Gut Check on Gastroenterology Archive

April 7th, 2009

Our Love-Hate Relationship with Bowel Preps: It’s Time to Split Up!

For the past couple years, my colleagues and I have been bemoaning the state of bowel preps, especially for colonoscopies done in the afternoon. As many as one third of those preps were so poor that we had to tell patients to resume screening at intervals sooner than 7 to 10 years, for fear of […]

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February 26th, 2009

Should Nurses Be Performing Endoscopy?

Two provocative articles recently appeared in BMJ (here and here) showing that experienced, well-trained nurses are as clinically effective — but not as cost-effective — as physicians in performing diagnostic upper endoscopy and sigmoidoscopy. This randomized trial definitively answers the question of whether nurses can deliver high-quality endoscopy, but the larger question is whether they should […]

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January 23rd, 2009

Ambulatory Endoscopy Centers: No Seniors Allowed!

Ambulatory endoscopy centers (AECs) have proven so successful in providing convenient, efficient, low-cost, high-quality endoscopy services to outpatients that they are now ubiquitous around the country. Given this success, you might assume that payers would steer business their way. However, that’s not the case with the Centers for Medicare & Medicaid Services (CMS). In fact, […]

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December 3rd, 2008

Are We Telling Patients the Truth About Colonoscopy?

Last week I heard one of our really talented GI fellows talking with a patient before her open access colonoscopy, and she told the patient that this test prevents colon cancer. I was somewhat surprised at the definitive implication of that statement and later asked her how much protection from colon cancer does colonoscopy screening provide? What […]

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November 4th, 2008

Whither Gastroenterology?

What does it mean to be a gastroenterologist in 2008? Is our field moving in the right direction? I suspect that most gastroenterologists were and are attracted to the specialty because it offered the opportunity to deal with multiple organs and diseases. My generation of gastroenterologists came of age along with the exciting and emerging ability to diagnose–and […]

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