Faculty Bibliography

AIM: To ascertain fine needle aspiration (FNA) techniques by endosonographers with varying levels of experience and environments. METHODS: A survey study was performed on United States based endosonographers. The subjects completed an anonymous online electronic survey. The main outcome measurements were differences in needle choice, FNA technique, and clinical decision making among endosonographers and how this relates to years in practice, volume of EUS-FNA procedures, and practice environment. RESULTS: A total of 210 (30.8%) endosonographers completed the survey. Just over half (51.4%) identified themselves as academic/university-based practitioners. The vast majority of respondents (77.1%) identified themselves as high-volume endoscopic ultrasound (EUS) (> 150 EUS/year) and high-volume FNA (> 75 FNA/year) performers (73.3). If final cytology is non-diagnostic, high-volume EUS physicians were more likely than low volume physicians to repeat FNA with a core needle (60.5% vs 31.2%; P = 0.0004), and low volume physicians were more likely to refer patients for either surgical or percutaneous biopsy, (33.4% vs 4.9%, P < 0.0001). Academic physicians were more likely to repeat FNA with a core needle (66.7%) compared to community physicians (40.2%, P < 0.001). CONCLUSION: There is significant variation in EUS-FNA practices among United States endosonographers. Differences appear to be related to EUS volume and practice environment.

Objectives: Colonoscopy is the gold standard for colon cancer screening, by detecting and removing adenomatous polyps. However, polyps can be missed in the proximal mucosal folds with traditional forward viewing colonoscopy. The ARC EndoCuff is a disposable attachment placed on the tip of the colonoscope. With soft, hair-like projections, the EndoCuff (Image 1.) helps to flatten colon mucosal folds during scope withdrawal allowing for increased mucosal inspection. A new technique often has to allow for proficiency and the aim of our study is to assess the learning curve for EndoCuff by comparing adenoma detection rate (ADR) with successive weeks of operator experience. Methods: We retrospectively analyzed patients who underwent colonoscopy with Endocuff for any indication at an outpatient urban practice over a 3-week period. ADR was calculated for each week and weeks 2 and 3 were compared to week 1, which served as our control. Total number of EndoCuff procedures in week 1 were divided by total number of operators to determine the average procedures needed to overcome the learning curve. Colonoscopy reports were retrospectively reviewed and paired t-tests were performed to assess for significance between ADR for each week. Results: A total of 58 patients underwent EndoCuff during the 3-week period. A total of 15, 21, and 22 patients had procedure performed in weeks 1,2, and 3, respectively (Table 1.). A total of 4 operators participated in week 1 and number of procedures ranged from 2 to 5 with a mean of 3.75. ADR for week 1 was 20% which increased to 54.5% in week 2 (p=0.03) and reached its peak at 63.6% in week 3 (p=0.004). Given the significant improvement in week 2 compared to week 1, learning curve was approximated to be 4 procedures based on a total of 15 procedures performed in week 1 divided amongst four operators. Conclusions: Our results suggest that a learning curve does exists for EndoCuff and that ADR significantly increases with operator experience after 4 procedures. Overall, End!

Objectives: Colonoscopy is the gold standard for colon cancer screening and prevention. Several new technologies have recently emerged in order to better assist gastroenterologists in their evaluation of the colonic mucosa to find and remove polyps during screening and surveillance colonoscopies. The ARC EndoCuff is a disposable plastic device with soft, hair-like projections that is placed at the tip of the colonoscope prior to the procedure (Image 1.). The device helps to stabilize the tip of the colonoscope and assists in flattening the folds of the colonic mucosa in order to better evaluate proximal colonic folds. We performed a retrospective chart review of patients who underwent screening and surveillance colonoscopy with and without EndoCuff. The aim of our study was to assess whether EndoCuff was more effective at detecting polyps and adenomas. Methods: Patients were retrospectively analyzed at a tertiary care medical center, urban and suburban outpatient practices from September 2013 thru November 2013. Only screening and surveillance colonoscopies were included. Based on previous learning curve results, the first 4 EndoCuff procedures for each operator were excluded. A comparison group was matched to Endocuff cases based on indication. Colonoscopy reports were retrospectively reviewed to obtain demographic information, total polyps and adenomas removed. This was used to calculate overall ADR and ADR by colon location (right vs. left). Paired t-tests were performed to assess for significance between EndoCuff and comparison group with respect to total polyps and adenomas removed and ADR. Results: 165 patients received EndoCuff and 153 patients underwent standard colonoscopy. Average polyps detected per patient in the EndoCuff group was 1.31 vs. 0.82 in standard colonoscopy (p=<0.001). Similar results were also observed in average adenoma per patient 0.8 vs 0.38 (p=<0.001). The ADR was highest amongst patients who underwent EndoCuff compared to standard colonoscopy (46.6% vs. 30.0%, p=0.!

Purpose: Racial disparities in the presentation of colorectal cancer (CRC) have been well documented. African Americans (AA) have a higher incidence of CRC, are diagnosed at a later stage, and have a decreased survival when compared to Caucasians. One suggested reason for these differences is decreased utilization of the diagnostic modalities currently available. Computed Tomographic Colonography (CTC) has been suggested as a potential non-invasive tool for CRC screening. To date no studies have examined the utility of CTC in average risk CRC screening in AA patients. We aimed to examine the utility of CTC for average risk CRC screening in AA patients as well as rates of follow-up colonoscopy, After an abnormal exam. Methods: Data from 229 consecutive AA patients presenting from February 2007 until August 2012 for average risk CRC screening with CTC at a large city hospital, in Brooklyn, NY, was collected in a prospective study design. The data was analyzed for reason for referral, polyp detection rate (PDR), follow-up colonoscopy, and pathology. In addition to the overall PDR, particular rates for segments of the colon not previously visualized during prior incomplete colonoscopies were calculated to account for possible decreased PDR due to prior polypectomies. Results: The most common reason for referral for CTC was incomplete colonoscopy. The overall PDR for all patients was 8.7%. However, the verified adenoma detection rate, determined by subsequent colonoscopy with biopsy or polypectomy was much lower at 2.2%, as many of the patients failed to follow up with further workup (45% of those with polyps), or follow-up endoscopy failed to detect adenomas (30%). Median time to follow-up colonoscopy was 188 days. By segment of previously unvisualized colon, there were 169 segments of ascending colon/cecum in which 5 polyps (3.0%) were noted, 115 segments of transverse colon in which no polyps were noted, 89 segments of descending colon in which 1 polyp (1.1%) was noted, 74 segments of sigmoid col!

OBJECTIVES: The Gastroenterology (GI) Core Curriculum is a culmination of efforts from the American Association for the Study of Liver Diseases, the American College of Gastroenterology, the American Gastroenterological Association, and the American Society for Gastrointestinal Endoscopy to develop a review of knowledge and skills for those training in a gastrointestinal subspecialty. Fellows are expected to conduct scholarly activity, attend seminars, and read textbooks and syllabus materials. While efforts to standardize education across the nation are welcomed, we sought to ascertain the learning preferences of GI fellows and attending physicians. METHODS: A national online survey was e-mailed to directors of US adult GI programs, who were also asked to invite their colleagues and fellows to participate. RESULTS: While majorities of both fellows and attendings affirmed regular attendance at national conferences, more attendings affirmed that their knowledge was improved by their participation. Asked how they acquire knowledge best, 45 fellows and 67 attendings responded; 42% of attendings favored journal articles, and 40% of fellows favored conferences. More attendings than fellows felt that writing a manuscript and belonging to a GI society improved knowledge. CONCLUSIONS: We believe the Gastroenterology Core Curriculum provides trainees with essential tools for becoming an autonomous gastroenterologist who can appreciate various learning modalities.

BACKGROUND: Stress ulcer prophylaxis (SUP) has been increasingly prescribed for patients admitted to medical wards. The knowledge, attitudes, and practices of those in the healthcare profession regarding use of SUP in medical wards are understudied. METHODS: A survey consisting of closed-ended questions and multiple-choice queries was handed out during grand rounds. RESULTS: One hundred people (39 attending physicians, 61 residents) completed the survey. More attending physicians (41 vs. 30 %) believed SUP was indicated for patients treated in a non-intensive-care medical ward (P = 0.2357). All residents preferred a proton-pump inhibitor (PPI) for SUP compared with 85 % of attending physicians (P < 0.05). Despite equal agreement that PPIs were not harmless, more attending physicians than residents agreed that using PPIs increased the risk of community-acquired pneumonia (P < 0.05). More residents than attending physicians agreed on the use of SUP for patients suffering from major burns and for those with liver failure. In situations of respiratory distress not requiring intubation and in cases of steroid treatment for a chronic obstructive pulmonary disease flare, more attending physicians than residents felt SUP was required. Approaching a statistically significant difference, more attending physicians than residents felt that being too busy to question SUP indication and the perception of PPIs as harmless affected decision making. CONCLUSION: Despite the publication of guidelines, misuse of gastric acid suppressants continues to occur, even by attending physicians. More complete understanding of the need and occasion for SUP use should result in more cautious use.