League, John

INTRODUCTION: Gastric food residue (GFR) identified during gastrointestinal (GI) endoscopy is assumed to reflect delayed gastric emptying (GE [i.e., gastroparesis]). The aims of this study aims were to determine i) the prevalence of GFR during upper GI endoscopy (EGD) and, ii) the relationship between GFR and GE, structural abnormalities and diseases associated with gastroparesis. METHODS: Electronic health records were used to identify patients who had undergone both EGD and gastric emptying scintigraphy (GES) between October 2013 and September 2018. The test meal included radiolabeled scrambled eggs (320 kcal, 30% fat). Data were collected via the Advanced Cohort Explorer (ACE) application available at Mayo Clinic. The presence of GFR, structural or physiological factors associated with delayed GE was determined. Descriptive and comparative analyses were performed. RESULTS: In the 5 year period, the prevalence of GFR during upper GI endoscopy was 3.2% per patient and 2.5% per procedure (37% or patients had undergone >1 procedure). Of 3169 patients who underwent both EGD and GES available for review, 230 (7.3%) had GFR. Type 1 diabetes mellitus (DM, 22% vs 7%, P < 0.001) and type 2 DM (13% vs 7%, P < 0.05), but not systemic sclerosis ( P = 0.1), were associated with GFR. Relative to patients with no GFR, patients with GFR had reduced GE at 2 and 4 hours (35% vs 46%, P < 0.001 and 67% vs 81%, P < 0.001 respectively) and were more likely to have structural abnormalities in the stomach or small bowel (e.g., surgery/stenosis, 14% GFR vs. 5%, P < 0.001) or have predisposing medical conditions (e.g. DM, systemic sclerosis, 20% GFR vs. 8%, P < 0.001). GE rates for patients with these conditions are shown in Table 1. Among those with no structural abnormalities or medical conditions associated with delayed GE, GE at 2 hours and 4 hours was significantly reduced in patient with GFR compared to those without GFR (37% vs 46%, and 69% vs 81%, both P < 0.001 respectively). The proportion of patients with delayed GE at 2 and 4 hours was greater in patients with GFR than without (42% vs 22% and 35% vs. 54%, both P < 0.001). CONCLUSION: GFR is encountered in 3% of all EGDs. In a cohort undergoing endoscopy and GES, ∼20% of patients with type 1 DM demonstrated GFR. The presence of GFR during endoscopy is associated with retarded GE. However, almost 50% of patients with GFR will have normal GE; therefore the presence of GFR at EGD does not accurately reflect gastric retention of digestible solids.

INTRODUCTION: Rates of musculoskeletal (MSK) injury among gastroenterologists are estimated to be as high as 75%, exceeding rates of 35% among non-proceduralists. Specific ergonomic/procedural factors influencing these injuries have yet to be defined. We sought to characterize potential risk factors for MSK injury by analyzing the physical traits and technical procedural data of a cohort of endoscopists. METHODS: The QuickDASH (Disabilities of Arm, Shoulder, and Hand) survey was sent to all gastroenterologists across a large tertiary care system. Added questions assessed injury characteristics, glove size, and other demographic data. Endpoints defining affected vs. unaffected groups include self-reported function-limiting upper extremity or back pain, injury necessitating limiting/stopping endoscopy, and trends toward higher QuickDash, Work Impairment, or Sport/Instrument Disability scores. A procedural database capturing all endoscopic activities of each respondent from 2011 to 2018 was queried to gather procedural types, volumes, durations, and insertion times; scope types; and polyp detection rates. RESULTS: 64 surveys were completed (28.1% female, mean age 44.4 ±10.8 yrs). The average time in practice was 18.9 (±10.8) years. 51% (n = 33) of respondents reported significant activity-limiting pain, including hand/wrist (n = 31), arm/elbow (n = 12), shoulder (n = 19), and back (n = 24) pain. Characteristics between affected and non-affected groups are detailed in Table 1 with further exploratory analyses found in Table 2. Those needing to limit/stop endoscopy due to pain more frequently used pediatric scopes (31% vs. 19%, P = 0.037), took longer to perform colonoscopy (25.3 vs. 22.1 minutes, P = 0.035) and had lower yearly procedural volumes (532 vs. 807, P = 0.009). Those with hand/wrist pain had longer colonoscopy insertion times (9.35 vs. 8.21 minutes, P = 0.03) and less colonoscopy hands-on scope hours per year (81.2 vs. 111.7 hours, P = 0.039). Females had more severe shoulder pain ( P = 0.04), but there were no other associations with sex or small glove size. CONCLUSION: Activity-limiting MSK injuries affect over 50% of endoscopists. MSK symptoms were associated with longer procedure times and higher EGD or push enteroscopy volumes. Symptomatic subjects were more likely to use pediatric colonoscopes. Hand/wrist pain is the most common and (presumably) the most limiting type of injury. Further prospective monitoring is warranted to better elucidate which variables are causative versus compensatory responses to injury.