Kathy P. Bull-Henry, MD, FACG Dr. Bull-Henry has indicated no relevant financial relationships. Don t Waste Time With No Chance to See

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Kathy P. Bull-Henry, MD, FACG Dr. Bull-Henry has indicated no relevant financial relationships. Don t Waste Time With No Chance to See"

Transcription

1 Don t Waste Time with No Chance to See Kathy P. Bull-Henry, MD, FACG Dr. Bull-Henry has indicated no relevant financial relationships. Don t Waste Time With No Chance to See Kathy Bull-Henry, MD, FACG Associate Professor of Medicine Division of Gastroenterology MedStar Georgetown University Hospital April 13,

2 No financial disclosures Cons of Urgent Colonoscopy Timing of colonoscopy remains controversial Low prevalence of stigmata of hemorrhage Colon preparation Sedation, experienced staff and procedure facilities Complications Strate L, et al. World J Gastrol 2012; 8:1185 2

3 Prospective studies supporting urgent colonoscopy are small and nonrandomized Case studies supporting urgent colonoscopy are small Elta G. GIE 2004; 59: Two RCT showed no difference in rebleeding rates and surgery for urgent colonoscopy Green B, et al. Am J Gastrol 2005;100:2395 Laine L, Shah A. Am J Gastrol 2010;105:2632 Green B, et al. Am J Gastrol 2005;100: pts were randomized d Urgent Colonoscopy (n=50) Colo < 8 h of presentation Standard Care (n=50) Colo < 4 days of presentation 3

4 Green B, et al. Am J Gastrol 2005;100:2395 Yes Ongoing bleeding No RBC Scan Positive Negative Angiography Elective Positive Colonoscopy Negative Angiographic hemostasis Elective Colonoscopy Elective Colonoscopy Elective Colonoscopy Standard Care Algorithm Bleeding Source : Results Urgent Colonoscopy (N=50) Standard care (N=50) Definitive Source Diverticulosis 13 8 Angioectasia 4 0 Ischemic colitis 4 3 Total 21 (42%) 11 (22%) Presumptive Source Diverticulosis Angioectasia 1 1 Colitis 0 3 Polyp 0 2 Ulcer 0 1 Total 27 (54%) 27 (54%) Unknown 2 12 Green B, et al. Am J Gastrol 2005;100: % CI 4

5 : Results Urgent Colonoscopy (N=50) Standard care (N=50) Difference (95% CI) Definitive source of 21 (42%) 11 (22%) 20% ( ) bleeding Early Rebleeding 11(22%) 15 (30 %) 8% ( ) Late rebleeding 8 (16%) 7 (14%) 2% (-12 16%) Units of units of 4.2 units 5 units blood transfused Length of hospital 58d 5.8 days 66d 6.6 days stay Surgery 7 (14%) 6 (12%) Mortality 1 (2%) 2 (4%) Green B, et al. Am J Gastrol 2005;100:2395 Green B, et al. Am J Gastrol 2005;100:2395 Limitations: Trial terminated early before the pre-specified sample size reached (58 in each group) Thus, not adequately powered to determine statistically significant differences Enrollment was over a 10 year period 5

6 Green B, et al. Am J Gastrol 2005;100:2395 Conclusion Urgent colonoscopy has a higher diagnostic yield But does not significantly decrease Initial hemostasis rate Early and late rebleeding rate Surgical intervention Transfusion requirement Complication rate Length of stay Mortality Laine L, Shah A. Am J Gastrol 2010;105: pts eligible Pts with hematochezia, HR > 100, SBP < 100, Orthostatic changes: HR > 20 or BP > 20, Hgb drop >1.5g/dl EGD < 6h 15% (13) had upper source on EGD No clinical evidence of UGI bleeding 7 duodenal ulcers, 3 gastric ulcers, 2 esophageal varices, 1 gastric varices 6

7 Laine L, Shah A. Am J Gastrol 2010;105: pts without UGI source were randomized Urgent Colonoscopy (n=36) Colo < 12 h of presentation (Median 11 hrs) Elective Colonoscopy (n=36) Colo h of presentation (Median 47 hrs) Groups were similar except: Urgent group had lower baseline hemoglobin and received more blood transfusions before randomization : Results Urgent Colonoscopy N=36 Poor Prep 2 (6%) 3 (8%) Diverticula with active bleeding or + stigmata 2 (6%) 0 Diverticula without active 9 (25%) 7 (19%) bleeding nor + stigmata Internal hemorrhoids 8 (22%) 6 (17%) Colon cancer 1 (3%) 5 (14%) Colon ulcers 2 (6%) 2 (6%) Colitis 3 (8%) 1 (3%) Vascular ectasias 2 (6%) 0 Rectal varices 0 1 (3%) Portal hypertensive 0 1 (3%) colopathy Nondiagnostic 8 (22%) 12 (33%) Laine L, Shah A. Am J Gastrol 2010;105:2632 Elective Colonoscopy N=36 7

8 : Results Urgent Elective Colonoscopy Colonoscopy (N=36) (N=36) Difference (95% CI) Rebleeding 8 (22%) 5 (14%) 8% (-9-26%) Units of units of 1.5 units 0.7 units 0.9 ( ) blood transfused Length of hospital 5.2 days 4.8 days 0.4 ( ) stay # of diagnostic or 13 (36%) 12 33% 3% (-19-25%) therapeutic interventions Hospital charges $27,590 $26, (-12,525-14,440) No further bleeding 28 (77%) 31 (86%) Laine L, Shah A. Am J Gastrol 2010;105:2632 Laine L, Shah A. Am J Gastrol 2010;105:2632 Limitations: Trial terminated early before the pre-specified sample size reached (134 in each group) Thus, not adequately powered to determine statistically significant differences 8

9 Laine L, Shah A. Am J Gastrol 2010;105:2632 Conclusion: UGI Source found in 15% patients with hematochezia About 80% of patients had no further rebleeding Endoscopic therapy performed in only 6% of patients for non-hemorrhoidal sources Urgent colonoscopy did not improve outcomes in LGI bleeding Colonoscopy Prep Prep should be given until clear 5-6 liters of polyethylene glycol given over 3-4hours (often via NG tube) until clear Colonoscopy should then be performed 1-2 hours after stool clearing Promotility agent may prevent nausea Requires coordination of the medical, nursing, and pharmacy staff Requires cooperation of the patient and family Jensen D. NEJM 2000;342:

10 Colonoscopy Prep Colon prep makes urgent colonoscopy difficult Blood and stool in the colon Increase the risk of perforation Impair identification of stigmata Green s study reported poor to fair prep in 62-64% of patients Laine s study reported 7% of patients needed repeat colonoscopy due to poor prep Green B. Am J Gastro 2005;100: Laine L. Am J Gastro 2010;105: Low Prevalence of Stigmata of Hemorrhage Purpose of urgent colonoscopy Identify and treat active bleeding or stigmata of recent bleeding Difficult to identify stigmata Residual blood and stool Intermittent bleeding Multiple potential bleeding sources Large surface area of the colon Low prevalence of stigmata of hemorrhage Strate L. CGH 2010;8:

11 The Most Common Colonic Sources Amenable to Endoscopic Therapy 486 Colonic Cases Cause % Diverticulosis 31.9% Internal hemorrhoids 12.8% Ischemic Colitis 11.9% Rectal ulcers 7.6% UC, Crohn s, other colitis 7.1% Colon angiomas/xrt 7.0% Other LGI sources 5.6% Post polypectomy ulcer 4.7% Focal stigmata amenable to colonoscopic hemostasis Jenson D. & CURE Hemostasis Group Oct 2009 Bleeding Source Low Prevalence of Stigmata of Hemorrhage Urgent Colonoscopy (N=50) Standard care (N=50) Definitive Source Diverticulosis 13 8 Angioectasia 4 0 Ischemic colitis 4 3 Total 21 (42%) 11 (22%) Presumptive Source Diverticulosis Angioectasia 1 1 Colitis 0 3 Polyp 0 2 Ulcer 0 1 Total 27 (54%) 27 (54%) Unknown 2 12 Green B, et al. Am J Gastrol 2005;100: % CI 11

12 Low Prevalence of Stigmata of Hemorrhage Urgent Colonoscopy (N=36) Poor Prep 2(6%) 3(8%) Diverticula with active bleeding or + stigmata 2(6%) 0 Diverticula without active 9(25%) 7(19%) bleeding nor + stigmata Internal hemorrhoids 8(22%) 6(17%) Colon cancer 1(3%) 5(14%) Colon ulcers 2(6%) 2(6%) Colitis 3(8%) 1(3%) Vascular ectasias 2(6%) 0 Rectal varices 0 1(3%) Portal hypertensive 0 1(3%) colopathy Nondiagnostic 8(22%) 12(33%) Laine L. Am J Gastrol 2010;105:2632 Elective Colonoscopy (N=36) Low Prevalence of Stigmata of Hemorrhage Study Pts n Timing hr Dx n(%) Definitive Dx n(%) Endoscopic Tx n(%) Jensen, < (100) 107 (88) 10 (37) Antuaco, <24 29 (74) 3 (8) 3 (8) Schulewitz, (89) (10) Smoot, (100) 38 (49) 7 (9) Strate, (89) 62 (43) 14 (10) Green, (96) 21 (42) 17 (34) Total (91) 231 (53) 93 (12) Angtuaco T. Am J Med 2001;96: Schmulewitz N. GIE 2003;58: Smoot R. Am J Gastro 2003;98: Strate L. CGH 2010;8: Jensen D. NEJM 2000;342:78-82 Strate L. Am J Gastro 2003;98: Green B. Am J Gastro 2005;100:

13 Complications Risk of perforation 6-8 liters large volume bowel prep Volume overload Electrolyte abnormality Risk of aspiration Parikh K. Cleve Clin J Med 2011;78: Ayus J. BMJ 2003;326: Sedation, Staffing, Procedure Facilities Coordination of the medical, nursing, technical support staffing for endoscopy at night and on weekends may be challenging and complex 13

14 Urgent Colonoscopy in Acute LGI Bleeding Conclusion Enthusiasm and support for urgent colonoscopy is not supported by randomized controlled studies The number of patients in supporting prospective studies and case reports is small Urgent Colonoscopy in Acute LGI Bleeding Conclusion Major limitations to performing colonoscopy urgently Bowel prep Coordinating the procedure after-hours Infrequent identification of stigmata Optimal timing of colonoscopy is not defined 6 h, 8h, 12h, 24h, 48h? Is secondary prevention important? Avoidance of NSAIDs, anticoagulants, popcorn, seeds, and nuts 14

15 Urgent Colonoscopy in Acute LGI Bleeding Conclusion Need for multicenter randomized controlled studies that: Use risk stratification tool that select patients who would benefit from urgent colonoscopy Define the optimal timing of colonoscopy in LGI bleeding Compare available options including RBC scans, angiography, and dmdct angiography Optimize colon preps Standardize endoscopic therapy Standardize criteria for early discharge Assess secondary prevention Suggested Algorithm Hematochezia with hemodynamic instability Yes EGD + Flexible sigmoidoscopy - Massive Bleeding Yes MDCT angiography, RBC Scan - + No No Colonoscopy + Therapy as indicated Colonoscopy Angiography with embolization + or - 15

16 Don t Waste Time When There Is No Chance to See On A Clear Day You Can See Forever 16

17 17

On-Call Upper GI Bleeding. Upper Gastrointestinal Bleeding

On-Call Upper GI Bleeding. Upper Gastrointestinal Bleeding On-Call Upper GI Bleeding John R Saltzman MD, FACG Director of Endoscopy Brigham and Women s Hospital Associate Professor of Medicine Harvard Medical School Upper Gastrointestinal Bleeding 300,000000 hospitalizations/year

More information

in Non-Variceal UGI Bleeding Etiology of Nonvariceal UGI Bleeding

in Non-Variceal UGI Bleeding Etiology of Nonvariceal UGI Bleeding Endoscopic Hemostasis in Non-Variceal UGI Bleeding Kathy Bull-Henry, MD, FACG Associate Professor of Medicine Georgetown University Hospital Etiology of Nonvariceal UGI Bleeding Nonvariceal UGI Bleeding

More information

The Role of Colonoscopy and Radiological Procedures in the Management of Acute Lower Intestinal Bleeding

The Role of Colonoscopy and Radiological Procedures in the Management of Acute Lower Intestinal Bleeding CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2010;8:333 343 STATE OF THE ART The Role of Colonoscopy and Radiological Procedures in the Management of Acute Lower Intestinal Bleeding LISA L. STRATE and CHRISTOPHER

More information

GI Bleeding: old problems and new challenges

GI Bleeding: old problems and new challenges GI Bleeding: old problems and new challenges Jonathan P. Terdiman, M.D. University of California, San Francisco Disclosures NONE Topics to Cover The basics Resuscitation and risk assessment Epidemiology

More information

GI BLEED ALAN NAIM, MD GASTROENTEROLOGY FELLOW

GI BLEED ALAN NAIM, MD GASTROENTEROLOGY FELLOW GI BLEED ALAN NAIM, MD GASTROENTEROLOGY FELLOW DISTINGUISHING UPPER VS LOWER Upper GI bleed History NSAID use Previous ulcers Alcoholism varices Previous stomach surgery Retching/vomiting Mallory Weiss

More information

on Anti-coagulants -- Is It Safe? And When to Stop?

on Anti-coagulants -- Is It Safe? And When to Stop? Endoscopy for Your Patient on Anti-coagulants -- Is It Safe? And When to Stop? John R. Saltzman MD, FACG Director of Endoscopy Brigham and Women s Hospital Associate Professor of Medicine Harvard Medical

More information

UGI BLEED. Dr. KPP Abhilash Associate Professor Department of Emergency Medicine Christian Medical College, Vellore

UGI BLEED. Dr. KPP Abhilash Associate Professor Department of Emergency Medicine Christian Medical College, Vellore UGI BLEED Dr. KPP Abhilash Associate Professor Department of Emergency Medicine Christian Medical College, Vellore Outline UGI bleed: etiology and presentation Management: Non variceal / variceal bleed

More information

Long-term Outcome of Patients With Obscure Gastrointestinal Bleeding Investigated by Double-Balloon Endoscopy

Long-term Outcome of Patients With Obscure Gastrointestinal Bleeding Investigated by Double-Balloon Endoscopy CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2010;8:151 158 Long-term Outcome of Patients With Obscure Gastrointestinal Bleeding Investigated by Double-Balloon Endoscopy SATOSHI SHINOZAKI, HIRONORI YAMAMOTO,

More information

Medical and Endoscopic Management of Upper GI Bleeding

Medical and Endoscopic Management of Upper GI Bleeding Medical and Endoscopic Management of Upper GI Bleeding David A. Greenwald, MD Albert Einstein College of Medicine Montefiore Medical Center ACG Annual Meeting 2013 1 Fu K, Fujimori T. N Engl J Med 2006;354:283-283

More information

What is a Colonoscopy?

What is a Colonoscopy? What is a Colonoscopy? A colonoscopy is a test to look inside your colon. A colonoscopy is done by a gastroenterologist, a doctor trained in looking at the gastrointestinal (GI) tract. The main tool used

More information

ORIGINAL INVESTIGATION. Early Predictors of Severity in Acute Lower Intestinal Tract Bleeding

ORIGINAL INVESTIGATION. Early Predictors of Severity in Acute Lower Intestinal Tract Bleeding ORIGINAL INVESTIGATION Early Predictors of Severity in Acute Lower Intestinal Tract Bleeding Lisa L. Strate, MD, MPH; E. John Orav, PhD; Sapna Syngal, MD, MPH Background: Identification of high-risk patients

More information

CLINICAL MANAGEMENT. Lower Gastrointestinal Bleeding. Clinical Case. Background

CLINICAL MANAGEMENT. Lower Gastrointestinal Bleeding. Clinical Case. Background GASTROENTEROLOGY 2006;130:165 171 CLINICAL MANAGEMENT Loren Laine, M.D. Clinical Management Editor University of Southern California Los Angeles, California Lower Gastrointestinal Bleeding DON C. ROCKEY

More information

The role of endoscopy in the patient with lower GI bleeding

The role of endoscopy in the patient with lower GI bleeding GUIDELINE The role of endoscopy in the patient with lower GI bleeding This is one of a series of statements discussing the use of GI endoscopy in common clinical situations. The Standards of Practice Committee

More information

Etiological profile of patients presenting with lower gastrointestinal bleeding at tertiary care hospital at Belagavi: a cross sectional study

Etiological profile of patients presenting with lower gastrointestinal bleeding at tertiary care hospital at Belagavi: a cross sectional study International Journal of Advances in Medicine Badiger RH et al. Int J Adv Med. 2017 Oct;4(5):1429-1433 http://www.ijmedicine.com pissn 2349-3925 eissn 2349-3933 Original Research Article DOI: http://dx.doi.org/10.18203/2349-3933.ijam20174297

More information

Gastroenterology Fellowship Program

Gastroenterology Fellowship Program Gastroenterology Fellowship Program Outpatient Clinical Rotations I. Overview A. Three Year Continuity Clinic Experience All gastroenterology fellows will be required to have a ½ day continuity clinic

More information

NORTH YORK ENDOSCOPY CENTER Dr. K. JeeJeebhoy

NORTH YORK ENDOSCOPY CENTER Dr. K. JeeJeebhoy Colonoscopy Instructions IMPORTANT INFORMATION: Prior to taking the preparation, please read the details of the procedure, including the risks and benefits. If you agree to the procedure after reading

More information

Colon Screening in 2014 Offering Patients a Choice. Clark A Harrison MD The Nevada Colon Cancer Partnership

Colon Screening in 2014 Offering Patients a Choice. Clark A Harrison MD The Nevada Colon Cancer Partnership Colon Screening in 2014 Offering Patients a Choice Clark A Harrison MD The Nevada Colon Cancer Partnership Objectives 1. Understand the incidence and mortality rates for CRC in the US. 2. Understand risk

More information

They know how to prevent colon cancer

They know how to prevent colon cancer They know how to prevent colon cancer and you can, too. Take a look inside. If you re 50 or older, you need to get tested for colon cancer. It s one cancer that can actually be prevented! Colon cancer:

More information

Cary Gastroenterology Associates Colonoscopy Consent Form

Cary Gastroenterology Associates Colonoscopy Consent Form Cary Gastroenterology Associates Colonoscopy Consent Form Your physician has requested that you undergo a procedure called Colonoscopy. Colonoscopy is a procedure that enables the physician to see inside

More information

Get tested for. Colorectal cancer. Doctors know how to prevent colon or rectal cancer- and you can, too. Take a look inside.

Get tested for. Colorectal cancer. Doctors know how to prevent colon or rectal cancer- and you can, too. Take a look inside. Get tested for Colorectal cancer Doctors know how to prevent colon or rectal cancer- and you can, too. Take a look inside. 1 If you re 50 or older, you need to get tested for colorectal cancer. It s one

More information

https://www.uptodate.com/contents/diverticular-disease-beyond-the-basics/print?source=se...

https://www.uptodate.com/contents/diverticular-disease-beyond-the-basics/print?source=se... Page 1 of 10 Official reprint from UpToDate www.uptodate.com 2017 UpToDate The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment.

More information

8/29/2016 DIVERTICULAR DISEASE: WHAT EVERY NURSE PRACTITIONER SHOULD KNOW. LENORE LAMANNA Ed.D, ANP-C LEARNING OBJECTIVES

8/29/2016 DIVERTICULAR DISEASE: WHAT EVERY NURSE PRACTITIONER SHOULD KNOW. LENORE LAMANNA Ed.D, ANP-C LEARNING OBJECTIVES DIVERTICULAR DISEASE: WHAT EVERY NURSE PRACTITIONER SHOULD KNOW LENORE LAMANNA Ed.D, ANP-C LEARNING OBJECTIVES Define Diverticular Disease Discuss Epidemiology and Pathophysiology of Diverticular disease

More information

Spectrum of Diverticular Disease. Outline

Spectrum of Diverticular Disease. Outline Spectrum of Disease ACG Postgraduate Course January 24, 2015 Lisa Strate, MD, MPH Associate Professor of Medicine University of Washington, Seattle, WA Outline Traditional theories and updated perspectives

More information

Colon Cancer Screening in 2016 Offering Patients a Choice. Clark A Harrison MD The Nevada Colon Cancer Partnership

Colon Cancer Screening in 2016 Offering Patients a Choice. Clark A Harrison MD The Nevada Colon Cancer Partnership Colon Cancer Screening in 2016 Offering Patients a Choice Clark A Harrison MD The Nevada Colon Cancer Partnership Objectives 1. Understand the incidence and mortality rates for CRC in the US. 2. Understand

More information

Historical perspective

Historical perspective Raj Santharam, MD GI Associates, LLC Clinical Assistant Professor of Medicine Medical College of Wisconsin Historical perspective FFS first widespread use in the early 1970 s Expansion of therapeutic techniques

More information

Patient Interview Form

Patient Interview Form Patient Interview Form Patient Information First Name: Last Name: Date of Birth: Age: Email Personal: Race Select one or more Referring Physician White Black or African Asian American Indian Native Hawaiian

More information

Clinical outcome of acute nonvariceal upper gastrointestinal bleeding after hours: the role of urgent endoscopy

Clinical outcome of acute nonvariceal upper gastrointestinal bleeding after hours: the role of urgent endoscopy ORIGINAL ARTICLE Korean J Intern Med 2016;31:470-478 Clinical outcome of acute nonvariceal upper gastrointestinal bleeding after hours: the role of urgent endoscopy Dong-Won Ahn 1,2,*, Young Soo Park 1,3,*,

More information

COLONOSCOPY INFORMATION

COLONOSCOPY INFORMATION Colorectal cancer is the second most common cancer in Luxembourg COLONOSCOPY INFORMATION Prepare yourself for the examination! Your doctor has advised you to have a colonoscopy done, and you will soon

More information

Esophageal Varices Beta-Blockers or Band Ligation. Cesar Yaghi MD Hotel-Dieu de France University Hospital Universite Saint Joseph

Esophageal Varices Beta-Blockers or Band Ligation. Cesar Yaghi MD Hotel-Dieu de France University Hospital Universite Saint Joseph Esophageal Varices Beta-Blockers or Band Ligation Cesar Yaghi MD Hotel-Dieu de France University Hospital Universite Saint Joseph Esophageal Varices Beta-Blockers or Band Ligation? Risk of esophageal variceal

More information

UNDERSTANDING X-RAYS: ABDOMINAL IMAGING THE ABDOMEN

UNDERSTANDING X-RAYS: ABDOMINAL IMAGING THE ABDOMEN UNDERSTANDING X-RAYS: ABDOMINAL IMAGING THE ABDOMEN Radiology Enterprises radiologyenterprises@gmail.com www.radiologyenterprises.com STOMACH AND SMALL BOWEL STOMACH AND SMALL BOWEL Swallowed air is a

More information

What Is Diverticulitis?

What Is Diverticulitis? What Is Diverticulitis? By age 50, about half of people have diverticulosis, a health issue in which pockets (or diverticula) form in the wall of the large bowel. In about 5 percent of people, these pockets

More information

Occult GI Bleed. July 2015

Occult GI Bleed. July 2015 Occult GI Bleed July 2015 Occult GI Bleed Occult vs Obscure Occult positive FOB and/or IDA, but no evidence of visible blood loss to pt or physician Obscure GI bleed that persist/ recurs without obvious

More information

Heme (Bleeding and Coagulopathies) in the ICU

Heme (Bleeding and Coagulopathies) in the ICU Heme (Bleeding and Coagulopathies) in the ICU General Topics To Discuss Transfusions DIC Thrombocytopenia Liver and renal disease related bleeding Lack of evidence in managing critical illness related

More information

Traditional nonsteroidal anti-inflammatory drugs

Traditional nonsteroidal anti-inflammatory drugs GASTROENTEROLOGY 2008;135:1517 1525 Lower Gastrointestinal Events in a Double-Blind Trial of the Cyclo-Oxygenase-2 Selective Inhibitor Etoricoxib and the Traditional Nonsteroidal Anti-Inflammatory Drug

More information

GASTROINTESTINAL HEMORRHAGE

GASTROINTESTINAL HEMORRHAGE Anatomy GASTROINTESTINAL HEMORRHAGE Bleeding can occur anywhere along the gastrointestinal (GI) tract from the oropharynx to the anus. Bleeding is the initial presentation in 1/3 of patients with gastrointestinal

More information

GENERAL COLORECTAL CANCER INFORMATION. What is colorectal cancer?

GENERAL COLORECTAL CANCER INFORMATION. What is colorectal cancer? GENERAL COLORECTAL CANCER INFORMATION What is colorectal cancer? Colorectal cancer is cancer that develops in the colon or the rectum. The colon and rectum are parts of the digestive system, which is also

More information

Impact of a bleeding care pathway in the management of acute upper gastrointestinal bleeding

Impact of a bleeding care pathway in the management of acute upper gastrointestinal bleeding Indian J Gastroenterol (March April 2011) 30(2):72 77 DOI 10.1007/s12664-011-0089-5 ORIGINAL ARTICLE Impact of a bleeding care pathway in the management of acute upper gastrointestinal bleeding Khalid

More information

Colonoscopy Preparation Using MiraLax and Dulcolax

Colonoscopy Preparation Using MiraLax and Dulcolax Colonoscopy Preparation Using MiraLax and Dulcolax Arrival time Appointment time Date Location Physician When What You Need to Do Details 7 days before your procedure 3 days before Arrange for someone

More information

Portal hypertension Current Status. Abraham Shaked MD PhD

Portal hypertension Current Status. Abraham Shaked MD PhD Portal hypertension Current Status Abraham Shaked MD PhD Portal Hypertension Defined as an increase in portal vein pressure to exceed 6 mmhg It is the underlying process responsible for the most common

More information

What is Colorectal Cancer?

What is Colorectal Cancer? COLORECTAL CANCER (CRC) What is Colorectal Cancer? Colorectal cancer (also known as colon cancer) is cancer of the colon and/or rectum and occurs when a growth in the lining of the colon or rectum becomes

More information

Neoplastic Colon Polyps. Joyce Au SUNY Downstate Grand Rounds, October 18, 2012

Neoplastic Colon Polyps. Joyce Au SUNY Downstate Grand Rounds, October 18, 2012 Neoplastic Colon Polyps Joyce Au SUNY Downstate Grand Rounds, October 18, 2012 CASE 55M with Hepatitis C, COPD (FEV1=45%), s/p vasectomy, knee surgery Meds: albuterol, flunisolide, mometasone, tiotropium

More information

Running head: EARLY IMPLEMENTATION OF CAPSULE ENDOSCOPY Chambers 1. A Cost-Benefit Analysis. Winde R. Chambers. Texas Woman's University

Running head: EARLY IMPLEMENTATION OF CAPSULE ENDOSCOPY Chambers 1. A Cost-Benefit Analysis. Winde R. Chambers. Texas Woman's University Running head: EARLY IMPLEMENTATION OF CAPSULE ENDOSCOPY Chambers 1 Early Implementation of Capsule Endoscopy in Iron Deficiency Anemia: A Cost-Benefit Analysis Winde R. Chambers Texas Woman's University

More information

Quality in Endoscopy and Cost Effective Practice

Quality in Endoscopy and Cost Effective Practice Quality in Endoscopy and Cost Effective Practice Sunanda Kane, MD MSPH FACG Director, ACG Quality Council 1 What is Quality and/or Cost Effectiveness in an Endoscopic Practice? Value Equation Quality (Outcomes,

More information

PAPER. Cinematic Nuclear Scintigraphy Reliably Directs Surgical Intervention for Patients With Gastrointestinal Bleeding

PAPER. Cinematic Nuclear Scintigraphy Reliably Directs Surgical Intervention for Patients With Gastrointestinal Bleeding PAPER Cinematic Nuclear Scintigraphy Reliably Directs Surgical Intervention for Patients With Gastrointestinal Bleeding Brian B. O Neill, MD; Jessica E. Gosnell, MD; Robert J. Lull, MD; William P. Schecter,

More information

Colorectal Cancer Screening. Paul Berg MD

Colorectal Cancer Screening. Paul Berg MD Colorectal Cancer Screening Paul Berg MD What is clinical integration? AMA Definition The means to facilitate the coordination of patient care across conditions, providers, settings, and time in order

More information

\.;" ... ESophagitis (530.1)... Reflux (530.1) '."""""""""""'"""", GI-14

\.; ... ESophagitis (530.1)... Reflux (530.1) '.', GI-14 GASTROENTEROlOGY (J / \.;" -..), GASTRONTESTNAL TABLE OF CONTENTS I. I. FORM LET'1'ER CONDI'1'ONS ESOPHAGUS Achalasia (530.0).....................................................GI-1 Esophageal Tear (Mallory-Weiss

More information

What Is an Endoscopic Ultrasound (EUS)?

What Is an Endoscopic Ultrasound (EUS)? ENDOSCOPIC ULTRASOUND (EUS) What Is an Endoscopic Ultrasound (EUS)? An endoscopic ultrasound (EUS) is a specialized procedure that blends: Endoscopy use of a scope to look at the inside lining of the gastrointestinal

More information

removal of adenomatous polyps detects important effectively as follow-up colonoscopy after both constitute a low-risk Patients with 1 or 2

removal of adenomatous polyps detects important effectively as follow-up colonoscopy after both constitute a low-risk Patients with 1 or 2 Supplementary Table 1. Study Characteristics Author, yr Design Winawer et al., 6 1993 National Polyp Study Jorgensen et al., 9 1995 Funen Adenoma Follow-up Study USA Multi-center, RCT for timing of surveillance

More information

Medical Policy An independent licensee of the Blue Cross Blue Shield Association

Medical Policy An independent licensee of the Blue Cross Blue Shield Association Virtual Colonoscopy / CT Colonography Page 1 of 19 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: Virtual Colonoscopy / CT Colonography Professional Institutional

More information

Characterization of patients with non-varicose upper GI bleeding at a Level 3 Hospital in Cundinamarca, Colombia

Characterization of patients with non-varicose upper GI bleeding at a Level 3 Hospital in Cundinamarca, Colombia Original articles Characterization of patients with non-varicose upper GI bleeding at a Level Hospital in Cundinamarca, Colombia Daysi Rivera H., MD, 1 Julián David Martínez M., MD, 2 José Rafael Tovar

More information

Familial and Hereditary Colon Cancer

Familial and Hereditary Colon Cancer Familial and Hereditary Colon Cancer Aasma Shaukat, MD, MPH, FACG, FASGE, FACP GI Section Chief, Minneapolis VAMC Associate Professor, Division of Gastroenterology, Department of Medicine, University of

More information

Colonoscopy Preparation Using Gavilyte/Colyte

Colonoscopy Preparation Using Gavilyte/Colyte Colonoscopy Preparation Using Gavilyte/Colyte Arrival time Appointment time Date Location Physician When What You Need to Do Details 7 days before your procedure 3 days before Arrange for someone to drive

More information

Screening for Colon Cancer

Screening for Colon Cancer Screening for Colon Cancer What is colon cancer? The colon is the last few feet of your digestive system. Colon cancer happens when cells that are not normal grow in your colon. These cancers usually begin

More information

Colonoscopy Quality Data

Colonoscopy Quality Data Colonoscopy Quality Data www.dhsgi.com Introduction Colorectal cancer is the second leading cause of cancer related deaths in the United States, in men and women combined. In 2016, there are expected to

More information

FREQUENTLY ASKED QUESTIONS

FREQUENTLY ASKED QUESTIONS FREQUENTLY ASKED QUESTIONS What is CRC? CRC (CRC) is cancer of the large intestine (colon), the lower part of the digestive system. Rectal cancer is cancer of the last several inches of the colon. Together,

More information

Colorectal Cancer Screening

Colorectal Cancer Screening Scan for mobile link. Colorectal Cancer Screening What is colorectal cancer screening? Screening examinations are tests performed to identify disease in individuals who lack any signs or symptoms. The

More information

Upper and lower gastrointestinal diseases in liver transplant candidates

Upper and lower gastrointestinal diseases in liver transplant candidates Int J Colorectal Dis (2008) 32:201 206 DOI 10.1007/s00384-007-0386-8 ORIGINAL ARTICLE Upper and lower gastrointestinal diseases in liver transplant candidates G. Gravante & D. Delogu & D. Venditti Accepted:

More information

Comparison of Immunochemical and Guaiac-Based Occult Fecal Tests with Colonoscopy Findings in Symptomatic Patients

Comparison of Immunochemical and Guaiac-Based Occult Fecal Tests with Colonoscopy Findings in Symptomatic Patients 16 The Open Colorectal Cancer Journal, 2009, 2, 16-20 Open Access Comparison of Immunochemical and Guaiac-Based Occult Fecal Tests with Colonoscopy Findings in Symptomatic Patients Jean Louis Frossard

More information

Rx Only. Detecting Cancer In Blood.

Rx Only. Detecting Cancer In Blood. Epi procolon is an FDA-approved blood test for colorectal cancer screening for patients who are unwilling or unable to be screened by recommended methods. Rx Only Intended Use, Contraindications, Warnings,

More information

Lahey Clinic Internal Medicine Residency Program: Curriculum for Gastroenterology

Lahey Clinic Internal Medicine Residency Program: Curriculum for Gastroenterology Lahey Clinic Internal Medicine Residency Program: Curriculum for Gastroenterology Faculty representative: David L. Burns, MD, CNSP Resident representative: Tom Castiglione, MD Revision date: March 6, 2006

More information

Please arrive at The Corvallis Clinic Surgery Center AM / PM

Please arrive at The Corvallis Clinic Surgery Center AM / PM Name: Please arrive at The Corvallis Clinic Surgery Center on @ AM / PM **You must be accompanied by an adult family member/friend, over the age of 18, who can take responsibility for you and sign your

More information

Medical Policy An independent licensee of the Blue Cross Blue Shield Association

Medical Policy An independent licensee of the Blue Cross Blue Shield Association Wireless Capsule Endoscopy to Diagnose Disorders Page 1 of 26 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: Wireless Capsule Endoscopy to Diagnose Disorders of

More information

Estimates of complications and clinically significant findings in screening and surveillance colonoscopy

Estimates of complications and clinically significant findings in screening and surveillance colonoscopy Oregon Health & Science University OHSU Digital Commons Scholar Archive February 2011 Estimates of complications and clinically significant findings in screening and surveillance colonoscopy J. Lucas Williams

More information

Surgery for Complications of Peptic Ulcer Disease (Definitive Treatment)

Surgery for Complications of Peptic Ulcer Disease (Definitive Treatment) Surgery for Complications of Peptic Ulcer Disease (Definitive Treatment) Amid Keshavarzi, MD UCHSC Grand Round 3/20/2006 Department of Surgery Introduction Epidemiology Pathophysiology Clinical manifestation

More information

Bleeding Prevention in an Era of Expanding Combination Antithrombotic Therapies

Bleeding Prevention in an Era of Expanding Combination Antithrombotic Therapies Bleeding Prevention in an Era of Expanding Combination Antithrombotic Therapies Muthiah Vaduganathan, MD MPH Cardiovascular Medicine Brigham and Women s Hospital December 8 th, 2017 Disclosures None Key

More information

Gastroenterology. Certification Examination Blueprint. Purpose of the exam

Gastroenterology. Certification Examination Blueprint. Purpose of the exam Gastroenterology Certification Examination Blueprint Purpose of the exam The exam is designed to evaluate the knowledge, diagnostic reasoning, and clinical judgment skills expected of the certified gastroenterologist

More information

Colonoscopy Preparation Using Generic for Colyte (GaviLyte - C)

Colonoscopy Preparation Using Generic for Colyte (GaviLyte - C) Colonoscopy Preparation Using Generic for Colyte (GaviLyte - C) It is very important that you read these instructions well in advance and follow them completely to ensure a successful exam. It is critical

More information

The focus of Chapter 9 is on anoscopy, proctosigmoidoscopy, flexible sigmoidoscopy, and colonoscopy procedures and all

The focus of Chapter 9 is on anoscopy, proctosigmoidoscopy, flexible sigmoidoscopy, and colonoscopy procedures and all 9 Anoscopy, 45380 45380 45385 Proctosigmoidoscopy, Flexible Sigmoidoscopy, and Colonoscopy 45378 The focus of Chapter 9 is on anoscopy, proctosigmoidoscopy, flexible sigmoidoscopy, and colonoscopy procedures

More information

What is Inflammatory Bowel Disease (IBD)?

What is Inflammatory Bowel Disease (IBD)? INFLAMMATORY BOWEL DISEASE (IBD) What is Inflammatory Bowel Disease (IBD)? Inflammatory bowel disease, or IBD, is when there is inflammation, or swelling, in the gastrointestinal (GI) tract and a lifelong

More information

Cancer Screening Programmes BOWEL CANCER SCREENING. The Facts

Cancer Screening Programmes BOWEL CANCER SCREENING. The Facts Cancer Screening Programmes BOWEL CANCER SCREENING The Facts What is the aim of this leaflet? This leaflet gives you information about bowel cancer, and the benefits and risks of bowel cancer screening.

More information

Safe Answers For The American Board of Surgery Certifying Exam & Recertifying Exam

Safe Answers For The American Board of Surgery Certifying Exam & Recertifying Exam Safe Answers For The American Board of Surgery Certifying Exam & Recertifying Exam By Sarmad Aji, MD., FACS. A comprehensive review of the most commonly asked questions on the American Board of Surgery

More information

Endoscopic Management of Vascular Lesions of the GI tract

Endoscopic Management of Vascular Lesions of the GI tract Endoscopic Management of Vascular Lesions of the GI tract Lake Louise, June 2014 Sergio Zepeda Gómez MD Assistant Professor Division of Gastroenterology University of Alberta, Edmonton Best Practice &

More information