Academic Gastroenterology Research Articles

Patched but Still Leaky: An Update on the Pipeline for Women in Gastroenterology.

Women remain underrepresented in gastroenterology (GI). Studies have identified that a lack of formal mentorship for women contributes to this underrepresentation. While many GI divisions have adopted models for supporting GI fellows and faculty, there is a gap in our knowledge regarding mentorship options for internal medicine (IM) residents interested in GI. To evaluate representation of women at each level of their career (resident, fellow, and attending) and examine trends in representation of women in GI compared to other IM subspecialties. We analyzed AAMC Physician Specialty Data Reports to compare gender representation and growth of women representation across all IM subspecialties and residencies from 2007 to 2021. In 2021, 44.3% of IM residents, 37.8% of GI fellows, and 19.7% of actively practicing attending gastroenterologists were women. Since 2007, GI comprised significantly lower proportions of women attendings except for cardiology, and lower representation in fellows, except for cardiology and nephrology, than other IM subspecialties (p < 0.001). There was a consistently higher proportion of women GI fellows than attendings over the past 14years (p < 0.01). GI has among the lowest representation of women at each career level compared to other IM subspecialties. Given the previously reported preference of gender congruent mentoring, the underrepresentation of senior academic gastroenterologists who are women may be a contributing factor to lower proportions of women trainees choosing to pursue GI.

Electronic medical record clinical workload metrics from 10,210 gastroenterologists in North America.

In the United States, clinical work had been primarily compensated via a relative value unit (RVU)system reliant on professional surveys estimating the value of clinical care events. However, with the advent of time-based billing in 2021, time accounting has become an important work compensation metric. The Signal functionality within Epic, the most widely used electronic medical record(EMR) system in North America, tracks clinician time within the system. We extracted Epic Signal data from 10,200 gastroenterologists at 356 North American institutions for analysis. Workload metrics were reported as group median (interquartile range) per month and comparisons were performed using nonparametric testing. Gastroenterologists exhibit different EMR time patterns based on clientele and practice arenas. Compared with counterparts, pediatric and academic gastroenterologists spend more time at each encounter which had not been compensated under prior RVU valuations. Clinical compensation benchmarks should be driven by time-based workload metrics to ensure appropriate compensation.

Indication to Colectomy in the Hands of the Academic Gastroenterologist Versus the Surgeon: Old Giant Combat While Modern "Precision Medicine" Is Timidly Waving Hand to Offer Possible Help.

Indication to Colectomy in the Hands of the Academic Gastroenterologist Versus the Surgeon: Old Giant Combat While Modern "Precision Medicine" Is Timidly Waving Hand to Offer Possible Help.

A Critical Review from the Perspective of 2 Years Thereafter of the Effectiveness of Revolutionary Changes in a Gastroenterology Division at a Medical School Teaching Hospital due to the Coronavirus Disease-2019 Pandemic: Gastrointestinal Physician Clinical Practice and Emotional Stresses, Gastrointestinal Graduate Medical Education, Gastrointestinal Professional Societies, and Pandemic Control.

Critically review approximately 2 years afterward the effectiveness of revolutionary changes at an academic gastroenterology division from coronavirus disease-2019 (COVID-19) pandemic surge at the metropolitan Detroit epicenter from 0 infected patients on March 9, 2020, to>300 infected patients (one-quarter of) in-hospital census in April 2020 and>200 infected patients in April 2021. GI Division, William Beaumont Hospital which had 36 GI clinical faculty who used to perform>23,000 endoscopies annually with a massive plunge in endoscopy volume during the past 2 years; fully accredited GI fellowship since 1973; employs>400 house staff annually since 1995; predominantly voluntary attendings; and primary teaching hospital, Oakland-University-Medical-School. Expert opinion, based on: Hospital GI chief>14years until September 2019; GI fellowship program director, at several hospitals for>20years; author of 320 publications in peer-reviewed GI journals; and committee-member Food-and-Drug-Administration-GI-Advisory Committee for>5years. Original study exempted by Hospital Institutional Review Board (IRB), April 14, 2020. IRB approval is not required for the present study because this opinion is based on previously published data. Advantageous changes: Division reorganized patient care to add clinical capacity and minimize risks to staff of contracting COVID-19. Affiliated medical school changes included: changing "live" to virtual lectures, meetings, and conferences. Initially, virtual meetings usually used telephone conferencing which proved cumbersome until meetings were changed to completely computerized virtual meetings using Microsoft Teams or Google Zoom, which performed superbly. Some clinical electives were canceled for medical students and residents because of the need to prioritize car for COVID-19 infection during the pandemic, and medical students graduated on time despite partly missing electives. Division reorganized by changing "live" GI lectures to virtual lectures; by four GI fellows temporarily reassigned as medical attendings supervising COVID-19-infected patients; postponing elective GI endoscopies; and drastically reducing an average number of endoscopies from 100/weekday to a small fraction long-term! GI clinic visits were reduced by half by postponing nonurgent visits, and physical visits were replaced by virtual visits. Economic pandemic impact included a temporary, hospital deficit initially relieved by federal grants and hospital employee terminations. GI program director contacted GI fellows twice weekly to monitor pandemic-induced stress. Applicants for GI fellowship were interviewed virtually. Graduate medical education changes included weekly committee meetings to monitor pandemic-induced changes; program managers working from home; canceling annual ACGME fellowship survey, ACGME site visits, and national GI conventions changed from physical to virtual. Dubious changes: Temporarily mandated intubation of COVID-19-infected patients for EGD; temporarily exempted GI fellows from endoscopy duties during surge; fired highly respected anesthesiology group employed for 20years during pandemic leading to anesthesiology shortages, and abruptly firing without warning or cause numerous senior respected faculty who greatly contributed to research, academics, and reputation. Profound and pervasive GI divisional changes maximized clinical resources devoted to COVID-19-infected patients and minimized risks of transmitting infection. Academic changes were degraded by massive cost-cutting while offering institutions to about 100 hospital systems and eventually "selling" institutions to Spectrum Health, without faculty input.

A Nationwide Survey of Gastroenterology Program Leadership Regarding Implementation of the GI Hospitalist Model.

Academic gastroenterology (GI) hospitalists are increasing, however the impacts on fellowship training and clinical care are unclear. Motivations for implementation of the GI hospitalist model are uninvestigated. We aimed to determine the prevalence of GI hospitalists, explore motivations for and against adoption of a GIH model, and investigate the model's effects on fellowship training. Leadership at current general GI fellowships were surveyed about current staffing models, as well as effects and perceptions of the hospitalist model. There was a total of 52 (26%) respondents and 12 (23%) reported having a GI hospitalist at their institution. A majority of respondents stated burnout and reduced time on service for other faculty was a primary reason for hiring a GI hospitalist. The largest perceived benefit of a hospitalist is reduced burnout and time on service for outpatient GI faculty. Many respondents also believed a GIH would improve fellowship education and quality of inpatient care.

S278 Assessing Adherence to Recommending 10-Year Intervals After Normal Screening Colonoscopy in Average-Risk Individuals Based on Specialty and Practice Status

Introduction: After a normal average-risk CRC screening colonoscopy, endoscopists should recommend repeat screening in 10 years. Target is 90% adherence per guidelines, and this has been a priority quality indicator for CMS Medical Incentive Payment System and the ACPs Choosing Wisely Program. Our 2017 quality improvement (QI) project showed poor adherence (less than 40%) among private gastroenterologists and academic surgeons. Prior to commencing a new QI initiative, this project assessed frequency of adherence in 2021 at a single site. Methods: Inclusion criteria: To minimize confounders, patients were limited to: (a) average-risk, 50-82 year old; (b) colonoscopy performed in 2021; (c) sole indication of CRC screening; (d) no biopsy, polypectomy, or reference to abnormal findings on procedure report. Study Setting: Hospital-based “open” endoscopy suite (i.e., utilized by academic/private gastroenterologists and academic surgeons) at an academic tertiary care center. Primary Outcome: Adherence to guideline intervals defined as repeat colonoscopy in 10 years, discontinuation of CRC screening due to patient’s age when bowel preparation is adequate or repeat colonoscopy within 1 year if bowel preparation is poor/inadequate. Adherence rates stratified by specialty and type of practice: academic gastroenterologist (n = 7), academic surgeon (n = 3), or private gastroenterologist (n = 6). Differences in adherence between groups assessed using chi-square analysis. Results: Among 465 eligible patients, mean age was 60.1 +/- 8.2 years, 38.5% male, and 76.8% African American. Adherence surpassed target of 90% adherence for academic gastroenterologists (total=96.0%) with (96.9%) or without GI fellows (88.9%) and was superior to adherence by private gastroenterologists or academic general surgeons (p < 0.001). The latter two groups were adherent in 32.4% and 42.3%, respectively (Figure). Adherence was significantly better with good/excellent bowel preps (71.8%) compared to other bowel prep categories (p< 0.001), and patients with poor, fair, or no documentation of prep were adherent in 42.1% (Table). Conclusion: In this project, adherence among academic gastroenterologist met guideline-specified target of 90% when a gastroenterology fellow participated in the procedure. In all other groups, adherence did not meet the recommended threshold. These data are similar to our 2017 QI project and identify an excellent opportunity for a quality intervention educational and monitoring project to improve performance.Figure 1.: Adherence to Guidelines per Endoscopic Specialty Table 1. - Adherence to Recommended Intervals stratified by Bowel Preparation Bowel Preparation Adherence to Recommended Intervals* P-value No Documentation 42.9% (9/21) < 0.001 Poor/Inadequate 62.2% (28/45) Fair 19.5% (8/41) Good/Excellent 71.8% (257/358) *Adherence to recommended intervals by guidelines defined as a 10-year repeat colonoscopy recommendation if colonoscopy was normal in an average-risk individual, < 1 year was recommended if the bowel preparation was inadequate, or repeat colonoscopy not recommended if patient was ≥66 years at time of normal colonoscopy.

S1011 Inflammatory Bowel Disease Patients Commonly but Inconsistently Change Diet for Flares

Introduction: Of growing interest for patients and physicians is understanding the impact of diet on IBD symptoms. Changing diet may alter environmental exposure, modulate the microbiome, and improve gut barrier permeability. Despite ongoing research, the optimal dietary changes during times of flares remain uncertain. We aimed to better understand the current dietary intake of our IBD patients and the relationship between diet changes and disease activity. Methods: A prospective, multi-center, cross-sectional study of eating habits and preferences was performed in a cohort of IBD patients at two academic gastroenterology practices. The Automated Self-Administered 24-hour diet recall tool and Fat and Fiber Behavior Questionnaire were used to estimate daily nutrient intake. Healthy Eating Index-2015(HEI), a measure of diet quality used to assess how well a set of foods aligns with key recommendations of the Dietary Guidelines for Americans scored 0-100 like a school grade, was calculated. Disease activity was assessed using the Harvey Bradshaw Index (Crohn’s disease) and Simple Clinical Colitis Activity Index (UC). Results: In this prelim analysis, 28 patients (18 Crohn’s, 8 UC, 2 IBDU) completed all study surveys. The overall cohort consumed an avg daily diet with a HEI of 53.5 (an “F”), 2023 kcal, 19% protein, 36% fat, 46% carbohydrates with 20g of fiber, 0.7 cup equivalents of fruit, 2.1 cup equivalents of vegeTables, 9.8g added sugars. On questioning, a majority of patients (92%) reported that they change their diets during flares (Figure). To better understand these changes, we compared nutrient intake between patents with active versus inactive disease based on activity indices. We found no significant differences between the groups in regard to intake though there was a modest trend towards lower vegeTable intake and lower fiber intake in those with more disease activity (Table). Conclusion: Based on the average HEI, our cohort is eating a diet that fails to meet key dietary guidelines, although not dissimilar to the average American, mean score 57. Interestingly, while a majority report they change their diet with flare symptoms, we did not find significant differences between dietary components in those with and without active disease. We speculate that patients make varied changes in diet during flares that are not able to be detected between the groups as a whole. High quality evidence to guide recommendations for dietary changes during flares is needed.Figure 1.: A majority of patients report that they change their diet for flare-ups of their IBD. Table 1. - Analysis of diet intake between patients with active and inactive disease (based on HBI or SCCAI) Dietary Component Inactive disease (n=21) Active disease (n=7) p-value Healthy Eating Index – 2015 Score 53.5 ± 16.0 53.4 ± 19.3 .99 Self-reported diet changes with flare (Likert scale 1-5, 1=no change, 5=a lot of change) 3.4 ± 1.5 4 ± 1.4 .38 Total Calories (kcal) 2126 ± 1062 1715 ± 764 .47 FATS Total Fat (g) 88.0 ± 59.2 72.5 ± 44.0 .64 Monounsaturated fat (g) 31.6 ± 22.4 24.5 ± 14.2 .60 Polyunsaturated fat (g) 22.3 ± 15.3 21.9 ± 16.1 .64 Saturated fat (g) 26.0 ± 20.9 20.7 ± 12.7 .76 Omega-3 (EPA/DHA) (g) 0.035 ± .029 .144 ± .224 .89 CARBOHYDRATES (g) 237.5 ± 117.1 196.2 ± 89.0 .27 Added sugar (tsp. eq.) 9.6 ± 9.6 10.5 ± 11.4 .92 FIBER Total fiber (g) 22.4 ± 15.5 12.6 ± 5.1 .16 Total fruit (cup eq.) .65 ± .93 .83 ± .61 .48 Total veggie (cup eq.) 2.4 ± 1.8 1.3 ± 1.0 .14 TOTAL PROTEIN (g) 99.2 ± 56.7 73.5 ± 33.0 .32 Red meat intake* 3.6 ± 0.7 3.9 ± 0.7 .56 PROCESSING Processed meats* 4.1 ± 0.9 3.9 ± 0.7 .45 Fast Foods* 3.9 ± 0.9 3.6 ± 0.5 .38 * Data from Fat and Fiber Behavior Questionnaire (FFBQ), scored 1-5, lower = higher consumption

Promoting the Pipeline of Diverse Individuals Within Gastroenterology: Reflections From AGA FORWARD Program Scholars

Promoting the Pipeline of Diverse Individuals Within Gastroenterology: Reflections From AGA FORWARD Program Scholars

Designing Your Ambulatory Endoscopy Center: Lessons from Accreditation

Endoscopy-specific ambulatory surgery centers (ambulatory endoscopy center [AEC]) are the dominant site of service for independent community-based and academic gastroenterology practices in the United States. For most gastroenterologists, constructing a new AEC is the most complex and capital-intensive project that they will encounter in their careers. Much has been written about AEC design, primarily with regard to maximizing functionality and efficient throughput.1,2 However, regulatory considerations are another critical factor, because new AECs require certification to provide care to Medicare recipients and external accreditation as required by state and local jurisdictions or private payers.

Closing the gender gap: building a successful career and leadership in research as a female gastroenterologist

The pillars of academic promotion include clinical service, research, teaching, and public engagement. Although women are more likely than men to pursue a career in academia after a gastroenterology fellowship (40% of women vs 25% of men choose this path), gender disparity in research and academic leadership remains. For example, only one woman was appointed assistant professor in all gastroenterology and hepatology divisions of university hospital centres in France in 2017–18, whereas ten men were appointed full professors and seven were appointed associate professors in that same period. 1 Aubart FC Roeser A Costedoat-Chalumeau N Papo T Piette J-C Women in internal medicine academic positions in France. Eur J Intern Med. 2019; 64: e18-e29 Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar Only 20% of faculty and 25% of full professors in divisions of gastroenterology in the USA are women; this gender disparity has not diminished over the past 35 years and is similar across basic science and clinical departments. 2 Richter KP Clark L Wick JA et al. Women physicians and promotion in academic medicine. N Engl J Med. 2020; 383: 2148-2157 Crossref PubMed Scopus (103) Google Scholar Even though the representation of female physicians as first authors (42%) and senior (23%) authors of original research published in US gastroenterology journals has increased over the past two decades, the proportion of female senior authors increased at a slower rate than female first authors and was lower than expected based on the proportion of women in academia. 3 Long MT Leszczynski A Thompson KD Wasan SK Calderwood AH Female authorship in major academic gastroenterology journals: a look over 20 years. Gastrointest Endosc. 2015; 81: 1440-1447 Summary Full Text Full Text PDF PubMed Scopus (78) Google Scholar , 4 Bhatia S Eluri S Kim E Angle H Dellon E Shaheen N Trends in female authorship of high impact publications in gastroenterology journals, 1997–2017. Am J Gastroenterol. 2018; 113: S652-S653 Google Scholar Similarly, representation of female first authors in high-impact European journals has increased since 1994, but it has plateaued in recent years. 5 Filardo G da Graca B Sass DM Pollock BD Smith EB Martinez MA-M Trends and comparison of female first authorship in high impact medical journals: observational study (1994–2014). BMJ. 2016; 352: i847 Crossref PubMed Scopus (271) Google Scholar In addition, the proportion of invited women speakers at major national gastroenterological meetings remains low: for example, at the British Society of Gastroenterology meeting in 2014, only 26% of speakers were female; at United European Gastroenterology week 2019, only 28% of speakers were female; and at Digestive Disease Week 2019, only 33% of speakers were female. 6 Brooks AJ Taylor EJ Arthurs EA et al. Gender differences in leadership, workforce and scholarly presentation within a national society: a gastroenterology perspective. Frontline Gastroenterol. 2019; 10: 2-6 Crossref PubMed Scopus (2) Google Scholar , 7 Khan Z Rukhshan R Bhatt A et al. persistent speaker gender gap at the premier digestive disease event. Dig Dis Sci. 2022; 67: 390-396 Crossref PubMed Scopus (1) Google Scholar , 8 Nakov R Alboraie M Tiniakos D UEG Equality and Diversity Task ForceHow to identify, encourage, and support suitable candidates for leading roles in scientific societies: the UEG experience. United European Gastroenterol J. 2021; 9: 874-876 Crossref PubMed Scopus (2) Google Scholar How can female gastroenterologists effectively build a successful career in research and overcome these barriers to achieving leadership and academic advancement?

Psychological Considerations in the Dietary Management of Patients With DGBI.

In this article, an expert team of 2 gastro-psychologists, a dietician, and an academic gastroenterologist provides insights into the psychological and social implications of evidence-based and “popular” dietary interventions in disorders of gut-brain interaction (DGBI). We focus on practical approaches for evaluating a patient's appropriateness for a dietary intervention, considering the nutritional, psychological, behavioral, and social context in which a patient may find themselves managing their DGBI with dietary intervention. We also discuss how to identify risk factors for and symptoms of avoidant/restrictive food intake disorder, a growing concern in the DGBI population.

Post-polypectomy follow-up recommendations by practicing academic gastroenterologists-does number of years in practice matter?

Colorectal cancer (CRC) is the third most deadly and fourth most common cancer worldwide. Early detection, resection, and appropriate surveillance of precursor polyps result in better outcomes. Colonoscopy is a safe, accurate, and effective tool for surveillance and follow-up of premalignant polyps. Recommended surveillance intervals are based on polyp, procedural, and patient-related factors. The United States Multi-Society Task Force (MSTF) on CRC publishes guidelines with periodic updates on surveillance. We sought to evaluate adherence to post-polypectomy surveillance guidelines by academic gastroenterologists at a high-volume center. One-year retrospective study evaluating compliance with post-polypectomy recommendations after average risk adult screening colonoscopies. Data was collected on number and size of polyps, quality of bowel prep, initial follow-up recommendations, polyp pathology, and follow-up recommendations. Correlation with the 2012 MSTF guidelines was also evaluated. Endoscopist experience was categorized as greater or less than 10years of practice experience. Binomial regression was used to model the association between the providers' years of experience (<10 vs. >10) and the likelihood of agreement between initial assessment and post-pathology assessment. There was a greater than 85% adherence to post-polypectomy surveillance guidelines, independent of endoscopist experience. There is a high level of adherence to post-polypectomy guidelines by practicing academic gastroenterologists independent of post-fellowship clinical experience.

Development of consensus-derived quality indicators for laparoscopic sleeve gastrectomy operative reports.

Synoptic operative reporting has been used as a solution to the poor quality of narrative reports. The aim of this study was to develop operative report quality indicators for the laparoscopic sleeve gastrectomy and to generate parameters by which these reports can be evaluated and improved. A Delphi protocol was used to determine quality indicators for LSG. Bariatric surgeons across Canada were recruited along with key physician stakeholders to participate via a secure web-based platform. Transferrable consensus items for LSG from previously developed Roux-en-Y gastric bypass operative indictors were put forward for consideration. Participants also initially submitted potential QIs. These were grouped by theme. Items were rated on 5-point Likert scales in subsequent rounds. Scores of 70% or higher were used for inclusion and 30% or less denoted exclusion. Elements scoring 30% to 70% agreement were recirculated by runoff in subsequent rounds to generate the final list of quality indicators. Seven bariatric surgeons, representing all regions preforming LSG in Canada, were invited to participate in the Delphi group. Multidisciplinary invitees included one academic minimally invasive/acute care surgeon, one tertiary abdominal radiologist, and one academic gastroenterologist with bariatric expertise. Two rounds were required to achieve consensus. Both rounds achieved a 100% response (10/10). In round 1, forty items reached consensus. In Round 2, an additional 28 items reached consensus, with three items excluded, bringing the total number of quality indicators to 65. This study establishes consensus-derived multidisciplinary quality indicators for LSG operative reports. Application of these findings aims to advance the quality and completeness of operative reporting in LSG in order to improve communication of important surgical details and quality measures to the multidisciplinary team involved in bariatric surgery care.

Next Generation Academic Gastroenterology

Academic medical centers (AMC) advance medical knowledge, train the next generation of providers, and care for patients with the most complex medical problems. Unfortunately, the tripartite mission (research, teaching, and clinical care), often is associated with high cost, difficult access, and inefficient operations. Traditionally, AMCs were insulated from many financial pressures faced by nonacademic systems because of their societal value. Recent trends such as price transparency and patient demand for convenient and affordable care have reduced payers’ willingness to subsidize AMCs and patients’ loyalty to the academic health system model.

Local COVID-19 Epicenter in Detroit Metropolitan Area Causing Profound and Pervasive Reorganization of Clinical, Educational, Research, and Financial Programs of a Large Academic Gastroenterology Division with a GI Fellowship and Primary Medical School Affiliation.

AimTo report revolutionary reorganization of academic gastroenterology division from COVID-19 pandemic surge at metropolitan Detroit epicenter from 0 infected patients on March 9, 2020, to > 300 infected patients in hospital census in April 2020 and > 200 infected patients in April 2021.SettingGI Division, William Beaumont Hospital, Royal Oak, has 36 GI clinical faculty; performs > 23,000 endoscopies annually; fully accredited GI fellowship since 1973; employs > 400 house staff annually since 1995; tertiary academic hospital; predominantly voluntary attendings; and primary teaching hospital, Oakland-University-Medical-School.MethodsThis was a prospective study. Expert opinion. Personal experience includes Hospital GI chief > 14 years until 2020; GI fellowship program director, several hospitals > 20 years; author of > 300 publications in peer-reviewed GI journals; committee-member, Food-and-Drug-Administration-GI-Advisory Committee > 5 years; and key hospital/medical school committee memberships. Computerized PubMed literature review was performed on hospital changes and pandemic. Study was exempted/approved by Hospital IRB, April 14, 2020.ResultsDivision reorganized patient care to add clinical capacity and minimize risks to staff of contracting COVID-19 infection. Affiliated medical school changes included: changing “live” to virtual lectures; canceling medical student GI electives; exempting medical students from treating COVID-19-infected patients; and graduating medical students on time despite partly missing clinical electives. Division was reorganized by changing “live” GI lectures to virtual lectures; four GI fellows temporarily reassigned as medical attendings supervising COVID-19-infected patients; temporarily mandated intubation of COVID-19-infected patients for esophagogastroduodenoscopy; postponing elective GI endoscopies; and reducing average number of endoscopies from 100 to 4 per weekday during pandemic peak! GI clinic visits reduced by half (postponing non-urgent visits), and physical visits replaced by virtual visits. Economic pandemic impact included temporary, hospital deficit subsequently relieved by federal grants; hospital employee terminations/furloughs; and severe temporary decline in GI practitioner’s income during surge. Hospital temporarily enhanced security and gradually ameliorated facemask shortage. GI program director contacted GI fellows twice weekly to ameliorate pandemic-induced stress. Divisional parties held virtually. GI fellowship applicants interviewed virtually. Graduate medical education changes included weekly committee meetings to monitor pandemic-induced changes; program managers working from home; canceling ACGME annual fellowship survey, changing ACGME physical to virtual site visits; and changing national conventions from physical to virtual.ConclusionReports profound and pervasive GI divisional changes to maximize clinical resources devoted to COVID-19-infected patients and minimize risks of transmitting infection.

Racial Differences for Gender, Age and BMI and the Presence of Adenomas in Screening and Surveillance Colonoscopies

Introduction: This study evaluated the correlation of the presence of polyps and adenomas with respect to age, gender, and BMI in the context of AA as compared to Non-AA patients in the setting of colonoscopy screening and surveillance. Methods: A retrospective medical chart review was conducted on 1095 screening or surveillance colonoscopy patients in 2017 to determine whether the colonoscopies were completed and if a polyp was removed successfully and sent for pathological examination. Results: There were 376 patients with at least one adenoma and 635 with no adenoma detected (376/1011=37%) with the majority undergoing screening by academic gastroenterologists. Age (OR 2.4) and gender (OR 1.95) were primary risk factors in screening whereas age (OR 5.6) and race (OR 4.07) dominated surveillance. Non-AA patients had an increase in adenoma risk with an increase in BMI (OR 6.58) while AA patients had the opposite result (OR 0.32). AA patients undergoing surveillance were also more likely to have a polyp be an adenoma (78%) than Non-AA patients (37%). Conclusion: The fact that BMI in AA as compared to Non-AA patients was not associated with the risk of adenomas was an unexpected observation. The fact that if a polyp was found on surveillance in AA patients, it was more likely to be an adenoma than in Non-AA patients may suggest an increased emphasis on the importance of repeat colonoscopy after detection of an adenoma in AA patients at shorter intervals.

Role of Bowel Preparation in Adenoma Detection Rate and Follow-up Recommendations in African American Dominant Patient Population.

Introduction: Bowel preparation quality in colonoscopy is one of the most essential components of quality assessment. According to the latest guidelines, inadequate bowel preparation warrants repeat colonoscopy in less than a year. Our aim was to investigate the role of bowel preparation in adenoma detection rate (ADR), its relationship with patients' demographics, and compliance with subsequent surveillance recommendations with guidelines.Methods: This is a retrospective chart review study. Bowel preparation quality was divided into three categories: high, intermediate, and low. ADR and polyp detection rates (PDR) were calculated as the number of patients with adenoma or polyp divided by the total number of patients.Results: Among 1,062 patients (934 African American and 128 non-African American) 81%, 11%, and 8% had high, intermediate, and low-quality bowel preparations, respectively. Race, gender, age, type of endoscopist, and body mass index did not play any role in bowel preparation quality. ADR and PDR were significantly higher in African Americans as compared to non-African Americans. ADR was significantly lower in the low-quality as compared to the high- and intermediate-quality bowel preparations (OR=2.13; p=0.0032). Bowel preparation quality was not correlated with subsequent follow-up recommendations. Academic gastroenterologists and surgeons had the highest and lowest compliance with surveillance guidelines, respectively.Conclusions: Racial and gender disparity appears to have no meaningful effect on the quality of bowel preparation. Only two categories (adequate [high/intermediate] or inadequate [low-quality]) may be used for follow-up recommendations. Non-compliance with surveillance guidelines is concerning and may inadvertently increase the interval risk of colorectal cancer.

Strategies to Improve Video Visit Use in Persons With Liver Disease

Strategies to Improve Video Visit Use in Persons With Liver Disease

How to Promote Career Advancement and Gender Equity for Women in Gastroenterology: A Multifaceted Approach

How to Promote Career Advancement and Gender Equity for Women in Gastroenterology: A Multifaceted Approach

Gender equality in academic gastroenterology: a review of gastroenterology literature over four decades.

Historically males have dominated the physician ranks, although in recent years, there has been an increase in the proportion of female doctors to redress this imbalance. With such attention being paid to gender equality in society, this study aimed to characterise the changing prevalence of female authorship of peer-reviewed published research with in the field of gastroenterology. In order to quantitatively assess the growth of female gastroenterologists, we decided to examine the changing face of gender equality within the field of academic gastroenterology from 1971 to 2010. All research published in the January and July issues ofGastroenterologyfrom 1971 to 2010 was reviewed. The gender of the first author and last author (considered the senior author) of each study was recorded. Research was subsequently categorised by type: basic science research, clinical trials, and epidemiologic research. Data was analysed in 5-year time periods. Author gender could be identified from a total of 865 abstracts from 80 journal issues. In total, there were 120 (13.8%) female first authors and 91 (10.5%) female senior authors. Female first authorship has tripled since 1995, from 11% (1991-1995) to 32% (2006-2010). Female senior authorship has also tripled since 2000, from 7% (1996-2000) to 24% (2006-2010). Results demonstrated that there has been a significant increase in the prevalence of female authorship of published research in Gastroenterology since 1995. The increasing prevalence of females within the field of academic gastroenterology can therefore be extrapolated to demonstrate the growing numbers of female gastroenterologists in the entire field including clinical and academic gastroenterology.