Faculty Bibliography

BACKGROUND AND AIMS/OBJECTIVE:The COVID-19 pandemic significantly decreased procedural volume in 2020, thus limiting training opportunities. First-year fellows (1YF) are particularly susceptible to reduction in endoscopic volume as they build foundational endoscopic skills. We used an objective validated tool, the Assessment of Competency in Endoscopy (ACE), to determine the effect of the pandemic on endoscopy competency in gastroenterology fellows. METHODS:This was a prospective cohort study conducted across two fellowship programs in New York City. Our primary outcome was the comparison of ACE scores of fellows starting gastroenterology fellowships in 2020 to the scores of those starting in 2016-2018. Our secondary outcome was to compare colonoscopy quality metrics and endoscopy volume between these cohorts. RESULTS:ACE scores were available from 11 pandemic and 10 pre-pandemic 1YFs, and five pandemic and 19 pre-pandemic second (2YF) and third-year fellows (3YF). ACE scores for 1YFs showed significantly higher rating in the pre-pandemic cohort for 4 domains including knowledge of indications and medical issues (p = 0.03), effective and efficient use of air, water, and suction (p = 0.04), pathology identification (p = 0.001), and overall hands-on skills (p = 0.004). 2YFs showed no significant differences. 3YFs showed significantly lower scores in the pandemic cohort in the effective and efficient use of air, water, and suction (p = 0.03), fellows' knowledge of therapeutic tools (p = 0.05), and fellows overall cognitive skills (p = 0.05). There were no significant differences in quality metrics between the cohorts, except longer procedure time for the pandemic cohort (p < 0.01). CONCLUSION/CONCLUSIONS:Following the COVID-19 pandemic, there was a decline in multiple aspects of endoscopic competency both at the beginning and the end of fellowship training. These trends are likely the result of a decrease in overall procedure volume early in training and highlight the need for supplementing trainee education with other modalities.

Monomorphic epitheliotropic intestinal T-cell lymphomas (MEITLs) are rare neoplasms that carry a poor prognosis. MEITLs originating in the duodenum are uncommon. There are only 3 published case reports of primary duodenal MEITLs. They are typically found in the jejunum or ileum because these parts of the small bowel have more lymphoid tissue. We present a 41-year-old man with weight loss and abdominal pain for 2 months. Imaging showed a heterogeneous duodenal mass, and subsequent endoscopy demonstrated a fungating, ulcerative mass with stigmata of recent bleeding in the duodenal sweep. Pathology from the biopsy revealed an MEITL.

BACKGROUND AND AIMS/OBJECTIVE:Endoscopic-related injuries (ERIs) for gastroenterologists are common and can impact longevity of an endoscopic career. This study examines sex differences in the prevalence of ERIs and ergonomic training during gastroenterology fellowship. METHODS:and Fisher exact tests. RESULTS:Of the 236 respondents (response rate, 33.9%), 113 (44.5%) were women and 123 (52.1%) were men. Female fellows reported on average smaller hand sizes and shorter heights. More female fellows reported endoscopic equipment was not ergonomically optimized for their use. Additionally, more female fellows voiced preference for same-gender teachers and access to dial extenders and well-fitting lead aprons. High rates of postendoscopy pain were reported by both sexes, with significantly more women experiencing neck and shoulder pain. Trainees of both sexes demonstrated poor ergonomic awareness with an average score of 68% on a 5-point knowledge-based assessment. CONCLUSIONS:Physical differences exist between male and female trainees, and current endoscopic equipment may not be optimized for smaller hand sizes. This study highlights the urgent need for formal ergonomic training for trainees and trainers with consideration of stature and hand size to enhance safety, comfort, and equity in the training and practice of endoscopy.

The challenges of consenting for procedures are well documented and are compounded when patients have limited English proficiency (LEP). Standardized video consent has been studied, but research in gastroenterology is limited. We created educational videos in English and Spanish covering the elements of traditional consent for colonoscopy and upper endoscopy. All participants underwent traditional verbal consent and a subset viewed the language and procedure specific video. Participants from a multilingual, safety-net hospital patient population were then given a questionnaire to assess their comprehension and satisfaction. Participants who watched the video had higher comprehension scores than those who received traditional verbal consent alone. This difference persisted when data was stratified by language and procedure, and when controlled for educational level and prior procedure. Video consent improves comprehension and satisfaction for endoscopy and may mitigate some of the challenges encountered when consenting patients with LEP.

Introduction: Approximately half of gastric ulcers are associated with H. pylori. Conversely, gastric ulceration secondary to ischemia is rare due to the stomach's abundant vascular supply from all three branches of the celiac artery. Here we present a case of a patient with upper gastrointestinal bleeding and concern for gastric ischemia who was diagnosed with H. pylori associated gastritis. Case Description/Methods: A 70-year-old female with severe peripheral artery disease, abdominal aortic aneurysm status post endovascular repair, hypertension, HIV, chronic kidney disease and B-cell lymphoma was admitted for pathologic right hip fracture and underwent open reduction and internal fixation. The procedure was complicated by lactic acidosis, an elevated troponin, and transaminitis in the setting of intraoperative hypotension. Six days later the patient had coffee ground emesis and melena with a lactate of 9.8 mmol/L and a hemoglobin of 6.4 g/dL, from 8.9 g/dL one day prior. 2 units of packed red blood cells were administered, anticoagulation was stopped, and a proton pump inhibitor was given. CT angiography of the abdomen and pelvis demonstrated splenic infarction, marked attenuation of multiple mesenteric vessels including the celiac artery, concern for ischemia of the stomach and cecum, and significant distention of the stomach (Figure A). Upper endoscopy demonstrated severe gastric mucosal pallor and decreased vascular pattern, diffuse linear erosions throughout the gastric fundus and body, and multiple large superficial ulcerations without active bleeding (Figure B and C). Given the appearance of the mucosa and overall clinical picture, there was concern for ischemic gastritis and biopsies were taken. Histology later revealed erosive gastritis, regenerative change and H. pylori without evidence of microthrombi or changes consistent with ischemia and the patient was started on quadruple therapy for H. pylori gastritis. She had one further episode of melena and received an additional blood transfusion before she was discharged one week later.
Discussion(s): Our patient had extensive vascular disease and systemic hypotension with endoscopic findings highly suspicious for ischemic injury but with biopsies consistent with severe H. pylori gastritis. Although ischemic gastropathy should be considered in cases of an upper GI bleed in patients with vascular risk factors, careful histopathologic review is important for accurate diagnosis, and severe presentations of more routine diagnoses should also be considered. (Figure Presented)

BACKGROUND:The COVID-19 pandemic significantly impacted the delivery of cancer screening. The resulting decrease in outpatient visits and cancellations of non-urgent procedures have negatively affected colorectal cancer (CRC) screening. We aimed to determine the effect of the pandemic on CRC screening at a safety-net hospital and a private health system based in New York City. METHODS:We identified individuals eligible for CRC screening aged 50 to 75 years presenting for outpatient care at a safety-net public hospital and private health system in April through September of 2019 and 2020. The primary outcome was the proportion of screening-eligible patients seen in primary care who underwent CRC screening. RESULTS:The safety-net hospital had 516 (6.1% of screening-eligible individuals) and 269 (4.3%) screening tests completed in 2019 and 2020, respectively (p < 0.01). Fecal immunochemical tests (FIT) accounted for 69.6% of screening in 2019 and 88.1% in 2020. Colonoscopy accounted for 20.3% of screening in 2019 and 11.9% in 2020. The private health system had 39 (0.7%) and 21 (0.6%) screening tests completed in 2019 and 2020, respectively (p = 0.48). FIT accounted for 61.9% of screening in 2019 and 57.1% in 2020. Colonoscopy accounted for 38.1% of screening in 2019 and 42.9% in 2020. CONCLUSION/CONCLUSIONS:Absolute numbers of screening tests decreased for both institutions during the COVID-19 pandemic. We observed a decrease in screening uptake and increase in proportional FIT use in the safety-net hospital but no change in the private health system.

The Association of Black Gastroenterologists and Hepatologists (ABGH) was established to improve health equity in Black communities and to provide academic and social support for Black gastroenterologists and hepatologists. In this Viewpoint, four members of ABGH (early career, mid-career and late career) discuss their route into gastroenterology and hepatology, how academia and medicine can promote inclusivity and equity, and their advice to Black students interested in a career in medicine or science.