Low rate of postpolypectomy bleeding among patients who continue thienopyridine therapy during colonoscopy.

Background & Aims: It is not clear whether the cardiovascular risk of discontinuing treatment with antiplatelet agents, specifically the thienopyridines, before elective colonoscopy outweighs the risks of postpolypectomy bleeding (PPB). We studied the rate of PPB in patients who continue thienopyridine therapy during colonoscopy.

Methods: We performed a prospective study of 516 patients not taking warfarin who received polypectomies during elective colonoscopies; 219 were receiving thienopyridines, and 297 were not (controls).

Prone positioning of obese patients for colonoscopy results in shortened cecal intubation times: a randomized trial.

Background: Obesity is a risk factor for colorectal cancer, and colonoscopy can be technically challenging in obese patients. It has been proposed (with little supporting data) that prone positioning of obese patients might facilitate a difficult colonoscopy.

Aim: The aim of this study was to determine if starting colonoscopy in the prone position for obese patients decreases cecal intubation times.

The rate of post-polypectomy bleeding for patients on uninterrupted clopidogrel therapy during elective colonoscopy is acceptably low.

Background: We do not routinely discontinue clopidogrel before colonoscopy because we have judged the cardiovascular risks of that practice to exceed the risks of post-polypectomy bleeding (PPB).

Aims: The aim of this study was to compare the rates of PPB for clopidogrel users and non-users.

Methods: We performed a retrospective, case-control study of patients who had colonoscopic polypectomy at our VA hospital from July 2008 through December 2009.

A comparison of palliative stenting or emergent surgery for obstructing incurable colon cancer.

Background: Acute colonic obstruction because of advanced colonic malignancy is a surgical emergency. Our aim was to review our experience with self-expanding metal stents (SEMS) compared to emergent surgery as the initial therapy for the management of patients with incurable obstructing colon cancer.

Methods: A retrospective review of patients with obstructing colon cancer who underwent insertion of a SEMS (n = 53) or surgery (n = 70) from 2002 to 2008 was performed.

Duration of the interval between the completion of bowel preparation and the start of colonoscopy predicts bowel-preparation quality.

Background: Recent studies suggest that colonoscopies done in the morning have better-quality bowel preparations than those done in the afternoon.

Objective: We aimed to determine how the duration of the interval between the end of the preparation and the start of the colonoscopy affects preparation quality.

Design: We prospectively studied consecutive outpatients who had colonoscopies performed at our hospital within a 3-month period.

The risk of acute myocardial infarction with etodolac is not increased compared to naproxen: a historical cohort analysis of a generic COX-2 selective inhibitor.

Background: This study compares the risk of acute myocardial infarction among patients exposed to etodolac, naproxen, celecoxib, and rofecoxib.

Methods: A retrospective cohort study in 38 258 veteran patients (26 376 patient-years) measured the adjusted odds ratios of acute myocardial infarction during exposure to etodolac, naproxen, celecoxib, or rofecoxib.

Results: Diagnosis of acute myocardial infarction was confirmed in 100 patients who were exposed to a study nonsteroidal anti-inflammatory drug.

Through-the-scope, wire-guided esophageal dilation for the treatment of food impaction.

Background: Acute esophageal food impaction (EFI) may be treated by endoscopic extraction of the food bolus either en bloc or in a piecemeal fashion. We have found this endoscopic extraction technique to be unsatisfactory.

Objective: Our purpose was to demonstrate the use of through-the-scope (TTS), wire-guided esophageal balloon dilation to treat EFI.

Five-year colon surveillance after screening colonoscopy.

Background & Aims: Outcomes of colon surveillance after colorectal cancer screening with colonoscopy are uncertain. We conducted a prospective study to measure incidence of advanced neoplasia in patients within 5.5 years of screening colonoscopy.

Colorectal cancer screening and surveillance.

Screening and surveillance substantially reduce both the incidence and mortality of colorectal cancer. Screening of normal-risk individuals may be accomplished by several methods, including fecal occult blood testing, fiberoptic sigmoidoscopy, double contrast barium enema, and colonoscopy. New technologies for screening are being developed, such as fecal immunochemical testing for blood,fecal DNA testing, and virtual colonoscopy.

Recurrent bleeding from peptic ulcer associated with adherent clot: a randomized study comparing endoscopic treatment with medical therapy.

Background: Endoscopic therapy reduces the recurrence of bleeding from actively bleeding peptic ulcers and those with visible vessels. However, the use of endoscopic therapy for ulcers with adherent clots remains controversial. The purpose of this study was to determine whether removal of clot from an ulcer and endoscopic therapy reduces the frequency of recurrent bleeding.