Advances In Colorectal Cancer Detection, Sedation Procedures And Computer-Assistance

New developments in polyp detection, colonoscopy preparation and sedation techniques that will increase the effectiveness of colonoscopy and ease patient concerns about the procedure were presented at Digestive Disease Week® 2008 (DDW®). Research advances in sedation include computer-assisted sedation systems and the new evidence supporting the administration of propofol by gastroenterologists. DDW is the largest international gathering of physicians and researchers in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery.



"A significant percent of the population is not undergoing colorectal cancer screening, despite the fact that it has been proven to save lives," according to Sidney J. Winawer, MD, FASGE, AGAF, Paul Sherlock Chair, gastroenterology and nutrition service, Memorial Sloan-Kettering Cancer Center. "We hope that new research, such as that presented today, will encourage patients to get screened and to work with their doctors to discuss which screening methods may be best for them."



Colorectal cancer is the second leading cause of cancer deaths in the U.S. - more than 24,000 men and nearly 26,000 women die of the disease each year. However, colorectal cancer is curable when detected early. Screening rates for colorectal cancer in the U.S. lag far behind those for other cancers despite research showing that high mortality rates are lowered by detecting colorectal cancer at an early stage.



"The most common neoplastic outcome of colorectal cancer screening is the identification of polyps which require follow-up. Colorectal cancer is curable and preventable when polyps are found and removed early," said Dr. Winawer. "If physicians followed recommended screening guidelines, there would be more appropriate surveillance which would help shift resources to screening."



A Computer-Assisted Personalized Sedation System to Administer Propofol Versus Standard of Care Sedation for Colonoscopy and EGD: A 1000 Subject Randomized, Controlled, Multi-Center Pivotal Trial (Late Breaking Abstract)



During endoscopic procedures, patients are placed under moderate sedation, which allows them to undergo these procedures comfortably. Traditional sedation agents, such as midazolam, meperidine and fentanyl, are often administered by the endoscopy team during the procedure. Propofol is an alternative medication which takes effect quickly and allows for a quicker recovery period, but may place the patient under a deeper sedation. Currently, propofol is administered by anesthesiologists or nurse anaesthetists.



The SEDASYS™ System is a computer-assisted personalized sedation (CAPS) monitor that allows an endoscopist and nurse team to administer on-label, propofol sedation during colonoscopy and endoscopy procedures. The system delivers propofol to the patient following the endoscopist's instructions and closely monitors the patient to help assure that the level of sedation is appropriate - even more closely than a human. This 1,000 subject controlled, randomized, multi-center trial sought to test the safety and efficacy of this sedation method, as well as the benefits to both physicians and patients.
















"A computer-assisted system of this type allows for sedation to be completely personalized to the patient, giving the physician greater, more precise control with improved safety," said Robert Hardi, MD, clinical faculty at George Washington University Hospital in Washington, DC. "The machine, which may have beneficial cost implications, also allows for a shorter recovery time."



The study found that physician and nurse teams were able to safely and effectively administer propofol sedation using the SEDASYS System during both colonoscopy and endoscopy procedures. In fact, patients who experienced SEDASYS sedation had significantly lower measure of cumulative oxygen desaturation (17.8 percent per second) compared to those who underwent traditional sedation (98.8 percent per second). Additionally, both patients and physicians were surveyed using a list of measures to determine the quality of their experience with their sedation and the procedure overall. Both the subjects treated with the SEDASYS System and particularly the physicians administering the procedure reported higher satisfaction with the sedation achieved with the SEDASYS System.



American College of Radiology (ACR) Recommendations for CT Colonography (CTC) Interpretation: Implications for Resection of High Risk Adenoma Findings (Abstract # 878)



The American College of Radiology (ACR) has released guidelines recommending that polyps < 5 mm in size not be reported on computed tomographic colonography (CTC) studies. As a result, investigators set out to determine the effect of the ACR guidelines by applying them to an endoscopic database that collected information about polyps that have been removed and processed.



The database results included information for 10,780 polyps that were removed from 5,079 patients (among 10,034 colonoscopies) over a five-year interval. These patients were then broken into two groups, those with low risk - whose findings included no more than one to two tubular adenomas (benign tumors) and who were recommended to go five to 10 years before receiving a follow-up colonoscopy - and those with high risk - whose findings include advanced adenoma or three or more adenomas of any size.



"Our findings suggest that because of the ACR's de-emphasis of small polyps, CTC may not identify enough patients with important polyp findings," said Douglas Rex, MD, Chancellors professor of medicine, Indiana University School of Medicine and director of endoscopy at Indiana University Hospital. "The full implications and impact of these findings on cancer prevention is not yet known, because the natural history of small adenomas is still not understood."



Researchers sought to determine how many patients would have been identified as high risk according to the post-polypectomy surveillance guidelines if they had undergone CTC as their initial diagnostic test instead of colonoscopy. In all, 5,079 patients (51 percent) had at least one polyp and 2,907 (29 percent) had at least one adenoma. More than 1,000 (10 percent) had high risk findings, including 421 patients (4.1 percent) with one adenoma that was >1 cm in size. Two hundred and ninety-three patients had > three adenomas Buy Prograf Without Prescription