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Dear Readers,
The past year was filled with new evidence-based information that impacts our practices and will lead to improved health in our patients. While research in the liver in 2017 will be dominated by new and emerging data on using direct-acting antivirals to cure nearly all patients with chronic hepatitis C infection, this past year was significant for new data on using esophageal stents instead of Minnesota tubes to stop variceal bleeding not responding to therapy and buy us time. What an amazing and innovative use of a readily available tool.
In the esophagus, if you have not read the new Barrett esophagus guidelines, you must. Much is changing in our knowledge of this commonly encountered disease, and our practices must evolve as well.
The stomach continues to be dominated by changing recommendations related to treating Helicobacter pylori infection — not only those emphasizing that the old gold standard of clarithromycin-based triple therapy should not be routinely used (as choice of therapy must account for local resistance rates) — but also that eradication of the infection does indeed impact future gastric cancer risk.
The colon still dominates our interest and the research literature. We have new information that using narrow-band imaging to guide a resect-and-discard policy is relevant and ready for implementation in practice and further support for adopting chromoendoscopy into our ulcerative colitis surveillance practice. In addition, mounting evidence suggests that employing anesthesia providers during colonoscopies is not safer (despite some practitioners' continuing suggestions to patients that it is) and that we should be using the avulsion technique over argon plasma coagulation for mopping up the lesion during polyp endoscopic mucosal resection. Finally, fecal transplantation is here and should be increasingly used for recurrent Clostridium difficile infection.
Finally, for those who perform endoscopic retrograde cholangiopancreatography (ERCP), it is hard to justify not using intra-rectal indomethacin to protect our patients from pancreatitis given its efficacy, low cost, and lack of associated morbidity.
Here are our summaries of these Top Stories from 2016:
Esophageal Stenting for Management of Acute Refractory Variceal Hemorrhage
Barrett Esophagus: Updated Guideline Recommendations
Treating Adults with Helicobacter Pylori Infection: An Update
Inexperienced Endoscopists Meet PIVI Thresholds for Diminutive Colorectal Polyps
Chromoendoscopy Is Better Than Standard Colonoscopy in Ulcerative Colitis
Still No Safety Benefit from Anesthesia in Routine Endoscopy
Avulsion Is Better Than APC for Flat Areas During EMR
Randomized Trial of Fecal Transplantation in C. difficile Infection
Indomethacin Prevents Post-ERCP Pancreatitis in Low-Risk Patients
Post-ERCP Pancreatitis — Time for Universal Use of Preprocedure Rectal Indomethacin
These remain exciting times to be a gastroenterologist. Who would have thought we would cure hepatitis C, C. difficile, gastric cancer, and post-ERCP pancreatitis and put surgeons out of business for large colon polyps? Yet, such a time appears to be upon us. Read on in the coming year and stay informed and excited for our patients.
Happy New Year to all of you.