Jennifer K. Maratt

Do larger periprocedural fluid volumes reduce the severity of post-endoscopic retrograde cholangiopancreatography pancreatitis?

Objective Fluid therapy is a cornerstone of the early treatment of acute pancreatitis (AP), but data are conflicting on whether it affects disease severity. Administering greater fluid volumes (FVs) during induction of experimental AP preserves pancreatic perfusion and reduces severity but does not prevent onset of AP. We hypothesized that administering larger FV during endoscopic retrograde cholangiopancreatography (ERCP) associates with less severe post-ERCP pancreatitis (PEP). Methods In a retrospective cohort study, we identified 6505 patients who underwent 8264 ERCPs between January 1997 and March 2009; 211 of these patients developed PEP (48 mild, 141 moderate, and 22 severe). Data for FVs were available for 173 patients with PEP. Results In univariable analysis, only 1 of 16 variables was significantly associated with moderate to severe PEP—larger periprocedural FV was protective (0.94 ± 0.3 L vs 0.81 ± 0.4 L; P = 0.0129). Similarly, multivariable analysis of moderate to severe PEP identified 1 independent predictor—larger periprocedural FV was protective (odds ratio, 0.20; 95% confidence interval, 0.05–0.83). Conversely, moderate to severe disease correlated with larger FV administered after PEP diagnosis (reflecting treatment decisions). Conclusions This hypothesis-generating study suggests that administering larger periprocedural FVs is protective against moderate to severe PEP. Prospective studies on this topic are warranted.

When and How to Stop Surveillance Colonoscopy in Older Adults: Five Rules of Thumb for Practitioners

When and How to Stop Surveillance Colonoscopy in Older Adults: Five Rules of Thumb for Practitioners

Adding Value to the Conversation About Colorectal Cancer Screening: Practical Pearls For Gastroenterologists

More often than not, colorectal cancer (CRC) screening is squarely in the domain of primary care. As gastroenterologists, we occasionally may encounter the patient who has never been screened (or offered a screening test), but this is becoming less common in our increasingly integrated health care system in which evidence-based preventive care is strongly incentivized. Moreover, our primary care colleagues bring substantial expertise in the optimal delivery of preventive services, routinely weighing the pros and cons of prevention in the context of individual health in patients who they have often followed for decades. However, as experts, we also have unique responsibilities. One such responsibility is advocacy. As professionals who have dedicated our careers to diagnosing and treating gastrointestinal (GI) disorders, it is only natural that we seek to promote long-term GI health, particularly for a prevalent and morbid condition such as CRC. However, we also are disease experts and scientists. In this context, how can we as gastroenterologists bring added value to this space beyond simple advocacy? What are the salient knowledge gaps and nuances when it comes to screening? Here, we present several key points to consider when talking to our patients and our colleagues.

Veterans’ Attitudes Towards De-Intensification of Surveillance Colonoscopy for Low-Risk Adenomas

*Department of Internal Medicine, Division of Gastroenterology and Hepatology, Michigan Medicine and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan; Department of Internal Medicine, University of Colorado, Aurora, Colorado; Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan; kDivision of Gastroenterology, Department of Internal Medicine, Providence-Providence Park Hospital, Michigan State University College of Human Medicine, Lansing, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan

Patients Are Willing to Repeat Colonoscopy at a Short Interval When Bowel Preparation Quality Is Suboptimal

*Department of Internal Medicine, Division of Gastroenterology and Hepatology, Institute for Healthcare Policy and Innovation, Michigan Medicine, Ann Arbor, Michigan; Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan; Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan; kCenter for Bioethics and Social Sciences in Medicine, Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, Michigan; **Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan