The Endoscopy Patient as a Vector and Victim
Patient and procedural factors can increase the risk of infectious adverse events during endoscopy. Prophylactic antibiotic use must be judicious and individualized in the era of antibiotic resistance. New and emerging procedures require high-quality studies to elucidate appropriate risk profiles. (Source: Gastrointestinal Endoscopy Clinics of North America)
Source: Gastrointestinal Endoscopy Clinics of North America - August 3, 2020 Category: Gastroenterology Authors: Brian P.H. Chan, Tyler M. Berzin Source Type: research

Gastrointestinal Endoscopy in the Era of Antibiotic Resistant Bacteria
What happened? How could it all go so terribly wrong? Where do we go from here? (Source: Gastrointestinal Endoscopy Clinics of North America)
Source: Gastrointestinal Endoscopy Clinics of North America - August 3, 2020 Category: Gastroenterology Authors: Jacques Van Dam Tags: Preface Source Type: research

Antimicrobial Resistance
Antimicrobial resistance is developing rapidly and threatens to outstrip the rate at which new antimicrobials are introduced. Genetic recombination allows bacteria to rapidly disseminate genes encoding for antimicrobial resistance within and across species. Antimicrobial use creates a selective evolutionary pressure, which leads to further resistance. Antimicrobial stewardship, best use, and infection prevention are the most effective ways to slow the spread and development of antimicrobial resistance. (Source: Gastrointestinal Endoscopy Clinics of North America)
Source: Gastrointestinal Endoscopy Clinics of North America - August 1, 2020 Category: Gastroenterology Authors: Lindsay Morrison, Teresa R. Zembower Source Type: research

Gastrointestinal Flexible Endoscopes
Flexible endoscopes require cleaning, high-level disinfection, and sterilization between each patient use to reduce risk of transmitting pathogens. Public health investigations have identified concerns, including endoscope damage, mishandling, and reprocessing deficiencies, placing patients at risk for transmission of bacterial, viral, and other pathogens. Findings from outbreak investigations and other studies have led to innovations in endoscope design, use, and reprocessing, yet infection risks related to contaminated or damaged endoscopes remain. Strict adherence to infection control guidelines and manufacturer instruc...
Source: Gastrointestinal Endoscopy Clinics of North America - August 1, 2020 Category: Gastroenterology Authors: Isaac Benowitz, Heather A. Moulton-Meissner, Lauren Epstein, Matthew J. Arduino Source Type: research

Nosocomial Infections
This article reviews the history, prevalence, economic costs, morbidity and mortality, and risk factors associated with HAIs. Types of infections described include bacterial, fungal, viral, and multidrug resistant infections that contribute to the most common causes of HAIs, which include catheter- associated urinary tract infections, hospital-acquired pneumonias, bloodstream infections, and surgical site infections. Most nosocomial infections are preventable and monitoring and prevention strategies are described. (Source: Gastrointestinal Endoscopy Clinics of North America)
Source: Gastrointestinal Endoscopy Clinics of North America - July 30, 2020 Category: Gastroenterology Authors: Jia-Yia Liu, Jana K. Dickter Source Type: research

Novel Algorithms for Reprocessing, Drying and Storing Endoscopes
After outbreaks of duodenoscope-transmitted infection with multidrug-resistant organisms, it has become clear that institutions must optimize their endoscope reprocessing programs. Standard endoscope reprocessing practices may not represent the ideal approach for preventing transmission of infection related to endoscopy. We discuss multiple approaches to enhance and optimize reprocessing, drying, and storage of standard duodenoscopes. The optimal enhanced duodenoscope reprocessing modality remains to be determined. Acknowledging the challenges and limitations in effectively reprocessing duodenoscopes, the FDA issued a safe...
Source: Gastrointestinal Endoscopy Clinics of North America - July 30, 2020 Category: Gastroenterology Authors: Monique T. Barakat, Subhas Banerjee Source Type: research

Society Guidelines —Where Is the Consensus?
This article critically analyzes currently available national and international duodenoscope reprocessing guidelines. (Source: Gastrointestinal Endoscopy Clinics of North America)
Source: Gastrointestinal Endoscopy Clinics of North America - July 30, 2020 Category: Gastroenterology Authors: David S. Vitale, Karl K. Kwok, Quin Y. Liu Source Type: research

Reducing the Risk of Infection from Reprocessed Duodenoscopes —Recent Actions by the US Food and Drug Administration
In addition to technological advancements, engagement and collaboration among the wider community of stakeholders will be beneficial toward reducing the risk of infection from reprocessed duodenoscopes. Such a community can raise awareness of the importance of duodenoscope cleaning, work to improve reprocessing training, identify the most pressing unanswered questions that merit further research, and develop tools that can be used by health care facilities to improve the quality of reprocessing at their sites. The Food and Drug Administration looks forward to working with the community to further reduce the risk of infecti...
Source: Gastrointestinal Endoscopy Clinics of North America - July 30, 2020 Category: Gastroenterology Authors: Shanil P. Haugen, Ann Ferriter, Jian Connell, Lauren J. Min, Hanniebey D. Wiyor, Stephanie Cole Source Type: research

Endoscopes and Antibiotic-Resistant Bacteria: Controlling the Risk
Threats to highly valuable systems abound in modern society. Think of airplanes for example. Changes are made, and innovations are developed, resulting in improved safety, only to be challenged by new risks. In the history of medicine, there have been many instances where inadvertent transmission of infection by physicians was identified, and corrective measures were taken. In modern times, antibiotic-resistant bacteria are among the latest microscopic terrorists. For interventional gastrointestinal endoscopists, the most prized instruments are duodenoscopes used mostly for endoscopic retrograde cholangiopancreatography. (...
Source: Gastrointestinal Endoscopy Clinics of North America - July 29, 2020 Category: Gastroenterology Authors: Charles J. Lightdale Tags: Foreword Source Type: research

Introduction to Transmission of Infection
Pathogen contamination of endoscopes depends on pathogen factors, surface factors, and environmental conditions. The most common pathogens associated with transmission and infections associated with gastrointestinal endoscope contamination are Klebsiella pneumoniae, Escherichia coli, and Pseudomonas aeruginosa. Biofilm production together with disruption to device surfaces play an outsized role in the risk of contamination. Sampling schemes are limited by these factors, and further developments are needed to improve the accuracy of sampling. (Source: Gastrointestinal Endoscopy Clinics of North America)
Source: Gastrointestinal Endoscopy Clinics of North America - July 20, 2020 Category: Gastroenterology Authors: Graham M. Snyder Source Type: research

Methods for Endoscope Reprocessing
Over the past 2  decades, in hospital centers worldwide, there have been numerous outbreaks of multidrug-resistant organisms that have since been attributed to endoscopic transmission of the infections between patients, primarily from duodenoscopes. These outbreaks have focused the attention of endoscope manufactu rers, professional societies, and regulatory agencies on improving the reprocessing of these devices. The key steps in this process are point-of-use precleaning, leak testing, manual cleaning, high-level disinfection, and finally drying and storage. The promise of these initial efforts suggest that the aim o...
Source: Gastrointestinal Endoscopy Clinics of North America - July 20, 2020 Category: Gastroenterology Authors: Neil B. Marya, Raman V. Muthusamy Source Type: research

Duodenoscope as a Vector for Transmission
This article reviews the historical context for these outbreaks, technical aspects of scope design contributing to this risk, and innovations in endoscope technology that have the potential to overcome these shortcomings. Also reviewed are interim solutions and the data that support use of some of these interventions. Still needed are a validated manufacturer-recommended schedule for routine duodenoscope and echoendoscope maintenance with reprocessing protocols that can be implemented in endoscopy units. (Source: Gastrointestinal Endoscopy Clinics of North America)
Source: Gastrointestinal Endoscopy Clinics of North America - July 15, 2020 Category: Gastroenterology Authors: Jennifer T. Higa, Andrew S. Ross Source Type: research

Forthcoming Issues
Endoscopy in the Era of Antibiotic Resistant Bacteria (Source: Gastrointestinal Endoscopy Clinics of North America)
Source: Gastrointestinal Endoscopy Clinics of North America - July 1, 2020 Category: Gastroenterology Source Type: research

Colorectal Cancer Screening
Colorectal cancer (CRC) screening is unquestionably effective in reducing CRC mortality. In the United States, CRC incidence rates have been falling for over four decades, and the rate of incidence decline accelerated to 3% to 4% per year in 2000. At least half this decline appears to result from screening. (Source: Gastrointestinal Endoscopy Clinics of North America)
Source: Gastrointestinal Endoscopy Clinics of North America - May 19, 2020 Category: Gastroenterology Authors: Douglas K. Rex Tags: Preface Source Type: research

Colorectal Cancer Screening
GASTROINTESTINAL ENDOSCOPY CLINICS OF NORTH AMERICA (Source: Gastrointestinal Endoscopy Clinics of North America)
Source: Gastrointestinal Endoscopy Clinics of North America - May 19, 2020 Category: Gastroenterology Authors: Douglas K. Rex Source Type: research

Copyright
ELSEVIER (Source: Gastrointestinal Endoscopy Clinics of North America)
Source: Gastrointestinal Endoscopy Clinics of North America - May 19, 2020 Category: Gastroenterology Source Type: research

Contributors
CHARLES J. LIGHTDALE, MD (Source: Gastrointestinal Endoscopy Clinics of North America)
Source: Gastrointestinal Endoscopy Clinics of North America - May 19, 2020 Category: Gastroenterology Source Type: research

Contents
Charles J. Lightdale (Source: Gastrointestinal Endoscopy Clinics of North America)
Source: Gastrointestinal Endoscopy Clinics of North America - May 19, 2020 Category: Gastroenterology Source Type: research

Gastrointestinal Endoscopy Clinics of North America
Endoscopy in the Era of Antibiotic Resistant Bacteria (Source: Gastrointestinal Endoscopy Clinics of North America)
Source: Gastrointestinal Endoscopy Clinics of North America - May 19, 2020 Category: Gastroenterology Source Type: research

What Is Organized Screening and What Is Its Value?
Most screening in the United States occurs in an opportunistic fashion, although organized screening occurs in some integrated health care systems. Organized colorectal cancer (CRC) screening consists of an explicit screening policy, defined target population, implementation team, health care team for clinical care delivery, quality assurance infrastructure, and method for identifying cancer outcomes. Implementation of an organized screening program offers opportunities to systematically assess the success of the program and develop interventions to address identified gaps in an effort to optimize CRC outcomes. There is ev...
Source: Gastrointestinal Endoscopy Clinics of North America - April 16, 2020 Category: Gastroenterology Authors: Jason A. Dominitz, Theodore R. Levin Source Type: research

Risk Stratification Strategies for Colorectal Cancer Screening
Risk stratification is a system by which clinically meaningful separation of risk is achieved in a group of otherwise similar persons. Although parametric logistic regression dominates risk prediction, use of nonparametric and semiparametric methods, including artificial neural networks, is increasing. These statistical-learning and machine-learning methods, along with simple rules, are collectively referred to as “artificial intelligence” (AI). AI requires knowledge of study validity, understanding of model metrics, and determination of whether and to what extent the model can and should be applied to the pati...
Source: Gastrointestinal Endoscopy Clinics of North America - April 16, 2020 Category: Gastroenterology Authors: Thomas F. Imperiale, Patrick O. Monahan Source Type: research

Multitarget Stool DNA for Average Risk Colorectal Cancer Screening
After 2 screen-setting studies showing high sensitivity for colorectal cancer and advanced precancerous lesions, multitarget stool DNA testing was endorsed by the US Preventative Services Task Force as a first-line colorectal cancer screening test. Uptake has increased exponentially since approval by the US Food and Drug Administration and Centers for Medicare and Medicaid Services. Adherence to testing is approximately 70%. Patients with positive results have high diagnostic colonoscopy completion rates in single-center studies. The positive predictive value for colorectal neoplasia in postapproval studies is high. Next-g...
Source: Gastrointestinal Endoscopy Clinics of North America - April 16, 2020 Category: Gastroenterology Authors: John B. Kisiel, Jason D. Eckmann, Paul J. Limburg Source Type: research

Colorectal Cancer Screening Decisions in the Opportunistic Setting
Colorectal cancer incidence and mortality have decreased in the United States in recent decades, largely through opportunistic screening. Although certain organizations have improved internal screening rates by implementing programmatic screening, most of the United States undergoes opportunistic screening. Much effort and resources have been expended comparing screening tests to determine the most effective; however, deeper analysis of the US population has revealed subsets of ethnicities may be grossly underscreened. The most effective screening test remains the test that is completed and adhered to, and a better questio...
Source: Gastrointestinal Endoscopy Clinics of North America - April 16, 2020 Category: Gastroenterology Authors: Andrew Han, Jennifer Maratt, Charles Kahi Source Type: research

The National Colorectal Cancer Roundtable
(NCCRT) is an organization of organizations with staffing, funding and leadership provided by the American Cancer Society (ACS) and guidance and funding by the Centers for Disease Control and Prevention (CDC). In 2014, ACS, CDC, and the NCCRT launched the 80% by 2018 campaign. This highly successful initiative activated hundreds of organizations to prioritize colorectal cancer screening, disseminated smart, evidence-based interventions, and ultimately led to 9.3 million more Americans being up to date with screening compared with the precampaign rate. It's new campaign, 80% in Every Community, is designed to address persi...
Source: Gastrointestinal Endoscopy Clinics of North America - April 16, 2020 Category: Gastroenterology Authors: Richard Wender, Durado Brooks, Katherine Sharpe, Mary Doroshenk Source Type: research

Quality in Colorectal Cancer Screening with Colonoscopy
The goal of colorectal cancer (CRC) screening with colonoscopy is to minimize CRC with minimal risk and cost. In order to continuously improve the quality of colonoscopy, different outcomes must be measured. For this topic, the priority indicators to be measured are (1) frequency of scheduling colonoscopy at appropriate interval based on current guidelines; (2) frequency of identifying adenomas in average-risk individuals undergoing their first screening colonoscopy; and, (3) providing guideline-consistent recommendations for repeat colonoscopy after the procedure. (Source: Gastrointestinal Endoscopy Clinics of North America)
Source: Gastrointestinal Endoscopy Clinics of North America - April 16, 2020 Category: Gastroenterology Authors: Philip Schoenfeld Source Type: research

Colorectal Cancer in Persons Under Age 50
Early onset colorectal cancer (EOCRC) refers to colorectal cancer (CRC) in individuals under age 50. Although the incidence and mortality due to later onset CRC ( ≥50 years) has been declining over several decades, both are increasing in those under 50. EOCRC is more likely to occur in the distal colon and rectum. There are some unique pathologic and genetic features to these tumors; they are not usually associated with a germline mutation in a gene that p redisposes to cancer, and at least some may have a distinct pathogenesis. Initiating CRC screening at an earlier age (40–45 years of age) would presumably ...
Source: Gastrointestinal Endoscopy Clinics of North America - April 16, 2020 Category: Gastroenterology Authors: Swati G. Patel, Clement Richard Boland Source Type: research

Colorectal Cancer Screening: Where We Are and Moving Forward
As I write the foreword to this issue of Gastrointestinal Endoscopy Clinics of North America devoted to “Colorectal Cancer Screening,” the COVID-19 pandemic continues to rage. Tens of thousands of Americans will die of respiratory complications of the highly contagious coronavirus infection. Mandatory “social distancing” is widely declared in cities and states across the country. In many place s, all elective gastrointestinal (GI) endoscopy procedures have been put on hold, including colonoscopies for colorectal cancer screening. (Source: Gastrointestinal Endoscopy Clinics of North America)
Source: Gastrointestinal Endoscopy Clinics of North America - April 15, 2020 Category: Gastroenterology Authors: Charles J. Lightdale Tags: Foreword Source Type: research

Update on Flexible Sigmoidoscopy, Computed Tomographic Colonography, and Capsule Colonoscopy
This article reviews alternative colorectal cancer (CRC) screening tests, including flexible sigmoidoscopy (FS), computed tomography (CT) colonography, and colon capsule endoscopy. FS has abundant and convincing evidence supporting its use for CRC screening and is a commonly used CRC test worldwide. CT colonography has demonstrated convincing results for CRC screening, but concerns regarding cost, accuracy for flat or sessile neoplasia, reproducibility, extracolonic findings, and lack of coverage have limited its use and development. Colon capsule endoscopy has demonstrated encouraging results for polyp detection in averag...
Source: Gastrointestinal Endoscopy Clinics of North America - April 15, 2020 Category: Gastroenterology Authors: Seung Won Chung, Seifeldin Hakim, Shaheer Siddiqui, Brooks D. Cash Source Type: research

Fecal Immunochemical Test
This article reviews current understanding of FIT performance as a 1-time test and when applied programmatically. It outlines how to apply the test at the patient level and track performance at the program level. Future prospects for FIT application are highlighted. (Source: Gastrointestinal Endoscopy Clinics of North America)
Source: Gastrointestinal Endoscopy Clinics of North America - April 15, 2020 Category: Gastroenterology Authors: Douglas J. Robertson, Kevin Selby Source Type: research

Foreword: Colorectal Cancer Screening: Where We Are and Moving Forward
As I write the Foreword to this issue of Gastrointestinal Endoscopy Clinics of North America devoted to “Colorectal Cancer Screening,” the COVID-19 pandemic continues to rage. Tens of thousands of Americans will die of respiratory complications of the highly contagious coronavirus infection. Mandatory “social distancing” is widely declared in cities and states across the country. In many place s, all elective gastrointestinal (GI) endoscopy procedures have been put on hold, including colonoscopies for colorectal cancer screening. (Source: Gastrointestinal Endoscopy Clinics of North America)
Source: Gastrointestinal Endoscopy Clinics of North America - April 15, 2020 Category: Gastroenterology Authors: Charles J. Lightdale Source Type: research

Evidenced-Based Screening Strategies for a Positive Family History
The most commonly recognized high-risk group for colorectal cancer (CRC) is individuals with a positive family history. It is generally recognized that those with a first-degree relative (FDR) with CRC are at a 2-fold or higher risk of CRC or advanced neoplasia. FDRs of patients with advanced adenomas have a similarly increased risk. Accordingly, all major US guidelines recommend starting CRC screening by age 40 in these groups. Barriers to screening this group include patient lack of knowledge on family and polyp history, provider limitations in collecting family history, and insufficient application of guidelines. (Sourc...
Source: Gastrointestinal Endoscopy Clinics of North America - April 14, 2020 Category: Gastroenterology Authors: Jennifer M. Kolb, Dennis J. Ahnen, N. Jewel Samadder Source Type: research

How Artificial Intelligence Will Impact Colonoscopy and Colorectal Screening
Artificial intelligence may improve value in colonoscopy-based colorectal screening and surveillance by improving quality and decreasing unnecessary costs. The quality of screening and surveillance as measured by adenoma detection rates can be improved through real-time computer-assisted detection of polyps. Unnecessary costs can be decreased with optical biopsies to identify low-risk polyps using computer-assisted diagnosis that can undergo the resect-and-discard or diagnose-and-leave strategy. Key challenges include the clinical integration of artificial intelligence-based technology into the endoscopists ’ workflo...
Source: Gastrointestinal Endoscopy Clinics of North America - April 11, 2020 Category: Gastroenterology Authors: Dennis L. Shung, Michael F. Byrne Source Type: research

Proven Strategies for Increasing Adherence to Colorectal Cancer Screening
This article reviews the current available evidence about interventions to increase adherence to CRC screening. (Source: Gastrointestinal Endoscopy Clinics of North America)
Source: Gastrointestinal Endoscopy Clinics of North America - April 9, 2020 Category: Gastroenterology Authors: Lynn F. Butterly Source Type: research

Cost-Effectiveness of Current Colorectal Cancer Screening Tests
Cost-effectiveness analysis compares benefits and costs of different interventions to inform decision makers. Alternatives are compared based on an incremental cost-effectiveness ratio reported in terms of cost per quality-adjusted life-year gained. Multiple cost-effectiveness analyses of colorectal cancer (CRC) screening have been performed. Although regional epidemiology of CRC, relevant screening strategies, regional health system, and applicable medical costs in local currencies differ by country and region, several overarching points emerge from literature on cost-effectiveness of CRC screening. Cost-effectiveness ana...
Source: Gastrointestinal Endoscopy Clinics of North America - April 9, 2020 Category: Gastroenterology Authors: Uri Ladabaum Source Type: research

The Case for High-Quality Colonoscopy Remaining a Premier Colorectal Cancer Screening Strategy in the United States
Most colorectal cancer screening in the United States occurs in the opportunistic setting, where screening is initiated by a patient-provider interaction. Colonoscopy provides the longest-interval protection, and high-quality colonoscopy is ideally suited to the opportunistic setting. Both detection and colonoscopic resection have improved as a result of intense scientific investigation. Further improvements in detection are expected with the introduction of artificial intelligence programs into colonoscopy platforms. We may expect recommended intervals or colonoscopy after negative examinations performed by high-quality d...
Source: Gastrointestinal Endoscopy Clinics of North America - April 9, 2020 Category: Gastroenterology Authors: Douglas K. Rex Source Type: research

Colorectal Cancer Screening for the Serrated Pathway
Serrated polyps are classified into hyperplastic polyps, sessile serrated adenomas/polyps, and traditional serrated adenomas. Although all serrated polyps share characteristic colonic crypts serrations, distinguishing hyperplastic polyps from sessile serrated adenomas/polyps is challenging. Traditional serrated adenomas are cytologically dysplastic lesions; sessile serrated adenomas/polyps develop cytologic dysplasia as they progress to colorectal cancer. A flat and pale appearance of serrated polyps may make detection difficult. Endoscopic mucosal resection has higher rates of complete resection. Close surveillance is rec...
Source: Gastrointestinal Endoscopy Clinics of North America - April 8, 2020 Category: Gastroenterology Authors: Joseph C. Anderson, Amitabh Srivastava Source Type: research

Management of GERD: Looking with 2020 Vision
GASTROINTESTINAL ENDOSCOPY CLINICS OF NORTH AMERICA (Source: Gastrointestinal Endoscopy Clinics of North America)
Source: Gastrointestinal Endoscopy Clinics of North America - March 6, 2020 Category: Gastroenterology Authors: Kenneth J. Chang Source Type: research

Copyright
ELSEVIER (Source: Gastrointestinal Endoscopy Clinics of North America)
Source: Gastrointestinal Endoscopy Clinics of North America - March 6, 2020 Category: Gastroenterology Source Type: research

Contributors
CHARLES J. LIGHTDALE, MD (Source: Gastrointestinal Endoscopy Clinics of North America)
Source: Gastrointestinal Endoscopy Clinics of North America - March 6, 2020 Category: Gastroenterology Source Type: research

Contents
Charles J. Lightdale (Source: Gastrointestinal Endoscopy Clinics of North America)
Source: Gastrointestinal Endoscopy Clinics of North America - March 6, 2020 Category: Gastroenterology Source Type: research

Forthcoming Issues
Colorectal Cancer Screening (Source: Gastrointestinal Endoscopy Clinics of North America)
Source: Gastrointestinal Endoscopy Clinics of North America - March 6, 2020 Category: Gastroenterology Source Type: research

Gastroesophageal Reflux Disease: Changing the Conversation
Every once in a while, a field that has felt static for decades begins to move. Gastroesophageal reflux disease (GERD) is in one of those times. GERD is a big modern problem with estimates of significant GERD in some 30 million in the United States. For a long while, treatment has boiled down to 2 options: the pill (proton pump inhibitors, PPIs) or the knife (laparoscopic fundoplication). There is no doubt that these treatments benefit a majority of patients suffering from GERD but have also left many dissatisfied. (Source: Gastrointestinal Endoscopy Clinics of North America)
Source: Gastrointestinal Endoscopy Clinics of North America - February 18, 2020 Category: Gastroenterology Authors: Charles J. Lightdale Tags: Foreword Source Type: research

The New Landscape of Gastroesophageal Reflux Disease Management: 2020 and Beyond
The landscape of gastroesophageal reflux disease (GERD) management is changing, in a good way. Several key forces have converged (Box  1), propelling us to see GERD with a new perspective. One of these forces is the expanding role of the interventional gastrointestinal endoscopist in foregut diseases, including GERD, Barrett’s and early esophageal cancer, achalasia, Zenker diverticulum, early gastric cancer, gastric outlet obst ruction, and obesity. Accordingly, when tapped by Dr Lightdale to be the editor of this issue devoted to GERD management, I had the privilege of assembling some of the top GERD authoritie...
Source: Gastrointestinal Endoscopy Clinics of North America - February 14, 2020 Category: Gastroenterology Authors: Kenneth J. Chang Tags: Preface Source Type: research

Transoral Incisionless Fundoplication
GERD is a spectrum disorder, and treatment should be individualized to the patient ’s anatomic alterations. Trans-oral incisionless fundoplication (TIF 2.0) is an endoscopic procedure which reduces EGJ distensibility, thereby decreasing tLESRs, and also creates a 3-cm high pressure zone at the distal esophagus in the configuration of a flap valve. As it produces a partial fundop lication with a controlled valve diameter, gas can still escape from the stomach, minimizing the side-effect of gas-bloat. Herein we discuss the rationale, mechanism of action, patient selection, step-by-step procedure, safety and efficacy da...
Source: Gastrointestinal Endoscopy Clinics of North America - February 13, 2020 Category: Gastroenterology Authors: Kenneth J. Chang, Reginald Bell Source Type: research

Innovations in Endoscopic Therapy for Gastroesophageal Reflux Disease
Minimally invasive endoscopic antireflux therapies are critical for bridging the gap between medical and surgical treatments for gastroesophageal reflux disease (GERD). Although multiple endoscopic devices have been developed, perhaps some of the most exciting options that are currently evolving are the full-thickness suturing techniques using widely available and low-cost platforms. Full-thickness endoscopic suturing can allow for a highly durable recreation of the anatomic and functional components of a lower esophageal sphincter, which are deficient in patients with GERD. Proper patient selection, endoscopic hiatal hern...
Source: Gastrointestinal Endoscopy Clinics of North America - February 13, 2020 Category: Gastroenterology Authors: Kara L. Raphael, Patrick Walsh, Petros C. Benias Source Type: research

Magnetic Sphincter Augmentation for Gastroesophageal Reflux Disease
Magnetic sphincter augmentation is an effective and safe surgical method for the treatment of gastroesophageal reflux disease (GERD). The device has been compared with twice-daily proton pump inhibitor therapy and laparoscopic fundoplication (in randomized trials and prospective cohort studies, respectively). Magnetic sphincter augmentation was superior to medical therapy and equivalent to surgery for the relief of GERD symptoms. Recent research focuses on implanting the device into more complex patients, such as those with larger hiatal hernias or those with Barrett ’s esophagus. Additional novel research topics inc...
Source: Gastrointestinal Endoscopy Clinics of North America - February 13, 2020 Category: Gastroenterology Authors: Colin Dunn, Nikolai Bildzukewicz, John Lipham Source Type: research

Nonablative Radiofrequency Treatment for Gastroesophageal Reflux Disease (STRETTA)
Gastroesophageal reflux disease (GERD) is the most frequent outpatient diagnosis in the United States. There has been significant development in the endoscopic treatment of GERD, with several devices that have reached the market. One of the endoscopic devices for the management of GERD in the United States is the Stretta system. This procedure uses radiofrequency energy, which is applied to the muscles of the lower esophageal sphincter and the gastric cardia resulting in an improvement of reflux symptoms. This review evaluates the most recent data on the efficacy, mechanisms of action, and safety of this procedure. (Source...
Source: Gastrointestinal Endoscopy Clinics of North America - February 6, 2020 Category: Gastroenterology Authors: Piotr Sowa, Jason B. Samarasena Source Type: research

Nonablative Radiofrequency Treatment for GERD (STRETTA)
Gastroesophageal reflux disease (GERD) is the most frequent outpatient diagnosis in the United States. There has been significant development in the endoscopic treatment of GERD, with several devices that have reached the market. One of the endoscopic devices for the management of GERD in the United States is the Stretta system. This procedure uses radiofrequency energy, which is applied to the muscles of the lower esophageal sphincter and the gastric cardia resulting in an improvement of reflux symptoms. This review evaluates the most recent data on the efficacy, mechanisms of action, and safety of this procedure. (Source...
Source: Gastrointestinal Endoscopy Clinics of North America - February 6, 2020 Category: Gastroenterology Authors: Piotr Sowa, Jason B. Samarasena Source Type: research

Laparoscopic Hernia Repair and Fundoplication for Gastroesophageal Reflux Disease
Antireflux surgery is challenging, and has become even more challenging with the introduction of alternative endoscopic and laparoscopic options for patients with gastroesophageal reflux disease (GERD). The Nissen fundoplication remains the gold standard for the durable relief of GERD symptoms and esophagitis. All antireflux procedures have a failure rate, and it is important to minimize factors that are associated with failure. The selection of patients for antireflux surgery as well as the choice of the procedure requires a thorough understanding of esophageal physiology and the pros and cons of various options. (Source:...
Source: Gastrointestinal Endoscopy Clinics of North America - February 6, 2020 Category: Gastroenterology Authors: Steven R. DeMeester Source Type: research

Mechanism and Pathophysiology of Gastroesophageal Reflux Disease
Gastroesophageal reflux (GER) describes a process in which gastric contents travel retrograde into the esophagus. GER can be either a physiologic phenomenon that occurs in asymptomatic individuals or can potentially cause symptoms. When the latter occurs, this represents GER disease (GERD). The process by which GER transforms into GERD begins at the esophagogastric junction. Impaired clearance of the refluxate also contributes to GERD. Reflux causes degradation of esophageal mucosal defense. The refluxate triggers sensory afferents leading to symptom generation. (Source: Gastrointestinal Endoscopy Clinics of North America)
Source: Gastrointestinal Endoscopy Clinics of North America - February 5, 2020 Category: Gastroenterology Authors: Robin A. Zachariah, Tyralee Goo, Robert H. Lee Source Type: research