CE generally should be considered a complementary test in patients with gastrointestinal bleeding, Crohn's disease, or celiac disease, who have had negative or inconclusive endoscopic or imaging studies.

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The global incidence of acute pancreatitis is increasing over time:A systematic review and meta-analysis• 34 studies in adults reported temporal incidence of acute pancreatitis in over time. • Incidence of acute pancreatitis has increased over time with an average annual percent change (AAPC) of 3.07%.No difference in incidence rates between women and men.AAPC of biliary and alcohol induced pancreatitis have increased but without significant differences in rate of increase. = BACKGROUND& AIMS: Acute pancreatitis is a common disease with significant associated morbidity and mortality. We performed a systematic review and meta-analysis of population-based studies to explore the changing temporal trends of acute pancreatitis incidence globally. METHODS: We performed a systematic literature search to identify populationbased studies reporting the annual incidence of acute pancreatitis. Abstracts were assessed independently to identify applicable articles for full-text review and data extraction. Joinpoint temporal trend analyses were performed to calculate the average annual percent change (AAPC) with 95% confidence intervals (CIs). The AAPCs were pooled in a metaanalysis to capture the overall and regional trends in acute pancreatitis incidence over time. Temporal data were summarized in a static map and an interactive, web-based map. RESULTS: Forty-four studies reported the temporal incidence of acute pancreatitis (online interactive map: https://kaplanacute-pancreatitis-ucalgary.hub.arcgis.com/). The incidence of acute pancreatitis has increased from 1961 to 2016 (AAPC, 3.07%; 95% CI, Q3 2.30% to 3.84%; n ¼ Q4 34). Increasing incidence was observed in North America (AAPC, 3.67%; 95% CI, 2.76% to 4.57%; n ¼ 4) and Europe (AAPC, 2.77%; 95% CI, 1.91% to 3.63%; n ¼ 23). The incidence of acute pancreatitis was stable in Asia (AAPC, -0.28%; 95% CI, -5.03% to 4.47%; n ¼ 4). CONCLUSIONS: This meta-analysis provides a comprehensive overview of the global incidence of acute pancreatitis over the last 56 years and demonstrates a steadily rising incidence over time in most countries of the Western world. More studies are needed to better define the changing incidence of acute pancreatitis in Asia, Africa, and Latin America.

An economic analysis of different screening methods for detection of colorectal cancers suggests that in US or Canadian settings, screening with fecal immunochemical testing results in lower health-care costs as compared with other screening approaches.

Objectives:Temporal changes for intestinal resections for Crohn’s disease (CD) are controversial. We validated administrative database codes for CD diagnosis and surgery in hospitalized patients and then evaluated temporal trends in CD surgical resection rates.Methods:First, we validated International Classification of Disease (ICD)-10-CM coding for CD diagnosis in hospitalized patients and Canadian Classification of Health Intervention coding for surgical resections. Second, we used these validated codes to conduct population-based surveillance between fiscal years 2002 and 2010 to identify adult CD patients undergoing intestinal resection (n=981). Annual surgical rate was calculated by dividing incident surgeries by estimated CD prevalence. Time trend analysis was performed and annual percent change (APC) with 95% confidence intervals (CI) in surgical resection rates were calculated using a generalized linear model assuming a Poisson distribution.Results:In the validation cohort, 101/104 (97.1%) patients undergoing surgery and 191/200 (95.5%) patients admitted without surgery were confirmed to have CD on chart review. Among the 116 administrative database codes for surgical resection, 97.4% were confirmed intestinal resections on chart review. From 2002 to 2010, the overall CD surgical resection rate was 3.8 resections per 100 person-years. During the study period, rate of surgery decreased by 3.5% per year (95% CI: −1.1%, −5.8%), driven by decreasing emergent operations (−10.1% per year (95% CI: −13.4%, −6.7%)) whereas elective surgeries increased by 3.7% per year (95% CI: 0.1%, 7.3%).Conclusions:Overall surgical resection rates in CD are decreasing, but a paradigm shift has occurred whereby elective operations are now more commonly performed than emergent surgeries.