Updated Guidelines From GI Societies

Updated Guidelines From GI Societies

Updated ACS guidelines on colorectal cancer screening (May 2018)

The American Cancer Society (ACS) has updated its colorectal cancer (CRC) screening guidelines [2]. On the basis of an apparent increase in the incidence of CRC in younger adults, the ACS guidelines now make a “qualified” recommendation to begin screening persons at average risk for CRC at age 45 years, with a strong recommendation to screen at age 50 years and above. The guidelines also now offer six testing options to select among: colonoscopy every 10 years, computed tomographic colonography (CTC) every five years, sigmoidoscopy every five years, take-home high-sensitivity guaiac-based fecal occult blood testing yearly, take-home fecal immunochemical testing (FIT) yearly, and multitargeted stool-DNA test every three years, noting that any positive result on a non-colonoscopy test should be followed up with timely colonoscopy. In including more tests, rather than prioritizing tests that could detect both polyps and cancer, the ACS notes that screening with a test acceptable to the patient is preferable to the patient declining screening. For average-risk patients, and in keeping with most guidelines, we continue to initiate screening starting at age 50 years. We prefer colonoscopy when possible, and FIT or CTC if the patient cannot or will not have colonoscopy.

Hemostatic nanopowder approved for use in gastrointestinal bleeding (July 2018)

Hemostatic nanopowder can be used to treat bleeding in the gastrointestinal tract due to lesions such as ulcers and tumors. It is sprayed onto a bleeding site under endoscopic guidance and forms a stable mechanical barrier at the site of bleeding. In prior reports, success rates for achieving initial hemostasis in patients with nonvariceal upper gastrointestinal bleeding are 75 to 100 percent, with rebleeding rates of 10 to 49 percent. In May 2018, Hemospray, a hemostatic nanopowder, was approved as a device by the US Food and Drug Administration (FDA) [5]. The data submitted to the FDA showed hemostasis on index endoscopy in 97.8 percent of 750 patients, with an overall rebleeding rate of 10.2 percent [6]. In patients with bleeding peptic ulcers, hemostatic sprays may be particularly helpful when a temporizing measure is needed to stabilize a patient pending definitive therapy or when traditional endoscopic techniques fail to control massive bleeding.

Revised diagnostic criteria for eosinophilic esophagitis (July 2018)

The 2018 Appraisal of Guidelines for Research and Evaluation (AGREE) conference has published new consensus criteria for the diagnosis of eosinophilic esophagitis [7]. The diagnosis of eosinophilic esophagitis requires symptoms of esophageal dysfunction, at least 15 eosinophils per high-power field on esophageal biopsy, and exclusion of other causes that may be responsible for or contributing to symptoms and esophageal eosinophilia. In contrast to prior guidelines, persistence of mucosal eosinophilia in the esophagus after two months of treatment with a proton pump inhibitor (PPI) is no longer a diagnostic criterion for eosinophilic esophagitis. The rationale for exclusion of a PPI trial is that patients with eosinophilic esophagitis who are PPI-responsive do not appear to be clinically distinct from patients who are not PPI-responsive, and their management should not differ.

AGA guidelines on acute pancreatitis (April 2018)

The American Gastroenterological Association (AGA) updated its guidelines on the management of acute pancreatitis [14]. They recommend goal-directed therapy for fluid management and advise against the use of hydroxyethyl starch-containing fluids. Prophylactic antibiotics should also be avoided. The guidelines also recommend early oral feeding and the use of enteral feeding rather than parenteral nutrition in patients who are unable to tolerate an oral diet.




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