Faculty Bibliography

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.!

BACKGROUND: Inconsistencies in adherence to evidence-based medicine practice guidelines and quality indicators for inflammatory bowel disease (IBD) have been a recognized limitation in the quality of care afforded to IBD patients. We designed an Objective Structured Clinical Examination (OSCE) to assess many of the core competencies and to provide GI fellows with a simulated, case-based learning experience in the management of IBD patients. To supplement this experience, we provided GI fellows with an easily accessible educational resource in the form of a pocket-sized guide to highlight key evidence-based concepts in IBD education stressed in the OSCE. We assessed the utility of the NYU Gastroenterology Fellowship Training Program Pocket Guide's usefulness, functionality, utilization, and the GI fellows' satisfaction with this educational resource. METHODS: The NYU Gastroenterology Fellowship Training Program's OSCE course included 4 real life IBD clinical scenarios. Five New York City GI training programs and 12 second-year GI fellows participated. Following the OSCE, each fellow was given a pocket guide entitled "NYU Gastroenterology Fellowship Training Program Pocket Guide: Key Concepts in Managing Patients with Inflammatory Bowel Disease." In addition, the pocket guide was given to the remaining 8 NYU GI fellows who did not participate in the OSCE. The white coat pocket-sized guide is comprised of 5 front and back laminated pages, with approximately 2 pages devoted to each OSCE case. Three months following the distribution of the pocket guide, 20 fellows were invited to participate in an online survey about the pocket guide in general as an education tool, and about its specific elements, and the fellows' answers were collected. RESULTS: Sixteen of 20 (80%) fellows responded to the survey. Nearly 94% (15/16) of responders found the pocket guide to be a useful supplement to their fellowship IBD training, and 100% agreed that the guide would have been a useful reference tool to have at the s!

The PathfinderTG biomarker panel is useful in the evaluation of pancreatic cysts that have clinical features suspicious for malignancy, but its utility in classifying fine-needle aspiration biopsies from small pancreatic cystic lesions is yet to be proven. We used morphology to classify 20 pancreatic cyst cytology aspirates, all of which met radiographic criteria for close observation. Cases were cytologically classified as consistent with pseudocyst, serous cystadenoma, or mucinous neoplasm with low-grade, intermediate-grade, or high-grade dysplasia and analyzed for carcinoembryonic antigen. Redpath Integrated Pathology Inc. rendered diagnoses of nonmucinous (reactive/indolent or serous) or mucinous (low-risk or at risk) cyst on the basis of results of the PathfinderTG panel (KRAS mutations, DNA content, and loss of heterozygosity at microsatellites linked to tumor suppressor genes). Cytologic and commercial laboratory diagnoses were concordant in only 7 (35%) cases. Seven cysts classified as mucinous with low-grade dysplasia by cytology were interpreted as nonmucinous on the basis of the PathfinderTG panel, 2 of which were resected mucinous cysts. Two pancreatitis-related pseudocysts were misdiagnosed as low-risk mucinous cysts; 1 mucinous cyst with low-grade dysplasia was considered at risk for neoplastic progression using the PathfinderTG panel. Only 1 cyst misclassified as pseudocyst by cytology, but low-risk mucinous cyst by molecular analysis, proved to be a mucinous cystic neoplasm with low-grade dysplasia after surgical resection. We conclude that the PathfinderTG panel may aid the classification of pancreatic lesions, but is often inaccurate and should not replace cytologic evaluation of these lesions.