Hamzeh Saraireh

Early colonoscopy in patients with acute diverticular bleeding is associated with improvement in healthcare-resource utilization

Abstract Background Diverticular bleeding (DB) is the most common cause of severe acute lower gastrointestinal bleeding (GIB) in developed countries. The role of early colonoscopy (<24 hours) continues to remain controversial and data on early colonoscopy in acute DB are scant. We aimed to evaluate the effect of timing of colonoscopy on outcomes in patients with acute DB using a nationwide inpatient sample. Methods Data from the nationwide inpatient sample from 2012 to 2014 were used. The ninth version of the International Classification of Diseases coding system ICD 9 was used for patient selection. We included discharges with the primary and secondary inpatient diagnosis of diverticulosis with bleeding and diverticulitis with bleeding. Discharges with no primary or secondary diagnosis of diverticulosis with bleeding, diverticulitis with bleeding, patients who were less than 18 years old and those who did not undergo colonoscopy during the admission were excluded. The primary outcomes were length of stay (LOS) and total hospitalization costs. Results A total of 88 600 patients were included in our analysis, amongst whom 45 020 (50.8%) had colonoscopy within 24 hours of admission (early colonoscopy), while 43 580 (49.2%) patients had colonoscopy after 24 hours of admission (late colonoscopy). LOS was significantly lower in patients with early colonoscopy as compared to those with late colonoscopy (3.7 vs 5.6 days, P < 0.0001). Total hospitalization costs were also significantly lower in patients with early colonoscopy (

Heart transplant recipient with mycophenolate mofetil-induced colitis: the great imitator

9317 vs

Role of endoscopic ultrasound in liver disease: Where do we stand in 2017?

11 767, P < 0.0001). There was no difference in mortality between both groups (0.7 vs 0.8%). After adjusting for potential confounders, the differences in LOS and total hospitalization costs between early and late colonoscopy remained statistically significant. Conclusions Early colonoscopy in acute DB significantly reduced LOS and total hospitalization costs. There was no significant difference in mortality observed. Performance of early colonoscopy in the appropriate patients presenting with acute DB can have potential cost-saving implications. Further research is needed to identify which patients would benefit from early colonoscopy in DB.

A Rare Case of a Metastatic Gastrointestinal Stromal Tumor (GIST): a Case Report and Review of the Literature

In this article, we report a case of a 55-year-old male heart transplant recipient who presented with diarrhoea. An extensive workup for infectious diseases was negative. The patient had a colonoscopy with biopsies showing colitis that mimicked graft-versus-host disease on histopathology. After excluding other potential causes and excluding acute cellular rejection, mycophenolate mofetil was discontinued, and the patient had significant clinical improvement with increased appetite and weight gain.

Dark colored duodenum: Has anyone dimmed the scope light? A case of pseudomelanosis duodeni

Endoscopic ultrasound (EUS) was first introduced into medical practice in 1980s as a diagnostic imaging modality for pancreatic pathology. EUS has the unique advantage of combining ultrasound and endoscopy to obtain detailed information of the gastrointestinal tract. Over the past decade, the use of EUS in liver diseases has been increasing. EUS, which was initially used as a diagnostic tool, is now having increasing therapeutic role as well. We provide a review of the application of EUS in the diagnostic and therapeutic aspects of liver disease. We also look at the evolving future research on the role of EUS in liver diseases.

Dieulafoy of cecum: A rare cause of a refractory gastrointestinal bleeding in an uncommon location

Gastrointestinal stromal tumors (GIST) are the most common mesenchymal neoplasms of gastrointestinal (GI) tract, accounting for less than 1% of all GI tumors. The incidence of GIST is estimated to be approximately 10–20 per million people, per year [1]. GISTs are typically seen in the stomach (50– 60%), followed by small intestine (30–35%), colon and rectum (5%), and esophagus (< 1%) [2, 3]. There are only 38 cases of GISTs with metastasis to the bone that have been reported in the English literature [4–28].

A unique appendiceal orifice: a striking foreign body in the cecum

A 43-year-old female with a past history of type II diabetes mellitus, hypertension, non-ischemic cardiac myopathy, end stage renal disease on hemodialysis and hypothyroidism presented to the emergency department with nausea, hematemesis and melenic stools for three days. She reported occasional naproxen ingestion for joint pain. She denied any previous episodes of similar gastrointestinal bleeding or any oral iron supplementation. Blood work was significant for 2-gram drop in her hemoglobin. An urgent esophagogastroduodenoscopy (EGD) revealed a gastric ulcer with a visible vessel in its base and black pigmentation involving the 2nd part of duodenum (Figure 1). The antral ulcer was treated with epinephrine injection and gold probe cautery. Biopsies were obtained from both the stomach and the duodenum. Gastric biopsies showed chronic active gastritis with immunostaining positive for Helicobacter pylori. Biopsies from duodenum

Tu1419 SAME HOSPITALIZATION CHOLECYSTECTOMY FOR ACUTE GALLSTONE PANCREATITIS: A NATIONWIDE ANALYSIS ACROSS A DECADE

Dieulafoy lesion in the gastrointestinal (GI) tract, initially escribed by Gallard in 1884 [1] and later named by the French urgeon Dieulafoy in 1898, is a rare yet an important cause of GI leeding [2]. By definition, it is a vascular abnormality consisting of large-caliber, aberrant tortuous submucosal artery that protrudes hrough a small mucosal defect without the presence of any overying ulceration [3,4]. Reported incidence of Dieulafoy lesion as a ause of acute GI bleeding is 1–2% [2]. Although this entity can be iagnosed and treated by endoscopy and angiography, the knowldge of its existence in the colon and of its deceptive presentation s critical to making the diagnosis because of its small size [5].

Su1705 PREDICTORS OF INCREASED LENGTH OF STAY IN ACUTE DIVERTICULAR BLEEDING: A NATIONWIDE ANALYSIS

A 64-year-old female with a history of hypertension, obesity and hyperlipidemia presented to the Gastroenterology clinic with fatigue. Laboratory workup was consistent with iron-deficiency anemia, supported by low mean corpuscular volume and low ferritin. Esophagogastroduodenoscopy (EGD) and colonoscopy were scheduled. EGD revealed two sessile polyps in the body of the stomach and the biopsy was consistent with welldifferentiated grade 1 neuroendocrine tumor. Colonoscopy was performed and on intubation of the cecum a unique incidental foreign body was seen in the appendiceal orifice (Fig. 1). The foreign body was successfully removed with the use of a rat tooth forceps. The foreign body was identified to be a piece of a “spork” (Fig. 2), and patient had no recollection of its ingestion. Ingestion of a foreign body in healthy adults is unusual and usually accidental. Risk factors for intentional foreign body ingestion include developmental delay, alcohol intoxication, incarceration and psychiatric illness [1]. Accidentally ingested foreign bodies usually go undetected and pass without any incidents. However, up to 20% require endoscopic removal [2]. Endoscopic removal of a foreign body is indicated if it is greater than 6 cm in length and 2.5 cm in diameter [3]. A foreign body in the appendiceal orifice or cecum may cause obstruction and could lead to subsequent acute appendicitis and perforation, resulting in significant morbidity and mortality.