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Episode 62 Show Notes July 2023
- Comparison of endoscopic sleeve gastroplasty versus surgical sleeve gastrectomy: a database analysis. – GIE
- Incidence and natural history of gastric high grade dysplasia in patients with FAP. – GIE
- Association of Life Expectancy with surveillance colonoscopy findings and follow up recommendations in Older adults – Jama IM
- Physician decision-making about surveillance in older adults with prior adenomas: results from a national study. – Am J Gastro
- Hpylori eradication for primary prevention of peptic ulcer bleeding in older patients prescribed aspirin in primary care (HEAT) – RCT – Lancet 2022
- Effectiveness and Safety of Colonic and Capsule Fecal Microbiota Transplantation for Recurrent Clostridiodes difficile Infection – CGH
This Article in December issue of Gastroenterology summarizes the findings from the Gastroparesis Clinical Research Consortium (7 tertiary care centers). Out of 262 patients- only 28% had a reduction in symptoms that was significant.
They also tabulated factors that are associated with reduction in symptoms – male sex, older age, infectious prodrome, antidepressant use, and 4-hr retention greater than 20%.
This is bad news for those with gastroparesis. Most importantly there was no difference in those with and without diabetes.
Most notably there is no post-treatment gastric emptying, which would be interesting to see who actually improved, and who just “felt” better, and whether there is a correlation between these.
I don’t know about you, but during my fellowship thus far, I’ve only done one or two cases where the patient was positioned on the right side. Both were ICU/CCU cases, and both times we’ve reached the cecum without an issue. Positioning in those cases was difficult secondary to all the cardiac/ICU hardware the patient was hooked up to.
This study, which is amazing to see, since it actually examines a commonly held practice, something arose more from tradition/long held beliefs, rather than evidence. There aren’t that many studies that actually go and do that.
The authors have found that right-sided positioning at the start of the colonoscopy results in a better, quicker, more comfortable procedure. N was about 80 for both arms, and about 75 cases were analyzed in post. Primary outcome was time to reach cecum.
Conclusion – 3 min and 33 seconds (30%) shorter if starter on the right side. Benefit stems largely from improved negotiation of the sigmoid.
Of note, there is a figure in the text, Figure 5, which shows how terrible fellows like me are at doing endoscopy in terms of time to cecal intubation. Also, shows that the dramatic reduction in time to cecum happens not after 500 colonoscopies, but after 5000 colonoscopies!
We need more of these kinds of studies. The types that test “tried and true” practices, simple design, simple conclusions.