Increasing the Yield: When More Is Better.

ABSTRACT: Indeterminate biliary strictures pose a diagnostic challenge, and current approaches in the evaluation of such strictures lack diagnostic sensitivity. The most common method of tissue acquisition remains endoscopic retrograde cholangiopancreatography (ERCP) with brush cytology, however, little is known about optimal brush technique. In this paper by Wang et al., the authors compare the diagnostic sensitivity of brush cytology for 10, 20, and 30 passes in patients with malignant biliary strictures. The authors found an increase in sensitivity with an increasing number of passes, without an associated increase in adverse events. This well-designed study offers a simple and safe intervention which can increase the diagnostic sensitivity of ERCP-based brushing without requiring significant time, expense, or additional expertise.

Hepatic Steatosis Is Associated with Increased Disease Severity and Liver Injury in Coronavirus Disease-19.

BACKGROUND: Coronavirus disease-2019 (COVID-19) is a global pandemic. Obesity has been associated with increased disease severity in COVID-19, and obesity is strongly associated with hepatic steatosis (HS). However, how HS alters the natural history of COVID-19 is not well characterized, especially in Western populations. AIMS: To characterize the impact of HS on disease severity and liver injury in COVID-19. METHODS: We examined the association between HS and disease severity in a single-center cohort study of hospitalized COVID-19 patients at Michigan Medicine. HS was defined by either hepatic steatosis index > 36 (for Asians) or > 39 (for non-Asians) or liver imaging demonstrating steatosis > 30 days before onset of COVID-19. The primary predictor was HS. The primary outcomes were severity of cardiopulmonary disease, transaminitis, jaundice, and portal hypertensive complications. RESULTS: In a cohort of 342 patients, metabolic disease was highly prevalent including nearly 90% overweight. HS was associated with increased transaminitis and need for intubation, dialysis, and vasopressors. There was no association between HS and jaundice or portal hypertensive complications. In a sensitivity analysis including only patients with liver imaging > 30 days before onset of COVID-19, imaging evidence of hepatic steatosis remained associated with disease severity and risk of transaminitis. CONCLUSIONS: HS was associated with increased disease severity and transaminitis in COVID-19. HS may be relevant in predicting risk of complications related to COVID-19.

Rethinking the Re-Prep: Attitudes Toward Noninvasive Colorectal Cancer Screening Tests After Inadequate Bowel Preparation.

OBJECTIVES: To assess patient preferences for colorectal cancer screening with stool-based tests after initial colonoscopy with suboptimal bowel preparation. METHODS: An online scenario-based survey of adults aged 45 to 75 years at average risk for colorectal cancer was performed. RESULTS: When presented with a hypothetical scenario of screening colonoscopy with suboptimal bowel preparation, 59% of respondents chose stool-based testing as a next step, 29% preferred a repeat colonoscopy within a year, and 12% preferred a repeat colonoscopy in 10 years (N = 1,080). CONCLUSIONS: Clinicians should consider offering stool-based screening tests as an alternative to repeat colonoscopy after suboptimal bowel preparation.

Risk Factors and Patient Care in Post-Polypectomy Surveillance Colonoscopy.

This paper highlights the potential importance of family history as an independent risk factor in those with a personal history of adenomas. It also raises important questions for future study about maternal versus paternal risk in CRC. However, we should be cautious about making changes to practice based on these data alone. In the future, such data could be used to generate individualized recommendations for post-polypectomy surveillance to ensure that we deliver the right care to the right patient at the right time.

Full metal jacket: salvage of EUS-guided gallbladder drainage.

Video 1Full metal jacket: salvage of EUS-guided gallbladder drainage.

Single-session EUS-guided gastrogastrostomy to facilitate cystgastrostomy in Roux-en-Y gastric bypass.

Video 1Single-session EUS-guided gastrogastrostomy creation to facilitate cystgastrostomy in Roux-en-Y gastric bypass.

If at first you don't succeed a complicated course of endoscopic reversal of a gastric bypass.

Video 1.If at first you don't succeed… A complicated course of endoscopic reversal of a gastric bypass.

Endoscopic sleeve gastroplasty: the "cable" technique.

Video 1Video demonstration of endoscopic sleeve gastroplasty performed using a novel suture pattern termed the "cable" technique.

A unique twist following treatment of a sleeve gastrectomy leak: a multidisciplinary approach.

Video 1A unique twist following treatment of a sleeve gastrectomy leak: a multidisciplinary approach.