Gut Check on Gastroenterology Archive

October 23rd, 2014

Clip, Burn, Inject, or All Three? How Do You Treat Ulcer Bleeding?

As endoscopists, we have all sorts of tools to treat ulcer bleeding or other gastrointestinal bleeding, such as injection with epinephrine and thermal coaptive coagulation with heater probes or multipolar electrodes like the Gold probe. More recently, a myriad of clips have become available for use. It seems to me that both operator and ulcer […]

---

March 14th, 2014

Dysphagia and Normal Endoscopy – Should We Biopsy Everyone?

The “discovery” of eosinophilic esophagitis (EoE) has added immensely to our understanding of many patients with dysphagia, and when endoscopic signs are present (furrowing, rings, white nodules, etc.), we should always confirm the diagnosis with endoscopic biopsies. However, many patients with EoE have a normal-appearing esophageal mucosa, and EoE would remain undetected if biopsies were […]

---

November 6th, 2013

Iron Deficiency Anemia: When Do We Stop Scoping?

It is standard practice to perform endoscopy in patients with iron deficiency anemia who have evidence of gastrointestinal bleeding or other symptoms. Even in the absence of symptoms, in patients aged 50 years or older, who are at increased risk for colorectal cancer, age alone would indicate that at least a colonoscopy is in order. However, […]

---

June 4th, 2013

Suspected Lower GI Bleeding: When do you do an Upper Scope?

Most gastroenterologists I know seem pretty confident that they can differentiate bright red blood from a lower GI (e.g., colonic) source and massive upper GI bleeding presenting as bright red blood in the lower GI tract. The location of bleeding is critical from a treatment and prognosis perspective. Lower GI bleeding usually ceases spontaneously, requires […]

---

April 10th, 2013

Barrett esophagus with dysplasia: Endoscopic resection or endoscopic burning?

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 […]

---

October 10th, 2012

Barrett esophagus with high-grade dysplasia: How should it be staged?

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 is […]

---

January 19th, 2012

Stewardship in medicine: Is it time to stop sending small polyps to the pathologist?

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 […]

---

November 15th, 2011

Water-aided colonoscopy: Does the temperature matter?

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 […]

---

September 19th, 2011

Is it time to make a U-turn in the right colon during colonoscopy?

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 have […]

---

June 13th, 2011

Foreign-body retrieval from the stomach: how do you do it?

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 […]

---