keyword
https://read.qxmd.com/read/38395478/assessment-resuscitation-and-medical-management-of-variceal-and-nonvariceal-gastrointestinal-bleeding
#1
REVIEW
Ali A Alali, Alan N Barkun
Upper gastrointestinal bleeding (UGIB) continues to be an important cause for emergency room visits and carries significant morbidity and mortality. Early resuscitative measures form the basis of the management of patients presenting with UGIB and can improve the outcomes of such patients including lowering mortality. In this review, using an evidence-based approach, we discuss the initial assessment and resuscitation of patients presenting with UGIB including identifying clues from history and physical examination to confirm UGIB, preendoscopic risk assessment tools, the role of early fluid resuscitation, utilization of blood products, use of pharmacologic interventions, and the optimal timing of endoscopy...
April 2024: Gastrointestinal Endoscopy Clinics of North America
https://read.qxmd.com/read/38333956/expert-endoscopist-assessment-of-colorectal-polyp-size-using-virtual-scale-endoscopy-visual-or-snare-based-estimation-a-prospective-video-based-study
#2
JOURNAL ARTICLE
Ioana Popescu Crainic, Roupen Djinbachian, Douglas K Rex, Alan Barkun, Aasma Shaukat, James East, Cesare Hassan, Yuichi Mori, Heiko Pohl, Amit Rastogi, Prateek Sharma, Joseph C Anderson, Mahsa Taghiakbari, Edgard Medawar, Daniel von Renteln
BACKGROUND AND AIMS: Accurate polyp size estimation during colonoscopy has an impact on clinical decision-making. A laser-based virtual scale endoscope (VSE) is available to allow measuring polyp size using a virtual adaptive scale. This study evaluates video-based polyp size measurement accuracy among expert endoscopists using either VSE or visual assessment (VA) with either snare as reference size or without any reference size information. METHODS: A prospective, video-based study was conducted with 10 expert endoscopists...
February 9, 2024: Scandinavian Journal of Gastroenterology
https://read.qxmd.com/read/38158721/review-article-advances-in-the-management-of-lower-gastrointestinal-bleeding
#3
REVIEW
Ali A Alali, Majid A Almadi, Alan N Barkun
BACKGROUND: Lower gastrointestinal bleeding (LGIB) is a common emergency with substantial associated morbidity and mortality. Elective colonoscopy plays an essential role in management, with an even more important role for radiology in the acute setting. Recent advances in the management of patients with LGIB warrant review as the management has recently evolved. AIMS: To provide a comprehensive and updated overview of advances in the approach to patients with LGIB METHODS: We performed a comprehensive literature search to examine the current data for this narrative review supplemented by expert opinion...
March 2024: Alimentary Pharmacology & Therapeutics
https://read.qxmd.com/read/37951281/aspirin-exposure-and-its-association-with-metal-stent-patency-in-malignant-biliary-obstruction-a-large-international-multicenter-propensity-score-matched-study
#4
JOURNAL ARTICLE
Kristina Candido, Simon Bouchard, Christopher Hansen-Barkun, Dora C Huang, Avijit Chatterjee, Charles Menard, Corey Miller, Gurpal Sandha, Fergal Donnellan, Jennifer Telford, Etienne Desilets, Nauzer Forbes, Andre Roy, Natalia Calo, Ian Gan, Eric Lam, Douglas Pleskow, Jeremy Liu Chen Kiow, Avi Sarker, Etienne Cadieux-Genesse, Avni Jain, Felix Louis, Mohammad Bilal, Pape-Mamadou Sene, Jehovan Fairclough, Jacqueline Reuangrith, Amine Benmassaoud, Olivia Geraci, Myriam Martel, Yen-I Chen
BACKGROUND AND AIMS: Stent dysfunction is common following endoscopic retrograde cholangiopancreatography (ERCP) with self-expanding metal stent (SEMS) insertion in malignant distal biliary obstruction (MDBO). Chronic aspirin exposure (ASA-E) has been previously shown to potentially decrease this risk. We aim to further ascertain the protective effect of ASA and to identify other predictors of stent dysfunction. METHOD: Multicenter retrospective cohort study (9 Canada and 1 US)...
November 9, 2023: Gastrointestinal Endoscopy
https://read.qxmd.com/read/37810903/measuring-the-observer-hawthorne-effect-on-adenoma-detection-rates
#5
JOURNAL ARTICLE
Mahsa Taghiakbari, Diana Elena Coman, Mark Takla, Alan Barkun, Mickael Bouin, Simon Bouchard, Eric Deslandres, Sacha Sidani, Daniel von Renteln
Background and study aims An independent observer can improve procedural quality. We evaluated the impact of the observer (Hawthorne effect) on important quality metrics during colonoscopies. Patients and Methods In a single-center comparative study, consecutive patients undergoing routine screening or diagnostic colonoscopy were prospectively enrolled. In the index group, all procedural steps and quality metrics were observed and documented, and the procedure was video recorded by an independent research assistant...
September 2023: Endoscopy International Open
https://read.qxmd.com/read/37549753/endoscopic-ultrasound-guided-biliary-drainage-of-first-intent-with-a-lumen-apposing-metal-stent-vs-endoscopic-retrograde-cholangiopancreatography-in-malignant-distal-biliary-obstruction-a-multicenter-randomized-controlled-study-element-trial
#6
JOURNAL ARTICLE
Yen-I Chen, Anand Sahai, Gianfranco Donatelli, Eric Lam, Nauzer Forbes, Jeffrey Mosko, Sarto C Paquin, Fergal Donnellan, Avijit Chatterjee, Jennifer Telford, Corey Miller, Etienne Desilets, Gurpal Sandha, Sana Kenshil, Rachid Mohamed, Gary May, Ian Gan, Jeffrey Barkun, Natalia Calo, Abrar Nawawi, Gad Friedman, Albert Cohen, Thibaut Maniere, Prosanto Chaudhury, Peter Metrakos, George Zogopoulos, Ali Bessissow, Jad Abou Khalil, Vicky Baffis, Kevin Waschke, Josee Parent, Constantine Soulellis, Mouen Khashab, Rastislav Kunda, Olivia Geraci, Myriam Martel, Kevin Schwartzman, Julio F Fiore, Elham Rahme, Alan Barkun
BACKGROUND AND AIMS: Endosonography-guided choledochoduodenostomy with a lumen-apposing metal stent (EUS-CDS) is a promising modality for the management of malignant distal biliary obstruction (MDBO) with potential for better stent patency. We compared its outcomes with endoscopic retrograde cholangiopancreatography with metal stenting (ERCP-M). METHODS: In this multicenter, randomized, controlled trial, we recruited patients with MDBO secondary to borderline resectable, locally advanced, or unresectable peri-ampullary cancers across 10 Canadian and one French institution(s)...
August 5, 2023: Gastroenterology
https://read.qxmd.com/read/37496492/strengths-and-limitations-of-risk-stratification-tools-for-patients-with-upper-gastrointestinal-bleeding-a-narrative-review
#7
REVIEW
Ali A Alali, Antoine Boustany, Myriam Martel, Alan N Barkun
INTRODUCTION: Despite advances in the management of patients with upper gastrointestinal bleeding (UGIB), associated morbidity and mortality remain significant. Most patients, however, will experience favorable outcomes without a need for hospital-based interventions. Risk assessment scores may assist in such early risk-stratification. These scales may optimize identification of low-risk patients, resulting in better resource utilization, including a reduced need for early endoscopy and fewer hospital admissions...
July 27, 2023: Expert Review of Gastroenterology & Hepatology
https://read.qxmd.com/read/37277078/hemostatic-powder-vs-standard-endoscopic-treatment-for-gastrointestinal-tumor-bleeding-a-multicenter-randomized-trial
#8
RANDOMIZED CONTROLLED TRIAL
Rapat Pittayanon, Wichitra Khongka, Sittikorn Linlawan, Rattikorn Thungsuk, Surasak Aumkaew, Nicha Teeratorn, Jeerawat Maytapa, Sayamon Kimtrakool, Piyapoom Pakvisal, Natanong Kongtub, Rungsun Rerknimitr, Alan Barkun
BACKGROUND & AIMS: Current guidelines vary as to their recommendations addressing the role of hemostatic powders when managing patients with malignant gastrointestinal (GI) bleeding because these are based on very-low- to low-quality evidence, in large part due to a paucity of randomized trial data. METHODS: This was a patient- and outcome assessor-blinded, multicenter, randomized controlled trial. Patients presenting with active bleeding from an upper or lower GI lesion suspected to be malignant at index endoscopy between June 2019 and January 2022 were randomly allocated to receive either TC-325 alone or standard endoscopic treatment (SET)...
September 2023: Gastroenterology
https://read.qxmd.com/read/37273971/a-simple-admission-order-set-improves-adherence-to-canadian-guidelines-for-hospitalized-patients-with-severe-ulcerative-colitis
#9
JOURNAL ARTICLE
Steven Li Fraine, Isabelle Malhamé, Teresa Cafaro, Camille Simard, Elizabeth MacNamara, Myriam Martel, Alan Barkun, Jonathan M Wyse
BACKGROUND: Individuals hospitalized with severe ulcerative colitis represent a complex group of patients. Variation exists in the quality of care of admitted patients with inflammatory bowel disease. We hypothesized that implementation of a standardized admission order set could result in improved adherence to current best practice guidelines (Toronto Consensus Statements) for the management of this patient population. METHODS: A retrospective cohort study of patients admitted with severe ulcerative colitis to a Montreal tertiary center was conducted...
June 2023: Journal of the Canadian Association of Gastroenterology
https://read.qxmd.com/read/37273970/cost-effectiveness-of-artificial-intelligence-aided-colonoscopy-for-adenoma-detection-in-colon-cancer-screening
#10
JOURNAL ARTICLE
Alan N Barkun, Daniel von Renteln, Hamid Sadri
BACKGROUND AND AIMS: Artificial intelligence-aided colonoscopy significantly improves adenoma detection. We assessed the cost-effectiveness of the GI Genius technology, an artificial intelligence-aided computer diagnosis for polyp detection (CADe), in improving colorectal cancer outcomes, adopting a Canadian health care perspective. METHODS: A Markov model with 1-year cycles and a lifetime horizon was used to estimate incremental cost-effectiveness ratio comparing CADe to conventional colonoscopy polyp detection amongst patients with a positive faecal immunochemical test...
June 2023: Journal of the Canadian Association of Gastroenterology
https://read.qxmd.com/read/37206693/incomplete-resection-rates-of-4-to-20-mm-non-pedunculated-colorectal-polyps-when-using-wide-field-cold-snare-resection-with-routine-submucosal-injection
#11
JOURNAL ARTICLE
Leslie Motchum, Roupen Djinbachian, Elham Rahme, Mahsa Taghiakbari, Simon Bouchard, Mickaël Bouin, Sacha Sidani, Érik Deslandres, Mark Takla, Nissim Max Frija-Gruman, Alan Barkun, Daniel von Renteln
Background and study aims  Incomplete resection of 4- to 20-mm colorectal polyps occur frequently (> 10 %), putting patients at risk for post-colonoscopy colorectal cancer. We hypothesized that routine use of wide-field cold snare resection with submucosal injection (CSP-SI) might reduce incomplete resection rates (IRRs). Patients and methods  Patients aged 45 to 80 years undergoing elective colonoscopies were enrolled in a prospective clinical study. All 4- to 20-mm non-pedunculated polyps were resected using CSP-SI...
May 2023: Endoscopy International Open
https://read.qxmd.com/read/36949934/an-update-on-the-management-of-non-variceal-upper-gastrointestinal-bleeding
#12
REVIEW
Ali A Alali, Alan N Barkun
Upper gastrointestinal bleeding (UGIB) continues to be a common gastrointestinal emergency that carries significant morbidity and mortality. The epidemiology of UGIB has been changing over the last few decades with an overall decrease in peptic ulcer disease and increase in the prevalence of other etiologies including vascular lesions and malignancy. Appropriate risk assessment and patient stratification are crucial to ensuring that optimal care is delivered to patients and some risk assessment tools have shown excellent ability to define a low-risk group who can be managed as outpatients safely...
2023: Gastroenterology Report
https://read.qxmd.com/read/36877978/what-is-the-current-role-of-an-over-the-scope-clip-used-as-first-line-endoscopic-hemostasis-in-patients-with-nonvariceal-upper-gastrointestinal-bleeding
#13
EDITORIAL
Alan N Barkun, Ali A Alali
No abstract text is available yet for this article.
April 2023: Annals of Internal Medicine
https://read.qxmd.com/read/36861509/eus-guided-biliary-drainage-in-malignant-distal-biliary-obstruction-an-international-survey-to-identify-barriers-of-technology-implementation
#14
JOURNAL ARTICLE
Vincent Palmieri, Alan Barkun, Nauzer Forbes, Myriam Martel, Eric Lam, Jennifer Telford, Gurpal Sandha, Sarto Paquin, Anand Sahai, Yen-I Chen
BACKGROUND AND OBJECTIVES: EUS-guided biliary drainage (EUS-BD) is a promising alternative to ERCP in malignant distal biliary obstruction (MDBO). Despite accumulating data, however, its application in clinical practice has been impeded by undefined barriers. This study aims to evaluate the practice of EUS-BD and its barriers. METHODS: An online survey was generated using Google Forms. Six gastroenterology/endoscopy associations were contacted between July 2019 and November 2019...
2023: Endoscopic Ultrasound
https://read.qxmd.com/read/36444363/interbleed-design-of-an-international-study-of-risk-factors-for-gastrointestinal-bleeding-and-cardiovascular-events-after-gastrointestinal-bleeding
#15
JOURNAL ARTICLE
Jacqueline Bosch, Paul Moayyedi, Marco Alings, Alvaro Avezum, Shrikant I Bangdiwala, Alan Barkun, Federico Cassella, Aloisio Marchi da Rocha, Irfan Duzen, Robert Enns, Nauzer Forbes, Leah Hamilton, Shofiqul Islam, Mustafa Kilickap, Paul Kruger, Yan Liang, Jose C Nicolau, Rafael Nunes, Martin O'Donnell, Gustavo Oliveira, Alejandro Rey, Yihong Sun, Thomas Vanassche, Peter Verhamme, Michael Walsh, Zhenyu Wang, Cynthia Wu, Li Zhao, Jun Zhu, John W Eikelboom
BACKGROUND: Bleeding is the most common adverse event in those with cardiovascular (CV) disease receiving antithrombotic therapy, and it most commonly occurs in the gastrointestinal (GI) tract. Clinicians often dismiss bleeding as an adverse event that is reversible with effective antithrombotic therapy, but bleeding is associated with substantial morbidity and mortality, most likely mediated through an increased risk of CV events. Reducing the burden of bleeding requires knowledge of the potentially modifiable risk factors for bleeding and the potentially modifiable risk factors for adverse outcomes after bleeding...
November 2022: CJC open
https://read.qxmd.com/read/36436154/an-expert-consensus-to-standardize-assessment-of-bowel-cleansing-for-clinical-trials-of-bowel-preparations-for-crohn-s-disease
#16
JOURNAL ARTICLE
Jennifer K Maratt, Corey A Siegel, Alan N Barkun, Yoram Bouhnik, Brian Bressler, Audrey H Calderwood, James E East, Monika Fischer, Johannes Grossmann, Joshua R Korzenik, Stacy B Menees, Julian Panes, Douglas K Rex, Michael S L Sey, Michael K Allio, K Adam Baker, Leonardo Guizzetti, Julie Remillard, Rocio Sedano, Brian G Feagan, Christopher Ma, Vipul Jairath
BACKGROUND: Despite regular need for colonoscopy in patients with Crohn's disease (CD), the efficacy and tolerability of bowel preparation (BP) agents is rarely assessed in this population. Assessing BP quality with existing scales may be challenging in CD due to presence of inflammation, bowel resection, and strictures. AIMS: To provide recommendations for assessing BP quality in clinical trials for CD using a modified Research and Development/University of California, Los Angeles appropriateness process...
November 27, 2022: Digestive Diseases and Sciences
https://read.qxmd.com/read/36434811/periprocedural-management-of-patients-with-atrial-fibrillation-receiving-a-direct-oral-anticoagulant-undergoing-a-digestive-endoscopy
#17
JOURNAL ARTICLE
Christopher Hansen-Barkun, Myriam Martel, James Douketis, Neena S Abraham, Zachary Liederman, Eric Kaplovitch, Sam Schulman, Alex C Spyropoulos, Almadi Majid, Alan N Barkun
INTRODUCTION: The periprocedural management of patients with atrial fibrillation (AF) using a direct oral anticoagulant (DOAC) undergoing elective gastrointestinal (GI) endoscopic procedure remains uncertain. We investigated the safety of a standardized periprocedural DOAC management strategy. METHODS: The Periprocedural Anticoagulation Use for Surgery Evaluation cohort study enrolled adult patients receiving a DOAC (apixaban, rivaroxaban, or dabigatran) for AF scheduled for an elective procedure or surgery...
May 1, 2023: American Journal of Gastroenterology
https://read.qxmd.com/read/36204791/eus-guided-biliary-drainage-in-malignant-distal-biliary-obstruction-an-international-survey-to-identify-barriers-of-technology-implementation
#18
JOURNAL ARTICLE
Vincent Palmieri, Alan Barkun, Nauzer Forbes, Myriam Martel, Eric Lam, Jennifer Telford, Gurpal Sandha, Sarto Paquin, Anand Sahai, Yen-I Chen
Background and Objectives: EUS-guided biliary drainage (EUS-BD) is a promising alternative to ERCP in malignant distal biliary obstruction (MDBO). Despite accumulating data, however, its application in clinical practice has been impeded by undefined barriers. This study aims to evaluate the practice of EUS-BD and its barriers. Methods: An online survey was generated using Google Forms. Six gastroenterology/endoscopy associations were contacted between July 2019 and November 2019...
October 5, 2022: Endoscopic Ultrasound
https://read.qxmd.com/read/36148830/sleep-disturbances-bowel-movement-kinetics-and-travel-interruption-with-bowel-preparation-a-bowel-cleansing-national-initiative-substudy
#19
RANDOMIZED CONTROLLED TRIAL
Carmen Tse, Alan Barkun, Myriam Martel, Zoann Nugent, Ian Epstein, Michael Sey, Sultanian Richard, Daniel von Renteln, Harminder Singh
INTRODUCTION: We investigated sleep disturbances, bowel movement (BM) kinetics, and travel experience with different bowel preparation regimens in a substudy of patients enrolled in a randomized multicenter Canadian clinical trial. METHODS: Patients scheduled to have a colonoscopy between 7:30 am and 10:30 am (early morning) were randomized to (i) 4-L single-dose polyethylene glycol (PEG) given in the evening before, (ii) 2-L split-dose PEG (+bisacodyl 15 mg), or (iii) 4-L split-dose PEG...
January 1, 2023: American Journal of Gastroenterology
https://read.qxmd.com/read/36118648/learning-curves-in-ercp-during-advanced-endoscopy-training-a-canadian-multicenter-prospective-study
#20
JOURNAL ARTICLE
Usman Khan, Rishad Khan, Eric Benchimol, Misbah Salim, Jennifer Telford, Robert Enns, Rachid Mohamed, Nauzer Forbes, Gurpal Sandha, Ali Kohansal, Jeffrey Mosko, Avijit Chatterjee, Gary May, Kevin Waschke, Alan Barkun, Paul D James
Background and study aims  Growing emphasis on quality and patient safety has supported the shift toward competency-based medical education for advanced endoscopy trainees (AETs). In this study, we aimed to examine Canadian AETs learning curves and achievement of competence using an ERCP assessment tool with strong evidence of validity. Methods  This prospective study was conducted at five institutions across Canada from 2017-2018. Data on every fifth procedure performed by trainees were collected using the United Kingdom Joint Advisory Joint Advisory Group of Gastrointestinal Endoscopy (JAG) ERCP Direct Observation of Procedural Skills (DOPS) tool, which includes a four-point rating scale for 27 items...
September 2022: Endoscopy International Open
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