Inside Scope

Dr. G.S. Raju, editor of the Gastro Grand Rounds section in Gastroenterology, is joined by Dr. David Ballard and Dr. Parakkal Deepak to discuss their Gastro Grand Rounds article, "Long-Standing Symptomatic Fistulizing Perianal Crohn’s Disease: Progression Beyond Inflammation."

https://www.gastrojournal.org/article/S0016-5085(23)04997-1/fulltext

Dr. Ballard is an assistant professor of radiology and director of the 3D Printing Lab at the Mallinckrodt Institute of Radiology at Washington University School of Medicine in St. Louis.

Dr. Deepak is an Associate Professor of Medicine in the Division of Gastroenterology at Washington University School of Medicine in St. Louis.

[0:27] Introduction of the authors and outline of the case.

[2:29] What initial steps does a gastroenterologist take to manage a patient who presents with possible perianal Crohn’s disease?

[6:47] How does an imaging specialist plan for imaging of the perianal disease, and what techniques are used in support of the endoscopist or gastroenterologist?

[11:33] The role of point-of-care ultrasound in perianal disease.

[15:38] When is a colorectal surgeon brought on board, and what does a colorectal surgeon do when examining the patient?

[19:57] How does the clinician manage abscess and fistula?

[25:13] Are there any radiological signs that indicate that a particular fistula may be particularly difficult to manage?

[29:38] What is a standard treatment for perianal fistula that evolves to cancer?

[31:27] Did the patient notice a change in the nature of the discharge?

[32:35] Final thoughts from the authors.

Thank you for listening. Find this and other articles on our website at https://www.gastrojournal.org. We welcome your feedback. Please email us at [email protected].

This discussion was recorded on Nov. 1, 2023, and reflects medical knowledge at that time. The views and opinions expressed in this podcast are those of the individual speakers only and do not necessarily represent those of the American Gastroenterological Association. The content of this podcast is provided for general information purposes only and does not offer medical or any other type of professional advice.

Welcome to the first in a series of new podcast episodes from the pages of Gastroenterology, the flagship journal of the American Gastroenterological Association and the most prominent journal in the field of gastrointestinal disease. This podcast series covers articles in the journal’s “Gastro Grand Rounds” section, which features discussions among multidisciplinary teams of experts on the management of complex clinical cases.

Gastro Grand Rounds: Managing Diverticulitis

Dr. G.S. Raju, editor of the Gastro Grand Rounds section in Gastroenterology, is joined by Dr. Lisa Strate to discuss her article, “Recurrent Lower Abdominal Pain, Altered Bowel Habits, and Malaise: Conservative or Surgical Approach to a Common Disorder.”

https://www.gastrojournal.org/article/S0016-5085(23)00042-2/fulltext

Dr. Strate is a professor of medicine at the University of Washington School of Medicine and is the section head of gastroenterology at Harborview Medical Center.

Dr. Strate’s research has examined risk factors for the development of diverticular disease. Her work has informed the development of guidelines, dietary recommendations, and measurements for the prevention of diverticulitis. She has investigated the role of chronic inflammation and the gut microbiome in diverticulitis. She is a fellow of AGA.

[0:27] Introduction of the author.

[2:20] The utility of CT in evaluating diverticulitis.

[5:49] Managing a patient with uncomplicated diverticulitis.

[11:00] Take-home instructions for the patient.

[14:12] Preparing the patient colonoscopy, strategies used during the procedure, and documenting findings.

[19:11] Utility of a barium enema.

[20:22] The patient returns and has left lower quadrant pain. What are the next steps?

[24:30] Laying out the pros and cons of continued medical management compared with surgery for a patient who has recurrent episodes of uncomplicated diverticulitis.

[28:00] Does the author’s institution have a support group for patients?

[28:55] What is the longest period of antibiotics the author has given to a patient who does not want surgery?

[30:34] Take-home messages for fellows and residents.

Thank you for listening. Find this and other articles on our website at https://www.gastrojournal.org. We welcome your feedback. Please email us at [email protected].

This discussion was recorded on Sept. 5, 2023, and reflects medical knowledge at that time. The views and opinions expressed in this podcast are those of the individual speakers only and do not necessarily represent those of the American Gastroenterological Association. The content of this podcast is provided for general information purposes only and does not offer medical or any other type of professional advice.

Welcome to our new six-episode series: C. difficile: Preparing the Field for Change. This program will explore how to take a patient-centered approach to treatment and diagnosis, explore emerging treatment options, and discuss best practices for transitions of care.

In this episode, Drs. Paul Feuerstadt and Sahil Khanna are joined by guest Dr. Jessica Allegretti to discuss FMT and new microbiome therapies.

You can now claim CME for listening – visit agau.gastro.org.

This series is supported by educational grants from Aimmune Therapeutics, Inc., Seres Therapeutics, and Ferring Pharmaceuticals, Inc.

Welcome to our new six-episode series: C. difficile: Preparing the Field for Change. This program will explore how to take a patient-centered approach to treatment and diagnosis, explore emerging treatment options, and discuss best practices for transitions of care.

In this episode, Drs. Paul Feuerstadt and Sahil Khanna are joined by guests Dr. Kevin Garey and a patient to discuss the impact of recurrent CDI on patients and their lives.

This episode does not offer Continuing Medical Education (CME) credits.

This series is supported by educational grants from Aimmune Therapeutics, Inc., Seres Therapeutics, and Ferring Pharmaceuticals, Inc.

Welcome to our new six-episode series: C. difficile: Preparing the Field for Change. This program will explore how to take a patient-centered approach to treatment and diagnosis, explore emerging treatment options, and discuss best practices for transitions of care.

In this episode, Drs. Paul Feuerstadt and Sahil Khanna are joined by guests Rebecca Perez and Cheri Lattimer to discuss case management and transitions of care in C. difficile infection.

You can now claim CME for listening – visit agau.gastro.org.

This series is supported by educational grants from Aimmune Therapeutics, Inc., Seres Therapeutics, and Ferring Pharmaceuticals, Inc.

Welcome to our new six-episode series: C. difficile: Preparing the Field for Change. This program will explore how to take a patient-centered approach to treatment and diagnosis, explore emerging treatment options, and discuss best practices for transitions of care.

In this episode, Drs. Paul Feuerstadt and Sahil Khanna are joined by guest Dr. Colleen Kelly to discuss how to reconcile guideline differences for testing and treatment of C. difficile.

You can now claim CME for listening – visit agau.gastro.org.

This series is supported by educational grants from Aimmune Therapeutics, Inc., Seres Therapeutics, and Ferring Pharmaceuticals, Inc.

Welcome to our new six-episode series: C. difficile: Preparing the Field for Change. This program will explore how to take a patient-centered approach to treatment and diagnosis, explore emerging treatment options, and discuss best practices for transitions of care.

In this episode, Drs. Paul Feuerstadt and Sahil Khanna describe the shifts in the microbiota with C. difficile infection. This episode was originally released as a bonus episode in November 2022.

You can now claim CME for listening – visit agau.gastro.org.

This series is supported by educational grants from Aimmune Therapeutics, Inc., Seres Therapeutics, and Ferring Pharmaceuticals, Inc.

Welcome to our new six-part series: C. difficile: Preparing the Field for Change. This program will explore how to take a patient-centered approach to treatment and diagnosis, explore emerging treatment options, and discuss best practices for transitions of care.

In this episode, Drs. Paul Feuerstadt and Sahil Khanna cover risk factors for initial and recurrent C. difficile infection. This episode was originally released as a bonus episode in November 2022.

You can now claim CME for listening – visit agau.gastro.org.

This series is supported by educational grants from Aimmune Therapeutics, Inc., Seres Therapeutics, and Ferring Pharmaceuticals, Inc.

Welcome to the final episode of our series Innovation in Duodenoscope Design. Guest host Nina Nandy, MD, is joined by Michael L. Kochman, MD, AGAF, to discuss the recently published multisociety guideline on reprocessing flexible GI endoscopes and if the recommendations put forth are sufficient to address the current challenges posed by duodenoscope-related infections.

This series is supported by an unrestricted educational grant from Boston Scientific.

To find additional resources and learn more about Innovation in Duodenoscope Design, visit scopeinnovation.gastro.org.

Uzma Siddiqui, MD, is here to host episode 3 of our series Innovation in Duodenoscope Design! She’s joined by Amrita Sethi, MD, to discuss opportunities with single-use scopes beyond infection control, with a focus on ergonomic design. They’ll talk through how disposable scopes impact workflow both on and off the unit. Continue listening for a discussion on advantages and disadvantages of the widespread use of disposable scopes now and in the future.

This series is supported by an unrestricted educational grant from Boston Scientific.

To find additional resources and learn more about Innovation in Duodenoscope Design, visit scopeinnovation.gastro.org.