Colorectal Cancer Screening and Race in an Equal Access Medical System.

National colorectal cancer (CRC) screening rates have improved, but significant racial disparities have been identified. Improved access to care has been proposed as a solution to eliminate such disparities. To determine if racial disparities in CRC screening rates persist in a medical system without barriers to access or cost. A retrospective review study was performed, examining the healthcare effectiveness data and information set data from patients between the ages of 50 and 65 years who were eligible for CRC screening. Data on the type of CRC screening and rates of up-to-date screening were also examined. Data were available for 14,196 patients of whom 8809 (62%) reported race. Subjects included were 53% male and 47% female, with breakdown by race as follows: 53% White, 34% Asian/Pacific Islander, 11% Black, 1% Hispanic, and <1% Native-American. Overall, CRC screening and up-to-date rates were higher than the national average (81 and 72%, respectively). Blacks were less likely than non-Blacks to have undergone CRC screening (75 vs. 82%, p < 0.001), and were also less likely to be up-to-date with CRC screening (66 vs. 72%, p < 0.001). Despite elimination of access and cost barriers, racial disparities in CRC screening persist. Equal access to CRC screening tools will be necessary, but not sufficient, to eliminate the currently observed national trends. Further study should focus on elucidating patient-specific barriers to successful completion and maintenance of CRC screening.

Intraoperative presentation of an undiagnosed tracheoesophageal fistula in an adult without history of abdominal or thoracic surgery.

Tracheoesophageal fistula is uncommon in adults but can cause devastating aspiration events. Herein, we report a unique case of a tracheoesophageal fistula in an adult that presented intraoperatively. The patient did not have any prior history of abdominal or thoracic surgery and was not intubated for a prolonged period of time. The diagnosis, subsequent hospital course, and recommendations for early recognition of this rare condition are discussed.

Endoscopic Sleeve Gastroplasty: A Practice Pattern Survey.

PURPOSE: Obesity is a complex, chronic disease that is strongly associated with complications which cost the US healthcare system billions of dollars per year. Endoscopic sleeve gastroplasty (ESG) has emerged as a safe and effective procedure for treatment of obesity, but without practice guidelines there are likely to be variations practice. We sought to describe current practice patterns amongst endoscopists who perform ESG to help define areas of focus for future research and guideline development. METHODS: We conducted an anonymous cross-sectional survey to examine practice patterns related to ESG. The survey was organized in 5 sections: Endoscopic Practice, Training, and Resources; Pre-ESG Evaluation and Payment Model; Perioperative/Operative Period; Post-operative Period; and Endobariatric Practice Other Than ESG. RESULTS: A variety of exclusion criteria were reported by physicians performing ESG. Most respondents (n = 21/32, 65.6%) would not perform ESG for BMI under 27, and 40.6% (n = 13/32) would not perform ESG on patients with BMI over 50. The majority of respondents (74.2%, n = 23/31) reported ESG was not covered in their region, and most reported patients covered residual costs (67.7%, n = 21/31). CONCLUSIONS: We found significant variability with respect to practice setting, exclusion criteria, pre-procedural evaluation, and medication use. Without guidelines for the selection of patients or standards for pre- and post-ESG care, substantial barriers to coverage will remain, and ESG will remain limited to those who can meet out-of-pocket costs. Larger studies are needed to confirm our findings, and future research should be focused on establishing patient selection criteria and standards in practices to provide guidance for endobariatric programs.

Isolated non-hemorrhagic cecal varices.

Ectopic varices (those outside of the gastro-esophageal region) are occasionally found on endoscopy in patients with portal hypertension; however they account for a small minority of all variceal bleeds. Cases of isolated cecal varices are quite rare and, when described, often present with acute hemorrhage or evidence of occult bleeding. We present the case of a 29-year-old male with a history of idiopathic portal vein thrombosis and known esophageal varices, who presented for evaluation of abdominal pain. Cecal varices were found on endoscopy, without evidence of bleeding and without varices in the remainder of the colon or rectum. Endoscopic ultrasound and computed tomography were useful in confirming the diagnosis and natural history of these unusual varices.