There is no debate that colonoscopies are vital for the early detection and treatment of cancers of the colon and rectum. Colorectal cancer is the third most deadly cancer among American men and women. The American Cancer Society recommends people begin regular colon screenings at age 50 or earlier if they have a family history of the disease or are presenting bothersome symptoms.

But the procedure is no cakewalk. It involves a one- to two-day prep of cleansing the bowel with a laxative solution that can make patients sick, if not uncomfortable. For the procedure, patients are sedated and a surgeon runs a thin, flexible scope into the colon to look for signs of cancer or polyps, which can be immediately removed.

Because of the uncomfortable nature of the exam, doctors worry that too few people actually have colonoscopies. And those who require follow-up exams may be less inclined to go.

Researchers analyzed data from 3,627 participants in a National Cancer Institute-sponsored trial and found “significant underuse” of surveillance colonoscopy among those considered high-risk for colorectal cancer. Within five years of an initial colonoscopy, only 58.3 percent of patients with advanced precancerous growths had a follow-up colonoscopy, which is typically recommended every three year for such patients.

But even more surprising, researchers also found what they called “substantial overuse” of surveillance colonoscopies among people considered low-risk for colorectal cancer.

“This is a clear example of an intervention not being utilized in relation to the risk,” said Dr. Robert Schoen, senior investigator of the study. The report appears in the latest issue of the journal Gastroenterology.

Source: Reuters

SOURCE: Fleet Attorney › Too many colonoscopies performed on those at low risk for colon cancer

The study focused on the rate of interval colorectal cancer in patients participating in the Polyp Prevention Trial Continued Follow-up Study, a four-year multicenter, randomized, controlled trial designed to examine the effects of a low-fat, high-fiber, high-fruit and vegetable diet on the recurrence of colorectal adenomas, or precancerous polyps. The University of Pittsburg study on the occurrence of interval colorectal cancer appears in the January issue of GIE: Gastrointestinal Endoscopy, the monthly scientific journal of the American Society for Gastrointestinal Endoscopy.

“Despite regular colonoscopy, interval colorectal cancer may occur,” says study lead author Robert E. Schoen. “We set out to examine the rate at which these interval cancers appear.”

The study found that nine cases of colorectal cancer were diagnosed over 7,626 person-years of observation, or a rate of 1.2 per 1,000 person-years of observation. In patients involved in the study who developed colorectal cancer, 78 percent had a history of precancerous polyps. The majority – about 78 percent – were detected at an early stage and thus were considered highly curable.

Colonoscopies are the “gold standard” for detection of colorectal cancer. Screenings are recommended for all individuals beginning at age 50 or earlier for people with a history of colorectal cancer or who are exhibiting symptoms such as blood in the stool. During colonoscopy exams, doctors can detect and remove polyps, some of which can become cancerous if not removed.

SOURCE: Fleet Attorney › Study shows need for thorough polyp removal, continued surveillance

The study, which was conducted by researchers at Sungkyunkwan University School of Medicine in Seoul, Korea, found that when patients drank 2 liters of warm water just prior to a colonoscopy, doctors were able to examine an average of 98.4 percent of large intestine surface. Doctors reported only examining an average of 90.6 percent of large intestine surface in patients who drank 2 liters of cold water prior to the procedure, and 92.2 percent in patients who had no water at all.

Sixty-four participants included mostly male patients, each about 33 years of age, and generally of normal weight. The patients either drank warm water, cold water, or no water along with the standard sodium phosphate solution normally prescribed for colonoscopy preparation. Ten to 11 patients in each group had previous abdominal or gynecological surgery. Twenty-one in the warm water group, 17 in the cold water group, and 17 in the no-water group, had irritable bowel syndrome, a chronic condition that can cause pain, bloating and bowel irregularities.

Under normal circumstances, patients who undergo colonoscopies are generally sedated. However, for the study, patients agreed to forgo sedation during their exams. Those who consumed warm water, in particular those 40 years of age and younger and those with irritable bowel syndrome, reported less pain both during the exam and two hours after the procedure. Patients in the warm water group also required less time for insertion and withdrawal of the examination probe.

While the findings are promising, researchers say that more studies should be done to determine how drinking warm water affects the bowel.

SOURCE: Fleet Attorney › Drinking warm water prior to colonoscopy proves effective

Colorectal cancer is the third most common cancer among men and women in the United States, and is among the most deadly of cancers. In an effort to improve those statistics, doctors began recommending that people have regular colon screenings, such as colonoscopies, to look for signs of the disease. Screenings are recommended beginning at age 50 or earlier for people who have a family history of colorectal cancer or are experiencing symptoms such as blood in the stool.

However, colonoscopies are intimidating. The procedure involves sending a tube with a camera on the end through the rectum and into the large intestines. Patients are sedated during the process, but they must prepare at least a day before the procedure by taking large amounts of laxatives to cleanse the bowel before a colonoscopy.

Between the uncomfortable prep required and the thought of the procedure itself, many people opt to go without. Studies show that less than 20 percent of the people who should be screened for colon cancer actually have a colonoscopy.

Which explains why companies like EDP Biotech are working tirelessly to find a more patient-friendly test. (Not to mention that approval of such a test would mean millions, if not billions, for the company that lands a suitable alternative to colonoscopies.)

EDP Biotech’s ColoMarker test involves adding a chemical to a small blood sample. The reading takes about 30 seconds, and the results are revealed on a computer screen. The test detects a certain marker in the blood that indicates if a patient is clear from colon cancer or needs further testing, perhaps by a colonoscopy.

In tests of 2,400 patients, the ColoMarker detected every case of colon cancer during treatable stages. The company is currently seeking FDA approval and hopes to have the ColoMarker available to the public in one to three years.

Source: WBIR.com

SOURCE: Fleet Attorney › Blood test to detect colon cancer seeks FDA approval

The new test can detect more than 50 percent of pre-cancers and 85 percent of cancers, compared to 85 and 90 percent of cancers with a colonoscopy, says Kevin Conroy with Exact Sciences Corp. There is no day-long prep required, as with colonoscopy procedures, and the cost of the test is far less expensive – $300 to $400 compared to $2,500 for a colonoscopy.

The new test is expected to undergo clinical trials in 2011 and be submitted for FDA approval in 2012. While Exact Sciences isn’t the only company working to develop more patient-friendly screenings for colorectal cancers, it is the only one that focuses on stool-based DNA testing for cancers of the colon and rectum.

“We’re taking it through an FDA clinical trial and then we intend to commercialize it broadly throughout the U.S., and then eventually globally,” Conroy said.

Colorectal cancer is the third most common cancer diagnosed in both men and women in the United States, with more than 106,000 new cases of colon cancer and 40,000 new cases of rectal cancer reported in 2009, according to the American Cancer Society. Regular colon screenings are recommended for people beginning at age 50 and earlier for people with a family history of colorectal cancer or who are experiencing symptoms such as blood in the stool.

Source: Milwaukee-Wisconsin Journal Sentinel

SOURCE: Fleet Attorney › Less invasive alternative to colonoscopy set for 2011 clinical trial

Doctors have been working to improve the technology used during the screening, and according to reports at the annual meeting, their efforts have paid off. One improvement is a disposable device that is passed through the instrument channel of a standard colonoscope, called a Third Eye Retroscope, or TER. The scopes let doctors get a better view of the areas they may otherwise miss with standard screening equipment.

Studies on the use of TER have found the new technique gave doctors 13 percent improved diagnostic yield. In the study of 300 patients, researchers concluded that 15 of 136 precancerous growths and 34 of 257 polyps would have been missed had it not been for the TER.

Another plus is high-definition technology in colonoscopies are giving doctors an even better view of the colon than traditional “white light” colonoscopies. One study included 2,400 patients, half of whom underwent standard exams while the other half had high-definition exams. Thirty percent of precancerous lesions were found in the high-def group compared to 24 in the standard-def group. High-definition is not available at all facilities but should become more widely available as facilities upgrade to newer machines.

SOURCE: Fleet Attorney › Advances in technology improve accuracy of colonoscopies

The study performed at the VA Medical Center in Phoenix, Ariz., cites inadequate bowel preparation by the patient prior to colonoscopies as resulting in earlier follow-up colonoscopies than when adequate cleansing is performed.

“Endoscopists’ ability to detect colonic legions, especially the flat or depressed ones, is greatly linked to the quality of bowel preparation. For years, we have emphasized the importance of adequate bowel preparation for patients to help ensure the detection of adenomas during colonoscopy, especially on the right side of the colon,” explains Dr. Veronika Karasek. “This new finding suggests that endoscopists are taking into consideration the quality of preparation when recommending a follow-up interval, regardless of the findings of the examination.”

As gastroenterologists consider the importance of bowel preparation, they are also evaluating new formulations of bowel preparation products for their patients. In December 2008, the FDA issued a black box warning on prescription brands of a type of laxative known as oral sodium phosphates, or OSPs. Fleet, maker of a popular over-the-counter brand of OSP, also pulled its products from shelves. OSPs were linked to a serious type of kidney injury known as acute phosphate nephropathy.

During the seminars, researchers at the American College of Gastroenterology presented papers evaluating new bowel preparation formulations and approaches.

In a pilot study led by Dr. Ron Palmon at the Mt. Sinai School of Medicine, researchers evaluated the safety and efficacy of Polyethelne Glycol (PEG) plus ascorbic acid (Moviprep) compared to magnesium citrate for bowel preparation before colonoscopy. The randomized study included 90 patients and found that overall colon preparation was excellent or good for 92 percent of those receiving the PEG and ascorbic acid solution, as well as 86 percent of those receiving the magnesium citrate formulation. Sixty-two percent of the patients given the PEG and ascorbic acid formulation indicated that it was easy to fairly easy to take, compared to 82 percent of those given the magnesium citrate formulation.

The study also showed a significant improvement in the quality of bowel preparation when using split dosing with either preparation. Split-dosing involves doses given both the night before a procedure and a few hours prior – versus traditional dosing, given the day before.

“Both PEG with ascorbic acid and magnesium citrate provided good to excellent colon cleansing in almost all the patients we evaluated,” explained Dr. Palmon. “The fact that patients were, for the most part, able to tolerate these products and found them relatively easy to administer suggests that they may be an alternative to phosphosoda. Regardless of which formulation a clinician chooses to recommend, we must all reinforce how vital proper procedure preparation is to colonoscopy.”

SOURCE: Fleet Attorney › Researchers consider new options in colonoscopy prep products

The computer model helps hospitals and clinics find the best combination of staff, equipment and rooms for the number of patients the facility expects. This, in turn, helps facilities determine the optimum number of patients it can see on any given day. This formula can be difficult for facility managers to determine because issues such as how long it takes to perform a procedure or how long it takes patients to recover can vary depending on the patient and the procedure.

Researchers used mathematics as the basis of studying systems in order to make them more efficient and effective. The model will benefit colonoscopy facilities, making them better able to handle scheduling. But the real beneficiaries will likely be the participating facilities’ patients, who will likely spend less money for the procedures and spend less time sitting in the waiting room because of it.

Researchers are currently working with the University of North Carolina hospitals to implement the model with plans to eventually make it available for general use.

Source: Science Centric

SOURCE: Fleet Attorney › Computer model aims to make colonoscopy facilities more efficient

Colonoscopies can be lifesavers, identifying colon and rectum polyps even before they become cancerous. Doctors recommend patients begin regular colon screenings at age 50, or earlier if they have a family history of or symptoms suggestive of colorectal cancer, such as blood in the stool.

Somewhere between age 75 and 85, your doctor may discuss ceasing your regular colonoscopy screenings. This is because the risk of complications increases among older patients. Serious complications are rare, but include perforations during the exam and adverse reactions to the laxatives used to cleanse the bowel prior to colonoscopy.

Earlier this year the Food and Drug Administration (FDA) issued a black box warning on some products used to prep the bowel prior to procedures such as colonoscopies. Those products, called oral sodium phosphates, or OSPs, were available both as a pill prescribed by doctors and solutions available over-the-counter, such as those made by Fleet.

While the FDA deemed that the over-the-counter OSP products were safe when used in lower doses as a laxative, when used in higher doses to cleanse the bowel many patients began to suffer from serious kidney injuries. The kidney injuries often occurred within a day or two, but sometimes as much as weeks or months later. One diagnosis specifically for patients who suffered ill effects from OSPs is acute phosphate nephropathy.

While the reaction most often occurs in older patients, younger ones are not immune. As a result of the black box warning on prescription OSPs Visicol and Osmo Prep, Fleet withdrew its over-the-counter OSP solutions from the market.

Since then, numerous lawsuits have been filed against the makers of OSP products for not fully warning about the risk of serious kidney injury. “In some cases, these serious adverse events occurred in patients with no pre-existing health factors that would have put them at risk for developing kidney injury,” says Janet Woodcock, director of the FDA’s Center for Drug Evaluation and Research.

SOURCE: Fleet Attorney › Colonoscopy prep important, but beware of OSP solutions

Pauly Polyp, developed by Theda Care, uses humor and a bit of attitude to convince people age 50 and older to get a colonoscopy. When you enter the site, aptly titled “I Don’t Want A Colonoscopy,” you enter “Excuse Central.” Just type in an excuse and Pauly Polyp sympathizes, but then offers a helpful tip, “Colorectal cancer is the second leading cause of cancer-related deaths in the United States. Schedule your colonoscopy today and kick colorectal cancer in the end.”

If you need to convince a loved one to get screened, consider sending him a Pauly Polyp e-card:

You spend a lot of time
In the bathroom anyway.
Get a colonoscopy.

Though the cards are humorous, they drive home the message that having colonoscopies are critically important.

Want a more intimate relationship with Pauly Polyp? Friend him on Facebook or follow him on Twitter.  As one Pauly Polyp fan writes, “If you are faced with the colonoscopy, don’t sweat it. The day before sucks. The procedure itself is a breeze.”

The fan is right. Colonoscopies are generally safe procedures, but do keep in mind that some risks have been associated with some products used to cleanse the bowel prior to colonoscopy. These products, known as oral sodium phosphates, or OSPs, are available by prescription under the brand names Visicol or OsmoPrep, and were available over-the-counter in solution from by Fleet. Earlier this year the Food and Drug Administration (FDA) issued a black box warning on OSPs after studies linked the use of the products to a serious kidney injury known as acute phosphate nephropathy.

Just make sure to talk to your doctor about the risks, and your concerns.

SOURCE: Fleet Attorney › Pauly Polyp encourages regular colon screenings

The New England Journal of Medicine says that a colonoscopy colorectal cancer screening is one of the few preventive services shown to reduce future health care costs.

“We know screening for colorectal cancer is good health policy, and makes good economic sense,” commented ACG President Dr. Eamonn Quigley. “When screening procedures detect colon cancer early, nine of ten patients beat the disease.  In the absence of screening, colon cancer is usually found too late and many patients die.  Those are starkly different outcomes that we have the power to change.”

It is the racial minorities, uninsured Americans and Medicare patients who should be tested but are not being screened appropriately, according to the ACG. ACG is committed to national policy changes to improve access to colorectal screening and increased use of these proven prevention strategies, including reversing Medicare’s massive cuts to reimbursement for these tests since the benefit was first introduced, as well as to payments in the ambulatory surgery centers where many screening tests are performed.

“We can point to impressive milestones indicating a trend moving in the right direction, yet much work remains,” Dr. Quigley said. “We will continue to champion the lifesaving potential of colonoscopy and work to expand access to lifesaving screening tests.”

SOURCE: Fleet Attorney › ACG applauds Obama’s support of colorectal screenings

OSP products include the prescription brands Visicol and Osmo Prep, as well as OTC brands including Fleet Phospha-soda. Over-the-counter OSP products are considered safe if used in low doses to treat constipation. But Fleet began marketing the product in higher doses as a bowel cleanser, which prompted the same risk of kidney damage and the form of kidney injury known as acute phosphate nephropathy.

OSPs work by pulling fluid from the body and out the colon, causing a laxative effect. While the body is purging itself of fluids, calcium-phosphate crystals can form in the kidneys, blocking the renal tubes. Symptoms of OSP-related kidney damage can come immediately or take as long as a few days or few weeks to surface. These symptoms include lethargy, drowsiness, decreased urine output, and swelling of the legs, ankles and feet. Often, the diagnosis isn’t immediately linked to use of OSP.

To date, more than 50 lawsuits have been filed against Fleet by people who suffered kidney injury from use of OSPs, including one recently settled in Virginia in which the lone plaintiff was awarded $10 million.

SOURCE: Fleet Attorney › Lawsuits mount against maker of over-the-counter bowel cleanser

Detox was once considered a medical procedure performed in hospitals or clinics designed to rid the body of dangerous and sometimes life-threatening levels of alcohol, drugs or poisons. Businesses picked up on the “healthier living through detox” idea, promoting various cleansings to eliminate toxins in the body that they say cause a host of nasty symptoms such as headaches, bloating, joint pain, fatigue and depression. But some of the body cleansing practices come with serious warnings.

Colon cleansing is perhaps the most talked about method of detox. The practice is used to cleanse the bowel prior to medical procedures such as colonoscopies. Some people follow a similar practice to relieve constipation or to cleanse their colon for health reasons. Solutions or pills – available both by prescription and over the counter – are taken by the consumer to induce a series of bowel movements designed to empty the intestines.

However, Dr. Reyes says there are serious risks associated with colon cleansing. For starters, the practice can cause dehydration, electrolyte imbalance, impaired bowel function, and disruption of the intestinal flora. But an even more serious condition has been linked to some colon cleansing products called oral sodium phosphates, or OSPs. OSP products include prescription brands Visicol and Osmo Prep, and over-the-counter brands such as Fleet Phosopha-soda, and have been linked to a serious kidney injury known as acute phosphate nephropathy.

The bottom line, says Dr. Reyes, is that the human body is well equipped to ward off environmental toxins. “If you’re generally healthy, concentrate on giving your body what it needs to maintain its robust self-cleaning system – a healthful diet, adequate fluid intake, regular exercise, sufficient sleep, and all recommended medical checkups,” he says. “If you experience fatigue, pallor, unexplained weight gain or loss, or changes in bowel function that persist for days or weeks, visit your doctor instead of a detox spa.”

SOURCE: Fleet Attorney › Some detox practices carry serious risks

Beginning at age 50, or earlier for those with symptoms of colorectal cancer or a family history of the disease, we should have regular colonoscopies. However, half of the Americans who should have a colonoscopy don’t have the procedure because it is just too, well, gross. “It’s just the idea that someone is going to be examining the rectal area. They’re just uncomfortable with it,” says patient Adwinna Heads.

The team of researchers put their minds – and hands – to samples of fecal matter to see if a non-invasive technique could identify cancer early. Early on, colorectal cancers have no symptoms at all, which makes it such a deadly disease. What the researchers found is that they could diagnose early stage colorectal cancers in patients based on stool samples alone. This finding suggests that people who have the stool sample test performed may be able to avoid colonoscopies all together.

That is good news considering many people are squeamish about the procedure. Not only does it involve a day of preparation in close proximity to a toilet, it also requires another day for the procedure to be performed. The invasive process has few risks, but some bowel cleansing solutions used in the preparation have been linked to a serious kidney injury known as acute phosphate nephropathy. The type of product is known as oral sodium phosphate (OSP) and is in prescription brand tablets Visicol and Osmo Prep, as well as OTC products such as Fleet Phospho-soda and Fleet Accu-Prep.

SOURCE: Fleet Attorney › Stool sampling may detect gastrointestinal cancers early

The study focused on a trend in the United Kingdom toward reduced sedative use during a colonoscopy in an effort to improve safety. Researchers recruited 109 patients, both male and female, to undergo colonoscopies. One hundred and three procedures were performed. Forty-three of the patients in the study received midazolam, is a very short-acting benzodiazepine that has potent anxiolytic, amnestic, hypnotic, anticulvulsant, skeletal muscle relaxant, and sedative properties.

Every two minutes during the exam patients were asked to grade their level of discomfort from 0 to 10 with 0 being the least uncomfortable and 10 being the most uncomfortable. The mean overall numeric rating scale score was 4.7. Men scored a mean rating of 4.0 and women a 5.2. The median peak score was 7. Discomfort was usually highest at the beginning of the procedure, while in the sigmoid colon.

The study found that discomfort scores were higher in patients with irritable bowel syndrome and diverticular disease. Patients who received midazolam were also more likely to express discomfort than those who received buscopan, an anti-spasmodic that works by relaxing the muscles in the wall of the gut, or nitrous oxide, an anesthetic and analgesic commonly known as laughing gas. Patients who had a preceding gastroscopy also expressed greater discomfort.

Researchers say the results also indicate that midazolam neither relieves discomfort nor makes patients forget the procedure, but some patients, such as those with a previous gastroscopy, females, and those with irritable bowel or diverticular disease may benefit from increased analgesia.

SOURCE: Fleet Attorney › Study of factors that contribute to discomfort during colonoscopy

Colorectal cancer is the third most common cancer diagnosed in both men and women and the second leading cause of cancer-related deaths among men and women combined in the United States, according to the American Cancer Society. The lifetime risk of developing colorectal cancer is about 1 in 19. Currently, the best defense against colorectal cancer is routine colonoscopies.

While colonoscopies carry few risks, the elderly do experience a higher percentage of complications from the procedure. Preparing for the colonoscopy may also present problems for some patients. Earlier this year the Food and Drug Administration (FDA) placed a black box warning – its strongest warning possible – on prescription oral sodium phosphate (OSP) products used to cleanse the bowel prior to colonoscopy, Visicol and Osmo Prep. The products have been associated with a rare kidney injury known as acute phosphate nephropathy.

The same concern was placed on over-the-counter OSP products such as those made by Fleet. The FDA warning prompted Fleet to remove its OSP products from store shelves.

Source: Technology Review

SOURCE: Fleet Attorney › Vaccine may eliminate need for routine colon screenings

The colon hydration is administered by a trained technician in a private room at a spa and takes about 45 minutes. During that time, the patient lies on a table on his back and sides. The method offers a more soothing environment than a hospital setting with less discomfort than the traditional method. Advocates say this makes colon hydration much easier to handle than drinking large doses of laxatives and staying at home, near the bathroom.

Colon hydrotherapy may catch on with more hospitals and physicians, especially since many of the products used to cleanse the bowel prior to colonoscopy have fallen under a black box warning by the Food and Drug Administration (FDA) for causing serious kidney injury called acute phosphate nephropathy in some patients who used oral sodium phosphate products (OSP) for bowel cleansing.

The prescription OSP products in question include Salix Pharmaceuticals’ Visicol and Osmo Prep. The FDA also raised serious concerns over over-the-counter OSP products, including Fleet Phospho-soda made by C.B. Fleet. Shortly after the FDA warning in December 2008, C.B. Fleet pulled its over-the-counter products from the market.

SOURCE: Fleet Attorney › Colon hydration offers alternative to OSP for bowel prep

The colonoscopy has been considered a gold standard in the detection of ulcers, colon polyps, tumors, and areas of inflammation or bleeding. During a colonoscopy, a thin, flexible tube called a colonocsope with a video camera attached at the end is inserted into the rectum and colon, which allows your doctor to look at the lining of the large intestine.

During the colonoscopy, doctors can collect tissue samples, and abnormal growths, like polyps, can be removed. During the screening tests, doctors can check for cancer or precancerous cells in the polyps collected from the colon or rectum.

Before having a colonoscopy, patients must clean out their colons. A clear liquid diet is ordered and prescription or over-the-counter medications are usually taken to help loosen the stool and encourage elimination.

The procedures are extremely beneficial, but patients should be aware of some risks associated with the bowel-clearing products often used to prior to colonoscopies. Two prescription oral sodium phosphate (OSP) products from Salix Pharmaceuticals – Visicol and Osmo Prep – recently fell under a black box warning by the Food and Drug Administration (FDA) after reports of a serious form of kidney injury in patients who had used the products.

The FDA expressed similar concern over over-the-counter OSP solutions, such as Fleet Phospho-soda and Fleet Accu-Prep, that are often used at higher doses to cleanse the bowel before colonoscopies. As a result, maker C.B. Fleet has pulled those products from the shelves, making them only available by prescription.

You should discuss any concerns with your doctor.

Sources:
American Cancer Society
WebMD

SOURCE: Fleet Attorney › Colonoscopies beneficial for finding cancer early