M. Brian Fennerty, MD, is the editor of Journal Watch Gastroenterology and Professor of Medicine and Section Chief of Gastroenterology in the Department of Internal Medicine at Oregon Health & Science University.
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(2 votes, average: 3.50 out of 5)The effectiveness of endoscopic ablation of neoplastic (dysplastic) Barrett esophagus (BE) has made it the new standard of care in many communities; referrals to surgeons have largely disappeared. However, the procedure is still evolving — from thermal ablation by laser in the 1980s and early 1990s to BICAP probes and Argon Plasma Catheter (APC) in [...]
(1 votes, average: 5.00 out of 5)I am amazed at the variation I have seen in the use of endoscopic ultrasound (EUS) in staging Barrett esophagus (BE). Some of us use EUS universally, and others (myself included) never use it to stage intramucosal carcinoma or high-grade dysplasia. So, let me propose a case and ask what you would do: The patient [...]
(3 votes, average: 4.67 out of 5)The American Society for Gastrointestinal Endoscopy has stated: “In order for colorectal polyps <5 mm in size to be resected and discarded without pathologic assessment, endoscopic technology (when used with high confidence) used to determine histology of polyps <5 mm in size, when combined with the histopathologic assessment of polyps >5 mm in size, should [...]
(3 votes, average: 4.33 out of 5)Many, if not most, colonoscopists are now convinced that using water infusion during scope insertion leads to less patient discomfort and lower sedation needs. What is often used in this situation is water that has been warmed under the assumption that warm is better (i.e., causing less spasm). However, using warm water out of the [...]
(1 votes, average: 5.00 out of 5)The right side of the colon seems to be the Achilles heel of colonoscopy because polyps there tend to be flat and harder to find, and we confer the least protection from later colon cancer in that zone. A recent article summary in Journal Watch Gastroenterology concludes that when we see a right-sided colon polyp, we may [...]
(1 votes, average: 1.00 out of 5)I have observed extreme variation in how my colleagues manage GI foreign-body retrieval from the stomach. Some always use general anesthesia and endotracheal intubation; others (myself included) use conscious sedation. Some use an overtube to withdraw the object into if possible; others simply pull it up to the endoscope and use the endoscope to guide [...]
(1 votes, average: 5.00 out of 5)I have noticed that we all think we are the best endoscopist around (in my case, that is indeed true!). However, we really never measured colonoscopy skill as a “patient-centered” metric and instead often use speed, efficiency, sedation needs, etc. when judging our colleagues. What is more important than these measures, however, is whether we find and remove [...]
(2 votes, average: 4.50 out of 5)It used to be dogma that the earlier we “scoped” patients with gastrointestinal bleeding the better off they would be in terms of outcomes such as fewer transfusions, less need for surgery, and shorter hospital stays. However, we now have good data that demonstrate for most patients with upper GI bleeding that this is not [...]
(4 votes, average: 4.75 out of 5)Many of you out there have done many tens of thousands of colonoscopy like I have and are well aware of the complications most known to be associated with this procedure, like bleeding or perforation. And most of us are aware of very unusual complications that have been reported, such as splenic lacerations or barotraumas. [...]
(5 votes, average: 4.40 out of 5)Plavix and other platelet inhibitors have saved countless lives by preventing cardiovascular events. But those same inhibitory effects on platelets theoretically could increase bleeding risks after GI procedures that include biopsy or tissue removal (polypectomy). Unfortunately there are little data regarding whether bleeding risk is increased when patients on Plavix undergo endoscopy procedures. The clinical [...]
