Andrew W. Yen

A novel method with significant impact on adenoma detection: combined water-exchange and cap-assisted colonoscopy.

BACKGROUND Water exchange provides salvage cleansing and improves adenoma detection, but drawbacks include prolonged procedure time. Cap-assisted colonoscopy decreases cecal intubation time but is limited by impaired views when feces lodge in the cap. OBJECTIVE To investigate the impact of combined water-exchange and cap-assisted colonoscopy (WCC) on detection of adenomas and proximal colon serrated polyps. DESIGN Retrospective, single-center, single-colonoscopist, consecutive group observational study. SETTING Veterans Affairs outpatient endoscopy suite. PATIENTS Outpatients undergoing screening or surveillance colonoscopy. INTERVENTION WCC data collected from 100 consecutive patients were compared to a control group of 101 consecutive patients examined with conventional air insufflation colonoscopy during the prior 4-month period. MAIN OUTCOME MEASUREMENTS Adenoma detection rate (ADR), adenomas detected per colonoscopy, proximal colon serrated polyp detection rate, and proximal colon serrated polyps per colonoscopy rate. RESULTS Compared with controls, the WCC group had a higher polyp detection rate (93.0% vs 84.2%; P = .07), ADR (75.0% vs 59.4%; P = .02), proximal colon ADR (61.0% vs 47.5%; P = .07), proximal colon serrated polyp detection rate (24.0% vs 9.9%; P = .009), number of adenomas per colonoscopy (2.70 vs 1.50; P = .002), and mean number of proximal colon serrated polyps per colonoscopy (0.38 vs 0.12; P = .004). LIMITATIONS Retrospective study; single, unblinded endoscopist. CONCLUSION ADR and adenomas per colonoscopy are both sensitive indicators of colonoscopy quality. WCC merges two simple methods to improve the performance of screening and surveillance colonoscopy. The data suggest that larger, prospective studies are necessary to determine if there are differences between water-exchange combined with cap-assisted maneuvers and the individual components used alone in lesion detection in screening and surveillance colonoscopy.

Blood transfusion strategies for acute upper gastrointestinal bleeding: are we back where we started?

Blood transfusion practices for acute upper gastrointestinal hemorrhage have changed over time. Restrictive strategies, which gave way to more liberal approaches for the greater part of the 20th century, have again gained traction as emerging research suggests restricting transfusion is associated with similar, or possibly better outcomes in UGI bleeding. In a large, retrospective cohort study from an integrated health care system in Taiwan, Chen, et al., report the association between early blood transfusion and clinical outcomes in patients presenting to the emergency department with UGI bleeding, and these findings are discussed in the context of current knowledge and practice.