American College of Gastroenterology's 71st Annual Scientific Meeting
The 71st Annual Scientific Meeting of the American College of Gastroenterology took place Oct. 20 to 25 in Las Vegas, and drew more than 5,000 attendees from around the world. Key topics included the need for more effective colon cancer screening methods, monitoring of hepatitis C patients and a newly identified condition: eosinophilic esophagitis.
"Screening is a huge health issue," said Girish Mishra, M.D., associate professor of internal medicine at Wake Forest University School of Medicine and a member of the academy's public relations committee. "We've increased public awareness of the need to screen for colon cancer. Now the mission is to screen more effectively."
Douglas Rex, M.D., of the Indiana University School of Medicine, addressed many of the screening challenges faced by gastroenterologists. "We still have not found the optimal bowel prep, and our patients can attest to that," Mishra said. "That's a barrier to colon cancer screening, and it can lead to the missing of colon cancers."
Another issue is the withdrawal time for colonoscopies, Mishra said. "It's extremely important that the colonoscope not come out too soon. The data shows that you need six to eight minutes minimum on average before the withdrawal of the colonoscope. If you take less time, you could miss polyps and lesions that could turn into cancer."
An academy task force may issue new recommendations based on this data, Mishra said. "It's a guideline that will come out soon and change clinical practice."
The conference also highlighted the development of new colonoscopes that provide a wider field of view. "They have a circumference of 170 degrees versus the current standard of 140 degrees, which means that we'll miss fewer polyps," Mishra said.
Another key theme was monitoring the early response of hepatitis C patients to interferon and ribaviron treatment. "In the past, we would monitor response at six to 12 weeks," Mishra said. "We learned at this meeting that we need to be more meticulous in monitoring virologic response as early as four weeks."
The conference also addressed a new condition: eosinophilic esophagitis, which causes swallowing difficulties in children as well as adults. "It's not due to a mechanical obstruction and may be tied to a food allergy," Mishra said. "Patients may need to be skin-tested for allergies and treated with inhaled steroids or oral steroids."
Thomas F. Imperiale, M.D., of the University of Indiana School of Medicine in Indianapolis, and colleagues presented research supporting current guidelines to perform colonoscopies every 10 years in patients who have no personal or family history of colorectal neoplasia or other risk factors for colon cancer. In patients with no polyps on baseline colonoscopy, the researchers found that a repeat colonoscopy five years later identified no cancers.
"Often, physicians recommend and sometimes patients request screening colonoscopy earlier than recommended," said Carol A. Burke, M.D., of the Cleveland Clinic and chair of the ACG's Educational Affairs Committee. "Previously, there were no studies that provided us direct evidence to support the 10-year interval. This data reassures us that going to five years and probably beyond is safe in this patient population."
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