Slower Colonoscopies Are More Effective

The slower that physicians withdraw endoscopes during colonoscopies, the fewer polyps and adenomas they'll miss, according to research presented last week at Digestive Disease Week in Orlando, Fla.

Researchers at Stanford School of Medicine in Palo Alto, Calif., examined 107 patients, assigning them to 3-minute and 6-minute scope withdrawal groups. All patients then underwent a second 6-minute exam to determine how many polyps and adenomas were missed on the initial pass.

Endoscopists who removed scopes from the cecum in 6 minutes instead of 3 minutes missed 31% fewer polyps and 24% fewer precancerous adenomas, notes the study. More polyps and adenomas were detected in the 3-minute group, but the miss rate was also higher, say the researchers.

Sheila Kumar, MD, a fellow in gastroenterology and hepatology at Stanford and the study's lead author, says a 6-minute withdrawal time is considered the standard of care in colonoscopy, but previous randomized research has not addressed its true efficacy. She says her study's findings suggest 6-minutue withdrawal times are in fact the most appropriate method for colorectal cancer screening.

Daniel Cook

Smartphone App Improves Colonoscopy Preps

Colonoscopy patients who use a smartphone application that guides them through bowel cleansing show up more effectively prepped on the day of the procedure, according to a recent study.

The physicians of Arizona Digestive Health in Phoenix developed a free app for that asks patients for the date and time of their scheduled colonoscopies and the prep solution they've been prescribed. It then sends timed alerts to remind them to carry out the steps of the bowel prepping process, along with tips and information on colonoscopies.

According to the practice's physicians, who designed the app themselves and announced their findings at Digestive Disease Week last week, 84% of patients who used it arrived for their screenings with a good score on the Boston Bowel Preparation Scale, as compared to only 56% of those who didn't.

"For patients, having an interactive, simplified and personalized app on their phone is like having a doctor at their side throughout the process," says gastroenterologist Nilay Kavathia, MD.

David Bernard

Endoscopic Ablation Effectively Treats Barrett's Esophagus

Endoscopic ablation therapy effectively eliminates Barrett's esophagus and prevents progression of the disease, say Dutch researchers.

The researchers assessed 136 patients with Barrett's who underwent either endoscopic ablation therapy or endoscopic observation. The researchers collected tissue samples at regular intervals over 2 years to assess for the presence of Barrett's tissue, dysplasia and esophageal cancer.

Endoscopic ablation therapy was found to reduce the relative risk of disease progression (defined as the development of high-grade dysplasia or esophageal cancer) by 94% as compared to observation alone, say the researchers, who reported their findings at Digestive Disease Week last week.

In addition, 90% of patients treated with endoscopic ablation were free of all signs of Barrett's tissue. The researchers note that 10% of the ablation patients suffered esophageal narrowing, but the complication was resolved with endoscopic dilation.

Barrett's develops from chronic gastroesophageal reflux disease. The condition could worsen through stages of low-grade or high-grade dysplasia before progressing to esophageal cancer.

Daniel Cook

InstaPoll: How Effective is Your Smoke Evacuation?

Tell us in this week's InstaPoll if you use a smoke evacuation device in every case that's appropriate.

Running a surgical facility is not a 9-to-5 job. Nearly one-third (31%) of the 983 respondents to last week's InstaPoll work between 40 and 50 hours per week. Another 8% log more than 60 hours per week.

How many hours do you typically work per week?
  • less than 30: 3%
  • 30 to 40: 14%
  • 40 to 50: 44%
  • 50 to 60: 31%
  • more than 60: 8%

Curious about the questions and results of past InstaPolls? Browse them all here for free.

Dan O'Connor

News & Notes
  • Safer polypectomies for anticoagulant patients? For colonoscopy patients who are taking anticoagulant medications, cold snare polypectomy — the removal of polyps with a wire instead of electrosurgically — can minimize the risk of GI bleeding and also completes the task more quickly, according to Japanese physicians who presented their findings at the recent Digestive Disease Week meeting.
  • Understanding unconsciousness The anesthetic agents IV ketamine, propofol and inhaled sevoflurane all disrupt communication between the frontal and parietal lobes of the brain, according to a study in the June issue of the journal Anesthesiology. This finding could shed light on the nature of anesthesia-induced unconsciousness. "Understanding a commonality among the actions of these diverse drugs could lead to a more comprehensive theory of how general anesthetics induce unconsciousness," says study author George Mashour, MD, PhD, an assistant professor in the department of anesthesiology at the University of Michigan in Ann Arbor. "Our research shows that studying general anesthesia from the perspective of consciousness may be a fruitful approach and create new avenues for further investigation of anesthetic mechanisms and monitoring."
  • How electronic data can pay off Researchers at Johns Hopkins Medical Institutions in Baltimore have determined that the data collected by anesthesia information management systems (AIMS) can, by highlighting trends, assist surgical providers decide whether blood should be ordered for specific procedures. They've reported their findings in the June issue of the journal Anesthesiology.