Git Colonoscopy For Tumors0307

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    03-Jun-2015

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screening colonoscopy.

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  • 1. www.themegallery.com

2. ESGIE DDW: Colonoscopy Introduction. Polyps prevalence. Withdrawal Time Procedure timing. Screening & surveillance colonoscopy. Improved endoscopic techniques. 3. Introduction

  • CRC is the second leading cause of Carelated deaths in the West.
  • Detection of CRC at an early stage improves the prognosis considerably.
  • Adenomas are the benign precursors of CRC& their removal results in a lower than expected incidence of CRC.
  • Adenomas( occur in 25% males/ 15% females > 50 ys.

4. Polyp prevalence

  • The effectiveness of colonoscopy in reducing the incidence of CRC depends on adequate visualization / inspection of the colonic mucosa.
  • Adequate colonoscopy reduces the risk of interval neoplasia & further improves the effectiveness of CRC screening /surveillance programs.

5. Withdrawal time

  • Recently WT added to ASGE quality guidelines for colonoscopy.
  • A WT of > 6 mins is recommended for a -ve colonoscopy.
  • Measurement/ documentation of WT resulted in a significant increase polyps detection rates.
  • Continuous recording / feedback are required to maintain adequate WTs.

6. Procedural timing

  • Significantly more polyps were detected during the first than during the last colonoscopy of the day.

7. Screening colonoscopy

  • Screening for CRC recommended by ASGE for averagerisk individuals > 50.
  • Colonoscopy seems to be the most effective screening strategy to offset the rising costs of new, expensive therapies for CRC.
  • The reduction in CRC incidence was 53% with colonoscopy screening, 47% with sigmoidoscopy, 46% with FOBT compared to no screening.
  • Colonoscopy may be the most likely screening strategy.

8. Screening colonoscopy

  • Colonoscopy screening seems to be feasible /safe& results in a high detection rate of advanced neoplasia& early carcinoma, suggesting a possible reduction in mortality.
  • Colonoscopy capacity remains an important issue for nationwide CRC screening.
  • The uptake of screening colonoscopy is low even in western countries with established screening programs.

9. Surveillance intervals

  • The risk for metachronous advanced neoplasia after 5 years was very low among subjects with a normal baseline colonoscopy.
  • Earlier surveillance colonoscopy should be offered to subjects with three adenomas or more or with advanced neoplasia at baseline.
  • Advanced neoplasia occurs more in older age, males, multiple adenomas ( five or more) & size at baseline colonoscopy.
  • Importance of risk stratification in patients after polypectomy:
  • The number of adenomas.
  • Advanced histological features
  • Size.
  • Proximal adenoma.

10. Interval cancer

  • The need for high quality baseline colonoscopy to reduce the proportion of missed lesions & complete resection of neoplasia to reduce incidence of interval cancers.

11. Improved endoscopic techniques:NBI

  • Using standard whitelight colonoscopy, a substantial polyp miss rate of 524%.
  • Polyp detection may improve with novel colonoscopy techniques &optimized visualization methods as NBI.
  • In one study miss rate for polyps / adenomas is lower with NBI than with standard colonoscopy.
  • In a large multicenter RT, no difference in the detection rate of adenomas (32% in the NBI vs. 34% in the standard colonoscopy).
  • The detection rates of rightside lesions, advanced adenomas, flat adenomas did not differ between NBI& standard colonoscopy.
  • Exact role of NBI for the detection of adenoma is not yet proved
  • NBI shows promise for differentiating between adenomatous &nonadenomatous tissue for selective polypectomy.

12. Improved endoscopic techniques:

  • Fluorescence colonoscopy increase visibility of adenomas,using an enema with the photosensitizer.

13. Improved endoscopic techniques:

  • Reduce the blind spots bythe use of a wide angle colonoscope , or third Eye Retroscope (TER), passed down the instrument channel, provides a retrograde view by turning the tip of the device to look behind folds/ flexures , to avoid missing polyps due to blind spots behind the folds of the colon.

14. Value of diminutive & small colonic polyps

  • ACR recommends that diminutive polyps (< 5 mm) should not be reported on CTC.
  • Patients with one or two small polyps 6-9mm in size should undergo CTC surveillance after 3 years in lieu of polypectomy at the time of detection.
  • Standard colonoscopy detected significantly more adenomas smaller than 5-9mm in size.
  • Biopsy/histopathology of small polyps is not cost effective.

15. Summary:

  • Quality indicators as withdrawal time proven to be effective, although continuous feedback seems to be necessary.
  • Procedural timing of colonoscopy was introduced as a new factor influencing polyp yield.
  • For prevention of CRC, a colonoscopy screening program seems to be the most cost-effective strategy, but colonoscopy capacity is a major issue.
  • DDW 2008 did not solve the ongoing discussion on the optimal screening strategy.
  • Surveillance should be targeted at patients at high risk of colorectal neoplasia, including patients with advanced or multiple adenomas.

16. Summary:

  • In the near future, new endoscopy techniques will be introduced on a broad basis, increasing the detection of polyps, especially diminutive& small polyps& may improve the endoscopic assessment of polyps &thereby decrease the need for& cost of histological examinations.

17. Prepared by:Dr.Mohammad Shaikhani www.themegallery.com Thank You !