Gastrointestinal Endoscopy Clinics Of North America

There is a broad spectrum of clinical problems that demand urgent attention and intervention by gastroenterologists. With recent expansion of armamentarium of devices and techniques for therapeutic endoscopy, there has been significant evolution of practices in this area. The focus of this issue will be on the endoscopic aspects of these emergencies, but will include clinical evaluation, and related medical and surgical management as well. We have assembled a world-class group of authors with expertise in individual areas. Dr Peter Stevens will cover triage and endoscopic management of acute nonvariceal hemorrhage, with emphasis on newer techniques of endoscopic hemostasis including clips as well as traditional thermal and injection therapies. Dr Arun Sanyal will review the medical and therapeutic endoscopic aspects of portal hypertensive bleeding. Dr Brenna Bounds will detail the emerging techniques and current approach to acute lower GI hemorrhage, including role of urgent colonoscopy, and adaptation of newer techniques for endoscopic hemostasis including clips and band ligation. Dr Todd Baron will cover management of acute colonic obstruction with particular emphasis on placement of colonic stents. Dr Michael Saunders will discuss medical and endoscopic management of colonic pseudoobstruction with emphasis on medical management of role of colonoscopic decompression. In the area of pancreaticobiliary emergencies, the role of endoscopic intervention for acute biliary and other forms of pancreatitis will be detailed by Dr Paul Tarnasky. Acute cholangitis and the role of ERCP will be discussed by Dr Tim Kinney. Dr XX (works with Dr Roy Wong) will discuss management of foreign body and food impaction, with emphasis on some of the newer devices and overtubes to facilitate safe extraction. Dr David Greenwald will cover the management of endoscopically-induced complications such as bleeding and perforation. Finally, the particulars of the pediatric approach to endoscopic emergencies in children and infants, and the approach to caustic ingestions will be reviewed by Dr Khalid Khan.

The topics covered in this issue, an update from what was first published in the Gastrointestinal Endoscopy Clinics in 2008, reflect the fact that NOTES is seeing a resurgence in popularity. Now, eight years later, there is more data to confirm safety, to look at the best options for using natural orifices, and to talk about optimal training scenarios. The Guest Editor has enlisted some of the top experts on NOTES to contribute articles devoted to Seminal Developments: SM Tunnel Technique; Peroral Endoscopic Myotomoy (POEM); Submucosal Tumor Endoscopic Resection; Endoscopic Full Thickness Resection; Submucosal Tunneling for NOTES Procedures Beyond Resection; Pyloromyotomy; New NOTES: Western Perspective; and Why Did the Old NOTES Fail: Lessons Learned that can Guide New NOTES Development.

In this issue an impressive group of contributors at the forefront of sedation research has been assembled to provide endoscopists and dedicated nursing personnel alike a comprehensive review of important topics in the field sedation and analgesia. A discussion on the pharmacology and agents used to provide moderate and deep sedation provides the basic framework that is a crucial element in determining the driving force behind the developments in sedation and analgesia. An evidence-based approach on the use of unsedated endoscopy is also provided. Other topics included the use of propofol, patient-controlled sedation and analgesia, extended physiologic monitoring, risk management, and quality assurance as they apply to the spectrum of sedation in the endoscopy suite. Sedation and analgesia in the pediatric patient is also addressed.

The need for women's leadership in gastroenterology has resulted in an increasing demand for gender-specific educational programs. In 2002, the first forum on women's issues in gastroenterology was held in an attempt to educate physicians on disease processes that are specific to women. Additional educational programs are needed to emphasize the unique challenges in performing endoscopy on woman. This edition is divided into three sections and focuses on endoscopic topics that are specific to women. The first section encompasses the challenges of performing various endoscopic procedures in the pregnant woman. The second section describes gender-specific abnormalities of the upper gastrointestinal tract. The last section includes the diverse pathologic and endoscopic abnormalities that are seen in the lower gastrointestinal tract of women. Keywords: Endoscopy, Pregnancy, Gastric-bypass, volvulus, autoimmune, rectal procidentia, Rapunzel's syndrome, microscopic colitis, NSAIDs, endoscopic ultrasound, ERCP, colonoscop

This issue presents a concise clinical overview on the most current knowledge on advanced imaging modalities. Dr. Ananadasabapathy has secured internationally recognized authors to write articles on endomicoscopy, molecular imagaing, optical coherence tomography, and chromoendoscopy. Articles are also devoted to imaging the biliary tree and red flag technologies in gastric neoplasia.

Over a short few decades, the field of pediatric endoscopy has matured from the exploratory to the routine. Performance of endoscopic procedures in children is now a fundamental aspect of the practice of more than 2000 pediatric gastroenterologists in North America, and endoscopic instruments are increasingly being developed with an eye to their pediatric applications. Ensuring safe and effective endoscopy in children requires specific medical knowledge and technical competency, in addition to appropriately designed equipment and settings. Obtaining consent from parents, as well as assent from patients, for the purposes of performing diagnostic and therapeutic gastrointestinal procedures begins with a deep understanding of risks and benefits that endoscopy affords and is typically gained through formal training in the field. Diagnostic endoscopy may help to confirm common pediatric conditions including eosinophilic esophagitis and inflammatory bowel disease, while therapeutic procedures to treat strictures in the GI tract may help children avoid more invasive surgeries. Using endoscopy in children to achieve hemostasis or to remove commonly swallowed foreign bodies, such as lithium batteries or high-powered magnets, can be lifesaving, and the insertion of feeding tubes can help medically complex patients to thrive. In short, pediatric endoscopy is an integral component of healthcare for children, and gaining and understanding of its best practices may help all clinicians to better recognize its role in pediatric disease outcomes.

Endoscopic access to the small bowel has advanced significantly since the introduction of video capsule endoscopy and deep enteroscopy in early 2000. Other major advances have occurred in imaging modalities involving computed tomography and magnetic resonance studies. Due to these advances, the recent 2015 ACG guideline changed the terminology from “obscure to “small bowel bleeding because the majority of cases now can be found to have a small bowel source. The improvements in technology have advanced our ability to visualized vascular findings, inflammatory lesions, and small bowel neoplasms. Articles in this issue are devoted to these improvements in technology.

Dr. Freeman has organized his issue address the continuum between acute and chronic pancreatitis, necrosis and pseudocysts, and the expanding role of endoscopic diagnosis and therapy. As a result, there are comprehensive articles devoted to: Role of EUS in the diagnosis of acute and chronic pancreatitis; ERCP for acute biliary pancreatitis;Prevention of post ERCP pancreatitis; Endoscopic therapy of necrotizing pancreatitis and pseudocysts; Endoscopic therapy for acute recurrent pancreatitis; Endoscopic therapy for chronic pancreatitis; ERCP for biliary strictures associated with chronic pancreatitis; EUS for pancreatic ductal access and drainage; Endoscopic therapy for pancreatic duct leaks and disruptions; autoimmune pancreatitis; role of endoscopy in diagnosis and treatment; and Palliation of pancreatic ductal obstruction in pancreatic cancer.