Showing posts with label colonoscopy. Show all posts
Showing posts with label colonoscopy. Show all posts

Saturday, May 18, 2013

DDW 2013 - New Colonscope Provides Ground-Breaking View of Colon

New Colonscope Provides Ground-Breaking View of Colon

Colonoscopy withdrawal time, polyp removal technique also examined at DDW® 2013

Orlando, FL (May 18, 2013) — A ground-breaking advance in colonoscopy technology signals the future of colorectal care, according to research presented today at Digestive Disease Week® (DDW). Additional research focuses on optimizing the minimal withdrawal time for colonoscopies and exploring safer methods for removing polyps.

During colonoscopy, doctors use a device called a colonoscope to examine the colon. This screening test for colorectal cancer allows a doctor to look for precancerous polyps called adenomas in the colon and rectum. Results from a study featuring a new colonoscope that allows doctors to see more of the colon hold promising results that could revolutionize colorectal cancer screening.

Researchers compared both the adenoma miss rate using the new colonoscope with the miss rate of a traditional colonoscope. The miss rate for the new colonoscope was only 7.6 percent as compared to 41.7 percent for the traditional colonoscope, in this study.

“It’s always our goal to minimize miss rates in colonoscopy,” said Professor Ian M. Gralnek of the Bruce and Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology and senior physician at the department of gastroenterology, Rambam Health Care Campus and Elisha Hospital in Haifa, Israel. “These results show us a way to achieve that and improve the efficacy of colorectal cancer screening and surveillance colonoscopy.”

Developed by EndoChoice, the Full Spectrum Endoscopy (FUSE) colonoscope maintains the identical technical features of the standard colonoscope, but allows the endoscopist to view 330 degrees, compared to the 170 degree viewing angle of the traditional colonoscope.

The study randomly assigned 197 patients for tandem colonoscopies using either the standard or the FUSE colonoscope first. In addition to a significantly lower adenoma miss rate, results showed a significantly higher adenoma detection rate favoring FUSE. Professor Gralnek credits FUSE’s improved imaging technology with these findings as adenomas can be difficult to detect with only forward-viewing capabilities.

“Adenomas often hide behind folds in the colon and can be very difficult to find with a forward-viewing scope,” Professor Gralnek said. “Lower adenoma miss rates have important implications for patient surveillance,” he added. The additional information FUSE provides to doctors may allow them to adjust patients’ surveillance intervals according to risk level, ultimately helping to prevent incremental colorectal cancers. The FUSE scope could be available as early as this summer.
Colonoscopy withdrawal time makes a big difference for diagnosis

DDW also features other advances in colonoscopy relating not to what doctors see, but to how long they look. Researchers at Stanford University compared a three-minute versus six-minute withdrawal time during colonoscopy. The polyp miss rate was almost twice as high during the shorter procedure.

“The de facto standard of care for colonoscopy withdrawal time, which is six minutes, was based on a single observational study,” said Sheila Kumar, research fellow in Stanford’s division of gastroenterology and hepatology. “More data were needed to ensure that we are providing the best care possible. Our findings provide evidence-based support that prolonging withdrawal time significantly decreases polyp miss rates at colonoscopy.”

Dr. Kumar’s research represents the first randomized control trial examining the effect of colonoscopy withdrawal times on polyp miss rates. The study was conducted with patients undergoing colonoscopies at Stanford and the Palo Alto Veterans Administration Hospital. Patients were randomized to an initial three-minute or six-minute colonoscopy withdrawal time. Patients then underwent a “second look” six-minute withdrawal to determine if polyps were missed with the first look.

“The study design also allowed for data collection for screenings up to 12 minutes long, by combining data for the first and second withdrawal,” Dr. Kumar said. “Future comparisons could help to confirm the optimal time parameters of a colonoscopy.”
A safer polypectomy option for high-risk patients

In another study, researchers at Showa Inan General Hospital in Komagane, Japan, found that a particular method of polypectomy — called a “cold snare” technique — is safer for patients on anticoagulants.

When a colon or rectal polyp is detected during colonoscopy, a polypectomy is often recommended to remove the growth. But for patients who use anticoagulants, or blood thinners, polypectomies carry higher risk because of bleeding that occurs during excision of the polyp and recovery.

“The results of our study represent an important opportunity for patients whose options have been severely limited up to this point,” said Akira Horiuchi, chief of the hospital’s Digestive Disease Center.

The study compared the bleeding associated with the conventional polypectomy technique and the cold snare technique.

With the first, the polyp is snared with a wire and then cut using electrocautery. The cold snare technique mechanically cuts off the polyp without electrocautery. With the latter method, bleeding was seen in only about 5 percent of cases compared to 23 percent of cases using the conventional technique. No delayed bleeding was associated with the cold snare technique, whereas 14 percent of the conventional patients required hemostasis afterward. Polyp removal rates were identical for both approaches.

“These differences are exciting and encouraging,” Dr. Horiuchi said. “We think the study paves the way for future research to validate a safer option for many patients.”

Professor Gralnek will present data from the study “Comparing traditional forward-viewing colonoscopy with “full spectrum endoscopy”: a randomized, multicenter tandem colonoscopy study - the Fuse study,” abstract 9a, on Saturday, May 18, at 9:44 a.m. ET in Room 415 Valencia of the Orange County Convention Center.

Dr. Kumar will present data from the study “Evaluating the optimal time for colonoscopy withdrawal: a prospective randomized comparison of three minute versus six minute withdrawal,” abstract Mo1559, on Monday, May 20, at 8 a.m. ET in Hall West A1of the Orange County Convention Center.

Dr. Horiuchi will present data from the study “Prospective randomized comparison of cold snare polypectomy and conventional polypectomy for small colorectal polys in patients receiving anticoagulation therapy,” abstract 852, on Monday, May 20, at 4 p.m. ET in Room 314B of the Orange County Convention Center.

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Digestive Disease Week® (DDW) is the largest international gathering of physicians, researchers and academics in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery. Jointly sponsored by the American Association for the Study of Liver Diseases (AASLD), the American Gastroenterological Association (AGA) Institute, the American Society for Gastrointestinal Endoscopy (ASGE) and the Society for Surgery of the Alimentary Tract (SSAT), DDW takes place May 18 to 21, 2013, at the Orange County Convention Center, Orlando, FL. The meeting showcases more than 5,000 abstracts and hundreds of lectures on the latest advances in GI research, medicine and technology.

More information can be found at Follow us on Twitter @DDWMeeting; hashtag #DDW13. Become a fan of DDW on Facebook.

Monday, May 21, 2012

Simple scope exam cuts colon cancer deaths

By news services
updated 1 hour 4 minutes ago

Screening for colon cancer using a flexible tube -- which is less invasive and more convenient than colonoscopy -- may also help prevent new cases and deaths from the disease, a large federal study finds.   

In a large trial of more than 150,000 older U.S. adults, those who were randomly assigned to get screened using so-called flexible sigmoidoscopy on two different occasions were 21 percent less likely to get colon cancer than those not offered the screening.

They were also 26 percent less likely to die of cancer, probably because screening picked up pre-cancerous lesions and early-stage cancers before they could cause serious harm, researchers reported Monday in the New England Journal of Medicine.

Many doctors recommend a more complete test — colonoscopy — but many people refuse that costly, unpleasant exam. The new study shows that the simpler test, flexible sigmoidoscopy, can be a good option. Although it may seem similar to having a mammogram on just one breast, experts say that even a partial bowel exam is better than none.

As one put it, "the best test is the one that gets done."

Laxative-free colon test may be as effective
Colonoscopy "is a very unpleasant thing," said Dr. Alfred Neugut, an epidemiologist and oncologist from Columbia University in New York, who wasn't part of the study team.
"Sigmoidoscopy is a much less elaborate procedure, so you can basically walk into the doctor's office and get it on the spot… and it's much less invasive," he said.

Flexible sigmoidoscopy is one of three colon cancer screening methods recommended by the U.S. Preventive Services Task Force, a government-backed body that sets screening guidelines.
The Task Force says that annual fecal occult blood testing, flexible sigmoidoscopy every five years with fecal testing every three years or colonoscopy every 10 years are all options for adults aged 50 to 75 at average risk of cancer.

But many Americans in that age group still don't get screened -- and one of the reasons may be the discomfort of preparing to get a colonoscopy, including taking laxatives, and the inconvenience and invasiveness of the procedure itself.

People ages 50 to 75 who are at average risk of colon cancer are urged to get screened, but only about 60 percent do. Government advisers recommend one of three methods: annual stool blood tests, a sigmoidoscopy every five years plus stool tests every three years, or a colonoscopy once a decade.
The new findings provide more evidence that sigmoidoscopy as an initial test -- followed by colonoscopy only in the case of positive findings -- may be a valid alternative, researchers said.
The data come from the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial, which compared new cases of cancer and cancer-related deaths in adults who did or didn't get different types of screening.

This analysis, led by Dr. Robert Schoen from the University of Pittsburgh Medical Center, involved 154,900 adults age 55 to 74 who were offered either two sigmoidoscopies, three or five years apart, or no colon cancer screening.

Over the next 12 years, there were 1,012 new cases of colon cancer in the screening group and 1,287 in the unscreened group. In addition, there were 252 related deaths among people offered sigmoidoscopy, compared to 341 in the unscreened group.

The lower mortality in the screening group seemed to be attributable entirely to fewer deaths from so-called distal colon cancer, which occurs in the part of the intestines closer to the rectum. There was no difference between the two groups in deaths from proximal colon cancer, which is cancer higher up in the intestines and beyond the reach of the sigmoidoscopy scope.

False positives common
The screening tests were not without their limitations. One in five men and one in eight women had a false-positive sigmoidoscopy, which resulted in more invasive testing that ultimately found no pre-cancers or cancers. In addition, 22 people suffered a bowel perforation either from the initial sigmoidoscopy or a follow-up colonoscopy.

A limitation of the trial itself is that the two study groups weren't as different as the researchers initially intended: almost half of people in the group assigned to no screening ended up getting a sigmoidoscopy or colonoscopy on their own during the study.
Trials in the UK and Italy have also suggested screening with sigmoidoscopy can reduce deaths from colon cancer.

Because of that, the UK plans to offer sigmoidoscopies free of charge to all adults in their mid-50s within the next five years, according to Wendy Atkin, a professor of gastrointestinal epidemiology at Imperial College London, who worked on the UK study.

"We need to revisit sigmoidoscopy in the United States," Atkin told Reuters Health.

Research suggests nurses can do the less-invasive test, she said. It's also significantly cheaper than colonoscopy -- at roughly $150, compared to about $1,000 for a colonoscopy.

Schoen doesn't expect colonoscopy to go out of style as the most popular method for colon cancer screening in the U.S. But, he added, flexible sigmoidoscopy as an initial test is a good choice for some people who want to avoid a colonoscopy unless it's completely necessary.
"Absolutely it's an option on the table," he told Reuters Health.

"If someone, for example, was afraid of anesthesia, if they want a test where the prep is not so aggressive -- they just take enemas as opposed to drinking laxatives, if they cannot spare a day… all those are good reasons if you want to go and have a (sigmoidoscopy)," Schoen said.

Neugut told Reuters Health many U.S. doctors don't do the less-invasive procedures anymore. But data are lacking to prove colonoscopy is any better than initially going for sigmoidoscopy, he said.
"Anyone who doesn't want to have a colonoscopy, they should consider sigmoidoscopy as certainly… a valid form of screening for colon cancer," Neugut said.