Gut Check on Gastroenterology Archive

May 17th, 2011

How good a colonoscopist are you?

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 […]

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March 7th, 2011

Lower gastrointestinal bleeding: Rush in now to scope or wait till morning?

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 […]

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February 14th, 2011

Can colonoscopy cause diverticulitis?

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. However, […]

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October 15th, 2010

Plavix (Clopidogrel) and endoscopy: the great dilemma!

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 […]

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October 1st, 2010

Esophageal food impaction: Are you a secret pusher?

I, like most endoscopists, remember being told that you should never push an esophageal food impaction into the stomach but instead all food should be removed first, then the cause of the impaction determined and treated. Well I suspect that most endoscopists do what I do and that is try and safely push the impaction into […]

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March 1st, 2010

When Should We Stop Surveillance of Barrett’s Patients?

Some of my patients who have undergone successful ablation therapy for Barrett’s esophagus ask a really good question: If I haven’t had Barrett’s for years, why do I need to keep having endoscopies?”  I admit, I do not have a uniform answer for that, nor do GI society guidelines. I would say that for patients […]

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February 25th, 2010

Who Is Better Qualified to Perform Colonoscopy?

Consider this: The American Society for Gastrointestinal Endoscopy requires physicians to perform at least 200 colonoscopies before it will assess their competency (much less grant them privileges), and most fellows complete at least 500 during their 3-year training programs.  However, the American Board of Surgery now “mandates” that surgical residents need to perform only 50 […]

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January 4th, 2010

Endoscopic Weight-Loss Procedures: What’s the Optimal Target?

As I contemplate the last few weeks of holiday parties and notice that the gym seems more crowded and the gym rats more focused, I realize I am not the only one who fears the added weight gain from too much food and libation! The world remains in search of a cure for obesity, and […]

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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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March 14th, 2009

Sedating HIV-Infected Endoscopy Patients

In a recent blog post, ID expert Paul Sax raised the question of which sedatives should be used when scoping HIV-infected patients on ritonavir or efavirenz. Both antiretrovirals inhibit the CYP3A enzyme, which metabolizes one of our most commonly used sedatives, midazolam. Use of midazolam with either antiretroviral is technically contraindicated because of significant increases […]

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