2017 · CGH · Podcast

GI Pearls – October 16 – November 10 2017 – Episode 12

Show Notes for October 16- November 10 – Episode 12

  1. A comparison of the resection rate for cold and hot snare polypectomy for 4–9 mm colorectal polyps: a multicentre randomised controlled trial  – GUT.
  2. Impact of preprocedure simethicone on adenoma detection rate during colonoscopy – Endoscopy
  3. Laparoscopic ileocaecal resection versus infliximab for terminal ileitis in Crohn’s disease: a randomised controlled, open-label, multicentre trial – The Lancet – Gastro
  4. Modifiable factors associated with patient-reported pain during and after screening colonoscopy – Gut
  5. Accuracy and Safety of the Cytosponge for Asessment of Histologic Activity in EOE: Two center study – Am J Gastro
  6. Air Insufflation May Still be Ideal For Adenoma Detection – Am J Gastro
  7. Patients with Crohn’s Disease with High Body Mass Index Present More Frequent and Rapid Loss of Response to Infliximab – IBD journal
  8. Anesthesia Assistance in outpatient colonoscopy and risk of aspiration pneumonia, bowel perforation, and splenic injury. – Gastro
  9. Increased Risk for Mother-to-Infant Transmission of HCV Among Medicaid Recipience – Wisconsin – MMWR
  10. Upper gastrointestinal complications following ablation therapy for atrial fibrillation – NeuroGastro&Motility
  11. Hemorrhagic angiodysplasia of the digestive tract – GIE
  12. Colorectal cancer screening with the fecal immunochemical test in persons aged 30 to 49 years: focusing on the age for commencing screening – GIE
2017 · Podcast

GI Pearls – September 1-15 2017 – Episode 9

Show Notes for September 1-15 2017  Episode 009
  1. Asthma Is Associated With Subsequent Development of Inflammatory Bowel Disease: A Population-based Case–Control Study  – CGH
  2. Laboratory predictors of bleeding and the effect of platelet and RBC transfusions on bleeding outcomes in the PLADO trial – Blood
  3. Therapeutic endoscopy-related GI bleeding and thromboembolic events in patients using warfarin or direct oral anticoagulants: results from a large nationwide database analysis – Gut
  4. Major Bleeding Risk During Anticoagulation with Warfarin, Dabigatran, Apixaban, or Rivaroxaban in Patients with Nonvalvular Atrial Fibrillation. – J of Managed Care & Spec Pharm
  5. Oral administration of conditioned medium obtained from mesenchymal stem cell culture prevents subsequent stricture formation after esophageal submucosal dissection in pigs. – GIE
  6. High Dietary Intake of Specific Fatty Acids Increases Risk of Flares in Patients With Ulcerative Colitis in Remission During Treatment With Aminosalicylates – CGH
  7. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Inherited Polyposis Syndromes – Dis of Col and Rectum.
  8. Measurement Bias of Polyp Size at Colonoscopy – Dis of Col and Rectum.
  9. Chronic Pancreatitis and Pancreatic Cancer Risk: A Systematic Review and Meta-analysis – Am J Gastro.
  10. Rural and Urban Residence During Early Life is Associated with Risk of Inflammatory Bowel Disease – AmJGastro
  11. What’s new in Rome IV – Neurogastro & Motility
  12. Fecal Calprotectin Levels Predict Histological Healing in Ulcerative Colitis – IBD Journal
  13. Weight and Metabolic Outcomes 12 Years after Gastric Bypass – NEJM
2017 · Article · CGH · Podcast · Study

GI Pearls Episode 7 – First two weeks of August 2017 Gastroenterology Literature Review

Show Notes for 2017 First two weeks of August 007

  1. The colonoscopist’s guide to the vocabulary of colorectal neoplasia: histology, morphology, and management – GIE
  2. Use of enteroscopy for the detection of malignant and premalignant lesions of the small bowel in complicated celiac disease: a meta-analysis – GIE
  3. Impact of cap-assisted colonoscopy on detection of proximal colon adenomas: systematic review and meta-analysis – GIE
  4. Outcomes and quality-of-life assessment after gastric per-oral endoscopic pyloromyotomy – GIE
  5. Randomized controlled trial of scleroligation versus band ligation alone for eradication of gastroesophageal varices – GIE
  6. Endoscopic multiple biopsy and rapid diagnosis by in situ fixation and histopathologic processing – GIE
  7. Diagnostic Accuracy of Fecal Immunochemical Test in Patients at Increased Risk of Colorectal Cancer: A Meta-analysis – Jama:Int Med
  8. Older Adults’ Views and Communication Preferences About Cancer Screening Cessation – Jama Int Med
  9. Celiac Disese and Nonceliac Gluten Sensitivity – A Review – JAMA
  10. Board Review Vignette: PPP Syndrome: Pancreatitis, Panniculitis, Polyarthritis – Am J Gastro
  11. EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection – Journal of Hepatology
  12. The impact of a Prior Diagnosis of Barrett’s Esophagus on Esophageal Adenocarcinoma Survival – Am J Gastro
  13. Old Farts – Fact or Fiction? Results From a Population-Based Survey of 16,000 Americans Examining the Association Between Age and Flatus – CGH
Podcast · Uncategorized

GI Pearls Episode 6 – First two weeks of July 2017 Gastroenterology Literature Review

Show Notes for 2017 First two weeks of July 006
  1. Treatment with Biologic Agents has not Reduced Surgeries among Patients with Crohn’s Disease with Short Bowel Syndrome – CGH
  2. Risk of colorectal cancer in chronic liver diseases: a systematic review and meta-analysis – GIE
  3. Effect of Alternate-Day Fasting on Weight Loss, Weight Maintenance, and Cardioprotection among Metabolically Healthy Obese Adults – JAMA Internal Medicine
  4. Urgent colonoscopy in patients with lower GI bleeding: a systematic review and meta-analysis – GIE
  5. Mobile phone in the stomach:call the emergency endoscopist! – GIE
  6. Impact of gum chewing on the quality of bowel preparation for colonoscopy: an endoscopist-blinded, randomized controlled trial – GIE
  7. Hepatitis B reactivation in Hepatitis B and C coinfected Patients treated with Antiviral Agents: A systematic Review and Meta-analysis. – Hepatology
  8. Gastostomies Preserve But Do Not Increease Quality of Life for Patients and Caregivers – CGH
  9. “Errare Humanum Est, Perseverare Autem Diabolicum” – Gastro
  10. Association of Changes in Diet Quality with Total and Cause-Specific Mortality – NEJM
  11. Association Between Proton Pump Inhibitor Use and Cognitive Function in Women – Gastro
  12. Increased Rate of Adenoma Detection Associates with Reduced Risk of Colorectal Cancer and Death – Gastro
  13. Risk Factors for 30-day Hospital Readmission for Diverticular Hemorrhage. – J of Clinical Gastro
2015 · Article · Case-Control

Unexpected reduction in polyp numbers in Chronic Inflammatory conditions of the Colon

Tubular_adenoma_4_low_magI have read this article back in July, and immediately found it interesting.  One reason is that it is (albeit a poor one) an example of the use of “Big Data” type analysis where a large database of patient biopsy specimens can be searched.

Second reason – is the actual clinical finding – less polyps than expected in those with microscopic colitis – prevalence of ALL types of polyps was reduced.

Summary:  130,000 patients with symptoms of diarrhea had a colonoscopy with biopsies.  Compared with 97,000 control cases.  So, in this CASE-CONTROL study for patients with workup of diarrhea – less polyps (Odds ratios = 0.46 for hyperplastic, 0.24for serrated adenomas, and 0.35 for tubular adenomas).

Criticism: It would have been nice if the authors have age-matched the cases one for one from the beginning, even though these were adjusted for. There is no duration of disease, so the mechanism would remain elusive. Although it would be interesting to have someone do a database review of patients whose clinical history is known. It can even be compared to the current study, if the data is available, i.e. authors had 14% of colons have polyps in normals, and 8.3% in microscopic colitis,  is there an influence of disease duration or is this an all or none phenomenon?

Study

ROLCOL – Right or Left-sided starting position in colonoscopy

110405-N-KA543-028 SAN DIEGO (April 5, 2011) Hospitalman Urian D. Thompson, left, Lt. Cmdr. Eric A. Lavery and Registered Nurse Steven Cherry review the monitor while Lavery uses a colonoscope on a patient during a colonoscopy at Naval Medical Center San Diego. (U.S. Navy photo by Mass Communication Specialist 2nd Class Chad A. Bascom/Released) 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.