Leung, Joseph W.

AbstractBackground and AimEndoscopy featured water‐aided colonoscopy (WAC) as novel in the Innovation Forum in 2011. Gastrointestinal Endoscopy published a modified Delphi consensus review (MDCR) that supports WAC for clinical practice in 2021. We tested the hypothesis that experience was an important predictor of WAC use, either as water immersion (WI), water exchange (WE), or a combination of WI and WE.MethodsA questionnaire was sent by email to the MDCR authors with an in‐depth knowledge of WAC. They responded and also invited colleagues and trainees without in‐depth knowledge to respond. Logistic regression analysis was used with the reasons for WAC use treated as the primary outcome. Reports related to WAC post MDCR were identified.ResultsOf 100 respondents, > 80% indicated willingness to adopt and modify practice to accommodate WAC. Higher adenoma detection rate (ADR) incentivized WE use. Procedure time slots ≤ 30 and > 30 min significantly predicted WI and WE use, respectively. Co‐authors of the MDCR were significantly more likely to perform WAC (odds ratio [OR] = 7.5, P = 0.037). Unfamiliarity with (OR = 0.11, P = 0.02) and absence of good experience (OR = 0.019, P = 0.002) were associated with colonoscopists less likely to perform WAC. Reports related to WAC post MDCR revealed overall and right colon WE outcomes continued to improve. Network meta‐analyses showed that WE was superior to Cap and Endocuff. On‐demand sedation with WE shortened nursing recovery time.ConclusionsAn important predictor of WAC use was experience. Superior outcomes continued to be reported with WE.

Activated platelets contribute to atherogenic processes. Experiments were designed to examine the sex distribution of platelet‐associated cytokines in middle aged men and women in whom coronary arterial calcification was defined. Blood was obtained from 17 healthy individuals (11 female, 6 male) between the ages 48–55. Coronary arterial calcification (CAC) was evaluated by electron beam computed tomography. Plasma cholesterol, lipids, and hs‐CRP were analyzed by the Mayo Clinic Clinical Laboratory and were not different between males and females. Serum cytokines were determined using cytokine arrays (Human Atherosclerosis Antibody Array I, RayBiotech, Inc., GA,. USA). Marker intensity was measured using dot blot analysis with the UN‐SCAN‐IT gel 6.1. CAC was detected in only 2 women (scores of 62 and 84%) but in 4 men (scores of 34, 63, 83 and 95%). Correcting for all other risk factors, expression of platelet‐associated cytokines RANTES and PDGF‐BB was 50% greater in females than in males. In conclusion, platelet activation as indicated by increases in RANTES and PDGF‐BB may precede arterial calcification in woman and may be useful in evaluating cardiovascular risk in early menopausal women. (IRB approval 1299‐05 and funded by Dept. Surgery, Mayo Clinic and Fnd.)