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  • Trends in Use of Sedation for Low-Risk Endoscopy: Looking Beyond Monitored Anesthesia Care

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    JAMA. 2017; 317(19):2006-2007. doi: 10.1001/jama.2017.4114

    This commentary discusses a study published in JAMA Internal Medicine that assessed trends in the use of monitored anesthesia care for outpatient gastrointestinal endoscopy in the Veterans Health Administration from 2000 to 2013.

  • JAMA March 22, 2016

    Figure 2: Per-Protocol Analysis of Change in Total Sum of Diameters of Duodenal Polyps for Each Participant Taking Sulindac-Erlotinib vs Those Taking Placebo

    Each participant is represented by a vertical bar starting at their baseline polyp burden and running to the 6-month polyp burden. The length of the vertical bar portrays the magnitude of change. The participants are ordered by baseline polyp burden. One participant not included in this Figure was described as “carpeted” with small polyps throughout the duodenum. Polyp burden at baseline was estimated as 700 mm. Endoscopy at the 6-month time point indicated no change for this participant. Circles indicate baseline data; data for some individuals were unchanged at 6 months (circles alone).
  • JAMA March 22, 2016

    Figure 1: Flow Diagram of Participants Through the Study

    aInsufficient duodenal polyps refers to a less than 5-mm sum of diameters at baseline endoscopy.bAdvanced duodenal disease refers to 1 patient with a greater than 1-cm duodenal polyp that was not amenable to endoscopic removal. The patient was referred to an experienced endoscopist.
  • Effect of Sulindac and Erlotinib vs Placebo on Duodenal Neoplasia in Familial Adenomatous Polyposis: A Randomized Clinical Trial

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    JAMA. 2016; 315(12):1266-1275. doi: 10.1001/jama.2016.2522

    This randomized clinical trial compares the effect of sulindac and erlotinib vs placebo on duodenal adenoma regression among people with familial adenomatous polyposis.

  • Effect of Covered Metallic Stents Compared With Plastic Stents on Benign Biliary Stricture Resolution: A Randomized Clinical Trial

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    JAMA. 2016; 315(12):1250-1257. doi: 10.1001/jama.2016.2619

    This randomized clinical trial investigated whether fully covered, self-expandable metallic stents are noninferior to plastic stents for achieving stricture resolution in patients with benign biliary strictures and a bile duct diameter ≥6 mm in whom the covered metallic stent would not overlap the cystic duct.

  • JAMA February 2, 2016

    Figure 2: Primary and Secondary End Points for All Patients

    The P value comparisons are for week 16. Compared with placebo plus mometasone furoate nasal spray (MFNS), dupilumab plus MFNS significantly improved the endoscopic NPS (maximum score = 8) and morning PNIF. Error bars indicate 95% CIs.aAssessed as change from baseline averaged over 4 weeks prior to each time point.
  • JAMA February 2, 2016

    Figure 4: End Points in Patients With Comorbid Asthma

    The P value comparisons are for week 16. Compared with placebo plus mometasone furoate nasal spray (MFNS), dupilumab plus MFNS was associated with improvements in endoscopic NPS (maximum score = 8), FEV1, FEV1 percent predicted, and ACQ5 score compared with placebo plus MFNS. Error bars indicate 95% CIs.
  • Initial Cholecystectomy vs Sequential Common Duct Endoscopic Assessment and Subsequent Cholecystectomy for Suspected Gallstone Migration: A Randomized Clinical Trial

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    JAMA. 2014; 312(2):137-144. doi: 10.1001/jama.2014.7587

    Iranmanesh and colleagues assess surgical treatment options for patients at intermediate risk of a common duct stone in a randomized clinical trial and 6-month follow-up of 100 patients in a Geneva, Switzerland hospital, June 2011-February 2013.

  • JAMA July 9, 2014

    Figure 2: Study Participation for Initial Cholecystectomy vs Sequential Common Duct Endoscopic Assessment, Clearance, and Cholecystectomy

    aLoss to follow-up was because patient was unreachable and did not complete the quality-of-life questionnaire. All occurred after hospitalization.
  • JAMA March 26, 2014

    Figure 1: Endoscopic Images From Patients With Barrett Esophagus and Low-Grade Dysplasia From Baseline Endoscopy and During and After Radiofrequency Ablation

    A, Endoscopic image showing the distal esophagus at the baseline endoscopy, looking toward the gastroesophageal junction. The Barrett epithelium is characterized by its salmon-colored appearance on endoscopy compared with the pale appearance of the normal squamous mucosa. B, A deflated circumferential radiofrequency ablation balloon (extending from the device on the right) is positioned in the segment of Barrett esophagus. The immediate treatment effect of the circumferential ablation can be seen as the whitish discoloration. C, The focal radiofrequency ablation device visible at the top of the image is used for targeted ablation of a small area. The immediate treatment effect is visible as whitish discoloration in the middle and at the bottom of the image of residual Barrett epithelium. D, Endoscopic photograph showing the distal esophagus after complete eradication of all Barrett epithelium. Images are not from the same patient.
  • Radiofrequency Ablation vs Endoscopic Surveillance for Patients With Barrett Esophagus and Low-Grade Dysplasia: A Randomized Clinical Trial

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    JAMA. 2014; 311(12):1209-1217. doi: 10.1001/jama.2014.2511

    Phoa and coauthors investigate whether endoscopic radiofrequency ablation could decrease the rate of neoplastic progression among 136 patients with Barrett esophagus and a confirmed diagnosis of low-grade dysplasia in Europe.

  • JAMA August 14, 2013

    Figure 1: Endoscopic Image of Barrett Esophagus

    Note the contrast between the Barrett columnar mucosa, with its reddish color and velvet-like texture, and the pale, glossy esophageal squamous mucosa. The yellow arrowheads mark the tops of the gastric folds, which identify the level of the gastroesophageal junction.
  • Barrett Esophagus and Risk of Esophageal Cancer: A Clinical Review

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    JAMA. 2013; 310(6):627-636. doi: 10.1001/jama.2013.226450

    Spechler reviews current concepts on the pathogenesis, diagnosis, and treatment of Barrett esophagus; discusses the importance of dysplasia and the role of endoscopic eradication therapy for its treatment; and reviews current management guidelines.

  • JAMA August 14, 2013

    Figure 3: Schematic of the Esophageal Wall and Grading of Esophageal Neoplasms

    Endoscopic eradication therapy cannot cure tumors that have metastasized to lymph nodes. Endoscopic eradication therapy is recommended for patients with mucosal neoplasms (high-grade dysplasia and intramucosal carcinoma), for whom the risk of lymph node metastases is only 1% to 2%. For invasive tumors that breach the muscularis mucosae to enter the submucosa, the risk of lymph node metastases is higher than 10% and endoscopic therapy generally is not recommended.
  • Endoscopic Vein-Graft Harvest Is Safe for CABG Surgery

    Abstract Full Text
    JAMA. 2012; 308(5):512-513. doi: 10.1001/jama.2012.9079
  • Association Between Endoscopic vs Open Vein-Graft Harvesting and Mortality, Wound Complications, and Cardiovascular Events in Patients Undergoing CABG Surgery

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    JAMA. 2012; 308(5):475-484. doi: 10.1001/jama.2012.8363
    Williams and coauthors assess the long-term outcomes of endoscopic vs open vein-graft harvesting for Medicare patients undergoing coronary artery bypass graft (CABG) surgery in the United States. In the related Editorial, Dacey discusses whether endoscopic harvesting is safe for CABG surgery.
  • Utilization of Anesthesia Services During Outpatient Endoscopies and Colonoscopies and Associated Spending in 2003-2009

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    JAMA. 2012; 307(11):1178-1184. doi: 10.1001/jama.2012.270
  • Assessing the Value of “Discretionary” Clinical Care: The Case of Anesthesia Services for Endoscopy

    Abstract Full Text
    JAMA. 2012; 307(11):1200-1201. doi: 10.1001/jama.2012.317
  • JAMA March 14, 2012

    Figure 1: Video-Assisted Retroperitoneal Debridement and Endoscopic Transgastric Necrosectomy

    A, Cross-sectional view depicting an enlarged, partially necrotic pancreas with a peripancreatic collection containing fluid and necrosis. The preferred access route for video-assisted debridement is within the left retroperitoneal space to reach the necrotic collection between the left kidney and descending colon. A laparoscope is inserted, and long grasping forceps are used to debride the necrosis. B, The access route for natural orifice transluminal endoscopic surgery is through the posterior wall of the stomach. The necrotic collection most often bulges into the stomach facilitating endoscopic transgastric necrosectomy. After balloon dilatation of the puncture site in the stomach wall, the endoscope is introduced into the retroperitoneal space and loose necrotic material is removed.
  • JAMA March 14, 2012

    Figure 3: Serum Interleukin 6 Levels After Endoscopic Transgastric or Surgical Necrosectomy

    Error bars indicate 95% confidence intervals. Data were available from all 10 participants in the endoscopic transgastric group at all times except at 1 week (8 of 10). Similarly, all data were available among the 10 participants in the surgery group except at 2 hours (8 of 10) and at 24 hours and 1 week (9 of 10).