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Introduction and study aims  Gastric antral vascular ectasia (GAVE) is a mucosal abnormality associated with multiple conditions, most notably cirrhosis and systemic sclerosis, that causes indolent gastrointestinal bleeding. It is primarily managed with endoscopic therapy. Traditionally, GAVE is endoscopically ablated using argon plasma coagulation (APC) but radiofrequency ablation (RFA) is emerging as an alternative modality. No prior comparison of the 2 modalities has been published. Patients and methods  After receiving IRB approval, we reviewed our electronic health records to identify all patients who underwent endoscopic evaluation for GAVE between January, 2011 and October, 2016. We compared important variables between APC and RFA, as well as between cirrhosis and non-cirrhosis, using the Chi-square test and the Wilcoxon two-sample test as appropriate. Results  During our study period, 81 patients were endoscopically evaluated for GAVE. 24 patients were treated with APC alone, 28 with RFA alone and 25 patients received both treatment modalities. Conclusions  RFA and APC were both effective in treating bleeding from GAVE. Though we found subtle differences, patients underwent a similar number of treatment sessions and had similar procedure times and a similar time between sessions no matter the treatment modality used.

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Background The relationship between body mass index (BMI) and cardiopulmonary adverse events (CAEs) for ambulatory colonoscopy is unclear. Aim To assess the association of BMI and CAEs associated with ambulatory colonoscopy. Methods This is a retrospective cohort analysis of 418 patients who underwent outpatient colonoscopy at the Durham Veterans Affairs Medical Center categorized as normal/overweight (BMI < 30), obese (BMI 30–34), or morbidly obese (BMI ≥ 35). Adjusted logistic regression analyses were performed. Results At least one CAE occurred in 46.4% of patients (220 events, 72.7% were hypoxia). The rate of CAEs (BMI < 30: 43.8%, BMI 30–34: 48.0%, BMI ≥ 35: 50.6%, p = 0.53) and rate of hypoxia (BMI < 30: 34.8%, BMI 30–34: 40.9%, BMI ≥ 35: 43.2%, p = 0.32) were numerically higher for obese and morbidly obese patients, but not statistically significant. Obese (OR 1.10, 95% CI 0.70–1.73) and morbidly obese (OR 1.07, 95% CI 0.61–1.85) patients did not have an increased risk of CAEs after adjusting for age, ASA class, obstructive sleep apnea (OSA), and type of sedation. OSA was independently associated with an increased risk of CAEs (OR 1.71, 95% CI 1.09–2.74, p = 0.02) after adjusting for BMI, age, ASA class, and type of sedation. Conclusion OSA confers a higher risk of CAEs independent of BMI and sedation type. Consideration of undiagnosed OSA is recommended for appropriate pre-procedure risk stratification. While not statistically significant in this study, there may be clinically significant increased risks of CAEs and hypoxia for patient with BMI > 30 that require further evaluation with larger studies.

Our data show that review of external cutaneous histopathology diagnoses on patients referred for SLNB is uncommon in our practice area, but is cost-effective and should be required to reduce unnecessary treatment.