Future of GI?

[Gastrapathy]

Did you read the paper? They randomized people by their trial design to ensure 8 to 2.5 to 1 so the "outcome" of the ratio was not relevant. Then they compared a SINGLE FIT to CTC. FIT has never worked as a single test and they know it will perform poorly. There was no statistical difference between colonoscopy and CTC despite higher detection rates with colonoscopy because they only did 150 colonoscopies (a screening study with 150 colos? thats just lazy). Advanced neoplasia is detected in as more like 10-12% of colonoscopies in the larger better studies. Other than the initial papers, I've yet to see a CTC paper that wasn't designed to get the desired outcome. You can almost hear the evil laughter as they figure out the desired outcome and work backwards. Once again, find me the paper that shows that CTC prevents cancer death. Otherwise you should post your crap research in the radiology forum.

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[Successor12]

How is the life style for GI like ? people keep saying its a life style friendly specialty , how true is that for both fellowship and then for practice in both settings private and academic?

 

[gutonc]

How is the life style for GI like ? people keep saying its a life style friendly specialty , how true is that for both fellowship and then for practice in both settings private and academic?

Who says that? Trauma surgeons?

 

[Successor12]

I have been under the impression that people get into GI for money and lifestyle, am a third year resident so I work in a university hospital where surgery tends to do the emergent EGDs, however am not sure if that is a true reflection of GI lifestyle

 

[PlutoBoy]

I have been under the impression that people get into GI for money and lifestyle, am a third year resident so I work in a university hospital where surgery tends to do the emergent EGDs, however am not sure if that is a true reflection of GI lifestyle

It's pretty sweet. If the patient has a severe GI bleed at 1:00 AM then you get to say that they are too unstable to scope and go back to sleep and you punt the procedure to 10:00 AM after the intensivist is forced to come in to stabilize the patient for you.

If the bleed is not bad enough then you get to say that they are stable and can wait until the morning.

Either way, you always win.

 

[BeardedRunner]

What about stool DNA test replacing screening colonoscopy?

 

[nycscope]

What about stool DNA test replacing screening colonoscopy?

Replacing? No way. Colonoscopy will continue to be the gold standard and discerning patients will opt for it. Otherwise, if you get a "positive" test, guess what they need anyway.

 

[Gastrapathy]

I don't think GI is a lifestyle specialty. Small groups can be pretty call intensive. Pay is good enough for people to work part time but a full time GI works pretty hard.

As for surgeons doing the urgent scopes, that is not the norm anywhere I've ever seen. Most places they have no role in therapeutic endoscopy.

Screening tests increase colo usage because positive tests lead to colo.

We get lots of nighttime calls and I go in at night about 1 night in 10 for food impactions or severe bleeders.

 

[Successor12]

I don't think GI is a lifestyle specialty. Small groups can be pretty call intensive. Pay is good enough for people to work part time but a full time GI works pretty hard.

As for surgeons doing the urgent scopes, that is not the norm anywhere I've ever seen. Most places they have no role in therapeutic endoscopy.

Screening tests increase colo usage because positive tests lead to colo.

We get lots of nighttime calls and I go in at night about 1 night in 10 for food impactions or severe bleeders.

thanks for the reply, would you mind sharing what is the expected pay and hours for someone who is a part time?

 

[Gastrapathy]

thanks for the reply, would you mind sharing what is the expected pay and hours for someone who is a part time?

Too many variables.

 

[Taurus]

http://www.auntminnie.com/index.aspx?sec=sup&sub=cto&pag=dis&itemid=114461

June 15, 2016 -- In a decision long-awaited by CT colonography (CTC) advocates, the U.S. Preventive Services Task Force (USPSTF) has finally deemed the modality to be an acceptable option for colorectal cancer screening. The determination paves the way for Medicare reimbursement and broader coverage by private payors.

 

[bronx43]

http://www.auntminnie.com/index.aspx?sec=sup&sub=cto&pag=dis&itemid=114461

June 15, 2016 -- In a decision long-awaited by CT colonography (CTC) advocates, the U.S. Preventive Services Task Force (USPSTF) has finally deemed the modality to be an acceptable option for colorectal cancer screening. The determination paves the way for Medicare reimbursement and broader coverage by private payors.

So the question is what percentage of people undergoing CT colonography will have polyps detected? Now that the DREADED colonoscopy can be replaced by a simple CT, you would have to assume that more people are going to go for screening. And if a large enough percentage of people have detectable polyps, then the overall volume of colonoscopies may not actually change by much.

 

[gutonc]

So the question is what percentage of people undergoing CT colonography will have polyps detected? Now that the DREADED colonoscopy can be replaced by a simple CT, you would have to assume that more people are going to go for screening. And if a large enough percentage of people have detectable polyps, then the overall volume of colonoscopies may not actually change by much.

I think FIT and ColoGuard will likely have a bigger impact on screening colo numbers that CT colonography will. Once people hear that they still need to do the bowel prep, and get CO2 blown up their butts for a CT colo, and then do it all over again if there's a polyp...well, why not just do it once and get it over with?

 

[Taurus]

I think the best protocol for patients is first get VC + stool test. If abnormal, get OC. With VC, get bowel prep but no sedation and maybe not even missing work. 15-30 minutes the entire exam hopefully. No sticking a tube up my butt. They will continue to refine the VC protocol and it will get better and better. I think those factors will really drive up demand for VC.

So yeah, we probably have peaked in terms of volume for screening OC. Diagnostic OC volume should go up. Maybe a wash in the end if total number of people screened increases.

For every 100 people screened with VC or stool test, how many will result in OC? That is the big question. OC volume will stay flat or go up only if total screening by all methods increases. If total screening stays flat, then OC volume will drop as people migrate to VC and stool tests since the USPTF did not give preference to any one test.

 

[Taurus]

I think FIT and ColoGuard will likely have a bigger impact on screening colo numbers that CT colonography will. Once people hear that they still need to do the bowel prep, and get CO2 blown up their butts for a CT colo, and then do it all over again if there's a polyp...well, why not just do it once and get it over with?

Because don't want to get sedated. Don't want to get long tube stuck up my butt.

Here's a true story. My father last year had an OC. That night, he was still having effects from the sedation and was sleep walking. Fell down the stairs and broke his neck. Luckily, he wasn't paralyzed. I think you underestimate these two factors. If they weren't such a big deal, how come only a fraction of eligible people get OC screening? That's why the USPTF changed their guidelines to include more tests and not give a preference to one. Get more people screened. VC now has grade "A" like OC.

 

[Brahnold Bloodaxe]

Is polyp excision typically performed at the same time as the diagnostic colonoscopy? If so, then between the radiation exposure from the CT and the likelihood that any adverse findings would result in having to come back for endoscopy anyway, I'd think many people would just prefer to have their analysis (heh) done in one sitting and be done with it, even at the cost of being butthumped.