Gastroenterology Commons^™

Scope Of Artificial Intelligence In Screening And Diagnosis Of Colorectal Cancer, Hemant Goyal Md, Rupinder Mann Md, Zainab Gandhi Mbbs, Abhilash Perisetti Md, Aman Ali Md, Khizar Amani Ali, Neil Sharma Md, Benjamin Tharian Md, Shreyas Saligram, Sumant Inamdar

PCI Publications and Projects

Globally, colorectal cancer is the third most diagnosed malignancy. It causes significant mortality and morbidity, which can be reduced by early diagnosis with an effective screening test. Integrating artificial intelligence (AI) and computer-aided detection (CAD) with screening methods have shown promising results for colorectal cancer screening. AI could provide a “second look” for endoscopists to decrease the rate of missed polyps during a colonoscopy. It can also improve detection and characterization of polyps by integration with colonoscopy, various advanced endoscopic modalities like magnifying narrow-band imaging, endocytoscopy, confocal endomicroscopy, laser-induced fluorescence spectroscopy, and magnifying chromoendoscopy. In this review, we have discussed …

Fecal Microbiota Transplantation And Gut Microbiome Effects On Psychiatric Illnesses, Mona Seresht

Physician Assistant Studies | Student Authored Articles

Despite the medical advances that have been made in regards to mental health, psychiatric medications, and alternative therapies, many patients continue to suffer day in and day out, unable to live the type of life they desire. Many times, the medication route includes many episodes of trial and error, side effects, and no significant improvement in actual symptoms. Therapy, although effective, typically necessitates a supplemental medication for the best results. Fecal microbiota transplantation (FMT) is a method where feces from a healthy donor is transferred to an affected patient, typically via colonoscopy. Theoretically, this alters the gut microbiome in a …

Safety Of Endoscopy And Its Outcome In Pregnancy, Lubna Kamani, Muhammad S. Achakzai, Faisal Wasim Ismail, Farhana Kayani

Section of Gastroenterology

Objective: Gastrointestinal (GI) endoscopy is an important tool for diagnosis and treatment of GI diseases. However, when endoscopy is indicated during pregnancy, concerns about its safety for mother and fetus often arise. Our objective was to evaluate the safety and efficacy of endoscopic procedures in pregnant patients along with maternal and fetal outcomes.
Methods: This study was conducted at the Aga Khan University Hospital after Ethics review committee approval. It was a retrospective study and medical records of all pregnant patients who underwent endoscopy during pregnancy from January 2000 to January 2014 were analyzed. Data regarding the indications and type …

Using Shared Decision Making And Team-Based Care To Overcome Socioeconomic And Cultural Barriers To Colorectal Cancer Screenings, Amanda Powell, Debra L. Pyle, Kristin Rowse, Misty Weeman, Rachel Kidder, Ruth Hanselman, Suneela Nayak, Stephen Tyzik, Amy Sparks

Operations Transformation

Colorectal cancer is the third leading cause of cancer death in the United States. It disproportionally affects minorities and those in lower socioeconomic groups. The use of fecal immunochemical testing (FIT) is a low barrier, low cost and low risk screening tool as compared to the traditional colonoscopy exam. The use of FIT offers the opportunity to overcome barriers such as cultural, economic and low health literacy.

As part of a large health care system, an internal medicine clinic wanted to increase the use and return of FIT in their clinic patients. A team developed a plan for implementing improvement …

One-Day Oral Polyethylene Glycol Based Cleanout Is Effective For Pre-Colonoscopy Preparation In Children., Ashwath S. Kumar, Brooke L. Beutler, Thomas M. Attard

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: The adequacy of pre-procedure preparation is the principal determinant of the quality of colonoscopy in pediatric as in adult patients. There is a lack of consensus, among providers on a standard pre-procedure regimen. Professional society guidelines include the use of Polyethylene glycol (PEG). Herein we report on the provider-assessed adequacy of a one day, age-categorized dosing, PEG based cleanout regimen in children undergoing colonoscopy in a tertiary institution.

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METHODS: The standard bowel preparation regime at our institution includes an age dependent minimum PEG dosing regimen in addition to clear liquids the day prior to the procedure. We retrospectively …

A Proposed Therapeutic Algorithm For Colorectal Cancer Prevention, Based On Endoscopic Polypectomies In Patients With Multiple Colonic Polyps, Septimiu Alexandru, Florin D. Ungureanu, Reka Incze Kutasi, Cosmin Alec Moldovan

Journal of Mind and Medical Sciences

Introduction. Results from single medical centers having large numbers of patients with multiple colonic polyps that have undergone colonoscopy management are rare.

Material and method. The present study is based on 2,000 cases enrolled during 2009 and 2017, including patients that underwent colonoscopy for various reasons in the Department for Upper and Lower Endoscopy of Witting Clinical Hospital, Bucharest, Romania.

Results. Of the 2,000 patients examined during 2009 - 2017, 594 tumor formations were detected; 148 (24.9%) patients had colorectal malignancies, and 446 (75%) polypoid formations in 313 patients who had one or more colon polyps were found.

Discussions. After …

A Systematic Review Of The Efficacy And Safety Of Fecal Microbiota Transplant For Clostridium Difficile Infection In Immunocompromised Patients, Oluwaseun Shogbesan, Dilli Ram Poudel, Samjeris Victor, Asad Jehangir, Opeyemi Fadahunsi, Gbenga Shogbesan, Anthony A. Donato

Reading Hospital Internal Medicine Residency

Background: Fecal microbiota transplantation (FMT) has been shown to be effective in recurrent

Methods: We searched MEDLINE and EMBASE for English language articles published on FMT for treatment of CD infection in immunocompromised patients (including patients on immunosuppressant medications, patients with human immunodeficiency virus (HIV), inherited or primary immunodeficiency syndromes, cancer undergoing chemotherapy, or organ transplant, including-bone marrow transplant) of all ages. We excluded inflammatory bowel disease patients that were not on immunosuppressant medications. Resolution and adverse event rates (including secondary infection, rehospitalization, and death) were calculated.

Results: Forty-four studies were included, none of which were randomized designs. A total …

Bowel Preparation Quality Scales For Colonoscopy., David Kastenberg, Gerald Bertiger, Stuart Brogadir

Division of Gastroenterology and Hepatology Faculty Papers

Colorectal cancer (CRC) is the third most common cancer and second leading cause of cancer-related death in the United States. Colonoscopy is widely preferred for CRC screening and is the most commonly used method in the United States. Adequate bowel preparation is essential for successful colonoscopy CRC screening. However, up to one-quarter of colonoscopies are associated with inadequate bowel preparation, which may result in reduced polyp and adenoma detection rates, unsuccessful screens, and an increased likelihood of repeat procedure. In addition, standardized criteria and assessment scales for bowel preparation quality are lacking. While several bowel preparation quality scales are referred …

Upper And Lower Gastrointestinal Endoscopic Findings In Hiv-Infected Patients In The Era Of Highly Active Antiretroviral Therapy., Russell Parvin, Sindhura Kolli, Jamil Shah, Manan Jhaveri, Madhavi Reddy

Articles, Abstracts, and Reports

Background: Endoscopic evaluation with biopsies are instrumental in the diagnosis and management of gastrointestinal (GI) disorders in the setting of human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS), especially in the era of highly active antiretroviral therapy (HAART).

Methods: A retrospective chart review of 304 HIV-positive and 199 HIV-negative patients who had undergone upper and/or lower endoscopy in an urban community hospital from the years 2012 - 2017 was performed. Inclusion criteria included men and women between the ages of 45 to 75 years, which had undergone colonoscopies between within 2012 - 2017 and had tested positive for HIV. …

Fmt Placed By Colonoscopy: Systematic Review And Meta-Analysis, Nadia Huq, Veena Kumaravel, Aboud Affi, Maharaj Singh

Journal of Patient-Centered Research and Reviews

Background: Fecal transplants are successful in the treatment of recurrent or refractory Clostridium difficile infections (CDI), but there is no consensus on the best method of instillation. Studies have shown greater success with lower gastrointestinal tract placement, but technical aspects of placement are not validated.

Purpose: This review aims to identify common traits and procedural techniques of successful fecal microbiota transplant (FMT) therapy via colonoscopy.

Methods: An electronic search was conducted using OVID Medline and PubMed for articles published from January 2010 to January 2016. The primary outcome of interest was cure by FMT placed via colonoscopy.

Results: Of the …

Colonoscopy: Advanced And Emerging Techniques-A Review Of Colonoscopic Approaches To Colorectal Conditions., Anjali S Kumar, Jennifer Kim Lee

Articles, Abstracts, and Reports

A complete colonoscopy is key in the diagnostic and therapeutic approaches to a variety of colorectal diseases. Major challenges are incomplete polyp removal and missed polyps, particularly in the setting of a difficult colonoscopy. There are a variety of both well-established and newer techniques that have been developed to optimize polyp detection, perform complete polypectomy, and endoscopically treat various complications and conditions such as strictures and perforations. The objective of this article is to familiarize the colorectal surgeon with techniques utilized by advanced endoscopists.

Colorectal Cancer Prevention: Perspectives Of Key Players From Social Networks In A Low-Income Rural Us Region, Nancy E. Schoenberg, Kathryn Eddens, Adam Jonas, Claire Snell-Rood, Christina R. Studts, Benjamin Broder-Oldach, Mira L. Katz

Behavioral Science Faculty Publications

Social networks influence health behavior and health status. Within social networks, “key players” often influence those around them, particularly in traditionally underserved areas like the Appalachian region in the USA. From a total sample of 787 Appalachian residents, we identified and interviewed 10 key players in complex networks, asking them what comprises a key player, their role in their network and community, and ideas to overcome and increase colorectal cancer (CRC) screening. Key players emphasized their communication skills, resourcefulness, and special occupational and educational status in the community. Barriers to CRC screening included negative perceptions of the colonoscopy screening procedure, …

Randomised Clinical Trial: Polyethylene Glycol 3350 With Sports Drink Vs. Polyethylene Glycol With Electrolyte Solution As Purgatives For Colonoscopy--The Incidence Of Hyponatraemia., Rebecca Matro, Constantine Daskalakis, Dan Negoianu, Leo Katz, Cassandra Henry, Michael Share, David Kastenberg

Division of Gastroenterology and Hepatology Faculty Papers

BACKGROUND: Polyethylene glycol 3350 plus sports drink (PEG-SD) is a hypo-osmotic purgative commonly used for colonoscopy, though little safety data are available.

AIM: To evaluate the effect of PEG-SD on serum sodium (Na) and other electrolytes compared with PEG-electrolyte solution (PEG-ELS).

METHODS: We performed a single center, prospective, randomised, investigator-blind comparison of PEG-ELS to PEG-SD in out-patients undergoing colonoscopy. Laboratories were obtained at baseline and immediately before and after colonoscopy. The primary endpoint was development of hyponatraemia (Na/L) the day of colonoscopy. Changes in electrolyte levels were computed as the difference between the lowest value on the day of colonoscopy …

Sessile Serrated Adenomas In The Proximal Colon Are Likely To Be Flat, Large And Occur In Smokers, Tarun Rustagi, Priya Rangasamy, Matthew Myers, Melinda Sanders, Haleh Vaziri, George Y. Wu, John W. Birk, Petr Protiva, Joseph C. Anderson

Dartmouth Scholarship

Aim: To examine the epidemiology and the morphology of the proximal sessile serrated adenomas (SSAs).

Methods: We conducted a retrospective study to identify patients with SSAs using a university-based hospital pathology database query from January 2007 to April 2011. Data collected included: age, gender, ethnicity, body mass index, diabetes, smoking, family history of colorectal cancer, aspirin, and statin use. We collected data on morphology of SSAs including site (proximal or distal), size, and endoscopic appearance (flat or protuberant). We also compared proximal SSAs to proximal tubular adenomas detected during same time period.

Yield Of Esophagogastroduodenoscopy And Colonoscopy In Cancer Of Unknown Primary, Muhammad Tayyab Usmani, Abdullah Bin Khalid, Syed Hasnain Ali Shah, Tauseef Ahmad, Saeed S Hamid, Syed M. Wasim Jafri

Section of Gastroenterology

Objectives: Carcinoma of unknown primary origin (CUP) is heterogeneous group of cancers. Role of gastrointestinal (GI) endoscopy in this entity is under investigated. Aim of this study was to evaluate yield of Colonoscopy and Esophagogastroduodenoscopy (EGD) in localizing primary tumor in patients with CUP.

METHODOLOGY: Patients with histopathologically proven CUP who underwent colonoscopy / EGD to find the primary tumor from December 2009 to December 2011 were included in the study. Abdominal symptoms and cytokeratin (CK) 7 and 20 markers were correlated with presence of primary in GI tract.

Results: After giving informed consent 86 patients were included …

Incomplete Polyp Resection During Colonoscopy—Results Of The Complete Adenoma Resection (Care) Study, Heiko Pohl, Amitabh Srivastava, Steve P. Bensen, Peter Anderson, Richard I. Rothstein, Stuart R. Gordon, L Campbell Levy, Arifa Toor, Todd A. Mackenzie, Thomas Rosch, Douglas J. Robertson

Dartmouth Scholarship

Although the adenoma detection rate is used as a measure of colonoscopy quality, there are limited data on the quality of endoscopic resection of detected adenomas. We determined the rate of incompletely resected neoplastic polyps in clinical practice.We performed a prospective study on 1427 patients who underwent colonoscopy at 2 medical centers and had at least 1 nonpedunculated polyp (5-20 mm). After polyp removal was considered complete macroscopically, biopsies were obtained from the resection margin. The main outcome was the percentage of incompletely resected neoplastic polyps (incomplete resection rate [IRR]) determined by the presence of neoplastic tissue in post-polypectomy biopsies. …

Idiopathic Adult Ileoileal And Ileocolic Intussusception In Situs Inversus Totalis: A Rare Coincidence, Nazish Butt, Syed H Shah, Abdul R. Alvi, Saba Hassan

Section of Gastroenterology

Situs inversus totalis is a rare autosomal recessive congenital anomaly that is characterized by mirror image anatomy of the abdominal and thoracic organs. We report a case of a 28-year-old male with situs inversus totalis, who developed an idiopathic ileoileal and ileocolic intussusception, which was diagnosed on computed tomography scan. Patient underwent successfully ileal resection and side-to-side functional anastomosis of ileum 12 cms from ileocecal junction. Postoperative course was uneventful. To the best of our knowledge, this is the first case of idiopathic adult intussusception with situs inversus totalis in the literature.

Efficacy Of Morning-Only Compared With Split-Dose Polyethylene Glycol Electrolyte Solution For Afternoon Colonoscopy: A Randomized Controlled Single-Blind Study., Rebecca Matro, Md, Anastasia Shnitser, Md, Maya Spodik, Md, Constantine Daskalakis, Sc.D, Leo Katz, Md, Alexandra Murtha, Ba, David Kastenberg, Md

Division of Internal Medicine Faculty Papers & Presentations

OBJECTIVES: Administering a purgative close to the time of colonoscopy is optimal for cleansing. The aim of this study was to compare the efficacy and tolerability of morning-only (AM-only) polyethylene glycol electrolyte solution (PEG-ELS) to split-dose (PM/AM) PEG-ELS for afternoon colonoscopy.

METHODS: This was a single-center, prospective, randomized, investigator-blinded, non-inferiority study comparing AM-only to PM/AM PEG-ELS for afternoon outpatient colonoscopy. The primary end point was whole colon prep adequacy. Tolerance and polyp detection were secondary outcomes.

RESULTS: Overall, 125 patients were randomized and 9 withdrew without taking any prep. Of 116 analyzed, 62 received AM-only prep and 54 received PM/AM …

Adenoma Characteristics At First Colonoscopy As Predictors Of Adenoma Recurrence And Characteristics At Follow-Up, Rosalind U. Van Stolk, Gerald J. Beck, John A. Baron, Robert Haile, Robert Summers

Dartmouth Scholarship

All patients with colorectal adenomas may not require identical follow-up. We aimed to determine if adenoma characteristics at initial colonoscopy could predict adenoma recurrence or characteristics at follow-up. The number of adenomas and the size, type, and degree of atypia in 479 patients in a polyp prevention trial were evaluated as predictors of the same characteristics at follow-up using odds ratios (ORs) with 95% confidence intervals (CIs). Multiple logistic regression analysis was performed to determine if several baseline characteristics were simultaneously associated with outcome.