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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June 13th, 2011

Foreign-body retrieval from the stomach: how do you do it?

I have observed extreme variation in how my colleagues manage GI foreign-body retrieval from the stomach. Some always use general anesthesia and endotracheal intubation; others (myself included) use conscious sedation. Some use an overtube to withdraw the object into if possible; others simply pull it up to the endoscope and use the endoscope to guide […]

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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 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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December 17th, 2009

Ulcer Bleeding: Tricks of the Trade!

One of the difficulties we face when performing urgent endoscopy on a patient with upper GI bleeding is to visualize the mucosa and the lesion when blood is still present in the stomach. IV erythromycin can help by evacuating blood from the stomach, but it has become increasingly scarce; we haven’t had any available at […]

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December 11th, 2009

Should Propofol Be Used for Routine Endoscopy?

Propofol is a remarkable drug that has revolutionized sedation for patients undergoing endoscopic procedures. It can produce rapid and, when necessary, deep sedation, and its effects can be reversed within seconds to minutes. Because it has proven to be more effective than hypnotics (such as versed) and narcotics (such as fentanyl), an estimated 40% of […]

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June 9th, 2009

Fennerty’s Top 10: Endoscopy News from DDW 2009

Here are ten key findings about endoscopy that were reported at Digestive Disease Week 2009, held May 30 – June 4, 2009 in Chicago: #10. We need to drop Bisacodyl from the new Gatorade prep. #9. Wire-guided cannulation during ERCP results in less pancreatitis. #8. Looking carefully during endoscopy finds lesions, enhanced imaging is not what does […]

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June 9th, 2009

Can We Justify Performing Upper and Lower Endoscopies on Consecutive Days?

I recently saw a patient who was referred after upper and lower endoscopies had not revealed the cause of his abdominal discomfort. What struck me was that the patient had these two exams on consecutive days. That meant two days lost from work, two days with altered diet, two trips to the endoscopy center, two days […]

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