5 Physicians on ADR, Standard Colonoscopy, Cost Savings & MoreGastroenterology and Endoscopy
Missed Adenomas: Is It Really an Issue?
Presented by Peter Siersma, MD, PhD, FACG, FASGE
Dr. Siersma opened the presentation with a discussion on missed adenomas. "Colonoscopy is the standard method for detecting and removing adenomas, but the miss rate can be as high as 25 percent," he said. Missed adenomas can be due to factors such as:
• Inadequate bowel preparation
• Withdrawal time
• Inadequate visualization
"The higher your adenoma detection rate is the lower the risk of colon cancer," said Dr. Siersma. "We should be aiming for this." He analyzed the effect of technologies such as high-definition colonoscopy, cap-assisted colonoscopy and third eye retroscope have on ADR. The results were variable, but the three different technologies did not dramatically increase adenoma detection rate.
Fuse Study: The Lancet Oncology Data
Presented by Ian Gralnek, MD, FACP, FACG, FASGE
Dr. Gralnek discussed the results of the Fuse Endoscopy System study published in the March issue of The Lancet Oncology. Standard forward-viewing colonoscopes have 170 degree field of view, while the Fuse scope has a 330 degree field of view. The purpose of the study was to determine whether or not the Fuse system improved ADR and if traditional scopes missed adenomas. Key findings include:
• Fuse endoscopy system detected 69 percent more adenomas than standard colonoscopes
• Standard colonoscopes missed 41 percent of adenomas
• Fuse endoscopy system had a 7.3 percent adenoma miss rate
• Fuse endoscopy resulted in no false negative examinations
• 6 percent of patients undergoing standard colonoscopy had a false negative
• Overall, Fuse resulted in shortened colonoscopy surveillance intervals for 9 percent of patients
Putting Fuse into Your Practice
Presented by Blair Lewis, MD, FACP, FACG, FASGE
Dr. Lewis performs cases at Carnegie Hill Endoscopy Center in New York. The center has five procedure rooms and performs 13,000 cases per year. "We put the Fuse system in all of our rooms," said Dr. Lewis. "We thought we could market this."
The endoscopy center has sent notice of the new endoscopy system to surrounding internists and family practitioners as a way to educate referring physicians. Additionally, patients have asked about the new scopes. Issues Dr. Lewis and the endoscopy center partners had to consider included the learning curve associated with any new technology and the financial investment. "We built a business plan before we acquired the Fuse scopes," said Dr. Lewis. "We found you will get more patients, more pathology and more [colonoscopy] recalls."
Cost-Reducing Impact of Fuse on Healthcare System
Presented by Cesare Hassan, MD
Dr. Hassan discussed the potential cost saving implications the Fuse endoscopy system has for the healthcare field. Key financial statistics to consider include:
• Colonoscopy price: $877
• Colonoscopy with polypectomy: $1,265 (50 percent higher than just a colonoscopy alone)
• Treatment cost of one case of cancer is 60 to 90 times the cost of one colonoscopy
"The Fuse strategy is less expensive than the standard approach," said Dr. Hassan. "It is more efficacious. You are saving $146 per person compared to standard colonoscopy." If this is projected across the entire United States population colorectal cancer cost savings are approximately $0.3 billion, though further research is needed to confirm.
"The higher detection rate of Fuse seems to translate to a substantial increase in colorectal cancer prevention," said Dr. Hassan. "If you prevent more cancer, you can compensate for the cost [of purchasing the system]."
Therapy With FUSE
Presented by Douglas Rex, MD, FACP, AGAF, FACG, FASGE
Dr. Rex provided a visual presentation of the Fuse endoscopy system in action. Several videos showed Dr. Rex using the system in polyp removal. "When I am performing therapy, I want to be sure we have enough resolution to complete the job," he said. “The 330 degree field of view assists in finding more lesions and has appropriate resolution to characterize the tissue characteristics,” Rex concluded.
More Articles on Gastroenterology:
Precancerous Polyp Removal Technique Could Save Millions of Healthcare Dollars
5 Highlights to Look for at Digestive Disease Week
9 Statistics on Gastroenterology Salary & Career Satisfaction
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