Faculty Bibliography

Introduction: The prevention of colorectal cancer (CRC) by colonoscopy is attributed to the identification and removal of adenomas. A significant number of adenomas are missed during Standard Colonoscopy (SC), e.g., due to polyps hidden behind colon folds and flexures. The newly developed G-EYETM Endoscope (SMART Medical Systems Ltd, Ra'anana, Israel) combines a forward viewing endoscope with an integral, reusable balloon at its bending section. During withdrawal of the G-EYETM Endoscope, the balloon is partially inflated, allowing for the flattening of colon folds, centralization of the optical image, and reduction in bowel slippage, thus providing enhanced visualization of the colon and increased detection of polyps and adenomas. Aims & Methods: The aim of this study is to compare the adenoma detection rate (ADR) of G-EYETM high definition (HD) colonoscopy with that of standard HD colonoscopy. From May 2014 to April 2015, patients (age450) referred to colonoscopy for screening, surveillance, following positive fecal occult blood test (FOBT), or due to change of bowel habits, were randomized to either SC group or G-EYETM group. The G-EYETM Endoscope was based on the same instrument as the conventional HD-colonoscope. Results: 360 subjects were enrolled to the study, of which 177 subjects were randomized to the SC group and 183 subjects were randomized to the GEYE TM group. The ADR, adenoma per patient, number of advanced adenomas and large-size adenomas for each group are presented in Table 1. Compared with conventional colonoscopy, G-EYETM colonoscopy increased ADR by 58%. Special attention should be given to 55% and 56% increase in number of advanced adenomas and large-size adenomas, respectively. Procedural times were similar between the two groups. Conclusion: Our study has shown that the G-EYETM endoscope has a substantially higher ADR, compared to SC, which is considered to be one of the indicators for quality in colonoscopy. Moreover, the G-EYETM endoscope is able to detect not only small and diminutive adenomas but also a larger number of advanced and large size adenomas. It is therefore concluded that the GEYETM has the potential to reduce colonoscopic miss rates and reduce interval cancer incidents. (Table Presented)

BACKGROUND: Medical management of patients with continuous-flow left ventricular assist devices (LVADs) remains challenging for the gastroenterologist given their high risk of gastrointestinal bleeding (GIB) and need for continuous anticoagulation. AIMS: Our aim was to better characterize LVAD patients who presented with a GIB at our facility and delineate the prevalence, presentation, time to diagnosis, management, and therapeutic endoscopic interventions, including small bowel tools that may offer additional benefit. METHODS: We retrospectively reviewed adult patients (>18 years) who underwent LVAD implantation at our tertiary care facility between October 2011 and October 2013. Electronic medical records were reviewed for presenting symptoms, average days to initial and repeat GIB, hospital course, and techniques that led to diagnosis and hemostasis. RESULTS: Eighteen patients underwent LVAD implantation, of which 61 % presented with a GIB for a total of 20 presentations (1.8 per patient). Mean time to initial GIB was 154 days. Patients required an average of 1.8 endoscopic procedures per admission. Esophagogastroduodenoscopy (EGD) and push enteroscopy (PE) were more likely to lead to a diagnosis, and EGD was the most commonly used diagnostic tool at initial presentation. Sixty percent of patients who initially received EGD presented with a recurrent GIB and required PE, which was diagnostic and therapeutic for small bowel angiodysplasias in 80 % of cases. CONCLUSION: We found a higher GIB rate compared with prior studies. Bleeding events were associated with multiple procedures and interventions. We recommend an algorithmic approach to LVAD patients who bleed. Our experience suggests that PE is warranted at initial presentation in order to achieve hemostasis, prevent recurrent GIB, and decrease subsequent readmission rates.

BACKGROUND AND STUDY AIMS: Although colonoscopy is the "gold standard" for colorectal cancer screening, a significant number of adenomas are still missed during standard colonoscopy, often because they are hidden behind colonic folds and flexures. The aim of this study was to assess the ability of a novel balloon colonoscope (G-EYE endoscope; Smart Medical Systems, Ra'anana, Israel) to increase adenoma detection and reduce the miss rate compared with standard colonoscopy. PATIENTS AND METHODS: This was a multicenter, randomized, prospective, controlled study in patients (age >/= 40 years) undergoing colonoscopy for screening or diagnostic work-up (including surveillance). Patients underwent same-day, back-to-back tandem colonoscopy. Patients in Group A underwent standard colonoscopy followed by balloon colonoscopy, and patients in Group B underwent balloon colonoscopy followed by the standard technique. The adenoma detection and miss rates were compared between the two colonoscopy procedures. RESULTS: A total of 126 patients were enrolled and randomized into Group A (n = 60) or Group B (n = 66). The adenoma miss rate of balloon colonoscopy was significantly lower than that of standard colonoscopy (7.5 % vs. 44.7 %; P = 0.0002). The detection of additional adenomas by balloon colonoscopy was significant (81.0 %; P = 0.0002), in particular, the relative amount of adenomas detected in the ascending colon by balloon colonoscopy was 41 % versus 14 % for standard colonoscopy. CONCLUSIONS: A novel balloon colonoscopy technique detected significantly more adenomas than standard colonoscopy, and missed fewer adenomas. Balloon colonoscopy has the potential to increase the effectiveness of colorectal cancer screening and surveillance colonoscopy.

BACKGROUND: Although standard colonoscopy is considered the optimal test to detect adenomas, it can have a significant adenoma miss rate. A major contributing factor to high miss rates is the inability to visualize adenomas behind haustral folds and at anatomic flexures. OBJECTIVE: To compare the diagnostic yield of balloon-assisted colonoscopy versus standard colonoscopy in the detection of simulated polyps in a colon model. DESIGN: Prospective, cohort study. SETTING: International gastroenterology meeting. SUBJECT: A colon model composed of elastic material, which mimics the flexible structure of haustral folds, allowing for dynamic responses to balloon inflation, with embedded simulated colon polyps (n = 12 silicone "polyps"). INTERVENTIONS: Fifty gastroenterologists were recruited to identify simulated colon polyps in a colon model, first using standard colonoscopy immediately followed by balloon-assisted colonoscopy. MAIN OUTCOME MEASUREMENTS: Detection of simulated polyps. RESULTS: The median polyp detection rate for all simulated polyps was significantly higher with balloon-assisted as compared with standard colonoscopy (91.7% vs 45.8%, respectively; P < .0001). The significantly higher simulated polyp detection rate with balloon-assisted versus standard colonoscopy was notable both for non-obscured polyps (100.0% vs 75.0%; P < .0001) and obscured polyps (88.0% vs 25.0%; P < .0001). LIMITATIONS: Non-randomized design, use of a colon model, and simulated colon polyps. CONCLUSION: As compared with standard colonoscopy, balloon-assisted colonoscopy detected significantly more obscured and non-obscured simulated polyps in a colon model. Clinical studies in human participants are being pursued to further evaluate this new colonoscopic technology.