You are here

Fisher, Deborah Anne

Overview:

As Associate Director for Gastroenterology Research at the Duke Clinical Research Institute I am building on the success of the Hepatology research program at DCRI GI and expanding the research portfolio to GI medical devices and GI luminal (e.g., upper GI, colorectal) research. My own research focus is colorectal cancer prevention, detection, and surveillance.  My research, advocacy, and clinical work are connected by the goal to improve the quality, efficiency, and effectiveness of medical care and in particular colorectal cancer screening and surveillance programs.  My work has been recognized by several awards and I am funded by NIH and VA.  I have served on national committees including chairing the National VA GI Field Advisory Committee and am currently a member of the American Gastroenterology Association (AGA) Publications Committee and the American Society for Gastrointestinal Endoscopy (ASGE) Quality in Endoscopy committee. My current educational work includes clinical teaching in medicine, clinical gastroenterology and endoscopy, directing the Department of Medicine https://medicine.duke.edu/education-and-training/mentors-program">MENTOR... program for clinical research fellows and research mentoring individual fellows and residents.  I am faculty of the GI Division T32 training grant and of the Duke Clinical Research Training Program. Finally, I am the Director of Social and Digital Media for the GI Division.

Positions:

Associate Professor of Medicine

Medicine, Gastroenterology
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Member in the Duke Clinical Research Institute

Duke Clinical Research Institute
School of Medicine

Education:

M.D. 1996

M.D. — Vanderbilt University

News:

Is lab testing the 'Wild West' of medicine?

December 11, 2015 — Wall Street Journal

Grants:

Duke Training Grant in Digestive Diseases and Nutrition

Administered By
Medicine, Gastroenterology
AwardedBy
National Institutes of Health
Role
Mentor
Start Date
July 01, 1988
End Date
June 30, 2017

Understanding recommendations for screening colonoscopy intervals

Administered By
Medicine, Gastroenterology
AwardedBy
National Institutes of Health
Role
Principal Investigator
Start Date
September 15, 2013
End Date
May 31, 2017

Colorectal Cancer Screening Behavior in VA Population

Administered By
Medicine, General Internal Medicine
AwardedBy
National Institutes of Health
Role
Principal Investigator
Start Date
January 15, 2005
End Date
December 31, 2007

Cancer Care Quality Measures: Diagnosis and Treatment of Colorectal Cancer

Administered By
Institutes and Centers
AwardedBy
Agency for Healthcare Research and Quality
Role
Investigator
Start Date
December 01, 2004
End Date
December 31, 2005
Show More

Awards:

Fellow of the American Gastroenterology Association. American Gastroenterology Association.

Type
National
Awarded By
American Gastroenterology Association
Date
January 01, 2011

ASGE Senior Investigator Mentoring Award. American Society for Gastrointestinal Endoscopy.

Type
National
Awarded By
American Society for Gastrointestinal Endoscopy
Date
January 01, 2010

Fellow of the American Society for Gastrointestinal Endoscopy. American Society for Gastrointestinal Endoscopy.

Type
National
Awarded By
American Society for Gastrointestinal Endoscopy
Date
January 01, 2010

VA National Center for Health Promotion and Disease Prevention Special Contribution Award. VA.

Type
National
Awarded By
VA
Date
January 01, 2010

AstraZeneca Emerging Leaders in GI Award. AstraZeneca.

Type
Other
Awarded By
AstraZeneca
Date
January 01, 2007

Fellow of the American College of Gastroenterology. American College of Gastroenterology.

Type
National
Awarded By
American College of Gastroenterology
Date
January 01, 2007

Gastroenterology Research Group AGA Abstract of the Year Award. GRG/AGA.

Type
Other
Awarded By
GRG/AGA
Date
January 01, 2002

Agency for Healthcare Research and Quality Fellowship. Duke University Medical Center.

Type
Other
Awarded By
Duke University Medical Center
Date
January 01, 2000

Diabetes Research and Training Center Fellowship. Vanderbilt School of Medicine.

Type
University
Awarded By
Vanderbilt School of Medicine
Date
January 01, 1993

Phi Beta Kappa. Vanderbilt University.

Type
School
Awarded By
Vanderbilt University
Date
January 01, 1991

Harold Sterling Vanderbilt Honors Scholarship. Vanderbilt University.

Type
School
Awarded By
Vanderbilt University
Date
January 01, 1988

Publications:

Socioeconomic disparities, financial toxicity, and opportunities for enhanced system efficiencies for patients with cancer.

Cancer care continues to stress the US healthcare system with increases in life expectancy, cancer prevalence, and survivors' complex needs. These challenges are compounded by socioeconomic, racial, and cultural disparities that are associated with poor clinical outcomes. One innovative and resource-wise strategy to address this demand on the system is expanded use of telehealth. This paradigm has the potential to decrease healthcare and patient out-of-pocket costs and improve patient adherence to recommended treatment and/or surveillance.

Authors
Abbott, DE; Voils, CL; Fisher, DA; Greenberg, CC; Safdar, N
MLA Citation
Abbott, DE, Voils, CL, Fisher, DA, Greenberg, CC, and Safdar, N. "Socioeconomic disparities, financial toxicity, and opportunities for enhanced system efficiencies for patients with cancer." Journal of surgical oncology 115.3 (March 2017): 250-256.
PMID
28105638
Source
epmc
Published In
Journal of Surgical Oncology
Volume
115
Issue
3
Publish Date
2017
Start Page
250
End Page
256
DOI
10.1002/jso.24528

Clinical Performance of Prediction Rules and Nasogastric Lavage for the Evaluation of Upper Gastrointestinal Bleeding: A Retrospective Observational Study.

Introduction. The majority of patients with acute upper gastrointestinal bleeding (UGIB) are admitted for urgent endoscopy as it can be difficult to determine who can be safely managed as an outpatient. Our objective was to compare four clinical prediction scoring systems: Glasgow Blatchford Score (GBS) and Clinical Rockall, Adamopoulos, and Tammaro scores in a sample of patients presenting to the emergency department of a large US academic center. Methods. We performed a retrospective cohort study of patients during 2008-2010. Our outcome was significant UGIB defined as high-risk stigmata on endoscopy, or receipt of blood transfusion or surgery, or death. Results. A total of 393 patients met inclusion criteria. The GBS was the most sensitive for detecting significant UGIB at 98.30% and had the highest negative predictive value (90.00%). Adding nasogastric lavage data to the GBS increased the sensitivity to 99.57%. Conclusions. Of all four scoring systems compared, the GBS demonstrated the highest sensitivity and negative predictive value for identifying a patient with a significant UGIB. Therefore, patients with a 0 score can be safely managed as an outpatient. Our results also suggest that performing a nasogastric lavage adds little to the diagnosis UGIB.

Authors
Dakik, HK; Srygley, FD; Chiu, S-T; Chow, S-C; Fisher, DA
MLA Citation
Dakik, HK, Srygley, FD, Chiu, S-T, Chow, S-C, and Fisher, DA. "Clinical Performance of Prediction Rules and Nasogastric Lavage for the Evaluation of Upper Gastrointestinal Bleeding: A Retrospective Observational Study." Gastroenterology research and practice 2017 (January 26, 2017): 3171697-.
PMID
28246528
Source
epmc
Published In
Gastroenterology Research and Practice
Volume
2017
Publish Date
2017
Start Page
3171697
DOI
10.1155/2017/3171697

Developing and Testing an Electronic Measure of Screening Colonoscopy Overuse in a Large Integrated Healthcare System.

Most existing performance measures focus on underuse of care, but there is growing interest in identifying and reducing overuse.We aimed to develop a valid and reliable electronic performance measure of overuse of screening colonoscopy in the Veterans Affairs Health Care System (VA), and to quantify overuse in VA.This was a cross-sectional study with multiple cross-sections.U.S. Veterans who underwent screening colonoscopy between 2011 and 2013.Overuse of screening colonoscopy, using a validated electronic measure developed by an expert workgroup.Compared to results obtained from manual record review, the electronic measure was highly specific (97 %) for overuse, but not sensitive (20 %). After exclusion of diagnostic and high-risk screening or surveillance procedures, the validated electronic measure identified 88,754 average-risk screening colonoscopies performed in VA during 2013. Of these, 20,530 (23 %) met the definition for probable (17 %) or possible (6 %) overuse. Substantial variation in colonoscopy overuse was noted between Veterans Integrated Care Networks (VISNs) and between facilities, with a nearly twofold difference between the maximum and minimum rates of overuse at the VISN level and a nearly eightfold difference at the facility level. Overuse at the VISN and facility level was relatively stable over time.Overuse of screening colonoscopy can be measured reliably and with high specificity using electronic data, and is common in a large integrated healthcare system. Overuse measures, such as those we have specified through a consensus workgroup process, could be combined with underuse measures to improve the appropriateness of colorectal cancer screening.

Authors
Saini, SD; Powell, AA; Dominitz, JA; Fisher, DA; Francis, J; Kinsinger, L; Pittman, KS; Schoenfeld, P; Moser, SE; Vijan, S; Kerr, EA
MLA Citation
Saini, SD, Powell, AA, Dominitz, JA, Fisher, DA, Francis, J, Kinsinger, L, Pittman, KS, Schoenfeld, P, Moser, SE, Vijan, S, and Kerr, EA. "Developing and Testing an Electronic Measure of Screening Colonoscopy Overuse in a Large Integrated Healthcare System." Journal of general internal medicine 31 Suppl 1 (April 2016): 53-60.
PMID
26951277
Source
epmc
Published In
Journal of General Internal Medicine
Volume
31 Suppl 1
Publish Date
2016
Start Page
53
End Page
60
DOI
10.1007/s11606-015-3569-y

Underuse and Overuse of Colonoscopy for Repeat Screening and Surveillance in the Veterans Health Administration.

Regular screening with colonoscopy lowers colorectal cancer incidence and mortality. We aimed to determine patterns of repeat and surveillance colonoscopy and identify factors associated with overuse and underuse of colonoscopy.We analyzed data from participants in a previous Veterans Health Administration (VHA) study who underwent outpatient colonoscopy at 25 VHA facilities between October 2007 and September 2008 (n = 1455). The proportion of patients who received a follow-up colonoscopy was calculated for 3 risk groups, which were defined on the basis of the index colonoscopy: no adenoma, low-risk adenoma, or high-risk adenoma.Colonoscopy was overused (used more frequently than intervals recommended by guidelines) by 16% of patients with no adenomas, 26% with low-risk adenomas, and 29% with high-risk adenomas. Most patients with high-risk adenomas (54%) underwent colonoscopy after the recommended interval or did not undergo colonoscopy. Patients who received a follow-up recommendation that was discordant with guidelines were more likely to undergo colonoscopy too early (no adenoma odds ratio [OR], 3.80; 95% confidence interval [CI], 2.31-6.25 and low-risk adenoma OR, 5.28; 95% CI, 1.88-14.83). Receipt of colonoscopy at nonacademic facilities was associated with overuse among patients without adenomas (OR, 5.26; 95% CI, 1.96-14.29) or with low-risk adenomas (OR, 3.45; 95% CI, 1.52-7.69). Performance of colonoscopies by general surgeons vs gastroenterologists (OR, 2.08; 95% CI, 1.02-4.23) and female sex of the patient (OR, 3.28; 95% CI, 1.06-10.16) were associated with overuse of colonoscopy for patients with low-risk adenomas. No factors examined were associated with underuse of colonoscopy among patients with high-risk adenomas.In an analysis of patients in the VHA system, more than one fourth of patients with low-risk adenomas received follow-up colonoscopies too early, whereas more than one half of those with high-risk adenomas did not undergo surveillance colonoscopy as recommended. Our findings highlight the need for system-level improvements to facilitate the appropriate delivery of colonoscopy that is based on individual risk.

Authors
Murphy, CC; Sandler, RS; Grubber, JM; Johnson, MR; Fisher, DA
MLA Citation
Murphy, CC, Sandler, RS, Grubber, JM, Johnson, MR, and Fisher, DA. "Underuse and Overuse of Colonoscopy for Repeat Screening and Surveillance in the Veterans Health Administration." Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association 14.3 (March 2016): 436-444.e1.
PMID
26492843
Source
epmc
Published In
Clinical Gastroenterology and Hepatology
Volume
14
Issue
3
Publish Date
2016
Start Page
436
End Page
444.e1
DOI
10.1016/j.cgh.2015.10.008

The accuracy and completeness for receipt of colorectal cancer care using Veterans Health Administration administrative data.

The National Comprehensive Cancer Network and the American Society of Clinical Oncology have established guidelines for the treatment and surveillance of colorectal cancer (CRC), respectively. Considering these guidelines, an accurate and efficient method is needed to measure receipt of care.The accuracy and completeness of Veterans Health Administration (VA) administrative data were assessed by comparing them with data manually abstracted during the Colorectal Cancer Care Collaborative (C4) quality improvement initiative for 618 patients with stage I-III CRC.The VA administrative data contained gender, marital, and birth information for all patients but race information was missing for 62.1% of patients. The percent agreement for demographic variables ranged from 98.1-100%. The kappa statistic for receipt of treatments ranged from 0.21 to 0.60 and there was a 96.9% agreement for the date of surgical resection. The percentage of post-diagnosis surveillance events in C4 also in VA administrative data were 76.0% for colonoscopy, 84.6% for physician visit, and 26.3% for carcinoembryonic antigen (CEA) test.VA administrative data are accurate and complete for non-race demographic variables, receipt of CRC treatment, colonoscopy, and physician visits; but alternative data sources may be necessary to capture patient race and receipt of CEA tests.

Authors
Sherer, EA; Fisher, DA; Barnd, J; Jackson, GL; Provenzale, D; Haggstrom, DA
MLA Citation
Sherer, EA, Fisher, DA, Barnd, J, Jackson, GL, Provenzale, D, and Haggstrom, DA. "The accuracy and completeness for receipt of colorectal cancer care using Veterans Health Administration administrative data." BMC health services research 16 (January 2016): 50-.
Website
http://hdl.handle.net/10161/11721
PMID
26869265
Source
epmc
Published In
BMC Health Services Research
Volume
16
Publish Date
2016
Start Page
50
DOI
10.1186/s12913-016-1294-9

Physician Non-adherence to Colonoscopy Interval Guidelines in the Veterans Affairs Healthcare System.

Colonoscopy can decrease colorectal cancer (CRC) mortality, although performing this procedure more frequently than recommended could increase costs and risks to patients. We aimed to determine rates and correlates of physician non-adherence to guidelines for repeat colonoscopy screening and polyp surveillance intervals.We performed a multi-center, retrospective, observational study using administrative claims, physician databases, and electronic medical records (EMR) from 1455 patients (50-64 y old) who underwent colonoscopy in the Veterans Affairs healthcare system in fiscal year 2008. Patients had no prior diagnosis of CRC or inflammatory bowel disease, and had not undergone colonoscopy examinations in the previous 10 years. We compared EMR-documented, endoscopist-recommended intervals for colonoscopies with intervals recommended by the 2008 Multi-Society Task Force guidelines.The overall rate of non-adherence to guideline recommendations was 36% and ranged from 3% to 80% among facilities. Non-adherence was 28% for patients who underwent normal colonoscopies, but 45%-52% after colonoscopies that identified hyperplastic or adenomatous polyps. Most of all recommendations that were not followed recommended a shorter surveillance interval. In adjusted analyses, non-adherence was significantly higher for patients whose colonoscopies identified hyperplastic (odds ratio [OR] = 3.1; 95% CI, 1.7-5.5) or high-risk adenomatous polyps (OR = 3.0; 95% CI, 1.2-8.0), compared to patients with normal colonoscopy examinations, but not for patients with low-risk adenomatous polyps (OR = 1.8; 95% CI, 0.9-3.7). Nonadherence was also associated with bowel preparation quality, geographic region, Charlson comorbidity score, and colonoscopy indication.In a managed care setting with salaried physicians, endoscopists recommend repeat colonoscopy sooner than guidelines for more than one third of patients. Factors associated with non-adherence to guideline recommendations were colonoscopy findings, quality of bowel preparation, and geographic region. Targeting endoscopist about non-adherence to colonoscopy guidelines could reduce overuse of colonoscopy and associated healthcare costs.

Authors
Johnson, MR; Grubber, J; Grambow, SC; Maciejewski, ML; Dunn-Thomas, T; Provenzale, D; Fisher, DA
MLA Citation
Johnson, MR, Grubber, J, Grambow, SC, Maciejewski, ML, Dunn-Thomas, T, Provenzale, D, and Fisher, DA. "Physician Non-adherence to Colonoscopy Interval Guidelines in the Veterans Affairs Healthcare System." Gastroenterology 149.4 (October 2015): 938-951.
PMID
26122143
Source
epmc
Published In
Gastroenterology
Volume
149
Issue
4
Publish Date
2015
Start Page
938
End Page
951
DOI
10.1053/j.gastro.2015.06.026

The role of endoscopy in benign pancreatic disease.

Authors
Chandrasekhara, V; Chathadi, KV; Acosta, RD; Decker, GA; Early, DS; Eloubeidi, MA; Evans, JA; Faulx, AL; Fanelli, RD; Fisher, DA; Foley, K; Fonkalsrud, L; Hwang, JH; Jue, TL; Khashab, MA; Lightdale, JR; Muthusamy, VR; Pasha, SF; Saltzman, JR; Sharaf, R; Shaukat, A; Shergill, AK; Wang, A; Cash, BD; DeWitt, JM
MLA Citation
Chandrasekhara, V, Chathadi, KV, Acosta, RD, Decker, GA, Early, DS, Eloubeidi, MA, Evans, JA, Faulx, AL, Fanelli, RD, Fisher, DA, Foley, K, Fonkalsrud, L, Hwang, JH, Jue, TL, Khashab, MA, Lightdale, JR, Muthusamy, VR, Pasha, SF, Saltzman, JR, Sharaf, R, Shaukat, A, Shergill, AK, Wang, A, Cash, BD, and DeWitt, JM. "The role of endoscopy in benign pancreatic disease." Gastrointestinal endoscopy 82.2 (August 2015): 203-214.
PMID
26077456
Source
epmc
Published In
Gastrointestinal Endoscopy
Volume
82
Issue
2
Publish Date
2015
Start Page
203
End Page
214
DOI
10.1016/j.gie.2015.04.022

The role of endoscopy in the management of premalignant and malignant conditions of the stomach.

Authors
Evans, JA; Chandrasekhara, V; Chathadi, KV; Decker, GA; Early, DS; Fisher, DA; Foley, K; Hwang, JH; Jue, TL; Lightdale, JR; Pasha, SF; Sharaf, R; Shergill, AK; Cash, BD; DeWitt, JM
MLA Citation
Evans, JA, Chandrasekhara, V, Chathadi, KV, Decker, GA, Early, DS, Fisher, DA, Foley, K, Hwang, JH, Jue, TL, Lightdale, JR, Pasha, SF, Sharaf, R, Shergill, AK, Cash, BD, and DeWitt, JM. "The role of endoscopy in the management of premalignant and malignant conditions of the stomach." Gastrointestinal endoscopy 82.1 (July 2015): 1-8.
PMID
25935705
Source
epmc
Published In
Gastrointestinal Endoscopy
Volume
82
Issue
1
Publish Date
2015
Start Page
1
End Page
8
DOI
10.1016/j.gie.2015.03.1967

Rates and correlates of potentially inappropriate colorectal cancer screening in the Veterans Health Administration.

Inappropriate use of colorectal cancer (CRC) screening procedures can inflate healthcare costs and increase medical risk. Little is known about the prevalence or causes of inappropriate CRC screening.Our aim was to estimate the prevalence of potentially inappropriate CRC screening, and its association with patient and facility characteristics in the Veterans Health Administration (VHA) .We conducted a cross-sectional study of all VHA patients aged 50 years and older who completed a fecal occult blood test (FOBT) or a screening colonoscopy between 1 October 2009 and 31 December 2011 (n = 1,083,965).Measures included: proportion of patients whose test was classified as potentially inappropriate; associations between potentially inappropriate screening and patient demographic and health characteristics, facility complexity, CRC screening rates, dependence on FOBT, and CRC clinical reminder attributes.Of 901,292 FOBT cases, 26.1 % were potentially inappropriate (13.9 % not due, 7.8 % limited life expectancy, 11.0 % receiving FOBT when colonoscopy was indicated). Of 134,335 screening colonoscopies, 14.2 % were potentially inappropriate (10.4 % not due, 4.4 % limited life expectancy). Each additional 10 years of patient age was associated with an increased likelihood of undergoing potentially inappropriate screening (ORs = 1.60 to 1.83 depending on screening mode). Compared to facilities scoring in the bottom third on a measure of reliance on FOBT (versus screening colonoscopy), facilities scoring in the top third were less likely to conduct potentially inappropriate FOBTs (OR = 0.,78) but more likely to conduct potentially inappropriate colonoscopies (OR = 2.20). Potentially inappropriate colonoscopies were less likely to be conducted at facilities where primary care providers were assigned partial responsibility (OR = 0.74) or full responsibility (OR = 0.73) for completing the CRC clinical reminder.A substantial number of VHA CRC screening tests are potentially inappropriate. Establishing processes that enforce appropriate screening intervals, triage patients with limited life expectancies, and discourage the use of FOBTs when a colonoscopy is indicated may reduce inappropriate testing.

Authors
Powell, AA; Saini, SD; Breitenstein, MK; Noorbaloochi, S; Cutting, A; Fisher, DA; Bloomfield, HE; Halek, K; Partin, MR
MLA Citation
Powell, AA, Saini, SD, Breitenstein, MK, Noorbaloochi, S, Cutting, A, Fisher, DA, Bloomfield, HE, Halek, K, and Partin, MR. "Rates and correlates of potentially inappropriate colorectal cancer screening in the Veterans Health Administration." Journal of general internal medicine 30.6 (June 2015): 732-741.
PMID
25605531
Source
epmc
Published In
Journal of General Internal Medicine
Volume
30
Issue
6
Publish Date
2015
Start Page
732
End Page
741
DOI
10.1007/s11606-014-3163-8

The role of endoscopy in inflammatory bowel disease.

Authors
Shergill, AK; Lightdale, JR; Bruining, DH; Acosta, RD; Chandrasekhara, V; Chathadi, KV; Decker, GA; Early, DS; Evans, JA; Fanelli, RD; Fisher, DA; Fonkalsrud, L; Foley, K; Hwang, JH; Jue, TL; Khashab, MA; Muthusamy, VR; Pasha, SF; Saltzman, JR; Sharaf, R; Cash, BD; DeWitt, JM
MLA Citation
Shergill, AK, Lightdale, JR, Bruining, DH, Acosta, RD, Chandrasekhara, V, Chathadi, KV, Decker, GA, Early, DS, Evans, JA, Fanelli, RD, Fisher, DA, Fonkalsrud, L, Foley, K, Hwang, JH, Jue, TL, Khashab, MA, Muthusamy, VR, Pasha, SF, Saltzman, JR, Sharaf, R, Cash, BD, and DeWitt, JM. "The role of endoscopy in inflammatory bowel disease." Gastrointestinal endoscopy 81.5 (May 2015): 1101-21.e1-13-.
PMID
25800660
Source
epmc
Published In
Gastrointestinal Endoscopy
Volume
81
Issue
5
Publish Date
2015
Start Page
1101-21.e1-13
DOI
10.1016/j.gie.2014.10.030

Comparative Clinical Performance of 4 Prediction Scores and Nasogastric Lavage for the Evaluation of Acute Upper Gastrointestinal Bleeding

Authors
Dakik, HK; Srygley, D; Chiu, S-T; Fisher, DA
MLA Citation
Dakik, HK, Srygley, D, Chiu, S-T, and Fisher, DA. "Comparative Clinical Performance of 4 Prediction Scores and Nasogastric Lavage for the Evaluation of Acute Upper Gastrointestinal Bleeding." April 2015.
Source
wos-lite
Published In
Gastroenterology
Volume
148
Issue
4
Publish Date
2015
Start Page
S624
End Page
S625

Bowel preparation before colonoscopy.

Authors
Saltzman, JR; Cash, BD; Pasha, SF; Early, DS; Muthusamy, VR; Khashab, MA; Chathadi, KV; Fanelli, RD; Chandrasekhara, V; Lightdale, JR; Fonkalsrud, L; Shergill, AK; Hwang, JH; Decker, GA; Jue, TL; Sharaf, R; Fisher, DA; Evans, JA; Foley, K; Shaukat, A; Eloubeidi, MA; Faulx, AL; Wang, A; Acosta, RD
MLA Citation
Saltzman, JR, Cash, BD, Pasha, SF, Early, DS, Muthusamy, VR, Khashab, MA, Chathadi, KV, Fanelli, RD, Chandrasekhara, V, Lightdale, JR, Fonkalsrud, L, Shergill, AK, Hwang, JH, Decker, GA, Jue, TL, Sharaf, R, Fisher, DA, Evans, JA, Foley, K, Shaukat, A, Eloubeidi, MA, Faulx, AL, Wang, A, and Acosta, RD. "Bowel preparation before colonoscopy." Gastrointestinal endoscopy 81.4 (April 2015): 781-794.
PMID
25595062
Source
epmc
Published In
Gastrointestinal Endoscopy
Volume
81
Issue
4
Publish Date
2015
Start Page
781
End Page
794
DOI
10.1016/j.gie.2014.09.048

The role of ERCP in benign diseases of the biliary tract.

Authors
Chathadi, KV; Chandrasekhara, V; Acosta, RD; Decker, GA; Early, DS; Eloubeidi, MA; Evans, JA; Faulx, AL; Fanelli, RD; Fisher, DA; Foley, K; Fonkalsrud, L; Hwang, JH; Jue, TL; Khashab, MA; Lightdale, JR; Muthusamy, VR; Pasha, SF; Saltzman, JR; Sharaf, R; Shaukat, A; Shergill, AK; Wang, A; Cash, BD; DeWitt, JM
MLA Citation
Chathadi, KV, Chandrasekhara, V, Acosta, RD, Decker, GA, Early, DS, Eloubeidi, MA, Evans, JA, Faulx, AL, Fanelli, RD, Fisher, DA, Foley, K, Fonkalsrud, L, Hwang, JH, Jue, TL, Khashab, MA, Lightdale, JR, Muthusamy, VR, Pasha, SF, Saltzman, JR, Sharaf, R, Shaukat, A, Shergill, AK, Wang, A, Cash, BD, and DeWitt, JM. "The role of ERCP in benign diseases of the biliary tract." Gastrointestinal endoscopy 81.4 (April 2015): 795-803.
PMID
25665931
Source
epmc
Published In
Gastrointestinal Endoscopy
Volume
81
Issue
4
Publish Date
2015
Start Page
795
End Page
803
DOI
10.1016/j.gie.2014.11.019

Rates and Correlates of Potentially Inappropriate Colorectal Cancer Screening in the Veterans Health Administration

© 2015, Society of General Internal Medicine.BACKGROUND: Inappropriate use of colorectal cancer (CRC) screening procedures can inflate healthcare costs and increase medical risk. Little is known about the prevalence or causes of inappropriate CRC screening. OBJECTIVE: Our aim was to estimate the prevalence of potentially inappropriate CRC screening, and its association with patient and facility characteristics in the Veterans Health Administration (VHA). DESIGN AND PARTICIPANTS: We conducted a cross-sectional study of all VHA patients aged 50 years and older who completed a fecal occult blood test (FOBT) or a screening colonoscopy between 1 October 2009 and 31 December 2011 (n = 1,083,965). MAIN MEASURES: Measures included: proportion of patients whose test was classified as potentially inappropriate; associations between potentially inappropriate screening and patient demographic and health characteristics, facility complexity, CRC screening rates, dependence on FOBT, and CRC clinical reminder attributes. KEY RESULTS: Of 901,292 FOBT cases, 26.1 % were potentially inappropriate (13.9 % not due, 7.8 % limited life expectancy, 11.0 % receiving FOBT when colonoscopy was indicated). Of 134,335 screening colonoscopies, 14.2 % were potentially inappropriate (10.4 % not due, 4.4 % limited life expectancy). Each additional 10 years of patient age was associated with an increased likelihood of undergoing potentially inappropriate screening (ORs = 1.60 to 1.83 depending on screening mode). Compared to facilities scoring in the bottom third on a measure of reliance on FOBT (versus screening colonoscopy), facilities scoring in the top third were less likely to conduct potentially inappropriate FOBTs (OR = 0.,78) but more likely to conduct potentially inappropriate colonoscopies (OR = 2.20). Potentially inappropriate colonoscopies were less likely to be conducted at facilities where primary care providers were assigned partial responsibility (OR = 0.74) or full responsibility (OR = 0.73) for completing the CRC clinical reminder. CONCLUSIONS: A substantial number of VHA CRC screening tests are potentially inappropriate. Establishing processes that enforce appropriate screening intervals, triage patients with limited life expectancies, and discourage the use of FOBTs when a colonoscopy is indicated may reduce inappropriate testing.

Authors
Powell, AA; Saini, SD; Breitenstein, MK; Noorbaloochi, S; Cutting, A; Fisher, DA; Bloomfield, HE; Halek, K; Partin, MR
MLA Citation
Powell, AA, Saini, SD, Breitenstein, MK, Noorbaloochi, S, Cutting, A, Fisher, DA, Bloomfield, HE, Halek, K, and Partin, MR. "Rates and Correlates of Potentially Inappropriate Colorectal Cancer Screening in the Veterans Health Administration." Journal of General Internal Medicine 30.6 (January 21, 2015): 732-741.
Source
scopus
Published In
Journal of General Internal Medicine
Volume
30
Issue
6
Publish Date
2015
Start Page
732
End Page
741
DOI
10.1007/s11606-014-3163-8

The role of endoscopy in the management of variceal hemorrhage.

Authors
Hwang, JH; Shergill, AK; Acosta, RD; Chandrasekhara, V; Chathadi, KV; Decker, GA; Early, DS; Evans, JA; Fanelli, RD; Fisher, DA; Foley, KQ; Fonkalsrud, L; Jue, T; Khashab, MA; Lightdale, JR; Muthusamy, VR; Pasha, SF; Saltzman, JR; Sharaf, R; Cash, BD
MLA Citation
Hwang, JH, Shergill, AK, Acosta, RD, Chandrasekhara, V, Chathadi, KV, Decker, GA, Early, DS, Evans, JA, Fanelli, RD, Fisher, DA, Foley, KQ, Fonkalsrud, L, Jue, T, Khashab, MA, Lightdale, JR, Muthusamy, VR, Pasha, SF, Saltzman, JR, Sharaf, R, and Cash, BD. "The role of endoscopy in the management of variceal hemorrhage." Gastrointestinal endoscopy 80.2 (August 2014): 221-227.
PMID
25034836
Source
epmc
Published In
Gastrointestinal Endoscopy
Volume
80
Issue
2
Publish Date
2014
Start Page
221
End Page
227
DOI
10.1016/j.gie.2013.07.023

The role of endoscopy in the patient with lower GI bleeding.

Authors
Pasha, SF; Shergill, A; Acosta, RD; Chandrasekhara, V; Chathadi, KV; Early, D; Evans, JA; Fisher, D; Fonkalsrud, L; Hwang, JH; Khashab, MA; Lightdale, JR; Muthusamy, VR; Saltzman, JR; Cash, BD
MLA Citation
Pasha, SF, Shergill, A, Acosta, RD, Chandrasekhara, V, Chathadi, KV, Early, D, Evans, JA, Fisher, D, Fonkalsrud, L, Hwang, JH, Khashab, MA, Lightdale, JR, Muthusamy, VR, Saltzman, JR, and Cash, BD. "The role of endoscopy in the patient with lower GI bleeding." Gastrointestinal endoscopy 79.6 (June 2014): 875-885.
PMID
24703084
Source
epmc
Published In
Gastrointestinal Endoscopy
Volume
79
Issue
6
Publish Date
2014
Start Page
875
End Page
885
DOI
10.1016/j.gie.2013.10.039

Modifications in endoscopic practice for pediatric patients.

We recommend that endoscopy in children be performed by pediatric-trained endoscopists whenever possible. We recommend that adult-trained endoscopists coordinate their services with pediatricians and pediatric specialists when they are needed to perform endoscopic procedures in children. We recommend that endoscopy be performed within 24 hours in symptomatic pediatric patients with known or suspected ingestion of caustic substances. We recommend emergent foreign-body removal of esophageal button batteries, as well as 2 or more rare-earth neodymium magnets. We recommend that procedural and resuscitative equipment appropriate for pediatric use should be readily available during endoscopic procedures. We recommend that personnel trained specifically in pediatric life support and airway management be readily available during sedated procedures in children. We recommend the use of endoscopes smaller than 6 mm in diameter in infants and children weighing less than 10 kg. We recommend the use of standard adult duodenoscopes for performing ERCP in children who weigh at least 10 kg. We recommend the placement of 12F or 16F percutaneous endoscopic gastrostomy tubes in children who weigh less than 50 kg.

Authors
Lightdale, JR; Acosta, R; Shergill, AK; Chandrasekhara, V; Chathadi, K; Early, D; Evans, JA; Fanelli, RD; Fisher, DA; Fonkalsrud, L; Hwang, JH; Kashab, M; Muthusamy, VR; Pasha, S; Saltzman, JR; Cash, BD
MLA Citation
Lightdale, JR, Acosta, R, Shergill, AK, Chandrasekhara, V, Chathadi, K, Early, D, Evans, JA, Fanelli, RD, Fisher, DA, Fonkalsrud, L, Hwang, JH, Kashab, M, Muthusamy, VR, Pasha, S, Saltzman, JR, and Cash, BD. "Modifications in endoscopic practice for pediatric patients." Gastrointestinal endoscopy 79.5 (May 2014): 699-710.
PMID
24593951
Source
epmc
Published In
Gastrointestinal Endoscopy
Volume
79
Issue
5
Publish Date
2014
Start Page
699
End Page
710
DOI
10.1016/j.gie.2013.08.014

One-step circumferential endoscopic mucosal cap resection of Barrett's esophagus with early neoplasia

Background and objective: Focal endoscopic mucosal resection (EMR) of visible intraepithelial lesions arising within Barrett's esophagus (BE) may miss synchronous lesions that are not endoscopically apparent. Stepwise radical endoscopic resection would obviate this concern by removing all BE; however, it requires repeated endoscopy which may increase the risk of complications, particularly for patients with circumferential BE. The aim of the study was to evaluate the safety and efficacy of one-step complete circumferential resection of BE by cap-assisted EMR (EMR-C) among patients with circumferential BE and high-grade dysplasia or intramucosal carcinoma. Patients and methods: Between January 2003 and March 2010, 47 patients with circumferential BE and biopsy-proven high-grade dysplasia or intramucosal cancer underwent EMR-C. We evaluated: (1) complete eradication of neoplasia, (2) complete eradication of metaplasia, and (3) complications including bleeding and esophageal stricture. Results: Complete eradication of neoplasia and complete eradication of metaplasia were achieved after a median follow-up of 18.4. months in 91% (43/47) of patients. After EMR-C, two patients (one IMC, one invasive cancer) underwent esophagectomy. Histology of the resected specimens showed no residual disease and a T1bN0 lesion, respectively. Two patients had progression of neoplasia. A stenosis occurred in 18 out of 45 patients (40%). All stenoses were treated with dilations and two required temporary placement of a covered stent. Conclusion: One-step complete EMR-C is a safe and effective technique which can be considered in patients with early neoplastic lesions. Although 40% of patients developed dysphagia, this could well be managed endoscopically. © 2013 Elsevier Masson SAS.

Authors
Conio, M; Fisher, DA; Blanchi, S; Ruggeri, C; Filiberti, R; Siersema, PD
MLA Citation
Conio, M, Fisher, DA, Blanchi, S, Ruggeri, C, Filiberti, R, and Siersema, PD. "One-step circumferential endoscopic mucosal cap resection of Barrett's esophagus with early neoplasia." Clinics and Research in Hepatology and Gastroenterology 38.1 (February 1, 2014): 81-91.
Source
scopus
Published In
Gastroenterologie clinique et biologique
Volume
38
Issue
1
Publish Date
2014
Start Page
81
End Page
91
DOI
10.1016/j.clinre.2013.05.015

The role of endoscopy in the evaluation and management of dysphagia.

Authors
Pasha, SF; Acosta, RD; Chandrasekhara, V; Chathadi, KV; Decker, GA; Early, DS; Evans, JA; Fanelli, RD; Fisher, DA; Foley, KQ; Fonkalsrud, L; Hwang, JH; Jue, TL; Khashab, MA; Lightdale, JR; Muthusamy, VR; Sharaf, R; Saltzman, JR; Shergill, AK; Cash, B
MLA Citation
Pasha, SF, Acosta, RD, Chandrasekhara, V, Chathadi, KV, Decker, GA, Early, DS, Evans, JA, Fanelli, RD, Fisher, DA, Foley, KQ, Fonkalsrud, L, Hwang, JH, Jue, TL, Khashab, MA, Lightdale, JR, Muthusamy, VR, Sharaf, R, Saltzman, JR, Shergill, AK, and Cash, B. "The role of endoscopy in the evaluation and management of dysphagia." Gastrointestinal endoscopy 79.2 (February 2014): 191-201.
PMID
24332405
Source
epmc
Published In
Gastrointestinal Endoscopy
Volume
79
Issue
2
Publish Date
2014
Start Page
191
End Page
201
DOI
10.1016/j.gie.2013.07.042

Temporary placement of a fully covered self-expanding metal stent to allow therapeutic ERCP.

Authors
Mangiavillano, B; Fisher, DA; Conio, M
MLA Citation
Mangiavillano, B, Fisher, DA, and Conio, M. "Temporary placement of a fully covered self-expanding metal stent to allow therapeutic ERCP." Endoscopy 46 Suppl 1 UCTN (January 2014): E419-.
PMID
25314171
Source
epmc
Published In
Endoscopy
Volume
46 Suppl 1 UCTN
Publish Date
2014
Start Page
E419
DOI
10.1055/s-0034-1377440

Reply to S.P.Sura et al.

Authors
Bian, J; Bennett, C; Fisher, D; Riberio, M; Lipscomb, J
MLA Citation
Bian, J, Bennett, C, Fisher, D, Riberio, M, and Lipscomb, J. "Reply to S.P.Sura et al." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 31.19 (July 2013): 2512-.
PMID
23967488
Source
epmc
Published In
Journal of Clinical Oncology
Volume
31
Issue
19
Publish Date
2013
Start Page
2512
DOI
10.1200/jco.2013.48.6613

Variability in resource use: diagnosing colorectal cancer.

OBJECTIVES: Efficient resource use is relevant in all healthcare systems. Although colorectal cancer is common, little has been published regarding the utilization of clinical resources in diagnosis. STUDY DESIGN: The primary aim was to evaluate the patterns and factors associated with clinical services used to diagnose colorectal cancer at 14 US Department of Veterans Affairs facilities. The secondary aim was to investigate whether using more clinical services was associated with time to diagnosis. METHODS: We reviewed medical records for 449 patients with colorectal cancer in an observational study. Study end points were the use of clinical diagnostic services grouped as laboratory tests, imaging studies, and subspecialty consultations. Cumulative logistic regression models were used to explore factors associated with each outcome. RESULTS: Facility variability contributed to the variability of resource use in all models. In adjusted analyses, older patients had higher use of laboratory tests (odds ratio [OR], 1.20; 95% confidence interval [CI], 1.02-1.43) and incidentally discovered colorectal cancer was associated with increased use of consultations (OR, 1.97; 95% CI, 1.27-3.05), imaging studies (OR, 1.70; 95% CI, 1.12-2.58), and laboratory tests (OR, 3.14; 95% CI, 2.06-4.77) compared with screen-detected cancers. There was a strong direct correlation between thenumber of diagnostic services performed and the median time to diagnosis (Spearman correlation coefficient, 0.99; P < .001). CONCLUSIONS: Variability in utilization of diagnostic clinical services was associated with patient age, patient presentation, and facility. Increased resource use was highly correlated with increased time to diagnosis.

Authors
Srygley, FD; Abbott, DH; Grambow, SC; Provenzale, D; Sandler, RS; Fischer, DA
MLA Citation
Srygley, FD, Abbott, DH, Grambow, SC, Provenzale, D, Sandler, RS, and Fischer, DA. "Variability in resource use: diagnosing colorectal cancer." The American journal of managed care 19.5 (May 2013): 370-376.
PMID
23781891
Source
epmc
Published In
American Journal of Managed Care
Volume
19
Issue
5
Publish Date
2013
Start Page
370
End Page
376

The role of endoscopy in the evaluation and treatment of patients with biliary neoplasia

Authors
Anderson, MA; Appalaneni, V; Ben-Menachem, T; Decker, GA; Early, DS; Evans, JA; Fanelli, RD; Fisher, DA; Fisher, LR; Fukami, N; Hwang, JH; Ikenberry, SO; Jain, R; Jue, TL; Khan, K; Krinsky, ML; Malpas, PM; Maple, JT; Sharaf, RN; Shergill, AK; Dominitz, JA; Cash, BD
MLA Citation
Anderson, MA, Appalaneni, V, Ben-Menachem, T, Decker, GA, Early, DS, Evans, JA, Fanelli, RD, Fisher, DA, Fisher, LR, Fukami, N, Hwang, JH, Ikenberry, SO, Jain, R, Jue, TL, Khan, K, Krinsky, ML, Malpas, PM, Maple, JT, Sharaf, RN, Shergill, AK, Dominitz, JA, and Cash, BD. "The role of endoscopy in the evaluation and treatment of patients with biliary neoplasia." Gastrointestinal Endoscopy 77.2 (2013): 167-174.
PMID
23219047
Source
scival
Published In
Gastrointestinal Endoscopy
Volume
77
Issue
2
Publish Date
2013
Start Page
167
End Page
174
DOI
10.1016/j.gie.2012.09.029

The role of endoscopy in the assessment and treatment of esophageal cancer

Authors
Evans, JA; Early, DS; Chandraskhara, V; Chathadi, KV; Fanelli, RD; Fisher, DA; Foley, KQ; Hwang, JH; Jue, TL; Pasha, SF; Sharaf, R; Shergill, AK; Dominitz, JA; Cash, BD
MLA Citation
Evans, JA, Early, DS, Chandraskhara, V, Chathadi, KV, Fanelli, RD, Fisher, DA, Foley, KQ, Hwang, JH, Jue, TL, Pasha, SF, Sharaf, R, Shergill, AK, Dominitz, JA, and Cash, BD. "The role of endoscopy in the assessment and treatment of esophageal cancer." Gastrointestinal Endoscopy 77.3 (2013): 328-334.
PMID
23410694
Source
scival
Published In
Gastrointestinal Endoscopy
Volume
77
Issue
3
Publish Date
2013
Start Page
328
End Page
334
DOI
10.1016/j.gie.2012.10.001

One-step circumferential endoscopic mucosal cap resection of Barrett's esophagus with early neoplasia

Background and objective: Focal endoscopic mucosal resection (EMR) of visible intraepithelial lesions arising within Barrett's esophagus (BE) may miss synchronous lesions that are not endoscopically apparent. Stepwise radical endoscopic resection would obviate this concern by removing all BE; however, it requires repeated endoscopy which may increase the risk of complications, particularly for patients with circumferential BE. The aim of the study was to evaluate the safety and efficacy of one-step complete circumferential resection of BE by cap-assisted EMR (EMR-C) among patients with circumferential BE and high-grade dysplasia or intramucosal carcinoma. Patients and methods: Between January 2003 and March 2010, 47 patients with circumferential BE and biopsy-proven high-grade dysplasia or intramucosal cancer underwent EMR-C. We evaluated: (1) complete eradication of neoplasia, (2) complete eradication of metaplasia, and (3) complications including bleeding and esophageal stricture. Results: Complete eradication of neoplasia and complete eradication of metaplasia were achieved after a median follow-up of 18.4 months in 91% (43/47) of patients. After EMR-C, two patients (one IMC, one invasive cancer) underwent esophagectomy. Histology of the resected specimens showed no residual disease and a T1bN0 lesion, respectively. Two patients had progression of neoplasia. A stenosis occurred in 18 out of 45 patients (40%). All stenoses were treated with dilations and two required temporary placement of a covered stent. Conclusion: One-step complete EMR-C is a safe and effective technique which can be considered in patients with early neoplastic lesions. Although 40% of patients developed dysphagia, this could well be managed endoscopically. © 2013.

Authors
Conio, M; Fisher, DA; Blanchi, S; Ruggeri, C; Filiberti, R; Siersema, PD
MLA Citation
Conio, M, Fisher, DA, Blanchi, S, Ruggeri, C, Filiberti, R, and Siersema, PD. "One-step circumferential endoscopic mucosal cap resection of Barrett's esophagus with early neoplasia." Clinics and Research in Hepatology and Gastroenterology (2013).
PMID
23856637
Source
scival
Published In
Gastroenterologie clinique et biologique
Publish Date
2013
DOI
10.1016/j.clinre.2013.05.015

Full thickness endoscopic resection of a colonic cancer: A case report

We present a case of a 40-year-old woman, diagnosed with a flat lesion (type 0-IIa + IIc) of the colon. There was a strong suspicion for submucosal invasion, however the patient initially refused surgical intervention. Therefore, the lesion was treated with full-thickness endoscopic resection. An over-the-scope clip device was applied to seal the resulting colonic wall defect. Histological examination demonstrated a T2 adenocarcinoma, therefore the patient agreed to a left hemicolectomy. Examination of the surgical specimen demonstrated no residual neoplasia or involvement of adjacent lymph nodes. We discuss the potential advantages and limitations of this new approach, which may be indicated for patients who are not surgical candidates. © 2013.

Authors
Picasso, M; Parodi, A; Fisher, DA; Blanchi, S; Conio, M
MLA Citation
Picasso, M, Parodi, A, Fisher, DA, Blanchi, S, and Conio, M. "Full thickness endoscopic resection of a colonic cancer: A case report." Clinics and Research in Hepatology and Gastroenterology (2013).
PMID
23916955
Source
scival
Published In
Gastroenterologie clinique et biologique
Publish Date
2013
DOI
10.1016/j.clinre.2012.10.005

Endoscopic mucosal tissue sampling

Authors
Sharaf, RN; Shergill, AK; Odze, RD; Krinsky, ML; Fukami, N; Jain, R; Appalaneni, V; Anderson, MA; Ben-Menachem, T; Chandrasekhara, V; Chathadi, K; Decker, GA; Early, D; Evans, JA; Fanelli, RD; Fisher, DA; Fisher, LR; Foley, KQ; Hwang, JH; Jue, TL; Ikenberry, SO; Khan, KM; Lightdale, J; Malpas, PM; Maple, JT; Pasha, S; Saltzman, J; Dominitz, JA; Cash, BD
MLA Citation
Sharaf, RN, Shergill, AK, Odze, RD, Krinsky, ML, Fukami, N, Jain, R, Appalaneni, V, Anderson, MA, Ben-Menachem, T, Chandrasekhara, V, Chathadi, K, Decker, GA, Early, D, Evans, JA, Fanelli, RD, Fisher, DA, Fisher, LR, Foley, KQ, Hwang, JH, Jue, TL, Ikenberry, SO, Khan, KM, Lightdale, J, Malpas, PM, Maple, JT, Pasha, S, Saltzman, J, Dominitz, JA, and Cash, BD. "Endoscopic mucosal tissue sampling." Gastrointestinal Endoscopy 78.2 (2013): 216-224.
PMID
23867371
Source
scival
Published In
Gastrointestinal Endoscopy
Volume
78
Issue
2
Publish Date
2013
Start Page
216
End Page
224
DOI
10.1016/j.gie.2013.04.167

Role of endoscopy in the staging and management of colorectal cancer

Authors
Fisher, DA; Shergill, AK; Early, DS; Acosta, RD; Chandrasekhara, V; Chathadi, KV; Decker, GA; Evans, JA; Fanelli, RD; Foley, KQ; Fonkalsrud, L; Hwang, JH; Jue, T; Khashab, MA; Lightdale, JR; Muthusamy, VR; Pasha, SF; Saltzman, JR; Sharaf, R; Cash, BD
MLA Citation
Fisher, DA, Shergill, AK, Early, DS, Acosta, RD, Chandrasekhara, V, Chathadi, KV, Decker, GA, Evans, JA, Fanelli, RD, Foley, KQ, Fonkalsrud, L, Hwang, JH, Jue, T, Khashab, MA, Lightdale, JR, Muthusamy, VR, Pasha, SF, Saltzman, JR, Sharaf, R, and Cash, BD. "Role of endoscopy in the staging and management of colorectal cancer." Gastrointestinal Endoscopy 78.1 (2013): 8-12.
PMID
23664162
Source
scival
Published In
Gastrointestinal Endoscopy
Volume
78
Issue
1
Publish Date
2013
Start Page
8
End Page
12
DOI
10.1016/j.gie.2013.04.163

Modifications in endoscopic practice for the elderly

We recommend that with optimal periprocedure evaluation and care, diagnostic and therapeutic endoscopic interventions can be safely performed in elderly patients. We recommend that electrolyte-balanced polyethylene glycol-based colonoscopy preparations be used in elderly individuals to avoid potentially harmful fluid and electrolyte shifts. We suggest using split-dosage cathartic bowel preparations in the elderly for colonoscopy preparation. We recommend evaluating the patient's baseline functional status, cognitive ability, and capacity to understand the anticipated endoscopic procedure as part of the preprocedure assessment in the elderly. We recommend standard monitoring procedures in the elderly during moderate sedation with heightened awareness of this population's increased response to sedatives. We recommend that lower initial doses of sedatives than standard adult dosing should be considered in the elderly and that titration should be more gradual to allow assessment of the full dose effect at each dose level. We suggest that practitioners exercise additional caution when performing colonoscopy in elderly patients because this procedure may confer a higher risk of adverse events. We recommend that colonoscopic screening and surveillance for colorectal cancer in patients of advanced age be individualized based on general health and comorbid medical illnesses. Copyright © 2013 by the American Society for Gastrointestinal Endoscopy.

Authors
Early, DS; Acosta, RD; Chandrasekhara, V; Chathadi, KV; Decker, GA; Evans, JA; Fanelli, RD; Fisher, DA; Foley, KQ; Fonkalsrud, L; Hwang, JH; Jue, T; Khashab, MA; Lightdale, JR; Muthusamy, VR; Pasha, SF; Saltzman, JR; Sharaf, R; Shergill, AK; Cash, BD
MLA Citation
Early, DS, Acosta, RD, Chandrasekhara, V, Chathadi, KV, Decker, GA, Evans, JA, Fanelli, RD, Fisher, DA, Foley, KQ, Fonkalsrud, L, Hwang, JH, Jue, T, Khashab, MA, Lightdale, JR, Muthusamy, VR, Pasha, SF, Saltzman, JR, Sharaf, R, Shergill, AK, and Cash, BD. "Modifications in endoscopic practice for the elderly." Gastrointestinal Endoscopy 78.1 (2013): 1-7.
PMID
23664042
Source
scival
Published In
Gastrointestinal Endoscopy
Volume
78
Issue
1
Publish Date
2013
Start Page
1
End Page
7
DOI
10.1016/j.gie.2013.04.161

Adverse events associated with EUS and EUS with FNA

Limited data suggest that EUS is associated with a rate of perforation that is similar to standard endoscopy. Lack of operator experience, older patient age, and a history of difficult esophageal intubation may be risk factors for cervical esophageal perforation. Duodenal perforations have also been reported to occur during EUS examinations, but their overall incidence has not been studied.22 No data on the incidence of perforations during EUS in the colon are available. Copyright © 2013 by the American Society for Gastrointestinal Endoscopy.

Authors
Early, DS; Acosta, RD; Chandrasekhara, V; Chathadi, KV; Decker, GA; Evans, JA; Fanelli, RD; Fisher, DA; Fonkalsrud, L; Hwang, JH; Jue, TL; Khashab, MA; Lightdale, JR; Muthusamy, VR; Pasha, SF; Saltzman, JR; Sharaf, RN; Shergill, AK; Cash, BD
MLA Citation
Early, DS, Acosta, RD, Chandrasekhara, V, Chathadi, KV, Decker, GA, Evans, JA, Fanelli, RD, Fisher, DA, Fonkalsrud, L, Hwang, JH, Jue, TL, Khashab, MA, Lightdale, JR, Muthusamy, VR, Pasha, SF, Saltzman, JR, Sharaf, RN, Shergill, AK, and Cash, BD. "Adverse events associated with EUS and EUS with FNA." Gastrointestinal Endoscopy 77.6 (2013): 839-843.
PMID
23684089
Source
scival
Published In
Gastrointestinal Endoscopy
Volume
77
Issue
6
Publish Date
2013
Start Page
839
End Page
843
DOI
10.1016/j.gie.2013.02.018

Radiofrequency ablation and endoscopic mucosal resection in Barrett's esophagus with early neoplasiaCan we avoid complications?

Authors
Conio, M; Fisher, DA; Palazzo, L
MLA Citation
Conio, M, Fisher, DA, and Palazzo, L. "Radiofrequency ablation and endoscopic mucosal resection in Barrett's esophagus with early neoplasiaCan we avoid complications?." Endoscopy 45.6 (2013): 506--.
PMID
23733732
Source
scival
Published In
Endoscopy
Volume
45
Issue
6
Publish Date
2013
Start Page
506-
DOI
10.1055/s-0032-1326486

Full thickness endoscopic resection of a colonic cancer: A case report

We present a case of a 40-year-old woman, diagnosed with a flat lesion (type 0-IIa. +. IIc) of the colon. There was a strong suspicion for submucosal invasion, however the patient initially refused surgical intervention. Therefore, the lesion was treated with full-thickness endoscopic resection. An over-the-scope clip device was applied to seal the resulting colonic wall defect. Histological examination demonstrated a T2 adenocarcinoma, therefore the patient agreed to a left hemicolectomy. Examination of the surgical specimen demonstrated no residual neoplasia or involvement of adjacent lymph nodes. We discuss the potential advantages and limitations of this new approach, which may be indicated for patients who are not surgical candidates. © 2013.

Authors
Picasso, M; Parodi, A; Fisher, DA; Blanchi, S; Conio, M
MLA Citation
Picasso, M, Parodi, A, Fisher, DA, Blanchi, S, and Conio, M. "Full thickness endoscopic resection of a colonic cancer: A case report." Clinics and Research in Hepatology and Gastroenterology 37.4 (2013): e99-e101.
Source
scival
Published In
Gastroenterologie clinique et biologique
Volume
37
Issue
4
Publish Date
2013
Start Page
e99
End Page
e101
DOI
10.1016/j.clinre.2012.10.005

Characteristics of primary care office visits to nurse practitioners, physician assistants and physicians in United States Veterans Health Administration facilities, 2005 to 2010: a retrospective cross-sectional analysis.

UNLABELLED: BACKGROUND: Primary care, an essential determinant of health system equity, efficiency, and effectiveness, is threatened by inadequate supply and distribution of the provider workforce. The Veterans Health Administration (VHA) has been a frontrunner in the use of nurse practitioners (NPs) and physician assistants (PAs). Evaluation of the roles and impact of NPs and PAs in the VHA is critical to ensuring optimal care for veterans and may inform best practices for use of PAs and NPs in other settings around the world. The purpose of this study was to characterize the use of NPs and PAs in VHA primary care and to examine whether their patients and patient care activities were, on average, less medically complex than those of physicians. METHODS: This is a retrospective cross-sectional analysis of administrative data from VHA primary care encounters between 2005 and 2010. Patient and patient encounter characteristics were compared across provider types (PA, NP, and physician). RESULTS: NPs and PAs attend about 30% of all VHA primary care encounters. NPs, PAs, and physicians fill similar roles in VHA primary care, but patients of PAs and NPs are slightly less complex than those of physicians, and PAs attend a higher proportion of visits for the purpose of determining eligibility for benefits. CONCLUSIONS: This study demonstrates that a highly successful nationwide primary care system relies on NPs and PAs to provide over one quarter of primary care visits, and that these visits are similar to those of physicians with regard to patient and encounter characteristics. These findings can inform health workforce solutions to physician shortages in the USA and around the world. Future research should compare the quality and costs associated with various combinations of providers and allocations of patient care work, and should elucidate the approaches that maximize quality and efficiency.

Authors
Morgan, PA; Abbott, DH; McNeil, RB; Fisher, DA
MLA Citation
Morgan, PA, Abbott, DH, McNeil, RB, and Fisher, DA. "Characteristics of primary care office visits to nurse practitioners, physician assistants and physicians in United States Veterans Health Administration facilities, 2005 to 2010: a retrospective cross-sectional analysis. (Published online)" Hum Resour Health 10 (November 13, 2012): 42-.
Website
http://hdl.handle.net/10161/9274
PMID
23148792
Source
pubmed
Published In
Human Resources for Health
Volume
10
Publish Date
2012
Start Page
42
DOI
10.1186/1478-4491-10-42

Management of occluded metal stents in malignant biliary obstruction: similar outcomes with second metal stents compared to plastic stents.

BACKGROUND: Covered or uncovered self expandable metallic stents (SEMS) placed in patients with malignant biliary obstruction can occlude in 19-40 %, but optimal management is unclear. AIM: We sought to summarize current evidence regarding management of occluded SEMS in patients with malignant biliary obstruction. METHODS: Two investigators independently searched Pubmed, Embase, and Web of Science using pre-defined search criteria, and reviewed bibliographies of included studies. Data were independently abstracted by two investigators, and analyzed using RevMan. We compared strategies of second SEMS versus plastic stents with respect to the following outcomes: rate of second stent re-occlusion, duration of second stent patency, and survival. RESULTS: Ten retrospective studies met inclusion criteria for the systematic review. Management options described were placement of an uncovered SEMS (n = 125), covered SEMS (n = 106), plastic stent (n = 135), percutaneous biliary drain (n = 7), mechanical cleaning (n = 18), or microwave coagulation (n = 7). Relative risk of re-occlusion was not significantly different in patients with second SEMS compared to plastic stents (RR 1.24, 95 % CI 0.92, 1.67, I(2) = 0, p 0.16). Duration of second stent patency was not significantly different between patients who received second SEMS versus plastic stents (weighted mean difference 0.46, 95 % CI -0.30, 1.23, I(2) = 83 %). Survival was not significantly different among patients who received plastic stents versus SEMS (weighted mean difference -1.13, 95 % CI -2.33, 0.07, I(2) 86 %, p = 0.07). CONCLUSIONS: Among patients with malignant biliary obstruction and occluded SEMS, available evidence suggests a strategy of placing a plastic stent may be as effective as second SEMS. Limitations of these findings were that all studies were retrospective and heterogeneity between studies was detected for two of the outcomes.

Authors
Shah, T; Desai, S; Haque, M; Dakik, H; Fisher, D
MLA Citation
Shah, T, Desai, S, Haque, M, Dakik, H, and Fisher, D. "Management of occluded metal stents in malignant biliary obstruction: similar outcomes with second metal stents compared to plastic stents." Dig Dis Sci 57.11 (November 2012): 2765-2773. (Review)
PMID
22732833
Source
pubmed
Published In
Digestive Diseases and Sciences
Volume
57
Issue
11
Publish Date
2012
Start Page
2765
End Page
2773
DOI
10.1007/s10620-012-2272-7

Understanding gastroenterologist adherence to polyp surveillance guidelines.

Authors
Shah, TU; Voils, CI; McNeil, R; Wu, R; Fisher, DA
MLA Citation
Shah, TU, Voils, CI, McNeil, R, Wu, R, and Fisher, DA. "Understanding gastroenterologist adherence to polyp surveillance guidelines." Am J Gastroenterol 107.9 (September 2012): 1283-1287.
PMID
22951869
Source
pubmed
Published In
The American Journal of Gastroenterology (Elsevier)
Volume
107
Issue
9
Publish Date
2012
Start Page
1283
End Page
1287
DOI
10.1038/ajg.2012.59

Management of Occluded Self-Expandable Metallic Stents in Patients With Malignant Biliary Obstruction: A Systematic Review and Meta-Analysis

Authors
Shah, T; Desai, SV; Haque, M; Dakik, HK; Fisher, DA
MLA Citation
Shah, T, Desai, SV, Haque, M, Dakik, HK, and Fisher, DA. "Management of Occluded Self-Expandable Metallic Stents in Patients With Malignant Biliary Obstruction: A Systematic Review and Meta-Analysis." April 2012.
Source
wos-lite
Published In
Gastrointestinal Endoscopy
Volume
75
Issue
4
Publish Date
2012
Start Page
487
End Page
488

Does this patient have a severe upper gastrointestinal bleed?

CONTEXT: Emergency physicians must determine both the location and the severity of acute gastrointestinal bleeding (GIB) to optimize the diagnostic and therapeutic approaches. OBJECTIVES: To identify the historical features, symptoms, signs, bedside maneuvers, and basic laboratory test results that distinguish acute upper GIB (UGIB) from acute lower GIB (LGIB) and to risk stratify those patients with a UGIB least likely to have severe bleeding that necessitates an urgent intervention. DATA SOURCES: A structured search of MEDLINE (1966-September 2011) and reference lists from retrieved articles, review articles, and physical examination textbooks. STUDY SELECTION: High-quality studies were included of adult patients who were either admitted with GIB or evaluated in emergency departments with bedside evaluations and/or routine laboratory tests, and studies that did not include endoscopic findings in prediction models. The initial search yielded 2628 citations, of which 8 were retained that tested methods of identifying a UGIB and 18 that identified methods of determining the severity of UGIB. DATA EXTRACTION: One author abstracted the data (prevalence, sensitivity, specificity, and likelihood ratios [LRs]) and assessed methodological quality, with confirmation by another author. Data were combined using random effects measures. DATA SYNTHESIS: The majority of patients (N = 1776) had an acute UGIB (prevalence, 63%; 95% CI, 51%-73%). Several clinical factors increase the likelihood that a patient has a UGIB, including a patient-reported history of melena (LR range, 5.1-5.9), melenic stool on examination (LR, 25; 95% CI, 4-174), a nasogastric lavage with blood or coffee grounds (LR, 9.6; 95% CI, 4.0-23.0), and a serum urea nitrogen:creatinine ratio of more than 30 (summary LR, 7.5; 95% CI, 2.8-12.0). Conversely, the presence of blood clots in stool (LR, 0.05; 95% CI, 0.01-0.38) decreases the likelihood of a UGIB. Of the patients clinically diagnosed with acute UGIB, 36% (95% CI, 29%-44%) had severe bleeding. A nasogastric lavage with red blood (summary LR, 3.1; 95% CI, 1.2-14.0), tachycardia (LR, 4.9; 95% CI, 3.2-7.6), or a hemoglobin level of less than 8 g/dL (LR range, 4.5-6.2) increase the likelihood of a severe UGIB requiring urgent intervention. A Blatchford score of 0 (summary LR, 0.02; 95% CI, 0-0.05) decreases the likelihood that a UGIB requires urgent intervention. CONCLUSIONS: Melena, nasogastric lavage with blood or coffee grounds, or serum urea nitrogen:creatinine ratio of more than 30 increase the likelihood of a UGIB. Blood clots in the stool make a UGIB much less likely. The Blatchford clinical prediction score, which does not require nasogastric lavage, is very efficient for identifying patients who do not require urgent intervention.

Authors
Srygley, FD; Gerardo, CJ; Tran, T; Fisher, DA
MLA Citation
Srygley, FD, Gerardo, CJ, Tran, T, and Fisher, DA. "Does this patient have a severe upper gastrointestinal bleed?." JAMA 307.10 (March 14, 2012): 1072-1079. (Review)
PMID
22416103
Source
pubmed
Published In
JAMA : the journal of the American Medical Association
Volume
307
Issue
10
Publish Date
2012
Start Page
1072
End Page
1079
DOI
10.1001/jama.2012.253

Colorectal cancer testing in the national Veterans Health Administration.

BACKGROUND: Colorectal cancer (CRC) screening is a priority for the Veteran's Health Administration (VHA). Optimizing fecal occult blood testing (FOBT) is integral to CRC screening in health care systems. AIMS: The purpose of this study was to characterize the utilization of CRC testing in a large integrated health care system (VHA), determine current rates of CRC testing by FOBT and examine factors associated with lack of FOBT card return. METHODS: The VHA Office of Quality and Performance (OQP) collected data from a national sample of Veterans from October 2008 to September 2009. Rates and modality of CRC testing for eligible Veterans were calculated. Among those offered FOBT, bivariate analyses were performed to describe population characteristics by FOBT return. Logistic regression was used to determine factors independently associated with lack of FOBT return. RESULTS: A total of 36,336 Veterans were included. On weighted analysis, 80.4% of Veterans received a form of CRC screening. The majority underwent colonoscopy in the prior 10 years (71.6%), followed by FOBT in the prior year (24.0%). A total of 31.0% did not return FOBT cards that were provided. Factors associated with a lack of FOBT return included: younger age, female gender, non-Caucasian race, living in the Northeast, current smoking and lack of influenza vaccination. CONCLUSIONS: Overall rates of CRC screening in VHA are high. Systems-based practices within VHA likely play a role in successful CRC screening. CRC screening is most often via colonoscopy, followed by FOBT. Characteristics associated with non-adherence with FOBT may inform future quality improvement initiatives in health care systems.

Authors
Long, MD; Lance, T; Robertson, D; Kahwati, L; Kinsinger, L; Fisher, DA
MLA Citation
Long, MD, Lance, T, Robertson, D, Kahwati, L, Kinsinger, L, and Fisher, DA. "Colorectal cancer testing in the national Veterans Health Administration." Dig Dis Sci 57.2 (February 2012): 288-293.
PMID
21922220
Source
pubmed
Published In
Digestive Diseases and Sciences
Volume
57
Issue
2
Publish Date
2012
Start Page
288
End Page
293
DOI
10.1007/s10620-011-1895-4

Adverse events of upper GI endoscopy

Authors
Ben-Menachem, T; Decker, GA; Early, DS; Evans, J; Fanelli, RD; Fisher, DA; Fisher, L; Fukami, N; Hwang, JH; Ikenberry, SO; Jain, R; Jue, TL; Khan, KM; Krinsky, ML; Malpas, PM; Maple, JT; Sharaf, RN; Dominitz, JA; Cash, BD
MLA Citation
Ben-Menachem, T, Decker, GA, Early, DS, Evans, J, Fanelli, RD, Fisher, DA, Fisher, L, Fukami, N, Hwang, JH, Ikenberry, SO, Jain, R, Jue, TL, Khan, KM, Krinsky, ML, Malpas, PM, Maple, JT, Sharaf, RN, Dominitz, JA, and Cash, BD. "Adverse events of upper GI endoscopy." Gastrointestinal Endoscopy 76.4 (2012): 707-718.
PMID
22985638
Source
scival
Published In
Gastrointestinal Endoscopy
Volume
76
Issue
4
Publish Date
2012
Start Page
707
End Page
718
DOI
10.1016/j.gie.2012.03.252

Guidelines for endoscopy in pregnant and lactating women

This is one of a series of statements discussing the use of GI endoscopy in common clinical situations. The Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy prepared this text. This guideline updates a previously issued guideline on this topic. In preparing this guideline, we performed a search of the medical literature by using PubMed. Additional references were obtained from the bibliographies of the identified articles and from recommendations of expert consultants. When few or no data exist from well-designed, prospective trials, emphasis was given to results from large series and reports from recognized experts. Guidelines for appropriate use of endoscopy are based on a critical review of the available data and expert consensus at the time that the guidelines are drafted. Further controlled clinical studies may be needed to clarify aspects of this guideline. This guideline may be revised as necessary to account for changes in technology, new data, or other aspects of clinical practice. The recommendations are based on reviewed studies and are graded on the strength of the supporting evidence (Table 1). The strength of individual recommendations is based on both the aggregate evidence quality and an assessment of the anticipated benefits and harms. Weaker recommendations are indicated by phrases such as "We suggest....," whereas stronger recommendations are typically stated as "We recommend...." This guideline is intended to be an educational device to provide information that may assist endoscopists in providing care to patients. This guideline is not a rule and should not be construed as establishing a legal standard of care or as encouraging, advocating, requiring, or discouraging any particular treatment. Clinical decisions in any particular case involve a complex analysis of the patient's condition and available courses of action. Therefore, clinical considerations may lead an endoscopist to take a course of action that varies from these guidelines. © 2012 American Society for Gastrointestinal Endoscopy.

Authors
Shergill, AK; Ben-Menachem, T; Chandrasekhara, V; Chathadi, K; Decker, GA; Evans, JA; Early, DS; Fanelli, RD; Fisher, DA; Foley, KQ; Fukami, N; Hwang, JH; Jain, R; Jue, TL; Khan, KM; Lightdale, J; Pasha, SF; Sharaf, RN; Dominitz, JA; Cash, BD
MLA Citation
Shergill, AK, Ben-Menachem, T, Chandrasekhara, V, Chathadi, K, Decker, GA, Evans, JA, Early, DS, Fanelli, RD, Fisher, DA, Foley, KQ, Fukami, N, Hwang, JH, Jain, R, Jue, TL, Khan, KM, Lightdale, J, Pasha, SF, Sharaf, RN, Dominitz, JA, and Cash, BD. "Guidelines for endoscopy in pregnant and lactating women." Gastrointestinal Endoscopy 76.1 (2012): 18-24.
PMID
22579258
Source
scival
Published In
Gastrointestinal Endoscopy
Volume
76
Issue
1
Publish Date
2012
Start Page
18
End Page
24
DOI
10.1016/j.gie.2012.02.029

The role of endoscopy in the management of acute non-variceal upper GI bleeding

Authors
Hwang, JH; Fisher, DA; Ben-Menachem, T; Chandrasekhara, V; Chathadi, K; Decker, GA; Early, DS; Evans, JA; Fanelli, RD; Foley, K; Fukami, N; Jain, R; Jue, TL; Khan, KM; Lightdale, J; Malpas, PM; Maple, JT; Pasha, S; Saltzman, J; Sharaf, R; Shergill, AK; Dominitz, JA; Cash, BD
MLA Citation
Hwang, JH, Fisher, DA, Ben-Menachem, T, Chandrasekhara, V, Chathadi, K, Decker, GA, Early, DS, Evans, JA, Fanelli, RD, Foley, K, Fukami, N, Jain, R, Jue, TL, Khan, KM, Lightdale, J, Malpas, PM, Maple, JT, Pasha, S, Saltzman, J, Sharaf, R, Shergill, AK, Dominitz, JA, and Cash, BD. "The role of endoscopy in the management of acute non-variceal upper GI bleeding." Gastrointestinal Endoscopy 75.6 (2012): 1132-1138.
PMID
22624808
Source
scival
Published In
Gastrointestinal Endoscopy
Volume
75
Issue
6
Publish Date
2012
Start Page
1132
End Page
1138
DOI
10.1016/j.gie.2012.02.033

Complications of ERCP.

Authors
Committee, ASGESOP; Anderson, MA; Fisher, L; Jain, R; Evans, JA; Appalaneni, V; Ben-Menachem, T; Cash, BD; Decker, GA; Early, DS; Fanelli, RD; Fisher, DA; Fukami, N; Hwang, JH; Ikenberry, SO; Jue, TL; Khan, KM; Krinsky, ML; Malpas, PM; Maple, JT; Sharaf, RN; Shergill, AK; Dominitz, JA
MLA Citation
Committee, ASGESOP, Anderson, MA, Fisher, L, Jain, R, Evans, JA, Appalaneni, V, Ben-Menachem, T, Cash, BD, Decker, GA, Early, DS, Fanelli, RD, Fisher, DA, Fukami, N, Hwang, JH, Ikenberry, SO, Jue, TL, Khan, KM, Krinsky, ML, Malpas, PM, Maple, JT, Sharaf, RN, Shergill, AK, and Dominitz, JA. "Complications of ERCP." Gastrointestinal endoscopy 75.3 (2012): 467-473.
PMID
22341094
Source
scival
Published In
Gastrointestinal Endoscopy
Volume
75
Issue
3
Publish Date
2012
Start Page
467
End Page
473
DOI
10.1016/j.gie.2011.07.010

Factors associated with survival of veterans with gastrointestinal neuroendocrine tumors.

Background. Gastrointestinal (GI) neuroendocrine tumor (NET) incidence has been increasing; however, GI NET within the national Veterans Affairs (VA) health system has not been described. Methods. We used the VA Central Cancer Registry to identify the cohort of patients diagnosed with GI NET in 1995-2009. Cox regression models were constructed to explore factors associated with survival. Results. We included 1793 patients with NET of the stomach (9%), duodenum (10%), small intestine (24%), colon (19%) or rectum (38%). Twenty percent were diagnosed in 1995-1999, 35% in 2000-2004, and 45% in 2005-2009. Unadjusted 5-year survival rates were: stomach 56%, duodenum 66%, small intestine 52%, colon 67%, and rectum 84%. Factors associated with shorter survival were increasing age, hazard ratio (HR) 1.05 (95% CI 1.04-1.06), NET location [compared to rectum: stomach HR 2.26 (95% CI 1.68-3.05), duodenum HR 1.70 (95% CI 1.26-2.28), small intestine HR 1.85 (95% CI 1.42-2.42), and colon 1.83 (95% CI 1.41-2.39)], stage [compared to in situ/local: regional HR 1.15 (95% CI 0.90-1.47), distant HR 2.38 (95% CI 1.87-3.05)], and earlier period of diagnosis [compared to 1995-1999: 2000-2004 HR 0.70 (95% CI 0.59-0.85), 2005-2009 HR 0.43 (95% CI 0.34-0.54)]. Conclusions. The incidence of GI NET has also increased over time in the VA system with similar survival rates to those observed in non-VA settings. Worsened survival was associated with older age, tumor site, advanced stage, and earlier year of diagnosis.

Authors
Balmadrid, BL; Thomas, CM; Coffman, CJ; Liddle, RA; Fisher, DA
MLA Citation
Balmadrid, BL, Thomas, CM, Coffman, CJ, Liddle, RA, and Fisher, DA. "Factors associated with survival of veterans with gastrointestinal neuroendocrine tumors." J Cancer Epidemiol 2012 (2012): 986708-.
PMID
22693504
Source
pubmed
Published In
Journal of Cancer Epidemiology
Volume
2012
Publish Date
2012
Start Page
986708
DOI
10.1155/2012/986708

Cap-assisted EMR of large, sporadic, nonampullary duodenal polyps

Background: EMR is an effective alternative to surgery for the removal of nonampullary duodenal polyps (NADPs). Cap-assisted EMR (EMR-C) has been rarely performed in the duodenum because of the risk of perforation. Objective: To evaluate the safety and effectiveness of EMR-C for the removal of large (<15 mm) NADPs. Design: Retrospective study. Setting: Tertiary-care referral center. Patients: Between 2000 and 2010, 26 consecutive patients with sporadic NADPs underwent EMR-C. Intervention: EMR with the cap technique. Main Outcome Measurements: Complete eradication of polyps, complications, and recurrence. Results: A total of 14 sessile polyps (53.8%), 7 lateral spreading type nongranular tumors (26.9%), and 5 lateral spreading type granular tumors (19.2%) were treated. The median size of lesions was 15 mm. Five lesions involved one-half of the luminal circumference. Post-EMR histologic assessment showed low-grade dysplasia in 5 patients (19.2%) and high-grade dysplasia in 18 patients (69.2%). Three patients (11.5%) had well-differentiated endocrine tumors. Complete eradication was obtained in 25 of 26 (96%) patients. No perforations occurred. Three cases of intraprocedural bleeding were managed endoscopically. Median follow-up was 6 years (range 1-10 years). Residual adenomatous tissue was observed in 3 patients in lesions of 50 mm. In one of these cases, an adenocarcinoma occurred after 8 months, which was managed surgically. Limitations: Retrospective design, single center. Conclusion: This study supports the efficacy and safety of EMR-C for removing NADPs. Regular follow-up is mandatory because of the high risk of residual or recurrent adenomatous tissue and even cancer. © 2012 American Society for Gastrointestinal Endoscopy.

Authors
Conio, M; Ceglie, AD; Filiberti, R; Fisher, DA; Siersema, PD
MLA Citation
Conio, M, Ceglie, AD, Filiberti, R, Fisher, DA, and Siersema, PD. "Cap-assisted EMR of large, sporadic, nonampullary duodenal polyps." Gastrointestinal Endoscopy 76.6 (2012): 1160-1169.
PMID
23021169
Source
scival
Published In
Gastrointestinal Endoscopy
Volume
76
Issue
6
Publish Date
2012
Start Page
1160
End Page
1169
DOI
10.1016/j.gie.2012.08.009

Unintended consequences of health information technology: Evidence from Veterans Affairs Colorectal Cancer Oncology Watch Intervention

Purpose: We evaluated the Colorectal Cancer (CRC) Oncology Watch intervention, a clinical reminder implemented in Veterans Integrated Service Network 7 (including eight hospitals) to improve CRC screening rates in 2008. Patients and Methods: Veterans Affairs (VA) administrative data were used to construct four cross-sectional groups of veterans at average risk, age 50 to 64 years; one group was created for each of the following years: 2006, 2007, 2009, and 2010. We applied hospital fixed effects for estimation, using a difference-in-differences model in which the eight hospitals served as the intervention sites, and the other 121 hospitals served as controls, with 2006 to 2007 as the preintervention period and 2009 to 2010 as the postintervention period. Results: The sample included 4,352,082 veteran-years in the 4 years. The adherence rates were 37.6%, 31.6%, 34.4%, and 33.2% in the intervention sites in 2006, 2007, 2009, and 2010, respectively, and the corresponding rates in the controls were 31.0%, 30.3%, 32.3%, and 30.9%. Regression analysis showed that among those eligible for screening, the intervention was associated with a 2.2-percentage point decrease in likelihood of adherence (P < .001). Additional analyses showed that the intervention was associated with a 5.6-percentage point decrease in likelihood of screening colonoscopy among the adherent, but with increased total colonoscopies (all indicators) of 3.6 per 100 veterans age 50 to 64 years. Conclusion: The intervention had little impact on CRC screening rates for the studied population. This absence of favorable impact may have been caused by an unintentional shift of limited VA colonoscopy capacity from average-risk screening to higher-risk screening and to CRC surveillance, or by physician fatigue resulting from the large number of clinical reminders implemented in the VA. © 2012 by American Society of Clinical Oncology.

Authors
Bian, J; Bennett, CL; Fisher, DA; Ribeiro, M; Lipscomb, J
MLA Citation
Bian, J, Bennett, CL, Fisher, DA, Ribeiro, M, and Lipscomb, J. "Unintended consequences of health information technology: Evidence from Veterans Affairs Colorectal Cancer Oncology Watch Intervention." Journal of Clinical Oncology 30.32 (2012): 3947-3952.
PMID
23045582
Source
scival
Published In
Journal of Clinical Oncology
Volume
30
Issue
32
Publish Date
2012
Start Page
3947
End Page
3952
DOI
10.1200/JCO.2011.39.7448

Endoscopic management of hilar cholangiocarcinoma

Hilar cholangiocarcinoma has a poor prognosis and surgery remains the only curative option. However, few patients are diagnosed at a curable stage and palliative therapies are, therefore, mandatory. Endoscopy could have a useful role in the work-up of patients with hilar cholangiocarcinoma who are unsuitable for surgery. Endoscopic retrograde cholangiopancreatography provides an opportunity to collect specimens for cytological or histological diagnosis, yet is often nondiagnostic. Other techniques, including fluorescence in situ hybridization, confocal laser endomicroscopy and endoscopic ultrasonography, are now improving the accuracy of tissue diagnosis. This Review presents an overview of the diagnostic and therapeutic role of endoscopic procedures in the management of hilar cholangiocarcinoma. The use of such procedures in guiding the therapeutic management of patients with hilar cholangiocarcinoma is discussed, and the relative success of endoscopic stenting as the main palliative therapy for obstructive jaundice (a common complication of hilar cholangiocarcinoma) is described. The potential role of photodynamic therapy as a palliative treatment for patients with hilar cholangiocarcinoma is also outlined. © 2012 Macmillan Publishers Limited. All rights reserved.

Authors
Parodi, A; Fisher, D; Giovannini, M; Baron, T; Conio, M
MLA Citation
Parodi, A, Fisher, D, Giovannini, M, Baron, T, and Conio, M. "Endoscopic management of hilar cholangiocarcinoma." Nature Reviews Gastroenterology and Hepatology 9.2 (2012): 105-112.
PMID
22269953
Source
scival
Published In
Nature Reviews Gastroenterology & Hepatology
Volume
9
Issue
2
Publish Date
2012
Start Page
105
End Page
112
DOI
10.1038/nrgastro.2011.271

Levels and Variation in Overuse of Fecal Occult Blood Testing in the Veterans Health Administration

BACKGROUND: Policy-makers have called for efforts to reduce overuse of cancer screening tests, including colorectal cancer screening (CRCS). Overuse of CRCS tests other than colonoscopy has not been well documented. OBJECTIVE: To estimate levels and correlates of fecal occult blood test (FOBT) overuse in a national Veterans Health Administration (VHA) sample. DESIGN: Observational PARTICIPANTS: Participants included 1,844 CRCS-eligible patients who responded to a 2007 CRCS survey conducted in 24 VHA facilities and had one or more FOBTs between 2003 and 2009. MAIN MEASURES: We combined survey data on race, education, and income with administrative data on region, age, gender, CRCS procedures, and outpatient visits to estimate overuse levels and variation. We coded FOBTs as overused if they were conducted <10 months after prior FOBT, <9.5 years after prior colonoscopy, or <4.5 years after prior barium enema. We used multinomial logistic regression models to examine variation in overuse by reason (sooner than recommended after prior FOBT; sooner than recommended after colonoscopy, barium enema, or a combination of procedures), adjusting for clustering of procedures within patients, and patients within facilities. KEY RESULTS: Of 4,236 FOBTs received by participants, 885 (21 %) met overuse criteria, with 323 (8 %) sooner than recommended after FOBT, and 562 (13 %) sooner than recommended after other procedures. FOBT overuse varied across facilities (9-32 %, p < 0.0001) and region (12-23 %, p < .0012). FOBT overuse after prior FOBT declined between 2003 and 2009 (8 %-5 %, p = .0492), but overuse after other procedures increased (11-19 %, p = .0002). FOBT overuse of both types increased with number of outpatient visits (OR 1.15, p < 0.001), but did not vary by patient demographics. More than 11 % of overused FOBTs were followed by colonoscopy within 12 months. CONCLUSIONS: Many FOBTs are performed sooner than recommended in the VHA. Variation in overuse by facility, region, and outpatient visits suggests addressing FOBT overuse will require system-level solutions. © 2012 Society of General Internal Medicine.

Authors
Partin, MR; Powell, AA; Bangerter, A; Halek, K; Jr, JFB; Fisher, DA; Nelson, DB
MLA Citation
Partin, MR, Powell, AA, Bangerter, A, Halek, K, Jr, JFB, Fisher, DA, and Nelson, DB. "Levels and Variation in Overuse of Fecal Occult Blood Testing in the Veterans Health Administration." Journal of General Internal Medicine (2012): 1-8.
PMID
22810358
Source
scival
Published In
Journal of General Internal Medicine
Publish Date
2012
Start Page
1
End Page
8
DOI
10.1007/s11606-012-2163-9

The role of endoscopy in Barrett's esophagus and other premalignant conditions of the esophagus

Authors
Evans, JA; Early, DS; Fukami, N; Ben-Menachem, T; Chandrasekhara, V; Chathadi, KV; Decker, GA; Fanelli, RD; Fisher, DA; Foley, KQ; Hwang, JH; Jain, R; Jue, TL; Khan, KM; Lightdale, J; Malpas, PM; Maple, JT; Pasha, SF; Saltzman, JR; Sharaf, RN; Shergill, A; Dominitz, JA; Cash, BD
MLA Citation
Evans, JA, Early, DS, Fukami, N, Ben-Menachem, T, Chandrasekhara, V, Chathadi, KV, Decker, GA, Fanelli, RD, Fisher, DA, Foley, KQ, Hwang, JH, Jain, R, Jue, TL, Khan, KM, Lightdale, J, Malpas, PM, Maple, JT, Pasha, SF, Saltzman, JR, Sharaf, RN, Shergill, A, Dominitz, JA, and Cash, BD. "The role of endoscopy in Barrett's esophagus and other premalignant conditions of the esophagus." Gastrointestinal Endoscopy 76.6 (2012): 1087-1094.
PMID
23164510
Source
scival
Published In
Gastrointestinal Endoscopy
Volume
76
Issue
6
Publish Date
2012
Start Page
1087
End Page
1094
DOI
10.1016/j.gie.2012.08.004

Appropriate use of GI endoscopy.

Authors
Committee, ASGESOP; Early, DS; Ben-Menachem, T; Decker, GA; Evans, JA; Fanelli, RD; Fisher, DA; Fukami, N; Hwang, JH; Jain, R; Jue, TL; Khan, KM; Malpas, PM; Maple, JT; Sharaf, RS; Dominitz, JA; Cash, BD
MLA Citation
Committee, ASGESOP, Early, DS, Ben-Menachem, T, Decker, GA, Evans, JA, Fanelli, RD, Fisher, DA, Fukami, N, Hwang, JH, Jain, R, Jue, TL, Khan, KM, Malpas, PM, Maple, JT, Sharaf, RS, Dominitz, JA, and Cash, BD. "Appropriate use of GI endoscopy." Gastrointestinal endoscopy 75.6 (2012): 1127-1131.
PMID
22624807
Source
scival
Published In
Gastrointestinal Endoscopy
Volume
75
Issue
6
Publish Date
2012
Start Page
1127
End Page
1131
DOI
10.1016/j.gie.2012.01.011

Levels and variation in overuse of fecal occult blood testing in the Veterans Health Administration.

Policy-makers have called for efforts to reduce overuse of cancer screening tests, including colorectal cancer screening (CRCS). Overuse of CRCS tests other than colonoscopy has not been well documented. To estimate levels and correlates of fecal occult blood test (FOBT) overuse in a national Veterans Health Administration (VHA) sample. Observational Participants included 1,844 CRCS-eligible patients who responded to a 2007 CRCS survey conducted in 24 VHA facilities and had one or more FOBTs between 2003 and 2009. We combined survey data on race, education, and income with administrative data on region, age, gender, CRCS procedures, and outpatient visits to estimate overuse levels and variation. We coded FOBTs as overused if they were conducted <10 months after prior FOBT, <9.5 years after prior colonoscopy, or <4.5 years after prior barium enema. We used multinomial logistic regression models to examine variation in overuse by reason (sooner than recommended after prior FOBT; sooner than recommended after colonoscopy, barium enema, or a combination of procedures), adjusting for clustering of procedures within patients, and patients within facilities. Of 4,236 FOBTs received by participants, 885 (21 %) met overuse criteria, with 323 (8 %) sooner than recommended after FOBT, and 562 (13 %) sooner than recommended after other procedures. FOBT overuse varied across facilities (9-32 %, p<0.0001) and region (12-23 %, p< .0012). FOBT overuse after prior FOBT declined between 2003 and 2009 (8 %-5 %, p= .0492), but overuse after other procedures increased (11-19 %, p= .0002). FOBT overuse of both types increased with number of outpatient visits (OR 1.15, p<0.001), but did not vary by patient demographics. More than 11 % of overused FOBTs were followed by colonoscopy within 12 months. Many FOBTs are performed sooner than recommended in the VHA. Variation in overuse by facility, region, and outpatient visits suggests addressing FOBT overuse will require system-level solutions.

Authors
Partin, MR; Powell, AA; Bangerter, A; Halek, K; Jr, JFB; Fisher, DA; Nelson, DB
MLA Citation
Partin, MR, Powell, AA, Bangerter, A, Halek, K, Jr, JFB, Fisher, DA, and Nelson, DB. "Levels and variation in overuse of fecal occult blood testing in the Veterans Health Administration." Journal of general internal medicine 27.12 (2012): 1618-1625.
Source
scival
Published In
Journal of General Internal Medicine
Volume
27
Issue
12
Publish Date
2012
Start Page
1618
End Page
1625
DOI
10.1007/s11606-012-2163-9

History of cancer in first degree relatives of Barrett's esophagus patients: a case-control study.

BACKGROUND AND OBJECTIVE: Familial clusters of Barrett's esophagus (BE) and esophageal adenocarcinoma (EAC) have been reported. This study evaluates the history of cancer in BE patients families. METHODS: In two years, patients with BE (272), esophagitis (456) and controls (517) were recruited in 12 Italian Endoscopy Units. Cancer family history in first-degree (FD) relatives was determined by a questionnaire. RESULTS: Approximately 53% of BE, 51% of esophagitis, and 48% of controls had at least one relative affected by any type of malignancy. Probands with at least one esophageal or gastric (E/G) cancer-affected relative showed a BE risk which was at least eighty-five percent higher than that of probands without affected relatives. The relative risk of BE was 4.18, 95% CL=0.76-23.04 if a FD relative had early (mean age ≤ 50 years) onset E/G cancer compared to late onset E/G cancer. CONCLUSION: In this sample there was no evidence that a family history of cancer was associated with the diagnosis of BE. An intriguing result was the association between the occurrence of E/G cancers at earlier ages (< 50 years) among BE relatives with respect the control group. This could suggest a genetic contribution in onset of these tumors, but the sample was too small to demonstrate a significant association. Further exploration of family history of E/G cancer and a diagnosis of BE in larger samples is warranted.

Authors
De Ceglie, A; Filiberti, R; Blanchi, S; Fontana, V; Fisher, DA; Grossi, E; Lacchin, T; De Matthaeis, M; Ignomirelli, O; Cappiello, R; Casa, DD; Foti, M; Laterza, F; Rosati, R; Annese, V; Iaquinto, G; Conio, M
MLA Citation
De Ceglie, A, Filiberti, R, Blanchi, S, Fontana, V, Fisher, DA, Grossi, E, Lacchin, T, De Matthaeis, M, Ignomirelli, O, Cappiello, R, Casa, DD, Foti, M, Laterza, F, Rosati, R, Annese, V, Iaquinto, G, and Conio, M. "History of cancer in first degree relatives of Barrett's esophagus patients: a case-control study." Clin Res Hepatol Gastroenterol 35.12 (December 2011): 831-838.
PMID
21924696
Source
pubmed
Published In
Clinics and Research in Hepatology and Gastroenterology
Volume
35
Issue
12
Publish Date
2011
Start Page
831
End Page
838
DOI
10.1016/j.clinre.2011.07.015

Complications of colonoscopy.

Authors
ASGE Standards of Practice Committee, ; Fisher, DA; Maple, JT; Ben-Menachem, T; Cash, BD; Decker, GA; Early, DS; Evans, JA; Fanelli, RD; Fukami, N; Hwang, JH; Jain, R; Jue, TL; Khan, KM; Malpas, PM; Sharaf, RN; Shergill, AK; Dominitz, JA
MLA Citation
ASGE Standards of Practice Committee, , Fisher, DA, Maple, JT, Ben-Menachem, T, Cash, BD, Decker, GA, Early, DS, Evans, JA, Fanelli, RD, Fukami, N, Hwang, JH, Jain, R, Jue, TL, Khan, KM, Malpas, PM, Sharaf, RN, Shergill, AK, and Dominitz, JA. "Complications of colonoscopy." Gastrointest Endosc 74.4 (October 2011): 745-752.
PMID
21951473
Source
pubmed
Published In
Gastrointestinal Endoscopy
Volume
74
Issue
4
Publish Date
2011
Start Page
745
End Page
752
DOI
10.1016/j.gie.2011.07.025

Electronic medical records and improving the quality of the screening process.

Authors
Fisher, DA
MLA Citation
Fisher, DA. "Electronic medical records and improving the quality of the screening process." J Gen Intern Med 26.7 (July 2011): 683-684.
PMID
21538167
Source
pubmed
Published In
Journal of General Internal Medicine
Volume
26
Issue
7
Publish Date
2011
Start Page
683
End Page
684
DOI
10.1007/s11606-011-1722-9

Longitudinal adherence to fecal occult blood testing impacts colorectal cancer screening quality.

OBJECTIVES: Existing cross-sectional quality measures for colorectal cancer (CRC) screening do not assess longitudinal adherence and thus may overestimate the quality of care. Our goal was to evaluate the adherence to repeated yearly fecal occult blood tests (FOBTs) in order to better understand the extent to which longitudinal adherence may impact screening quality. METHODS: This was a retrospective cohort analysis of 1,122,645 patients aged 50-75 years seen at any of the 136 Department of Veterans Affairs medical centers across the United States in 2000 and followed through 2005. The primary outcome was receipt of adequate CRC screening as defined by receipt of FOBTs in at least 4 out of 5 years or receipt of any number of FOBTs in addition to at least one colonoscopy, flexible sigmoidoscopy, or double-contrast barium enema. In a predefined subset of patients receiving exclusively FOBT, adherence with repeated testing was determined over the 5-year study period. RESULTS: Only 41.1% of men and 43.6% of women received adequate screening. Of the 384,527 men who received exclusively FOBT, 42.1% received a single FOBT, 26.0% received 2 tests, 17.8% received 3 tests, and only 14.1% were documented to have received at least 4 tests during the study period. Among the 10,469 female veterans receiving FOBT alone, rates were similar with only 13.7% completing at least 4 FOBTs in the 5-year study period. CONCLUSIONS: Adherence to repeated FOBT is low, suggesting that cross-sectional measurements of quality may overestimate the programmatic success of CRC screening.

Authors
Gellad, ZF; Stechuchak, KM; Fisher, DA; Olsen, MK; McDuffie, JR; Ostbye, T; Yancy, WS
MLA Citation
Gellad, ZF, Stechuchak, KM, Fisher, DA, Olsen, MK, McDuffie, JR, Ostbye, T, and Yancy, WS. "Longitudinal adherence to fecal occult blood testing impacts colorectal cancer screening quality." Am J Gastroenterol 106.6 (June 2011): 1125-1134.
PMID
21304501
Source
pubmed
Published In
The American Journal of Gastroenterology (Elsevier)
Volume
106
Issue
6
Publish Date
2011
Start Page
1125
End Page
1134
DOI
10.1038/ajg.2011.11

Systematic Review of Clinical Factors to Differentiate Upper Gastrointestinal Bleeding From Lower Gastrointestinal Bleeding

Authors
Srygley, FD; Gerardo, CJ; Tran, TH; Fisher, DA
MLA Citation
Srygley, FD, Gerardo, CJ, Tran, TH, and Fisher, DA. "Systematic Review of Clinical Factors to Differentiate Upper Gastrointestinal Bleeding From Lower Gastrointestinal Bleeding." May 2011.
Source
wos-lite
Published In
Gastroenterology
Volume
140
Issue
5
Publish Date
2011
Start Page
S209
End Page
S209

Systematic Review of Pre-Endoscopic Factors Predictive of Upper Gastrointestinal Bleeding Requiring Urgent Intervention

Authors
Srygley, FD; Gerardo, CJ; Tran, TH; Fisher, DA
MLA Citation
Srygley, FD, Gerardo, CJ, Tran, TH, and Fisher, DA. "Systematic Review of Pre-Endoscopic Factors Predictive of Upper Gastrointestinal Bleeding Requiring Urgent Intervention." May 2011.
Source
wos-lite
Published In
Gastroenterology
Volume
140
Issue
5
Publish Date
2011
Start Page
S209
End Page
S209

Presence and correlates of racial disparities in adherence to colorectal cancer screening guidelines.

OBJECTIVES: We examined the presence and correlates of Black/White racial disparities in adherence to guidelines for colorectal cancer screening (CRCS). METHODS: The sample included 328 Black and 1827 White patients age 50-75 from 24 VA medical facilities who responded to a mailed survey with phone follow-up (response rate: 73% for Blacks and 89% for Whites). CRCS adherence and race were obtained through surveys and supplemented with administrative data. Logistic regressions estimated the contribution of demographic, health, cognitive, and environmental factors to racial disparities in adherence to CRCS guidelines. RESULTS: In unadjusted analyses, Blacks had slightly lower rates of adherence to CRCS guidelines than Whites (72% versus 77%, p<0.05). This racial disparity in CRCS adherence was explained by race differences in demographic, health, and environmental factors but not by cognitive factors. Tests for interactions revealed that the association of race with adherence varied significantly across levels of income, education, and marital status. In particular, among those who were married with higher levels of education, CRCS adherence was significantly higher for Whites; whereas among those who were unmarried, with low levels of education, adherence was significantly higher for Blacks. CONCLUSION: We found that disparities in CRCS are greatly attenuated in the VA system and both Whites and Blacks have substantially higher rates of CRCS than the national average. These results point to the success of the VA at implementing CRCS system-wide. Our findings also suggest additional initiatives may be needed for unmarried low income white men and higher income black men.

Authors
Burgess, DJ; van Ryn, M; Grill, J; Noorbaloochi, S; Griffin, JM; Ricards, J; Vernon, SW; Fisher, DA; Partin, MR
MLA Citation
Burgess, DJ, van Ryn, M, Grill, J, Noorbaloochi, S, Griffin, JM, Ricards, J, Vernon, SW, Fisher, DA, and Partin, MR. "Presence and correlates of racial disparities in adherence to colorectal cancer screening guidelines." J Gen Intern Med 26.3 (March 2011): 251-258.
PMID
21088920
Source
pubmed
Published In
Journal of General Internal Medicine
Volume
26
Issue
3
Publish Date
2011
Start Page
251
End Page
258
DOI
10.1007/s11606-010-1575-7

Barrett's esophagus, esophageal and esophagogastric junction adenocarcinomas: The role of diet

Identification of modifiable risk factors is an attractive approach to primary prevention of esophageal adenocarcinoma (EAC) and esophagogastric junction adenocarcinoma (EGJAC). We conducted a review of the literature to investigate the association between specific dietary components and the risk of Barrett's esophagus (BE), EAC and EGJAC, supposing diet might be a risk factor for these tumors. Consumption of meat and high-fat meals has been found positively associated with EAC and EGJAC. An inverse association with increased intake of fruit, vegetables and antioxidants has been reported but this association was not consistent across all studies reviewed. Few studies have examined the association between diet and BE. Additional research is needed to confirm the aforementioned association and clarify the mechanisms by which dietary components affect the risk of developing EAC and EGJAC. Future studies could advance our knowledge by emphasizing prospective designs to reduce recall bias, by using validated dietary intake questionnaires and biological measures and by considering important confounders such as gastro-esophageal reflux disease (GERD) symptoms, tobacco and alcohol use, biometrics, physical activity, and socioeconomic factors. © 2010 Elsevier Masson SAS.

Authors
De Ceglie, A; Fisher, DA; Filiberti, R; Blanchi, S; Conio, M
MLA Citation
De Ceglie, A, Fisher, DA, Filiberti, R, Blanchi, S, and Conio, M. "Barrett's esophagus, esophageal and esophagogastric junction adenocarcinomas: The role of diet." Clinics and Research in Hepatology and Gastroenterology 35.1 (January 1, 2011): 7-16.
Source
scopus
Published In
Gastroenterologie clinique et biologique
Volume
35
Issue
1
Publish Date
2011
Start Page
7
End Page
16
DOI
10.1016/j.gcb.2010.08.015

Barrett's esophagus, esophageal and esophagogastric junction adenocarcinomas: the role of diet.

Identification of modifiable risk factors is an attractive approach to primary prevention of esophageal adenocarcinoma (EAC) and esophagogastric junction adenocarcinoma (EGJAC). We conducted a review of the literature to investigate the association between specific dietary components and the risk of Barrett’s esophagus (BE), EAC and EGJAC, supposing diet might be a risk factor for these tumors. Consumption of meat and high-fat meals has been found positively associated with EAC and EGJAC. An inverse association with increased intake of fruit, vegetables and antioxidants has been reported but this association was not consistent across all studies reviewed. Few studies have examined the association between diet and BE. Additional research is needed to confirm the aforementioned association and clarify the mechanisms by which dietary components affect the risk of developing EAC and EGJAC. Future studies could advance our knowledge by emphasizing prospective designs to reduce recall bias, by using validated dietary intake questionnaires and biological measures and by considering important confounders such as gastro-esophageal reflux disease (GERD) symptoms, tobacco and alcohol use, biometrics, physical activity, and socioeconomic factors.

Authors
De Ceglie, A; Fisher, DA; Filiberti, R; Blanchi, S; Conio, M
MLA Citation
De Ceglie, A, Fisher, DA, Filiberti, R, Blanchi, S, and Conio, M. "Barrett's esophagus, esophageal and esophagogastric junction adenocarcinomas: the role of diet." Clin Res Hepatol Gastroenterol 35.1 (January 2011): 7-16. (Review)
PMID
20970272
Source
pubmed
Published In
Clinics and Research in Hepatology and Gastroenterology
Volume
35
Issue
1
Publish Date
2011
Start Page
7
End Page
16
DOI
10.1016/j.gcb.2010.08.015

The role of endoscopy in the management of choledocholithiasis

This is one of a series of statements discussing the use of GI endoscopy in common clinical situations. The Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy (ASGE) prepared this text. In preparing this guideline, a search of the medical literature was performed using PubMed. Additional references were obtained from the bibliographies of the identified articles and from recommendations of expert consultants. When few or no data exist from well-designed prospective trials, emphasis is given to results of large series and reports from recognized experts. Guidelines for appropriate use of endoscopy are based on a critical review of the available data and expert consensus at the time the guidelines are drafted. Further controlled clinical studies may be needed to clarify aspects of this guideline. This guideline may be revised as necessary to account for changes in technology, new data, or other aspects of clinical practice. The recommendations were based on reviewed studies and were graded on the strength of the supporting evidence (Table 1).1 The strength of individual recommendations is based on both the aggregate evidence quality and an assessment of the anticipated benefits and harms. Weaker recommendations are indicated by phrases such as "we suggest," whereas stronger recommendations are typically stated as "we recommend." This guideline is intended to be an educational device to provide information that may assist endoscopists in providing care to patients. This guideline is not a rule and should not be construed as establishing a legal standard of care or as encouraging, advocating, requiring, or discouraging any particular treatment. Clinical decisions in any particular case involve a complex analysis of the patient's condition and available courses of action. Therefore, clinical considerations may lead an endoscopist to take a course of action that varies from these guidelines. Copyright © 2011 by the American Society for Gastrointestinal Endoscopy.

Authors
Maple, JT; Fisher, L; Fukami, N; Hwang, JH; Jain, R; Jue, T; Khan, K; Krinsky, ML; Malpas, P; Ben-Menachem, T; Sharaf, RN; Dominitz, JA; Ikenberry, SO; Anderson, MA; Appalaneni, V; Decker, GA; Early, D; Evans, JA; Fanelli, RD; Fisher, D
MLA Citation
Maple, JT, Fisher, L, Fukami, N, Hwang, JH, Jain, R, Jue, T, Khan, K, Krinsky, ML, Malpas, P, Ben-Menachem, T, Sharaf, RN, Dominitz, JA, Ikenberry, SO, Anderson, MA, Appalaneni, V, Decker, GA, Early, D, Evans, JA, Fanelli, RD, and Fisher, D. "The role of endoscopy in the management of choledocholithiasis." Gastrointestinal Endoscopy 74.4 (2011): 731-744.
PMID
21951472
Source
scival
Published In
Gastrointestinal Endoscopy
Volume
74
Issue
4
Publish Date
2011
Start Page
731
End Page
744
DOI
10.1016/j.gie.2011.04.012

Role of EUS for the evaluation of mediastinal adenopathy

Authors
Jue, TL; Sharaf, RN; Appalaneni, V; Anderson, MA; Ben-Menachem, T; Decker, GA; Fanelli, RD; Fukami, N; Ikenberry, SO; Jain, R; Khan, KM; Krinsky, ML; Malpas, PM; Maple, JT; Fisher, D; Hwang, JH; Early, D; Evans, JA; Dominitz, JA
MLA Citation
Jue, TL, Sharaf, RN, Appalaneni, V, Anderson, MA, Ben-Menachem, T, Decker, GA, Fanelli, RD, Fukami, N, Ikenberry, SO, Jain, R, Khan, KM, Krinsky, ML, Malpas, PM, Maple, JT, Fisher, D, Hwang, JH, Early, D, Evans, JA, and Dominitz, JA. "Role of EUS for the evaluation of mediastinal adenopathy." Gastrointestinal Endoscopy 74.2 (2011): 239-245.
PMID
21802583
Source
scival
Published In
Gastrointestinal Endoscopy
Volume
74
Issue
2
Publish Date
2011
Start Page
239
End Page
245
DOI
10.1016/j.gie.2011.03.1255

Predictive algorithms: uses and limitations.

Authors
Jou, JH; Fisher, DA
MLA Citation
Jou, JH, and Fisher, DA. "Predictive algorithms: uses and limitations." Dig Dis Sci 55.11 (November 2010): 3016-3017.
PMID
20945094
Source
pubmed
Published In
Digestive Diseases and Sciences
Volume
55
Issue
11
Publish Date
2010
Start Page
3016
End Page
3017
DOI
10.1007/s10620-010-1436-6

Variation in use of surveillance colonoscopy among colorectal cancer survivors in the United States.

BACKGROUND: Clinical practice guidelines recommend colonoscopies at regular intervals for colorectal cancer (CRC) survivors. Using data from a large, multi-regional, population-based cohort, we describe the rate of surveillance colonoscopy and its association with geographic, sociodemographic, clinical, and health services characteristics. METHODS: We studied CRC survivors enrolled in the Cancer Care Outcomes Research and Surveillance (CanCORS) study. Eligible survivors were diagnosed between 2003 and 2005, had curative surgery for CRC, and were alive without recurrences 14 months after surgery with curative intent. Data came from patient interviews and medical record abstraction. We used a multivariate logit model to identify predictors of colonoscopy use. RESULTS: Despite guidelines recommending surveillance, only 49% of the 1423 eligible survivors received a colonoscopy within 14 months after surgery. We observed large regional differences (38% to 57%) across regions. Survivors who received screening colonoscopy were more likely to: have colon cancer than rectal cancer (OR = 1.41, 95% CI: 1.05-1.90); have visited a primary care physician (OR = 1.44, 95% CI: 1.14-1.82); and received adjuvant chemotherapy (OR = 1.75, 95% CI: 1.27-2.41). Compared to survivors with no comorbidities, survivors with moderate or severe comorbidities were less likely to receive surveillance colonoscopy (OR = 0.69, 95% CI: 0.49-0.98 and OR = 0.44, 95% CI: 0.29-0.66, respectively). CONCLUSIONS: Despite guidelines, more than half of CRC survivors did not receive surveillance colonoscopy within 14 months of surgery, with substantial variation by site of care. The association of primary care visits and adjuvant chemotherapy use suggests that access to care following surgery affects cancer surveillance.

Authors
Salz, T; Weinberger, M; Ayanian, JZ; Brewer, NT; Earle, CC; Elston Lafata, J; Fisher, DA; Weiner, BJ; Sandler, RS
MLA Citation
Salz, T, Weinberger, M, Ayanian, JZ, Brewer, NT, Earle, CC, Elston Lafata, J, Fisher, DA, Weiner, BJ, and Sandler, RS. "Variation in use of surveillance colonoscopy among colorectal cancer survivors in the United States. (Published online)" BMC Health Serv Res 10 (September 1, 2010): 256-.
Website
http://hdl.handle.net/10161/4366
PMID
20809966
Source
pubmed
Published In
BMC Health Services Research
Volume
10
Publish Date
2010
Start Page
256
DOI
10.1186/1472-6963-10-256

The interrelationships between and contributions of background, cognitive, and environmental factors to colorectal cancer screening adherence.

OBJECTIVES: We examined the interrelationships between and contributions of background, cognitive, and environmental factors to colorectal cancer (CRC) screening adherence. METHODS: In this study, 2,416 average risk patients aged 50-75 from 24 Veterans Affairs medical facilities responded to a mailed survey with phone follow-up (response rate 81%). Survey data (attitudes, behaviors, demographics) were linked to facility (organizational complexity) and medical records data (diagnoses, screening history). Patients with a fecal occult blood test within 15 months, sigmoidoscopy or barium enema within 5.5 years, or colonoscopy within 11 years of the survey were considered adherent. Logistic regressions estimated the association between adherence and background, cognitive, and environmental factors. Deviance ratios examined interrelationships between factors. Population attributable risks (PAR) were used to identify intervention targets. RESULTS: The association of background factors with adherence was partially explained by cognitive and environmental factors. The association of environmental factors with adherence was partially explained by cognitive factors. Cognitive and environmental factors contributed equally to adherence. Factors with the highest PARs for non-adherence were age 50-64, less than two comorbidities, and lack of physician recommendation. CONCLUSIONS: Efforts to increase physician screening recommendations for younger, healthy patients at facilities with the lowest screening rates may improve CRC adherence in this setting.

Authors
Partin, MR; Noorbaloochi, S; Grill, J; Burgess, DJ; van Ryn, M; Fisher, DA; Griffin, JM; Powell, AA; Halek, K; Bangerter, A; Vernon, SW
MLA Citation
Partin, MR, Noorbaloochi, S, Grill, J, Burgess, DJ, van Ryn, M, Fisher, DA, Griffin, JM, Powell, AA, Halek, K, Bangerter, A, and Vernon, SW. "The interrelationships between and contributions of background, cognitive, and environmental factors to colorectal cancer screening adherence." Cancer Causes Control 21.9 (September 2010): 1357-1368.
PMID
20419343
Source
pubmed
Published In
Cancer Causes & Control
Volume
21
Issue
9
Publish Date
2010
Start Page
1357
End Page
1368
DOI
10.1007/s10552-010-9563-0

Obesity and receipt of clinical preventive services in veterans.

Although obese individuals utilize health care at higher rates than their normal weight counterparts, they may be less likely to receive certain preventive services. We conducted a retrospective cohort study of veterans with visits to 136 national Veterans Affairs (VA) outpatient clinics in the United States in the year 2000. The cohort included 1,699,219 patients: 94% men, 48% white, and 76% overweight or obese. Overweight and obese patients had higher adjusted odds of receiving each of the targeted clinical preventive services as recommended over 5 years compared with normal weight patients. The odds for receiving vaccinations increased linearly with BMI category: influenza (men: odds ratio (OR) = 1.13 for overweight to OR = 1.42 for obese class 3; women: OR = 1.15 for overweight to OR = 1.61 for obese class 3) and pneumococcus (men: OR = 1.02 for overweight to OR = 1.15 for obese class 3; women: OR = 1.08 for overweight to OR = 1.28 for obese class 3). The odds for receiving the cancer screening services typically peaked in the mild-moderately obese categories. The highest OR for prostate cancer screening was in obese class 2 (OR = 1.29); for colorectal cancer, obese class 1 (men: OR = 1.15; women OR = 1.10); for breast cancer screening, obese class 2 (OR = 1.19); and for cervical cancer screening, obese class 2 (OR = 1.06). In a large national sample, obese patients received preventive services at higher, not lower, rates than their normal weight peers. This may be due to the VA health service coverage and performance directives, a more homogeneous patient demographic profile, and/or unmeasured factors related to service receipt.

Authors
Yancy, WS; McDuffie, JR; Stechuchak, KM; Olsen, MK; Oddone, EZ; Kinsinger, LS; Datta, SK; Fisher, DA; Krause, KM; Østbye, T
MLA Citation
Yancy, WS, McDuffie, JR, Stechuchak, KM, Olsen, MK, Oddone, EZ, Kinsinger, LS, Datta, SK, Fisher, DA, Krause, KM, and Østbye, T. "Obesity and receipt of clinical preventive services in veterans." Obesity (Silver Spring) 18.9 (September 2010): 1827-1835.
PMID
20203629
Source
pubmed
Published In
Obesity
Volume
18
Issue
9
Publish Date
2010
Start Page
1827
End Page
1835
DOI
10.1038/oby.2010.40

Quality of colonoscopy reporting in community practice.

BACKGROUND: Quality endoscopy reporting is essential when community endoscopists perform colonoscopies for veterans who cannot be scheduled at a Veterans Administration (VA) facility. OBJECTIVE: To examine the quality of colonoscopy reports received from community practices and to determine factors associated with more complete reporting, by using national documentation guidelines. DESIGN: Cross-sectional analysis. SETTING: Reports submitted to the Durham VA Medical Center, Durham, North Carolina, from 2007 to 2008. PATIENTS: Subjects who underwent fee-basis colonoscopy. MAIN OUTCOME MEASUREMENTS: Scores created by comparing community reports with published documentation guidelines. Three scores were created, one for each category of information: Universal Elements (found on all endoscopy reports), Indication Elements (specific to the procedure indication), and Finding Elements (specific to examination findings). RESULTS: For the 135 included reports, the summary scores were Universal Elements, 57.6% (95% confidence interval [CI], 55%-60%); Indication Elements, 73.7% (95% CI, 69%-78%); and Finding Elements, 75.8% (95% CI, 73%-79%). Examples of poor reporting included patient history (20.7%), last colonoscopy date (18.0%), average versus high risk screening (32.0%), withdrawal time (5.9%), and cecal landmark photographs (45.2%). Only the use of automated reporting software was associated with more thorough reporting. LIMITATIONS: Modest sample size, mostly male participants, frequent pathologic findings, limited geography, and lack of complete reporting by a minority of providers. CONCLUSIONS: The overall completeness of colonoscopy reports was low, possibly reflecting a lack of knowledge of reporting guidelines or a lack of agreement regarding important colonoscopy reporting elements. Automated endoscopy software may improve reporting compliance but may not completely standardize reporting quality.

Authors
Palmer, LB; Abbott, DH; Hamilton, N; Provenzale, D; Fisher, DA
MLA Citation
Palmer, LB, Abbott, DH, Hamilton, N, Provenzale, D, and Fisher, DA. "Quality of colonoscopy reporting in community practice." Gastrointest Endosc 72.2 (August 2010): 321-327.e1.
PMID
20591430
Source
pubmed
Published In
Gastrointestinal Endoscopy
Volume
72
Issue
2
Publish Date
2010
Start Page
321
End Page
327.e1
DOI
10.1016/j.gie.2010.03.002

Cap-assisted endoscopic mucosal resection of large polyps involving the ileocecal valve.

Standard endoscopic mucosal resection (EMR) is limited with regard to lesions below or involving the ileocecal valve. We describe the treatment and outcomes when using cap-assisted EMR (EMR-C) to remove large laterally spreading tumors (LSTs) with ileal infiltration in seven patients (median age 74 years). Each LST (median size 40 mm) was successfully resected in one session (median procedure time 50 minutes). Intraprocedural and early bleeding occurred in two patients, and delayed hemorrhage in one. Circumferential resection of the ileum caused asymptomatic strictures in six patients, with regression during follow-up for five. We conclude that the novel EMR-C method is a potentially effective treatment for cecal LST involving the distal ileum. Serious complications such as perforation or symptomatic strictures of the ileocecal valve were not observed and any procedure-related bleeding was easily controlled.

Authors
Conio, M; Blanchi, S; Filiberti, R; Ruggeri, C; Fisher, DA
MLA Citation
Conio, M, Blanchi, S, Filiberti, R, Ruggeri, C, and Fisher, DA. "Cap-assisted endoscopic mucosal resection of large polyps involving the ileocecal valve." Endoscopy 42.8 (August 2010): 677-680.
PMID
20593344
Source
pubmed
Published In
Endoscopy
Volume
42
Issue
8
Publish Date
2010
Start Page
677
End Page
680
DOI
10.1055/s-0030-1255565

Ascertainment of colonoscopy indication using administrative data.

BACKGROUND: Administrative procedure code data can estimate colonoscopy utilization; however, determining colonoscopy indication is more difficult as procedure codes do not inherently reflect the purpose (screening, surveillance, diagnosis) of the colonoscopy. AIM: To improve the reported sensitivity (70%) and specificity (72%) of a published algorithm for identifying screening colonoscopies using Veterans Health Administration (VHA) administrative data. METHODS: We validated three algorithms for determining colonoscopy indication using medical records as the gold standard in a national sample of 650 patients. Algorithms used International Classification of Diseases, 9th Revision (ICD-9) and Current Procedural Terminology (CPT) codes. Medical records were manually abstracted using standardized protocols. RESULTS: The best algorithm had 83% sensitivity and 76% specificity for screening indication. Over 99% of colonoscopy CPT codes corresponded to a colonoscopy in the medical record. CONCLUSIONS: VHA procedure codes are very accurate for colonoscopy utilization; however, algorithms to ascertain indication have only moderate accuracy.

Authors
Fisher, DA; Grubber, JM; Castor, JM; Coffman, CJ
MLA Citation
Fisher, DA, Grubber, JM, Castor, JM, and Coffman, CJ. "Ascertainment of colonoscopy indication using administrative data." Dig Dis Sci 55.6 (June 2010): 1721-1725.
PMID
20393875
Source
pubmed
Published In
Digestive Diseases and Sciences
Volume
55
Issue
6
Publish Date
2010
Start Page
1721
End Page
1725
DOI
10.1007/s10620-010-1200-y

Cap-assisted endoscopic mucosal resection for colorectal polyps.

PURPOSE: Cap-assisted endoscopic mucosal resection has been used to treat superficial esophageal and gastric cancers. Efficacy data in the colon are limited. The aim of the study was to evaluate the safety and efficacy of this technique in the treatment of sessile polyps and lateral spreading tumors in the colorectum. METHODS: Two-hundred and fifty-five consecutive patients with sessile polyps or lateral spreading tumors >or=20 mm were treated between January 2000 and December 2007. RESULTS: A total of 146 sessile polyps and 136 lateral spreading tumors were treated with cap-assisted endoscopic mucosal resection. Complications occurred in 22 (8.6%) patients (5.5% in sessile polyps and 10.3% in lateral spreading tumors). Intraprocedural bleeding occurred in 21 (7%) of polypectomies (6% in sessile polyps and 10% in lateral spreading tumors); all were controlled endoscopically. Postcoagulation syndrome occurred in 1 patient with lateral spreading tumor. No perforation occurred. Invasive adenocarcinoma was found in 35 patients, of whom 15 underwent surgery. Endoscopic follow-up in 200 patients with 216 adenomas for a median of 12.1 months showed recurrence in 8 (4%) who were treated with resection and/or ablation. CONCLUSIONS: Cap-assisted endoscopic mucosal resection is an effective treatment for sessile polyps and lateral spreading tumors. A disadvantage of the technique is that the resection is piecemeal. Close surveillance provides the opportunity for additional tissue ablation, when required, to achieve complete lesion removal.

Authors
Conio, M; Blanchi, S; Repici, A; Ruggeri, C; Fisher, DA; Filiberti, R
MLA Citation
Conio, M, Blanchi, S, Repici, A, Ruggeri, C, Fisher, DA, and Filiberti, R. "Cap-assisted endoscopic mucosal resection for colorectal polyps." Dis Colon Rectum 53.6 (June 2010): 919-927.
PMID
20485006
Source
pubmed
Published In
Diseases of the Colon and Rectum
Volume
53
Issue
6
Publish Date
2010
Start Page
919
End Page
927
DOI
10.1007/DCR.0b013e3181d95a54

Determinants of medical system delay in the diagnosis of colorectal cancer within the Veteran Affairs Health System.

BACKGROUND AND AIMS: The goals of this study are to evaluate determinants of the time in the medical system until a colorectal cancer diagnosis and to explore characteristics associated with stage at diagnosis. METHODS: We examined medical records and survey data for 468 patients with colorectal cancer at 15 Veterans Affairs medical centers. Patients were classified as screen-detected, bleeding-detected, or other (resulting from the evaluation of another medical concern). Patients who presented emergently with obstruction or perforation were excluded. We used Cox proportional hazards models to determine predictors of time in the medical system until diagnosis. Logistic regression models were used to determine predictors of stage at diagnosis. RESULTS: We excluded 21 subjects who presented emergently, leaving 447 subjects; the mean age was 67 years and 98% were male, 66% Caucasian, and 43% stage I or II. Diagnosis was by screening for 39%, bleeding symptoms for 27%, and other for 34%. The median times to diagnosis were 73-91 days and were not significantly different by diagnostic category. In the multivariable model for time to diagnosis, older age, having comorbidities, and Atlantic region were associated with a longer time to diagnosis. In the multivariable model for stage-at-diagnosis, only the diagnostic category was associated with stage; the screen-detected category was associated with decreased risk of late-stage cancer. CONCLUSIONS: Our results point to several factors associated with a longer time from the initial clinical event until diagnosis. This increased time in the health care system did not clearly translate into more advanced disease at diagnosis.

Authors
Fisher, DA; Zullig, LL; Grambow, SC; Abbott, DH; Sandler, RS; Fletcher, RH; El-Serag, HB; Provenzale, D
MLA Citation
Fisher, DA, Zullig, LL, Grambow, SC, Abbott, DH, Sandler, RS, Fletcher, RH, El-Serag, HB, and Provenzale, D. "Determinants of medical system delay in the diagnosis of colorectal cancer within the Veteran Affairs Health System." Dig Dis Sci 55.5 (May 2010): 1434-1441.
PMID
20238248
Source
pubmed
Published In
Digestive Diseases and Sciences
Volume
55
Issue
5
Publish Date
2010
Start Page
1434
End Page
1441
DOI
10.1007/s10620-010-1174-9

Using VA administrative data to measure colorectal cancer screening adherence among average-risk non-elderly veterans

This study represents a new application of Veterans Affairs (VA) administrative data for measuring VA system-wide performance of colorectal cancer (CRC) screening adherence among veterans at average-risk for CRC. Our new measurement has two features: it is specifically designed for average-risk populations and is applied repeatedly at the veteran level each year over the study period. Using 1997-2007 VA administrative data, we developed an algorithm that first constructed 7 independent cohorts of average-risk veterans eligible for CRC screening, one for each year from 2001 to 2007, and then appended the seven cohorts together to form 2001-2007 veteran-level panel data. Veterans in a cohort for a given year were considered adherent if they received fecal occult blood test (FOBT) during that given year, or received flexible sigmoidoscopy (FS), double-contrast barium enema (DCBE), or colonoscopy during that given year or the 4 previous years. The main analysis shows that VA CRC screening rates increased from 30.11% in 2001 to 35.51% in 2004, but declined to 31.54% in 2007. Among the screened, the proportion adherent to colonoscopy increased over the 7-year period while the proportion adherent to FOBT, FS, or DCBE decreased during the same period. Sensitivity analyses, including use of a 10-year retrospective window for determining the screening adherence of colonoscopy, show the robustness of the main analysis. This new algorithm demonstrates that VA administrative data may be used for assessing VA performance of CRC screening adherence of average-risk veterans. Furthermore, our panel data may enhance understanding of factors associated with CRC screening adherence. © 2010 Springer Science+Business Media, LLC.

Authors
Bian, J; Fisher, DA; Gillespie, TW; Halpern, MT; Lipscomb, J
MLA Citation
Bian, J, Fisher, DA, Gillespie, TW, Halpern, MT, and Lipscomb, J. "Using VA administrative data to measure colorectal cancer screening adherence among average-risk non-elderly veterans." Health Services and Outcomes Research Methodology 10.3-4 (2010): 165-177.
Source
scival
Published In
Health Services and Outcomes Research Methodology
Volume
10
Issue
3-4
Publish Date
2010
Start Page
165
End Page
177
DOI
10.1007/s10742-010-0068-9

Esophageal strictures, tumors, and fistulae: Stents for primary esophageal cancer

Self-expandable metal stents (SEMS) have become the most used endoprostheses for palliation of dysphagia in obstructive malignancies of the esophagus or esophagogastric junction. They allow immediate relief from dysphagia and resumption of an almost normal diet within a short period. However, SEMS are associated with early and late complications and procedure-related death has been reported. This article reviews currently available SEMS, considerations for choosing SEMS type, indications for SEMS, techniques for SEMS placement, efficacy data, and complications. © 2010 Elsevier Inc.

Authors
Conio, M; Ceglie, AD; Blanchi, S; Fisher, DA
MLA Citation
Conio, M, Ceglie, AD, Blanchi, S, and Fisher, DA. "Esophageal strictures, tumors, and fistulae: Stents for primary esophageal cancer." Techniques in Gastrointestinal Endoscopy 12.4 (2010): 191-202.
Source
scival
Published In
Techniques in Gastrointestinal Endoscopy
Volume
12
Issue
4
Publish Date
2010
Start Page
191
End Page
202
DOI
10.1016/j.tgie.2011.02.013

Time from positive screening fecal occult blood test to colonoscopy and risk of neoplasia.

There is no guideline defining the optimal time from a positive screening fecal occult blood test to follow-up colonoscopy. We reviewed records of 231 consecutive primary care patients who received a colonoscopy within 18 months of a positive fecal occult blood test. We examined the relationship between time to colonoscopy and risk of neoplasia on colonoscopy using a logistic regression analysis adjusting for potential confounders such as age, race, and gender. The mean time to colonoscopy was 236 days. Longer time to colonoscopy (OR = 1.10, P = 0.01) and older age (OR 1.04, P = 0.01) were associated with higher odds of neoplasia. The association of time with advanced neoplasia was positive, but not statistically significant (OR 1.07, P = 0.14). In this study, a longer interval to colonoscopy after fecal occult blood test was associated with an increased risk of neoplasia. Determining the optimal interval for follow-up is desirable and will require larger studies.

Authors
Gellad, ZF; Almirall, D; Provenzale, D; Fisher, DA
MLA Citation
Gellad, ZF, Almirall, D, Provenzale, D, and Fisher, DA. "Time from positive screening fecal occult blood test to colonoscopy and risk of neoplasia." Dig Dis Sci 54.11 (November 2009): 2497-2502.
PMID
19093199
Source
pubmed
Published In
Digestive Diseases and Sciences
Volume
54
Issue
11
Publish Date
2009
Start Page
2497
End Page
2502
DOI
10.1007/s10620-008-0653-8

Validation of a questionnaire to assess self-reported colorectal cancer screening status using face-to-face administration.

PURPOSE: The aim of this study was to assess the accuracy of a National Cancer Institute (NCI)-developed colorectal cancer screening questionnaire. METHODS: We conducted 36 cognitive interviews and made iterative changes to the questionnaire to improve comprehension. The revised questionnaire was administered face-to-face to 201 participants. The primary outcome was agreement between questionnaire responses and medical records for whether or not a participant was up-to-date for any colorectal cancer screening test. RESULTS: Comprehension of descriptions and questions was generally good; however, the barium enema description required several revisions. The sensitivity of the questionnaire for up-to-date screening status was 94%, specificity 63%, and concordance 88%. CONCLUSIONS: The modified questionnaire was highly sensitive for determining if a person was up-to-date for any colorectal cancer screening test, although the specificity was low. Given the difficulty of obtaining all relevant records, self-report using this questionnaire is a reasonable option for identifying people who have undergone testing.

Authors
Fisher, DA; Voils, CI; Coffman, CJ; Grubber, JM; Dudley, TK; Vernon, SW; Bond, JH; Provenzale, D
MLA Citation
Fisher, DA, Voils, CI, Coffman, CJ, Grubber, JM, Dudley, TK, Vernon, SW, Bond, JH, and Provenzale, D. "Validation of a questionnaire to assess self-reported colorectal cancer screening status using face-to-face administration." Dig Dis Sci 54.6 (June 2009): 1297-1306.
PMID
18726152
Source
pubmed
Published In
Digestive Diseases and Sciences
Volume
54
Issue
6
Publish Date
2009
Start Page
1297
End Page
1306
DOI
10.1007/s10620-008-0471-z

Noninvasive tests for colorectal cancer screening

Authors
Fisher, DA
MLA Citation
Fisher, DA. "Noninvasive tests for colorectal cancer screening." Gastroenterology and Hepatology 5.5 (2009): 315-318+323.
Source
scival
Published In
Gastroenterology & hepatology
Volume
5
Issue
5
Publish Date
2009
Start Page
315
End Page
318+323

Randomized trial showed requesting medical records with a survey produced a more representative sample than requesting separately.

OBJECTIVES: The objective of the study was to compare the effect of two approaches to requesting medical records on survey response rates, sample representativeness, and the quality of self-reported screening. STUDY DESIGN AND SETTING: Eight hundred ninety veterans aged 50-75 years from the Minneapolis VA Medical Center were randomly assigned to (1) records request included with a colorectal cancer screening survey ("with-survey" group) or (2) request in a separate mailing following a completed survey ("after-survey" group). Analyses compared response rates, the proportion and characteristics of patients providing records, and the validity of self-reported screening, by group. RESULTS: Response rates did not vary by group (with-survey 76%; after-survey 78%, P=0.45). 54% of with-survey and 47% of after-survey participants provided complete medical records (P = 0.06). In the with-survey group, patients with complete medical records were significantly more likely to be married and to have a diagnosis of posttraumatic stress disorder; in the after-survey group, they were more likely to be aged 65-75 years, Caucasian, to have a family history of colorectal cancer, and to report being screened. Validity of self-reported screening did not vary significantly by group. CONCLUSION: The with-survey approach did not significantly reduce response rates or the quality of self-reported screening and produced a higher number and more representative sample with complete records.

Authors
Partin, MR; Burgess, DJ; Halek, K; Grill, J; Vernon, SW; Fisher, DA; Griffin, JM; Murdoch, M
MLA Citation
Partin, MR, Burgess, DJ, Halek, K, Grill, J, Vernon, SW, Fisher, DA, Griffin, JM, and Murdoch, M. "Randomized trial showed requesting medical records with a survey produced a more representative sample than requesting separately." J Clin Epidemiol 61.10 (October 2008): 1028-1035.
PMID
18550333
Source
pubmed
Published In
Journal of Clinical Epidemiology
Volume
61
Issue
10
Publish Date
2008
Start Page
1028
End Page
1035
DOI
10.1016/j.jclinepi.2007.11.015

Validation of self-reported colorectal cancer screening behavior from a mixed-mode survey of veterans.

OBJECTIVE: The aim of the study was to validate self-reported colorectal cancer (CRC) screening using the National Cancer Institute Colorectal Cancer Screening questionnaire. MATERIALS AND METHODS: 890 patients, ages 50 to 75 years, from the Minneapolis Veterans Affairs (VA) Medical Center were surveyed by mail. Phone administration was attempted with mail nonresponders. VA and non-VA records were combined for the reference standard. Sensitivity, specificity, concordance, and report-to-records ratio (R2R) were estimated for overall and test-specific CRC adherence among respondents providing complete medical records. Secondary analyses examined variation in estimates by patient characteristics, treatment of missing and uncertain responses, and whether a strict or liberal time interval was used for assessing concordance. RESULTS: Complete medical records were available for 345 of the 686 survey responders. For overall adherence, sensitivity was 0.98, specificity was 0.59, concordance was 0.88, and R2R was 1.14. Sensitivity was 0.82 for fecal occult blood test (FOBT), 0.75 for sigmoidoscopy, 0.97 for colonoscopy, and 0.63 for double-contrast barium enema (DCBE). Specificity was 0.89 for FOBT, 0.76 for sigmoidoscopy, 0.72 for colonoscopy, and 0.85 for DCBE. Concordance was >0.80 for all tests other than sigmoidoscopy (0.76). R2R was 1.31 for FOBT, 1.33 for sigmoidoscopy, 1.42 for colonoscopy, and 6.13 for DCBE. The R2R was lower for a combined sigmoidoscopy and colonoscopy measure. Overreporting was more pronounced for older, less-educated individuals with no family history of CRC. Sensitivity and R2R improved using a liberal interval and treating uncertain responses as nonadherent (versus missing), but differences were not statistically significant. CONCLUSIONS: Self-reported CRC screening validity is generally acceptable and robust across definitional decisions, but varies by screening test and patient characteristics.

Authors
Partin, MR; Grill, J; Noorbaloochi, S; Powell, AA; Burgess, DJ; Vernon, SW; Halek, K; Griffin, JM; van Ryn, M; Fisher, DA
MLA Citation
Partin, MR, Grill, J, Noorbaloochi, S, Powell, AA, Burgess, DJ, Vernon, SW, Halek, K, Griffin, JM, van Ryn, M, and Fisher, DA. "Validation of self-reported colorectal cancer screening behavior from a mixed-mode survey of veterans." Cancer Epidemiol Biomarkers Prev 17.4 (April 2008): 768-776.
PMID
18381474
Source
pubmed
Published In
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
Volume
17
Issue
4
Publish Date
2008
Start Page
768
End Page
776
DOI
10.1158/1055-9965.EPI-07-0759

Time from positive screening fecal occult blood test to colonoscopy and risk of neoplasia

Authors
Gellad, ZF; Almirall, D; Provenzale, D; Fisher, DA
MLA Citation
Gellad, ZF, Almirall, D, Provenzale, D, and Fisher, DA. "Time from positive screening fecal occult blood test to colonoscopy and risk of neoplasia." GASTROENTEROLOGY 134.4 (April 2008): A151-A152.
Source
wos-lite
Published In
Gastroenterology
Volume
134
Issue
4
Publish Date
2008
Start Page
A151
End Page
A152

Prevalence and predictors of fecal occult blood testing after colonoscopy

Authors
Fisher, DA; Grubber, J; Coffman, CJ; Voils, CI; Vernon, SW; Provenzale, D
MLA Citation
Fisher, DA, Grubber, J, Coffman, CJ, Voils, CI, Vernon, SW, and Provenzale, D. "Prevalence and predictors of fecal occult blood testing after colonoscopy." April 2008.
Source
wos-lite
Published In
Gastroenterology
Volume
134
Issue
4
Publish Date
2008
Start Page
A160
End Page
A160

Do patients know why they had a colonoscopy?

Authors
Fisher, DA; Grubber, J; Coffman, CJ; Voils, CI; Vernon, SW; Provenzale, D
MLA Citation
Fisher, DA, Grubber, J, Coffman, CJ, Voils, CI, Vernon, SW, and Provenzale, D. "Do patients know why they had a colonoscopy?." April 2008.
Source
wos-lite
Published In
Gastroenterology
Volume
134
Issue
4
Publish Date
2008
Start Page
A317
End Page
A317

Assessing the quality of colorectal cancer care: do we have appropriate quality measures? (A systematic review of literature).

RATIONALE, AIMS AND OBJECTIVES: The burden of illness from colorectal cancer (CRC) can be reduced by improving the quality of care. Identifying appropriate quality measures is the first step in this direction. We identified process measures currently available to assess the quality of diagnosis and management of CRC. We also evaluated the extent to which these measures are ready to be implemented in clinical practice, and identified areas for future research. METHODS: We searched MEDLINE, Cochrane Database of Systematic Reviews, and relevant grey literature. We identified 3771 abstracts and reviewed 74 articles that included quality measures for diagnosis or management of CRC. Measures from traditional quality improvement literature, and from epidemiological and other studies that included quality measures as part of their research agenda, were considered. In addition, we devised a summary rating scale (IST) to appraise the extent of a measure's importance and usability, scientific acceptability and extent of testing. RESULTS: The coverage of general process measures in CRC is extensive. Most measures are important, but need to be developed and field-tested. The best available measures relate to pathology and chemotherapy. No measures are available for assessing quality of management of stage IV rectal cancer and hepatic metastasis; chemotherapy for stage II colon cancer; and procedure notes. CONCLUSIONS: There is an urgent need to refine existing measures and to develop scientifically accurate quality measures for a comprehensive assessment of the quality of CRC care. The role of the federal government and professional societies is critical in pursuing this goal.

Authors
Patwardhan, M; Fisher, DA; Mantyh, CR; McCrory, DC; Morse, MA; Prosnitz, RG; Cline, K; Samsa, GP
MLA Citation
Patwardhan, M, Fisher, DA, Mantyh, CR, McCrory, DC, Morse, MA, Prosnitz, RG, Cline, K, and Samsa, GP. "Assessing the quality of colorectal cancer care: do we have appropriate quality measures? (A systematic review of literature)." J Eval Clin Pract 13.6 (December 2007): 831-845. (Review)
PMID
18070253
Source
pubmed
Published In
Journal of Evaluation in Clinical Practice
Volume
13
Issue
6
Publish Date
2007
Start Page
831
End Page
845
DOI
10.1111/j.1365-2753.2006.00762.x

Adherence to polyp surveillance guidelines at an academic VA medical center

Authors
Wachter, AC; Fisher, DA
MLA Citation
Wachter, AC, and Fisher, DA. "Adherence to polyp surveillance guidelines at an academic VA medical center." September 2007.
Source
wos-lite
Published In
The American Journal of Gastroenterology (Elsevier)
Volume
102
Publish Date
2007
Start Page
S555
End Page
S555

Impact of comorbidity on colorectal cancer screening in the veterans healthcare system.

BACKGROUND & AIMS: The quality assessment measure of colorectal cancer screening in the veteran's health system reports the proportion of patients aged 52-80 years who were tested. This approach does little to assess for comorbid illnesses, which might limit the utility of screening. Our aim was to determine the relationship between patient comorbidity and screening by fecal occult blood test in a national sample of veterans. METHODS: We examined the Veterans Health Administration's national databases (October 2003-February 2005) for a random sample of primary care patients, aged > or = 50 years. The Charlson score, a validated measure of comorbidity burden, was calculated from diagnosis codes by the Deyo method. The association between Charlson score and colorectal cancer screening was assessed with logistic regression. RESULTS: The sample of 77,268 was 97% men; mean age was 67 years. Charlson score distribution was 0, 45%; 1, 24%; 2, 14%; 3, 7%; 4, 4%; 5, 2%; 6, 1%; 7, 0.8%; 8, 0.6%; 9, 0.4%; > or = 10, 1%. Overall there was no consistent significant association between Charlson score and use of fecal occult blood testing except in the sickest 1%. There was a strong and incremental relationship between Charlson score and 1-year mortality. CONCLUSIONS: Although there was a strong relationship in the veteran population between the Charlson score and survival, colorectal cancer screening utilization was not impacted by Charlson score. Instead, resources were expended evenly throughout the population, rather than directed toward screening the patients with the most life-years at stake. The quality measure for colorectal cancer screening should be modified to account for patient comorbidity.

Authors
Fisher, DA; Galanko, J; Dudley, TK; Shaheen, NJ
MLA Citation
Fisher, DA, Galanko, J, Dudley, TK, and Shaheen, NJ. "Impact of comorbidity on colorectal cancer screening in the veterans healthcare system." Clin Gastroenterol Hepatol 5.8 (August 2007): 991-996.
PMID
17627900
Source
pubmed
Published In
Clinical Gastroenterology and Hepatology
Volume
5
Issue
8
Publish Date
2007
Start Page
991
End Page
996
DOI
10.1016/j.cgh.2007.04.010

Calling a spade a spade--are we biased against "normal"?

Authors
Fisher, DA
MLA Citation
Fisher, DA. "Calling a spade a spade--are we biased against "normal"?." Am J Gastroenterol 102.8 (August 2007): 1588-1589.
PMID
17686063
Source
pubmed
Published In
The American Journal of Gastroenterology (Elsevier)
Volume
102
Issue
8
Publish Date
2007
Start Page
1588
End Page
1589
DOI
10.1111/j.1572-0241.2006.00963.x

The bottom line: offer the colorectal cancer screening test that you can deliver.

Authors
Fisher, DA
MLA Citation
Fisher, DA. "The bottom line: offer the colorectal cancer screening test that you can deliver." Gastrointest Endosc 65.4 (April 2007): 646-647.
PMID
17173919
Source
pubmed
Published In
Gastrointestinal Endoscopy
Volume
65
Issue
4
Publish Date
2007
Start Page
646
End Page
647
DOI
10.1016/j.gie.2006.07.027

Fecal occult blood testing completion in a VA population: Low and strongly related to race

Objective: To assess the proportion of subjects who complete an ordered fecal occult blood test (FOBT) and to determine predictors of FOBT card return in the Veterans Affairs (VA) health care system. Design: Retrospective medical record review. Setting: Single VA facility. Participants: 500 consecutive patients who had screening FOBT ordered. Measurements: Patient demographics and FOBT completion. Results: The sample was 97% men and had a mean age of 64 years. The racial distribution was 62% white, 30% African American, 6% race unknown, and < 1% "other." Approximately 46% of the patients had previously completed an FOBT. Only 46% of the patients had returned the FOBT cards at 9 months. 51% of whites returned FOBT cards compared with 37% of African-American patients. The adjusted odds (95% confidence intervals) of FOBT return were 2.6 (1.8-3.8) for those with a prior completed FOBT and 1.6 (1.1-2.5) for whites compared with African-American patients. Logistic regression showed no significant association with returned FOBT cards and age, urban/rural status, or having a post office box. Conclusions: The benefit of colorectal cancer screening was lost by over half the study sample because the FOBT cards were not returned. Prior FOBT completion predicted current FOBT adherence. White patients were almost twice as likely to return FOBT cards. The poor return rate, particularly for African-American patients, inflates estimates of colorectal cancer screening utilization in our facility.

Authors
Fisher, DA; Johnson, MR; Shaheen, NJ
MLA Citation
Fisher, DA, Johnson, MR, and Shaheen, NJ. "Fecal occult blood testing completion in a VA population: Low and strongly related to race." Journal of Clinical Outcomes Management 14.2 (2007): 93-98.
Source
scival
Published In
Journal of clinical outcomes management : JCOM
Volume
14
Issue
2
Publish Date
2007
Start Page
93
End Page
98

The utility of upper endoscopy in patients with concomitant upper gastrointestinal bleeding and acute myocardial infarction.

Patients who present with upper gastrointestinal bleeding (UGIB) in the setting of acute myocardial infarction (AMI) may have suffered an UGIB that subsequently led to an AMI or endured an AMI and subsequently suffered a UGIB as a consequence of anticoagulation. We hypothesized that patients in the former group bled from more severe upper tract lesions. The aim of this study was to evaluate predictors for endoscopic therapy in patients who suffer a concomitant UGIB and AMI. Retrospective, single center medical record abstraction of hospital admissions from January 1, 1996-December 31, 2002. During the study period, 183 patients underwent an esophagogastroduodenoscopy (EGD) within 7 days of suffering an AMI and UGIB (AMI group N=105, UGIB group N=78). A higher proportion of patients in the UGIB group (41%) was found to have high-risk UGI lesions requiring endoscopic treatment compared to patients in the AMI group (17%; P < 0.004). UGIB as the inciting event and patients suffering from hematemesis and hemodynamic instability were significantly associated with requiring endoscopic therapy. Although predominantly diagnostic, endoscopic findings in the AMI group did alter the decision to perform cardiac catheterization in 43% of patients. Severe complications occurred in 1% (95% confidence interval, 0%-4%) of patients. We conclude that in patients suffering from concomitant UGIB and AMI, urgent endoscopy was most beneficial in patients with UGIB as the initial event and those presenting with hematemesis and hemodynamic instability. In patients without these clinical features, urgent endoscopy may be delayed, unless cardiac management decisions are dependent on endoscopic findings.

Authors
Lin, S; Konstance, R; Jollis, J; Fisher, DA
MLA Citation
Lin, S, Konstance, R, Jollis, J, and Fisher, DA. "The utility of upper endoscopy in patients with concomitant upper gastrointestinal bleeding and acute myocardial infarction." Dig Dis Sci 51.12 (December 2006): 2377-2383.
PMID
17151907
Source
pubmed
Published In
Digestive Diseases and Sciences
Volume
51
Issue
12
Publish Date
2006
Start Page
2377
End Page
2383
DOI
10.1007/s10620-006-9326-7

Quality measures for the use of adjuvant chemotherapy and radiation therapy in patients with colorectal cancer: a systematic review.

BACKGROUND: Chemotherapy (CT) and radiation therapy (RT) are essential components of adjuvant (preoperative or postoperative) therapy for many patients with colorectal cancer (CRC); however, quality measures (QMs) of these critical aspects of CRC treatment have not been characterized well. Therefore, the authors conducted a systematic review of the literature to determine the available QMs for adjuvant CT and RT in patients with CRC and rated their usefulness for assessing the delivery of quality care. METHODS: The MEDLINE and Cochrane data bases were searched for all publications that contained potential/actual QMs pertaining to adjuvant therapy for CRC. Identified QMs were rated by using criteria developed by the National Quality Forum. RESULTS: Thirty-two articles met the established inclusion/exclusion criteria. Those 32 articles contained 12 potential or actual QMs, 6 of which had major flaws that limited their applicability. The most useful QMs identified were 1) the percentage of patients with AJCC Stage III colon cancer who received postoperative CT and 2) the percentage of patients with Stage II or III rectal cancer who received chemoradiotherapy. CONCLUSIONS: To the authors' knowledge, very few QMs pertaining to adjuvant CT or RT for CRC have been published to date, and only half of those measures were rated as useful, acceptable, and valid in the current literature review. Future research should focus on refining existing QMs and on developing new QMs that target important leverage points with respect to the provision of adjuvant therapy for patients with CRC.

Authors
Prosnitz, RG; Patwardhan, MB; Samsa, GP; Mantyh, CR; Fisher, DA; McCrory, DC; Cline, KE; Gray, RN; Morse, MA
MLA Citation
Prosnitz, RG, Patwardhan, MB, Samsa, GP, Mantyh, CR, Fisher, DA, McCrory, DC, Cline, KE, Gray, RN, and Morse, MA. "Quality measures for the use of adjuvant chemotherapy and radiation therapy in patients with colorectal cancer: a systematic review." Cancer 107.10 (November 15, 2006): 2352-2360. (Review)
PMID
17039499
Source
pubmed
Published In
Cancer
Volume
107
Issue
10
Publish Date
2006
Start Page
2352
End Page
2360
DOI
10.1002/cncr.22278

Colorectal cancer screening, comorbidity, and follow-up in elderly patients.

OBJECTIVE: We examined the relationship between comorbid disease and performance of complete colon examination by colonoscopy or double contrast barium enema (DCBE) after positive screening fecal occult blood test (FOBT) in patients 70 years of age or older. BACKGROUND: FOBT is an accepted form of colorectal cancer (CRC) screening. Factors that influence follow-up of positive FOBT have been largely unknown. METHODS: Patients aged 70 years and older with positive FOBT between March 1, 2000 and Feb 28, 2001 were included in this retrospective medical record review performed at a single center. Comorbidity was measured by the Charlson Comorbidity Scale. RESULTS: : In our sample of 266 subjects, 193 (73%) were referred for evaluation of positive FOBT and 109 (41%) underwent a colonoscopy or DCBE within 12 months. Using the Charlson score for comorbidity, 27% of our sample scored 0, 24% scored 1, and 23% scored 2 while 26% had a Charlson score of 3 or higher. There was no association between Charlson score (0, 1, 2, and > or =3) and referral for evaluation (chi test, P = 0.28) or performance of a complete colon examination (chi test, P = 0.38). CONCLUSIONS: In this sample, only 41% of patients with positive FOBT underwent a full colon examination within 12 months of a positive FOBT. Although comorbidity burden was considerable, there was no association between comorbidity score and referral for or performance of a full colon examination. These results suggest that inappropriate patients receive CRC screening, which may contribute to delays for screening appropriate patients and diagnostic delays for others with positive screening test findings.

Authors
Garman, KS; Jeffreys, A; Coffman, C; Fisher, DA
MLA Citation
Garman, KS, Jeffreys, A, Coffman, C, and Fisher, DA. "Colorectal cancer screening, comorbidity, and follow-up in elderly patients." Am J Med Sci 332.4 (October 2006): 159-163.
PMID
17031239
Source
pubmed
Published In
American Journal of the Medical Sciences
Volume
332
Issue
4
Publish Date
2006
Start Page
159
End Page
163

Quality measures for the diagnosis and management of colorectal cancer.

16031 Background: The huge burden of illness from colorectal cancer (CRC) can be reduced by improving the quality of care for CRC patients. Identifying appropriate quality measures that can assess the processes of care is the first step in this process. Therefore we conducted a comprehensive literature search to identify process measures available in the United States to assess the quality of care for diagnosing and managing patients with CRC and the extent to which they were field-ready.We conducted a standard literature search using MEDLINE and the Cochrane Database; also explored gray literature, and identified 3771 abstracts. By sequential exclusion, 74 of them were finally included. We included quality measures from traditional QI literature, and supplemented them with those included in studies where these measures were used as part of their research agenda. All measures were abstracted into evidence tables and evaluated using a set of standard criteria regarding their importance, usability, and scientific acceptability. In order to assess the extent to which they were field-ready, we devised a summary rating scale for each quality measure using three criteria: importance and usability, scientific acceptability, and extent of testing.Overall, the coverage of general process measures in CRC is extensive. Process measures are available for diagnostic imaging, staging, surgical therapy, adjuvant chemotherapy, adjuvant radiation therapy, and colonoscopic surveillance. The highest rated measures were those related to chemotherapy (abstract submitted by Morse et al) and pathology reporting. There were no process measures for assessing the quality of: polyp removal, surgical management of stage IV rectal cancer, hepatic metastasis, chemotherapy for stage II colon cancer, stage IV rectal cancer, radiation for stage IV rectal cancer, and notes for endoscopy, surgery, chemotherapy and radiology - all because of lack of guidelines.Our evidence report suggests that we need to actively pursue the task of developing scientifically accurate quality measures for leverage points in the diagnosis and management of CRC; so we can evaluate the quality of care delivered by providers and initiate quality improvement activities, with the aim of providing better patient care. No significant financial relationships to disclose.

Authors
Patwardhan, MB; Samsa, GP; Michael, MA; Prosnitz, RG; Fisher, DA; Mantyh, CR; McCrory, DC
MLA Citation
Patwardhan, MB, Samsa, GP, Michael, MA, Prosnitz, RG, Fisher, DA, Mantyh, CR, and McCrory, DC. "Quality measures for the diagnosis and management of colorectal cancer." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 24.18_suppl (June 2006): 16031-.
PMID
27954983
Source
epmc
Published In
Journal of Clinical Oncology
Volume
24
Issue
18_suppl
Publish Date
2006
Start Page
16031

Barriers to full colon evaluation for a positive fecal occult blood test.

BACKGROUND: Failure to appropriately evaluate a positive cancer screening test may negate the value of doing that test. The primary aim of this study was to explore the factors associated with undergoing a full colon evaluation for a positive fecal occult blood test (FOBT) in a single Veterans Affairs center. METHODS: Medical records of consecutive patients ages > or = 50 years, who had a positive screening FOBT from March 2000 to February 2001, were abstracted. Patient demographics, dates of ordering and doing follow-up test(s), and adherence with scheduled procedures were collected. The primary outcome, full colon evaluation, was defined as having a colonoscopy or double-contrast barium enema plus flexible sigmoidoscopy completed within 12 months. RESULTS: The sample (N = 538) was 98% men (58% Caucasian, 29% African-American, and 13% unknown race). Approximately 77% of the patients were referred to gastroenterology. Ultimately, only 44% underwent full colon evaluation within 12 months. Approximately 20% of the patients failed to attend a scheduled procedure. Referral to gastroenterology and adherence to follow-up appointments were associated with full colon evaluation. There was no association between African-American versus Caucasian race and full colon evaluation. CONCLUSIONS: Less than half of the patients with a positive FOBT had a full colon evaluation within 12 months. Multiple failures were identified, including lack of referral for further testing and patient nonadherence. Although the overall performance in evaluating a positive colorectal cancer screening test was poor, no racial disparity was observed.

Authors
Fisher, DA; Jeffreys, A; Coffman, CJ; Fasanella, K
MLA Citation
Fisher, DA, Jeffreys, A, Coffman, CJ, and Fasanella, K. "Barriers to full colon evaluation for a positive fecal occult blood test." Cancer Epidemiol Biomarkers Prev 15.6 (June 2006): 1232-1235.
PMID
16775188
Source
pubmed
Published In
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
Volume
15
Issue
6
Publish Date
2006
Start Page
1232
End Page
1235
DOI
10.1158/1055-9965.EPI-05-0916

Cancer care quality measures: diagnosis and treatment of colorectal cancer.

OBJECTIVES: To identify measures that are currently available to assess the quality of care provided to patients with colorectal cancer (CRC), and to assess the extent to which these measures have been developed and tested. DATA SOURCES: Published and unpublished measures identified through a computerized search of English-language citations in MEDLINE (1966-January 2005), the Cochrane Database of Systematic Reviews, and the National Guideline Clearinghouse; through review of reference lists contained in seed articles, all included articles, and relevant review articles; and through searches of the grey literature (institutional or government reports, professional society documents, research papers, and other literature, in print or electronic format, not controlled by commercial publishing interests). Sources for grey literature included professional organization websites and the Internet. REVIEW METHODS: Measures were selected by reviewers according to standardized criteria relating to each question, and were then rated according to their importance and usability, scientific acceptability, and extent of testing; each domain was rated from 1 (poor) to 5 (ideal). RESULTS: We identified a number of well-developed and well-tested CRC-related quality-of-care measures, both general process-of-care measures (on a broader scale) and technical measures (pertaining to specific details of a procedure). At least some process measures are available for diagnostic imaging, staging, surgical therapy, adjuvant chemotherapy, adjuvant radiation therapy, and colonoscopic surveillance. Various technical measures were identified for quality of colonoscopy (e.g., cecal intubation rate, complications) and staging (adequate lymph node retrieval and evaluation). These technical measures were guideline-based and well developed, but less well tested, and the linkage between them and patient outcomes, although intuitive, was not always explicitly provided. For some elements of the care pathway, such as operative reports and chemotherapy reports, no technical measures were found. CONCLUSIONS: Some general process measures have a stronger evidence base than others. Those based on guidelines have the strongest evidence base; those derived from basic first principles supported by some research findings are relatively weaker, but are often sufficient for the task at hand. A consistent source of tension is the distinction between the clinically derived fine-tuning of the definition of a quality measure and the limitations of available data sources (which often do not contain sufficient information to act on such distinctions). Although some excellent technical measures were found, the overall development of technical measures seems less advanced than that of the general process measures.

Authors
Patwardhan, MB; Samsa, GP; McCrory, DC; Fisher, DA; Mantyh, CR; Morse, MA; Prosnitz, RG; Cline, KE; Gray, RN
MLA Citation
Patwardhan, MB, Samsa, GP, McCrory, DC, Fisher, DA, Mantyh, CR, Morse, MA, Prosnitz, RG, Cline, KE, and Gray, RN. "Cancer care quality measures: diagnosis and treatment of colorectal cancer." Evid Rep Technol Assess (Full Rep) 138 (May 2006): 1-116. (Review)
PMID
17764215
Source
pubmed
Published In
Evidence report/technology assessment
Issue
138
Publish Date
2006
Start Page
1
End Page
116

Watchful waiting after endoscopic removal of common bile duct stones: cheaper and better?

Drake et al. constructed a decision model to compare, in an older population, the costs and 2-yr survival rates of elective cholecystectomy versus expectant management after endoscopic removal of common bile duct (CBD) stones. The base case analysis indicated that the expectant management strategy dominated (less expensive and more effective) the elective surgery strategy. Sensitivity analysis suggested that the two strategies likely had equivalent effectiveness and that results were sensitive to the rate of recurrent biliary symptoms. Patient preferences for the different strategies (i.e., utilities) were not included in the model but are important to elicit and consider in clinical practice.

Authors
Fisher, DA
MLA Citation
Fisher, DA. "Watchful waiting after endoscopic removal of common bile duct stones: cheaper and better?." Am J Gastroenterol 101.4 (April 2006): 753-754.
PMID
16635223
Source
pubmed
Published In
The American Journal of Gastroenterology (Elsevier)
Volume
101
Issue
4
Publish Date
2006
Start Page
753
End Page
754
DOI
10.1111/j.1572-0241.2006.00489.x

Strategies to improve colorectal cancer screening rates

• Objective: To review the literature on interventions designed to increase rates of colorectal cancer screening in the United States. • Methods: The MEDLINE database and Cochrane Database of Systematic Reviews were searched for randomized and quasi-randomized controlled trials, systematic reviews, and observational studies of interventions to increase colorectal cancer screening. Additional studies were identified by reviewing the reference lists of reviewed articles. Intervention was broadly defined as a strategy beyond current care to increase colorectal cancer screening rates among eligible individuals. • Results: Interventions targeted at changing provider behavior, including automated reminders, were most successful when baseline screening rates were below the national average, approximately 55%. Similarly, interventions aimed at patient behaviors, including decision aid videos and written materials, were more likely to succeed if the preintervention screening rates were relatively low. • Conclusion: No intervention, either patient- or provider-based, appears to be successful at increasing screening rates in all study populations. With most interventions, the improvements seen in populations with low baseline screening rates were not seen in populations where baseline screening rates were at or above the national average. Future research is needed to test which approaches (eg, multifaceted interventions) are required to impact colorectal cancer screening in populations where baseline screening rates are greater than 55% but still below target.

Authors
Garrett, MM; Fisher, DA
MLA Citation
Garrett, MM, and Fisher, DA. "Strategies to improve colorectal cancer screening rates." Journal of Clinical Outcomes Management 13.9 (2006): 512-517.
Source
scival
Published In
Journal of clinical outcomes management : JCOM
Volume
13
Issue
9
Publish Date
2006
Start Page
512
End Page
517

Inappropriate colorectal cancer screening: findings and implications.

OBJECTIVES: Inclusion of colorectal cancer screening as a performance measure in the Veterans Health Administration (VHA) health system appears to have improved screening rates but may have also increased inappropriate screening. Our aim was to ascertain whether the fecal occult blood test (FOBT) was being ordered appropriately. METHODS: We examined records of 500 consecutive primary care patients at a single VHA facility for whom FOBT had been ordered to determine whether the FOBT was appropriate and, if not, the reason why. RESULTS: We found that 18% of the sample had severe comorbid illness, 13% had signs or symptoms of gastrointestinal blood loss, 7% had a history of colorectal neoplasia or inflammatory bowel disease (high risk), 5% had undergone colonoscopy within prior 5 yr, and 3% were younger than 50 yr of age. Overall, 35% of the patients had at least one reason that the FOBT was inappropriate and at least 19% of the patients should not have undergone any colorectal cancer test for screening or diagnosis. CONCLUSIONS: The FOBT order was inappropriate in a third of the sample, most commonly because of a documented life-limiting comorbidity. In addition, data suggested that FOBT was being used for diagnosis instead of screening. Screening patients unlikely to live long enough to develop and die from colorectal cancer provides no benefit and places these individuals at unjustifiable risk. Additionally, inappropriate screening utilizes resources that could be used to improve screening and follow-up for eligible individuals.

Authors
Fisher, DA; Judd, L; Sanford, NS
MLA Citation
Fisher, DA, Judd, L, and Sanford, NS. "Inappropriate colorectal cancer screening: findings and implications." Am J Gastroenterol 100.11 (November 2005): 2526-2530.
PMID
16279910
Source
pubmed
Published In
The American Journal of Gastroenterology (Elsevier)
Volume
100
Issue
11
Publish Date
2005
Start Page
2526
End Page
2530
DOI
10.1111/j.1572-0241.2005.00322.x

Impact of functional support on health-related quality of life in patients with colorectal cancer.

BACKGROUND: It has been shown that social integration and the availability of social support influence quality of life. However, little is known about the relation between social support and mental and physical health in patients with colorectal cancer. In the current study, the authors examined the effects of social network size, as well as emotional and instrumental support, on health-related quality of life (HRQOL) in patients with colorectal cancer. METHODS: Six hundred thirty-six veterans with colorectal cancer were asked to complete a telephone interview, which included a measure of social support (the Berkman-Syme Index) and the Medical Outcomes Study Short Form 12-Item Survey. Mean physical composite scale (PCS) and mental composite scale (MCS) scores were compared across groups. RESULTS: No difference in mean PCS or MCS scores was found between patients who had larger social networks and patients who had smaller social networks. The availability of emotional and instrumental support was associated with higher MCS scores, whereas the availability of instrumental support was associated with lower PCS scores. CONCLUSIONS: Irrespective of network size, the availability of emotional support and instrumental support had an impact on HRQOL in patients with colorectal cancer. More emphasis needs to be placed on understanding how various types of social support, individually and collectively, influence physical and mental health in patients with colorectal cancer.

Authors
Sultan, S; Fisher, DA; Voils, CI; Kinney, AY; Sandler, RS; Provenzale, D
MLA Citation
Sultan, S, Fisher, DA, Voils, CI, Kinney, AY, Sandler, RS, and Provenzale, D. "Impact of functional support on health-related quality of life in patients with colorectal cancer." Cancer 101.12 (December 15, 2004): 2737-2743.
PMID
15536617
Source
pubmed
Published In
Cancer
Volume
101
Issue
12
Publish Date
2004
Start Page
2737
End Page
2743
DOI
10.1002/cncr.20699

Risk factors for advanced disease in colorectal cancer.

OBJECTIVES: The goal of this study was to identify predictors of presenting with late-stage colorectal cancer with a focus on potentially modifiable factors. METHODS: This was a multicenter, case-based study of patients with colorectal cancer. Detailed information about the cancer was abstracted from the tumor registries, pathology reports, and medical records. The remaining information was obtained by telephone interview. Inclusion criteria were age 40-85 yr with a first diagnosis of histologically proven colorectal cancer between July 1, 1997 and January 1, 2001. Simple contingency table methods were used to examine the relationship between potential risk factors for early versus advanced-stage disease. Logistic regression was performed to simultaneously control for potential confounding factors. RESULTS: There was complete information for 549 respondents. Approximately, 43% of the sample presented with late-stage colorectal cancer. In univariate analysis, lacking a usual source of health care (doctor's office or clinic), no participation in any colorectal cancer screening test in the prior 10 yr, symptoms of blood in stool, and unexplained weight loss were associated with late-stage colorectal cancer. In the logistic regression model, only lacking a usual source of healthcare and unexplained weight loss were associated with late-stage colorectal cancer with odds ratios (95% confidence intervals) of 0.4 (0.2-0.6) and 1.9 (1.2-3.0), respectively. CONCLUSIONS: These results suggest that system changes in the VA health-care system that increase access to and improve utilization of primary care may reduce presentation with late-stage colorectal cancer and thus, reduce mortality from colorectal cancer in veterans.

Authors
Fisher, DA; Martin, C; Galanko, J; Sandler, RS; Noble, MD; Provenzale, D
MLA Citation
Fisher, DA, Martin, C, Galanko, J, Sandler, RS, Noble, MD, and Provenzale, D. "Risk factors for advanced disease in colorectal cancer." Am J Gastroenterol 99.10 (October 2004): 2019-2024.
PMID
15447766
Source
pubmed
Published In
The American Journal of Gastroenterology (Elsevier)
Volume
99
Issue
10
Publish Date
2004
Start Page
2019
End Page
2024
DOI
10.1111/j.1572-0241.2004.40010.x

Race and colorectal cancer screening: a population-based study in North Carolina.

OBJECTIVE: National and state data document racial differences in colorectal cancer (CRC) mortality and incidence. Screening for CRC reduces cancer incidence and deaths. Racial differences in colorectal cancer screening behavior may contribute to the racial disparity in incidence and mortality. The purpose of this study was to determine if colorectal cancer screening rates are different between blacks and whites while controlling for potential confounders. STUDY DESIGN: Cross-sectional survey. DATA SOURCE(S)/STUDY SETTING: We used data from the North Carolina Colon Cancer Study, a population-based case-control study conducted in 33 counties of North Carolina. We analyzed data from 598 control subjects who were eligible for colorectal cancer screening. METHODS: Trained nurses conducted face-to-face interviews from October 1996 through October 2000. RESULTS: Overall, 50% of the respondents were compliant with CRC screening guidelines. In the multivariable logistic regression model having a regular doctor and participation in a general medical exam were significantly associated with current screening status with odds ratios (OR) (95% confidence interval (CI)) of 3.8 (1.7-8.3) and 3.7 (2.1-6.7), respectively. Older age was a significant predictor of current screening status with an OR (95% CI) of 2.9 (1.7-4.8) for those 60-69 compared to respondents 50-59 and OR 3.2 (1.9-5.5) for those 70 and older compared to respondents 50-59. After adjusting for age, having a regular doctor and participation in general medical exams, race was not significantly associated with current CRC screening status, with an OR of 1.1 (95% CI 0.7-1.6). CONCLUSION: CRC screening rates in North Carolina were low. Race was not a significant determinant of screening behavior and therefore does not explain the racial disparity in incidence or survival. Older age, having a regular doctor and participating in general medical exams were significant predictors of CRC screening. RELEVANCE: This study reinforces the fact that screening rates in North Carolina are low despite the strong evidence that colorectal cancer screening reduces cancer deaths.

Authors
Fisher, DA; Dougherty, K; Martin, C; Galanko, J; Provenzale, D; Sandler, RS
MLA Citation
Fisher, DA, Dougherty, K, Martin, C, Galanko, J, Provenzale, D, and Sandler, RS. "Race and colorectal cancer screening: a population-based study in North Carolina." N C Med J 65.1 (January 2004): 12-15.
PMID
15052704
Source
pubmed
Published In
North Carolina Medical Journal
Volume
65
Issue
1
Publish Date
2004
Start Page
12
End Page
15

Early colonoscopy for acute lower GI bleeding predicts shorter hospital stay: a retrospective study of experience in a single center.

BACKGROUND: Appropriate management of lower-GI hemorrhage remains controversial largely because outcomes data are lacking. It is our hypothesis that clinical factors, such as comorbidity, hemodynamic instability, and timing of colonoscopy, are associated with hospital lengths of stay. METHODS: Medical records of patients hospitalized for lower-GI hemorrhage from 1993 to 2000 were reviewed and abstracted, and a Cox regression model was constructed to explore associations between time to discharge (i.e., length of stay) and clinical parameters. RESULTS: A total of 565 hospitalizations for acute lower-GI hemorrhage were examined in which mean length of stay was 6.7 days. Colonoscopy was performed during 415 hospitalizations. Approximately a third of patients were discharged within 48 hours after colonoscopy. In the regression model, hemodynamic instability, higher comorbidity, performance of a tagged red blood cell nuclear scan, and surgery for hemostasis were significantly associated with a decreased likelihood of discharge. Having a colonoscopy was associated with an increased likelihood of being discharged compared with not having a colonoscopy at any given time point during hospitalization (hazard ratio 1.5: 95% CI[1.2, 1.8]. The mean lengths of stay for patients having colonoscopy within 24 hours of hospitalization was shorter than those having colonoscopy after 24 hours of hospitalization (5.4 vs. 7.2 days; p<0.008). CONCLUSIONS: In patients with lower-GI hemorrhage, earlier colonoscopy predicted earlier hospital discharge. However, colonoscopy did not necessarily lead to expedited post-procedural discharge. Although early colonoscopy appears to shorten hospital length of stay, prospective studies of inpatient colonoscopy are needed to determine the impact of this approach on outcomes.

Authors
Schmulewitz, N; Fisher, DA; Rockey, DC
MLA Citation
Schmulewitz, N, Fisher, DA, and Rockey, DC. "Early colonoscopy for acute lower GI bleeding predicts shorter hospital stay: a retrospective study of experience in a single center." Gastrointest Endosc 58.6 (December 2003): 841-846.
PMID
14652550
Source
pubmed
Published In
Gastrointestinal Endoscopy
Volume
58
Issue
6
Publish Date
2003
Start Page
841
End Page
846

Re: Mortality and follow-up colonoscopy after colorectal cancer - Response

Authors
Fisher, DA; Jeffreys, A; Grambow, SC; Provenzale, D
MLA Citation
Fisher, DA, Jeffreys, A, Grambow, SC, and Provenzale, D. "Re: Mortality and follow-up colonoscopy after colorectal cancer - Response." AMERICAN JOURNAL OF GASTROENTEROLOGY 98.12 (December 2003): 2801-2803.
Source
wos-lite
Published In
The American Journal of Gastroenterology (Elsevier)
Volume
98
Issue
12
Publish Date
2003
Start Page
2801
End Page
2803

Mortality and follow-up colonoscopy after colorectal cancer.

OBJECTIVE: There have been no studies that demonstrate surveillance colonoscopy decreases mortality in patients with a history of colorectal cancer. The purpose of this study was to compare the mortality of patients with colorectal cancer who received at least one colonoscopy after their diagnosis with patients who had no further procedures after adjusting for age, race, chemotherapy, radiation therapy, and comorbidity using the national Veterans Affairs (VA) databases. METHODS: We studied a cohort of 3546 patients within the VA national databases with a new diagnosis of colorectal cancer during fiscal year 1995-1996. Patients with inflammatory bowel disease, metastatic disease at presentation, or who died within 1 yr of initial diagnosis were excluded. We collected data for demographics, comorbidities, colonoscopies, chemotherapy, and radiation therapy. The primary outcome was adjusted 5-yr mortality. RESULTS: In the adjusted analysis, the risk of death was decreased by 43% (hazard ratio = 0.57, 95% CI = 0.51-0.64) in the group who had at least one follow-up colonoscopy compared with patients who had no follow-up colonoscopies. CONCLUSIONS: This study strongly supports a mortality benefit for follow-up colonoscopy in patients with a history of nonmetastatic colorectal cancer.

Authors
Fisher, DA; Jeffreys, A; Grambow, SC; Provenzale, D
MLA Citation
Fisher, DA, Jeffreys, A, Grambow, SC, and Provenzale, D. "Mortality and follow-up colonoscopy after colorectal cancer." Am J Gastroenterol 98.4 (April 2003): 901-906.
PMID
12738475
Source
pubmed
Published In
The American Journal of Gastroenterology (Elsevier)
Volume
98
Issue
4
Publish Date
2003
Start Page
901
End Page
906
DOI
10.1111/j.1572-0241.2003.07376.x

Re: Mortality and Follow-Up Colonoscopy after Colorectal Cancer [1] (multiple letters)

Authors
Hilsden, RJ; Fisher, DA; Jeffreys, A; Grambow, SC; Provenzale, D
MLA Citation
Hilsden, RJ, Fisher, DA, Jeffreys, A, Grambow, SC, and Provenzale, D. "Re: Mortality and Follow-Up Colonoscopy after Colorectal Cancer [1] (multiple letters)." American Journal of Gastroenterology 98.12 (2003): 2801-2803.
PMID
14687835
Source
scival
Published In
American Journal of Gastroenterology
Volume
98
Issue
12
Publish Date
2003
Start Page
2801
End Page
2803

Exposure to EGD and mortality in a VA population with GERD

Authors
Kearney, DJ; Crump, C; Maynard, C; Fisher, D
MLA Citation
Kearney, DJ, Crump, C, Maynard, C, and Fisher, D. "Exposure to EGD and mortality in a VA population with GERD." Evidence-Based Gastroenterology 4.4 (2003): 120-121.
Source
scival
Published In
Evidence-Based Gastroenterology
Volume
4
Issue
4
Publish Date
2003
Start Page
120
End Page
121
DOI
10.1097/00132579-200311000-00001

Quality of life in patients with Barrett's esophagus undergoing surveillance.

OBJECTIVES: Practice guidelines recommend surveillance for Barrett's esophagus (BE) because of the risk of esophageal cancer. The quality of life of patients undergoing surveillance is unknown. The objectives of this study were to develop a new utility instrument to measure quality of life of patients undergoing BE surveillance and determine if Quality of Life in Reflux and Dyspepsia (QOLRD) scores correlate with utility ratings. METHODS: Fifteen patients were administered 16 scenarios describing possible BE surveillance outcomes. Each scenario was rated from 0 (equivalent to being dead) to 10 (equivalent to being in perfect health). Each patient also completed the QOLRD, a validated instrument. A t test was performed to compare the QOLRD means with published means. The Spearman's rank correlation coefficient was calculated for the median QOLRD score and the median utility rating. RESULTS: QOLRD means ranged from 5.80 to 6.65 (previously published means 4.3-5.4). Lower scores denoted a worsened quality of life. The difference was significant (p < 0.001). The correlation coefficient of median QOLRD score (6.8) and median utility rating (4.0) was 0.10 (p = 0.71). CONCLUSIONS: This population of BE patients had significantly higher QOLRD scores than a previously published population referred for endoscopy. Quality of life using the utility measure was reduced. The utility measure did not correlate with the disease-specific instrument, suggesting that the concerns of patients undergoing surveillance are distinct from their reflux symptoms.

Authors
Fisher, D; Jeffreys, A; Bosworth, H; Wang, J; Lipscomb, J; Provenzale, D
MLA Citation
Fisher, D, Jeffreys, A, Bosworth, H, Wang, J, Lipscomb, J, and Provenzale, D. "Quality of life in patients with Barrett's esophagus undergoing surveillance." Am J Gastroenterol 97.9 (September 2002): 2193-2200.
PMID
12358232
Source
pubmed
Published In
The American Journal of Gastroenterology (Elsevier)
Volume
97
Issue
9
Publish Date
2002
Start Page
2193
End Page
2200
DOI
10.1111/j.1572-0241.2002.05972.x

Mortality and follow-up colonoscopy for colorectal cancer

Authors
Fisher, DA; Jeffreys, A; Grambow, SC; Provenzale, D
MLA Citation
Fisher, DA, Jeffreys, A, Grambow, SC, and Provenzale, D. "Mortality and follow-up colonoscopy for colorectal cancer." AMERICAN JOURNAL OF GASTROENTEROLOGY 97.9 (September 2002): S237-S237.
Source
wos-lite
Published In
The American Journal of Gastroenterology (Elsevier)
Volume
97
Issue
9
Publish Date
2002
Start Page
S237
End Page
S237
DOI
10.1016/S0002-9270(02)05206-1

Patient-centered outcomes in colorectal cancer screening and treatment

Outcomes research has been identified for all phases of colorectal cancer care. The reports that have been summarized reflect the variable quality and application of outcomes research to colorectal cancer screening and treatment. There were several articles that examined screening for colorectal cancer, and compliance with screening. In general, compliance with screening was associated with education level, socioeconomic status, belief in the efficacy of screening and treatment for colorectal cancer, and physician recommendation of screening tests. Economic analyses represented a substantial portion of the screening articles. There is general agreement among these articles that, compared to other screening programs such as breast cancer screening,6 colorectal cancer screening, regardless of the test employed, is cost-effective. Regarding surveillance of high-risk groups, compliance with follow-up among those with a history of resected colorectal cancer is greater among those whose surgery was performed with curative intent. In this group, mortality is associated with compliance and stage at time of diagnosis. For those with an inherited risk for colorectal cancer (e.g., hereditary nonpolyposis colorectal cancer (HNPCC), familial adenomatous polyposis (FAP)), genetic testing is more common among those who have increased anxiety about cancer, perceived increased risk, and a desire to plan for their own and their children's futures. Treatment for colorectal cancer was the subject of nearly half of the articles in this review. Quality of life was a focus of many of these articles. Methods for measuring quality of life were diverse and genetic for the most part. However, certain observations are noteworthy. Most studies found little correlation between HRQL and other disease outcomes such as survival or disease-free survival. While this may truly reflect that treatment for colorectal cancer, particularly chemotherapy, does not affect HRQL, an alternative explanation is that the largely generic measures used to assess it were insensitive to the quality of life concerns of patients undergoing treatment for colorectal cancer. Regarding care at the end of life, one study170 revealed that, although functional status remained high up to the last month on life, pain was a frequent symptom in the last 6 months of life. The articles for which the phase of care was unspecified examined a variety of topics including the testing of alternative methods for measuring quality of life, caregiver burden, impact of age on HRQL, and others. Their diversity reflects the diversity of patient and caregiver centered outcomes. Finally, the development of colorectal cancer-specific quality of life instruments in the latter part of the decade provides the opportunity to more adequately address patient-specific concerns related to colorectal cancer care. This review has considered patient centered outcomes of colorectal cancer screening and treatment. The last decade revealed a move towards incorporating these important outcomes into assessments of screening programs and treatment regimens. The lack of standardization of measures makes comparisons somewhat difficult, but the development of disease-specific instruments to measure quality of life provides an opportunity to standardize future measurements and study methods. Research that focuses on standard approaches to economic analysis and measurement of HRQL, and that addresses patient satisfaction and compliance with screening for colorectal cancer, may provide us with critical information about effective and cost-effective modalities to increase both length and quality of life.

Authors
Provenzale, D; Gray, RN; Fisher, DA; Schmidt, T
MLA Citation
Provenzale, D, Gray, RN, Fisher, DA, and Schmidt, T. "Patient-centered outcomes in colorectal cancer screening and treatment." Evidence-Based Gastroenterology 3.1 (2002): 12-25.
Source
scival
Published In
Evidence-Based Gastroenterology
Volume
3
Issue
1
Publish Date
2002
Start Page
12
End Page
25

History of cancer in first degree relatives of Barrett's esophagus patients: A case-control study

Background and objective: Familial clusters of Barrett's esophagus (BE) and esophageal adenocarcinoma (EAC) have been reported. This study evaluates the history of cancer in BE patients families. Methods: In two years, patients with BE (272), esophagitis (456) and controls (517) were recruited in 12 Italian Endoscopy Units. Cancer family history in first-degree (FD) relatives was determined by a questionnaire. Results: Approximately 53% of BE, 51% of esophagitis, and 48% of controls had at least one relative affected by any type of malignancy. Probands with at least one esophageal or gastric (E/G) cancer-affected relative showed a BE risk which was at least eighty-five percent higher than that of probands without affected relatives. The relative risk of BE was 4.18, 95% CL = 0.76-23.04 if a FD relative had early (mean age ≤50 years) onset E/G cancer compared to late onset E/G cancer. Conclusion: In this sample there was no evidence that a family history of cancer was associated with the diagnosis of BE. An intriguing result was the association between the occurrence of E/G cancers at earlier ages (< 50 years) among BE relatives with respect the control group. This could suggest a genetic contribution in onset of these tumors, but the sample was too small to demonstrate a significant association. Further exploration of family history of E/G cancer and a diagnosis of BE in larger samples is warranted. © 2011 Elsevier Masson SAS. All rights reserved.

Authors
Ceglie, AD; Filiberti, R; Blanchi, S; Fontana, V; Fisher, DA; Grossi, E; Lacchin, T; Matthaeis, MD; Ignomirelli, O; Cappiello, R; Casa, DD; Foti, M; Laterza, F; Rosati, R; Annese, V; Iaquinto, G; Conio, M
MLA Citation
Ceglie, AD, Filiberti, R, Blanchi, S, Fontana, V, Fisher, DA, Grossi, E, Lacchin, T, Matthaeis, MD, Ignomirelli, O, Cappiello, R, Casa, DD, Foti, M, Laterza, F, Rosati, R, Annese, V, Iaquinto, G, and Conio, M. "History of cancer in first degree relatives of Barrett's esophagus patients: A case-control study." Clinics and Research in Hepatology and Gastroenterology.
Source
scival
Published In
Gastroenterologie clinique et biologique
DOI
10.1016/j.clinre.2011.07.015
Show More

Research Areas:

  • Activities of Daily Living
  • Adaptation, Psychological
  • Adolescent
  • Adult
  • Algorithms
  • Ambulatory Care Facilities
  • Attitude of Health Personnel
  • Barrett Esophagus
  • Blood
  • Chi-Square Distribution
  • Colonoscopy
  • Community Health Services
  • Constriction, Pathologic
  • Continental Population Groups
  • Data Mining
  • Databases as Topic
  • Decision Support Techniques
  • Diet
  • Dilatation
  • Early Detection of Cancer
  • Early Diagnosis
  • Endoscopy, Digestive System
  • Epidemiologic Methods
  • Feces
  • Gastrointestinal Diseases
  • Gastrointestinal Hemorrhage
  • Guideline Adherence
  • Health Behavior
  • Health Care Costs
  • Health Resources
  • Health Services Accessibility
  • Health Services Misuse
  • Health Services Research
  • Health Status
  • Healthcare Disparities
  • Hemostasis, Endoscopic
  • Humans
  • Hypopharynx
  • Intubation, Gastrointestinal
  • Liver
  • Lower Gastrointestinal Tract
  • Mass Screening
  • Melena
  • Mental Health
  • Needs Assessment
  • Neoplasm Recurrence, Local
  • Neoplasm Staging
  • Occult Blood
  • Odds Ratio
  • Outcome and Process Assessment (Health Care)
  • Patient Selection
  • Physical Examination
  • Preventive Health Services
  • Prognosis
  • Quality Assurance, Health Care
  • Quality Indicators, Health Care
  • Quality of Health Care
  • Quality of Life
  • Questionnaires
  • Reproducibility of Results
  • Research Design
  • Risk Reduction Behavior
  • Sensitivity and Specificity
  • Social Class
  • Socioeconomic Factors
  • Standard of Care
  • Stents
  • Survivors
  • Time Factors
  • Treatment Outcome
  • Upper Gastrointestinal Tract
  • Veterans