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Colonoscopy versus double-contrast barium enema for surveillance after polypectomy
Whole Grain Consumption and lschemic Stroke
traepithelial neoplasia grade 2-3 using risk assessment and human papillomavirus testing in women with atypia on Papanicolaou smears. Obstet Gynecol 2000;96: 410-6.
Synopsis: This study was undertaken to study the ability of human papillomavirus (HPV) testing and risk assessment to predict CIN 2-3 on biopsy. Women in the study had atypia on Papanicolaou smears and were referred for colposcopic examination. There were 195 women who consented to participate. The diagnosis of CIN was made in 70 of the 195 women. Of this number, 55 (28.2%) had CIN 1 and 15 (7.7%) had CIN 2 or 3. High-risk HPV types were found in 31.3% of the subjects. CIN 2-3 was associated only with detection of high-risk HPV. They concluded that HPV testing of patients with abnormal cytology would result in only 31% of patients being referred for colposcopy. (Level 11-2)
. . *
Commentary: Cost-effective medicine has become an important aspect of all medical care in this managed care environment. Colposcopic examination with biopsy is a procedure that some third party payers are reluctant to reimburse, unless there has been careful reevaluation. This study was designed to show that HPV evaluation before referral for colposcopy could reduce the cost. The big question in this study is whether their calculations of cost are accurate and whether the use of prior HPV testing is valid as a screening procedure. If we accept their data, the answer is yes. However, this study must be better controlled and performed prospectively with a large group of women who come for screening. The real value of this study is that it again identifies the relationship of HPV to abnormal cytologic findings. The article by Elfgren reviewed in this issue of ACOG Clinical Review about HPV has shown that spontaneous resolution can occur. This information is not available in this study and adds a parameter that should be considered.
Ralph
W. Hale,
MD
Editor
Colonoscopy Versus Double-Contrast Barium Enema for Surveillance After Polypectomy Winawer SJ, Stewart ET, Zauber AC;, Bond JH, Ansel H, Waye JD, et al, for the National Polyp Study Work Group. A comparison of colonoscopy and double-contrast barium enema for surveillance after polypectomy. N Engl J Med 2000:342:1766-72.
Synopsis: This is a report from the National Polyp Study Work Croup. This randomized, controlled trial was designed to evaluate the diagnostic modalities of colonoscopy and barium enema in patients after a polypectomy for an adenoma. There were seven participating clinical centers. A total of 862 paired colonoscopy and barium enema procedures were carried out. In the comparison of findings, the authors concluded that colonoscopic examination was more effective as a surveillance method.
. . * Commentary: Colonoscopy is an important diagnostic procedure that has gradually been replacing barium enema as a tool for identification of polyps. This blinded, prospective, randomized, controlled evaluation of the two methods showed colonoscopy to find more polyps than double-contrast barium enema in patients with a prior polypectomy. The authors asked the important question as to whether the polyps missed on barium enema (usually smaller) are clinically significant. This is an important question because polyps have a slow growth, but it was not answered in this study. The other question that is important 1s the skill of the colonoscopist. In this study, all were experienced, skilled examiners. Would the results have been the same if the colonoscopists had had less experience? Only time will tell.
Liu S. Manson JE. Stampfer MJ, Rextode KM. Hu FB. Rimm EB, et al. Whole grain consumption and risk of ischemic. stroke in women. JAMA 2000;284:1534--40.
Synopsis: This prospective cohort study included 75,521 women who were 38 to 63 years of age. Patients with diabetes mellitus, coronary heart disease, stroke. or other cardiovascular disease were excluded. The study used a questionnaire and was part of the Nurses’ Health Study. The goal was to evaluate the role of whole grain intake in relation to risk of ischcmic stroke in an attempt to determine if higher levels had a beneficial effect. There were 352 confirmed ischemic strokes in these women in the 861,900 patient years of the study. 111 the statistical analysis, there was an inverse relationship between whole grain intake and ischemic stroke. Smoking appeared to attenuate the relationship, whereas fatty acid intake or lack ofexercise had no effect. Thus, they concluded that higher intake of whole grain foods is beneficial. (l,evel 11-2)
. . *
Commentary: This is another report based on the findings associated with the Nurses’ Health Study. Because of the large numbers in the study, there is validity to these data and subsequent conclusions. However, any study that is based on a questionnaire that uses recall as the main modality is subject to question. This report is no exception, although other aspects of this study have been shown to be valid when prospective controlled studies have been Confirmatory. Despite these concerns with the format, this study again points out the benefits of whole grain products. Other reports also emphasize the benefits to the gastrointestinal tract and cardiovascular system. As we become well versed in the role of nutrition in health. we will continue to see benefits from dietary changes. What that will contribute to the overall health of our nation is still subject to speculation.
traepithelial neoplasia grade 2-3 using risk assessment and human papillomavirus testing in women with atypia on Papanicolaou smears. Obstet Gynecol 2000;96: 410-6.
Synopsis: This study was undertaken to study the ability of human papillomavirus (HPV) testing and risk assessment to predict CIN 2-3 on biopsy. Women in the study had atypia on Papanicolaou smears and were referred for colposcopic examination. There were 195 women who consented to participate. The diagnosis of CIN was made in 70 of the 195 women. Of this number, 55 (28.2%) had CIN 1 and 15 (7.7%) had CIN 2 or 3. High-risk HPV types were found in 31.3% of the subjects. CIN 2-3 was associated only with detection of high-risk HPV. They concluded that HPV testing of patients with abnormal cytology would result in only 31% of patients being referred for colposcopy. (Level 11-2)
. . *
Commentary: Cost-effective medicine has become an important aspect of all medical care in this managed care environment. Colposcopic examination with biopsy is a procedure that some third party payers are reluctant to reimburse, unless there has been careful reevaluation. This study was designed to show that HPV evaluation before referral for colposcopy could reduce the cost. The big question in this study is whether their calculations of cost are accurate and whether the use of prior HPV testing is valid as a screening procedure. If we accept their data, the answer is yes. However, this study must be better controlled and performed prospectively with a large group of women who come for screening. The real value of this study is that it again identifies the relationship of HPV to abnormal cytologic findings. The article by Elfgren reviewed in this issue of ACOG Clinical Review about HPV has shown that spontaneous resolution can occur. This information is not available in this study and adds a parameter that should be considered.
Ralph
W. Hale,
MD
Editor
Colonoscopy Versus Double-Contrast Barium Enema for Surveillance After Polypectomy Winawer SJ, Stewart ET, Zauber AC;, Bond JH, Ansel H, Waye JD, et al, for the National Polyp Study Work Group. A comparison of colonoscopy and double-contrast barium enema for surveillance after polypectomy. N Engl J Med 2000:342:1766-72.
Synopsis: This is a report from the National Polyp Study Work Croup. This randomized, controlled trial was designed to evaluate the diagnostic modalities of colonoscopy and barium enema in patients after a polypectomy for an adenoma. There were seven participating clinical centers. A total of 862 paired colonoscopy and barium enema procedures were carried out. In the comparison of findings, the authors concluded that colonoscopic examination was more effective as a surveillance method.
. . * Commentary: Colonoscopy is an important diagnostic procedure that has gradually been replacing barium enema as a tool for identification of polyps. This blinded, prospective, randomized, controlled evaluation of the two methods showed colonoscopy to find more polyps than double-contrast barium enema in patients with a prior polypectomy. The authors asked the important question as to whether the polyps missed on barium enema (usually smaller) are clinically significant. This is an important question because polyps have a slow growth, but it was not answered in this study. The other question that is important 1s the skill of the colonoscopist. In this study, all were experienced, skilled examiners. Would the results have been the same if the colonoscopists had had less experience? Only time will tell.
Liu S. Manson JE. Stampfer MJ, Rextode KM. Hu FB. Rimm EB, et al. Whole grain consumption and risk of ischemic. stroke in women. JAMA 2000;284:1534--40.
Synopsis: This prospective cohort study included 75,521 women who were 38 to 63 years of age. Patients with diabetes mellitus, coronary heart disease, stroke. or other cardiovascular disease were excluded. The study used a questionnaire and was part of the Nurses’ Health Study. The goal was to evaluate the role of whole grain intake in relation to risk of ischcmic stroke in an attempt to determine if higher levels had a beneficial effect. There were 352 confirmed ischemic strokes in these women in the 861,900 patient years of the study. 111 the statistical analysis, there was an inverse relationship between whole grain intake and ischemic stroke. Smoking appeared to attenuate the relationship, whereas fatty acid intake or lack ofexercise had no effect. Thus, they concluded that higher intake of whole grain foods is beneficial. (l,evel 11-2)
. . *
Commentary: This is another report based on the findings associated with the Nurses’ Health Study. Because of the large numbers in the study, there is validity to these data and subsequent conclusions. However, any study that is based on a questionnaire that uses recall as the main modality is subject to question. This report is no exception, although other aspects of this study have been shown to be valid when prospective controlled studies have been Confirmatory. Despite these concerns with the format, this study again points out the benefits of whole grain products. Other reports also emphasize the benefits to the gastrointestinal tract and cardiovascular system. As we become well versed in the role of nutrition in health. we will continue to see benefits from dietary changes. What that will contribute to the overall health of our nation is still subject to speculation.