What is the interpretation of normal findings on upper endoscopy and colonoscopy with no evidence of gastrointestinal inflammation or malignancy?

From the Guidelines

The patient should undergo routine surveillance colonoscopy in 5 years, following national guidelines, as the current endoscopy and colonoscopy findings are completely normal and show no evidence of gastrointestinal inflammation or malignancy. The upper endoscopy examined the esophagus, stomach, and duodenum, finding no abnormalities such as inflammation, ulcers, or suspicious lesions. The colonoscopy thoroughly examined the entire colon and terminal ileum, also showing normal mucosa throughout with no signs of inflammation, ulceration, or neoplasia. Multiple biopsies were taken from various areas for histological examination, though these results are still pending. The procedures were performed with advanced imaging techniques including texture and color enhancement, narrow band imaging, and artificial intelligence assistance to ensure thorough examination.

Key Points:

• The endoscopy and colonoscopy findings were normal, with no evidence of gastrointestinal inflammation or malignancy 1.
• The procedures were performed with advanced imaging techniques to ensure thorough examination.
• Multiple biopsies were taken for histological examination, though results are pending.
• The recommendation for routine surveillance colonoscopy in 5 years is based on national guidelines and represents standard follow-up timing for someone with normal findings who likely underwent screening colonoscopy 1.

Considerations:

• The patient's risk profile and individual factors should be considered when determining the surveillance interval, as recommended by recent guidelines 1.
• The quality of the preparation and withdrawal time can significantly affect the detection rate of lesions, as noted in previous studies 1.
• Regular monitoring should start earlier in cases of pancolitis than left-sided or distal colitis, and patients with PSC should be monitored from the time of PSC diagnosis 1.

From the Research

Endoscopy and Colonoscopy Findings

• The patient underwent an upper endoscopy and colonoscopy, with the Olympus GIF-EZ1500 gastroscope inserted to the third part of the duodenum and the Olympus cap-fitted CF-EZ1500DL colonoscope inserted to the terminal ileum.
• The mucosa of the oesophagus, stomach, and duodenum were normal, with no evidence of erosive oesophagitis, columnar-lined oesophagus, or hiatus hernia.
• The mucosa of the visualised terminal ileum, proximal and distal colon was normal throughout, with no evidence of mucosal inflammation, ulceration, or further neoplasia.
• Biopsies were taken from multiple areas of the duodenum, gastric antrum and body, and the gastro-oesophageal junction (GOJ) for histology.

Surveillance and Follow-up

• The findings are reassuring, with no evidence of gastrointestinal colorectal inflammation or malignancy 2.
• Surveillance colonoscopy should be performed in 5 years per national guidelines, as recommended by the Japan Gastroenterological Endoscopy Society 3.
• The importance of endoscopic screening and surveillance for both detection and post-treatment follow-up of colorectal cancer has been recognized as essential to reduce disease mortality.

Diagnostic Yield of Endoscopy

• Upper gastrointestinal endoscopy yields important findings in asymptomatic patients with a positive fecal occult blood test and negative colonoscopy, with a detection rate of 13% for upper gastrointestinal sources of occult bleeding 4.
• The positive predictive value (PPV) for bowel wall thickening in the upper GI tract was 64%, compared to 33% in the lower GI tract, highlighting the utility of endoscopy in evaluating gastrointestinal luminal wall thickening found on computed tomography 5.

Infection Risk and Prevention

• Infections after GI endoscopies most commonly result from the patient's endogenous gut flora, with a composite infection rate of 0.2% following GI endoscopic procedures 6.
• Prevention methods such as antimicrobial prophylaxis, adequate sterilization methods for reprocessing endoscopes, periodic surveillance, and the use of disposable endoscopes can minimize the chances of endoscope-associated infections.