While split-dose preparation significantly improves overall bowel cleanliness, there is no significant adenoma detection rate improvement with high baseline rate, suggesting a threshold which may not improve with enhanced preparations. Split-dose preparation significantly reduces the frequency with which inadequate preparation prompts an early repeat examination, which has important clinical implications on performance, costs, and patient experience, providing further evidence supporting split-dose preparation use.

Patient: Male, 68Final Diagnosis: Esophageal mucosal calcinosisSymptoms: DysphagiaMedication: —Clinical Procedure: EsophagogastroduodenoscopySpecialty: Gastroenterology and HepatologyObjective:Rare co-existance of disease or pathologyBackground:Gastrointestinal tract mucosal calcinosis (MC) tends to affect the gastric mucosa, while esophageal involvement is rare. Gastric MC may be seen with solid organ transplantation, use of aluminum-containing antacids or sucralfate, malignancy, and chronic renal failure. While the incidence of gastric MC in renal transplant patients undergoing gastric biopsy is common (between 15–29%), to our knowledge esophageal MC has only been previously reported 3 times.Case Report:A 68-year-old male dialysis-dependent end stage renal disease status-post deceased donor kidney transplant underwent an esophagogastroduodenoscopy (EGD) for dysphagia and diffuse esophageal wall thickening seen on imaging studies. EGD demonstrated diffuse, circumferential thick white esophageal plaques and mucosal friability. Esophageal biopsies demonstrated erosive esophagitis with basophilic calcium deposits within the fibrinopurulent exudate and squamous mucosa. Stains for fungal organisms and viruses were negative. A diagnosis of esophageal MC was made. Although the patient had a protracted postoperative course after transplantation, he had improvement of the esophageal wall thickening on imaging after transplantation.Conclusions:Esophageal MC is a rare phenomenon and all of the previously reported cases of esophageal MC, including our case, have been in patients with end stage renal disease who were on dialysis. Although prolonged hypercalcemia and hyperphosphatemia, an elevated calcium-phosphorus product, and associated underlying inflammation are likely key etiologic factors, the pathogenesis of esophageal MC is not fully understood and is likely due to multiple collective etiologies. Likewise, more reported cases are likely to increase our understanding of the clinical significance and management of this rare disorder.

Starting a new job as an academic gastroenterologist can be very exciting and anxiety provoking at the same time. This is particularly true when the junior faculty member is faced with the unique challenges of practicing medicine in today's world while still attempting to maintain work-life balance and avoid professional burnout. In discussions with several junior colleagues in the specialty over the years, it became clear that there is a relative lack of structured guidance in the literature regarding helping them navigate these turbulent waters in their early careers and setting them up for professional success in the long term. Although there is no guaranteed single formula or recipe for academic success, in this review, we attempt to outline in a stepwise fashion the critical components that we believe are important for junior faculty to consider as they embark on this journey. The significance and value of each step from job selection through promotion and mentorship is discussed in detail based on insights gleaned from experience and the published literature. The importance of citizenship, networking, mission and community-based activities, and work-life balance is highlighted as well. The concept of appreciating and enjoying the “journey,” rather than focusing solely on the destination, is emphasized in this paper. We truly believe that these are critical core concepts for junior faculty to grasp that will allow them to derive immense professional gratification in the long run while building successful professional careers along the way.

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