Who gets treated where for colonoscopy, and how effective is that treatment?

Posted By News On May 10, 2011 - 3:30pm

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CHICAGO, IL (May 10, 2011) — Research being presented at Digestive Disease Week® (DDW) continues to show the effectiveness of colonoscopy for the prevention and detection of colorectal cancer. However, studies show that patients in lower socioeconomic groups are less likely to receive care for colorectal disease at high-volume centers, and that ambulatory surgical centers provide safe alternatives to hospitals for performing screening colonoscopies. Additionally, studies emphasize that how screening is administered may determine patient outcomes. DDW is the largest international gathering of physicians and researchers in the field of gastroenterology, hepatology, endoscopy and gastrointestinal surgery.

"As the third most common cancer and the second leading cause of cancer deaths in the U.S., colorectal cancer continues to be a serious public health issue, despite being a disease that can be prevented through screening," said moderator Jerome Waye, MD, FASGE, clinical professor of medicine and director of endoscopic education, Mount Sinai Medical Center, New York. "As gastroenterologists, we need to continue to improve the way we screen and treat colorectal cancer patients to reduce the associated morbidity and mortality."

Disparities in the Use of Minimally Invasive Surgery for Colorectal Disease (Abstract #305)

Patients in lower socioeconomic groups and under- and uninsured patients are less likely to undergo minimally invasive surgery for colorectal disease at high volume centers, even though high volume centers have improved outcomes for some high-risk surgical procedures, according to a new study from the Baylor College of Medicine. While previous studies have also demonstrated the underuse of newer surgical techniques in lower socioeconomic groups and the underinsured, this study demonstrates that disparities persist even in more urban, high-volume hospital settings.

Dr. Robinson will present these data on Sunday, May 8 at 8:15 a.m. CT in S504, McCormick Place.

The utilization and complication rates of outpatient colonoscopy performed at ambulatory surgical centers versus hospitals 1992-2007 (Abstract #678)

Ambulatory surgical centers (ASCs), which are steadily increasing around the country, provide safe alternatives to hospitals for performing screening colonoscopies, according to new research from Emory University. While some studies have shown that ASCs are more efficient and may be associated with lower costs, no previous study evaluated the safety of outpatient colonoscopies at ASCs in comparison to hospitals. When researchers

evaluated the safety of the procedures in both settings and looked only at the complications without adjusting other factors, they found that the ambulatory surgical centers were safer. However, when they took into account the other factors mentioned previously, they found that the risk of complication between both settings was comparable.

Dr. Azrak will present these data on Monday, May 9 at 8:30 a.m. CT in S104, McCormick Place.

The presence of anesthesiology professional services during colonoscopy is associated with increased adenoma detection rates and decreased incidence of colorectal cancer: a medical outcomes registry analysis (Abstract #1094)

Could having an anesthesiologist during colonoscopy improve results? In a recent study, researchers examined the effectiveness of colonoscopy when sedation was administered by an anesthesia professional versus other provider by comparing the differences between polyp detection rates (PDR) and the detection of colorectal cancer (CRC) within three years of colonoscopy. The study is the first to examine the clinical outcomes of PDR and CRC incidence in relation to anesthesiology services during colonoscopy. While the findings were statistically significant in favor of anesthesiologist provided sedation, the margin was so small that it is unclear whether the findings translate into clinical significance to justify the additional expense.

Dr. Cash will present these data on Tuesday, May 10 at 2:15 p.m. CT in S502, McCormick Place.

Increased Risk of New or Missed Colorectal Cancer After Flexible Sigmoidoscopy Compared with Colonoscopy Among Older Patients in the U.S.: A Population-Based Analysis of the SEER-Medicare Linked Database, 1998-2005 (Abstract #906)

Older patients face a four-fold risk of colorectal cancer going undetected after a flexible sigmoidoscopy compared to a colonoscopy, according to new research from the Mayo Clinic Florida. The retrospective study couldn't determine why sigmoidoscopies proved far less sensitive in identifying colorectal cancer. Its authors suggested differences in bowel preparation, lack of sedation and uncertainty of depth reached as possible explanations, but they said the question warrants further investigation.

Dr. Wang will present these data on Monday, May 9, at 8:30 a.m. CT in S104, McCormick Place.

"Retrograde colon capsule endoscopy from anus using a new self-propelling capsule; the first human trial" (Abstract #Su1552)

A new study for the first time allowed the observation of the human colon using a self-propelled capsule endoscope (SPCE) from the anus. This method is beneficial because a normal capsule endoscope (CE) cannot control its movement and may not allow the examiner to observe a lesion from the desired location in real time. Capsule endoscopy has been widely used in clinical practice, but the movement of the capsule is fully dependent on the movement of the intestine system and it cannot be actively maneuvered; therefore its results are limited. Study results showed clear images, that the SCPE moved smoothly through the colon, and that the SPCE could be removed from the anus easily and safely.

Dr. Kuramoto will present these findings on Sunday, May 8 at 8:00 a.m. CT in Hall A, McCormick Place.

Source: Digestive Disease Week

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