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David A Lieberman

Publications and source records attributed to David A Lieberman.

25 records · Page 2Linked to original sources
PubMed2003

Prevalence of advanced neoplasia at screening colonoscopy in men in private practice versus academic and Veterans Affairs medical centers.

OBJECTIVES: Several large population studies assessing the yield of average risk screening colonoscopy have evaluated Veterans Affairs (VA) populations. It remains uncertain how generalizable these findings are to men in the general population. The aim of this study was to define the prevalence of advanced neoplasia in male patients undergoing screening colonoscopy in diverse practice settings. METHODS: The Clinical Outcomes Research Initiative (CORI) national endoscopic database was analyzed to compare the findings in men undergoing average risk screening colonoscopy in community, academic, and VA endoscopy settings. RESULTS: Between January, 1998, and May, 2002, a total of 9109 men underwent screening colonoscopy in community (5625), academic (2269), and VA (1215) settings. Overall yield of colonic lesions (mass or polyp >9 mm) on average risk colonoscopy was 5.1%; 5.7% (community), 3.4% (academic), and 5.9% (VA) in each site, respectively. Among patients with lesions identified, multiple lesions >9 mm were less common in academic settings (6.4%) compared to community (12.0%) or VA (8.9%) sites. When adjusting for age and ethnicity on multivariate analysis, colonic lesion detection at VA sites was similar to community settings. However, lesion identification was more likely in both settings (VA: OR = 1.72; community: OR = 1.56) compared to academic centers. CONCLUSIONS: Age- and race-adjusted prevalence of polyps >9 mm in men who receive screening colonoscopy was significantly lower in academic sites compared to VA and community practice sites. One must be cautious in generalizing the findings of male patient studies from academic centers to the entire population.

Academic Medical Centers↗
PubMed2002

Screening for colorectal cancer.

Colorectal cancer screening can prevent the development of colorectal cancer and reduce the risk for death. Screening recommendations include fecal occult blood testing, sigmoidoscopy, radiographic imaging of the colon, and colonoscopy. This article focuses on recommendations for average-risk individuals and discusses the potential benefits and limitations of each. High-risk individuals should be screened with colonoscopy. Cost-effectiveness analyses of colorectal cancer screening are summarized.

Colonoscopy↗
PubMed2002

Effect of multipolar electrocoagulation on EUS findings in Barrett's esophagus.

BACKGROUND: Restoration of squamous epithelium in patients with Barrett's epithelium may be achieved by treatment with a proton pump inhibitor plus selective electrocoagulation of the metaplastic epithelium. The effect of such treatment on esophageal wall thickness and morphology, as determined by EUS, is unknown. METHODS: Patients with Barrett's esophagus were treated with omeprazole (40 mg by mouth, twice daily) and underwent selective multipolar electrocoagulation of the metaplastic segment monthly until complete squamous re-epithelialization or a maximum of 6 treatments was achieved. EUS was performed before and 6 months after the end of treatment. Four-quadrant large-forceps biopsy specimens were taken every 2 cm at the 6-month follow-up. RESULTS: Twenty-five patients with Barrett's epithelium (mean length 3.1 cm, range 2-6 cm) were included. Complete endoscopic reversal was achieved in 24 patients. Residual intestinal metaplasia beneath squamous epithelium was observed in 1 patient. In 4 patients there was intestinalized mucosa at the neosquamocolunmar junction. The thickness of the treated distal esophageal wall decreased from 4.0 +/- 0.1 mm to 3.7 +/- 0.1 mm (mean +/- SEM; p < 0.05, 2-tailed paired t test). Untreated (control) esophageal wall thickness at the level of the aortic arch (2.1 +/- 0.1 mm vs. 2.2 +/- 0.1 mm) and the mid-body gastric wall thickness (2.9 +/- 0.1 mm vs. 3.1 +/- 0.1 mm) did not change. Among the 6 patients with residual intestinal metaplasia there was no change in mean wall thickness (3.7 +/- 0.2 mm vs. 3.8 +/- 0.2 mm); among the 19 without metaplasia, thickness decreased from 4.1 +/- 0.2 mm to 3.6 +/- 0.2 mm; p < 0.01. Of 11 patients with a decrease in wall thickness, only 1 had residual intestinal metaplasia. No changes in the 5-layer sonographic pattern of the esophageal wall were observed. CONCLUSIONS: Multipolar electrocoagulation of Barrett's esophagus results in a slight decrease in thickness of the treated esophageal wall. A decrease in wall thickness by EUS was associated with the absence of intestinal metaplasia in follow-up biopsy specimens.

Barrett Esophagus↗
PubMed2002

Procedural success and complications of large-scale screening colonoscopy.

BACKGROUND: Indirect evidence and modeling analyses suggest that colonoscopy may be the most cost-effective way to screen the average-risk population for colorectal neoplasia. However, the success and safety of primary colonoscopic screening has not been prospectively evaluated in a multicenter trial. METHODS: Asymptomatic subjects age 50 to 75 years who had not undergone examination of the colon within 10 years were recruited from the general medicine clinics of 13 Department of Veterans Affairs Medical Centers. Eligible patients underwent colonoscopy by study coinvestigators, at which time all polyps were measured, photographed, and removed. Patients were contacted at 24 hours and 1 week to track procedure-related complications. RESULTS: Primary screening colonoscopy was performed in a cohort of 3196 asymptomatic subjects. A "good" preparation was reported in 81% of patients, and colonoscopy to the cecum was successful in 97.2% of cases. Mean insertion time to the cecum and total procedure times were 10.5 (8.7) and 30.6 (19.1) minutes, respectively. No preprocedural patient characteristics were identified that were predictive of an incomplete procedure. At least one polyp was resected in 1672 patients. There was no perforation and no death attributed to colonoscopy. Major morbidity considered to be definitely related to colonoscopy occurred in 9 of 3196 procedures (0.3%): lower GI bleeding requiring intervention (6), myocardial infarction and/or cerebrovascular accident (2), and thrombophlebitis (1). In subjects undergoing only diagnostic procedures, the major complication rate was 0.1%. CONCLUSIONS: Screening colonoscopy can be performed in multiple centers with a high degree of success and safety in large numbers of asymptomatic, average-risk men.

Aged↗
PubMedDate not supplied

Guidelines for colonoscopy surveillance after polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society.

Adenomatous polyps are the most common neoplastic findings uncovered in people who undergo colorectal screening or have a diagnostic workup for symptoms. It was common practice in the 1970s for these patients to have annual follow-up surveillance examinations to detect additional new adenomas as well as missed synchronous adenomas. As a result of the National Polyp Study report in 1993, which demonstrated clearly in a randomized design that the first postpolypectomy examination could be deferred for 3 years, guidelines published by a gastrointestinal consortium in 1997 recommended that the first follow-up surveillance be 3 years after polypectomy for most patients. In 2003, these guidelines were updated, colonoscopy was recommended as the only follow-up examination, and stratification at baseline into lower and higher risk for subsequent adenomas was suggested. The 1997 and 2003 guidelines dealt with both screening and surveillance. However, it has become increasingly clear that postpolypectomy surveillance is now a large part of endoscopic practice, draining resources from screening and diagnosis. In addition, surveys have demonstrated that a large proportion of endoscopists are conducting surveillance examinations at shorter intervals than recommended in the guidelines. In the present paper, a careful analytic approach was designed addressing all evidence available in the literature to delineate predictors of advanced pathology, both cancer and advanced adenomas, so that patients can be more definitely stratified at their baseline colonoscopy into those at lower or increased risk for a subsequent advanced neoplasia. People at increased risk have either three or more adenomas, or high-grade dysplasia, or villous features, or an adenoma > or =1 cm in size. It is recommended that they have a 3-year follow-up colonoscopy. People at lower risk who have one or two small (< 1 cm) tubular adenomas with no high-grade dysplasia can have a follow-up in 5 to 10 years, whereas people with hyperplastic polyps only should have a 10-year follow-up as average-risk people. Recent papers have reported a significant number of missed cancers by colonoscopy. However, high-quality baseline colonoscopy with excellent patient preparation and adequate withdrawal time should minimize this and reduce clinicians' concerns. These guidelines were developed jointly by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society to provide a broader consensus and thereby increase utilization of the recommendations by endoscopists. Adoption of these guidelines nationally can have a dramatic impact on shifting available resources from intensive surveillance to screening. It has been shown that the first screening colonoscopy and polypectomy produces the greatest effects on reducing the incidence of colorectal cancer in patients with adenomatous polyps.

Adenomatous Polyps↗
PubMedDate not supplied

Guidelines for colonoscopy surveillance after cancer resection: a consensus update by the American Cancer Society and US Multi-Society Task Force on Colorectal Cancer.

Patients with resected colorectal cancer are at risk for recurrent cancer and metachronous neoplasms in the colon. This joint update of guidelines by the American Cancer Society (ACS) and US Multi-Society Task Force on Colorectal Cancer addresses only the use of endoscopy in the surveillance of these patients. Patients with endoscopically resected Stage I colorectal cancer, surgically resected Stage II and III cancers, and Stage IV cancer resected for cure (isolated hepatic or pulmonary metastasis) are candidates for endoscopic surveillance. The colorectum should be carefully cleared of synchronous neoplasia in the perioperative period. In nonobstructed colons, colonoscopy should be performed preoperatively. In obstructed colons, double contrast barium enema or computed tomography colonography should be done preoperatively, and colonoscopy should be performed 3 to 6 months after surgery. These steps complete the process of clearing synchronous disease. After clearing for synchronous disease, another colonoscopy should be performed in 1 year to look for metachronous lesions. This recommendation is based on reports of a high incidence of apparently metachronous second cancers in the first 2 years after resection. If the examination at 1 year is normal, then the interval before the next subsequent examination should be 3 years. If that colonoscopy is normal, then the interval before the next subsequent examination should be 5 years. Shorter intervals may be indicated by associated adenoma findings (see Postpolypectomy Surveillance Guideline). Shorter intervals are also indicated if the patient's age, family history, or tumor testing indicate definite or probable hereditary nonpolyposis colorectal cancer. Patients undergoing low anterior resection of rectal cancer generally have higher rates of local cancer recurrence, compared with those with colon cancer. Although effectiveness is not proven, performance of endoscopic ultrasound or flexible sigmoidoscopy at 3- to 6-month intervals for the first 2 years after resection can be considered for the purpose of detecting a surgically curable recurrence of the original rectal cancer.

American Cancer Society↗