Cardiothoracic Surgery

Endoscopic Colonoscopy has been the mainstay of investigation of colorectal symptoms and screening of high risk individuals since the introduction of the fiberoptic flexible colonoscope in the 1970s. It allows direct visualisation of the colonic mucosa and enables biopsy sampling of mucosal abnormalities and polypectomy snare excision of colonic polyps. Colonoscopy is thought to reduce the mortality of colorectal malignancy through earlier diagnosis. This comes at the expense of a small but real morbidity and mortality, intravenous sedation requirement, and the need for a mechanical bowel preparation, which reduces its acceptability as a screening investigation. The need for accurate colonic assessment will increase with the advent of population based screening for colorectal cancer. Barium enema has until recently been the only other widely used and reliable modality for imaging of the colon. Advances in computed tomography data acquisition and post processing have enabled the development of virtual colonography to image colonic mucosa in a clinically meaningful way. Limitations remain with these new techniques including the persistent need for high quality mechanical bowel preparation, ionising radiation exposure, the lack of facility for sampling or therapeutic intervention, the requirement for all patients with positive or questionable findings to go onto endoscopic colonoscopic assessment, and the high cost. Further developments in MRI and faecal subtraction techniques will address some of these issues and probably see endoscopic colonoscopy reserved for cases requiring intervention after initial radiological assessment. 73 01 RACS Annual Scientific Congress, 2003 ANZJ. SURG. 203; 73 (Suppl.) bstracts BEES SGML CR02 WHAT FOLLOW UP AFTER CURATIVE RESECTION FOR COLORECTAL CANCER?