of the large bowel. In expert hands, after appropriate explanation to the patient (which increases the chances of the procedure being well tolerated), bowel preparation, and (usually) some form of ‘conscious sedation’, then total colonoscopy is possible in 98 to 99% of cases in the absence of obstruction, a severely ulcerated colon, or other contraindication.

The indications for colonoscopy are wide and constantly expanding, and are likely to continue to do so until alternative less invasive techniques (‘virtual colonoscopy’ or genetic tests) are perfected. Common indications include patients with or requiring: (1) bleeding, anaemia, or occult blood loss; (2) chronic diarrhoea or known inflammatory bowel disease, which is accurately and easily assessed by endoscopy and biopsy; (3) polyps that can be removed endoscopically; (4) surveillance for cancer prevention. Abnormalities found by other diagnostic methods frequently turn out to be spurious when checked colonoscopically. Findings such as anastomotic strictures, typically after Crohn’s resection, are usually easily and effectively dilated by the endoscopist using a ‘through the scope’ balloon.

Flexible sigmoidoscopy is the best means of examining the bowel proximal to the rectosigmoid junction (the distal rectum and anal canal are well seen with a rigid instrument).

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