Scope to improve: a multi-centre audit of 16 064 colonoscopies looking at caecal intubation rates, over a 2-year period - Frontline Gastroenterology

Scope to improve: a multi-centre audit of 16 064 colonoscopies looking at caecal intubation rates, over a 2-year period -- Frontline Gastroenterology

Conclusion 

"....Endoscopists performing low volume colonoscopy (<100 per annum), have CIR of <90%. Endoscopists with low volume practice who do not meet the quality standards should engage in skills augmentation plus further training and increase volume of colonoscopy with local mentorship, or stop performing colonoscopy."

Editorial: Why You Should Care about Screening Flexible Sigmoidoscopy — NEJM

Blogger's Note: read the whole editorial for further information regarding colonoscopies, this blog also has trial data on colonoscopies/research/opinions

Why You Should Care about Screening Flexible Sigmoidoscopy — NEJM

"...The real question for U.S. (blogger's note: and others)  clinicians is whether we are prepared to refocus attention on a screening strategy that has been likened to performing mammography on one breast..."

...Where does this leave us with regard to screening flexible sigmoidoscopy? First, it should be acknowledged that flexible sigmoidoscopy reduces colorectal-cancer incidence and mortality for the portion of the colon that it is designed to examine. Next, high-quality evidence must show the superiority of colonoscopy over other screening tests before we dismiss the use of flexible sigmoidoscopy and fecal occult-blood testing, both of which have randomized, controlled trials supporting their benefit. Especially critical are data that confirm the ability of colonoscopy to reduce mortality from proximal cancers. Finally, patient preferences for screening tests should be identified and respected — in this case, the best test is the one that gets done.

New Data Concludes Wait Times for Patients With Gastrointestinal Disease Are Increasing Across Canada - MarketWatch

New Data Concludes Wait Times for Patients With Gastrointestinal Disease Are Increasing Across Canada - MarketWatch

OAKVILLE, ONTARIO, May 17, 2012 (MARKETWIRE via COMTEX) -- The Canadian Association of Gastroenterology (CAG) today joined the Ontario Association of Gastroenterology (OAG) in voicing their objection to the Government of Ontario's May 7, 2012 decision to overhaul the fee structure for approximately 40 medical procedures and services that Ontario doctors provide. Colonoscopies are among the medical tests for which professional fees face a cut of 10%.

Pointing to new initial data gathered in April 2012 from the Canadian Association of Gastroenterology Survey of Access to GastroEnterology (SAGE), Desmond Leddin, Lead of the SAGE, says "a comparison of data from surveys performed in 2005 and 2008 shows that wait times for patients with gastrointestinal disease have increased across Canada."

"This CAG national survey information combined with the new fee structure in Ontario gives us cause for concern about patient safety," says CAG President Dan Sadowski.

"With evidence in hand that patient wait times have been increasing over the past seven years, we can't support any government decision - in Ontario or elsewhere in Canada - that results in reduced access to, or longer wait times for, important medical procedures including colonoscopy, which can prevent and reduce cancer rates.".....

Medscape: Colonoscopy No Help in Finding Melena Source - in Gastroenterology, General Gastroenterology

 Wiki: Melena

Medical News: Colonoscopy No Help in Finding Melena Source - in Gastroenterology, General Gastroenterology

"Colonoscopy had a lower-than-expected yield when used after a negative upper endoscopy in stable patients with melena, researchers found.
The procedure diagnosed a suspected source of the bleeding in just 4.8% of patients with melena in a retrospective case-control study by Jason P. Etzel, MD, of Oregon Health and Science University, Portland, and colleagues......

Abstract: Adherence to Colorectal Cancer Screening: A Randomized Clinical Trial of Competing Strategies

 Abstract: Adherence to Colorectal Cancer Screening: A Randomized Clinical Trial of Competing Strategies

""We have seen benefit from colon cancer screening with fewer people dying from it," said Dr. Theodore Levin, (MedicineNet quote) a gastroenterologist at the Kaiser Permanente Medical Center in Walnut Creek, Calif., and the author of an accompanying journal editorial. "If we want to raise our screening rates then we need to offer people choices other than colonoscopy."

Adherence to Colorectal Cancer Screening
A Randomized Clinical Trial of Competing Strategies

Background  Despite evidence that several colorectal cancer (CRC) screening strategies can reduce CRC mortality, screening rates remain low. This study aimed to determine whether the approach by which screening is recommended influences adherence.

Methods  We used a cluster randomization design with clinic time block as the unit of randomization. Persons at average risk for development of CRC in a racially/ethnically diverse urban setting were randomized to receive recommendation for screening by fecal occult blood testing (FOBT), colonoscopy, or their choice of FOBT or colonoscopy. The primary outcome was completion of CRC screening within 12 months after enrollment, defined as performance of colonoscopy, or 3 FOBT cards plus colonoscopy for any positive FOBT result. Secondary analyses evaluated sociodemographic factors associated with completion of screening.

Results  A total of 997 participants were enrolled; 58% completed the CRC screening strategy they were assigned or chose. However, participants who were recommended colonoscopy completed screening at a significantly lower rate (38%) than participants who were recommended FOBT (67%) (P < .001) or given a choice between FOBT or colonoscopy (69%) (P < .001). Latinos and Asians (primarily Chinese) completed screening more often than African Americans. Moreover, nonwhite participants adhered more often to FOBT, while white participants adhered more often to colonoscopy.

Conclusions  The common practice of universally recommending colonoscopy may reduce adherence to CRC screening, especially among racial/ethnic minorities. Significant variation in overall and strategy-specific adherence exists between racial/ethnic groups; however, this may be a proxy for health beliefs and/or language. These results suggest that patient preferences should be considered when making CRC screening recommendations.

abstract: Incontinence after colonoscopy - an unrecognized and preventable problem. A cross-sectional study from the Gastronet quality assurance program

 Abstract

"Female patients had a higher risk of incontinence than men."

Background: 
Colonoscopy requires insufflation of gas for visualization of the bowel wall. Worldwide, this is usually done using air. The aim of the present study was to assess the risk of post colonoscopy incontinence, and to investigate whether insufflation of CO₂ instead of air may reduce this risk, since it is easily absorbed through the bowel mucosa.
 

Conclusion:
About every 20th patient undergoing colonoscopy using standard air insufflation experiences post examination incontinence. This proportion can be reduced by 60 % by converting from air insufflation to insufflation with the absorbable CO₂.

Clinical Oncology News - Stool DNA Test Promising for Colorectal Screening

Clinical Oncology News - Stool DNA Test Promising for Colorectal Screening

"Stool DNA testing is moving the colorectal cancer (CRC) screening field a step closer to eradicating the disease, according to David Ahlquist, MD, Department of Gastroenterology and Hepatology at Mayo Clinic, Rochester, Minn., who helped develop this approach and presented recent findings at the 2012 Gastrointestinal Cancers Symposium.


Stool DNA testing detects tumor-specific DNA alterations in cells that are continually being shed into the stool from precancerous and cancerous lesions. The test is now being developed by Exact Sciences, a molecular diagnostics company in Madison, Wis.

The broad application of stool DNA testing in longitudinal screening programs is to prevent CRC through high precancer detection. In an invited lecture, Dr. Ahlquist said this claim is “not too bold and not hyperbole.” New-generation stool DNA testing, he said, offers “extraordinarily” high detection rates for curable cancers and precancers that are likely to progress. The test detects lesions on both sides of the colon with equal accuracy and reveals flat or serrated polyps likely to be missed by both fecal occult blood test and colonoscopy.
The noninvasive DNA test involves no diet or medication restrictions, no bowel preparation and is done at home using a stool sample. “It is user-friendly, affordable and offers individuals unlimited access by mail,” he added............

open access (pdf) Familial Cancer: A prospective study of bowel preparation for colonoscopy with polyethylene glycol-electrolyte solution versus sodium phosphate in Ly

Familial Cancer

Original Article

A prospective study of bowel preparation for colonoscopy with polyethylene glycol-electrolyte solution versus sodium phosphate in Lynch syndrome: a randomized trial

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Abstract 

Lynch gene carriers undergo regular surveillance colonoscopies.

Polyethylene glycol-electrolyte solution (PEG) is routinely prescribed for bowel cleansing, but often poorly tolerated by patients. Sodium phosphate (NaP) may be an alternative. (note warnings published within the past several years on sodium phosphate) Prospective and random comparison of bowel preparation with PEG and NaP on colon cleansing and patients’ acceptance.
Patients, who previously underwent a colonoscopy, were invited to participate and randomly assigned to either PEG or NaP. They were asked to fill in a questionnaire about preparation tolerability and future preferences. The endoscopist filled out a report about the quality of colon cleansing. 125 Patients were included in the study. Nine (7%) were excluded because of missing data. The remaining 116 patients (53 PEG and 63 NaP) were included in the analysis. Baseline characteristics did not differ between groups. Before colonoscopy 20 (38%) patients using PEG experienced the preparation almost intolerable, in contrast to 7(11%) of those using NaP (P = 0.001). Eleven patients in the PEG group and 48 in the NaP group would prefer NaP in the future.
The colonoscopy was poorly tolerated in 17% of the individuals in both groups (P = 0.963). The endoscopist observed a more than 75% clean colon in 83% of patients on PEG and in 71% of patients on NaP (P = 0.076), however the coecum (P = 0.025) and ascending colon was cleaner after PEG.
Lynch patients tolerated NaP better and preferred this formula for future bowel preparation. Colon cleansing was suboptimal with both treatments with a tendency towards a cleaner proximal colon with PEG.

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Keywords Lynch syndrome – Colonoscopy – Polyethylene glycol – Sodium phosphate

Colon cancer screening news coverage all over the map & readers are probably lost - Health News Review (includes professional commentaries)

Colonoscopy versus Fecal Immunochemical Testing in Colorectal-Cancer Screening — NEJM

Colonoscopic Polypectomy and Long-Term Prevention of Colorectal-Cancer Deaths — NEJM

abstract: A literature review of quality in lower gastrointestinal endoscopy from the patient perspective.

Abstract

BACKGROUND:

Given the limited state of health care resources, increased demand for colorectal cancer (CRC) screening raises concerns about the quality of endoscopy services. Little is known about quality in colonoscopy and endoscopy from the patient perspective.

OBJECTIVE:

To systematically review the literature on quality that is relevant to patients who require colonoscopy or endoscopy services.

METHODS:

A systematic PubMed search was performed on articles that were published between January 2000 and February 2011.


"Qualitative studies eliciting the patient perspective on what constituted quality in colonoscopy⁄endoscopy were not found."

Gastroenterology & Endoscopy News - Is Colonoscopy the Optimal Method for Colorectal Cancer Screening? (no specific mention of Lynch Syndrome

Note: no mention of Lynch Syndrome (biology/genetics), full free access with registration (free)

Q&A: Focus on Virtual Colonoscopy - Cancerwise | Cancer blog from MD Anderson Cancer Center

included comment:

What types of research is MD Anderson doing?

"Since bowel preparation is the largest barrier to most people seeking colon cancer screening, my research involves the development of new bowel cleansing approaches. These include solutions to dissolve feces and remove it from below without the need to drink the usual cleansing agents."

High detection rate of adenomas in familial colorectal cancer - Gut

Conclusion
The yield of colonoscopic surveillance in familial CRC is substantially higher than the yield of screening reported for the general population."

Colorectal adenomas in the lynch syndromes: Results of a colonoscopy screening program

Abstract
Forty-four asymptomatic putative Lynch syndrome patients participated in a colonoscopy screening program. There were 18 men and 26 women; mean age was 44 yr. Thirty percent of Lynch syndrome patients had at least one adenoma; 20% had multiple adenomas. In 18% of the patients, adenomas were discovered proximal to the splenic flexure. In a reference group of 88 age- and sex-matched patients, 11% had adenomas, 4% had multiple adenomas, and 1% had right-sided adenomas. Twenty-one Lynch syndrome patients had follow-up colonoscopies. Of 7 patients with adenomas on initial examinations, 6 had adenomas at follow-up. Of 14 patients with negative initial examination results, 3 had adenomas at follow-up. The prevalence of adenomas in the Lynch syndromes is greater than in an unselected reference group. The adenomas are more proximally located, corresponding to the site of cancer distribution in the Lynch syndromes. A high rate of synchronous and metachronous lesions is found. Our findings support the hypothesis that adenomatous changes are the premalignant lesion in the Lynch syndromes. We also found evidence of heterogeneity among Lynch syndrome families in adenoma incidence.

Efficacy of Annual Colonoscopic Surveillance in Individuals With Hereditary Nonpolyposis Colorectal Cancer (Lynch Syndrome) - MS status

Note: MS - microsatellite status
  
Methods:In a prospective, multicenter cohort study, 1126 individuals underwent 3474 colonoscopies. We considered individuals from 3 groups of HNPCC families: those with a pathogenic germline mutation in a mismatch repair gene (MUT group), those without a mutation but with microsatellite instability (MSI group), and those who fufilled the Amsterdam criteria without microsatellite instability (MSS group).

Conclusions:
Annual colonoscopic surveillance is recommended for individuals with HNPCC. Less intense surveillance might be appropriate for MSS families.