MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'Gastrointestinal Endoscopy Clinics of North America' source. Wed, 08 Feb 2012 16:28:18 +0100 http://www.medworm.com/index.php?rid=5422990&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711001334%2Fabstract%3Frss%3Dyes (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5422990 Sat, 19 Nov 2011 09:47:58 +0100 5422990 http://www.medworm.com/index.php?rid=5422989&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711000900%2Fabstract%3Frss%3Dyes Patient registries have evolved to support goals within medical specialties that have traditionally fallen outside their core missions. Quality measurement and reporting can support payor advocacy, meet federal and state requirements, evolve practices into novel care environments, and facilitate coordination among multiple health care providers. Registries can additionally be of use in safety and event monitoring, and supporting comparative effectiveness research. Through integration with electronic health records, registries also serve as a vehicle for the delivery of guidelines and the implementation of decision support and care pathways. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5422989 Sat, 19 Nov 2011 09:47:58 +0100 5422989 http://www.medworm.com/index.php?rid=5422984&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711000894%2Fabstract%3Frss%3Dyes Historically, gastroenterologists entered into solo, small group, or academic practices. The current economic environment and looming regulatory mandates have led to gastroenterologists integrating into large, single-specialty groups to acquire costly practice infrastructure, gain negotiating leverage with health plans, promote high-quality care, and benefit from professional practice management. Individual gastroenterologists must assess whether a large practice will meet their personal goals, financial needs, and professional visions. The decision to integrate into a large practice will also be affected by local practice patterns and regulatory issues. For these and other reasons, gastroenterologists are going big in private practice. (Source: Gastrointestinal Endoscopy Clinics of North ... Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5422984 Sat, 19 Nov 2011 09:47:57 +0100 5422984 http://www.medworm.com/index.php?rid=5422983&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711000912%2Fabstract%3Frss%3Dyes The end of training marks the beginning of learning. Moving into practice is exciting, and there are good opportunities. Although there is still a great deal of uncertainty with the economy, you have a skill set that is in demand. By understanding your real priorities, being deliberate and organized in your search, and being willing to extend outside your comfort zone, you will find a practice that fits you. Each person has an ideal practice. Choose your new practice setting with your eyes wide open, especially regarding new changes that are expected with health care reform. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5422983 Sat, 19 Nov 2011 09:47:57 +0100 5422983 http://www.medworm.com/index.php?rid=5422975&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711001322%2Fabstract%3Frss%3Dyes (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5422975 Sat, 19 Nov 2011 09:47:56 +0100 5422975 http://www.medworm.com/index.php?rid=5422974&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711001310%2Fabstract%3Frss%3Dyes (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5422974 Sat, 19 Nov 2011 09:47:56 +0100 5422974 http://www.medworm.com/index.php?rid=5422973&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711001309%2Fabstract%3Frss%3Dyes (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5422973 Sat, 19 Nov 2011 09:47:56 +0100 5422973 http://www.medworm.com/index.php?rid=5422987&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711000869%2Fabstract%3Frss%3Dyes This article, written by an experienced entrepreneur and practicing gastroenterologist, outlines some of the implications of this emerging challenge. Few other sources of information are available that truly articulate the insider view of coming changes. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5422987 Mon, 24 Oct 2011 04:00:00 +0100 5422987 http://www.medworm.com/index.php?rid=5422985&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711000870%2Fabstract%3Frss%3Dyes This article discusses a proposed evolution toward clinical service line management that might be achieved by an independent single specialty practice. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5422985 Mon, 24 Oct 2011 04:00:00 +0100 5422985 http://www.medworm.com/index.php?rid=5422979&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711001231%2Fabstract%3Frss%3Dyes Gastroenterology (GI) is constantly changing in response to technological, demographic, economic, and political influences. Current health care reform efforts will accelerate this change. The increase in demand for GI services and the imperative to provide higher quality care, at less cost, through novel delivery and payment models with greater transparency and better care coordination between providers, will transform the independent GI practice and force consolidation and integration to leverage combined clinical, financial, and management resources. Which practice models will prevail in the postreform era will depend on the details of health care reform implementation over the next several years. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5422979 Mon, 24 Oct 2011 04:00:00 +0100 5422979 http://www.medworm.com/index.php?rid=5422982&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711000882%2Fabstract%3Frss%3Dyes This is an age of disruptive innovation in health care in which the business model is changing. Fee-for-service, volume-based systems are being replaced by fixed-fee, value-based systems. One of the major facilitating forces behind this change has been the development of the electronic health record, which is providing the medical community with the ability to have real-time quality metrics that will drive the development of web-based clinical decision support tools that will transform the current peer-review–based rules of practice with an eclectic fluid environment of continuous quality measurement and improvement. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5422982 Wed, 19 Oct 2011 04:00:00 +0100 5422982 http://www.medworm.com/index.php?rid=5422988&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711000821%2Fabstract%3Frss%3Dyes This article outlines these challenges and discusses possible ways to improve the situation. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5422988 Mon, 10 Oct 2011 04:00:00 +0100 5422988 http://www.medworm.com/index.php?rid=5422981&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711000845%2Fabstract%3Frss%3Dyes This article explains the proposed ACO model and discusses major implications regarding this model of health care reform including the following: What will it take to implement the program successfully? What are the opportunities for savings under the model? What are the potential downfalls of the program as proposed? What impact would the implementation of an ACO have on the practice of gastroenterology? (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5422981 Mon, 10 Oct 2011 04:00:00 +0100 5422981 http://www.medworm.com/index.php?rid=5422980&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711000857%2Fabstract%3Frss%3Dyes This article is one of the first to articulate these challenges and is written by authors well positioned to understand this arena. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5422980 Mon, 10 Oct 2011 04:00:00 +0100 5422980 http://www.medworm.com/index.php?rid=5422978&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711000833%2Fabstract%3Frss%3Dyes This article reviews the elements of health care reform most relevant to clinical gastroenterology, discusses the ongoing challenges that health care reform legislation faces, and considers the potential implications for clinical practice. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5422978 Mon, 10 Oct 2011 04:00:00 +0100 5422978 http://www.medworm.com/index.php?rid=5422977&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711001243%2Fabstract%3Frss%3Dyes The practice of Gastroenterology and the practice of United States medicine both are undergoing tectonic changes as a result of increasing economic constraints, patient demographics, the aging of practitioners, and, of course, the Patient Protection and Accountable Care Act (PPACA). Last January, at the American Gastroenterological Association Clinical Congress, Dr Charles Lightdale asked us to publish content from the Practice Management and Practice Skills Workshops. The Practice Management portion of the Congress is a 2-day course designed to update physicians and administrators on current changes in the practice of gastroenterology. The Practice Skills workshop is a course focused on GI Fellows transitioning into practice. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5422977 Mon, 10 Oct 2011 04:00:00 +0100 5422977 http://www.medworm.com/index.php?rid=5422976&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS105251571100122X%2Fabstract%3Frss%3Dyes As a participant in the American Gastroenterological Association’s Clinical Congress about a year ago, I had the opportunity to carefully review the program and attend many of the presentations. It was overall a splendid educational event aimed at practicing gastroenterologists, but what struck me as the most unique aspects of the Congress were the Practice Management Course and the Practice Skills Workshop. Here were assembled many of the senior thought leaders in gastroenterology providing practical advice to clinicians faced with bewildering choices on how to manage in changing times. I thought this might be the basis for a Gastrointestinal Endoscopy Clinics of North America issue, and I contacted the Course and Workshop Directors, Dr John Allen and Dr Mark DeLegge, to see if they mig... Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5422976 Mon, 10 Oct 2011 04:00:00 +0100 5422976 http://www.medworm.com/index.php?rid=5422986&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS105251571100081X%2Fabstract%3Frss%3Dyes The budgetary impact of the cost of health care on the United States economy is far-reaching. An understanding of the provisions in the Affordable Care Act is essential to preparing one’s practice to proactively deal with a rapidly changing and evolving system whereby local, regional, and national actions are affecting the ability of clinicians to maintain success on a daily basis. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5422986 Fri, 07 Oct 2011 04:00:00 +0100 5422986 http://www.medworm.com/index.php?rid=5261559&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711001073%2Fabstract%3Frss%3Dyes (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5261559 Thu, 29 Sep 2011 08:28:07 +0100 5261559 http://www.medworm.com/index.php?rid=5261558&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711000766%2Fabstract%3Frss%3Dyes The age of patients admitted to hospital for gastrointestinal bleeding will probably continue to rise, pushing the mortality rate upward, and the use of arthritic and blood thinning drugs will increase the incidence of gastrointestinal bleeding, especially in elderly patients. A slow decrease may be seen in the incidence of Helicobacter-induced ulceration and consequent bleeding in the west. New vaccine development has the best chance of reducing upper gastrointestinal bleeding worldwide, especially that caused by viral infections. Innovations in mechanical and compressive thermal hemostasis offer the best prospects for improvement in outcome from flexible therapeutic endoscopy. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5261558 Thu, 29 Sep 2011 08:28:07 +0100 5261558 http://www.medworm.com/index.php?rid=5261554&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711000754%2Fabstract%3Frss%3Dyes This article summarizes these techniques and, when possible, compares them with other methods such as surgery and endoscopy. The specific role of transcatheter embolotherapy is highlighted, alongside an additional discussion on pharmacologic infusion of vasopressin. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5261554 Thu, 29 Sep 2011 08:28:07 +0100 5261554 http://www.medworm.com/index.php?rid=5261553&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS105251571100078X%2Fabstract%3Frss%3Dyes This article discusses the important aspects of the diagnosis and treatment of bleeding from ulcers, with a focus on endoscopic therapy. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5261553 Thu, 29 Sep 2011 08:28:07 +0100 5261553 http://www.medworm.com/index.php?rid=5261551&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711000675%2Fabstract%3Frss%3Dyes This article presents a practical overview of the approach to managing a patient presenting with nonvariceal upper gastrointestinal bleeding (NVUGIB). The authors focus on initial resuscitation and risk stratification strategies that should be used in the Emergency Department, and put into context the subsequent optimal use of pharmacologic and endoscopic therapies and postendoscopic management. It is hoped that this framework will provide the reader with a practical and evidence-based approach to the management of NVUGIB from the patient's initial presentation through to hospital discharge. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5261551 Thu, 29 Sep 2011 08:28:07 +0100 5261551 http://www.medworm.com/index.php?rid=5261549&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711000778%2Fabstract%3Frss%3Dyes Due to heightened awareness regarding testing for and eradication of infection, the prevalence and incidence of H pylori infection (and by extension the prevalence and incidence of peptic ulcer disease) appear to have declined in recent years. However, antimicrobial resistance is mounting and traditional clarithromycin- or metronidazole-containing triple therapies may no longer be highly effective at eradicating the infection. Combined bismuth- and metronidazole-containing quadruple therapy or sequential 4-drug therapy may be better choices for first-line treatment against this unique pathogen that is ideally suited to survive in the human stomach. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5261549 Thu, 29 Sep 2011 08:28:07 +0100 5261549 http://www.medworm.com/index.php?rid=5261548&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711000699%2Fabstract%3Frss%3Dyes This article outlines the epidemiology and role of nonsteroidal antiinflammatory drugs (NSAIDs) in causing gastrointestinal (GI) bleeding. The morbidity and mortality associated with NSAID-induced GI bleeding are discussed, and the mechanisms of NSAID-related GI injury, the potency of various NSAIDs, new NSAIDs associated with a decrease in GI pathology, dual-acting antiinflammatory drugs, hydrogen sulfide-releasing NSAIDs, lipoxygenase/cyclooxygenase, phospholipid NSAIDs, and the comprehensive effects of NSAIDs on the GI tract are described. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5261548 Thu, 29 Sep 2011 08:28:07 +0100 5261548 http://www.medworm.com/index.php?rid=5261545&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711000808%2Fabstract%3Frss%3Dyes Upper gastrointestinal bleeding (UGIB) is an important medical problem for patients and the medical system. The causes of UGIB are varied and their accurate identification guides appropriate management. The major cause of UGIB is peptic ulcer disease, for which Helicobacter pylori and nonsteroidal antiinflammatory drug use are major risk factors. Lesser causes include Dieulafoy lesion, gastric antral vascular ectasia, hemobilia, aortoenteric fistulas, and upper gastrointestinal tumors. Awareness of causes and management of UGIB should allow physicians to treat their patients more effectively. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5261545 Thu, 29 Sep 2011 08:28:07 +0100 5261545 http://www.medworm.com/index.php?rid=5261544&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711001206%2Fabstract%3Frss%3Dyes There is no question that upper GI bleeding (UGIB) represents a significant diagnostic and therapeutic dilemma to the gastroenterologist. With the world’s aging population, the expenditure of manpower and costs to treat UGIB is considerable. A complete understanding of UGIB requires knowledge of epidemiologic and demographic world trends, pathology and factors influencing these patterns such as NSAID use, antisecretory agents, anticoagulants, and the status of Helicobacter pylori today. The standard of care for treating UGIB should be well defined while new technologies continue to simplify and treat bleeding lesions more definitively. When the going gets tough and endoscopic and pharmacologic therapy is ineffective, interventional radiology and surgery become our best friends. But wait,... Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5261544 Thu, 29 Sep 2011 08:28:07 +0100 5261544 http://www.medworm.com/index.php?rid=5261543&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711001218%2Fabstract%3Frss%3Dyes An enduring emergency for gastroenterologists has been upper GI bleeding. The etiologies have shifted in incidence over the years, but not the presentation: a frightened patient vomiting blood or passing black tarry stools, perhaps feeling lightheaded or having fainted. Most will respond to resuscitation and blood transfusion, and in most the bleeding will stop, but in others it will persist or recur. Into this fraught situation comes the gastroenterologist to the rescue, like the cavalry but riding an endoscope, and armed to the teeth with an array of endoscopy-guided weapons capable of stanching, sealing, cauterizing, vasoconstricting, banding, sclerosing, and clipping the ruptured blood vessel. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5261543 Thu, 29 Sep 2011 08:28:07 +0100 5261543 http://www.medworm.com/index.php?rid=5261542&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711001061%2Fabstract%3Frss%3Dyes (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5261542 Thu, 29 Sep 2011 08:28:07 +0100 5261542 http://www.medworm.com/index.php?rid=5261541&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711001048%2Fabstract%3Frss%3Dyes (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5261541 Thu, 29 Sep 2011 08:28:07 +0100 5261541 http://www.medworm.com/index.php?rid=5261540&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711001036%2Fabstract%3Frss%3Dyes (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5261540 Thu, 29 Sep 2011 08:28:07 +0100 5261540 http://www.medworm.com/index.php?rid=5261557&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711000730%2Fabstract%3Frss%3Dyes This article reviews the components of adequate training required for a gastroenterologist to treat upper gastrointestinal bleeding (UGIB). The current status of endoscopic simulators is critically reviewed to determine whether these should be part of the UGIB armamentarium in the training of individuals and whether credentialing could be accomplished through this method of instruction. Finally, the author discusses the appropriate use of sedation in patients with UGIB. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5261557 Thu, 18 Aug 2011 04:00:00 +0100 5261557 http://www.medworm.com/index.php?rid=5261556&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711000687%2Fabstract%3Frss%3Dyes Early surgical involvement in the management of a patient at high risk for recurrent bleeding, despite endoscopic intervention, is often optimal to assure continuity of care. Close collaboration of the surgical team with gastroenterologic endoscopy teams greatly benefits the patient. A detailed description of the location of the bleeding process is of great help for the surgeon as surgical decision making will be influenced by the distance from the gastroesophageal junction or pylorus, location on the anterior or posterior wall, greater or lesser curvature or incisura, and the size of the process. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5261556 Thu, 18 Aug 2011 04:00:00 +0100 5261556 http://www.medworm.com/index.php?rid=5261555&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711000791%2Fabstract%3Frss%3Dyes This article covers new endoscopic imaging modalities in nonvariceal upper gastrointestinal bleeding, such as Doppler ultrasound probe technology, endoscopic ultrasonography, color Doppler optical coherence tomography, and magnification endoscopy. A more in-depth discussion of these modalities and the published evidence supporting their use are included. Furthermore, the shift in focus from identification of conventional visual surface stigmata of recent hemorrhage to an assessment and understanding of subsurface blood flow as it relates to the bleeding lesion is discussed. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5261555 Thu, 18 Aug 2011 04:00:00 +0100 5261555 http://www.medworm.com/index.php?rid=5261552&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711000742%2Fabstract%3Frss%3Dyes This article provides an overview of different pharmacologic agents that have been used in the management of UGIB. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5261552 Thu, 18 Aug 2011 04:00:00 +0100 5261552 http://www.medworm.com/index.php?rid=5261550&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711000717%2Fabstract%3Frss%3Dyes There is increasing concern regarding a possible adverse interaction between proton pump inhibitors (PPIs) and clopidogrel that could lead to reduced cardiovascular protection by clopidogrel. We performed a literature search for relevant original studies and systematic reviews. PPIs likely affect the antiplatelet activity of clopidogrel as measured in vitro, and this may be a class effect. We conclude that the pharmacodynamic effect has not been translated into any clinically meaningful adverse effect. PPI cotherapy reduces the incidence of recurrent peptic ulcer and of upper gastrointestinal bleeding among patients on clopidogrel. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5261550 Thu, 11 Aug 2011 04:00:00 +0100 5261550 http://www.medworm.com/index.php?rid=5261547&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711000729%2Fabstract%3Frss%3Dyes Acute and chronic bleeding from the upper gastrointestinal tract is a common indication for endoscopy and hospitalization and is associated with significant morbidity and mortality. The causes of upper gastrointestinal bleeding are numerous and can result in both acute and chronic hemorrhage. The aim of this article is to examine the pathologic features of various diseases associated with upper gastrointestinal tract bleeding. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5261547 Thu, 11 Aug 2011 04:00:00 +0100 5261547 http://www.medworm.com/index.php?rid=5261546&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711000705%2Fabstract%3Frss%3Dyes Despite major advances in diagnosis, prevention, and treatment, nonvariceal upper gastrointestinal bleeding still is a serious problem in clinical practice. Current evidence indicates that most peptic ulcer bleeding–linked deaths are not a direct sequela of the bleeding ulcer itself. Instead, mortality derives from multiorgan failure, cardiopulmonary conditions, or terminal malignancy, suggesting that improving further current treatments for the bleeding ulcer may have a limited impact on mortality unless supportive therapies are developed for the global management of these patients. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5261546 Thu, 11 Aug 2011 04:00:00 +0100 5261546 http://www.medworm.com/index.php?rid=4946950&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711000547%2Fabstract%3Frss%3Dyes (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4946950 Mon, 20 Jun 2011 18:01:17 +0100 4946950 http://www.medworm.com/index.php?rid=4946947&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711000432%2Fabstract%3Frss%3Dyes This article reviews the major indication for pancreatic stent placement and focuses on the choice of stent, technique of implantation and followup. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4946947 Mon, 20 Jun 2011 18:01:17 +0100 4946947 http://www.medworm.com/index.php?rid=4946946&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711000365%2Fabstract%3Frss%3Dyes Most patients with malignant hilar stenoses are candidates for palliation. For this purpose, biliary drainage plays a major role in improving liver function and managing or avoiding cholangitis. Endoscopic interventions are less invasive than the percutaneous approach and should be considered as the first-line drainage procedures in most cases. Transhepatic interventions should be reserved for endoscopic failures or performed as a complementary approach in a combined procedure. After successful endoscopic access to biliary obstruction, implantation of self-expandable metal stents offers advantages over plastic endoprostheses in terms of stent patency and number of reinterventions. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4946946 Mon, 20 Jun 2011 18:01:17 +0100 4946946 http://www.medworm.com/index.php?rid=4946945&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711000419%2Fabstract%3Frss%3Dyes This article focuses on malignant distal biliary obstruction and its management. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4946945 Mon, 20 Jun 2011 18:01:17 +0100 4946945 http://www.medworm.com/index.php?rid=4946944&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711000390%2Fabstract%3Frss%3Dyes This article reviews the currently published experience on SEMS and attempts to define their current role in the treatment of benign biliary diseases. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4946944 Mon, 20 Jun 2011 18:01:17 +0100 4946944 http://www.medworm.com/index.php?rid=4946942&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711000444%2Fabstract%3Frss%3Dyes Biliary plastic stenting plays a key role in the endoscopic management of benign biliary diseases. Complications following surgery of the biliary tract and liver transplantation are amenable to endoscopic treatment by plastic stenting. Insertion of an increasing number of plastic stents is currently the method of choice to treat postoperative biliary strictures. Benign biliary strictures secondary to chronic pancreatitis or primary sclerosing cholangitis may benefit from plastic stenting in select cases. There is a role for plastic stent placement in nonoperative candidates with acute cholecystitis and in patients with irretrievable bile duct stones. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4946942 Mon, 20 Jun 2011 18:01:17 +0100 4946942 http://www.medworm.com/index.php?rid=4946941&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711000341%2Fabstract%3Frss%3Dyes Malignant gastric outlet obstruction (GOO) is a commonly encountered entity, defined as the inability of the stomach to empty because of mechanical obstruction at the level of either the stomach or the proximal small bowel. In this article, current literature on GOO is reviewed with a focus on enteral stents to include symptoms and diagnosis, stent and nonstent treatment, types of enteral stents, indications and contraindications to stent placement, and technical and clinical success rates. In comparison with gastrojejunostomy, enteral stent placement is better suited for patients with a shorter life expectancy and/or those who are poor surgical candidates. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4946941 Mon, 20 Jun 2011 18:01:17 +0100 4946941 http://www.medworm.com/index.php?rid=4946939&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS105251571100033X%2Fabstract%3Frss%3Dyes Partially covered self-expandable esophageal stents have been associated with unacceptable complications when used for benign esophageal disorders. With the introduction of removable or potentially removable fully covered stents and biodegradable stents, interest in using expandable stents for benign indications has been revived. Although expandable stents can offer a minimally invasive alternative to surgery, they can be associated with serious complications; hence, this approach should be considered in carefully selected patients, preferably on a protocol basis. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4946939 Mon, 20 Jun 2011 18:01:16 +0100 4946939 http://www.medworm.com/index.php?rid=4946938&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711000407%2Fabstract%3Frss%3Dyes Expandable stents are widely used in gastroenterology. The basic principle of all of these devices is that they can be constrained onto a delivery system of small diameter and then deployed in an area of stenosis without the risk of complications due to excessive dilation. Understanding tissue responses to stents is important both for the design of new stents and for clinicians to balance the benefits and risks of covered and uncovered stents. With biodegradable stents and removable stents, understanding tissue responses provides the basis for timing of removal and assessing treatment response. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4946938 Mon, 20 Jun 2011 18:01:16 +0100 4946938 http://www.medworm.com/index.php?rid=4946937&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711000456%2Fabstract%3Frss%3Dyes When searching PubMed, the term “stent” first appeared in the title of a publication in 1952. At the time of this writing, a search in PubMed using “stent” produced 52,629 articles. The origin has been conjectured to be from the Scottish word stynt or stent, meaning stretched out river fishing nets (an extension if you will). However, in an excellent review by Sterioff on the etymology of the word stent, it is widely accepted that the word evolved from Stent’s compound, created by British dentist Charles. T. Stent (1807–1885) and used for dental impressions. Subsequently, in 1917 a surgeon, Johannes F.S. Esser (1877–1946), used the compound for facial plastic surgery and referred to it as Stent’s mould. In 1954, William H. Re Mine and John H. Grindlay used Stent’s princip... Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4946937 Mon, 20 Jun 2011 18:01:16 +0100 4946937 http://www.medworm.com/index.php?rid=4946936&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711000468%2Fabstract%3Frss%3Dyes Placing stents to maintain patency of ducts and lumens has become a major therapeutic tool for interventional gastrointestinal endoscopists. The evolution from handmade rigid stents to a wide array of flexible, expandable metal and plastic devices has been rapid and remarkable. GI stents provide successful treatment, and palliation for an extensive variety of blockages, obstructions, and stenoses within the esophagus, stomach, small intestine, and colon, have become staples in interventional ERCP and are key elements in the developing field of therapeutic EUS. GI stents will no doubt continue to proliferate and improve, driven in no small part by the enormous markets for stents in cardiology and interventional radiology. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4946936 Mon, 20 Jun 2011 18:01:16 +0100 4946936 http://www.medworm.com/index.php?rid=4946935&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711000535%2Fabstract%3Frss%3Dyes (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4946935 Mon, 20 Jun 2011 18:01:16 +0100 4946935 http://www.medworm.com/index.php?rid=4946934&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711000523%2Fabstract%3Frss%3Dyes (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4946934 Mon, 20 Jun 2011 18:01:16 +0100 4946934 http://www.medworm.com/index.php?rid=4946933&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711000511%2Fabstract%3Frss%3Dyes (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4946933 Mon, 20 Jun 2011 18:01:16 +0100 4946933 http://www.medworm.com/index.php?rid=4946948&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711000377%2Fabstract%3Frss%3Dyes The surgical management of malignant colorectal obstruction is still controversial and has higher associated mortality and complication rates compared with elective surgery. Placement of self-expanding metallic stents (SEMS) has been proposed as an alternative therapeutic approach for colonic decompression of patients with acute malignant obstruction. SEMS placement may be used both as a bridge to surgery in patients who are good candidates for curative resection and for palliation of those patients presenting with advanced stage disease or with severe comorbid medical illnesses. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4946948 Sun, 15 May 2011 23:00:00 +0100 4946948 http://www.medworm.com/index.php?rid=4946943&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711000420%2Fabstract%3Frss%3Dyes Plastic biliary endoprostheses have not changed much since their introduction more than 3 decades ago. Although their use has been challenged by the introduction of metal stents, plastic stents still remain commonly used. Much work has been done to improve the problem of stent obstruction but without substantial clinical success. In this review, the authors discuss the history of plastic biliary stent development and the current use of plastic stents for malignant biliary diseases. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4946943 Sun, 15 May 2011 23:00:00 +0100 4946943 http://www.medworm.com/index.php?rid=4946949&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711000353%2Fabstract%3Frss%3Dyes The use of stents throughout the gastrointestinal tract has evolved over the past century. The evolution of endoscopic ultrasound and significant improvements in stent design are key factors that have allowed endoscopists to drive the use of stents in gastroenterology into new directions. Endoscopic creativity remains crucial in the evolution of any new endoscopic technology. Finally, the use of multidisciplinary teams, including endoscopists, radiologists, and surgeons, allows for the exchange of ideas and procedural planning necessary for successful innovation. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4946949 Tue, 10 May 2011 23:00:00 +0100 4946949 http://www.medworm.com/index.php?rid=4946940&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711000389%2Fabstract%3Frss%3Dyes Esophageal cancer is diagnosed in about 400,000 patients each year worldwide, and its incidence is increasing faster than that of any other malignancy. This makes it the ninth most common malignancy and sixth on the list of cancer mortality causes. Most patients with esophageal cancer present at a stage that is too advanced for curative therapy, and many die within a few months. Treatment of dysphagia is the main goal of palliative care in more than 50% of incurable cases. Although many different palliative options for malignant dysphagia are available, expandable stent placement is the most commonly performed treatment modality. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4946940 Tue, 10 May 2011 23:00:00 +0100 4946940 http://www.medworm.com/index.php?rid=4814663&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711000249%2Fabstract%3Frss%3Dyes (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4814663 Thu, 31 Mar 2011 23:00:00 +0100 4814663 http://www.medworm.com/index.php?rid=4814662&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711000109%2Fabstract%3Frss%3Dyes Although innovation marches forward and places new therapeutic options at our doorsteps, the regulatory and payer environment must be considered if any of these new opportunities will be available in the clinical mainstream. Endolumenal treatment of bariatric disease will face many of the same challenges as those the endolumenal treatment of gastroesophageal reflux has faced over the last decade. In an era of shrinking health care dollars, the challenge of reimbursement will be significant. Strategies for the implementation of endolumenal therapies for the treatment of obesity must include a data-driven approach that addresses not only regulatory but also financial concerns to be successful. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4814662 Thu, 31 Mar 2011 23:00:00 +0100 4814662 http://www.medworm.com/index.php?rid=4814661&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711000055%2Fabstract%3Frss%3Dyes This article focuses on the various endoscopic devices and procedures that pertain to primary and revisional treatments. Additionally, the article discusses the potential for applying these various devices and procedures to other points of intervention, including early intervention, bridge to surgery, and primary metabolic treatment (eg, diabetes management). Devices that are currently in human use are preferentially discussed, followed by references to devices that may see clinical use in the near future. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4814661 Thu, 31 Mar 2011 23:00:00 +0100 4814661 http://www.medworm.com/index.php?rid=4814660&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711000043%2Fabstract%3Frss%3Dyes The Roux-en-Y gastric bypass (RYGB) accounts for more than 60% of bariatric procedures performed in the United States today. The RYGB anatomy poses particular challenges to interventional endoscopists who intend to access the papilla. Deep enteroscopy-assisted endoscopic retrograde cholangiopancreatography seems to be the least invasive technique for this purpose, and is often the best initial choice. However, considerable experience is needed to optimize the success rate of reaching the biliopancreatic limb, with subsequent successful cannulation, and which approach is taken should be determined on a case-by-case basis. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4814660 Thu, 31 Mar 2011 23:00:00 +0100 4814660 http://www.medworm.com/index.php?rid=4814659&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711000092%2Fabstract%3Frss%3Dyes Postsurgical leaks after bariatric procedures are a significant cause of morbidity and mortality. They usually arise from anastomotic and staple line failures that are attributed to surgical technique, ischemia, and patient comorbid conditions. Timely diagnosis from subtle clinical clues is the key to appropriate management. Traditional treatment consists of adequate control of the intra-abdominal infection via surgical or percutaneous drainage maneuvers, antibiotics, and nutrition support via parenteral or feeding tube routes. Recently, endoscopically placed covered esophageal stents have been used to exclude the leak site, allowing oral nutrition and speeding healing. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4814659 Thu, 31 Mar 2011 23:00:00 +0100 4814659 http://www.medworm.com/index.php?rid=4814658&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711000031%2Fabstract%3Frss%3Dyes Bariatric surgery is one of the treatment options for achieving and preserving weight loss and managing medical complications related to obesity. After bariatric surgery, early or late adverse events, such as intraluminal or extraluminal gastrointestinal hemorrhage, can occur. Early gastrointestinal bleeding is more often a complication associated with Roux-en-Y gastric bypass surgery than other bariatric procedures and usually arises from the gastrojejunal anastomosis. Early postoperative bleeding may be potentially life threatening, although death after postbariatric surgery as a consequence of acute bleeding is uncommon. Although early postoperative intraluminal bleeding can usually be managed conservatively, endoscopic therapy may be required. (Source: Gastrointestinal Endoscopy Clinic... Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4814658 Thu, 31 Mar 2011 23:00:00 +0100 4814658 http://www.medworm.com/index.php?rid=4814657&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711000080%2Fabstract%3Frss%3Dyes The primary role of endoscopic intervention in the care of bariatric surgery patients is in the management of late bariatric surgical complications and non-operative revision of the surgical anatomy. In the future, indications for therapeutic endoscopy will involve the gastroenterologist in primary weight loss interventions as cutting edge technology is currently undergoing rigorous scientific evaluation. Endoscopists caring for these patients should become familiar with post-bariatric surgical anatomy, potential complications, common presenting symptoms, anticipated luminal/extra-luminal findings, and endoscopic management of common bariatric complications; this review addresses these issues. This review will discuss common presenting symptoms, luminal as well as extra-luminal findings an... Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4814657 Thu, 31 Mar 2011 23:00:00 +0100 4814657 http://www.medworm.com/index.php?rid=4814656&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711000146%2Fabstract%3Frss%3Dyes This article details endoscopy unit considerations pertaining to the bariatric patient, which may apply to pretreatment endoscopic evaluation, managing postoperative bariatric surgical complications, and emerging endoluminal bariatric therapies. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4814656 Thu, 31 Mar 2011 23:00:00 +0100 4814656 http://www.medworm.com/index.php?rid=4814655&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711000122%2Fabstract%3Frss%3Dyes This article explores these issues and how they may impact the risk profile of current standards for endoscopic sedation. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4814655 Thu, 31 Mar 2011 23:00:00 +0100 4814655 http://www.medworm.com/index.php?rid=4814654&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711000134%2Fabstract%3Frss%3Dyes Bariatric surgery remains the only effective method to initiate and sustain massive weight loss in morbidly obese patients. Along with the advent of minimal access surgery, its popularity has not only resulted in an exponential increase in number of cases but also a subsequent increase in number of complications. Although most postsurgical bariatric complications are managed surgically, it is imperative that all physicians be aware of the unique potential complications to effectively communicate and optimize the medical management in this emergent set of patients. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4814654 Thu, 31 Mar 2011 23:00:00 +0100 4814654 http://www.medworm.com/index.php?rid=4814653&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711000110%2Fabstract%3Frss%3Dyes This article gives an overview of the comprehensive evaluation and preoperative preparation of a bariatric patient. Medical, psychological, and behavioral evaluation is discussed. The role of routine preoperative endoscopy is controversial but can be very important and may alter the operation performed. Immediate postoperative care is also addressed. Undergoing bariatric surgery is a lifelong commitment, and frequent follow up with reinforcement and monitoring for nutritional deficiencies is extremely important. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4814653 Thu, 31 Mar 2011 23:00:00 +0100 4814653 http://www.medworm.com/index.php?rid=4814652&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711000067%2Fabstract%3Frss%3Dyes Because bariatric surgery is becoming increasingly common, gastroenterologists need to be familiar with the surgical and endoscopic anatomy of the operations in use today. This review focuses on the 4 most commonly performed bariatric operations in the United States: Roux-en-Y gastric bypass, adjustable gastric band, sleeve gastrectomy, and biliopancreatic diversion with duodenal switch. The anatomy and mechanism of action of each procedure is discussed and illustrated. Emphasis is placed on the endoscopic anatomy, with review of the commonly encountered complications. Emerging techniques and devices are reviewed. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4814652 Thu, 31 Mar 2011 23:00:00 +0100 4814652 http://www.medworm.com/index.php?rid=4814651&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711000079%2Fabstract%3Frss%3Dyes The large number of people with mild to moderate obesity contribute more to its overall public health burdens than the smaller number of people with severe obesity. High-risk, high-efficacy strategies and population strategies focusing on lifestyle and behavioral modifications have failed to address the population burden of disease. An individualized approach is likely to provide the most effective management of this disease for the largest number of patients. This review discusses advances in pharmacologic therapies for obesity with a focus on currently approved drugs and those in later stages of development. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4814651 Thu, 31 Mar 2011 23:00:00 +0100 4814651 http://www.medworm.com/index.php?rid=4814650&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS105251571100002X%2Fabstract%3Frss%3Dyes The aim of this article is to describe the context in which this issue of Gastrointestinal Endoscopy Clinics of North America is established. The authors review the current worldwide dimensions and trends of the obesity epidemic; associated mortality and comorbid diseases including diabetes, cancer, cardiovascular disease and obstructive sleep apnea; the financial impact of obesity; and current national and international guidelines for referral and qualification for surgical treatment of obesity. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4814650 Thu, 31 Mar 2011 23:00:00 +0100 4814650 http://www.medworm.com/index.php?rid=4814647&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711000237%2Fabstract%3Frss%3Dyes (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4814647 Thu, 31 Mar 2011 23:00:00 +0100 4814647 http://www.medworm.com/index.php?rid=4814646&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711000225%2Fabstract%3Frss%3Dyes (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4814646 Thu, 31 Mar 2011 23:00:00 +0100 4814646 http://www.medworm.com/index.php?rid=4814645&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711000213%2Fabstract%3Frss%3Dyes (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4814645 Thu, 31 Mar 2011 23:00:00 +0100 4814645 http://www.medworm.com/index.php?rid=4814649&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515711000158%2Fabstract%3Frss%3Dyes In the United States approximately one in five individuals over 18 years of age is obese, and it is clear that this very real epidemic is rapidly becoming global in scope. Dietary programs, behavioral modification, and medical therapies have thus far provided inadequate long-term results. Bariatric surgery, however, does offer a means of durable weight loss for many patients with morbid obesity, and it is estimated that over 200,000 procedures are performed in the United States annually. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4814649 Wed, 16 Mar 2011 00:00:00 +0100 4814649 http://www.medworm.com/index.php?rid=4814648&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS105251571100016X%2Fabstract%3Frss%3Dyes Evident from any casual observation in an airport, theme park, or stadium, obesity has emerged as the major public health menace of our time. Clearly linked to diabetes, cardiovascular disease, liver disease, and many cancers, obesity has become widely prevalent in our society in children and adults. While national attention has focused on a healthier food supply, diet control, and regular exercise for prevention of obesity, these measures often are insufficient for the already obese patient. Pharmacologic treatments have also been disappointing and sometimes dangerous. Bariatric surgery, which at first seemed a drastic approach, has now become commonplace and in wide demand. The surgical procedures alter upper GI anatomy to variably restrict food intake or cause malabsorption. (Source: Ga... Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4814648 Wed, 16 Mar 2011 00:00:00 +0100 4814648 http://www.medworm.com/index.php?rid=4215601&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710001443%2Fabstract%3Frss%3Dyes (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4215601 Wed, 01 Dec 2010 14:45:56 +0100 4215601 http://www.medworm.com/index.php?rid=4215600&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710001297%2Fabstract%3Frss%3Dyes This article describes potential future advances regarding screening, surveillance, risk stratification, endoscopic eradication therapies, and chemoprevention and provides a potential future management strategy for patients with BE. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4215600 Wed, 01 Dec 2010 14:45:56 +0100 4215600 http://www.medworm.com/index.php?rid=4215599&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710001248%2Fabstract%3Frss%3Dyes Esophageal adenocarcinoma is increasing in incidence. The main risk factor is the premalignant condition of Barrett's esophagus. There is great interest in chemoprevention to prevent or slow malignant transformation. There are many agents proposed as playing a role in chemoprevention; however, none is licensed for this role as yet. Aspirin possesses many favorable qualities for chemoprevention and is the focus of the largest randomized control trial in this field. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4215599 Wed, 01 Dec 2010 14:45:56 +0100 4215599 http://www.medworm.com/index.php?rid=4215598&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710001236%2Fabstract%3Frss%3Dyes This article reviews the current literature on the cost analyses of commonly used Barrett endoscopic interventions and summarizes the overall cost-effectiveness of these treatments as compared with surveillance or surgery. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4215598 Wed, 01 Dec 2010 14:45:56 +0100 4215598 http://www.medworm.com/index.php?rid=4215597&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710001273%2Fabstract%3Frss%3Dyes Gastroesophageal reflux disease (GERD) is a highly prevalent disease. Population studies have demonstrated that a significant proportion of individuals weekly experience GERD symptoms. Barrett's esophagus (BE), defined by the presence of intestinal metaplasia (columnar epithelium with goblet cells), is considered a consequence of chronic reflux. This review defines the role of surgery in the modern treatment of BE, taking into consideration the pathophysiology of the disease and the new endoscopic procedures available at present. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4215597 Wed, 01 Dec 2010 14:45:56 +0100 4215597 http://www.medworm.com/index.php?rid=4215596&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710001200%2Fabstract%3Frss%3Dyes This article reviews the currently available BE endoscopic treatments with emphasis on appropriate selection of patients, indications and timing of use, and clinical management considerations. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4215596 Wed, 01 Dec 2010 14:45:55 +0100 4215596 http://www.medworm.com/index.php?rid=4215595&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710001261%2Fabstract%3Frss%3Dyes Cryotherapy is a noncontact ablation method that has long been used clinically in the treatment of a wide variety of malignant and premalignant diseases. The relative ease of use and unique mechanisms of cellular destruction make cryotherapy particularly attractive for the eradication of dysplastic Barrett's esophagus. Currently, liquid nitrogen and carbon dioxide are the most common cryogens used. Preliminary data with these agents have shown high efficacy in the reversal of dysplastic Barrett mucosa and excellent safety profiles. Intense investigation on cryotherapy ablation of Barrett's esophagus is ongoing. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4215595 Wed, 01 Dec 2010 14:45:55 +0100 4215595 http://www.medworm.com/index.php?rid=4215594&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710001285%2Fabstract%3Frss%3Dyes This article reviews the evidence behind RFA to differentiate it from other management strategies in terms of efficacy, durability, safety, tolerability, and cost-effectiveness. The role of RFA in the management of BE is described, including endoscopic resection. Future directions are identified for research that will help to better define the role of RFA in the management of BE. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4215594 Wed, 01 Dec 2010 14:45:55 +0100 4215594 http://www.medworm.com/index.php?rid=4215593&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710001340%2Fabstract%3Frss%3Dyes Endoscopic resection (ER) has become the most important endoscopic treatment method of early cancers of the upper GI tract. ER serves as a therapeutic but also as a diagnostic tool by providing a specimen for histologic assessment. In expert hands ER is easy to performa and has a very low complication rate. Long-term results in early esophageal and gastric cancer are excellent. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4215593 Wed, 01 Dec 2010 14:45:55 +0100 4215593 http://www.medworm.com/index.php?rid=4215592&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710001212%2Fabstract%3Frss%3Dyes Photodynamic therapy (PDT) is a photochemical process that uses a photosensitizer drug activated by laser light to produce mucosal ablation. Porfimer sodium PDT has proved long-term efficacy and durability in the treatment of Barrett's esophagus and high-grade dysplasia and early esophageal adenocarcinoma. Its use has been limited by serious side effects including prolonged cutaneous photosensitivity and stricture formation. Other photosensitizers with a better safety profile have been used mostly in Europe with limited experience. The future of PDT lies on a better understanding of dosimetry, tissue properties, and host genetic factors. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4215592 Wed, 01 Dec 2010 14:45:55 +0100 4215592 http://www.medworm.com/index.php?rid=4215591&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS105251571000125X%2Fabstract%3Frss%3Dyes The main goal in the staging of patients with early neoplasia arising in the context of Barrett's esophagus (BE) is to identify individuals who are eligible for endoscopic therapy and differentiate them from those who require surgical management. To make the proper patient selection a combined staging strategy consisting of endoscopy evaluation, endoscopic ultrasonography, and endoscopic mucosal resection is necessary. In this article, the authors summarize the evidence behind each different staging modality in the setting of early BE adenocarcinoma and propose a staging approach that helps to select patients who are suitable for endoscopic therapy. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4215591 Wed, 01 Dec 2010 14:45:55 +0100 4215591 http://www.medworm.com/index.php?rid=4215590&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710001327%2Fabstract%3Frss%3Dyes Enhanced visualization techniques are available for Barrett's esophagus and have promise in the detection of dysplasia and cancer. Several of these techniques, such as narrow band imaging and chromoendoscopy, are being applied clinically. These techniques will allow the endoscopist to screen the surface of the Barrett's esophagus to detect areas of neoplasia. Once detected, it is hoped that either magnification techniques, such as confocal laser endomicroscopy, or spectroscopic techniques can be of value in allowing in vivo real-time diagnostic capabilities. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4215590 Wed, 01 Dec 2010 14:45:54 +0100 4215590 http://www.medworm.com/index.php?rid=4215589&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710001303%2Fabstract%3Frss%3Dyes This article provides a useful conceptual basis for understanding the molecular events involved in the making of Barrett metaplasia and in its neoplastic progression, and provides a rationale for evaluating studies on the application of molecular medicine to the diagnosis and management of patients with Barrett's esophagus and esophageal adenocarcinoma. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4215589 Wed, 01 Dec 2010 14:45:54 +0100 4215589 http://www.medworm.com/index.php?rid=4215588&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710001224%2Fabstract%3Frss%3Dyes Barrett's esophagus is a well-known risk factor for the development of esophageal adenocarcinoma. Current practice guidelines recommend endoscopic surveillance of patients with Barrett's esophagus in an attempt to detect cancer at an early and potentially curable stage. This review addresses the rationale behind surveillance and criteria for inclusion of patients in surveillance programs as well as the appropriate technique and intervals that should be used. This work addresses other key topics in Barrett's esophagus surveillance, including the efficacy of surveillance programs, physician compliance with surveillance guidelines, cost-effectiveness of surveillance programs, and areas for future research. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4215588 Wed, 01 Dec 2010 14:45:54 +0100 4215588 http://www.medworm.com/index.php?rid=4215587&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710001315%2Fabstract%3Frss%3Dyes This article considers some key clinical issues that impact the management of patients with Barrett's esophagus. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4215587 Wed, 01 Dec 2010 14:45:54 +0100 4215587 http://www.medworm.com/index.php?rid=4215586&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710001352%2Fabstract%3Frss%3Dyes Barrett’s esophagus (BE) is clearly recognized as the most important risk factor for the development of esophageal adenocarcinoma. The incidence of this cancer has increased by approximately sixfold during the last 30 years, a rate greater than that of any other cancer in the United States during this period of time. Matching this challenge, the past decade has seen marked advances in our understanding of the risk of neoplastic progression in BE, new and promising endoscopic imaging technologies for identification of dysplasia, and the development of numerous modalities to achieve endoscopic eradiation of this tissue. Nevertheless, the answers today to the fundamental questions of in whom, when, how, and which techniques to perform screening, surveillance, and treatment remain elusive. T... Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4215586 Wed, 01 Dec 2010 14:45:53 +0100 4215586 http://www.medworm.com/index.php?rid=4215585&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710001364%2Fabstract%3Frss%3Dyes The continuing dramatic rise in the incidence of esophageal adenocarcinoma has driven progress in our understanding and management of Barrett’s esophagus, the premalignant condition most associated with this highly lethal cancer. The relatively easy accessibility of Barrett’s esophagus to the gastrointestinal endoscopist has also resulted in new approaches in prevention, early detection, and treatment. Exciting new discoveries in understanding carcinogenesis in Barrett’s tissue have emerged, along with new optical methods for identification of early neoplasia in Barrett’s epithelium. Progress has been most notable in the endoscopic treatment of early neoplasia in Barrett’s esophagus, where endoscopic mucosal resection and radiofrequency ablation have become important and demonstr... Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4215585 Wed, 01 Dec 2010 14:45:53 +0100 4215585 http://www.medworm.com/index.php?rid=4215584&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710001431%2Fabstract%3Frss%3Dyes (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4215584 Wed, 01 Dec 2010 14:45:53 +0100 4215584 http://www.medworm.com/index.php?rid=4215583&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS105251571000142X%2Fabstract%3Frss%3Dyes (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4215583 Wed, 01 Dec 2010 14:45:53 +0100 4215583 http://www.medworm.com/index.php?rid=4215582&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710001418%2Fabstract%3Frss%3Dyes (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4215582 Wed, 01 Dec 2010 14:45:53 +0100 4215582 http://www.medworm.com/index.php?rid=4028541&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710001108%2Fabstract%3Frss%3Dyes (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4028541 Thu, 30 Sep 2010 23:00:00 +0100 4028541 http://www.medworm.com/index.php?rid=4028540&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710000954%2Fabstract%3Frss%3Dyes Gastroenterologists who understand future reimbursement and health care trends are already preparing their practice infrastructure to meet new challenges of transparency and bundled payments. Market-based pressures derived from quality and cost transparency will be sufficient to drive change. Robust measurement and public reporting of results are firmly embedded in some regions of the country and will spread nationally within the next few years. The path is clear for those who study these issues; monitor process measures for internal improvement, push resource efficiency, connect to national registries to demonstrate quality externally, and constantly try to provide a service with the highest health value. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4028540 Thu, 30 Sep 2010 23:00:00 +0100 4028540 http://www.medworm.com/index.php?rid=4028539&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710000942%2Fabstract%3Frss%3Dyes This article presents a cost-effectiveness analysis of colorectal cancer screening tests that have been recommended by the United States Preventive Services Task Force, American Cancer Society US Multi-Society Task Force on Colorectal Cancer American College of Radiology, or the American College of Gastroenterology. This cost-effectiveness analysis supports a common theme of the 3 guideline groups that there are multiple acceptable colorectal cancer screening strategies (including colonoscopy). The article shows which recommended strategies are also cost-effective given a range of willingness to pay per life-year gained. The set of cost-effective strategies includes tests that primarily detect cancer early (annual sensitive fecal occult blood tests [FOBTs]; either guaiac or fecal immunoche... Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4028539 Thu, 30 Sep 2010 23:00:00 +0100 4028539 http://www.medworm.com/index.php?rid=4028538&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710001017%2Fabstract%3Frss%3Dyes Working with a group of key stakeholders, the authors developed an episode-based resource use measure focused on the use of colonoscopy. This measure is intended to identify differences in health care resource use in a short time frame surrounding the colonoscopy. The ultimate intent in the development of this measure was to pair it with a measure of quality so that both the cost and quality of care can be evaluated together. In initial testing, the authors found the use of general anesthesia with colonoscopy to be associated with higher episode costs. Eventually, when paired with quality measures, it is hoped this measure will provide actionable information for health care payers and providers to more efficiently provide colonoscopy services without compromising quality. (Source: Gastroin... Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4028538 Thu, 30 Sep 2010 23:00:00 +0100 4028538 http://www.medworm.com/index.php?rid=4028536&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710000991%2Fabstract%3Frss%3Dyes Colorectal cancer is the second major cause of cancer-related death in the United States. The long time involved in progression of mucosal dysplasia from a small polyp to an invasive cancer and the ability to image the colon mucosa are features that make early detection and prevention of colorectal cancer by colonoscopy possible. Although colonoscopy has contributed to a marked decline in the number of colorectal cancer-related deaths, the protective effect of colonoscopy, when used in routine clinical practice, has not lived up to the expectations raised by carefully controlled prospective research studies. Therefore new systems that assess quality of colonoscopy are needed. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4028536 Thu, 30 Sep 2010 23:00:00 +0100 4028536 http://www.medworm.com/index.php?rid=4028534&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS105251571000098X%2Fabstract%3Frss%3Dyes Colonoscopy is sometimes considered the preferred colorectal cancer screening modality, yet this modality may be subject to variation in operator performance more than any other screening test. Failures of colonoscopy to consistently detect precancerous lesions threaten the effectiveness of this technique for the prevention of colorectal cancer. Studies on high-level adenoma detectors under optimal conditions have begun to establish the true efficacy of colonoscopy and further widen the gap between efficacy and effectiveness. Research is required to establish the component skills, attitudes, and behaviors for high-level mucosal inspection competence necessary for training and assessment. Interventions to bridge the gap between efficacy and effectiveness are lacking, yet they should emphasi... Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4028534 Thu, 30 Sep 2010 23:00:00 +0100 4028534 http://www.medworm.com/index.php?rid=4028533&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710000917%2Fabstract%3Frss%3Dyes This article reviews the magnitude of and risk factors for major and minor colonoscopy complications, discusses management of complications, and suggests ways to design quality improvement programs to reduce the risk of complications. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4028533 Thu, 30 Sep 2010 23:00:00 +0100 4028533 http://www.medworm.com/index.php?rid=4028531&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710001029%2Fabstract%3Frss%3Dyes Rapidly evolving knowledge of the pathogenesis and natural history of colorectal cancer (CRC), especially in high-risk groups, is allowing the development of new tools to identify those who will benefit most from preventive measures. Currently, screening for adenomas, dysplasia, and early-stage invasive cancers provides the best opportunity to prevent and improve survival from CRC. Screening of high-risk groups almost always includes colonoscopy. This review discusses what represents quality colonoscopy. Proper risk stratification, understanding the natural history of each disease, proper patient counseling, and optimal techniques all help define quality colonoscopy in high-risk groups. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4028531 Thu, 30 Sep 2010 23:00:00 +0100 4028531 http://www.medworm.com/index.php?rid=4028529&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710000875%2Fabstract%3Frss%3Dyes Colonoscopy is a well recognized diagnostic and therapeutic tool. Endoscope reprocessing must be done correctly every time; a breach of protocol leading to transmission of infection has the potential to bring endoscopy to a halt. Standards exist that guide the practitioner in all health care settings to minimize the chance of transmission of infection. Safe injection practices and reprocessing of endoscopes using high-level disinfection and sterilization methods may help avert the risk of contracting possible infections during colonoscopy procedures. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4028529 Thu, 30 Sep 2010 23:00:00 +0100 4028529 http://www.medworm.com/index.php?rid=4028528&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710000887%2Fabstract%3Frss%3Dyes This article reviews potential risk areas and legal issues in quality and colonoscopy. These include issues about open access colonoscopy, informed consent for colonoscopy, missed colorectal cancer, problems related to anticoagulation or its withdrawal for colonoscopy, procedural problems with sedation, failure to follow up appropriately, and failure to identify and warn of high genetic risk. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4028528 Thu, 30 Sep 2010 23:00:00 +0100 4028528 http://www.medworm.com/index.php?rid=4028525&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710001091%2Fabstract%3Frss%3Dyes (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4028525 Thu, 30 Sep 2010 23:00:00 +0100 4028525 http://www.medworm.com/index.php?rid=4028524&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS105251571000108X%2Fabstract%3Frss%3Dyes (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4028524 Thu, 30 Sep 2010 23:00:00 +0100 4028524 http://www.medworm.com/index.php?rid=4028523&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710001078%2Fabstract%3Frss%3Dyes (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4028523 Thu, 30 Sep 2010 23:00:00 +0100 4028523 http://www.medworm.com/index.php?rid=4028537&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710000930%2Fabstract%3Frss%3Dyes Administrative databases, registries, and clinical databases are designed for different purposes and therefore have different advantages and disadvantages in providing data for enhancing quality. Administrative databases provide the advantages of size, availability, and generalizability, but are subject to constraints inherent in the coding systems used and from data collection methods optimized for billing. Registries are designed for research and quality reporting but require significant investment from participants for secondary data collection and quality control. Electronic health records contain all of the data needed for quality research and measurement, but that data is too often locked in narrative text and unavailable for analysis. National mandates for electronic health record i... Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4028537 Wed, 01 Sep 2010 23:00:00 +0100 4028537 http://www.medworm.com/index.php?rid=4028535&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710000929%2Fabstract%3Frss%3Dyes Quality improvement of colonoscopy continues to be an important topic. This effort begins with creating detailed and accurate colonoscopy reports. Quality indicators are measurable endpoints that may be used in quality assurance and improvement plans. Key quality measures include cecal intubation rate, adenoma detection, withdrawal time, preparation quality, follow-up recommendations, and American Society of Anesthesiologists classification. Unresolved issues include establishing proper benchmarks, documenting the correlation between process measures and outcomes, aligning incentives to improved quality outcomes, and issues regarding access to quality data. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4028535 Sun, 22 Aug 2010 23:00:00 +0100 4028535 http://www.medworm.com/index.php?rid=4028532&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710000905%2Fabstract%3Frss%3Dyes Good communication between clinician and pathologist is essential for optimal patient care and management of colorectal polyps and carcinoma. General principles of communication include making sure that the pathologist and endoscopist have all the information needed to make an accurate diagnosis and that the pathologist communicates the diagnosis back to the endoscopist in a clear and timely fashion. The increasing complexity of classification of colorectal polyps and carcinomas has added to the need for clear communication pathways. The first part of this article is devoted to an outline of general communication issues; the second is a discussion of current concepts in colorectal polyps and carcinomas. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4028532 Sun, 22 Aug 2010 23:00:00 +0100 4028532 http://www.medworm.com/index.php?rid=4028530&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710000899%2Fabstract%3Frss%3Dyes This article examines recent trends in endoscopic sedation; the impact of sedation on the quality, safety, and patient tolerability of colonoscopy; and reviews the economic implications of current sedation practices. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4028530 Sun, 22 Aug 2010 23:00:00 +0100 4028530 http://www.medworm.com/index.php?rid=4028526&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710001005%2Fabstract%3Frss%3Dyes Colonoscopy for screening, surveillance, and prevention of colorectal cancer is one of the great success stories of modern gastrointestinal endoscopy. In the United States, at least in part because of widespread utilization of colonoscopy, colon cancer incidence and mortality are decreasing. Yet the mass application of colonoscopy in populations at risk has not unexpectedly focused intense scrutiny on colonoscopy practice. For most clinical gastroenterologists, colonoscopy examinations for cancer prevention are a central part of their practice. The electronic medical record and powerful computers will provide rivers of data for analysis of what they actually do and accomplish. How to achieve the highest quality in these procedures at a cost compatible with national health priorities has be... Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4028526 Sun, 22 Aug 2010 23:00:00 +0100 4028526 http://www.medworm.com/index.php?rid=4028527&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710000966%2Fabstract%3Frss%3Dyes A high-quality colonoscopy exam performed by an experienced endoscopist is safe and comfortable and offers patients a high value for their health care dollar. Colonoscopy helps provide accurate assessment of an individual’s colorectal cancer (CRC) risk, allows the endoscopist to diagnose prevalent neoplasia, and reduces risk for future CRC when physicians find and remove precancerous polyps. This nation’s infrastructure for CRC screening has grown substantially over the last decade and real gains in cancer prevention and survival have been achieved based in part on the effectiveness of colonoscopy. In 2010, colonoscopy is the most widely used CRC screening and surveillance intervention, and approximately 12 million exams are performed annually in the United States. The cost for these e... Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4028527 Wed, 11 Aug 2010 23:00:00 +0100 4028527 http://www.medworm.com/index.php?rid=3788250&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710000723%2Fabstract%3Frss%3Dyes (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3788250 Wed, 30 Jun 2010 23:00:00 +0100 3788250 http://www.medworm.com/index.php?rid=3788249&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710000425%2Fabstract%3Frss%3Dyes Molecular imaging is a rapidly growing new discipline in gastrointestinal endoscopy that involves the development of novel imaging probes and instruments to visualize the molecular expression pattern of mucosa in the digestive tract. Several platforms for imaging agents, including antibody and peptide, are being developed to target over expressed biomolecules in cancer. In addition, novel imaging instruments, including fluorescence endoscopy and confocal microscopy, are being developed to provide wide-area surveillance and microscopic examination, respectively. These methods are being applied to detect the presence of flat and depressed colonic neoplasms and to identify tumor margins. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3788249 Wed, 30 Jun 2010 23:00:00 +0100 3788249 http://www.medworm.com/index.php?rid=3788248&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710000334%2Fabstract%3Frss%3Dyes Colorectal cancer is a heterogeneous disease arising through multiple possible pathways. Elucidating the genetic factors controlling molecular phenotype, morphology, histology, and prognosis of different tumor types continues to be a challenge. Non-polypoid colorectal neoplasms provide opportunities for ongoing study of their underlying genetic abnormalities and molecular phenotypes. The varied data from different groups, however, highlight the need for further studies in different populations. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3788248 Wed, 30 Jun 2010 23:00:00 +0100 3788248 http://www.medworm.com/index.php?rid=3788247&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710000401%2Fabstract%3Frss%3Dyes This article describes the potential and limitations of CTC and computer-aided diagnosis in the detection of flat neoplasms. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3788247 Wed, 30 Jun 2010 23:00:00 +0100 3788247 http://www.medworm.com/index.php?rid=3788246&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710000413%2Fabstract%3Frss%3Dyes Until recently, 2 major forms of colorectal polyp were recognized: the adenoma and the hyperplastic polyp. Adenomas were known to represent a precursor to colorectal cancer, whereas hyperplastic polyps were viewed as nonneoplastic, having no potential for progression to malignancy. We now recognize, however, that the lesions diagnosed as hyperplastic polyps in the past represent a heterogeneous group of polyps, some of which truly are hyperplastic, and others that truly have a significant risk for transformation to colorectal cancer. These polyps have a characteristic serrated architecture, and include not only hyperplastic polyps but also the recently recognized serrated adenomas. Serrated adenomas occur in 2 forms: the traditional serrated adenoma, which is usually a polypoid lesion endo... Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3788246 Wed, 30 Jun 2010 23:00:00 +0100 3788246 http://www.medworm.com/index.php?rid=3788245&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710000619%2Fabstract%3Frss%3Dyes The incidence of colorectal cancer associated with ulcerative colitis (UC) increases with time. It is imperative to identify dysplasia-associated lesions or masses (DALM) and non-polypoid colorectal neoplasms (NP-CRN) to reduce the morbidity and mortality from colorectal cancer associated with UC. Recent findings suggest most dysplastic lesions in UC can be considered as visible under careful endoscopic observation. To find NP-CRN in UC, the careful examination of well-prepared mucosa and noting subtle differences is necessary. Magnifying chromoendoscopy, therefore, can be useful to endoscopically diagnose these subtle findings. The authors believe that targeted biopsies during chromoendoscopy will increasingly be used and replace random biopsies in the future. (Source: Gastrointestinal E... Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3788245 Wed, 30 Jun 2010 23:00:00 +0100 3788245 http://www.medworm.com/index.php?rid=3788244&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710000395%2Fabstract%3Frss%3Dyes This article explains in detail how ESD is performed and compares it with endoscopic mucosal resection. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3788244 Wed, 30 Jun 2010 23:00:00 +0100 3788244 http://www.medworm.com/index.php?rid=3788241&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS105251571000036X%2Fabstract%3Frss%3Dyes Although of lower prevalence compared with polypoid neoplasms, the non-polypoid neoplasms, especially the depressed type, are important to diagnose because they belong to a distinct biologically aggressive subset, given the high rate of intramucosal or submucosal cancers. The detection and diagnosis of the non-polypoid colorectal neoplasm presents a challenge and an opportunity. Above all, characteristic colonoscopic findings obtained by a combination of conventional colonoscopy and magnifying chromoendoscopy are useful for determination of the invasion depth of non-polypoid colorectal cancers, an essential factor in selecting a treatment modality. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3788241 Wed, 30 Jun 2010 23:00:00 +0100 3788241 http://www.medworm.com/index.php?rid=3788240&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710000607%2Fabstract%3Frss%3Dyes Colonoscopy, the most sensitive test used to detect advanced adenoma and cancer, has been shown to prevent colorectal cancer (CRC) when combined with polypectomy. CRC remains the third most commonly diagnosed cancer and the second leading cause of cancer death in men and women in the United States. Image-enhanced endoscopy (IEE) is an integral part in the detection, diagnosis, and treatment of non-polypoid colorectal neoplasms. Both the dye-based and equipment-based varieties of IEE are readily available for application in today's practice of colonoscopy. Data are available to support its use, although further studies are needed to simplify the classification of colorectal lesions by the different techniques of equipment-based IEE. (Source: Gastrointestinal Endoscopy Clinics of North Ameri... Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3788240 Wed, 30 Jun 2010 23:00:00 +0100 3788240 http://www.medworm.com/index.php?rid=3788239&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710000437%2Fabstract%3Frss%3Dyes The importance and prevalence of the superficial lesions in the colon and rectum caught worldwide public attention in 2008 when Soetikno and colleagues reported the prevalence of non-polypoid (flat and depressed) colorectal neoplasms in asymptomatic and symptomatic adults in North America and the public media disseminated their findings. The publication put to rest the question of whether or not the flat and depressed colorectal neoplasms exist in Western countries; flat and depressed colorectal neoplasms can be found throughout the world. In this article, the author highlights the importance of the macroscopic classification of the colorectal neoplasm and emphasizes the distinction between so-called flat lesions (IIa and IIb) and 0-IIc (superficial depressed) neoplastic colorectal lesions... Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3788239 Wed, 30 Jun 2010 23:00:00 +0100 3788239 http://www.medworm.com/index.php?rid=3788238&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710000358%2Fabstract%3Frss%3Dyes We describe a summary of the path to develop expertise in detection and management of NP-CRNs, based on experience at our academic GI unit. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3788238 Wed, 30 Jun 2010 23:00:00 +0100 3788238 http://www.medworm.com/index.php?rid=3788237&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710000346%2Fabstract%3Frss%3Dyes This article discusses the methods that are useful to improve the quality of bowel preparation and examination technique. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3788237 Wed, 30 Jun 2010 23:00:00 +0100 3788237 http://www.medworm.com/index.php?rid=3788236&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710000322%2Fabstract%3Frss%3Dyes This article will summarize the available data to gain some estimates of the natural history of NP-CRN. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3788236 Wed, 30 Jun 2010 23:00:00 +0100 3788236 http://www.medworm.com/index.php?rid=3788235&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710000310%2Fabstract%3Frss%3Dyes Flat adenomas are found commonly at colonoscopy throughout the world. Similarly, small, flat submucosally invasive cancers have been described worldwide but are relatively rare, accounting for 5% to 10% of all cancers detected at colonoscopy. Although there appears to be no difference in frequency of non-polypoid colorectal neoplasms between East and West, considerable variation has been reported by individual studies, probably because of lack of consistency when defining a flat lesion. Flat elevated lesions are the most common type of flat lesion and do not appear to have a greatly increased risk of harboring invasive malignancy; however, flat lesions with depression have a significant risk of malignancy and are probably the precursor lesions for most small, flat, or ulcerating cancers. (... Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3788235 Wed, 30 Jun 2010 23:00:00 +0100 3788235 http://www.medworm.com/index.php?rid=3788234&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710000309%2Fabstract%3Frss%3Dyes Colonoscopy is a dominant modality for colorectal cancer prevention in average-risk patients aged 50 years and older. Non-polypoid colorectal neoplasms (NP-CRNs) are likely a significant contributing factor to interval colorectal cancers because they have a higher prevalence in Western populations than previously thought, are more difficult to detect visually with conventional colonoscopy, and are more likely to contain advanced histology than polypoid neoplasms, regardless of size. The accurate identification and complete removal of NP-CRNs is thus an integral part of high-quality colonoscopy, and a critical component of the ongoing efforts to make colorectal cancer screening programs widely available, effective, and accepted by patients. In this article, the authors examine the quality i... Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3788234 Wed, 30 Jun 2010 23:00:00 +0100 3788234 http://www.medworm.com/index.php?rid=3788233&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710000632%2Fabstract%3Frss%3Dyes “Here's to the crazy ones. The misfits. The rebels. The troublemakers. The round pegs in the square holes. The ones who see things differently. They're not fond of rules. And they have no respect for the status quo. You can quote them, disagree with them, glorify or vilify them. About the only thing you can't do is ignore them. Because they change things. They push the human race forward. And while some may see them as the crazy ones, we see genius. Because the people who are crazy enough to think they can change the world, are the ones who do.”Authored by Steve Jobs - according to Apple folklore. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3788233 Wed, 30 Jun 2010 23:00:00 +0100 3788233 http://www.medworm.com/index.php?rid=3788232&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710000644%2Fabstract%3Frss%3Dyes Every once in a while the publication of a single clinical research article can have a tremendously powerful effect by shining a bright light on a shadowed area. The article can provoke widespread discussion and reassessment of clinical practice, and can be a key factor in galvanizing changes leading to improved outcomes. Such an article was published in the Journal of the American Medical Association on March 5, 2008, and the lead author was Dr Roy M. Soetikno, the Guest Editor for this issue of the Gastrointestinal Endoscopy Clinics of North America dedicated to “non-polypoid colorectal neoplasms.” It demonstrated in 1819 patients evaluated in the Veterans Affairs Palo Alto (California) Health Care System, in the year July 2003 to June 2004, that nonpolypoid neoplasms in the colon we... Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3788232 Wed, 30 Jun 2010 23:00:00 +0100 3788232 http://www.medworm.com/index.php?rid=3788231&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710000711%2Fabstract%3Frss%3Dyes (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3788231 Wed, 30 Jun 2010 23:00:00 +0100 3788231 http://www.medworm.com/index.php?rid=3788230&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS105251571000070X%2Fabstract%3Frss%3Dyes (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3788230 Wed, 30 Jun 2010 23:00:00 +0100 3788230 http://www.medworm.com/index.php?rid=3788229&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710000693%2Fabstract%3Frss%3Dyes (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3788229 Wed, 30 Jun 2010 23:00:00 +0100 3788229 http://www.medworm.com/index.php?rid=3788242&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710000371%2Fabstract%3Frss%3Dyes This article describes the submucosal injection technique applied in the endoscopic resection of non-polypoid colorectal neoplasms, with an emphasis on a particular technique, the dynamic submucosal injection technique. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3788242 Wed, 09 Jun 2010 23:00:00 +0100 3788242 http://www.medworm.com/index.php?rid=3788243&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710000383%2Fabstract%3Frss%3Dyes Endoscopic mucosal resection (EMR) is preferred to standard polypectomy for the resection of non-polypoid lesions because these lesions can be technically difficult to capture with a snare; furthermore, without submucosal injection the underlying muscularis propria may be excessively coagulated or even inadvertently resected. Because the resection plane of EMR is in the middle or deeper part of the submucosa, EMR allows the precise depth of the lesion to be evaluated. Although the majority of non-polypoid lesions are adenomatous, non-polypoid colorectal neoplasm has a high association with advanced pathology, irrespective of size. Using EMR, a complete pathologic specimen is obtained, the risk of lymph node metastasis can be accurately assessed based on the depth of invasion, and patients ... Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3788243 Sun, 06 Jun 2010 23:00:00 +0100 3788243 http://www.medworm.com/index.php?rid=3544246&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710000267%2Fabstract%3Frss%3Dyes (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3544246 Wed, 31 Mar 2010 23:00:00 +0100 3544246 http://www.medworm.com/index.php?rid=3544245&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710000176%2Fabstract%3Frss%3Dyes This article describes the steps involved in establishing a screening computed tomographic colonography (CTC) practice and integrating that practice within a gastroenterology practice. The standard operating procedures followed at the National Naval Medical Center's Colon Health Initiative are presented and are followed by a discussion of practical aspects of establishing a CTC practice, such as equipment specifications, CTC performance, and interpretation training requirements for radiologists and nonradiologists. Regulatory considerations involved in establishing a screening CTC program are examined along with the salient features of a CTC business plan. Finally, reimbursement issues, quality control, and the potential impact of screening CTC on colonoscopy practice are discussed. (Sourc... Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3544245 Wed, 31 Mar 2010 23:00:00 +0100 3544245 http://www.medworm.com/index.php?rid=3544244&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710000097%2Fabstract%3Frss%3Dyes This article describes the potential role of CTC within the framework of colorectal cancer screening. Current screening recommendations and traditional screening tests are reviewed, followed by a summary of recent study results on the use of CTC as a screening tool. Several factors that are affecting the acceptance and adoption of CTC are outlined. Although CTC is valuable and holds considerable promise as a way to increase the use of CRC screening, these issues need to be addressed before CTC becomes more widely disseminated as a screening modality. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3544244 Wed, 31 Mar 2010 23:00:00 +0100 3544244 http://www.medworm.com/index.php?rid=3544243&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710000188%2Fabstract%3Frss%3Dyes This article examines the techniques and clinical applications of CTE in comparison with CT enteroclysis, focusing on Crohn disease, obscure GI bleeding, GI tumors, acute abdominal pain, and bowel obstruction. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3544243 Wed, 31 Mar 2010 23:00:00 +0100 3544243 http://www.medworm.com/index.php?rid=3544242&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710000115%2Fabstract%3Frss%3Dyes The bowel is a common site for pathologic processes, including malignancies and inflammatory disease. Colorectal cancer accounts for 10% of all new cancers and 9% of cancer deaths. A significant decrease in the incidence of colorectal cancer and cancer death rates has been attributed to screening measures, earlier detection, and improved therapies. Virtual colonoscopy (VC), also known as computed tomography colonography, is an effective method for detecting polyps. However, in light of increasing concerns about ionizing radiation exposure from medical imaging and potential increased risk of future radiation-induced malignancies, magnetic resonance imaging (MRI) is seen as an increasingly attractive alternative. Improvements in MRI technology now permit three-dimensional volumetric imaging ... Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3544242 Wed, 31 Mar 2010 23:00:00 +0100 3544242 http://www.medworm.com/index.php?rid=3544241&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710000140%2Fabstract%3Frss%3Dyes Computed tomographic colonography (CTC) is a validated tool for the evaluation of the colon for polyps and cancer. The technique employed for CTC includes a low-dose CT scan of the abdomen and pelvis that is typically performed without the administration of intravenous contrast. Using this technique it is possible to discover findings outside of the colon. By far, most extracolonic findings are determined to be clinically inconsequential on CTC and most patients are not recommended for further testing. However, some findings may result in additional diagnostic evaluation or intervention, which can lead to patient anxiety and increased morbidity and health care costs. Alternatively, some findings can lead to the earlier diagnosis of a clinically significant lesion, which could result in dec... Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3544241 Wed, 31 Mar 2010 23:00:00 +0100 3544241 http://www.medworm.com/index.php?rid=3544240&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710000024%2Fabstract%3Frss%3Dyes Colon screening examinations have been shown to discover neoplastic lesions at an early stage. Even the most careful studies by colonoscopy and by computed tomographic colonography (CTC) can overlook tumors with a diameter greater than 5 mm. Advances in technology have continually improved the ability to find polyps, which will lead to a real decrease in colorectal cancer incidence. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3544240 Wed, 31 Mar 2010 23:00:00 +0100 3544240 http://www.medworm.com/index.php?rid=3544239&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710000048%2Fabstract%3Frss%3Dyes Computed tomographic colonography (CTC) has emerged as an alternative screening tool for colorectal cancer due to the potential to provide good efficacy combined with greater acceptability than optical colonoscopy or fecal occult blood testing. However, some organizations have raised concerns about the potential harms, including perforation rates and radiation-related cancer risks, and have not recommended that it currently be used as a screening tool in the general population in the US. In this article the authors review the current evidence for these potential harms from CTC and compare them to the potential harms from the alternatives including colonoscopy and double-contrast barium enema. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3544239 Wed, 31 Mar 2010 23:00:00 +0100 3544239 http://www.medworm.com/index.php?rid=3544238&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710000073%2Fabstract%3Frss%3Dyes Screening for colorectal neoplasms has become the standard of care in advanced medical settings worldwide. Identifying asymptomatic colorectal neoplastic lesions has been shown to reduce colorectal cancer incidence and the overall cost of medical care. Clinicians have several alternatives at their disposal as they consider screening for their respective patient population. Two important methods to consider are optical colonoscopy and computed tomographic colonography (CTC). The purpose of this article is to make the case that gastroenterologists should read CTC. Central to the argument that gastroenterologists read CTC is the benefit of experience with video-assisted colonic imaging and the physician-patient relationship. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3544238 Wed, 31 Mar 2010 23:00:00 +0100 3544238 http://www.medworm.com/index.php?rid=3544237&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710000061%2Fabstract%3Frss%3Dyes This article defines the necessary skill set and knowledge base required for accurate computed tomography colonography (CTC) interpretation. The components of the interpretative process as well as the various strategies currently employed are discussed. The role of extracolonic evaluation as an integral part of this examination is also covered. Within this context, the question of whether a radiologist or gastroenterologist is better suited to interpret this examination is explored. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3544237 Wed, 31 Mar 2010 23:00:00 +0100 3544237 http://www.medworm.com/index.php?rid=3544236&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS105251571000005X%2Fabstract%3Frss%3Dyes Computer-aided polyp detection aims to improve the accuracy of the colonography interpretation. The computer searches the colonic wall to look for polyplike protrusions and presents a list of suspicious areas to a physician for further analysis. Computer-aided polyp detection has developed rapidly in the past decade in the laboratory setting and has sensitivities comparable with those of experts. Computer-aided polyp detection tends to help inexperienced readers more than experienced ones and may also lead to small reductions in specificity. In its currently proposed use as an adjunct to standard image interpretation, computer-aided polyp detection serves as a spellchecker rather than an efficiency enhancer. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3544236 Wed, 31 Mar 2010 23:00:00 +0100 3544236 http://www.medworm.com/index.php?rid=3544235&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710000139%2Fabstract%3Frss%3Dyes New diagnostic technologies can visualize colon polyps, but not remove them. There is clear consensus that polyps 10 mm or larger need to be removed. There is still controversy surrounding the appropriate reporting and management of small 1 to 5 mm and 6 to 9 mm polyps. The author recommends that patients whose largest polyp is 6 mm or larger should be offered colonoscopy. If the largest polyp is less than 6 mm in size, and imaged with high reliability, the author recommends reporting the finding, and individualizing the decision to pursue colonoscopy versus repeat imaging. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3544235 Wed, 31 Mar 2010 23:00:00 +0100 3544235 http://www.medworm.com/index.php?rid=3544234&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710000036%2Fabstract%3Frss%3Dyes Colorectal polyps less than 6 mm in size pose a negligible risk to the development of colorectal carcinoma. The sensitivity and specificity for detection of diminutive lesions on all available examinations including CT colonography (CTC) and optical colonoscopy (OC) is relatively low. In the context of regular screening, the low clinical significance and slow to negligible growth of diminutive polyps, as well as the low detection performance of CTC and OC for these lesions, would contribute to wasted health care resource and excess morbidity if each diminutive polyp were referred for potential resection. Respect for patient safety, attention to proper use of resources, and appropriate focus on larger, clinically significant polyps lead the authors to the conclusion that colonic polyps of l... Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3544234 Wed, 31 Mar 2010 23:00:00 +0100 3544234 http://www.medworm.com/index.php?rid=3544233&cid=s_33226_17_f&fid=33226&url=http%3A%2F%2Fwww.giendo.theclinics.com%2Farticle%2FPIIS1052515710000127%2Fabstract%3Frss%3Dyes This article addresses these controversial and often misunderstood issues. (Source: Gastrointestinal Endoscopy Clinics of North America) Gastrointestinal Endoscopy Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3544233 Wed, 31 Mar 2010 23:00:00 +0100 3544233