American Society For Gastrointestinal Endoscopy Research Articles

GIE Editorial Board top 10 topics: advances in GI endoscopy in 2019

The American Society for Gastrointestinal Endoscopy's GIE Editorial Board reviewed original endoscopy-related articles published during 2019 in Gastrointestinal Endoscopy and 10 other leading medical and gastroenterology journals. Votes from each individual member were tallied to identify a consensus list of 10 topic areas of major advances in GI endoscopy. Individual board members summarized important findings published in these 10 areas of disinfection, artificial intelligence, bariatric endoscopy, adenoma detection, polypectomy, novel imaging, Barrett's esophagus, third space endoscopy, interventional EUS, and training. This document summarizes these "top 10" endoscopic advances of2019.

Colonoscopy Surveillance in Liver Transplant Recipients for Primary Sclerosing Cholangitis Associated With Inflammatory Bowel Disease

ObjectiveThe aim of this study was to assess gastrointestinal (GI) monitoring in the group of patients who underwent orthotopic liver transplantation (OLTx) because of primary sclerosing cholangitis (PSC) concomitant with inflammatory bowel disease (IBD). MethodsAnalysis was performed of data collected from medical histories and telephone calls in 33 patients who underwent OLTx in the Department of General and Transplantation Surgery of the Medical University of Warsaw from 2001 through 2017 because of PSC concomitant with IBD. ResultsOnly 52% of patients claimed they stayed under constant supervision of a GI clinic. The remaining 48% patients were exclusively under transplantation clinic supervision, which controlled graft function. Of 27 patients, 18 (67%) underwent regular colonoscopy examination. According to the American Society of Gastrointestinal Endoscopy and other international organizations’ guidelines, patients with PSC and IBD should have yearly screening colonoscopy. Only 9 patients met these guidelines. The median of intervals between colonoscopies among the other 9 patients was 2 years. Among the remaining 9 patients who did not have regular colonoscopy, the gap between endoscopic examinations reached 10-14 years. Fifteen patients (55%) had at least 1 polyp resected during the colonoscopy examination. ConclusionsFewer than half of patients follow the medical recommendations concerning their health condition and screening. The main reason for not performing regular colonoscopies was remission and/or lack of symptoms of IBD. According to the previously mentioned guidelines, the absence of symptoms of IBD does not exempt patients from annual colonoscopy.Some of the negligence was a result of lack of adequate access to gastroenterology specialists.

How To Maximize Trainee Education During the Coronavirus Disease-2019 Pandemic: Perspectives From Around the World

How To Maximize Trainee Education During the Coronavirus Disease-2019 Pandemic: Perspectives From Around the World

Retrospective Multicenter Matched Controlled Comparison of Endoscopic Retrograde Cholangiopancreatography in Pediatric Patients: A 10-year Experience.

This study was designed to evaluate outcomes in pediatric patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) as compared with an American Society of Gastrointestinal Endoscopy (ASGE) complexity grade-matched adult cohort. In this retrospective case-control study, ERCPs performed in pediatric patients from January 2008 to December 2018 in 2 tertiary referral hospitals were compared with a complexity-matched adult control group with similar procedural indications. Primary outcomes included the clinical success rate, technical success rate, and complication rate. Secondary outcomes included postprocedural admission rates, mode of sedation, procedure time, fluoroscopy time, hospitalization length, and the number of repeat procedures. Two hundred thirty-two ERCPs performed in 110 pediatric patients (average age 13.3) and 318 ERCPs performed in 160 ASGE grade-matched adult controls (average age 47.2 years) were analyzed. All procedures were therapeutic. There was no difference in the technical success rate (P = 0.2), clinical success rate (P = 0.5), complication rates (P = 0.1), and fluoroscopy time (P = 0.4), between the pediatric and adult cohorts. General anesthesia use and length of stay were significantly higher in the pediatric group (P = 0.0001). In subgroup analysis, technical (P = 0.2) and clinical success (P = 0.2) as well as complication rates (P = 0.6) were comparable between patients 10 years or less and patients 11 to 18 years within pediatric cohort. ERCP in pediatric cohorts appears to be safe and effective with equivalent outcomes relative to an ASGE complexity-matched adult cohort. Pediatric patients are more likely to require general anesthesia and have a longer average length of stay relative to adult controls.

Endoscopic Yield, Appropriateness, and Complications of Pediatric Upper Gastrointestinal Endoscopy in an Adult Suite: A Retrospective Study of 822 Children.

Background/AimsThis study aimed to study the endoscopic yield, appropriateness, and complications of pediatric endoscopy performed by adult gastroenterologists in an adult endoscopic suite. MethodsThis a retrospective study in which records of all the patients less than 18 years of age who underwent endoscopy in the last 5 years were studied. The indications of endoscopy in children were categorized as appropriate or inappropriate per the latest guidelines by American Society for Gastrointestinal Endoscopy and North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. Positive endoscopic yield was defined as the presence of any abnormality on endoscopy. ResultsAmong the total of 822 children (age <18 years), the most common indications were variceal surveillance/eradication in 157 (19.1%), followed by dyspepsia in 143 (17.4%), upper gastrointestinal (UGI) bleeding in 136 (16.5%), recurrent abdominal pain in 94 (11.4%), unexplained anemia in 74 (9%), recurrent vomiting in 50 (6.08%), chronic refractory gastroesophageal reflux disease in 34 (4.1%) and others; 780 out of 822 endoscopic procedures (94.9%) done in children were appropriate as per the guidelines. The endoscopic yield was 45.8%, highest in patients with UGI bleeding (71.3%), followed by variceal surveillance (54.8%), recurrent vomiting (38%), dyspepsia (37.8%), and recurrent abdominal pain (36%). Minor adverse events occurred in 7.3% of children. ConclusionsPediatric endoscopy performed by an experienced adult gastroenterologist may be acceptable if done in cooperation with a pediatrician.

COVID-19 pandemic through the lens of a gastroenterology fellow: looking for the silver lining

COVID-19 pandemic through the lens of a gastroenterology fellow: looking for the silver lining

AGA Rapid Recommendations for Gastrointestinal Procedures During the COVID-19 Pandemic

Abbreviations used in this paper AGAAmerican Gastroenterological AssociationCDCCenters for Disease Control and PreventionCIconfidence intervalCOVID-19coronavirus disease 2019GIgastrointestinalGRADEGrading of Recommendations Assessment, Development and EvaluationMERS-CoVMiddle East respiratory syndrome–related coronavirusORodds ratioPAPRpowered air-purifying respiratorPPEpersonal protective equipmentRRrisk ratioSARS-CoV-2severe acute respiratory syndrome coronavirus 2WHOWorld Health Organization

Appropriateness of Referral for Upper Gastrointestinal Endoscopy in a Tertiary Care Hospital

Introduction: Upper gastrointestinal endoscopy (UGE) allows physicians to directly schedule endoscopic procedures for their patients without prior consultation. Evaluation of appropriateness of endoscopic procedures is associated with costs and benefits.&#x0D; Objectives: To assess the appropriateness of the use of UGE in an open-access setting in Bangladesh.&#x0D; Materials and Methods: This cross-sectional multicenter study was conducted among 300 patients referred for UGE at Dhaka Medical College Hospital and Shaheed Suhrawardi Medical College and Hospital from January 2016 to June 2016. The American Society for Gastrointestinal Endoscopy (ASGE) guidelines was used to assess the appropriateness of referral. The participants were selected by purposive nonprobability sampling and a pre-tested questionnaire was used for data collection.&#x0D; Results: Out of 300 respondents 62.3% was male. History of smoking was more in male and taking NSAIDs were more in the female. In UGE 46.7% revealed normal findings but majority 53.3% had some pathology. About 86% cases, UGE was found appropriate according to ASGE guideline and majority appropriate cases 37.3% were referred by internal medicine specialist. Appropriateness of referral among different physicians was not statistically significant.&#x0D; Conclusion: Appropriateness of referral for UGE performed in tertiary care level hospitals in an open-access setting like Bangladesh was satisfactory.&#x0D; Journal of Armed Forces Medical College Bangladesh Vol.14 (2) 2018: 152-155

Clinical utility of ESGE and ASGE guidelines for prediction of suspected choledocholithiasis in patients undergoing cholecystectomy.

Recent guidelines from the European Society of Gastrointestinal Endoscopy (ESGE) and American Society for Gastrointestinal Endoscopy (ASGE) recommend risk stratification according to liver function test (LFT) and abdominal ultrasound in patients with suspected choledocholithiasis. We evaluated and validated the clinical utility of these new risk stratification criteria for choledocholithiasis. We retrospectively analyzed prospectively maintained data of patients with suspected choledocholithiasis between January 2016 and December 2018 in patients undergoing cholecystectomy. Patients with common bile duct stricture, cirrhosis, and portal biliopathy were excluded. After LFT and ultrasound, all patients were stratified according to ESGE and ASGE criteria into high, intermediate, and low likelihood of choledocholithiasis. 1042 patients were analyzed. Using ESGE guidelines, 213 patients (20.4 %) met high likelihood criteria, 637 (61.1 %) met intermediate, and 192 (18.4 %) met low likelihood criteria. Using ASGE guidelines, 230 (22.1 %), 678 (65.1 %), and 134 (12.9 %) met high, intermediate, and low likelihood criteria, respectively. Specificity and positive predictive value (PPV) of ASGE high likelihood criteria were 96.87 % (95 % confidence interval [CI] 95.37 - 97.98) and 89.57 % (95 %CI 85.20 - 92.75) for choledocholithiasis compared with 98.96 % (95 %CI 97.95 - 99.55) and 96.24 % (95 %CI 92.76 - 98.09), respectively, for ESGE criteria. ASGE classified 17 (7.4 %) additional patients as high likelihood compared with ESGE, only one of whom had choledocholithiasis. ASGE classified 58 (8.6 %) additional patients as intermediate, none of whom had choledocholithiasis. This study validates the clinical utility of new ESGE and ASGE criteria for predicting choledocholithiasis. ESGE risk stratification appears more specific than ASGE.

Capsule Endoscopy Transit Time to Duodenum: Relation to Patient Demographics.

BackgroundAnesthesia guidelines recommend fasting for at least two hours to minimize aspiration risk related to endoscopic procedures, and the American Society for Gastrointestinal Endoscopy (ASGE) states that the final oral preparation liquid can be administered three to eight hours before the procedure. We have observed the cancellation of endoscopy procedures if liquids were consumed within four, six, or eight hours of the start time. Objectively, documenting gastric transit time via a review of pill endoscopy data could address clinician concerns, prevent delays in patient care, and improve the rate at which our clinicians practice within national guidelines. The objective was to utilize capsule endoscopy data from our center to report the relationship between patient factors that could affect gastric transit time (GTT) and small bowel transit time (SBTT) such as chronic kidney disease (CKD), diabetes mellitus (DM), nutritional status, and obesity.MethodsThis retrospective review obtained data on adult pill endoscopy (PillCam™ SB 3) (Medtronic, Minneapolis MN) studies on in- and outpatients. Past medical history and laboratory data were abstracted from electronic medical records. Mean GTT and SBTT are reported in minutes + standard deviation (SD) and times were compared accounting for conditions that could prolong transit, such as diabetes mellitus or chronic kidney disease (CKD).ResultsOne hundred and sixty-three records reviewed. Four patients were excluded as the pill did not pass out of the stomach. The mean age was 66 years, 57% were female, and 26% were evaluated for gastrointestinal (GI) bleeding. The mean GTT for all patients (n = 159) was 35 + 49 with a median of 19 minutes. There were no statistically significant differences in GTT between the following subgroups: CKD0 (n = 100) 40 + 58 versus CKD5 (n = 11) 35 + 39, albumin > 3.0 (n = 123) 37 + 53 versus albumin < 3.0 (n = 36) 27 + 30, diabetes mellitus (DM) (n = 40) 51 + 71 vs. non-DM (n = 119) 42 + 79, body mass index (BMI) > 30, or aspirin use. The SBTT results in all patients (n = 124) was 238 + 88 minutes. Similarly, there was no relation between SBTT and albumin, any CKD, CKD0 versus CKD5, DM status, or BMI. The patients with the capsule stuck in the stomach did not have any other clinical history to explain this occurrence.ConclusionsThis analysis of objective data regarding pill endoscopy found that the mean GTT was 44 minutes, and it was < 60 minutes for 85% of the cohort. Patient factors were not associated with longer transit times, and this is the first report to document PillCam times in relation to CKD. These data support recommendations that endoscopic procedures, in accordance with anesthesia and ASGE guidelines, can be safely conducted in the majority of patients within 60 minutes of ingesting liquids.

Clinical Validation of BASIC Classification for the Resect and Discard Strategy for Diminutive Colorectal Polyps

Blue-light imaging (BLI) is a chromoendoscopy technique that uses direct (not filtered) emission of blue light with short wavelength (410 nm) to increase visibility of microvascular pattern and superficial mucosa. A BLI-based classification system for colorectal polyps (also called BLI Adenomas Serrated International Classification, BASIC) has been created and was validated using still images or short videos. We aimed to validate BASIC in a clinical practice setting, using thresholds recommended by the American Society for Gastrointestinal Endoscopy for the resect and discard strategy as the reference standard. We studied 333 patients (mean age, 62.7±8.1 y; 176 men) who underwent screening colonoscopy from January through July 2019. Six endoscopists trained in BASIC participated in the study. All detected diminutive polyps were characterized by real-time BLI and categorized as adenoma or non-adenoma according to BASIC. All polyps were removed and evaluated by histopathology. The BLI-directed surveillance intervals (based on high-confidence characterization of polyps 5 mm or smaller and pathology feature for others) were compared with histology-directed surveillance intervals, according to United States Multi-society Task Force and European Society of Gastrointestinal Endoscopy recommendations. We calculated negative-predictive values of optical real-time analysis of diminutive rectosigmoid adenomas. When we applied BASIC, 748 polyps smaller than 5 mm were categorized with 89% accuracy (95% CI, 85.9%-90.6%). BLI-directed surveillance was correct for 90% of patients according to the United States Multi-society task force criteria (95% CI, 86%-93%) and for 96% of patients according to European Society of Gastrointestinal Endoscopy criteria (95% CI, 93%-97%). The negative-predictive value for 302 polyps smaller than 5 mm, located in the rectosigmoid colon and evaluated with high confidence, based on histologic features of adenomatous polyps, was 91% (95% CI, 85%-95%). Our analysis of data from 333 patients undergoing screen colonoscopies supports the validity of BASIC discriminating diminutive colorectal polyps with histologic features of adenomas from non-adenomas. This allows for the implementation of the resect and discard strategy based on BLI in clinical practice. ClinicalTrials.gov no: NCT03746171.

Appropriate use of colonoscopy in Nigeria: a retrospective study using the American Society of Gastrointestinal Endoscopy (ASGE) 2012 guidelines

Introduction: Colonoscopy is the standard investigation for assessing colonic disease, with moderate yield. The American Society for Gastrointestinal Endoscopy (ASGE) published guidelines to tailor the appropriate use of colonoscopy. The aims of this study were to determine the frequency at which colonoscopy was performed for an appropriate indication based on ASGE´s 2012 guidelines, and to determine if there was an association of appropriateness of indication with endoscopic findings.

Optimal Laxatives for Oral Colonoscopy Bowel Preparation: from High-volume to Novel Low-volume Solutions

Optimal bowel preparation is essential for a more accurate, comfortable, and safe colonoscopy. The majority of postcolonoscopy colorectal cancers can be explained by procedural factors, mainly missed polyps or inadequate examination. Therefore the most important goal of optimal bowel preparation is to reduce the incidence of colorectal cancer. Although adequate preparation should be achieved in 85-90% or more of all colonoscopy as a quality indicator, unfortunately 20-30% shows inadequate preparation. Laxatives for oral colonoscopy bowel preparation can be classified into polyethylene glycol (PEG)-electrolyte lavage solution, osmotic laxatives, stimulant laxatives, and divided into high-volume solution (≥3 L) and low-volume solution (<3 L). The updated 2019 European Society of Gastrointestinal Endoscopy (ESGE) guideline is broadly similar to the 2014 American Society for Gastrointestinal Endoscopy (ASGE) recommendations and reaffirms the importance of split-dosing. However, new ESGE guideline, unlike the 2014 ASGE recommendation, suggests the use of high volume or low volume PEG-based regimens as well as that of non-PEG based agents that have been clinically validated for most outpatient scenarios. For effective, safe, and highly adherent bowel preparation, physicians who prescribe and implement colonoscopy should properly know the advantages and limitations, the dosing, and the timing of regimens. Recently many studies have attempted to find the most ideal regimens, and more convenient, effective, and safe regimens have been developed by reducing the dosing volume and improving the taste. The high tolerability and acceptability of the new low-volume regimens suggest us how we should use it to increase the participation of the national colorectal cancer screening program.

Automated endoscopic detection and classification of colorectal polyps using convolutional neural networks.

Background:Recently the American Society for Gastrointestinal Endoscopy addressed the ‘resect and discard’ strategy, determining that accurate in vivo differentiation of colorectal polyps (CP) is necessary. Previous studies have suggested a promising application of artificial intelligence (AI), using deep learning in object recognition. Therefore, we aimed to construct an AI system that can accurately detect and classify CP using stored still images during colonoscopy.Methods:We used a deep convolutional neural network (CNN) architecture called Single Shot MultiBox Detector. We trained the CNN using 16,418 images from 4752 CPs and 4013 images of normal colorectums, and subsequently validated the performance of the trained CNN in 7077 colonoscopy images, including 1172 CP images from 309 various types of CP. Diagnostic speed and yields for the detection and classification of CP were evaluated as a measure of performance of the trained CNN.Results:The processing time of the CNN was 20 ms per frame. The trained CNN detected 1246 CP with a sensitivity of 92% and a positive predictive value (PPV) of 86%. The sensitivity and PPV were 90% and 83%, respectively, for the white light images, and 97% and 98% for the narrow band images. Among the correctly detected polyps, 83% of the CP were accurately classified through images. Furthermore, 97% of adenomas were precisely identified under the white light imaging.Conclusions:Our CNN showed promise in being able to detect and classify CP through endoscopic images, highlighting its high potential for future application as an AI-based CP diagnosis support system for colonoscopy.

Endoscopy for Colonic Volvulus and Acute Colonic Pseudo-Obstruction

Sponsoring Organization: American Society for Gastrointestinal Endoscopy (ASGE)Background and ObjectiveColonic volvulus and acute colonic

Predicting common bile duct stones by non-invasive parameters

Common bile duct (CBD) stone affect about 10% of patients with symptomatic cholelithiasis. The American Society for Gastrointestinal Endoscopy (ASGE) published a strategy in 2010 for managing patients with suspected choledocholithiasis. This study aimed to assess the performance of different clinical parameters in predicting CBD stones. A total of 344 patients suspected to suffer from CBD stone and referred to endoscopic ultrasound (EUS) were included. Parameters were collected and their prediction power for CBD stones was assessed. One hundred and sixty-seven patients without CBD stone according to EUS (group A) were compared to 177 patients with CBD stones (group B). Several predictive factors for CBD stone were identified on univariate analysis. In multivariate regression analysis, CBD width by US (OR=1.224, 95% CI: 1.073-1.359; P=0.0026), age (OR=1.023, 95% CI: 1.011-1.035; P=0.0002) and gamma glutamyl transferase (GGT) level (OR=1.001, 95% CI: 1.000-1.002; P=0.0018) were significantly correlated with CBD stone, with receiver operator characteristics (ROC) of 0.7259. We generated a diagnostic equation [age (yr)×0.1+CBD width (mm) by US×1+GGT (U/L)×0.005] to predict CBD stone with ROC of 0.7287. We suggest this score as a very strong predictor for CBD stones, and to reduce the strength of total bilirubin and transaminases as predictors.

104 AGT Score as a Predictor of Common Bile Duct Stone Using Endoscopic Ultrasound (EUS) in Patients With Intermediate Probability Criteria According to ASGE Guidelines

INTRODUCTION: The performance of intermediate criteria guideline for the prediction of choledocholithiasis (CL) has been validated in very few studies. The objective of our study was to prospectively assess the accuracy of the American Society for Gastrointestinal Endoscopy (ASGE) guidelines intermediate criteria for the identification of CL. Furthermore, to identify the noninvasive predictors of CL. METHODS: A one-year prospective assessment of ASGE intermediate criteria was performed for the prediction of CL considering endoscopic retrograde cholangiopancreatography (ERCP) as gold standard test. Each patient underwent endoscopic ultrasound (EUS) prior to ERCP. Lab investigations were performed for all the patients and AGT score was calculated as a noninvasive predictor for CL. AGT score was calculated for each individual as. Sensitivity and specificity was calculated for predicting CBD stone by using AGT score. RESULTS: A total of 71 patients were suspected for choledocholithiasis according to ASGE intermediate probability criteria. The Mean age of patiens were 52.9 + 11.9 years and there were 42 (59.1%) males. At presentation, 66 (92.9%) had abdominal pain, five patients (7%) had gall stone pancreatitis and three (4.2%) had jaundice. On Endoscopic ultrasound (EUS), sludge was found to be in 7 patients (9.9%) and stones were reported in 43 (60.5%). On ERCP, 47 patients (66.2%) were found to have CL. Whereas, it was found in the study that TLC (8.11 vs 6.97 and P = 0.03), ALP (398 vs 197, P = 0.0001) and GGT (313 vs 215, P = 0.046) was significantly raised in stone positive group as compared to stone negative group. The product of Alkaline phosphatase (ALP) and GGT was also found to be significantly raised in stone positive group (130360 vs 57254 and P value 0.002). Using these variables AGT score was formulated and it was found to be significantly associated with presenct of CL (P = 0.001, 90222 vs 46746). Area under ROC of AGT score is 0.83. At a cut off value of 50069 the sensitivity, specificity, NPV and PPV were 82.9%, 76.1%, 88.64% and 66.6% respectively for AGT score in predicting choledocholithiasis. CONCLUSION: Performance of intermediate probability criteria for the prediction of CL was accurate in 66.2% of patients. Total bilirubin, gamma glutamyle transferase and AGT score was found to be the predictor of CBD stone.

15 Utilization Patterns of Prophylactic Pancreatic Stents for the Prevention of Post-ERCP Pancreatitis: A 2018 National Survey Study

INTRODUCTION: Post ERCP Pancreatitis (PEP) is the most frequent complication of endoscopic retrograde cholangiopancreatography (ERCP). Prophylactic pancreatic stents (PPS) and rectal indomethacin (IND) prevent PEP, decrease severity in PEP and are endorsed by GI societies. It is unclear the extent to which these interventions are practiced throughout the United States (US). The impact of such factors as training, experience and practice setting on the use of PPS for PEP prophylaxis is unclear. The aims of our study are to describe utilization patterns and identify factors that impact physician decisions to use PPS for PEP prophylaxis. METHODS: A 27-question electronic survey was distributed using a cloud based program (Qualtrics). Questions assessed ERCP training, practice setting, experience, practice patterns and perceptions for PEP prophylaxis interventions. Endoscopists with practices based in the US, listed in the American Society for Gastrointestinal Endoscopy (ASGE) member directory received a survey invitation via e-mail. The invitation outlined the study and contained a link with instructions to complete the voluntary survey if they had an active ERCP practice. Data was de-identified for the purposes of analysis. RESULTS: Of survey respondents (n = 319/6276), 46% reported therapeutic endoscopy fellowship training and 37% practiced in teaching programs (Table 1). Annualized ERCP volume of &gt;100 cases per year were reported by 47%, with pancreatic ERCP comprising ≤5% of procedures in the majority of respondents (61%). The majority of respondents utilized PPS and 54% reported frequent use (Table 2). The most common indications for PPS were: difficult cannulation, to assist biliary access and multiple pancreatic duct injections. The majority of respondents reported frequent use of IND (89%). Of physicians that do not use PPS, use of IND was the most common reason (80%). Variables associated with frequent use of PPS were therapeutic fellowship training (P = &lt;0.001), practice at a teaching program (P = &lt;0.001), &lt;10 yrs in practice (P = 0.005), higher procedure volume (P = &lt;0.001), higher proportion of pancreatic cases (P = &lt;0.001), and selective use of IND (P = 0.002) (Table 3). CONCLUSION: Physicians with higher volume, teaching hospital based ERCP practices and regularly perform pancreatic ERCP are more likely to use PPS. Therapeutic fellowship training and recent entry into practice also associate with PPS utilization. Indomethacin use was prevalent and the most cited reason for electing not to use PPS.

561 Appropriateness and Safety of Direct Access Endoscopy (DAE) in Hospitalized Patients

INTRODUCTION: Direct access endoscopy (DAE) allows hospitalists to refer patients for endoscopy without first being seen by a gastroenterologist (GI), potentially decreasing wait time, improving patient turn over, and facilitating earlier discharge from the hospital. This study aims to evaluate the efficacy and safety of DAE for low-risk endoscopic procedures. DAE has previously been employed in an outpatient setting, but this is the first study exploring DAE use in an inpatient setting in the US. METHODS: A retrospective chart review was performed comparing patients who underwent a DAE requested by hospitalists, with patients who underwent an endoscopy ordered by GI physicians from August 2017 till December 2018 at a tertiary medical center. The indication for each procedure obtained from endoscopy reports and hospitalist progress notes prior to each procedure. The appropriateness of each procedure was determined based on guidelines from the American Society for Gastrointestinal Endoscopy (ASGE). Endoscopic procedures were performed by the same endoscopist on the same day and findings were recorded and clinical significance was determined. Major complication(s) that occurred during and after the procedure were also assessed. RESULTS: A total of 110 patients were included in this study; 40 were DAE and 70 were ordered by GI physicians. The mean age was 55.5 years with 69 males and 41 females. In the DAE group, there were 31 EGD and 9 colonoscopies ordered, while in the GI group, there were 58 EGD, 11 colonoscopies, and 1 enteroscopy ordered. All of the procedures met ASGE criteria, with 73 procedures having clinically relevant findings. Of these 73 procedures, 20 were DAE (50% had clinically significant findings) and 53 were ordered by GI physicians (76% had clinically significant findings). There were two major complications: one was an apneic episode during the procedure (DAE patient); the other was oozing from a major vessel during the procedure (GI patient). CONCLUSION: DAE allows a physician to send a patient for an endoscopy without prior consultation with a GI physician. This study showed that all of the procedures requested by hospitalists met ASGE criteria for appropriateness, with 50% having clinically-relevant findings. There was no difference in adverse events between the groups. These results suggest that DAE is effective and safe in evaluating hospitalized patients for low-risk endoscopy.

3076 Post Colonoscopy Diverticulitis in a 50-Year-Old Woman Undergoing Surveillance Colonoscopy

INTRODUCTION: Colonoscopy is used as a diagnostic and therapeutic tool to treat a wide range of gastrointestinal disorders. Acute diverticulitis after colonoscopy is a rare but potentially serious complication. The incidence of acute diverticulitis after colonoscopy is reported to be 0.084%. Since this is a rare entity, there is limited data regarding the risk, prevention and management of acute diverticulitis after colonoscopy. CASE DESCRIPTION/METHODS: A 50 year old woman with a history of adenomatous polyp with villous component detected 4 years prior presented for surveillance colonoscopy. She did not have any abdominal pain. Her labs from a year prior showed WBC 6.86 k/uL. Colonoscopy was notable for pan-colonic diverticulitis (Figure 1), most prominent in sigmoid colon. There was a 2 mm sessile polyp in recto-sigmoid colon that was removed with cold biopsy forceps. The procedure was otherwise uncomplicated. She presented to the emergency department (ED) 3 days later with left lower quadrant pain (LLQ) and fever up to 101 Fahrenheit. The pain started 2 days after she underwent colonoscopy. She did not have nausea, vomiting or rectal bleeding. In the ED, she was afebrile with moderate LLQ tenderness without rebound or guarding. Labs showed WBC 15.41 k/uL (72.5% segmented neutrophils), BUN 11 mg/dL, Cr 1.0 mg/dL. CT of the abdomen and pelvis had findings concerning for acute sigmoid colon diverticulitis without abscess (Figure 2). The patient was discharged from the ED on moxifloxacin and metronidazole. DISCUSSION: The American Society for Gastrointestinal Endoscopy (ASGE) lists diverticulitis as a miscellaneous complication, however, there is limited data regarding the risk of developing diverticulitis after colonoscopy. In a retrospective cohort of 236, 377 patients who underwent colonoscopy, 68 patients (0.029%) developed post-colonoscopy diverticulitis. The mean time to develop diverticulitis after colonoscopy was 12 ± 8 days. 34 patients (50%) had a history of diverticulitis prior to colonoscopy and 30 patients (44%) required hospitalization. Prospective studies are now needed to evaluate the risk, mechanism and prevention of colonoscopy induced diverticulitis. If significant diverticula are noted on colonoscopy, post-colonoscopy diverticulitis should be discussed as a potential complication, and it should be considered in a patient who presents with fever and abdominal pain after undergoing colonoscopy.