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Walled-off pancreatic necrosis (WON) is a defined entity that occurs following an episode of acute necrotizing pancreatitis. Direct endoscopic necrosectomy (DEN) is performed by advancing an endoscope transmurally into WON and has become an accepted modality. However, clinicians have many questions about endoscopic necrosectomy. Some of these questions will be addressed. 1. Is DEN required […]

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Over the years there have been attempts at standardizing care for the patient with inflammatory bowel disease (IBD). I was the director of AGA’s initiative to establish quality metrics for the care of patients with IBD in 2011. Subramanian and Triadafilopoulos published a review in 2016,1 and Berry and Melmed published an excellent review this […]

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I cannot think of many areas in medicine where there are more divergent opinions than in extraesophageal manifestations (EEMs) of gastroesophageal reflux disease (GERD). There are fervent believers and deniers, with frequent swings of the pendulum depending on the latest proposed mechanism and the tests used to support them. Furthermore, the long list of purported […]

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Although there is a downward trend of patients with Crohn’s disease undergoing surgical management, surgery remains an important treatment option for Crohn’s disease. In fact, no guidelines or specific evidence base exists that directs the optimal timing of surgery for Crohn’s disease. It is the experience of the gastroenterologist that guides him or her on […]

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In the hospital setting, upper gastrointestinal (GI) bleeding remains the most common reason for consulting a gastroenterologist. The care of patients with upper GI bleeding has recently changed, including the approach to initial management, timing of endoscopy, use of blood products, and available techniques for endoscopic therapy. I am going to provide an overview of […]

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The term autoimmune pancreatitis (AIP) is used for two rare, steroid-responsive pancreatitides that present most commonly with a pancreatic mass and occasionally with acute pancreatitis. They are the only pancreatic diseases with a potential cure through effective medical therapies. Although their increased recognition has led to the avoidance of unnecessary surgery in numerous patients, it […]

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Significant advances in antiviral therapy with direct acting antivirals (DAAs) have transformed hepatitis C virus (HCV) treatment over the past four years (Table). We have achieved nearly every characteristic of an ideal regimen: pangenotypic, excellent safety and tolerability, high sustained virologic response (SVR), low pill burden, simplified dosing schedule, short treatment duration, and high genetic […]

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Endoscopic eradication therapies for Barrett’s esophagus (BE) have evolved and improved in the last 20 years. We excise nodular disease using endoscopic mucosal resection (EMR) and treat flat BE with radiofrequency ablation (RFA) based on accumulated, abundant and high-quality scientific evidence that shows pooled RFA eradication rates of 91 and 78 percent for dysplasia and […]

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The obesity epidemic is upon us. The most recent data from the Behavioral Risk Factors Surveillance System on self-reported rates of obesity show that, even in the “fittest” states in the country, obesity is reported in one in five individuals.1 The obesity epidemic has overwhelmed our practices, bariatric surgeons and health care systems. The direct […]