AGA White Paper: Training and Implementation of Endoscopic Image Enhancement Technologies.

Endoscopic image-enhancement technologies provide opportunities to visualize normal and abnormal tissues within the gastrointestinal (GI) tract in a manner that complements conventional white light endoscopic imaging. The additional information that is obtained enables the endoscopist to better identify, delineate, and characterize lesions and can facilitate targeted biopsies or, in some cases, eliminate the need to send samples for histologic analysis. Some of these technologies have been available for more than a decade, but despite this fact, there is limited use of these technologies by endoscopists.

White Paper AGA: Advanced Imaging in Barrett's Esophagus.

Enhanced imaging technologies such as narrow band imaging, flexible spectral imaging color enhancement, i-Scan, confocal laser endomicroscopy, and optical coherence tomography are readily available for use by endoscopists in routine clinical practice. In November 2014, the American Gastroenterological Association's Center for GI Innovation and Technology conducted a 2-day workshop to discuss endoscopic image enhancement technologies, focusing on their role in 2 specific clinical conditions (colon polyps and Barrett's esophagus) and on issues relating to training and implementation of these technologies (white papers). Although the majority of the studies that use enhanced imaging technologies have been positive, these techniques ideally need to be validated in larger cohorts and in community centers.

Management of Diminutive Colon Polyps Based on Endoluminal Imaging.

Diminutive colon polyps, defined as 5 mm or less, are encountered increasingly at colonoscopy. The risk of serious pathology in such polyps is low. There is a risk and cost of resecting all such polyps and sending tissue for pathologic evaluation.

Barrett's esophagus on repeat endoscopy: should we look more than once?

Background: Barrett's esophagus (BE) is the precursor lesion for esophageal adenocarcinoma. The major risk factor for BE is chronic gastroesophageal reflux disease (GERD). Screening patients with longstanding GERD for BE with upper esophagogastroduodenoscopy (EGD) has become the standard practice, and guidelines from national gastrointestinal (GI) societies recommend only a single screening EGD because of limited evidence, suggesting that BE develops early in the course of GERD.

A prospective study of the diagnostic accuracy of PillCam ESO esophageal capsule endoscopy versus conventional upper endoscopy in patients with chronic gastroesophageal reflux diseases.

Introduction: Endoscopy is commonly performed to evaluate for suspected or established esophageal diseases including gastroesophageal reflux disease (GERD) and its complications. The newly developed PillCam ESO Esophageal Capsule offers an alternative approach to visualize the esophagus and to evaluate patients with suspected esophageal disease.

Aim: Compare the accuracy (specificity, sensitivity, positive predictive value [PPV], and negative predictive value [NPV]) of esophageal capsule endoscopy (ECE) compared with esophagogastroduodenoscopy (EGD) in evaluating patients with GERD.

Reversal of Barrett's esophagus with acid suppression and multipolar electrocoagulation: preliminary results.

Background: Barrett's esophagus is a premalignant lesion for esophageal adenocarcinoma. This study tests the hypothesis that re-injury of the metaplastic the epithelium in an acid-controlled environment will result in reversal of Barrett's to squamous epithelium.

Methods: Patients with at least 2 cm of Barrett's esophagus were treated with omeprazole, and half the circumference of the Barrett's was treated with multipolar electrocoagulation (MPEC); the other half served as an internal control.

The economics of eradicating Helicobacter pylori infection in duodenal ulcer disease.

Approximately 5 million people in the United States suffer from peptic ulcer disease, making this an important clinical problem. In addition to the huge costs associated with treatment, peptic ulcer disease also results in losses to industry as a result of loss of productivity. Infection with Helicobacter pylori is now accepted as the cause of duodenal ulcer in the majority of patients.

Demonstration of a field defect in gastric intestinal metaplasia by biological marker analysis.

Gastric intestinal metaplasia (GIM) is a precursor lesion for gastric cancer. It most frequently involves the antrum and the angularis. At endoscopy, it is not possible to visually distinguish GIM from normal stomach.

Design and analysis of studies to reduce the incidence of colon polyps.

Decisions regarding the design and analysis of a phase III study to reduce the incidence of colorectal polyps must take into account two complicating factors: the possibility that polyps are missed during screening exams, and variable lengths of follow-up. In this paper we investigate the effects due to misclassification on the power of statistical tests to detect a change in polyp recurrence rates. We also use Monte Carlo studies to examine the relative efficiency of different methods of adjusting for variable times of follow-up.

Ornithine decarboxylase assay in human colorectal mucosa. Methodologic issues of importance to quality control.

Ornithine decarboxylase may be a useful biomarker for risk of neoplasia in colorectal tissues. Investigators have reported enzyme activities varying by as much as 10- to 20-fold using variations of the usual 14CO2 release assay. We have examined the effect of different methodologic factors on calculated ornithine decarboxylase activity.

Gallstone pancreatitis. Choosing and timing treatment.

Patients with gallstone pancreatitis are often seen initially by primary care physicians. Prompt diagnosis and timely intervention are crucial in reducing morbidity and mortality. Initial management should include supportive medical care and surgical consultation.

Clinical review of histamine2 receptor antagonists.

Histamine2 receptor antagonists are beneficial in treating gastric and duodenal ulcers, gastroesophageal reflux, and hypersecretory states. Histamine2 receptor antagonists are helpful for the prevention of stress ulceration and recurrence of gastric and duodenal ulcer. Four histamine2 blockers are approved for clinical use: cimetidine, famotidine, ranitidine, and nizatidine.