July 21st, 2014
Hepatitis C Virus Infection: How Are You Managing the Cost of Newer Treatments?
Recently, we have seen remarkable progress in the treatment of chronic infection with hepatitis C virus — from long courses of injectable interferon plus ribavirin to short courses of once-daily oral sofosbuvir. Not only have these shorter, more-manageable regimens proven more effective, they are substantially better tolerated. So, what’s the problem? It seems to be […]
June 25th, 2014
Right-Sided Colon Polyps: Are You and Your Pathologist Up to Date?
It used to be relatively simple for gastroenterologists to determine colonoscopy surveillance intervals when removing right-sided polyps: We considered whether the polyp was hyperplastic or adenomatous and its size. Now, we have a new classification system that includes adenomas, hyperplastic lesions, sessile serrated polyps (SSPs), and sessile serrated adenomas (SSAs) — all of which may […]
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 […]
January 28th, 2014
What Bowel Prep for the Sensitive Stomach?
Although it is clear that split-dose polyethylene glycol (PEG), our first-line bowel prep, provides the optimal bowel cleansing for colonoscopy, many of my patients find it difficult or even impossible to tolerate this solution (i.e., due to vomiting). Although alternatives such as Gatorade/Miralax, with or without magnesium citrate and Dulcolax, are used by many endoscopy […]
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, […]
August 8th, 2013
Probiotics: Which one, and in whom?
I continue to be intrigued by the burgeoning use of probiotics — by both patients and practitioners, including myself — to treat patients’ symptoms of digestive diseases. The problem I run into when considering their use in patients, or when answering patients’ questions about them, is in determining which patients are good candidates for probiotics, […]
July 16th, 2013
Follow-up after Barrett esophagus ablation: How do you do it, and when do you stop (if ever)?
We have shifted the paradigm of treating neoplastic Barrett esophagus (BE) away from a choice between intensive surveillance or surgery and towards endoscopic ablation. In the last 5 years, I have done hundreds of BE ablations using radiofrequency ablation (RFA) and endoscopic mucosal resection (EMR), and many thousands have been performed worldwide. However, on post-ablation […]
June 28th, 2013
Colonoscopy Preps: Patient Marketing vs. Patient Quality
There are innumerable bowel preps on the market as well as “home brewed” ones (e.g. Miralax™ and Gatorade™). In my community, many gastroenterology practices appear to choose their colonoscopy prep based on patient acceptability and/or taste preference. I find this choice of bowel prep based on “marketing” to patients troublesome. Although I absolutely understand the issues […]
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 […]