2021 National Survey on Prior Authorization Burden and Its Impact on Gastroenterology Practice.

INTRODUCTION: Prior authorizations (PAs) are intended to control prescription drug expenditures. METHODS: One hundred fifty-six physician and advanced practice provider members of the American College of Gastroenterology completed a national survey to assess PA burden and impact. RESULTS: One-half of PA requests relate to prescription refills. Greater than 50% of the respondents choose inferior treatments at least weekly because of perceived PA burden for preferred agents. One-half of the respondents reported a patient who experienced serious adverse events due to PA-related care delays. DISCUSSION: PA is an administrative burden that exhausts practice resources and may have a negative impact on patient care.

Acinar cell carcinoma presenting as a duodenal mass: review of the literature and a case report.

Heterotopic pancreatic tissue is not uncommon. Although the cancerous transformation of heterotopic pancreatic tissue is a theoretical possibility, it is an extremely rare phenomenon. The majority of the heterotopic pancreatic malignancies reported in the literature are adenocarcinomas (32 cases). An Acinar Cell Carcinoma (ACC) arising from heterotopic pancreatic tissue is even less common with only six cases being reported. This report presents an extremely rare case of heterotopic pancreatic ACC presenting as a duodenal mass. We propose that heterotopic pancreatic ACC should be considered as a possibility in the differential diagnosis of a duodenal mass.

Verrucous carcinoma of the esophagus: a rare variant of squamous cell carcinoma for which a preoperative diagnosis can be a difficult one to make.

Verrucous carcinoma of the esophagus is an extremely rare entity. It is associated with severe epithelial hyperplasia and parakeratosis of the epithelial layers. Superficial biopsies are usually falsely negative for malignant cells, as the biopsied mucosa usually demonstrates the hyperplastic epithelium. The tumor spread is through submucosal and paraesophageal infiltration. Endoscopically, verrucous carcinoma appears as a wartlike, exophytic lesion, hence the name verrucous. The diagnosis can be difficult to make, even after repeated endoscopic biopsies. We report a rare case of verrucous carcinoma of the esophagus in a 45-year-old man whose final pathologic diagnosis was confirmed only after an Ivor-Lewis esophagectomy was performed.

Disparities Between Blacks and Whites in Stage at Diagnosis, Incidence, and Anatomic Subsite of Colorectal Cancer.

Background A disparity in colorectal cancer (CRC) incidence and mortality has been reported for black men and women in the United States. Objective To determine the magnitude and direction of temporal change in black/white disparity, by anatomic subsites of the colon and rectum. Design Population-based, epidemiologic study. Setting Pennsylvania, 1997-2002. Measurements Black/white ratios of the percentage of cases diagnosed at late stage and of age-adjusted incidence rates, by anatomic subsite, for four 3-year time periods. Results In 2000-2002, 54.6% of CRC cases among blacks were diagnosed at late stage, compared with 51.3% among whites. The percentage of cases in the cecum, transverse colon, splenic flexure, descending colon, sigmoid colon, rectum, and recto-sigmoid diagnosed at a late stage was larger among blacks than among whites. The disparity in the percentage of cases diagnosed at a late stage in the colon and rectum, transverse colon, and descending colon increased during the study period (P<.05). In 2000-2002, incidence was greater among blacks (64.1/100,000) than among whites (59.8/100,000). Incidence for segments of the proximal colon tended to be higher among blacks than among whites. The disparity in the incidence in the transverse colon increased during the study period (P=.021), while the increase in the disparity in the appendix approached statistical significance (P=.051). Limitations The effect of race may have been confounded by unavailable data, including socioeconomic position. Conclusions The black/white disparity in the percentage of cases diagnosed at late stage increased during the study period. The disparity in the percentage of cases diagnosed at a late stage and incidence for the transverse colon also increased. Efforts to increase screening for CRC, especially among blacks, should be enhanced.