Here are 10 recent findings on colonoscopies, based on recent studies published in various journals.
1. Poor bowel prep leads to missed polyps. In a study of colonoscopies involving poor bowel preps, 42 percent of polyps were discovered only in a repeat colonoscopy, according to a report in GIE: Gastrointestinal Endoscopy. The miss rate for advanced adenomas was 27 percent. In view of the findings, authors suggested scheduling follow-up examination within a year when an adenoma is found during a colonoscopy with poor bowel prep.
2. Experienced physicians have better cecal intubation rates. A new study published in the Journal of Gastroenterology and Hepatology found that colonoscopies performed under deep sedation by experienced physicians resulted in high cecal intubation rates. The study found that the only modifiable factor among significant patient-related predictors influencing cecal intubation was the quality of the bowel preparation.
3. Unscreened patients over 75 can undergo colonoscopies. Studies presented at Digestive Disease Week supported screening colonoscopies for elderly patients who have not been screened before, contradicting a 2008 recommendation against such screenings for people over age 75. Using a cost analysis based on microsimulation modeling, researchers found that people ages 75-85 would benefit in life years gained from screening colonoscopies.
4. Colonoscopy catches more colorectal cancer than flexible sigmoidoscopy. The rate of new or missed left-sided colorectal cancers quadrupled with flexible sigmoidoscopy compared with colonoscopy in a retrospective analysis of 25,541 cases, according to research presented at the annual Digestive Disease Week. The overall interval CRC rate, defined as colorectal cancer diagnosed 6-36 months after a lower endoscopy, was 11.7 percent after flexible sigmoidoscopy. After colonoscopy, overall interval colorectal cancer rates were only 2.6 percent.
5. ASCs and hospitals are equally safe for colonoscopies. Ambulatory surgery centers provide safe alternatives to hospitals for performing screening colonoscopies, according to research from Emory University. The researchers studied a random sample of Medicare beneficiaries who underwent outpatient colonoscopies between 1992 and 2007 and found that after adjusting for risk factors, ASCs and hospitals were equally safe for the procedure.
6. Current guidelines for colonoscopy training are inadequate. The new benefit for preventive colonoscopies in the healthcare reform law is complicating collection efforts for providers such as gastroenterologists' offices and ASCs, according to a report by Kaiser Health News. The change from a screening to therapeutic visit is hampering physician offices' usual practice of asking for out-of-pocket charges before the procedure. Medicare and at least two large private insurers, Kaiser Permanente and Health Net, are charging fees to patients when polyps are discovered, while seven other major insurers are not.
7. New colonoscopy benefit is complicating GI collection efforts. A study by Robert E. Sedlack, MD, and colleagues at the Mayo Clinic suggested that gastroenterologists need more practice on colonoscopies than professional societies currently recommend. While gastroenterological professional societies currently recommend physicians perform 140 procedures before testing competency, Dr. Sedlack's findings showed an average of 275 procedures may be required for a gastroenterology fellow to "reach minimal cognitive and motor competency."
8. Racial disparities persist in colorectal screening. New research shows blacks and Hispanics are still getting colorectal cancer screening tests at lower rates than others, according to a report by the journal Cancer, Epidemiology, Biomarkers & Prevention. Researchers studied the use of colorectal cancer screenings among Medicare beneficiaries aged 70-89 years with no history of tumors. Although screening rates increased over time, they were still low compared with rates if screening recommendations were followed and were especially low for blacks and Hispanics.
9. Physician fatigue is linked to inaccurate colonoscopy reads. A study in the American Journal of Gastroenterology supported the idea that physician fatigue causes less accurate readings in the afternoon than in the morning. The study found that when physicians worked a full day, polyps were detected in 26 percent of procedures in the morning but only 21 percent in the afternoon. The difference did not exist for physicians on half-day schedules, where polyps were found in about 27 percent of morning and afternoon procedures.
10. No difference exists between CTC and colonoscopy polyp size. CT colonography polyp size is not significantly different from colonoscopy polyp size, according to research findings published in the journal Clinical Gastroenterology and Hepatology. For their study, researchers studied 56 polyps. They found there were no significant differences between CTC polyp size, real-time colonoscopy size estimation or probe measurement.
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1. Poor bowel prep leads to missed polyps. In a study of colonoscopies involving poor bowel preps, 42 percent of polyps were discovered only in a repeat colonoscopy, according to a report in GIE: Gastrointestinal Endoscopy. The miss rate for advanced adenomas was 27 percent. In view of the findings, authors suggested scheduling follow-up examination within a year when an adenoma is found during a colonoscopy with poor bowel prep.
2. Experienced physicians have better cecal intubation rates. A new study published in the Journal of Gastroenterology and Hepatology found that colonoscopies performed under deep sedation by experienced physicians resulted in high cecal intubation rates. The study found that the only modifiable factor among significant patient-related predictors influencing cecal intubation was the quality of the bowel preparation.
3. Unscreened patients over 75 can undergo colonoscopies. Studies presented at Digestive Disease Week supported screening colonoscopies for elderly patients who have not been screened before, contradicting a 2008 recommendation against such screenings for people over age 75. Using a cost analysis based on microsimulation modeling, researchers found that people ages 75-85 would benefit in life years gained from screening colonoscopies.
4. Colonoscopy catches more colorectal cancer than flexible sigmoidoscopy. The rate of new or missed left-sided colorectal cancers quadrupled with flexible sigmoidoscopy compared with colonoscopy in a retrospective analysis of 25,541 cases, according to research presented at the annual Digestive Disease Week. The overall interval CRC rate, defined as colorectal cancer diagnosed 6-36 months after a lower endoscopy, was 11.7 percent after flexible sigmoidoscopy. After colonoscopy, overall interval colorectal cancer rates were only 2.6 percent.
5. ASCs and hospitals are equally safe for colonoscopies. Ambulatory surgery centers provide safe alternatives to hospitals for performing screening colonoscopies, according to research from Emory University. The researchers studied a random sample of Medicare beneficiaries who underwent outpatient colonoscopies between 1992 and 2007 and found that after adjusting for risk factors, ASCs and hospitals were equally safe for the procedure.
6. Current guidelines for colonoscopy training are inadequate. The new benefit for preventive colonoscopies in the healthcare reform law is complicating collection efforts for providers such as gastroenterologists' offices and ASCs, according to a report by Kaiser Health News. The change from a screening to therapeutic visit is hampering physician offices' usual practice of asking for out-of-pocket charges before the procedure. Medicare and at least two large private insurers, Kaiser Permanente and Health Net, are charging fees to patients when polyps are discovered, while seven other major insurers are not.
7. New colonoscopy benefit is complicating GI collection efforts. A study by Robert E. Sedlack, MD, and colleagues at the Mayo Clinic suggested that gastroenterologists need more practice on colonoscopies than professional societies currently recommend. While gastroenterological professional societies currently recommend physicians perform 140 procedures before testing competency, Dr. Sedlack's findings showed an average of 275 procedures may be required for a gastroenterology fellow to "reach minimal cognitive and motor competency."
8. Racial disparities persist in colorectal screening. New research shows blacks and Hispanics are still getting colorectal cancer screening tests at lower rates than others, according to a report by the journal Cancer, Epidemiology, Biomarkers & Prevention. Researchers studied the use of colorectal cancer screenings among Medicare beneficiaries aged 70-89 years with no history of tumors. Although screening rates increased over time, they were still low compared with rates if screening recommendations were followed and were especially low for blacks and Hispanics.
9. Physician fatigue is linked to inaccurate colonoscopy reads. A study in the American Journal of Gastroenterology supported the idea that physician fatigue causes less accurate readings in the afternoon than in the morning. The study found that when physicians worked a full day, polyps were detected in 26 percent of procedures in the morning but only 21 percent in the afternoon. The difference did not exist for physicians on half-day schedules, where polyps were found in about 27 percent of morning and afternoon procedures.
10. No difference exists between CTC and colonoscopy polyp size. CT colonography polyp size is not significantly different from colonoscopy polyp size, according to research findings published in the journal Clinical Gastroenterology and Hepatology. For their study, researchers studied 56 polyps. They found there were no significant differences between CTC polyp size, real-time colonoscopy size estimation or probe measurement.
Related Articles on GI/Endoscopy-Driven ASCs:
Top 6 Risk Factors for Weight Loss Surgery
Study Shows When to Use Endoscopy to Remove Objects From Esophagus
Study: Gastric Bypasses Won't Prolong Life in Older Obese Patients