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Douglas Rex, MD

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Gastroenterology

Distinguished Professor; Chancellor's Professor, IUPUI; Professor of Medicine
Director of Endoscopy

Academic Office

University Hospital, Suite 2300
550 University Blvd
Indianapolis IN 46202-5250 Map

Contact Information

Phone: (317) 948-9763
Fax: (317) 274-5449
Email:

Research Interests

Colorectal Cancer Screening, Colonoscopy

Clinical Interests

Barrett's Esophagus, Colorectal Cancer Screening, Colorectal Polyps, Endoscopy, Gastrointestinal Bleeding, Inflammatory Bowel Disease, Severe Constipation.

Education and Training

Fellowship Indiana University Medical Center
Residency Indiana University Medical Center
Medicine (M.D.) Indiana University (Iupui)
Biology, General Harvard University

Board Certifications

Internal Medicine 1985
Gastroenterology 1987

Publications (139)¹

Recurrence rates after EMR of large sessile serrated polyps.
Journal: Gastrointestinal endoscopy
Authors: Rex KD; Vemulapalli KC; Rex DK;
Publication Date: 2015 Apr 4

Abstract

Little is known regarding the recurrence rate after EMR of large (=20 mm) sessile serrated adenoma/polyps (SSA/Ps).
View details for PubMedID 25851161
Clip artifact after closure of large colorectal EMR sites: incidence and recognition.
Journal: Gastrointestinal endoscopy
Authors: Sreepati G; Vemulapalli KC; Rex DK;
Publication Date: 2015 Apr 2

Abstract

Clip closure of large colorectal EMR defects sometimes results in bumpy scars that are normal on biopsy. We refer to these as "clip artifact." If unrecognized, clip artifact can be mistaken for residual polyp, leading to thermal treatment and potential adverse events.
View details for PubMedID 25843616
Advances in colonoscopy.
Journal: Gastrointestinal endoscopy clinics of North America
Authors: Kahi CJ; Rex DK;
Publication Date: 2015 Apr
Serrated lesions in colorectal cancer screening: detection, resection, pathology and surveillance.
Journal: Gut
Authors: East JE; Vieth M; Rex DK;
Publication Date: 2015 Mar 6
Response:.
Journal: Gastrointestinal endoscopy
Authors: Rex DK;
Publication Date: 2015 Mar
Efficacy and safety of endoscopic resection of large colorectal polyps: a systematic review and meta-analysis.
Journal: Gut
Authors: Hassan C; Repici A; Sharma P; Correale L; Zullo A; Bretthauer M; Senore C; Spada C; Bellisario C; Bhandari P; Rex DK;
Publication Date: 2015 Feb 13

Abstract

To assess the efficacy and safety of endoscopic resection of large colorectal polyps.
View details for PubMedID 25681402
The Big Picture: Does Colonoscopy Work?
Journal: Gastrointestinal endoscopy clinics of North America
Authors: Hewett DG; Rex DK;
Publication Date: 2015 Feb 7

Abstract

Colonoscopy for average-risk colorectal cancer screening has transformed the practice of gastrointestinal medicine in the United States. However, although the dominant screening strategy, its use is not supported by randomized controlled trials. Observational data do support a protective effect of colonoscopy and polypectomy on colorectal cancer incidence and mortality, but the level of protection in the proximal colon is variable and operator-dependent. Colonoscopy by high-level detectors remains highly effective, and ongoing quality improvement initiatives should consider regulatory factors that motivate changes in physician behavior.
View details for PubMedID 25839693
Accuracy of Capsule Colonoscopy in Detecting Colorectal Polyps in a Screening Population.
Journal: Gastroenterology
Authors: Rex DK; Adler SN; Aisenberg J; Burch WC Jr; Carretero C; Chowers Y; Fein SA; Fern SE; Fernandez-Urien Sainz I; Fich A; Gal E; Horlander JC Sr; Isaacs KL; Kariv R; Lahat A; Leung WK; Malik PR; Morgan D; Papageorgiou N; Romeo DP; Shah SS; Waterman M;
Publication Date: 2015 Jan 22

Abstract

Capsule colonoscopy is a minimally invasive imaging method. We measured the accuracy of this technology in detecting polyps 6 mm or larger in an average-risk screening population.
View details for PubMedID 25620668
Determining the adenoma detection rate and adenomas per colonoscopy by photography alone: proof-of-concept study.
Journal: Endoscopy
Authors: Rex DK; Hardacker K; MacPhail M; Rahmani F; Vemulapalli KC; Kahi CJ;
Publication Date: 2015 Jan 15

Abstract

The adenoma detection rate (ADR) and adenomas detected per colonoscopy (APC) are measures of the quality of mucosal inspection during colonoscopy. In a resect and discard policy, pathologic assessment for calculation of ADR and APC would not be available. The aim of this study was to determine whether ADR and APC calculation based on photography alone is adequate compared with the pathology-based gold standard.
View details for PubMedID 25590185
Implementation of optical diagnosis for colorectal polyps: standardization of studies is needed.
Journal: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
Authors: Kaltenbach T; Rex DK; Wilson A; Hewett DG; Sanduleanu S; Rastogi A; Wallace M; Soetikno R;
Publication Date: 2015 Jan
Letters to the editor concerning the article: alexandre oliveira ferreira, andrea riphaus. Propofol to increase colorectal cancer screening in portugal. Acta med port 2014;27:541-42.
Journal: Acta médica portuguesa
Authors: Rex DK;
Publication Date: 2014 Dec 30
Colonoscopy: The Current King of the Hill in the USA.
Journal: Digestive diseases and sciences
Authors: Rex DK;
Publication Date: 2014 Dec 16

Abstract

Colonoscopy is the dominant colorectal cancer screening strategy in the USA. There are no randomized controlled trials completed of screening colonoscopy, but multiple lines of evidence establish that colonoscopy reduces colorectal cancer incidence in both the proximal and distal colon. Colonoscopy is highly operator dependent, but systematic efforts to measure and improve quality are impacting performance. Colonoscopy holds a substantial advantage over other strategies for detection of serrated lesions, and a recent case-control study suggests that once-only colonoscopy or colonoscopy at 20-year intervals, by a high-level detector, could ensure lifetime protection from colorectal cancer for many patients.
View details for PubMedID 25511920
Prediction of colorectal polyp pathologic lesions with image-enhanced endoscopy: What will it take to make it matter?
Journal: Gastrointestinal endoscopy
Authors: Rex DK;
Publication Date: 2014 Dec
Optimizing adequacy of bowel cleansing for colonoscopy: recommendations from the US multi-society task force on colorectal cancer.
Journal: Gastroenterology
Authors: Johnson DA; Barkun AN; Cohen LB; Dominitz JA; Kaltenbach T; Martel M; Robertson DJ; Boland CR; Giardello FM; Lieberman DA; Levin TR; Rex DK; US Multi-Society Task Force on Colorectal Cancer;
Publication Date: 2014 Oct
Optimizing adequacy of bowel cleansing for colonoscopy: recommendations from the U.S. multi-society task force on colorectal cancer.
Journal: Gastrointestinal endoscopy
Authors: Johnson DA; Barkun AN; Cohen LB; Dominitz JA; Kaltenbach T; Martel M; Robertson DJ; Boland CR; Giardello FM; Lieberman DA; Levin TR; Rex DK;
Publication Date: 2014 Oct
Optimizing adequacy of bowel cleansing for colonoscopy: recommendations from the US Multi-Society Task Force on Colorectal Cancer.
Journal: The American journal of gastroenterology
Authors: Johnson DA; Barkun AN; Cohen LB; Dominitz JA; Kaltenbach T; Martel M; Robertson DJ; Richard Boland C; Giardello FM; Lieberman DA; Levin TR; Rex DK; US Multi-Society Task Force on Colorectal Cancer;
Publication Date: 2014 Sep 16
Respiratory complications in outpatient endoscopy with endoscopist-directed sedation.
Journal: Journal of gastrointestinal and liver diseases : JGLD
Authors: Friedrich K; Scholl SG; Beck S; Gotthardt D; Stremmel W; Rex DK; bng-Study-Group; Sieg A;
Publication Date: 2014 Sep

Abstract

Respiratory complications represent an important adverse event of endoscopic procedures. We screened for respiratory complications after endoscopic procedures using a questionnaire and followed-up patients suggestive of respiratory infection.
View details for PubMedID 25267952
Water exchange vs. water immersion during colonoscope insertion.
Journal: The American journal of gastroenterology
Authors: Rex DK;
Publication Date: 2014 Sep

Abstract

Water exchange (water infusion with water removal primarily during insertion) and water immersion (water infusion with water removal during withdrawal) reduce patient discomfort during colonoscope insertion compared with air insufflation, and represent a major achievement in colonoscopy. Hsieh et al. found that water exchange, relative to water immersion, resulted in more painless insertions to the cecum and improved adenoma detection in the right colon. However, water exchange is also associated with better bowel cleansing and longer insertion and procedure times. These factors are not specific to water exchange, but could account for all or part of the better results with water exchange. Additional controlled investigation is needed to define the benefits of water exchange compared with water immersion.
View details for PubMedID 25196871
Response:.
Journal: Gastrointestinal endoscopy
Authors: Kahi CJ; Eckert GJ; Vemulapalli K; Rex DK;
Publication Date: 2014 Sep
Guidelines on genetic evaluation and management of Lynch syndrome: a consensus statement by the US Multi-Society Task Force on colorectal cancer.
Journal: Gastroenterology
Authors: Giardiello FM; Allen JI; Axilbund JE; Boland CR; Burke CA; Burt RW; Church JM; Dominitz JA; Johnson DA; Kaltenbach T; Levin TR; Lieberman DA; Robertson DJ; Syngal S; Rex DK; US Multi-Society Task Force on Colorectal Cancer;
Publication Date: 2014 Aug

Abstract

The Multi-Society Task Force, in collaboration with invited experts, developed guidelines to assist health care providers with the appropriate provision of genetic testing and management of patients at risk for and affected with Lynch syndrome as follows: Figure 1 provides a colorectal cancer risk assessment tool to screen individuals in the office or endoscopy setting; Figure 2 illustrates a strategy for universal screening for Lynch syndrome by tumor testing of patients diagnosed with colorectal cancer; Figures 3-6 provide algorithms for genetic evaluation of affected and at-risk family members of pedigrees with Lynch syndrome; Table 10 provides guidelines for screening at-risk and affected persons with Lynch syndrome; and Table 12 lists the guidelines for the management of patients with Lynch syndrome. A detailed explanation of Lynch syndrome and the methodology utilized to derive these guidelines, as well as an explanation of, and supporting literature for, these guidelines are provided.
View details for PubMedID 25043945
Guidelines on genetic evaluation and management of Lynch syndrome: a consensus statement by the US Multi-Society Task Force on Colorectal Cancer.
Journal: Diseases of the colon and rectum
Authors: Giardiello FM; Allen JI; Axilbund JE; Boland CR; Burke CA; Burt RW; Church JM; Dominitz JA; Johnson DA; Kaltenbach T; Levin TR; Lieberman DA; Robertson DJ; Syngal S; Rex DK;
Publication Date: 2014 Aug

Abstract

The Multi-Society Task Force, in collaboration with invited experts, developed guidelines to assist health care providers with the appropriate provision of genetic testing and management of patients at risk for and affected with Lynch syndrome as follows: provides a colorectal cancer risk assessment tool to screen individuals in the office or endoscopy setting; illustrates a strategy for universal screening for Lynch syndrome by tumor testing of patients diagnosed with colorectal cancer; -6 provide algorithms for genetic evaluation of affected and at-risk family members of pedigrees with Lynch syndrome; provides guidelines for screening at-risk and affected persons with Lynch syndrome; and lists the guidelines for the management of patients with Lynch syndrome. A detailed explanation of Lynch syndrome and the methodology utilized to derive these guidelines, as well as an explanation of, and supporting literature for, these guidelines are provided.
View details for PubMedID 25003300
Findings in the Distal Colorectum Are Not Associated With Proximal Advanced Serrated Lesions.
Journal: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
Authors: Kahi CJ; Vemulapalli KC; Snover DC; Abdel Jawad KH; Cummings OW; Rex DK;
Publication Date: 2014 Jul 30

Abstract

Serrated lesions are an important contributor to colorectal cancer (CRC), notably in the proximal colon. Findings in the distal colorectum are markers of advanced proximal adenomatous neoplasia. However, it is not known whether they affect the odds of advanced proximal serrated lesions.
View details for PubMedID 25083562
Guidelines on genetic evaluation and management of Lynch syndrome: a consensus statement by the US Multi-society Task Force on colorectal cancer.
Journal: The American journal of gastroenterology
Authors: Giardiello FM; Allen JI; Axilbund JE; Boland CR; Burke CA; Burt RW; Church JM; Dominitz JA; Johnson DA; Kaltenbach T; Levin TR; Lieberman DA; Robertson DJ; Syngal S; Rex DK;
Publication Date: 2014 Jul 22

Abstract

The Multi-Society Task Force, in collaboration with invited experts, developed guidelines to assist health care providers with the appropriate provision of genetic testing and management of patients at risk for and affected with Lynch syndrome as follows: Figure 1 provides a colorectal cancer risk assessment tool to screen individuals in the office or endoscopy setting; Figure 2 illustrates a strategy for universal screening for Lynch syndrome by tumor testing of patients diagnosed with colorectal cancer; Figures 3,4,5,6 provide algorithms for genetic evaluation of affected and at-risk family members of pedigrees with Lynch syndrome; Table 10 provides guidelines for screening at-risk and affected persons with Lynch syndrome; and Table 12 lists the guidelines for the management of patients with Lynch syndrome. A detailed explanation of Lynch syndrome and the methodology utilized to derive these guidelines, as well as an explanation of, and supporting literature for, these guidelines are provided.
View details for PubMedID 25070057
A comparison of oral sulfate solution with sodium picosulfate: magnesium citrate in split doses as bowel preparation for colonoscopy.
Journal: Gastrointestinal endoscopy
Authors: Rex DK; DiPalma JA; McGowan J; Cleveland Mv;
Publication Date: 2014 Jul 12

Abstract

There are few data comparing U.S. Food and Drug Administration-approved low-volume bowel preparations for colonoscopy.
View details for PubMedID 25028274
Sessile serrated polyp prevalence determined by a colonoscopist with a high lesion detection rate and an experienced pathologist.
Journal: Gastrointestinal endoscopy
Authors: Abdeljawad K; Vemulapalli KC; Kahi CJ; Cummings OW; Snover DC; Rex DK;
Publication Date: 2014 Jul 3

Abstract

The prevalence of sessile serrated adenomas and/or polyps (SSA/Ps) is uncertain.
View details for PubMedID 24998465
Intraprocedural cleansing work during colonoscopy and achievable rates of adequate preparation in an open-access endoscopy unit.
Journal: Gastrointestinal endoscopy
Authors: MacPhail ME; Hardacker KA; Tiwari A; Vemulapalli KC; Rex DK;
Publication Date: 2014 Jul 3

Abstract

Rates of adequate bowel preparation in the 60% to 80% range continue to be reported for colonoscopy.
View details for PubMedID 24998464
Radiation exposure in gastroenterology: improving patient and staff protection.
Journal: The American journal of gastroenterology
Authors: Ho IK; Cash BD; Cohen H; Hanauer SB; Inkster M; Johnson DA; Maher MM; Rex DK; Saad A; Singh A; Rehani MM; Quigley EM;
Publication Date: 2014 May 20

Abstract

Medical imaging involving the use of ionizing radiation has brought enormous benefits to society and patients. In the past several decades, exposure to medical radiation has increased markedly, driven primarily by the use of computed tomography. Ionizing radiation has been linked to carcinogenesis. Whether low-dose medical radiation exposure will result in the development of malignancy is uncertain. This paper reviews the current evidence for such risk, and aims to inform the gastroenterologist of dosages of radiation associated with commonly ordered procedures and diagnostic tests in clinical practice. The use of medical radiation must always be justified and must enable patients to be exposed at the lowest reasonable dose. Recommendations provided herein for minimizing radiation exposure are based on currently available evidence and Working Party expert consensus.
View details for PubMedID 24842339
A randomized, controlled trial of oral sulfate solution plus polyethylene glycol as a bowel preparation for colonoscopy.
Journal: Gastrointestinal endoscopy
Authors: Rex DK; McGowan J; Cleveland Mv; Di Palma JA;
Publication Date: 2014 May 13

Abstract

No bowel preparation for colonoscopy is optimal with regard to efficacy, safety, and tolerability. New options for bowel preparation are needed.
View details for PubMedID 24830577
Risk of advanced lesions at first follow-up colonoscopy in high-risk groups as defined by the United Kingdom post-polypectomy surveillance guideline: data from a single U.S. center.
Journal: Gastrointestinal endoscopy
Authors: Vemulapalli KC; Rex DK;
Publication Date: 2014 May 3

Abstract

The United Kingdom (U.K.) post-adenoma resection guidelines recommend earlier surveillance for patients with 5 or more adenomas or 3 to 4 adenomas of which one is 10 mm or larger compared with U.S. guidelines.
View details for PubMedID 24796960
Optimal bowel preparation--a practical guide for clinicians.
Journal: Nature reviews. Gastroenterology & hepatology
Authors: Rex DK;
Publication Date: 2014 Apr 1

Abstract

High-quality bowel preparation is essential for effective colonoscopy. Bowel preparations are judged by their safety, efficacy and tolerability. Between efficacy and tolerability, efficacy is the clinical priority because inadequate preparations are disruptive and costly. Achieving high rates of adequate preparation depends first on using split-dose or same-day dosing. Patients who have medical predictors of inadequate preparation quality (for example chronic constipation) should be prescribed more aggressive preparations and patients who have factors that predict they are less likely to follow the instructions (such as English not being their first language) should receive intensified education. On the day of the procedure, patients with persistent brown effluent should be considered for large-volume enemas or additional oral preparation before proceeding with colonoscopy. During the procedure, preparation quality should be graded after the clean-up has been completed.
View details for PubMedID 24686267
Standard forward-viewing colonoscopy versus full-spectrum endoscopy: an international, multicentre, randomised, tandem colonoscopy trial.
Journal: The Lancet. Oncology
Authors: Gralnek IM; Siersema PD; Halpern Z; Segol O; Melhem A; Suissa A; Santo E; Sloyer A; Fenster J; Moons LM; Dik VK; D'Agostino RB Jr; Rex DK;
Publication Date: 2014 Feb 20

Abstract

Although colonoscopy is the accepted standard for detection of colorectal adenomas and cancers, many adenomas and some cancers are missed. To avoid interval colorectal cancer, the adenoma miss rate of colonoscopy needs to be reduced by improvement of colonoscopy technique and imaging capability. We aimed to compare the adenoma miss rates of full-spectrum endoscopy colonoscopy with those of standard forward-viewing colonoscopy.
View details for PubMedID 24560453
New colonoscope technology: impact on image capture and quality and on confidence and accuracy of endoscopy-based polyp discrimination.
Journal: Endoscopy
Authors: Bade K; MacPhail ME; Johnson CS; Kahi CJ; Rex DK;
Publication Date: 2014 Feb 5

Abstract

A newer colonoscope series has optical magnification and improvement in image freezing function. We aimed to assess the impact on image capture, image quality, and polyp discrimination.
View details for PubMedID 24500976
Potential screening benefit of a colorectal imaging capsule that does not require bowel preparation.
Journal: Journal of clinical gastroenterology
Authors: Chatrath H; Rex DK;
Publication Date: 2014 Jan

Abstract

Check-Cap is a capsule device that images the colon using low-dose radiation (total dose equivalent to a plain abdominal radiograph) and does not require bowel preparation. Check-Cap is in development for colorectal cancer imaging.
View details for PubMedID 23632347
Endoscopic detection of proximal serrated lesions and pathologic identification of sessile serrated adenomas/polyps vary on the basis of center.
Journal: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
Authors: Payne SR; Church TR; Wandell M; Rösch T; Osborn N; Snover D; Day RW; Ransohoff DF; Rex DK;
Publication Date: 2013 Dec 10

Abstract

We investigated rates of detection of proximal serrated lesions in a cohort of average-risk patients undergoing screening colonoscopies.
View details for PubMedID 24333512
Improving measurement of the adenoma detection rate and adenoma per colonoscopy quality metric: the Indiana University experience.
Journal: Gastrointestinal endoscopy
Authors: Kahi CJ; Vemulapalli KC; Johnson CS; Rex DK;
Publication Date: 2013 Nov 15

Abstract

The adenoma detection rate (ADR) is a validated marker of colonoscopy quality. However, the optimal measurement method is unclear.
View details for PubMedID 24246797
Bowel preparation for colonoscopy: entering an era of increased expectations for efficacy.
Journal: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
Authors: Rex DK;
Publication Date: 2013 Nov 13
Real-time endoscopic pathology assessment of colorectal polyps.
Journal: Current gastroenterology reports
Authors: Rex DK;
Publication Date: 2013 Nov
Rapid intraluminal growth of a colorectal cancer observed by endoscopy.
Journal: Gastrointestinal endoscopy
Authors: Vemulapalli KC; Rex DK;
Publication Date: 2013 Nov
Treatment of esophageal leaks, fistulae, and perforations with temporary stents: evaluation of efficacy, adverse events, and factors associated with successful outcomes.
Journal: Gastrointestinal endoscopy
Authors: El Hajj II; Imperiale TF; Rex DK; Ballard D; Kesler KA; Birdas TJ; Fatima H; Kessler WR; DeWitt JM;
Publication Date: 2013 Oct 11

Abstract

Factors associated with successful endoscopic therapy with temporary stents for esophageal leaks, fistulae, and perforations (L/F/P) are not well known.
View details for PubMedID 24125513
Variable interpretation of polyp size by using open forceps by experienced colonoscopists.
Journal: Gastrointestinal endoscopy
Authors: Rex DK; Rabinovitz R;
Publication Date: 2013 Oct 8

Abstract

Endoscopic measurement of colorectal polyps by using open forceps is commonly used in clinical trials but is subject to several sources of error.
View details for PubMedID 24119506
Colonoscopy.
Journal: Gastrointestinal endoscopy
Authors: Rex DK;
Publication Date: 2013 Sep
Colonoscopy.
Journal: Endoscopy
Authors: Rex DK;
Publication Date: 2013 Aug 29
Agreement in interpreting villous elements and dysplasia in adenomas less than one centimetre in size.
Journal: Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver
Authors: Lasisi F; Mouchli A; Riddell R; Goldblum JR; Cummings OW; Ulbright TM; Rex DK;
Publication Date: 2013 Jul 19

Abstract

Villous elements and dysplasia grade in small adenomas are used in many countries to guide post-polypectomy colonoscopy intervals.
View details for PubMedID 23871251
Optimal withdrawal and examination in colonoscopy.
Journal: Gastroenterology clinics of North America
Authors: Rex DK;
Publication Date: 2013 Jun 15

Abstract

The primary goal of most colonoscopies, whether performed for screening, surveillance, or diagnostic examinations (those performed for symptoms or positive screening tests other than colonoscopy) is the detection of neoplasia and its subsequent removal by either endoscopic polypectomy or referral for surgical resection. Unfortunately, colonoscopy has proved to be a highly operator-dependent procedure with regard to detection. Variable detection results in some of the cancers that occur in the interval before the next colonoscopy.
View details for PubMedID 23931852
Epithelialized omental patch masquerading as a duodenal lipoma.
Journal: Gastrointestinal endoscopy
Authors: Sagi SV; Kum JB; House MG; Rex DK;
Publication Date: 2013 May 13
Split-dose administration of a dual-action, low-volume bowel cleanser for colonoscopy: the SEE CLEAR I study.
Journal: Gastrointestinal endoscopy
Authors: Rex DK; Katz PO; Bertiger G; Vanner S; Hookey LC; Alderfer V; Joseph RE;
Publication Date: 2013 Apr 6

Abstract

New bowel cleansers for colonoscopy that lead to improved efficacy, safety, and tolerability are needed.
View details for PubMedID 23566639
A low-residue diet improved patient satisfaction with split-dose oral sulfate solution without impairing colonic preparation.
Journal: Gastrointestinal endoscopy
Authors: Sipe BW; Fischer M; Baluyut AR; Bishop RH; Born LJ; Daugherty DF; Lybik MJ; Shatara TJ; Scheidler MD; Wilson SA; Rex DK;
Publication Date: 2013 Mar 23

Abstract

Preprocedural dietary restrictions have been identified as a common reason potential candidates for colorectal cancer screening do not undergo colonoscopy as recommended.
View details for PubMedID 23531424
Colonoscopic splenic injury warrants more attention.
Journal: Gastrointestinal endoscopy
Authors: Rex DK;
Publication Date: 2013 Mar 8
Retroflexion in colonoscopy: why? Where? When? How? What value?
Journal: Gastroenterology
Authors: Rex DK; Vemulapalli KC;
Publication Date: 2013 Mar 7
Screening and surveillance for colorectal cancer: state of the art.
Journal: Gastrointestinal endoscopy
Authors: Kahi CJ; Anderson JC; Rex DK;
Publication Date: 2013 Mar
Elevated phospholipase A2 activities in plasma samples from multiple cancers.
Journal: PloS one
Authors: Cai H; Chiorean EG; Chiorean MV; Rex DK; Robb BW; Hahn NM; Liu Z; Loehrer PJ; Harrison ML; Xu Y;
Publication Date: 2013 Feb 22

Abstract

Only in recent years have phospholipase A2 enzymes (PLA2s) emerged as cancer targets. In this work, we report the first detection of elevated PLA2 activities in plasma from patients with colorectal, lung, pancreatic, and bladder cancers as compared to healthy controls. Independent sets of clinical plasma samples were obtained from two different sites. The first set was from patients with colorectal cancer (CRC; n?=?38) and healthy controls (n?=?77). The second set was from patients with lung (n?=?95), bladder (n?=?31), or pancreatic cancers (n?=?38), and healthy controls (n?=?79). PLA2 activities were analyzed by a validated quantitative fluorescent assay method and subtype PLA2 activities were defined in the presence of selective inhibitors. The natural PLA2 activity, as well as each subtype of PLA2 activity was elevated in each cancer group as compared to healthy controls. PLA2 activities were increased in late stage vs. early stage cases in CRC. PLA2 activities were not influenced by sex, smoking, alcohol consumption, or body-mass index (BMI). Samples from the two independent sites confirmed the results. Plasma PLA2 activities had approximately 70% specificity and sensitivity to detect cancer. The marker and targeting values of PLA2 activity have been suggested.
View details for PubMedID 23451150
Avoiding and defending malpractice suits for postcolonoscopy cancer: advice from an expert witness.
Journal: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
Authors: Rex DK;
Publication Date: 2013 Feb 1
Prophylactic clip closure reduced the risk of delayed postpolypectomy hemorrhage: experience in 277 clipped large sessile or flat colorectal lesions and 247 control lesions.
Journal: Gastrointestinal endoscopy
Authors: Liaquat H; Rohn E; Rex DK;
Publication Date: 2013 Jan 11

Abstract

Endoscopic resection of large colorectal lesions is associated with high complication rates.
View details for PubMedID 23317580
A survey of potential adherence to capsule colonoscopy in patients who have accepted or declined conventional colonoscopy.
Journal: Journal of clinical gastroenterology
Authors: Rex DK; Lieberman DA;
Publication Date: 2012 Sep

Abstract

Capsule colonoscopy might improve adherence to colorectal cancer screening.
View details for PubMedID 22334223
Water immersion simplifies cecal intubation in patients with redundant colons and previous incomplete colonoscopies.
Journal: Gastrointestinal endoscopy
Authors: Vemulapalli KC; Rex DK;
Publication Date: 2012 Aug 14

Abstract

Interest in effective ways to complete colon examinations in patients who had previously undergone failed colonoscopies has increased recently.
View details for PubMedID 22901988
Split dosing for bowel preparation.
Journal: Gastroenterology & hepatology
Authors: Rex DK;
Publication Date: 2012 Aug
Serrated lesions of the colorectum: review and recommendations from an expert panel.
Journal: The American journal of gastroenterology
Authors: Rex DK; Ahnen DJ; Baron JA; Batts KP; Burke CA; Burt RW; Goldblum JR; Guillem JG; Kahi CJ; Kalady MF; O'Brien MJ; Odze RD; Ogino S; Parry S; Snover DC; Torlakovic EE; Wise PE; Young J; Church J;
Publication Date: 2012 Jun 19

Abstract

Serrated lesions of the colorectum are the precursors of perhaps one-third of colorectal cancers (CRCs). Cancers arising in serrated lesions are usually in the proximal colon, and account for a disproportionate fraction of cancer identified after colonoscopy. We sought to provide guidance for the clinical management of serrated colorectal lesions based on current evidence and expert opinion regarding definitions, classification, and significance of serrated lesions. A consensus conference was held over 2 days reviewing the topic of serrated lesions from the perspectives of histology, molecular biology, epidemiology, clinical aspects, and serrated polyposis. Serrated lesions should be classified pathologically according to the World Health Organization criteria as hyperplastic polyp, sessile serrated adenoma/polyp (SSA/P) with or without cytological dysplasia, or traditional serrated adenoma (TSA). SSA/P and TSA are premalignant lesions, but SSA/P is the principal serrated precursor of CRCs. Serrated lesions have a distinct endoscopic appearance, and several lines of evidence suggest that on average they are more difficult to detect than conventional adenomatous polyps. Effective colonoscopy requires an endoscopist trained in the endoscopic appearance of serrated lesions. We recommend that all serrated lesions proximal to the sigmoid colon and all serrated lesions in the rectosigmoid > 5 mm in size, be completely removed. Recommendations are made for post-polypectomy surveillance of serrated lesions and for surveillance of serrated polyposis patients and their relatives.
View details for PubMedID 22710576
Leaving distal colorectal hyperplastic polyps in place can be achieved with high accuracy by using narrow-band imaging: an observational study.
Journal: Gastrointestinal endoscopy
Authors: Hewett DG; Huffman ME; Rex DK;
Publication Date: 2012 Jun 12

Abstract

Accurate colonoscopic assessment of colorectal polyp histology could avoid resection of distal nonadenomatous polyps and reduce costs and risk.
View details for PubMedID 22695207
Multisociety Sedation Curriculum for Gastrointestinal Endoscopy.
Journal: The American journal of gastroenterology
Authors: Vargo JJ; DeLegge MH; Feld AD; Gerstenberger PD; Kwo PY; Lightdale JR; Nuccio S; Rex DK; Schiller LR;
Publication Date: 2012 May 22
Validation of a simple classification system for endoscopic diagnosis of small colorectal polyps using narrow-band imaging.
Journal: Gastroenterology
Authors: Hewett DG; Kaltenbach T; Sano Y; Tanaka S; Saunders BP; Ponchon T; Soetikno R; Rex DK;
Publication Date: 2012 May 15

Abstract

Almost all colorectal polyps = 5 mm are benign, yet current practice requires costly pathologic analysis. We aimed to develop and evaluate the validity of a simple narrow-band imaging (NBI)-based classification system for differentiating hyperplastic from adenomatous polyps.
View details for PubMedID 22609383
Deep sedation in natural orifice transluminal endoscopic surgery (NOTES): a comparative study with dogs.
Journal: Surgical endoscopy
Authors: Al-Haddad M; McKenna D; Ko J; Sherman S; Selzer DJ; Mattar SG; Imperiale TF; Rex DK; Nakeeb A; Jeong SM; Johnson CS; Freeman LJ;
Publication Date: 2012 May 12

Abstract

Natural orifice transluminal endoscopic surgery (NOTES) has been mostly performed with the animal under general and inhalational anesthesia (IA-NOTES). To date, NOTES using propofol sedation (PS-NOTES) has not been investigated. This study aimed to assess the feasibility and safety of PS-NOTES for transgastric oophorectomy with carbon dioxide insufflation and to compare its success rates with those of conventional IA-NOTES.
View details for PubMedID 22580877
Failure to recognize serrated polyposis syndrome in a cohort with large sessile colorectal polyps.
Journal: Gastrointestinal endoscopy
Authors: Vemulapalli KC; Rex DK;
Publication Date: 2012 Mar 15

Abstract

Serrated polyposis syndrome (SPS) is a rare condition of multiple serrated colorectal polyps and cancers. Colorectal cancer risk is increased in SPS.
View details for PubMedID 22425271
Risks and potential cost savings of not sending diminutive polyps for histologic examination.
Journal: Gastroenterology & hepatology
Authors: Rex DK;
Publication Date: 2012 Feb
Prospective description of coughing, hemodynamic changes, and oxygen desaturation during endoscopic sedation.
Journal: Digestive diseases and sciences
Authors: El Chafic AH; Eckert G; Rex DK;
Publication Date: 2012 Jan 24

Abstract

Deep sedation is increasingly used for endoscopy. The impact of sedation level on hemodynamic status, oxygenation, and aspiration risk is incompletely described.
View details for PubMedID 22271416
Improving protection against proximal colon cancer by colonoscopy.
Journal: Expert review of gastroenterology & hepatology
Authors: Lasisi F; Rex DK;
Publication Date: 2011 Dec

Abstract

Colonoscopy protection against proximal cancer can be achieved, but the level of protection has thus far been less than left colon protection. Improved proximal protection begins with effective right colon bowel preparation, best achieved by split dosing the preparation regimen. Cecal intubation in screening examinations should exceed 95%, and must be documented by photography. Examiners must be proficient in detection of subtle right colon lesions, including serrated lesions as well as flat and depressed adenomas. Effective examination should be demonstrated by meeting recommended targets for adenoma detection.
View details for PubMedID 22017701
High colonoscopic prevalence of proximal colon serrated polyps in average-risk men and women.
Journal: Gastrointestinal endoscopy
Authors: Kahi CJ; Li X; Eckert GJ; Rex DK;
Publication Date: 2011 Oct 21

Abstract

Proximal colon serrated polyps likely contribute to the decreased protection of colonoscopy against right-sided colorectal cancer.
View details for PubMedID 22018551
Evolving techniques in colonoscopy.
Journal: Current opinion in gastroenterology
Authors: Vemulapalli KC; Rex DK;
Publication Date: 2011 Sep

Abstract

This review summarizes recent clinical studies of colonoscopy technique and new technologies.
View details for PubMedID 21785352
Miss rate of right-sided colon examination during colonoscopy defined by retroflexion: an observational study.
Journal: Gastrointestinal endoscopy
Authors: Hewett DG; Rex DK;
Publication Date: 2011 Jun 15

Abstract

Colonoscopy is less effective in the proximal compared with the distal colon.
View details for PubMedID 21679946
A quantitative assessment of the risks and cost savings of forgoing histologic examination of diminutive polyps.
Journal: Endoscopy
Authors: Kessler WR; Imperiale TF; Klein RW; Wielage RC; Rex DK;
Publication Date: 2011 May 27

Abstract

Endoscopic prediction of polyp histology is rapidly improving to the point where it may not be necessary to submit all polyps for formal histologic assessment. This study aimed to quantify the expected costs and outcomes of removing diminutive polyps without subsequent pathologic assessment.
View details for PubMedID 21623556
Effect of the Centers for Medicare & Medicaid Services policy about deep sedation on use of propofol.
Journal: Annals of internal medicine
Authors: Rex DK;
Publication Date: 2011 May 3

Abstract

On 11 December 2009, the Centers for Medicare & Medicaid Services issued a policy stating that deep sedation can only be administered by an anesthesiologist, a certified registered nurse anesthetist, or a trained medical doctor or a doctor of osteopathy not involved in the performance of a medical procedure. Propofol is a popular sedation agent that is usually administered by anesthesia specialists in a service termed monitored anesthesia care (MAC). Monitored anesthesia care adds substantial new fees to procedural sedation. However, available evidence shows that propofol can be used safely by non-anesthesiologists for procedural sedation. The American Society of Anesthesiologists considers that propofol implies deep sedation and should only be administered by anesthesia specialists. The Centers for Medicare & Medicaid Services policy on deep sedation can be viewed as supporting an ongoing conversion to MAC to deliver propofol for procedural sedation. However, the absence of an evidence base supporting a need for MAC to deliver propofol, combined with its high cost, suggests that alternatives to MAC to deliver propofol deserve fair and balanced evaluation.
View details for PubMedID 21536938
The impact of videorecording on the quality of colonoscopy performance: a pilot study.
Journal: The American journal of gastroenterology
Authors: Rex DK; Hewett DG; Raghavendra M; Chalasani N;
Publication Date: 2010 Nov

Abstract

Colonoscopy provides imperfect protection against colorectal cancer and is operator dependent. Colonoscopies typically are poorly documented. We aimed to determine whether videorecording impacts short-term performance of colonoscopy.
View details for PubMedID 21048675
Colonoscopy and diminutive polyps: hot or cold biopsy or snare? Do I send to pathology?
Journal: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
Authors: Hewett DG; Rex DK;
Publication Date: 2010 Oct 15
Efficacy and effectiveness of colonoscopy: how do we bridge the gap?
Journal: Gastrointestinal endoscopy clinics of North America
Authors: Hewett DG; Kahi CJ; Rex DK;
Publication Date: 2010 Oct

Abstract

Colonoscopy is sometimes considered the preferred colorectal cancer screening modality, yet this modality may be subject to variation in operator performance more than any other screening test. Failures of colonoscopy to consistently detect precancerous lesions threaten the effectiveness of this technique for the prevention of colorectal cancer. Studies on high-level adenoma detectors under optimal conditions have begun to establish the true efficacy of colonoscopy and further widen the gap between efficacy and effectiveness. Research is required to establish the component skills, attitudes, and behaviors for high-level mucosal inspection competence necessary for training and assessment. Interventions to bridge the gap between efficacy and effectiveness are lacking, yet they should emphasize quality measurement and operate at various levels within the health system to motivate change in endoscopist behavior.
View details for PubMedID 20889071
Prevalence and variable detection of proximal colon serrated polyps during screening colonoscopy.
Journal: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
Authors: Kahi CJ; Hewett DG; Norton DL; Eckert GJ; Rex DK;
Publication Date: 2010 Oct 1

Abstract

Colonoscopy may have a greater protective effect for distal colorectal cancer (CRC) than proximal CRC. Serrated polyps are frequently located in the proximal colon, can be missed during colonoscopy, and may progress to CRC. We investigated the prevalence and endoscopist detection rates of proximal serrated polyps in a large cohort of average risk patients undergoing screening colonoscopy.
View details for PubMedID 20888435
Colorectal cancer prevention with colonoscopy: recent research and debate.
Journal: Gastroenterology & hepatology
Authors: Rex DK;
Publication Date: 2010 Jul
Relationship of non-polypoid colorectal neoplasms to quality of colonoscopy.
Journal: Gastrointestinal endoscopy clinics of North America
Authors: Kahi CJ; Hewett DG; Rex DK;
Publication Date: 2010 Jul

Abstract

Colonoscopy is a dominant modality for colorectal cancer prevention in average-risk patients aged 50 years and older. Non-polypoid colorectal neoplasms (NP-CRNs) are likely a significant contributing factor to interval colorectal cancers because they have a higher prevalence in Western populations than previously thought, are more difficult to detect visually with conventional colonoscopy, and are more likely to contain advanced histology than polypoid neoplasms, regardless of size. The accurate identification and complete removal of NP-CRNs is thus an integral part of high-quality colonoscopy, and a critical component of the ongoing efforts to make colorectal cancer screening programs widely available, effective, and accepted by patients. In this article, the authors examine the quality indicators for colonoscopy, present the reasons for interval cancers, and discuss the relation between NP-CRNs and quality colonoscopy.
View details for PubMedID 20656239
Cap-fitted colonoscopy: a randomized, tandem colonoscopy study of adenoma miss rates.
Journal: Gastrointestinal endoscopy
Authors: Hewett DG; Rex DK;
Publication Date: 2010 Jun 25

Abstract

Failures of adenoma detection diminish the effectiveness of colonoscopy.
View details for PubMedID 20579648
Differentiating adenomas from hyperplastic colorectal polyps: narrow-band imaging can be learned in 20 minutes.
Journal: Gastrointestinal endoscopy
Authors: Raghavendra M; Hewett DG; Rex DK;
Publication Date: 2010 Jun 19

Abstract

Colonoscopy with narrow-band imaging can allow real-time determination of polyp histology.
View details for PubMedID 20561618
Split-dose bowel preparation for colonoscopy and residual gastric fluid volume: an observational study.
Journal: Gastrointestinal endoscopy
Authors: Huffman M; Unger RZ; Thatikonda C; Amstutz S; Rex DK;
Publication Date: 2010 Jun 19

Abstract

Split-dose bowel preparations for colonoscopy are more effective and better tolerated than preparations given entirely the day or evening before the procedure; however, some resistance to split-dose preparation stems from concerns about an increased risk of aspiration with same-day preparation.
View details for PubMedID 20646700
A randomized clinical study comparing reduced-volume oral sulfate solution with standard 4-liter sulfate-free electrolyte lavage solution as preparation for colonoscopy.
Journal: Gastrointestinal endoscopy
Authors: Rex DK; Di Palma JA; Rodriguez R; McGowan J; Cleveland M;
Publication Date: 2010 Jun 19

Abstract

Low-volume bowel preparations for colonoscopy improve tolerability.
View details for PubMedID 20646695
Improving colonoscopy quality through health-care payment reform.
Journal: The American journal of gastroenterology
Authors: Hewett DG; Rex DK;
Publication Date: 2010 Jun 15

Abstract

Problems with the quality of colonoscopy are well recognized. Variation in colonoscopist performance is compounded by payment structures that reward volume rather than quality. Payment reform has emerged as one strategy to address these and more systemic problems in the quality of health care. Various forms of value-based purchasing might encourage a realignment of incentives, and allow reimbursement to be directly linked with clinically important goals of colonoscopy. This paper proposes criteria for the selection of quality measures, and three candidate indicators to define quality for the purpose of payment reform in colonoscopy: cecal intubation rate, adenoma detection rate, and recommended post-polypectomy surveillance interval. These measures represent valid, credible, and reliable indicators of the quality of colonoscopy for colorectal cancer screening and surveillance. Payment reform should explicitly link public reporting and performance on these quality measures to payment for colonoscopy.
View details for PubMedID 20551937
Patients' description of rectal effluent and quality of bowel preparation at colonoscopy.
Journal: Gastrointestinal endoscopy
Authors: Fatima H; Johnson CS; Rex DK;
Publication Date: 2010 Apr 1

Abstract

There are few data evaluating how accurately patients can predict the quality of their colonoscopy preparation.
View details for PubMedID 20362286
High-definition chromocolonoscopy vs. high-definition white light colonoscopy for average-risk colorectal cancer screening.
Journal: The American journal of gastroenterology
Authors: Kahi CJ; Anderson JC; Waxman I; Kessler WR; Imperiale TF; Li X; Rex DK;
Publication Date: 2010 Feb 23

Abstract

Flat and depressed colon neoplasms are an increasingly recognized precursor for colorectal cancer (CRC) in Western populations. High-definition chromoscopy is used to increase the yield of colonoscopy for flat and depressed neoplasms; however, its role in average-risk patients undergoing routine screening remains uncertain.
View details for PubMedID 20179689
Patient interest in video recording of colonoscopy: a survey.
Journal: World journal of gastroenterology : WJG
Authors: Raghavendra M; Rex DK;
Publication Date: 2010 Jan 28

Abstract

To find if patients are interested in obtaining a video recording of their colonoscopy procedure.
View details for PubMedID 20101771
Willingness to undergo split-dose bowel preparation for colonoscopy and compliance with split-dose instructions.
Journal: Digestive diseases and sciences
Authors: Unger RZ; Amstutz SP; Seo da H; Huffman M; Rex DK;
Publication Date: 2010 Jan 16

Abstract

Split-dose bowel preparations for colonoscopy have superior effectiveness compared with giving all the preparation the evening before colonoscopy. Some physicians believe that split-dose preparations would be unpopular with patients scheduled for early morning colonoscopies.
View details for PubMedID 20082216
Does colonoscopy work?
Journal: Journal of the National Comprehensive Cancer Network : JNCCN
Authors: Hewett DG; Kahi CJ; Rex DK;
Publication Date: 2010 Jan

Abstract

Through its impact on the adenoma-carcinoma sequence, colonoscopy has a central role in the detection and prevention of colorectal cancer (CRC). Observational data support a protective effect of colonoscopy and polypectomy on CRC incidence and mortality. However, recent studies suggest that the degree of CRC protection afforded by colonoscopy is dependent on the effectiveness of identification of prevalent cancers or their precursors, particularly in the proximal colon. Biologic variation in tumor genetics and growth likely contribute to diminished protection in the proximal colon. Operator variability is known to be a key factor predicting adenoma detection. Evidence supports the immediate adoption of specific quality improvement initiatives to reduce the failure rate of colonoscopy. Further interventions should target individual, organizational, and health system factors which influence physician behavior.
View details for PubMedID 20064290
Reinterpretation of histology of proximal colon polyps called hyperplastic in 2001.
Journal: World journal of gastroenterology : WJG
Authors: Khalid O; Radaideh S; Cummings OW; O'Brien MJ; Goldblum JR; Rex DK;
Publication Date: 2009 Aug 14

Abstract

To evaluate how proximal colon polyps interpreted as hyperplastic polyps in 2001 would be interpreted by expert pathologists in 2007.
View details for PubMedID 19673017
Colorectal anatomy in adults at computed tomography colonography: normal distribution and the effect of age, sex, and body mass index.
Journal: Endoscopy
Authors: Khashab MA; Pickhardt PJ; Kim DH; Rex DK;
Publication Date: 2009 Aug 10

Abstract

Computed tomography colonography (CTC) is an accurate tool for assessing the large intestinal anatomy. Our aims were to determine the normal distribution of in vivo colorectal anatomy and to investigate the effect of age, sex, and body mass index (BMI) on colorectal length.
View details for PubMedID 19670134
Endoscopy: insertion versus withdrawal phases for polyp detection.
Journal: Nature reviews. Gastroenterology & hepatology
Authors: Rex DK;
Publication Date: 2009 Aug
Endoscopist-directed administration of propofol: a worldwide safety experience.
Journal: Gastroenterology
Authors: Rex DK; Deenadayalu VP; Eid E; Imperiale TF; Walker JA; Sandhu K; Clarke AC; Hillman LC; Horiuchi A; Cohen LB; Heuss LT; Peter S; Beglinger C; Sinnott JA; Welton T; Rofail M; Subei I; Sleven R; Jordan P; Goff J; Gerstenberger PD; Munnings H; Tagle M; Sipe BW; Wehrmann T; Di Palma JA; Occhipinti KE; Barbi E; Riphaus A; Amann ST; Tohda G; McClellan T; Thueson C; Morse J; Meah N;
Publication Date: 2009 Jun 21

Abstract

Endoscopist-directed propofol sedation (EDP) remains controversial. We sought to update the safety experience of EDP and estimate the cost of using anesthesia specialists for endoscopic sedation.
View details for PubMedID 19549528
Colon cleansing before colonoscopy: does oral sodium phosphate solution still make sense?
Journal: Canadian journal of gastroenterology = Journal canadien de gastroenterologie
Authors: Rex DK; Vanner SJ;
Publication Date: 2009 Mar

Abstract

Oral sodium phosphate (NaP) solution has been withdrawn from the market in the United States but remains available for over-the-counter purchase for bowel preparation for colonoscopy in Canada. The present review summarizes recent data regarding the renal toxicity of oral NaP as well as its efficacy and tolerability relative to other preparations. Given the availability of effective alternatives to NaP solution, its use for colonoscopy preparation in Canada should be limited. Candidate patients for oral NaP solution should be assessed for eligibility and preparation instructions should adhere to the current recommendations for maximizing the safety of oral NaP.
View details for PubMedID 19319385
Incidence and predictors of "late" recurrences after endoscopic piecemeal resection of large sessile adenomas.
Journal: Gastrointestinal endoscopy
Authors: Khashab M; Eid E; Rusche M; Rex DK;
Publication Date: 2009 Feb 27

Abstract

Large sessile colorectal adenomas (>/=2 cm in size) resected piecemeal have a 0% to 55% rate of residual adenoma at the first follow-up. Guidelines recommend inspection of the polypectomy site 3 to 6 months after resection. Some patients with a negative examination at 3 to 6 months have a subsequent "late" recurrence.
View details for PubMedID 19249767
American College of Gastroenterology guidelines for colorectal cancer screening 2009 [corrected].
Journal: The American journal of gastroenterology
Authors: Rex DK; Johnson DA; Anderson JC; Schoenfeld PS; Burke CA; Inadomi JM; American College of Gastroenterology;
Publication Date: 2009 Feb 24

Abstract

This document is the first update of the American College of Gastroenterology (ACG) colorectal cancer (CRC) screening recommendations since 2000. The CRC screening tests are now grouped into cancer prevention tests and cancer detection tests. Colonoscopy every 10 years, beginning at age 50, remains the preferred CRC screening strategy. It is recognized that colonoscopy is not available in every clinical setting because of economic limitations. It is also realized that not all eligible persons are willing to undergo colonoscopy for screening purposes. In these cases, patients should be offered an alternative CRC prevention test (flexible sigmoidoscopy every 5-10 years, or a computed tomography (CT) colonography every 5 years) or a cancer detection test (fecal immunochemical test for blood, FIT).
View details for PubMedID 19240699
Effect of screening colonoscopy on colorectal cancer incidence and mortality.
Journal: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
Authors: Kahi CJ; Imperiale TF; Juliar BE; Rex DK;
Publication Date: 2009 Jan 11

Abstract

Colonoscopy is used widely for colorectal cancer (CRC) screening; however, its long-term impact on the incidence and mortality of CRC is not known.
View details for PubMedID 19268269
Estimation of impact of American College of Radiology recommendations on CT colonography reporting for resection of high-risk adenoma findings.
Journal: The American journal of gastroenterology
Authors: Rex DK; Overhiser AJ; Chen SC; Cummings OW; Ulbright TM;
Publication Date: 2009 Jan

Abstract

The American College of Radiology (ACR) recommends that polyps < or =5 mm in size not be reported on computed tomography (CT) colonography studies. Patients with 1 or 2 polyps 6-9 mm in size can be offered "CTC surveillance" in 3 years in lieu of polypectomy. The aim of the study was to determine the impact of ACR recommendations on resection of high-risk adenoma findings using an endoscopic polyp/histology database.
View details for PubMedID 19098863
Narrow-band imaging without optical magnification for histologic analysis of colorectal polyps.
Journal: Gastroenterology
Authors: Rex DK;
Publication Date: 2008 Dec 10

Abstract

The ability to determine colorectal polyp pathology by endoscopy could reduce the risks of polypectomy and the cost of pathologic evaluation. This study evaluated the ability of the Olympus Exera 180 high-definition colonoscope (Olympus America, Inc, Center Valley, PA), with narrow-band imaging, to predict colorectal polyp histology.
View details for PubMedID 19187781
Routine rectal retroflexion during colonoscopy has a low yield for neoplasia.
Journal: World journal of gastroenterology : WJG
Authors: Saad A; Rex DK;
Publication Date: 2008 Nov 14

Abstract

To investigate the value of retroflexion in detecting neoplasia in the distal rectum.
View details for PubMedID 19030202
Gastroenterologists' patient instructions for oral sodium phosphate solution for colonoscopy preparation: a survey among gastroenterologists in the state of Indiana.
Journal: Journal of clinical gastroenterology
Authors: Gagovic V; Rex DK;
Publication Date: 2008 Nov

Abstract

Oral sodium phosphate solution (OSPS) has been associated with acute renal failure when used as a bowel preparation for colonoscopy.
View details for PubMedID 18633334
Gastroenterologist-directed propofol: an update.
Journal: Gastrointestinal endoscopy clinics of North America
Authors: Rex DK; Deenadayalu V; Eid E;
Publication Date: 2008 Oct

Abstract

Gastroenterologist directed propofol has been proven safe in more than 220,000 published cases. Administration of low doses of opioid and/or benzodiazepine ("balanced propofol sedation") is the safest format for gastroenterologist directed propofol. Specific training is needed to undertake gastroenterologist directed propofol administration.
View details for PubMedID 18922410
Variable detection of nonadenomatous polyps by individual endoscopists at colonoscopy and correlation with adenoma detection.
Journal: Journal of clinical gastroenterology
Authors: Chen SC; Rex DK;
Publication Date: 2008 Jul

Abstract

There is variation between endoscopists in their detection of colorectal adenomas. There is less understanding of variation between endoscopists in detection and management of nonadenomas.
View details for PubMedID 18496392
Large sessile adenomas are associated with a high prevalence of synchronous advanced adenomas.
Journal: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
Authors: Mattar W; Rex DK;
Publication Date: 2008 Jun 30

Abstract

The prevalence of synchronous neoplasia in patients with large sessile colorectal adenomas is uncertain.
View details for PubMedID 18585969
Screening, surveillance, and primary prevention for colorectal cancer: a review of the recent literature.
Journal: Gastroenterology
Authors: Kahi CJ; Rex DK; Imperiale TF;
Publication Date: 2008 Jun 26
Pro: Villous elements and high-grade dysplasia help guide post-polypectomy colonoscopic surveillance.
Journal: The American journal of gastroenterology
Authors: Rex DK; Goldblum JR;
Publication Date: 2008 Jun
Considerations regarding the present and future roles of colonoscopy in colorectal cancer prevention.
Journal: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
Authors: Rex DK; Eid E;
Publication Date: 2008 May

Abstract

Effective and safe colonoscopy is essential to colorectal cancer prevention, regardless of the method used for colorectal cancer screening. The level of colorectal cancer incidence reduction provided by colonoscopy and polypectomy varies widely in available studies. There are several mechanisms by which colonoscopy might fail to prevent colorectal cancer, and some of the mechanisms might be overcome by simple currently available measures. Further, advances in colonoscope technology could enhance the effectiveness of colonoscopy or render it less operator-dependent. The large market for colorectal cancer screening in the United States has spawned innovative noncolonoscopic technologies for colorectal cancer and polyp detection. Because these technologies are diagnosis only, their overall impact on outcomes ultimately may be determined by whether they successfully increase adherence to screening (which should reduce colorectal cancer incidence) versus displace patients from colonoscopy screening (which potentially could increase colorectal cancer incidence), as well as their cost effectiveness and the extent to which they reduce colonoscopy complications. As these strategies emerge, monitoring their effects on adherence, cancer prevention, and procedural complications will be needed to optimize their roles relative to primary colonoscopy screening.
View details for PubMedID 18455696
Achieving cecal intubation in the very difficult colon.
Journal: Gastrointestinal endoscopy
Authors: Rex DK;
Publication Date: 2008 May
Risk factors for advanced sporadic colorectal neoplasia in persons younger than age 50.
Journal: Cancer detection and prevention
Authors: Imperiale TF; Kahi CJ; Stuart JS; Qi R; Born LJ; Glowinski EA; Rex DK;
Publication Date: 2008 Apr 8

Abstract

Colorectal cancer (CRC) screening is recommended for average-risk adults beginning at age 50. However, 7% of CRC occurs in persons younger than age 50, a group for which risk factors are not well defined. We sought to determine whether a retrospective case-control study could identify risk factors for sporadic CRC and advanced adenomatous polyps (together known as sporadic colorectal neoplasia [CRN]).
View details for PubMedID 18400417
Colonoscopic polypectomy.
Journal: Gastroenterology clinics of North America
Authors: Tolliver KA; Rex DK;
Publication Date: 2008 Mar

Abstract

Colonoscopic polypectomy is the most effective visceral cancer prevention tool in clinical medicine. In general, risks associated with the technique of polyp removal should match the likelihood that the polyp will become or already is malignant (eg, low-risk technique for low risk for malignant potential). Cold techniques are preferred for most diminutive polyps. Polypectomy techniques must be effective and minimize complications. Complications can occur even with proper technique, however. Aggressive evaluation and treatment of complications helps ensure the best possible outcome.
View details for PubMedID 18313548
Small-bowel obstruction: state-of-the-art imaging and its role in clinical management.
Journal: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
Authors: Maglinte DD; Howard TJ; Lillemoe KD; Sandrasegaran K; Rex DK;
Publication Date: 2008 Jan 9

Abstract

Small-bowel obstruction (SBO) is a common clinical condition with signs and symptoms similar to other acute abdominal disorders. The radiologic investigation of patients with SBO as well as the indications and timing of surgical intervention have changed over the past 2 decades. This review focuses on modern imaging techniques and their role in both the diagnosis and treatment of patients with SBO.
View details for PubMedID 18187365
Cecal insertion and withdrawal times with wide-angle versus standard colonoscopes: a randomized controlled trial.
Journal: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
Authors: Fatima H; Rex DK; Rothstein R; Rahmani E; Nehme O; Dewitt J; Helper D; Toor A; Bensen S;
Publication Date: 2007 Dec 11

Abstract

The aim of this study was to see if a 170 degrees angle of view (wide angle [WA]) colonoscope allowed faster withdrawal without decreasing adenoma detection.
View details for PubMedID 18065277
Colonoscopy-induced splenic injury: report of 3 cases and literature review.
Journal: Digestive diseases and sciences
Authors: Saad A; Rex DK;
Publication Date: 2007 Oct 13

Abstract

Since its first report in 1974, 66 cases of splenic injury after colonoscopy have been reported in the world literature. Splenic injury is among the rarest complications of colonoscopy. However, it can be associated with severe morbidity and has rarely been fatal.
View details for PubMedID 17934832
Primer: Applying the new postpolypectomy surveillance guidelines in clinical practice.
Journal: Nature clinical practice. Gastroenterology & hepatology
Authors: Kahi CJ; Rex DK;
Publication Date: 2007 Oct

Abstract

Colonoscopy is being increasingly used for colorectal cancer screening, which has resulted in a growing cohort of patients who have polyps that require postpolypectomy surveillance. Risk stratification enables postpolypectomy surveillance to be tailored to individual patient needs, and this is one of the fundamental points emphasized by the unified US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society (USMSTF-ACS) guidelines. Most patients do not require intensive surveillance; those patients who have one or two small (<1 cm) adenomas can safely undergo repeat colonoscopy after 5-10 years. Consensus guidelines that merge the recommendations of all societies are more user-friendly than individual guidelines, decrease confusion, and eliminate conflicting recommendations that are a barrier to guideline uptake. Nonetheless, studies have shown that specialists and nonspecialists overutilize colonoscopy for postpolypectomy surveillance, which places a large burden on already strained resources. Barriers to guideline implementation include factors involving the patient, physician, and health-care system. Physician education and widespread implementation of continuous quality improvement programs are required to bridge the gap between the guidelines and their clinical application.
View details for PubMedID 17909534
Colonoscopy withdrawal times and adenoma detection rates.
Journal: Gastroenterology & hepatology
Authors: Rex DK;
Publication Date: 2007 Aug
Dosing considerations in the use of sodium phosphate bowel preparations for colonoscopy.
Journal: The Annals of pharmacotherapy
Authors: Rex DK;
Publication Date: 2007 Jul 24

Abstract

To review dosing considerations and other treatment recommendations to maximize the efficacy, tolerability, and safety of sodium phosphate (NaP) preparations.
View details for PubMedID 17652123
Work and resources needed for endoscopic resection of large sessile colorectal polyps.
Journal: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
Authors: Overhiser AJ; Rex DK;
Publication Date: 2007 Jul 10

Abstract

Large sessile colon polyps often are referred for surgical resection, even when amenable to endoscopic resection. The aim of this study was to describe the resource use of endoscopic resection of large sessile colon polyps compared with small polyps with respect to physician time and equipment use.
View details for PubMedID 17625979
Colonoscopy technique in consecutive patients referred for prior incomplete colonoscopy.
Journal: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
Authors: Rex DK; Chen SC; Overhiser AJ;
Publication Date: 2007 Jun 4

Abstract

Cecal intubation is one of the goals of colonoscopy. In some patients cecal intubation is unsuccessful. The aim of this study was to describe the approach used by a gastroenterologist with special interest in colonoscopy to perform colonoscopy in patients with a prior incomplete colonoscopy.
View details for PubMedID 17544873
High yields of small and flat adenomas with high-definition colonoscopes using either white light or narrow band imaging.
Journal: Gastroenterology
Authors: Rex DK; Helbig CC;
Publication Date: 2007 Apr 20

Abstract

Detection of adenomas is an important goal of colonoscopy. Narrow band imaging (NBI) might highlight adenomas and lead to higher rates of adenoma detection.
View details for PubMedID 17631129
Endoscopist can be more powerful than age and male gender in predicting adenoma detection at colonoscopy.
Journal: The American journal of gastroenterology
Authors: Chen SC; Rex DK;
Publication Date: 2007 Jan 11

Abstract

Both advancing age and male gender are known predictors of adenomas and large adenomas at colonoscopy. However, the importance of endoscopist compared with both age and gender as predictors of adenomas is not known. In this study, we assessed the adenoma detection rates of nine endoscopists performing colonoscopy and the effects of endoscopist on adenoma detection compared with the established predictors of advancing age and male gender.
View details for PubMedID 17222317
Minimizing endoscopic complications: colonoscopic polypectomy.
Journal: Gastrointestinal endoscopy clinics of North America
Authors: Fatima H; Rex DK;
Publication Date: 2007 Jan

Abstract

Current polypectomy tools and techniques are inadequate to prevent all postpolypectomy bleeding, perforation, and postpolypectomy syndrome; however, adherence to certain principles can substantially reduce the risk of these complications. This review does not focus on technical aspects of colonoscopy that are directed toward preventing complications of failed eradication. Rather, the authors focus on the classic complications of bleeding, perforation, and their prevention. New technologies that could further reduce or eliminate perforation and bleeding after polypectomy are sorely needed.
View details for PubMedID 17397781
Maximizing detection of adenomas and cancers during colonoscopy.
Journal: The American journal of gastroenterology
Authors: Rex DK;
Publication Date: 2006 Dec

Abstract

Some patients who undergo colonoscopy that appeared to have cleared the colorectum of neoplasia return within a short interval (1-3 yr) with colorectal cancer. Although several a priori mechanisms could account for this occurrence, wide variation in detection rates of adenomas and cancer at colonoscopy suggests that suboptimal colonoscopic technique is a significant contributor. Optimal technique with white-light colonoscopy involves taking adequate time for inspection during withdrawal (an average of at least 6 min in normal colons), interrogating the proximal sides of folds, flexures, and valves, clearing fluid and debris, and distending adequately. Some adjunctive techniques are directed toward exposing more colonic mucosa during colonoscopy. Wide-angle colonoscopy appears to improve efficiency but does not eliminate miss rates. Colonoscopy in retroflexion was unsuccessful in reducing miss rates in one study, whereas cap-fitted colonoscopy was successful in reducing miss rates in one small study. Techniques to improve detection of flat lesions include pancolonic chromoendoscopy (CE). In two randomized controlled trials, CE improved adenoma detection, but CE does not appear to provide substantially greater yields than those obtained by the more sensitive white-light colonoscopists. Narrow band imaging and autofluorescence are being assessed for improved detection of flat lesions. Adenoma detection rates are an important measure of the quality of colonoscopy and should be reported to endoscopists in quality improvement programs in colonoscopy.
View details for PubMedID 17227527
Safety and colon-cleansing efficacy of a new residue-free formulation of sodium phosphate tablets.
Journal: The American journal of gastroenterology
Authors: Rex DK; Schwartz H; Goldstein M; Popp J; Katz S; Barish C; Karlstadt RG; Rose M; Walker K; Lottes S; Ettinger N; Zhang B;
Publication Date: 2006 Oct 4

Abstract

A residue-free sodium phosphate tablet (RF-NaP) was formulated that lacks microcrystalline cellulose, which can appear as a whitish residue in the colon. A multicenter, randomized, investigator-blinded study was conducted to compare the colon-cleansing efficacy of 40 or 32 tablets of RF-NaP with the marketed 40-tablet NaP treatment regimen.
View details for PubMedID 17029618
Propofol alone titrated to deep sedation versus propofol in combination with opioids and/or benzodiazepines and titrated to moderate sedation for colonoscopy.
Journal: The American journal of gastroenterology
Authors: VanNatta ME; Rex DK;
Publication Date: 2006 Oct

Abstract

Propofol by nonanesthesiologists is controversial because the drug is commonly used to produce deep sedation or general anesthesia. Propofol in combination with opioids and/or benzodiazepines can be titrated to moderate sedation, which might be safer.
View details for PubMedID 17032185
Efficacy of bispectral monitoring as an adjunct to nurse-administered propofol sedation for colonoscopy: a randomized controlled trial.
Journal: The American journal of gastroenterology
Authors: Drake LM; Chen SC; Rex DK;
Publication Date: 2006 Sep

Abstract

Bispectral (BIS) monitoring provides an objective, non-invasive measure of the level of consciousness in sedated patients. BIS has been shown to lag behind the level of sedation during induction and emergence of sedation with propofol. In this study, we sought to determine whether BIS is a useful adjunctive maneuver to registered nurse-administered propofol sedation (NAPS) as measured by reductions in recovery time and doses of propofol administered.
View details for PubMedID 16968506
Endoscopic treatment of chronic radiation proctopathy.
Journal: Current opinion in gastroenterology
Authors: Wilson SA; Rex DK;
Publication Date: 2006 Sep

Abstract

Chronic radiation proctopathy is a complication of pelvic radiation therapy. The acute phase of radiation injury to the rectum occurs during or up to 3 months following radiation. Acute radiation injury can continue into a chronic phase or chronic radiation proctopathy may develop after a latent period of several months or years. Symptoms associated with the condition include diarrhea, rectal pain, bleeding, tenesmus, and stricture formation. Of the various symptoms, only bleeding from radiation-induced telangiectasias is amenable to endoscopic therapy. This paper summarizes the findings of experts in the field on endoscopic treatment of bleeding from chronic radiation proctopathy.
View details for PubMedID 16891886
Review article: moderate sedation for endoscopy: sedation regimens for non-anaesthesiologists.
Journal: Alimentary pharmacology & therapeutics
Authors: Rex DK;
Publication Date: 2006 Jul 15

Abstract

Moderate sedation is a drug-induced depression of consciousness during which patients respond purposefully to verbal commands with or without light tactile stimulation. Moderate sedation is typically accepted in the anaesthesia community as an appropriate target for sedation by non-anaesthesiologists.
View details for PubMedID 16842446
A patient has a 3-centimeter cecal polyp on chronic anticoagulation for a mechanical mitral valve prosthesis.
Journal: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
Authors: Overhiser AJ; Rex DK;
Publication Date: 2006 Jul 14
ACG colorectal cancer prevention action plan: update on CT-colonography.
Journal: The American journal of gastroenterology
Authors: Rex DK; Lieberman D; ACG;
Publication Date: 2006 Jul
Guidelines for colonoscopy surveillance after cancer resection: a consensus update by the American Cancer Society and US Multi-Society Task Force on Colorectal Cancer.
Journal: CA: a cancer journal for clinicians
Authors: Rex DK; Kahi CJ; Levin B; Smith RA; Bond JH; Brooks D; Burt RW; Byers T; Fletcher RH; Hyman N; Johnson D; Kirk L; Lieberman DA; Levin TR; O'Brien MJ; Simmang C; Thorson AG; Winawer SJ;
Publication Date: 2006 May

Abstract

Patients with resected colorectal cancer are at risk for recurrent cancer and metachronous neoplasms in the colon. This joint update of guidelines by the American Cancer Society (ACS) and US Multi-Society Task Force on Colorectal Cancer addresses only the use of endoscopy in the surveillance of these patients. Patients with endoscopically resected Stage I colorectal cancer, surgically resected Stage II and III cancers, and Stage IV cancer resected for cure (isolated hepatic or pulmonary metastasis) are candidates for endoscopic surveillance. The colorectum should be carefully cleared of synchronous neoplasia in the perioperative period. In nonobstructed colons, colonoscopy should be performed preoperatively. In obstructed colons, double contrast barium enema or computed tomography colonography should be done preoperatively, and colonoscopy should be performed 3 to 6 months after surgery. These steps complete the process of clearing synchronous disease. After clearing for synchronous disease, another colonoscopy should be performed in 1 year to look for metachronous lesions. This recommendation is based on reports of a high incidence of apparently metachronous second cancers in the first 2 years after resection. If the examination at 1 year is normal, then the interval before the next subsequent examination should be 3 years. If that colonoscopy is normal, then the interval before the next subsequent examination should be 5 years. Shorter intervals may be indicated by associated adenoma findings (see Postpolypectomy Surveillance Guideline). Shorter intervals are also indicated if the patient's age, family history, or tumor testing indicate definite or probable hereditary nonpolyposis colorectal cancer. Patients undergoing low anterior resection of rectal cancer generally have higher rates of local cancer recurrence, compared with those with colon cancer. Although effectiveness is not proven, performance of endoscopic ultrasound or flexible sigmoidoscopy at 3- to 6-month intervals for the first 2 years after resection can be considered for the purpose of detecting a surgically curable recurrence of the original rectal cancer.
View details for PubMedID 16737948
Guidelines for colonoscopy surveillance after cancer resection: a consensus update by the American Cancer Society and the US Multi-Society Task Force on Colorectal Cancer.
Journal: Gastroenterology
Authors: Rex DK; Kahi CJ; Levin B; Smith RA; Bond JH; Brooks D; Burt RW; Byers T; Fletcher RH; Hyman N; Johnson D; Kirk L; Lieberman DA; Levin TR; O'Brien MJ; Simmang C; Thorson AG; Winawer SJ; American Cancer Society; US Multi-Society Task Force on Colorectal Cancer;
Publication Date: 2006 May

Abstract

Patients with resected colorectal cancer are at risk for recurrent cancer and metachronous neoplasms in the colon. This joint update of guidelines by the American Cancer Society and the US Multi-Society Task Force on Colorectal Cancer addresses only the use of endoscopy in the surveillance of these patients. Patients with endoscopically resected Stage I colorectal cancer, surgically resected Stages II and III cancers, and Stage IV cancer resected for cure (isolated hepatic or pulmonary metastasis) are candidates for endoscopic surveillance. The colorectum should be carefully cleared of synchronous neoplasia in the perioperative period. In nonobstructed colons, colonoscopy should be performed preoperatively. In obstructed colons, double-contrast barium enema or computed tomography colonography should be performed preoperatively, and colonoscopy should be performed 3 to 6 months after surgery. These steps complete the process of clearing synchronous disease. After clearing for synchronous disease, another colonoscopy should be performed in 1 year to look for metachronous lesions. This recommendation is based on reports of a high incidence of apparently metachronous second cancers in the first 2 years after resection. If the examination at 1 year is normal, then the interval before the next subsequent examination should be 3 years. If that examination is normal, then the interval before the next subsequent examination should be 5 years. Shorter intervals may be indicated by associated adenoma findings (see "Guidelines for Colonoscopy Surveillance After Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society"). Shorter intervals also are indicated if the patient's age, family history, or tumor testing indicate definite or probable hereditary nonpolyposis colorectal cancer. Patients undergoing low anterior resection of rectal cancer generally have higher rates of local cancer recurrence compared with those with colon cancer. Although effectiveness is not proven, performance of endoscopic ultrasound or flexible sigmoidoscopy at 3- to 6-month intervals for the first 2 years after resection can be considered for the purpose of detecting a surgically curable recurrence of the original rectal cancer.
View details for PubMedID 16697749
Colonoscopic polypectomy in retroflexion.
Journal: Gastrointestinal endoscopy
Authors: Rex DK; Khashab M;
Publication Date: 2006 Jan

Abstract

Little has been written about the value of retroflexion in the removal of large sessile colon polyps.
View details for PubMedID 16377332
Advances in colonoscopic imaging.
Journal: Reviews in gastroenterological disorders
Authors: Rex DK;
Publication Date: 2006

Abstract

Recent studies have indicated that the levels of protection against colorectal cancer provided by colonoscopy and polypectomy may be considerably lower than what was once commonly believed. Improvements in colonoscopic detection of neoplasia could be enormously beneficial in reducing the incidence of colorectal cancer related to missed lesions. Factors that interfere with detection of neoplasia during colonoscopy, as well as technologic advances that can improve both neoplasia detection and real-time determination of polyp histology, are reviewed.
View details for PubMedID 16957664
Trained registered nurses/endoscopy teams can administer propofol safely for endoscopy.
Journal: Gastroenterology
Authors: Rex DK; Heuss LT; Walker JA; Qi R;
Publication Date: 2005 Nov

Abstract

Propofol has advantages as a sedative for endoscopic procedures. Its administration by anesthesia specialists is associated with high cost. Administration by nonanesthesiologists is controversial because of concerns about safety, particularly respiratory depression.
View details for PubMedID 16285939
Sedation and the technical performance of colonoscopy.
Journal: Gastrointestinal endoscopy clinics of North America
Authors: Rex DK; Khalfan HK;
Publication Date: 2005 Oct

Abstract

The use of sedation for routine endoscopic procedures, including colonoscopy, varies widely across cultures. This variation in sedation practice is greater than any other culturally based variation in the technical performance of endoscopy. This article sequentially reviews the technical performance of colonoscopy in patients who undergo unsedated colonoscopy, sedation with narcotics and benzodiazepines, and deep sedation with propofol. For each of these approaches to colonoscopy, the advantages and disadvantages also are listed and discussed.
View details for PubMedID 16278131
PRO: Patients with polyps smaller than 1 cm on computed tomographic colonography should be offered colonoscopy and polypectomy.
Journal: The American journal of gastroenterology
Authors: Rex DK;
Publication Date: 2005 Sep
Colon polyp retrieval after cold snaring.
Journal: Gastrointestinal endoscopy
Authors: Deenadayalu VP; Rex DK;
Publication Date: 2005 Aug

Abstract

The removal of small colon polyps by cold snare transection without electrocautery effectively eliminates polyps, and anecdotal reports indicate a low risk of bleeding and perforation. Concerns about using cold snaring have centered on the risk of immediate bleeding and the difficulty in retrieving the polyp. The objective was to determine the retrieval rates of polyps after cold snaring after two different methods of resection and retrieval.
View details for PubMedID 16046990
Screening and surveillance of colorectal cancer.
Journal: Gastrointestinal endoscopy clinics of North America
Authors: Kahi CJ; Rex DK;
Publication Date: 2005 Jul

Abstract

Although colorectal cancer (CRC) is the second leading cause of cancer deaths in the United States, it is preventable. Screening modalities include fecal occult blood testing, flexible sigmoidoscopy, double-contrast barium enema, and colonoscopy. Colonoscopy allows effective detection and removal of precursor adenomatous polyps and is the dominant CRC screening modality. Emerging technologies include CT and MR colonography and fecal DNA tests. Effective and cost-effective surveillance after polypectomy and curative CRC resection requires balancing the protective effect of polypectomy while maximizing intervals between examinations; thus, estimation of the risk of recurrence determines the intensity of surveillance for individual patients.
View details for PubMedID 15990056
Preprocedure patient values regarding sedation for colonoscopy.
Journal: Journal of clinical gastroenterology
Authors: Subramanian S; Liangpunsakul S; Rex DK;
Publication Date: 2005 Jul

Abstract

Adherence rates for screening colonoscopy remain low. There are little data describing pre-colonoscopy patient concepts, values, and preferences for sedation during colonoscopy. In this study, we sought to investigate preprocedure patient values regarding sedation use for colonoscopy.
View details for PubMedID 15942439
Impact of bending section length on insertion and retroflexion properties of pediatric and adult colonoscopes.
Journal: The American journal of gastroenterology
Authors: Kessler WR; Rex DK;
Publication Date: 2005 Jun

Abstract

Colonoscopes with short bending sections facilitate retroflexion but their effect on other aspects of colonoscope insertion are unknown. We sought to determine the impact of short bending on cecal insertion, terminal ileal intubation, and proximal colon retroflexion.
View details for PubMedID 15929759
Watermelon colon treated by argon plasma coagulation.
Journal: Gastrointestinal endoscopy
Authors: Chen SC; Liangpunsakul S; Rex DK;
Publication Date: 2005 Apr
Insertability and safety of a shape-locking device for colonoscopy.
Journal: The American journal of gastroenterology
Authors: Rex DK; Khashab M; Raju GS; Pasricha J; Kozarek R;
Publication Date: 2005 Apr

Abstract

Loop formation during colonoscopy insertion results in patient pain and delays in advancement of the colonoscope tip.
View details for PubMedID 15784024