This commentary addresses the recent article by Yılmaz et al,featured in the May 2025 issue of this journal.Even though endoscopic procedures are common for both gastroenterologists and surgeons,there are clear differ...This commentary addresses the recent article by Yılmaz et al,featured in the May 2025 issue of this journal.Even though endoscopic procedures are common for both gastroenterologists and surgeons,there are clear differences between the two fields regarding when to use endoscopy,how to prepare for it,and how to monitor patients afterward.A primary determinant of these discrepancies lies in the variations in the duration and pedagogical frameworks of endoscopy training inherent to each discipline.These basic differences are very important for keeping patients safe and ensuring the procedures are done correctly,especially for treatments like endoscopic retrograde cholangiopancreatography(ERCP).This article aims to outline specific criticisms related to this topic,particularly in response to information shared about ERCP procedures performed in Türkiye.展开更多
AIM： To clarify the prevalence of defensive medicine and the specific defensive medicine practices among gastroenterologists in Japan. METHODS： A survey of gastroenterologists in Hiroshima, Japan, was conducted by m...AIM： To clarify the prevalence of defensive medicine and the specific defensive medicine practices among gastroenterologists in Japan. METHODS： A survey of gastroenterologists in Hiroshima, Japan, was conducted by mail in March 2006. The number of gastroenterologists reporting defensive medicine behaviors or changes in their scope of practice and the reported defensive medicine practices, i.e., assurance and avoidance behaviors, were examined. RESULTS： A total of 131 （77%） out of 171 gastroenterologists completed the survey. Three （2%） respondents were sued, and most respondents （96%） had liability insurance. Nearly all respondents （98%） reported practicing defensive medicine. Avoidance behaviors, such as avoiding certain procedures or interventions and avoiding caring for high-risk patients, were very common （96%）. Seventy-five percent of respondents reported often avoiding certain procedures or interventions. However, seasoned gastroenterologists （those in practice for more than 20 years） adopted avoidance behaviors significantly less often than those in practice for less than 10 years. Assurance behaviors, i.e., supplying additional services of marginal or no medical value, were also widespread （91%）. Sixty-eight percent of respondents reported that they sometimes or often referred patients to other specialists unnecessarily. CONCLUSION： Defensive medicine may be highly prevalent among gastroenterologists throughout 3apan, with potentially serious implications regarding costs, access, and both technical and interpersonal quality of care.展开更多
AIM: To explore gastroenterologist perceptions towards and experience with faecal microbiota transplantation(FMT).METHODS: A questionnaire survey consisting of 17 questions was created to assess gastroenterologists...AIM: To explore gastroenterologist perceptions towards and experience with faecal microbiota transplantation(FMT).METHODS: A questionnaire survey consisting of 17 questions was created to assess gastroenterologists' attitude towards and experience with FMT. This was anonymously distributed in hard copy format amongst attendees at gastroenterology meetings in Australia between October 2013 and April 2014. Basic descriptive statistical analyses were performed.RESULTS: Fifty-two clinicians participated. Twenty one percent had previously referred patients for FMT,8% more than once. Ninety percent would refer patients with Clostridium difficile infection(CDI) for FMT if easily available,37% for ulcerative colitis,13% for Crohn's disease and 6% for irritable bowel syndrome. Six percent would not refer any indication,including recurrent CDI. Eighty-six percent would enroll patients in FMT clinical trials. Thirty-seven percent considered the optimal mode of FMT administration transcolonoscopic,17% nasoduodenal,13% enema and 8% oral capsule. The greatest concerns regarding FMT were: 42% lack of evidence,12% infection risk,10% non infectious adverse effects/lack of safety data,10% aesthetic,10% lack of efficacy,4% disease exacerbation,and 2% inappropriate use; 6% had no concerns. Seventy seven percent believed there is a lack of accessibility while 52% had an interest in learning how to provide FMT. Only 6% offered FMT at their institution.CONCLUSION: Despite general enthusiasm,most gastroenterologists have limited experience with,or access to,FMT. The greatest concerns were lack of supportive evidence and safety issues. However a significant proportion would refer indications other than CDI for FMT despite insufficient evidence. These data provide guidance on where education and training are required.展开更多
AIM： To elucidate the preferences of gastroenterologists at our institution and compare them to those of obstetricians when making decisions in the pregnant patient, including which type of bowel preparations to use ...AIM： To elucidate the preferences of gastroenterologists at our institution and compare them to those of obstetricians when making decisions in the pregnant patient, including which type of bowel preparations to use for flexible sigmoidoscopy or colonoscopy, as well as which laxatives can be used safely.METHODS： Surveys were mailed to all attending gastroenterologists （n = 53） and obstetricians （n = 99） at our institution. Each survey consisted of the 14 most common laxative or motility agents used in pregnancy and inquired about the physician＇s prescribing habits in the past as well as their willingness to prescribe each medication in the future. The survey also listed four common bowel preparations used prior to colonoscopy and sigmoidoscopy and asked the physician to rank the order of the preferred agent in each case.RESULTS： With regard to common laxatives, both gastroenterologists and obstetricians favor the use of Metamucil, Colace, and Citrucel. Both groups appear to refrain from using Fleets Phosphosoda and Castor oil. Of note, obstetricians are less inclined to use PEG solution and Miralax, which is not the case ,with gastroenterologists. In terms of comparing bowel preparations for colonoscopy, 50% of gastroenterologists prefer to use PEG solution and 50% avoid the use of Fleets Phosphosoda. Obstetricians seem to prefer Fleets Phosphosoda （20%） and tend to avoid the use of PEG solution （26%）. With regard to bowel preparation for sigmoidoscopy, both groups prefer Fleets enema the most （51%）, while magnesium citrate is used least often （38%）.CONCLUSION： It is clear that preferences in the use of bowel cleansing preparations between the two groups exist, but there have not been many case controlled human studies in the pregnant patient that give clear cut indications for using one versus another drug. In light of the challenge of performing controlled trials in pregnant women, more extensive surveys should be undertaken to gather a larger amount of data on physicians＇ experiences and individual preferences.展开更多
AIM To compare the adenoma detection rate(ADR) between gastroenterologists and colorectal surgeons at Box Hill Hospital, Melbourne, Australia.METHODS A total of 300 colonoscopies performed by gastroenterologists and c...AIM To compare the adenoma detection rate(ADR) between gastroenterologists and colorectal surgeons at Box Hill Hospital, Melbourne, Australia.METHODS A total of 300 colonoscopies performed by gastroenterologists and colorectal surgeons at Box Hill Hospital were retrospectively reviewed from May 2016 to June 2017. Exclusion criteria were: Patients ≤ 50 years old, colonoscopies with failure of caecal intubation, patients who previously had colon cancer and/or a colonic resection, history of polyposis syndromes or inflammatory bowel disease, or a colonoscopy within the last 10 years. Patient demographics, indications, symptoms and procedural-related outcomes were measured.RESULTS The ADR was not significantly different between gastroenterologists and colorectal surgeons(34% vs 34.67%; P = 0.90). The adjusted odds ratio correcting for gender, age, 1^(st) degree relative with colorectal cancer, previous colonoscopy, trainee involvement and caecal or terminal ileum intubation rate was 1.19(0.69-2.05).CONCLUSION Both specialties at our institution exceed benchmark standards suggested by published Australian and American guidelines. An association between endoscopist specialty and ADR was not observed.展开更多
This is a commentary on the recently published metaanalysis by Wilkins et al which concluded that primary care physicians are able to provide comparable quality in performing colonoscopic colon cancer screening as gas...This is a commentary on the recently published metaanalysis by Wilkins et al which concluded that primary care physicians are able to provide comparable quality in performing colonoscopic colon cancer screening as gastroenterologists.展开更多
In this editorial,we provide commentary on a recently published study by Zhao et al in the World Journal of Gastrointestinal Oncology.The study discusses the clinical characteristics of patients undergoing endoscopic ...In this editorial,we provide commentary on a recently published study by Zhao et al in the World Journal of Gastrointestinal Oncology.The study discusses the clinical characteristics of patients undergoing endoscopic resection for gastric cancers.We feel it is important to engage our endoscopy community in a discussion on the current evidence in the literature on the necessary number of cases for training in endoluminal surgery techniques,particularly endoscopic submucosal dissection.This includes the latest recommendations from the European Society of Gastrointestinal Endoscopy,as well as a summary of key studies on the learning curve for these techniques.Additionally,we explore the impact of an endo-scopist’s specialty on endoscopy outcomes,drawing from current evidence in the literature to shape our perspective in this evolving field.展开更多
BACKGROUND Long-term use of proton pump inhibitors(PPIs)has been associated with poten-tial adverse effects,including an increased risk of gastric cancer.Despite wide-spread use awareness of these risks among physicia...BACKGROUND Long-term use of proton pump inhibitors(PPIs)has been associated with poten-tial adverse effects,including an increased risk of gastric cancer.Despite wide-spread use awareness of these risks among physicians varies considerably.Under-standing physicians’perceptions and prescribing behaviors is critical to impro-ving patient safety and promoting evidence-based practices.This study aimed to assess the level of awareness and risk perception among gastroenterologists and non-gastroenterologists regarding prolonged PPI use and its association with gastric malignancy.AIM To assess physicians’awareness of gastric cancer risk associated with long-term PPI use and compare perceptions between specialties.METHODS A cross-sectional observational study was conducted among 33 physicians(15 gastroenterologists and 18 non-gastroenterologists)in Israel.Participants com-pleted a structured questionnaire evaluating knowledge,attitudes,and prescri-bing behaviors related to PPI use.Data were analyzed using descriptive statistics and nonparametric tests to assess differences between groups and correlation patterns.Ethical approval and informed consent were obtained.RESULTS Gastroenterologists demonstrated significantly higher awareness of the potential gastric cancer risks linked to prolonged PPI use(mean awareness score:6.9±1.2)compared with non-gastroenterologists(4.1±1.3,P<0.01).Despite their awa-reness 80%of gastroenterologists reported frequent long-term prescribing.Non-parametric correlation analysis revealed associations between specialty,know-ledge level,and prescribing habits.Several misconceptions about cancer risk mechanisms were identified across specialties.CONCLUSION Physician awareness regarding gastric cancer risk of long-term PPI use remains inconsistent,especially among non-specialists,emphasizing the need for targeted educational programs and clearer prescribing guidelines.展开更多
AIM: To explore Chinese physicians' perceptions towards fecal microbiota transplantation(FMT) and to provide information and an assessment of FMT development in China.METHODS: A self-administered questionnaire was...AIM: To explore Chinese physicians' perceptions towards fecal microbiota transplantation(FMT) and to provide information and an assessment of FMT development in China.METHODS: A self-administered questionnaire was developed according to the FMT practice guidelines and was distributed to physicians in hospitals via Internet Research Electronic Data Capture(REDcap) software and electronic mails to assess their attitudes toward and knowledge of FMT. The questionnaire included a brief introduction of FMT that was followed by 20 questions. The participants were required to respond voluntarily, under the condition of anonymity and without compensation. Except for the fill-in-the-blank questions, all of the other questions were required in the REDcap data collection systems, and the emailed questionnaires were completed based on eligibility.RESULTS: Up to December 9, 2014, 844 eligible questionnaires were received out of the 980 distributed questionnaires, with a response rate of 86.1%. Among the participants, 87.3% were from tertiary hospitals, and there were 647(76.7%) gastroenterologists and 197(23.3%) physicians in other departments(nongastroenterologists). Gastroenterologists' awareness of FMT prior to the survey was much higher than non-gastroenterologists'(54.3 vs 16.5%, P < 0.001); however, acceptance of FMT was not statistically different(92.4 vs 87.1%, P = 0.1603). Major concerns of FMT included the following: acceptability to patients(79.2%), absence of guidelines(56.9%), and administration and ethics(46.5%). On the basis of understanding, the FMT indications preferred byphysicians were recurrent Clostridium difficile infection(86.7%), inflammatory bowel disease combined with Clostridium difficile infection(78.6%), refractory ulcerative colitis(70.9%), ulcerative colitis(65.4%), Crohn's disease(59.4%), chronic constipation(43.7%), irritable bowel syndrome(39.1%), obesity(28.1%) and type 2 diabetes(23.9%). For donor selection, the majority of physicians preferred individuals with a similar gut flora environment to the recipients. 76.6% of physicians chose lower gastrointestinal tract as the administration approach. 69.2% of physicians considered FMT a safe treatment. CONCLUSION: Chinese physicians have awareness and a high acceptance of FMT, especially gastroenterologists, which provides the grounds and conditions for the development of this novel treatment in China. Physicians' greatest concerns were patient acceptability and absence of guidelines.展开更多
AIM: To identify risk factors to help predict which patients are likely to fail to appear for an endoscopic procedure. METHODS: This was a retrospective, chart review, cohort study in a Canadian, tertiary care, academ...AIM: To identify risk factors to help predict which patients are likely to fail to appear for an endoscopic procedure. METHODS: This was a retrospective, chart review, cohort study in a Canadian, tertiary care, academic, hospital-based endoscopy clinic. Patients included were: those undergoing esophagogastroduodenoscopy, colonoscopy or flexible sigmoidoscopy and patients who failed to appear were compared to a control group. The main outcome measure was a multivariate analysis of factors associated with truancy from scheduled endoscopic procedures. Factors analyzed included gender, age, waiting time, type of procedure, referring physician, distance to hospital, first or subsequent endoscopic procedure or encounter with gastroenterologist, and urgency of the procedure. RESULTS: Two hundred and thirty-four patients did not show up for their scheduled appointment. Compared to a control group, factors statistically significantly associated with truancy in the multivariate analysis were: non-urgent vs urgent procedure (OR 1.62, 95% CI 1.06, 2.450), referred by a specialist vs a family doctor (OR 2.76, 95% CI 1.31, 5.52) and office-based consult prior to endoscopy vs consult and endoscopic procedure during the same appointment (OR 2.24, 95% CI 1.33, 3.78). CONCLUSION: Identifying patients who are not scheduled for same-day consult and endoscopy, those referred by a specialist, and those with non-urgent referrals may help reduce patient truancy.展开更多
BACKGROUND Musculoskeletal injuries(MSI)have plagued endoscopists and ancillary staff for decades without any innovative and strong ergonomic guidelines.It has placed a physical and mental strain on our endoscopists a...BACKGROUND Musculoskeletal injuries(MSI)have plagued endoscopists and ancillary staff for decades without any innovative and strong ergonomic guidelines.It has placed a physical and mental strain on our endoscopists and ancillary staff.We have very have limited data supporting this claim in our region and most data is supported by western literature.AIM To document the prevalence of MSI,and awareness and practices of ergonomics by endoscopists and ancillary staff.METHODS This is an observational cross-sectional study,conducted in Karachi,a city that boasts the maximum number of daily endoscopies in the country.An eleven-point self-administered questionnaire was distributed and used to evaluate MSI and ergonomic adjustments amongst three tertiary care setups in Karachi.An onsite survey via a 13-point checklist for endoscopy suite facilities was used to assess the ergonomically friendly conveniences at five tertiary care setups in Karachi.A total of 56 participants replied with a filled survey.RESULTS There were 56 participants in total with 39(69.6%)males.Pain and numbness were documented by 75%of the patients,with pain in the neck(41.1%),lower back(32.1%),shoulder(21.4%),thumb(12.5%),hand(23.2%),elbow(8.9%),and carpal tunnel syndrome(CTS)(7.1%).Of those,33.3%attributed their symptoms to endoscopy, 14.2% said that symptoms were not caused by endoscopy, and 52.4% were notcertain whether endoscopy had caused their symptoms. Twenty-one point four percent of patientshad to take time off their work, while 33.9% took medications for pain. Ergonomic modifications toprevent musculoskeletal injury, including placement of endoscopic monitor at eye level and thecardiac monitor in front, stopping the procedure to move patients, sitting while performingcolonoscopy, and navigating height-adjustable bed were used by 21.4%. Nine out of 13 ergonomicfacilities were not present in all five tertiary care hospitals. Conveniences, such as anti-fatiguemats, height-adjustable computer stations, and time out between patients were not present.CONCLUSIONThree-fourth of our endoscopists reported MSI, of which more than half were not sure orattributed this problem to endoscopy. The prevalence of MSI warrants urgent attention.展开更多
Aim: To compare outcomes by sedation class in community patients undergoing index endoscopic retrograde cholangiopancreatography (ERCP). Methods: Nineteen hundred sixteen consecutive patients underwent ERCP from May 2...Aim: To compare outcomes by sedation class in community patients undergoing index endoscopic retrograde cholangiopancreatography (ERCP). Methods: Nineteen hundred sixteen consecutive patients underwent ERCP from May 2005 to May 2011. Eight hundred thirty seven patients were excluded due to prior papillary intervention or attempted ERCP. A total of 1079 patients were included. The 981 patients who underwent gastroenterologist directed sedation (GDS) served as the control population, while the 98 patients who received anesthesiologist directed sedation (ADS) served as the case population. Medical records were analyzed for patient demographics, procedure indication, adverse events, case complexity, procedural failure and sedation failure. Case complexity was defined by the grading system proposed by the working party of the ASGE Quality Committee. Sedation failure was defined by agitation or airway compromise prompting termination of the ERCP. Reasons for procedural failure included surgically altered anatomy, luminal obstruction, and technical failure. Study endpoint was defined as successful deep cannulation of the intended target duct. Results: Demographic distribution did not differ between the GDS and the ADS groups. Cannulation success rates were similar between the two groups, with 89.85% in the GDS group, and 89.58% in the ADS group (P = 0.864). There were no statistical differences between sedation groups in procedural or respiratory adverse events. Technical failure was the predominant basis for deep cannulation failure in both groups. Agitation and airway compromise accounted for deep cannulation failure similarly in both groups. The need for reversal agents was low but similar in both groups. There was no statistical advantage in deep cannulation success rate by complexity grade in either sedation class. Conclusion: Excellent procedural outcomes and low adverse event rates were achieved using GDS, a more accessible and cost-effective method in a community-based setting.展开更多
文摘This commentary addresses the recent article by Yılmaz et al,featured in the May 2025 issue of this journal.Even though endoscopic procedures are common for both gastroenterologists and surgeons,there are clear differences between the two fields regarding when to use endoscopy,how to prepare for it,and how to monitor patients afterward.A primary determinant of these discrepancies lies in the variations in the duration and pedagogical frameworks of endoscopy training inherent to each discipline.These basic differences are very important for keeping patients safe and ensuring the procedures are done correctly,especially for treatments like endoscopic retrograde cholangiopancreatography(ERCP).This article aims to outline specific criticisms related to this topic,particularly in response to information shared about ERCP procedures performed in Türkiye.
文摘AIM： To clarify the prevalence of defensive medicine and the specific defensive medicine practices among gastroenterologists in Japan. METHODS： A survey of gastroenterologists in Hiroshima, Japan, was conducted by mail in March 2006. The number of gastroenterologists reporting defensive medicine behaviors or changes in their scope of practice and the reported defensive medicine practices, i.e., assurance and avoidance behaviors, were examined. RESULTS： A total of 131 （77%） out of 171 gastroenterologists completed the survey. Three （2%） respondents were sued, and most respondents （96%） had liability insurance. Nearly all respondents （98%） reported practicing defensive medicine. Avoidance behaviors, such as avoiding certain procedures or interventions and avoiding caring for high-risk patients, were very common （96%）. Seventy-five percent of respondents reported often avoiding certain procedures or interventions. However, seasoned gastroenterologists （those in practice for more than 20 years） adopted avoidance behaviors significantly less often than those in practice for less than 10 years. Assurance behaviors, i.e., supplying additional services of marginal or no medical value, were also widespread （91%）. Sixty-eight percent of respondents reported that they sometimes or often referred patients to other specialists unnecessarily. CONCLUSION： Defensive medicine may be highly prevalent among gastroenterologists throughout 3apan, with potentially serious implications regarding costs, access, and both technical and interpersonal quality of care.
基金Supported by The Clinical trial(Clinical Trials.gov Identifier:NCT01896635)this study was performed in conjunction with has received funding from the Broad Medical Research Program at CCFAthe GESA IBD Clinical Research Grant
文摘AIM: To explore gastroenterologist perceptions towards and experience with faecal microbiota transplantation(FMT).METHODS: A questionnaire survey consisting of 17 questions was created to assess gastroenterologists' attitude towards and experience with FMT. This was anonymously distributed in hard copy format amongst attendees at gastroenterology meetings in Australia between October 2013 and April 2014. Basic descriptive statistical analyses were performed.RESULTS: Fifty-two clinicians participated. Twenty one percent had previously referred patients for FMT,8% more than once. Ninety percent would refer patients with Clostridium difficile infection(CDI) for FMT if easily available,37% for ulcerative colitis,13% for Crohn's disease and 6% for irritable bowel syndrome. Six percent would not refer any indication,including recurrent CDI. Eighty-six percent would enroll patients in FMT clinical trials. Thirty-seven percent considered the optimal mode of FMT administration transcolonoscopic,17% nasoduodenal,13% enema and 8% oral capsule. The greatest concerns regarding FMT were: 42% lack of evidence,12% infection risk,10% non infectious adverse effects/lack of safety data,10% aesthetic,10% lack of efficacy,4% disease exacerbation,and 2% inappropriate use; 6% had no concerns. Seventy seven percent believed there is a lack of accessibility while 52% had an interest in learning how to provide FMT. Only 6% offered FMT at their institution.CONCLUSION: Despite general enthusiasm,most gastroenterologists have limited experience with,or access to,FMT. The greatest concerns were lack of supportive evidence and safety issues. However a significant proportion would refer indications other than CDI for FMT despite insufficient evidence. These data provide guidance on where education and training are required.
文摘AIM： To elucidate the preferences of gastroenterologists at our institution and compare them to those of obstetricians when making decisions in the pregnant patient, including which type of bowel preparations to use for flexible sigmoidoscopy or colonoscopy, as well as which laxatives can be used safely.METHODS： Surveys were mailed to all attending gastroenterologists （n = 53） and obstetricians （n = 99） at our institution. Each survey consisted of the 14 most common laxative or motility agents used in pregnancy and inquired about the physician＇s prescribing habits in the past as well as their willingness to prescribe each medication in the future. The survey also listed four common bowel preparations used prior to colonoscopy and sigmoidoscopy and asked the physician to rank the order of the preferred agent in each case.RESULTS： With regard to common laxatives, both gastroenterologists and obstetricians favor the use of Metamucil, Colace, and Citrucel. Both groups appear to refrain from using Fleets Phosphosoda and Castor oil. Of note, obstetricians are less inclined to use PEG solution and Miralax, which is not the case ,with gastroenterologists. In terms of comparing bowel preparations for colonoscopy, 50% of gastroenterologists prefer to use PEG solution and 50% avoid the use of Fleets Phosphosoda. Obstetricians seem to prefer Fleets Phosphosoda （20%） and tend to avoid the use of PEG solution （26%）. With regard to bowel preparation for sigmoidoscopy, both groups prefer Fleets enema the most （51%）, while magnesium citrate is used least often （38%）.CONCLUSION： It is clear that preferences in the use of bowel cleansing preparations between the two groups exist, but there have not been many case controlled human studies in the pregnant patient that give clear cut indications for using one versus another drug. In light of the challenge of performing controlled trials in pregnant women, more extensive surveys should be undertaken to gather a larger amount of data on physicians＇ experiences and individual preferences.
文摘AIM To compare the adenoma detection rate(ADR) between gastroenterologists and colorectal surgeons at Box Hill Hospital, Melbourne, Australia.METHODS A total of 300 colonoscopies performed by gastroenterologists and colorectal surgeons at Box Hill Hospital were retrospectively reviewed from May 2016 to June 2017. Exclusion criteria were: Patients ≤ 50 years old, colonoscopies with failure of caecal intubation, patients who previously had colon cancer and/or a colonic resection, history of polyposis syndromes or inflammatory bowel disease, or a colonoscopy within the last 10 years. Patient demographics, indications, symptoms and procedural-related outcomes were measured.RESULTS The ADR was not significantly different between gastroenterologists and colorectal surgeons(34% vs 34.67%; P = 0.90). The adjusted odds ratio correcting for gender, age, 1^(st) degree relative with colorectal cancer, previous colonoscopy, trainee involvement and caecal or terminal ileum intubation rate was 1.19(0.69-2.05).CONCLUSION Both specialties at our institution exceed benchmark standards suggested by published Australian and American guidelines. An association between endoscopist specialty and ADR was not observed.
文摘This is a commentary on the recently published metaanalysis by Wilkins et al which concluded that primary care physicians are able to provide comparable quality in performing colonoscopic colon cancer screening as gastroenterologists.
文摘In this editorial,we provide commentary on a recently published study by Zhao et al in the World Journal of Gastrointestinal Oncology.The study discusses the clinical characteristics of patients undergoing endoscopic resection for gastric cancers.We feel it is important to engage our endoscopy community in a discussion on the current evidence in the literature on the necessary number of cases for training in endoluminal surgery techniques,particularly endoscopic submucosal dissection.This includes the latest recommendations from the European Society of Gastrointestinal Endoscopy,as well as a summary of key studies on the learning curve for these techniques.Additionally,we explore the impact of an endo-scopist’s specialty on endoscopy outcomes,drawing from current evidence in the literature to shape our perspective in this evolving field.
文摘BACKGROUND Long-term use of proton pump inhibitors(PPIs)has been associated with poten-tial adverse effects,including an increased risk of gastric cancer.Despite wide-spread use awareness of these risks among physicians varies considerably.Under-standing physicians’perceptions and prescribing behaviors is critical to impro-ving patient safety and promoting evidence-based practices.This study aimed to assess the level of awareness and risk perception among gastroenterologists and non-gastroenterologists regarding prolonged PPI use and its association with gastric malignancy.AIM To assess physicians’awareness of gastric cancer risk associated with long-term PPI use and compare perceptions between specialties.METHODS A cross-sectional observational study was conducted among 33 physicians(15 gastroenterologists and 18 non-gastroenterologists)in Israel.Participants com-pleted a structured questionnaire evaluating knowledge,attitudes,and prescri-bing behaviors related to PPI use.Data were analyzed using descriptive statistics and nonparametric tests to assess differences between groups and correlation patterns.Ethical approval and informed consent were obtained.RESULTS Gastroenterologists demonstrated significantly higher awareness of the potential gastric cancer risks linked to prolonged PPI use(mean awareness score:6.9±1.2)compared with non-gastroenterologists(4.1±1.3,P<0.01).Despite their awa-reness 80%of gastroenterologists reported frequent long-term prescribing.Non-parametric correlation analysis revealed associations between specialty,know-ledge level,and prescribing habits.Several misconceptions about cancer risk mechanisms were identified across specialties.CONCLUSION Physician awareness regarding gastric cancer risk of long-term PPI use remains inconsistent,especially among non-specialists,emphasizing the need for targeted educational programs and clearer prescribing guidelines.
基金Supported by Chinese PLA General Hospital,No.2014FCTSYS-2001 and No.2013FC-TSYS-1009National High-tech Research and Development Projects(863),No.2015AA020702National Natural Science Foundation of China,No.81402345
文摘AIM: To explore Chinese physicians' perceptions towards fecal microbiota transplantation(FMT) and to provide information and an assessment of FMT development in China.METHODS: A self-administered questionnaire was developed according to the FMT practice guidelines and was distributed to physicians in hospitals via Internet Research Electronic Data Capture(REDcap) software and electronic mails to assess their attitudes toward and knowledge of FMT. The questionnaire included a brief introduction of FMT that was followed by 20 questions. The participants were required to respond voluntarily, under the condition of anonymity and without compensation. Except for the fill-in-the-blank questions, all of the other questions were required in the REDcap data collection systems, and the emailed questionnaires were completed based on eligibility.RESULTS: Up to December 9, 2014, 844 eligible questionnaires were received out of the 980 distributed questionnaires, with a response rate of 86.1%. Among the participants, 87.3% were from tertiary hospitals, and there were 647(76.7%) gastroenterologists and 197(23.3%) physicians in other departments(nongastroenterologists). Gastroenterologists' awareness of FMT prior to the survey was much higher than non-gastroenterologists'(54.3 vs 16.5%, P < 0.001); however, acceptance of FMT was not statistically different(92.4 vs 87.1%, P = 0.1603). Major concerns of FMT included the following: acceptability to patients(79.2%), absence of guidelines(56.9%), and administration and ethics(46.5%). On the basis of understanding, the FMT indications preferred byphysicians were recurrent Clostridium difficile infection(86.7%), inflammatory bowel disease combined with Clostridium difficile infection(78.6%), refractory ulcerative colitis(70.9%), ulcerative colitis(65.4%), Crohn's disease(59.4%), chronic constipation(43.7%), irritable bowel syndrome(39.1%), obesity(28.1%) and type 2 diabetes(23.9%). For donor selection, the majority of physicians preferred individuals with a similar gut flora environment to the recipients. 76.6% of physicians chose lower gastrointestinal tract as the administration approach. 69.2% of physicians considered FMT a safe treatment. CONCLUSION: Chinese physicians have awareness and a high acceptance of FMT, especially gastroenterologists, which provides the grounds and conditions for the development of this novel treatment in China. Physicians' greatest concerns were patient acceptability and absence of guidelines.
文摘AIM: To identify risk factors to help predict which patients are likely to fail to appear for an endoscopic procedure. METHODS: This was a retrospective, chart review, cohort study in a Canadian, tertiary care, academic, hospital-based endoscopy clinic. Patients included were: those undergoing esophagogastroduodenoscopy, colonoscopy or flexible sigmoidoscopy and patients who failed to appear were compared to a control group. The main outcome measure was a multivariate analysis of factors associated with truancy from scheduled endoscopic procedures. Factors analyzed included gender, age, waiting time, type of procedure, referring physician, distance to hospital, first or subsequent endoscopic procedure or encounter with gastroenterologist, and urgency of the procedure. RESULTS: Two hundred and thirty-four patients did not show up for their scheduled appointment. Compared to a control group, factors statistically significantly associated with truancy in the multivariate analysis were: non-urgent vs urgent procedure (OR 1.62, 95% CI 1.06, 2.450), referred by a specialist vs a family doctor (OR 2.76, 95% CI 1.31, 5.52) and office-based consult prior to endoscopy vs consult and endoscopic procedure during the same appointment (OR 2.24, 95% CI 1.33, 3.78). CONCLUSION: Identifying patients who are not scheduled for same-day consult and endoscopy, those referred by a specialist, and those with non-urgent referrals may help reduce patient truancy.
文摘BACKGROUND Musculoskeletal injuries(MSI)have plagued endoscopists and ancillary staff for decades without any innovative and strong ergonomic guidelines.It has placed a physical and mental strain on our endoscopists and ancillary staff.We have very have limited data supporting this claim in our region and most data is supported by western literature.AIM To document the prevalence of MSI,and awareness and practices of ergonomics by endoscopists and ancillary staff.METHODS This is an observational cross-sectional study,conducted in Karachi,a city that boasts the maximum number of daily endoscopies in the country.An eleven-point self-administered questionnaire was distributed and used to evaluate MSI and ergonomic adjustments amongst three tertiary care setups in Karachi.An onsite survey via a 13-point checklist for endoscopy suite facilities was used to assess the ergonomically friendly conveniences at five tertiary care setups in Karachi.A total of 56 participants replied with a filled survey.RESULTS There were 56 participants in total with 39(69.6%)males.Pain and numbness were documented by 75%of the patients,with pain in the neck(41.1%),lower back(32.1%),shoulder(21.4%),thumb(12.5%),hand(23.2%),elbow(8.9%),and carpal tunnel syndrome(CTS)(7.1%).Of those,33.3%attributed their symptoms to endoscopy, 14.2% said that symptoms were not caused by endoscopy, and 52.4% were notcertain whether endoscopy had caused their symptoms. Twenty-one point four percent of patientshad to take time off their work, while 33.9% took medications for pain. Ergonomic modifications toprevent musculoskeletal injury, including placement of endoscopic monitor at eye level and thecardiac monitor in front, stopping the procedure to move patients, sitting while performingcolonoscopy, and navigating height-adjustable bed were used by 21.4%. Nine out of 13 ergonomicfacilities were not present in all five tertiary care hospitals. Conveniences, such as anti-fatiguemats, height-adjustable computer stations, and time out between patients were not present.CONCLUSIONThree-fourth of our endoscopists reported MSI, of which more than half were not sure orattributed this problem to endoscopy. The prevalence of MSI warrants urgent attention.
文摘Aim: To compare outcomes by sedation class in community patients undergoing index endoscopic retrograde cholangiopancreatography (ERCP). Methods: Nineteen hundred sixteen consecutive patients underwent ERCP from May 2005 to May 2011. Eight hundred thirty seven patients were excluded due to prior papillary intervention or attempted ERCP. A total of 1079 patients were included. The 981 patients who underwent gastroenterologist directed sedation (GDS) served as the control population, while the 98 patients who received anesthesiologist directed sedation (ADS) served as the case population. Medical records were analyzed for patient demographics, procedure indication, adverse events, case complexity, procedural failure and sedation failure. Case complexity was defined by the grading system proposed by the working party of the ASGE Quality Committee. Sedation failure was defined by agitation or airway compromise prompting termination of the ERCP. Reasons for procedural failure included surgically altered anatomy, luminal obstruction, and technical failure. Study endpoint was defined as successful deep cannulation of the intended target duct. Results: Demographic distribution did not differ between the GDS and the ADS groups. Cannulation success rates were similar between the two groups, with 89.85% in the GDS group, and 89.58% in the ADS group (P = 0.864). There were no statistical differences between sedation groups in procedural or respiratory adverse events. Technical failure was the predominant basis for deep cannulation failure in both groups. Agitation and airway compromise accounted for deep cannulation failure similarly in both groups. The need for reversal agents was low but similar in both groups. There was no statistical advantage in deep cannulation success rate by complexity grade in either sedation class. Conclusion: Excellent procedural outcomes and low adverse event rates were achieved using GDS, a more accessible and cost-effective method in a community-based setting.
