EndoFLIP is a novel technique that can be used to assess pyloric physiologic characteristics. Early satiety and postprandial fullness were inversely correlated with diameter and CSA of the pyloric sphincter. No significant differences were seen comparing diabetic and idiopathic gastroparetics. This technology may be of benefit to help select patients with pyloric sphincter abnormalities.

Hemosuccus pancreaticus (bleeding from the pancreatic duct into the gastrointestinal tract via the ampulla of Vater) is a rare, potentially life-threatening and obscure cause of upper gastrointestinal bleeding. It is caused by rupture of the psuedoaneurysm of a peripancreatic vessel into pancreatic duct or pancreatic psuedocyst in the context of pancreatitis or pancreatic tumors. It can pose a significant diagnostic and therapeutic dilemma due to its anatomical location and that bleeding into the duodenum is intermittent and cannot be easily diagnosed by endoscopy. A 61-year-old female with HIV and alcoholism presented with 3 weeks of intermittent abdominal pain and melena. Examination revealed hypotension with pallor and mild epigastric tenderness. She was found to have severe anemia and a high serum lipase. It was decided to perform a contrast-enhanced computed tomography (CT) scan that demonstrated a hemorrhagic pancreatic pseudocyst with possible active bleeding into the cyst. An emergent angiogram showed a large pseudoaneurysm of the pancreaticoduodenal artery that was successfully embolized. Subsequent endoscopy showed blood near ampulla of Vater confirming the diagnosis of hemosuccus pancreaticus. Thus the bleeding pseudocyst was communicating with pancreatic duct. The patient had no further episodes of gastrointestinal bleeding. Hemosuccus pancreaticus should be considered in patients with intermittent crescendo-decrescendo abdominal pain, gastrointestinal bleeding and a high serum lipase. Contrast-enhanced CT scan can be an excellent initial diagnostic modality and can lead to prompt angiography for embolization of the bleeding pseudoaneurysm and can eliminate the need for surgery.

Background The American College of Gastroenterology recommends colorectal cancer (CRC) screening for average risk Blacks Americans ages 45-49. This is based on this group’s younger age for the development of adenomas and CRC. Our purpose was to determine the yield of CRC screening in average risk Black Americans including those < age 50. We also aimed to identify whether there was a higher prevalence of proximal adenomas in Black Americans. Study Cross sectional, retrospective. All colonoscopy examinations from 2007 through 2010 were reviewed. Complete examinations with a good/excellent preparation in average risk Black patients 45-49 were selected. We excluded patients with signs, symptoms, or family history of CRC. Defined two control groups: average risk Black and White patients ages 50-59 who completed a colonoscopy during the same period. Patient’s height, weight and use of statin medications and aspirin were recorded. Patients currently using tobacco at least weekly were identified. Results There were 1,230 patients with an adenoma for a prevalence of 40.7%. We included 304 Black Americans 45-49 years, 669 Black Americans 50-59 years, and 257 Whites 50-59 years. There was no association between race/age group and the presence of at least one adenoma, proximal adenomas, or advanced adenomas. In regression modeling, both male sex and active smoking were associated with all three outcomes. Conclusions Male sex and active smoking are risk factors for prevalent adenomas, proximal adenomas, and advanced adenomas. The prevalence of adenomas is similar in Black Americans 45-49 compared to older Black and White patients. We did not find that the recognized proximal distribution of CRC in Black Americans parallels a similar distribution in adenomas in this group.

In this cohort of patients with refractory gastroparesis, GES improved symptoms in 75 % of patients with 43 % being at least moderately improved. Response in diabetics was better than in nondiabetic patients. Nausea, loss of appetite, and early satiety responded the best.

In our cohort, 39 % of gastroparesis patients tested positive for SIBO by LBT. Positive H2@90min testing by LBT was associated with increased symptoms of bloating and excessive fullness during and after meals.