Gi Insights

Guest: Peter Cotton, MD Host: Mark DeLegge, MD The outcomes for endoscopy can vary greatly, depending on the training and technique of the endoscopist. Dr. Peter Cotton, professor of medicine at the Digestive Disease Center at the Medical University of South Carolina, discusses the risks of endoscopy, and quality-control measures, from the establishment of benchmarks to voluntary report cards to ensure quality outcomes. Dr. Mark DeLegge hosts.

Guest: Thomas D. Wang, MD, PhD Host: Mark DeLegge, MD Microscopic imaging of the digestive tract moves beyond examination of tissue at subcellular levels, helping us identify molecular regions in which to probe for dysplasia. Dr. Thomas Wang, assistant professor of medicine and biomedical engineering at the University of Michigan Medical School, details this 'biopsy inside the body' with host Dr. Mark DeLegge. How could this technology shape the future of GI practice? How does this differ from chromoendoscopy, autofluorescence, and other current technologies?

Guest: William Chey, MD Host: Mark DeLegge, MD Guest: Nicholas Shaheen, MD, MPH Gastrointestinal (GI) disease is a major source of morbidity and mortality, yet physicians and patients often regard it as a basic nuisance. What contributes to this perception, and how can we change it? Host Dr. Mark DeLegge welcomes two chairmen of the upcoming AGA Clinical Congress, Dr. William Chey, professor of internal medicine at the University of Michigan Medical School, and Dr. Nicholas Shaheen, associate professor of medicine at the University of North Carolina School of Medicine, to discuss strategies to help us and our patients keep current on GI disease.

Host: Jay Goldstein, MD Guest: Douglas Rex, MD Gastroenterology-directed propofol is controversial among many practitioners, even though evidence suggests it is very safe. What barriers are there to gastroenterologists administering propofol, without an anesthesiologist on site? Guest Dr. Douglas Rex, Chancellor's Professor and professor of medicine at Indiana University School of Medicine, and host Dr. Jay Goldstein examine the reasons for the slow growth of gastroenterologist-directed propofol, and what the future of anesthesiology might be for gastroenterologists.

Guest: Ronald Fogel, MD Host: Jay Goldstein, MD It's the third most commonly diagnosed cancer, with more than 150,000 new cases projected in 2008, and the second leading cancer killer at more than 50,000 deaths this year alone, yet questions remain about screening strategies for colorectal cancer. Given that many health insurance plans don't cover screenings, how can we find other avenues to address this dilemma? Dr. Ronald Fogel, chair of the Public Policy and Advocacy Committee of the AGA, probes vital issues with host Dr. Jay Goldstein.

Guest: Pankaj Jay Pasricha, MD Host: Jay Goldstein, MD Is Natural Orifice Transluminal Endoscopic Surgery (NOTES) the wave of the future, or just a wrinkle in the endoscopy movement? According to Dr. Pankaj Jay Pasricha, professor of medicine and chief of gastroenterology and hepatology at the Stanford University School of Medicine, the direction taken by NOTES may impact the core of gastroenterology. Dr. Pasricha shares his perspective, in the context of other emerging technologies that will shape the future of GI practice and endoscopy. Dr. Jay Goldstein hosts.

Guest: Sheila Crowe, MD Host: Jay Goldstein, MD Food allergies are becoming increasingly common. Such allergies are often not easy to diagnose, and can present differently in adults and children. What is the difference between a food allergy and a specific food intolerance? What causes food allergies, and are there effective treatments beyond avoidance? Host Dr. Jay Goldstein probes the truth about food allergies with Dr. Sheila Crowe, professor of medicine in the division of gastroenterology and hepatology at the University of Virginia.

Guest: Lawrence Cohen, MD Host: Mark DeLegge, MD Propofol is used for deep sedation, and is often preferred by patients undergoing an endoscopy, since it's a short-acting agent. Can it be administered safely and effectively by trained gastroenterologists, or should an anesthesiologist be present to monitor the procedure? Dr. Larry Cohen, associate clinical professor at Mount Sinai School of Medicine, joins host Dr. Mark DeLegge to discuss the benefits, costs and risks of using propofol during endoscopy. From a medical-legal perspective, are gastroenterologists at more risk if they administer propofol during endoscopy than they would be if an anesthesiologist had been present?

Guest: Lawrence Kosinski, MD Host: Mark DeLegge, MD We've heard quite a bit about electronic medical record (EMR) systems. Many of us have also counted the reasons why we're hesitant to make the switch. But are the benefits of EMRs too real and too many to pass up? Dr. Lawrence Kosinski, a member of the AGA's Practice Management and Economics Committee, counts simplified compliance, and valuable feedback from clinical performance improvement studies, as a few of the many advantages of EMRs in his group practice. Find out more with host Dr. Mark DeLegge.

Guest: Stephen A. McClave, MD Host: Mark DeLegge, MD Physicians were previously obligated to provide nutrition and hydration to all patients during end of life care. Now, the courts have placed the responsibility with the patient. How can you best counsel patients and their families in making difficult decisions on feeding for the terminally ill? Dr. Stephen McClave, professor of medicine and director of clinical nutrition at the University of Louisville School of Medicine, takes a closer look at the ethical, legal and practical ramifications related to end-of-life nutrition with host Dr. Mark DeLegge.

Guest: David Whitcomb, MD, PhD Host: Mark DeLegge, MD Because there are no early stage symptoms for pancreatic cancer, diagnosis is often delayed until after the cancer has metastasized. The search for a clue to the onset of this disease is a priority. Dr. David C. Whitcomb, professor of medicine, chief of gastroenterology and medical director of the Comprehensive Pancreas Program at the University of Pittsburgh School of Medicine discusses the latest biomarkers for cancer on the pancreas with host Dr. Mark DeLegge.

Guest: Phillip Toskes, MD Host: Jay Goldstein, MD A squeeze on federal funding is forcing researchers to explore different avenues for financing. What paths are most effective for finding support? Dr. Philip Toskes, professor of medicine in the division of gastroenterology, hepatology, and nutrition at the University of Florida College of Medicine, and former president of the AGA, speaks with host Dr. Jay Goldstein about NIH paylines, and the potential for small business innovation research grants, as well as the landscape for career building in academia.

Guest: Stephen O'Keefe, MD Host: Jay Goldstein, MD There is expanding evidence that colonic health is based on diet and the microenvironment of the colon and its contents. Dr. Stephen O'Keefe, professor of medicine in the division of gastroenterology at the University of Pittsburgh School of Medicine, joins host Dr. Jay Goldstein to discuss the microbiota of the colonic tract. How do these bacteria, many of which are linked to patients' diet and lifestyle, generate byproducts that lead to the health or disease processes of the colon?

Guest: Christopher Thompson, MD Host: Jay Goldstein, MD Advances in minimally invasive devices are fostering new endoscopic strategies in gastroenterology, including Natural Orifice Translumenal Endoscopic Surgery (NOTES). Dr. Christopher Thompson, assistant professor of medicine at Harvard Medical School and director of developmental endoscopy at Brigham and Women's Hospital in Boston, details the near-term impact of NOTES for liver biopsy, as well as long-range goals in bariatrics. Dr. Jay Goldstein hosts.

Guest: Peter Kaufman, MD Host: Jay Goldstein, MD Our healthcare system is methodically assimilating the age of electronic information, despite several barriers to widespread adoption for physicians. One key aspect of this trend centers on e-prescribing. In terms of safety, ease of use, and savings of time and cost, is e-prescribing a viable option? Host Dr. Jay Goldstein examines the issue and its effect on the GI practice with Dr. Peter Kaufman, a partner in the Metropolitan GI Group based in greater Washington, DC, and chief medical officer of DrFirst, a company specializing in electronic prescribing.

Guest: John Kuemmerle, MD Host: Jay Goldstein, MD Recertification for internal medicine (and subspecialties, including gastroenterology) continues to evolve, with new requirements for certification designed to improve practice quality and management. Dr. John Kuemmerle, professor of medicine and physiology, and associate chair of GI research at the Medical College of Virginia, details these requirements with host Dr. Jay Goldstein. How are these requisites impacting clinical practice?

Guest: James Leavitt, MD Host: Jay Goldstein, MD In these suffocating times of decreased reimbursement and intensified regulation, will electronic medical records (EMR) provide an opportunity to increase your service output and improve functionality? Dr. James Leavitt, assistant clinical professor of gastroenterology at the University of Miami Miller School of Medicine, weighs the immediate impact of EMRs on your practice and offers tips for approaching the choice of EMR adoption with host Dr. Jay Goldstein.

Guest: Kim Barrett, PhD Host: Jay Goldstein, MD Successfully navigating the tenure process in academic gastroenterology requires strategy, fortitude, and a firm understanding of its implications. What are the unwritten rules of the academic ladder? What can you do to make sure that you receive the promotion for which you strive? Host Dr. Jay Goldstein aims to remove the mystery behind tenure with Kim Barrett, PhD, professor of medicine and dean of graduate studies at the University of California, San Diego School of Medicine.

Guest: Helen Shields, MD Host: Jay Goldstein, MD Dr. Helen Shields, associate professor of medicine at Harvard Medical School, reviews key preparatory factors for a successful screening colonoscopy with host Dr. Jay Goldstein. Have we resolved recent controversies surrounding sodium phosphate preps? Beyond sodium phosphate, what alternatives can we rely on to cleanse the colon prior to colonoscopy? Dr. Shields addresses split-dosing considerations and provides dietary advice for your patients.

Guest: Helen Shields, MD Host: Jay Goldstein, MD Though sodium phosphate preparations for colonoscopy have been around for many years, we've recently encountered an influx of kidney problems related to this procedure. Which patient populations face the greatest risk of nephrotoxicity? How severe are these maladies, and what are possible alternatives for our patients? Host Dr. Jay Goldstein discusses the quality of current colonoscopy preps with Dr. Helen Shields, associate professor of medicine at Harvard Medical School.