Git Colonoscopy For Tumors0307.


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Git Colonoscopy For Tumors0307.

  1. 1.
  2. 2. ESGIE DDW: Colonoscopy Introduction. Polyps prevalence. Withdrawal Time Procedure timing. Screening & surveillance colonoscopy. Improved endoscopic techniques.
  3. 3. Introduction <ul><li>CRC is the second leading cause of Ca−related deaths in the West. </li></ul><ul><li>Detection of CRC at an early stage improves the prognosis considerably. </li></ul><ul><li>Adenomas are the benign precursors of CRC& their removal results in a lower than expected incidence of CRC. </li></ul><ul><li>Adenomas( occur in 25% males/ 15% females > 50 ys. </li></ul>
  4. 4. Polyp prevalence <ul><li>The effectiveness of colonoscopy in reducing the incidence of CRC depends on adequate visualization / inspection of the colonic mucosa. </li></ul><ul><li>Adequate colonoscopy reduces the risk of interval neoplasia & further improves the effectiveness of CRC screening /surveillance programs. </li></ul>
  5. 5. Withdrawal time <ul><li>Recently WT added to ASGE quality guidelines for colonoscopy. </li></ul><ul><li>A WT of > 6 mins is recommended for a -ve colonoscopy. </li></ul><ul><li>Measurement/ documentation of WT resulted in a significant increase polyps detection rates. </li></ul><ul><li>Continuous recording / feedback are required to maintain adequate WTs. </li></ul>
  6. 6. Procedural timing <ul><li>Significantly more polyps were detected during the first than during the last colonoscopy of the day. </li></ul>
  7. 7. Screening colonoscopy <ul><li>Screening for CRC recommended by ASGE for average−risk individuals > 50. </li></ul><ul><li>Colonoscopy seems to be the most effective screening strategy to offset the rising costs of new, expensive therapies for CRC. </li></ul><ul><li>The reduction in CRC incidence was 53% with colonoscopy screening, 47% with sigmoidoscopy, 46% with FOBT compared to no screening. </li></ul><ul><li>Colonoscopy may be the most likely screening strategy. </li></ul>
  8. 8. Screening colonoscopy <ul><li>Colonoscopy screening seems to be feasible /safe& results in a high detection rate of advanced neoplasia& early carcinoma, suggesting a possible reduction in mortality. </li></ul><ul><li>Colonoscopy capacity remains an important issue for nationwide CRC screening. </li></ul><ul><li>The uptake of screening colonoscopy is low even in western countries with established screening programs. </li></ul>
  9. 9. Surveillance intervals <ul><li>The risk for metachronous advanced neoplasia after 5 years was very low among subjects with a normal baseline colonoscopy. </li></ul><ul><li>Earlier surveillance colonoscopy should be offered to subjects with three adenomas or more or with advanced neoplasia at baseline. </li></ul><ul><li>Advanced neoplasia occurs more in older age, males, multiple adenomas ( five or more) & size at baseline colonoscopy. </li></ul><ul><li>Importance of risk stratification in patients after polypectomy: </li></ul><ul><li>The number of adenomas. </li></ul><ul><li>Advanced histological features </li></ul><ul><li>Size. </li></ul><ul><li>Proximal adenoma. </li></ul>
  10. 10. Interval cancer <ul><li>The need for high quality baseline colonoscopy to reduce the proportion of missed lesions & complete resection of neoplasia to reduce incidence of interval cancers. </li></ul>
  11. 11. Improved endoscopic techniques:NBI <ul><li>Using standard white−light colonoscopy, a substantial polyp miss rate of 5±24%. </li></ul><ul><li>Polyp detection may improve with novel colonoscopy techniques &optimized visualization methods as NBI. </li></ul><ul><li>In one study miss rate for polyps / adenomas is lower with NBI than with standard colonoscopy. </li></ul><ul><li>In a large multicenter RT, no difference in the detection rate of adenomas (32% in the NBI vs. 34% in the standard colonoscopy). </li></ul><ul><li>The detection rates of right−side lesions, advanced adenomas, flat adenomas did not differ between NBI& standard colonoscopy. </li></ul><ul><li>Exact role of NBI for the detection of adenoma is not yet proved </li></ul><ul><li>NBI shows promise for differentiating between adenomatous &nonadenomatous tissue for selective polypectomy. </li></ul>
  12. 12. Improved endoscopic techniques: <ul><li>Fluorescence colonoscopy increase visibility of adenomas,using an enema with the photosensitizer. </li></ul>
  13. 13. Improved endoscopic techniques: <ul><li>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. </li></ul>
  14. 14. Value of diminutive & small colonic polyps <ul><li>ACR recommends that diminutive polyps (< 5 mm) should not be reported on CTC. </li></ul><ul><li>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. </li></ul><ul><li>Standard colonoscopy detected significantly more adenomas smaller than 5-9mm in size. </li></ul><ul><li>Biopsy/histopathology of small polyps is not cost effective. </li></ul>
  15. 15. Summary: <ul><li>Quality indicators as withdrawal time proven to be effective, although continuous feedback seems to be necessary. </li></ul><ul><li>Procedural timing of colonoscopy was introduced as a new factor influencing polyp yield. </li></ul><ul><li>For prevention of CRC, a colonoscopy screening program seems to be the most cost-effective strategy, but colonoscopy capacity is a major issue. </li></ul><ul><li>DDW 2008 did not solve the ongoing discussion on the optimal screening strategy. </li></ul><ul><li>Surveillance should be targeted at patients at high risk of colorectal neoplasia, including patients with advanced or multiple adenomas. </li></ul>
  16. 16. Summary: <ul><li>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. </li></ul>
  17. 17. Prepared by: Dr.Mohammad Shaikhani Thank You !