ACG MAGAZINE | Vol. 4, No. 3 | Fall 2020

ACG MAGAZINE Fall 2020

MEMBERS. MEDICINE. MEANING.

Pivot to

Virtual ACG 2020 & Leadership Lessons

in the Time of pandemic

APPLY

for an ACG Clinical

Research Award

Deadline: Friday, DECEMBER 4, 2020 Mid-Career/Senior Clinical Scientist Bridge Funding Award $150,000 a year for two years ACG Junior Faculty Development Award $150,000 a year for three years Clinical Research Award up to $50,000; pilot data required Clinical Research Pilot Award up to $15,000 for pilot projects “Smaller Programs” Clinical Research Awards up to $35,000 for programs with 15 or fewer full-time faculty Resident Clinical Research Award up to $10,000 Medical Student Research Award up to $5,000 for 6–10 week summer project

ACG/ASGE Epidemiologic Research Award in Gastrointestinal Endoscopy $50,000 for one or two years

Deadline: Friday, December 11, 2020 5pm CST

APPLY: asge.org/forms/research-awards

Learn more about ACG 2021 Clinical Research Opportunities and Submit Your Application:

GI.ORG/GRANT-ANNOUNCEMENTS

FALL 2020 // VOLUME 4, NUMBER 3

FEATURED CONTENTS COVER STORY

PIVOT TO VIRTUAL ACG 2020 & LEADERSHIP LESSONS IN THE TIME OF PANDEMIC ACG President Dr. Mark Pochapin and President-Elect Dr. David Greenwald reflect on a year of challenges and what the future holds

PAGE 18

GETTING IT RIGHT: ANSWERING THE CALL

Guidance on improving telephone management in your practice PAGE 13

ACG PERSPECTIVES: THE IMPACT OF TWITTER

How getting involved on Twitter can help you grow professionally PAGE 27

|1

Attend an upcoming

ACG POSTGRADUATE COURSE 2020 ACG’s Functional GI Disorders School December 5, 2020 |

Virtual! v

2021 ACG’s IBD School January 30, 2021 |

ACG We Virtual Gra ekly nd Ro Register N unds ow:

GI.ORG/A CGVGR

Virtual! v

ACG/FGS Annual Spring Symposium Naples Grande Beach Hotel | Naples, FL February 26-28, 2021

ACG/LGS Regional Postgraduate Course Hilton New Orleans Riverside | New Orleans, LA March 5–7, 2021

ACG’s Functional GI Disorders School and ACG Eastern Regional Postgraduate Course Seaport Hotel | Boston, MA April 9 – 11, 2021

ACG’s Functional GI Disorders School and ACG Midwest Regional Postgraduate Course Hilton St. Louis at the Ballpark | St. Louis, MO August 13 – 15, 2021

ACG’s Hepatology School and ACG / VGS / ODSGNA Regional Postgraduate Course Williamsburg Lodge | Williamsburg, VA September 10 – 12, 2021

ACG 2021 Annual Scientific Meeting and Postgraduate Course Mandalay Bay Resort & Casino | Las Vegas, NV October 22 – 27, 2021

MORE INFO: gi.org/acg-course-calendar

FALL 2020 // VOLUME 4, NUMBER 3

CONTENTS

"We continue to support each other through these difficult financial and emotional times, and I am confident that our collective resilience will lead us to bounce back even stronger for the experiences that we have had." —ACG President-Elect David A. Greenwald, MD, FACG, “Pivot to Virtual ACG 2020 & Leadership Lessons in the Time of Pandemic” PG 18

6 // MESSAGE FROM THE PRESIDENT

18 // COVER STORY

43 // INSIDE THE JOURNALS

Dr. Mark Pochapin on the shift to a virtual Annual Scientific Meeting and the opportunities and advantages the new platform offers for learning, collaboration, and engagement

PIVOT TO VIRTUAL ACG 2020 & LEADERSHIP LESSONS IN THE TIME OF PANDEMIC ACG President Dr. Mark Pochapin and President-Elect Dr. David Greenwald share insights on leading the College during an unprecedented year and adapting to the needs of members and the GI community

44 AJG Author insight on ACG’s recent clinical guideline on Clinical Use of Esophageal Physiologic Testing by Dr. Prakash Gyawali

7 // NOVEL & NOTEWORTHY Standards for Advanced IBD Fellowship curricula; remembering Dr. Rakesh Tandon; celebrating achievements of past ACG program participants; and more

13 // GETTING IT RIGHT ANSWERING THE CALL: IMPROVING TELEPHONE MANAGEMENT IN YOUR PRACTICE A practical guide to optimize well-managed phone processes to improve practice operations by Dr. Syed Hussain and Dr. Sapna Thomas

27 // ACG PERSPECTIVES THE IMPACT OF TWITTER Dr. Mohammad Bilal and Dr. Amy Oxentenko share why you should get involved on Twitter, and tips and tricks on how to get started

31 // EDUCATION ACG GOES VIRTUAL A Q&A with ACG Educational Affairs Committee Chair Dr. Brooks Cash and ACG Postgraduate Course Co-Directors Dr. Vivek Kaul and Dr. Laura Raffals on planning a virtual educational experience in 2020

45 ACGCRJ Meet the 2020-2021 ACGCRJ editorial board and read reflections from the new CoEditors-in-Chief 46 CTG Novel Insights Into Tissue-Specific Biochemical Alterations in Pediatric Eosinophilic Esophagitis by Hiremath, et al.

47 // A LOOK BACK 50 YEARS AGO IN AJG In a 1970 report in The American Journal of Gastroenterology, Dr. Marcel Patterson reported his experience with five patients with Zollinger-Ellison syndrome, including measuring basal gastric acid secretion, at the dawn of the radioimmunoassay era

Caption L to R: ACG President Mark B. Pochapin, MD, FACG, and ACG President-Elect David A. Greenwald, MD, FACG, Central Park, New York, NY, October 18, 2020. Photo Credit: Susie Zimmermann

|3

ACG MAGAZINE MAGAZINE STAFF

CONNECT WITH ACG

Executive Director Bradley C. Stillman, JD

youtube.com/ACGastroenterology

Editor in Chief; Vice President, Communications Anne-Louise B. Oliphant Manager, Communications & Member Publications Becky Abel

facebook.com/AmCollegeGastro

twitter.com/amcollegegastro

instagram.com/amcollegegastro Copy Editors; Staff Writers Liz Starnes

bit.ly/ACG-Linked-In Art Director Emily Garel Graphic Designer Antonella Iseas

CONTACT

BOARD OF TRUSTEES

IDEAS & FEEDBACK We'd love to hear from you.

Send us your ideas, stories and comments.

President: Mark B. Pochapin, MD, FACG President-Elect: David A. Greenwald, MD, FACG Vice President: Samir A. Shah, MD, FACG Secretary: Jonathan A. Leighton, MD, FACG Treasurer: Daniel J. Pambianco, MD, FACG Immediate Past President: Sunanda V. Kane, MD, MSPH, FACG

ACGMag@ @gi.org

CONTACT ACG American College of Gastroenterology 6400 Goldsboro Rd., Suite 200 Bethesda, MD 20817 (301) 263-9000 | gi.org

Past President: Irving M. Pike, MD, FACG Director, ACG Institute: Nicholas J. Shaheen, MD, MPH, FACG Co-Editors, The American Journal of Gastroenterology: Brian E. Lacy, MD, PhD, FACG

DIGITAL EDITIONS

GI.ORG/ACGMAGAZINE

Brennan M. R. Spiegel, MD, MSHS, FACG Chair, Board of Governors: Neil H. Stollman, MD, FACG

ACG MAGAZINE Summer 2020

MEMBERS. MEDICINE. MEANING.

Vice Chair, Board of Governors: Patrick E. Young, MD, FACG Trustee for Administrative Affairs: Delbert L. Chumley, MD, FACG ACG MAGAZINE Summer 2020

MEMBERS. MEDICINE. MEANING.

TRUSTEES

Feeling fine with fear:

Mastering Risk Perception and Decision Making in Medical Practice

Feeling fine with fear:

Mastering Risk Perception and Decision Making in Medical Practice

Jean-Paul Achkar, MD, FACG William D. Chey, MD, FACG Immanuel K. H. Ho, MD, FACG Costas H. Kefalas, MD, MMM, FACG Caroll D. Koscheski, MD, FACG Paul Y. Kwo, MD, FACG Amy S. Oxentenko, MD, FACG David T. Rubin, MD, FACG John R. Saltzman, MD, FACG Renee L. Williams, MD, MHPE, FACG

4 | GI.ORG/ACGMAGAZINE

American College of Gastroenterology is an international organization with more than 14,000 physician members representing some 85 countries. The College's vision is to be the pre-eminent professional organization that champions the evolving needs of clinicians in the delivery of high-quality, evidence-based and compassionate health care to gastroenterology patients. The mission of the College is to advance world-class care for patients with gastrointestinal disorders through excellence, innovation and advocacy in the areas of scientific investigation, education, prevention and treatment.

CONTRIBUTING WRITERS

Mohammad Bilal, MD Dr. Bilal is an advanced endoscopist and gastroenterologist at the University of Minnesota and the Minneapolis VA Health Care System and is a member of ACG’s Professionalism and Training Committees.

Amy S. Oxentenko, MD, FACG Dr. Oxentenko is Chair of the Department of Medicine and Professor of Medicine at Mayo Clinic Arizona. She serves as a Trustee of the College and is a member of ACG’s Credentials and Professionalism Committees.

Brooks D. Cash, MD, FACG ACG’s Chair of Educational Affairs, Dr. Cash serves as Chief, Division of Gastroenterology, Hepatology, and Nutrition at the University of Texas Health Science Center at Houston, where he is the Dan and Lillie Sterling Professor of Medicine. He is Co-Director of the ACG 2020 What’s New in GI Pharmacology Course.

Laura E. Raffals, MD, MS, FACG Dr. Raffals is a Professor of Medicine and the Program Director, Gastroenterology and Hepatology, at Mayo Clinic in Rochester, MN, and serves as Co-Director of the ACG 2020 Postgraduate Course.

Walter W. Chan, MD, MPH, FACG Dr. Chan is Director of the Center for Gastrointestinal Motility at Brigham & Women’s Hospital and was recently appointed as the first Social Media Editor for The American Journal of Gastroenterology’s new Twitter handle, @AmJGastro.

David A. Greenwald, MD, FACG Dr. Greenwald is the incoming 20202021 ACG President and is Director of Clinical Gastroenterology and Endoscopy at Mount Sinai Hospital and Professor of Medicine at Icahn School of Medicine at Mount Sinai in New York City.

Syed M. Hussain, MD Dr. Hussain is a gastroenterologist at GI Associates in Kenosha, WI, and is a member of ACG’s Practice Management Committee.

Sapna V. Thomas, MD, FACG Dr. Thomas is Medical Director of Gastroenterology at University Hospitals Cleveland Medical Center, Westlake, and Assistant Professor of Medicine at Case Western Reserve University School of Medicine. She is Co-Director of the ACG 2020 Practice Management Summit and served as ACG Governor for Northern Ohio.

Mark B. Pochapin, MD, FACG Dr. Pochapin is ACG’s 2019-2020 President; the Sholtz-Leeds Professor of Gastroenterology; and Director, Division of Gastroenterology and Hepatology at NYU Langone Health

Lawrence R. Schiller, MD, MACG ACG Past President Dr. Schiller is the Program Director of the Gastroenterology Fellowship at Baylor University Medical Center and chairs ACG’s Archives Committee

Vivek Kaul, MD, FACG Dr. Kaul, Chair of ACG’s Innovation and Technology Committee, is Segal-Watson Professor of Medicine at University of Rochester Medical Center and serves as Co-Director of the ACG 2020 Postgraduate Course.

|5

MESSAGE FROM THE PRESIDEN

ACG 2020 GOING VIRTUAL

By Mark B. Pochapin, MD, FACG, ACG President

AS I READ THIS SPECIAL EDITION OF ACG MAGAZINE dedicated to the Virtual ACG 2020 Annual Scientific Meeting & Postgraduate Course, this year, more than any other, I am grateful for the digital platforms that are available to us – for telemedicine, for video meetings and social connection, and for virtual educational opportunities.

I am appreciative not only of the technology, but also the incredible ACG team that made it possible to convert our regional and national courses to a virtual format, while also adding the COVID-related updates in a Virtual Grand Rounds format that have been so critical this year.

And, of course, the monster of all virtual conferences is the ACG Annual Scientific Meeting. If you think about it, the ACG has spent decades perfecting an amazing annual course and now, within just a few months, we had to change to an online platform, and keep the same collegiality and interactive tone of the meeting that so many of us enjoy year after year.

Of course, we would prefer to be meeting in person, but our goal as we convene virtually is to present an amazing experience, unlike any other ACG meeting to date. So many dedicated people have worked to ensure Virtual ACG 2020 has all of the expertise, collegiality, networking, and other

6 | GI.ORG/ACGMAGAZINE

“Join us, be part of this experience.

Login and connect.

You have an unprecedented opportunity to immerse yourself in an incredible array of educational content, and to learn in a way that is convenient for you.”

mainstays of our annual conferences of past years—just without the travel.

Join us, be part of this experience.

Log in and connect. You have an unprecedented opportunity to immerse yourself in an incredible array of educational content and to learn in a way that is convenient for you.

This year the dilemma of simultaneous sessions is solved— you have access to all the sessions.

Another benefit of the digital platform is that all the educational sessions will remain available until January 31, 2021. And the livestreaming sessions from October 23 to 28 will also be available to view­—so you can come back to sessions, listen to the lectures, benefit from the faculty insights and Q&A exchanges that will hopefully deepen and enrich your learning experience and provide clinical pearls you can apply to your patients and your practice.

Virtual ACG 2020 will go down in the record books, and I am excited that we are able to offer such a strong program. I’m grateful to the many people who worked so hard to bring this experience to life in a challenging time. But I am mindful that their commitment to clinical GI education, to scientific exchange, and to advancing our profession energized and inspired them as they adapted to an online meeting.

I invite you to explore the content, participate in the virtual livestreaming sessions, and to share the experience with the GI community and your colleagues, the ACG family.

­­—Mark B. Pochapin, MD, FACG

Note hy wor t ACG MAGAZINE SHOWCASES THE ACCOMPLISHMENTS of ACG members and serves as a forum to share developments in the GI profession as well as College news, including the publication of entrustable professional activities for advanced IBD fellowship training in partnership with The Crohn’s & Colitis Foundation under the leadership of Dr. Benjamin Cohen and Dr. Stephen Hanauer.

The College celebrates the life and career of Professor Rakesh Tandon of New Delhi, India, in a memorial tribute that includes a reflection by his son, Dr. Manish Tandon of Brookline, Massachusetts.

The notable activities of younger College members include a concert performance at TEDxWrigleyville by former ACG Young Physician Leadership Scholar Dr. Benjamin Levy, and a publication by Dr. Aiya Aboubakr, the College’s first Summer Scholar, a mentoring program of the ACG Committee on Diversity, Equity & Inclusion.

Novel & Noteworthy | 7

// N&N [IN MEMORIAM]

[PATIENT CARE]

RAKESH KUMAR TANDON, MD (MED), PHD, FRCP (EDIN), FAMS, AGAF (1941-2020)

GI OnDEMAND EXPANDS LEADERSHIP TEAM AND YOUR ABILITY TO OFFER INTEGRATED GI PATIENT CARE

It is with sadness that the College notes the demise of Prof. Dr. Rakesh Tandon on August 3rd, 2020. Dr. Tandon was a member of the American College of Gastroenterology, a Fellow of AGA, and the former head of the department of Gastroenterology at the All India Institute of Medical Sciences in New Delhi, India and later Medical Director & Head of Department of Gastroenterology at the Pushpawati Singhania Research Institute for Liver, Renal & Digestive Diseases in New Delhi.

He was born in Allahabad, India in 1941. According to his obituary, Dr. Tandon “carried the legacy of his grandfather Bharat Ratna Late Sh. Purushottam Das Tandon in the service of mankind as a caring doctor and passionate researcher.”

Dr. Tandon trained in India and the United States and was a pioneer in gastroenterology in India, recognized for his contributions to the understanding of GI diseases, especially biliary and pancreatic diseases and therapeutic endoscopy. He was a mentor and teacher to numerous physicians who are now academic leaders and researchers around the world.

His son, Manish Tandon, MD, a gastroenterologist in Brookline, MA, reflected on his father’s life and career: “Dad has lived a very fulfilling and rewarding life, and I am most proud of him as being my father and his numerous achievements. He has always shown amazing kindness and has been very humble in his ways. Despite his dedication to his patients, and his clinical work, he has been a most caring father, husband, brother, and general human being.

He has an amazing passion for knowledge and learning and gained satisfaction from teaching and mentoring a number of young gastroenterologists over his career.

In addition, he was an avid tennis player, enjoyed travelling, and interacting and collaborating with his colleagues from all over the world!”

8 | GI.ORG/ACGMAGAZINE

Former ACG Trustee Dr. Peter Banks of Brigham & Women’s Hospital remembers Dr. Tandon: “Rakesh was an outstanding clinician, teacher, and investigator with expertise in chronic liver disease, pancreatitis, and therapeutic endoscopy. He was a kind, compassionate person, and a close friend for almost 50 years.”

Dr. Tandon served as President and Secretary General of the Indian Society of Gastroenterology and President of the Indian Pancreas Club. He received the prestigious Dr. B. C. Roy Award conferred by the Medical Council of India in 2000 and was recognized as a Master of the World Gastroenterology Organization in 2009. He was the recipient of Lifetime Achievement Awards from institutions such as the All India Institute of Medical Sciences, New Delhi, and organizations such as the Indian Society of Gastroenterology and the Crohn’s & Colitis Foundation. He was Editor-in-Chief of The Journal of Gastroenterology and Hepatology, section editor of hepatobiliary and pancreatology of the Biomedical Journal of Gastroenterology, and an editorial board member of many journals including the Scandinavian Journal of Gastroenterology and Pancreatology. He published over 300 research papers, 87 chapters in books, and 6 books including one in Hindi, Ham Swastha Kaise Rahen.

He always said, “We are here to do our Dharma (duty) to mankind,” and he truly dedicated his life to serving his patients and mentoring his students over the years. He is survived by his wife, a physician in India, and his son and daughter, also physicians practicing in the Boston area.

He will be dearly missed by his family, friends, students, and colleagues but his legacy will live on for his contributions to the field of gastroenterology.

Aligned with its mission to bring the full ecosystem of support to gastroenterologists and their patients, GI OnDEMAND has expanded its leadership team to include Daniel Pambianco, MD, FACG, Chairman of the Board; William D. Chey, MD, FACG, Senior Director, Nutrition and Behavioral Health Services and Support; Megan Riehl, PsycD, Director, Behavioral Health Services; and Kate Scarlata, RD, Director, Dietary and Nutrition Services.

GI OnDEMAND now makes it easier for you to adopt a virtual integrated care model and amplify the expertise and value your practice brings to patients with access to vetted GI expert registered dietitians, GI psychologists, and genetic counselors.

 LEARN MORE: giondemand.com

[#FUTUREOFGI]

ACG’S FIRST SUMMER SCHOLAR PUBLISHES IN DIGESTIVE DISEASES AND SCIENCES Aiya Aboubakr, MD, recently published a first-author manuscript, “Identifying Patient Priorities for Preconception and Pregnancy Counseling in IBD,” in Digestive Diseases and Sciences. Dr. Aboubakr was the first participant in ACG’s Summer Scholars program, which awards research opportunities to medical students from racial/ethnic groups underrepresented in GI. She was mentored by Dr. Marla Dubinsky, investigating IBD and pregnancy at the Marie and Barry Lipman IBD Preconception and Pregnancy Planning Clinic, and is currently a second year Internal Medicine resident at New-York Presbyterian/

Weill Cornell. “The ACG Summer Scholars program has provided me with invaluable mentorship and professional development and solidified my interest in pursuing a career in gastroenterology,” she says.

Since her participation in the program, Dr. Aboubakr has presented her findings as a poster at the Advances in IBD 2018 Annual Meeting and an oral presentation at the ACG 2019 Annual Scientific Meeting.

Her current interests include colorectal cancer screening, IBD, and obesity and nutrition in immigrant and minority populations.

[IBD EXPERTISE]

DEFINING WHAT CONSTITUTES AN IBD EXPERT IN PRACTICE

[YOUNG PHYSICIAN LEADERSHIP]

PAST YOUNG PHYSICIAN LEADERSHIP SCHOLAR DELIVERS TALK FOR TEDxWRIGLEYVILLE Benjamin Levy III, MD, member of the Young Physician Leadership Scholars Program’s 2018-2019 cohort, delivered a cello performance and talk on “Motivating Health Education with Music” during the TEDxWrigleyville event Humanity: A View from Inside the Pandemic. The event featured

speakers across a wide range of fields and focused on ideas on managing the response to the COVID-19 pandemic, inspiring hope, and sharing stories of humanity’s experience and resilience to support Chicago’s local and broader communities. Talks were recorded individually at Wrigley Field for this first-ever virtual TEDx event.  VIEW the event: tedxwrigleyville.

com/watch

[MILESTONE]

[TELEMEDICINE]

YALE DIGESTIVE

ERIC SHAH CONTRIBUTES TO HHS TELEMEDICINE HACK LECTURE FOR UNM/PROJECT ECHO

WELCOMES DR. JILL GAIDOS Jill K. J. Gaidos, MD, FACG, joins Yale Medicine as Director of Clinical Research for the Yale Inflammatory Bowel Disease Program and Associate Professor at Yale School of Medicine. She completed medical school and residency at Virginia Commonwealth University, where she most recently served as Associate Professor and Director of Inflammatory Bowel Disease at the McGuire VA Medical Center.

The College wishes Dr. Gaidos continued success in her new position.

Eric Shah, MD, MBA, recently contributed a lecture and Q&A “office hours” session on telemedicine workflows and documentation to the US Department of Health and Human Services (HHS) Telemedicine Hack series.

HHS, in collaboration with the University of New Mexico’s ECHO Institute and the Public Health Foundation’s TRAIN Learning Network, developed the 10-week, virtual peer-to-peer learning community to address knowledge gaps in video-based telemedicine, support wide adoption of telemedicine in the ambulatory setting, and accelerate implementation for ambulatory providers. Recordings of Dr. Shah’s presentation and office hours, as well as other Telemedicine Hack sessions, are available.

ACG and The Crohn’s & Colitis Foundation this summer jointly published “Development of Entrustable Professional Activities for Advanced Inflammatory Bowel Disease Fellowship Training in the United States,” in both The American Journal of Gastroenterology and the Foundation’s journal, Inflammatory Bowel Diseases.

A Guide for Curriculum Development in Advanced IBD The two organizations collaborated on the development of a defined list of key physician activities that is expected to serve as a guide for developing advanced IBD fellowship curricula by providing advanced fellows a more specific framing of the entrustment tasks expected by the end of fellowship.

On a broader level, the advanced IBD EPAs serve as a consensus statement for what constitutes an IBD expert in practice.

Learn More A complete overview of the Task Force methodologies and recommendations can be found in Inflammatory Bowel Diseases.

Cohen, et al., “Development of Entrustable Professional Activities for Advanced Inflammatory Bowel Disease Fellowship Training in the United States.”

 READ in IBD: bit.ly/IBD-Journal-EPAs-Cohen  READ the Executive Summary, highlights,

and key tables in The American Journal of Gastroenterology Red Section: bit.ly/AJG-EPAs-Exec-Summary

 VISIT:

bit.ly/ECHO-Telemedicine-Hack

Novel & Noteworthy | 9

THE AMET R I CEA A N CEO LLE G EC O L L E G E TH HE AM MER R II C CA AN N COLLEGE OF GASTR O EGNAT SETRROOLEONGTYE R O L O G Y O F OF GASTROENTEROLOGY

gniteeM esruoC e lacinilC IG reim e taudargt soP & rP ehT

DECEMBER 4, 2020 RESEARCH GRANTS DEADLINE

, 2E0R2203–28, 2020 8 2 – 3 2 R E B | OCTO | OCTOB

g eeting g al Meetinrselinicall M a MeCeotiunrs GI Clinic ateieCroG C u I r ic rse n ie li m C e I re m G u u te r d re a o u P ie C ra d The P e m tg te h ra The Pre & Posstg dua & PosT & Po tgra

tisiv ot eunitnoC gro.ig.sgniteemgca .noitamrofni detadpu rof

0202 GCA EHT DNETTA GNITEEM CIFITNEICS LAUNNA ESRUOC ETAUDARGTSOP & lacinilc ni tsetal eht nrael ot htiw saedi egnahcxe ,ecitcarp thgisni niag dna ,seugaelloc 0202 GCA .strepxe eht morf ,ellivhsaN ni dleh eb lliw cisuM eht ta eessenneT .retneC ytiC

!etaD eht e vaS

EGELLOC NACIREMA EHT YGOLORETNEORTSAG FO

REBOTCO |

!Date! e t a D e e h t h t e Sav Save

0202 ,82–32

The rich array of educational content for Virtual ACG 2020 will be available on-demand through Jan 31, 2021.

Register ATTEND THE ACG 2020 ATTEND ATTEND THE THE ACG ACG 2020 2020 now, and get access to all of ANNUAL SCIENTIFIC MEETING ANNUAL ANNUAL SCIENTIFIC SCIENTIFIC MEETING MEETING the content and earn CME & POSTGRADUATE COURSE & & POSTGRADUATE POSTGRADUATE COURSE COURSE and MOC. to learn the latest in clinical to to learn learn the the latest latest in in clinical clinical practice, exchange ideas with practice, practice, exchange exchange ideas ideas with with colleagues, and gain insight gain insight colleagues, REGISTER NOW: colleagues, and and gain insight from the experts.

ACG 2020 from from the the experts. experts. ACG ACG 2020 2020 acgmeetings.gi.org will be held inwill Nashville, be held in Nashville, will be held in Nashville, Tennessee at the Music Tennessee Tennessee at at the the Music Music City Center. City Center.

City Center.

Continue to visit Continue Continue to to visit visit acgmeetings.gi.org acgmeetings.gi.org acgmeetings.gi.org for updated information. for for updated updated information. information.

DECEMBER 27, 2020

More Info: gi.org/research-awards

DECEMBER

5

FUNCTIONAL GI DISORDERS SCHOOL Register: meetings.gi.org

JANUARY

30

2021 IBD SCHOOL Register: meetings.gi.org

AMERICAN COLLEGE OF GASTRONTEROLOGY'S BIRTHDAY DECEMBER 27, 1932 The College became incorporated as The Society for the Advancement of Gastroenterology

FEBRUARY

26–28 2021 ACG/FGS ANNUAL SPRING SYMPOSIUM  Naples, FL

MARCH

Register: meetings.gi.org

5–7

MARCH 2021

2021 ACG/LGS REGIONAL POSTGRADUATE COURSE

NORTH AMERICAN TRAINING GRANTS APPLICATION DEADLINE

 New Orleans, LA Register: meetings.gi.org

10 | GI.ORG/ACGMAGAZINE

More Info:

gi.org/gi-training-grants

APRIL 2021 ACG AWARD NOMINATIONS Nominate Your Colleague Learn More: gi.org/award-nominations

IMPORTANT SAFETY INFORMATION SUPREP® Bowel Prep Kit (sodium sulfate, potassium sulfate and magnesium sulfate) Oral Solution is an osmotic laxative indicated for cleansing of the colon as a preparation for colonoscopy in adults. Most common adverse reactions (>2%) are overall discomfort, abdominal distention, abdominal pain, nausea, vomiting and headache.

Use is contraindicated in the following conditions: gastrointestinal (GI) obstruction, bowel perforation, toxic colitis and toxic megacolon, gastric retention, ileus, known allergies to components of the kit. Use caution when prescribing for patients with a history of seizures, arrhythmias, impaired gag reflex, regurgitation or aspiration, severe active ulcerative colitis, impaired renal function or patients taking medications that may affect renal function or electrolytes. Use can cause temporary elevations in uric acid. Uric acid fluctuations in patients with gout may precipitate an acute flare. Administration of osmotic laxative products may produce mucosal aphthous ulcerations, and there have been reports of more serious cases of ischemic colitis requiring hospitalization. Patients with impaired water handling who experience severe vomiting should be closely monitored including measurement of electrolytes. Advise all patients to hydrate adequately before, during, and after use. Each bottle must be diluted with water to a final volume of 16 ounces and ingestion of additional water as recommended is important to patient tolerance.

BRIEF SUMMARY: Before prescribing, please see Full Prescribing Information and Medication Guide for SUPREP® Bowel Prep Kit (sodium sulfate, potassium sulfate and magnesium sulfate) Oral Solution.

INDICATIONS AND USAGE: An osmotic laxative indicated for cleansing of the colon as a preparation for colonoscopy in adults. CONTRAINDICATIONS: Use is contraindicated in the following conditions: gastrointestinal (GI) obstruction, bowel perforation, toxic colitis and toxic megacolon, gastric retention, ileus, known allergies to components of the kit. WARNINGS AND PRECAUTIONS: SUPREP Bowel Prep Kit is an osmotic laxative indicated for cleansing of the colon as a preparation for colonoscopy in adults. Use is contraindicated in the following conditions: gastrointestinal (GI) obstruction, bowel perforation, toxic colitis and toxic megacolon, gastric retention, ileus, known allergies to components of the kit. Use caution when prescribing for patients with a history of seizures, arrhythmias, impaired gag reflex, regurgitation or aspiration, severe active ulcerative colitis, impaired renal function or patients taking medications that may affect renal function or electrolytes. Pre-dose and post-colonoscopy ECGs should be considered in patients at increased risk of serious cardiac arrhythmias. Use can cause temporary elevations in uric acid. Uric acid fluctuations in patients with gout may precipitate an acute flare.

Administration of osmotic laxative products may produce mucosal aphthous ulcerations, and there have been reports of more serious cases of ischemic colitis requiring hospitalization. Patients with impaired water handling who experience severe vomiting should be closely monitored including measurement of electrolytes. Advise all patients to hydrate adequately before, during, and after use. Each bottle must be diluted with water to a final volume of 16 ounces and ingestion of additional water as recommended is important to patient tolerance. Pregnancy: Pregnancy Category C. Animal reproduction studies have not been conducted. It is not known whether this product can cause fetal harm or can affect reproductive capacity. Pediatric Use: Safety and effectiveness in pediatric patients has not been established.

Geriatric Use: Of the 375 patients who took SUPREP Bowel Prep Kit in clinical trials, 94 (25%) were 65 years of age or older, while 25 (7%) were 75 years of age or older. No overall differences in safety or effectiveness of SUPREP Bowel Prep Kit administered as a split-dose (2-day) regimen were observed between geriatric patients and younger patients. DRUG INTERACTIONS: Oral medication administered within one hour of the start of administration of SUPREP may not be absorbed completely. ADVERSE REACTIONS: Most common adverse reactions (>2%) are overall discomfort, abdominal distention, abdominal pain, nausea, vomiting and headache. Oral Administration: Split-Dose (Two-Day) Regimen: Early in the evening prior to the colonoscopy: Pour the contents of one bottle of SUPREP Bowel Prep Kit into the mixing container provided. Fill the container with water to the 16 ounce fill line, and drink the entire amount. Drink two additional containers filled to the 16 ounce line with water over the next hour. Consume only a light breakfast or have only clear liquids on the day before colonoscopy. Day of Colonoscopy (10 to 12 hours after the evening dose): Pour the contents of the second SUPREP Bowel Prep Kit into the mixing container provided. Fill the container with water to the 16 ounce fill line, and drink the entire amount. Drink two additional containers filled to the 16 ounce line with water over the next hour. Complete all SUPREP Bowel Prep Kit and required water at least two hours prior to colonoscopy. Consume only clear liquids until after the colonoscopy.

STORAGE: Store at 20°-25°C (68°-77°F). Excursions permitted between 15°-30°C (59°-86°F). Rx only. Distributed by Braintree Laboratories, Inc. Braintree, MA 02185

For additional information, please call 1-800-874-6756 or visit www.suprepkit.com

©2018 Braintree Laboratories, Inc. All rights reserved.

HH27314B

September 2018

THE ORIGINAL 1 LITER PRESCRIPTION BOWEL PREP SOLUTION

1 MOST PRESCRIBED,

#

BRANDED BOWEL PREP KIT1 WITH MORE THAN 15 MILLION KITS DISPENSED SINCE 20101

A CLEAN SWEEP

EFFECTIVE RESULTS IN ALL COLON SEGMENTS2 · SUPREP® Bowel Prep Kit has been FDA-approved as a split-dose oral regimen3 · >90% of patients had no residual stool in all colon segments2* †

These cleansing results for the cecum included 91% of patients2*

†

SUPREP Bowel Prep Kit also achieved ≥64% no residual fluid in 4 out of 5 colon segments (ascending, transverse, descending, and sigmoid/rectum)2* †

Aligned with Gastrointestinal Quality Improvement Consortium (GIQuIC) performance target of ≥85% quality cleansing for outpatient colonoscopies.4

*This clinical trial was not included in the product labeling. †Based on investigator grading.

References: 1. IQVIA. National Prescription Audit Report. September 2018. 2. Rex DK, DiPalma JA, Rodriguez R, McGowan J, Cleveland M. A randomized clinical study comparing reduced-volume oral sulfate solution with standard 4-liter sulfate-free electrolyte lavage solution as preparation for colonoscopy. Gastrointest Endosc. 2010;72(2):328-336. 3. SUPREP Bowel Prep Kit [package insert].

Braintree, MA: Braintree Laboratories, Inc; 2017. 4. Rex DK, Schoenfeld PS, Cohen J, et al. Quality indicators for colonoscopy. Gastrointest Endosc. 2015;81(1):31-53.

©2018 Braintree Laboratories, Inc. All rights reserved.

HH27314B

September 2018

GETTING IT

GETTING it Right

SO MUCH DEPENDS UPON THE PHONE. Even in this age of social media, mobile devices, and portals and websites, telephones remain the backbone of communication with our patients. Although search engines and the internet have become the first “contact,� phone calls remain the most common first two-way interaction between a medical practice and patients. Well-managed phone processes will improve practice operations and strengthen the patient-provider relationship. This toolbox article seeks to provide a practical guide to optimize telephone management in your practice.

Answering the Call: Improving Telephone Management

in Your Practice

By Syed Hussain, MD, GI Associates LLC, Kenosha, Wisconsin and Sapna Thomas, MD, FACG, University Hospitals, North Ridgeville, Ohio

Phone Calls Bring A Staggering Variety of Issues Phone calls reveal or create important issues for a practice to act upon and resolve. Unfortunately, attempts to simplify telephone management are often frustrated by several realities. First, medical practices receive calls from a great variety of sources. These include patients and their family members, the practice's own staff, other medical professionals, various medical facilities, vendors, payors, and many others. Second, the variety of reasons for these calls is extensive. Major categories include scheduling and cancellations, care coordination, follow-up on results, prescription medication issues, and patient satisfaction. Even inside these categories, the situations and requirements for a successful resolution of the issues vary tremendously. Simple automated phone-tree solutions will never fully account for this variety. A comprehensive strategy is required.

Getting it Right | 13

// GETTING IT RIGHT

Phones—A Vital Hub for the Entire Operation How telephone calls are handled, routed, and categorized is a major contributor to a successful operation.

Clinical personnel must often give full attention to patients currently in the office. Intermittent or continuous interruption of those duties results in poor care, reduced patient satisfaction, and staff frustration or burn out. Phone calls are often a major source of those frustrations.

The phone hub or “call center” in your practice must function to resolve issues as quickly as possible and route calls and messages to appropriate personnel. If many questions and issues are resolved immediately, the rest of the operation will benefit.

Phone Management: Open Access, Call Centers, and IVR Systems Some practices continue to rely on open phone lines answered by the first available employee. This may be called “open access.” The result of this approach, however, can be highly inconsistent and cause significant operational difficulty. Not only does this approach fail to account for factors such as call volume variation throughout the work day and staff availability, staff members will almost certainly vary in their talent in answering calls and questions. For these reasons, the open access model is usually replaced by one of two approaches: automated systems using Interactive Voice Response Systems (IVR) or dedicated call centers (phone hubs) with staff specifically trained and dedicated to appropriately answer calls, take messages, answer questions, and route messages to appropriate locations.

Goals of the Phone Hub  To resolve call issues as quickly and effectively as possible  To limit distraction to patient care by clinical staff and physicians  To improve office operations  To satisfy patients

14 | GI.ORG/ACGMAGAZINE

Automated versus Human Generally, practices attempt to resolve telephone management with either one or more staff members to directly answer calls (phone hub) or an automated system to receive and route calls to the appropriate people. The phone hub should be a more effective dynamic in dealing with the tremendous variety of calls, but requires trained and dedicated staff. If the people answering calls are simultaneously expected to carry out other duties, such as with the open-access model, the results will

hub model works best for practices of at least four to five providers and requires two or more operators. The hub may be expanded based on call volume or as the number of providers increases. Many phone systems can now help track volume, wait times, and other metrics to help organize your plan and staffing needs.

Solo-practice physicians and very small practices are more likely to use an open-access structure, but automated systems are usually still

ADVANTAGES AND DISADVANTAGES OF PHONE MANAGEMENT TYPES ADVANTAGES Open-Access Phones

Automated

Phone Hub

• No Specialized Staff

• No Specialized Staff

• No Automated systems

• No Special Technology

• Immediate access to automated answering

• Immediate access to human staff

• Immediate access to human staff

• Superior routing • Accounts for variation in call types DISADVANTAGES

Open-Access Phones • Variation in staff availability • Potential interruption in clinical duties • Inefficient • Variation in staff training and ability

Automated

Phone Hub

• Menus may confuse patients

• Requires specialized staff

• Voice prompts may be difficult to understand • Inappropriate routing • Delays in issue resolution

usually be inefficient. Dedicated phone staff may not be realistic for very small practices.

Automated systems have the benefit of continuous availability but leave incoming callers to navigate imperfect options and wait for issue resolution later. Improperly routed calls reduce office efficiency and frustrate callers. It is critical to recognize that automated systems cannot work alone.

Most issues raised by calls will eventually be resolved by providers or staff.

Phone Management and Practice Size Phone management solutions can vary based on your practice size and structure.

A trained phone specialist (operator) can handle and rout ebetween 75 and 100 calls per day, but phone hubs that completely depend on one individual are susceptible to significant disruption if that employee becomes unavailable. Therefore, the phone

an advantage for them. Since most calls must eventually be handled by staff, the difference in staffing may be nominal. Even small practices that have a receptionist receiving all initial calls usually benefit from an automated system that uses prompts to route calls and triage issues.

Most larger practices with separate departments also use automated triage capabilities. It is recommended that the merits of each model be evaluated carefully, considering the practices needs and resources.

Disadvantages of Automated Systems The greatest disadvantage of IVR systems is that people do not like talking to machines. Many patients have a hard time following menus and instructions. Patients may become frustrated with the slow process of

rise of Internet communication and social media is also undeniable. Details on these best practices are outlined in the ACG toolbox article ‘Marketing Your Practice in the

Summary

working through menus and choosing Setting Patient Expectations Certain 'soft skills' need to be taught, options and choose options that A great deal of stress and hassle is such as handling an upset patient and promise fastest access. Long menus of potentially avoidable when customers diffusing a crisis. Newly hired staff options are usually counterproductive, know what to expect when they call. With should be trained by an experienced and we recommend a menu of no every new patient and established patient, manager who orients them to the more than four choices. As previously the practice should provide a summary of practice telephone policy and carefully discussed, many issues do not fit neatly the telephone policy with hours, expected supervises the process. Script options into one of those options and voice time required for returned calls, and for common questions and situations prompts can be difficult to choose. frequency of voicemail checks. A summary are especially valuable. These scripts Practices will need to be prepared for of the policy can be included in the postmust be written to streamline answers a high percentage of incorrect choices visit clinical summary and on the practice and minimize hold time. Training and inappropriate routing. The quality website. Patients should be encouraged should be ongoing, and coaching of voice prompts is also important. to use other methods of contacting the and follow-up supervision are critical.

Professional voice talent may help practice as well. Patient portals provide Structured metrics such as wait-times, Figure 1: CHOICE ARCHITECTURE FOR AUTOMATED PHONE MANAGEMENT craft and read more effective prompts. a convenient method of contact for nonissue-resolution, and patient experience Poorly managed IVR systems will result urgent medical questions and concerns. can be measured and used for process in improper routing of calls, frustrated patients, failure to resolve important FIGURE 1: CHOICE ARCHITECTURE FOR AUTOMATED PHONE MANAGEMENT issues, poor patient satisfaction, and can even have negative impact on your medical care.

Despite the advances in technology, the telephone call remains a vital line of c for any medical practice. A “one size fits all” approach is not practical and eac develop a system that works for their team members and patients. Internal au measurable metrics can be useful for annual staff reviews, recognition, or bon and efficient telephone management can strengthen the entire practice by m frustration of all involved.

Initial Call Structure Automated IVR systems use a choice architecture driven by recorded prompts. We recommend the use of a simple decision tree, with an early option to reach the physician representative (MA, RN) to address medical questions and concerns. Staff members with clinical responsibility must have the training to recognize significant issues and the ability to triage the call and contact the physician or another appropriate provider throughout the work day.

The other prompt choices such as scheduling, billing issues, and prescriptions will route calls to their respective departments. It is important that the automated triage connects the caller to a live person within a few minutes.

See Sample Choice Architecture: Figure 1

The IMPORTANCE of Training Answering phone calls properly in a medical practice is a critical task. It is vital for staff to be trained in active listening and be equipped with the tools necessary to handle the most common types of phone calls. They must also be familiar with practice operations, call schedules, clinic schedules, and organizational structure.

improvement. We also recommend the physicians (yes, doctors) remain involved in the process and participate when appropriate. Providers must be alert to call-related complaints and communicate them to administrators.

Finally, value an excellent telephone employee highly! Customer service by phone is a valuable skill that practices must not underestimate.

Providers may also benefit by a policy that differentiates medical concerns that will require office visits. Since patients will also use websites and social media to contact practices, access to the practice through these methods must be carefully monitored. In the end, patients will choose the pathway of least resistance to get access to your practice. Considering the notion that 90% of calls are made by

Getting it Right | 15

// GETTING IT RIGHT

10% of the patients, it is important to manage a patient’s expectation and support our multi-tasking staff.

Managing Physician Referrals A direct prompt should be available to address physician referrals and consultation requests so as not to inconvenience referring providers.

Minimize friction on these important calls. We recommend requiring only minimal information such as patient identifiers, location, reason for consultation, and urgency (same day, within 24 hours). Easy access to a practice is a major marketing strength, especially in highly competitive environments.

Practice Improvement for Phone Management Like any aspect of your practice, telephone management should be audited internally by an assigned manager. There are several measurable metrics that can used for constant and ongoing quality improvement.

1. On-hold times and the time taken to either call patient back or connect with a scheduler or provider 2. Evaluate staffing ratios by performing a ‘traffic study’ to evaluate the average call volume at certain times of the day 3. Seek feedback from referring providers to assess ease of consult calls and urgent office visits 4. Incorporate patient feedback and allow comments regarding the telephone system

interactions are being routed to telemedicine as a better way for providers to resolve issues and directly provide care. We strongly encourage readers to refer to ACG Practice Management Committee Toolbox article ‘Essential Guide to Telemedicine in Clinical Practice: EASY STEPS TO RAPID DEPLOYMENT.’ The rise of internet communication and social media is also undeniable. Details on these opportunities and best practices are outlined in the ACG Toolbox article ‘Marketing Your Practice in the Digital Era.’ Summary Despite the advances in technology, the telephone call remains a vital line of communication for any medical practice. A “one size fits all” approach is not practical and each practice should develop a system that works for their team members and patients. Internal audits with measurable metrics can be useful for annual staff reviews, recognition, or bonuses. Prompt and efficient telephone management can strengthen the entire practice by minimizing frustration of all involved.

References 1. www.physicianspractice.com/managersadministrators/telephone-etiquette-tipsmedical-practice-staff 2. Elnicki D, Ogden P, Flannery M. Telephone Medicine for Internists. J Gen Intern Med. 2000; May; 15(5): 337-343 3. AAFP Guide for Improving Telephone Management in Your Practice: www.aafp.org/ fpm/2005/0500/p49.pdf 4. AHRQ Toolkit for Telephone Quality Improvement: www.ahrq.gov/sites/default/ files/wysiwyg/professionals/quality-patientsafety/quality-resources/tools/literacy-toolkit/ healthlittoolkit2_tool7.pdf

New Opportunities to Supplement Telephone Access Recent events have rapidly pushed telemedicine to the forefront in medical practice. Many patient

Syed Hussain, MD, GI Associates LLC, Kenosha, Wisconsin

16 | GI.ORG/ACGMAGAZINE

Sapna Thomas, MD, FACG, University Hospitals, North Ridgeville, Ohio

Accessible. Relevant. Practical.

The information you need to improve your practice.

The ACG Practice Management Committee’s mission is to equip College members with accessible tools to overcome management challenges, improve operations, enhance productivity, and support physician leadership in their private and physician-lead clinical practices.

Learn from practicing colleagues through monthly articles on topics important to you. Articles include a topic overview, suggestions, examples, and a list of resources or references.

Explore the 2020

PRACTICE MANAGEMENT TOOLBOX and LAW MIND insights!

Download the e-Book: bit.ly/PM20EBOOK

"Pressures are high as gastroenterologists make important management decisions that profoundly affect their business future, their private lives, and their ability to provide care to patients." —Louis J. Wilson, MD, FACG

Start Building Success Today.

GI.ORG/TOOLBOX Getting it Right | 17

// COVER STORY

Pivot

Virtu Leade

in t

t to

ual ACG 2020 & ership Lessons

the Time of pandemic Reflections on a Year of Challenges and What the Future Holds

Cover Story | 19

// COVER STORY

An Interview with ACG President Mark B. Pochapin, MD, FACG

I

IN A YEAR WHEN THE REALITIES OF THE COVID-19 PANDEMIC COMPELLED THE COLLEGE TO RE-ENVISION its Annual Scientific Meeting as a virtual program and respond to the rapid changes in the landscape facing our members, their patients, and our world, the College has stepped up to help illuminate the way forward for gastroenterologists by offering resources, programs, education, scientific publications, and leadership.

Over its history of more than eight decades, ACG has evolved and perfected the experience of its Annual Scientific Meeting—one that is the highlight of our year, a signature experience viewed by so many in clinical gastroenterology as a welcome and valued opportunity for collegiality, clinical education, and professional connection.

As the College makes the historic pivot to a Virtual ACG 2020 Annual Scientific Meeting, here are the personal reflections of the two College leaders most intimately involved with the critical determinations of this extraordinary year, whose unique collaboration brought ACG through 2020 and whose vision will help lead the College into the future. ACG MAGAZINE is proud to share excerpts of interviews with ACG President Mark B. Pochapin, MD, FACG, and President-Elect David A. Greenwald, MD, FACG.

20 | GI.ORG/ACGMAGAZINE

You were interviewed as you were about to begin your Presidency last year and you were asked about what your goals were and what you thought the biggest challenges would be. Then, five months into it, the COVID-19 pandemic hit with your hometown of New York City as the epicenter. Can you share your perspective on the impact of the pandemic on the work of the College?

What a difference between a year ago and today, for all of us. One of my main goals as the incoming ACG President in October 2019 was to increase the engagement of our members – to let GIs across the country know about the invaluable expertise, guidelines, educational opportunities, and collaborations that the ACG makes available to its members. Little did I know just how much we would need those resources, or the pivotal role they would play, just a few months later. When COVID-19 arrived in the United States, and then New York City became the epicenter of the world, we had to learn about this deadly novel coronavirus with its ever-growing list of clinical manifestations in real time. From how it spreads, to testing recommendations, to recognition of COVID symptoms, data on treatments, and PPE, to how to provide a safe environment for ourselves, our staff, and our patients. It was and remains an unprecedented crisis.

The ACG—its leadership, faculty, and staff—has focused on providing frequent communications, updates, guidelines, and educational programs throughout this crisis. Unfortunately, this pandemic is not yet over, and our job is still ongoing. But most definitely, the ACG was faced this year with the need to abruptly and rapidly re-focus a significant part of its agenda on addressing the fight against COVID-19—and to do it all in the virtual setting. Fortunately, the ACG Strategic Plan that we had completed

“Ultimately, as physicians, we stand for “do no harm.”

We stand for the protection of the health, well-being, and dignity of our fellow human beings. Racism and racial discrimination in all its forms are a threat to our public health, to our patients’ health, and to our own and our colleagues’ health and well-being.”

the year before, with our mission, vision, and key priorities, was spot on and allowed for a solid template to work off of and guide us. At every new juncture, I looked at that document to help make sure we were going down the right path. I am so grateful to ACG Past Presidents Dr. Sunanda Kane and Dr. Carol Burke and our entire Board, who put so much effort into this Strategic Plan. It was my guiding light during these very challenging times.

It has been said in a variety of situations, including this year with you as ACG President, that the leadership we have is exactly the one we needed. As your term as ACG President is winding down, how do you feel about the experience?

This year has been a humbling experience for me. In New York City, I have been overwhelmed by the professionalism and generosity of spirit shown by so many faculty, fellows, and staff who stepped up and put themselves at potential risk to help protect and care for others. As the current ACG President, I feel great appreciation for the former presidents and other leadership who over the years have helped develop the structure, depth, and culture of the ACG to prepare us for any crisis, including those encountered during a year like this.

Leadership is about helping others reach their potential, perform at their best, and elevate others in the process. I believe we all felt empowered to handle this crisis not only because of the dedication and support of the ACG leadership, but also because of the incredible dedication to patient care demonstrated by our over 15,000 members.

When asked how he was able to land a jet on the Hudson River, Captain Chesley “Sully” Sullenberger said, “…My entire life up to that moment has been a preparation to handle that particular moment.” I believe that is true about the leadership of the ACG. In many ways, we have all been preparing our entire professional lives, and as an organization have been preparing since our inception in 1932, to help our members through this crisis and provide the very best guidance, recommendations, and science to allow for the highest quality and safest care for our patients. You ask how I feel? Exhausted by the experience, but energized by the acts of human kindness; horrified by this virus, but grateful for the

opportunity to fight it on the frontlines; disappointed by not getting together in person for meetings, but appreciative of the ability to connect virtually. And I feel proud: proud to represent the ACG, and proud to be a part of our greater GI family working side by side with colleagues who put the health and welfare of our patients above all else.

Our profession demonstrated that, at its core, we are here to help others. There is nothing more gratifying than that.

During your time on the Board of Trustees, you have been a leader in reviewing and updating the College’s Mission and Vision statements. In your opinion, how have those documents impacted the manner in which the College has dealt with the impact of the COVID-19 pandemic on the organization and the membership?

Our strategic planning­—which includes our vision, mission, and key priorities—is aimed at serving to advance the profession of gastroenterology and improve patient care. The best way to achieve this is to provide our members with the leadership, educational programming, advocacy, opportunities for collaboration, and other resources they need to enhance their ability to offer the highest quality, compassionate, and evidence-based patient care.

As I mentioned before, the ACG vision, mission, and key priority statements were critically important to help guide me and our Board when making important decisions. When faced with a challenging issue, I would take out our Strategic Plan document to make sure our actions mapped to our stated priorities. For example, the decision to speak out against racism this year hit directly on 7 of our 10 key priorities and indirectly on the other 3.

It was not only the right thing to do, it was part of who we are as a College.

ACG’s mission also became more critically important in another area this year: COVID-19. It was our job to ensure that our members were able to secure the information and resources they needed to provide optimal clinical care in the safest

possible environment during the pandemic. Gastroenterologists around the country needed to receive in real time the latest developments on COVID-19, such as the gastrointestinal symptoms associated with this virus, as well as the appropriate safety precautions to protect themselves, their staff, and their patients in the office, endoscopic, and inpatient settings. On top of this, in areas where hospitals experienced a surge of COVID cases, gastroenterologists and gastroenterology fellows were an important part of what we at NYU Langone called “The COVID Army”— the collective team of physicians and other healthcare professionals from all specialties who stepped forward to serve in the rapidly expanding inpatient medicine services and intensive care units.

I will never forget the first COVID-19 webinar that Dr. David Greenwald and I ran on April 17, 2020, about what we had learned from our colleagues in Wuhan and Italy and what we were beginning to experience at that time in New York City. We realized that gastroenterologists in many parts of the country, along with other internal medicine specialists, were going to need to become internists again and care for COVID patients in the hospital. It was all hands on deck. At the ACG, we once again went to our mission, vision, and key priorities and realized that training gastroenterologists to care for patients with COVID was part of who we are as a College, advancing the provision of “the highest quality, compassionate, and evidence-based patient care.”

As you mentioned, amidst the strains related to the pandemic, the country also saw the spotlight on racial disparities in the country intensify following the death of George Floyd. You felt it was vitally important for the College to speak out immediately on the issue of racial injustice and also its relationship to public health and health disparities. And ultimately, the ACG became one of the first medical societies to do so. Can you share your thoughts on these challenges

Cover Story | 21

// COVER STORY

“

ACG’s mission also became more critically important in another area this year: COVID-19. It was our job to ensure that our members were able to secure the information and resources they needed to provide optimal clinical care in the safest possible environment during the pandemic.”

22 | GI.ORG/ACGMAGAZINE

and the productive role organizations like ours can play to advance the country?

Martin Luther King, Jr., said, “In the end, we will remember not the words of our enemies, but the silence of our friends.” When we see racial discrimination or injustice, when we see murder, we cannot remain silent. If we remain silent, then we become complicit with the people or the structures that support those acts. I believe it is our responsibility to speak out—as individuals and as organizations, communities, and all the way up. That is why I am so proud of the ACG Board who quickly and unanimously agreed that we must speak out publicly against these horrific acts following the murder of Mr. Floyd.

And this statement meant so much to our colleagues and patients who were hurting so badly. As an organization, the ACG holds diversity, equity, and inclusion as a top priority—in our leadership and in our membership— in race and ethnicity, in gender, in geographical location, in practice type, and across the full range of human experience.

The College also has tremendous leadership in this area with Dr. Darrell Gray, our chair of the Diversity, Equity & Inclusion (DEI) Committee; Dr. Sophie Balzora, our Chair of the Public Relations Committee; and Dr. Renee Williams, a Trustee of the College.

Now we need to follow our words with action. For this reason, the ACG created a dedicated work-group which consists of Dr. Williams, Dr. Gray, Dr. Balzora, and Dr. Fola May that will work with our DEI Committee to address disparities, equity, and inclusion in the medical profession and healthcare system, and come up with actionable items for the College to initiate.

Ultimately, as physicians, we stand for “do no harm.” We stand for the protection of the health, well-being, and dignity of our fellow human beings. Racism and racial discrimination in all its forms are a threat to our public health, to our patients’ health, and to our own and our colleagues’ health and well-being.

We know that there is inequity in our communities and in our healthcare system, and the clinical effects of this can be seen across the gamut of care from colon cancer screening to COVID-19. This commitment on behalf of the ACG and other medical societies is essential for the future of the medical profession and for the provision of high-quality clinical care for all. We have to do better and, together, we can do better.

Much of the College’s educational programming has had to pivot to online programming due to the pandemic. The College also began a weekly Virtual Grand Rounds program that has reached tens of thousands of people. Can you talk a bit about your impressions of ACG’s educational offerings and the impact on members?

There are some things that will come out of this pandemic that will make the College stronger. I believe our Virtual Grand Rounds (VGR) is one of them.

These weekly lectures have been a homerun, and I have to give a shout out to my colleague, Dr. Seth Gross, for giving me the idea. In addition to providing special evening sessions with COVID-related webinars, our VGR programming has attracted more than 30,000 participants from late March, when they started, through the summer. This really demonstrates the passion we all have for our profession and how much we crave to learn about gastroenterology and hepatology.

Clearly, we love what we do!

I have been extremely impressed by the work of the ACG executive and administration team, as well as our Board, governors, and committee chairs and members, and all of the speakers in making our regularly scheduled regional and national educational events possible—and also adding the tremendous amount of educational programming around COVID-19—in the midst of this unprecedented crisis. It was important to address the educational gaps around COVID-19, but also to continue to provide the needed information around gastroenterology

2O2O ACG AWARDS EXCELLENCE

Recognizing at an EXTRAORDINARY TIME VIRTUAL ACG 2020 LEADERSHIP AWARDS The College is not able to convene in person for the Annual Scientific Meeting this year; nevertheless, in the virtual meeting format, ACG will pay tribute to those who receive awards and become Masters of the College in 2020 in a special video awards ceremony. This event during Virtual ACG 2020 Annual Scientific Meeting will celebrate the achievements of this year’s winners.

You can watch the ACG 2020 Leadership Awards video on the College website at gi.org/Awards.

The ACG Awards Committee, under the leadership of ACG Past President John W. Popp, Jr., MD, MACG, solicits recommendations from the ACG membership for awards. In turn, the recommendations of the Awards Committee are discussed and acted upon by the College’s Board of Trustees.

The appreciation and admiration of one’s peers is one of life’s finest honors, and the caliber of the awardees each year certainly reflects the highest level of achievement in the field of gastroenterology.

While ACG’s virtual meeting format for 2020 precludes congratulating this year’s awardees at a gathering of peers, the College recognizes their accomplishments and honors their contributions to the field and to ACG, and offers hearty congratulations and gratitude to this year’s honorees.

BERK/FISE CLINICAL ACHIEVEMENT AWARD William D. Chey, MD, FACG, Ann Arbor, MI Dr. Chey is this year’s Berk/Fise Clinical Achievement Awardee for his significant and distinguished contributions to clinical gastroenterology. This annual award recognizes not only clinical excellence, but also contributions in patient care, clinical science, clinical education, technological innovation, and public and community service.

On the merits of his numerous and significant contributions to clinical practice, education, research, and leadership, Dr. Chey fulfills the qualifications and embodies the spirit of the Berk/Fise Clinical Achievement Award.

SAMUEL S. WEISS AWARD Eugene M. Bozymski, MD, MACG, Chapel Hill, NC Recognized as an outstanding teacher and clinician, Dr. Eugene Bozymski is the 2020 Samuel Weiss Award recipient for his extensive and longstanding service to ACG. This award in commemoration of ACG’s founding father, Samuel S. Weiss, is presented periodically, and not necessarily annually, to a Fellow of the College in recognition of outstanding career service to ACG. Dr. Bozymski is recognized for his many years of exemplary service to the College, and for embodying qualities of leadership and mentorship both in his professional life and in his work for ACG.

INTERNATIONAL LEADERSHIP AWARD Mahesh K. Goenka, MD, FACG, Kolkata, India The College is proud to present the 2020 International Leadership Award to Manesh K. Goenka, MD, FACG. Dr. Goenka is one of the most prolific and experienced endoscopists in India, has pioneered innovative endoscopic techniques, and has been instrumental in providing training in basic and advanced endoscopy in India and internationally. In addition to his clinical excellence, he has served as a medical educator and mentor, provided community aid and educational campaigns, and demonstrated his sustained commitment to the College by expanding the network of ACG members in India.

COMMUNITY SERVICE AWARD Hari S. Conjeevaram, MD, FACG, Ann Arbor, MI Hari Conjeevaram, MD, MSc, FACG, FACP, is recognized by the College for his commitment to serve in and develop resources for care in underserved communities locally and globally, and his dedication to developing the next generation of service-oriented gastroenterologists. He has been actively in involved with students in providing service in the city of Detroit through ‘Street Medicine,’ and extending his work beyond Michigan into Illinois and Ohio where he coordinates medical camps focused on health screening and education in communities of need. He has also led multiple international medical relief missions to India, Guyana, Sri Lanka, Haiti, the Philippines, Kazakhstan, and, mostly recently, Ecuador.

MASTER OF THE AMERICAN COLLEGE OF GASTROENTEROLOGY As a result of their recognized stature and achievement in clinical gastroenterology and/ or teaching, and because of their contributions to the College in service, leadership, and education, the following individuals have been recommended by the Awards Committee and approved by the Board of Trustees for designation as Master.

• Delbert L. Chumley, MD, MACG, San Antonio, TX • Francis A. Farraye, MD, MSc, MACG, Jacksonville, FL • Stephen B. Hanauer, MD, MACG, Chicago, IL • Nicholas J. Shaheen, MD, MPH, MACG, Chapel Hill, NC

SCOPY—Awareness of Colorectal Cancer Prevention in a Challenging Year The College is grateful to everyone who committed their time and energy to envisioning, planning, and delivering colorectal cancer awareness programs and who responded to the call for submissions for the 2020 SCOPY Award—Service Award for Colorectal Cancer Outreach, Prevention & YearRound Excellence.

This year, many efforts devoted to increasing awareness and prevention of colorectal cancer (CRC), particularly during Colorectal Cancer Awareness Month, were thwarted by the COVID-19 pandemic. Throughout this challenging time, resources have been shifted away from colorectal cancer screening to mitigating the pandemic. In soliciting applications for the SCOPY awards, we recognized the difficult position members of our College grapple with—addressing the present danger of COVID-19 and the reality that in the absence of CRC screening, incidence of this preventable cancer may rise.

A total of 16 SCOPY Awards will be presented to an outstanding slate of CRC awareness champions.

This year’s initiatives demonstrated sustained engagement with community members, effective collaboration to deliver comprehensive CRC awareness campaigns, a commitment to improving accessibility of CRC screening, and the use of humor to communicate this significant, but under-addressed, public health issue.

Two judges, Sophie M. Balzora, MD, FACG, Chair of the ACG Public Relation Committee assisted by Jacques C. Beauvais, MD, of NYU Langone Medical Center, pared down the remarkable efforts to this outstanding group of winners.  LEARN MORE Watch a video of the 2020 SCOPY Awards ceremony, view the 2020 awards booklet, and be inspired by this year’s projects: gi.org/SCOPY

 LEARN MORE Watch a video of the 2020 ACG Leadership Awards ceremony, view the 2020 awards booklet and be inspired by this year’s winners: gi.org/Awards

Cover Story | 23

// COVER STORY

and hepatology overall. I found the content to be exceptional, and actually invited our GI faculty and fellows at NYU Langone to view the ACG VGR lectures each week. It has been one of the silver linings of this pandemic.

Has your term as President provided you with any unique insight into the College that you would like to share with the membership?

The College is special. It really is like an extended family that truly cares.

During this challenging time, we were asking ACG staff and leadership to work non-stop at an intensity never before required. Days, nights, and weekends were all the same. I like to quote a fortune cookie I once got, “When times are good, your friends know you. When times are bad, you know your friends.” The ACG is definitely our friend! Instead of backing away from tough issues and decisions during the most difficult time in ACG history, the ACG stepped up and provided guidelines, educational webinars, virtual grand rounds, cuttingedge journal articles, PPE and testing guidance, access to PPE, and now a virtual Annual Scientific Meeting.

It’s ironic that I started out my presidency saying in my incoming interview, “I would like all of our members to recognize the incredible resources the ACG has that can improve their professional lives and the care of their patients.” No one wanted the COVID-19 pandemic, but it did certainly bring to greater light the incredible expertise, resources, and critically important guidance the ACG provides to facilitate the improvement of both our professional lives and the care of our patients.

24 | GI.ORG/ACGMAGAZINE

An Interview with incoming ACG President David A. Greenwald, MD, FACG On Monday evening, October 26, 2020, at the ACG Business Meeting, David A. Greenwald, MD, FACG, will become the College’s next President. Dr. Greenwald shares some of his ideas and aspirations for the coming year.

As you prepare to assume the Presidency of the American College of Gastroenterology during these most unusual of times, do you have specific goals in mind and challenges that you hope to tackle and have these changed in light of the pandemic?

Indeed, the “most unusual of times” would be a perfect way to describe this past year, and unfortunately, unpredictable situations may continue to be the rule for some time to come. The COVID-19 pandemic no doubt represents the most important challenge in the upcoming year for ACG members, gastroenterologists, physicians, and all of society, both here in the United States and globally. The impact of COVID-19 on the practice of gastroenterology, in all settings has been, and will continue to be, unprecedented, and I am confident ACG will help its members meet those challenges directly and effectively.

As I think about the upcoming year, three words that begin with the letter “R” come to mind: resilience, respect, and relationships. Maximizing each of these will be critical to our personal and professional success over the next 12 months.

Our GI community has already shown enormous resilience in meeting the enormous professional and economic difficulties brought on by COVID-19.

Resilience is manifested in numerous ways. Many of us transformed ourselves from gastroenterologists to COVID-19 physicians and intensivists nearly overnight when the need arose. In an instant, gastroenterologists went from our “daily routine” as clinicians and proceduralists to thinking carefully about how to protect the safety of our patients and ourselves from a previously unknown infectious threat, and then participated in

writing a roadmap to reopening and restarting our practices. We seized a seemingly out of control situation and used the opportunity to do groundbreaking research, and then rapidly published the experiences of some so the rest of the community could benefit. We continue to support each other through these difficult financial and emotional times, and I am confident that our collective resilience will lead us to bounce back even stronger for the experiences that we have had.

Respect for one another, again, both in the professional and private arena, continues to be crucial for all of us, especially when spotlighted in a moment of increased national awareness of racial and social injustice.

We recognize the need for diversity, equity, and inclusion in all that we do; achieving that starts with a foundation of mutual respect. As physicians and gastroenterologists, we simply must strive to better understand the background of every one of our patients, co-workers, colleagues and all in society, and respect their values and opinions.

Which brings me to relationships.

My focus here for ACG members is to focus on your professional relationships and treasure them. Gastroenterologists are often described as “fun.” Indeed, your physician and other professional colleagues are intelligent, caring, sensitive, and have so much to share.

We are very lucky to meet so many people through education, training and throughout our careers, and we have so much to share with each other.

Embrace those connections—they are unique—and I‘d like to highlight the importance of those relationships in the coming year.

You have served as a point person for the College in efforts to strike an appropriate balance between policies related to safe endoscopic procedures with strong scientific support while maintaining clinical practicality. What is the current status of those activities and how do you think the COVID-19 pandemic has or will influence this issue?

Endoscopy is the bedrock of much of the practice of gastroenterology in the United States and around the world; effective and safe reprocessing of the tools we use each day on every patient cannot be underestimated. Even one endoscope or device-related infection can undermine all the good that comes from the endoscopic procedures we do. The public puts their trust in us and in our standards.

I have been fortunate over the years to collaborate with many groups, including the ASTM (American Society for Testing and Materials); AAMI (American Association for Medical Instrumentation); ASGE and AGA; as well as FDA and CDC, to develop standards and guidelines for reprocessing endoscopic equipment and accessories. These efforts are ongoing, as the development of new technology leads to new needs in the safety and reprocessing arena. For example, difficulties in cleaning and reprocessing duodenoscope and linear echo endoscope elevator mechanisms were identified in recent years and tied to outbreaks of infections. The response was an investigation, followed by multisociety efforts to update reprocessing protocols while, in parallel, encouraging development of newer technologies that might obviate the problem altogether.

ACG, along with the other GI Societies, has led the way in making certain that updated guidelines are supported only by validated data where it exists. COVID-19 fears only accentuate the concerns about transmission of infection in general, but there is good news…COVID-19 is easily eradicated by standard methods of reprocessing endoscopes.

excited about the 2020 ACG Annual Scientific Meeting. Our goals are to deliver high-level education, as we always do, and maintain the collegiality that is part of every ACG meeting. And yes, we think we have done that. The ACG staff has worked tirelessly, yes, tirelessly to recraft the meeting in an innovative and thoughtful way. They deserve so much credit and so much praise. Special thanks to Brad Stillman, Maria Susano, Meridith Phillips, Elaine McCubbin, and Anne-Louise Oliphant, but it is truly a team effort. Everything has been prepared so carefully, with pre-recorded material, live lecture highlights, live discussion panels, radio broadcasts, virtual hands-on learning, prime time “specials,” and so much more. So, while COVID may have prevented us from all meeting in person in Nashville, COVID won’t prevent us from having a “rocking” great meeting.

Any final thoughts?

Yes, I have two. First, there’s always room for more kindness and more gratitude in this world, and we can lead the way. And, second, take a moment, hug your family, hug your loved ones, cherish those who support you. In my case, those people are Beth and my two children, Allison and Michael, and I can’t thank them enough for all they have done for me.

You are taking on the Presidency during a most unusual time and an unusual way­— virtually. As an organization which has tried to create opportunities for connection at the national and regional level to learn face-to-face together with colleagues, how do you think we navigate these times when in-person meetings are not possible without losing what makes the College so special?

As others have said, great challenges lead to great opportunities. So, yes, this is a very unusual time and a strange set of circumstances, but we have worked very hard to make this ACG Annual Scientific Meeting set and be the new standard for a virtual meeting. Yes, we are truly Cover Story | 25

COVID-19 Resources for Gastroenterology & Endoscopy Clinical Guidance & Insights for ACG Members

Throughout the COVID-19 pandemic, the College has been a leader with up-to-the minute resources and insights for clinical gastroenterologists. Now with the focus on re-opening and ramping up endoscopy practices, ACG has provided a great roadmap to help our members at every turn on gi.org/COVID19.

Resources and Webinars from ACG’s Endoscopic Resumption Task Force

Patient Education Handouts in English & Spanish

Latest COVID-19 Clinical Science from The American Journal of Gastroenterology

Links to Registries for COVID-19 Patients with GI and Liver Diseases ACG In the News during the Pandemic

Policy, Practice Management & Telehealth Insights

9 POST-COVID-1 DOSCOPY N E G IN RESUM

GUIDANCE ON OUR SAFELY REOPENINCEGNYTER EN D O S C O P Y

The ACG Endoscopy Resumption Task Force:

GUIDANCE ON SAFELY REOPENING YOUR ENDOSCOPY CENTER ACG Task Force on Endoscopic Resumption: Roadmap for Safely Resuming or Ramping-Up Endoscopy in the COVID-19 Pandemic May 2020 Resuming endoscopy during this pandemic is a tremendous challenge, with a daily deluge of new information, regulatory guidelines, expert opinions, and society recommendations. The ACG Task Force on Endoscopic Resumption to critically reviews the available information and offers practical guidance for our members.

Read: bit.ly/Resuming-Endo-Guidance 26 | GI.ORG/ACGMAGAZINE

The Impact of Twitter: Why Should You Get Involved, and Tips and Tricks to Get Started

By Mohammad Bilal, MD1 and Amy S. Oxentenko, MD, FACP, FACG, AGAF2

Am J Gastroenterol 2020;00:1–4. https://doi.org/10.14309/ ajg.0000000000000763; published online July 27, 2020

TWITTER WAS ESTIMATED TO HAVE 330 MILLION USERS IN 2019, which highlights its impact and reach (1). Currently, many major medical institutions, societies, scientific journals, and healthcare conferences have a Twitter handle to disseminate information, promote engagement with followers, and strategically market services. This article aims to describe the impact and benefits of Twitter use and provide tips and tricks for getting started.

DEFINE YOUR GOAL FOR USING TWITTER For those new to Twitter, the initial step is to identify your goals for use. These could range from wanting to stay up-todate in medicine, networking, disseminating work or ideas, career advancement, or becoming a healthcare influencer.

Moreover, it could be to promote your practice, market your program or institution, or provide patient education.

Defining your goals a priori will allow focused branding and tailor groups or individuals to follow. For instance, if your goal is to advertise your fellowship program, then following other training programs and engaging in conversations with education leaders could be a helpful strategy.

SETTING UP A PROFILE The first step in using Twitter is to set up an effective profile.

Ideally, your profile should quickly convey your mission, interests, and persona. For providers, it is ideal to list your full name along with your degree and include a professional ACG Perspectives | 27

DIGITAL DIALOGUE

// PERSPECTIVES

HE RED SECTION

TAXONOMY OF TWEETING HOW TO EFFECTIVELY TWEET Twitter can feel daunting when getting To effectively use Twitter, it is important started, but akin to professional to understand the anatomy of a tweet success, “slow and steady” is a safe (Figure 2). When viewing a tweet, it shows approach. Similar to bloom taxonomy the profile picture, handle of the person for learning theory, we suggest a who tweeted the material, the main tweet similar and may include links, Figure 1. An example of a content, complete Twitter profile. (a) The first thing in the profile ishashtags, your name and usually having a title (e.g., MD) is encouraged. (b) The“taxonomy of tweeting”for handle starts with “@” and is going to be used when people tag you in conversations. (c) The twitter biosketch is 160 characters which should highlight your those new to Twitter (Figure 4). Start position, title, and interests.or (d) You can add a websiteA linksingle or an institutional website. (e) is where the cover will appear. pictures. tweet isThislimited tophotograph a on your twitter page with “liking tweets,” then “retweeting” tweets of others, followed by “retweet ure 1. An example of a complete Twitter profile. (a) The first thing in the profile is your name and usually having a title (e.g., MD) is encouraged. (b) The with comment,” which allows you to dle starts with “@” and is going to be used when people tag you in conversations. (c) The twitter biosketch is 160 characters which should highlight your ition, title, and interests. (d) You can add a website link or an institutional website. (e) This is where the cover photograph on your twitter page will appear. add your own summary of another’s tweet, and culminating in “creating headshot. The next step is to choose your own tweet.” your Twitter handle, which is how

you will be searched, mentioned, and tagged by others (Figure 1). The THE IMPACT OF TWITTER—WHY handle should ideally identify who you SHOULD YOU GET INVOLVED? are; although most use one’s name The impact of effective use of (@AmyOxentenkoMD), others have social media can be immense used interests to define their handle Figure 2. This is an example of how a tweet looks once posted, with different components of a tweet highlighted. and multifaceted. (@IBDMD). A brief biosketch can be Research further impacts the Altmetric Attention Score for that study. Twitter has maximum of 280 characters.

This allows Social media use is not purely for social means as the name implies; recently been used to carry out research using its “polling” feature (6). inserted into your profile, which allows Twitter is a valuable way to promote science. Studies have shown that Research quickly readContinued and medical requires articles shared on social tweets media tend toto havebe increased citations and education aofdescription of with your ure 2. This is an example how a tweet looks once posted, differentbackground: components of a tweet highlighted. higher Altmetric scores (4,5). For this reason, many medical journals Twitter is being increasingly used for journal clubs and to disSocial media use is not purely for messages to be succinct and eye-catching. now have Twitter handles and use the Altmetric Attention Score to seminate cutting edge research by clinicians, educators, and rerole, institution, clinical or academic search further impacts the Altmetric Attention Scorearticles. for that Any study.Twitter Twitteruser has who clicks the linked article searchers. Twitter has been a great tool for “unofficial continued track published social means as the name implies; Adding ial media use is not purely for social means as the name implies; recently been used to carry out research using its “polling” feature (6). relevant images and tagging interests, and personal interests. This itter is a valuable way to promote science. Studies have shown that The American Journal of GASTROENTEROLOGY cles shared on social media tend to have increased citations and Twitter is a valuable way to promote like-minded colleagues can increase the Continued medical education is For limited to 160 Finally,Copyright doused for© journal her Altmetric scores (4,5). this reason, many medical characters. journals Twitter is being increasingly clubs to dis- College of Gastroenterology. Unauthorized reproduction of this article is prohibited.

2020 by Theand American w have Twitter handles and use the Altmetric Attention Score to seminate cutting edge research by clinicians, educators, and re-and reach of your tweet. science. Studies have shown that impact not forget totheinclude background Twitter has been a great tool for “unofficial continued ck published articles. Any Twitter user who clicks linked article asearchers. articles shared on social media tend photograh on your profile because this American Journal of GASTROENTEROLOGY to have increased citations and higher WHAT TO TWEET pyright © 2020 by The American College of Gastroenterology.

Unauthorized reproduction of this article is prohibited. allows an additional opportunity to Altmetric scores (4,5). For this reason, You can build your social media presence showcase your brand.

(2) many medical journals now have by tweeting credible content regularly .

Tweeting summaries of newly-published Twitter handles and use the Altmetric journal articles and live tweeting from Attention Score to track published  GETTING STARTED ON TWITTER conferences, including key conference articles. Any Twitter user who clicks 1. SIGN UP: Sign up for a Twitter slides and take-home messages, is wellthe linked article further impacts account online at twitter.com. received.

Another powerful educational the Altmetric Attention Score for 2. SET UP a username and password tool is through the use of a “tweetorial,” that study. Twitter has recently been and add a photo and brief which is a collective thread of tweets used to carry out research using its description to your profile. from a single user that aims to convey “polling” feature (6). multiple teaching points around a single MORE POINTERS: Explore ACG’s topic (Figure 3) (3).

“Social Media 101” Flyer developed by VOLUME 115 | OCTOBER 2020 www.amjgastro.com

VOLUME 115 | OCTOBER 2020 www.amjgastro.com

THE RED SECTION

WHO TO FOLLOW? It is important to reflect on your initial goal for using social media and start following those who are aligned with your mission. For example, if you are a hepatologist, you can follow leaders in the field, liver societies (e.g., @ AASLDTweets), and hepatology journals that have a social media presence. The same principle holds true for other clinical, research, or educational interests.

Figure 3. This is an example of few tweets from one tweetorial using Twitter polls, images, and published articles as tools to engage the readers.

28 | GI.ORG/ACGMAGAZINE

1551

DIGITAL DIALOGUE

the ACG Public Relations Committee: bit.ly/ACG2020-Social-Media-101

and metrics related to social media use, such as tweet engagement, impressions, and Altmetric scores (11).

Figure 3. This is an example of few tweets from one tweetorial using Twitter polls, images, and published articles as tools to engage the rea

FOLLOW US!

and metrics related to social media use, such as tweet e ACG: twitter.com/AmCollegeGastro impressions, and Altmetric scores (11).

AJG: twitter.com/AmJGastro

Patient education Who’s Who in GI on Twitter

In today’s of excess online content, patients m Certainworld ACG members have an active socialpresence media for information.

Many gastroenterolog on Twitter.

As you follow in theeducation GI space, you will tions more tweetpeople patient material on a regular see recommendations from has Twitter example, the GI community used Twitter effectiv you may be interested in mythsfor ofaccounts colon cancer screening.

Twitter also provide following. You can also search ACGwhere patients and physicians can interact regardi affiliated hashtags to make connections, educational content, leading to active engagement. P including the ACG meeting (#ACG2020), patient advocates (e.g., @Empoweringpts9) who Diversity in GI (#DiversityInGI), and ACG chronic medical illnesses provide valuable insight and virtual learning (#GIhomeschooling) support to others dealing with challenges related to ill hashtags. Using these is a convenient way current era, misinformation regarding disease and h to aggregate social media posts from those in ACG’s GI community. amplified (12).

Therefore, it has never been more im have physicians and organizations dispel misinforma The evidenced-based #ACG2020 Meetinghealthcare.

Hashtag and promote

Figure 4. Taxonomy of tweeting.

Continued medical education given posts are to social media use, such as tweet medical education,” able to quickly distill takeHow to Get Started on Twitter Twitter home is beingpoints increasingly used engagement, impressions, from key articles and conferences. Recently, aand popu(11) Increasingly, physicians are engaging on . for journal clubs and to disseminate Altmetric scores lar gastroenterology (GI) Twitter chat “@MondayNightIBD” was Professional networking social media to stay abreast of trends, cuttingrecognized edge research by clinicians, to grant official continued medical education.

There has never been in anthe easier way to interact with l news, and research medical Patient education educators, and researchers. Twitter profession.

Some GI physicians are leading individuals and leaders in the field.

Twitter allows has been a greatfor toolacademic for “unofficial Criteria promotion In today’s world of excess online theof way whenwithout it comeslimitations to sharing links to sharing ideas, to when, where, a content,have patients may turn to continued medical education,” Many hospitals and academic institutions a Twitter account. clinical resources and interesting news.

For program is can connect with.

For example, if a GI for information. given posts able to quickly Someareinstitutions have recognizedsocial thatmedia physician presenceMany on others, platforms like Twitter are a way to improve their education curriculum, they can quick gastroenterology organizations distill take home points from key network with other physicians, establish social media is essential to their academic mission. This has led to gestions by asking other GI colleagues via Twitter. tweet patient education material articlesthe and incorporation conferences. Recently, collaborative relationships, and keep of social media scholarship into academic on a regular basis. For example, a popular gastroenterology (GI) abreast of happenings at conferences such promotion criteria by Mayo Clinic (7). If you engage in social the GI community has used Twitter Twitter chat “@MondayNightIBD” as the ACG Scientific Meeting. or program Promoting yourAnnual practice, department, media use, you should prepare a social media scholarship porteffectively to dispel myths of colon was recognized to grant official Twitter can be used to promote your practice, dep folio, given this may become an important consideration in all cancer screening. Twitter also continued medical education.

Monitor and Share Insights Using program.

A departmental newsletter or practice ad cases of academic promotion (7–11).

A social media portfolio provides a platform where patients Hashtag #ACG2020 will have limited reach, but using the principles out should keep track of all social media activity by the author, such as The hashtag for the Virtual ACG 2020 physicians can interact regarding Criteria for academic promotion original posts, tweetorials, links ofand educational/scientific tweets, regarding effective tweeting, you can promote you Annual Scientific Meeting is #ACG2020. tweeted educational content, leading Many hospitals and academic Follow the hashtag by searching #ACG2020 to active engagement. Patients institutions have a Twitter account. © 2020 by The American College of Gastroenterology Theand American Journal on Twitter, Facebook, Instagram.

Insertof GASTROEN and patient advocates (e.g., @ Some institutions have recognized that #ACG2020 into meeting-related posts on Empoweringpts9) who deal with physician presence on social media is Copyright © 2020 by The American College of Gastroenterology. Unauthorized reproduction all social media platforms so othersof canthis findarticle is pr chronic medical illnesses provide essential to their academic mission. and engage with your posts. valuable insight and offer peer This has led to the incorporation support to others dealing with of social media scholarship into NEW! Share and Discuss Red Journal challenges related to illness. In the academic promotion criteria by Mayo Science on Twitter with @AmJGastro (7) current era, misinformation regarding Clinic . If you engage in social media and #AmJGastro use, you should prepare a social media disease and healthcare is amplified The College recently launched a Twitter (12) . Therefore, it has never been more scholarship portfolio, given this may account for The American Journal of important to have physicians and become an important consideration Gastroenterology as an independent organizations dispel misinformation in all cases of academic promotion account to share emerging science from (7–11) . A social media portfolio should and to promote evidence-based the Red Journal. Be sure to follow @AmJGastro for the latest in clinical GI, keep track of all social media activity healthcare. where Social Media Editor Dr. Walter Chan by the author, such as original posts, shares visual abstracts that communicate tweetorials, links of educational/ Professional networking study findings and prompts discussion of scientific tweets, and metrics related There has never been an easier way recent AJG published studies.

Mohammad Bilal, MD

Amy S. Oxentenko, MD, FACP, FACG, AGAF

ACG Perspectives | 29

ITAL DIALOGUE

1552

// PERSPECTIVES

to interact with like-minded individuals and leaders in the field. Twitter allows for instant sharing of ideas, without limitations to when, where, and who you can connect with. For example, if a GI program is looking to improve their education curriculum, they can quickly get suggestions by asking other GI colleagues via Twitter.

Promoting your practice, department, or program Twitter can be used to promote your practice, department, or program. A departmental newsletter or practice advertisement will have limited reach, but using the principles outlined above regarding effective tweeting, you can promote your program brand and its initiatives across the globe, cultivating broader impact.

Inspiration Social media may have impact in ways that may not be anticipated—to inspire or be inspired. A great example is the success of certain hashtags, such as those that have resulted out of the work of @JulieSilverMD (e.g., “#SheLeadsHealthCare,” “#NeedHerScience,” and “#BeEthical”). Similarly, the hashtag “#BlackMenInMedicine” has been a source of inspiration for many minority students and physicians. The popular hashtag “#DiversityInGI” has promoted diversity and inclusion in the gastroenterology community (Figure 5).

Twitter is also a great platform to amplify others, especially mentees or colleagues.

THE RED SECTION

PITFALLS For some, the concern of potential Twitter pitfalls prevents engagement, but using sound judgement and following key principles should prevent issues. First, know your institutional and state social media policies. Second, to avoid attracting unwelcome attention, it is ideal to stay away from controversial topics. Third, always review a tweet before posting anything related to clinical care to ensure patient identifiers have been removed and there are no violations of Health Insurance Portability and Accountability Act (13).

of the manuscript. Financial support: None to report. Potential competing interests: None to report.

1

Division of Gastroenterology and Hepatology, Beth Israel

Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA; 2 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA. Correspondence: Amy S. Oxentenko, MD, FACP, FACG, AGAF. E-mail: Oxentenko.amy@ mayo.edu. Received February 19, 2020; accepted June 25, 2020

REFERENCES 1. Most Popular Social Networks Worldwide as of October 2019, Ranked by Number of Active Users. Statista, 2019. https://www.statista.com/ statistics/248074/most-popularus-social-networking-apps-ranked-byaudience. Accessed April 12, 2020.

2. Gray DM II, Fisher DA. Making social media work for your practice. Clin Gastroenterol Hepatol 2017;15:1651– 3. Breu AC. Why is a cow? Curiosity, tweetorials, and the return to Why. N Engl J Med 2019;381:1097–8.

4. Cawcutt KA, Erdahl LM, Englander MJ, et al. Use of a coordinated social media strategy to improve dissemination

CONCLUSIONS Social media and Twitter use are exploding with inspiration, knowledge, and science. The power to have an impact in patient care, education, research, and worldwide collaboration is immense. Describing the true power of sensible social media use is beyond the scope of this article but hopefully this will entice nonusers to get involved and will allow those on Twitter to further enhance their social media experience.

If you are not using Twitter, we hope to see you there soon!

of research and collect solutions related to workforce gender equity. J Womens Health (Larchmt) 2019;28: 849–62.

5. Smith ZL, Chiang AL, Bowman D, et al. Longitudinal relationship between social media activity and article citations in the Journal Gastrointestinal Endoscopy.

Gastrointest Endosc 2019;90:77–83.

6. Bilal M, Simons M, Rahman AU, et al. What constitutes urgent endoscopy? A social media snapshot of gastroenterologists’ views during the COVID-19 pandemic.

Endosc Int Open 2020;8:E693–8.

7. Cabrera D, Vartabedian BS, Spinner RJ, et al. More than likes and tweets: Creating social media portfolios for academic promotion and tenure. J Grad Med Educ 2017;9:421–5.

8. Social media evaluation for Jerad Gardner, MD, promotion to associate professor. SurveyMonkey Web site. https:// www.surveymonkey.com/ results/SM-VRPSJKLM/. (2016).

Accessed May 12, 2020.

9. Cabrera D, Gardner JM. Webinar: Using social media in Promotion & Tenure. [Video]. Altmetric YouTube Channel. https://youtu.be/ YPfbgVKXehA. (2017). Accessed May 12, 2020.

10. Andersen DL. Digital Scholarship in the Tenure, Promotion, and Review Process. Oxfordshire, United Kingdom: ME Sharpe: 2004.

11. Cabrera D, Roy D, Chisolm MS. Social media scholarship and alternative metrics for academic promotion and tenure.

CONFLICTS OF INTEREST Guarantor of the article: Amy S. Oxentenko, MD, FACP, FACG, AGAF. Specific author contributions: M.B. and A.O. were involved in concept design, drafting, editing, and writing

J Am Coll Radiol 2018;15: 135–41.

12. Merchant RM, Asch DA. Protecting the value of medical science in the age of social media and “fake news”. JAMA 2018;320:2415–6.

13. Bilal M, Taleban S, Riegler J, et al. The do’s and don’ts of social media: A guide for gastroenterologists. Am J Gastroenterol 2019;114:375–6.

FIGURE 1. An example of a complete Twitter profile. (a) The first thing in the profile is your name and usually having a title (e.g., MD) is encouraged. (b) The handle starts with “@” and is going to be used when people tag you in conversations. (c) The twitter biosketch is

immense. Describing the true pow is beyond the scope of this article an institutional website. (e) This is where the cover nonusers get and will al photograph on your to twitter pageinvolved will appear. enhance their social media expe FIGURE 2. This is an example of how a tweet looks once posted, with different components a tweetyou there s Twitter, we hope toofsee 160 characters which should highlight your position, title, and interests. (d) You can add a website link or

highlighted.

FIGURE 3. This is an example of few tweets from one

CONFLICTS OF INTEREST

tweetorial using Twitter polls, images, and published articles as tools to engage the readers

Guarantor of the article: Amy S. Ox AGAF. FIGURE 5. An example of a Hashtag “#” that was Specific author contributions: M.B successfully used to identify an inspiring movement, as shown in this figure. concept design, drafting, editing, and Financial support: None to report.

Potential competing interests: Non FIGURE 4. Taxonomy of tweeting.

Figure 5. An example of a Hashtag “#” that was successfully used to identify an inspiring movement, as shown in this figure.

30 | GI.ORG/ACGMAGAZINE

EDUCATION

THE PLANNING PROCESS for the 2020 ACG Annual Scientific Meeting and Postgraduate Course was well underway when the COVID-19 pandemic struck, so the fundamental “bones” of the scientific meeting and the postgraduate course envisioned by the College’s Educational Affairs Committee were already in place and proved extremely useful when the decision was made by the Board of Trustees in June to cancel the in-person meeting and offer a digital program.

At the helm of the Educational Affairs Committee this year is Dr. Brooks D. Cash. Thanks to his efforts, and those of his hardworking committee, along with the vision and leadership of Postgraduate Course Co-Directors Dr. Laura E. Raffals and Dr. Vivek Kaul, the 2020 virtual program solidified, the schedule was shifted and tweaked, and the offerings strengthened to maximize engagement, scientific dialogue, and a sense of connection.

Their planning evolved to encompass a hybrid program combining on-demand content supported and enhanced by livestreaming interactive sessions—bringing the insights of expert faculty and the opportunity for engagement to life for participants this year. Special programs, lectures and new offerings emerged.

Innovative ways of presenting favorite in-person sessions were identified, and a spirit of excitement and optimism prevailed as the program came together. The monumental effort to deliver the Virtual 2020 ACG Annual Scientific Meeting and Postgraduate Course is a tribute to their hard work and that of all this year’s faculty and presenters.

ACG MAGAZINE invited Dr. Cash, Dr. Raffals, and Dr. Kaul to reflect on the opportunities of a digital meeting, their objectives in the extraordinary year, and asked what they are most looking forward to in this year’s program. 

s e o G G AC ! l a u t Vir

Education | 31

// EDUCATION

All of the content for the Virtual ACG 2020 Annual Meeting is online and will remain there through January 31, 2021, providing access to a rich array of educational content. Recordings of the livestreaming sessions will also be available so there will be many ways to engage with the educational content, explore the offerings, and immerse yourself in a timely, relevant, and thoughtful update in clinical gastroenterology and hepatology.

EXPLORE: View and engage with the ACG 2020 education content and register for sessions at acgmeetings.gi.org

Q&A WITH BROOKS D. CASH MD, FACG, CHAIR, ACG EDUCATIONAL AFFAIRS COMMITTEE What are your overall goals and objectives for the Virtual 2020 Annual Scientific Meeting?

I sincerely hope that the meeting, as with past ACG Annual Scientific Meetings, continues to serve as a forum for the presentation and dissemination of ground-breaking research that translates into meaningful practice improvement for attendees. As the premier clinicallyoriented scientific gastroenterology conference, the ACG Annual Scientific Meeting offers a wealth of learning opportunities for attendees to increase or refresh their knowledge and take what they have learned home to their practices. Of course, another objective is to foster clinical innovation and showcase the investigations and hard work of clinician scientists, and I believe that this year’s meeting will once again fulfill that objective for junior, as well as senior, investigators.

Despite all the challenges of delivering clinical education and presenting research findings in a digital platform, what do you see as the opportunities?

I have had the opportunity to demo the platform that the ACG has elected to use for the meeting and I am very excited about its appearance and functionality.

32 | GI.ORG/ACGMAGAZINE

One of the main advantages I see is the ability to view content on-demand and in a repeated fashion, if so desired. So often we are forced to make tough decisions with regards to what sessions and content we are able to attend at live meetings and having a virtual site that will permit prolonged and convenient access outside the “scheduled” meeting times is a very attractive option.

The other opportunity that this venue allows is greater flexibility in start and end times for sessions that I hope will foster attendance for our learners in disparate locales and enhance the convenience of attending those sessions. In addition, the virtual meeting platform this year retains the ability for human interaction with scheduled live sessions that attendees will be able

view content and develop questions in a more leisurely manner, without the constraints of a 10-15 minute period after a presentation or having to catch a speaker after their lecture in a noisy hall that is being prepared for the next meeting. So I am really hopeful that we will see not only an elevation in educational content, but also in the interaction with learners, which is good for all involved.

to attend and interact with speakers and moderators. I also believe that the ability for speakers to record their presentations before the meeting commences may elevate the quality and clarity of those messages, since they will be able to deliver their presentations in comfortable surroundings of their homes or offices. While presenting in front of others can be exhilarating and is an important life skill, it can also be fraught with unanticipated issues that can sometimes affect the message.

spin on something as life-changing and devastating as the COVID-19 pandemic.

However, as we have seen with other worldwide catastrophes, these events can serve to foster innovation and a promote a stronger sense of community. I do believe that we have seen a tremendous amount of both of those through the pandemic, both within and outside the United States.

I think that many of these innovations will continue to be used in the future to enhance education and scientific sharing, especially for international meetings—and to promote access and convenience when faced with the realities limiting travel or physical interaction. I suspect we will see more on-demand, virtual offerings in the future, in some cases as a replacement to live meetings and in other cases as an adjunct to those meetings.

What do you hope ACG learners will gain from this online experience?

I hope that ACG learners will come away from this meeting even more convinced of the ACG’s commitment to them to deliver important, value-added educational and professional offerings. I fully expect that learners will be exposed to at least the same high quality content that they would get from an in-person experience, but am also really pleased and excited that they will actually be able to access even more content than usual through this platform.

Finally, I hope that the methodology of the meeting, utilizing a combination of recorded, on-demand presentations coupled with live interactivity will be both engaging as well as enlightening for attendees as they consider their own educational approaches.

How will the live sessions support the learners’ experience of the on-demand content?

The live sessions will retain the flavor of the traditional live lecture experience, and I hope will foster even greater discussion as attendees will have opportunities to

What, if any, “silver linings” has the pandemic offered in terms of a path forward for postgraduate education and scientific sharing for gastroenterologists in the future? Any predictions?

Obviously, it’s difficult to put a positive

For you personally, what sessions of the Annual Scientific Meeting are you most looking forward to and why?

That’s kind of like asking if I have a favorite child (I don’t, by the way). I am looking forward to the entirety of the meeting and can’t wait to attend and participate. I think Dr. Kaul and Dr. Raffals have designed a fabulous Postgraduate Course agenda. I am also so appreciative of all of the hard work and dedication that all of the members of the ACG Educational Affairs Committee contributed to craft what I hope will be a valuable and well-received ACG Annual Scientific Meeting.

We had a record number of abstracts submitted to this year’s meeting, and the abstracts that have been selected for both oral and poster presentations are fantastic, so I think the virtual poster hall will be a great opportunity for attendees and presenters.

The Friday GI Pharmacology course and Practice Management Summit will present great talks by wonderful speakers/educators, and I am also excited about additional offerings that other ACG committees have created such as the ACG Town Hall on Health Equity and Career Opportunities for Women in GI session. Of course, the named lectures look incredible as well. The staff and leadership of the ACG have worked tirelessly to position this meeting for success and I am so hopeful that this will be the opinion of everybody who attends the meeting.

Q&A WITH LAURA E. RAFFALS, MD, MS, FACG, AND VIVEK KAUL, MD, FACG, CO-DIRECTORS, ACG 2020 POSTGRADUATE COURSE What are your overall goals and objectives for the Virtual 2020 ACG Postgraduate Course?

Our goal for the 2020 ACG Postgraduate Course is to provide an educational experience that will serve as a clinical practice update where our attendees can learn from experts with a variety of experiences and perspectives. We hope that attendees will expand their own knowledge and take home some great ideas that will allow them to take better care of the patients they serve. We have worked hard to build a program that is practical in the sense that the content should be relevant to our GI colleagues regardless of practice type. We also hope the content gives a glimpse into what advances are on the horizon for our field! Importantly, it is a time for College members to invest in themselves for a couple of days and feel energized by the great content and discussions!

Dr. Cash is Division Director, Gastroenterology, Hepatology, and Nutrition and serves as the Dan And Lillie Sterling Professor of Medicine University of Texas Health Science Center at Houston, where he is also a Visiting Professor of Medicine at the University of Texas McGovern Medical School.

Despite all the challenges of delivering clinical education in a digital platform, what do you see as the opportunities?

While we will miss seeing colleagues in person, ACG has done an outstanding job adapting to our current environment and putting together an incredible platform that will meet all of our objectives and then some! The talks will be available in an on-demand format so attendees can view these talks at a time that works best for them! There is no worry of missing the start or end of a talk due to other meeting conflicts.

We’ll still have the opportunity to hear from our expert presenters during the live session with the opportunity to hear key points from their presentations and discussion on questions that arise. We expect parts of this format will carry on even in the post-COVID world.

What do you hope ACG learners will gain from this online experience?

Our hope is that our learners will still feel connected to our ACG community during the course, particularly with the live sessions. The convenience of attending the meeting and listening to talks on your own time also resonates with the busy clinician, particularly when our practices have been strained by the pandemic.

We’re thrilled we were able to incorporate a live component into the course as we need to interact, even if virtually, with all of our colleagues from around the country!

less from our virtual meeting!

What if any “silver linings” has the pandemic offered in terms of a path forward for postgraduate education for gastroenterologists in the future? Any predictions?

The pandemic has forced us to get creative in how we deliver educational content to our learners in an engaging and effective manner. We have had to embrace technology, and, in the process, have made advances in a few months that otherwise may have taken years!

We might also learn that geography or distance doesn’t always have to be a barrier to connecting with colleagues.

We are all becoming much more comfortable with connecting virtually!

For you personally, what sessions of the PG course are you most looking forward to and why?

We are most excited to hear Dr. Brian Lacy’s talk, “Osler and Functional GI Disorders.” It is a presentation that takes an innovative approach to teach the learner how to incorporate a patient centered care approach into their practice, particularly when caring for patients with functional disorders. His insights and tips are invaluable. He also takes it a step further and teaches us how we can do this while caring for ourselves as clinicians in the process so that we feel more engaged in our profession (and less burned out). Every single clinician could learn something from this talk. It’s outstanding!

How will the live sessions 10/24 and 10/25 support the learners’ experience of the on-demand content?

The live sessions will focus on the key take-away points. They will be the “Cliff Notes” versions of the presentations. The question and answer sessions are also great as we find there are so many great questions and controversies that arise in the live meetings and we expect nothing

Dr. Kaul is the Segal-Watson Professor of Medicine & Chief of the Division of Gastroenterology & Hepatology at the University of Rochester Medical Center. His clinical, research and medical education efforts are focused on complex interventional endoscopy, especially in the patient with GI cancer.

Dr. Raffals is Professor of Medicine at Mayo Clinic, Rochester, MN whose research is focused on understanding the role of bacteria in the pathogenesis of inflammatory bowel disease (IBD).

Education | 33

// EDUCATION

FRIDAY COURSE

ON-DEMAND SESSIONS

WHAT’S NEW IN GI PHARMACOLOGY COURSE Causes and Solutions for PPI-Refractory Heartburn Rena Yadlapati, MD, FACG The Latest “Need to Know” Information on Gastric Acid Inhibition Michael F. Vaezi, MD, PhD, MSc(Epi), FACG

ON-DEMAND CONTENT CG,

Your A way. your

\ FRIDAY COURSES & 2020 POSTGRADUATE COURSE ON-DEMAND \ VIRTUAL ACG 2020 ANNUAL SCIENTIFIC MEETING ON-DEMAND

Disaccharidase Deficiencies: When to Consider and How to Treat?

William D. Chey, MD, FACG Exocrine Pancreatic Insufficiency: What the Busy Clinician Needs to Know David C. Whitcomb, MD, PhD, FACG The Ins and Outs of Fecal Incontinence Treatments Brooks D. Cash, MD, FACG Choosing Among the Expanding Armamentarium of IBD Therapies Sunanda V. Kane, MD, MSPH, FACG Contemporary Management of Hepatitis B Kimberly A. Brown, MD Celiac Disease: Will There Ever Be a Medicine Available?

Joseph A. Murray, MD, FACG

GI PATHOLOGY AND IMAGING COURSE Swallowing and Digestion: Pathology and Imaging of the Esophagus and Stomach Pathologist: Nicole C. Panarelli, MD Radiologist: Douglas S. Katz, MD, FACR Understanding the Hepatobiliary System: Pathology and Imaging of the Liver and Gallbladder Pathologist: Scott R. Owens, MD Radiologist: Zarine Shah, MD Polyps, Tumors, IBD, and More: Pathology and Imaging of the Colon and Rectum Pathologist: Emma E. Furth, MD Radiologist: David J. Vining, MD

YOUR ACG, YOUR WAY. Learn on your on time, on your own terms. The rich array of educational content for Virtual ACG 2020

Exploring the GI Tract: Pathology and Imaging of the Small Bowel and Pancreas Pathologist: David N. Lewin, MD Radiologist: Jessica G. Zarzour, MD

2021, so it is not too late to register and get

PRACTICE MANAGEMENT SUMMIT AT ACG: SOMETHING FOR EVERYONE

access to all of the content and earn CME and

SESSION 1: Year in Review: Updates for 2020

will be available on-demand through Jan 31,

MOC. To bring this on-demand content to life, we have scheduled live sessions with clinical pearls and key take-aways by expert faculty to distill the lessons learned from each session and at the end of each day.

34 | GI.ORG/ACGMAGAZINE

• Legislative Updates and 2020 Elections: Do We Have a Crystal Ball?

John F. Jonas, JD • Lessons Learned From Going the Private Equity Route Jay N. Yepuri, MD, MS, FACG • Coding Updates Kathleen A. Mueller, RN, CPC, CCS-P, CMSCP

SESSION 2: Improving Efficiency in Your Practice • In Pursuit of Efficiency: How Tech Can Help Us Save Time and Stay Sane

Sapna V. Thomas, MD, FACG • Artificial Intelligence in Gastroenterology: The Future Is Here

Prateek Sharma, MD, FACG • Time Well Spent: Encouraging Staff to Perform at Their Top Tier

Shivangi T. Kothari, MD, FACG SESSION 3: Importance of “Customer Care” in Your Practice • Customer Care in Your Medical Practice: Improving Your Bottom Line

Harish K. Gagneja, MD, FACG

SESSION 3: Bariatric Endoscopy Update • Bariatric Endoscopy Tools and Techniques in 2020

Reem Z. Sharaiha, MD, MSc • Scoping the Bariatric Patient: Dealing with Altered Anatomy and Post-op Complications

Christopher Chapman, MD SESSION 4: Endoscopic Survival in The COVID Era • Ways to Minimize Physician Burnout

Rajesh N. Keswani, MD • Improving Quality in the Endoscopy Unit

Vanessa M. Shami, MD, FACG, FASGE • Preparing for the Next Pandemic

Klaus Mergener, MD, PhD, MBA, FACG, FASGE

• Effective Patient Education and Communication

Amy S. Oxentenko, MD, FACG • Improving Flow in the Endoscopy Suite: Customer Care Experience

Klaus Mergener, MD, PhD, FACG SESSION 4: Compensation and Financial Management in Your Practice • Cost Containment in GI Medical Practice Without Cutting Corners

Louis J. Wilson, MD, FACG • Compensation for Non-Revenue Generating Activities

SESSION 5: Pancreaticobiliary Adventures • Tricks for Ensuring Successful Cannulation at ERCP

Marianna Arvanitakis, MD, PhD • Management of Biliary Strictures: Malignant vs. Benign

V. Raman Muthusamy, MD, FACG, FASGE • Sweep, Crush, and Clear: Endotherapy for Bile Duct Stones

Jeanin E. Van Hooft, MD, PhD, FASGE • Optimizing ERCP Outcomes

Badih Joseph Elmunzer, MD, MPH • Dealing with Pancreatic Collections: When to Drain and How

Ji Young Bang, MD, MPH

David J. Hass, MD, FACG SESSION 5: Leadership and Emotional Intelligence • What It Takes to Be a Leader: Qualities of an Effective Leader

Mark B. Pochapin, MD, FACG, ACG President • Emotional Intelligence (EI): What Are You Talking About?

Aasma Shaukat, MD, MPH, FACG • The Art and Science of Recruiting and Retaining Top Talent

Vivek Kaul, MD, FACG

ASGE VIRTUAL ENDOSCOPY COURSE: CREATIVE SOLUTIONS TO EVERYDAY ENDOSCOPIC CHALLENGES SESSION 1: BEST PRACTICES IN COLONOSCOPY • Updated Surveillance Guidelines after Colonoscopy and Polypectomy

Douglas K. Rex, MD, MACG, MASGE • Advanced Imaging in the Colon: Lights, Camera, Action!

Tonya R. Kaltenbach, MD, MS, FACG, FASGE

SESSION 6: Don’t Panic: Evidence-Based Approach To Managing Gi Emergencies • Halting the Hemorrhage: Esophageal and Gastric Variceal Bleeding

Anna Duloy, MD • Achieving Hemostasis in Non Variceal UGI Bleeding

Alan N. Barkun, MD, CM, MSc, FACG, FASGE • Optimal Timing of ERCP in Cholangitis Management

Jeanin E. Van Hooft, MD, PhD, FASGE • Damage Control in Perforations: Endoscopic Closure Techniques

Payal Saxena, MBBS, FRACP • Paving the Way for Patency: Managing Duodenal and Colonic Obstruction

Kevin E. Woods, MD, MPH SESSION 7: EUS Enigmas and More • Pancreatic Cyst Guidelines: What You Need to Know

Vanessa M. Shami, MD, FACG, FASGE • Thinking Outside the Box: Therapeutic EUS

Uzma D. Siddiqui, MD, FACG, FASGE

• Optimal Resection Methods for Colon Polypectomy and EMR

Douglas K. Rex, MD, MACG, MASGE • More Tissue is the Issue: Role of ESD and FTRD

Amrita Sethi, MD, MASGE SESSION 2: ENDOSCOPY IN THE ESOPHAGUS • Barrett’s Basics: Screening and Surveillance Guidelines

Sachin B. Wani, MD, FASGE • Evolution of Endoscopic Therapy for Barrett’s Dysplasia

V. Raman Muthusamy, MD, FACG, FASGE • Endoscopic Workup and Management of Achalasia: Can We Tunnel to Success?

Amrita Sethi, MD, MASGE

The rich array of educational content for Virtual ACG 2020 will be available on-demand through Jan 31, 2021.

Register now, and get access to all of the content and earn CME and MOC.

• Endoscopic Plumbing for Esophageal Stricture

Rehan Haidry, BSc (Hons), MRCP

Education | 35

// EDUCATION

POSTGRADUATE COURSE ON-DEMAND & BONUS SESSIONS ON-DEMAND SESSIONS SESSION 1A: IBD: A Personalized Approach to a Complex Disease • Pearls in IBD Management Laura E. Raffals, MD, MS, FACG Appreciate importance of early intervention treatment strategies, the role of therapeutic monitoring, and alternative causes of symptoms other than inflammation in the IBD patient.

• Updates in the Treatment of Crohn’s Disease David A. Schwartz, MD, FACG Review current treatment strategies for moderate to severe Crohn’s disease.

• Positioning Treatment in Ulcerative Colitis Marla C. Dubinsky, MD Discuss positioning of therapies to improve long-term outcomes in ulcerative colitis.

• De-escalation of IBD Treatment: When Can We Back Off? David T. Rubin, MD, FACG Review evidence and strategies for de-escalation of therapy in IBD patients.

SESSION 2A: Functional GI Disorders – Leveraging the Mind-Gut Connection • Brain-Gut Axis and Its Interaction With the Enteric Microbiome Lin Chang, MD, FACG Explore the communication between the brain and the gut and role of the gut microbiome in functional GI disorders.

• Positive Psychology Interventions for Functional GI Disorders Laurie A. Keefer, PhD Discuss opportunities for gastroenterologists to incorporate positive psychology interventions into their patient care strategies.

• A Practical Approach to the Use of Anti-Depressants for Functional Disorders Brian E. Lacy, MD, PhD, FACG Review indications and use of anti-depressants for treatment of functional GI disorders.

• Dietary and CAM Approaches for Management of IBS William D. Chey, MD, FACG Examine the latest evidence for use of diet and alternative medicines for IBS management.

SESSION 2B: Hepatology Issues in Everyday Practice SESSION 1B: Esophagus • Esophageal Dysmotility: Evaluation and Treatment John E. Pandolfino, MD, MSCI, FACG Discuss the differential diagnosis of esophageal dysmotility, approach to evaluation, and current management concepts.

• Management of Esophageal Strictures Vani J.A. Konda, MD, FACG Outline the latest evidence-based recommendations for management of benign and malignant esophageal strictures.

• Multimodal Management of BE Dysplasia/Neoplasia Nicholas J. Shaheen, MD, MPH, MACG Demonstrate the current state-of-the-art approach to endoscopic management of dysplastic Barrett’s esophagus and early esophageal neoplasia.

• Eosinophilic Esophagitis Treatment Approaches in 2020 Prasad G. Iyer, MD, FACG Analyze evidence-based approaches to the treatment of eosinophilic esophagitis including dietary modifications, medical therapy, and endoscopic esophageal dilation.

SESSION 1C: Endoscopy • Risk Management, Quality, and Safety in the Endoscopy Unit Vivek Kaul, MD, FACG Identify the latest guideline and evidence-based recommendations as well as best practices to ensure quality and safety in the endoscopy unit and strategies to mitigate risk.

• Evidence-Based Approach to Endosurgery: Does It Make the Cut? Navtej S. Buttar, MD For the general gastroenterologist, review appropriate utilization of endoscopic resection, techniques, and devices in various clinical scenarios based on best evidence and guidelines.

• Interventional EUS: A Primer for the General Gastroenterologist Laith H. Jamil, MD, FACG Summarize the well-established and paradigm shifting interventional EUS procedures that the general gastroenterologist needs to be aware of, including limitations, risks, benefits, and alternatives.

36 | GI.ORG/ACGMAGAZINE

• Multidisciplinary Management of the NASH Patient Arun J. Sanyal, MD Describe the importance of a multidisciplinary management approach to the patient with obesity, including lifestyle, medical, endoscopic, and surgical management options.

• Liver Disease in Pregnancy Nancy S. Reau, MD, FACG Review the approach to differential diagnosis and management of various types of clinically significant liver conditions that develop during pregnancy.

• Drug-induced Liver Injury K. Gautham Reddy, MD, FACG Discuss the current concepts related to investigation and management of drug-induced liver diseases.

• Viral Hepatitis Treatment Update Kimberly A. Brown, MD Summarize the recent advances in viral hepatitis treatment and discuss future trends in this realm, to include access to care, healthcare economics, and public health impact issues.

• Evaluation of the Patient With a Liver Mass Stanley M. Cohen, MD, FACG Discuss principles, strategies, and best practice approaches for evaluating liver masses based on differential diagnosis.

SESSION 2C: All Things Colon!

• Colorectal Cancer Screening and Surveillance - Incorporating Guidelines Into Practice Mark B. Pochapin, MD, FACG Summarize colorectal cancer screening guidelines and identify the role of noninvasive screening methods.

• Management of Lower GI Bleeding John R. Saltzman, MD, FACG Review diagnostic and therapeutic options for management of diverticular bleeding.

• Hereditary Colorectal Polyposis and Cancer Syndromes Carol A. Burke, MD, FACG Review diagnosis and management of hereditary colon cancer syndromes.

SYMPOSIUM A: Practical Tips and Pearls in IBD Management • Managing the Hospitalized IBD Patient Christina Y. Ha, MD, FACG Discuss therapeutic approaches to the hospitalized IBD patient including importance of nutrition, VTE prophylaxis, and pain management.

• IBD Surveillance, Chromoendoscopy, and Future Directions Samir A. Shah, MD, FACG Review appropriate surveillance strategies and role of chromoendoscopy in practice and discuss proper methods for performing chromoendoscopy.

• Preventive Care in IBD Millie D. Long, MD, MPH, FACG Discuss best practice recommendations for optimal preventive care in the IBD patient.

SYMPOSIUM B: Pancreaticobiliary Disease: Recent Advances

SYMPOSIUM E: Endoscopy • All the Endoscopy vs Surgery RCTs I Could Come Up With!

Michael B. Wallace, MD, MPH, FACG Discuss recent landmark RCTs that have resulted in a huge impact on GI medical-surgical practice.

• GI Emergencies: How to Optimize Outcomes in Dire Circumstances John R. Saltzman, MD, FACG Apply strategies to achieve the best outcomes in patients presenting with acute GI emergencies.

• Endoscopy in Special Populations Douglas G. Adler, MD, FACG Evaluate the approach to endoscopy in unique patient populations (pediatrics, geriatrics, pregnancy, etc.) with higher risk and special needs or challenges.

SYMPOSIUM F: Autoimmune and Cholestatic Liver Disease

• Acute Pancreatitis: Why Are Patients Still Dying?

Timothy B. Gardner, MD, MS, FACG Discuss the importance of goal-directed fluid therapy and multidisciplinary medical management in patients with severe acute pancreatitis to ensure good outcomes.

• Predictors of Disease Course in Primary Sclerosing Cholangitis Kris V. Kowdley, MD, FACG Review the clinical course of primary sclerosing cholangitis and predictors of disease progression and complications.

• Screening for Sporadic Pancreatic Cancer: An Update Suresh T. Chari, MD, FACG Discuss recent advances and data in pancreas cancer screening.

• Advances in Primary Biliary Cholangitis Treatment David E. Bernstein, MD, FACG Discuss precision treatment of primary biliary cholangitis.

• Evaluation/Management of the Indeterminate Biliary Stricture Prabhleen Chahal, MD, FACG Review best practice approaches to the evaluation and management of indeterminate biliary strictures.

• Autoimmune Hepatitis Paul Y. Kwo, MD, FACG Describe the clinical management of patients with autoimmune hepatitis.

SYMPOSIUM C: Obesity • Bariatric Endoscopy: An Inflated Sense of Success?

Allison Schulman, MD, MPH Interpret the evidence-based literature supporting the role of endoscopic interventions in patients with obesity.

• Bariatric Surgery: Cannot Bypass the Surgeon!

John M. Morton, MD, MPH, MHA, FACS Compare surgical options for optimal outcomes in patients with obesity.

• Medical and Behavioral Management of Patients with Obesity: The Foundation for Long-Term Success Shelby A. Sullivan, MD, FACG Recognize the importance of lifestyle, nutrition, and behavioral interventions as part of the comprehensive approach to obesity management.

SYMPOSIUM D: A Practical Approach to Anorectal Disorders • The Role of Pelvic Floor Retraining for Dyssynergic Defecation Satish S.C. Rao, MD, PhD, FACG Outline treatment approaches for dyssynergic defecation disorders.

The rich array of educational content for Virtual ACG 2020 will be available on-demand through Jan 31, 2021.

Register now, and get access to all of the content and earn CME and MOC.

• Modern Approaches to Fecal Incontinence Stacy B. Menees, MD, MS Appraise available therapies for fecal incontinence.

• Anorectal Manometry Testing: A Primer for the General Gastroenterologist Darren M. Brenner, MD, FACG Review anorectal manometry testing and its role in clinical practice.

Education | 37

POSTGRADUATE COURSE

ON-DEMAND & BONUS SESSIONS (CONT.) BONUS SESSIONS Evaluating the Patient with Chronic Diarrhea Lea Ann Chen, MD, FACG Discuss the principles and evidence-based approach to evaluating a patient with chronic diarrhea.

Tips and Tricks for Difficult Biliary Cannulation Douglas K. Pleskow, MD Review evidence-based recommendations along with practical tips and tricks that are useful at ERCP when faced with a difficult biliary cannulation.

Infectious Complications of IBD Jordan E. Axelrad, MD, MPH Identify infections commonly encountered in IBD patients and their management strategies.

What’s the Real Story of Those Trending “Google MD” Diagnoses (POTS, Mast Cell Activation Syndrome, Ehlers Danlos, and More!)

Linda Anh B. Nguyen, MD Review the evidence of trending “Google MD” diagnoses our patients expect us to know and understand their associated gastrointestinal symptoms.

A Practical Approach to Checkpoint Inhibitor Immune-Related Gastrointestinal Adverse Events Kara M. De Felice, MD Discuss mechanisms and treatment approaches of gastrointestinal immune-related adverse events from checkpoint inhibitor therapy.

Approach to Evaluation of Abnormal Liver Tests Nancy S. Reau, MD, FACG Discuss the approach to evaluation of abnormal liver tests to formulate a differential diagnosis.

Ischemic Disorders of the GI Tract Lawrence J. Brandt, MD, MACG Discuss common ischemic disorders of the GI tract and appropriate diagnostic and management approaches.

MACRA/MIPS/Public Policy Update Caroll D. Koscheski, MD, FACG Review the current healthcare economics landscape relevant to GI practice, including value-based purchasing and alternate payment models.

Optimizing the Colonoscopy Bowel Prep Audrey H. Calderwood, MD, MS, FACG Discuss the importance of high-quality bowel prep and tips and tricks to optimize the prep for colonoscopy.

The Risk of PPI Therapy: What’s the Real Story?

Paul Moayyedi, MB ChB, PhD, MPH, FACG Interpret the latest evidence vis a vis PPI risks and benefits and discuss best practice recommendations for clinical use.

GI Bleeding 2020: Tools, Techniques, Tips and Tricks!

Seth A. Gross, MD, FACG Describe updates in endoscopic management of GI bleeding including newer devices, techniques, and best practice guidelines.

38 | GI.ORG/ACGMAGAZINE

Pancreatic Cysts: Which Ones Matter?

Vanessa M. Shami, MD, FACG Discuss etiology, diagnosis, and management of pancreatic cysts incorporating clinical guidelines.

Managing the Difficult Colon Polyp Tonya R. Kaltenbach, MD, MS, FACG Describe the approach and technical aspects of managing difficult colon polyps with an evidence-based perspective.

The Difficult Foreign Body: Tools and Techniques David A. Greenwald, MD, FACG Discuss novel endoscopic approaches and principles of safe and effective foreign body/food bolus management.

Osler’s Approach to Counseling the Functional GI Patient Brian E. Lacy, MD, PhD, FACG Formulate approaches to challenging patients with functional GI disorders through observation of the interview and counseling of a functional GI patient.

The Pregnant IBD Patient: What You Really Need to Know Sunanda V. Kane, MD, MSPH, FACG Discuss best practices for managing the pregnant IBD patient.

Chronic Abdominal Pain: Approach to Evaluation and Treatment Lin Chang, MD, FACG Apply evidence-based strategies and algorithms to efficiently diagnose and treat chronic abdominal pain states.

Tackling GI Complications of Opioid Treatment Darren M. Brenner, MD, FACG Define the management of opioid-related constipation and narcotic bowel syndrome.

Endoscopic Treatments for GERD Prasad G. Iyer, MD, FACG Appraise advances in the endoscopic management of GERD. Managing Refractory Symptoms in Celiac Disease Amy S. Oxentenko, MD, FACG Identify causes and management strategies of refractory symptoms in patients with celiac disease.

Gastric Metaplasia and Neoplasia Update Douglas R. Morgan, MD, MPH, FACG Review pathogenesis, diagnosis, and treatment of gastrointestinal metaplasia, adenocarcinoma, lymphoma, carcinoid, and GIST. Evaluation and Management of Upper Gastrointestinal Motility Disorders Linda Anh B. Nguyen, MD Describe the role of physiologic testing and management strategies for upper GI motility disorders.

The Emerging Role of Diet in IBD Management: Physician and Nutritionist Perspectives Jonathan A. Leighton, MD, FACG, and Kelly Issokson, MS, RD, CNSC Detail the newer therapies for the management of variceal bleeding.

Management of Hemorrhoids Waqar A. Qureshi, MD, FACG Evaluate recent advances, including techniques and technology, in the management of hemorrhoids.

VIRTUAL ACG 2020 ANNUAL SCIENTIFIC MEETING ON-DEMAND & BONUS SESSIONS ON-DEMAND SESSIONS SYMPOSIUM 1: Non-IBD Colitides • Microscopic/Collagenous Colitis: Beyond Budesonide Anita Afzali, MD, MPH, FACG Explain the diagnosis and etiologies of colitis, with a focus on treatment of difficult-to-treat disease.

• Poo-pourri: Immune, NSAIDs, and Beyond Aline Charabaty, MD Discuss the presentation and management of common non-IBD etiologies of colitis, including NSAID-induced, immunemediated, and more.

• Bugs, Vectors and Toxins: A Primer on Infectious Colitides Brooks D. Cash, MD, FACG Recognize infectious colitides commonly seen in GI practice.

SYMPOSIUM 2: Common Scenarios in Crohn’s Disease: What Should I Do? • Post-Operative Recurrence Miguel D. Regueiro, MD, FACG Describe monitoring and medical treatment of Crohn’s disease after surgical resection.

• Management of Perianal Disease David A. Schwartz, MD, FACG Explain traditional and experimental treatments used in management of perianal Crohn’s disease.

• Small Bowel Crohn’s Gil Y. Melmed, MD, MS, FACG Discuss the available tests for diagnosis and treatment of small bowel Crohn’s using CT, MR, capsule, and balloon enteroscopy.

SYMPOSIUM 3: Refractory Conditions of the Esophagus: Diagnosis and Treatment • Approach to Refractory Esophageal Strictures John C. Fang, MD Identify the different methods to successfully treat refractory esophageal strictures.

• Identification and Management of Esophageal Manifestations of Dermatologic Conditions Magnus Halland, MD Recognize the clinical, endoscopic, and histopathologic presentations of dermatologic diseases affecting the esophagus.

• Management of Treatment Failure in Achalasia Joel E. Richter, MD, MACG Explain management strategies for post myotomy reflux and chest pain in patients with achalasia

The rich array of educational content for Virtual ACG 2020 will be available on-demand through Jan 31, 2021.

Register now, and get access to all of the content and earn CME and MOC.

SYMPOSIUM 4: Recent Developments in Barrett’s Esophagus • New Tools for Diagnosis Gary W. Falk, MD, MS, FACG Describe the recent advances in diagnosis and surveillance of Barrett’s, including pre- and post-ablation which may allow for earlier, better detection of dysplasia and cancer.

• Current Approach to Ablation Nicholas J. Shaheen, MD, MPH, MACG Discuss the outcomes of studies on RFA/cryoablation for Barrett’s esophagus—dysplastic and non-dysplastic—and the current controversies in treatment of BE. • Role of Chemoprevention Joel H. Rubenstein, MD, FACG Evaluate current chemoprevention options—as well as drugs in the clinical trial stage—aimed at preventing dysplasia and cancer in patients with BE.

SYMPOSIUM 5: NASH • Natural History of NAFLD Cynthia A. Moylan, MD Discuss the epidemiology and epigenetics of NAFLD. • Diagnostic Approach to NAFLD Naim Alkhouri, MD Identify the diagnostic approaches to NAFLD. • Therapy for NAFLD Zobair M. Younossi MD, MPH, FACG Outline the dietary and medical therapies for NAFLD.

SYMPOSIUM 6: Updates in Liver Transplantation and HCC for the Busy Gastroenterologist • Liver Transplantation Philip K. Henderson, DO Recognize patients in need of liver transplant evaluation.

• Outpatient Management of OLT Patients Gina Choi, MD Understand the long-term follow-up for patients who have undergone liver transplantation to promote quality care.

• Hepatocellular Carcinoma Primer Anjana A. Pillai, MD Identify patients with HCC and those who would benefit from medical therapy or liver transplantation.

SYMPOSIUM 7: Nausea and Vomiting: Evolving Insights and Clinical Challenges • Practical Insights From the Neurobiology of Nausea and Vomiting Braden Kuo, MD Describe how the neurobiology of nausea and vomiting influences treatment options.

• Emerging Treatment: Pharmacologic and Non-Pharmacologic Options for Nausea and Vomiting Linda Anh B. Nguyen, MD Compare latest treatment strategies for nausea and vomiting.

• Treatment of Gastroparesis: Beyond the Old Standbys Baharak Moshiree, MD, FACG Summarize recent pharmacologic and interventional advances in the management of gastroparesis.

Education | 39

VIRTUAL ACG 2020 ANNUAL SCIENTIFIC MEETING ON-DEMAND & BONUS SESSIONS (CONT.) SYMPOSIUM 8: 50 Shades of Bloating: Multiple Perspectives on a Vexing Condition • It’s All Gas Production: Dietary and Microbial Factors Ali Rezaie, MD, MSc Recognize the role of gut microbiota and diet in the pathogenesis of bloating.

• It’s All Hot Air: Bloating Is a Sensory Symptom Kyle D. Staller, MD, MPH Explain the role of the brain-gut axis in the generation of bloating symptoms.

• Motility Matters Most!

Gregory S. Sayuk, MD, MPH, FACG Appraise the evidence available regarding motility agents in bloating.

SYMPOSIUM 9: Endoscopy in 2020 and Beyond: An Update • Best Practice Paradigms for Performing a High Quality ERCP Vivek Kaul, MD, FACG Explain the evidence-based best practice principles for performing a high quality ERCP for optimal patient outcomes.

• Endoscopic Ultrasound: Current Status and Future Direction Michael J. Levy, MD Illustrate current and future developments in EUS as they relate to a general GI practice and quality parameters.

• Bariatric Endoscopy: Strides Made and the Road Ahead Violeta B. Popov, MD, PhD, FACG Discuss how the field of bariatric endoscopy has evolved and what the future holds, including challenges and opportunities.

SYMPOSIUM 10: What’s New With Small Bowel Disorders?

• Common Clinical Scenarios Surrounding Celiac Disease Peter H.R. Green, MD, FACG Differentiate celiac disease from mimicking conditions and define the approach to non-responders on a gluten-free diet.

• Small Intestinal Bacterial Overgrowth: What’s New? Richard J. Saad, MD, FACG Discuss the ACG guidelines on diagnosis and treatment of SIBO. • Short Bowel Syndrome: An Update Carol E. Semrad, MD, FACG Identify current challenges in the care of patients with short bowel syndrome and describe treatment strategies.

PAST PRESIDENT'S SYMPOSIUM • New Developments in Hereditary Cancer Syndromes Past President: Carol A. Burke, MD, FACG Sapna Syngal, MD, MPH, FACG Appraise and apply contemporary best evidence in the management of hereditary cancer syndromes.

• Endoscopic Management of IBD Past President: Sunanda V. Kane, MD, MSPH, FACG Bo Shen, MD, FACG Recognize evolving endoscopic techniques to manage IBD complications.

• New Treatments for IBS Past President: Eammon M. M. Quigley, MD, MACG Yuri A. Saito-Loftus, MD, MPH Discuss and apply emerging therapeutic options for IBS.

40 | GI.ORG/ACGMAGAZINE

ANNUAL SCIENTIFIC MEETING ORAL ABSTRACT PAPER PRESENTATIONS Oral papers #12-69 will be available as individual on-demand presentations. Additionally, highlights of this year’s clinicallyrelevant and noteworthy oral abstracts will be discussed by expert faculty on Wednesday, October 28, from 3:30pm4:30pm (Eastern time). See page 17 for details.

Oral papers #1-6 will be presented during the live-streamed Presidential Plenary Session on Monday, October 26, from 3:00pm-4:00pm (Eastern time) (see page 14 for these selected papers). Oral papers #7-11 will be presented during the livestreamed Presidential Plenary Session on Tuesday, October 27, from 3:00pm-4:00pm (Eastern time) (see page 16 for these selected papers).

Note: All oral papers will appear in the supplement to the October 2020 issue of the AJG. Their supplement IDs are listed in parentheses before the abstract title.

BONUS SESSIONS SESSION A: Clinical Challenges in Acute and Chronic Pancreatitis • Evaluation and Management of Acute Recurrent Pancreatitis Santhi Swaroop Vege, MD, MACG Outline the definition, diagnosis, and evaluation of the patient with ARP, including the indications and roles of endoscopic, medical, and surgical treatments.

• A Practical Multidisciplinary Approach to the Diagnosis and Management of Chronic Pancreatitis Tyler Stevens, MD, FACG Summarize the indications and roles of medical, endoscopic, and surgical management of CP, including pain management.

• Management of Acute Necrotizing Pancreatitis in 2020: An Update Prabhleen Chahal, MD, FACG Discuss the evidence-based, multidisciplinary and state of the art approach to management of the patient with severe necrotizing pancreatitis.

SESSION B: IBD: The Latest and Greatest In… • …Efficacy David P. Hudesman, MD Analyze up-to-date evidence, including comparative effectiveness, of biologic and small molecule efficacy in IBD. • …Safety Raymond K. Cross, Jr., MD, MS, FACG Recognize current safety concerns for biologics and small molecules used to treat IBD. • …Emerging Therapies Bincy P. Abraham, MD, FACG Identify promising therapeutics for the treatment of IBD.

VIRTUAL ACG 2020 ANNUAL SCIENTIFIC MEETING ON-DEMAND & BONUS SESSIONS (CONT.) SESSION C: Hot Topics in Liver Disease • Management of Cirrhotic Complications Mitchell A. Mah’moud, MD, FACG Discuss the current strategies for high quality management of HE, ascites, and complications of end stage liver disease.

• AKI in Cirrhotics Paul Y. Kwo, MD, FACG Describe the current definition of acute kidney injury (AKI) in cirrhotics and identify the strategies to prevent and treat.

• Alcoholic Liver Disease Mark W. Russo, MD, MPH, FACG Identify the epidemiology of alcoholic liver disease, current management, and future therapies.

SESSION D: Symptoms Following Foregut Interventions: It’s Back in Your Court • Reflux and Recurrent Dysphagia After Achalasia Interventions Rena H. Yadlapati, MD, MSHS Formulate a treatment strategy for patients who remain symptomatic after intervention for achalasia.

• Dysphagia, Dyspepsia, and Bloating After Anti-Reflux Surgery Scott L. Gabbard, MD Manage dysphagia and functional gastrointestinal symptoms after antireflux surgery.

• Weight Lost, Symptoms Gained: Complaints After Bariatric Surgery Violeta B. Popov, MD, PhD, FACG Identify and manage common patient concerns after bariatric surgery.

SESSION E: Innovations in Practice Management • Social Media and Your Practice: The Why and How Mark B. Pochapin, MD, FACG Discuss benefits and risks of having a social media presence for your practice and how to establish one, including creating a website and handling patient reviews.

• Telemedicine and Your Practice: Is It Worth It? Jordan J. Karlitz, MD, FACG Describe infrastructure, settings, coding, reimbursement, and the specific experience/advantage for hepatology and IBD, especially in underserved areas.

• APPs and Your Practice: Maximizing Their Potential While Providing Quality Care Daniel J. Pambianco, MD, FACG Identify the role of APPs in various practice and specialty settings, how to train APPs, utilizing various billing scenarios, and how to make it profitable.

The rich array of educational content for Virtual ACG 2020 will be available on-demand through Jan 31, 2021.

Register now, and get access to all of the content and earn CME and MOC.

SESSION F: Colonic Conundrums • Pseudo-Obstruction – Update on Management Charles J, Kahi, MD, MSc, FACG Summarize the current practice standards for diagnosis and management of pseudo-obstruction of the colon.

• Know When to Stent ‘em and When to Cut ‘em: Managing Malignant Obstruction Amrita Sethi, MD Identify when to stent versus when to operate in malignant colorectal obstruction.

• Acute and Recurrent Diverticulitis – To Cut or Not to Cut Susan Galandiuk, MD, FACG, FACS, FASCRS Discuss the updated guidelines for treatment of acute and recurrent diverticulitis and when to operate.

SESSION G: Minimizing and Managing Endoscopic Complications: Tips and Tricks from the Experts • Endoscopic Resection Amit Bhatt, MD Describe management of complications associated with EMR, ESD, EFTR and STER procedures.

• ERCP/EUS Shivangi T. Kothari, MD, FACG Discuss management of common and uncommon complications in ERCP and EUS. • Endoscopic Complication Pot-pourri Patrick I. Okolo, III, MD, MPH Identify the various types of endoscopic complications and their optimal management.

SESSION H: When GI Meets Surgery in IBD – The Severe UC Patient • Steroid Refractory UC Jimmy K. Limdi, MD, FACG Describe treatments available for steroid refractory ulcerative colitis.

• Time to Meet the Surgeon Jean H. Ashburn, MD Discuss key components of the surgical consultation in medically refractory ulcerative colitis.

• Back to the GI – J-Pouch Complications Shannon Chang, MD Categorize common complications arising in patients with ileal pouch-anal anastomosis.

SESSION I: Recent ACG Liver Guidelines • Vascular Disorders of the Liver Douglas A. Simonetto, MD Distinguish the different vascular disorders of the liver and recognize management strategies.

• Hemochromatosis Vinay Sundaram, MD Evaluate patients for iron overload and describe treatment plans.

• Alcoholic Liver Disease Ashwani K. Singal, MD, MS, FACG Explain the different aspects of alcoholic liver disease and summarize the latest guideline recommendations.

Education | 41

VIRTUAL ACG 2020 ANNUAL SCIENTIFIC MEETING ON-DEMAND & BONUS SESSIONS (CONT.) SESSION J: 2020 Hindsight: Where We Have Been and Where We Are Going • High-Quality Endoscopic Mucosal Resection: When and How Christina J. Tofani, MD Discuss the appropriate use of EMR, provide practical pearls, and demonstrate the techniques used for EMR. • I Should Have Seen It Coming! Preventing and Managing Polypectomy Complications Douglas K. Rex, MD, MACG Explain how to decrease complications of polypectomy, including tips regarding cautery, snares, and prophylactic clipping, and how to manage bleeding and perforations.

• Today and Tomorrow: Technological Advances That Matter Seth A. Gross, MD, FACG Identify the hot technology of today and what is around the corner that could change the practice of GI and quality metrics.

SESSION K: Hey, It’s Legal Now: Cannabinoids and the Gut • Cannabinoid Effects on Motility and Pain Ron Schey, MD, FACG Differentiate various effects of cannabinoids on the gastrointestinal tract.

• Cannabinoids: Friend or Foe in Nausea and Vomiting?

Thangam Venkatesan, MD Contrast risk and benefits of cannabinoids in patients with chronic nausea and vomiting.

• It’s High Time We Learn How to Talk to Patients About Cannabis Linda Anh B. Nguyen, MD Formulate an approach to the discussion of cannabinoids in patients with gastrointestinal symptoms.

SESSION L: Management Strategies for Eosinophilic Esophagitis • Medical Management: PPI and Steroid Therapy Jennifer Horsley-Silva, MD Identify the benefits of each individual approach to therapy in EoE: PPI, topical steroids, or both.

• Dietary Management: Two, Four or Six Food Elimination?

Nirmala Gonsalves, MD Describe the benefits and burden of different food elimination diets in the management of EOE. • Management of Refractory EoE Evan S. Dellon, MD, MPH, FACG Define refractory EoE and describe potential alternative therapies/approaches to control disease.

SESSION M: FMT • How to Introduce FMT Into Your Practice – Formulation, Administration, and Regulation Neilanjan Nandi, MD Explain the how to’s involved in setting up FMT in a GI practice.

• The Science Behind the Stool Jessica R. Allegretti, MD, MPH Identify clinically relevant information for the practicing gastroenterologist regarding how FMT works, potential side effects, precautions, and how this applies to managing patients.

• Current and Future Indications for FMT Colleen R. Kelly, MD, FACG Discuss current and speculate future uses of FMT.

SESSION N: Reproduction in IBD: From Conception to Postpartum • Fertility and Conception: It Takes Two! Shayla A. Schoenoff, PA Discuss common fertility and preconception concerns for men and women with IBD. • Pregnancy: The Three Trimesters Eugenia Shmidt, MD Describe the management of IBD during pregnancy and delivery.

• Postpartum: The Fourth Trimester Lisa B. Malter, MD, FACG Outline challenges of IBD treatment in the postpartum period, including lactation, resumption of therapy, and infant vaccinations.

SESSION O: Fundamentals of Quality Liver Care • Updates in Viral Hepatitis Joseph C. Ahn, MD, MS, MBA, FACG Distinguish between the different viral hepatitides and identify the best management options.

• Preop Management of Patients With Liver Disease Mitchell L. Shiffman, MD, FACG (VA) Describe best practices for preoperative management of patients with liver disease.

• Noninvasive Evaluation of Fibrosis Michael F. Chang, MD Compare the latest options on noninvasive evaluation of hepatic fibrosis and understand how to choose the between the options.

The rich array of educational content for Virtual ACG 2020 will be available on-demand through Jan 31, 2021.

Register now, and get access to all of the content and earn CME and MOC.

42 | GI.ORG/ACGMAGAZINE

Inside the

JOURNALS

G

AC RTS EPO CASE RO J URN L G OM I.OR TS.C TS.G POR POR ERE ERE CAS CAS ACG ACG

VOLUME 6

ed by orts edit e Rep ed by nal of CasRep orts edit ne Jour ows An Onli nal of Case atology Fell ne Jour ows An Onli ology & Hep atology Fell Gastroenter ology & Hep Gastroenter

The College proudly introduces the new ACG Case Reports Journal Editorial Board for 2020-2021 under the leadership of Co-Editors-in-Chief Dr. Ahmad Bazarbashi and Dr. Isabel Hujoel who share their vision for the year ahead and describe the unique role played by this open-access journal edited by GI fellows-in-training. Explore ACG Case Reports Journal at acgcasereports.com A new ACG Clinical Guideline by Gyawali, et al., “Clinical Use of Esophageal Physiologic Testing,” describes the performance characteristics and clinical value of esophageal physiologic tests and provides recommendations for their utilization in routine clinical practice.

In a recent study in Clinical and Translational Gastroenterology, Hiremath, et al., report findings from the first study to identify spectral traits of the esophageal samples related to eosinophilic esophagitis (EoE) activity and tissue pathology and to profile tissue-level biochemical composition associated with pediatric EoE. Enjoy an enlightening conversation with Co-Editors-in-Chief of The American Journal of Gastroenterology discussing, “COVID-19 and the Digestive System.” Dr. Brian Lacy interviews Dr. Brennan Spiegel about a review article by Ma, et al.  Listen: bit.ly/AJG-Podcast-COVID-Ma  Read: bit.ly/AJG-Ma-COVID-Article

Inside the Journals | 43

// INSIDE THE JOURNALS

INSIDE THE JOURNALS [THE AMERICAN JOURNAL OF GASTROENTEROLOGY]

ACG Clinical Guideline: Clinical Use of Esophageal Physiologic Testing C. Prakash Gyawali, MD, MRCP, FACG; Dustin A. Carlson, MD; Joan W. Chen, MD, MS; Amit Patel, MD; Robert J. Wong, MD, MS, FACG (GRADE Methodologist); Rena H. Yadlapati, MD, MSHS

 ESOPHAGEAL SYMPTOMS ARE COMMON AND MAY INDICATE THE PRESENCE OF GASTROESOPHAGEAL REFLUX DISEASE (GERD), structural processes, motor dysfunction, behavioral conditions, or functional disorders. Esophageal physiologic tests are often performed when initial endoscopic evaluation is unrevealing, especially when symptoms persist despite empiric management. Commonly used esophageal physiologic tests include esophageal manometry, ambulatory reflux monitoring, and barium esophagram. Functional

lumen imaging probe (FLIP) has recently been approved for the evaluation of esophageal pressure and dimensions using volumetric distension of a cathetermounted balloon and as an adjunctive test for the evaluation of symptoms suggestive of motor dysfunction. Targeted utilization of esophageal physiologic tests can lead to definitive diagnosis of esophageal disorders but can also help rule out organic disorders while making a diagnosis of functional esophageal disorders. Esophageal physiologic tests can evaluate obstructive symptoms (dysphagia and regurgitation), typical and atypical GERD symptoms, and

behavioral symptoms (belching and rumination). Certain parameters from esophageal physiologic tests can help guide the management of GERD and predict outcomes. In this ACG Clinical Guideline, we used the Grading of Recommendations Assessment, Development and Evaluation process to describe performance characteristics and clinical value of esophageal physiologic tests and provide recommendations for their utilization in routine clinical practice.

 READ the article: bit.ly/ACG-Guideline-Esoph-PhysTesting

Clinical Use of Esophageal Physiologic Testing FIGURE 1

Figure 1. Clinical scheme for the evaluation of esophageal symptoms. Endoscopy is typically performed in the evaluation of persisting esophageal symptoms to look for a structural or mucosal mechanism of symptoms; if abnormal, management proceeds accordingly. Pathways for the evaluation of 44 | GI.ORG/ACGMAGAZINE obstructive, typical, and extraesophageal symptoms suspicious for reflux and atypical symptoms (belching and rumination) differ. A PPI test may be an

1417

Meet the 2020–2021 ACGCRJ Editorial Board

NEW CO-EDITORS-IN-CHIEF REFLECT ON THE ACG CASE REPORTS JOURNAL

By Ahmad N. Bazarbashi, MD, Brigham & Women’s Hospital Boston, MA & Isabel A. Hujoel, MD, Mayo Clinic Rochester, MN

Ahmad N. Bazarbashi, MD Co-Editor-in-Chief Brigham and Women's Hospital

Isabel A. Hujoel, MD Co-Editor-in-Chief Mayo Clinic

We are thrilled to serve as CoEditors-in-Chief of the ACG Case Reports Journal. This long-standing fellow-run journal represents the College’s commitment to supporting gastroenterology trainees by promoting academic and professional growth.

Pursuing a career in gastroenterology and hepatology has many challenges, one of which is the growing competitiveness of this dynamic field. Research in gastroenterology has become an essential part of a trainee’s application. We are fortunate to train in a field with a plethora of radiologic, endoscopic, and laboratory-based findings which allows for the publication of interesting case reports. The process of writing, submitting, and ultimately publishing these case reports is a significant opportunity to develop the skills required for academic pursuit.

ACG Case Reports Journal has provided the perfect platform

for medical students, residents, and fellows interested in gastroenterology and hepatology to both enhance their applications but, more importantly, to contribute to medical literature.

WRITING A CASE REPORT EMPOWERS CRITICAL THINKING, ALLOWS FOR ROBUST LITERATURE REVIEW, AND HELPS DEVELOP THE SKILLS NEEDED TO BUILD A CAREER IN RESEARCH. We have both been fortunate to serve as associate editors for this journal. During our year in this role, we have learned how to read and carefully dissect case reports, provide constructive feedback, make editorial decisions, and most importantly, learn from outstanding rare and interesting case reports from all over the world. We are now humbled and honored to serve as Co-Editors-inChief with an outstanding group of

talented associated editors, each with their own interest in various subspecialties and strong clinical and research backgrounds. We are excited to serve the GI and liver community with interesting case reports and provide a platform to allow professional and academic growth for those who are seeking a career in gastroenterology.

An Invitation We invite the GI community, nationally and internationally, to look through our journal, learn from the various case reports, images and videos, and to browse through the editorials written by current and past associate editors. We invite gastroenterology fellows to apply as reviewers for the journal in order to learn and practice the fundamental skills of peer reviewing manuscripts. Finally, we invite gastroenterology trainees to apply to our journal as associate editors next year and join the ever-growing family at ACG Case Reports Journal.

Neal Mehta, MD

Malav P. Parikh, MD

Ramzi H. Mulki, MD

Associate Editor Cleveland Clinic

Associate Editor SUNY Downstate Health Sciences University

Associate Editor The University of Alabama

Mike T. Wei, MD

Hirsh D. Trivedi, MD

Cassandra D. Fritz, MD

Associate Editor Beth Israel Deaconess Medical Center

Associate Editor Washington University

Associate Editor Stanford University

Sobia N. Laique, MD

Katherine A. Falloon, MD

Associate Editor Cleveland Clinic

Associate Editor Cleveland Clinic

 View all published cases without a subscription: ACGCASEREPORTS.COM

Thanks to outgoing ACGCRJ Editorial Board members!

Sanchit Gupta, MD

Judy A. Trieu, MD

Associate Editor Brigham and Women's Hospital

Associate Editor Loyola University Medical Center

We thank the outgoing members of the Editorial Board for their outstanding service to the Journal and wish them continued success in their careers.

Editor-in-Chief • C. Roberto Simons-Linares, MD Editors • Brett W. Sadowski, MD • Alexander J. Podboy, MD

• Yuri Hanada, MD • Kenechukwu O. Chudy-Onwugaje, MD • Akshata Moghe, MD • Kalpit H. Devani, MD.

Inside the Journals | 45

// INSIDE THE JOURNALS [CLINICAL & TRANSLATIONAL GASTROENTEROLOGY]

ESOPHAGUS

8

Novel Insights into Tissue-Specific Biochemical Hiremath et al.

Alterations in Pediatric Eosinophilic Esophagitis Using Raman Spectroscopy Girish Hiremath, MD, MPH; Andrea Locke, PhD; Giju Thomas, MBBS, PhD; Rekha Gautam, PhD; Sari Acra, MD, MPH; Hernan Correa, MD; Evan S. Dellon, MD, MPH; Anita Mahadevan-Jansen, PhD (July 2020)

ď‚Š ELUCIDATING ESOPHAGEAL BIOCHEMICAL COMPOSITION IN EOSINOPHILIC ESOPHAGITIS (EOE) can offer novel insights into its pathogenesis, which remains unclear. Using Raman spectroscopy, the investigators profiled and compared the biochemical composition of esophageal samples obtained from children with active (aEoE) and inactive EoE (iEoE) with non-EoE controls, examined the relationship between spectral markers and validated

corroborated with Raman mapping performed on an independent set of samples. These novel findings show, for the first time, that the biochemical composition of the esophageal mucosa, as identified by Raman spectroscopy, is altered in EoE, and this might have diagnostic and prognostic implications.

CLINICAL IMPLICATIONS This is the first study to identify spectral traits of the esophageal samples related to EoE activity and tissue pathology and to profile tissue-level biochemical composition associated with pediatric EoE. Future research to determine the role of these biochemical alterations in development and clinical course of EoE can advance our understanding of EoE pathobiology.

EoE activity indices.

In this prospective, in vitro study, using Raman spectroscopy, Hiremath and co-authors found key

ď‚Š READ: bit.ly/CTG-Hiremath-Peds-EoE

differences in the spectral intensities assigned to glycogen, protein, and lipid content in children with EoE compared with non-EoE controls. These differences hold potential to serve as spectral

Figure 5. Scatter plot with fitted lines depicting the inverse relationship between glycogen content (at Raman intensity ratio of 936/1,449 cm21) and the

markers of both EoE activity status and the extent peak eosinophil counts by study groups. CI, confidence inerval; EoE, eosinophilic esophagitis. of pathology. The findings from spectral analysis

FIGURE 6. Raman mapping of representative samples from non-EoE controls, inactive EoE and active EoE showing reduced glycogen content in inactive EoE and active EoE compared to non-EoE controls, and abundance of proteins in inactive EoE and active EoE when compared to non-EoE control (magnification 200 mm). EoE, eosinophilic esophagitis.

Figure 6. Raman mapping of representative samples from non-EoE controls, inactive EoE and active EoE showing reduced glycogen content in inactive EoE and active EoE compared to non-EoE controls, and abundance of proteins in inactive EoE and active EoE when compared to non-EoE control (magnification 200 mm). EoE, eosinophilic esophagitis.

46 | GI.ORG/ACGMAGAZINE

50 YEARS AGO... from the pages

of The American Journal of Gastroenterology

By Lawrence R. Schiller, MD, MACG for the ACG Archives Committee

Zollinger-Ellison Syndrome at the Dawn of the Radioimmunoassay Era

F

Fifty years ago, Marcel Patterson, MD, one of the founders of the Texas Society for Gastroenterology and Endoscopy, reported his experience with 5 cases of Zollinger-Ellison Syndrome at the University of Texas Medical Branch in Galveston in the pages of The American Journal of Gastroenterology.1 He had presented these cases the year before at the ACG Postgraduate Course in Houston in 1969.

His report summarized his observations on these patients in the 1960s. The patients all had gastrointestinal bleeding, one had perforation and two had gastrojejunocolic fistulas.

Multiple ulcers and distorted small bowel were seen with barium radiography (Figure 1). Basal gastric acid secretion was measured in several patients and was voluminous with high acid output. Three patients had a family history and were recognized as having “multiple endocrine adenoma-peptic ulcer complex,” what we now know as multiple endocrine neoplasia type 1 (MEN1) (Figure 2).

Two patients had hypercalcemia and multiple parathyroid adenomas and a third had hypercalcemia without firm evidence of parathyroid disease.

Robert M. Zollinger and Edwin H. Ellison, surgeons at The Ohio State University, reported two cases with jejunal ulcers and pancreatic tumors and postulated a causal relationship between endocrine pancreatic tumors and aggressive peptic ulcer disease in 1955.2 By 1964 they had accumulated 260 cases and the general outlines of the syndrome were apparent.3 Patients had aggressive ulcer disease, often with multiple ulcers and ulcer complications, such as bleeding, penetration, perforation, and fistula formation. Diarrhea was common among these patients.

Basic science caught up with these clinical observations in the 1960s.

Although John S. Edkins showed that extracts of cat or pig FIGURE 2.

antral mucosa could stimulate gastric acid secretion in 1905, his identification of “gastric secretin” was not widely accepted because of possible contamination with histamine.4 Simon Komarov published a method that produced a histamine-free extract that stimulated gastric acid secretion in 1942, resurrecting the concept of “gastrin,” a hormone from the distal stomach that stimulates gastric acid secretion.5 The study of gastrointestinal hormones in the 1950s and 1960s involved chemical extraction and bioassays. Rod Gregory and collaborators in Great Britain extracted a “gastrin-like substance” from the pancreatic tumor of one patient with Zollinger-Ellison syndrome in 1960.6 Wilfred Sircus from Scotland showed evidence for a gastric secretagogue in blood samples from two patients in 1964.7 Gregory with Morton Grossman (then at the Wadsworth VA Hospital) did more precise analysis of tumor samples from two patients with Zollinger-Ellison syndrome in 1967 and showed that the amino acid composition of the tumor secretagogue was identical to gastrin.8 The big breakthrough in the endocrinology of gastrointestinal peptides was the development of radioimmunoassay (RIA) by Rosalyn Yalow, Roger Guillemin and Andrew Schally in the 1950s, for which they received the Nobel Prize in Physiology or Medicine in 1977.

Insulin was the first peptide hormone measured with this technique in 1959.9 James McGuigan and Walter Trudeau at Washington University of St. Louis developed an RIA for gastrin in 1968 and showed much higher than normal levels in 4 patients with ZollingerEllison syndrome.10 Yalow and Solomon Berson developed a sensitive RIA for gastrin at the Bronx VA Hospital, first reported in 1970.11 Those discoveries and subsequent experiments by many investigators expanded our understanding of the physiology of gastrin and its key roles in postprandial acid secretion and Zollinger-Ellison syndrome.

References: 1. Patterson M. The diagnosis of the Zollinger-Ellison syndrome. Am J Gastroenterol 1970; 54(5):470-479.

2. Zollinger RM, Ellison EH. Primary peptic ulcerations of the jejunum associated with islet cell tumors of the pancreas. Ann Surg 1955; 142:709-723.

3. Ellison EH, Wilson SD. The Zollinger-Ellison syndrome: Reappraisal and evaluation of 260 registered cases. Ann Surg 1964; 160:512-530.

4. Yeung MJ, Pasieka JL. Gastrinomas: A historical perspective. J Surg Oncol 2009; 100:425-433.

5. Komarov S. Methods of isolation of a specific gastric secretagogue from the pyloric mucous membrane and its chemical properties. Rev Can Biol 1942; 1:191-207.

6. Gregory RA, Tracy HJ, French JM, Sircus W. Extraction of a gastrin-like substance from a pancreatic tumour in a case of Zollinger-Ellison syndrome. Lancet 1960; 1(7133): 1045-1048.

7. Sircus W. Evidence for a gastric secretagogue in the circulation and gastric juice of patients with the Zollinger-Ellison syndrome. Lancet 1964; 2(7361): 671-672.

8. Gregory RA, Grossman MI, Tracy HJ, Bentley PH. Nature of the gastric secretagogue in Zollinger-Ellison tumours. Lancet 1967; 2(7515): 543-544.

9. Yalow RS, Berson SA. Immunoassay of endogenous plasma insulin in man. J Clin Invest. 1960; 39: 1157-1175.

10. McGuigan JE, Trudeau WL. Immunochemical measurement of elevated levels of gastrin in the serum of patients with pancreatic tumors of the Zollinger-Ellison variety. New Engl J Med 1968; 278(24): 1308-1313.

11. Yalow RS, Berson SA. Radioimmunoassay of gastrin. Gastroenterology 1970; 58(1): 1-14.

Figure 1. Barium radiogram showing multiple duodenal ulcers and dilated duodenum in a patient with Zollinger-Ellison syndrome.1 Figure 2. Family history of one of the patients with Zollinger-Ellison syndrome.1

RE 1.

FIGU

Inside the Journals | 47

Eastern Time

48 | GI.ORG/ACGMAGAZINE

IMPORTANT SAFETY INFORMATION SUPREP® Bowel Prep Kit (sodium sulfate, potassium sulfate and magnesium sulfate) Oral Solution is an osmotic laxative indicated for cleansing of the colon as a preparation for colonoscopy in adults. Most common adverse reactions (>2%) are overall discomfort, abdominal distention, abdominal pain, nausea, vomiting and headache.

Use is contraindicated in the following conditions: gastrointestinal (GI) obstruction, bowel perforation, toxic colitis and toxic megacolon, gastric retention, ileus, known allergies to components of the kit. Use caution when prescribing for patients with a history of seizures, arrhythmias, impaired gag reflex, regurgitation or aspiration, severe active ulcerative colitis, impaired renal function or patients taking medications that may affect renal function or electrolytes. Use can cause temporary elevations in uric acid. Uric acid fluctuations in patients with gout may precipitate an acute flare.

Administration of osmotic laxative products may produce mucosal aphthous ulcerations, and there have been reports of more serious cases of ischemic colitis requiring hospitalization. Patients with impaired water handling who experience severe vomiting should be closely monitored including measurement of electrolytes. Advise all patients to hydrate adequately before, during, and after use. Each bottle must be diluted with water to a final volume of 16 ounces and ingestion of additional water as recommended is important to patient tolerance.

BRIEF SUMMARY: Before prescribing, please see Full Prescribing Information and Medication Guide for SUPREP® Bowel Prep Kit (sodium sulfate, potassium sulfate and magnesium sulfate) Oral Solution. INDICATIONS AND USAGE: An osmotic laxative indicated for cleansing of the colon as a preparation for colonoscopy in adults. CONTRAINDICATIONS: Use is contraindicated in the following conditions: gastrointestinal (GI) obstruction, bowel perforation, toxic colitis and toxic megacolon, gastric retention, ileus, known allergies to components of the kit.

WARNINGS AND PRECAUTIONS: SUPREP Bowel Prep Kit is an osmotic laxative indicated for cleansing of the colon as a preparation for colonoscopy in adults. Use is contraindicated in the following conditions: gastrointestinal (GI) obstruction, bowel perforation, toxic colitis and toxic megacolon, gastric retention, ileus, known allergies to components of the kit. Use caution when prescribing for patients with a history of seizures, arrhythmias, impaired gag reflex, regurgitation or aspiration, severe active ulcerative colitis, impaired renal function or patients taking medications that may affect renal function or electrolytes. Pre-dose and post-colonoscopy ECGs should be considered in patients at increased risk of serious cardiac arrhythmias. Use can cause temporary elevations in uric acid. Uric acid fluctuations in patients with gout may precipitate an acute flare. Administration of osmotic laxative products may produce mucosal aphthous ulcerations, and there have been reports of more serious cases of ischemic colitis requiring hospitalization. Patients with impaired water handling who experience severe vomiting should be closely monitored including measurement of electrolytes. Advise all patients to hydrate adequately before, during, and after use. Each bottle must be diluted with water to a final volume of 16 ounces and ingestion of additional water as recommended is important to patient tolerance. Pregnancy: Pregnancy Category C. Animal reproduction studies have not been conducted. It is not known whether this product can cause fetal harm or can affect reproductive capacity. Pediatric Use: Safety and effectiveness in pediatric patients has not been established. Geriatric Use: Of the 375 patients who took SUPREP Bowel Prep Kit in clinical trials, 94 (25%) were 65 years of age or older, while 25 (7%) were 75 years of age or older. No overall differences in safety or effectiveness of SUPREP Bowel Prep Kit administered as a split-dose (2-day) regimen were observed between geriatric patients and younger patients. DRUG INTERACTIONS: Oral medication administered within one hour of the start of administration of SUPREP may not be absorbed completely. ADVERSE REACTIONS: Most common adverse reactions (>2%) are overall discomfort, abdominal distention, abdominal pain, nausea, vomiting and headache. Oral Administration: Split-Dose (Two-Day) Regimen: Early in the evening prior to the colonoscopy: Pour the contents of one bottle of SUPREP Bowel Prep Kit into the mixing container provided. Fill the container with water to the 16 ounce fill line, and drink the entire amount. Drink two additional containers filled to the 16 ounce line with water over the next hour. Consume only a light breakfast or have only clear liquids on the day before colonoscopy. Day of Colonoscopy (10 to 12 hours after the evening dose): Pour the contents of the second SUPREP Bowel Prep Kit into the mixing container provided. Fill the container with water to the 16 ounce fill line, and drink the entire amount. Drink two additional containers filled to the 16 ounce line with water over the next hour. Complete all SUPREP Bowel Prep Kit and required water at least two hours prior to colonoscopy.

Consume only clear liquids until after the colonoscopy. STORAGE: Store at 20°-25°C (68°-77°F). Excursions permitted between 15°-30°C (59°-86°F). Rx only. Distributed by Braintree Laboratories, Inc. Braintree, MA 02185.

For additional information, please call 1-800-874-6756 or visit www.suprepkit.com

©2018 Braintree Laboratories, Inc. All rights reserved.

HH27314A

September 2018

THE ORIGINAL 1 LITER PRESCRIPTION BOWEL PREP SOLUTION

1 MOST PRESCRIBED,

#

BRANDED BOWEL PREP KIT1 WITH MORE THAN 15 MILLION KITS DISPENSED SINCE 20101 2

FIVE-STAR EFF1CACY WITH SUPREP ® Distinctive results in all colon segments • SUPREP Bowel Prep Kit has been FDA-approved as a split-dose oral regimen3 • 98% of patients receiving SUPREP Bowel Prep Kit had “good” or “excellent” bowel cleansing2* †

• >90% of patients had no residual stool in all colon segments2*

†

These cleansing results for the cecum included 91% of patients2*

†

Aligned with Gastrointestinal Quality Improvement Consortium (GIQuIC) performance target of ≥85% quality cleansing for outpatient colonoscopies.4 *This clinical trial was not included in the product labeling. †Based on investigator grading.

References: 1. IQVIA. National Prescription Audit Report. September 2018. 2. Rex DK, DiPalma JA, Rodriguez R, McGowan J, Cleveland M. A randomized clinical study comparing reduced-volume oral sulfate solution with standard 4-liter sulfate-free electrolyte lavage solution as preparation for colonoscopy. Gastrointest Endosc.

2010;72(2):328-336. 3. SUPREP Bowel Prep Kit [package insert]. Braintree, MA: Braintree Laboratories, Inc; 2017. 4. Rex DK, Schoenfeld PS, Cohen J, et al.

Quality indicators for colonoscopy. Gastrointest Endosc. 2015;81(1):31-53.

©2018 Braintree Laboratories, Inc. All rights reserved.

HH27314A

September 2018