Clinical, endoscopic, and histologic characteristics of lymphocytic esophagitis: a systematic review.

OBJECTIVE: Lymphocytic esophagitis (LyE) is a novel, yet poorly described, clinicopathologic entity. The aim of this systematic review was to characterize the demographic, clinical, endoscopic, and histologic features of LyE in observational studies of adult and pediatric patients. DESIGN: We searched the Embase, MEDLINE, and SCOPUS databases for relevant studies in 2018. Two authors reviewed and extracted data from studies that met the inclusion and exclusion criteria. RESULTS: We identified 20 studies for analysis of demographic, clinical, and endoscopic features of LyE. The mean age ranged from 9 to 67 years. When pooled, there were 231 (52.7%) patients with LyE that were female. The most common presenting symptom was dysphagia reported in 191 (48.8%) patients. On endoscopy, most patients with LyE tended to have abnormal findings (69.0%), which included erosive esophagitis, multiple esophageal rings, linear furrows, and narrow-caliber esophagus. In the 31 studies used to assess the histologic definition, the cut-off number of intraepithelial lymphocytes (IELs) was reported in 16 (51.6%) studies, peripapillary IEL specification in 18 (58.1%) studies, and presence of spongiosis in 6 (19.4%) studies. CONCLUSION: We identified a spectrum of demographic, clinical, and endoscopic findings characteristic of patients with LyE. A consensus on the diagnostic criteria of LyE is required.

Advanced Endoscopy Trainee Involvement Early in EUS Training May Be Associated with an Increased Risk of Adverse Events.

BACKGROUND: The quality of endoscopic ultrasound (EUS) involving advanced endoscopy trainees (AETs) is not well understood. In this study, we aimed to examine adverse events (AE) risk and diagnostic yield of EUS procedures involving AETs. METHODS: We conducted a retrospective single-centre review from September 2009 to August 2015. Clinical, procedural, cytological, and hospital visit data within 30 days of the EUS procedure was collected. Primary outcomes were occurrence of an AE and a diagnostic specimen on cytopathology. Each AE was classified as "definitely related," "possibly related," or "not related" to the EUS procedure based on a previously defined consensus approach. Advanced endoscopy trainee involvement was established through the operative report. RESULTS: Our study included 1657 EUS procedures, of which 27% (451 of 1657) involved AETs. Endoscopic ultrasound was most commonly performed to evaluate pancreatic pathology (46% of cases). Overall AE incidence was 3.4%; it was 4.9% when an AET was involved and 2.8% when the EUS was performed without an AET (P = 0.04). The risk of an AE when AETs were involved was greatest in the first three months of training (7.9% versus 2.7%, P = 0.04). Multivariate analysis limited to the first three months of training demonstrated AET involvement to be associated with an increased AE risk after adjusting for patient and procedural factors (adjusted OR 3.2; 95% CI, 1.1-8.7; P = 0.03). The overall diagnostic yield was 76%. This was not compromised by AET involvement for any quartile of training. CONCLUSIONS: We observed an increased risk of EUS-related AEs when procedures involved AETs during the first three months of training.

Influence of video-based feedback on self-assessment accuracy of endoscopic skills: a randomized controlled trial.

Background and study aims Novice endoscopists are inaccurate in self-assessment of procedures. One means of improving self-assessment accuracy is through video-based feedback. We aimed to determine the comparative effectiveness of three video-based interventions on novice endoscopists' self-assessment accuracy of endoscopic competence. Materials and methods Novice endoscopists (performed < 20 previous procedures) were recruited. Participants completed a simulated esophagogastroduodenoscopy (EGD) on a virtual reality simulator. They were then randomized to one of three groups: self-video review (SVR), which involved watching a recorded video of their own performance; benchmark review (BVR), which involved watching a video of a simulated EGD completed by an expert; and self- and benchmark video (SBVR), which involved both videos. Participants then completed two additional simulated EGD cases. Self-assessments were conducted immediately after the first procedure, after the video intervention and after the additional two procedures. External assessments were conducted by two experienced endoscopists, who were blinded to participant identity and group assignment through video recordings. External and self-assessments were completed using the global rating scale component of the Gastrointestinal Endoscopy Competency Assessment Tool (GiECAT GRS). Results Fifty-one participants completed the study. The BVR group had significantly improved self-assessment accuracy in the short-term, compared to the SBVR group ( P  = .005). The SBVR group demonstrated significantly improved self-assessment accuracy over time ( P  = .016). There were no significant effects of group or of time for the SVR group. Conclusions Video-based interventions, particularly combined use of self- and benchmark video review, can improve accuracy of self-assessment of endoscopic competence among novices.

Smoking status and sex as indicators of differences in 2582 obese patients presenting for weight management.

BACKGROUND: Smoking remains the most common preventable cause of death. Very little tobacco exposure can increase cardiovascular disease risk. The relationship between smoking, sex, and weight remains unclear. METHODS: Between September 1992 and June 2007, 2582 consenting patients starting the Ottawa Hospital Weight Management program were grouped by sex and smoking status. "Former smokers" (771 females, 312 males) had quit for at least 1 year. "Smokers" (135 females, 54 males) smoked > 9 cigarettes daily. There were 979 females and 331 males who never smoked. Using SAS 9.2 statistical software, the prevalence of coronary artery disease (CAD), type 2 diabetes (T2DM), major depressive disorder (MDD), and medication use among the groups was compared (Chi-square [χ(2)]). Anthropometric measurements, lipid, glucose and thyroid levels were compared using analysis of variance (ANOVA). Interactions were assessed using 2-way ANOVA analysis for continuous data, and logistic regression for discrete data. RESULTS: Smokers were more likely to have MDD (χ(2)), lower high-density lipoprotein levels and higher triglyceride levels than other groups. Former smokers had a greater prevalence of CAD, T2DM on pharmacotherapy, and impaired fasting glucose than other groups. They were also more likely to be taking lipid-lowering agents and antihypertensives (χ(2)). Never smokers had less MDD, CAD, and were less likely to be on antidepressants than the other groups. Males were more likely to have CAD and T2DM than females. Females were more likely to have MDD than males. Interactions between smoking status and sex were found for age, weight, fasting glucose and thyroid-stimulating hormone levels. CONCLUSION: Obese never smokers suffer from the fewest chronic diseases. Obese former smokers have a greater prevalence of CAD, T2DM on pharmacotherapy, and impaired fasting glucose than other groups. Thus, clinicians and researchers should avoid combining former smokers with never smokers as "nonsmokers" in research and treatment decisions. The results of this study call for a longitudinal study comparing these groups over the weight management program.