Debates

Gastroesophageal reflux disease (GERD) testing has evolved ever since the initial introduction of the catheter-based pH test more than half a century ago. More accurate pH measurements and improved patient tolerability were achieved by reducing the catheter’s diameter and stiffness, and the catheter-based pH test has continued to improve over the years.1 Introduction of the […]

Debates

Prolonged pH or reflux monitoring is neither essential to the primary evaluation or treatment of patients with suspected gastroesophageal reflux disease (GERD) who respond to therapy nor needed for patients who have endoscopydocumented erosive esophagitis that responds to antisecretory therapy. The history, endoscopic findings and clinical response to therapy provide adequate support for the diagnosis of GERD in […]

Debates

As a card-carrying gastroenterologist, I enjoy performing screening colonoscopy just like most of my society brethren. However, I feel strongly that the fecal immunochemical test (FIT) is a fully acceptable alternative for colorectal cancer (CRC) screening. Perhaps the easiest defense for those of us who are enthusiastic about stool-based screening is the quality of evidence supporting it. […]

Debates

In Australia and some European countries, colorectal cancer (CRC) screening occurs in an organized or programmatic setting, usually funded by the national government. Organized screening commonly relies on fecal occult blood testing (FOBT) as the primary means of screening, and usually the fecal immunochemical test (FIT). FIT is a good option for these programs as […]

Debates

F or patients found to have low-grade dysplasia (LGD) in Barrett’s esophagus, two recent studies suggest that the decision between treating with radiofrequency ablation (RFA) or simply continuing endoscopic surveillance is a slam dunk for RFA.1,2 In a European, randomized trial of surveillance versus radio frequency ablation (SURF) for 136 patients who had LGD confirmed […]

Debates

The primary goal of ablation in Barrett’s esophagus is to reduce progression to high-grade dysplasia (HGD) and esophageal adenocarcinoma (EAC). The decision to perform endoscopic therapy (with the goal to eliminate intestinal metaplasia), is based on the principles of: 1. documenting an elevated risk of progression, 2. demonstrating reduction in risk of progression using robust […]

Debates

Celiac disease is diagnosed by small intestinal biopsy. As the popularity of the gluten-free diet has surged in the past decade, histology has largely remained intact as the arbiter between celiac disease and non-celiac gluten sensitivity, a condition whose etiology, pathogenesis and natural history remain incompletely understood. Though a pathway for a biopsy-free diagnosis of […]

Debates

Broadly, my celiac patients suffer from two main problems. The first is poorly controlled celiac disease, with some combination of ongoing symptoms, enteropathy and laboratory abnormalities. This group, collectively referred to as nonresponsive celiac disease, is significant and although all current data on this issue comes from a few tertiary referral centers, it is likely […]

Debates

In the absence of robust prospective data, the conversation about pancreatic cysts has mostly been driven by low-quality evidence, expert consensus and opinion. Hence, when debating an issue such as the role of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in pancreatic cysts greater than 3 cm, one can, within reason, construct an argument to support either […]

Debates

Pancreatic cystic lesions are widely identified now because of the increased use and improved resolution of cross-sectional imaging. The majority of these cysts are found in older patients, often when imaging is performed for an unrelated condition such as our patient with a suspected kidney stone. This leads to tremendous anxiety for the patient and […]