Study of the sensitivity of Hydrocolonic Sonography (HS) in the detection of colonic lesions and how hydrocolonic sonography with echographic contrast agent (HSEC) can improve this technique.
Hirschsprung’s disease in adults: Clinical and therapeutic featuresPremier Publishers
Hirschsprung’s disease (HD) is rare in adults and it is thus often undiagnosed or misdiagnosed. Through this series of 12 patients we try to study the clinical characteristics of this pathology, to define its diagnostic clues and to assess the different therapeutic approaches.
Definitive diagnosis is established on histology of specimens from the rectum and colon. The disease involved the rectum and the sigmoid colon in 2 patients and was confined to the rectum, in the 10 others.
Treatment was in all cases surgical consisting of recto-colic resection associated with coloanal anastomosis and a protective right lateral ileostomy.
We conclude that Hirschsprung’s disease is rare in adults but by no means exceptional. It should be considered in young adults with a history of chronic constipation. Diagnosis is first of all clinical. When barium enema appearances are pathognomonic we needn’t resort to histology to confirm the diagnosis. Anorectal manometry does not usually show RAIR. Current primary treatment of HD diagnosed in adults consists mainly of surgical resection.
Background: Transanal total Mesorectal Excision (TaTME) combined with traditional laparoscopy might be a promising alternative for locally advanced mid-low rectal cancer. However, some potential complications were recorded and should be evaluated further. The aim of this prospective study was assessment the results of TaTME combined with traditional laparoscopy in treatment of locally advanced mid-low rectal cancer of a single institution.Methods: Prospective study of patients with mid-low locally advanced rectal cancer who were undergone rectal resection with TaTME technique.
A clinical study of intussusception in childreniosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Hirschsprung’s disease in adults: Clinical and therapeutic featuresPremier Publishers
Hirschsprung’s disease (HD) is rare in adults and it is thus often undiagnosed or misdiagnosed. Through this series of 12 patients we try to study the clinical characteristics of this pathology, to define its diagnostic clues and to assess the different therapeutic approaches.
Definitive diagnosis is established on histology of specimens from the rectum and colon. The disease involved the rectum and the sigmoid colon in 2 patients and was confined to the rectum, in the 10 others.
Treatment was in all cases surgical consisting of recto-colic resection associated with coloanal anastomosis and a protective right lateral ileostomy.
We conclude that Hirschsprung’s disease is rare in adults but by no means exceptional. It should be considered in young adults with a history of chronic constipation. Diagnosis is first of all clinical. When barium enema appearances are pathognomonic we needn’t resort to histology to confirm the diagnosis. Anorectal manometry does not usually show RAIR. Current primary treatment of HD diagnosed in adults consists mainly of surgical resection.
Background: Transanal total Mesorectal Excision (TaTME) combined with traditional laparoscopy might be a promising alternative for locally advanced mid-low rectal cancer. However, some potential complications were recorded and should be evaluated further. The aim of this prospective study was assessment the results of TaTME combined with traditional laparoscopy in treatment of locally advanced mid-low rectal cancer of a single institution.Methods: Prospective study of patients with mid-low locally advanced rectal cancer who were undergone rectal resection with TaTME technique.
A clinical study of intussusception in childreniosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
A Prospective Study on Role of Water Soluble Contrast in Management of Small ...Kundan Singh
There is no definite protocol in management of small bowel obstruction in relation to duration and need of surgery. The aim is to study the role of gastrografin in management of small bowel obstruction.In this study patients who were diagnosed with intestinal obstruction were administered gastrografin. The patients were followed serially using x-ray at 4hrs interval for 24hrs; decision to operate was taken on non-progression of dye in two consecutive x-ray. Among 20 patients of this study 9 patients were operated on basis of gastrografin study. 11 were treated conservatively. 8 patients were of adhesive bowel obstruction. Out of which 1 was operated, 7 were treated conservatively. The sensitivity, specificity, positive and negative predictive value of gastrografin administration in this study was 100%, 89%, 92%, 100% respectively.Gas¬trografin helps in strengthening the clinical decision about the management of intestinal obstruction; it helps in early decision making regarding continuing the conservative or operative management and allows the introduction of oral intake earlier and earlier discharge from the hospital as well as reduction in operative rate.
DOI: 10.21276/ijlssr.2016.2.3.15
ABSTRACT- Abnormal cervical cytology includes lesions of the cervix caused due to various infections, hormonal
disturbances, premalignant and malignant conditions. Screening of all the symptomatic women complaining of vaginal
discharge, irregular menstrual bleeding, dyspareunia, post-coital bleeding or post-menopausal bleeding is necessary for
detection and also to pick up any aberration in cervix epithelium i.e. dysplasia or early cervical cancer.
Key-words- Negative for Intraepithelial Lesion or Malignancy, Atypical Squamous Cell of Undetermined Significance,
Low grade Squamous Intraepithelial Lesion, High grade Squamous Intraepithelial Lesion, Squamous Cell Carcinoma
Self-Expandable Metal Stents for the Management of Gastric Outlet Obstruction...JapaneseJournalofGas
Gastric outlet obstruction is commonly considered as advanced malignancies of the stomach, duodenum, pancreas, hepatobiliary, and ampullary regions. Surgical bypass and chemotherapy are the common treatment modalities for gastric obstruction. This study was done to determine the outcomes of self-expandable metal stents in patients with gastric outlet obstruction.
Gastric cancer was until the 1980s the most frequent diagnosed cancer all around the world, and it still remains even nowadays one of the most frequent and aggressive malignant tumors, having the power to cause annually an amazingly high number of deaths and affected people. Even if it went through some difficult phases for more 11 years, the stomach surgery managed to become today quite well defined even if it is not yet fully outlined.
More Related Content
Similar to Hydrocolonic Sonography. A Forgotten Technique
A Prospective Study on Role of Water Soluble Contrast in Management of Small ...Kundan Singh
There is no definite protocol in management of small bowel obstruction in relation to duration and need of surgery. The aim is to study the role of gastrografin in management of small bowel obstruction.In this study patients who were diagnosed with intestinal obstruction were administered gastrografin. The patients were followed serially using x-ray at 4hrs interval for 24hrs; decision to operate was taken on non-progression of dye in two consecutive x-ray. Among 20 patients of this study 9 patients were operated on basis of gastrografin study. 11 were treated conservatively. 8 patients were of adhesive bowel obstruction. Out of which 1 was operated, 7 were treated conservatively. The sensitivity, specificity, positive and negative predictive value of gastrografin administration in this study was 100%, 89%, 92%, 100% respectively.Gas¬trografin helps in strengthening the clinical decision about the management of intestinal obstruction; it helps in early decision making regarding continuing the conservative or operative management and allows the introduction of oral intake earlier and earlier discharge from the hospital as well as reduction in operative rate.
DOI: 10.21276/ijlssr.2016.2.3.15
ABSTRACT- Abnormal cervical cytology includes lesions of the cervix caused due to various infections, hormonal
disturbances, premalignant and malignant conditions. Screening of all the symptomatic women complaining of vaginal
discharge, irregular menstrual bleeding, dyspareunia, post-coital bleeding or post-menopausal bleeding is necessary for
detection and also to pick up any aberration in cervix epithelium i.e. dysplasia or early cervical cancer.
Key-words- Negative for Intraepithelial Lesion or Malignancy, Atypical Squamous Cell of Undetermined Significance,
Low grade Squamous Intraepithelial Lesion, High grade Squamous Intraepithelial Lesion, Squamous Cell Carcinoma
Self-Expandable Metal Stents for the Management of Gastric Outlet Obstruction...JapaneseJournalofGas
Gastric outlet obstruction is commonly considered as advanced malignancies of the stomach, duodenum, pancreas, hepatobiliary, and ampullary regions. Surgical bypass and chemotherapy are the common treatment modalities for gastric obstruction. This study was done to determine the outcomes of self-expandable metal stents in patients with gastric outlet obstruction.
Gastric cancer was until the 1980s the most frequent diagnosed cancer all around the world, and it still remains even nowadays one of the most frequent and aggressive malignant tumors, having the power to cause annually an amazingly high number of deaths and affected people. Even if it went through some difficult phases for more 11 years, the stomach surgery managed to become today quite well defined even if it is not yet fully outlined.
Three Different Presentations of Metastatic Gastric MelanomaJapaneseJournalofGas
Melanoma is the most common metastatic tumor of the gastrointestinal (GI) tract and its diagnosis is rare during life since its symptoms are non-specific. The endoscopic gastric metastases appearance is heterogenous with no typical pattern. We report a patient who presented three different morphologies of metastatic gastric melanoma although the patient remained asymptomatic. This finding shows the importance of early upper digestive endoscopy in patients diagnosed with melanoma even in the absence of gastrointestinal symptoms.
Approximately one third of the world’s population has serological evidence of past or present infection with the hepatitis B virus (HBV). An estimated 350-400 million people are surface HBV antigen (HBsAg) carriers. India has 40 million HBV carriers i.e. 10–15% share of total pool of HBV carriers of the world. In India.
The primary indication for an esophagectomy is esophageal cancer or Barrett’s esophagus with high-grade dysplasia. Patients undergoing esophagectomy often present with dysphagia, side effects from chemotherapy, decreased appetite, and weight loss. Esophagectomy may be an operation involving the abdomen, neck, and/or chest requiring 5 to 7 days of NPO status to permit healing of the anastomosis between the upper esophagus and new esophageal conduit (usually the stomach).
HCC is the most common primary liver malignancy and cause of cancer-related death worldwide including Bangladesh. It occurs more often in males than females. The incidence of HCC continues to escalate due to HBV, HCV infection, non-alcoholic fatty liver disease (NAFLD). HBV and HCV are also important etiological factors for developing chronic liver disease (CLD) and HCC.
Epidemiology of Hepatocellular Carcinoma (HCC) In Tertiary Level Hospitals in...JapaneseJournalofGas
HCC is the most common primary liver malignancy and cause of cancer-related death worldwide including Bangladesh. It occurs more often in males than females. The incidence of HCC continues to escalate due to HBV, HCV infection, non-alcoholic fatty liver disease (NAFLD). HBV and HCV are also important etiological factors for developing chronic liver disease (CLD) and HCC.
Synthesis, Characterization, Biological Evaluation of Some Heterocyclic Oxaze...JapaneseJournalofGas
The new serious of pentyloxy and aryloxy benzaldehyde (3ae) were synthesized from the substitution reaction of 4-hydroxy benzaldehyde with different aryl bromide and alkyl bromide, on the basis of Williamson ether synthesis in the presence of Potassium carbonate using absolute ethanol as a solvent. The second step was the synthesis of 2-amino-5-(p-tolyl)1,3,4-thiadiazole.
Long-Term Outcomes of Endoscopic Treatment for Bile Duct Stones in Patients A...JapaneseJournalofGas
There are limited data regarding the safety and efficacy of complete stone removal for the treatment of bile duct stones in elderly patients. Hence, this study evaluated the long-term outcomes of complete stone removal in elderly patients.
The Corona Virus Disease 2019(COVID-19) could be a viral respiratory disorder that caused
by a new coronavirus called SARS-CoV-2 [1]. Severe acute respiratory syndrome coronavirus
(SARS- CoV) and Middle East respiratory syndrome coronavirus (MERS- CoV) are two
pathogenic viruses in humans. Both SARS?CoV and MERS?CoV are zoonotic in origin and
both viruses originated in bats, during this review; we summarize the origin of COVID-19.
In spite of the deep insight that has been gathered hitherto in Molecular Genetics, a few obscurities are as challenging as they were. Among these, introns, with reference to its functionality, have been debated quite often. And many theories that have emerged following such grappling discussions have given believable explanations but have failed to give a convincing answer eventually.
Alpha-Fetoprotein and the Early Diagnosis of Hepatocellular CarcinomaJapaneseJournalofGas
Hepatocellular carcinoma is the most common primary malignant tumor of the liver. Cirrhosisis associated with its carcinogenesis, so periodic surveillance is necessary. Ultrasonography is currently the most appropriate test for screening hepatocellular carcinoma, and alpha-fetoprotein is the most used biomarker despite its low sensitivity
Aortojejunal Fistula on Healthy Aorta Due to Jejunal DiverticulumJapaneseJournalofGas
Aortoenteric Fistula (AEF) is a rare cause of massive gastrointestinal bleeding. Primary AEF are rare and generally the consequence of an aortic aneurysm. The duodenum and esophagus are the main locations of AEF. Diagnosis is difficult and patients are often hemodynamically unstable at the time of management
We describe here the clinical history of a 74-year old man presenting with a gradually worsening pharyngeal dysphagia with globus, occasional intra-deglutitory coughing, hoarseness and a 5 kg weight loss in the previous two months. Apart from type II Diabetes Mellitus, the patient’s clinical history was unremarkable
Gallbladder Cancer (GBC)-Contemporary Aspects of Diag- nosis and TreatmentJapaneseJournalofGas
Gallbladder cancer is an uncommon malignant disease leading to the fact that even big centers only analyze small series of patients over a long time. GBC is the most common biliary tumor and the fifth most common gastrointestinal cancer
Combined Single Surgical Cession Anatomical Trans-Sphinc- ter Anal Fistulecto...JapaneseJournalofGas
Surgical techniques applied to treat ano-rectal fistulas has proved variable results, depending on how complex the fistula is. Many publications report promising results regarding simple and complex trans-sphincter fistulas
G-POEM in Patients with Gastro paresis – Gambling for Healing or Bigger Armam...JapaneseJournalofGas
Despite the euphoria about the introduction of a novel and apparently successful treatment in gastroparesis, the amount of high quality data supporting the clinical utility of G-POEM are limited. Above all, the selection of patients with gastroparesis for G-POEM is problematic
Diversion colitis is characterized by mucosal inflammation in segments of the colon that are surgically diverted from the fecal stream. This inflammatory disorder is reported to occur in up to 100% of individuals after colostomy or ileostomy, often occurring within a year following surgery
Atypical Presentation of Salmonella Typhi Blood Stream Infection in an Immuno...JapaneseJournalofGas
The genus Salmonella is an important enteric pathogen which carries high morbidity and mortality in many parts of the world [1, 2]. The serotypes of Salmonella enteric namely serovars Typhi, Paratyphi A, Paratyphi B and Paratyphi C are the causative agents of the enteric fever. Other serovars collectively called as Non Typhoidal Salmonella (NTS) mainly cause gastroenteritis
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
2. 2021, V6(21): 1-2
https://jjgastrohepto.org/ 2
main limitation is the presence of intracolonic gas, which prevents
the correct visualization of the colonic wall. However, this gas can
be removed by the retrograde instillation of a water or saline solution
in the colon as an enema [2-12]. This technique called Hydrocolonic
Sonography (HS), fills and relaxes the colon, significantly improving
its visualization.
3. Material and Methods
We present a prospective study of 73 patients (34 women and 39
men), with an average age of 61 and a range of 39 to 88. Seven-
ty-three ultrasounds, 65 hydrocolonic sonographies (HS) and 8 hy-
drocolonic sonographies with echographic contrast agent (HSEC)
were performed. Of the 65 HS, 64 corresponded to patients in the
colorectal cancer screening program and 1 to a patient with a family
history of polyposis. The HS was performed on the same day and
two hours before the OC, so that the patients had already undergone
the cleaning preparation. The bowel preparation included a low-res-
idue diet for 72 hours prior to the test, a liquid diet 24 hours prior
to the test and taking an evacuating solution (polyethylene glycol).
No cleaning preparation was used for the HSEC and the patients
were awaiting surgery for colon tumours, also the sonographer was
unaware of the location, type and number of lesions. A single charge
of Sono-Vue® was used as the echographic contrast agent, which is
a second-generation contrast agent formed of sulphur hexafluoride
microbubbles.
To distend the colon, a warm saline solution bag was placed on a
drip stand 150-180 cm high. The bag was attached to an infusion
system anastomosed to a balloon-catheter probe. The amount of sa-
line solution depended on tolerance, but ranged from 1200 to 2000
ml. In lateral decubitus, the patient was catheterised and once the
balloon catheter had been introduced into the rectal ampulla, the bal-
loon was inflated. After placing the patient in the supine position, the
infusion system was opened and the saline solution filled the colon
retrogradely by gravity. During the study, the patients were turned on
their sides to distend poorly repleted areas. In HSEC, the echograph-
ic contrast agent was injected intravenously after completing the ret-
rograde instillation of the saline solution and after the localization of
the lesion. No antispasmodics or sedation was used.
The ultrasounds were performed by a single abdominal ultrasound
specialist using a low frequency convex probe. The lesions were
studied by a pathologist and classified by size into three categories:
smaller than or equal to 5 mm, 6-10 mm, and larger than 10 mm.
The reference size of the lesion was the major axis measured by the
colonoscopist or by the pathologist in surgical cases. The results of
the HS were compared with those of the OC. In the case of stenos-
ing lesions, since patients required a CT-colonography, the results of
the echography and the CT-colonography were compared to with the
results of the control OC after surgery. In addition, when HSEC was
carried out, the location of the lesion was marked on the skin with a
permanent marker.
Sensitivity and specificity were calculated from the rectum-sigma
junction to the cecum, excluding the rectum. Sensitivity was calcu-
lated using the total number of lesions in each size category and
specificity using the number of patients who had a negative OC in
each size category. Statistical analysis was performed using analysis
of variance (ANOVA).
4. Results
Of the 73 ultrasounds, in one HSEC patient (1.4%), complete disten-
sion of the colon from the rectal ampulla to the cecum was not pos-
sible, due to an 8 cm stenosing lesion in the transverse colon. With
the exception of another HSEC (1.4%) due to a stenosing neoplasm
of 40 mm sigma, all patients tolerated the full scan.
The OC detected 178 lesions but only 175 were included in the histo-
logical study, since two polyps of 3 and 7 mm could not be recovered
and another of 5 mm had artefacts that prevented their assessment.
In addition, four lesions of between 2 and 5 mm had inflammatory
changes and two lesions of 3 and 4 mm corresponded to healthy
mucosa. In the remaining 169 lesions we observed 40 hyperplastic
polyps, 86 low-grade dysplasias, 22 high-grade dysplasias and 21 ad-
enocarcinomas including those in situ (Tables 1 and 2). Our data
showed a direct relationship between lesion size and the degree of
histological severity (p <0.05) (Figure 1) (Tables 1 and 2). No sig-
nificant differences were observed between hyperplastic lesions and
low-grade dysplasias, although both groups differed from high-grade
dysplasias and adenocarcinomas (p <0.05) (Figure 1).
The sonographer detected 84 lesions, with a total of 4 false positives
(haustra falsely classified as lesions of 11, 11, 10 and 9 mm). In le-
sions exceeding 10 mm, the sensitivity was 93% and the specificity
was 95.1% (Table 3). The OC detected 45 lesions while the sonogra-
pher described 42 lesions, with 2 false positives. Of the 5 lesions not
detected by HS, two of them were in the rectum and the other was a
flat lesion. In the lesions measuring 6-10 mm, the sensitivity obtained
was 70 % and the specificity was 96.1 % (Table 3). The HS detected
28 lesions with 2 false positives, while the OC detected 39. In the
case of the 13 undetected lesions, 2 were in the rectum and another
was a flat lesion. In lesions smaller or equal to 5 mm, the sensitivity
was 15.9% and the specificity was 100% (Table 3). HS detected 14
lesions, compared with the 94 detected by OC. In this size range, too,
11 flat lesions and 6 rectal lesions were not detected. In the case of
adenocarcinomas, sensitivity and specificity was 100%.
In one HS (1.5%), the sonographer judged the preparation to be
poor, but the colonoscopist considered it optimal. This patient pre-
sented 12 lesions: nine polyps of 0-5 mm, one of 8 mm and two of
15mm. None was detected by HS. On two occasions, the colonos-
copist considered the preparation poor, while the sonographer con-
sidered it optimal. In the first case, the sonographer did not see any
lesions, but in a second OC two polyps of 5 and 7 mm were detected.
In the second case, two OC were performed, in the first of which, a
stenosing lesion of 40 mm and four anterior lesions of 20,8,7 and 4
3. 2021, V6(21): 1-3
https://jjgastrohepto.org/ 3
mm were detected. In the second OC, the stenosing lesion could not
be crossed. In the HS, a stenosing lesion of 40 mm and five previous
lesions of 27, 21, 20, 19 and 10 mm were observed, which were con-
firmed by intraoperative OC.
Figure 1: Mean size of lesions according to histological grade
Table 1: Number of lesions arranged by size interval, according to histological grade and stage
Histological grade /Stage Number of lesions ≤ 5 mm Number of lesions (6-10) mm Number of lesions >10 mm
Hyperplastic polyps 34 5 1
Low-grade dysplasias 53 28 5
High-grade dysplasias 1 5 16
In situ Adenocarcinoma 0 0 12
T1 Adenocarcinoma 0 0 1
T2 Adenocarcinoma 0 0 1
T3 Adenocarcinoma 0 0 6
T4 Adenocarcinoma 0 0 1
In situ adenocarcinoma: Tumour in the mucosa. T1 adenocarcinoma: Invasion of the submucosa. T2 adenocarcinoma: Invasion of the
muscularis propria. T3 adenocarcinoma: Invasion of the serosa. T4 adenocarcinoma: invasion of other organs or structures.
Table 2: Histological grade, number of lesions and size.
Histological grade /Stage
Number
of lesions
Average size
(mm)
Range
(mm)
Hyperplastic
polyps 40 3,73 1-18
Low-grade dysplasias 86 5,8 2-45
High-grade dysplasias 22 14,32 5-30
In situ Adenocarcinoma 12 23,75 13-40
T1 Adenocarcinoma 1 40
T2 Adenocarcinoma 1 35
T3 Adenocarcinoma 6 30,17 19-40
T4
Adenocarcinoma 1 80
In situ adenocarcinoma: Tumour in the mucosa. T1 adenocarcinoma: Invasion of the submucosa. T2 adenocarcinoma: Invasion
of the muscularis propria. T3 adenocarcinoma: Invasion of the serosa. T4 adenocarcinoma: invasion of other organs or
structures.
4. 2021, V6(21): 1-4
https://jjgastrohepto.org/ 4
Table 3: Sensitivity and specificity (HS)
Size Sensitivity Specificity
≤ 5 mm 15,9 % 100%
6-10 mm 70% 96,1 %
>10 mm 93% 95,1 %
Regarding the results of the HSEC (Table 4). In the 8 HSEC per-
formed all the lesions were enhanced, enabling 9 lesions to be ob-
served, 7 adenocarcinomas, 1 high-grade dysplasia and 1 low-grade
dysplasia. In one case, complete repletion of the colon was not
achieved. In our study, where no cleaning preparation was used, fae-
cal debris was the main cause of poor visualization. Faecal remains
produced suboptimal acoustic windows, due to adherence to the co-
lonic wall or accumulation in the colonic lumen. Therefore, within
the case of HS, lesions were only totally observed faecal matter did
not produce suboptimal acoustic windows. However, with HSEC all
lesions were fully visualised, except on one occasion. Although lesion
enhancement allowed clear differentiation from faecal debris, on four
occasions the presence of faecal matter made it impossible to deter-
mine the total lesion enhancement time. On one occasion, discom-
fort forced a premature ending to of the procedure. The pre-surgical
location of the 9 lesions was correct with and without the application
of an echographic contrast agent.
Table 4: Findings in HSEC
Histological grade and stage Size and localization Acoustic window Enhancement time Limiting factor
Low-grade dysplasia
45 mm
Cecum Suboptimal
Not
determined Faecal remains
High-grade dysplasia
20 mm
Descending Optimal 100 sec. No
In situ adenocarcinoma
18 mm
Transverse Suboptimal
Not
determined Faecal remains
In situ adenocarcinoma
36 mm
Sigma Optimal 330 sec. No
T3 adenocarcinoma
19 mm
Rectum-sigma Suboptimal
Not
determined Faecal remains
T3 adenocarcinoma
35 mm
Descending Optimal 100 sec. No
T3 adenocarcinoma
40 mm
Sigma Suboptimal 120 sec. Faecal remains
T3 adenocarcinoma
40 mm
Sigma Suboptimal
Incomplete
140 sec.
Faecal remains
Discomfort
T4 adenocarcinoma
80 mm
Transverse Suboptimal
Not
determined
Faecal remains
Distension
In situ adenocarcinoma: Tumour in the mucosa. T1 adenocarcinoma: Invasion of the submucosa. T2 adenocarcinoma: Invasion of
the muscularis propria. T3 adenocarcinoma: Invasion of the serosa. T4 adenocarcinoma: invasion of other organs or structures.
Of the 21 adenocarcinomas, five were stenosing (the OC was unable
to study proximal segments to the lesion). In our study, there were
ten proximal lesions undergoing stenosis, and HS detected all lesions
of 10 mm or more. Lesions between 3 and 5 mm proximal to the
stenosis were not detected by HS or by CT-colonography. On three
occasions HS and CT-colonography did not detect lesions prior to
the stenosis, but in the control OC after surgery, five small lesions be-
tween 3 and 5mm were detected, in one patient, none of which had
been described by HS or CT- colonography. In one case, CT-colo-
nography was not performed, as HS detected five lesions between 10
and 27 mm, which were confirmed by intraoperative OC. Of these
lesions, the largest corresponded to a malignant polyp (adenocarci-
noma in situ). Finally, in an 80 mm adenocarcinoma located in the
transverse colon, the enema did not cross the stenosis and proximal
sections could not be studied with HS or using CT-colonography.
In the same patient an HSEC was performed and no lesions were
observed, findings which were confirmed in the control OC after
surgery.
5. Discussion
In our study, HS sensitivity for small lesions was low, but improved in
the case of larger lesions (Table 3). This relation, directly proportion-
al between sensitivity and size, has been observed in previous studies,
in which lesions smaller than 7 mm sensitivity ranged between 0 [3]
and 5% [5], while in lesions equal to or greater than 7 mm a sensitiv-
ity of 12,5 % has been mentioned [6], although most range between
50 and 91% [2,3,5]. In adenocarcinomas, which are bigger lesions
(Table 1 and 2), sensitivity was higher between 70.6 and 100% [2-5,
7-11]. In our study it sensitivity was 100 %.
In a CT-conolography meta-analysis, Mulhall [13] reported a sensitiv-
ity of 21-70% for polyps less than 6 mm, 55-84% for polyps between
6 and 9 mm and 48-100% in polyps greater than 10 mm. Comparing
the sensitivity of HS and CT-colonography, the sensitivity of HS
for small lesions is lower than the sensitivity of CT-colonography.
However, in our study, these small lesions showed a low histological
degree (Tables 1 and 2). We only observed one high degree dysplasia
in a polyp of 5 mm (Table 1) and the smallest adenocarcinoma was
13 mm (Table 2). Although characteristics such as a villous or tubulo-
villois histology, left-side location and age ≥ 60 are independient risk
factors for advanced pathological features in colorectal adenomas,
adenoma size is the most important factor for advanced pathological
features [14]. There is a direct relation between lesion size and risk
of cancer [15-17]. In those measuring 0-5 mm, the risk of invasive
5. 2021, V6(21): 1-5
https://jjgastrohepto.org/ 5
growth is 0-0.1%, which increases to 0-0.4 % in lesions measuring
6-9 mm [15] and then gradually increases to 19.4% in polyps mea-
suring more than 20 mm [16]. In a study by CT- colonography, while
not reporting any lesions of less than 6 mm, Kim [18], obtained an
incidence of 0.2 cancers per 1000 patients/year when realizing a fol-
low up study years later.
HS exhibits the typical limitations of ultrasound such as those related
with obsesity [3,6], poor acoustic window [3], the presence of gas [3,
5] or high operator dependency. Furthermore, the presence of faecal
remains [3, 5], the existence of anatomical variants such as the redun-
dancy of sigmoid colon [5], the existence of poorly repleted areas or
the disposition of the transverse colon make the study difficult. HS
requires toleration to repletion and although it is possible to decrease
the volume of saline solution that is introduced, incomplete studies
may result [3, 6]. Complications such as vasovagal episodes and dia-
phoresis have also been reported [6].
With the data obtained, HS cannot be considered a suitable technique
for studying the rectum, since, as other authors have also found [6,
19, 20], our results were poor. The lower portion of the rectum was
not visible [7], since the colon was distended from the rectal ampulla.
Furthermore, the presence of the balloon in the ampulla produces
poor visualization [5]. Other factors such as pubic symphysis [3, 8]
and its depth [3] also make it difficult to visualize. Thus, most of the
studies carried out inclusively cover the zone from the rectum-sigma
junction to the cecum [2-5, 9].
In advanced stages, adenocarcinomas usually present a thickening of
the wall with irregular morphology that narrows the lumen of the
colon (Figure 2 and 3). However, adenocarcinomas can also appear
in lesions of polypoid morphology (Figure 4 and 5). Although this
usually occurs in large polyps, it is not always easy to differentiate
polyps from haustra. Haustra of the colon [5, 12] (Figure 5,6 and 7)
and polyps [2, 3], appear as hyperechoic structures projected into the
colon lumen. Polyps differ from haustra in their morphology (sessile,
pedunculated or semi-pedunculated) (Figure 4, 5, 6,7, 8 and 9) and
by their behavior. Thus, they tend to move in the colon lumen during
retrograde instillation [2, 4], with external compression [2, 4] or when
the patient turns [12], since they are less rigid and more mobile than
the haustra. However, in flat lesions which have minimal or no relief
[21], these criteria are not applicable. In our study, flat lesions were
not detected because the complexity involved: first, due to the vari-
ability in wall thickness, which ranges from 3 to 4 mm [19,22], but
may frequently reach 5 mm in the sigmoid colon due to the hypertro-
phy of the muscular is propria [19]: and secondly, it is not possible
to use linear transducers, which are more suitable for small details, in
deep regions due to their lower penetration. Finally, faecal remains
need to be kept to a minimum.
Figure 2: Adenocarcinoma
Heterogeneous mass of 36 mm located at a splenic angle (thin arrow), diagnosed as
adenocarcinoma with invasion of the serosa
6. 2021, V6(21): 1-6
https://jjgastrohepto.org/ 6
Figure 3: Adenocarcinoma located in the sigmoid colon
Segment of sigmoid colon with an adenocarcinoma of 30 mm. Among the marks, the ends of an unreplenished area. Hypoechoic thickening
of the colon walls (thin arrows). To the left of the image but lower than the tumor, the saline solution that distends the sigmoid colon (short
arrow) can be observed.
Figure 4: Multilobulated polyp with diagnosis of adenocarcinoma
Polyp of 33 mm (thin arrow) with pathological diagnosis of adenocarcinoma in situ, and its lobulations (short arrows).
7. 2021, V6(21): 1-7
https://jjgastrohepto.org/ 7
Figure 5: Sessile polyp with diagnosis of adenocarcinoma
Polyp of 23 mm (thin arrow) with pathological diagnosis of adenocarcinoma in situ. Adjacent to the lesion, a haustrum (thick arrow) can be
observed.
Figure 6: Sessile polyp
Sessile polyp of 12 mm (thin arrow), with pathological diagnosis of high-grade dysplasia. Haustra of the colon (thick arrow).
8. 2021, V6(21): 1-8
https://jjgastrohepto.org/ 8
Figure 7: Pedunculated polyp
Among the marks is a pedunculated polyp, with a thick peduncle (thin arrow). The polyp is 26 mm long and is located in the sigmoid colon. Colonic
haustra (short arrows).
Figure 8: Pedunculated polyp with thin peduncle.
Pedunculated polyp of 12 mm. In the colonic lumen, the head of the polyp (thick arrow) and the peduncle (thin arrow) that connects it to
the colon wall are visible. This polyp located at liver angle was anterior to the stenosing mass of figure 2.
9. 2021, V6(21): 1-9
https://jjgastrohepto.org/ 9
Figure 9: Lobulated polyp
Lobulated polyp (thin arrow) and faecal remains (thick arrow).
Faecal remains, which usually accumulate in the right colon [5, 12],
produce incomplete studies [3] and are the main cause of poor visu-
alization [5]. The faecal remains can be observed as they move using
the transducer to compress the abdomen quickly and lightly [2, 4,
12], during retrograde instillation or when the patient is turned. To
improve the visualization of the colon wall, it is recommended thata
higher volume of saline solution be infused [12]. This process de-
creases the concentration of faecal remains but is not always possible
due to the patient's tolerance level to repletion. In these cases, lower-
ing the saline solution bag until the colon is empty and then placing
another bag to perform a new retrograde instillation is a simple way
to decrease the concentration of faecal remains without having to
resort to a new rectal probe.
In HSEC (Table 4), faecal remains were abundant since no cleaning
preparation was used. HSEC is a useful tool for differentiating le-
sions from faecal remains, as the latter are not enhanced (videos 1
and 2). However, the presence of faecal matter made it impossible
to determine the complete enhancement time on four occasions. As
long as the lesion is very enhanced it is easily distinguishable from
faecal matter, but enhancement gradually diminishes until the lesion
in no longer distinguishable from faecal matter, which prevents the
determination of complete enhancement time. A limitation of the
echographic contrast agent is the enhancement time, understood as
the time in which the enhancement of the lesion permits it to be
clearly defined. Although its determination may suffer from subjec-
tivity, the time reached a maximum of 330 sec. in our study, which is
much lower than the average time taken by HS (between 13.7 and 30
minutes) [2-7, 9, 12]. Although very few patients have been studied
by HSEC, this limited time represents a handicap for studying ex-
tensive regions and its use is better suited to local or poorly repleted
zones, such as flexures (Figure 10), sigmoid colon (video 1) or nar-
rowing’s of the colonic lumen (video 2).
HS can also be used as a tumour marking technique. Normally, mark-
ing the lesion with ink made by OC is sufficient for its to be located
during surgery. However, the dyes injected during OC can migrate
from the lesion or fail to show [23], sometimes making it necessary
to perform another OC to make a new mark. Although intraopera-
tive HS has been used to locate these lesions [24-26], its preoperative
performance is less complex. In our study, the pre-surgical location
of the nine lesions was correct with and without the application of
an echographic contrast agent. Pre-surgical marking of the lesion is
performed on the skin with the patient lying supine, but the retro-
grade instillation has to be slow, suspending the infusion if the filling
process cannot be followed visually, since it is necessary to detect
anatomical variants such as sigma redundancy or transverse arrange-
ment which can cause localization errors. Pre-surgical localization is
not a widely used technique, but it can be helpful for small lesions,
partially resected lesions or in bordering locations, which may lead to
changing the surgical technique to be used.
10. 2021, V6(21): 1-10
https://jjgastrohepto.org/ 10
Figure 10: Dual image of stenosing adenocarcinoma
Dual image of stenosing adenocarcinoma in the splenic angle, with ultrasound contrast in the left half and with no contrast in the right half.
The thickened wall is highlighted on the left half and the hypoechoic thickening on the right half (thin arrows). In both images, the filiform
passage of the serum (arrowheads) can be observed, appearing in the form of an “inverted apple core” in the left half of the image.
Although CT-colonography is the gold-standard in the case of in-
complete colonoscopies for stenosing neoplasms, HS/HSEC is an
option without radiation that can offer good results. In our study,
with few stenosing lesions, the HS data for the detection of lesions
proximal to the stenosis appear to be similar to the data obtained in
an examination in which no stenosis exists, that is, high sensitivity in
lesions of 10 mm or more and low in lesions less than or equal to 5
mm. However, these small lesions (smaller than or equal to 5 mm)
have a lower risk of presenting severe histological changes (Figure
1) (Tables 1 and 2). On one occasion, the stenosis prevented the
assessment of the proximal colonic sections, which was not possible
using HS or CT-colonography. Although, in our study, this occurred
with a large 80 mm lesion in stage T4, the impossibility of distend-
ing segments proximal to the lesion using HS is already known [5].
To study the sections proximal to this large lesion, the echographic
contrast agent (HSEC) technique was used, however, although this
may be helpful for adequate visualization, it is necessary to achieve
distension of the area to be studied.
6. Conclusions
The sensitivity of hydrocolonic sonography increases progressively
with the size of the lesion and, although it is low in the case of small
lesions, these are normally of low histological severity and present
a lower risk of adenocarcinoma. HS has a sensitivity comparable
to CT-colonography in lesions greater than or equal to 6 mm but
lower in lesions of less than or equal to 5 mm. HS is not a suitable
technique for studying the rectum, or flat lesions. The application of
an echographic contrast agent (HSEC) produces an improvement
in visualization, especially when there are faecal remains or poorly
repleted areas. HS/HSEC can offer good results for the detection of
proximal lesions to the stenosis mass.
References
1. AGA Clinical Practice and Economics Committee. Position of the
American Gastroenterological Association (AGA) Institute on com-
puted tomographic colonography. Gastroenterology. 2006;131: 1627-8.
2. Limberg B. Diagnosis and staging of colonic tumors by conventional
abdominal sonography as compared with hydrocolonic sonography. N
Engl J Med. 1992; 327: 65-9.
3. Caldeira A, Pereira E, Silva BF. Role of hydrocolonic sonography in the
detection of colonic neoplastic lesions. Journal of Diagnostic Medical
Sonography. 2011; 27: 160-4.
4. Limberg B. Diagnosis of large bowell tumors by colonic sonography.
Lancet. 1990; 335: 144-6.
5. Segura JM, Molina E, Herrera A. Hidrocolonic ultrasonography in the
detection of tumoral processes in the inferior gastrointestinal tract. Rev
Esp Enferm Dig. 1998; 90: 779-87.
6. Chui DW, Gooding GA, McQuaid KR, Griswold V, Grendell JH. Hy-
drocolonic ultrasonography in the detection of colonic polyps and tu-
mors. N Engl Med. 1998; 331: 1685-8.
7. Socorro HCR, Guerra C, Romero HJ, Rey A, Facal LP, Santullano AV,
et al. Colorectal carninomas: diagnosis and preoperative staging by hy-
drocolonic sonography. Surgery. 1995; 117: 609-15.
8. Dux M, Roeren T, Kuntz C, Ritcher GM, Kauffmann GW. TNM stag-
ing of gastrointestinal tumors by hydro sonography: results of a his-
topathological controlled study in 60 patients. Abdom Imaging 1997;
22: 24-34.
9. Dixit R, Chowdhury V, Kumar N. Hydrocolonic sonography in the
evaluation of colonic lesions. Abdom Imaging. 1999; 24: 497-505.
10. Candia C, Ciacci V, Di Segni R, Santini E. Hydrocolonic sonography in
the study of colonic diseases: comparison with double-contrast enema.
Radiol Med. 1995; 89: 258-63.
11. Elewaut AE, Afschrift M. Hydrocolonic sonography: a novel screening
method for the detection of colon disease Bildgebung. 1995; 62: 230-4.
12. Ling UP, Chen JY, Hwang CJ, Lin CK, Chang MH. Hydro sonography
11. 2021, V6(21): 1-11
https://jjgastrohepto.org/ 11
in the evaluation of colorectal polyps. Archives of Disease in Child-
hood 1995; 73: 70-3.
13. Mulhall BP, Veerappan GR, Jackson JL. Meta-analysis: computed to-
mographic colonography. Annals of Internal. Medicine. 2005; 142:
635-50.
14. Gschwantler M, Kriwanek S, Langer E. High-grade dysplasia and in-
vasive carninoma in colorectal adenomas: a multivariate analysis of the
impact of adenoma and patient characteristics. Eur J Gastroenterol
Hepatol. 2002; 14: 183-8.
15. Vleugels JLA, Hazewinkel Y, Fockens P, Dekker E. Natural history of
diminutive and small colorrectal polyps: a systematic literature review.
Gastrointest Endosc. 2017; 85: 1169-76.
16. Odom SR, Duffy SD, Barone JE, Ghevariya V, McClane SJ. The rate
of adenocarcinoma in endoscopically removed colorectal polyps. Am
Surg. 2005; 71: 1024-6.
17. Kaminski MF, Hassan C, Bisschops R. Advanced imaging for detec-
tion and differentiation of colorectal neoplasia: European Society of
Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2014; 46:
435-49.
18. Kim DH, Pooler BD, Weiss JM, Pickhardt PJ. Five-year colorectal can-
cer outcomes in a large negative CT colonography screening conhort.
Eur Radiol. 2012; 22: 1488-94.
19. Giovanni M, Radice E, Bareggi E, Porro GB. Hydronosonography of
the gastrointestinal tract. AJR. 2009; 193: 700-8.
20. Siripongsakun S, Charoenvisal L, Brown PL, Dusitanond N, Siripong-
preeda B. Hydrocolonic sonography: a complete corectal evaluation
technique with preliminary results. J Clin Ultrasound. 2013; 41: 402-7.
21. Participants in the Paris Workshop. The Paris endoscopic classification
of superficial neoplastic lesions: esophagus, stomach, and colon. Gas-
trointestinal Endoscopy. 2003; 58: 3-43.
22. Fraquelli M, Colli A, Casazza G. Role of US in detection of Crohn
disease: meta-analysis. Radiology. 2005; 236: 95-101.
23. Greif F, Aranovich D, Zilbermints V, Hannanel N, Belenky A. Intra-
operative hydrocolonic ultrasonography for localization of small col-
orectal tumors in laparoscopic surgery. Surg Endosc. 2010; 24: 3144-8.
24. Luck AJ, Thomas ML, Roediger EW, Hewett PJ. Localization of the
nonpalpable colonic lesion with intraoperative ultrasound. Surg En-
dosc 1999; 13: 526-7.
25. Luck A, Copley J, Hewett P. Ultrasound of colonic neoplasia. An op-
erative tool?. Surg Endosc. 2000; 14: 185-8.
26. Greif F, Belenky A, Aranovich D, Yampolski I, Hannanel N. Intraop-
erative ultrasonography: a tool for localizalizing small colonic polyps.
Int J Colorectal Dis. 2005; 20: 502-6.