Colonoscopy quality is directly related to the bowel preparation. It is well established that bow... more Colonoscopy quality is directly related to the bowel preparation. It is well established that bowel preparations are improved when at least part of the laxative is ingested on the day of the procedure. However, there is concern that this can result in higher gastric residual volumes (GRV) and increase the risk of pulmonary aspiration. The aim of this study is to evaluate GRV and gastric pH in patients who received day-before bowel preparation versus those ingesting their laxative on the day of colonoscopy under anesthesiologist-directed propofol deep sedation. This is a prospective observational study for patients undergoing same-day upper endoscopy and colonoscopy. All included patients had large-volume polyethylene glycol lavage preparation and received propofol sedation. Gastric fluid was collected during the upper endoscopy for volume and pH measurement. The study included 428 patients with 56% receiving same-day laxative preparation and the remainder evening-before preparation....
Journal of clinical gastroenterology, Jan 17, 2016
Colorectal cancer (CRC) screening guidelines likely over-generalizes CRC risk, 35% of Americans a... more Colorectal cancer (CRC) screening guidelines likely over-generalizes CRC risk, 35% of Americans are not up to date with screening, and there is growing incidence of CRC in younger patients. We developed a practical prediction model for high-risk colon adenomas in an average-risk population, including an expanded definition of high-risk polyps (≥3 nonadvanced adenomas), exposing higher than average-risk patients. We also compared results with previously created calculators. Patients aged 40 to 59 years, undergoing first-time average-risk screening or diagnostic colonoscopies were evaluated. Risk calculators for advanced adenomas and high-risk adenomas were created based on age, body mass index, sex, race, and smoking history. Previously established calculators with similar risk factors were selected for comparison of concordance statistic (c-statistic) and external validation. A total of 5063 patients were included. Advanced adenomas, and high-risk adenomas were seen in 5.7% and 7.4%...
World journal of gastrointestinal endoscopy, Jan 10, 2015
Gastroparesis (GP) is a common disease seen in gastroenterology practice particularly in western ... more Gastroparesis (GP) is a common disease seen in gastroenterology practice particularly in western countries, and it may be underdiagnosed. The available drug therapies for this condition are quite disappointing. Botulinum toxin type A (BT) has been found to be effective therapy in various spastic disorders of smooth muscle of gastrointestinal tract. However, the benefits of BT injections in GP have been unclear. Several retrospective and open label studies have shown clinical advantages of intrapyloric Botulinum toxin type A injections, while two small randomized trials did not show positive results. Therefore, the available published studies yielded conflicting results leading to fading out of botox therapy for GP. We recognize possible clinical benefit of BT injections without any disadvantages of this treatment. We are calling for revisiting the endoscopy guided botox therapy in refractory GP. In this review we discuss important features of these studies pointing out differences i...
the age group of 50-55, Cauc had the highest mean number of adenomas detected (2.0) compared to A... more the age group of 50-55, Cauc had the highest mean number of adenomas detected (2.0) compared to AA (1.2, p<0.02). Cauc were not significantly different than Asians (1.5) or Hisp (1.5). In the age group of 65-70, AA had the highest mean number of adenomas detected (2.1) compared to Asian (1.5, p <0.02), Hisp (1.6) (p< 0.03) and Cauc (1.7, p= 0.07). Conclusions: Our data demonstrate that Cauc have the highest mean number of adenomas detected when undergoing screening between the ages of 50-55 whereas AA have the highest mean number of adenomas detected at the age group of 65-70. The ethnic variation by age group found in this study in the mean number of adenomas detected does not correlate with the overall ADR in these ethnic groups. The higher mean adenoma rates in younger Cauc and older AA, should be further analyzed as they may impact surveillance intervals.
Russia is still suboptimal, both in terms of adenoma detection-and caecal intubationrates. Educat... more Russia is still suboptimal, both in terms of adenoma detection-and caecal intubationrates. Educational programs and the implementation of sedation and a split regimen of preparation may be necessary to increase the key quality indicators Sa1059
Background In November 2011, the SCOPE (Stop Colorectal Cancer through Prevention and Education) ... more Background In November 2011, the SCOPE (Stop Colorectal Cancer through Prevention and Education) Program was created as the Edmonton medical zone arm of the Alberta Colorectal Cancer Screening Program (ACRCSP). The aim of the program was to provide consistent, high quality colon cancer screening while adhering to provincial, national and international screening and endoscopic quality guidelines. AIM To evaluate the quality of colonoscopy and colon cancer screening completed during the first year of the SCOPE program and to assess the impact of the endoscopist's area of expertise on outcomes. METHOD All colonoscopies performed in 2012 through the SCOPE program were assessed for polyp detection rate (PDR), adenoma detection rate (ADR), withdrawal time and rectal retroflexion and then stratified based on the specialty of endoscopist performing the procedure. Data was derived retrospectively from the dictated reports and pathology findings. RESULTS From January 1 to December 31, 2012, a total of 3013 screening colonoscopies were performed through the SCOPE program. Gastroenterologists (GI) performed the majority of the cases (2353), with the remaining cases being performed by General Surgeons (GS)(331), Internists (IM)(221), or a Nurse practitioner (NP)(108). The overall mean PDR and ADR for the program was 53% and 35% respectively. The mean ADR was highest amongst GI (37%) and significantly different compared to GS (27%) (p < 0.001) but not statistically different from IM (31%)(p=0.09) or to nurse practitioner (NP) (32%)(p=0.24). GI had significantly longer withdrawal times compared to GS (6.82 min vs. 5.92 min; p<0.001) and to IM (6.82 min vs. 4.08 min; p < 0.001) but no different compared to the NP (6.82 min vs. 7.17 min; p=0.07). The highest mean retroflexion reporting rate was achieved by IM at 93%, which was significantly superior to GI (81%), NP (82%) and GS (52%), all with p < 0.0001. Both GI and NP had significantly higher retroflexion reporting rates than GS (each p < 0.001), but were similar between GI and NP (p=0.91). CONCLUSION The SCOPE program currently meets endoscopic quality standards for overall ADR and withdrawal time, even though there is some variability in the quality of colonoscopy between specialties. This data represents a baseline standard, allowing individual endoscopists participating in the SCOPE program to reflect on areas to maintain or improve patient care through high quality colorectal cancer screening.
The African American population has a higher prevalence of advanced colon adenomas when compared ... more The African American population has a higher prevalence of advanced colon adenomas when compared with non-Hispanic whites and Hispanics, but the risk in other black populations has not been evaluated. Although the Afro-Caribbean population is a significant demographic segment in some regions of the United States, the data are limited on the prevalence of colon adenomas in this group and there is no comparison with a non-Hispanic white population. The objective of our study was to compare the prevalence of adenomas in Afro-Caribbean versus non-Hispanic white populations. A total of 880 Afro-Caribbean patients and 1828 non-Hispanic white patients undergoing their first screening colonoscopy between January 2008 and August 2014 was included in the study. A total of 2708 patients met entry criteria for the study. The adenoma detection rate among Afro-Caribbeans was 29% and 31% among non-Hispanic whites. There was no statistically significant difference in the prevalence of adenomas in t...
Sarcoidosis is a disease with an unknown cause that affects multiple organ systems and has a vari... more Sarcoidosis is a disease with an unknown cause that affects multiple organ systems and has a varied clinical presentation. Often, its symptomatology mimics other disease processes, such as lymphoma, tuberculosis, and amyloidosis. The reticuloendothelial involvement and typical B symptoms of weight loss, fatigue, night sweats, and lymphadenopathy can make sarcoidosis often easily confused with lymphoma. Sarcoidosis has a myriad of central nervous system (CNS) effects, which are often not recognized as symptoms of the disease. These neuropsychiatric symptoms can include, but are not limited to, cognitive decline, headaches, and personality changes. In this report, we discuss a case of a patient who presented with symptoms consistent with indolent lymphoma but was eventually diagnosed with sarcoidosis with extrapulmonary manifestations.
Colonoscopy quality is directly related to the bowel preparation. It is well established that bow... more Colonoscopy quality is directly related to the bowel preparation. It is well established that bowel preparations are improved when at least part of the laxative is ingested on the day of the procedure. However, there is concern that this can result in higher gastric residual volumes (GRV) and increase the risk of pulmonary aspiration. The aim of this study is to evaluate GRV and gastric pH in patients who received day-before bowel preparation versus those ingesting their laxative on the day of colonoscopy under anesthesiologist-directed propofol deep sedation. This is a prospective observational study for patients undergoing same-day upper endoscopy and colonoscopy. All included patients had large-volume polyethylene glycol lavage preparation and received propofol sedation. Gastric fluid was collected during the upper endoscopy for volume and pH measurement. The study included 428 patients with 56% receiving same-day laxative preparation and the remainder evening-before preparation....
Journal of clinical gastroenterology, Jan 17, 2016
Colorectal cancer (CRC) screening guidelines likely over-generalizes CRC risk, 35% of Americans a... more Colorectal cancer (CRC) screening guidelines likely over-generalizes CRC risk, 35% of Americans are not up to date with screening, and there is growing incidence of CRC in younger patients. We developed a practical prediction model for high-risk colon adenomas in an average-risk population, including an expanded definition of high-risk polyps (≥3 nonadvanced adenomas), exposing higher than average-risk patients. We also compared results with previously created calculators. Patients aged 40 to 59 years, undergoing first-time average-risk screening or diagnostic colonoscopies were evaluated. Risk calculators for advanced adenomas and high-risk adenomas were created based on age, body mass index, sex, race, and smoking history. Previously established calculators with similar risk factors were selected for comparison of concordance statistic (c-statistic) and external validation. A total of 5063 patients were included. Advanced adenomas, and high-risk adenomas were seen in 5.7% and 7.4%...
World journal of gastrointestinal endoscopy, Jan 10, 2015
Gastroparesis (GP) is a common disease seen in gastroenterology practice particularly in western ... more Gastroparesis (GP) is a common disease seen in gastroenterology practice particularly in western countries, and it may be underdiagnosed. The available drug therapies for this condition are quite disappointing. Botulinum toxin type A (BT) has been found to be effective therapy in various spastic disorders of smooth muscle of gastrointestinal tract. However, the benefits of BT injections in GP have been unclear. Several retrospective and open label studies have shown clinical advantages of intrapyloric Botulinum toxin type A injections, while two small randomized trials did not show positive results. Therefore, the available published studies yielded conflicting results leading to fading out of botox therapy for GP. We recognize possible clinical benefit of BT injections without any disadvantages of this treatment. We are calling for revisiting the endoscopy guided botox therapy in refractory GP. In this review we discuss important features of these studies pointing out differences i...
the age group of 50-55, Cauc had the highest mean number of adenomas detected (2.0) compared to A... more the age group of 50-55, Cauc had the highest mean number of adenomas detected (2.0) compared to AA (1.2, p<0.02). Cauc were not significantly different than Asians (1.5) or Hisp (1.5). In the age group of 65-70, AA had the highest mean number of adenomas detected (2.1) compared to Asian (1.5, p <0.02), Hisp (1.6) (p< 0.03) and Cauc (1.7, p= 0.07). Conclusions: Our data demonstrate that Cauc have the highest mean number of adenomas detected when undergoing screening between the ages of 50-55 whereas AA have the highest mean number of adenomas detected at the age group of 65-70. The ethnic variation by age group found in this study in the mean number of adenomas detected does not correlate with the overall ADR in these ethnic groups. The higher mean adenoma rates in younger Cauc and older AA, should be further analyzed as they may impact surveillance intervals.
Russia is still suboptimal, both in terms of adenoma detection-and caecal intubationrates. Educat... more Russia is still suboptimal, both in terms of adenoma detection-and caecal intubationrates. Educational programs and the implementation of sedation and a split regimen of preparation may be necessary to increase the key quality indicators Sa1059
Background In November 2011, the SCOPE (Stop Colorectal Cancer through Prevention and Education) ... more Background In November 2011, the SCOPE (Stop Colorectal Cancer through Prevention and Education) Program was created as the Edmonton medical zone arm of the Alberta Colorectal Cancer Screening Program (ACRCSP). The aim of the program was to provide consistent, high quality colon cancer screening while adhering to provincial, national and international screening and endoscopic quality guidelines. AIM To evaluate the quality of colonoscopy and colon cancer screening completed during the first year of the SCOPE program and to assess the impact of the endoscopist's area of expertise on outcomes. METHOD All colonoscopies performed in 2012 through the SCOPE program were assessed for polyp detection rate (PDR), adenoma detection rate (ADR), withdrawal time and rectal retroflexion and then stratified based on the specialty of endoscopist performing the procedure. Data was derived retrospectively from the dictated reports and pathology findings. RESULTS From January 1 to December 31, 2012, a total of 3013 screening colonoscopies were performed through the SCOPE program. Gastroenterologists (GI) performed the majority of the cases (2353), with the remaining cases being performed by General Surgeons (GS)(331), Internists (IM)(221), or a Nurse practitioner (NP)(108). The overall mean PDR and ADR for the program was 53% and 35% respectively. The mean ADR was highest amongst GI (37%) and significantly different compared to GS (27%) (p < 0.001) but not statistically different from IM (31%)(p=0.09) or to nurse practitioner (NP) (32%)(p=0.24). GI had significantly longer withdrawal times compared to GS (6.82 min vs. 5.92 min; p<0.001) and to IM (6.82 min vs. 4.08 min; p < 0.001) but no different compared to the NP (6.82 min vs. 7.17 min; p=0.07). The highest mean retroflexion reporting rate was achieved by IM at 93%, which was significantly superior to GI (81%), NP (82%) and GS (52%), all with p < 0.0001. Both GI and NP had significantly higher retroflexion reporting rates than GS (each p < 0.001), but were similar between GI and NP (p=0.91). CONCLUSION The SCOPE program currently meets endoscopic quality standards for overall ADR and withdrawal time, even though there is some variability in the quality of colonoscopy between specialties. This data represents a baseline standard, allowing individual endoscopists participating in the SCOPE program to reflect on areas to maintain or improve patient care through high quality colorectal cancer screening.
The African American population has a higher prevalence of advanced colon adenomas when compared ... more The African American population has a higher prevalence of advanced colon adenomas when compared with non-Hispanic whites and Hispanics, but the risk in other black populations has not been evaluated. Although the Afro-Caribbean population is a significant demographic segment in some regions of the United States, the data are limited on the prevalence of colon adenomas in this group and there is no comparison with a non-Hispanic white population. The objective of our study was to compare the prevalence of adenomas in Afro-Caribbean versus non-Hispanic white populations. A total of 880 Afro-Caribbean patients and 1828 non-Hispanic white patients undergoing their first screening colonoscopy between January 2008 and August 2014 was included in the study. A total of 2708 patients met entry criteria for the study. The adenoma detection rate among Afro-Caribbeans was 29% and 31% among non-Hispanic whites. There was no statistically significant difference in the prevalence of adenomas in t...
Sarcoidosis is a disease with an unknown cause that affects multiple organ systems and has a vari... more Sarcoidosis is a disease with an unknown cause that affects multiple organ systems and has a varied clinical presentation. Often, its symptomatology mimics other disease processes, such as lymphoma, tuberculosis, and amyloidosis. The reticuloendothelial involvement and typical B symptoms of weight loss, fatigue, night sweats, and lymphadenopathy can make sarcoidosis often easily confused with lymphoma. Sarcoidosis has a myriad of central nervous system (CNS) effects, which are often not recognized as symptoms of the disease. These neuropsychiatric symptoms can include, but are not limited to, cognitive decline, headaches, and personality changes. In this report, we discuss a case of a patient who presented with symptoms consistent with indolent lymphoma but was eventually diagnosed with sarcoidosis with extrapulmonary manifestations.
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