Thanks for opening the year-end edition of the CRH “Banding Bulletin”! As 2013 comes to a close, we’d like to announce a few enhancements that will be instituted in our training and support programs, and see how we might better be able to support you and your practice in the New Year. We’ve also added a computer-generated, “3-D” simulation of our procedure in order to help you moving forward!
We are very excited to announce some new enhancements to our current training and support programs. These changes are being implemented in order to improve our service offerings and to assure that our Partners are able to provide the finest possible care to their patients. The addition of Mr. Allen Hansard (Clinical Specialist) to our traveling training team will now allow us to offer 3 levels of training and support in the future!
• Initial training session: CRH will continue to offer a comprehensive training session at your practice, featuring an hour-long didactic presentation covering the care of hemorrhoids, fissures and other anorectal disorders, followed by a “hands-on” banding session. These sessions will be led by a Board Certified Surgeon, and the session will be offered at no cost. The key to having a successful training session is to have a sufficient number of patients present for that banding session, and your account manager will work with you in order to help coordinate efforts in advance of these sessions.
• “Follow-up session: The typical patient requires 3 treatments (1 for each hemorrhoid) at 2 to 3 week intervals. After the completion of an initial training, CRH will work with you to have Allen, Andy Gorchynsky or me there for the patients’ second banding in order to help cement the techniques which have been demonstrated, as well as to address any questions that might have come up.
• “Advanced” training sessions: These sessions generally take place a couple of months after the initial visits, and are offered to those that would like a bit of a “refresher”, to address any questions that may have popped up, to further discuss other anorectal issues that your patients may present with, etc. We are always happy to include any of your partners, midlevels, MA’s or other office staff in these sessions to make certain that every member of your team is more comfortable dealing with your anorectal patients!
All three levels of training sessions will continue to be offered at no cost — our only request is that you have a sufficient number of patients scheduled for a given session, in order to ensure that you receive the maximum benefit from them!
Colonoscopy has long been the “gold standard” in the detection of lesions and other abnormalities in the bulk of the rectum and the entirety of the colon. Unfortunately, it does a very poor job of evaluating the region of the anus! This was demonstrated in a wonderful piece published in 1986 by Kelly utilizing a series of 115 consecutive patients with perianal issues. In this prospective study, anoscopy identified 99% of the issues, while straight withdrawal of the scope and retroflexion identified only 78% and 54% respectively!(1). Colonoscopy, especially when in retroflexion, is a crummy way to evaluate the perianal area!!!
There are some maneuvers that can be used in an effort to increase the clinical yield of colonoscopy in your patients, but ANOSCOPY is the “gold standard” in the evaluation of these patients! The procedure takes a minute or so to perform, is very inexpensive, can be performed without sedation or preparation, and can yield a wealth of information!! In my own practice, I have seen innumerable patients with hemorrhoidal symptoms who report that they had just had a colonoscopy and “didn’t even have hemorrhoids”. Anoscopic examination would often demonstrate significant hemorrhoidal disease in these patients (who were very grateful for the help that RBL using the CRH O’Regan System was able to offer).
CRH has developed a brief 3-D animation video demonstrating some of these points (along with a step by step guide to the procedure itself) which can be found at https://physicians.crhsystem.com/practice-support/videos/. Please have a look, and let us know if you have any questions or comments. Also, if you’d like more information in regard to anoscopy as a part of your practice, please contact ME.
(1) Kelly SM, Sanowski RA, Foutch PG, et al. A prospective comparison of anoscopy and fiberendoscopy in detecting anal lesions. J Clin Gastroenterol 1986;8:658–660.
Please contact SHAUN GERRITS or ME if you have any interest in being trained in the use of the CRH O’Regan System. We generally are booking out 6 weeks or so, and we’ll be very happy to get you on our calendar. For those of you who are GI Fellows, or for those who participate in one of the various “Gut Clubs” around the country, we are also happy to make a “Grand Rounds”-type presentation which discusses the nonsurgical care of anorectal disease. We present this in a very non-proprietary manner, and we’ve given similar presentations at CME-granting venues in the past. Please let ME know if you have any interest in this, and we’ll get you on our calendar.
We will be attending the NYSGE meeting in New York later this week as well as the AGA Clinical Congress of Gastroenterology and Hepatology in Miami Beach, FL in mid-January. If you are attending either, please come by and say “hello”!!
We’d like to close this Bulletin by wishing you and yours the happiest of Holiday Seasons, and a healthy, happy, prosperous New Year! Thanks to everyone for their continued support, and we hope to hear from you soon.
Mitchel Guttenplan, MD, FACS
CRH Medical Corporation
C: 770.363.0125 F: 770.475.9953