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Dysphagia is the tenth leading cause of ambulatory care visits to gastroenterology practices in the United States. However, there is limited information about the population prevalence and burden of illness related to dysphagia in the United States. Adkins and colleagues1Adkins C. Takakura W. Spiegel B.M.R. et al.Prevalence and characteristics of dysphagia based on a population-based survey.Clin Gastroenterol Hepatol. 2020; 18: 1970-1979Abstract Full Text Full Text PDF Scopus (9) Google Scholar conducted a population-based survey of more than 31,000 adults to evaluate the epidemiology, clinical characteristics, and healthcare-seeking behavior of individuals with dysphagia. The online survey measured gastroenterology symptoms using the National Institutes of Health Patient-Reported Outcomes Measurement Information System items. Participants were also asked about compensatory behavioral techniques to manage dysphagia, the presence of odynophagia, a physician diagnosis of eosinophilic esophagitis, and global health. Of the 31,129 eligible participants, 4998 (16.1%) reported having dysphagia. Of those with dysphagia, 67.3% had dysphagia for <5 years, 16.0% had dysphagia for 6–10 years, and 15.6% for ≥11 years. The vast majority (92.3%) had symptoms in the previous week and 16.3% described their dysphagia during the past week as either “quite a bit” or “very” severe. About 42% of participants also reported odynophagia within the past week. The most common compensatory maneuvers were drinking liquids to help with dysphagia (86.0%) and taking longer to finish eating (76.5%). Overall, 51.1% of participants sought care for their dysphagia. Older age, male sex, and those with a usual source of care and insurance, a history of comorbidities, and more severe dysphagia symptoms increased the odds for seeking care. The most commonly reported esophageal comorbidities were gastroesophageal reflux disease (30.9%), eosinophilic esophagitis (8.0%), and esophageal stricture (4.5%). The vast majority of eosinophilic esophagitis patients were receiving treatment for their condition. A subset of individuals reported having an esophageal dilation (15.3%) and a food impaction (8.3%). This large population-based survey demonstrated that dysphagia is reported by 1 of 6 adults in the United States. Most of the affected individuals used compensatory mechanisms to manage their dysphagia, but only about 50% sought medical care for their potentially treatable symptoms. See page 1970. Duodenoscope-related infections with antibiotic-resistant bacteria, particularly carbapenem-resistant Enterobacteriaceae and Pseudomonas aeruginosa, are a serious health care threat as they are spread by cross-contamination and can sometimes be associated with increased mortality and pan-resistance. Infection has been reported in 5% of endoscopic retrograde cholangiopancreatography (ERCPs). Single-use duodenoscopy is a novel device to decrease infectious outbreaks associated with endoscope reuse. Muthusamy and colleagues2Muthusamy V.R. Bruno M.J. Kozarek R.A. et al.Clinical evaluation of a single-use duodenoscope for endoscopic retrograde cholangiopancreatography.Clin Gastroenterol Hepatol. 2020; 18: 2108-2117Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar conducted a study to test the feasibility, preliminary safety and performance of a new single-use, disposable duodenoscope in a clinical setting. A case series of a new single-use duodenoscope (EXALT Model D, Boston Scientific, Marlborough, MA) was conducted by seven expert endoscopists at 6 tertiary referral centers in the US Study participants were adults without altered pancreaticobiliary anatomy who underwent ERCP for common indications. After completion of a roll-in phase to confirm the ability to insert and advance the single-use duodenoscope to the major papilla in 13 patients, 60 ERCPs were performed in separate patients. The 60 ERCPs were of varying complexities and 96.7% were completed using the single-use duodenoscope only. Two cases (3.3%) required the crossover to a reusable duodenoscope (1 required balloon dilation of a biliary stricture and the other was an unsuccessful cannulation of the pancreatic duct). Median overall satisfaction was 9 out of 10. Three patients experienced post-ERCP pancreatitis, 1 had a post-sphincterotomy bleed, and 1 with preexisting infection worsened and required rehospitalization. In summary, expert endoscopists completed ERCP cases with a wide range of complexity using a single-use duodenoscope with a low rate of crossover to a reusable duodenoscope and with a serious adverse rate typical of standard ERCP practice. The single use duodenoscope is an alternative to reusable duodenoscopes to improve infection control. Future studies are needed to support its efficacy, feasibility and optimal use. This article is highlighted by an editorial by Steven A. Edmundowicz.3Edmundowicz S.A. Is a solution to duodenoscope-transmitted infections good enough and can we afford it?.Clin Gastroenterol Hepatol. 2020; 18: 1933-1934Abstract Full Text Full Text PDF Scopus (1) Google Scholar See page 2108. Microscopic colitis is a common cause of chronic non-bloody diarrhea, can occur with other lymphocytic disorders of the GI tract, and is associated with high overall mortality.4Sonnenberg A. Turner K.O. Genta R.M. Associations of microscopic colitis with other lymphocytic disorders of the gastrointestinal tract.Clin Gastroenterol Hepatol. 2018; 16: 1762-1767Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar, 5Morgan D.M. Cao Y. Miller K. et al.Microscopic Colitis Is Characterized by Intestinal Dysbiosis.Clin Gastroenterol Hepatol. 2020; 18: 984-986Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar, 6Khalili H, Bergman D, Roelstraete B, et al. Mortality of patients with microscopic colitis in Sweden. Clin Gastroenterol Hepatol 2019 Dec 16;S1542-S3565(19)31443-0. https://doi.org/10.1016/j.cgh.2019.12.012. Online ahead of print.Google Scholar Because there are no macroscopic features of microscopic colitis that can be detected during colonoscopy, it is recommended to take two or more biopsies from the right, transverse, left and sigmoid colon; however, these recommendations have not been validated. Driman et al7Virine B. Chande N. Driman D.K. Biopsies from ascending and descending colon are sufficient for diagnosis of microscopic colitis.Clin Gastroenterol Hepatol. 2020; 18: 2003-2009Abstract Full Text Full Text PDF Scopus (5) Google Scholar conducted a retrospective study to identify sites within the colon from which biopsies could reliably be used to diagnose microscopic colitis, hence eliminating the need for redundant sampling. In this study, 101 consecutive cases of microscopic colitis in which biopsy sites were specified or randomly obtained were evaluated to measure their diagnostic sensitivity. The analysis assessed the proportion of biopsies positive for lymphocytic or collagenous colitis at each site as well as combinations of sites. Overall, 52 cases (51.5%) were positive for collagenous colitis, 42 (40.6%) were positive for lymphocytic colitis and 7 (6.9%) had diagnostic features for both. The proportions of biopsies that were positive for microscopic colitis were: cecum, 90.0%; ascending colon, 96.9%; hepatic flexure, 77.8%; transverse colon, 95.7%; splenic flexure, 75.0%; descending colon, 85.0%; sigmoid colon, 90.9%; and rectum, 82.2%. When ascending and descending colon biopsies were combined, 100% of microscopic colitis cases were detected and 82.1% of cases were positive at both sites. Thus, collecting biopsies from both the ascending and descending colon has the same overall sensitivity as sampling 4 colonic sites (ascending, transverse, left and sigmoid colon). Based on the study results, the authors propose a “Western protocol” of obtaining two biopsies from the ascending and descending colon each when assessing for the presence of microscopic colitis. The study has limitations associated with its retrospective design, and therefore, a prospective study is needed to assess the optimal biopsy protocol for microscopic colitis. See page 2003. Patients with inflammatory bowel disease (IBD) undergo regular colonoscopy surveillance because of their increased risk of colorectal cancer.8Long M.D. Sands B.E. When do you start and when do you stop screening for colon cancer in inflammatory bowel disease?.Clin Gastroenterol Hepatol. 2018; 16: 621-623Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar,9Kisiel J.B. Klepp P. Allawi H.T. et al.Analysis of DNA methylation at specific loci in stool samples detects colorectal cancer and high-grade dysplasia in patients with inflammatory bowel disease.Clin Gastroenterol Hepatol. 2019; 17: 914-921Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar It is not clear if high-definition chromoendoscopy (HD-CE) or high-definition white light endoscopy (HD-WLE) is the optimal method for colonoscopy-based surveillance. Guidelines recommend chromoendoscopy but its value in this era high-definition colonoscopy is not clear. Similarly, the value of random biopsies is a topic of debate. In a single-center, prospective, randomized trial conducted in Sweden by Alexandersson et al,10Alexandersson B. Hamad Y. Andreasson A. et al.High-definition chromoendoscopy superior to high-definition white-light endoscopy in surveillance of inflammatory bowel diseases in a randomized trial.Clin Gastroenterol Hepatol. 2020; 18: 2101-2107Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar 305 patients with ulcerative colitis or Crohn’s colitis underwent surveillance colonoscopy (152 had HD-CE and 153 had HD-WLE) by 25 endoscopists (median of 6 procedures per endoscopist). In both groups, a collection of 32 random biopsies (4 biopsies from 8 colonic segments) and targeted biopsies or polypectomies were performed. The primary endpoint was one or more dysplastic lesions. A greater number of macroscopic dysplastic lesions were detected in patients with HD-CE than those with HD-WLE (17 vs 7, P = .032). Compared to the HD-WLE group, the HD-CE group had a significantly higher macroscopic dysplastic lesions (24 vs 7, P = .029). In 9760 random biopsy samples, dysplasia was detected in 9 patients with 6 (3.9%) in the HD-CE group and 3 (2.0%) in the HD-WLE group (P = .72). Primary sclerosing cholangitis is a risk factor for colorectal cancer in IBD.11Shah S.C. Ten Hove J.R. Castaneda D. et al.High risk of advanced colorectal neoplasia in patients with primary sclerosing cholangitis associated with inflammatory bowel disease.Clin Gastroenterol Hepatol. 2018; 16: 1106-1113Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar Only 18% of patients in this study had primary sclerosing cholangitis. Of the 9 patients with dysplasia, 3 patients (33%) had primary sclerosing cholangitis. The HD-CE procedure took an average of 7 min longer than the HD-WLE. However, the number of dysplastic lesions per 10 min of withdrawal time was 0.066 with HD-CE and 0.027 with HD-WLE (P = .056). This study concluded that HD-CE was superior to HD-WLE in the detection of dysplasia in patients with long-standing IBD. Although the study was limited to a single center and had a mix of expert and non-expert endoscopists, the results are noteworthy and support use of chromoendoscopy for surveillance of patients with inflammatory bowel diseases. See page 2101. Prevalence and Characteristics of Dysphagia Based on a Population-Based SurveyClinical Gastroenterology and HepatologyVol. 18Issue 9PreviewAlthough dysphagia is common, there is limited information about the prevalence and burden of illness of dysphagia in the United States. We performed a population-based survey of more than 31,000 adults to evaluate the epidemiology, clinical characteristics, and health care–seeking behavior of individuals with dysphagia. Full-Text PDF Open AccessClinical Evaluation of a Single-Use Duodenoscope for Endoscopic Retrograde CholangiopancreatographyClinical Gastroenterology and HepatologyVol. 18Issue 9PreviewDisposable, single-use duodenoscopes might reduce outbreaks of infections associated with endoscope reuse. We tested the feasibility, preliminary safety, and performance of a new single-use duodenoscope in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). Full-Text PDF Biopsies From Ascending and Descending Colon Are Sufficient for Diagnosis of Microscopic ColitisClinical Gastroenterology and HepatologyVol. 18Issue 9PreviewLymphocytic and collagenous colitis are types of microscopic colitis (MC) that commonly cause chronic watery diarrhea, but there are no macroscopic features of MC that can be detected during colonoscopy. Endoscopists therefore often collect multiple random colonic biopsies, potentially oversampling, increasing times of colonoscopy and slide review. We sought to identify sites from which biopsies could be taken and analyzed to identify patients with MC with a high level of sensitivity and determine the appropriate number of biopsies to take at these sites. Full-Text PDF High-Definition Chromoendoscopy Superior to High-Definition White-Light Endoscopy in Surveillance of Inflammatory Bowel Diseases in a Randomized TrialClinical Gastroenterology and HepatologyVol. 18Issue 9PreviewThere is debate over the optimal method for colonoscopic surveillance of patients with inflammatory bowel diseases. Guidelines recommend chromoendoscopy, but the value of chromoendoscopy in high-definition colonoscopy has not been proven. Furthermore, the value of random biopsies is controversial. Full-Text PDF