bluuebunny/crossref_metadata_2025_split huggingface dataset:
2857 Acute Esophageal Necrosis: A Systematic Review of the Literature
Authors: Zafar Yousaf , Gondi Keerthi , Maitra Neil , Altom Keaton , Luke Alex 
Published: October 2019

INTRODUCTION:
Acute Esophageal Necrosis (AEN) is a condition characterized by necrosis of the esophageal with black-appearing mucosa, commonly terminating at the gastroesophageal junction. This study aimed to identify the clinical characteristics of AEN.

METHODS:
We conducted a systematic review of the literature to identify all published cases of AEN between 1980 and 2019. All available cases were analyzed for clinical characteristics and outcomes.

RESULTS:
271 cases of AEN were identified. The majority of patients were male (72.3%) and of old age (62.9 years). The most common coexisting comorbidities were hypertension, diabetes mellitus, coronary artery disease, and alcohol abuse. AEN commonly presented alongside acute kidney injury, diabetic ketoacidosis, and sepsis. Reported etiologies of AEN included ischemia (32.5%), DKA (8.1%) alcohol use (5.9%), and medications (3.3%). Endoscopy revealed AEN most commonly occurs in the distal esophagus with circumferential involvement. Most patients were treated with medical management (60.9%). Mortality rate was 35.1%. Common complications included perforation, mediastinitis, and superinfection.

CONCLUSION:
AEN is a rare condition with severe morbidity and mortality. Acid suppressive therapy and supportive care is sufficient in the majority of patients. Perforation predicts a poor prognosis.
2866 Association of Metabolic Syndrome in Patients With Barrett’s Esophagus With High-Grade Dysplasia Compared to Low-Grade Dysplasia
Authors: Baldwin Nicholas , Nunley Benjamin , Spencer Chad , Peter Shajan 
Published: October 2019

INTRODUCTION:
Barrett’s esophagus (BE) is a premalignant condition with potential to progress to esophageal adenocarcinoma. In the general population, the incidence and prevalence are increasing based on recent data. Newer studies, including a recent meta analysis, report an association of metabolic syndrome (MS) with an increased risk of BE.

METHODS:
Single-center, retrospective cohort study of patients who had both MS and BE with biopsy-proven HGD vs. LGD during a 5-year period. Descriptive statistics were used to summarize clinical categorical variables into frequencies and percentages. The chi-squared test was performed to make the statistical comparisons of categorical and continuous variables, respectively.

RESULTS:
308 patients with MS were included in the study, 125 had BE with HGD and 183 had BE with LGD. The proportion of metabolic syndrome in HGD patients was not significantly higher than LGD patients (27.2% vs. 25.7%, P = 0.77). Based on our results, HGD patients were 8.1% more likely to experience metabolic syndrome than LGD patients, although the result was not significant (OR 1.081; 95% CI 0.646 – 1.809).

CONCLUSION:
While there is an association of metabolic syndrome resulting in an increased risk for BE based on recent studies, our results show that there is not a stronger association of MS in patients with HGD compared to LGD.
2867 Barrett's Esophagus Screening: A Survey of Primary Care Physicians to Assess Knowledge Gaps
Authors: David Allison , Vitolo Melissa , Elden Andrew C. , Tarassoff Christopher , Altshuler Marc , Ziring Barry , Infantolino Anthony , Tofani Christina 
Published: October 2019

INTRODUCTION:
Barrett’s esophagus (BE) is a condition in which metaplastic columnar epithelium with goblet cells replaces the stratified squamous epithelium normally found in the distal esophagus. It is a precursor for esophageal adenocarcinoma (EAC), however screening for BE remains a controversial topic and any guidelines that exist may not be well known among primary care physicians (PCPs). The transformation from nondysplastic BE to EAC has a slow rate of progression, giving screening for BE the potential to identify patients earlier via endoscopic visualization and confirmatory biopsy. A prior study found that less than 5% of patients undergoing resection for EAC had a prior diagnosis of BE, 1 indicating potential missed opportunities for screening of appropriate patients. Newer data recommends selective screening via stratification of patients based on risk factors. PCPs are often a patients first line of contact within the healthcare system; therefore, they should have an thorough understanding of the risk factors for BE and be comfortable in identifying appropriate patients to refer for screening.

METHODS:
We conducted a survey of PCPs (n = 63) at a large urban university hospital. The survey consisted of eight questions regarding risk factors, screening recommendations and physician comfort in identifying appropriate patients for BE screening.

RESULTS:
Collectively, PCPs scored 60%, suggesting a significant lack of knowledge regarding BE, with only 13% of participants answering all questions correctly. In regards to identifying risk factors, only 25% answered correctly. 41% of respondents indicated they are comfortable identifying appropriate patients for screening. Comfortability was assessed on a scale of 1-5, with 1 being not comfortable at all. The average response was 3.02, reflecting neutrality in physician comfort.

CONCLUSION:
Our survey found that knowledge of risk factors among PCPs may be inadequate. Additionally, PCPs acknowledge they are not comfortable identifying appropriate patients for screening. This may stem from not being familiar with known risk factors or not being up to date with screening guidelines. Those in practice longer said they are more comfortable, however were not more knowledgeable in risk factors and screening guidelines, indicating that increased education is necessary throughout a physician's career. 1. Dulai, Gareth S., et al. "Preoperative prevalence of Barrett's esophagus in esophageal adenocarcinoma: a systematic review." Gastroenterology (2002): 26-33.
2873 The Demographic, Clinical, and Endoscopic Features of Patients With Eosinophilic Esophagitis (EOE) in a Rural Gastroenterology Solo Practice in Central Maine
Authors: Henry Winoah A. 
Published: October 2019

INTRODUCTION:
Eosinophilic esophagitis (EoE) is a chronic, food-triggered, immune-mediated disorder of the esophagus. The average age of adult diagnosis is 30 years and the M:F ratio is 3:1. Rural patients may be at higher risk of EoE and may present with heartburn rather than dysphagia. This study aimed to characterize the demographic, clinical, and endoscopic features of adult rural EoE patients.

METHODS:
This was a retrospective, descriptive analysis of data obtained between 2013 and 2018. Adults ≥ 18 years with ≥ 15 eos/HPF regardless of PPI-response were included. The reported incidence of EoE is 7.2/100,000 and the expected sample size was 22. Statistical analysis of demographics, clinical history, and endoscopy data was conducted.

RESULTS:
During the study period there were 51 cases and the mean age at diagnosis was 45 years. There was no significant difference between the mean age at diagnosis in males and females, 44 vs 45 years. The M:F ratio was 1.8:1. The average BMI was 31.3, 80% were overweight or obese, and 57% were obese. There was no significant difference between the BMI of males and females. The frequency of tobacco use was 41% and cannabis use was 14%. Half (49%) had other atopic conditions, 16% had a family history of atopy, and 2% had a family history of EoE. Fifty-two percent were PPI-responsive and 53% were responsive to PPI or H2-blocker. While 51% of patients presented with dysphagia, females more often presented with dysphagia when compared to males (61% vs 45%; P = 0.0002). Food impaction on presentation was rare and no female patient presented with food impaction (0% vs 9%). Compared to males, more females had rings (72% vs 55%; P < 0.0001) but significantly more males had fibrotic strictures (36% vs 33%; P = 0.04).

CONCLUSION:
EoE is common in this rural solo GI practice and the incidence was higher than predicted. EoE is more common in males but rural females may be impacted more than urban females. Obesity and tobacco exposure are prevalent features in this population. In contrast to previous study, most rural EoE patients present with dysphagia and not heartburn and dysphagia is more prevalent in females than males. Rings are the most common endoscopic feature however rings are more prevalent in females whereas strictures are more prevalent in males. Rings are likely associated with the symptom of dysphagia but not with the presence of fibrotic strictures. EoE diagnosis is delayed by 15 years in this rural environment emphasizing the need for increased awareness.
2874 Gastrointestinal (GI) and Hepatobiliary Conditions Among Medical Students: A Single Center Study
Authors: Ahmed Monjur , Papadopoulos Konstantinos 
Published: October 2019

INTRODUCTION:
Medical students go through many stressful situations and suffer from various GI and hepatobiliary conditions. The purpose of the study was to assess the prevalence of GI and hepatobiliary conditions among medical students, the variability among gender and race, and what effect it had on their daily life.

METHODS:
A survey questionnaire link via surveymonkey.com was emailed to every medical student at Sidney Kimmel Medical College. The survey was completely voluntary and anonymous.

RESULTS:
246 students answered the survey and 67 of had a GI and/or hepatobiliary conditions. 42.6% were female and 57.4% were male. 50% were aged between 21-25, 50% between 26-30, and family history of GI and hepatobiliary conditions was positive in 52.2%. Among the different ethnicities, 82.0% identified as Caucasians, 13.4% as Asians, 4.5% as African Americans, and 1.4% as Middle-Eastern. The different GI and hepatobiliary conditions reported were as follows: gastroesophageal reflux disease (GERD) – 40.2%, irritable bowel syndrome (IBS) – 38.8%, ulcerative colitis – 5.9%, lactose intolerance - 4.4%, 2.9% (2 cases) had eosinophilic esophagitis, Crohn’s disease, liver hemangioma, and esophageal spasm, and 1.4% (1 response) had: peptic ulcer disease. Regarding treatment, 45.50% were not taking any medication, 44.1% were taking medication, 7.30% took both medication and psychotherapy, and 2.90% psychiatric ttreatment. The gastrointestinal and hepatobiliary conditions affected their daily life mildly (rated 1-3) in 64.7%, moderately (rated 4-7) in 26.4%, and severely (rated 8-10) in 8.8%.

CONCLUSION:
A significant number of medical students suffered from gastrointestinal disorders, most had the illness for over 5 years, and greater than half were taking medications. The disorders were more common in males than in females and greater than half had a positive family history. In addition, 35.2% mentioned that the condition had a moderate-to-severe effect on their daily life. GERD was the most common disorder followed by IBS which were both prevalent in almost one-third of the students with a GI condition. Overall, these findings are significant for the effect on the daily life of these medical students and the possible long-term effects on their morbidity and mental health. This study gives further evidence of the importance of stress reduction and renewed focus on student wellness in stressful academic environments.
2890 Too Fast or Too Slow: Do Sedation Protocols Improve Outcomes?
Authors: Walker Caroline , Smallfield George B. , Kaspar Matthew 
Published: October 2019

INTRODUCTION:
Moderate sedation improves patient tolerance and satisfaction of colonoscopy, but few guidelines exist regarding optimal sedation. While sedation has not been shown to increase ADR, it can decrease pain and discomfort and increase the likelihood that patients may return for repeat exams. Typically ordered by the endoscopist, variation in sedation practices may alter time to discharge, overall risk, cost, and time to complete. This study sought to determine if adherence to a sedation protocol decreased procedure time and overall medication dose without altering time to discharge.

METHODS:
A retrospective chart review based on a database of 3,382 screening colonoscopies at a tertiary care center. Of these, 152 included necessary data. Adherence to dosing protocol was defined as 2-3 minutes between each induction dose. Induction doses were doses given prior to scope-in time. The outcomes of total fentanyl, versed, maintenance fentanyl, maintenance versed, procedure duration and recovery time were collected. Patient sex, scope vintage, and if at least one lesion found during the procedure were summarized by frequencies and percentages. Two-sample t-tests were used to compare outcomes between the adherence groups. Linear mixed effects models were performed to determine if there were differences in the means of the 6 outcomes while adjusting for sex, scope vintage and presence of a polyp. The endoscopist was included as a random effect. A model with recovery time as an outcome was run after excluding 4 recovery time outliers.

RESULTS:
Of the 152 analyzed, 42.1% adhered to dosing protocol, while 57.9% did not. Two sample t-tests did not show a difference for any of the outcomes between groups adhering to protocol and those not. The linear mixed models adjusting for sex, scope vintage, presence of a polyp removed during procedure, and performing MD as a random effect did not show a difference in means for any of the outcomes between groups. 4 colonoscopies were outliers for recovery time. An additional mixed model was performed after excluding these outliers also failed to show significance between the two groups.

CONCLUSION:
Adjusted and unadjusted analysis show that adherence to the proposed dosing protocol does not impact total dose, procedure duration, or recovery time. Lack of quality measures for moderate sedation makes choosing and monitoring outcomes difficult. Our data no not show better outcomes with a conscious sedation protocol compared to endoscopist driven conscious sedation.
2892 Adenoma Detection With Endocuff at a Veterans Affairs Medical Center: Encouraging Results From a Single Endoscopist Consecutive Series
Authors: Chung Jae , Nassar Yousef , Long Mary , Thompson Douglas , Malecki Elise 
Published: October 2019

INTRODUCTION:
Improving adenoma detection rate should improve the colorectal cancer prevention that can be expected from screening and surveillance colonoscopies.

METHODS:
To address this goal, one endoscopist at the Albany Veterans Affairs Medical Center employed the Endocuff device (AEC120 or AEC130, Arc Medical, Leeds, UK), which attaches to the end of the colonoscope and has flexible projections that splay open the colonic lumen on withdrawal. Consecutive charts of all outpatients undergoing screening and surveillance colonoscopies were prospectively reviewed starting three months prior to institutional availability of the Endocuff and continued three months after. 91 cases were done with the Endocuff and 143 without. 21 cases were done without the Endocuff after institutional availability due to exhaustion of the supply, endoscopist failure to request the device, or fellow preference, and these are included in the analysis in the “without Endocuff” group.

RESULTS:
After excluding cases aborted for poor prep, 91 cases with and 135 cases without the Endocuff remained. The groups were not different with respect to sex, age, body mass index or hemoglobin A1c. Similar proportions of patients in each group had IBD, diverticulosis, family history of colorectal cancer, personal history of colorectal cancer or partial colectomy. The groups were also similar in quality of preparation, fellow participation, withdrawal time or sedative used for the procedure. Adenomas were detected in 47 of 91 (51.6%) patients in whom the Endocuff was used, with a total of 104 adenomas, vs. 61 of 135 (42.7%) patients in whom it was not, with a total of 143 adenomas. As the Endocuff provides a good view of the distal rectum on direct endoscopy, retroflexion in the rectum was not routinely performed with this device but was done without the device if there was suspicion for a distal rectal lesion. Even without retroflexed views, one rectal adenocarcinoma and one anal squamous cell carcinoma were detected in patients undergoing colonoscopy with the Endocuff. No cancers were detected in the patients in whom the Endocuff was not used but retroflexion in the rectum was performed. Results did not reach the P < 0.05 level of significance with Pearson’s chi-squared test.

CONCLUSION:
High baseline rate of adenomas and small sample size were limitations of this study. These preliminary results show a trend toward increased adenoma detection with the Endocuff device in our patient population, and the trial is ongoing.
2893 Epidemiology of Sub-Epithelial Gastrointestinal Lesions and Factors Influencing Their Tissue Yield by EUS Guided Sampling in a Predominantly African-American and Hispanic Population at a Tertiary Care County Hospital
Authors: Mathew Madhu , Mbachi Chimezie , Desai Parth M. , Salazar Miguel , Vohra Ishaan , Wang Yuchen , Gandhi Seema , Attar Bashar M. 
Published: October 2019

INTRODUCTION:
Gastrointestinal subepithelial lesions are generally found incidentally during endoscopy or abdominal imaging, with an approximate prevalence of 0.4%. Our study aims at obtaining the Epidemiology of Sub-Epithelial Gastrointestinal lesions and factors influencing their Tissue yield by Endoscopic Ultrasound guided sampling in a predominantly African- American and Hispanic population.

METHODS:
In this retrospective observational study, we included the patients from a busy tertiary care County hospital, who underwent EUS from Jan 2010 through Jan 2018 for Sub-Epithelial Gastrointestinal lesions or found to have and SEL on EUS. Data was collected on basic demographic factors, EUS indications, finding, Histopathology and mode of final diagnosis. After collecting the data, we performed analysis with STATA 14.0 College Station, Texas. with Univariate and Multivariate Logistic Regression analysis for tissue sampling yield.

RESULTS:
84 patients were included in our study of which 53% women 31% men. 18.6% of our population was uninsured and 41.4% were of African American ethnicity. Out of all the lesions majority were Gastric nodules [54.9%], 21.4% esophageal, 14.3% duodenal, 7.1 rectosigmoid and 1.2% periampullary. Of the total patients, 52.5% had some form of a tissue sampling [FNA, FNB, Forceps biopsy or EMR] and 47.6% had no biopsy. Of all the lesions seen in EUS, 41.7% were less than 1 cm nodules and 4.8% nodules measured >4cm. Echogenicity and the layer of lesion were also assessed. Univariate and Multivariate Logistic Regression to analyze the tissue sampling yield based on the above variables which showed that none of the variables had a statistically significant correlation to the tissue sampling yield, thus inferring that the yield may likely be dependent on the sampling method and the operator.

CONCLUSION:
Subepithelial lesions are those located beneath the epithelium and originate from any layer of the gastrointestinal wall.EUS is the best imaging modality to assess gastrointestinal subepithelial lesions and can be used for EUS guided tissue sampling, in addition to diagnostic sonological imaging of the nodule. It helps to distinguish extrinsic lesions from intramural ones based on the originating layer, echogenicity and tissue acquisition to reach an accurate diagnosis. In clinical practice, cytological and immunocytochemical results determine the final diagnosis. In contrary to other literature available, our study was done in a predominantly African American and Hispanic population.
2896 30-Day Outcomes, Trends of Admission and Readmission of Gastrointestinal Bleeding for Last Decade
Authors: Kirshan Ravi Shri Jai , Yang Tsujung , Ravi Priyanika , Ahuja Satish Kumar , Essrani Rajesh , Lal Darshan , Chand Raja , Ahuja Keerat Rai , Kumar Ravi 
Published: October 2019

INTRODUCTION:
Gastrointestinal (GI) bleeding is one of the major medical problems causing about 300000 hospitalizations in the United States. We report the trend of the number of patients who were admitted & readmitted for GI bleeding in a tertiary care setting of Northern Pennsylvania.

METHODS:
Patients admitted with Gastrointestinal bleeding were extracted using ICD 10 codes K92.0, K92.1 and K92.2. Essential baseline characteristics including age, race, Primary Diagnosis, Readmission Diagnosis, Patients on bleeding medications, atrial fibrillation, Deep Vein Thrombosis, Pulmonary embolism, Metallic Heart Valve, History of CVA, 30-day mortality, causes of readmissions were identified by reviewing the electronic medical record of individual patients. Statistical analysis was performed using SPSS version 25.

RESULTS:
Total of 1296 patients was admitted in the last decade from 2009-2018 with the diagnosis of Gastrointestinal bleeding. Mean age of patients was 70.31 ± 15.38(Mean ± SD), the majority were Males (50.2%) and Caucasians (97.1%). Patients had following associated co-morbidities such as Deep venous thrombosis (9.0%), Pulmonary Embolism (5.8%), Atrial Fibrillation (33.4%), Metallic Heart Valve(5.8%) and History of Stroke/TIA (16.4%). Patients' mean hemoglobin at the time of admission was 10.1 ± 1.72(Mean ± SD) mg/dl. Median Length of stay was 4 days (IQ Range 2-6), 30 days Readmission rate was 19.4% and overall 30-day mortality was 6%. Among readmitted patients, 38.1% of patients were readmitted due to GI causes and 61.9% were readmitted due to Non-GI causes. The rate of readmission was observed to be increasing from 2009-2018 but was not statistically significant from (13.3% vs. 17.9% linear by linear P-value 0.717).

CONCLUSION:
This study showed that the number of admissions with a diagnosis of Gastrointestinal bleeding in the tertiary care setting of Northern Pennsylvania increased from 2009 to 2018 but the rate of readmission was not significantly affected.