New CT Colonography Data Released - Complete Colonoscopy Still the Best Screening Test - September 2008

Complete Colonoscopy Still the Best Screening Test

The long awaited ACRIN Trial on CT colonography is being released in the September 18, 2008 issue of the New England Journal of Medicine.  While all of us on the front lines battling colorectal cancer welcome effective and clinically proven new tools, the evidence must be closely evaluated, and patients need to recognize that CT colonography is not without significant potential risks in its own right. 
Screening by CT colonography for patients who would otherwise forego preventive screening clearly improves the likelihood of early detection.  However, substituting CTC for complete colonoscopy creates the unfortunate potential for a sizeable miss rate or significant delay in detection of high risk pre-cancerous lesions.  Delay could be dangerous or deadly.

Complete Colonoscopy is the Preferred Screening Strategy

Because of its excellent sensitivity in detecting polyps and its potential for removing them and breaking the sequence of polyp to cancer in a single diagnostic and therapeutic intervention, complete colonoscopy is one of the most powerful preventive tools in clinical medicine.

ACG Sees a Significant Potential Downside to CTC

Many patients who have polyps detected by CT colonography will still have to undergo complete colonoscopy; more than 17% in this study would have been referred and other studies have shown higher rates.

Radiation Risk a Concern

With a proposed screening schedule of five years or less for CTC, depending upon the findings, the cancer risks from the CTC test itself are not insignificant.  Although it is a challenge to define precise risk estimates related to low doses of radiation exposure, the ionizing radiation exposure from a single abdominal or chest CT may be associated with elevated risk for DNA damage and cancer formation.

Patient Acceptability      

In light of the underutilization of proven lifesaving colorectal cancer screening tests, the issue of patient acceptability is essential.
Patients need to understand that CT colonography does not represent a painless or risk-free procedure, nor does it eliminate the need for bowel cleansing which patients report as a barrier to screening.  There is also evidence that due to the insertion of a tube in the rectum and insufflation of the abdomen with air or gas, the patients, who are not sedated and awake, tend to feel discomfort.

Role of the Clinical Gastroenterologist

Nobody in medicine knows understands the colon better than a gastroenterologist.  It is critical that insurance companies and policymakers secure the ability for gastroenterologists to include appropriate tests of all kinds into their practices as the science proves their effectiveness.  ACG will continue to fight for your interests.
To read ACG’s press release regarding the study, click on this link: http://acg.gi.org/media/releases/ACGCT091708FINAL.pdf

Bringing HDTV From the Living Room to the Procedure Room - June 2007

Physicians Endoscopy Center Introduces High-Definition Endoscopy from Olympus

HOUSTON, Texas (June 7, 2007) – High-definition television (HDTV) is making its way from the living room to the endoscopy procedure room. Now, Physicians Endoscopy Center is among the first endoscopy center in Houston, Texas to introduce the technology as part of a new endoscope platform to help doctors diagnose diseases in the upper and lower gastrointestinal tract. Colorectal cancer (CRC) is the second leading cause of cancer-related deaths for men and women combined in the U.S.

Compared to conventional systems, high-definition endoscopy, combined with Narrow Band ImagingTM, provides doctors with sharper images and better contrast, which in turn may help them to better detect lesions during examinations when using the wide-angle colonoscope. As a result, patients may receive more accurate diagnoses. The new system can also shorten procedure times for patients.

Dr. Marc Kudisch, Medical Director, is one of the doctors at Physicians Endoscopy Center who already uses the new endoscope platform, the world’s first to deliver both HDTV and Narrow Band Imaging™ (NBI) technologies. Called EVIS EXERA II™, the 180 series from Olympus provides doctors with enhanced observation capabilities, and has been shown to reduce overall procedure time when used with a new wide-angle scope offered as part of the 180 series.

“This new technology will be of great benefit to the community as we screen for early changes in the mucous membranes associated with cancers of the esophagus, stomach, and colon,” said Dr. Kudisch. “Eliminating the abnormally appearing internal lining of these organs before it develops into cancer, is our objective.”

The HDTV signal from the endoscope platform’s video processor is designed to produce an impressive 1080 lines of resolution, more than twice the number of scan lines used by conventional systems, offering doctors breathtaking images of the colon with a high level of detail and color. NBI is a new image processing technique which takes advantage of the scattering and absorption properties of human tissue, thereby improving visual contrast on mucosal surfaces during endoscopic observation of the GI tract. The result is remarkably clear views of anatomical structures and fine capillary patterns of the surface of the colon, which are normally difficult to distinguish.

The American Cancer Society (ACS) projects that colon and rectal cancer will kill 55,170 Americans this year. The ACS also points out that the 5-year survival rate for people whose CRC is treated in an early stage, before it has spread, is greater than 90%.

The ACS recommends that beginning at age 50, both men and women should be screened for colon and rectal cancer. People with CRC risk factors, such as a personal history of CRC or adenomatous polyps or a strong family history of CRC or polyps, should talk to their doctor about starting CRC screening earlier and/or undergoing screening more often .

ABOUT Physicians Endoscopy Center
Physicians Endoscopy Center (PEC) is a modern ambulatory surgery center dedicated to colorectal cancer screening and other endoscopic services. The center was designed with patient quality, safety, privacy and convenience in mind. PEC offers a friendly and comfortable environment with the latest technology, where the staff is committed to total patient satisfaction.

PEC offers a spacious waiting area for patients and their families. Eight state-of-the-art Endoscopy Rooms are equipped with the latest procedure and monitoring equipment for maximum accuracy, quality and safety. PEC’s clinical staff is highly trained and specialized in gastrointestinal nursing.

Licensed by the Texas Department of State Health Services, PEC is also a Medicare (CMS)-approved endoscopy center. PEC is accredited by the Accreditation Association for Ambulatory Health Care (AAAHC), the leader in developing standards to advance and promote patient safety, quality and value for ambulatory health care. Please call (713) 587-0909

ABOUT OLYMPUS
Olympus is a precision technology leader in designing and delivering imaging solutions in healthcare, life science and photography.