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 […]

Debates

Anesthesiologist-directed sedation for ambulatory endoscopic procedures has enjoyed an unparalleled and unbridle growth in recent years. Between 2003 and 2009, payments for anesthesiologist-directed sedation tripled from just under $400 million to 1.3 billion. This dramatic upsurge was driven not by increased cost but by increased utilization, which occurred almost exclusively in the commercial payor sector. […]

Debates

The question of who may administer endoscopic sedation has burned for over a decade, but recent developments have fanned the flames again. The approval by FDA of the SedaSys system and its subsequent withdrawal from the market has increased the heat, but not the light, surrounding this controversy. I am hopeful that this pro-con discussion […]

Debates

Histologic assessment of liver disease has been a cornerstone of therapeutic decisions and predicting prognosis in chronic liver disease for much of modern hepatology. Although we still regard liver biopsy as the gold standard for assessment of injury, inflammation and fibrosis stage, its clinical application for chronic hepatitis C (HCV) has significantly decreased over the […]

Debates

Given the option of a diagnostic procedure that is invasive, even with a small risk of death, over a noninvasive equivalent, the choice seems obvious. As an analogy, why in 2016 would a patient with ulcerative colitis, a raised alkaline phosphatase level and suspected primary sclerosing cholangitis undergo ERCP first and not magnetic resonance cholangiopancreatography Now […]

Debates

In his 2015 State of the Union Address, President Obama launched the era of precision medicine, which proposes medical decisions and practices tailored to the individual patient. While the concept of precision medicine is not new, what is new is the broader scope in which precision medicine will eventually apply. Broader application of precision medicine […]