Gut Check on Gastroenterology Archive

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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February 18th, 2009

Sedation-Free Colonoscopy: Why Isn’t It the Standard?

This Saturday’s Wall Street Journal featured an intriguing article on sedation-free colonoscopy, which is standard in Europe and Asia but rarely done in the U.S. One could argue that Americans are just “weenies,” but I think the blame rests solely with us doctors. Sedation-free colonoscopy is successful in most who try it (I did!), but it […]

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February 18th, 2009

CMS and CT Colonography: What’s the Beef About?

Last week, the Centers for Medicare and Medicaid Services (CMS) announced that they are not likely to cover virtual colonoscopy (CT colonography or CTC) for colorectal cancer screening in Medicare beneficiaries. The announcement came just months after the U.S. Preventive Services Task Force declined to recommend the test, citing insufficient evidence. Not surprisingly, the radiology […]

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February 5th, 2009

PPIs and Plavix: There Are No Simple Answers but Maybe a Simple Solution!

In response to my earlier post on PPIs and upper GI bleeding, Bahman N Shokouhi writes: A recent article in the Canadian Medical Association Journal (published online Jan 28, 2009), suggests that this is not a class effect and that Pantoprazole does not seem to have an effect. It has been suggested that the cause of […]

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