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Top Tips: Using image-enhanced endoscopy for colonoscopy (with videos)

Cohen, Jonathan
PMID: 34890696
ISSN: 1097-6779
CID: 5110482

Gastrointestinal endoscopy during the coronavirus pandemic in the New York area: results from a multi-institutional survey

Mahadev, Srihari; Aroniadis, Olga C; Barraza, Luis H; Agarunov, Emil; Smith, Michael S; Goodman, Adam J; Benias, Petros C; Buscaglia, Jonathan M; Gross, Seth A; Kasmin, Franklin; Cohen, Jonathan; Carr-Locke, David L; Greenwald, David; Mendelsohn, Robin; Sethi, Amrita; Gonda, Tamas A
Background and study aims  The coronavirus disease 2019 (COVID-19), and measures taken to mitigate its impact, have profoundly affected the clinical care of gastroenterology patients and the work of endoscopy units. We aimed to describe the clinical care delivered by gastroenterologists and the type of procedures performed during the early to peak period of the pandemic. Methods  Endoscopy leaders in the New York region were invited to participate in an electronic survey describing operations and clinical service. Surveys were distributed on April 7, 2020 and responses were collected over the following week. A follow-up survey was distributed on April 20, 2020. Participants were asked to report procedure volumes and patient characteristics, as well protocols for staffing and testing for COVID-19. Results  Eleven large academic endoscopy units in the New York City region responded to the survey, representing every major hospital system. COVID patients occupied an average of 54.5 % (18 - 84 %) of hospital beds at the time of survey completion, with 14.5 % (2 %-23 %) of COVID patients requiring intensive care. Endoscopy procedure volume and the number of physicians performing procedures declined by 90 % (66 %-98 %) and 84.5 % (50 %-97 %) respectively following introduction of restricted practice. During this period the most common procedures were EGDs (7.9/unit/week; 88 % for bleeding; the remainder for foreign body and feeding tube placement); ERCPs (5/unit/week; for cholangitis in 67 % and obstructive jaundice in 20 %); Colonoscopies (4/unit/week for bleeding in 77 % or colitis in 23 %) and least common were EUS (3/unit/week for tumor biopsies). Of the sites, 44 % performed pre-procedure COVID testing and the proportion of COVID-positive patients undergoing procedures was 4.6 % in the first 2 weeks and up to 19.6 % in the subsequent 2 weeks. The majority of COVID-positive patients undergoing procedures underwent EGD (30.6 % COVID +) and ERCP (10.2 % COVID +). Conclusions  COVID-19 has profoundly impacted the operation of endoscopy units in the New York region. Our data show the impact of a restricted emergency practice on endoscopy volumes and the proportion of expected COVID positive cases during the peak time of the pandemic.
PMID: 33269322
ISSN: 2364-3722
CID: 4694312

Advances in training for advances in endoscopic therapy [Editorial]

Cohen, Jonathan
PMID: 33160485
ISSN: 1097-6779
CID: 4671252

Obesity: Core Curriculum

Pannala, Rahul; Sharaiha, Reem Z; Sullivan, Shelby A; Wagh, Mihir S; Cohen, Jonathan; Thompson, Christopher C
This is a document prepared by the Association for Bariatric Endoscopy (ABE), a division of the American Society for Gastrointestinal Endoscopy (ASGE) and the ASGE Training Committee. This curriculum document contains recommendations for training and is intended for use by gastroenterology program directors and faculty, including those involved in teaching endoscopy, and trainees in gastroenterology. Although only a small proportion of gastroenterologists currently treat obesity, given the burden of disease, an urgent need exists for greater involvement of physicians from multiple specialties, including gastroenterology, to be actively involved in the care of patients with obesity. This curriculum was developed to provide an overview of the cognitive and technical content areas that gastroenterology (GI) fellows should learn pertaining to the evaluation and management of patients with obesity and to serve as a guide to published references, videos, and other available resources. Specifically, this document addresses the core concepts that all general gastroenterology fellows should acquire about lifestyle intervention; pharmacologic, endoscopic, and surgical treatments for obesity; evaluation and management of gastrointestinal comorbidities in patients with obesity; challenges associated with sedation in patients with obesity; endoscopic evaluation of postbariatric surgical anatomy; and the management of selected adverse events in patients who have had bariatric surgery. The document also suggests recommendations for those fellows who are interested in acquiring further skills in the treatment of obesity such as incorporating medical treatment of obesity in their practice or those interested in offering endoscopic bariatric therapies (EBTs), treatment of more complex bariatric surgical adverse events, or endoscopic treatment of weight regain after Roux-en-Y gastric bypass (RYGB). By providing this framework to trainers and trainees, the ASGE hopes to facilitate the incorporation of this important material into training programs to ensure that trainees are adequately prepared for future professional responsibilities in this area.
PMID: 31302093
ISSN: 1097-6779
CID: 3977522

ASGE principles of endoscopic training

Waschke, Kevin A; Anderson, John; Valori, Roland M; MacIntosh, Donald G; Kolars, Joseph C; DiSario, James A; Faigel, Douglas O; Petersen, Bret T; Cohen, Jonathan
This White Paper shares guidance on the important principles of training endoscopy teachers, the focus of an American Society for Gastrointestinal Endoscopy (ASGE)/World Endoscopy Organization Program for Endoscopic Teachers and Leaders of Endoscopic Training held at the ASGE Institute for Training and Technology. Key topics included the need for institutional support and continuous skills development, the importance of consensus and consistency in content and approach to teaching, the role of conscious competence and content breakdown into discreet steps in effective teaching, defining roles of supervisors versus instructors to ensure teaching consistency across instructors, identification of learning environment factors and barriers impacting effective teaching, and individualized training that incorporates effective feedback and adapts with learner proficiency. Incorporating simulators into endoscopy teaching, applying good endoscopy teaching principles outside the endoscopy room, key principles of hands-on training, and effective use of simulators and models in achieving specific learning objectives were demonstrated with rotations through hands-on simulator stations as part of the program. A discussion of competency-based assessment was followed by live sessions in which attendees applied endoscopy teaching principles covered in the program. Conclusions highlighted the need for the following: formal training of endoscopy teachers to a level of conscious competence, incorporation of formal training structures into existing training curricula, intentional teaching preparation, feedback to trainees and instructors alike aimed at improving performance, and competency-based trainee assessment. The article is intended to help motivate individuals who play a role in training other endoscopists to develop their teaching abilities, promote discussions about endoscopy training, and engage both endoscopy trainers and trainees in a highly rewarding learning process that is in the best interest of patients.
PMID: 31122745
ISSN: 1097-6779
CID: 3957872

ASGE EndoVators Summit: simulators and the future of endoscopic training

Walsh, Catharine M; Cohen, Jonathan; Woods, Karen L; Wang, Kenneth K; Andersen, Dana K; Anderson, Michelle A; Dunkin, Brian J; Edmundowicz, Steven A; Faigel, Douglas O; Law, Joanna K; Marks, Jeffrey M; Sedlack, Robert E; Thompson, Christopher C; Vargo, John J
Interest in the use of simulation for acquiring, maintaining, and assessing skills in GI endoscopy has grown over the past decade, as evidenced by recent American Society for Gastrointestinal Endoscopy (ASGE) guidelines encouraging the use of endoscopy simulation training and its incorporation into training standards by a key accreditation organization. An EndoVators Summit, partially supported by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health, (NIH) was held at the ASGE Institute for Training and Technology from November 19 to 20, 2017. The summit brought together over 70 thought leaders in simulation research and simulator development and key decision makers from industry. Proceedings opened with a historical review of the role of simulation in medicine and an outline of priority areas related to the emerging role of simulation training within medicine broadly. Subsequent sessions addressed the summit's purposes: to review the current state of endoscopy simulation and the role it could play in endoscopic training, to define the role and value of simulators in the future of endoscopic training and to reach consensus regarding priority areas for simulation-related education and research and simulator development. This white paper provides an overview of the central points raised by presenters, synthesizes the discussions on the key issues under consideration, and outlines actionable items and/or areas of consensus reached by summit participants and society leadership pertinent to each session. The goal was to provide a working roadmap for the developers of simulators, the investigators who strive to define the optimal use of endoscopy-related simulation and assess its impact on educational outcomes and health care quality, and the educators who seek to enhance integration of simulation into training and practice.
PMID: 31122744
ISSN: 1097-6779
CID: 3957862

The path to quality colonoscopy continues after graduation [Editorial]

Poppers, David M; Cohen, Jonathan
PMID: 30784496
ISSN: 1097-6779
CID: 3687842

Evaluating Women's Preferences for Hepatitis C Treatment During Pregnancy

Kushner, T; Cohen, J; Tien, P C; Terrault, N A
There is a rising prevalence of hepatitis C (HCV) among women of child-bearing age nationally, which prompted a recommendation by national guidelines to screen all women for HCV during pregnancy. Women with HCV during pregnancy are at risk of perinatal transmission of HCV. Directly acting antiviral (DAA) therapy during pregnancy can potentially reduce the risk of perinatal transmission as well as cure women while they are engaged in antenatal care. However, data on the safety and efficacy of DAAs during pregnancy are limited. We aimed to evaluate the preferences of women with HCV regarding potential DAA treatment during pregnancy. We conducted a survey of women with a history of HCV followed in the University of California, San Francisco HCV clinic and in the Women's Interagency HIV Study (most of whom are coinfected with HIV) to determine their preferences for DAA treatment during pregnancy. A total of 141 women completed the survey. Sixty percent reported that they would be willing to take antepartum DAA therapy if it lowered the risk of perinatal transmission. Only 21% reported that they would agree to take DAA therapy during pregnancy for self-cure; 20% of women stated that they would not, yet indicated that they might change their minds if there were more human data available regarding use of DAAs during pregnancy. In multivariable analysis, having a previous history of taking DAAs and being of childbearing age at the time of the survey were associated with willingness to take DAA medication during pregnancy (odds ratios 4.29 and 4.11, respectively).
Conclusion(s): These results point to the need for further investigation of the role of HCV therapy during pregnancy.
ISSN: 2471-254x
CID: 4983282

The clinical significance of persistent trigeminal nerve contrast enhancement in patients who undergo repeat radiosurgery

Mousavi, Seyed H; Akpinar, Berkcan; Niranjan, Ajay; Agarwal, Vikas; Cohen, Jonathan; Flickinger, John C; Kondziolka, Douglas; Lunsford, L Dade
OBJECTIVE Contrast enhancement of the retrogasserian trigeminal nerve on MRI scans frequently develops after radiosurgical ablation for the management of medically refractory trigeminal neuralgia (TN). The authors sought to evaluate the clinical significance of this imaging finding in patients who underwent a second radiosurgical procedure for recurrent TN. METHODS During a 22-year period, 360 patients underwent Gamma Knife stereotactic radiosurgery (SRS) as their first surgical procedure for TN at the authors' center. The authors retrospectively analyzed the data from 59 patients (mean age 72 years, range 33-89 years) who underwent repeat SRS for recurrent pain at a median of 30 months (range 6-146 months) after the first SRS. The isocenter was 4 mm, and the median maximum doses for the first and second procedures were 80 Gy and 70 Gy, respectively. A neuroradiologist and a neurosurgeon blinded to the treated side evaluated the presence of nerve contrast enhancement on MRI series at the time of the repeat procedure. The authors correlated the presence of this imaging change with clinical outcomes. Pain outcomes and development of trigeminal sensory dysfunction were evaluated with the Barrow Neurological Institute (BNI) Pain Scale and BNI Numbness Scale, respectively. The mean length of follow-up after the second SRS was 58 months (95% CI 49-68 months). RESULTS At the time of the repeat SRS, contrast enhancement of the trigeminal nerve on MRI scans was observed in 31 patients (53%). Five years after the SRS, patients with this enhancement had lower actuarial rates of complete pain relief after the repeat SRS (27% [95% CI 7%-47%]) than patients without the enhancement (76% [95% CI 58%-94%]) (p < 0.001). At the 5-year follow-up, patients with the contrast enhancement also had a higher risk for trigeminal sensory loss after repeat SRS (75% [95% CI 59%-91%]) than patients without contrast enhancement (26% [95% CI 10%-42%]) (p = 0.001). Dysesthetic pain after repeat SRS was observed for 8 patients with and for 2 patients without contrast enhancement. CONCLUSIONS Trigeminal nerve contrast enhancement on MRI scans observed at the time of a repeat SRS for TN was associated with less satisfactory pain control and more frequently detected facial sensory loss. Residual contrast enhancement at the time of a repeat SRS may warrant consideration of dose reduction or further separation of the radiosurgical targets.
PMID: 27471888
ISSN: 1933-0693
CID: 2191722

The benefit of narrow-band imaging after EMR of laterally spreading lesions [Editorial]

Cohen, Jonathan
PMID: 28215765
ISSN: 1097-6779
CID: 2459772