Colonoscopies in Ambulatory Surgery Centers: Saving Lives Through Increased Screening and Advances in Technology

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The latest data from the American Cancer Society released in March 2014 shows colon cancer incidence rates have dropped 30 percent in the United States in the last 10 years among adults 50 and older "due to the widespread uptake of colonoscopy."

The study appeared online in the American Cancer Society’s CA: A Cancer Journal for Clinicians. The largest decrease in incidence was found among people over 65, whose rate of decline went from 3.6 percent per year during 2001 and 2008 to 7.2 percent between 2008 and 2012.

Groups including the American Cancer Society and the Centers for Disease Control and Prevention (CDC) have committed to "80% by 2018," an initiative spearheaded by the National Colorectal Cancer Roundtable that seeks to increase screening rates for colorectal cancer among people 50 and older to 80 percent by 2018. It is estimated that currently only about one-third of adults between 50 and 75, about 23 million people, are not getting tested as recommended. The organizations believe colorectal cancer as a major public health problem can be eliminated and thousands of lives can be saved through increased screening. A New England Journal of Medicine study from 2012 found that if everyone over the age of 50 were to have colonoscopy, colorectal cancer rates would decrease by 60 percent.  

An increasing amount of this screening is taking place at ambulatory surgery centers (ASC), which are becoming a first line of defense against a cancer that is highly treatable and curable, if caught early. The CDC estimates that each year about 140,000 Americans are diagnosed with colorectal cancer, and more than 50,000 people die from it.

Greater use of colonoscopy has been shown to reduce mortality and next generation colonoscopes may help to further increase survival. These scopes provide greater visualization with high definition (HD) lenses and greater maneuverability to help endoscopists see inside the colon with unprecedented clarity and detail. This may lead to finding polyps that would otherwise be missed or more difficult to detect with older technologies.

"If you aren’t using an HD colonoscope, you certainly ought to be. The quality of the image is greatly improved, the likelihood of missing polyps is reduced and we are better able to clinically characterize polyps," said Sharmila Anandasabapathy, MD, Chief of Endoscopy, The Mount Sinai Medical Center in New York City. "Colonoscopy is one of the few screening technologies that has been proven to increase survival."

Next generation technology that employs new video processors, high definition lenses, monitors, zoom magnification, image enhancement and improved handling characteristics have enabled identification and evaluation of smaller and smaller pre-cancerous polyps that can be removed to reduce the risk of cancer. In addition to improving outcome-driven care, these new colonoscopies may also increase efficiency and reduce costs. Many of these technologies are already being used in ASCs throughout the country.

One of the newest colonoscopes available today is the PENTAX Medical EC-3490TLi Video Colonoscope ("RetroView™"), a high definition device that is intended to visualize polyps through retroflex visualization of the proximal side of colon folds and flexures. In addition, RetroView has a short-turn radius bending section that is designed to easily navigate around the sharp turns and tight areas of a difficult colon.

PENTAX Medical has also recently introduced the PENTAX Medical EC-2990Li (UltraSlim) Colonoscope, the smallest outer diameter HD colonoscope on the market today. Due to its smaller size, the scope enables ease of passage through areas of the colon that are smaller due to inflammation, strictures or obstructions and may provide less discomfort for patients.

"Great strides have been made in technology and by healthcare providers in reducing colorectal cancer rates by nearly a third, but experts say these rates can be reduced even further with more screening, and ASCs can play an important role in all of this," said Len Farris, Vice President of Marketing, PENTAX Medical. "ASCs offer screening in an outpatient setting and have the ability to provide safe, effective and efficient quality care in an era that places high value on both quality and cost. Our company shares these values and is committed to providing quality, innovative and clinically relevant devices and solutions across the spectrum of endoscopic imaging and disease states, including colon disease."

According to a study published in the Journal of the American Medical Association (JAMA) in 2011, screening colonoscopy performed on an outpatient basis had a safety profile comparable to that of hospitals. Study investigators from Emory University School of Medicine in Atlanta said colonoscopies performed at ambulatory surgical centers may result in healthcare cost savings.

Colorectal cancer is one of the most treatable forms of cancer if detected early. The American Cancer Society suggests several factors including lack of public and health professional awareness, financial barriers and inadequate insurance coverage and/or benefits could be limiting the use of screening tools. The Affordable Care Act requires coverage for colorectal cancer screening tests.

The U.S. Preventive Services Task Force recommends colorectal cancer screening for men and women aged 50 to 75 using high-sensitivity fecal occult blood testing (FOBT), sigmoidoscopy, or colonoscopy. Colonoscopy is considered the current gold standard for screening to identify colorectal cancer, but the CDC says increasing the use of all recommended colorectal cancer tests can save lives and is more cost effective.

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