Vendor Highlights - updated daily

Vendor Highlights - updated daily

Focusing on innovative technology, news, and advertisements regarding gastrointestinal endoscopy. Vendor Highlights provides ease of access into the window of tomorrow.

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Obesity Linked to Higher Mortality Rate in Colon Cancer
In patients with colon cancer, obesity was associated with higher rates of cancer recurrence and mortality, according to research published online March 9 in Clinical Cancer Research.
Frank A. Sinicrope, M.D., of the Mayo Clinic in Rochester, Minn., and colleagues analyzed data from 4,381 patients with stage II and III colon carcinoma who were participating in randomized trials of 5-fluorouracil-based adjuvant chemotherapy. Patients had been treated surgically, and most had received effective chemotherapy.
The authors note that 20 percent of patients were obese. Compared to normal-weight patients, obese patients were found to have more distal tumors and lymph node metastases. Body mass index (BMI) was associated with both disease-free survival and overall survival. Men with a BMI of 35 or above had a 35-percent increased risk of death compared with normal-weight patients. Women with a BMI of 30 to 34 had a 24-percent higher risk of death. The association between BMI and clinical outcome was stronger in men than women, per the researchers.
"Our findings extend the effect of obesity beyond its known association with colon cancer risk by showing that obesity is an independent prognostic variable in colon cancer survivors that shows differences by gender. Obesity was a poor prognostic factor despite adjuvant chemotherapy. Such information has the potential to influence patient management decisions and surveillance strategies," the authors conclude.
(ModernMedicine, 3/10/10)

Rotating Shift Work May Raise Irritable Bowel Risk
Symptoms of irritable bowel syndrome (IBS) include constipation and diarrhea, abdominal pain, cramping, and bloating. It’s unclear what causes the syndrome, which affects as many as one in five Americans, according to the National Institutes of Health.
Shift workers often report altered bowel habits similar to people with IBS, Dr. Willemijntje A. Hoogerwerf, at the University of Michigan in Ann Arbor, and colleagues note in the American Journal of Gastroenterology.
Their evaluation of bowel disorders among 399 nurses implies that rotating work schedules, which commonly disrupt the intestinal tract’s rhythm, are "associated with a greater chance of having irritable bowel syndrome," Hoogerwerf said in an email to Reuters Health.
She and colleagues assessed self-reported bowel disorders and sleep quality among mostly female nurses with no other conditions potentially associated with bowel dysfunction.
A total of 214 worked straight days, 110 worked straight nights, and 75 rotated between day and night shifts. Generally those working night and rotating shifts were younger, while day shift nurses tended to have longer work experience - nearly 20 years versus 11 to 13 years.
Overall, 36 (48 percent) working rotating shifts reported symptoms of IBS, as did 44 (40 percent) of those working straight nights.
By comparison, 66 (about 31 percent) working straight days had IBS symptoms - still more than what might be expected in the general population (up to about 20 percent).
The investigators found reports of sleeping badly, having trouble falling asleep, and daytime sleepiness all more common among nurses with IBS, regardless of their work shift.
But working a rotating shift remained significantly associated with IBS even after taking into account sleep quality, age, gender, years of experience, and number of years working night or rotating shifts.
Nurses working night and rotating shifts were also more likely to report abdominal pain or discomfort than their day-working peers.
Based on these results, Hoogerwerf questions whether IBS results from "an underlying biological rhythm disorder of the intestine." She and her colleagues call for further studies to assess this.
Meanwhile, Hoogerwerf recommends shift workers with IBS-like symptoms consult their physician "to discuss the potential impact" their work schedule has on their symptoms.
SOURCE: American Journal of Gastroenterology, published online February 16, 2010.
(Reuters, 3/9/10)

Physicians come together on National Colorectal Cancer Awareness and Screening Day
Colorectal cancer (CRC) is the third leading cause of cancer death among men and women nationwide, yet only half of people who need CRC screening receive it. The American Gastroenterological Association (AGA) Institute is working to educate patients about the importance of screening and to encourage everyone age 50 and older to get screened for CRC.
Recognizing that those without insurance have limited access to screening, gastroenterologists and physicians throughout the country have established free CRC screening programs for the uninsured. On National Colorectal Cancer Awareness and Screening Day (March 20, 2010), programs in ten states are holding simultaneous screening events on March 19 and 20, 2010, to check patients for this deadly cancer and raise awareness of the importance of screening.
"The AGA Institute firmly believes that all Americans should have access to life-saving colorectal cancer screenings. If caught early, colorectal cancer is very treatable," said Carla H. Ginsburg, MD, MPH, AGAF, chair of the AGA Institute Social Conscience Task Force. "The AGA applauds the physicians who are donating their time to screen patients who wouldn’t otherwise be checked for colorectal cancer. We encourage all patients over age 50 to talk with their doctor about their colorectal cancer screening options."
There are a number of colorectal screening options, which vary by the extent of bowel preparation, as well as test performance, limitations, time interval and cost. The AGA considers colonoscopy the definitive test for CRC screening and prevention since it can detect cancer at an early, curable stage and prevent cancer by removing pre-cancerous polyps. For detailed information on CRC screening options, please see the AGA Institute brochure CRC Prevention and Treatment.
In addition to supporting grassroots efforts to screen patients without insurance, the AGA is hopeful that current provisions for CRC screening included in both the House and Senate health-care reform bills are included in the final bill. Both bills provide incentives for more individuals to get screened for CRC screenings and would provide a technical correction to the current Medicare CRC deductible and would waive the deductible regardless if a polyp or lesion is found.
AGA Institute President Gail A. Hecht, MD, MS, AGAF, said, "Legislation needs to be enacted that provides screening programs for the uninsured and medically underserved. Additionally, legislation should require that both public and private health insurers cover all recommended options for colorectal cancer screening for everyone aged 50 years and older, or 45 years and older for those at higher risk, with reasonable copayment."
In addition to following recommended screening guidelines, people can reduce their risk of developing or dying from CRC through regular physical activity and maintaining a healthy body weight.
More than 20 gastroenterologists in the following states are conducting free colonoscopies on March 19 and 20:
Colorado
Connecticut
Maryland
Massachusetts
Minnesota
New York
Ohio
Rhode Island
South Carolina
Washington
(EurekAlert, 3/8/10)

Gut Bacteria May Spur Obesity, Research Suggests
Intestinal bacteria may contribute to obesity and metabolic syndrome, a new study in mice suggests.
"It has been assumed that the obesity epidemic in the developed world is driven by an increasingly sedentary lifestyle and the abundance of low-cost, high-calorie foods. However, our results suggest that excess caloric consumption is not only a result of undisciplined eating but that intestinal bacteria contribute to changes in appetite and metabolism," senior study author Andrew Gewirtz, an associate professor of pathology and laboratory medicine at Emory University School of Medicine, said in a university news release.
He and his colleagues found that increased appetite and insulin resistance can be transferred from one mouse to another via intestinal bacteria. The findings are published online March 4 in the journal Science.
It’s believed that intestinal bacteria populations in people are acquired at birth from family members and are relatively stable. However, they can be affected by diet and antibiotics.
"Previous research has suggested that bacteria can influence how well energy is absorbed from food, but these [new] findings demonstrate that intestinal bacteria can actually influence appetite," Gewirtz explained.
He said the findings from mice suggest "that it’s possible to ’inherit’ metabolic syndrome through the environment, rather than genetically. Do obese children get that way because of bad parenting? Maybe bacteria that increase appetite are playing a part."
A gene called toll-like receptor 5 (TLR5) plays an important role in controlling intestinal bacteria. Gewirtz and colleagues plan to investigate TLR5 variations in humans and how bacteria in TLR5-deficient mice influence appetite and metabolism.
(HealthDay, 3/5/10)

Gastroenterologists Bash CT Colonoscopy in Letter to Obama
News that President Obama received a clean bill of health from a virtual colonoscopy several days ago rubbed influential gastroenterologists the wrong way.
On Monday the American College of Gastroenterology (ACG) fired off a letter to the president stating that �while a �virtual� exam is better than no exam, for most people, colorectal screening by colonoscopy is the preferred strategy.�
�Our 11,000 physician members are concerned that you missed an important opportunity to set an example of the power of prevention by taking the test proven to prevent colorectal cancer by polyp detection and removal,� said the letter signed by ACG president Dr. Philip O. Katz.
Not only has the president done a disservice to the nation, Katz asserts, he has particularly hurt African Americans, he said.
�Evidence reveals that African Americans are diagnosed with colorectal cancer at a younger age, and African Americans with colorectal cancer have decreased survival compared with other racial groups,� he said.
Dr. Perry Pickhardt, who nearly a decade ago set up the CT colonography program at Bethesda Naval Hospital where the president underwent CT colonoscopy, called the letter �unbelievable.� Pickhardt, now a professor of radiology at the University of Wisconsin in Madison, said he thinks the ACG is trying to bash virtual colonoscopy to protect its �cash cow.�
Pickhardt�s former colleague at the Bethesda Naval Hospital, Dr. Michael Puckett, said he believes the college might have �felt they had to say this.� The two men say ACG�s fears are misplaced.
Puckett, now a diagnostic radiologist at San Diego Imaging, which supports four hospitals and two imaging centers, works closely with gastroenterologists in the San Diego area. He provides virtual colonoscopy to patients who cannot complete optical exams, as well as those who, for one reason or another, prefer a less invasive approach.
�Almost all my patients are referred by gastroenterologists,� Puckett said. �They have come to know me and know what I can do.�
Pickhardt says he has performed 7000 virtual colonoscopies since he came to the UW seven years ago and demand for optical colonoscopy �has only gone up.� CT colonography, he said has �been complementary.�
Collaboration was not on Katz�s mind, however, when the leader of the gastroenterology world scolded the leader of the free world for his poor choice of diagnostic procedures.
�We hope that any healthcare reform policies endorsed by the White House will be informed by the best clinical science and the best economic evidence � which clearly demonstrates that colonoscopy has the power to both save lives and save healthcare resources in the long run,� he said.
Katz does not mention that the American Cancer Society recommends both conventional and CT colonoscopy. Instead the page and a half letter to Obama refers to optical colonoscopy as the preferred test for detecting colorectal cancer.
The answer to the implicit question preferred by whom?�is clear when Katz notes in the letter that �The American College of Gastroenterology recommends colonoscopy as the preferred colorectal cancer detection test.�
(Diagnostic Imaging, Greg Freiherr, 3/4/10)

Safety, Efficacy of Propofol During Endoscopy Evaluated
With careful attention paid to maintaining clear and effective airways, the sedative propofol can be safely used to induce deep sedation in patients for advanced endoscopic procedures, according to a study in the February issue of Clinical Gastroenterology and Hepatology.
Gregory A. Cot�, M.D., of Washington University in St. Louis, and colleagues studied 799 patients undergoing sedation with propofol for a variety of advanced gastric endoscopic procedures. The researchers looked for sedation-related adverse events and complications, such as hypoxemia, hypotension necessitating vasopressors, and early termination of procedure. The researchers also tracked a novel metric: the need for airway modification (chin lift, modified face mask ventilation, and nasal airway) during sedation.
The researchers reported hypoxemia in 12.8 percent of subjects, hypotension in 0.5 percent, and premature procedure termination in 0.6 percent. Airway modification was performed in 14.4 percent of patients, including chin lift (12.1 percent), modified face mask ventilation (3.6 percent), and nasal airway (3.5 percent). No patients needed bag-mask ventilation or endotracheal intubation. Predictors of the need for airway modification included male sex, increased body mass index, and American Society of Anesthesiologists class of 3 or higher.
"With the major gastroenterology societies supporting gastroenterologist-supervised, nurse-administered propofol for sedation, it is paramount to identify which patients are at highest risk of developing sedation-related complications. Perhaps the highest-risk groups should be managed by professionals trained in advanced airway interventions whereas lower-risk populations can be managed safely by professionals with less-intensive airway training," the authors write.
(Modern Healthcare, 3/2/10)