OBJECTIVE: There are few data to guide the choice between colonoscopy and flexible sigmoidoscopy in patients with nonacute rectal bleeding, especially in younger age groups. Our aim was to determine the yield of colonoscopy for significant proximal large bowel disease in the absence of significant distal disease, with special reference to young patients.METHODS: This was a retrospective study of data collected prospectively in 1766 patients (median age 57 yr, 711 women). The endoscopic database (GI-Trac) contained 152 discrete fields for data input. Multiple logistic regression analysis was performed to identify variables independently associated with the presence of isolated significant proximal disease.RESULTS: Young patients had a higher percentage of normal examinations than did older patients. The incidence of diverticular disease, small polyps, large polyps, and cancer rose with increasing age. No patient aged <40 yr had an isolated proximal cancer, but 7% had other significant isolated proximal disease. There was no overall association between age and significant proximal disease in the absence of significant distal disease (p = 0.66). The only variable associated with isolated proximal disease was anemia (odds ratio = 1.81; 95% CI = 1.11-2.93; p = 0.02).CONCLUSION: The yield of colonoscopy (beyond the range of sigmoidoscopy) for neoplasia is low in patients aged <40 yr, but other significant disease may be missed if age is the only criterion determining colonoscopy use. (Am J Gastroenterol 2002;97:328-333. (C) 2002 by Am. Coll. of Gastroenterology).

OBJECTIVES: Colonoscopy is an effective method for discovery of adenomas and for colon cancer screening and prevention. Studies evaluating back-to-back colonoscopies have estimated significant miss rates but are limited by the lack of a definitive gold standard. Our study evaluated the sensitivity of colonoscopy compared with examination of surgically resected colon as a gold standard. METHODS: This was a retrospective analysis of patients who had a portion of colon surgically removed and had lower endoscopy within 5 months. The focus of the review was not for the particular lesion for which the surgery was indicated but, rather, for the synchronous lesions in the portions of bowel that were removed. Sensitivity was determined by counting the number of lesions detected at colonoscopy compared with those found in the surgically resected segment. RESULTS: A total of 73 synchronous lesions were present in the resected segments of 156 patients. Colonoscopy detected 56 of 73 the lesions (sensitivity 76.7%: 95% CI = 67–86). Of the 17 missed lesions, 14 of 17 (82%, 95% CI = 64–100) were <1-cm polyps. Endoscopy overlooked one 1-cm adenoma in the ascending colon. Two cancers were missed, both in the same patient in whom endoscopy detected a sigmoid cancer but missed synchronous lesions in the cecal and ascending colon. CONCLUSIONS: Colonoscopy is an effective method of finding cancers and polyps, but it is associated with significant miss rates for polyps <1 cm. The entire bowel should be carefully evaluated to exclude synchronous tumors in patients with known colorectal cancer. Further improvement of colonoscopic techniques and technologies is warranted.

Es wird ein modifiziertes Schema der Wirkungsrichtungen aller äußeren Augenmuskeln entworfen, aus welchem die Änderung der Tätigkeit der Horizontalmotoren in der Hebungs-und Sekungsposition des Bulbus ersichtlich ist.