Controversies in Gastroenterology in Asia

Size: px
Start display at page:

Download "Controversies in Gastroenterology in Asia"

Transcription

1 June 13-15, 2013 Berlin, Germany Prof. Joseph Sung The Chinese University of Hong Kong Controversies in Gastroenterology in Asia Disclosure of Potential Conflict of Interest: Nothing to Disclose

2 June 13-15, 2013 Berlin, Germany Controversies in Gastroenterology in Asia 1. Is PPI response different in Asia? 2. Is IBD rare in Asia? 3. Is flat lesions in colon a special feature in Asia?

3 Patients With Recurrent Rebleeding (%) IV Omeprazole Effect on Rebleeding Rates in High-Risk Patients With PUD After Endoscopic Therapy 25% 20% Endoscopy + IV omeprazole Endoscopy + placebo 21.7% 20.0% 22.5% Omeprazole Rx Reduced 15% Endosc. retreat. P < % 5% 4.2%* 5.8%* 6.7%* Transfusions P = 0.03 Length of stay P = % 3 Days 7 Days 30 Days *P <0.001 vs endoscopy + placebo. Lau JYW, et al. N Engl J Med. 2000;343:

4 Median units IV PPI reduces need of endoscopic re-rx and transfusion Omeprazole Placebo Omeprazole Placebo 25 P< P= Endoscopic retreatment Transfusion 4

5 PPI effects: Asian=European Europe Asia Brunner Cardi Corragio Daneshmend Desprez Fried Lanas Michel Perez Flores Schaffalitsky Villanueva Hasselgren Odds Ratio, 95% CI Javid Kaviani Khuroo Lau Lin Sheu Odds Ratio, 95% CI 62/852 vs. 39/ (1.11, 2.55) 8/519 vs. 25/ (0.16, 0.73) Favors treatment Favors control P= Favors treatment Favors control P=.006

6 PUB Study: IV Nexium vs Placebo Randomised, double-blind, placebo-controlled study at 91 centres in 16 countries i.v. treatment (72 hours) Oral treatment (27 days) Endoscopic Haemostasis 1. Single 2. Combo R Esomeprazole i.v. 80 mg over 30 min followed by esomeprazole i.v. 8 mg/h for 71.5 hours Placebo i.v. for 30 min followed by placebo for 71.5 hours Esomeprazole 40 mg qd Just like any other PPI, esomeprazole is not indicated for the management of peptic ulcer bleeding in the world including Malaysia ClinicalTrials.gov identifier: NCT Sung et al. Ann Intern Med 2009 Apr 7;150(7):

7 Significantly less rebleeding with IV Nexium (ITT Population) Esomeprazole Placebo P value (n=375) (n=389) Re-bleed, n 22 (5.9%) 40 (10.3%) % CI 3.7% 8.8% 7.5% 13.7% Risk reduction: 43% (PP Population) Esomeprazole Placebo P value (n=292) (n=316) Re-bleed, n 14 (4.8%) 33 (10.4%) % CI 2.6% 7.9% 6.9% 14% Risk reduction: 54% Sung et al. Ann Intern Med 2009;150:

8 Cumulative percentage (%) Re-bleeding Within 30 Days (ITT Population) Placebo 13.6% (n=53) Log-rank p= Esomeprazole 7.7% (n=29) Days from randomisation Sung et al. Ann Intern Med 2009 Apr 7;150(7):

9 Benefit irrespective of endsocopic Rx Esomeprazole n=375 Placebo n=389 Endoscopy treatment Single Rebleed No rebleed 9 (5.1) 166 (94.9) 17 (9.4) 163 (90.6) Combination Rebleed No rebleed 12 (6.3) 180 (93.8) 21 (10.5) 179 (89.5) Sung et al. Ann Intern Med 2009 Apr 7;150(7):455-64

10 Benefit more Hp positive patients Esomeprazole n=375 Placebo n=389 Hp status Negative Rebleed No rebleed 9 (9.8) 83 (90.2) 14 (11.8) 105 (88.2) Positive Rebleed No rebleed 9 (3.7) 237 (96.3) 19 (8.4) 207 (91.6) Sung et al. Ann Intern Med 2009 Apr 7;150(7):455-64

11 Oral PPI Solutions in Prevention of Rebleeding From PUD Study Endo Rx Drug/Regimen N Rebleeding P Value Comments Kuroo 1 None Omeprazole 40 mg q12hr x 5 days % Placebo % <0.001 >benefit VV, clots ARR = 25.5 NNT = 3 Javid 2 Omeprazole 40 mg q12hr x 5 days % Placebo % 0.02 ARR = 14 NNT = 7 Kaviani 3 Omeprazole 40 mg q12hr x 5 days % Placebo % ARR = 16 NNT = 6 1. Khuroo M, et al. N Engl J Med. 1997;336: Javid G, et al. Am J Med. 2001;111: Kaviani MJ, et al. Aliment Pharmacol Ther. 2003;17: VV, visible vessel. ARR, absolute risk reduction. NNT, number needed to treat.

12 Study period : Jan 1, 2008 to Sept 24, 2011 Sung et al. UEGW screened 215 randomized 348 not randomized 108 no consent 88 other clinical trials 56 On PPI 33 moribund 16 Failed endoscopic Px 6 suspected perforated ulcers 14 Previous gastric surgery 12 unable to withhold antiplatelet agent 15 other treatments 10 Cancer of stomach 105 IV 110 Oral 2 did not start treatment Acute coronary syndrome, antiplatelet agents cont d 2 Lymphoma of stomach 1 Disseminated lung cancer 95 analyzed 105 analyzed

13 Severity of Bleeding and Ulcer Characteristics Sung et al. UEGW 2012 Intravenous n=95 Oral n=105 Gastric Ulcer n, % 41 (43.2) 45 (42.9) Ulcer size >2cm n, % 14 (14.7) 15 (14.3) Helicobacter pylori infection n, % 35 (36.8) 40 (38.1) Stigmata of bleeding n Visible Vessel Clot Oozing Spurter Systolic BP < 100 mmhg n, % 18 (18.9) 24 (22.9) Hb < 9 g/dl n, % 43 (45.3) 40 (38.1) Blood transfusion before endoscopy N, % 38 (40) 51 (48.6)

14 Recurrent bleeding in 30 days Oral PPI Intravenous PPI P = 0.8, Log rank test Days Number at risk Oral IV Sung et al. UEGW 2012

15 Secondary outcomes Intravenous PPI N=95 Oral PPI N=105 P Hospital stay (days) Mean (S.D) median (range) ICU admission (no. of days) ICU admission (no. of patients) 6.2 (4.6) 4 (1-35) (3.3) 5 (3-26) Blood transfusion (units) Post randomization median (range) 2 (0-14) 1 (0-13) 0.14 Unscheduled second look EGD 2 nd endoscopic treatment Angiographic embolization Surgery 1 0 -

16 Early Administration of High-dose Intravenous Omeprazole Prior to Endoscopy in Patients with Upper Gastrointestinal Bleeding: A Double-blind Placebo-controlled Randomized Trial James Y Lau, Wai-K Leung, Justin C Wu, Francis KL Chan, Vincent Wong, Lawrence Hung, Ka-Y Cheung, Man-Y Yung, Vivian W Lee#, Philip W Chiu, Enders K Ng, Kenneth KK Lee#, Joseph JY Sung Institute of Digestive Disease and School of Pharmacy #, the Chinese University of Hong Kong, Hong Kong SAR, China N Engl J Med

17 Pre-endoscopy PPI may reduce the use of endoscopic hemostasis Omeprazole Placebo P, OR (95%CI) N=179 N=190 Endoscopy therapy n, % bleeding ulcers Others 28, 15.6% , 31.1% , 2.4 (1.5-4) Urgent intervention Surgery for hemostasis Rebleeding in 30 days day mortality

18 Pre-endoscopy PPI may reduce the use of endoscopic hemostasis Omeprazole N=179 Placebo N=190 P Mean *VAS for endoscopic therapy in cm, SD 3.7, , Blood transfusion Mean, SD 1.7, , Median range 0, , Hospital stay (all patients) Mean, SD 4.2, , Median, range 3, , Hospital stay (out-bleeders) Mean, SD 3.8, , Median, range 3, , *VAS: visual analogue scale 18

19 Outcomes of patients with PUB Endoscopic treatment n, % Signs of bleeding Spurting / oozing NBVV Clots Flat pigments Clean base Omeprazole N=110 Placebo N=112 P OR (95%CI) 19, 17.2% 40, 35.7%.002, 2.6 (1.4-5) Urgent intervention Surgery

20 Global Map of Inflammatory Bowel Disease Cosnes et al. Gastroenterology 2010; Ng et al. Gut 2013 >10 per 100,000 <4 per 100, per 100,000

21 IBD Epidemiology Worldwide Molodecky et al. Gastroenterology 2012 High Incidence 20-25/100,000 Low Incidence <5/100,000 Canada United States Europe Asia South America Africa High Incidence 10-25/100,000 Australia New Zealand

22 IBD in Hong Kong (Leong et al. 2003) hospital-based UC CD UC in Korea (Yang et al.2008) Songpa-Kangdong district UC in Japan (National IBD Registry) Goh et al. Inflamm Bowel Dis 2004

23 Why is it Important to Understand the True Incidence of IBD in Asia? 4.2 billion people live in the Asia-Pacific region (61% of the world's population) Estimate disease burden Anticipate healthcare needs Better understanding of causative factors

24 Epidemiology of IBD in Asia Limited prospective, population-based, incidence data Most reports hospital-based Little known of regional differences in disease phenotype and severity at presentation

25 Gastroenterology 2013 (epub ahead of print)

26 Study Aim To prospectively investigate the incidence of IBD across 9 countries in Asia-Pacific To determine the phenotype of IBD at diagnosis in Asia

27 Background Study Population China Guangzhou 2.6X10 6 Chengdu 2.7X10 6 Xian 8.9X10 6 Thailand Chiangmai 1.6X10 6 Bangkok 3.9X10 6 Hong Kong 3.2X10 6 Macau 5X10 5 Sri Lanka 2.2X10 6 Malaysia 8.5X10 5 Singapore 3.7X10 6 Indonesia 9X10 5 Australia Melbourne 3X10 5

28 Case Identification Diagnostic criteria Gastroenterologists, pediatricians, surgeons, radiologists, and pathologists within each hospital Suspected incident cases Referred to gastroenterologist Clinical diagnosis of IBD Reminder to all doctors every month Main investigators meet every 3 months to review case notes Cross-checking Exclude if diagnosis uncertain Follow up review of case notes 3-6 months after diagnosis Confirmed diagnosis of IBD A retrospective search of all histology reports, colonoscopy reports, medical records and pharmacy records at each hospital

29 Results 419 new IBD cases 232 (55.4%) ulcerative colitis 166 (39.6%) Crohn s disease 21 (5.0%) indeterminate colitis 58% of patients were male Median age at diagnosis was 39 years (range, 5 to 81)

30 Crude Annual Incidence of IBD (per 100,000) Ng et al. Gastroenterology 2013 (epub ahead of print) Country Crude annual incidence (per 100,000 persons) 95% confidence interval Australia Mainland China (Guangzhou) Hong Kong Macau Sri Lanka Singapore Malaysia Indonesia Thailand (Chiangmai) Thailand (Bangkok) Mainland China (Chengdu) Mainland China (Xian)

31 Ratio of Ulcerative colitis : Crohn s disease Country Ulcerative Colitis Crohn s disease UC/CD Ratio Australia Mainland China (Guangzhou) Hong Kong Macau Sri Lanka Singapore Malaysia Indonesia Thailand (Chiangmai) Thailand (Bangkok) Mainland China (Chengdu) Mainland China (Xian)

32 Disease Demographics Australia Asia P Value N (%) N (%) Age, (mean± SD) (18.67) (15.96) Sex (male) 35 (49%) 209 (60%) Median time from 5 (1-15) 6 (3-24) symptom onset to diagnosis, months (IQR) Smoking history Current Ex Never 8(11%) 19 (26%) 45 (63%) 28 (8%) 70 (20%) 250 (72%) Family history of IBD 12 (17%) 10 (3%) <0.001 Diagnosis as inpatient 18 (25%) 97 (28%) 0.637

33 Isolated terminal ileal disease is uncommon Crohn s disease Terminal ileum alone 4 (5%) Location of disease Colon alone 19 (24%) Ileocolonic 40 (50%) Proximal to TI 14 (18%)

34 Colon involvement is more common Crohn s disease Location of disease Hong Kong Minnesota Ileum Colon Ileocolon Proximal

35 Disease Phenotype at Diagnosis CD location L1 (Terminal ileum) L2 (Colon) L3 (Ileocolon) L4 (Upper gastrointestinal) Australia N (%) 13 (31%) 10 (24%) 19 (45%) 2 (5%) Asia N (%) 38 (31%) 30 (24%) 56 (45%) 6 (5%) P Value CD behavior B1 (Inflammatory) B2 (Stricturing) B3 (Penetrating) B1p (Perianal) 37 (88%) 4 (10%) 1 (2%) 5 (12%) 82 (66%) 21 (17%) 23 (19%) 22 (18%) UC location E1 (Proctitis) E2 (Distal) E3 (Extensive) 7 (32%) 6 (27%) 9 (41%) 78 (37%) 67 (32%) 65 (31%)

36 Proportion (%) Evolution of disease behavior as determined by the Montreal Classification over 10 years in Chinese patients with Crohn s Disease. Chow et al. Inflamm Bowel Dis B1 Nonstricturing, nonpenetrating B2 Stricturing B3 Penetrating Time (years) (P = 0.025) (P = 0.005)

37 Cumulative survival of Chinese CD patients free from major surgery upon 10 years of follow-up Chow and Sung et al. Inflamm Bowel Dis 2008

38 Cumulative colectomy-free survival in the Chinese UC patients Chow and Sung et al. Am J Gastroenterol 2009

39 CRC Incidence Globocan 2013 Man Woman

40 Colorectal Cancer in Asia F e m a le M a le J a p a n, N a g a s a k i C ity J a p a n, M iya g i P re fe c tu re J a p a n, Y a m a g a ta P re fe c tu re S in g a p o re : C h in e s e J a p a n, O s a k a P re fe c tu re C h in a, H o n g K o n g P h ilip p in e s, M a n ila C h in a, S h a n g h a i S in g a p o re : M a la y C h in a, T ia n jin S in g a p o re : In d ia n T h a ila n d, C h ia n g M a i C o lo n R e ctu m In d ia, B o m b a y U K, S o u th T h a m e s R e g io n U S A, S E E R : W h ite C a n a d a U K, S c o tla n d U S A, S E E R : B la c k A g e -sta n d a rd ize d ra te (p e r 1 0 0,0 0 0 ) Sung et al. Lancet Oncology Lan

41 Asian Pacific Working Group Studies 860 asymptomatic subjects underwent colonoscopy in 11 cities Advanced neoplasm found in 4.5% 1.8% of proximal advanced neoplasm found in the absence of distal lesion

42 Adenoma: Screening Population (N=860) All Adenoma (%) Adv Neoplasm (%) Invasive Cancer (%) Distal Colon 76 (8.8) 19 (2.1) 6 (0.7) Proximal Colon 66 (7.7) 17 (2.0) 3 (0.3) Synchronous Lesions 26 (3.0) 3 (0.3) 0 (0) Total 168 (18.5) 39 (4.5) 9 (1.0) Byeon et al. GIE 2006

43 Pathway of colorectal carcinogenesis Adenoma-carcinoma sequence De novo pathway

44 Evidence of de novo Cancer Type I pits Type IIIs pits

45 Flat adenoma: more difficult to find, but more dangerous lesions Chiu et al. Gut 2007

46 How common is flat and depressed lesion? Japan multi-center data Center Prevalence of depressed lesion Percentage of high grade dysplasia NCCH 2.7% (154/5634) 55.3% (47/85) Showa Univ. 2.4% (443/18310) 45.3% (139/307) Hiroshima Univ. 2.3% (187/8035) 56.8% (75/132) Tama Cancer Center 1.6% (219/13960) 61.0% (89/146) NCCHE 1.6% (128/8234) 41.0% (32/78) Kobe Univ. 1.5% (63/4154) 52.2% (12/23) Sapporo Kosei 1.4%(73/5092) 62.5% (30/48) JR Sendai 0.7% (24/3251) 60.0% (3/5) Prevalence: 1.89% (95%CI: %)

47 Is this a Japanese disease only? Western data Soetikno R et al, Gastroenterol 2006 Authors (country) and number of patients studied Jaramillo (Sweden) N = 232 Fujii (UK) N = 208 Rembacken (UK) N = 1000 Saitoh (US) N = 211 Tsuda (Sweden) N = 973 Hurlstone(UK) N = 850 % of patients with NP- CRN % of all CRN with non polypoid morphology % of all NP-CRN with high-grade dysplasia, % of flat NP-CRN with submucosal invasive carcinoma % of depressed NP-CRN with submucosal invasive carcinoma Not stated Not stated Not stated Not stated

48 New endoscopic modalities: is it better?

49 Performance of different modalitis Sensitivity (%) Specificity (%) Accuracy (%) PPV (%) NPV (%) Likelihood Ratio Endoscopic Modality Reader 1 Reader 2 Reader 1 Reader 2 Reader 1 Conventional colonoscopy NBI-Low NBI-High Chromoendoscop y-l Chromoendoscop y-h Reader 2 Reader 1 Reader 2 Reader 1 Reader 2 Reader 1 Reader 2 Chiu Chiu HM et al. Gut (in press)

50 CRC Screening Recommendation CTC Polyp <5mm 1-2 Polyp 6-9mm 3 Polyp 6-9mm Polyp >10mm Need not be reported Continue CTC Surveillance in 3 years Polypectomy Polypectomy Repeat CTC In 5-10 years Repeat colonoscopy in 3 years if 1. Adenoma >10mm 2. >3 adenoma, 3. Villous architecture in adenoma Zalis et al. Radiology 2005;236:

51 Distribution of Patients on ACR Recommendations (Overall, n=1,752) no. of patients 5 mm mm 10 mm Any size 1 to 2 polyp(s): All Adenoma ACN 3 polyps or more: All Adenoma ACN Any number of polyps: All Adenoma ACN (57.6%) 140 (84.3%) 63 (82.9%) 377 (69.3%) 3 (1.0%) 19 (11.4%) 66 (86.8%) 88 (16.2%) (61.1%) 2 (3.7%) (58.1%) 5 (1.4%) 10 9 (90%) 4 (40%) 5 5 (100%) 5 (100%) (68.1%) 11 (15.9%) (84.7%) 68 (84.0%) 424 (69.2%) 23 (13.1%) 61 (75.3%) 89 (14.5%) Sung et al. CGH % 21.3% 51

52 June 13-15, 2013 Berlin, Germany Controversies in Gastroenterology in Asia 1. Is PPI response different in Asia? 2. Is IBD rare in Asia? 3. Is flat lesions in colon a special feature in Asia?

Helicobacter pylori. Objectives. Upper Gastrointestinal Bleeding Peptic Ulcer Disease

Helicobacter pylori. Objectives. Upper Gastrointestinal Bleeding Peptic Ulcer Disease Upper Gastrointestinal Bleeding Peptic Ulcer Disease Pharmacotherapy Issues in Acute Management and Secondary Prevention Peter J. Zed, B.Sc., B.Sc.(Pharm), Pharm.D. Pharmacotherapeutic Specialist - Emergency

More information

Review article: management of peptic ulcer bleeding the roles of proton pump inhibitors and Helicobacter pylori eradication

Review article: management of peptic ulcer bleeding the roles of proton pump inhibitors and Helicobacter pylori eradication Aliment Pharmacol Ther 2004; 19 (Suppl. 1): 66 70. Review article: management of peptic ulcer bleeding the roles of proton pump inhibitors and Helicobacter pylori eradication G. HOLTMANN* & C. W. HOWDEN

More information

Occult small bowel bleeding - Video capsule first

Occult small bowel bleeding - Video capsule first Occult small bowel bleeding - Video capsule first Prof. Joseph Sung The Chinese University of Hong Kong Disclosure of Potential Conflict of Interest: Nothing to Disclose Obscure Gastrointestinal Bleeding

More information

Simon Everett. Consultant Gastroenterologist, SJUH, Leeds. if this is what greets you in the morning, you probably need to go see a doctor

Simon Everett. Consultant Gastroenterologist, SJUH, Leeds. if this is what greets you in the morning, you probably need to go see a doctor Simon Everett Consultant Gastroenterologist, SJUH, Leeds if this is what greets you in the morning, you probably need to go see a doctor Presentation Audit data and mortality NICE guidance Risk assessment

More information

Page 1. Is the Risk This High? Dysplasia in the IBD Patient. Dysplasia in the Non IBD Patient. Increased Risk of CRC in Ulcerative Colitis

Page 1. Is the Risk This High? Dysplasia in the IBD Patient. Dysplasia in the Non IBD Patient. Increased Risk of CRC in Ulcerative Colitis Screening for Colorectal Neoplasia in Inflammatory Bowel Disease Francis A. Farraye MD, MSc Clinical Director, Section of Gastroenterology Co-Director, Center for Digestive Disorders Boston Medical Center

More information

A bleeding ulcer: What can the GP do? Gastrointestinal bleeding is a relatively common. How is UGI bleeding manifested? Who is at risk?

A bleeding ulcer: What can the GP do? Gastrointestinal bleeding is a relatively common. How is UGI bleeding manifested? Who is at risk? Focus on CME at the University of British Columbia A bleeding ulcer: What can the GP do? By Robert Enns, MD, FRCP Gastrointestinal bleeding is a relatively common disorder affecting thousands of Canadians

More information

ACG Clinical Guideline: Management of Patients with Ulcer Bleeding

ACG Clinical Guideline: Management of Patients with Ulcer Bleeding ACG Clinical Guideline: Management of Patients with Ulcer Bleeding Loren Laine, MD 1,2 and Dennis M. Jensen, MD 3 5 1 Section of Digestive Diseases, Yale University School of Medicine, New Haven, Connecticut,

More information

In What Asia-Pacific Populations is CRC Screening Justified?

In What Asia-Pacific Populations is CRC Screening Justified? WEO CRC SC Meeting APDW Taipei, December 3, 2015 In What Asia-Pacific Populations is CRC Screening Justified? K.G. YEOH MBBS, MMed, FRCP (London), FRCP (Glasg), FAMS Dean, NUS School of Medicine, Senior

More information

Scottish Medicines Consortium

Scottish Medicines Consortium Scottish Medicines Consortium esomeprazole, 40mg vial of powder for solution for intravenous injection or infusion (Nexium I.V. ) No. (578/09) AstraZeneca 09 October 2009 The Scottish Medicines Consortium

More information

New Techniques. Incidence of Peptic Ulcer. Changing. Contents - with an emphasis on peptic ulcer bleeding. Cause of death in peptic ulcer bleeding

New Techniques. Incidence of Peptic Ulcer. Changing. Contents - with an emphasis on peptic ulcer bleeding. Cause of death in peptic ulcer bleeding Contents - with an emphasis on peptic ulcer bleeding New Techniques in Treating GI Bleeding Incidence and cause of death Acid suppression Endoscopic hemostasis Prediction of rebleeding and death Second

More information

T he aim of a scheduled second endoscopy is to detect and

T he aim of a scheduled second endoscopy is to detect and 1403 STOMACH Effect of scheduled second therapeutic endoscopy on peptic ulcer rebleeding: a prospective randomised trial P W Y Chiu, C Y W Lam, S W Lee, K H Kwong, S H Lam, D T Y Lee, S P Y Kwok... See

More information

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

Improved risk assessment in upper GI bleeding

Improved risk assessment in upper GI bleeding EDITORIAL Improved risk assessment in upper GI bleeding Acute upper GI bleeding is the most common GI emergency, with a reported incidence in various epidemiological studies ranging from 50 to over 100

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

Chromoendoscopy - Should It Be Standard of Care in IBD?

Chromoendoscopy - Should It Be Standard of Care in IBD? Chromoendoscopy - Should It Be Standard of Care in IBD? John F. Valentine, MD, FACG Professor of Medicine Division of Gastroenterology, Hepatology and Nutrition University of Utah What is the point of

More information

James Irwin Gastroenterology Department Palmerston North Hospital. Acute Medicine Meeting Hutt Hospital. June 21, 2015

James Irwin Gastroenterology Department Palmerston North Hospital. Acute Medicine Meeting Hutt Hospital. June 21, 2015 The Management of Acute Upper Gastrointestinal Bleeding James Irwin Gastroenterology Department Palmerston North Hospital Acute Medicine Meeting Hutt Hospital June 21, 2015 Outline Common Definitions and

More information

Endoscopic Corner CASE 1. Kimtrakool S Aniwan S Linlawan S Muangpaisarn P Sallapant S Rerknimitr R

Endoscopic Corner CASE 1. Kimtrakool S Aniwan S Linlawan S Muangpaisarn P Sallapant S Rerknimitr R 170 Endoscopic Corner Kimtrakool S Aniwan S Linlawan S Muangpaisarn P Sallapant S Rerknimitr R CASE 1 A 54-year-old woman underwent a colorectal cancer screening. Her fecal immunochemical test was positive.

More information

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

More information

Disclosures. Gastric Intestinal Metaplasia and Early Gastric Cancer: Screening, Surveillance, and Endoscopic Therapy. ASGE Guidelines.

Disclosures. Gastric Intestinal Metaplasia and Early Gastric Cancer: Screening, Surveillance, and Endoscopic Therapy. ASGE Guidelines. Gastric Intestinal Metaplasia and Early Gastric Cancer: Screening, Surveillance, and Endoscopic Therapy Consultant for: Olympus Medtronic US Endoscopy Disclosures Joo Ha Hwang, MD, PhD Associate Professor

More information

SUMMARY INTRODUCTION. Accepted for publication 11 May 2005

SUMMARY INTRODUCTION. Accepted for publication 11 May 2005 Aliment Pharmacol Ther 2005; 22: 169 174. doi: 10.1111/j.1365-2036.2005.02546.x Systematic review and meta-analysis: proton-pump inhibitor treatment for ulcer bleeding reduces transfusion requirements

More information

Early Management of the Patient with Acute GI Bleeding

Early Management of the Patient with Acute GI Bleeding Early Management of the Patient with Acute GI Bleeding Dr Sarah Hearnshaw Consultant Gastroenterologist Newcastle upon Tyne NHS Trust Go through.. Stats Transfusion / resuscitation PPIs When to call us

More information

Peptic ulcer bleeding remains the most common cause of hospitalization

Peptic ulcer bleeding remains the most common cause of hospitalization CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2009;7:311 316 Predicting Mortality in Patients With Bleeding Peptic Ulcers After Therapeutic Endoscopy PHILIP W. Y. CHIU,* ENDERS K. W. NG,* FRANCES K. Y. CHEUNG,*

More information

The effectiveness of telephone reminders and SMS messages on compliance with colorectal cancer screening: an open-label, randomized controlled trial

The effectiveness of telephone reminders and SMS messages on compliance with colorectal cancer screening: an open-label, randomized controlled trial Page1 of 5 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 The effectiveness of telephone reminders and SMS messages on compliance with colorectal cancer screening: an

More information

COLON: Innovations 3 steps, 3 parts..

COLON: Innovations 3 steps, 3 parts.. COLON: Innovations 3 steps, 3 parts.. Detection: I see an abnormality (usually a polyp) Characterization: Is this abnormality neoplastic? (for example: an adenoma) Treatment: it is neoplastic. Can I treat

More information

ASGE and AGA Issue Consensus Statement on Surveillance and Management of Dysplasia in Patients With Inflammatory Bowel Disease

ASGE and AGA Issue Consensus Statement on Surveillance and Management of Dysplasia in Patients With Inflammatory Bowel Disease ASGE and AGA Issue Consensus Statement on Surveillance and Management of Dysplasia in Patients With Inflammatory Bowel Disease DOWNERS GROVE, Ill., (March 5, 2015) The American Society for Gastrointestinal

More information

Latest Endoscopic Guidelines for FAP, HNPCC, IBD, and the General Population

Latest Endoscopic Guidelines for FAP, HNPCC, IBD, and the General Population Latest Endoscopic Guidelines for FAP, HNPCC, IBD, and the General Population David T. Rubin, M.D. Assistant Professor of Medicine Inflammatory Bowel Disease Center MacLean Center for Clinical Medical Ethics

More information

Prevalence and Characteristics of Nonpolypoid Colorectal Neoplasm in an Asymptomatic and Average-Risk Chinese Population

Prevalence and Characteristics of Nonpolypoid Colorectal Neoplasm in an Asymptomatic and Average-Risk Chinese Population CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2009;7:463 470 Prevalence and Characteristics of Nonpolypoid Colorectal Neoplasm in an Asymptomatic and Average-Risk Chinese Population HAN MO CHIU,*,, JAW TOWN

More information

Management of pt1 polyps. Maria Pellise

Management of pt1 polyps. Maria Pellise Management of pt1 polyps Maria Pellise Early colorectal cancer Malignant polyp Screening programmes SM Invasive adenocar cinoma Advances in diagnostic & therapeutic endoscopy pt1 polyps 0.75 5.6% of large-bowel

More information

Predicting the natural history of IBD. Séverine Vermeire, MD, PhD Department of Gastroenterology University Hospital Leuven Belgium

Predicting the natural history of IBD. Séverine Vermeire, MD, PhD Department of Gastroenterology University Hospital Leuven Belgium Predicting the natural history of IBD Séverine Vermeire, MD, PhD Department of Gastroenterology University Hospital Leuven Belgium Patient 1 Patient 2 Age 22 Frequent cramps and diarrhea for 6 months Weight

More information

Turning off the tap: Endoscopy Blood & Guts: Transfusion and bleeding in the medical patient

Turning off the tap: Endoscopy Blood & Guts: Transfusion and bleeding in the medical patient Turning off the tap: Endoscopy Blood & Guts: Transfusion and bleeding in the medical patient John Greenaway 1 Turning off the tap: Endoscopy Answer the questions Benefits and risks of endoscopy Urgency

More information

Safety and Efficacy of Endoscopic Dilatation of Strictures in Crohn s Disease

Safety and Efficacy of Endoscopic Dilatation of Strictures in Crohn s Disease Safety and Efficacy of Endoscopic Dilatation of Strictures in Crohn s Disease Vinna An, Ashwinna Asairinachan, Michael Johnston, James Keck, Paul Salama, Steven Brown, Rodney Woods Department of Colorectal

More information

Lower GI bleeding Management DR EHSANI PROFESSOR IN GASTROENTEROLOGY AND HEPATOLOGY

Lower GI bleeding Management DR EHSANI PROFESSOR IN GASTROENTEROLOGY AND HEPATOLOGY Lower GI bleeding Management DR EHSANI PROFESSOR IN GASTROENTEROLOGY AND HEPATOLOGY 15 FEB 2018 Sources Sources Sources Initial evaluation History Physical examination Laboratory evaluation Obtained at

More information

When to Scope in Lower GI Bleeding: It Must Be Done Now. Lisa L. Strate, MD, MPH Assistant Professor of Medicine University of Washington, Seattle, WA

When to Scope in Lower GI Bleeding: It Must Be Done Now. Lisa L. Strate, MD, MPH Assistant Professor of Medicine University of Washington, Seattle, WA When to Scope in Lower GI Bleeding: It Must Be Done Now Lisa L. Strate, MD, MPH Assistant Professor of Medicine University of Washington, Seattle, WA Outline Epidemiology Overview of available tests Urgent

More information

Sangrado Gastrointestinal Alto Upper GI Bleeding

Sangrado Gastrointestinal Alto Upper GI Bleeding Sangrado Gastrointestinal Alto Upper GI Bleeding Curso Internacional Retos Clinicos en la Gastroenterologia de Urgencias Asociacion Colombiana de Gastroenterologia 31 de Agosto, 2012 Pereira, Risaralda

More information

Dysplasia 4/19/2017. How do I practice Chromoendoscopy for Surveillance of Colitis? SCENIC: Polypoid Dysplasia in UC. Background

Dysplasia 4/19/2017. How do I practice Chromoendoscopy for Surveillance of Colitis? SCENIC: Polypoid Dysplasia in UC. Background SCENIC: Polypoid in UC Definition How do I practice for Surveillance of Colitis? Themos Dassopoulos, M.D. Director, BSW Center for IBD Themistocles.Dassopoulos@BSWHealth.org Tel: 469-800-7189 Cell: 314-686-2623

More information

Razvan I. Arsenescu, MD Assistant Professor of Medicine Division of Digestive Diseases EARLY DETECTION OF COLORECTAL CANCER

Razvan I. Arsenescu, MD Assistant Professor of Medicine Division of Digestive Diseases EARLY DETECTION OF COLORECTAL CANCER Razvan I. Arsenescu, MD Assistant Professor of Medicine Division of Digestive Diseases EARLY DETECTION OF COLORECTAL CANCER Epidemiology of CRC Colorectal cancer (CRC) is a common and lethal disease Environmental

More information

Intragastric ph With Oral vs Intravenous Bolus Plus Infusion Proton- Pump Inhibitor Therapy in Patients With Bleeding Ulcers

Intragastric ph With Oral vs Intravenous Bolus Plus Infusion Proton- Pump Inhibitor Therapy in Patients With Bleeding Ulcers Intragastric ph With Oral vs Intravenous Bolus Plus Infusion Proton- Pump Inhibitor Therapy in Patients With Bleeding Ulcers LOREN LAINE, ABBID SHAH, and SHAHROOZ BEMANIAN Division of Gastrointestinal

More information

Differentiation Between Ileocecal Tuberculosis and Crohn s Disease using a Combination of Clinical, Endoscopic and Histological Characteristics

Differentiation Between Ileocecal Tuberculosis and Crohn s Disease using a Combination of Clinical, Endoscopic and Histological Characteristics 38 Original Article Differentiation Between Ileocecal Tuberculosis and Crohn s Disease using a Combination of Clinical, Endoscopic and Histological Characteristics Anuchapreeda S Leelakusolvong S Charatcharoenwitthaya

More information

EARLY DETECTION OF COLORECTAL CANCER. Epidemiology of CRC

EARLY DETECTION OF COLORECTAL CANCER. Epidemiology of CRC Razvan I. Arsenescu, MD Assistant Professor of Medicine Division of Digestive Diseases EARLY DETECTION OF COLORECTAL CANCER Epidemiology of CRC Colorectal cancer (CRC) is a common and lethal disease Environmental

More information

Does Viral Cure Prevent HCC Development

Does Viral Cure Prevent HCC Development Does Viral Cure Prevent HCC Development Prof. Henry LY Chan Head, Division of Gastroenterology and Hepatology Director, Institute of Digestive Disease Director, Center for Liver Health Assistant Dean,

More information

Advanced techniques for resection of large polyps. John G. Lee, MD February 2, 2018

Advanced techniques for resection of large polyps. John G. Lee, MD February 2, 2018 Advanced techniques for resection of large polyps John G. Lee, MD February 2, 2018 Background 1cm - large polyp on screening 2cm - large for polypectomy 3cm giant polyp 10-15% of polyps can t be removed

More information

Diagnostic and Therapeutic Approaches to Dysplasia in Inflammatory Bowel Diseases

Diagnostic and Therapeutic Approaches to Dysplasia in Inflammatory Bowel Diseases Diagnostic and Therapeutic Approaches to Dysplasia in Inflammatory Bowel Diseases Parakkal Deepak, M.B.B.S., M.S. Assistant Professor of Medicine Division of Gastroenterology John T. Milliken Department

More information

Colorectal cancer screening in Asia

Colorectal cancer screening in Asia Published Online January 8, 2013 Colorectal cancer screening in Asia Siew C. Ng * and Sunny H. Wong Institute of Digestive Disease, Department of Medicine and Therapeutics, Chinese University of Hong Kong,

More information

Predict, Resect and discard : Yes we can! (at least in some hands)

Predict, Resect and discard : Yes we can! (at least in some hands) Diminutive polyps : Real time endoscopic histology Predict, Resect and discard : Yes we can! (at least in some hands) Robert Benamouzig Hôpital Avicenne AP-HP & Paris 13 University France Why it is important?

More information

CASE DISCUSSION: The Patient with Dysplasia: Surgery or Active Surveillance? Noa Krugliak Cleveland, MD David T. Rubin, MD

CASE DISCUSSION: The Patient with Dysplasia: Surgery or Active Surveillance? Noa Krugliak Cleveland, MD David T. Rubin, MD CASE DISCUSSION: The Patient with Dysplasia: Surgery or Active Surveillance? Noa Krugliak Cleveland, MD David T. Rubin, MD Disclosure Statement NKC: No relevant conflicts to disclose. DTR: No relevant

More information

Quality in Endoscopy: Can We Do Better?

Quality in Endoscopy: Can We Do Better? Quality in Endoscopy: Can We Do Better? Erik Rahimi, MD Assistant Professor Division of Gastroenterology, Hepatology, and Nutrition UT Health Science Center at Houston McGovern Medical School Ertan Digestive

More information

British Society of Gastroenterology. St. Elsewhere's Hospital. National Comparative Audit of Blood Transfusion

British Society of Gastroenterology. St. Elsewhere's Hospital. National Comparative Audit of Blood Transfusion British Society of Gastroenterology UK Com parat ive Audit of Upper Gast roint est inal Bleeding and t he Use of Blood Transfusion Extract December 2007 St. Elsewhere's Hospital National Comparative Audit

More information

Chromoendoscopy and Endomicroscopy for detecting colonic dysplasia

Chromoendoscopy and Endomicroscopy for detecting colonic dysplasia Chromoendoscopy and Endomicroscopy for detecting colonic dysplasia Ralf Kiesslich I. Medical Department Johannes Gutenberg University Mainz, Germany Cumulative cancer risk in ulcerative colitis 0.5-1.0%

More information

Objectives. Definitions. Colorectal Cancer Screening 5/8/2018. Payam Afshar, MS, MD Kaiser Permanente, San Diego. Colorectal cancer background

Objectives. Definitions. Colorectal Cancer Screening 5/8/2018. Payam Afshar, MS, MD Kaiser Permanente, San Diego. Colorectal cancer background Colorectal Cancer Screening Payam Afshar, MS, MD Kaiser Permanente, San Diego Objectives Colorectal cancer background Colorectal cancer screening populations Colorectal cancer screening modalities Colonoscopy

More information

Chromoendoscopy or Narrow Band Imaging with Targeted biopsies Should be the Cancer Surveillance Endoscopy Procedure of Choice in Ulcerative Colitis

Chromoendoscopy or Narrow Band Imaging with Targeted biopsies Should be the Cancer Surveillance Endoscopy Procedure of Choice in Ulcerative Colitis Chromoendoscopy or Narrow Band Imaging with Targeted biopsies Should be the Cancer Surveillance Endoscopy Procedure of Choice in Ulcerative Colitis Bret A. Lashner, M.D. Professor of Medicine Director,

More information

Topic. Speaker. Session. Detection. Buffet Lunch. Session Beginner to. Expert. Tea Break. Diseases

Topic. Speaker. Session. Detection. Buffet Lunch. Session Beginner to. Expert. Tea Break. Diseases 24 Feb 2017 (Fri) Lectures and n Venue: Cheung Kung Hai Lecturee Theatre, LKS Faculty of Medicine Co organized by Department of Medicine & Department of Surgery The University of Hong Kong & Queen Mary

More information

Risk assessment in UGIB: recent PCI & ACS. Dr Martin James PhD FRCP October 20 th 2016 Nottingham Endoscopy Masterclass

Risk assessment in UGIB: recent PCI & ACS. Dr Martin James PhD FRCP October 20 th 2016 Nottingham Endoscopy Masterclass Risk assessment in UGIB: recent PCI & ACS Dr Martin James PhD FRCP October 20 th 2016 Nottingham Endoscopy Masterclass Clinical scenario 65 yr male Previous smoker, hyperlipidaemia, DM PCI < 48 hours Dual

More information

Chromoendoscopy as an Adjunct to Colonoscopy

Chromoendoscopy as an Adjunct to Colonoscopy Chromoendoscopy as an Adjunct to Colonoscopy Policy Number: 2.01.84 Last Review: 1/2018 Origination: 7/2017 Next Review: 7/2018 Policy Blue Cross and Blue Shield of Kansas City (Blue KC) will not provide

More information

Accepted Manuscript. Does eradication of Helicobacter pylori cause inflammatory bowel disease? Johan Burisch, Tine Jess

Accepted Manuscript. Does eradication of Helicobacter pylori cause inflammatory bowel disease? Johan Burisch, Tine Jess Accepted Manuscript Does eradication of Helicobacter pylori cause inflammatory bowel disease? Johan Burisch, Tine Jess PII: S1542-3565(19)30153-3 DOI: https://doi.org/10.1016/j.cgh.2019.02.013 Reference:

More information

Fujiya M, Saitoh Y, Watari J, Moriichi K, Kohgo Y.

Fujiya M, Saitoh Y, Watari J, Moriichi K, Kohgo Y. Digestive Endoscopy (2007) 19(s1):S145-S149. Auto-Fluorescence Imaging is useful to assess the activity of ulcerative colitis Fujiya M, Saitoh Y, Watari J, Moriichi K, Kohgo Y. Auto-Fluorescence Imaging

More information

Effect of oral omeprazole in reducing re-bleeding in bleeding peptic ulcers: a prospective, double-blind, randomized, clinical trial

Effect of oral omeprazole in reducing re-bleeding in bleeding peptic ulcers: a prospective, double-blind, randomized, clinical trial Aliment Pharmacol Ther 2003; 17: 211 216. doi: 10.1046/j.0269-2813.2003.01416.x Effect of oral omeprazole in reducing re-bleeding in bleeding peptic ulcers: a prospective, double-blind, randomized, clinical

More information

Upper GI Bleeding. HH Tsai MD FRCP FECG Consultant Gastroenterologist

Upper GI Bleeding. HH Tsai MD FRCP FECG Consultant Gastroenterologist Upper GI Bleeding HH Tsai MD FRCP FECG Consultant Gastroenterologist Financial Disclosures I have no financial relationship with any manufacturer or supplier of any product mentioned in this talk. GI Audits:

More information

Crohn s Disease: Should We Treat Based on Symptoms or Based on Objective Markers of Inflammation?

Crohn s Disease: Should We Treat Based on Symptoms or Based on Objective Markers of Inflammation? Crohn s Disease: Should We Treat Based on Symptoms or Based on Objective Markers of Inflammation? Edward V. Loftus, Jr., M.D. Professor of Medicine Division of Gastroenterology and Hepatology Mayo Clinic

More information

Disclosures. GI Motility Disorders. Gastrointestinal Motility Disorders & Irritable Bowel Syndrome

Disclosures. GI Motility Disorders. Gastrointestinal Motility Disorders & Irritable Bowel Syndrome Gastrointestinal Motility Disorders & Irritable Bowel Syndrome None Disclosures Jasmine Zia, MD Acting Assistant Professor Division of Gastroenterology, University of Washington 6 th Asian Health Symposium

More information

Development of Robotic Endoscopic Surgical Platform for Treatment of Early Gastrointestinal Cancers

Development of Robotic Endoscopic Surgical Platform for Treatment of Early Gastrointestinal Cancers Development of Robotic Endoscopic Surgical Platform for Treatment of Early Gastrointestinal Cancers Philip WY Chiu MD, MBChB, FRCSEd, FCSHK FHKAM (Surg) Professor, Department of Surgery, Institute of Digestive

More information

Oral versus intravenous proton pump inhibitors in preventing re-bleeding for patients with peptic ulcer bleeding after successful endoscopic therapy

Oral versus intravenous proton pump inhibitors in preventing re-bleeding for patients with peptic ulcer bleeding after successful endoscopic therapy Yen et al. BMC Gastroenterology 2012, 12:66 RESEARCH ARTICLE Open Access Oral versus intravenous proton pump inhibitors in preventing re-bleeding for patients with peptic ulcer bleeding after successful

More information

Acute Upper Gastro Intestinal (UGI) Bleeding

Acute Upper Gastro Intestinal (UGI) Bleeding T Acute Upper Gastro Intestinal (UGI) Bleeding University Hospitals of Leicester NHS Trust Guidelines for Management of Acute Medical Emergencies 1. Has there been a GI bleed? There are also UHL trust

More information

ESMO Preceptorship Program Head & Neck Cancer NPC: Epidemiology, diagnosis and work-up

ESMO Preceptorship Program Head & Neck Cancer NPC: Epidemiology, diagnosis and work-up ESMO Preceptorship Program Head & Neck Cancer NPC: Epidemiology, diagnosis and work-up Dr. John Woo Consultant, ENT Department, PWH Honorary Clinical Professor, Department of Otorhinolaryngology, H&N Surgery

More information

BENEFIT APPLICATION BLUE CARD/NATIONAL ACCOUNT ISSUES

BENEFIT APPLICATION BLUE CARD/NATIONAL ACCOUNT ISSUES Medical Policy BCBSA Ref. Policy: 2.01.84 Last Review: 11/15/2018 Effective Date: 11/15/2018 Section: Medicine Related Policies 2.01.87 Confocal Laser Endomicroscopy 6.01.32 Virtual Colonoscopy/Computed

More information

How to characterize dysplastic lesions in IBD?

How to characterize dysplastic lesions in IBD? How to characterize dysplastic lesions in IBD? Name: Institution: Helmut Neumann, MD, PhD, FASGE University Medical Center Mainz What do we know? Patients with IBD carry an increased risk of developing

More information

NON INVASIVE MONITORING OF MUCOSAL HEALING IN IBD. THE ROLE OF BOWEL ULTRASOUND. Fabrizio Parente

NON INVASIVE MONITORING OF MUCOSAL HEALING IN IBD. THE ROLE OF BOWEL ULTRASOUND. Fabrizio Parente NON INVASIVE MONITORING OF MUCOSAL HEALING IN IBD. THE ROLE OF BOWEL ULTRASOUND Fabrizio Parente Gastrointestinal Unit, A.Manzoni Hospital, Lecco & L.Sacco School of Medicine,University of Milan - Italy

More information

General and Colonoscopy Data Collection Form

General and Colonoscopy Data Collection Form Identifier: Sociodemographic Information Type: Zip Code: Inpatient Outpatient Birth Date: m m d d y y y y Gender: Height: (inches) Male Female Ethnicity: Weight: (pounds) African American White, Non-Hispanic

More information

Prof Rupert Leong, Director of Endoscopy, Head of IBD Professor of Medicine UNSW, University of Sydney, Concord Hospital Australia IBDSydney

Prof Rupert Leong, Director of Endoscopy, Head of IBD Professor of Medicine UNSW, University of Sydney, Concord Hospital Australia IBDSydney 10:30-10:50 25 Sept 2017 Monday A-PSDE / WEO Colorectal Cancer Screening Committee (CRCSC) Meeting Room S228 (2/F) Prof Rupert Leong, Director of Endoscopy, Head of IBD Professor of Medicine UNSW, University

More information

Global colorectal cancer screening appropriate or practical? Graeme P Young, Flinders University WCC, Melbourne

Global colorectal cancer screening appropriate or practical? Graeme P Young, Flinders University WCC, Melbourne Global colorectal cancer screening appropriate or practical? Graeme P Young, Flinders University. 2014 WCC, Melbourne Outline WHO criteria to justify screening Appropriateness: Global variation in incidence

More information

LIST OF ABBREVIATIONS

LIST OF ABBREVIATIONS Gastroenter oenterology 2005 Royal College of Physicians of Edinburgh Screening and surveillance for upper and lower gastrointestinal cancer JN Plevris Consultant Gastroenterologist and Honorary Senior

More information

ESMO Preceptorship Program Head & Neck Cancer NPC: Epidemiology, diagnosis and work-up

ESMO Preceptorship Program Head & Neck Cancer NPC: Epidemiology, diagnosis and work-up ESMO Preceptorship Program Head & Neck Cancer NPC: Epidemiology, diagnosis and work-up Dr. John Woo Consultant, ENT Department, PWH Honorary Clinical Professor, Department of Otorhinolaryngology, H&N Surgery

More information

Barrett s Esophagus. Abdul Sami Khan, M.D. Gastroenterologist Aurora Healthcare Burlington, Elkhorn, Lake Geneva, WI

Barrett s Esophagus. Abdul Sami Khan, M.D. Gastroenterologist Aurora Healthcare Burlington, Elkhorn, Lake Geneva, WI Barrett s Esophagus Abdul Sami Khan, M.D. Gastroenterologist Aurora Healthcare Burlington, Elkhorn, Lake Geneva, WI A 58 year-old, obese white man has had heartburn for more than 20 years. He read a magazine

More information

C olorectal adenomas are reputed to be precancerous

C olorectal adenomas are reputed to be precancerous 568 COLORECTAL CANCER Incidence and recurrence rates of colorectal adenomas estimated by annually repeated colonoscopies on asymptomatic Japanese Y Yamaji, T Mitsushima, H Ikuma, H Watabe, M Okamoto, T

More information

Dr. LEUNG Lok Hang, Will

Dr. LEUNG Lok Hang, Will Direct access endoscopy booking by family physicians: evaluating a new service model and clinical predictors of positive endoscopy findings at primary care setting Dr. LEUNG Lok Hang, Will Department of

More information

Quality Measures In Colonoscopy: Why Should I Care?

Quality Measures In Colonoscopy: Why Should I Care? Quality Measures In Colonoscopy: Why Should I Care? David Greenwald, MD, FASGE Professor of Clinical Medicine Albert Einstein College of Medicine Montefiore Medical Center Bronx, New York ACG/ASGE Best

More information

Deep Enteroscopy Methods to Diagnose Small Bowel IBD

Deep Enteroscopy Methods to Diagnose Small Bowel IBD Deep Enteroscopy Methods to Diagnose Small Bowel IBD Name: Institution: Peter Draganov University of Florida, Gainesville, FL Overview Types of enteroscopy Enteroscopy equipment Enetoscopy do and don'ts

More information

Comparison of adrenaline injection and bipolar electrocoagulation for the arrest of peptic ulcer bleeding

Comparison of adrenaline injection and bipolar electrocoagulation for the arrest of peptic ulcer bleeding Gut 1999;44:715 719 715 Division of Gastroenterology, Department of Medicine, Veterans General Hospital, Taipei, Taiwan, Republic of China H-J Lin G-Y Tseng C-L Perng F-Y Lee F-Y Chang S-D Lee Correspondence

More information

How to differentiate Segmental Colitis Associated with Diverticulosis and Inflammatory Bowel Diseases?

How to differentiate Segmental Colitis Associated with Diverticulosis and Inflammatory Bowel Diseases? How to differentiate Segmental Colitis Associated with Diverticulosis and Inflammatory Bowel Diseases? Alessandro Armuzzi Lead IBD Unit Complesso Integrato Columbus Fondazione Policlinico Gemelli Università

More information

GIQIC18 Appropriate follow-up interval of not less than 5 years for colonoscopies with findings of 1-2 tubular adenomas < 10 mm

GIQIC18 Appropriate follow-up interval of not less than 5 years for colonoscopies with findings of 1-2 tubular adenomas < 10 mm GI Quality Improvement Consortium, Ltd. (GIQuIC) 1 Following is an overview of the clinical quality measures in GIQuIC that can be reported to CMS for the Quality performance category of the Merit-Based

More information

Continuation of Low-Dose Aspirin Therapy with Either PR or PO Administration in Patients with Peptic Ulcer Bleeding

Continuation of Low-Dose Aspirin Therapy with Either PR or PO Administration in Patients with Peptic Ulcer Bleeding Continuation of Low-Dose Aspirin Therapy with Either PR or PO Administration in Patients with Peptic Ulcer Bleeding IRB Protocol Lucian Iancovici February 4, 2010 A. Study Design and Purpose Aspirin has

More information

Colorectal Cancer Screening: A Clinical Update

Colorectal Cancer Screening: A Clinical Update 11:05 11:45am Colorectal Cancer Screening: A Clinical Update SPEAKER Kevin A. Ghassemi, MD Presenter Disclosure Information The following relationships exist related to this presentation: Kevin A. Ghassemi,

More information

Korean gastric cancer screening program, algorithms and experience.

Korean gastric cancer screening program, algorithms and experience. Korean gastric cancer screening program, algorithms and experience. Jun Haeng Lee, MD. Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea Today s topics Korean cancer screening

More information

When is a programmed follow-up meaningful and how should it be done? Professor Alastair Watson University of Liverpool

When is a programmed follow-up meaningful and how should it be done? Professor Alastair Watson University of Liverpool When is a programmed follow-up meaningful and how should it be done? Professor Alastair Watson University of Liverpool Adenomas/Carcinoma Sequence Providing Time for Screening Normal 5-20 yrs 5-15 yrs

More information

GUIDANCE ON THE INDICATIONS FOR DIAGNOSTIC UPPER GI ENDOSCOPY, FLEXIBLE SIGMOIDOSCOPY AND COLONOSCOPY

GUIDANCE ON THE INDICATIONS FOR DIAGNOSTIC UPPER GI ENDOSCOPY, FLEXIBLE SIGMOIDOSCOPY AND COLONOSCOPY Position Statement produced by BSG, AUGIS and ACPGBI GUIDANCE ON THE INDICATIONS FOR DIAGNOSTIC UPPER GI ENDOSCOPY, FLEXIBLE SIGMOIDOSCOPY AND COLONOSCOPY Introduction In 2011 the Independent Practice

More information

Quality of and compliance with colonoscopy in Lynch Syndrome surveillance: are we getting it right?

Quality of and compliance with colonoscopy in Lynch Syndrome surveillance: are we getting it right? Quality of and compliance with colonoscopy in Lynch Syndrome surveillance: are we getting it right? Hartery K 1, Sukha A 1, Thomas-Gibson S 1, Thomas H 1,2, Latchford A 1,2. 1 Wolfson Endoscopy Unit, St.

More information

EMR, ESD and Beyond. Peter Draganov MD. Professor of Medicine Division of Gastroenterology, Hepatology and Nutrition University of Florida

EMR, ESD and Beyond. Peter Draganov MD. Professor of Medicine Division of Gastroenterology, Hepatology and Nutrition University of Florida EMR, ESD and Beyond Peter Draganov MD Professor of Medicine Division of Gastroenterology, Hepatology and Nutrition University of Florida Gastrointestinal Cancer Lesion that Can be Treated by Endoscopy

More information

Position of Biologics in IBD Circa 2006: Top Down vs. Step Up Therapy

Position of Biologics in IBD Circa 2006: Top Down vs. Step Up Therapy Position of Biologics in IBD Circa 2006: Top Down vs. Step Up Therapy Stephen B. Hanauer, MD University of Chicago Potential Conflicts: Centocor/Schering, Abbott, UCB, Elan, Berlex, PDL Goals of Treatment

More information

The Incidence Rate of Inflammatory Bowel Disease in an Urban Area of Iran: A Developing Country

The Incidence Rate of Inflammatory Bowel Disease in an Urban Area of Iran: A Developing Country 32 Original Article The Incidence Rate of Inflammatory Bowel Disease in an Urban Area of Iran: A Developing Country Mohammad Javad Zahedi 1, Sodaif Darvish Moghadam 1, Mehdi Hayat Bakhsh Abbasi 1, Masood

More information

Management of Lower Gastrointestinal Bleeding. Patrick Lau Department of Surgery Kwong Wah Hospital

Management of Lower Gastrointestinal Bleeding. Patrick Lau Department of Surgery Kwong Wah Hospital Management of Lower Gastrointestinal Bleeding Patrick Lau Department of Surgery Kwong Wah Hospital Lower Gastrointestinal bleeding The challenge Account for 20% of gastrointestinal bleeding 80% stopped

More information

Outcome of endoscopic treatment for peptic ulcer bleeding: Is a second look necessary? A meta-analysis

Outcome of endoscopic treatment for peptic ulcer bleeding: Is a second look necessary? A meta-analysis Outcome of endoscopic treatment for peptic ulcer bleeding: Is a second look necessary? A meta-analysis Riccardo Marmo, MD, Gianluca Rotondano, MD, Maria Antonia Bianco, MD, Roberto Piscopo, MD, Antonio

More information

Present Status and Perspectives of Colorectal Cancer in Asia: Colorectal Cancer Working Group Report in 30th Asia-Pacific Cancer Conference

Present Status and Perspectives of Colorectal Cancer in Asia: Colorectal Cancer Working Group Report in 30th Asia-Pacific Cancer Conference Present Status and Perspectives of Colorectal Cancer in Asia: Colorectal Cancer Working Group Report in 30th Asia-Pacific Cancer Conference Jpn J Clin Oncol 2010;40(Supplement 1)i38 i43 doi:10.1093/jjco/hyq125

More information

Diagnostic techniques for surveillance of dysplasia

Diagnostic techniques for surveillance of dysplasia January 27th 2017, 8th Gastro Foundation Weekend for Fellows; Spier Hotel & Conference Centre, Stellenbosch Diagnostic techniques for surveillance of dysplasia Gerhard Rogler, Department of Gastroenterology

More information

Prevention of Bowel Cancer: which patients do I send for colonoscopy?

Prevention of Bowel Cancer: which patients do I send for colonoscopy? Prevention of Bowel Cancer: which patients do I send for colonoscopy? Dr Chris Groves Consultant Gastroenterologist and Honorary Senior Lecturer St George s Hospital and Medical School Director, SW London

More information

Barrett s Esophagus: Old Dog, New Tricks

Barrett s Esophagus: Old Dog, New Tricks Barrett s Esophagus: Old Dog, New Tricks Stuart Jon Spechler, M.D. Chief, Division of Gastroenterology, VA North Texas Healthcare System; Co-Director, Esophageal Diseases Center, Professor of Medicine,

More information

Colon Polyps: Detection, Inspection and Characteristics

Colon Polyps: Detection, Inspection and Characteristics Colon Polyps: Detection, Inspection and Characteristics Stephen Kim, M.D. Assistant Professor of Medicine Interventional Endoscopy Services UCLA Division of Digestive Diseases September 29, 2018 1 Disclosures

More information

Guidelines for Colonoscopy Surveillance After Screening and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer

Guidelines for Colonoscopy Surveillance After Screening and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer Guidelines for Colonoscopy Surveillance After Screening and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer David A. Lieberman, 1 Douglas K. Rex, 2 Sidney J. Winawer,

More information

Pantoprazole infusion as adjuvant therapy to endoscopic treatment in patients with peptic ulcer bleeding: Prospective randomized controlled trial

Pantoprazole infusion as adjuvant therapy to endoscopic treatment in patients with peptic ulcer bleeding: Prospective randomized controlled trial Blackwell Publishing AsiaMelbourne, AustraliaJGHJournal of Gastroenterology and Hepatology0815 93192006 Blackwell Publishing Asia Pty Ltd200621716721Original Article Pantoprazole in bleeding peptic ulcerssa

More information

Objec-ve. Case Presenta-ons and Ques-ons to Panel. Dysplasia case 11/13/11

Objec-ve. Case Presenta-ons and Ques-ons to Panel. Dysplasia case 11/13/11 Case Presenta-ons and Ques-ons to Panel UCSF IBD Symposium November 12, 2011 Moderator Fernando Velayos MD Panelists Brian Feagan, MD James Lewis, MD MSCE Robert Cima, MD Hueylan Chern, MD Sunanda Kane,

More information

Intermittent vs Continuous Proton Pump Inhibitor Therapy for High-Risk Bleeding Ulcers A Systematic Review and Meta-analysis

Intermittent vs Continuous Proton Pump Inhibitor Therapy for High-Risk Bleeding Ulcers A Systematic Review and Meta-analysis Research Original Investigation Intermittent vs Continuous Proton Pump Inhibitor Therapy for High-Risk Bleeding Ulcers A Systematic Review and Meta-analysis Hamita Sachar, MD; Keta Vaidya, MD; Loren Laine,

More information

Asia-Pacific Working Group consensus on non-variceal upper gastrointestinal bleeding

Asia-Pacific Working Group consensus on non-variceal upper gastrointestinal bleeding Asia-Pacific Working Group consensus on non-variceal upper gastrointestinal bleeding Joseph J Y Sung, 1 Francis K L Chan, 2 Minhu Chen, 3 Jessica Y L Ching, 3 K Y Ho, 4 Udom Kachintorn, 3 Nayoung Kim,

More information