10 recent updates in colonoscopy
Colonoscopy was a hot topic on Healio.com last month, with an abundance of new research in the journals and two new guidelines issued from the U.S. Multi-Society Task Force on Colorectal Cancer and The Canadian Task Force on Preventive Health Care.
In case you missed them, Healio Gastroenterology has compiled a list of ten updates in colonoscopy research and recommendations from February.
1. New guidelines urge colonoscopy surveillance after CRC resection
Charles J. Kahi
The U.S. Multi-Society Task Force on Colorectal Cancer has released updated recommendations on the use of endoscopy in patients after colorectal cancer resection, which emphasize the importance of colonoscopic surveillance in these patients to prevent metachronous cancer or diagnose recurrent and metachronous cancers at a curable stage.
“The recommendations address the appropriate use and timing of colonoscopy for perioperative clearing and detection of metachronous neoplasms, considerations for the detection of local recurrence in the case of rectal cancer, and the role of CT colonography and fecal tests,” Charles J. Kahi, MD, from the Richard L. Roudebush VA Medical Center and Indiana University School of Medicine in Indianapolis, told Healio Gastroenterology. Read more
2. Canadian guideline opposes colonoscopy for routine screening of CRC
The Canadian Task Force on Preventive Health Care has released an updated guideline on screening for colorectal cancer, which recommends that instead of colonoscopy, fecal occult blood testing every 2 years or flexible sigmoidoscopy every 10 years should be used for adults aged 50 to 74 years who are asymptomatic and not at high risk for colorectal cancer. Read more
3. Gastroenterologist office visits prior to screening colonoscopy may lead to unnecessary costs
Kevin R. Riggs
Precolonoscopy office visits to a gastroenterologist may increase unnecessary costs associated with the procedure, according to an analysis of billing data.
“Widely accepted guidelines for colon cancer screening and polyp surveillance and the generally low risk of colonoscopy may obviate the need for many of these visits,” Kevin R. Riggs, MD, MPH, instructor in medicine at Johns Hopkins University in Baltimore, and colleagues wrote. Read more
4. Colonoscopy highly effective in reducing CRC incidence, mortality in general population
In patients with nonmalignant findings, colorectal cancer incidence and mortality rates were found to be significantly lower after colonoscopy when researchers conducted a meta-analysis of observational studies. The incidence and mortality rates were even lower after screening colonoscopy in the general population.
“[This study] provides additional evidence for the effectiveness of colonoscopy in the general population,” the researchers wrote. Read more
5. Time to colonoscopy following positive fecal blood test varies greatly
The time between a positive fecal blood test result and a follow-up colonoscopy varied greatly across four U.S. health care systems, according to study results.
Older patients and those with more comorbidities appeared most likely to not receive a follow-up colonoscopy, Jessica Chubak, PhD, associate investigator at Group Health Research Institute in Seattle, and colleagues found. Read more
6. Most patients at risk for Lynch syndrome not advised to undergo genetic testing, appropriate colonoscopy screening
Individuals at risk for Lynch syndrome are not often being advised to undergo genetic testing and may not be getting colonoscopies at intervals recommended by current guidelines, according to study results.
Participants meeting Amsterdam II criteria have poor knowledge of appropriate screening guidelines, and their endoscopists do not appear to recognize their increased risk and typically do not recommend appropriate screening intervals,” the researchers wrote. Read more
7. Researchers define adequate bowel preparation for colonoscopy using quantitative scale
Researchers have provided an objective definition of adequate bowel preparation for screening or surveillance colonoscopy using the quantitative, validated Boston Bowel Preparation Scale.
These findings support “a recommendation for early repeat colonoscopic evaluation in patients with a BBPS score of 0 or 1 in any colon segment,” the researchers concluded. Read more
8. Boston bowel preparation scale superior for use in colonoscopy
A systematic review of existing bowel preparation scales for colonoscopy showed that the Boston bowel preparation scale is the most user-friendly and validated scale available and, therefore, should be the first choice in a clinical setting.
“The BBPS remains the most extensively validated and most user-friendly scale published to date and should be used in a clinical setting at this time,” the researchers wrote. Read more
9. Capnography fails to improve patient safety, satisfaction in routine colonoscopy
Daniel A. Leffler
Routine capnographic monitoring used in high-volume colonoscopy procedures with moderate sedation increased cost significantly, but did not improve patient safety or satisfaction in a recent case-controlled observational study.
Daniel A. Leffler, MD, from the department of gastroenterology at Beth Israel Deaconess Medical Center in Boston, and colleagues evaluated the safety of sedation and patient satisfaction with capnographic monitoring in 966 patients undergoing outpatient colonoscopy procedures. Read more
10. Capnographic monitoring fails to reduce hypoxemia in routine upper endoscopy, colonoscopy
John J. Vargo
Among healthy patients undergoing routine esophagogastroduodenoscopy or colonoscopy with moderate sedation, capnographic monitoring did not reduce the incidence of hypoxemia in a recent trial.
“This study very much clarifies the use of capnography in this patient subset, and that capnography does not appear to have a safety advantage,” John J. Vargo, MD, MPH, from the Digestive Disease Institute at the Cleveland Clinic in Ohio, told Healio Gastroenterology. Read more