Gut Check on Gastroenterology Archive

December 30th, 2012

Quality Colonoscopy: How do you let your patients know you meet the mark?

Colonoscopy prevents most colorectal cancers, but only when it is performed as part of a high-quality examination. The quality measures most often discussed include cecal intubation rate, cecal withdrawal time, documentation of bowel prep quality in endoscopy reports, adenoma detection rate  (ADR), and appropriate recommendation of subsequent screening or surveillance intervals after colonoscopy. While third-party payers […]

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November 11th, 2012

C. difficile: How many stool samples do you send for a diagnosis?

The diagnosis of this increasing and now epidemic infection has been evolving as well. When I first started testing for this infection, a cytotoxin assay was used that delayed the diagnosis and was very operator-dependent. Enzyme immunoassays came next, and more recently PCR testing of stool has become available. Despite the increased accuracy and more […]

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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 […]

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August 29th, 2012

SIBO (small intestinal bacterial overgrowth): How common is it, and how should we diagnose it?

Our hospital used to provide hydrogen breath testing for the community but recently discontinued this practice. I was asked to comment on whether it should be discontinued and how often I used the test. It surprised me that I had not ordered a hydrogen breath test in the 2 decades I have been here but […]

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April 29th, 2012

How do you treat eosinophilic esophagitis?

We all are seeing this disease more often than in the past. Whereas the diagnostic criteria now seem firmly entrenched, the optimal treatment strategy remains to be determined. Treatments have included food avoidance, anti-secretory drugs, topical steroids, immunomodulators, and combinations of these approaches. So I am interested in how you treat eosinophilic esophagitis. What is your first […]

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February 20th, 2012

Fecal transplants: The new cure-all?

The importance of our normal gut flora becomes apparent when antibiotics wipe out a portion of it and give Clostridium difficile a niche to reside in, which can lead to severe colitis. Relapse of the colitis is the rule until the normal gut flora is reestablished, and treatment of relapsing C. difficile colitis has usually […]

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October 24th, 2011

Is it time to stop surveying Barrett esophagus?

One area of gastroenterology that is guided more by dogma than evidence regards surveillance of nondysplastic Barrett esophagus (BE). Surveillance of BE lesions is widely practiced, despite a large body of evidence that the practice is not cost-effective, the cancer risk from BE is very low, and the life expectancy of BE patients is normal. […]

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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 […]

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August 7th, 2011

Ablating short-segment Barrett esophagus: What’s your weapon of choice?

The first cases of Barrett esophagus (BE) ablation in the late 1980s used YAG and Argon laser. Since then, a myriad of ablation techniques have been described, including multipolar electrocautery (MPEC), argon plasma coagulation (APC), cryotherapy, radiofrequency ablation (RFA), and endoscopic mucosal resection (EMR). Each technique has had its advocates, and some of the techniques […]

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July 10th, 2011

Pancreatic cancer pain: Better treated in the endoscopy unit or pain clinic?

I had always assumed EUS-directed celiac plexus blocks, if they worked, were the best therapy for pancreatic cancer pain. However, when speaking recently with one of my pain clinic colleagues, he indicated that splanchnic nerve blocks also work pretty well in these patients. The literature supports both approaches, but I was somewhat surprised that the evidence for […]

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