Risk Factors for Rescue Therapy in Crohn's Patients Maintained on Infliximab After Withdrawal of the Immunomodulator: A Long-Term Follow-Up.

Background: Usefulness of thiopurine and scheduled infliximab combination therapy in non-immunomodulator (IM)-naïve Crohn's disease (CD) patients and the optimal length of dual therapy are still debated.

Aims: To determine proportion of patients developing disease flare requiring rescue therapy and risk factors associated with disease flare after de-escalation of IM from combination therapy.

Methods: Adult CD patients in clinical remission on combination therapy were identified from a large single-center database between 2002 and 2009.

Comparing diagnostic yield of a novel pan-enteric video capsule endoscope with ileocolonoscopy in patients with active Crohn's disease: a feasibility study.

Background And Aims: Crohn's disease (CD) is typically diagnosed with ileocolonoscopy (IC); however, when inflammation is localized solely in the small bowel, visualization of the entire small-bowel mucosa can be challenging. The aim of this study was to compare the diagnostic yield of a pan-enteric video capsule endoscope (small-bowel colon [SBC] capsule) versus IC in patients with active CD.

Methods: This was a prospective, multicenter study.

Narrow-band imaging versus white light for the detection of proximal colon serrated lesions: a randomized, controlled trial.

Background: The value of narrow-band imaging (NBI) for detecting serrated lesions is unknown.

Objective: To assess NBI for the detection of proximal colon serrated lesions.

Design: Randomized, controlled trial.

Incidence and risk factors for lymphoma in a single-center inflammatory bowel disease population.

Aims: Previous studies on the risk of lymphoma in inflammatory bowel disease (IBD) have yielded conflicting results. We aim to determine the incidence and risk factors for lymphoma in a large IBD population.

Methods: Patients with lymphoma were identified from a single-center IBD database.

Recognition, diagnosis, and treatment of histoplasmosis complicating tumor necrosis factor blocker therapy.

Life-threatening histoplasmosis is one of the most common opportunistic infections in patients receiving tumor necrosis factor (TNF) blockers. Delays in considering the diagnosis may lead to increased morbidity and mortality. Most affected patients present with pneumonitis, usually accompanied by additional signs of progressive dissemination, or with signs of progressive dissemination alone.

Predictors of depth of maximal insertion at double-balloon enteroscopy.

The aim of this study was to determine the factors predictive of the depth of maximal insertion (DMI) at double-balloon enteroscopy (DBE). Eligible patients from the DBE database at our institution were stratified based on their anterograde or retrograde approach. The factors predictive of the DMI were calculated using ANOVA, Spearman, univariate, and multivariate regression analysis.

Medical management of Crohn's disease: a guide for radiologists.

The choice of therapies for Crohn's disease has expanded greatly over the past 30 years. Increasingly it is important that we attempt to identify subgroups of patients who will benefit most from each type of therapy. This article reviews the therapeutic options currently available, organized by the goal the practitioner hopes to achieve.

Cecal insertion and withdrawal times with wide-angle versus standard colonoscopes: a randomized controlled trial.

Background & Aims: The aim of this study was to see if a 170 degrees angle of view (wide angle [WA]) colonoscope allowed faster withdrawal without decreasing adenoma detection.

Methods: Eight colonoscopists at 2 institutions participated in the study. Patients were randomized so that each colonoscopist performed 50% of the exams with a 160 series (140 degrees angle of view; standard [ST]) colonoscope and 50% with a prototype 160 series colonoscope with a 170 degrees angle of view (WA instrument).

Screening for Barrett's esophagus in colonoscopy patients with and without heartburn.

Background & Aims: The population prevalence of Barrett's esophagus (BE) is uncertain. Our aim was to describe the prevalence of BE in a volunteer population.

Methods: Upper endoscopy (EGD) was performed in 961 persons with no prior history of EGD who were scheduled for colonoscopy.

Wide angle colonoscopy with a prototype instrument: impact on miss rates and efficiency as determined by back-to-back colonoscopies.

Objective: Polyps are missed during conventional colonoscopy, even with meticulous technique. The aim of this study was to investigate whether a prototype wide angle colonoscope is associated with a reduced miss rate for polyps.

Methods: Two studies were performed.

Positive predictive value of endoscopic features deemed typical of gastric fundic gland polyps.

Background: Fundic gland polyps (FGPs) are now the most common gastric polyp encountered by endoscopists. However, they have minimal clinical significance. If they could be reliably predicted by endoscopic features, it might prevent the need for and cost of biopsy.

Safety of propofol administered by registered nurses with gastroenterologist supervision in 2000 endoscopic cases.

Objectives: Propofol has certain advantages over benzodiazepines plus narcotics as sedation for endoscopy. In a few centers, propofol has reportedly been used in endoscopic procedures and administered by nurses supervised by gastroenterologists without attendance by anesthesiologists or nurse anesthetists.

Methods: As part of our continuous quality improvement program, we prospectively recorded the doses of propofol and adverse reactions to the drug in our initial 2000 cases.

Inflammatory bowel disease.

The pathogenesis of inflammatory bowel disease (IBD) continues to be explored, with the emphasis on genetically determined host immune dysregulation as it applies to interactions with luminal bacteria. The role of endoscopic ultrasound in the evaluation of IBD continues to be studied. Recent advances in the evaluation of enterocutaneous fistulas have been made through the use of hydrogen peroxide to enhance definition of the fistula course and characteristics of the neighboring bowel, as evaluated by transabdominal ultrasound.

Colonoscopic miss rates of adenomas determined by back-to-back colonoscopies.

Background & Aims: The miss rate of colonoscopy for neoplasms is poorly understood. The aim of this study was to determine the miss rate of colonoscopy by same day back-to-back colonoscopy.

Methods: Two consecutive same day colonoscopies were performed in 183 patients.

5-year incidence of adenomas after negative colonoscopy in asymptomatic average-risk persons [see comment].

Background & Aims: Cost-effectiveness of colorectal cancer screening will be maximized by selecting the widest screening intervals that effectively prevent cancer mortality. However, data on the incidence of neoplasia in persons with no abnormal findings on initial examination are limited. The aim of this study was to describe the incidence of colonic neoplasia 5 years after negative screening colonoscopy in asymptomatic average-risk persons.

Colonic adenomas in asymptomatic women with a history of breast cancer.

One hundred ninety-three asymptomatic women with a personal history of breast cancer underwent screening colonoscopy. One hundred sixty-eight women had breast cancer as their only potential risk factor for colonic neoplasia, and 25 had a family history of colorectal neoplasia in addition to their personal history of breast cancer. Among women with breast cancer, increasing age and body weight were each predictive of an increasing prevalence of colonic adenomas.

Colonic neoplasia in asymptomatic persons with negative fecal occult blood tests: influence of age, gender, and family history.

Six hundred twenty-one asymptomatic persons with negative fecal occult blood tests (ages 50-75 yr), including 496 with no known risk factors for colorectal cancer and 125 with a single first-degree relative with a history of colonic neoplasia developed after age 40, underwent screening colonoscopy. Three Dukes A cancers were detected in average-risk persons. The overall prevalence of adenomatous polyps was 27%.

Distribution of isoelectric variants of the 17,000-dalton myosin light chain in mammalian smooth muscle.

Isoelectric focusing of purified vascular smooth muscle myosin revealed two variants of the 17,000-dalton light chain subunits. The isoelectric points of the light chain variants were determined to be 4.13 (LC17a) and 4.

Diastolic collapse of the right ventricle with cardiac tamponade: an echocardiographic study.

The value of a newly described echocardiographic sign for the detection of cardiac tamponade was retrospectively evaluated in 91 patients. M-mode echocardiograms were reviewed in 86 patients, 36 of whom had concurrent two-dimensional echocardiographic examinations; in five patients, only two-dimensional echocardiography was performed. Cardiac tamponade was clinically present in 17 patients, 14 of whom had abnormal posterior motion of the right ventricular free wall in early diastole.