Therapeutic Procedures in Colorectal Endoscopy - Essay Example

Running Head: Therapeutic Procedures in Colorectal Endoscopy Endoscopic Polypectomy A Paper on the Therapeutic Procedures in Colorectal Endoscopy In APA Style Name University Abstract The study that was conducted is related to the therapeutic procedures that are connected to colorectal endoscopy. Colorectal endoscopy can be considered important procedure to be able to either diagnostically determine the condition of the colorectal passages or to assess the state of the said system in terms of severity. There are different issues that are related to the study of the procedure colorectal endoscopy. The issues can be classified on the basis of the medical, clinical, legal and even ethical aspects. The study that was conducted present an analysis in certain areas related to the said aspects. Colorectal endoscopy can be considered as one of the procedures that play an important role in the detection of the status and health of the colon and the rectal area. This can be attributed to the fact that its can capture the state of the related organs on video and present a view on the severity of the polyps in the body of the patient (National Cancer Institute, 2007a). Although the said procedure can determine and can contribute essential data on the severity of the polyps that can be found in the colon and rectal areas of the patient, the colorectal endoscopy is not considered as a primary procedure. This can be attributed to the risks and the insufficiency of the proofs that can justify the use of the instruments for the procedure. Included in the risks that are associated with colorectal endoscopy are complication, perforation of the polyps and the mortality rate. In terms of the complication rate, based on results of prior studies, there is an overall percentage of 1 to 2 percent. On the other hand 0.1 percent of the perforation rate in the patients with the polyps in the colon and rectal areas were recorded. The mortality rate of 0.05 percent had also been recorded. Also, on the basis of the studies pertaining to the U. Department of Veterans Affairs, the incidence of severity was increased in the patients that had been studied and monitored prior to the discovery of the polyps ("Role of endoscopy",1995). The main goal of the study that was conducted is to be able to present a general view in the pertinent issues that can be considered to affect the condition of the patients. The importance of the study then can be critically weighted on the basis of the evidences presented by prior studies that the risks of the colorectal endoscopy outnumber the benefits Indications for Therapeutic Procedures in Colorectal Endoscopy In cases of application of the colorectal endoscopy, there are different therapeutic procedures that can be undertaken. The main focus of the said type of endoscopy is the diagnosis and determination of the state of patients with ailments related to the colon and the rectal area. A. Colon Area Diseases related to the colon area can be monitored and determined. One of the most detrimental diseases that can diagnosed through the colorectal endoscopy procedure is the cancer of the colon, specifically referring to the area of the large intestine which is approximately 6 feet in length (National Cancer Institute, 2005c). The determination then of the treatment procedures and intervention in the diseases that can be studied through colorectal endoscopy can be attributed to certain factors. Prior to the diagnosis of the patient diseases, the medical condition and history of the patient is determined. In terms of the colon cancer, risk factors can are the main priority in terms of the monitoring and study of the patient. An important factor is age, 50 years old and above can be considered at risk of colon cancer and is increasing as one gets older. In terms of the family, an individual with a history of cancer particularly in the colon and rectum area is of the highest risk in the particular type of cancer. Also, for the individual himself, diseases of related areas such as colon, rectum, ovary, endometrium or breast can be related to the development of the disease. The occurrence of polyps in the colon can also be an important sign and increases the risk for the patient to have the cancer. Monitoring and in depth study is often required specifically in patients with Crohn's disease, ulcerative colitis (National Cancer Institute, 2005c). Upon determination then of the said risk factors, the onset of treatments and interventions are often undertaken specifically when there are symptoms and indications that are observed. The symptoms that can be observed can serve as indication of the diseases in the colon, the most severe of which is the colon cancer. Generally, there are observed alteration and inconsistencies in the bowel habit can be observed. Also blood can be observed in the stool. Even the size of the stool can be different from the normal size, it is usually slimmer. Other indications are gas pains, bloating and cramps. Tiredness, weight loss and vomiting can also be observed. Basically, upon the observation of the symptoms of the colon diseases, assessment is undertaken to be able to determine the ways and interventions for treatment. The colorectal endoscopy is included in the methods used for assessment. Other methods are physical examination, fecal occult blood test, digital rectal examination, barium enema, biopsy, virtual colonoscopy and sigmoidoscopy (National Cancer Institute, 2005c). The main focus of the study is the applicability and the necessity of sigmoidoscopy and colorectal edoscopy. It basically a procedure that visually present the state of the internal colon and rectal area. The instrument is referred to as the sigmoidscope, which is a tube lighted on the tip, which is put in through the anus. The main targets the procedure are detection of polyps, abnormalities and cancer tissues. In colonoscopy sample tissues can be retrieved and biopsy can be undertaken to analyse the components of the pertinent areas in the tract (National Cancer Institute, 2005c). There are different procedures that can be undertaken in cases of colon and rectal diseases and infection but the factors that are given such as the risk factors, the severity and affected areas. Also, the history of the patient and the present state of health are vital to the treatments that can be given. On the other hand, prognosis can be considered as an important area which can also be based in different factors. For cancer, the prognosis can be based on the capability of the patient to react to the treatment and the rate of recovery. B. Rectum The condition of the rectum area can be related to the colon. This can be attributed to the fact that the two parts are adjacent to each other. The diseases that are then related to the colon area can also affect the rectum. The cancer of the rectum can also be considered as the most detrimental condition that can affect the rectum and is related to the colon area. The treatments that can be undertaken as well as the interventions are also related to the different factors that are commonly based similarly to the factors that can trigger the colon cancer (National Cancer Institute, 2007b). In relation to the conditions and disease that can be related to the colon, the risks factor for acquiring different rectum ailments can be similar to that of the colon. The age can be one of the bases for the risk in having diseases in the rectum. As individual becomes older, the danger for having such conditions increases, specifically cancer. Family history of the disease in areas of the rectum and colon is another factor that is monitored. The diseases in the ovary, endometrium and breast also present another risk, e.g. in patients with cancer wherein metastasis and spreading of the infection can be considered. The medical history with ailments such as the Crohn's disease and the other hereditary conditions is also another risk. (National Cancer Institute, 2007b). The use of the colorectal endoscopy can be attributed to different purpose. This can be related to the fact that it can be applied to be able to confirm results of the physical and clinical examinations wherein there are still questions. The procedure can then determine the severity of the disease in the colorectal areas. The effectiveness and the utilization then of the said procedure along with the benefits and advantages that can be attributed to colorectal endoscopy can is based on the contribution for early prevention and the confirmation of the state of the disease through ocular inspection and biopsy. The results of the colorectal cancer screening are the main basis of intervention which can be medication, operation or other procedures for treatment. Based on the study of certain groups, the use of the colorectal endoscopy can be considered dangerous. It is important to consider through that the condition of the patient is studied prior to the recommendation and undertaking of the procedure. The proper time of the procedure can be considered as a vital factor in line with the health condition of the patient. There are still questions though until the present time on the application of the said procedures, thus, further research is required. In is important to consider though that colonoscopy is a common procedure. Sigmoidoscopy on the other can be considered of greater specificity that limits its applications. But the said procedures are the major subdivisions of colorectal endoscopy (National Cancer Institute, 2005c; (National Cancer Institute, 2007b). Evaluation of the Indications and Contraindications for Intervention The application of colorectal endoscoy as compared to other medical procedures still has questions in terms of its use and application. This can be attributed to the risks over the advantages that the procedure can bring about. In terms of the reasons for the skepticism in relation to the use of colonoscopy, there are certain studies that had been conducted to focus on the possible risks that are involved. One of the most important areas that can be related to risk in undertaking endoscopy is in relation to the complication of the diseases that the patients were diagnosed. In most cases colonoscopy is the final stage in the colorectal screening specifically in cases such as cancer. But preliminary studies are undertaken to be able to determine the recommendations, the indications and the contraindications to be able to maintain the remaining vitality of the patient. In the study that was conducted, the complications related to colonoscopy were undertaken and studied through retrospective cohort research. The results showed that the danger in colonoscopies are always present on the basis that an instrument is inserted in the area wherein there can me ulcerations and lacerations and can be considered as highly sensitive. Also, the danger and complications are comparatively lower in the primary screening procedure. This can be attributed to the fact that the severity of the case is one of the most important bases in the assessment and judgment if the patient is safe to undergo colorectal endoscopy. Healthy people can be considered of lower risk in the possible effects of the procedure (Levin, Zhao, Conell, Seeff, Manninen, Shapiro & Schulman, 2006). There are different risks that can be associated to susceptible people. It is important then to consider with precaution the procedures to be undertaken for interventions and screening. Included in the risks and complications that can be attributed to colorectal endoscopy is colonic perforations in cases wherein the passage is sensitive. Another is bleeding due to biopsy and polypectomy. Another complication is the transmural colonic burn due to the after effect of polypectomy. Diverticulitis is another complication of colorectal endoscopy which can be described as minute damages in the colon (Levin, Zhao, Conell, Seeff, Manninen, Shapiro & Schulman, 2006). Although the procedure has a group of firm critics that questions every risks that can be attributed to the procedure, there are increasing amount of studies and evidences that supports the application of colorectal endoscopy but with limitations. Individuals that belong to the age 50 years and above are considered of average risk thus the results of other test are still vital to the determination of the application of the procedure. Due to the queries that are related to the risks in undertaken colorectal endoscopy, the efficiency of the said procedure can be considered as one of the subjects of the research in the said. Also included in the said area is the determination of effective alternative methods to be able to present choices to the patients in cases wherein there is a very high risk if the said procedure is undertaken (Imperiale, Ransohoff, Itzkowitz, Turnbull & Ross, 2004). There are studies on the other hand that presents the advantageous effects of screening interventions including colonoscopy on the decrease in the mortality of the patients diagnosed with colorectal cancer. A comparative study of chosen screening interventions was undertaken on the basis of different methods of research. The results revealed a 50 % effect that can be attributed to the sigmoidoscopy procedure as presented in Table 1 (Lieberman, Weiss, Bond, Ahnen, Garewal, & Chejfec, 2000; National Cancer Institute, 2007a). Table 1. Effect of Screening Intervention on Reducing Mortality from Colorectal Cancer. Fecal Occult Blood Test Sigmoidoscopy Digital Rectal Exam Study Design Randomized controlled trials Case-control studies, randomized controlled trials in progress Case-control studies Consistency Good Fair Good Magnitude of Effects 15%-33% About 50% for left colon No effect Source: (National Cancer Institute, 2007a) Policies Related to Colorectal Endoscopy In terms of the policies in the application of the colorectal endoscopy procedure, the concerns such as the safety and the health of the patients are still considered of major priority. Also the policies of the particular medical facilities wherein the procedure can be undertaken are also considered. On the basis of the community and the action of the domestic and local communities, there is a lack of specific governing rules and guidelines. Medical organizations are also important in the establishment of rules in the medical institutions. The American Cancer Society is one of the organizations in the US that are aimed to be able to present the population with a healthy environment. The National Colorectal Cancer Roundtable (NCCRT) is a national organization with the main goal to be able to achieve control in the cases of colorectal cancers and related diseases in the country. This is undertaken through information dissemination and research of the feasibility and safety of the different procedures available, such as the colorectal endoscopy for the treatment of the patients, which is mainly achieved through research. One important role is coordination with the health agencies to be able to promote the utilization of proven colorectal cancer screening tests to the public (American Cancer Society, 2007). Effects of Related Procedures to the Procedure of Colorectal Endoscopy There are related issues that are often considered in the study and application of colorectal endoscopy. Due to the fact that it can be classified under a major procedure, the application of antibiotic prophylaxis can be required. Such procedure can present certain effects to the patients, with the greater probability of being risk to the health. Another concern that can be considered important prior to the procedure is the medical history and the present health condition of the patient. Both of the said factors had effects on the risks that the patient can face upon the application of the procedure. A. The Application of Antibiotic Prophylaxis Due to the high risks of complication in the process of colorectal endoscopy, antibiotic prophylaxis is undertaken. Assessment of the state of the patient is one of the vital rules. Upon the determination of the physical condition of the patient, preparation us undertaken. An example of antibiotic prophylaxis is through the enterical introduction in the gut of a person a sufficient amount of aminoglycoside antibiotic (El-Serag, Petersen, Hampel, Richardson & Cooper, 2006; Imperiale, Ransohoff, Itzkowitz, Turnbull, & Ross, 2004). B. The Medical Conditions and History of the Patients The medical condition and the history of the patient can be considered as two of the most important concepts that are considered prior to the application of the procedure. This can be attributed to the danger and risks associated with the utilization of the procedure in terms of the complication, perforation and even mortality. In a study conducted on the risks that can be undertaken by patients with predetermined diseases, there are detrimental effects if the procedure of colorectal endoscopy is undertaken. In the sample that had been diagnosed with rectal cancer, there are different conditions that are examined prior to recommendation of the colorectal endoscopy. In cases wherein there is predisposition of the Crohn's disease the procedure is not recommended. Another is the presence of ulcerative colitis and familial polyposis ("Role of endoscopy,"1995) Based on the results of the study then, the applicability of the colorectal endoscopy can be limited by the severity of the condition. In patients with the mentioned diseases but are not diagnosed with rectal or colon cancer, the procedure can be undertaken. The hindrance can be associated with the fact that the colorectal endoscopy procedure is one of the major procedures that can be undertaken. But it is important to consider that the procedure when done early, e.g. approximately 5 years prior to the onset of the disease ("Role of endoscopy,"1995) Alternative Procedures for Colonoscopy Aside from the fact that there are different risks that can be associated with the colorectal endoscopy procedure, alternative procedures can be presented for the patient. The physical examination and the chemical analysis of the composition of the fecal materials can be considered as important procedures of common application. On the other hand, the continuous research and development of different alternative procedures that can present choices for the patients and the medical advisers. Innovative screening procedures are being developed and studied in depth to be able to be introduced to the public for utilization. Included in such procedures are the use of molecular markers, high-resolution endoscopy, and virtual colonoscopy, also referred to as computed tomography or CT colonography. Also, continuous study of biomarkers presents potential for use in the said purpose. The said procedure can be considered similar in procedure as the Pap testing (Imperiale, Ransohoff, Itzkowitz, Turnbull & Ross, 2004). Such focus can be considered important due to the fact that colon cancer is one of the major types of cancer that affects the US, specifically second in rank, which has an average of 50 thousand mortalities each year (Imperiale, Ransohoff, Itzkowitz, Turnbull & Ross, 2004). Study of the Different Interventions In terms of the different procedures that are related to colorectal screening, the FOBT and the sigmoidoscopy are the most essential procedures. For FOBT, one of the possible ways of undertaking the procedure is through immunologic test on the basis of reverse passive hemoagglutination. The said procedure can be undertaken without preparation as compared to other tests, thus, it can be considered as a more convenient way of examination. Although the effects of the said procedure can be considered, integration of the different interventions is vital to the result of the screening and treatment (Segnan et al., 2005) Sigmoidoscopy on the other hand is consists of different procedures. Bowel preparation is required through enema prior to the procedure. Although this is the case, diet management and changes is not necessary. The procedure is undertaken through a gastroenterologist's command using a 140 cm colonoscope. There are related types of the endoscopy that are important on colorectal screening (Segnan et al., 2005). Sedation is also required in the colonoscopy process. It can be considered as a short procedure that can only last a few minutes. The length of the procedure though can be lengthened on the basis of the result of the study (Winawer, Stewart, Zauber, Bond, Ansel, Waye, Hall, Hamlin, Schapiro, O'Brien, Sternberg & Gottlieb, 2000). Issues Related to Flexible Sigmoidoscopy Flexible Sigmoidoscopy is a specific type of colorectal endoscopy that makes use of a slender, flexible, hollow, lighted tube as the main instrument of assessment. The instrument is entered through the rectum and observations can be undertaken in the said area. There are different issues that are related to the application. As mentioned the risks in complication that can be considered as the most disadvantageous issue. Aside from that preparation is required unlike other procedure (Winawer, Stewart, Zauber, Bond, Ansel, Waye, Hall, Hamlin, Schapiro, O'Brien, Sternberg & Gottlieb, 2000). Effective Management of Colorectal Endoscopy Service In terms of the establishment of Colorectal Endoscopy Service, effective management requires a holistic approach. This can be attributed to the fact that there are different aspects that are related to such endeavor. There are many subdivisions in the issue namely the medical and the technical aspect, the legal and also the economic aspects. The medical aspect can be related to the application of the system, thus professional are required, both health professionals and the personnel that can operate the system. Technical management on the other hand is related to the maintenance of the required facilities and instruments. Financial aspects and considerations of the service fee is also an important area that should be dealt with. Due to the fact that the service involved the health of the patients, research and development as well as assimilation of important and pertinent data related to the procedure is a vital area. These factors can be considered as an overview of the possible areas that are vital in managing a colorectal endoscopy service. There are more in depth issues that can be encountered upon the actual undertaking. A View on Endoscopy Modernization Plan by the DoH Modernization in the field of endoscopy can be considered as an indication of the continuing study and development of ways to improve the area. In relation to the multi-professional training, it is important to be able to acquire skills that are needed specifically when the procedure has been improved and the limitations have been lessened. It is important to provide trainings, even if it is multi-professional in nature. One concern in such undertaking though is the knowledge on the possible risks of the procedure. For a multi-professional training and performance, it is important that dangers are explicitly provided to the personnel that will conduct the procedure. In terms of the service provision, it is important to consider that the main issue is the health of the patient and the provision of the proper intervention. In relation to this condition then, concern for the patient is important. This can be attributed as one of the most essential platform of service. Proper knowledge, training and concern are vital to the quality of performance provided. In relation the equipments are also important. To generalize the situation then, the understanding and the delivery of service is essential to achieve success in the performance. Proper data are also vital to the health of the patient. Evaluation of the Role of Endoscopic Practitioner The endoscopic practitioner plays an important role in the success of the procedure. Due to the fact that the profession involves responsibility on the health and well being of the patient, the legal, ethical and multidisciplinary working aspects are involved. The legal aspect presents ways of protection for the patient. Also in cases wherein danger and risk can be considered high, legality serves as protection for the practitioner in terms of endangering the patients life, that to their consent. This is only an example of the application of the legal aspect. There are still other areas to consider. Ethical considerations are also essential. This aspect in fact is important in every field of discipline. This can be related to respect of the right and morale of the person. The area can be related to legal aspects and in terms of decision making regarding the welfare of the patient. Multidisciplinary working is important since health conditions are commonly affecting different areas of the body, thus cooperation is required and inputs from different specialists can be essential. References American Cancer Society (2007). National Colorectal Cancer Roundtable. ACS. Brenner, H., Chang-Claude, J., Seiler, C. M., Strmer, T. and Hoffmeister, M. (2007). Potential for Colorectal Cancer Prevention of Sigmoidoscopy Versus Colonoscopy: Population-Based Case Control Study. Cancer Epidemiology Biomarkers & Prevention, 2007 March 1, 16, 494-499. 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