The study involved videotaping without their knowledge seven experienced endoscopists during 8 to 10 colonoscopies. The same endoscopists were then videotaped with their knowledge during 8 to 10 more colonoscopies. Those colonoscopies were graded based on various parameters, such as quality of the examination and length of time taken.

The average inspection time for colonoscopies performed while physicians knew they were being videotaped was longer (7.3 minutes) than when endoscopists were not aware they were being taped (4.9 minutes). Overall quality scores were also higher in the videotaped-aware group, with 3.8 vs. 2.9 on a 5-point scale. Significant improvements were also noticed in examinations of folds, distension and clean up when doctors knew they were being taped.

While videotaping colonoscopy procedures is not standard, given the study outcomes, “perhaps systematic video recording of colonoscopies will be considered” in the future, Dr. Rex says.

SOURCE: Fleet Attorney › Videotaping colonoscopies results in better physician performance

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

Two years ago, nephrologists and other health care providers who attended the ASN Renal Week seminars heard talks about an emerging concern in the field. Diagnostic test preparations, such as products used to cleanse the bowel prior to colonoscopies, were identified as causing damage to the kidneys.

During the 2007 conference, Dr. Glen S. Markowitz of Columbia University provided an update on the risks of acute and chronic renal failure related to the use of oral sodium phosphate solution, also known as OSPs. This product is widely used to prepare the bowels before procedures such as colonoscopy or surgery. Dr. Markowitz point out that there was a special concern about a rare but serious type of renal failure called acute phosphate nephropathy associated with the use of OSPs.

A year after the 2007 Renal Week conference, the Food and Drug Administration (FDA), after receiving several reports of kidney injury associated with use of OSPs, issued a black box warning on prescription brands of the product, such as Visicol and Osmo Prep. Fleet, makers of over-the-counter OSP solutions, followed suit by pulling their products from store shelves.

The 2009 ASN Renal Week conference will be held in San Diego, California. The annual scientific meeting includes presentations of original research such as free communications and posters, as well as a wide array of symposia, conferences and courses on a full range of topics from basic science to clinical practice and public policy.

SOURCE: Fleet Attorney › 2009 ASN Renal Week is Oct. 27-Nov. 1

Kidney injury is a devastating disorder that often occurs as a complication of other serious illnesses and sometimes even treatments. For example, one form of kidney injury known as acute phosphate nephropathy, has been associated with the use of oral sodium phosphates (OSP), a type of laxative often given to patients to cleanse the bowel prior to colonoscopies. Incidents of the injury have skyrocketed in the past decade as more patients have regular colon screenings.

The new test will enable doctors to predict a patient’s outcome in a matter of hours as opposed to one to three days for existing methods of testing for kidney injury.

“The icing on the cake is that the NGAL test is designed to be used on apparatus that already exists in laboratories and hospitals. In this way we have secured that the test will be affordable and readily available to doctors worldwide,” says Thea Olesen, CEO of BioPorto.

The test will be presented this month at ASN Renal Week in San Diego, the yearly meeting point for kidney specialists from all over the world.

SOURCE: Fleet Attorney › New test can identify kidney injury earlier