Endoscopic submucosal dissection (ESD) is an effective strategy for complete resection of superficial esophageal neoplasia. However, such lesions in patients with cirrhosis and portal hypertension
ASGE Journal Scan
ASGE Journal Scan
ESD Is Safe and Effective for Esophageal Lesions in Cirrhotic Patients With Small Esophageal Varices
Cold Snare Defect Protrusions Are Associated With Forced Pull-Throughs and Higher Rate of Residual Polyp
Cold snare polypectomy of colorectal polyps sometimes leaves a cord of white tissue consisting of submucosa and, sometimes, muscularis mucosa. These defects are called “cold
Are Anesthesia Specialists Necessary for Complex Colorectal Endoscopic Mucosal Resections?
Sedation practice for endoscopy varies widely in the United States. One model is to use anesthesia specialists to administer propofol for complex endoscopic procedures, such
Both Balloon Enteroscopy ERCP and EUS-Guided Antegrade Treatment Are Reasonable Options for Choledocholithiasis After Roux-en-Y Gastrectomy
Managing choledocholithiasis in patients after Roux-en-Y gastrectomy is challenging, and with no excluded stomach, endoscopic ultrasound (EUS)-guided transmural lumen-apposing metal stent placement is significantly more
Do DPP4 Inhibitors and GLP-1 Receptor Agonists Increase the Risk of Intestinal Obstruction?
The treatment of type 2 diabetes has evolved over the past decade, and incretin-based drugs, including dipeptidyl peptidase 4 (DPP4) inhibitors and glucagon-like peptide-1 (GLP-1)
Being Breastfed Associated With Increased Risk of Colorectal Cancer
This study utilized data from two cohorts of the Nurses’ Health Study involving nearly 159,000 women and 3.5 million person-years of follow-up. The investigators discovered
Colon Polyps Extending Across an Anastomosis Can Be Effectively Removed by Endoscopic Mucosal Resection
Among 2629 large nonpedunculated colorectal polyps in 2350 patients, 10 were classified as anastomotic and had a median lesion size of 35 mm. All lesions
Manual Review of pH Tracings Helpful in Defining GERD After POEM
The prevalence of GERD after peroral endoscopic myotomy (POEM) ranges from 13% to 58%. This variation is due to a lack of precise definitions and
Is There an Environmental Impact From Inappropriate Endoscopy?
Endoscopy plays a significant role in a gastroenterologist’s practice. Unindicated or inappropriate endoscopies increase costs, take away resources from other patients, and may have a
Post-EMR Adenoma Recurrences Are Effectively Treated Endoscopically
About 15% of large (≥20 mm) nonpedunculated colorectal polyps (LNPCPs) removed by piecemeal endoscopic mucosal resection (EMR) have evidence of recurrence at the first endoscopic
Texture and Color Enhancement Feature on New Olympus Scopes Improved Detection
Texture and color enhancement imaging (TXI) is a new image-processing feature on the latest generation of Olympus colonoscopes (Tokyo, Japan). These instruments have been commercially
Risks of Cancer and Cancer Death in Peutz-Jeghers and Juvenile Polyposis From Danish National Registry
Peutz-Jeghers syndrome (PJS) and juvenile polyposis syndrome (JPS) are hamartomatous polyposis syndromes associated with increased cancer risk. The Danish national health registries systematically record health
Most Patients Who Have Not Had Colorectal Cancer Screening Have Not Been Offered Screening
Previous studies have shown that most patients who had not undergone colorectal cancer (CRC) screening reportedly had not been offered screening by their primary care
Preservation of Oblique Sling Fibers During POEM Does Not Reduce Postprocedure GERD
Peroral endoscopic myotomy (POEM) is a standard treatment option for patients with achalasia but is associated with a high incidence of postprocedure gastroesophageal reflux disease
Performance of Published Criteria in Predicting Choledocholithiasis in Practice
Choledocholithiasis can be identified through multiple means, including a right upper quadrant ultrasound, endoscopic ultrasound (EUS), endoscopic retrograde cholangiography (ERCP), magnetic resonance cholangiopancreatography (MRCP), and
Endoscopic Therapy Is Highly Successful for Early Barrett’s Cancer
For patients with intramucosal esophageal adenocarcinoma (T1a EAC), endoscopic treatment (endoscopic resection, followed by ablation) is the current standard. This study focused on patients with
Endoscopist Characteristics May Predict Improved Detection With CADe
Most randomized controlled trials (RCTs) of computer-aided detection (CADe) demonstrate increased detection, but some RCTs and real-world experiences with CADe have failed to show a
Serrated Polyposis Syndrome Remains Very Underdiagnosed by Community Endoscopists
Serrated polyposis syndrome (SPS) is the most common type of polyposis syndrome, affecting as many as one in every 250 persons undergoing screening colonoscopy. It
Is Upfront EUS-Guided Biliary Drainage a Wise Option in Patients With Malignant Distal Biliary Obstruction?
Traditionally, malignant biliary obstruction is relieved by placing a transpapillary stent during endoscopic retrograde cholangioscopy (ERCP). Pancreatitis is a possible adverse event of ERCP. Additionally,
Cancers Detected in Second-Round Fecal Immunochemical Test Screening Still Early Stage
The value of colorectal cancer (CRC) screening lies in CRC prevention through polyp detection and prevention of CRC mortality by early-stage CRC detection. Compared with
Delay in Colonoscopy After Positive FIT May Be Lethal, Particularly in 40- to 49-Year-Olds
These data are from a population-based Chinese screening program involving 595,180 persons aged 40 to 74 years with 16 years of follow-up. There were 42,353
Behavioral Interventions Have a Large Impact on Colonoscopy Uptake
Twenty-five studies with 30 interventions were analyzed for this study on the effect of behavioral interventions on colonoscopy uptake. Of the interventions evaluated by the
PPIs and Dementia: A Tale of Two Studies – Part One
Previous research has suggested a potential connection between proton pump inhibitors (PPIs) and a higher risk of dementia, causing concern among patients and health care
PPIs and Dementia: A Tale of Two Studies – Part Two
Previous research has suggested a potential connection between proton pump inhibitors (PPIs) and a higher risk of dementia, causing concern among patients and health care
Risk Factors for Metachronous Advanced Serrated Lesions
Current recommended postpolypectomy surveillance intervals for patients with serrated lesions are based on limited evidence. This single-center study evaluated risk factors for metachronous advanced serrated
Modified POEM Technique Can Be Effective for Postfundoplication Dysphagia
Laparoscopic fundoplication (LF) as a treatment option for GERD involves 3 techniques based on the wrap extension: Nissen (total, 360°), Toupet (posterior, 270°), and Dor
Pure Cut Current for Biliary Sphincterotomy Is Associated With Less Delayed Bleeding and May Reduce Post-ERCP Pancreatitis Risk
Thermal injury from biliary sphincterotomy is thought to play a role in at least a proportion of post-ERCP pancreatitis (PEP) cases. Thus, the present study
Two Experts Give Advice on Best Basic Colonoscopy Techniques
Among the key and newer points from a recent review on the best performance of basic colonoscopy, including the resection of lesions <20 mm in
Randomized Controlled Trial of Over-the-Scope Versus Through-the-Scope Suturing of ESD Defects
Over-the-scope suturing (OTSS) requires a double-channel gastroscope, and closure of defects in the right side of the colon may require an overtube. Through-the-scope suturing (TTSS)
Currently Available Drugs Work for Patients With Eosinophilic Esophagitis
Presently, there is no specific drug recommendation as the preferred treatment for active eosinophilic esophagitis (EoE) nor clear guidance on the comparative effectiveness of various
FDA-Approved Sports Drink-Like Flavored Colonoscopy Preparation
This is a single, blind, multicenter, randomized, controlled trial that compared oral sulfate solution (OSS) to a sports drink-like flavored solution of polyethylene glycol and
Patients With Refractory GERD Should Be Screened for Psychological Symptoms
In patients with GERD, there is a need to understand the poor symptom-reflux association and the potential role of psychological processes in reporting esophageal symptom
Does Low-Dose Aspirin Result in Anemia in Older Patients?
Daily intake of low-dose aspirin increases the risk of major bleeding, but its effect on iron deficiency and anemia is less studied. This study, a
Ultrasound Capsule Endoscopy Produces Images Comparable to EUS Images
The current standard method for diagnosing and staging esophageal subepithelial lesions and tumors is endoscopic ultrasound (EUS). This study focused on a newly developed medical
Large Single-Use Duodenoscope Experience Shows High Success and Low Crossover Rates
Single-use duodenoscopes were developed to eliminate the risk of duodenoscope-associated transmission of infections. However, there are concerns that the performance of single-use duodenoscopes may not
Meta-Analysis of Appendicitis Risk With Endoscopic Full-Thickness Resection of Appendiceal Orifice Lesions
There is agreement that endoscopic full-thickness resection (EFTR) is a great procedure for lesions extending into the appendiceal orifice (AO) when there has been a
Early-Onset Colon Cancers Have More Synchronous Advanced Adenomas
In a cross-sectional retrospective study at a single U.S. health care system, colonoscopic findings of 150 randomly selected patients with early-onset colorectal cancer (CRC) were
Monoallelic Variants in Recessive CRC Genes Not Associated With Increased CRC Risk
Increasingly, we are consulted on or asked to perform colonoscopies on patients who previously underwent multigene panel testing for oncogenes associated with colorectal cancer (CRC).
One-Fourth of Patients Do Not Get Appropriate Follow-up After Esophageal Food Bolus Impaction
Dealing with esophageal food bolus impactions (FBIs) is a frequent gastrointestinal emergency. Effective handling of esophageal FBIs entails promptly conducting an endoscopic assessment and addressing
To Optimally Prevent Colorectal Cancer, We Need to Detect Both Adenomas and Serrated Lesions
Recent studies have found that significant fractions of colonoscopists possess adequate detection of conventional adenomas, as measured by adenoma detection rate (ADR), but low detection
About Half of Cancers in Serrated Polyposis Syndrome Arise Through the Adenoma-Carcinoma Sequence
The serrated pathway of colorectal cancer (CRC) is considered to account for about 20% of all CRCs. Patients with serrated polyposis syndrome (SPS) have higher
Photodocumentation of Large Colorectal Polyps Is Suboptimal
The U.S. Multi-Society Task Force on Colorectal Cancer recommends that polyps ≥1 cm be photographed before resection to document size and the resection site photographed
Meta-Analysis of Tip-in Versus Conventional EMR for Colorectal Lesions
Tip-in endoscopic mucosal resection (T-EMR) involves submucosal injection, followed by a small incision into the submucosal mound on the cecal side of the lesion. The
Cold Snare Looks Good for Pedunculated Polyps Smaller Than 10 mm
This systematic review and meta-analysis identified 6 studies with 1025 patients and 1111 polyps with a mean size ranging from 4 to 8.5 mm. Cold
Increasing Prevalence and Incidence of Eosinophilic Esophagitis Globally
Given reports on the rising global incidence and prevalence of eosinophilic esophagitis (EoE) and the associated societal impact, investigators conducted a systematic review and meta-analysis
Is Digital Gut-Directed Hypnotherapy Better Than Muscle Relaxation in Patients With Irritable Bowel Syndrome?
In addition to dietary modification and pharmacologic therapy, behavioral therapy has become a recognized treatment for irritable bowel syndrome (IBS) and is now integrated into
GERD After Sleeve Gastrectomy Related to Proximal Gastric Pressurization
Sleeve gastrectomy (SG) has become a popular choice for weight loss due to its ease and effectiveness. However, it can worsen symptoms of esophageal reflux
Consider Endoscopic Upper GI Screening in Patients With Head and Neck Squamous Cell Cancer
It is known that some patients with head and neck squamous cell carcinoma (HNSCC) can develop a second primary tumor (SPT). Timely detection of SPTs
More Evidence for Early Cholecystectomy After Gallstone Pancreatitis
Same-admission cholecystectomy is recommended for patients with mild gallstone pancreatitis (GSP) to reduce recurrent GSP events and lower costs. However, adherence to same-admission cholecystectomy remains
Underwater ESD Associated With Less Post-ESD Coagulation Syndrome in Retrospective Study
Underwater endoscopic submucosal dissection (U-ESD; typically performed with saline rather than water) has several potential advantages over conventional ESD (C-ESD; performed with carbon dioxide insufflation).
Malignant Tumor Bleeding: Is Hemostatic Powder Superior to Standard Endoscopy?
Treating bleeding malignant tumors is challenging because they tend to be diffusely friable. Hemostatic powder is a relatively new tool in the endoscopic armamentarium for
Declines in Colorectal Cancer Incidence in Older Persons Are Slowing
This study used SEER (Surveillance, Epidemiology, and End Results) data to update colorectal cancer (CRC) incidence and mortality trends from 1992 to 2019. The well-known
Video-Based Feedback Improves Cold Snare Polypectomy Among Fellows but Learning Curve Is Long
Cold snare polypectomy (CSP) is the preferred resection method for colorectal lesions ≤10 mm. Competence in CSP can be assessed using the CSPAT (Cold Snare
Band and Biopsy: An Easier Way to Sample and Remove Small Subepithelial Lesions?
Diagnosis and resection of subcentimeter subepithelial tumors (SETs) can be challenging. One problem with endoscopic band ligation (EBL) and allowing the lesion to slough is
European Society of Gastrointestinal Endoscopy Issues Comprehensive Curriculum for Endoscopic Mucosal Resection in the Colon
Those performing endoscopic mucosal resection (EMR) in the colorectum should be aware of this remarkably comprehensive document from the European Society of Gastrointestinal Endoscopy that
Lessons Learned After Post-ERCP Mortality
ERCP is a vital endoscopic procedure for the management of pancreatobiliary disease but is associated with serious adverse events, including mortality. Although a central tenet
Effectiveness of EUS Gallbladder Drainage as Primary Therapy for Malignant Biliary Obstruction
ERCP is generally the first-line approach for palliation of distal malignant biliary obstruction (DMBO), but interest in the use of endoscopic ultrasound (EUS)-guided transmural drainage
More on Expanding ADR Measurement Beyond Screening
Current recommendations suggest measuring the adenoma detection rate (ADR) in first-time screening colonoscopies. Several studies have found that including surveillance and diagnostic colonoscopies in an
Fully Covered Self-Expanding Metal Stents Are Safe and May Be More Durable in Distal Malignant Biliary Obstruction
It is clear that metal stents are superior to plastic stents for palliation of distal malignant biliary obstruction (dMBO). Among self-expanding metal stents (SEMS), there
Tissue Is Often Retained in the Cap or Channel After EGD and Colonoscopy With Biopsy
This study looked at retained tissue in the endoscope after EGD and colonoscopy in which only cold forceps biopsies were performed. The study cases were
Retrieval Bag Allows Removal of ESD Specimens From Rectum Without Fragmentation
Very large specimens obtained by endoscopic submucosal dissection may fragment during retrieval through the anus. The Endo Carry Large Type (Hakko Co, Tokyo, Japan) is
Submucosal Injection Unnecessary for 3- to 9-mm Polyps, per Randomized Controlled Trial Results
Cold snare resection is the treatment of choice for 4- to 9-mm polyps, yet some practitioners perform submucosal injection for polyps in this size range.
New AI Can Tell Normal From Abnormal Colon Biopsies, Would Reduce Pathology Workload
In some countries, pathologists and pathology departments are overworked. A number of artificial intelligence (AI) programs have shown substantial accuracy in interpretation of whole slide
ChatGPT Provides Good Answers to Patient Questions About Colonoscopy
This study examined the quality of answers provided by ChatGPT (OpenAI, San Francisco, Calif) to 8 common questions about colonoscopy, compared with answers to the
General Familial Adenomatous Polyposis Cancer Risks in Danish National Registries
Cancer incidence studies in national registries, such as that maintained in Denmark, are of interest because they reduce referral bias. A study used nationwide Danish
Does Eradication of Helicobacter pylori Lower the Chance of Gastric Cancer?
Helicobacter pylori eradication has been shown to decrease the risk of noncardia gastric adenocarcinoma (NCGA) in Asia; however, the data in the United States are limited.
Short POEM as Good as Long POEM for Achalasia Treatment
For the treatment of patients with achalasia, peroral endoscopic myotomy (POEM) has shown comparable effectiveness to surgery. During POEM, the typical length of the myotomy
Using AI To Identify Patients With Barrett’s Esophagus and Dysplasia From Pathology Reports
Natural language processing (NLP) is a computer technology that uses language cues and context to interpret findings and mine large databases to identify desired clinical
Simultaneous Population-Based Testing for Specific Cancer Genes, Including Lynch Syndrome, Found Conditionally Cost-Effective
According to data, 1.5% of the U.S. population has hereditary breast and ovarian cancer syndrome (0.72%), Lynch syndrome (0.35%), or familial hypercholesterolemia (FH; 0.43%). This
More on Mucus Production by Water Filling During Colonoscope Insertion
Water instillation is now commonly used for a variety of purposes during colonoscopy. Water filling during colonoscope insertion has been shown to decrease pain, reduce
Primary EUS Choledochoduodenostomy Is Safe and Efficacious in Malignant Biliary Obstruction
Palliation of malignant biliary obstruction is required to facilitate oncologic therapy and relief of symptoms. Although this is almost always performed with ERCP, biliary cannulation
Pneumatic Dilation Associated With Higher Complication and Readmission Rates in Patients With Achalasia
Data directly comparing treatment options for achalasia are limited, namely peroral endoscopic myotomy (POEM), laparoscopic Heller myotomy (LHM), and endoscopic pneumatic dilation (PD). The current
Changing Advanced/High-Risk Adenoma Definition Would Reduce Colonoscopies With Limited Delay in CRC Diagnoses
Patients with advanced or high-risk adenomas are recommended to undergo surveillance earlier than patients with low-risk adenomas. In the U.S., the traditional high-risk group classification
Endoscopy Unit-Level Measures That Improve ADR: Report Cards and a Second Observer
In a systematic review and meta-analysis, 15 studies evaluating the impact of report cards on adenoma detection rate (ADR) were among the 34 studies that
Cesarean Delivery Associated With Early-Onset Colorectal Cancer in Women
Birth by cesarean delivery has been associated with intestinal dysbiosis in childhood. This study is a population-based, nationwide, case-control study from Sweden involving 564 cases
Relief of Gastric Outlet Obstruction: Is Endoscopy Treatment Better Than Surgery?
Malignant gastric outlet obstruction (mGOO) results in significant morbidity and decreased quality of life. Treatment options include surgical gastrojejunostomy (SGJ) and endoscopic ultrasound-guided gastroenterostomy (EUS-GE).
Consensus Guidelines Recommend Monitored Anesthesia Care for Most ERCPs
Adequate patient sedation is essential for the successful completion of ERCP; however, delivery methods of anesthesia vary between providers, with most endoscopists favoring deep sedation
A Severity Index May Be Clinically Useful in the Management of Patients With EoE
The Index of Severity for EoE (I-SEE) is a new tool created by a multidisciplinary team to identify meaningful features of eosinophilic esophagitis (EoE) disease
Long-Term Exposure to Air Pollution Is a Risk Factor for Esophageal Cancer
Long-term exposure to PM2.5 (fine particulate matter) is a known risk factor for lung cancer. However, the evidence linking PM2.5 to esophageal cancer is sparse
Computer-Aided Diagnosis System Bombs in a Real-World Colon Polyp Histology Prediction Trial
In a prospective study from Singapore, the computer-aided diagnosis (CADx) program CAD EYE (Fujifilm, Tokyo, Japan) was assessed in 661 consecutive polyps of all sizes
Free Online 30-Minute Interactive Training Improves ADR and Lowers Interval Cancer Risk
This study from the Northern California Kaiser Permanente health care system evaluated the impact of a 30-minute online interactive training program collaboratively developed by endoscopists,
Endocuff Vision Enhances Detection in CADe-Assisted Colonoscopy
In a randomized trial, 1316 patients underwent colonoscopy with either computer-aided detection (CADe) assistance alone or CADe plus Endocuff Vision (ECV; Olympus America, Center Valley,
Predictors of Prolonged Rectal Endoscopic Submucosal Dissection
In a Japanese experience of endoscopic submucosal dissection (ESD) performed on 483 rectal lesions over 23 years, a prolonged ESD was considered longer than 120
Local Steroid Injection After Esophageal ESD Does Not Prevent Strictures in All Patients
Local triamcinolone (TA) therapy involves injecting approximately a 100-mg dose of TA into the ulcer immediately after an endoscopic submucosal dissection procedure to reduce the
Another Tool in the Endoscopic Closure Toolbox
Endoscopic closure techniques are essential for successful closure of resection sites and acute perforations. Initially largely limited to through-the-scope (TTS) clips, the armamentarium has evolved
If the Right Side of the Colon Deserves Double Examination, so Does the Rectum
This study used the World Endoscopy Organization classification of postcolonoscopy colorectal cancer (PCCRC) to assess 762 PCCRC cases that accumulated during 1995 to 2021. PCCRC
In U.S. Veterans, Advanced Adenomas, Not Nonadvanced Adenomas, Before Age 50 Associated With Higher CRC Risk
Adenomas are commonly diagnosed in patients younger than age 50 undergoing colonoscopy. Adenomas in young people often initiate surveillance at shorter than the recommended intervals,
Offering a Blood Test Increases CRC Screening in Patients Who Had Declined Colonoscopy and FIT
This was a randomized controlled trial in 359 veterans aged 50 to 75 years who had declined colonoscopy and a fecal immunochemical test (FIT) in
Papillary Morphology Predicts Difficult Biliary Cannulation
Successful and safe ERCP requires the endoscopist to cannulate the duct of interest successfully and efficiently. Although operator skill clearly influences procedure success, there is
Single U.S. Center Reports High Rates of Screening Colonoscopy in Older Patients With Low Life Expectancy: Low Yield and Very High Complication Rates
The U.S. Preventive Services Task Force recommends that the decision regarding whether to screen persons aged 75 to 85 years for colorectal cancer be individualized
There Is an Endoscopic Mucosal Transition Zone on the Ileocecal Valve
Experienced endoscopists are aware that the mucosa on the ileocecal valve (ICV) lips has a 3- to 10-mm-wide transition zone between normal colonic mucosa and
Colonoscopy Quality Appears To Be Good in U.S. Veterans Administration Hospitals
In a study of 29,877 patients with colorectal cancer (CRC) in the U.S. Veterans Affairs (VA) health care system, the rate of postcolonoscopy colorectal cancer
Not All Patients Require Radiotherapy After ESD for T1b Esophageal Cancer
Endoscopic resection (ER) plays a critical role in both treating and diagnosing superficial esophageal cancer. However, the incidence of lymph node metastasis in patients with
Can We Improve Quality in ERCP and EUS?
ERCP and EUS are essential in treating a variety of disease entities. Metrics exist to measure performance quality, but data are necessary to improve quality
Endoscopic Therapy Can Successfully Treat Post-POEM GERD
Peroral endoscopic myotomy (POEM) is increasingly being used as mainline therapy for patients with achalasia. After POEM, approximately 30% to 50% of patients experience abnormal
You Removed a Small Lesion With High-grade Dysplasia or Cancer Using a Cold Snare, Now What?
Cold snare polypectomy is now the resection method of choice for colorectal lesions ≤10 mm in size. The risk of resecting a cancerous lesion in
Combined EMR and Full-Thickness Resection for Large Nonlifting Colorectal Adenomas
Endoscopic submucosal dissection (ESD) is an option for scarred, large colorectal adenomas that do not lift well and/or contain a suspicious area of an advanced
True Rate of Post-ERCP Pancreatitis: Do Randomized Trials Provide the Answer?
Pancreatitis after ERCP is one of the most common and morbid adverse events following any gastrointestinal endoscopy procedure. It is imperative that the consent process
For American Patients Interested in Screening, Colonoscopy Resulted in Higher Adherence and Detection Than Annual Fecal Testing
In 3 U.S. centers, asymptomatic patients aged 50 to 69 years (or 40-69 if Black) were randomized to screening colonoscopy or annual sequential high-sensitivity guaiac
Just Because Something Is New, Does It Mean It Works?
The development of hemostatic powders has increased the tools in our armamentarium to treat GI bleeding. However, data on their utility in peptic ulcer bleeding
POEM Better Than Pneumatic Dilation in Treating Achalasia Symptoms After Surgical Myotomy
Research into peroral endoscopic myotomy (POEM) as a rescue therapy for patients with persistent or recurrent symptoms after laparoscopic Heller myotomy (LHM) is increasing. Although
Majority of At-Risk Patients Not Screened for Barrett’s Esophagus
The current screening model for Barrett’s esophagus (BE) has limitations because patients need to be identified by their primary care physician and then referred to
CADe Fails To Improve Polyp Detection in Community-Based Randomized Controlled Trial
The overwhelming majority of randomized trials testing the impact of computer-aided detection (CADe) programs have shown substantial benefits. In a randomized controlled trial in 4
Dietary Therapy Can Be Extremely Helpful for Patients With Eosinophilic Esophagitis
There are several elimination diet regimens available, including the 6-food elimination diet (SFED), 4-food elimination diet (FFED), one-food elimination diet (OFED), and targeted elimination diet
What Should You Photograph During Colonoscopy?
An expert colonoscopist recommends the following for photography during colonoscopy: Cecal landmarks Terminal ileum, if intubated Bowel preparation quality Large lesions before and after endoscopic
Surveillance Colonoscopy Recommended Too Often in Older Patients With Limited Life Expectancy
Colonoscopists are advised to consider age, comorbidities, and colonoscopy findings before recommending surveillance. In a study of the New Hampshire Colonoscopy Registry, 9831 adults older
Uncontrolled Description of X-Tack Efficacy for Colonic EMR Defects
X-Tack (Apollo Endosurgery, Austin, Texas) is a through-the-scope suturing device that can be an alternative to through-the-scope clips. No controlled trial of X-Tack versus clips
Cold Snare Safer Than Hot Snare for 4- to 10-mm Colorectal Polyps in Pragmatic Randomized Controlled Trial
Cold snare polypectomy is now widely accepted as the treatment of choice for colorectal polyps 4 to 10 mm in size. Despite overwhelming evidence that
Another Real-World U.S. Trial of Computer-Aided Detection Fails To Impress
Randomized controlled trials (RCTs) have generally shown consistent improvements in adenoma detection rates (ADRs) with the use of computer-aided detection (CADe) during colonoscopy, but a
Can Artificial Intelligence Eliminate the Need for Postdiverticulitis Colonoscopy?
Colonoscopy is often recommended after an episode of acute diverticulitis, particularly complicated diverticulitis, and when no colonoscopy was performed the previous year. Colonoscopy in prior
Serrated Appendiceal Lesions Common in Serrated Polyposis but Not Clinically Important
Some previous work has suggested that the prevalence of advanced lesions in the appendix is high enough to warrant routine appendectomy in patients with serrated
Peroral Endoscopic Myotomy Is Also Effective in Patients With Prior Achalasia Treatment
Some studies suggest that prior treatment may increase the difficulty and success of tunneling during a peroral endoscopic myotomy (POEM) procedure, but recent studies have
Does EUS-Guided Gastroenterostomy Improve Quality of Life in Patients With Malignant Gastric Outlet Obstruction?
Malignant gastric outlet obstruction (GOO) has a profound negative impact on quality of life (QoL). Options for palliation include surgical gastroenterostomy, enteral stent placement, and,
Time To Start Paying Attention to Postendoscopy Upper GI Cancers
Upper gastrointestinal cancers (UGICs) are typically diagnosed through endoscopy, but some cases may be missed and diagnosed later, known as postendoscopy UGICs (PEUGICs). PEUGICs are
Assessing Visualization During Upper Endoscopy
Esophagogastroduodenoscopy (EGD) requires clear visualization of the upper gastrointestinal (UGI) mucosa, but there is no standardized method to assess mucosal visualization. Lesions are often missed
Continuing Antithrombotics Substantially Increases Risk of Delayed Bleeding After Colorectal ESD
In this retrospective study from Japan, researchers compared delayed bleeding rates for 82 patients who underwent ESD while continuing antithrombotic medications versus 386 patients without
Optimum Barrett’s Inspection Time Is Critical for a High-Quality Endoscopy
Endoscopic surveillance of Barrett’s esophagus (BE) is recommended to reduce mortality and morbidity related to esophageal adenocarcinoma. A thorough endoscopic inspection of a BE segment
Synchronous Large Nonpedunculated Lesions Are Most Common With a Left-Sided Nongranular Index Lesion
Large (≥20 mm) colorectal lesions are often accompanied by synchronous lesions, including a high prevalence of synchronous advanced lesions. This study examined the relationship between
A New Treatment for Endoscopic Palliation of Colorectal Cancer
Patients with colorectal cancer (CRC) metastatic to the liver or lung often do not undergo surgical resection of their primary tumor. However, the primary tumor
Is Motorized Spiral Enteroscopy All That It Is Cut Out To Be?
In 2016, motorized spiral enteroscopy (mSe) was introduced to facilitate visualization for diagnosis and therapy of the small bowel. The primary aim of this review
Cold Snare Resection, at Least Cold EMR, Looks Good for 10- to 19-mm Polyps, Including Adenomas
Cold snare polypectomy is the accepted treatment of choice for all colorectal polyps smaller than 10 mm and with no suggestion of cancer on endoscopic
No Metachronous Cancers Observed in MSH6 and PMS2 Carriers
Lynch syndrome is caused by germline mutations in MLH1, MSH2, MSH6, or PMS2 genes, but the most commonly affected genes are MLH1 and MSH2. Increasingly, surveillance recommendations are on a gene-specific basis, with
71% of U.S. ESD Patients in Study Were Discharged Without Hospital Admission
Endoscopic submucosal dissection (ESD) is frequently followed by hospital admission for multiple days in Asian countries. However, hospitalization is much more expensive in the U.S.,
Intravenous Acetaminophen Said To Distinguish Benign Postcolorectal EMR Pain From Pain Potentially Reflecting Complications
In an observational study of colorectal EMR, 67 of 336 patients (19.9%) experienced postprocedural pain. All EMRs were performed with electrocautery and adrenaline injection. Pain
Anticoagulant and Antiplatelet Agents Affect Fecal Immunochemical Test Performance
In a very large study, 11.8% of 77,007 patients receiving antithrombotic treatment had a positive fecal immunochemical test (FIT) result, compared with 6% of those
Patients With Superficial Esophageal Squamous Cell Cancer With Lymphovascular or Submucosal Invasion Need Additional Therapy After Endoscopic Resection
In patients with esophageal squamous cell carcinoma with invasion into the muscularis mucosa (pMM-ESCC) with lymphovascular invasion (LVI), the Japan Esophageal Society recommends additional treatment
Is Cold Snare Resection a Good Idea for Duodenal Adenomas?
Resection of duodenal adenomas (DAs) can be challenging, in part due to the thinness of the duodenal wall and its vascularity. Both postprocedural bleeding (PPB)
Should a Biopsy of Normal-Appearing EMR Scars Be Performed at Follow-up?
Traditionally, even if careful inspection of an EMR scar at follow-up shows no residual polyp, a biopsy should still be performed to rule out histologic
Should Older Adults With Adenomas Continue Surveillance Colonoscopy?
Although there are rules for when to stop colorectal cancer screening, there are no rules about when to stop surveillance colonoscopy in patients with precancerous
Colonoscopy Screening at Intervals Longer Than 10 Years Is Feasible
Case-control studies and cohort studies have found that colonoscopy prevents colorectal cancer (CRC) for 15 to 20 years or more. However, only a few small
The Strongest Predictor of Colonoscopy Completion After a Positive Stool Test Is a Multitarget Stool DNA Test
It is well known that the rates of follow-up colonoscopy after a positive fecal screening test are suboptimal, and delays in colonoscopy versus prompt colonoscopy
Trainees Often Look at Polyps and Don’t Recognize Them
This study used eye tracking of 7 endoscopy trainees to determine whether missed polyps had not been seen versus seen but not recognized. Trainees identified
Endoscopic Presence of LA Grade B but Not Grade A Erosive Esophagitis Confirms GERD
Per the Lyon Consensus, endoscopic documentation of Los Angeles (LA) grade C or D esophagitis is conclusive evidence of GERD, whereas LA grades A and
Quality Indicators for Eosinophilic Esophagitis Management
Eosinophilic esophagitis (EoE) is a chronic condition increasingly encountered in clinical practice. The establishment of quality indicators (QIs) in EoE will lead to the standardization
Another CADx Program With Good but Limited Performance for Diminutive Colorectal Polyps
This study describes the prospective testing of a computer-aided diagnosis (CADx) system called POLyp Artificial Recognition (POLAR), developed for real-time diagnosis of diminutive colorectal polyps.
Does Appendectomy Increase Risk of Colorectal Cancer?
This systematic review and meta-analysis identified 22 studies from 3 continents that addressed the risk of colorectal cancer (CRC) after appendectomy in the general population.
Peroral Endoscopic Myotomy Is Effective in Chronic Opioid Use-related Esophageal Motility Disorders
Chronic opioid use can lead to a variety of esophageal disorders, including type III achalasia, esophagogastric outflow obstruction (EGJOO), diffuse esophageal spasm (DES), and hypercontractile
Could Upper GI Eosinophilia Account for Abdominal Pain?
Eosinophilic gastrointestinal diseases (EGIDs) are rare inflammatory conditions of the GI tract characterized by tissue eosinophilia and chronic GI symptoms. EGIDs include eosinophilic gastritis (EoG)
FIT-Fecal DNA Test Had High Positive Predictive Value in Second-Round Screening
This study examined the positive predictive value (PPV) of a second round of screening with a fecal immunochemical test (FIT)-fecal DNA test (Cologuard, Exact Sciences).
Colorectal Cancer Screening Rates Increased During the COVID Pandemic, but With Stool-based Tests, Not Colonoscopy
This report is from the National Health Interview Survey, an annual survey of U.S. households covering a wide range of health topics. Response rates were
Two Doses of Linaclotide Replaced 1 Liter of Polyethylene Glycol-Electrolyte Lavage Solution in Bowel Preparation for Colonoscopy
In a study from China, 548 patients were randomized to receive 2 L of polyethylene glycol (PEG) on the day of colonoscopy or 290 µg
Artificial Intelligence Continues To Be Impressive for Characterization of Barrett’s Neoplasia
Barrett’s esophagus (BE)-related neoplasia is frequently missed during upper endoscopy, and characterization of mucosal changes may help in its detection. The primary aim of this
Randomized Trial of Endoscopic Retrograde Appendicitis Therapy Versus Appendectomy for Acute Uncomplicated Appendicitis
Increasingly, antibiotics are used to treat acute uncomplicated appendicitis. Successful antibiotic treatment can be followed by recurrence. An alternative nonoperative approach is endoscopic retrograde appendicitis
Second Proximal Colon Examination Produced Significant Rise in Adenoma Detection Rates
Many experts now routinely examine the proximal colon twice because colonoscopy is less protective against colorectal cancer in the proximal colon than in the distal
How Good Is Single-Incision Needle-Knife Biopsy in Diagnosing Gastrointestinal Subepithelial Tumors?
Tissue sampling of subepithelial lesions (SELs) is needed to determine the diagnosis, malignant potential, and management of these lesions. Endoscopic ultrasound-guided fine needle aspiration and/or
Artificial Intelligence Accurately Delineates the Extent of Early Esophageal Squamous Cell Cancer
Subtle surface changes associated with early-stage esophageal squamous cell cancer (ESCC) can be difficult to detect during standard endoscopy. The primary aim of this study
Computer-aided Detection Failed in Pragmatic Trial in Clinical Practice
Computer-aided detection (CADe) programs are expensive to implement in clinical practice; therefore, endoscopy groups often want to trial the programs before purchase or lease. In
Computer-aided Detection Said To Fail in Randomized Controlled Trial, but It Actually Performed Well
Artificial intelligence programs for highlighting or detecting polyps during colonoscopy are designated computer-aided detection (CADe) programs. In general, randomized controlled trials of CADe have been
Randomized Controlled Trial Shows Hemostatic Peptide Solution TDM-621 Reduces Need for Coagulation Forceps Treatment During ESD by 80%
Bleeding can be problematic during endoscopic submucosal dissection (ESD). The bleeding point may be difficult to identify, and coagulation may lead to muscle injury and
Artificial Intelligence for Adenoma Detection Rate: Simply the Best?
This study assessed 94 randomized controlled trials with 61,172 patients to determine how artificial intelligence (AI) impacts the adenoma detection rate (ADR). In short, AI
Obese Patients With Eosinophilic Esophagitis Have Lower Response to Therapy
Current treatment options for patients with eosinophilic esophagitis (EoE) include the use of topical corticosteroids. This study aimed to demonstrate whether outcomes of topical corticosteroids
Is There an Increased Risk of Proximal Gastrointestinal Cancer After a Positive Fecal Immunochemical Test?
The fecal immunochemical test (FIT) is a simple, noninvasive, at-home study that detects blood in the stool and is used for colon cancer (CRC) screening
Postcolonoscopy Cancer Still Mostly Associated With Missed Lesions, but Failed Resections Are Also Important
Postcolonoscopy colorectal cancer (PCCRC) is a dreaded event. Previous studies have found that PCCRC is associated with a lower adenoma detection rate (ADR), nongastroenterologist performance
Male Gender and Hot Avulsion Are Associated With Recurrence After Colorectal Endoscopic Mucosal Resection
Endoscopic mucosal resection (EMR) is the cornerstone of the treatment of large (≥20 mm) nonpedunculated colorectal lesions. This study from a Canadian expert center examined
Ampullary Adenomas Are Associated With Increased Colorectal Neoplasia Risk
Nonampullary adenomas are frequently associated with an increased risk of colorectal adenomas. There is less known about the association between ampullary adenomas and colorectal neoplasia.
Is EUS-guided Ablation Feasible To Treat Nonfunctioning Pancreatic Neuroendocrine Tumors Smaller Than 2 cm?
Although small (<2 cm), nonfunctioning pancreatic neuroendocrine tumors (PNETs) are typically followed, there are instances, such as patient anxiety, that prompt resection. Endoscopic ultrasound-guided ethanol
GERD: Atypical Symptoms and Endoscopic Therapy
Atypical GERD symptoms, including cough and hoarseness, can be difficult to treat, even with proton pump inhibitors and laparoscopic surgical fundoplication. Transoral incisionless fundoplication (TIF),
Artificial Intelligence Beats General Endoscopists for the Detection of Barrett’s Neoplasia
Barrett’s esophagus (BE) is a precancerous condition that can lead to the development of dysplasia and esophageal adenocarcinoma (neoplasia). Since neoplasia can present as subtle
Cold Snare Polypectomy Failed for 10- to 20-mm Colorectal Polyps
Cold snare is now considered the polypectomy method of choice for polyps <10 mm in size, and recent studies have extended the use of cold
Endoscopic Biopsy in Patients Exposed to Direct Oral Anticoagulants Is Claimed To Be Safe
Patients taking direct oral anticoagulants (DOACs) are often considered to be at increased risk for bleeding after therapeutic endoscopic procedures such as polypectomy and sphincterotomy.
Update on Adverse Events With Colorectal Endoscopic Full-thickness Resection
This study updates complication rates associated with the full-thickness resection device (FTRD) from a combined Dutch and German registry, with 1892 procedures performed between July
Endoscopic Resection Plus Chemoradiotherapy Similar to Surgical Resection for
High-risk Stage I Esophageal Cancer Traditionally, surgical resection has been the standard for the treatment of patients with clinical stage I T1a-bN0M0 esophageal squamous cell
Genetic Risk Loci, Biomarkers, and Lifestyle Risk Factors in Barrett’s Esophagus and Cancer
Genome-wide association studies (GWAS) involve scanning the DNA of a large cohort to identify any genetic variants associated with the disease in question. Previous GWAS
High Synchronous Neoplasia Burden in Patients With Large Pedunculated Colon Polyps
Previous studies have found that patients with large (≥20 mm) nonpedunculated colorectal polyps have a high prevalence of synchronous colorectal neoplasia. This study investigated synchronous
Online Yoga Good for Irritable Bowel Syndrome
Previous studies have found yoga as effective as other treatments for irritable bowel syndrome (IBS) symptoms. This study tested whether virtually delivered yoga improved IBS
Mental Illness Delayed Colorectal Cancer Diagnosis in England
This study evaluated 3766 patients with colon cancer in the U.K., of whom 16.5% had preexisting mental health morbidities (MHMs) recorded in their primary care
Prevention of Cholecystitis in Patients Undergoing ERCP for Malignant Distal Biliary Obstruction Involving the Cystic Duct: A Novel Technique
Cholecystitis following biliary drainage with a self-expandable metallic stent (SEMS) in patients with distal malignant biliary obstruction (MBO) and cystic duct orifice involvement is significant.
Favorable Long-Term Outcomes With ESD for Esophageal Squamous Cell Cancer
Endoscopic resection is a minimally invasive and curative treatment option for those with superficial esophageal squamous cell carcinoma (ESCC). Endoscopic submucosal dissection (ESD), although more
Evidence for Variation in the Number of Colonoscopies Required To Achieve a Clear Colon
Ideally, patients presenting for colonoscopy should have a complete examination and identification and resection of all precancerous polyps in a well-prepared colon, followed by assignment
Metabolic Syndrome Increases All-Cause and Disease-Specific Mortality in Colorectal Cancer
Metabolic syndrome (MS), diabetes mellitus, and obesity are all associated with an increased prevalence of precancerous colorectal polyps and incidence of colorectal cancer (CRC). This
Snare Tip Soft Coagulation Reduced Recurrence After EMR in Routine Practice
Thermal treatment of endoscopic mucosal resection (EMR) margin defects after complete resection of large (≥20 mm) nonpedunculated colorectal polyps has reduced the recurrence rate at
Potassium Competitive Acid Blocker Better Than Proton Pump Inhibitor in Healing Higher Grades of Erosive Esophagitis
Erosive esophagitis, a complication of chronic gastroesophageal reflux disease (GERD), is documented in 30% to 50% of GERD patients undergoing endoscopy. Current guidelines recommend proton
U.S. GI Societies Announce Strategic Plan to Promote and Support Sustainable Digestive Health Care
As a subspecialty, GI medicine is typically ranked in the top 3 for its high carbon footprint and production of plastic waste. The 4 U.S. GI
Randomized Controlled Trial Finds Lower Recurrence Rate With Underwater Versus Conventional Colorectal EMR
In a randomized controlled trial (RCT) performed in Brazil, 120 colorectal lesions with a mean size of 17.5 mm were randomized to underwater endoscopic mucosal
Colonoscopist Adenoma Detection Rate Predicts Advanced Neoplasia Risk After Polypectomy
Investigators evaluated 30,897 individuals with baseline polypectomy and at least 1 surveillance colonoscopy between 2004 and 2016 across 73 Veterans Administration sites in the U.S.,
Study Shows Margin Treatment Was Good but Not Perfect for Colorectal Laterally Spreading Lesions 40 mm or Larger
Thermal treatment of the margin after piecemeal endoscopic mucosal resection (EMR) of laterally spreading lesions (LSLs) ≥20 mm is now considered standard of care because
Wireless pH Monitoring Is Better at 96 Hours Than 48 Hours in Patients With GERD Unresponsive to PPI Therapy
A significant portion of patients with reflux-like symptoms do not have GERD and could potentially discontinue proton pump inhibitor (PPI) therapy. Although wireless pH monitoring
Is Juvenile Polyposis Syndrome Associated With a Significant Risk of Gastric Cancer?
Juvenile polyposis syndrome (JPS), in which patients develop juvenile polyps, is uncommon but is thought to be associated with an increased risk of gastrointestinal cancers.
GI Patients Like Telehealth
This is a survey of 5134 patients who participated in a telehealth visit in 1 year across 105 practices in the Digestive Health Physicians Association.
Prediagnosis Obesity Eliminates Survival Advantage Associated With Aspirin Use in Stage IV Colorectal Cancer
This study divided 656 participants with stage IV colorectal cancer (CRC) into groups according to their prediagnosis body mass index (BMI): normal (38.3%), overweight (36.3%),
More on Withdrawal Time in Colonoscopy
Current recommendations are that minimum withdrawal times in screening colonoscopy that are negative should average at least 6 minutes. In an analysis of a previously
Top Recommendations for the Diagnosis and Management of Esophagogastric Variceal Bleeding
The European Society of Gastrointestinal Endoscopy has released updated recommendations on the diagnosis and management of esophagogastric variceal hemorrhage. Of the 16 recommendations, all are
Combining CADe and a Mucosal Exposure Device Provides Best Detection During Colonoscopy
In a randomized controlled trial, 1245 participants aged 50 to 75 years were randomized to standard colonoscopy, standard colonoscopy plus an artificial intelligence (AI) detection
Large Tandem Study Shows 9-Minute Withdrawal Time Better Than 6 Minutes
In a randomized tandem study from China, 2 study arms compared the standard colonoscopy withdrawal time of 6 minutes versus 9 minutes. The colon was
Treat Traditional Serrated Adenomas as Advanced Lesions
Traditional serrated adenomas (TSAs) are rare lesions. They are predominantly in the left side of the colon, and unlike sessile serrated lesions, they can be
Fifteen-Year Benefits of Screening Sigmoidoscopy, Based on Pooled Results of 4 Randomized Controlled Trials
This is a pooled analysis of 4 randomized controlled trials of one-time sigmoidoscopy screening in patients aged 55 to 64 years. The trials were conducted
Increased Risk of Eosinophilic Gastritis and Enteritis in Families of Patients With Eosinophilic Esophagitis
Eosinophilic esophagitis (EoE) is influenced by both genetic and environmental factors. The genetic risk of distal eosinophilic gastrointestinal diseases in patients with EoE is not
ADR Works in FIT-Positive Populations: Target ADR Must Be Substantially Higher Than Primary Screening ADR
It is well known that the prevalence of adenomas is higher in patients with a positive result from a stool test, including both the fecal
Review Indicates Colorectal Cancer Screening Guidelines Have Inadequate Reporting and Discussion of Screening Harms
Cancer screening can lead to patient-level harms from screening tests, diagnostic follow-up, and cancer treatment. This review examined U.S. screening guidelines on breast, cervical, colorectal,
Increasing Distance From Treatment Centers Associated With Advanced Stage Colorectal Cancer
In a study of the National Cancer Database, the distance of patients from their medical facility was found to be associated with a risk of
Wide Geographic Variation in Colorectal Cancer Screening Rates in the U.S. Associated With CDC’s Social Vulnerability Index
The Centers for Disease Control and Prevention (CDC) quantifies social vulnerability in the U.S. at the county level. The Social Vulnerability Index (SVI) reflects infrastructure,
The Impact of Different Bowel Preparation Approaches on Nocturnal Awakenings, Sleep Loss, and Travel Interruption
This is a subinvestigation of a randomized bowel preparation trial in 10 Canadian centers. Patients were divided into 2 groups and underwent colonoscopy either in
Rare Causes of Abdominal Pain
Gastroenterologists commonly evaluate unexplained chronic or recurrent abdominal pain. In a review of overlooked causes of recurrent abdominal pain, some key points were: Chronic abdominal
Expert Endoscopists (>1000 Procedures) Can Generally Assess Their Own Competency Accurately; Those With Less Experience Can’t
This systematic review and meta-analysis identified 13 qualitative studies of the accuracy of GI endoscopist self-assessment and 3 studies for individual patient data meta-analysis. These
Artificial Intelligence Can Help Extract Dysplasia Diagnoses From Electronic Health Records
Natural language processing (NLP) is a branch of artificial intelligence (AI) systems that involves teaching computers the ability to understand written text like how humans
First Randomized Controlled Trial Comparing Colonoscopy With No Screening Finds Less Benefit Than Expected for Colonoscopy
In the first report of incidence and mortality results from a randomized controlled trial (RCT) comparing colonoscopy with no screening, 84,585 previously unscreened persons aged
GI Reimbursement Being Hammered by Medicare: 15-Year Trends
This study looked at reimbursement from Medicare for 10 commonly used EGD and colonoscopy codes as well as several inpatient and outpatient services over a
Dietary Therapy for Eosinophilic Esophagitis Unpopular Among Gastroenterologists
Recent studies have demonstrated that dietary elimination therapy is an effective nonprescription treatment for eosinophilic esophagitis (EoE), yet many providers are still hesitant about recommending
Refractory Celiac Disease: What to Do
Refractory celiac disease (RCD) is defined as celiac disease with persistent symptoms despite at least 12 months of a strict gluten-free diet. There are 2
Postcolonoscopy Symptoms Are Related to Gender, Mood, Prior Somatic Symptoms
There are few prospective, detailed studies on factors such as time lost from work and symptoms after colonoscopy. This study prospectively measured postcolonoscopy symptoms in
Dutch Describe Impact of Their National Biennial Fecal Immunochemical Test Screening Program
In 2014, the Netherlands instituted a national program of every-other-year fecal immunochemical test (FIT) screening for colorectal cancer (CRC). Since the start of screening, within
Trigger-Food Elimination Diets Are Effective for Patients With Eosinophilic Esophagitis
One treatment method for patients with eosinophilic esophagitis (EoE) is the six-food elimination diet (SFED), which removes milk, wheat, soy, egg, tree nuts/peanuts, and fish/shellfish
Risk-Stratified CRC Screening Using Fecal Immunochemical Test and Stool DNA
This is a post hoc analysis of a risk-stratification screening strategy based on the Asia-Pacific Colorectal Screening (APCS) scoring system. This score ranks patients as
Substantial Risk of Advanced Adenomas but No Colorectal Cancer in a Cohort of Patients With CDH1 Mutations
CDH1 mutations are associated with a very high risk of gastric cancer, early age of onset of gastric cancer, and a high risk of breast cancer
Healing of Mucosal Ablation Areas After Radiofrequency Ablation in Patients With Barrett’s Esophagus
Endoscopic therapy for patients with neoplastic Barrett’s esophagus (BE) involves resection followed by mucosal ablation. Radiofrequency ablation (RFA) of the flat BE mucosa leads to
Global Trends in Colorectal Cancer
Data on colorectal cancer (CRC) incidence and deaths were extracted from the GLOBOCAN database for 2020, and projections were made for 2040. Some of the
Decrease in Dietary Sugar Reduces GERD Symptoms and Esophageal Acid Exposure
Although dietary changes are recommended for patients with gastroesophageal reflux disease (GERD), randomized controlled trials (RCTs) supporting these management strategies are lacking. This RCT evaluated
Metachronous Adenomas Occur More Often in the Same Segment or a Proximal Segment Than in a Distal Segment
It is well-known that some clustering of adenomas occurs in the colorectum. In a single-center study in patients each with a single index adenoma, 61%
Second-Generation Endocuff Again Found to Be Effective in New Randomized Controlled Trial
The second-generation Endocuff (Olympus America, Center Valley, Penn, USA) is called Endocuff Vision (ECV). It differs from the original Endocuff by having only a single
Adherence to Low-Risk Adenoma Recommendations From 2020 U.S. Multi-Society Task Force Postpolypectomy Guideline Has Not Yet Caught On
The U.S. Multi-Society Task Force on Colorectal Cancer (USMSTF) creates postpolypectomy surveillance interval recommendations for the U.S. The main change to the 2020 guideline was
Artificial Intelligence Increased Fraction of Colonoscopy Patients Needing 3-Year Surveillance: Relative Increase of 35% and Absolute Increase of 2.9%
This study examined the fraction of patients undergoing colonoscopy with versus without artificial intelligence (AI) in 9 randomized controlled trials (6 parallel and 3 tandem)
Review Your Bowel Preparation Program Regularly
In an article published by Gastrointestinal Endoscopy in its new Top Tips section, Shaukat reviews methods to improve bowel preparation in the endoscopy unit: Map the bowel
Endoscopic Submucosal Dissection Plus Radiofrequency Ablation Exhibits High Eradication Rates in Patients With Barrett’s Esophagus
Current strategies for the endoscopic treatment of Barrett’s esophagus (BE) focus on resection of nodular lesions within BE and then the ablation of the flat
Interval Cancers Are More Deadly Than Screen-Detected Cancers but Are Not Different in Molecular Features
Previous studies have found that interval or postcolonoscopy cancers have molecular profiles that differ somewhat from those of cancers detected at a baseline colonoscopy, including
Do Patients With Young-Onset Colorectal Cancer Require More Frequent Surveillance Colonoscopy?
Current recommendations for sporadic colorectal cancer (CRC) are to perform surveillance colonoscopy 1 year after surgical resection, then at 3 years, and then at 5-year
Upper Endoscopy Is an Aerosol-Generating Procedure
It is unclear whether SARS-CoV-2 can be transmitted through the aerosol route during GI endoscopic procedures. As more hospitals and endoscopy units are resuming prepandemic
Deaths From GI Cancers Declined in the U.S. From 2003 to 2019 but Less So in Rural Areas
Based on the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiological Research database, nationwide GI cancer age-adjusted mortality rates (AAMRs) per 100,000
Colonoscopy Every 10 Years Starting at Age 40 Modeled as Cost-Effective for Men With Body Mass Index ≥35
Obesity is a known risk factor for colorectal cancer (CRC) in both men and women. A previously developed decision analytic was used to model the
Steps To Consider in Deciding Whether To Incorporate a New Endoscopic Technique Into Your Practice
This interesting opinion piece provides advice regarding a process for deciding whether to incorporate a new endoscopic technique into your practice. The authors suggest you
What Is the Best Option for the Endoscopic Management of Malignant Gastric Outlet Obstruction?
Malignant gastric outlet obstruction (GOO) requires prompt surgical or endoscopic decompression. Surgery is associated with significant morbidity and mortality. Fortunately, with the evolution of endoscopic
Endoscopy Units Should Establish a Management Algorithm for Acute Iatrogenic Endoscopic Perforations
In this single-center study, 8 gastroenterology fellows and 20 practicing gastroenterologists answered a 10-question pretest regarding acute iatrogenic endoscopic perforation (AIEP) diagnosis and management. This
Observational Study Indicates Early Colonoscopy, Within 24 Hours of Admission, Benefits Patients With Shock Index ≥1, Performance Status ≥3
Randomized controlled trials of early versus late colonoscopy in acute lower GI bleeding suggest no or limited benefit from early colonoscopy, but some of these
Chronic Opioid Exposure Can Lead to a Higher Likelihood of Hypercontractile Esophagus and Distal Esophageal Spasm
Given a major increase (50%) in opioid prescriptions across the United States from 2000 to 2010, there is renewed interest in evaluating the effects of
Improving Quality in Upper Endoscopy
With more than 6.1 million EGDs performed in the United States annually, establishing quality measures is imperative. Having well-defined quality measures can ensure consistency for
Artificial Intelligence Increased Adenoma and Advanced Adenoma Detection Rates in Multicenter Randomized Controlled Trial
Artificial intelligence (AI) has been shown to increase adenoma detection rates (ADRs) by an average of about 10% in randomized controlled trials (RCTs). Meta-analyses of
Double Right-Sided Colon Examination Effective No Matter How You Do It
This study identified 5 randomized controlled trials that addressed the value of a second right-sided colon examination in the forward view versus no second examination.
ESGE and ESGENA Issue Position Statement on the Environmental Footprint of Endoscopy
Endoscopists interested in reducing their carbon and plastic footprints will find this set of recommendations from the European Society of Gastrointestinal Endoscopy and the European
Predicting Residual Neoplasia Risk After “Noncurative” Endoscopic Submucosal Dissection for Malignant Colorectal Lesions
This is a retrospective study from 15 Western centers performing colorectal endoscopic submucosal dissection (ESD) in Europe and Australia. A curative resection was defined as
Liquid Biopsy Shows Promise for Early-Onset Colorectal Cancer
Early-onset colorectal cancer (EOCRC), or CRC occurring before age 50, is associated with advanced tumor stage at diagnosis, distal colon location, and signet ring histology.
Peroral Endoscopic Myotomy for Achalasia Is Effective up to 4 Years
Recent guidelines have recommended peroral endoscopic myotomy (POEM) as first-line therapy for all subtypes of achalasia, given that POEM and laparoscopic Heller myotomy have comparable
New Recommendations on Anticoagulant and Antiplatelet Management During Acute GI Bleeding and the Periendoscopic Period
A new GRADE guideline from the American College of Gastroenterology and Canadian Association of Gastroenterology includes recommendations for the periendoscopic management of anticoagulants and antiplatelets
Impact of Preresection Biopsy on Subsequent Endoscopic Mucosal Resection
We often hear that physician-identified large nonpedunculated colorectal polyps (LNPCPs) that warrant referral to an advanced endoscopist for endoscopic mucosal resection (EMR) or endoscopic submucosal
Risk of Ileoanal Pouch Cancer Is Greater in Familial Adenomatous Polyposis Than in Ulcerative Colitis
This report identified 46 studies that included 19,964 patients with ulcerative colitis (UC) in whom 73 cases of pouch cancer occurred and 3741 patients with
Are Over-the-Scope Clips Superior to Other Methods of Hemostasis?
Nonvariceal upper gastrointestinal bleeding (NVUGIB) is potentially life-threatening and a common cause of hospitalization. Endoscopy is the procedure of choice for the evaluation and management
Breath Test for Colon Cancer Shows Promise
Patients with certain cancers expel volatile organic compounds (VOCs). VOCs are the basis of previous reports in which dogs were trained to identify patients with
Randomized Trial Finds Tip-In (Anchoring) EMR Superior to Conventional EMR for 10- to 25-mm Nonpedunculated Colorectal Polyps
“Tip-in” or “anchoring” endoscopic mucosal resection (A-EMR) involves submucosal injection followed by a small incision on the proximal side of the injection mound. The snare
Tip-in EMR Compared With ESD for 20- to 30-mm Nonpedunculated Colorectal Neoplasms
Tip-in endoscopic mucosal resection (EMR) involves submucosal injection, followed by an incision on the proximal side of the injection mound using a snare tip with
Are Proton Pump Inhibitors Truly Dangerous?
The use of proton pump inhibitors (PPIs) has continually increased over the past 20 to 30 years. As a result, interest has grown in the
Cap-Assisted EMR Produced Faster Resection Times and Lower Recurrence Rates Compared to Traditional EMR
Cap-assisted EMR (EMR-C) involves submucosal injection followed by resection using a stiff Olympus cap (MH-597, Olympus Optical Co, Ltd, Tokyo, Japan) with an outer diameter
Gender, Mood Among Factors Predicting Severe Symptoms With Bowel Preparation
In a study performed in 10 Italian centers, 1137 colonoscopy patients completed validated questionnaires prior to colonoscopy and had symptoms from bowel preparation tracked. Overall,
Ketogenic Diets and ß-Hydroxybutyrate May Suppress Colorectal Cancer
High-sugar diets and hyperglycemia have been associated with colorectal cancer (CRC). In this study, investigators showed that ketogenic diets both prevented and treated CRC induced
How Often Do Patients With Dyspepsia Have Pathology on Endoscopy?
Dyspepsia is a worldwide disease that interferes with quality of life. A 2010 systematic review investigated the prevalence of endoscopic findings in patients with dyspepsia;
Serrated Polyp Detection Predicted Interval Cancer Independent of Adenoma Detection Rate
The adenoma detection rate (ADR) is currently the recommended measure of the quality of mucosal inspection during colonoscopy. ADR does not include sessile serrated lesions
Hybrid Argon Plasma Coagulation Endorsed to Reduce Recurrence Rate After Colorectal EMR
Thermal coagulation of the normal-appearing margin using snare tip soft coagulation (STSC) treatment after endoscopic mucosal resection (EMR) has been shown to reduce recurrence rates
Badge Sign-in Plus Report Cards Increased First Case On-time Starts
At a single U.S. academic center with 20 endoscopists, including 13 academic and 7 voluntary, there were initial baseline measurements of first case on-time starts
Treating High-Grade Squamous Intraepithelial Lesions in HIV Prevents Anal Cancer
Anal cancer is 10 times more common in HIV-positive men than cervical cancer is in women in the general population; however, women with HIV are
Pilot Study Finds Submucosal Thickness Is Greater With Colorectal EMR Than ESD
Discussions of colorectal endoscopic mucosal resection (EMR) versus endoscopic submucosal dissection (ESD) usually focus on en bloc resection and recurrence rates. Little is known about
Artificial Intelligence Detects Dysplasia in Histopathology Slides From Patients With Barrett’s Esophagus
The degree of dysplasia in patients with Barrett’s esophagus (BE) is key to determining the application of BE endoscopic therapy and assigning surveillance intervals. Multiple
What Are the Risk Factors for Abdominal Pain Disorders of Gut-Brain Interaction?
Abdominal pain-related disorders of gut-brain interaction (AP-DGBI) affect a sizable portion of the population. Irritable bowel syndrome (IBS) is one of the most common forms
12 of 12 Patients With Mismatch Repair-Deficient, Locally Advanced Rectal Cancer Had Complete Response to Dostarlimab Alone
It is well known that mismatch repair-deficient colorectal cancer (CRC), also called microsatellite instability (MSI)-high CRC, fails to respond to traditional fluorouracil-based chemotherapy but has
Systematic Review and Meta-analysis Indicates Snare Tip Soft Coagulation of EMR Margins Is Likely Better Than Argon Plasma Coagulation
Thermal treatment of the margin of piecemeal endoscopic mucosal resection (EMR) defects is now considered an effective treatment for reducing recurrences. Some practitioners have adopted
Motorized Spiral Enteroscopy Effective for Previous Incomplete Colonoscopies Related to Redundant Colon
The motorized spiral enteroscope has been shown to be safe and effective for deep enteroscopy. This study from a single center included 36 patients who
Might Biliary Radiofrequency Ablation Be Less Effective Than We Thought?
Most inoperable malignant biliary strictures are best treated with self-expanding metal stents (SEMS); however, a significant portion of patients develop stent occlusion from neoplastic or
Liquid Biopsy After Resection of Stage II Colon Cancer Reduced the Need for Adjuvant Chemotherapy
Patients with stage III (node-positive) colorectal cancer (CRC) benefit from adjuvant chemotherapy. Patients with stage II (invading muscularis propia or deeper and node-negative) CRC typically
Median Thickness of Submucosa in the Resected Specimen Is Less With Underwater Than Conventional EMR for Polyps <20 mm
The thickness of submucosal tissue resection can be important for predicting whether the resection margin and submucosal assessment will be adequate when there is suspicion
Benign Tight Esophageal Strictures Can Be Managed With Weekly Dilations
For patients with complex benign esophageal strictures, including tight, long, or tortuous strictures, endoscopic dilation is usually performed at 2- to 4-week intervals. The success
Adenoma Detection Rate Says It All in FIT-Positive Patients
This is a study of detection indicators in 13,067 fecal immunochemical test (FIT)-positive colonoscopies performed by 80 community gastroenterologists. The cutoff for FIT positivity was
Actual Impact of COVID-19 on CRC (8.7% Reduction) and Advanced Adenoma (26.9% Reduction) Diagnoses in a U.S. Health Care System
This study utilized the Kaiser Permanente Northern California (KPNC) health care system to evaluate the actual impact of the COVID-19 pandemic on colorectal cancer (CRC).
Again, No Need To Adjust Adenoma Detection Rate After Inclusion of 45- To 49-Year-Olds
This study looked at a large health care system’s first-time screening colonoscopies from the period October 2017 through December 2018, prior to the American Cancer
Does Eradication of Helicobacter pylori Really Decrease Gastric Cancer Incidence and Mortality?
Gastric cancer is the third most common cause of cancer-related death in the world. Through the intestinal metaplasia pathway, Helicobacter pylori is a class 1 carcinogen and
Fully Covered Metal Stents Are the Most Cost-Effective Option for Benign Biliary Strictures in Chronic Pancreatitis
Benign distal biliary strictures (BBS) are common sequelae of chronic pancreatitis. The usual treatment involves prolonged maximal-caliber stenting, using either serial exchange of multiple plastic
Computer-Aided Detection Improves Adenoma Detection Rate and Adenomas Per Colonoscopy in Fecal Immunochemical Test-Positive Patients
In parallel-arm randomized trials involving mostly primary screening and surveillance colonoscopy patients, computer-aided detection (CADe) has increased the adenoma detection rate (ADR) by about 10%.
ORISE Associated With Submucosal Fullness and Distortion at Follow-Up EMR
ORISE (Boston Scientific, Marlborough, Mass, USA) is a viscous gel for submucosal injection. When ORISE is used for endoscopic mucosal resection (EMR) or endoscopic submucosal
Gastroenterology Fellows Need More Training in Detection of Sessile Serrated Lesions
Detection skills by gastroenterology fellows are difficult to quantitate. One way to measure detection is to have the fellow perform a complete colonoscopy and clear
CADx Program Met PIVI Thresholds for Diminutive Rectosigmoid Polyps but Not in Proximal Colon
A computer-assisted diagnosis (CADx) program is artificial intelligence (AI) software that predicts histology. In a prospective evaluation of the Fujifilm CADx program (CAD EYE, Fujifilm
For Resection Without Injection, Histologic Study Indicates Underwater Gives Most Complete Resection
Previous studies have indicated that cold snare polypectomy effectively removes colorectal lesions up to 15 mm in size but cuts more superficially than hot snare
Complications of Colonoscopy Remain Stable During Surveillance in VA Cooperative Study 380
Most studies of colonoscopy complications examine adverse event rates at a single time point. The Department of Veterans Affairs Cooperative Study #380 was one of
Utility of Motorized Spiral Enteroscopy
Motorized spiral enteroscopy (MSE) is innovative technology designed to facilitate advancement of the enteroscope across the small bowel. Preliminary studies have shown MSE to be
More on Recurrence After Endoscopic Resection of T1 Colorectal Cancer: In Large Study, Only Rectal Location Predicted Recurrence
Widely accepted predictors of local recurrence after endoscopic resection of T1 cancers include rectal location, positive resection margin, poor differentiation (PD), lymphovascular invasion (LVI), high-grade
New Study Suggests T2 Colorectal Cancers Could Be Resected Endoscopically and Analyzed for Risk of Lymph Node Metastases Before Surgical Resection
T2 colorectal cancers (CRCs) are almost invariably treated by surgical resection, but only 25% have lymph node metastases (LNM). An alternative approach in selected cases
New Distal Attachment Combines Hood and Finger Features
Distal attachments that utilize fingers include the Endocuff Vision (Olympus America, Center Valley, Penn, USA) and AmplifEYE (Medivators Inc, Minneapolis, Minn, USA). An alternative approach
Multi-Society Task Force Issues New Recommendations for Management of Hamartomatous Polyposis Syndromes
The hamartomatous polyposis syndromes include Peutz-Jeghers syndrome, juvenile polyposis syndrome, PTEN hamartoma tumor syndrome (Cowden’s and Bannayan-Riley-Ruvalcaba syndromes), and hereditary mixed polyposis syndrome. This document is a
Randomized Controlled Trial Finds Cold Forceps Are Equally Effective and Faster Than Cold Snare for Colorectal Polyps ≤3 mm
Previous studies have found that a cold snare is more effective than cold forceps for polypectomy of polyps ≥4 mm in size, but data are
Cold Snare Polypectomy of Pedunculated Polyps ≤10 mm: Choking Stalk for ≥10 Seconds Before Resection Reduces Immediate Bleeding
Cold snare polypectomy is now accepted as safer than hot resection of lesions ≤10 mm in size, though it is still widely believed that electrocautery
T1 Colorectal Cancer With Free Resection Margins Between 0.1 and 1 mm: High-Grade Tumor Budding Makes the Difference in Recurrence Risk
A free resection margin, often interpreted as >1 mm between cancer and the resection line, is an independent predictor of low risk for recurrent cancer
Large Japanese Real-World Experience Suggests Self-Expandable Metal Stents Are Beneficial in Obstructive Colorectal Cancer
Randomized controlled trials (RCT) of emergency surgery versus colonic stent placement using self-expandable metal stents (SEMS) have mostly suggested limited or no benefits from SEMS.
Hang Some Pictures of Sessile Serrated Lesions in Your Endoscopy Unit
The first requirement in detecting subtle colorectal lesions during colonoscopy is to know what they look like. In this study from Minneapolis, a poster with
What Are the Long-Term Outcomes of Gastric Peroral Endoscopic Myotomy Performed for Gastroparesis?
Refractory gastroparesis (RG) negatively impacts the quality of life, and treatments to date have worked variably. Gastric peroral endoscopic myotomy (G-POEM), first performed in 2013,
Systematic Review and Meta-analysis of Adenoma Detection Rates in FIT-positive Patients
The U.S. Multi-Society Task Force on Colorectal Cancer recommends minimally acceptable adenoma detection rates (ADRs) in primary screening colonoscopy of 30% in men and 20%
Artificial Intelligence Detection Program Assessment by a High Detector: Improved Adenoma Detection Rate, but Some Misses of Large, Flat Lesions
Artificial intelligence (AI) programs for computer-aided detection (CADe) of colorectal polyps have increased adenoma detection rates (ADR) by about 10% in parallel randomized trials and
Prophylactic Clipping to Prevent Postpolypectomy Bleeding After Oral Anticoagulants
Prophylactic clipping is generally considered effective for endoscopic mucosal resection (EMR) defects of lesions ≥20 mm removed with electrocautery and proximal to the splenic flexure.
Endoscopic Submucosal Dissection of Lesions at the Dentate Line Compared With Rectal Lesions Above the Dentate Line
This systematic review and meta-analysis sought to quantify the differences in outcomes after endoscopic submucosal dissection (ESD) of rectal lesions at the dentate line versus
Empiric Prophylactic Plastic Stenting for Disconnected Pancreatic Duct After Necrosectomy Is Not Uniformly Beneficial
Pancreatic necrosis often results in main pancreatic duct injury and eventual discontinuity, or so-called disconnected pancreatic duct syndrome (DPDS), with recurrent symptoms from duct obstruction
Linked Color Imaging Improves Sessile Serrated Lesion Detection
Linked color imaging (LCI) emphasizes red color and is available on Fujinon endoscopes (Fujifilm Corp, Tokyo, Japan). Previous studies found LCI improved adenoma detection and
Real-world Efficacy of Fecal Microbiota Transplantation for All C difficile Infection Subtypes: 81% for Recurrent, 78% for Refractory, 71% for Severe
This report describes a 4-year prospective, observational assessment of fecal microbiota transplantation (FMT) performed in 681 health care facilities across 50 U.S. states and 7
Smartphone Apps on Bowel Preparation for Colonoscopy Improve Bowel Prep and Increase Adenoma Detection Rate
This is a meta-analysis of 12 eligible randomized controlled trials with a total of 4165 patients that compared the effect of education using a smartphone
Expert Review Advises Personalized Approach to GERD Diagnosis and Treatment
GERD, manifested by typical symptoms of heartburn as well as regurgitation and additional extraesophageal symptoms, such as chronic cough, sore throat, and globus sensation, affects
Continuing Clopidogrel Increases Intraprocedural Bleeding and Clip Use After Cold Snare Polypectomy, but Not Delayed Bleeding
Guidelines have often recommended the continuation of clopidogrel for diagnostic colonoscopy but discontinuation for polypectomy, which is impractical because polypectomy rates are so high during
Advanced Adenoma Findings at Screening Colonoscopy Associated With Noncolorectal Cancer Mortality
This study used the VA Cooperative Screening Colonoscopy Study, one of the pivotal trials that led to federal legislation directing the Centers for Medicare and
Declining Colectomy Rates for Benign Colorectal Polyps in an Integrated Health Care System in the U.S.
Population-based studies have found no decline in colectomy rates for benign colorectal polyps over the past 10 to 15 years, even though a recent study
Chronic Physical and Mental Comorbidities Decrease Colonoscopy Uptake After Positive Fecal Blood Test
This study evaluated 168,701 individuals with a positive fecal occult blood test (FOBT) result, of whom 80.5% underwent colonoscopy within 12 months. Compared with patients
ASGE Guideline on Screening for Pancreatic Cancer in High-Risk Cohorts
Pancreatic ductal adenocarcinoma (PDAC) continues to have a dismal prognosis at the time of presentation. Survival is improved with diagnosis at an early stage, but
How to Manage Anticoagulants and Antiplatelets During Endoscopic Procedures
The increasing use of anticoagulant and antiplatelet agents has made the management of these medications during and around the time of endoscopy for GI bleeding
American Gastroenterological Association Updates Diet Recommendations for Irritable Bowel Syndrome
Irritable bowel syndrome (IBS) can be managed with a variety of treatments but commonly with diet and medications. This document from the American Gastroenterological Association
Detection Measures Other Than Adenoma Detection Rate Predict Postcolonoscopy Cancer
The adenoma detection rate (ADR) predicts the incidence of interval cancer after colonoscopy. Although ADR correlates in retrospective studies with other detection measures, it is
CMS Reduction in RVU Payment for Endoscopy With Anesthesia Slowed but Did Not Stop Growth in Anesthesia Use
In 2017, the Centers for Medicare and Medicaid Services (CMS) instituted a small relative value unit (RVU) reduction in the professional fee payment for endoscopy
Cold Snaring Effective for Colorectal Lesions Up to 15 mm
Cold snare resection is well established as comparably effective to and safer than hot snare resection for lesions ≤10 mm in size. In a study
Randomized Tandem Study Shows Artificial Intelligence Decreases Adenoma Miss Rate
In a randomized tandem study of 230 patients, the adenoma miss rate (AMR) was lower at 15.5% when colonoscopy with artificial intelligence (AI) was performed
Prospective Comparison of Needle Knives With Scissor Knives for Colorectal Endoscopic Submucosal Dissection
This is a post-hoc propensity score-matched analysis of 2498 colorectal lesions removed with needle-type or scissor-type knives for endoscopic submucosal dissection (ESD) in 11 Japanese
Salvage Endoscopic Submucosal Dissection After Chemoradiation for Locally Advanced Rectal Cancer
Patients with locally advanced rectal cancer who undergo neoadjuvant chemoradiation sometimes have remarkable responses to treatment. These may include evidence of no residual disease or
Green Tea Does Not Prevent Recurrent Adenomas in Females, but It Might in Males
Green tea contains catechins, which have anticancer properties and reduce the incidence of polyps in mouse models with a mutation in the Adenomatous polyposis coli gene. In
The Veterans Health Administration Instituted a National Policy Converting Screening Colonoscopy to FIT During the COVID Pandemic: Was the Policy Followed?
During the COVID-19 pandemic, the Veterans Health Administration (VHA) instituted a national policy converting screening colonoscopy to fecal immunochemical testing (FIT) to manage reduced access
Screening Endoscopy Should Be Considered in Patients With Head and Neck Cancer to Identify a Second Primary Esophageal Tumor
Individuals diagnosed with head and neck squamous cell carcinoma (HNSCC) are known to have an increased risk of developing a second primary tumor in the
When Proton Pump Inhibitors Should Be Discontinued: American Gastroenterological Association Clinical Practice Update
Proton pump inhibitors (PPIs) are prescribed for various indications, sometimes with clear evidence-based benefit and sometimes with little to no proven benefit. The purpose of
Small Tubular Adenomas Plus Small Serrated Polyps Equals Higher Risk of Metachronous Advanced Neoplasms
Recent studies have added complexity to our understanding of postpolypectomy surveillance risk, such as the risk of metachronous advanced neoplasia is higher with 6- to
Frequency of Splenic Injury in U.S. Inpatients
A previous study of U.S. inpatients suggested that the frequency of splenic injury was about 1 in 6000. The current study utilized 2012-2018 data from
Rectal Lesions Really Are, Well, Different
Previous studies have indicated that the rectosigmoid colon location is an independent risk factor for cancer in large nonpedunculated colorectal polyps. Surgical procedures for cancer
Poor Squamous Regeneration After Barrett’s Endoscopic Therapy Increases Risk for Treatment Failure and Disease Progression
A small subset of patients who undergo Barrett’s endoscopic therapy (BET) using radiofrequency ablation (RFA) will have evidence of poor mucosal healing (mucosal edema, ulcers,
Robotic Endoscopy Improves Efficacy and Safety of Endoscopic Submucosal Dissection
Endoscopic submucosal dissection (ESD) is technically difficult and relies on appropriate countertraction and visibility to safely remove lesions of interest. Robot-assisted endoscopy has been under
Adenoma Detection Rate in 45- to 49-year-olds in the GIQuIC Registry
According to 2014-2020 data from the GI Quality Improvement Consortium (GIQuIC) Registry, 2.81 million screening colonoscopies were performed by 814 endoscopists in patients aged 45
Hemorrhoids Are Associated With Diverticulosis Not Constipation or Dietary Fiber Intake
This was a case-control study of patients undergoing screening colonoscopy between 2013 and 2015. Patients completed a detailed diet and bowel habit questionnaire, and a
Endoscopic Intermuscular Dissection for Deep Submucosal Invasion in Rectal Cancer
Endoscopic submucosal dissection (ESD) for T1 rectal cancer can leave positive margins, particularly for lesions invasive to the middle or deep thirds of the submucosa.
Impact of Simethicone During Bowel Preparation on Colonoscopy Quality: Systematic Review and Meta-analysis of 38 Randomized Controlled Trials
Many endoscopists utilize simethicone (SIM) in their bowel preparations for colonoscopy. This systematic review and meta-analysis identified 38 randomized controlled trials relevant to SIM impact
Formal Training in Endoscope Handling and Care Reduces Repair Costs
In the current study, a medical center in Thailand instituted a formal educational program focused on personal awareness of endoscope handling and manipulation, the correct
The Functional Lumen Imaging Probe Can Be Used to Assess Response to Peroral Endoscopic Myotomy
Clinical response after peroral endoscopic myotomy (POEM) is subjectively assessed using the Eckardt score (ES) or objectively tested using high-resolution manometry (HRM) or barium esophagram.
Stopping Direct Oral Anticoagulants on the Day of Colonoscopy Was Enough to Prevent Bleeding After Cold Snare Polypectomy
Direct oral anticoagulants (DOACs) are often stopped a couple of days before colonoscopy and resumed one or more days after the procedure, depending on thromboembolism
Colonoscopy Without Bowel Preparation for Acute Lower GI Bleeding
Colonoscopy for acute lower GI bleeding is usually performed after bowel purge. In a retrospective study with clinical diverticular bleeding, 266 patients received bowel preparation
Does a Low FODMAP Diet Help Patients With Celiac Disease?
The incidence of celiac disease has been increasing over time and is commonly encountered in GI practice. Although a gluten-free diet leads to pathologic disease
Endoscopic Submucosal Dissection for Early Colorectal Cancer and High-Risk Surgery: Okay to Not Operate
This study investigated outcomes in patients who underwent endoscopic submucosal dissection (ESD) for T1 colorectal cancer (CRC) and then had adverse histologic features that predict
Cold Snare Polypectomy Failed to Achieve Complete Resection in 11% of 4- to 9-mm Polyps
In a randomized controlled trial (RCT) performed at 8 hospitals in 4 countries, patients with nonpedunculated polyps ranging in size from 4 to 9 mm
Oral Microbiome Therapy Made of Purified Firmicutes Spores Effective for Treatment of Recurrent C difficile Infection
This study was a double-blind, randomized, placebo-controlled trial. It included patients with ≥3 episodes of C difficile infection (CDI) within 12 months, including the qualifying acute episode.
Progression in Barrett’s Esophagus Score Can Be Used for Estimating Neoplastic Progression
Barrett’s esophagus (BE) is a known precancerous lesion for esophageal dysplasia and adenocarcinoma (EAC); however, it is unclear who will progress to high-grade dysplasia (HGD)
American College of Physicians Endorses No Antibiotics for Most Uncomplicated Acute Diverticulitis
The American College of Physicians (ACP) has issued a clinical guideline regarding acute left-sided diverticulitis. There are 3 recommendations, which were developed using the GRADE
American College of Physicians Issues Guideline on Colonoscopy and Interventions to Prevent Recurrence After Acute Left-sided Diverticulitis
This guideline from the American College of Physicians appears with a summary of the supporting literature review and has 3 recommendations: Colonoscopy should be performed
Examining Cost-Utility Data for Interventions to Prevent Infection Transmission by Duodenoscopes
Transmission of multidrug-resistant organisms between patients undergoing ERCP prompted the U.S. Food and Drug Administration to issue guidance for endoscopy departments to adopt intensified reprocessing
Is Cold Snare Piecemeal EMR Adequate in Treating Duodenal Adenomas?
Traditionally, nonampullary small-bowel adenomas ≥10 mm in diameter are resected utilizing cautery. Unfortunately, since the small bowel is thin-walled and highly vascular, adverse events are
Empiric Esophageal Dilation Is Not Useful for Nonobstructive Dysphagia
Empiric esophageal dilation often is performed for patients presenting with dysphagia who have no evidence of an anatomic obstruction or lesion. However, there is little
Clip Closure Did Not Reduce Delayed Hemorrhage After Resection of Large Sessile Serrated Lesions Using Electrocautery, Even From the Proximal Colon
Recent large randomized controlled trials have demonstrated that clip closure reduces the risk of delayed hemorrhage after endoscopic mucosal resection (EMR) using electrocautery if the
Proving What We All Know: Hot Snare Polypectomy Causes More Delayed Bleeding Than Cold Snare
This was a retrospective analysis of bleeding after cold snare polypectomy (CSP) and hot snare polypectomy (HSP) for colorectal lesions with a diameter <10 mm.
Artificial Intelligence False Positives in Colonoscopy Are Not Time Consuming
Computer-aided detection (CADe), or artificial intelligence (AI), programs are now commercially available and have been shown to increase the adenoma detection rate. These AI programs
Cutting Plane Between Underwater and Conventional EMR Is Similar
Randomized controlled trials (RCT) show that underwater EMR (UEMR) is more likely than conventional EMR (CEMR) to result in en bloc and R0 resection for
Guideline on Informed Consent for Endoscopic Procedures
Informed consent is mandatory before an endoscopic procedure. Its purpose is to educate the patient about the procedure and review the associated risks, benefits, and
Second-Generation Endocuff Versus Distal Cap Versus Standard High-Definition White-Light: No Overall Difference but More Detected Adenomas and Shorter Withdrawal Times in Screening Exams With Endocuff
This study from 3 U.S. centers is the first to compare the second-generation Endocuff Vision (Olympus America, Center Valley, Penn, USA) to distal cap (Reveal;
Endoscopic Submucosal Dissection Use Changes Histologic Diagnosis in More Than Half of All Patients With Visible Barrett’s Esophagus Neoplasia
Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) have emerged as important treatment techniques for patients with visible lesions in Barrett’s esophagus (BE). Whereas
Electrohydraulic Lithotripsy Safe and Effective for Clearing Obstructive Pancreatic Stones Near the Duodenum
Electrohydraulic lithotripsy (EHL) and laser lithotripsy are both well-established methods for the treatment of biliary and genitourinary stones. Several retrospective series have described successful pancreatoscopy-guided
Endoscopic Submucosal Dissection Enough to Cure Early Gastric Cancer?
Over the past decade, with advances in endoscopic resection (ER) techniques, there has been a trend toward removing early gastric cancer (EGC) with ER, especially
Cancer Risk in Serrated Polyposis Syndrome and Sporadic Sessile Serrated Lesion Patients and Their Relatives
This study used the Utah Cancer Registry to examine cancer risk in patients with serrated polyposis syndrome (SPS) and their relatives as well as patients
A Way Forward for Side-Viewing Colonoscopy?
Previous attempts to improve polyp detection during colonoscopy using extreme wide-angle or side-viewing optics have been unsuccessful, largely because of issues with diminished image resolution
Exploring Panendoscopy With a Colon Capsule: Issues of Bowel Preparation, Transit, Completion, Acceptance
This study looked at issues of technical success and acceptance of panendoscopy with a colon capsule in 451 generally healthy adults aged 50 to 75
Dye-based Chromoendoscopy Added Nothing to Prediction of Cancer in Colorectal Nonpedunculated Lesions
In a prospective study, 2 experts independently assessed the surfaces of 400 large, laterally spreading colorectal lesions (median size, 35 mm) for predictors of submucosal
Epinephrine Caused Increased Postprocedural Pain When Used for Colorectal EMR
Including epinephrine in the submucosal injectate for endoscopic mucosal resection (EMR) varies among endoscopists – some endoscopists prefer epinephrine, whereas others do not. Of those
Rivaroxaban Again Shown to Cause More GI Bleeding Than Other Direct Oral Anticoagulants
In a study from Iceland, investigators compared GI bleeding rates among 3217 patients receiving rivaroxaban, 2157 receiving apixaban, and 494 receiving dabigatran. Patients were excluded
Impact of Colonoscopy on Patients’ Work Productivity
The impact of colonoscopy on work productivity was assessed prospectively in 1137 employed patients in 10 Italian centers, utilizing a diary for 7 days after
Asking Patients With Colorectal Cancer to Help Get Their Siblings Screened Is Not That Helpful
We often tell our patients with colorectal cancer (CRC) or advanced adenomas that guidelines indicate their siblings are at increased risk of developing CRC or
Barrett’s Endoscopic Therapy Using Hybrid-Argon Plasma Coagulation Is Safe and Effective
Endoscopic therapy for Barrett’s esophagus (BE) usually involves resection of visible lesions by endoscopic mucosal resection followed by mucosal ablation using radio frequency ablation. Hybrid
Should We Mark the Margins Before EMR?
One approach sometimes used in endoscopic mucosal resection (EMR) to improve complete resection is to use cautery to mark the normal tissue at the margins
Transferring Endoscopic Submucosal Dissection Skills From Hands-on to Human Cases
This report from The Netherlands describes the results of a survey of 118 participants in an endoscopic submucosal dissection (ESD) training workshop using live porcine
Study Suggests Computer-Aided Quality Assurance More Important Than Computer-Aided Detection in Polyp Detection
Artificial intelligence (AI) that highlights lesions seen at endoscopy is called computer-aided detection (CADe) or detection software. Computer-aided quality (CAQ) programs assess the completeness of
How Best to Treat Collagenous Gastritis?
Collagenous gastritis (CG) is an uncommon disorder characterized by subepithelial collagen deposition in the stomach. Symptoms vary depending on the phenotype (pediatric-onset vs adult-onset). Treatment
Too Much Forceps Removal of Small Polyps, but It Could Be Modified
Anecdotally, many colonoscopists still use forceps to remove small and diminutive colorectal polyps that are more effectively and efficiently removed by snare polypectomy. In 2
Randomized Controlled Trial of Thin Versus Thick Cold Snare Polypectomy for Small Polyps: Not Much Difference
Cold snare polypectomy is now considered the resection method of choice for colorectal lesions ≤10 mm in size. Dedicated snares with a wire diameter about
Randomized Controlled Trial Confirms Clipping Is Effective in Prevention of Right-Sided Colon Bleeding After EMR With Electrocautery
Previous randomized controlled trials (RCTs) have indicated that prophylactic clip closure is effective in preventing delayed hemorrhage after EMR of colonic lesions that are ≥20
Evacuation Problems? Check the RED Test
The balloon expulsion test (BET) is a screening tool for rectal evacuation disorders. BET is often performed in conjunction with anorectal manometry. In this report,
Gluten Intake Not Associated With GI Cancer Risk
Gluten exposure triggers an immune reaction in celiac disease that is associated with an increased risk of GI cancers. In this study, the effect of
Endoscopic Resection for Early Esophageal Squamous Cell Carcinoma Invading the Muscularis Mucosae Without Lymphovascular Invasion
Superficial esophageal squamous cell carcinoma (ESCC) involving the epithelium and lamina propria is treated with endoscopic resection (ER) due to negligible risk of lymph node
U.S. Multi-Society Task Force Endorses Colorectal Cancer Screening in Average-Risk Persons at Age 45
In a recommendation characterized as “weak recommendation; low-quality evidence,” the U.S. Multi-Society Task Force on Colorectal Cancer (MSTF) now recommends initiating screening for colorectal cancer
Laterally Spreading Lesions With Focus of T1 Cancer Treated by Hybrid EMR and EFTR
Patients with laterally spreading lesions and endoscopic evidence of T1 cancer (usually of morphologic change combined with NBI International Colorectal Endoscopic classification 3 or Kudo
Management of Large Polyps in a French Colorectal Cancer Screening Program Using Fecal Immunochemical Testing Suboptimal, With Widely Varying Endoscopic Resection Rates
In a study of fecal immunochemical test-positive patients in France, 1256 large polyps (LPs), defined as polyps ≥20 mm, were detected by 102 community gastroenterologists.
Single Dose of Intravenous Antibiotics Before Peroral Endoscopic Myotomy Is Sufficient for Infection Prevention
Peroral endoscopic myotomy (POEM) is an endoscopic procedure that exposes the contents of the esophagus to the sterile mediastinum during the myotomy. This allows microbial
Key to Optimal Pathology Reporting for Endoscopic Gastric Cancer Resection Specimens
Endoscopic resection (ER) of early gastric neoplasia is being performed with increasing frequency by endoscopists. Complete and accurate reporting of pathology is imperative to provide
Cholecystectomy Optimally Performed Within 8 Weeks for Necrotizing Biliary Pancreatitis
Cholecystectomy before hospital dismissal is advised for most cases of acute biliary pancreatitis (ABP). Surgery is often delayed in the setting of pancreatic necrosis to
Predicting Diverticulitis and Surgery for Diverticulitis Based on Endoscopic and Clinical Features: DICA and CODA Scoring
The Diverticular Inflammation and Complication Assessment (DICA) endoscopic scale is a scoring system that predicts diverticulitis and related surgery. Briefly, this scale takes into account
There Are Now 5 Randomized Controlled Trials of Flexible Sigmoidoscopy Screening, and They All Show It Works
Four previous randomized controlled trials of flexible sigmoidoscopy (FS) have shown reductions in at least distal colorectal cancer (CRC) incidence and mortality after FS screening.
Cryoballoon Ablation Has Similar Efficacy to but Higher Stricture Rates Than Radiofrequency Ablation in Barrett’s Endoscopic Therapy
Radiofrequency ablation (RFA) is widely utilized in the treatment of neoplastic Barrett’s esophagus (BE) after endoscopic resection of all visible lesions. Cryotherapy is another form
European Society of Gastrointestinal Endoscopy Issues Guideline on Lower GI Tract Endoscopic Tissue Sampling
These evidence-based recommendations from the European Society of Gastrointestinal Endoscopy (ESGE) cover principles of tissue sampling and removal in the lower GI tract. Some points
Endocuff Vision Effective in “Real-World” Experience
Endocuff Vision (ECV; Olympus America, Center Valley, Pa) has produced adenoma detection rate (ADR) gains in randomized controlled trials, but it has not received widespread
Do We Keep Measuring and Measuring and Measuring Adenoma Detection Rate?
The adenoma detection rate (ADR), first recommended by the U.S. Multi-Society Task Force on Colorectal Cancer in 2002, is a validated predictor of colorectal cancer
U.S. GI Endoscopy Volumes: Biggest Change Is Increases in Upper Endoscopic Ultrasound
This article uses data from multiple sources to estimate gastrointestinal, liver, and pancreatic health care expenditures, ambulatory visits, and hospitalizations, as well as endoscopic procedural
Birth Cohort Effects in Colorectal Cancer Impacting 50- to 54-Year-Olds
As birth cohorts younger than age 50 become progressively younger, the relative increase in colorectal cancer (CRC) risk compared to past decades becomes progressively greater.
Constipation Is Not a Risk Factor for Colorectal Cancer
Patients are often concerned that chronic constipation will put them at risk for colorectal cancer (CRC), and previous data on this topic have been mixed.
Refractory Gastroparesis: Expert Recommendations
Gastroparesis is a vexing problem and often has overlapping symptoms with functional dyspepsia. In this update from the American Gastroenterological Association, medically refractory gastroparesis is
A Negative Upper Endoscopy in Patients With GERD Reduces Incidence and Mortality From Upper GI Cancers
Gastroesophageal reflux disease (GERD) is the most common reason for referral for upper endoscopy. This study sought to determine whether there is a relationship between
Further Validation for a Motorized Endoscopic Necrosectomy Device
Many patients with walled-off pancreatic necrosis (WON) require debridement following minimally invasive drainage. This often entails serial procedures with cumulative expense and risk. These authors
Systematic Review and Meta-Analysis Finds That 9-Minute Withdrawal Is Indeed Better Than 6 Minutes
Very large retrospective studies of withdrawal time and colonoscopy yield have indicated that interval cancer prevention levels out with a withdrawal time of 8 to
Meta-Analysis of Full-Thickness Resection in the Colorectum
In a meta-analysis of 14 studies of colorectal endoscopic full-thickness resection (EFTR) involving 1936 patients, 76% of lesions were in the colon and the remainder
World Gastroenterology Organisation Reports on Gastroenterology, Climate Change, and Nonrecyclable Waste
This report from the World Gastroenterology Organisation (WGO) reviews the potential health impact of climate change on GI disease, but it also calls on gastroenterology
Surveillance Rather Than Immediate Resection Appears Advisable for Most Familial Adenomatous Polyposis-Related Ampullary Adenomas
Ampullary, periampullary, and duodenal adenomas commonly occur in familial adenomatous polyposis (FAP). Their detection and management are fraught with challenges related to balancing the risk
Predictors of Endoscopy Procedure Volume During Fellowship: Male Gender and Private (vs Academic) Program
The American Society for Gastrointestinal Endoscopy recommends that gastroenterology fellows complete a minimum of 130 EGDs and 275 colonoscopies before assessing competency. In a survey
Genetic Testing for Everyone With 10 or More Adenomas? It’s Low Yield
Germline genetic testing for inherited colorectal cancer syndromes often is recommended in patients with ≥10 cumulative adenomas. However, the evidence to support this recommendation is
Barrett’s Esophagus-Specific Training Improves Adherence to Diagnosis and Treatment Guidelines
The accurate diagnosis and management of patients with Barrett’s esophagus (BE) are important for the early recognition and minimally invasive treatment of BE neoplasia. Despite
Artificial Intelligence Similar to Expert Endoscopists at Differentiating Between Mucosal and Submucosal Barrett’s Cancer
Artificial intelligence (AI) systems using convolutional neural networks have been developed to differentiate between esophageal cancer (EAC), high-grade dysplasia, and nondysplastic Barrett’s esophagus. However, until
Oral Sulfate Solution and 2-Liter Polyethylene Glycol-Ascorbic Acid Are Both Safe and Effective in Older Patients
In a trial of 199 patients aged 65 to 80 years, standard oral sulfate solution (OSS) was compared with 2-L polyethylene glycol with ascorbic acid
Current Rates of Colorectal Cancer in Average-Risk Screening Are About 1 in 500
Older studies have suggested that the prevalence of cancer detected with average-risk screening colonoscopy is 0.5% to 1% or about 1 cancer per 100 to
Multi-Society Task Force Said to Repeat Colonoscopy Within One Year for Inadequate Preparation, but a Lot of Colonoscopists Aren’t
In 2015, the U.S. Multi-Society Task Force (MSTF) on Colorectal Cancer, composed of members of the 3 luminal GI societies, recommended that patients with inadequate
Cap-Assisted Endoscopic Mucosal Resection Effective for Flat and Fibrotic Colorectal Polyps
Everyone performing EMR in the colorectum encounters flat or fibrotic polyp tissue that resists standard snaring. In a multicenter European study, 70 nonlifting polyps with
Incision Improves Success and Safety for Difficult Biliary Access Compared With Wire- or Stent-Guided Entry
A variety of techniques have been described for achieving deep biliary cannulation, a necessary prelude to most endoscopic retrograde cholangiographic (ERCP) procedures. The rate of
Does Hemostatic Powder Lessen Bleeding After Endoscopic Submucosal Dissection?
Bleeding after endoscopic submucosal dissection (ESD) is one of the most common adverse events, but the risk of post-ESD bleeding varies, depending on antiplatelet or
How Much Will Screening 45- to 49-Year-Olds Affect ADR?
With the advent of screening average-risk persons beginning at age 45, many are wondering whether minimum acceptable adenoma detection rate (ADR) thresholds will need adjustment,
Endoscopic Full-Thickness Resection for T1 Colorectal Cancers: Update on Short-Term Outcomes
Endoscopic full-thickness resection (eFTR) can be used for lesions <30 mm in size, and when used for early colorectal cancer (CRC), it provides a histologic
Perioperative Antibiotics Did Not Prevent Postendoscopic Submucosal Dissection Coagulation Syndrome in Study
Postendoscopic coagulation syndrome (PECS) is common after endoscopic submucosal dissection (ESD), and prior data have indicated that perioperative antibiotics reduced the syndrome. In this Japanese
Artificial Intelligence for Detection During Colonoscopy Works in the U.S. Too
Artificial intelligence programs that detect lesions are called computer-aided detection (CADe) systems. Randomized controlled trials of CADe for colonoscopy have, thus far, mostly been performed
Smoking, Obesity, Alcohol, and GERD Continue To Be Common, Modifiable Risk Factors for Upper GI Cancers
Among upper gastrointestinal (UGI) cancers, gastric and esophageal cancers rank third and sixth, respectively, as the most common cause of death due to cancer worldwide.
Upper GI Screening Endoscopy in Individuals With a Family History of Barrett’s Esophagus or Esophageal Cancer
The incidence of esophageal adenocarcinoma (EAC) continues to increase and is still associated with a poor prognosis with a 5-year survival rate of 20%. The
Endoscopic Septotomy Is Safe and Effective for the Treatment of Zenker’s Diverticulum
Zenker’s diverticulum (ZD) can lead to dysphagia to both solids and liquids and can be treated endoscopically or surgically. This retrospective, single-center, observational study evaluated
Pericolonoscopy Antibiotics Associated With Postcolonoscopy Irritable Bowel Syndrome
Experienced colonoscopists have seen occasional patients date the onset of irritable bowel syndrome (IBS) to colonoscopy (and, occasionally, patients who date improvement of digestive symptoms
Diagnosis and Management of Atrophic Gastritis: Clinical Practice Update From the American Gastroenterological Association
Patients with atrophic gastritis (AG) are at increased risk for gastric cancer; however, the diagnosis and surveillance of AG are not well-defined. Algorithms for the
PEG Placement: Is the Radiologic, Surgical, or Endoscopic Technique Safest?
The optimal technique for gastrostomy tube placement remains undefined. This retrospective study used the Nationwide Readmissions Database and the International Classification of Diseases Procedure Coding
On Balance, Benefit of Sphincterotomy for Biliary Stenting Appears to Outweigh the Risk
Limited reports have suggested that endoscopic biliary sphincterotomy (ES) at the time of transpapillary biliary stent placement may reduce the risk of post-ERCP pancreatitis (PEP).
Problems With Colorectal EMR Training for Some GI Fellows
In a 2019-2020 academic year survey of all 1730 GI fellows in the U.S. regarding endoscopic mucosal resection (EMR) training and knowledge, the response rate
Maternal Obesity and Pregnancy Weight Gain and Colorectal Cancer Risk in Offspring
This study utilized a database of women and their prenatal care between 1959 and 1966, involving 18,751 live births and 14,507 mothers. Sixty-eight offspring developed
Cold Snare Polypectomy Without Submucosal Injection May Be the Treatment of Choice for Sessile Serrated Lesions 10 mm or Larger
In a multicenter, multinational study, retrospectively obtained data for 379 patients showed 615 sessile serrated lesions ≥10 mm in size resected by cold snare polypectomy
Are Gastroenterologists Better at Colonoscopy Than Other Specialists? Yep
Numerous studies have found that colonoscopies performed by nongastroenterologists are associated with lower rates of polyp detection and higher rates of interval cancer than colonoscopies
Artificial Intelligence During Barrett’s Endoscopy Is Accurate for Reporting Prague Criteria
During endoscopy, the extent of Barrett’s esophagus (BE) is quantified by endoscopists using the widely accepted Prague C&M (circumferential and maximal lengths) criteria. Prague C&M
Peroral Endoscopic Myotomy Is Effective and Safe for Spastic Esophageal Motility Disorders
Spastic esophageal motility disorders (SEMDs) include a group of esophageal dysmotility conditions that are difficult to treat and often refractory to nonsurgical and/or endoscopic measures.
Endo-SPONGE Analysis Shows Device Effective in Treating Colorectal Anastomotic Leaks
Anastomotic leak after low anterior resection is a dreaded complication. Patients with generalized peritonitis must undergo surgery, and treatment of localized walled-off leaks is not
Sessile Serrated Lesions, Unspecified Serrated Polyps, and Colorectal Cancer Risk
This study examined the risk of colorectal cancer (CRC) associated with serrated polyp subtypes in patients undergoing their first colonoscopy between 2006 and 2016. There
Updated Guideline on Endoscopy and Antiplatelet or Anticoagulant Therapy From British and European Gastroenterology Organizations
This guideline from the British Society of Gastroenterology and the European Society of Gastrointestinal Endoscopy relies on the traditional division of procedures into low risk
Does Better Sleep Prevent Colon Cancer?
In this study from Sweden, 58,657 persons aged 50 years and older prescribed melatonin were matched with 175,971 nonusers of melatonin. The adjusted hazard ratio
Are There Signs or Symptoms That Predate the Diagnosis of Pancreatic Cancer?
Pancreatic ductal adenocarcinoma (PDAC) is the third leading cause of cancer mortality since most cancers are advanced at diagnosis. Early identification of these cancers is
Neoplasia Detection Rate Can Be Used as a Quality Indicator for Endoscopy in Barrett’s Esophagus
Standardized quality metrics evaluating the performance of a high-quality examination in patients with Barrett’s esophagus are lacking. The neoplasia detection rate (NDR), defined as the
Underwater EMR Outperforms Conventional EMR for 20- to 40-mm Nonpedunculated Polyps in Randomized Controlled Trial
In a single-center randomized controlled trial from Germany, 148 nonpedunculated lesions 20 to 40 mm in size were included in a per-protocol analysis and randomized
Incompletely Resected Polyps Associated With Subsequent Neoplasia and Advanced Neoplasia in Observational Study
Interval cancers are thought to result primarily from missed lesions, with a smaller component in the 10% to 30% range arising from incomplete polyp resection.
Summary of Evidence: Overweight and Obesity Are Both Associated With Early-Onset Colorectal Cancer Incidence
Intense ongoing investigation has suggested a number of risk factors for early-onset colorectal cancer (EOCRC), defined as CRC in persons younger than aged 50 years
Removing Duodenal Epithelial Lesions: Does Underwater Endoscopic Resection Work?
Underwater endoscopic mucosal resection (UEMR) has been increasingly utilized in the resection of colonic and duodenal mucosal lesions. Its use for resection of nonpolypoid superficial
Computer-Based Measurement of Polyp Size Getting Closer
Polyp size measurements by endoscopists during colonoscopy are notoriously inaccurate, with both over-measurements and under-measurements. Computerized assessments of polyp size are promising for more accurate
Narrow-Band Imaging Is a Good Screening Modality for Esophageal Squamous Cell Cancer for Expert and General Endoscopists
Those at high risk or with a prior history of esophageal squamous cell cancer (SCC) are recommended to undergo screening or surveillance using dye-based chromoendoscopy.
Tip-In EMR Increases En Bloc Resection Rate for 15- to 25-mm Colorectal Lesions
Tip-in EMR is a method of anchoring the snare tip in the submucosa before snare resection. First, a mound of submucosal injection is created. Then,
Is a Second Right-Side Colon Examination Needed When Using Mucosal Exposure Devices? Yes
Double right-sided colon examination has been advocated as a way to reduce interval cancers, which are more common in the proximal colon. Mucosal exposure devices,
Patients Live a Healthier Lifestyle After Endoscopic Screening
Previous studies have been inconclusive as to whether endoscopic screening contributes to patients leading a healthier or unhealthier lifestyle. For example, patients with normal examinations
Protein Assays Added to the Fecal Immunochemical Test Improve Sensitivity for Advanced Adenomas
The fecal immunochemical test (FIT) is widely chosen by organized colorectal cancer (CRC) screening programs as the screening test of choice. FIT detects about 80%
Only 80% Eradication Rates of Barrett’s Esophagus With Long-Term Follow-Up of Endoscopic Therapy Studies
Patients with high-grade dysplasia and/or early cancer in Barrett’s esophagus (BE) are treated with endoscopic therapy (BET), with the goal of complete eradication of all
New Data Indicate That Surgery Rates for Benign Polyps Might Be Finally Declining
Several recent studies have collectively reported that surgery rates for benign colorectal polyps in the U.S. have continued to increase even though surgery results in
Low Vitamin D Intake Associated With Early Onset Colorectal Cancer in Nurses’ Health Study
Many investigators are trying to understand the increasing risk of colorectal cancer (CRC) developing before age 50, or so-called early-onset CRC. The Nurses’ Health Study
Diet High in Processed Meats and Low in Mixed Vegetables and Legumes Associated With Early-Onset Adenomas
This study utilized the Nurses’ Health Study II data to evaluate a sulfur microbial diet (high intake of processed meats and low intake of vegetables
No Increase in Adenomas in Microscopic Colitis
Although ulcerative colitis and Crohn’s colitis are associated with an increased risk of colorectal cancer (CRC), chronic inflammation associated with microscopic colitis (MC) has not
DNA Methylation Studies of Biliary Brush Cytology Samples Likely to Aid in Diagnosis of Cholangiocarcinoma
Establishing a firm diagnosis for indeterminate biliary strictures is often challenging. The current standard of practice is fluoroscopic and cholangioscopic characterization with brush and biopsy
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
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
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
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
Peroral Endoscopic Myotomy Is Safe and Effective: A 10-Year Follow-Up of Patients
Peroral endoscopic myotomy (POEM), an endoscopic modality for managing major esophageal motility disorders, has gained popularity in the last decade. Multiple controlled studies and systematic
Endoscopic Management of Perforations: AGA Clinical Practice Update
A practice update from the American Gastroenterological Association used expert review and focus on methodologies to develop best practice recommendations for the management of endoscopic
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
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
Esophageal Dilation Is Safe and Effective in Patients With Difficult-to-Treat Eosinophilic Esophagitis
The phenotypes of eosinophilic esophagitis (EoE) range from mild inflammation to severe fibrostenotic disease. Although current therapies (diet, proton pump inhibitors, and steroids) have shown
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
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
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
Do Individuals With Celiac Disease Really Have an Increased Risk of Cancer?
Diagnosis of celiac disease has increased significantly over the past decade. The risk of cancer in this patient population is thought to be increased, although
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
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
Does Ranitidine Use Increase Risk of Bladder Cancer?
In 2020, the U.S. Food and Drug Administration and other similar bodies recalled all ranitidine products, secondary to a possible increased association with several types
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
Adverse Events Are Uncommon After Peroral Endoscopic Myotomy, Score Predicts Those at Risk
Peroral endoscopic myotomy (POEM) is a widely accepted, effective endoscopic procedure for the management of achalasia. Although POEM is considered a relatively safe procedure, studies
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
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
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
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
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
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
Oral Budesonide Suspension Is Effective in Patients With Eosinophilic Esophagitis
Eosinophilic esophagitis (EoE), a chronic inflammatory disorder, can be treated with steroids, proton pump inhibitors, and dietary modifications. There have been advances in the formulations
Is There a Method to Improve Examination of the Small Bowel With Capsule Endoscopy?
The ability of video capsule endoscopy (VCE) to detect small-bowel (SB) pathology is dependent on adequate visibility and motility. This single-center, prospective, randomized, controlled trial
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
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
Endoscopic GERD Treatment With Full-Thickness Plication Is Safe and Effective
Gastroesophageal reflux disease (GERD), a relatively common condition impacting up to 40% of the adult population, can be treated with proton pump inhibitors (PPIs), laparoscopic
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
BILE Criteria to Assess ERCP Need in Cholangitis May Be More Sensitive, Less Cumbersome Than Others
Biliary obstruction with associated cholangitis usually is managed with the use of endoscopic retrograde cholangiopancreatography (ERCP) for stone extraction or stent decompression of the bile
Nonendoscopic Detection of Barrett’s Esophagus Using Methylated DNA Markers
Currently, an upper GI endoscopy with biopsies of the columnar-lined distal esophagus is necessary to diagnose Barrett’s esophagus (BE). Easier, noninvasive, nonendoscopy-based testing techniques have
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,
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
Pancreatic Cystic Lesions: Is Fluid Glucose Better Than Carcinoembryonic Antigen?
Differentiating pancreatic mucinous from nonmucinous cysts can be challenging, and the pancreatic cyst fluid (PCF) carcinoembryonic antigen (CEA) level has suboptimal accuracy. Adjunct tests, such
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
Covered Metal Stents Equal to Multiple Plastic Stents for Treatment of Biliary Strictures From Chronic Pancreatitis but Require Fewer Procedures
Compression of the distal bile duct within a fibrotic pancreas is one complication of chronic pancreatitis (CP), which can lead to chronic cholestasis, cholangitis, and
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
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
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
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
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
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
POEM and Surgical Myotomy for Achalasia Show Comparable Functional Luminal Imaging Probe Measurement Results at 1 Year
The functional luminal imaging probe (FLIP) measures the distensibility index (DI) at the gastroesophageal junction (GEJ). This is a measure of GEJ compliance, which has
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
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
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%)
Transpapillary Gallbladder Stent Placement Usually Successful as Destination Therapy
Severe acute cholecystitis (AC) often is palliated with percutaneous or endoscopic drainage 6 to 12 weeks prior to preplanned interval cholecystectomy. Many patients with severe
Antireflux Surgery Is Associated With a Low 90-Day Mortality Rate in Patients With GERD
Laparoscopic antireflux surgery (ARS) is an effective treatment for patients with well-documented gastroesophageal reflux disease (GERD). In this retrospective cohort study, investigators used national databases
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
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
Management of Bariatric Complications: An American Gastroenterological Association Clinical Practice Update
More than 200,000 bariatric surgeries took place in 2018. Of these, 95% were either a sleeve gastrectomy or Roux-En-Y gastric bypass. Although the 90-day mortality
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
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
Pneumatic Dilation Is Ineffective for Postfundoplication Dysphagia
Persistent dysphagia (ie, symptoms for more than 3 months) after fundoplication surgery is reported in up to 25% of patients. After anatomical causes of dysphagia
“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
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
Radiofrequency Ablation Plus Stent Placement for Extrahepatic Cholangiocarcinoma Shows Benefit Over Stenting Alone
The optimal treatment for cholangiocarcinoma (CCA) or ampullary carcinoma (AC) is surgery. When deemed unresectable and not amenable to neoadjuvant therapy followed by liver transplantation,
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
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
Linked Color Imaging Improves Neoplasia Detection
Image-enhanced endoscopy is aimed at improving the detection of neoplastic lesions in the luminal GI tract during standard white-light endoscopy (WLE). Linked color imaging (LCI)
Better, but Insufficient Results From Duodenoscope Reprocessing With Double Wash and High-Level Disinfection or Liquid Chemical Sterilization
The potential for interpatient transmission of infections by contaminated duodenoscopes is a significant concern in the practice of ERCP. Pending further understanding and development of
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
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
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
Is Gastroparesis Truly Different From Functional Dyspepsia?
Patients with functional dyspepsia (FD) and gastroparesis are commonly seen, diagnosed, and treated in gastroenterology clinics. Though we think of these diseases as two separate
Endoscopic Features for Recognizing Buried Barrett’s Esophagus
Buried Barrett’s esophagus (BE) mucosa, or subsquamous intestinal metaplasia, is defined as intestinal metaplasia that is present under a lining of endoscopically intact squamous epithelium.
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
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)
New Study Associates Hyperlipidemia, Obesity, and Alcohol Consumption With Early-Onset Colorectal Cancer
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
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
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
Endoscopic Screening Reduces Mortality From Esophageal Cancer in High-Risk Population
Although esophageal adenocarcinoma (EAC) is the most common type of esophageal cancer in the Western world, esophageal squamous cell carcinoma (ESCC) is the dominant type
Are Proton Pump Inhibitors Associated With Increased Mortality?
There has been significant media attention on the risks of proton pump inhibitors (PPIs) noted in observational studies, including associated risks of pneumonia, Clostridium difficile,
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
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
Cholecystectomy Before Dismissal Confirmed as Optimal in Large Population of Veterans With Biliary Pancreatitis
Multiple guidelines recommend performing cholecystectomy (CCy) before hospital dismissal for patients with mild gallstone pancreatitis that is not complicated by infection or necrosis. In this
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
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;
Artificial Intelligence Accurately Identifies Esophageal Lesions
Artificial intelligence (AI) studies for detecting and differentiating gastrointestinal lesions are on the rise. Various groups have developed a multitude of machine-learning algorithms to accurately
Does Ranitidine Use Increase Cancer Risk?
Ranitidine is a widely used H2-receptor antagonist used to treat reflux and peptic ulcer disease. Recently, the U.S. Food and Drug Association (FDA) discontinued sales
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
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
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
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
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
Can We Decrease Lesion Recurrence After Duodenal Endoscopic Mucosal Resection?
Laterally spreading lesions (LSLs) of the duodenum are increasingly being diagnosed and treated endoscopically. Although endoscopic resection of the thin and vascular duodenal wall is
Recurrence of Intestinal Metaplasia in the Cardia After Barrett’s Endoscopic Therapy: What To Do?
In patients undergoing Barrett’s endoscopic therapy (BET), complete eradication of intestinal metaplasia (CE-IM) is the final goal. However, studies have reported recurrence of IM, specifically
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
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
Hydrogen Peroxide, One Way or Another, Appears Beneficial During Endoscopic Necrosectomy
Management of walled-off pancreatic necrosis often benefits from direct transmural endoscopic necrosectomy. This retrospective chart review assessed the utility of hydrogen peroxide (H2O2) lavage as
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
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
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
Reflux Monitoring Can Reduce the Inappropriate Use of Proton Pump Inhibitors in Patients With GERD
Proton pump inhibitors (PPIs) are the main treatment for gastroesophageal reflux disease (GERD). However, 30% to 50% of patients with GERD fail to achieve adequate
Diaphragmatic Breathing Can Help Reduce GERD
Upright gastroesophageal reflux disease (GERD), also known as upright reflux, is thought to be a result of increased intragastric pressure. In turn, increases in intragastric
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,
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.
Best Conformation for Hilar Self-Expanding Metal Stents Remains Undefined
Bilateral placement of metal stents for malignant hilar strictures (MHS) can be challenging. Two approaches have been used, each with potential benefits and challenges. In
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
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
Updated Criteria for Prediction of Choledocholithiasis Add Specificity
A variety of recommendations have been proposed for predicting choledocholithiasis based upon presenting signs, symptoms, initial laboratory studies, and imaging. In this retrospective study, the
Endoscopic Management of Gastroduodenal Obstruction
Gastric outlet obstruction (GOO) can result in significant morbidity. Symptoms include early satiety, nausea, vomiting, and abdominal pain, which are frequently associated with weight loss.
Is Gastric Electric Stimulation Cost-Effective in Patients With Refractory Vomiting?
Medication-refractory nausea and vomiting, which is often due to gastric dysmotility, is a challenging problem. High-frequency gastric electrical stimulation (GES), which was approved by the
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
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
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
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
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
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
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
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
Achalasia Patients at Increased Risk for Esophageal Cancer
Achalasia can cause food retention, leading to bacterial overgrowth, irritation, and chronic inflammation, a proposed pathophysiological process that may lead to squamous cell carcinoma (SCC).
Should We Be Treating Postsurgical Leaks Endoscopically?
Postoperative leaks are difficult to treat; however, the evolution of therapeutic endoscopy has allowed less-invasive repair techniques in an attempt to avoid repeat surgery. This
Further Evidence Supporting Early, Primary Use of Precut Sphincterotomy for Duct Access
Deep access to the bile duct or the pancreatic duct is required in order to complete all subsequent therapeutic ERCP maneuvers. Precut sphincterotomy (PCS) refers
Cryoballoon Ablation Can Be Used for Barrett’s Esophagus Endoscopic Therapy
Cryotherapy involves the application of a cryogen by way of spraying liquid nitrogen to the esophageal mucosa or by surface contact with a nitrous oxide-filled
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
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
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
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
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
How Safe Is Endoscopic Gastrostomy Tube Placement?
The invasive nature of the endoscopic placement of a gastrostomy tube is associated with higher morbidity and mortality compared to other routine endoscopic procedures. Alternative
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
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
Endoscopic Approaches to Drainage for Acute Cholecystitis Are Optimal in Nonoperative Patients
Gallbladder removal or drainage is a key component of treatment for acute cholecystitis. When the risk of urgent cholecystectomy is considered prohibitive, the optimal alternative
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)
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
Relapse in Eosinophilic Esophagitis Occurs Despite Treatment With Swallowed Topical Corticosteroids
Swallowed topical corticosteroids (STC) are effective as initial treatment in patients with eosinophilic esophagitis (EoE) and in achieving histological remission. However, their role in the
First Single-Use Duodenoscope Measures up in Direct Comparison for Low-Complexity Procedures
The development of single-use (disposable) endoscopes is one approach to eliminating infection transmission between sequential patients during endoscopy. This single-center study randomized patients undergoing endoscopic
Neoplasia Detection Rate in Barrett’s Esophagus: A Measure of High-Quality Upper Endoscopy
Studies have reported that up to 25% of esophageal adenocarcinomas (EACs) are detected within 1 year of index endoscopy (missed cancer), emphasizing the need for
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
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
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
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
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
Is Endoscopic Sleeve Gastroplasty the Solution?
The prevalence of obesity in the United States has reached an epidemic level and is associated with conditions such as insulin resistance (IR) and nonalcoholic
Ileal and Rectal Ulcers Heal Slower and May Be More Refractory to Therapy Than Colonic Lesions in Crohn’s Disease
Researchers performed a post hoc analysis of endoscopic outcomes in participants of the pivotal SONIC trial that compared the efficacy of azathioprine, infliximab, and the
Budesonide Can Be Used for Maintaining Long-Term Remission in Eosinophilic Esophagitis
Eosinophilic esophagitis (EoE) is a chronic antigen-mediated immunological disorder that has a high relapse rate of >80% with cessation of therapy. Although corticosteroids (both topical
Discovering Adverse Events By Phone – the Sweet Spot is 7 Days After ERCP
Identification of adverse events following gastrointestinal endoscopy can be challenging due to patient reticence to present for mild to moderate problems and dispersed follow-up among
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
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
Implementing a Standardized Protocol Helps to Increase Diagnosis of Eosinophilic Esophagitis
The incidence of eosinophilic esophagitis (EoE), a condition characterized by esophageal eosinophilia and dysfunction, has been reported in about 5 to 10 per 100,000 individuals.
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
Large-Caliber Dilation Without Sphincterotomy Is Efficacious and Safe for Stones >10 mm
Endoscopic biliary sphincterotomy (ES) is the standard prelude to duct stone removal; however, it carries moderate risk for both pancreatitis and bleeding and can be
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,
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
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
Motility Disorders Can Exist in Patients With Eosinophilic Esophagitis, Specifically in Those Not Responding to Therapy
Eosinophilic esophagitis (EoE) is characterized by the presence of esophageal dysfunction along with histological evidence of ≥15 eosinophils per high-power field from esophageal biopsies. Recent
Pancreatic Extracorporeal Shock Wave Lithotripsy: Efficient and Effective in Gastroenterologists’ Hands
Extracorporeal shock wave lithotripsy (ESWL) has become the dominant therapy for the treatment of symptomatic pancreatic duct stone obstruction in chronic calcific pancreatitis. In the
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
Low Incidence of Colorectal Cancer After Endoscopic Dysplasia Resection in Patients With IBD
Given the paucity of high-quality outcome data, the optimal management of polypoid and/or nonpolypoid colonic lesions in IBD is an ongoing debate. Guidelines recommend that
Should Asian Americans Be Routinely Screened for Gastric Cancer With Endoscopy?
There are no current guidelines in the United States for gastric cancer screening, even with a high population of immigrants from Asian-Pacific countries. Studies have
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
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
Dysphagia Is Common After Bariatric Surgery
Symptoms of dysphagia due to obstruction (mechanical or functional) can be caused by a noncompliant gastric pouch after bariatric surgery and, theoretically, could lead to
When Draining Walled-Off Pancreatic Necrosis, Attention to Disconnected Pancreatic Duct Syndrome Guides Terminal Steps in Therap
Internal drainage using large-caliber lumen-apposing metal stents (LAMS) is now a dominant therapy for acute fluid collections and walled-off pancreatic necrosis associated with acute pancreatitis.
Video Auditing of Duodenoscope Reprocessing Contributes to High Performance in a Tertiary Care Center
Lapses in reprocessing of flexible endoscopes have been demonstrated in many environments and are thought to contribute to the transmission of infection between patients. The
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).
Nonendoscopic Screening for Barrett’s Esophagus: Are We There?
Upper endoscopy (EGD) with biopsy remains the gold standard for the diagnosis of Barrett’s esophagus (BE). Several nonendoscopic techniques (sponge, capsule) have utilized biomarkers, such
Hope for Those Suffering From Gastroparesis?
Gastroparesis is a chronic medical condition that can cause unpleasant and refractory symptoms that adversely affect quality of life. Unfortunately, metoclopramide, which can cause serious
Peroral Endoscopic Myotomy Can Be Safe and Effective for Persistent Symptoms After Heller Myotomy
Persistent and recurrent symptoms have been reported in up to 20% of patients with achalasia after surgical treatment with Heller myotomy. The aim of this
Recycled Precolectomy Anti-Tumor Necrosis Factor Does Not Work for Chronic Pouchitis
Following total proctocolectomy with restorative ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC), about one-third of patients develop chronic pouchitis. Treatment of antibiotic-refractory and Crohn’s
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
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
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
Fully Covered Metal Stents Provide Respectable Efficacy for Posttransplant Strictures
Biliary leaks and strictures are among the most common adverse events after liver transplantation. Anastomotic strictures are generally managed using endoscopic balloon dilation and stenting
Is Barrett’s Esophagus Thickness a Marker for Response to Radiofrequency Ablation Therapy?
Radiofrequency ablation (RFA) is a widely used modality for treating flat Barrett’s esophagus (BE) dysplasia, with the goal of achieving complete eradication of intestinal metaplasia
Relapse Half as Likely With Ulcerative Colitis in Clinical and Endoscopic Remission Than Clinical Remission with Mild Endoscopic Disease Activity
The current treatment target in ulcerative colitis (UC) is clinical and endoscopic remission, defined by patient-reported outcomes and a Mayo endoscopic subscore of 0 or
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
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
Endoscopic Submucosal Dissection Outcomes for Early Gastric Lesions in North America
There are sufficient data in Asia to demonstrate that endoscopic submucosal dissection (ESD) has equivalent outcomes to surgical intervention for early gastric cancer (EGC). Moreover,
Is Obesity a Risk Factor for Barrett’s Esophagus?
While the role of obesity in gastroesophageal reflux disease (GERD) and the role of GERD in Barrett’s esophagus (BE) are independently well established, there is
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.
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
Familial Adenomatous Polyposis: Should Routine Ampulla Biopsies Be Performed?
Duodenal and ampullary cancers are the most common causes of death in patients with familial adenomatous polyposis (FAP) who have undergone colectomy. Current guidelines recommend
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
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
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
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
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