How I Approach the Management of Stricturing Crohn's Disease No abstract available

Evaluating an Outpatient With an Elevated Bilirubin No abstract available

The VA MISSION Act and Community Care for Veterans: What Every Community GI Doc Needs to Know No abstract available

The “Doughnut Sign” Indicating Base Appendectomy in Device-Assisted Endoscopic Full-Thickness Resection No abstract available

A Rare Cause of Gastric Injury: Arsenic Intake No abstract available

Multifocal Nitrous Oxide Cryoballoon Ablation for High-Grade Anal Intraepithelial Neoplasia No abstract available

Continuing Medical Education Questions: August 2019 Article Title: ACG Clinical Guideline: Hereditary Hemochromatosis

Continuing Medical Education Questions: August 2019 Article Title: Sarcoidosis Involving the Gastrointestinal Tract: Diagnostic and Therapeutic Management

What Quality Metrics Should We Apply in Barrett's Esophagus? A GI Quality improvement consortium registry study published in this issue of The American Journal of Gastroenterology confirms the lack of adherence to surveillance intervals and guidelines in patients with Barrett's esophagus (BE). Given the widespread use of upper endoscopy for evaluation of patients with gastroesophageal reflux disease and surveillance of BE, the lack of well-defined standard criteria for performing a high quality upper endoscopy calls for the establishment of valid quality indicators in BE endoscopy. These quality metrics should be able to help define and rate endoscopist performance for screening, surveillance, and management of patients with BE. Neoplasia detection rate and Barrett's inspection time could serve as key benchmarks. The issue of nonadherence and overutilization of endoscopy can be addressed by continuing education, feedback, and incorporation of better healthcare models.

Managing the Measurement of Colonoscopy Quality The adenoma detection rate (ADR) is our current best colonoscopy quality indicator, but it is not without limitations. In this issue of the Journal, novel ADR benchmarks are proposed based on historical local colonoscopy results. These minimally acceptable, standard of care, and aspirational benchmarks may encourage continuous quality improvement through the explicit determination of notably higher but proven achievable ADR targets, although validation in clinical practice is needed. Ultimately, we must transition from ADR measurement to the implementation of robust quality improvement processes that assure the best outcomes for our patients.