November 2013 Vol XXXVII Issue 11

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Frontiers in Endoscopy, Series #7

Fully Covered Metal Biliary Stents: Current And Future Uses

Thiruvengadam Muniraj, Priya A. Jamidar

The development of self-expanding metal stents (SEMS) represents a major advance in the treatment of obstructive biliary disease, providing an increased luminal diameter and patency. The recent introduction of fully covered self-expanding metal stents (FCSEMS) has helped overcome some of the limitations of metallic biliary stenting. Randomized clinical trials using FCSEMS have shown a reduction in stent ingrowth and an increased ability to remove stents as compared with uncovered metal stents. In this article, we summarize recent developments in the design and applications of FCSEMS, and compare findings of recent clinical studies.

Inflammatory Bowel Disease: A Practical Approach, Series #85

The Genetics of Inflammatory Bowel Disease: What Have We Learned and How Can We Use it in Our Clinical Practice?

Oriana M. Damas, Maria T. Abreu, Jacob L. McCauley

It is believed that Inflammatory Bowel Disease (IBD) occurs as a combination of environmental exposures and alterations in the intestinal microbiome that, in genetically susceptible individuals, leads to dysregulated aberrant immune activation. Genome-wide association studies have become commonplace in the last decade and have in turn elucidated many new IBD risk loci facilitating our understanding of relevant biological pathways. Here we discuss the importance of a better understanding of disease etiology, inherited mutations, and aberrant pathways, which will help to develop reliable biomarkers that are useful in identifying patients at risk for more aggressive disease in earlier stages, and may also serve to direct a more personalized and effective treatment regimen.

Nutrition Issues in Gastroenterology, Series #123

Food Allergies: Dietary Management


Food allergies are a serious public health concern now estimated to affect more than 12 million Americans. Allergen elimination diets can significantly affect quality of life and are not without nutritional risk. Patients must learn how to identify their allergen(s) in our vast food supply and meet their nutritional needs within the context of the elimination diet. The purpose of this article is to prepare practitioners to provide expert guidance to patients and their families to decrease risk of allergen exposure and to ensure nutritional adequacy of the elimination diet.

A Case Report

Superior Mesenteric Artery Syndrome Diagnosed by Small Bowel Push Enteroscopy

Tilak Shah, Alison Jazwinski, Saurabh Gupta

A Case Report

Alagille Syndrome and Colonic Polyposis: A True Connection?

Suneal Agarwal, Leon Kundrotas, Swapna Gupta

Unusual Causes of Abdominal Pain

Introduction To A New Series: Unusual Causes of Abdominal Pain


Departments Section

From the Literature

Patients Identified at Lower Risk for Adenocarcinoma on a Histologic Basis

To evaluate whether persistence of nondysplastic Barrett’s esophagus (NDBE) over multiple consecutive surveillance endoscopic evaluations could be used in risk stratification of patients with Barrett’s esophagus (BE), a multi-center outcomes study of a large cohort of patients with BE was carried out. Based on the number of consecutive surveillance endoscopies showing NDBE, five groups of patients were identified. Group One was found to have NDBE at their first EGD. Patients in Group Two were found to have NDBE on their first two consecutive EGDs. Patients in Groups Three, Four, and Five were found to have NDBE on three, four, and five consecutive surveillance EGDs.

Endoscopic Versus Surgical Treatment for Pancreatic Pseudocysts

Surgery is the standard technique for drainage of pancreatic pseudocysts. A single-center, open-label, randomized trial to compare endoscopic and surgical cystogastrostomy for pancreatic pseudocyst drainage was carried out with 20 patients treated endoscopically and 20 patients treated surgically. The primary endpoint was pseudocyst recurrence after a 24-month follow up period.

Bloating and Distention and Irritable Bowel Syndrome

Bloating and distention are often attributed to dietary factors by patients with irritable bowel syndrome (IBS). To examine the effects of gas production and visceral hypersensitivity on digestive symptoms after lactose ingestion in a population with lactose deficiency, 277 IBS patients and 64 healthy controls (HCs), underwent a 20-gram lactose hydrogen breath test (LHBT) with evaluation of hydrogen gas production and lactose intolerance (LI) symptoms. Abdominal distention was measured during LHBT. Rectal sensitivity was assessed by barostat studies.

Postgastrectomy Endoscopic Submucosal Dissection for Early Gastric Cancer

This technically difficult procedure because of limited working space in a remnant stomach post gastrectomy was evaluated, including results and long-term outcomes to determine the feasibility and effectiveness of this procedure utilizing retrospective information. The procedure is difficult because of the presence of severe gastric fibrosis and staples under the suture line. This was carried out at the National Cancer Center Hospital in Tokyo, Japan from 1997 to 2011.

Diagnosing Pancreatic Carcinoma without CT Evidence of Mass

Diagnosis of pancreatic neoplasm is difficult in patients with inconclusive findings on CT scan and other imaging. To determine the diagnostic accuracy and to determine predictors of pancreatic neoplasm by EUS with FNA in this setting, a retrospective chart review was carried out between January 2002 to December 2010 at a tertiary referral center of 1046 patients who underwent pancreatic EUS. A total of 116 patients were selected because their clinical presentation was suspicious for pancreatic malignancy, but multidetector row CT (MDCT) findings were inconclusive.

Narrow Band Imaging Predicting Histology of Distal Diminutive Polyps

To assess whether NBI is able to predict colonoscopic surveillance intervals and histology of distal diminutive polyps according to the ASGE criteria, a prospective, multicenter study at five endoscopy centers was carried out on consecutive patients undergoing colonoscopy. The endoscopists involved were required to pass a before-study, qualifying examination and histology of polyps that were less than 10 mm were predicted at NBI and assigned a designation of high or low confidence.

Treatment of Diabetic and Idiopathic Gastroparesis

The relationship between symptom improvement (SI) and acceleration of gastric emptying (GE) for different drugs used in the treatment of idiopathic and diabetic gastroparesis is uncertain. The study-specific correlations between SI and GE were examined and a meta-regression analysis of the association of across multiple studies was performed. Medline database from 1946 to present was searched and only control trials or trials with an established effector comparator that completed both SI and GE were included.

Medical Bulletin Board


Over 320 US Gastroenterologists Have Now Used New Looping Solution
DURHAM, NC – Despite numerous technological advances over recent decades, looping of the colon remains an all-too-frequent complication of colonoscopy. ColoWrap aims to change that. At the American College of Gastroenterology conference, held Oct. 11-16, 2013, in San Diego, the Company launched its new ColoWrap Colonoscopy Binder. And as of November 11, ColoWraps have reached the hands of over 320 US gastroenterologists.

Study Shows WATS3D Biopsy Increases Detection of Pre-Cancer in the Esophagus by 50% in Post-Ablation Patients

Data Underscores Value of Using WATS3D as a Surveillance Tool for Residual or Recurrent Pre-Cancer
SAN DIEGO, CA - CDx Diagnostics announced today that a new study adds to the growing body of evidence supporting the use of Wide Area Transepithelial Sampling with 3-Dimensional analysis (WATS3D) as a surveillance tool in patients who have received ablation therapy for Barrett’s esophagus.

BroadcastMed Network Expands Digital Library Featuring Leading Physicians and Medical Centers

FARMINGTON, CT - BroadcastMed, Inc. announced expansion of the BroadcastMed Network’s extensive digital library. The library offers open access to medical procedures and advances from world- renowned physicians and healthcare organizations. The BroadcastMed Network receives more than 2 million visits annually and since the October 1 launch of its specialty-specific syndication channels, traffic has increased 48%.