Reevaluating the Benefits of GI Screening

Surgical procedures that once required major surgery and in-patient stays are being replaced with minimally invasive procedures with faster recovery times. Among these preventative technologies include computed tomograpy (CT) scans, colonoscopies, and x-rays.

Research presented in May 2007 at Digestive Disease Week 2007 (DDW) in Washington DC, USA, provided guidance as to which tests are best for which patients. It can be difficult to assess whether a patient is experiencing acute appendicitis or has intestinal distress. CT scans can help determine if the patient needs to have his or her appendix removed. However, while having a clear image showing the appendix confirms patient and physician suspicions, the time required to conduct the scan delays time to a potential surgical procedure, with the attendant risk that the appendix could perforate while the patient awaits the test results. Researchers at the University of Wisconsin (Madison, WI, USA) evaluated the differences between patients who received a CT scan before removal of their appendix and those who went directly to surgery without the test.

In this study, investigators reviewed the hospital records for 412 adult patients admitted to University of Wisconsin Hospital during a three-year period. Of the 410 patients showing signs of acute appendicitis, more than half (62%) had a CT scan before the removal of their appendix.

When screening for colorectal cancer, there are many different testing options; however, there has been no consensus on the most appropriate screening technique for specific subsets of patients. Investigators reviewed 16,737 colonoscopies performed at Emory University Hospital and Grady Memorial Hospital (Atlanta, GA, USA) between January 2000 and December 2005. Colonoscopies give more precise images of bends in the colon than another screening approach called flexible sigmoidoscopy, which uses a slender hallow lighted tube to detect cancer.

One-third (n = 5,597) of the patients screened had an average risk for colorectal cancer and 8% (n = 462) were confirmed to have advanced neoplastic lesions. For more than 50% of the patients with advanced neoplastic lesions (57%, n = 262), the lesions were confined to the proximal colon, making it very difficult for the flexible sigmoidoscopy to detect. Significantly, Caucasian patients had a higher risk for proximal tubular adenoma whereas African American patients had a higher risk for proximal adenocarcinoma and proximal tubulovillous adenoma.

"These results direct doctors to perform colonoscopies rather than other methods, such as the flexible sigmoidoscopy, as they detect more colon tumors that may have been missed with flexible sigmoidoscopy,” said Mohammed A. Wehbi, M.D., from Emory University (Atlanta, GA, USA) and investigator of this study.


Related Links:
University of Wisconsin
Emory University