GI Division Research Articles

402. BRAIN METASTASES FROM ESOPHAGEAL CANCER AFTER MULTIMODAL TREATMENT: EARLY DETECTION AND AGGRESSIVE LOCAL TREATMENT CAN LEAD TO BETTER OUTCOMES

Abstract Background International guidelines do not recommend imaging investigations to rule out the presence of BM (brain metastases) during clinical staging or follow-up in patients with oesophageal cancer. Patients with single or up to three BM can be considered oligometastatic: in our study we analysed patients with BM focusing on the management and outcomes of BM. Methods We retrospectively identified patients who underwent surgical resection for oesophageal adenocarcinoma or squamous cell carcinoma from 2006 to 2022 in our Upper GI division and subsequently developed brain metastasis (BM). Starting from January 2018, a brain CT scan was added to the routine follow-up procedures in our centre. We divided patients in two groups based on the treatment received for BM: local therapy group treated with surgery and/or stereotactic body radiation therapy/stereotactic radiosurgery (SBRT/SRS) versus no local therapy group treated with chemotherapy or whole brain radiotherapy (WBRT). Results 34 patients developed BM (three didn’t receive treatment); 23 patients in local therapy versus 8 in no local therapy group. Median overall survival (OS, from BM diagnosis to patient’s death or last follow-up) in local therapy group was 14.52 months whereas in no-local therapy 3.41 months, p<0.001. At univariable analysis predictors of OS were pathological stage, pathological response, GI-GPA score, number of metastases, treatment. In multivariable analysis, only pathological stage was statistically significative. We diagnosed 17 BM recurrence before 2018 (17 patients of 355, 4,7%) and 17 after 2018 with introduction of routine brain CT (17 of 217, 7.8%). Conclusion BM from oesophageal cancer benefit from local aggressive treatment in terms of overall survival and to apply a local treatment is necessary that BM are diagnosed early. The introduction of brain CT scan during follow up may have improved the detection rate of BM and therefore in our opinion routine brain CT scan could be necessary.

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Address correspondence to: Clay Cothren Burlew, MD, FACS, Professor of Surgery, Program Director, SCC & TACS Fellowships, Division of GI, Trauma, and Endocrine Surgery, Department of Surgery, University of Colorado 12631 East 17th Ave. Box C313 Aurora, CO 80045. Email: cla[email protected]

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 12-Year North American Longitudinal Study of Gender Equity and Equality in Gastroenterology

A 12-Year North American Longitudinal Study of Gender Equity and Equality in Gastroenterology

Urinary Cannabis Metabolite Concentrations in Cannabis Hyperemesis Syndrome.

Cannabis Hyperemesis Syndrome (CHS) is characterized by recurrent episodes of intractable emesis associated with heavy use of cannabis. Recognition of CHS can be problematic due to the lack of specific biomarkers, which can point the clinician to the diagnosis. We present, retrospectively, a series of adolescent/young adult patients who presented to a pediatric gastroenterology (GI) service with acute on chronic nausea and vomiting, subsequently found to have CHS with associated elevated urinary cannabis metabolite concentrations. We describe 15 patients referred to our pediatric GI division for intractable emesis with spot urinary cannabis metabolite carboxy-THC (THC-COOH) concentrations from January 1, 2018 through April 20, 2019. Urinary testing was performed using gas chromatography mass-spectrometry (GC-MS) in a manner consistent with Clinical Laboratory Improvement Amendments (CLIA) requirements at Mayo Clinic laboratory (Rochester, MN). The laboratory cutoffs were 3.0 ng/mL. Data was extracted via chart review and analyzed via online statistical application. Fifteen patients (seven females, eight males) were studied with an average age of 17.7 years. All patients reported frequent cannabis use for at least 1 month and exhibited intractable, non-bilious emesis for at least 2 weeks. Twelve patients also reported weight loss. Two patients had underlying gastrointestinal disease (one with Crohn disease and one with irritable bowel syndrome). All patients had essentially normal GI workup including laboratory tests, imaging studies and endoscopies.Fourteen of 15 patients had urinary THC-COOH concentrations >100 ng/mL, with seven individuals exhibiting levels >500 ng/mL. One patient had a urinary TCH-COOH concentration level under 100 ng/mL had not used cannabis for 2 weeks. Most other patients had used cannabis within 2 days of providing a urine sample. The Binomial test for CHS patients with urinary THC-COOH levels over 100 ng/mL was significant with a P-value of <0.0005 (one tail test). CHS is associated with an elevated urinary THC-COOH level usually exceeding 100 ng/mL, which is indicative of significant chronic cannabis exposure. In patients with a history consistent with CHS, urine THC-COOH testing may help guide the diagnostic evaluation of these patients and decrease the need for further workup.

Editorial introductions.

Editorial introductions.

Addressing Gender Disparity: Increase in Female Leadership Increases Gender Equality in Program Director and Fellow Ranks.

Women make up 15% of the total number of practicing gastroenterology (GI) physicians in the US. Despite this disparity, only 33% of the current GI fellows are female. Increasing female GIs is a major goal of all four GI societies. It is known that gender disparity exists in the field of gastroenterology, and women are underrepresented in the leadership ranks and trainee level at academic programs. Whether an increase in female leadership in academic medicine is associated with an increase in female program directors and trainees is unknown. The aim of this study was to assess this relationship in GI. Data were collected via a standardized protocol from all 173 US gastroenterology fellowship programs up until October 2018 from program websites and supplemented by online surveys completed by program coordinators. Any missing information was collected by calling the program coordinators. Data were collected on gender and academic rank of the program director, associate program director, division chief, chair of medicine, program size, academic center affiliation, number, and academic rank of female faculty and geographic region. The association was assessed using a Chi-square test or independent samples t test. In leadership positions, men were listed as comprising 86% of chairs, 82% of division chiefs, 76% of program directors and 63% of associate program directors. Forty-three percent of programs did not have female representation at any leadership level. The presence of a female program director or female associate program director was associated with an increase in the number of female fellows (4.03 vs 3.20; p = 0.076; 4.26 vs 3.36; p = 0.041), respectively. Overall, the presence of a female in any leadership position led to an increase in the number of female fellows (4.04 females vs 2.87 females; p = 0.007) enrolled in a program. If a GI division chief was male, the program director was more likely to be male as well (81% male vs. 18.8% female). Conversely, having a female division chief was likely to lead to a more equitable program director representation, 54% female to 48% male (p value < 0.0001, OR 5.03 95% CI 2.04-12.3). Furthermore, if either the internal medicine department chair or GI chief was female, the proportion of female program directors increased to 41% as compared to 19% if both were male (p value < 0.0001, OR 2.99 95% CI 1.34-6.6). Women are significantly underrepresented in the number of practicing gastroenterologists, at all levels of leadership in GI fellowship programs, and at the fellow level. Increasing the number of women in fellowship leadership positions is associated with an increase in female program directors and trainees. Per our knowledge, this is the first study to examine the relationship between female leadership in fellowship programs and the gender of trainees. Increasing female representation in leadership positions would not only address current gender disparity, but it may also increase the number of female future GI trainees.

A171 MAGNETIC RESONANCE IMAGING IN CHILDREN WITH EARLY ONSET INFLAMMATORY BOWEL DISEASE- A RETROSPECTIVE COHORT STUDY

Abstract Background Magnetic Resonance (MR) Imaging is the preferred imaging method in Inflammatory Bowel Disease (IBD) patients to investigate for small bowel disease. There are challenges in performing MR imaging in Early Onset IBD (EO-IBD) patients, and in particular in children with Very Early Onset IBD (VEO-IBD). These children often need a general anaesthetic which exposes them to adverse effects and preclude conventional luminal distention influencing the quality of the test. Therefore, the utility of MR imaging in this age group is questionable. Aims To assess the quality of MRI studies in VEO-IBD and EO-IBD patients and to compare the utility of this test between the two groups. Methods We retrospectively identified and reviewed IBD patients diagnosed under 10 years of age, between January 1999 and December 2011, from the British Columbia Children’s Hospital (BCCH) GI Division IBD database. Patients’ first diagnostic MRI results were recorded. Disease location and severity were documented according to the Paris classification. Results 124 patients were included in the cohort, 54 VEO-IBD and 70 EO-IBD patients (See Table 1). Median age at diagnosis was 6.46 (IQR 3.94–8.71), 65.32% males and 43.54% were diagnosed with Crohn’s disease. Overall, 52 patients underwent MRI, 17 (31.48%) in the VEO-IBD group and 35 (50%) in the EO-IBD group; median time from diagnosis to MRI was 3.02 years (IQR 1.08–5.83) for VEO-IBD and 0.44 years (IQR 0.07–1.58) for EO-IBD (p&amp;lt;0.001). In the EO-IBD group there was a significantly higher percentage of patients with MRI findings than in the VEO-IBD group, 23 (67.31%) and 5 (29.41%) respectively (p=0.014). Only one patient in the VEO-IBD group had a disease characteristic identified by MR imaging that could not be diagnosed by endoscopy (small bowel disease). Conclusions The diagnostic yield of MRI in children with VEO-IBD appears to be quite limited but requires further study. Funding Agencies None

Conducting an Effective Quality and Patient Outcomes (QPO) Conference: A Tertiary Care Center Experience

Introduction: M&M (Morbidity & Mortality)/ QPO (Quality and Patient Outcomes) conferences in gastroenterology play a crucial role in Quality Improvement (QI) and fellowship training. Gastroenterology societies have long advocated regular review of endoscopic complications, with few replicable models or references published so far. We propose a QPO conference format that is useful in monitoring the quality of patient care and adherence to quality indicators, while also enhancing trainee education. Methods: Gastroenterology faculty, fellows and endoscopy staff voluntarily report all observed procedural adverse events through a standardized electronic reporting system available on all computer terminals or a cellphone application. Documented events or irregularities included un-anticipated interventions in the endoscopy suite, unplanned admissions, and ED referrals. A detailed prospective database is used to capture of all these events. Reported events are evaluated monthly by a committee which includes nursing staff, a GI fellow, and a faculty member, who directs the GI division's QPO conference. At the meeting, all reported events are discussed and the contributing factors identified. A scoring system is used to rate the type of adverse events (Image 1). The most serious adverse events are presented at the GI division's quarterly QPO conference, attended by members of GI division and representatives of the risk-management team. Results: Regular analysis of the prospective database and discussions at QPO conference enables the review committee to focus on areas of quality improvement, either related to provider care and/or to system issues, allowing existing policies to be revised or new protocols to be developed. Since implementation of this M&M/QPO approach, we developed closed loop communication strategy between endoscopy staff and respiratory therapy personnel thereby reducing respiratory events. We have also identified sedation related corneal injuries and developed preventative measures. Conclusion: With the increasingly procedural nature of GI practice, QPO conferences play a vital role in monitoring and improving patient care, fellowship education, and identifying quality improvement opportunities. We believe that our current QPO conference model is unique with dynamic electronic reporting and creation of a systematic prospective database to track all adverse events. This can be replicated and further expanded to improve quality of care in both academic and nonacademic institutions.1100_A Figure 1. QPO /M&M Scoring system1100_B Figure 2. QPO /M&M Flow chart

Real-time Nurse Interpretation of Video Capsule Endoscopy in Overt Obscure Gastrointestinal Bleeding

Introduction: Video capsule endoscopy (VCE) is an emerging tool used in the management of GI bleeding. VCE has a crucial role diagnostically and maximizing its efficiency will lead to more rapid localization of bleeding sources and shorter time to therapy. We hypothesized that a trained nurse can accurately interpret acute bleeding by VCE in real time. The primary outcome was inter-observer agreement between nurse and physician interpretation. Secondary outcomes were time to formal physician interpretation, endoscopy, and hospital length of stay (LOS). Methods: Two physicians from our GI division gave a registered nurse a tutorial in VCE. Patients admitted for overt obscure GI bleeding to our center between 12/2016 and 6/2017 were enrolled. A VCE was deployed per protocol. The nurse interpreted the patient's video recorder at the bedside for 2 minutes in 30-minute intervals for the duration of the study. The nurse would document a “blood” or “no blood” interpretation. The VCE interpreting physician was blinded to the nurse's findings. We retrospectively reviewed outcomes for 12 patients admitted to our unit for inpatient VCE who had received the standard of care for comparison to the live-view (LV) group. Means and proportions of demographic and clinical characteristics were compared using two-sided two-group t-test and two-sided two-group chi-square test, respectively. The kappa statistic indicated the level of agreement between the physicians and nurse.Table: Table. Patient CharacteristicsTable: Table. Secondary OutcomesResults: Nine subjects have been enrolled to date. The overall agreement between the 2 physicians and the nurse was 8/9 giving a kappa statistic of 0.73, 95% CI (0.24,1.00), p=0.023. Delay in time to physician interpretation in LV group was 0.5±0.1 days (d) vs standard group 0.7±0.3 d (p=0.059). Time to endoscopy in LV group was 1.7±1.5 d vs standard group 3±1.6 d (p=0.16). LOS in LV group was 8.9±5.7 d vs standard group was 11.4±7.8 d (p=0.46). Conclusion: This first of its kind pilot trial utilized a nurse for live-view VCE found interobserver agreement that was statistically significant. Patients in the live-view group had shorter times to physician interpretation, endoscopy, and shorter LOS. We suggest the positive impact on outcomes relates to the fostering of a team approach integrating nursing more directly into diagnostic evaluation. If nurse real time accurate interpretation of VCE bleeding can be confirmed, it will translate to more efficient and cost-effective care.

P-229 YI Utilization of an Education Handbook to Optimize Self-Management Skills in Pediatric IBD

Our newly diagnosed pediatric IBD patients receive intensive education within a few weeks of diagnosis. However, we had no process for ongoing education. Therefore, our team developed an interactive self-management handbook to be used at both their initial education day and at follow-up clinic visits. A self-management handbook was developed in 2011 to provide an ongoing educational resource for pediatric patients and families with IBD. Chapters are divided into sections including the following topics: “What we expect of you. What you should expect from us.” Why this is important. “Let's review and Things to Do.” Examples of chapters include: Your IBD: Where is it located in your body; When to call your IBD team; Growth and Nutrition, Psychosocial Issues. These topics provide a list of skills that are crucial to effective self-management and help guide patients in the skills they are expected to incorporate in their medical care. Furthermore, this structured approach allows for active patient participation in the learning process. The handbook is given at the initial teaching and patients are instructed to review one chapter between office visits. All members of the IBD team are responsible for reviewing chapters with the patient at each visit. Informal verbal feedback from patients and families found the information to be helpful. Reviewing one chapter every few weeks was not overwhelming for the patient. Healthcare providers within our GI division found the structured approach helpful to assure essential information was reviewed with the patient. Utilization of the self-management handbook has provided an effective way to provide ongoing structured education for patients and families with IBD. Patients are more involved in their care and have a better understanding of their disease. This process has given us the impression the handbook has helped to streamline teaching. Patients and families are more engaged in the teaching process. Providers have a standardized template to assure comprehensive education.

Ulcerative Colitis: The Influence of BMI at Time of Diagnosis on Disease Severity and Progression

Introduction: It has been noted that one of the mediating factors in inflammatory bowel disease (IBD) is tumor necrosis factor (TNF), produced by adipose cells. Several studies have analyzed the influence of body mass index (BMI) in overweight and obese patients on the course of disease in patients with Crohn’s disease (CD), with some but not all studies demonstrating an inverse relationship between BMI and disease prognosis in this patient population. This relationship has been inadequately explored in patients with ulcerative colitis (UC). This study therefore aims to evaluate the effect of BMI at diagnosis on UC patients with relation to severity and disease extent, defined as use of medical therapy, rate and type of surgery (subtotal colectomy, total colectomy, or total proctocolectomy), time to surgery, and inflammation (rectal, left-sided, or pancolitis). Methods: This was a retrospective, single center chart review conducted using the EMR at a large university medical center. All patients with UC seen in the GI division from June 1, 2009 to June 1, 2012 were initially eligible (n=676). Records were then analyzed to select those who had confirmation of UC on colonoscopy and height and weight recorded within 1 year of diagnosis. BMI was calculated from this in kg/M2. Additional information regarding disease course was recorded. Overall, 137 patient charts met criteria. Results: There was no association between inflammatory extent and BMI, (p=0.12; 95% confidence interval [CI]= -0.56-0.06). There was similarly, no association between escalation of medical therapy or rate and severity of surgery, (p=0.21; 95% CI= -0.05-0.21; p=0.24, 95% CI= -0.17-0.68). Additionally, there was no significant difference between time to surgery between healthy weight patients and those who were overweight or obese (p=0.27; 95% CI = -0.14-0.57). There was a statistically significant association between age of diagnosis and BMI (p=<0.001), with every 1.0 kg/M2 increase in BMI increasing predicted age at diagnosis by 0.9697. Conclusion: BMI does not appear to influence disease parameters in the UC population including need for escalation of medical therapy, rates and severity of surgery, time to surgery, and inflammatory extent in the colon and small bowel. It is, however, associated with age of diagnosis, though it is unclear whether this is secondary to inherent disease characteristics versus the propensity for patients to gain weight over time, therefore having higher BMIs at more advanced ages. These findings are in contrast to those reported previously in the literature which note shorter time to surgery (CGH 2006;4(4):482-488), higher disease activity (Clinical Nutrition 2002;21(1): 51-57), and more colonic distribution (Digestion 2013;88(1):26-32) in patients with CD.

Training Directors Have Positive Perceptions of a Competency-Based Gastroenterology and Transplant Hepatology Fellowship Program

In 2012, the American Board of Internal Medicine approved a pilot competency-based transplant hepatology (TH) training program. This program allows gastroenterology (GI) and TH fellowships to be completed in 3 years. We investigated the perceptions and beliefs of GI and TH division and fellowship program directors on the competency-based TH training program. All current GI and TH division and fellowship program directors from the 162 fellowship programs accredited by the Accreditation Council for Graduate Medical Education were invited via e-mail to anonymously complete the online survey. The survey questioned their perceptions of the 3-year combined GI and TH training program. A total of 116 participants completed the survey (∼38% response rate). Most respondents were GI fellowship directors (61%); 15% were GI and hepatology division directors, 19% were TH fellowship directors, 14% were TH division directors, and 5% were GI division directors. Most of the respondents were in favor of the pilot program (85%). Only 63% of all respondents believed that graduates of the pilot program would achieve the same level of competency in GI as those who completed the traditional program. Overall, 71% believed incorporation of the 3-year training model would increase interest and participation in TH fellowships. Most of the academic GI and TH division and fellowship program directors embrace competency-based fellowship education and TH subspecialty training during the designated 3-year GI fellowship. Future studies will be needed to reevaluate these beliefs after several years.

Overweight and Obese Patients with Ulcerative Colitis (UC): Prevalence and Epidemiology in a University-based Population Cohort

Purpose: Obesity in the IBD population has historically been considered to be uncommon. This study aims to determine prevalence of obesity in a university-based cohort of UC patients (pts) and to evaluate whether overweight and obese status is associated with pt demographics or disease characteristics. Methods: All pts with UC seen in our GI division from 6/1/2009 to 6/1/2012 were eligible (n=676) for analysis. EMRs were then reviewed to identify pts who had confirmation of UC on colonoscopy, two recorded weights >1 year apart, and one recorded height. Weights were averaged to calculate BMI (kg/M2). Overall, 404 pt records (59.8%) were included for calculation of obesity prevalence and weight trends in association with history of surgery. Results: In our population, 194 (47.9%) were male. Mean age was 46.0 years (yrs) with mean age of diagnosis of 32.5 yrs. Mean disease duration was 13.5 yrs. Mean BMI was 25.8, compared to 28.6, the national average for American adults, as reported by the CDC. Pts were divided into BMI subcategories based on the WHO's definition of underweight (<18.5), healthy (18.5-24.9), overweight (25.0-29.9), and obese (>30) individuals. There were 12 (3.0%) underweight pts, 192 (47.5%) healthy, 127 (31.4%) overweight, and 73 (18.1%) obese. This is in comparison to national averages reporting 33.3% of American adults overweight, 35.9% obese. There was no difference in rates of IBD-related surgery between those with BMI >25 vs. <25 (21.0% vs. 23.0%, OR 0.888, CI 0.5543-1.4224). In subset analysis, there was no statistical difference between rates of surgery in the underweight vs. healthy (41.7% vs. 21.9%, OR 2.551, CI 0.7702-8.4492), overweight vs. healthy (22.8% vs. 21.9%, OR 1.0569, CI 0.6175-1.8088), or obese vs. healthy (17.8% vs. 21.9%, OR 0.7738, CI 0.388-1.5433). There was also no difference in time to surgery after diagnosis in overweight or obese pts vs. healthy (9.6yrs vs. 7.7yrs, p=0.33711) or underweight vs. healthy (12.8yrs vs. 7.7yrs, p=0.47177). Conclusion: Approximately 1 in 2 adults with UC are overweight or obese, in comparison to 2 in 3 in the general population. There was no difference in rates of surgery between healthy weight and underweight, overweight, or obese pts. These findings differ distinctly from that previously reported by our group in pts with CD (CGH 2006;4(4):482-488). We also previously reported that obese CD patients had a shorter time to surgery after disease diagnosis, which was not found in this UC cohort. It is clear further studies are needed to determine the effects of obesity on the IBD population.

Su1350 Quality Endoscopy: Tracking Endoscopic Adverse Events Using an Electronic Medical Record System Is Superior to a Voluntary Reporting System

Endoscopy units traditionally track adverse events (AEs) and complications through reliance on self-reporting and close patient follow-up. These methods are subject to limitations that result in the under reporting of procedure-related AE. Our institution currently uses a voluntary electronic incident reporting system to track AEs. In addition, the GI division sends a weekly notice requesting AE reporting from on-service faculty, fellows and staff. Both tracking systems have a low reported rate of incidents involving high-risk procedures.

Editorial introductions

Current Opinion in Gastroenterology was launched in 1985. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of gastroenterology is divided into 12 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce one of the Section Editors for this issue. SECTION EDITORS David H. AlpersDavid H. AlpersDavid H. Alpers received his bachelor and medical degrees from Harvard University, was a medical house officer at the Massachusetts General Hospital, and a research fellow at NIH under Gordon Tomkins. After a fellowship in gastroenterology at the Massachusetts General Hospital and serving as a junior faculty member at Harvard Medical School, he served as chief of the GI Division at Washington University School of Medicine from 1969–1997. His laboratory research was focused on the regulation of protein synthesis in the GI tract, and on the biology of proteins unique to the GI mucosa, including especially intestinal alkaline phosphatase, gastric intrinsic factor, and the intrinsic factor-cobalamin receptor (cubilin). He has published over 220 peer reviewed scientific papers related to this work. Dr Alpers has had many editorial responsibilities, including associate editor of the J Clin Invest, editor of the Am J Physiol Gastrointest Liver Physiol (1991–97), editorial board of the J Biol Chem (1998–2003), Editor of Small Intestine and Nutrition sections of Current Opinion in Gastroenterology (1997-present), and Associate Editor of the Am J Clin Nutr (2008-present). He is Associate Editor of the Textbook of Gastroenterology (5th edition), T. Yamada (editor-in-chief), and coauthor (with W Stenson, B Taylor, and DM Bier) of the Manual of Nutritional Therapeutics (5th edition). He served as director of the Undergraduate Teaching Project of the American Gastroenterological Association from 1985–2001, and was president of the AGA in 1990–91. He received the Julius Friedenwald medal of the AGA for lifetime contributions to the field of gastroenterology. Currently he serves as William B Kountz Professor of Medicine and Geriatrics and is Co-director for the Center for Human Nutrition and the Center for Clinical Research Unit at Washington University School of Medicine. William F. StensonWilliam F. StensonDr Stenson graduated from the Washington University School of Medicine and was a medical resident at Barnes Hospital in St Louis, USA. This was followed by a gastroenterology fellowship and laboratory training in immunology with Dr Charles Parker, both at Washington University. After training he joined the gastroenterology faculty at Washington University and has spent his entire career there. He is currently the Nicholas V Costrini Professor of Gastroenterology and Inflammatory Bowel Disease. His clinical interests have focused on inflammatory bowel disease, celiac disease and nutrition. His laboratory interests include intestinal inflammation and the epithelial response to injury. The role of prostaglandins in these processes has been a particular interest. He has published more than a hundred scientific articles. He is the co-author of the Manual of Nutritional Therapeutics which is now in its fifth edition. He is a member of the Digestive Disease Commission and was the chairman of the Gastrointestinal Mucosal Pathobiology Study Section for the NIH.

Sa1647 Surveillance of Gastric Ulcer in a Hispanic and African American Predominant Community

Surveillance of Gastric Ulcer in a Hispanic and African American Predominant Community Prospere Remy, Haritha R. Chelimilla, Umair Siddiqui, Harish Patel, Myrta Daniel, David Widjaja Medicine, Bronx Lebanon Hospital Center, Bronx, NY Background: Endoscopic surveillance for benign gastric ulcer (GU) has been a common practice although it is neither recommended by the US GI societies nor is cost effective. Furthermore, the yield of the endoscopic surveillance in Hispanic and African American community has not been studied, particularly with the advent of Helicobacter Pylori (HP) treatment. Purpose: To analyze key factors and outcomes associated with endoscopic surveillance of GU in our South Bronx hospital. Methods: Persons aged 18 years or older who were diagnosed with GU on initial esophagogastroduodenoscopy (EGD) at GI division of Bronx Lebanon Hospital Center between January 1, 2002 and April 3

Endoscopic Test for Helicobacter pylori Infection in Patients without Alarm Symptoms: A Study in a Minority Population

Purpose: In addition to detecting common lesions in the upper gastrointestinal (UGI) tract, upper endoscopy is commonly used for diagnosis of H. pylori. In this study we would like to evaluate the yield of endoscopic test in detecting H. pylori infection, premalignant or malignant UGI lesions in patients with dyspepsia who did not have alarm symptoms or use NSAIDs chronically in our minority population. Methods: All men and women between 18-55 years of age with chronic abdominal pain who underwent EGD at the GI division of Bronx Lebanon Hospital Center (BLHC) between July 1, 2008 - December 31, 2009 were included in this retrospective study. Exclusion criteria were the presence of alarm symptoms and chronic NSAIDs use. Results: There were 205 patients who fulfilled the inclusion and exclusion criteria with median age of 43 years old. Of these patients, 59% were women, 66% hispanics, 24% African Americans and 9% other race. Most of the patients (92%) had upper abdominal pain. The endoscopic findings of these patients were esophagitis (12%), hiatus hernia (14%), erythema of gastric mucosa (49%), gastric ulcers (14%), erosion of gastric mucosa (23%), gastric polyp (5.9%), erythema of duodenal mucosa (4%) and erosion of duodenal mucosa (1%). Tissue biopsy from gastric mucosa revealed 22% (45/205) of positive urea based test and 17% (35/205) of positive H. pylori bacteria on histologic assessment. The yield of tissue biopsy for H. pylori was significantly higher among patients with gastric ulcers compared to those without gastric ulcers (12/30 in patients with gastric ulcers versus 35/175 in patients without gastric ulcers, p=0.02). Other findings from the tissue biopsy were esophageal inflammatory changes (7%), esophageal intestinal metaplasia (0.5%), gastric inflammatory changes (40%), hyperplastic gastric mucosa (1%), gastric foveolar hyperplasia (2%) and duodenal inflammatory changes (5%). None of the patients was diagnosed for upper gastrointestinal malignancy. Conclusion: Among patients with dyspepsia who did not have alarm symptoms or use NSAIDs chronically, endoscopic test revealed 22% of H. pylori infection. None of the patients were found to have premalignant or malignant lesions. Similar to previous studies in other communities, study in our minority population may indicate that the use of nonendoscopic test is an appropriate initial approach for detection of H. pylori infection in patients with dyspepsia who do not have have alarm symptoms or use NSAIDs chronically.

For distinguished contributions to psychophysiology: Robert M. Stern

Robert “Bob” Stern received the Distinguished Scientific Contribution to Psychophysiology award in 2004 for his scientific achievements in psychophysiology of visceral, particularly gastrointestinal, psychophysiology. The Society for Psychophysiological Research honors a pioneer whose contributions paved the way for the development of Behavioral Medicine and Social Cognitive Psychophysiology. Robert Stern's textbooks educated and inspired countless students worldwide for psychophysiology and shaped a positive and critical attitude of the public toward our discipline. Bob was born and raised in the Bronx in the “shadow of the Yankee-Stadium.” He describes his childhood often as “unremarkable,” hiding the information on the warm and loving atmosphere of the family environment. In this caring and altruistic–empathic climate a person grew who, later in adult life, reciprocated that attitude to all around him. As Department Head and head of countless Minority Committees his tolerant and open personality won him the sympathy of all around. At Franklin & Marshall College in Lancaster, Pennsylvania, he earned a degree in philosophy, instigating his lifelong interest in the mind–body problem and social–ethical problems of science. After an “intermezzo” at Tufts University, he met his mentor, R.C. Davis, at Indiana University, whose work on the electrogastrogram left him “imprinted” on the psychophysiology of the gastrointestinal tract and its function and its pathology in nausea, eating disorders, and motion sickness. Most of his 100 publications from then on (the mid-1960s) were devoted to the topic of gastric motility and responsiveness. But in his early career as a young scientist at Penn State University, he wrote brilliant essays on “sociopsychophysiology,” detection of deception, and he conducted the first critical experiments on operant conditioning (“biofeedback”) of skin conductance. The mechanisms behind visceral perception and its implication for somatic and psychosomatic diseases then became a major focus of his research. This work remained one of the founding pillars of behavioral medicine. A lifelong mutual friendship with the European “father” of visceroception, Gyorgi Adam of the Hungarian Academy of Science in Budapest, brought Bob's ideas and writings to the old continent and had a lasting influence on the rapid growth of European psychophysiology. Several awards from European and U.S. funding agencies for scholarships abroad intensified Bob's international reputation. As a visiting professor at several German Universities (Mainz, Tübingen, Vienna), he contributed substantially to the amazing recovery of biological psychology in Germany after its destruction by Nazi rule. The book Psychophysiological Recording (first edition with W. Ray and R.C. Davis, second edition with Bill Ray and Karen Quigley) and his teaching at Penn State and abroad set the standards for scholarly education of psychophysiology until today. After decades of careful experimentation with electrogastrographic (EGG) recordings using—among other methods—a rotating drum developed by the famous perception researcher and friend at Penn State, Herschel Leibowitz, Bob came to the conclusion that motion sickness and sensitivity to nausea have a genetic and a learned component. He tested numerous treatment approaches for nausea induced by motion sickness. He favors a habituation–desensitization approach and thoroughly tested it in the controlled laboratory, a tantalizing task combining the huge rotating drum environment with the delicate measurement of gastric activity. Robert Stern has been an active member of our society for more than 40 years, serving on the board and several committees, and is a brilliant scientist and an adviser on ethical and social–political issues. Bob recently retired, but he maintains his office at Penn State, where, with two colleagues, he is writing a book on the mechanisms and management of nausea. He spends his winters as a visiting professor in the GI division of the Wake Forest University Medical School in Winston-Salem, North Carolina. Scientists of his stature and with a broad view of our place in society and culture constitute a model mentor for students and scholars of psychophysiology.

EUS-Guided Drainage of a Diverticular Abscess as an Adjunct to Surgical Therapy

612 GASTROINTESTINAL ENDOSCOPY VOLUME 58, NO. 4, 2003 Current affiliations: Division of Gastroenterology and Division of GI, Tumor and Endocrine Surgery, University of Colorado Health Sciences Center, Denver, Colorado. Reprint requests: Yang K. Chen, MD, Division of Gastroenterology and Hepatology, University of Colorado Hospital, Anschutz Centers for Advanced Medicine, 1635 N. Ursula St., Mail Stop F735, Aurora, Colorado 80010-0510. Copyright © 2003 by the American Society for Gastrointestinal Endoscopy 0016-5107/2003/$30.00 + 0 PII:S0016-5107(03)01966-7 EUS-guided drainage of a diverticular abscess as an adjunct to surgical therapy