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Trends in Anesthesia Use During Gastroenterology Procedures

In the United States, use of anesthesia during gastrointestinal endoscopies and colonoscopies appears to have increased substantially from 2003 to 2009, according to a retrospective analysis of claims data during this study period. The proportion of procedures that used anesthesia services increased from about 14% in 2003 to more than 30% in 2009. Researchers noted that more than 65% of services were delivered to low-risk patients. Use ranged from 13% in the western part of the U.S. to 59% in the northeastern Abstract: JAMA, March 21,...
CRC Surveillance in Patients With IBD

CRC Surveillance in Patients With IBD

Certain patients with inflammatory bowel diseases (IBD), including ulcerative colitis and Crohn’s disease of the colon, have an increased risk of developing colorectal cancer (CRC) when compared with patients without IBD. While IBD is relatively rare in the general population, it remains one of the important high-risk conditions predisposing patients to CRC. The majority of patients with IBD will not develop CRC, but two factors that increase CRC risk have been identified: 1) CRC risk increases after 8 to 10 years of having ulcerative colitis, and 2) the more extensive the colonic involvement, the higher the CRC risk. Patients with disease limited to the rectum do not have an increased risk of CRC, while patients with ulcerative proctosigmoiditis or left sided colitis have an intermediate risk. The greatest risk is for those whose entire colon is diseased. The risks are similar for those with extensive Crohn’s colitis. An individualized and sensible approach to CRC surveillance in patients with IBD is essential. In the February 2010 issue of Gastroenterology, the American Gastroenterological Association (AGA) released a medical position statement and technical review on the diagnosis and management of colorectal neoplasia in IBD. The goal of the statement was to ensure that patients receive the highest level of treatment. The recommendations were designed to help identify high-risk individuals and develop individualized surveillance plans based on each patient’s unique situation. Assessing Risks The AGA position statement provides important information on assessing CRC risk in IBD patients. Disease duration, more extensive disease, severity of inflammation, primary sclerosing cholangitis, and a family history of sporadic CRC have all been associated with an increased risk...

CRC & Follow-Up Screening

Patients with colorectal cancer (CRC) who undergo potentially curative surgery have been shown to have an increased risk of disease recurrence. To reduce this risk, several professional societies have issued guidelines that specify a combination of regularly scheduled office visits, colonoscopy, and the carcinoembryonic antigen (CEA) test to detect changes that could indicate a recurrence. The hope is that early detection of recurrence can enable clinicians to treat patients appropriately and prolong their lives. Unfortunately, studies show that some patients may not receive these services as recommended. In fact, others may be sent for CT or PET scans even though they...
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