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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 RSSOther Illnesses, Body Weight Do Not Explain Racial Disparities in Colon Cancer Survival, UAB Researchers Say
A new study by University of Alabama at Birmingham (UAB) researchers shows that body-mass index (BMI) and co-existing medical conditions (co-morbidity) do not explain the decreased survival observed among African-Americans compared to Caucasians who also have colon cancer.
Paradoxical protein might prevent cancer
One difficulty with fighting cancer cells is that they are similar in many respects to the body's stem cells. By focusing on the differences, researchers at Karolinska Institutet have found a new way of tackling colon cancer. The study is presented in the prestigious journal Cell.
Coffee break: Compound brewing new research in colon, breast cancer
A compound in coffee has been found to be estrogenic in studies by Texas AgriLife Research scientists.
Curry-cure? Spicing up the effectiveness of a potential disease-fighter
Scientists are reporting development of a nano-size capsule that boosts the body's uptake of curcumin, an ingredient in yellow curry now being evaluated in clinical trials for treatment of several diseases.
Colon cancer screening more effective earlier in day, UCLA study finds
The effectiveness of a screening colonoscopy may depend on the time of day it is performed. According to a new UCLA study, early-morning colonoscopies yielded more polyps per patient than later screenings, and fewer polyps were found hour by hour as the day progressed.
Study shows hormone replacement therapy decreases mortality in younger postmenopausal woman
Hormone replacement therapy (HRT) to treat menopausal estrogen deficiency has been in widespread use for over 60 years. Several observational studies over the years showed that HRT use by younger postmenopausal women was associated with a significant reduction in total mortality; available evidence supported the routine use of HRT to increase longevity in postmenopausal women.
Experts issue call to reconsider screening for breast cancer and prostate cancer
Twenty years of screening for breast and prostate cancer - the most diagnosed cancer for women and men - have not brought the anticipated decline in deaths from these diseases, argue experts from the University of California, San Francisco and the University of Texas Health Science Center at San Antonio in an opinion piece published in the "Journal of the American Medical Association."
Metals could forge new cancer drug
Drugs made using unusual metals could form an effective treatment against colon and ovarian cancer, including cancerous cells that have developed immunity to other drugs, according to research at the University of Warwick and the University of Leeds.
New data: Hospital imaging centers poised to pull back, hitting patients hardest in rural areas
Survivors and patients with cancers and heart disease, along with patient advocate organizations and physicians, today urged policymakers to enhance early diagnosis of deadly diseases by preserving access to advanced imaging, such as MRI and CT scans, in final health care reform legislation.
Whole-brain radiotherapy after surgery or radiosurgery not recommended for brain metastases
Whole-brain radiotherapy should not be given routinely to all patients whose cancer has spread to the brain, say researchers who found that using it after surgery or radiosurgery in patients with a limited number of brain metastases and stable cancer in the rest of the body did not extend lives or help patients remain functionally independent for longer.
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