Joel V. Brill

Treating clostridium difficile infection with fecal microbiota transplantation

Clostridium difficile infection is increasing in incidence, severity, and mortality. Treatment options are limited and appear to be losing efficacy. Recurrent disease is especially challenging; extended treatment with oral vancomycin is becoming increasingly common but is expensive. Fecal microbiota transplantation is safe, inexpensive, and effective; according to case and small series reports, about 90% of patients are cured. We discuss the rationale, methods, and use of fecal microbiota transplantation.

Sedation for gastrointestinal endoscopy: new practices, new economics.

Gastroenterologists in the United States have routinely sedated patients as a part of the endoscopic service. In recent years, more and more endoscopists are turning to anesthesiologists or nurse anesthetists to provide sedation rather than administering it themselves.a Numerous factors are driving this transition, including increasing use of propofol (a sedation agent which in most settings is administered only by an anesthesiologist), efforts to offset falling reimbursements, and effective marketing by anesthesiologists. The clinical merits and the politics of this trend have been recently reviewed (1, 2). The economic implications are less appreciated by clinical gastroenterologists, however, and are the subject of this paper. To approach the subject, it is useful to ask three questions: (1) How significant is the transition to non-gastroenterologist administered sedation? (2) How are the payors responding to this transition? and (3) Where are the payors headed?

A Bundled Payment Framework for Colonoscopy Performed for Colorectal Cancer Screening or Surveillance

Predictive Health, LLC, Paradise Valley, Arizona; Texas Digestive Disease Consultants, Dallas, Texas; University Gastroenterology, Providence, Rhode Island; Illinois Gastroenterology Group, Elgin, Illinois; Humana, Inc, Louisville, Kentucky; Minnesota Gastroenterology, PA, Saint Paul, Minnesota; South Denver Gastroenterology, PC, Englewood, Colorado; American Gastroenterological Association, Bethesda, Maryland; and Yale University School of Medicine, New Haven, Connecticut

White Paper AGA: Advanced Imaging in Barrett’s Esophagus

Enhanced imaging technologies such as narrow band imaging, flexible spectral imaging color enhancement, i-Scan, confocal laser endomicroscopy, and optical coherence tomography are readily available for use by endoscopists in routine clinical practice. In November 2014, the American Gastroenterological Associations Center for GI Innovation and Technology conducted a 2-day workshop to discuss endoscopic image enhancement technologies, focusing on their role in 2 specific clinical conditions (colon polyps and Barretts esophagus) and on issues relating to training and implementation of these technologies (white papers). Although the majority of the studies that use enhanced imaging technologies have been positive, these techniques ideally need to be validated in larger cohorts and in community centers. As it stands today, detailed endoscopic examination with high-definition white-light endoscopy and random 4-quadrant biopsy remains the standard of care. However, the workshop panelists agreed that in the hands of endoscopists who have met the preservation and incorporation of valuable endoscopic innovation thresholds (diagnostic accuracy) with enhanced imaging techniques (specific technologies), use of the technique in Barretts esophagus patients is appropriate.

Endoscopic sedation: legislative update and implications for reimbursement.

Endoscopic sedation has traditionally been considered to be an element of the endoscopic examination. Endoscopists, together with endoscopy nurses, administered benzodiazepines and opioids with acceptable safety and efficiency. Today, sedation practices for endoscopy have become more diversified due to the entry of anesthesia specialists into the endoscopy unit, gastroenterologist-directed propofol administration, and prolonged diagnostic and therapeutic procedures that require deeper sedation. The economic implications of these changes in sedation are examined in this article.

Colorectal testing utilization and payments in a large cohort of commercially insured US adults.

OBJECTIVES:Screening decreases colorectal cancer (CRC) mortality. The national press has scrutinized colonoscopy charges. Little systematic evidence exists on colorectal testing and payments among commercially insured persons. Our aim was to characterize outpatient colorectal testing utilization and payments among commercially insured US adults.METHODS:We conducted an observational cohort study of outpatient colorectal test utilization rates, indications, and payments among 21 million 18–64-year-old employees and dependants with noncapitated group health insurance provided by 160 self-insured employers in the 2009 Truven MarketScan Databases.RESULTS:Colonoscopy was the predominant colorectal test. Among 50–64-year olds, 12% underwent colonoscopy in 1 year. Most fecal tests and colonoscopies were associated with screening/surveillance indications. Testing rates were higher in women, and increased with age. Mean payments for fecal occult blood and immunochemical tests were

Health Care Reform and the Road Ahead for Gastroenterology

5 and

AGA standards for gastroenterologists for performing and interpreting diagnostic computed tomography colonography: 2011 update.

21, respectively. Colonoscopy payments varied between and within sites of service. Mean payments for diagnostic colonoscopy in an office, outpatient hospital facility, and ambulatory surgical center were

Management of Diminutive Colon Polyps Based on Endoluminal Imaging

586 (s.d.

Compilation of recommendations from summit on increasing physician nutrition experts

259),