Dial behind esophageal cancer screening: internists

By Genevra Pittman

Mon Dec 3, 2012 5:00pm EST

NEW YORK (Reuters Health) – A organisation of U.S. inner medicine doctors currently endorsed tying esophageal cancer screening to people with ongoing heartburn who have additional, some-more critical symptoms.

Known as top endoscopy, a screening procession is mostly used to diagnose and conduct gastroesophageal reflux illness (GERD) – that can be tied to a aloft risk of esophageal cancer.

But some of that use might be unnecessary, a American College of Physicians (ACP) pronounced – adding costs and putting patients during risk of side effects though justification of a transparent benefit.

“Not each studious with GERD who comes in should be removing this procession done,” pronounced Dr. Amir Qaseem, ACP’s executive of clinical policy, who co-wrote a guidelines.

“It’s a low-risk procedure, though each procession carries risk of complications,” he told Reuters Health.

During an top endoscopy, a alloy inserts a stretchable tube with a camera, called an endoscope, into a mouth and down a throat. Some patients accept anesthesia beforehand.

Earlier this year, a Reuters Health news suggested another form of screening, transnasal esophagoscopy, is apropos increasingly renouned notwithstanding a miss of justification it lowers a risk of failing from esophageal cancer (see Reuters Health story of Apr 20, 2012: reut.rs/I3mkij).

One in 125 organisation and one in 400 women in a United States will get esophageal cancer in their lifetime, according to a American Cancer Society, and many people who are diagnosed with a illness die within 5 years.

But there’s no justification that normal top endoscopy lowers those risks either, according to a ACP’s Clinical Guidelines Committee.

The organisation laid out recommendations for use of a procession in people with GERD on Monday in a Annals of Internal Medicine.

Most people with GERD, including patients with heartburn and regurgitation, should start diagnosis with acid-suppressing drugs and usually bear endoscopy if remedy doesn’t assistance them, a cabinet said. People with some-more critical symptoms, such as draining and visit vomiting, can go true to endoscopy to order out some-more critical conditions – though screening shouldn’t be frequently steady if a initial exam is negative.

In a box of Barrett’s esophagus, in that a esophageal backing is shop-worn by stomach acid, patients with no signs of cancer shouldn’t be screened some-more than once each 3 years, according to a guidelines.


Even among many people with Barrett’s, a risk of cancer is utterly low, according to Dr. Lauren Gerson, a gastroenterologist during Stanford University in California who wasn’t concerned in a new study.

“Use of top endoscopy over a indications listed here is expected to beget nonessential costs and display patients to risks though improving clinical outcomes,” a cabinet wrote.

In particular, a ACP does not suggest slight screening for women or adults younger than 50, since their risk of esophageal cancer is most revoke than that of comparison men.

An top endoscopy costs some-more than $800. Rare side effects embody esophageal perforation, pneumonia and respirating problems. False positives could also lead to some-more nonessential tests and procedures with their possess set of side effects, Qaseem said.

Although a new discipline are destined during physicians, Qaseem pronounced it’s also critical for patients to know a advantages and stipulations of esophageal cancer screening. And people shouldn’t be fearful to ask their doctors because they’re grouping an endoscopy and either it’s unequivocally necessary, he said.

Most cases of GERD, Qaseem added, will not be dangerous and can get improved with lifestyle changes, such as weight loss.

“There is justification that losing weight is effective, not eating late during night is effective, and so-forth,” Gerson told Reuters Health.

“That’s a initial recommendation to patients, to try to make lifestyle changes to revoke their GERD symptoms and try to get off medications, if possible.”

SOURCE: bit.ly/R1w1Xu Annals of Internal Medicine, online Dec 3, 2012.

Source: Health Medicine Network