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

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.

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Patients were referred to GIA by the InterFaith Health Clinic and The Free Medical Clinic of America, both Knoxville-based organizations that provide health care to the needy. More than half of the people screened had polyps removed. Of the 48 persons screened Saturday, a total of 25 had polyps removed and sent for testing, 16 women and nine men. Twenty-three had no polyps, 15 women and eight men. Polyps, which are typically benign, may contain a small area of cancer or develop into cancer if not removed.

Colon cancer is the second most deadly cancer. “This is a higher percentage than in the population as a whole,” said Dr. Bergein F. (Gene) Overholt of GIA. “This is a big step in the battle against colon cancer. It was a real privilege to serve this group of people.”

Overholt called on other U.S. gastrointestinal practices to replicate “GIA Screening Colonoscopy Day” to help those less fortunate and to make everyone aware of the need for colon screenings. “The national health care debate has focused attention on the role of physicians and other health care professionals,” he said. “I think this can be a great demonstration of the concern medical professionals have for the well-being of their patients.”

Other screening sponsors include Anesthesia Associates of Knoxville, Mercy Health Partners, Premier Surgical Associates, The Endoscopy Center, GI Pathology of Memphis, Boston Scientific, Interactive Optics, the American Cancer Society and Braintree Laboratories Inc.

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Dr. Rina Rosin-Arbesfeld of Tel Aviv University’s Sackler School of Medicine has reformulated an antibiotic that has reduced the sizes of polyps in about 80 percent of mice. On average, the mice that were given the drug lived about 30 percent longer than mice that were not treated with the antibiotic. Dr. Rosin-Arbesfeld hopes these findings will lead to a preventative therapy in the suppression of polyp growth, and in stronger doses, in combination with chemotherapy and radiation, to fight existing cancers.

“Our new drug may be able to slow down polyp growth so that it never manifests to full-blown colon cancer,” says Dr. Rosin-Arbesfeld.

Using out-of-circulation and old generation antibiotics, such as that used in Dr. Rosin-Arbesfeld’s research, means that treatment with the antibiotics will not interfere with antibiotics currently used to treat bacterial infections. And it should also speed up the approval process for clinical trials, as it has previously been on the market. TAU’s commercial transfer company, Ramot, has filed for a patent for the new use and discussion is already underway with potential partners about experimental human trials of the drug.

Source: Science Blog

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During a colonoscopy, a doctor inserts a long tube with a camera on the end through the rectum and the intestines to look for polyps, signs of early colon cancer. The procedure can virtually remove the risk of colon cancer if detected early, making regular colon screenings a must for individuals age 50 and older and earlier for those with a family history or who are showing signs of colon cancer.

The second bowel cleaning some physicians recommend prior to a colonoscopy follows the day-before rigors of drinking a laxative solution or taking a pill that purges the bowels of its contents. Doctors have found that even after the bowel has been prepped the day before and no more food consumed, sometimes a collection of dead cells, bacterial secretions, mucus, bile and other debris collect in the bowels during the night and can interfere with the physician’s view during the procedure. The second cleansing is usually preformed about five hours before the colonoscopy is scheduled, requiring some patients to wake extra early to “get moving.”

But one word of caution about the bowel cleansing process. Take a close look at the laxative your are prescribed or told to purchase over-the-counter by your doctor. A type of laxative often used to cleanse the bowel before colonoscopies, called oral sodium phosphates, or OSPs, have been linked to serious kidney injury. In some cases, the injury has resulted in kidney failure. The finding has resulted in a black box warning on prescription brands of OSPs, such as Visicol and Osmo Prep, and the removal of over-the-counter Fleet OSPs. If you have experienced kidney injury days, weeks or even months after taking OSP products to cleanse the bowel, you may have a claim against the manufacturer.

Source: Boston.com

SOURCE: Fleet Attorney › Second bowel cleansing recommended for colonoscopies