Niyati M. Gupta

Testing of a Tool for Prostate Cancer Screening Discussions in Primary Care

Background As prostate cancer (PCa) screening decisions often occur in outpatient primary care, a brief tool to help the PCa screening conversation in busy clinic settings is needed. Methods A previously created 9-item tool to aid PCa screening discussions was tested in five diverse primary care clinics. Fifteen providers were recruited to use the tool for 4 weeks, and the tool was revised based upon feedback. The providers then used the tool with a convenience sample of patients during routine clinic visits. Pre- and post-visit surveys were administered to assess patients’ knowledge of the option to be screened for PCa and of specific factors to consider in the decision. McNemar’s and Stuart–Maxwell tests were used to compare pre-and post-survey responses. Results 14 of 15 providers completed feedback surveys and had positive responses to the tool. All 15 providers then tested the tool on 95 men aged 40–69 at the five clinics with 2–10 patients each. The proportion of patients who strongly agreed that they had the option to choose to screen for PCa increased from 57 to 72% (p = 0.018) from the pre- to post-survey, that there are factors in the personal or family history that may affect PCa risk from 34 to 47% (p = 0.012), and that their opinions about possible side effects of treatment for PCa should be considered in the decision from 47 to 61% (p = 0.009). Conclusion A brief conversation tool for the PCa screening discussion was well received in busy primary-care settings and improved patients’ knowledge about the screening decision.

Peroral Endoscopic Myotomy Is Effective for Patients With Achalasia and Normal Lower-Esophageal Sphincter Relaxation Pressures

Increased lower esophageal sphincter integrated relaxation pressure (LES-IRP) is a cardinal feature of achalasia. However, some patients with characteristic features of achalasia have normal LES-IRP.1,2 The efficacy of peroral endoscopic myotomy (POEM) in achalasia patients with normal LES-IRP is not well known. Hence, we aimed to compare POEM outcomes in achalasia patients with normal (<15 mm Hg) and increased (≥15 mm Hg) LES-IRP.

Erratum: Use of a Novel Submucosal Tunneling and Endoscopic Resection (STER) Technique for the Removal of an Esophageal Leiomyoma

Use of a Novel Submucosal Tunneling and Endoscopic Resection (STER) Technique for the Removal of an Esophageal Leiomyoma

Proximal Sessile Serrated Adenomas Are More Prevalent in Caucasians, and Gastroenterologists Are Better Than Nongastroenterologists at Their Detection

Background and Aim Proximal sessile serrated adenomas (PSSA) leading to colorectal cancer (CRC) represent an alternate pathway for CRC development. In this study, we aim to determine the prevalence of PSSAs and the impact of patient, colonoscopy, and endoscopist-related factors on PSSA detection. Methods Patients ≥ 50 years of age undergoing a screening colonoscopy between 2012 and 2014 were included. Detection rates based on patient gender, race, colonoscopy timing, fellow participation, bowel preparation quality, and specialty of the endoscopist were calculated. t-tests were used to compare detection rates and a multivariate-adjusted analysis was performed. Results 140 PSSAs were detected from 4151 colonoscopies, with a prevalence of 3.4%. Detection rate was higher in Caucasians compared to African-Americans (AA) (3.7 ± 4.1 versus 0.96 ± 3.5; p < 0.001). Gastroenterologists detected more PSSAs compared to nongastroenterologists (3.9 ± 3.5 versus 2.2 ± 3.0; p = 0.028). These findings were still significant after adjusted multivariate analysis. The rest of the factors did not make significant difference in PSSA detection rate. Conclusions PSSAs are more prevalent in Caucasians compared to AAs. Racial difference in prevalence of PSSAs is intriguing and warrants further investigation. Gastroenterologists have a significantly higher PSSADR compared to nongastroenterologists. Educational measures should be implemented in nongastroenterologists to improve their PSSA detection rates.

A Congenital Gastric Anomaly That Appears as a Tumor of the Gastrointestinal Stroma

Question: A 25-year-old man was admitted to the hospital with complaints of nausea, vomiting and abdominal pain of 2-3 months’ duration. He reported early satiety, poor appetite and weight loss of 20 lbs over 3 months. On examination, he was noted to be hypotensive (blood pressure, 96/60 mm Hg) and tachycardic (heart rate, 116/min). Complete blood count, serum electrolytes, liver function tests, and lipase levels were within normal limits. A computed tomography (CT) scan of the abdomen revealed a 9.8 7.4-cm heterogeneous mass in the fundus of the stomach (Figure A), which was also noted on a subsequent esophagogastroduodenoscopy (Figure B). Magnetic resonance imaging (MRI) of the abdomen (Figure C) further defined a well-circumscribed, heterogeneous mass with contrast enhancement, raising the suspicion for a gastrointestinal stromal tumor (GIST). A surgical exploration was planned for definitive resection of the gastric mass. Intraoperatively, the suspected gastric lesion was noted to have poorly defined surgical planes with significant surrounding fibrosis and eventually a total gastrectomywith Roux-en-Y-esophagojejunostomywas performed. Histologic examination of the gross (Figure D) and microscopic specimens (Figure E) revealed the correct diagnosis. What is the correct diagnosis? See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI.

A Case of Gastrointestinal Opportunistic Infection

Division of Hospital Medicine, and Division of Gastroenterology and Hepatology, Cleveland clinic Foundation, Cleveland, Ohio 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 Question: A 34-year-old man with past medical history of human immunodeficiency virus (HIV) infection, presented to the hospital with complaints of dysphagia, epigastric abdominal pain, and watery diarrhea for last 2 months. This was accompanied by low-grade fever and weight loss of 20 pounds in the same time period. Patient reported noncompliance with highly active antiretroviral treatment. Routine blood work showed pancytopenia, low serum albumin level, CD4 count of 45 cells/mm, and HIV viral load of 1,380,000 copies/mL. Esophagogastroduodenoscopy showed diffuse esophageal candidiasis (Figure A) and stomach was normal in appearance. The mucosa of the second part of the duodenum was denuded and studded with white lesions of 1 to 2 mm in diameter each that were biopsied (Figure B). Histologic examination of the biopsy specimen revealed numerous macrophages with intracellular organisms (Figure C-E). What is the diagnosis? See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI. 107 108 109 110 111 112 113 Conflicts of interest The authors disclose no conflicts.