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 […]

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August 14th, 2014

EMR: What Is Your Solution?

Endoscopic mucosal resection (EMR) has become an indispensable part of the therapeutic endoscopy armamentarium. However, the technique varies from endoscopist to endoscopist — including differences in volume used, solution ingredients, and snare type. In my institution, the three of us who do the most EMR all differ in our approaches in many respects, including choice of […]

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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 […]

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November 25th, 2013

Does Suppressing Gastric Acid Cause Community-Acquired Pneumonia?

Ever since early observational studies documented an association between acid suppression and pneumonia, many clinicians have assumed this association meant causation. This intrigues me because results of numerous prospective trials that have controlled for underlying patient comorbidities have refuted any causative effect. Moreover, acid suppression does not result in a gastric environment conducive to bacterial […]

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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, […]

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September 23rd, 2013

Making Bowel Preps Palatable

We know that split-dose, polyethylene glycol (PEG)–based bowel preparation solutions provide the best cleansing before colonoscopy. However, many patients are not compliant with the bowel prep procedure because of the poor taste of the PEG solution. Results of a recent trial suggest a practical approach to overcoming this problem: Use candy. In the trial, use […]

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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 […]

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February 10th, 2013

What is your best treatment for “refractory” constipation?

In treating patients with constipation, we have several options for first-line agents: bulking agents/fiber, osmotic laxatives, or stimulant laxatives. When a patient has a suboptimal result, we commonly add or move to another class of laxative agents. Fortunately, most patients respond to these interventions, but we all have patients whose condition is “refractory” to these […]

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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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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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