Colonoscopy as an adjunctive technique in evaluating acquired colonic narrowing.

Fiberoptic colonscopy is a useful adjunct to the barium enema in establishing the nature of colonic narrowing for which surgical intervention is being considered in patients who are not clinically obstructed. When the mucosa can be demonstrated to be free of disease, celiotomy and resection can be avoided. Even without significant narrowing, it is sometimes possible to limit the extent of resection by proving the process to be benign. On review of 500 consecutive colonscopic procedures, "colonic narrowing" was the indication or finding in 47 patients. Barium enema had been inconclusive in 34 of these, whereas colonoscopy was inconclusive in only seven. In 34 patients the decision concerning surgical amangement was influenced by colonoscopy, and the accuracy of the endoscopic findings in the majority was confirmed by biopsy, laparoscopy, or celiotomy. On the basis of radiographic and endoscopic studies, 29 patients were not explored and in none was there delay or failure in the diagnosis of malignancy. There were no complications or deaths. Three illustrative cases are presented with correlative endoscopic and radiographic material.