Endoscopic closure of a recto-pelvic fistula with a cardiac septal occluder device.

Video 1Endoscopic closure of a recto-pelvic fistula with a cardiac septal occluder device in a patient for whom other surgical and endoscopic interventions had failed.

EUS of a submucosal lesion at the appendiceal orifice using a double-balloon endoluminal intervention platform.

Video 1Video demonstrating the use of a DEIP to facilitate both radial and linear EUS in the proximal colon.

Use of a novel endoscopic tack and suture system for the management of pancreatocolonic fistula.

Video 1Use of a novel endoscopic tack and suture system for the management of pancreatocolonic fistula.

Metabolic bone disease and fracture risk after gastric bypass and sleeve gastrectomy: comparative analysis of a multi-institutional research network.

BACKGROUND: Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the two most performed bariatric procedures. Multiple studies have investigated the metabolic bone complications after bariatric surgery, but there is a paucity of data comparing bone health after RYGB and SG. OBJECTIVES: To compare the rates of major fractures and osteoporosis after Roux-en-Y gastric bypass and sleeve gastrectomy. SETTING: Data from TriNetX multi-institutional research network that includes data from multiple health care organizations in the USA was analyzed at West Virginia University. METHODS: We conducted a retrospective cohort study using TriNetX, a federated multi-institutional research network. We identified patients who underwent RYGB or SG. Primary outcome was the rate of major fractures at 3 years after the procedure. Other outcomes included the rate of spine fracture, femur fracture, osteoporosis, and vitamin D deficiency at follow-up. RESULTS: In unmatched analysis, patients with SG were less likely to have major fractures or an osteoporosis diagnosis than RYGB patients at 3 years after the procedure (P < .05). After propensity-score matching, similar results were noted; patients with SG were less likely to have major fractures than RYGB patients at 3 years after procedure (2.85% versus 3.66%, risk ratio [RR]: .78, 95% confidence interval [CI]: .71-.85), and a lower rate of osteoporosis diagnosis was noted in the SG group. High rates of vitamin D deficiency were noted in both cohorts. The incidence of spine fractures was significantly lower in the SG group than in the RYGB group (.76% versus 1.18%, RR: .65, 95% CI: .54-.77). Similarly, the incidence of femur fracture was significantly lower after SG (RR: .62, 95% CI: .44-.88). Female sex, higher age, smoking history, and diabetes were independently associated with osteoporosis diagnosis during follow-up (all P values <.05). CONCLUSION: Our analyses showed that RYGB is associated with a higher risk of osteoporosis, vitamin D deficiency, and osteoporotic fractures. Thus, in patients with a higher baseline osteoporotic risk, SG may be preferred option; however, further studies are needed.

Not so Goody's powder.

Over-the-counter analgesic medications are widely used amongst American adults and are also available in powder forms. Their adverse effects have been well documented in literature. Gastrocolic fistulas as a complication of peptic ulcer disease from analgesic powder usage have been previously unreported. Here, we report a patient with upper gastrointestinal bleeding and acute anaemia secondary to peptic ulcer complicated by gastrocolic fistula in a patient using analgesic powder.

Improving bone mineral density screening in patients with inflammatory bowel disease: a quality improvement report.

The prevalence of osteopenia and osteoporosis in patients with inflammatory bowel disease (IBD) is estimated between 17% and 41%, partly due to repeat courses of glucocorticoids which enhance the risk for bone disease. Multiple gastroenterological and endocrine societies have established guidelines for bone mineral density (BMD) screening in patients with IBD, with estimates suggesting providers vary in their adherence. We aimed to improve the rate of BMD screening in patients with IBD in a large academic outpatient practice. Using the Plan-Do-Study-Act (PDSA) model, we first conducted a retrospective review and determined that only 10.8% of patients with IBD in our practice were adequately undergoing BMD screening. Over the course of five PDSA cycles, we conducted three interventions focusing on education and provider reminders. Through an informative lecture, a flyer and an electronic medical record-based prompt, we were able to increase our rate of BMD screening to 81.8%. Current rates of BMD screening in patients with IBD are not adequate. We demonstrate a simple quality improvement initiative that successfully improved our adherence to standards of practice.

Detection of hiatal hernias: comparison of high-resolution manometry and physician reported in an obese-predominant population.

BACKGROUND: The diagnosis of a hiatal hernia (HH) can be made by barium oesophagram or upper endoscopy. Data regarding the ability of high-resolution manometry (HRM) with oesophageal pressure topography (OPT) to identify HH remains limited. We aim to assess the diagnostic accuracy of the automated localisation on high-resolution manometry compared with physician visual interpretation on the detection of HH. METHODS: Patients (n=181) from West Virginia, Pennsylvania, Maryland, Virginia and Ohio, undergoing HRM with OPT from 1 January 2015 to 1 December 2017 were reviewed. The BMIs of this patient population are of the highest in the USA. Demographics, presenting symptoms, laboratory data, endoscopic findings, radiographic findings, and HRM findings were collected. Diagnosis of HH through HRM automated identification of oesophageal landmarks were compared with diagnosis by physician visual interpretation of OPT. RESULTS: Automated identification of HH using HRM had high specificity (99.1%), but low sensitivity (11.4%). Physician visual interpretation of OPT similarly had high specificity (82.9%, 83.8%), but low sensitivity (30.0%, 28.6%). Automated identification of HH had a greater positive predictive value (88.9%) compared with physician visual interpretation (52.5%, 52.6%) but was found to have a similar negative predictive value (63.9%) as physician visual interpretation (65.3%, 65.0%). CONCLUSION: Compared with physician visual interpretation of OPT, automated identification of HH was more specific, but less sensitive in the diagnosis of HH. Use of automated identification of HH using HRM alone may lead to an increased number of false negatives, and subsequent underdiagnosis of this condition.