Colonoscopy: Advanced and Emerging Techniques-A Review of Colonoscopic Approaches to Colorectal Conditions

EUS-guided management of anastomotic stricture: A case report

INTRODUCTION AND IMPORTANCE

Anastomotic stenosis after low anterior resection is a serious complication and at times even requires surgical revision of the anastomosis.

CASE PRESENTATION AND CLINICAL DISCUSSION

The patient presented with a 4.0 cm tubulovillous adenoma of the proximal rectum and underwent low anterior resection with loop ileostomy and subsequent reversal. The case was complicated by complete anastomotic stenosis. A novel technique was utilized to create an Endoscopic Ultrasound (EUS)-guided neo-anastomosis endoscopically.

CONCLUSION

EUS-guided creation of a neo-colorectal anastomosis is a safe and effective alternative to surgical anastomosis revision of a completely stenosed anastomosis.

(Technically) Difficult colonoscope insertion - Tips and tricks

Cecal intubation is a critical aspect of effective, complete colonoscopy. Difficult colonoscopy is most often considered as one in which it is challenging or impossible to reach the cecum. It may be a common occurrence due to patient and/or endoscopist factors. Incomplete colonoscopies should be avoided, since patients in this context present an important prevalence of lesions that escape examination. The approach to successful cecal intubation should depend on characterization of the problem as redundant colon or difficult sigmoid colon. Most patients with a prior incomplete colonoscopy can be colonoscoped successfully, if careful attention is paid to technique, using a variety of scopes, colonoscopy methods and additional equipment. Sufficient time should be allotted to make the attempt.

A complex microsatellite at chromosome 7q33 as a new prognostic marker of colorectal cancer

Disease-specific markers are critical for early diagnosis, targeted therapy and prognostic prediction of diseases. Current study reports a complex microsatellite as a new prognostic marker of sporadic colorectal cancer. This microsatellite located at Chromosome 7q33 is composed of three tetranucleotide tandem repeats, (TTCC)₂(TCCC)₅(TCCT)₇, flanked by a CT-rich sequence. We analyzed polymorphisms of this microsatellite in 158 sporadic colorectal cancer, 143 matched normal adjacent tissues (NAT) and 150 health donors. Our results showed that this complex microsatellite was instable with polymorphic frequency of 77.2% in colorectal cancer, 52.4% in NAT and 54.7% in health donors (p<0.01) when compared to reference sequence. In the three tandem repeats, (TCCT)₇ site was most polymorphic accounting for over 70.0% of polymorphisms in this complex microsatellite, followed by (TTCC)₂ site for approximately 20%. Polymorphisms in (TCCC)₅ was rare. Polymorphisms at the (TCCT)₇ site were mainly insertions of 1 to 4 copies of TCCT (88.6%), and deletions occurred in about 6.4% of cases. The (TTCC)₂ site was featured with one copy TTCC insertions. Pair-wise analyses between colorectal tumors and NAT revealed that 88 of 121 (72.7%) tumors displayed expansion, contraction or both in these tetranucleotide tandem repeats when compared to NAT. A cross-analysis with clinicopathological data of 158 colorectal cancers revealed that polymorphic alterations of the microsatellite associated with less lymphatic metastasis (p<0.001), and the colorectal cancer patients with polymorphic changes in this microsatellite demonstrated better survival (n=112, p=0.0058). Together these data suggest that this complex microsatellite is a potential prognostic marker of sporadic colorectal cancer.