Gut Check on Gastroenterology Archive

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 […]

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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 […]

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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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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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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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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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February 18th, 2009

Sedation-Free Colonoscopy: Why Isn’t It the Standard?

This Saturday’s Wall Street Journal featured an intriguing article on sedation-free colonoscopy, which is standard in Europe and Asia but rarely done in the U.S. One could argue that Americans are just “weenies,” but I think the blame rests solely with us doctors. Sedation-free colonoscopy is successful in most who try it (I did!), but it […]

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February 18th, 2009

CMS and CT Colonography: What’s the Beef About?

Last week, the Centers for Medicare and Medicaid Services (CMS) announced that they are not likely to cover virtual colonoscopy (CT colonography or CTC) for colorectal cancer screening in Medicare beneficiaries. The announcement came just months after the U.S. Preventive Services Task Force declined to recommend the test, citing insufficient evidence. Not surprisingly, the radiology […]

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