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ASGE Journal Scan | Kolon

Practice Patterns for Stopping Surveillance in Older Patients Are Highly Variable Among Endoscopists

The U.S. Multi-Society Task Force on Colorectal Cancer recommends individualizing the decision to stop surveillance colonoscopy in patients aged 75 years and older.  This is

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ASGE Journal Scan | Kolon

Randomized Controlled Trial in Patients With Failed Bowel Preparation

When a patient is compliant with bowel preparation instructions, but the preparation is inadequate, there are little data from controlled trials to guide the bowel

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ASGE Journal Scan | Kolon

Artificial Intelligence Improves Detection, Regardless of Endoscopist Experience

Five randomized controlled trials (4 from China and 1 from Europe and the U.S.) have demonstrated that artificial intelligence (AI) increases the adenoma detection rate

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Strong Evidence That Long-Term Proton Pump Inhibitor Use Increases Colorectal Cancer Risk

Data vary regarding whether hypergastrinemia and proton pump inhibitor (PPI) use increase adenoma progression and risk of colorectal cancer (CRC).  The current study from the

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Amoxicillin-Clavulanate Favored Over Fluoroquinolone-Metronidazole for Outpatient Diverticulitis

A combination of fluoroquinolone (ciprofloxacin, levofloxacin) and metronidazole is the most commonly used antibiotic treatment for outpatient diverticulitis. However, the U.S. Food and Drug Administration

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ASGE Journal Scan | Kolon

Average U.S. Adenoma Detection Rate Hits 40%

Currently recommended minimum thresholds for adenoma detection rates (ADRs), defined as the fraction of patients undergoing first-time screening colonoscopy who have one or more conventional

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Skinny Scopes Better for Women Requesting Unsedated Colonoscopy

On average, colonoscope insertion is considered more difficult in women than men, and most colonoscopists meet patients, including women, who request an attempt at unsedated

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ASGE Journal Scan | Kolon

Is Leaving the Rectum in Place in Familial Adenomatous Polyposis Still Okay?

In this study from a French hospital, 296 patients with familial adenomatous polyposis (FAP) underwent either proctocolectomy with ileoanal anastomosis (IAA; 31.1%) or abdominal colectomy

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Microbiome Predicts Metachronous Colorectal Adenomas

This Chinese study examined 367 patients in a retrospective cohort and 238 in a prospective group for the amount of fecal Fusobacterium nucleatum, quantitated by

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ASGE Journal Scan | Kolon

Estimating Cancer Risk in Serrated Polyposis Syndrome

In a meta-analysis involving 36 studies and 2788 patients with serrated polyposis syndrome (SPS), the overall risk of colorectal cancer (CRC) was 19.9%. However, most

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Colorectal Cancer Rates Increasing in Younger People Since 1980: What About Before Then?

Many U.S. cancer registries extend back to only a few years before cancer incidence in younger people began to rise, but the Connecticut Tumor Registry

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ASGE Journal Scan | Kolon

New European Society of Gastrointestinal Endoscopy Guideline on Acute Lower GI Bleeding

These are highlights of the European Society of Gastrointestinal Endoscopy’s new guideline on the diagnosis and management of acute lower GI bleeding: In cases of

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ASGE Journal Scan | Kolon

Predicting Recurrence After Cold Endoscopic Mucosal Resection

Cold EMR is increasingly popular because of its low risk of complications. However, there do seem to be more recurrences after cold EMR.  In a

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ASGE Journal Scan | Kolon

Turn up the Lights During Colonoscopy

Traditionally, room lights are turned down quite low during endoscopy. In a single-center retrospective study, 498 colonoscopies were performed by 9 gastroenterologists in low light

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ASGE Journal Scan | Kolon

How Things Have Changed: Management of Colonoscopic Perforations

Fifteen years ago, tools to close acute perforations during colonoscopy became available, beginning with hemostatic clips, followed by over-the-scope clips and suturing.  To examine the

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ASGE Journal Scan | Kolon

Updated Colorectal Cancer Screening Recommendations From the U.S. Preventive Services Task Force: Some of the Details

The U.S. Preventive Services Task Force (USPSTF) recommendations are key for screening because they influence the policies of the Centers for Medicare and Medicaid Services

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ASGE Journal Scan | Kolon

Cancer Can Be Accurately Predicted Endoscopically in Flat Colorectal Lesions; Nodular and Bulky Lesions, Not so Much

Before endoscopic resection, large nonpedunculated colorectal lesions should be thoroughly inspected for evidence of submucosal invasive cancer (SMIC). The features to look for are disruption

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ASGE Journal Scan | Kolon

Surgery for Benign Colorectal Polyps

This report from the U.S. evaluated 144 patients undergoing surgical resection for benign colorectal polyps. There were 118 referred patients without an attempt at endoscopic

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Does Endoscopic Resection of High-Risk T1 Colorectal Cancer Cause Adverse Oncologic Outcomes?

High-risk T1 colorectal cancer means there are adverse histologic features associated with an increased risk of lymph node metastases (LNM). The features are typically deep

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ASGE Journal Scan | Kolon

Ileocecal Valve Lesions No Longer Defy Endoscopic Resection

Laterally spreading lesions on the ileocecal valve (ICV) have traditionally been among the most challenging to resect endoscopically, and some centers refer them for surgical

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Stalk Injection and Prophylactic Clipping of Pedunculated Polyps Increase Delayed Bleeding

In this Japanese study from 5 institutions, 1147 pedunculated (stalk length of ≥5 mm) colorectal polyps were evaluated for predictors of immediate bleeding after being

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Up to 4% of Colorectal Cancers Have Unexplained Positive Immunohistochemistry

Universal screening of colorectal cancers (CRCs) is recommended to increase the diagnosis of Lynch syndrome. Tumor screening can be done by microsatellite instability (MSI) testing,

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Colonoscopy More Effective Than the Fecal Immunochemical Test in Case-Control Study

Randomized controlled trials comparing the use of colonoscopy to the fecal immunochemical test (FIT) for colorectal cancer (CRC) screening are underway.   A case-control study from

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ASGE Journal Scan | Kolon

Using Family History to Guide Surveillance of “Other” Cancers in Lynch Syndrome: Does That Work?

The “other” cancers in Lynch syndrome include small-bowel, pancreatobiliary, urinary tract, and brain cancers, as well as sebaceous neoplasms. Routine screening for many of these

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ASGE Journal Scan | Kolon

Germline Testing for Cancer Genes in Everyone With Colorectal Cancer?

Current guidelines recommend universal screening of patients with newly diagnosed colorectal cancer (CRC) for tumor features of Lynch syndrome. This is usually done by immunohistocompatibility

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New Test for “Leaky Gut” Proposed

We often hear about the idea of “leaky gut,” which refers to intestinal permeability resulting from medications or certain diets, and that this condition may

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What Is the Prevalence of Sessile Serrated Lesions Anyway?

In a systematic review and meta-analysis of 280,370 screening colonoscopies in the literature, the pooled prevalence of sessile serrated lesion (SSL) detection was 2.5%. The

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Liquid Biopsy Assay Predicts Lymph Node Metastases in T1 Colorectal Cancer

When patients have T1 colorectal cancer (CRC) resected, histologic features, such as deep submucosal invasion, poor differentiation, lymphovascular invasion, and high-grade tumor budding, are used

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ASGE Journal Scan | Kolon

Tattoos Claimed Unnecessary for Finding EMR Scars

Referring physicians sometimes tattoo large nonpedunculated lesions before referral, and resectionists sometimes tattoo the resection site for easy identification of the scar later. Neither practice

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ASGE Journal Scan | Kolon

Modeling Suggests Later Starting Age and 3-Year Intervals for Colonoscopy in MSH6 and PMS2

Lynch syndrome is associated with increased cancer risk, particularly in the colorectum, as a result of germline mutations in any of 4 mismatch repair genes

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Cold EMR for Large Nonpedunculated Colon Polyps Dominates Hot EMR in Cost-Effectiveness Analysis

Cold EMR is becoming increasingly popular for large nonpedunculated colorectal lesions, particularly sessile lesions and adenomas without major 1s or pseudodepressed components. These researchers performed

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Multicenter International Study Confirms That Snare-Tip Soft Coagulation of EMR Margin Dramatically Lowers Recurrence Rate

A previous randomized controlled trial showed that thermal ablation of a normal-appearing EMR margin after complete polyp resection reduced the recurrence rate from 21% to

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ASGE Journal Scan | Kolon

Bad Outcomes for Patients Not Undergoing Colonoscopy After Positive Fecal Immunochemical Test

In an Italian study using a fecal immunochemical test (FIT)-positivity cutoff of 20 µg Hb/g feces, 88,013 FIT-positive patients (79%) underwent colonoscopy, and 23,410 (21%)

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ASGE Journal Scan | Kolon

Don’t Refer Large Nonpedunculated Colorectal Lesions to Surgeons After Failed EMR Attempts

In clinical practice, colonoscopists sometimes think that patients with large nonpedunculated colorectal lesions should be referred to surgery after one or two attempts at resection

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Adherence To Colonoscopy After Positive Fecal Immunochemical Testing Is Related To Patient Navigation and Distance From Center

In a comparison of colonoscopy adherence after positive fecal immunochemical testing (FIT) in 2017 without patient navigation (PN) versus 2018 with navigation, overall completion of

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ASGE Journal Scan | Kolon

Selective Serotonin Reuptake Inhibitors Reduce Colorectal Cancer Risk, and the Effect Is Additive to Aspirin

In a nationwide Swedish registry study, 24,786 colorectal cancer (CRC) cases and 74,358 randomly matched controls for birth year and sex were evaluated to determine

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Brits Evaluate Their New Postpolypectomy Surveillance Guidelines

The UK revised its postpolypectomy surveillance guidelines to reduce the use of surveillance colonoscopy. According to the guidelines, patients considered to be high risk for

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ASGE Journal Scan | Kolon

“Step-Clipping” Technique Reported as Effective for Endoscopic Localization of Colonic Diverticular Bleed

Colonic diverticular bleeding (CDB) often stops spontaneously, and a meticulous colonoscopic search of the colon for the bleeding diverticulum is often unsuccessful. The “step-clipping” method

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ASGE Journal Scan | Kolon

Individual Patient Data Meta-Analysis of Randomized Trials Fails To Show Benefit of Chromoendoscopy in Lynch Syndrome

An individual patient data meta-analysis, which was performed for this study, utilizes the individual data from separate studies rather than summary data. However, this study

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ASGE Journal Scan | Kolon

Want To Take Out Polyps in Anticoagulated Patients? New Data Indicate Apixaban Is the Drug To Be On

This retrospective cohort study evaluated postpolypectomy bleeding and thromboembolism risks with warfarin, apixaban, dabigatran, and rivaroxaban use in Hong Kong public hospitals between January 2012

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ASGE Journal Scan | Kolon

Three Minutes of Verbal Instructions Improved Bowel Preparation in Mobile Inpatients

Clinicians everywhere struggle with colonoscopy bowel preparation in inpatients. In a randomized trial performed in 4 cities, 300 patients (180 mobile and 120 bedridden) received

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ASGE Journal Scan | Kolon

Adenoma Detection Rate Can Be Measured in Combined Screening, Surveillance, and Diagnostic Examinations

When the adenoma detection rate (ADR) was originally proposed as a quality measure in 2002, the recommendation did not constrain its indication to screening colonoscopies

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High Success Rates for Endoscopic Submucosal Dissection in Prospective North American Study

There are limited data on success rates of endoscopic submucosal dissection (ESD) in North America. In this study, 10 centers in the United States and

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ASGE Journal Scan | Kolon

Virtual Reality for Colonoscopy Sedation?

In this study, a virtual reality program playing nature and animal scenes was tested in 27 patients who had previously undergone moderate sedation for colonoscopy

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Endocuff Vision Raises Adenoma Detection Rate by 7% in Randomized Controlled Trial in FIT-Positive Patients

Recent analyses suggest that colonoscopy with the original Endocuff or newer Endocuff Vision (EV) is superior to standard colonoscopy but that Endocuff has a greater

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ASGE Journal Scan | Kolon

Europeans Report Japanese-Like en Bloc and R0 Colonic Endoscopic Submucosal Dissection Rates Using Double-Clip Traction

Colonic endoscopic submucosal dissection (ESD) is generally considered more challenging than esophageal, stomach, or rectal ESD.  The authors have previously described a double-clip traction (DCT)

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ASGE Journal Scan | Kolon

Off-Label Use of Multitarget Stool DNA Test Is Common in Primary Care

In a retrospective analysis of all multitarget stool DNA (mt-sDNA) tests ordered at a single center over one year by 62 primary care providers (50

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ASGE Journal Scan | Kolon

Cancer Incidence and Mortality Risk After Index Colonoscopies Showing Low-Risk Adenomas, High-Risk Adenomas, or No Adenomas

Postpolypectomy surveillance recommendations are based on observational studies, often using advanced adenomas at follow-up as their primary outcome.  A new meta-analysis focused on the risk

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ASGE Journal Scan | Kolon

Screening With Fecal Immunochemical Test More Impactful for Distal Than Proximal Cancers

In a nationwide biennial fecal immunochemical test (FIT) screening program in Taiwan, more than 5.4 million individuals were invited to undergo screening between 2004 and

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ASGE Journal Scan | Kolon

WASP Optical Classification Criteria Are Not So Good for Diminutive Sessile Serrated Lesions

The optical features of sessile serrated lesions (SSLs) identified in narrow-band imaging are a cloud-like surface, indistinct borders, irregular shape, and dark spots. In a

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ASGE Journal Scan | Kolon

Is Endocuff Vision As Good As the Original Endocuff?

The original Endocuff (EC) had two rows of fingers, whereas the currently marketed Endocuff Vision (ECV) has a single row of longer fingers. Although EC

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ASGE Journal Scan | Kolon

Colorectal cancer screening occurs broadly in two settings, termed “organized” and “opportunistic.” Organized programs are typically run by nations or health care systems and usually

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Colon Capsule Gives CT Colonography Another Drubbing

In a prospective randomized trial including 320 average-risk screenees, polyps ≥6 mm were found more often with colon capsule endoscopy than with CT colonography (CTC;

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ASGE Journal Scan | Kolon

Lower Back, Neck, and Left Thumb Injuries Most Common Types of Injuries Among Colonoscopists

In a survey of primarily UK endoscopists (72% of all respondents) that included endoscopists from 45 countries and had an overall 20.2% response rate, the

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ASGE Journal Scan | Kolon

Diverticulitis Not Associated With Constipation

In this study, researchers evaluated the Nurses’ Health Study (NHS) and Health Professional Follow-up Study (HPFS) databases to examine the association of diverticulitis with bowel

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Risks of Recurrence and Mortality After Local Endoscopic Resection of T1 Colorectal Cancer

In a meta-analysis of 71 studies involving 5167 endoscopically treated T1 colorectal cancers (CRCs), the cumulative recurrence rate was 3.3%, the local recurrence rate was

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ASGE Journal Scan | Kolon

Yes, Early Onset Colorectal Adenocarcinoma Rates Are Increasing, But Rectal Carcinoid Rates Are Increasing Faster

There is now widespread recognition that there are increasing rates of colorectal cancer in persons under age 50 (early-onset colorectal cancer), that most of the

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ASGE Journal Scan | Kolon

Depressed Lesions Are Different at a Histologic and Molecular Level

In a study from Japan, T1 colorectal cancers and adenomas were classified as “depressed,” “flat,” or “protruded” subtypes. Depressed lesions constituted only 1.2% of all

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ASGE Journal Scan | Kolon

Predicting Complete Closure of EMR Sites

Clip closure of endoscopic mucosal resection (EMR) defects ≥20 mm located proximal to the splenic flexure and removed by electrocautery is associated with a reduction

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ASGE Journal Scan | Kolon

Patients With Multifocal Cancer: Evidence for Intraluminal Spread of Tumor

In various series, 2% to 7% of patients with colorectal cancer (CRC) have either synchronous or metachronous second cancer. Second CRCs have generally been considered

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Hot Snare Polypectomy of 5-9 mm Polyps Leads To More Next-Day Abdominal Pain

Cold snare polypectomy is widely considered to be comparably effective and safer than hot snare polypectomy for colorectal polyps <10 mm. In a randomized trial

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ASGE Journal Scan | Kolon

New Expert Review From the American Gastroenterological Association on Managing Colonic Diverticulitis

The American Gastroenterological Association has issued a clinical practice update on the management of colonic diverticulitis. The recommendations are as follows: Physicians should order a

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ASGE Journal Scan | Kolon

Positive Incidental Colorectal PET/CT: Sometimes Serious Lesions, Sometimes Not

There is general agreement that when positron emission tomography (PET) incidentally lights up the colon, there is a substantial positive predictive value for cancer and

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Appendicitis Treatments: Large Randomized Controlled Trial Compares Antibiotics With Appendectomy

Antibiotic treatment is now widely recognized as an option for appendicitis therapy. In a nonblinded randomized trial of 1552 adults, including 414 with an appendicolith,

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ASGE Journal Scan | Kolon

When Is Clip Closure of EMR Defects Cost-Effective?

Randomized controlled trials demonstrate that prophylactic clip closure of endoscopic mucosal resection (EMR) defects of large (≥20 mm) nonpedunculated colorectal lesions effectively prevents delayed hemorrhage.

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Multi-Society Task Force Issues Malignant Polyp Management Recommendations

The U.S. Multi-Society Task Force on Colorectal Cancer, which consists of experts from the 3 luminal GI societies, has issued recommendations on the management of

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Oral Sulfate Tablets for Bowel Preparation Are Effective and Safe

This study compared a new formulation of oral sulfate in tablet form to polyethylene glycol with ascorbate (PEG-EA). Both types of preparation were given in

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Non-White Race and Low Socioeconomic Status Associated With Longer Wait for Treatment After Colorectal Cancer Diagnosis

The time between diagnosis of colorectal cancer (CRC) and initiation of treatment is associated with mortality. In this study of 330,988 CRC cases in the

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ASGE Journal Scan | Kolon

Sessile Serrated Lesions That Are 10 mm or Larger: No Need To Inject

Cold resection of sessile serrated lesions (SSLs) ≥10 mm in size is increasingly accepted as effective and, compared to electrocautery, is safer. Many experts prefer

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ASGE Journal Scan | Kolon

Poor Compliance With Antithrombotic Guidelines Associated With Bad Outcomes

Rates of polypectomy in colonoscopy are high for all indications; therefore, clinicians usually stop antiplatelet and antithrombotic agents other than aspirin prior to colonoscopy and

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Lynch Syndrome Colonoscopy: Quality Matters

In the U.S., colonoscopy is usually performed at 1- to 2-year intervals in Lynch syndrome. This multicenter study evaluated the relationship of adenoma detection and

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Colonoscopy Performance Produces Force Levels and Durations of Force Elevation That Are Associated With Upper Extremity Injury

Musculoskeletal injuries are common in endoscopists. This study used surface electromyography of wrist flexors and extensors as well as pressure transducers on the thumbs to

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Colon Capsule Endoscopy Scorches CT Colonography in Fecal Immunochemical Test-Positive Trial

Comparative trials in patients with prior incomplete colonoscopy suggest that colon capsule endoscopy (CCE) detects polyps with higher sensitivity than CT colonography (CTC). In the

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Postcolorectal Endoscopic Mucosal Resection Follow-up Is Essential

There is a well-known risk of adenoma recurrence after piecemeal endoscopic mucosal resection (EMR).  In a single-center study of 2411 nonpedunculated lesions ≥20 mm in

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ASGE Journal Scan | Kolon

Polish Study Calls for Using Adenoma Detection Rate to Stratify Screening and Surveillance Recommendations

In this study, the risk of interval cancer was compared between doctors with high (≥20%) versus low (<20%) adenoma detection rates (ADRs) in the Polish

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Anesthesia and Pathology Charges Lead to Surprise Billing in Commercially Insured Colonoscopy

This study reviewed colonoscopies identified in a claims database from a large national insurer in the United States. The database was queried for commercially insured

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Kaiser Achieved Greater Than 80% Screening Adherence; How Did They Do It?

Organized screening, in which a nation or health care system systematically offers colorectal cancer screening for eligible patients, usually by fecal immunochemical testing (FIT), is

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Symptoms are Common After Total Proctocolectomy With Ileal Pouch Creation in Patients With Familial Adenomatous Polyposis

Pouch symptoms are typically considered to occur less frequently after total proctocolectomy and ileal pouch-anal anastomosis (IPAA) for familial adenomatous polyposis (FAP) compared to after

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New Clinical Model Predicts Need for Screening Colonoscopy

A risk-stratified approach to colorectal cancer screening within the average-risk population is seldom used. In this approach, patients whose prescreening predicted prevalence of advanced neoplasia

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Which Rectal Neuroendocrine Tumors are Dangerous?

In this study of 309 rectal neuroendocrine tumors (NETs), often called rectal carcinoids in the past, endoscopic factors were studied to understand their association with

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Negative Colonoscopy for FIT-Positive Patients: Should We Keep Doing FIT?

In this study from Taiwan, patients with a negative colonoscopy after a positive fecal immunochemical test (FIT) during the interval 2004 through 2009 were followed

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Chemoprevention for Colorectal Cancer: What Works and What Doesn’t?

This was a systematic review of 80 meta-analyses of colorectal cancer prevention with medications, vitamins, supplements, and dietary factors.  Of the factors found to be

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Even Expert Pathologists Have Only Moderate Agreement Regarding Differentiating Sessile Serrated Lesions From Hyperplastic Polyps

Current recommendations for measurement of the adenoma detection rate (ADR) recommend that sessile serrated lesions (SSLs; also called sessile serrated adenomas and sessile serrated polyps)

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Artificial Intelligence System Outperforms Guideline Predictive Criteria for Lymph Node Metastasis in T1 Cancers

In a study from 7 centers in Japan, a deep learning artificial intelligence (AI) program trained on 3134 T1 colorectal cancers (CRCs) from 6 Japanese

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ESGE Issues Comprehensive Training Curriculum on Optical Diagnosis

The extent to which optical diagnosis is used in routine endoscopy in the United States to improve treatment decisions in endoscopy is virtually unknown.  The

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More Evidence That Negative Screening Colonoscopy Can Be Followed by Intervals of More Than 10 Years

This study compared the incidence of advanced neoplasms in 2456 German screening colonoscopy patients who had a previous colonoscopy without polyps to the results from

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Computerized Imaging of Vessels in EMR Defects Predicts Postprocedural Bleeding

Recent studies indicate that prophylactic clip closure of postendoscopic mucosal resection defects from colonic lesions >20 mm in size and proximal to the splenic flexure

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Monoallelic NTHL1 Loss of Function Not Associated With Colorectal Cancer

NTHL1 encodes endonuclease III-like protein 1, an enzyme involved in base-excision repair that identifies and removes oxidized pyrimidines. Biallelic loss-of-function mutations of base-excision repair genes, such

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Optical Character Recognition Combined With Natural Language Processing to Improve Extraction of Quality Parameters From Colonoscopy Reports

Measurement and improvement of colonoscopy quality measures, such as the adenoma detection rate (ADR), are critical to optimizing colorectal cancer prevention by colonoscopy. The process

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Most Primary Care Physicians Not Following the American Cancer Society’s Recommendation to Screen at Age 45

The American Cancer Society (ACS) recommended in 2018 that all Americans should undergo colorectal cancer (CRC) screening beginning at age 45. Thus far, other major

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American Gastroenterological Association Issues Guidelines on GI Evaluation of Iron Deficiency Anemia

The American Gastroenterological Association (AGA) has issued the following recommendations regarding GI evaluation of iron deficiency anemia (IDA): In patients with anemia, IDA should be

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What Are Cold Snare Protrusions and Are They a Bad Thing?

During cold snare polypectomy, removal of larger lesions and/or larger specimens sometimes results in a cold snare protrusion (CSP), appearing as a white cord in

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Hemostasis Peptide Reduces Need for Electrocoagulation of Bleeding Points During ESD

Bleeding is common during endoscopic submucosal dissection (ESD). It can obscure dissection planes and often requires electrocoagulation that could injure the muscularis propria. PuraStat (3D-Matrix,

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Risk of Death From Colonoscopy in the Italian FIT Screening Program

Organized fecal immunochemical test (FIT)-based screening programs offer the opportunity to prospectively assess adverse events of colonoscopy. A recent large study from the Netherlands found

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All That Time That Cannot Be Billed

Previous data found that primary care physicians and some specialists spend about an hour on electronic health records (EHRs) for each hour they are scheduled

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Risk of Death From Colonoscopy in a FIT-Positive Program

In any screening program, it is important to know the benefits and harms of screening. Patients who have a positive fecal immunochemical test (FIT) result

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Early Colorectal Cancer Screening in African Americans: High Uptake and High Yield

Recommendations from GI societies to screen African Americans for colorectal cancer (CRC) starting at age 45 were based largely on age-related incidence and mortality data

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Granular Laterally Spreading Tumors With Nodule: Rectal Location and at Least 4-cm Size Warrant en Bloc Resection

Granular laterally spreading tumors (G-LST) in the colorectum are more common than nongranular lesions, less likely to have cancer, and in general, easier to remove

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Acetic Acid and Blue Light Highlight Sessile Serrated Lesions

This case study demonstrates how acetic acid in combination with blue-light imaging (BLI), a relatively new mode of chromoendoscopy technology, highlights sessile serrated lesions (SSLs).

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Delayed Start Times Associated With Reduced Adenoma Detection

Previous studies have shown that the adenoma detection rate (ADR) is sometimes lower in colonoscopies performed in the afternoon versus the morning, though the results

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Surgery Not Needed After Complete Endoscopic Resection of Intramucosal Colorectal Cancer

Intramucosal cancer (IMC) refers to dysplasia in the lamina propria of the mucosa with or without invasion of the muscularis mucosa. Such lesions are usually

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Initial Experience With EndoRotor Tissue Resection Device

The EndoRotor nonthermal powered endoscopic debridement (PED) instrument (Interscope, Inc., Whitinsville, Mass) is a new tissue resection device that can be passed through endoscopes. There

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ESGE Expands the Postpolypectomy Cohort With No Recommended Surveillance

The European Society of Gastrointestinal Endoscopy (ESGE) has issued its first update of postpolypectomy surveillance recommendations since 2013. Key recommendations include the following: Patients with

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Adding Time for Inspection During Colonoscope Insertion Does Not Work

There remain occasional advocates of dedicated time during colonoscope insertion to look for polyps as a way of increasing detection. In this analysis of 7

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Prophylactic Clipping Ineffective for Polyps Less Than 20 mm in Size

Analyses of randomized trials indicate that prophylactic clipping of EMR sites ≥20 mm in size in the proximal colon reduces the risk of delayed hemorrhage.

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Dutch Endoscopic Full-Thickness Resection Experience in Colorectum

This report summarizes a prospectively acquired experience using the endoscopic full-thickness resection device (FTRD) in the colorectum. Among 367 procedures performed between July 2015 and

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Adenomas in the Young: What Do They Mean?

The incidence of colorectal cancer (CRC) is increasing in persons under age 50 in much of the world. Endoscopists commonly encounter sporadic adenomas when performing

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Sarcopenia (Loss of Skeletal Muscle Mass) Associated With Metachronous Adenomas

Sarcopenia is a progressive loss of skeletal muscle mass in relation to aging. Sarcopenia is associated with metabolic syndrome, diabetes, and nonalcoholic steatohepatitis and has

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Negative Colonoscopy Predicts Reduced Risk of Colon Cancer for 17 Years

Previous studies in symptomatic populations have found that a negative colonoscopy predicts a reduction in colorectal cancer (CRC) incidence for greater than 20 years. The

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Malpractice Trends in Colon Cancer

This study identified 240 malpractice cases related to colorectal cancer (CRC) between 1988 and 2018 by using a legal database called VerdictSearch. This database is

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Randomized Controlled Trial of Fellow Impact on Detection

There is widespread acceptance of a second-observer effect in improving adenoma detection in colonoscopy and general acceptance that this effect extends, in some regard, to

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Lynch Syndrome Testing on Preoperative Biopsy Specimens Is Accurate

In this study, there were 96 patients with matched preoperative and postoperative immunohistochemistry (IHC) and microsatellite instability testing results for Lynch syndrome. The concordance of

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No Correlation Between Detection and Optical Diagnosis in Colon Polyps

This is a Dutch multicenter study involving 24 colonoscopists who performed at least 50 colonoscopies in a fecal immunochemical test-positive population. All were high-performing colonoscopists

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Artificial Intelligence Program Increases Adenoma Detection Rate in Randomized Controlled Trial by 14%

In a randomized controlled trial conducted at 3 Italian centers with 6 experienced endoscopists and 685 patients with a mix of screening, surveillance, and fecal

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Meta-analysis Favors Low-Residue Diet Before Colonoscopy

This meta-analysis comparing a low-residue diet to a clear liquid diet the day before colonoscopy identified 20 relevant randomized controlled trials that were published between

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Collagenous Colitis Is a Genetic Disease

Collagenous colitis (CC) produces a watery diarrhea syndrome, occurs mostly in older women, and is associated with several drug classes. Recent studies show that patients

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Predicting CRC in Unscreened Populations by CBC

About one-third of the U.S. population is unscreened for colorectal cancer (CRC). One approach to early detection in this population is to screen health care

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Some GI Doctors May Not Understand Significance of Intramucosal Adenocarcinoma in the Colon

Several studies have found that rates of surgery for benign colorectal polyps continue to be high, despite clear evidence that endoscopic resection is safer and

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Meta-analysis for 6- to 9-mm Adenomas Shows Higher Risk of Subsequent Advanced Neoplasia Compared to 1 to 5 mm

Current surveillance recommendations classify patients with 1 or 2 tubular adenomas <10 mm in size and with low-grade dysplasia as low risk. Several studies have

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Randomized Colorectal Cancer Screening Trial Includes Risk-Stratified Arm

Colorectal cancer (CRC) screening can be offered to patients as a menu of screening options; sequential testing (colonoscopy offered first with another testing option offered

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Evidence for Routine Double Right-Sided Colon Examination

Double right-sided colon examination during colonoscopy is often recommended, and randomized controlled trials have compared a second examination of the right-sided colon in the forward

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Risks of Colonoscopy: Not Just Bleeding and Perforation

This French study evaluated 4,088,799 patients undergoing a first-time colonoscopy during a 6-year interval. Patients with inflammatory bowel disease, colorectal cancer, or complicated diverticular disease

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Quantitative Assignment of Ages to Start Screening Based on Family History

In a study from Sweden involving 12,829,251 persons who had family history information and were followed from 1958 to 2015, 173,796 developed colorectal cancer (CRC).

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No Benefit of Endocuff Vision in Screening Flexible Sigmoidoscopy

Endocuff Vision (EV) has well-established benefits in colonoscopy, both for improved detection and faster withdrawal without reduced detection.  EV has not been tested for its

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High-Volume Colonoscopy Predicts Higher Cecal Intubation Rates and Lower Perforation Risk, but Not Higher Detection or Cancer Prevention

Douglas K. Rex, MD, FASGE, reviewing Forbes N, et al. Clin Gastroenterol Hepatol 2020 Mar 20. In a systematic review and meta-analysis encompassing 27 studies

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Endocuff Vision Improves Detection in High Performers

In meta-analyses, Endocuff Vision (ECV) typically increases adenoma detection rates (ADRs) by about 7%. However, one meta-analysis found that the benefit was primarily in doctors

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Smartphone App for Bowel Prep Reduced Inadequate Preps and Improved ADR

Douglas K. Rex, MD, FASGE, reviewing Walter B, et al. Clin Gastroenterol Hepatol 2020 Mar 30. A variety of apps to assist in bowel preparation

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Pocket Method Beats Conventional Colorectal Endoscopic Submucosal Dissection in Randomized Controlled Trial

Douglas K. Rex, MD, FASGE, reviewing Yamashina T, et al. Gastrointest Endosc 2020 Feb 28. The conventional method (CM) of endoscopic submucosal dissection (ESD) involves

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Microprocessor-Controlled Endo Cut Versus Forced Coagulation: No Difference in Delayed Hemorrhage

Douglas K. Rex, MD, FASGE, reviewing Pohl H, et al. Gastroenterology 2020 Mar 12. Previous uncontrolled studies indicated that forced-coagulation (FC) current (the blue pedal)

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Molecular Markers Predict Prognosis in Colorectal Cancer

Douglas K. Rex, MD, FASGE, reviewing Phipps AI, et al. Gastroenterology 2020 Feb 20. Current recommendations from the U.S. Multi-Society Task Force recommend that all

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Two From the Ascending Colon and Two From the Descending Colon: Biopsies From Microscopic Colitis Simplified

Douglas K. Rex, MD, FASGE, reviewing Virine, B, et al. Clin Gastroenterol Hepatol 2020 Feb 25. Guidelines recommend that clinicians perform 8 biopsies total from

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Deciding on Surgery After Endoscopic Resection of T1-CRC? Repeat Colonoscopy and Biopsy Do Not Help

Douglas K. Rex, MD, FASGE, reviewing Gijsbers KM, et al. Gastrointest Endosc 2020 Feb 24. In general, when a flat or sessile T1 colorectal cancer

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Primary Care Physicians Order 88% of FIT-Fecal DNA Tests

Douglas K. Rex, MD, FASGE, reviewing Weiser E, et al. J Med Screen 2020 Feb 13. This industry-sponsored study examined adherence rates to the fecal

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Improving ADR Shown Again to Save Lives

Douglas K. Rex, MD, FASGE, reviewing Lam AY, et al. Gastrointest Endosc 2020 Feb 21. A 2017 study from the Polish screening colonoscopy program showed

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Radiographic Studies Unreliable for Polyp Detection in Patients With Incomplete Colonoscopy

Douglas K. Rex, MD, FASGE, reviewing Parsa N, et al. Gastrointest Endosc 2020 Feb 4. In a single U.S. center with a large experience performing

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Meta-analysis Associates Helicobacter pylori Infection With Colorectal Neoplasia

Douglas K. Rex, MD, FASGE, reviewing Choi DS, et al. Clin Transl Gastroenterol 2020 Feb. Helicobacter pylori (H. pylori) infection has been previously associated with colorectal

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Calculating Effect of Surveillance Colonoscopy on Colon Cancer Prevention

he U.S. Multi-Society Task Force on Colorectal Cancer recently presented new postpolypectomy surveillance recommendations. Perhaps the most impactful new recommendation is that patients with 1

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New Evidence Supports Surveillance Colonoscopy for Patients With Stage I Colon Cancer

Gastroenterologists may be surprised to learn that some guideline groups do not endorse surveillance colonoscopy after resection of stage I colon cancer because of a

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Vitamin D Supplementation Did Not Prevent Adenomas or Serrated Lesions

Douglas K. Rex, MD, FASGE, reviewing Song M, et al. Clin Gastroenterol Hepatol 2020 Feb 13. There is an association between vitamin D levels and

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Updated Postpolypectomy Surveillance Recommendations of the Multi-Society Task Force

Douglas K. Rex, MD, FASGE, reviewing Gupta S, et al. Gastroenterology 2020 Feb 7. The U.S. Multi-Society Task Force on Colorectal Cancer has updated its

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Considering Endoscopy in Iron Deficiency Anemia? Don’t Rely on Fecal Blood Testing to Decide

Douglas K. Rex, MD, FASGE, reviewing Lee MW, et al. Am J Gastroenterol 2020 Jan 10. Fecal blood testing is approved as a colorectal cancer

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Berberine Reduces Metachronous Colorectal Adenomas in Randomized Trial

Douglas K. Rex, MD, FASGE, reviewing Chen YX, et al. Lancet Gastroenterol Hepatol 2020 Jan 8. Berberine is a Chinese herbal extract used to treat

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Improving the Message of Mailed Outreach Improves CRC Screening Adherence

Douglas K. Rex, MD, FASGE, reviewing Bakr O, et al. Clin Transl Gastroenterol 2020 Jan. Mailed outreach, in which a fecal immunochemical test (FIT) kit

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Expanding Cold EMR to Large Laterally Spreading Lesions

Douglas K. Rex, MD, FASGE, reviewing Mangira D, et al. Gastrointest Endosc 2020 Jan 15. In 5 Australian academic hospitals, cold EMR was performed on

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High Definition Is Still the Only Way to Go

Douglas K. Rex, MD, FASGE, reviewing Tziatzios G, et al. Gastrointest Endosc 2020 Jan 15. Previous meta-analyses have suggested that the use of high-definition (HD)

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Artificial Intelligence for the Other Half of Detection at Colonoscopy

Douglas K. Rex, MD, FASGE, reviewing Thakkar S, et al. Gastroenterology 2020 Jan 13. Assuming that a colonoscopist knows what precancerous lesions look like, high-level

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Cancer After Colonoscopy in UK Study Associated With, Well, Some Very Poor-Quality Colonoscopy

Douglas K. Rex, MD, FASGE, reviewing Anderson R, et al. Gastroenterology 2020 Jan 8.  Interval cancer, or postcolonoscopy cancer, is one of the dreaded outcomes

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End-Stage Renal Disease Still Risk Factor for Colonoscopy Complications

Douglas K. Rex, MD, FASGE, reviewing Yang SC, et al. J Gastroenterol Hepatol 2020 Jan 3. End-stage renal disease (ESRD) has been considered a risk

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For Left-Sided Colon Lesions up to 25 mm and Right-Sided Colon Lesions up to 20 mm, Piecemeal EMR Is as Good as en Bloc Resection

Douglas K. Rex, MD, FASGE reviewing Tate DJ, et al. Gastrointest Endosc 2019 Dec 27. Advanced endoscopists are often tempted to remove laterally spreading lesions

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Observations on FIT-Fecal DNA Testing in Clinical Practice

Douglas K. Rex, MD, FASGE reviewing Vakil N, et al. Gastrointest Endosc 2020 Jan 2. The commercially available FIT (fecal immunochemical test)-fecal DNA test is

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Small Left-Sided Polyps Seen During Colonoscope Insertion: Remove Them When You See Them

Douglas K. Rex, MD, FASGE reviewing Teramoto A, et al. Gastrointest Endosc 2019 Dec 23. Experienced colonoscopists know that when a small polyp is encountered

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How Do We Get to 80% Screening?

Douglas K. Rex, MD, FASGE reviewing Inadomi JM, et al. Clin Gastroenterol Hepatol 2019 Dec 27. The National Colorectal Cancer Roundtable set a goal of

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Brits Shake Up Postpolypectomy Surveillance

Douglas K. Rex, MD, FASGE reviewing Rutter MD, et al. Gut 2019 Nov 27. British societies have always had their own postpolypectomy guidelines. Previous recommendations

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Review and Meta-analysis Finds FIT CRC Sensitivity Lower in Stage I and T1

Douglas K. Rex, MD, FASGE reviewing Niedermaier T, et al. Am J Gastroenterol 2019 Dec 10. Fecal immunochemical test (FIT) sensitivity for colorectal cancer (CRC)

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Polygenic Risk Score Has Predictive Value for Early Onset Colorectal Cancer

Douglas K. Rex, MD, FASGE reviewing Archambault AN, et al. Gastroenterology 2019 Dec 19. Everyone wants to understand the underlying drivers for why early-onset colorectal

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Not Asking Enough Questions: Low Rates of Recommending and Receiving Genetic Testing in U.S. in Those at Risk for Lynch Syndrome

Douglas K. Rex, MD, FASGE reviewing Faust N, et al. Gastroenterology 2019 Dec 6. The National Health Interview Survey is conducted every 5 years and

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New ASGE Guideline on Endoscopy and Management of ACPO and Colonic Volvulus

Douglas K. Rex, MD, FASGE reviewing Naveed M, et al. Gastrointest Endosc 2019 Nov 29. Some of the key and/or interesting findings in the new

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Endoscopic Resection Effective for SSPs ≥10 mm in Meta-analysis; Cold EMR May Be Best

Douglas K. Rex, MD, FASGE reviewing Chandrasekar VT, et al. Clin Gastroenterol Hepatol 2019 Nov 28. This systematic review and meta-analysis identified 911 patients with

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Endocuff Vision Defeats Cap in Tandem Study

Douglas K. Rex, MD, FASGE reviewing Rameshshanker R, et al. Gastrointest Endosc 2019 Dec 10. Recent controlled trials comparing Endocuff Vision (EV) to cap-assisted colonoscopy

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Colonoscopy in Inpatient Octogenarians: Beware

Douglas K. Rex, MD, FASGE reviewing Olaiya B, Adler DG. J Clin Gastroenterol 2019 Nov 22. Population-based studies have consistently shown that the risk of

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Pay Attention to Anal Cancer

Douglas K. Rex, MD, FASGE reviewing Deshmukh AA, et al. J Natl Cancer Inst 2019 Nov 19. In the period 2001 to 2015, squamous cell

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Endoscopic Mucosal Resection: First-Line Treatment for Laterally Spreading Lesions at Anorectal Junction

Douglas K. Rex, MD, FASGE reviewing Shahidi N, et al. Gut 2019 Nov 12. Laterally spreading lesions at the anorectal junction can be treated by

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ESGE Endorses Resect and Discard in Routine Practice

Douglas K. Rex, MD, FASGE reviewing Bisschops R, et al. Endoscopy 2019 Nov 11. The European Society of Gastrointestinal Endoscopy (ESGE) has issued an updated

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Another Study Supports Underwater Versus Conventional Endoscopic Mucosal Resection for Lesions ≥10 mm

Recent randomized controlled trials found that underwater endoscopic mucosal resection (UEMR) results in more en bloc resections and faster resection for flat and sessile colorectal

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Randomized Trial of Sequential Testing Versus Multiple Choices for CRC Screening

Many guidelines on colorectal cancer (CRC) screening advocate that the choice of screening tests should be based on a discussion between the provider and patient

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Ontario Physicians More Likely to Get Colonoscopy Than Their Patients

This study evaluated administrative health care data from Ontario, Canada, to determine colorectal cancer screening rates among physicians, aged 52 to 74 years, and their

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Colon Capsule Doesn’t Help in FIT-Positive Patients

Douglas K. Rex, MD, FASGE reviewing Pecere S, et al. Gastrointest Endosc 2019 Oct 17. In some European countries with limited colonoscopy resources, capsule colonoscopy

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Biennial Surveillance Is the Right Interval in Lynch

Douglas K. Rex, MD, FASGE reviewing Peterese EFP, et al. Clin Gastroenterol Hepatol 2019 Oct 17. Universal screening of colorectal cancers (CRCs) for Lynch syndrome

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ACP Issues CRC Screening “Guidance Statement”; Declines to Endorse Either FIT-Fecal DNA or CT Colonography

Douglas K. Rex, MD, FASGE reviewing Qaseem A, et al. Ann Intern Med 2019 Nov 5. The American College of Physicians (ACP) has issued a

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More on Bad Outcomes After Surgery for Benign Colon Polyps

Douglas K. Rex, MD, FASGE reviewing Ma C, et al. Am J Gastroenterol 2019 Oct 11.  Recent studies have established that surgery for benign colon

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Seven Percent Are “One-and-Done” Colonoscopists

Douglas K. Rex, MD, FASGE reviewing Fedewa SA, et al. Endosc Int Open 2019 Nov. “One and done” in colonoscopy refers to endoscopists who find

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Dual Antiplatelet Therapy Judged Safe for Cold Snare Polypectomy ≤10 mm

Douglas K. Rex, MD, FASGE reviewing Won D, et al. Clin Transl Gastroenterol 2019 Oct 10.  Patients on both aspirin and a second antiplatelet agent

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Endocuff Vision Made Polypectomy Faster

Douglas K. Rex, MD, FASGE reviewing von Figura G, et al. Endoscopy 2019 Oct 15. Endocuff Vision (EV) has been shown in randomized controlled trials

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Modeling Study Shows Current Surveillance Colonoscopy Paradigms Are Cost-Effective

Douglas K. Rex, MD, FASGE reviewing Meester RGS, et al. Ann Intern Med 2019 Sep 24. Some modeling studies suggest that surveillance colonoscopy in patients

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Follow Pyogenic Liver Abscess With Colonoscopy

Douglas K. Rex, MD, FASGE reviewing Mohan BP, et al. Dig Liver Dis 2019 Oct 7.  Researchers examined results from 12 previous studies including a

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Younger Physicians Are Better Detectors at Colonoscopy

Douglas K. Rex, MD, FASGE reviewing Shaukat A, et al. Clin Gastroenterol Hepatol 2019 Sep 10. A previous study showed that female endoscopists had higher

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Meta-analysis Confirms Two Observers Better Than One for Polyp Detection

Douglas K. Rex, MD, FASGE reviewing Aziz M, et al. Clin Gastroenterol Hepatol 2019 Oct 4. Among 5 randomized controlled trials, 2 observers increased the

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Cancer Incidence and Mortality in Adenoma Cohorts in Northern California Kaiser

Douglas K. Rex, MD, FASGE reviewing Lee JK, et al. Gastroenterology 2019 Oct 4. Databases developed from colonoscopies performed in the Kaiser Permanente Northern California

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Large RCT Shows No Benefit of Early Colonoscopy in Patients With Acute LGIB

A benefit of early colonoscopy (in the first 24 hours) after hospitalization for acute lower-GI bleeding (LGIB) remains uncertain. In a large, randomized, controlled trial

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One Positive FIT and One Negative? Still Do Colonoscopy

Most fecal immunochemical testing as a screen for colon cancer is done with one sample. However, patients with a positive test sometimes request a second

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Acute Diverticulitis Still an Indication for Colonoscopy

Acute diverticulitis is generally considered an indication for colonoscopy, but the results of studies have been mixed with regard to the risk of colorectal cancer

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6- to 9-mm Adenomas Again Shown to Predict Advanced Neoplasia Versus Diminutive Adenomas

Current postpolypectomy surveillance guidelines lump adenomas 1 to 9 mm in size together in a category of low-risk adenomas. Advanced adenomas are defined as those

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What’s the Best Way to Examine Lynch Colons?

Because of the more rapid transformation of adenomas to cancer in Lynch syndrome, one often sees recommendations that colonoscopists performing Lynch examinations should be proven

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Rising Rates of CRC in Young People: Not Unique to U.S.

It is now widely recognized that colorectal cancer (CRC) rates have been increasing in the U.S. in persons under age 50, while simultaneously decreasing in

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Screening Rates Still Behind in Blacks

Blacks have higher colorectal cancer (CRC) incidence and mortality rates, develop CRC at a younger age, and are screened for CRC less often than whites

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When Colonoscopy for a Positive Cologuard Is Negative, STOP the Workup

The Cologuard test from Exact Sciences looks for hemoglobin and abnormal DNA in the stool. Because abnormal DNA can be shed from the GI tract

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