BACKGROUND/AIMS: While endoscopic resection could be considered as the best choice for the treatment of small rectal carcinoid, the colonoscopic biopsies performed at the time of detection may lead to scar and ulcer formation and cause unpredicted difficulty in the endoscopic resection. This study was evaluated to analyze the relationship between the post-biopsy scar and the limitation of submucosal elevation for the endoscopic resection of rectal carcinoids. METHODS: Twenty two cases of rectal carcinoid which received prior biopsies before the endoscopic resection were retrospectively compared with 20 non-biopsied cases. All two groups were treated by endoscopic resection from January 2000 to December 2007. There was no difference in the clinical characteristics and endoscopic findings such as size and location between the two groups. RESULTS: The limited submucosal elevation was experienced in 17 cases (77%) in the biopsy group, significantly more frequent than 9 cases (45%) in the non-biopsy group (p=0.03). The colonoscopic findings which contribute to difficult submucosal elevation were the depressive scar formation after biopsy, the size less than 5 mm in the biopsy group, active ulcer formation after biopsy. Regarding the resection method, endoscopic submucosal dissection was frequently adopted (23% vs. 5%) in the biopsy group. The frequency of endoscopic piecemeal resection in biopsy group was higher than non-biopsy group (23% vs 10%), and all cases were subsequently resected by other endoscopic methods. CONCLUSIONS: The post-biopsy scar can interfere with successful submucosal elevation for endoscopic resection of rectal carcinoids. The number of forcep biopsy should be minimized in the diagnostic colonoscopy when endoscopic resection is planned rectal carcinoids.
Adult ; Aged ; Biopsy ; Carcinoid Tumor/*pathology/surgery ; Cicatrix/pathology ; Colonoscopy ; Female ; Humans ; Intestinal Mucosa/surgery ; Male ; Middle Aged ; Rectal Neoplasms/*pathology/surgery ; Risk Factors

PURPOSE: This study was designed to determine the utility of bispectral index scores (BIS) compared to Glasgow coma scale (GCS) or Observer's Assessment of Alertness/Sedation Scale (OAA/S), in measuring changes in consciousness, prognosis and management of sedative-intoxication patients. METHODS: Sedative intoxication patients, who came to the emergency department with a severe deficit in consciousness, or a GCS less than 12, were analyzed. Patients' consciousness states were evaluated using OAA/S and GCS and compared with BIS scores. Patients' consciousness recovery time and hospitalization were recorded to see if these could be predicted by BIS using regression analysis. BIS, OAS/S and GCS were compared with regard to intubation, admission and ICU admission. Furthermore, usefulness and cut-off values of BIS were evaluated for those intubated. RESULTS: Of 128 sedative intoxication patients, 32 were enrolled for this study. Mean age was 50.94+/-18.01. They took 20.76+/-16.95 times over the average recommended dose. OAA/S and GCS ranged between 1~4 and 4~12, respectively; BIS was 39~88. The Spearman bivariate correlation coefficient was 0.619 between OAA/S and BIS and 0.651 between GCS and BIS, both showing a positive correlation (p<0.001). The coefficient of determination between BIS and recovery time was 0.182 and was statistically significant (Recovery time = -0.321xBIS+34.806) (p=0.015). However, admission, ICU admission and hospitalization were not significant (p>0.05). BIS was an effective index for intubation (p=0.012) showing a sensitivity of 91% and a specificity of 50% when the boundary value was set to 65.5. When set to 77.5, sensitivity and specificity were 59%, 100%, respectively. CONCLUSION: In sedative intoxication patients, BIS is useful in determining the degree of sedation, predicting time to recovery of consciousness and as an objective index of intubation.
Consciousness ; Consciousness Monitors ; Emergencies ; Glasgow Coma Scale ; Hospitalization ; Humans ; Hypnotics and Sedatives ; Intubation ; Porphyrins ; Prognosis ; Sensitivity and Specificity