STICHTING BG DIAGNOSTIEK DOOR MDL ARTS. endoscopy ? early late associated diseases bleeding diverticulum giant diverticulum van Waesberghen.

STICHTING BG

DIAGNOSTIEK DOOR MDL ARTS

endoscopy ? early lateassociated diseases

bleeding diverticulum

giant diverticulum

vanWaesberghen

Diverticulitis endoscopy

• to rule out other disease (cancer)

• postpone colonoscopy for 6 weeks

(to avoid conversion of a sealed perforation into a free one)

ENDOSCOPY2004

Complete colonoscopy 81,7 %

Carcinoma 2

Polyps 11 in 9 patients

Chicken bone 1

7878622

4275964

Association between sigmoid diverticulitis and left sided colon cancer

• increased risk of left-sided cancer 10 years after the first discharge with

diverticular disease

• risk 4-5 fold increased

• risk due to diverticulitis and not diverticulosis

Kronborg, 2005Stefanson,1993Stefanson,2004

Colitis associated with diverticulosis

• diverticular colitis-crescentic fold disease• polyp-simulating mucosal prolapse syndrome• cap polyposis • segmental colitis• prolapsing mucosal polyps

7377049

7377049

Diverticular colitis

• not related to diverticulitis• sometimes pre-diverticular disease• in 1,4 % of all colonoscopies• in 1,3 % of sigmoid resections• caused by mucosal prolapse• inflammation is centred on the mucosal folds• can mimick ulcerative colitis• can mimick Crohn’s disease (granulomatous cryptitis)

J Cli Gastroenterol 2006 aug40;supl 3 S 132

SCAD

• 117 cases in literature since 1980

• complaints: painless hematochezia

(lower abdominal cramps)

• normal rectum and proximal colon

• diverse range of histologic changes:

IBD-like

mucosal prolapse

Prolapsing mucosal polyps

• associated with diverticulosis• symptoms: 3/15 asymptomatic 7/15 bleeding 6/15 obstructive symptoms• histologic findings: 15/15 crypt abnormalities 14/15 fibromuscular obliteration of lamina propria 13/15 extension of muscle fibers in lamina propria

CAP - POLYPOSIS

ManouryGUT,2004

KonishiGUT 2005

2004

BLEEDING DIVERTICULUM

• > 40 % of lower GI-bleeding episodes• more often in proximal colon• ceases spontaneously in 70 – 80 %• rebleeding in 22 – 38 %• urgent colonoscopy (within 12 hours) or colonoscopy within 24 hours?

Dis Colon Rectum2008,jan

Kethu,NEJM2003

StollmanLancet 2004

FarrellEndoscopy2003

Duodenal diverticular hemostasis withhemoclip placement on the bleeding andfeeder vessels: a case report

Gottumukkala S. Raju, MD, DM, Samir Nath, MD, PhD,Xiaotuan Zhao, MD, PhD, Syed Jafri, MD, GuillermoGomez, MD, Gurinder Luthra, DO

Gastrointestinal Endoscopy2003

13-01-2000

Dis Colon Rectum1998

103 cases type 1: pseudodiverticulum type 2: real diverticulum

Choong1998

•DIVERTICULITIS: endoscopy, yes but later

•SCAD

•DIVERTICULAR BLEEDING: urgent endoscopy

•GIANT DIVERTICULUM