The Diagnostic Value of Colonoscopy in Understanding Inflammatory Mucosal Damage in Patients with Ulcerative Colitis and Predicting Clinical Response to Adsorptive Leucocytapheresis as a Non-Pharmacologic Treatment Intervention

Abstract

Endoscopic Procedures in Colon and Rectum 82by diverse environmental factors (2). From here on, we shall focus only on UC. The severity of UC is often presented by clinical activity index (CAI). Another, but complementary parameter is endoscopic activity index, not used in this chapter. Colonoscope, the gastroenterologist's eye and arms in modern timesColonoscopy is a revolutionary development in gastroenterology, now days like both arm and eyes for specialist gastroenterologists that can reach the inside of the large and distal segment of the small intestine. Introduced in the late 1960s (3), the term, colonoscopy refers to the endoscopic examination of the bowel with a charge-coupled device (CCD) camera or a fiber optic camera on a flexible tube passed through the rectal opening. As the name implies, colonoscopy allows a visual diagnosis of intestinal wall lesions like inflammation, ulceration, polyps and provides the opportunity for biopsy or removal of suspected cancerous lesions. Colonoscopy can remove polyps as small as one millimetre or less. Once polyps are removed, they can be studied with the aid of a microscope to determine if they are precancerous or not. Retrograde colonoscopy of the entire colon, and endoscopic excision of polyps from anywhere in the colon, began in 1969 (4). Momentous advances have occurred over the past two decades, and the two procedures are now widely accepted and practiced. Development and perfection of the methodology were, at first, fraught with many difficulties, both procedural and technical, which had to be overcome. Significant opposition was engendered in the early years by some who claimed that the methods were both unnecessary and unduly dangerous. Time has proven otherwise. Progress came about as the result of a steady stream of publications from a number of centres documenting the successful and safe application of the methodology. More advanced versions include virtual colonoscopy, which uses 2D and 3D imagery reconstructed from computed tomography (CT) scans or from nuclear magnetic resonance (MR) scans, is also possible, as a totally non-invasive medical test. However, unlike standard colonoscopy, virtual colonoscopy does not allow for therapeutic maneuvers such as polyp/tumour removal or biopsy nor visualization of lesions smaller than 5 millimeters. If a growth or polyp is detected by using CT colonography, a standard colonoscopy would still need to be performed. Further, colonoscopy is similar to, but not the same as, sigmoidoscopy, the difference being related to which parts of the colon each can examine. A colonoscopy allows an examination of the entire colon (measuring more than 1.5m in length). A sigmoidoscopy allows an examination of only the final 60cm of the colon. A sigmoidoscopy is often used as a screening procedure for a full colonoscopy to be followed in many instances in conjunction with a faecal occult blood test, which can detect the formation of cancerous cells throughout the colon. At other times, a sigmoidoscopy is preferred to a full colonos...

Looking for predictive factors of clinical response to adsorptive granulocyte and monocyte apheresis in patients with ulcerative colitis: markers of response to GMA

“…In a subsequent study, Suzuki, et al [27] reported that all patients with a short duration of UC (about 3 months), and first episode cases readily responded to GMA, while all of the 8 GMA non-responders in that study had a very long duration of UC together with a long history of exposure to multiple conventional medications. The observations by Suzuki, et al [9,27] were independently confirmed by Tanaka and colleagues in much larger cohorts of UC patients [16,17,25]. …”