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New techniques ease colon cancer procedures for patients
May 24, 2006LOS ANGELES (May 23, 2006) - Developing superior screening options is paramount in the treatment of colon cancer, as it has one of the highest cure rates of all cancers when detected early. Scientists are continuing to refine the practice of colorectal screening, evaluating novel methods aimed at increasing patient comfort while improving outcomes and further decreasing the risk of developing the disease. Research presented today at Digestive Disease Week® 2006 (DDW) offers updates in colon screening sedation to improve patient quality of life while accurately assessing colon health. DDW is the largest international gathering of physicians and researchers in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery.
Computer-Assisted Colonoscopy (The NeoGuide System): Results of the First Human Clinical Trial [Abstract 719]
While colonoscopy is the most effective procedure to screen for early signs of colon cancer, many people avoid the screening because of the discomfort associated with the process. A novel colonoscope may be able to reduce the pain of the procedure, along with the need for sedation, and help to increase rates of colorectal cancer screening.
The NeoGuide Endoscopy System, a computer-assisted colonoscope, has previously been tested with successful results in animal trials, and now demonstrates similar success in its first human clinical trial. A research team from Stanford University and Klinikum Ludwigshafen in Germany evaluated the function of the colonoscope with the help of five physicians of varying levels of experience and 10 patient volunteers.
The colonoscopy was successfully completed in all patients, with the scope reaching the cecum in the 10 patients and the terminal ileum in nine. Although speed was not an endpoint of the study, the cecum was reached in less than six minutes in three patients. The NeoGuide colonoscope allows for standard therapies to be given during the procedure; this study included biopsies and the removal of multiple polyps. Patients were evaluated after the procedure at discharge, 48 hours and 30 days, with no complications or adverse effects. In fact, all 10 patients were contacted shortly after the procedure and expressed willingness to undergo the same procedure again.
"With the success of colonoscopy to detect cancer early, patient comfort is extremely important to raise the rates of screening," said Jacques Van Dam, M.D., of Stanford University and lead author of the study. "We hope that larger clinical trials will confirm that the technology improves the comfort and success of the procedure."
Pain during colonoscopies is often related to "looping" of the colonoscope, which stretches the colon and the surrounding tissue. The NeoGuide system is designed to avoid looping by following the natural shape of the colon. The system builds a three dimensional map of the colon as the scope is inserted and then directs multiple bendable sections to follow the path taken by the tip.
Randomized Controlled Trial of Sedation for Colonoscopy: Entonox versus Intravenous Sedation [Abstract 645]
Most patients request some sedation when undergoing a colonoscopy to make the process more comfortable. Although intravenous sedation (IV) is the most frequently used type of sedation, it has been associated with cardio-respiratory complications, delayed recovery and prolonged drowsiness. Researchers from the University of Hull in the United Kingdom evaluated the efficacy of entonox, an inhaled sedative using nitrous oxide and oxygen, and found it to be more effective than IV, providing greater patient pain relief and facilitating earlier discharge.
Study authors recruited 120 patients, asking them to complete anxiety and pain questionnaires and a baseline letter-cancellation test. Patients were then administered either entonox or midazolam/fentanyl, a commonly used IV sedation, before undergoing a routine colonoscopy. After the colonoscopy, patients again completed the letter-cancellation test and a marked pain assessment. Finally, patients completed a satisfaction survey at discharge and 24 hours after the procedure.
While patients experienced similar pre-procedure anxiety scores, entonox patients reported significantly less pain post-procedure (mean score of 25 for Entonox patients versus 40 for intravenous sedation patients,) and also reported a higher satisfaction rate (98 versus 80). Entonox patients were typically released within 26 minutes after the procedure while the intravenous group waited an average of 44 minutes.
Patients receiving entonox experienced faster recovery because the medicine is discharged from the body within one to two minutes after patients stop inhaling it, whereas IV sedation effects last for a longer period of time. Entonox causes less sedation and grogginess while providing effective pain relief, so the recovery is faster. The results of the letter test showed that patients with IV sedation were not completely back to normal at discharge whereas those with entonox were fully normal at discharge, meaning that patients who are given entonox can likely drive themselves home immediately after the procedure.
"Entonox shows significant value in improving patient satisfaction after colonoscopy, better accommodating a patient's lifestyle by enabling them to drive home after the procedure and, perhaps, making them less apprehensive about undergoing the procedure again," said Sushil Maslekar, M.D., University of Hull and lead study author. "Physicians will also benefit from a sedative that is more cost-effective and less time-consuming than current sedation options." A letter cancellation test is a simple test used to assess the psychomotor awareness of the patient, gauging how well the patient has recovered from sedation. The pain assessment and patient satisfaction were determined by simple visual analogue scales - a straight line from 0-100. For pain, 0 equals no pain and 100 equals intolerable pain, and for satisfaction, 0 means no satisfaction or extreme dissatisfaction and 100 means extremely satisfied.
American Gastroenterological Association
The NeoGuide Endoscopy System, a computer-assisted colonoscope, has previously been tested with successful results in animal trials, and now demonstrates similar success in its first human clinical trial. A research team from Stanford University and Klinikum Ludwigshafen in Germany evaluated the function of the colonoscope with the help of five physicians of varying levels of experience and 10 patient volunteers.
The colonoscopy was successfully completed in all patients, with the scope reaching the cecum in the 10 patients and the terminal ileum in nine. Although speed was not an endpoint of the study, the cecum was reached in less than six minutes in three patients. The NeoGuide colonoscope allows for standard therapies to be given during the procedure; this study included biopsies and the removal of multiple polyps. Patients were evaluated after the procedure at discharge, 48 hours and 30 days, with no complications or adverse effects. In fact, all 10 patients were contacted shortly after the procedure and expressed willingness to undergo the same procedure again.
"With the success of colonoscopy to detect cancer early, patient comfort is extremely important to raise the rates of screening," said Jacques Van Dam, M.D., of Stanford University and lead author of the study. "We hope that larger clinical trials will confirm that the technology improves the comfort and success of the procedure."
Pain during colonoscopies is often related to "looping" of the colonoscope, which stretches the colon and the surrounding tissue. The NeoGuide system is designed to avoid looping by following the natural shape of the colon. The system builds a three dimensional map of the colon as the scope is inserted and then directs multiple bendable sections to follow the path taken by the tip.
Randomized Controlled Trial of Sedation for Colonoscopy: Entonox versus Intravenous Sedation [Abstract 645]
Most patients request some sedation when undergoing a colonoscopy to make the process more comfortable. Although intravenous sedation (IV) is the most frequently used type of sedation, it has been associated with cardio-respiratory complications, delayed recovery and prolonged drowsiness. Researchers from the University of Hull in the United Kingdom evaluated the efficacy of entonox, an inhaled sedative using nitrous oxide and oxygen, and found it to be more effective than IV, providing greater patient pain relief and facilitating earlier discharge.
Study authors recruited 120 patients, asking them to complete anxiety and pain questionnaires and a baseline letter-cancellation test. Patients were then administered either entonox or midazolam/fentanyl, a commonly used IV sedation, before undergoing a routine colonoscopy. After the colonoscopy, patients again completed the letter-cancellation test and a marked pain assessment. Finally, patients completed a satisfaction survey at discharge and 24 hours after the procedure.
While patients experienced similar pre-procedure anxiety scores, entonox patients reported significantly less pain post-procedure (mean score of 25 for Entonox patients versus 40 for intravenous sedation patients,) and also reported a higher satisfaction rate (98 versus 80). Entonox patients were typically released within 26 minutes after the procedure while the intravenous group waited an average of 44 minutes.
Patients receiving entonox experienced faster recovery because the medicine is discharged from the body within one to two minutes after patients stop inhaling it, whereas IV sedation effects last for a longer period of time. Entonox causes less sedation and grogginess while providing effective pain relief, so the recovery is faster. The results of the letter test showed that patients with IV sedation were not completely back to normal at discharge whereas those with entonox were fully normal at discharge, meaning that patients who are given entonox can likely drive themselves home immediately after the procedure.
"Entonox shows significant value in improving patient satisfaction after colonoscopy, better accommodating a patient's lifestyle by enabling them to drive home after the procedure and, perhaps, making them less apprehensive about undergoing the procedure again," said Sushil Maslekar, M.D., University of Hull and lead study author. "Physicians will also benefit from a sedative that is more cost-effective and less time-consuming than current sedation options." A letter cancellation test is a simple test used to assess the psychomotor awareness of the patient, gauging how well the patient has recovered from sedation. The pain assessment and patient satisfaction were determined by simple visual analogue scales - a straight line from 0-100. For pain, 0 equals no pain and 100 equals intolerable pain, and for satisfaction, 0 means no satisfaction or extreme dissatisfaction and 100 means extremely satisfied.
American Gastroenterological Association
Colon Cancer Current Events and Colon Cancer News RSSFeedback loop explains inflammatory effect on intestinal lining
Signals released by immune cells during a bout of inflammatory bowel disease interfere with intestinal cells' ability to regenerate. Yet people with inflammatory bowel diseases have a significantly higher risk of developing colon cancer: a hyper-activation of growth in those same intestinal cells.
Could regulating intestinal inflammation prevent colon cancer?
Every day, our gut comes in contact with bacteria, inducing an inflammatory response that is tolerated and controlled. Sometimes the control of inflammation is lost and this can lead to inflammatory bowel disease that may predispose to colon cancer.
Study says therapeutics for trauma patients may not be effective due to an infection
A Kansas State University study aimed at alleviating intestinal damage in trauma patients digressed to an important finding that could affect medication given to the individuals.
Opposing functions of a key molecule in the development of organisms
Scientists headed by ICREA researcher Marco Milán, at the Institute for Research in Biomedicine (IRB Barcelona), reveal a surprising new function of Notch protein that contrasts with the one known to date. Found in the cell membrane, this protein activates a signalling pathway that regulates the expression of genes that make the cell divide, grow, migrate, specialise or die.
K-State professor finds link between low oxygen levels in body and cancer-aiding protein
What began as research into how diabetics could possibly preserve their eyesight has led to findings that could prolong the vision of children afflicted with retinoblastoma.
Irritable Bowel Syndrome patients not at more risk of colon cancer, polyps
Patients with irritable bowel syndrome are at no greater risk of having polyps, colon cancer or inflammatory bowel diseases than healthy people undergoing colonoscopies, according to new research published in the American Journal of Gastroenterology.
New biomarkers for predicting the spread of colon cancer
Scientists in China are reporting discovery of two proteins present in the blood of people with colon cancer that may serve as the potential biomarkers for accurately predicting whether the disease will spread. Their study is in ACS' Journal of Proteome Research, a monthly publication.
Gene signature may improve colon cancer treatment
A gene signature, first identified in mouse colon cancer cells, may help identify patients at risk of colon cancer recurrence, according to a recent study by Vanderbilt-Ingram Cancer Center researchers.
Mayo Clinic Researchers Find Oncogene is Important in Pancreatic Cancer Growth and Spread
Researchers at the Mayo Clinic campus in Florida have found that PKC-iota (PKCi), an oncogene important in colon and lung cancers, is over-produced in pancreatic cancer and is linked to poor patient survival. They also found that genetically inhibiting PKCi in laboratory animals led to a significant decrease in pancreatic tumor growth and spread.
Diapers' contents could change way of finding intestinal disease
A medical test initially researched for aging adults also could be helpful for premature babies, according to scientists with Texas AgriLife Research.
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