Jeffrey Hubers

Ischemic cholangiopathy is a feared complication after liver transplantation. We present a 68-year-old man who is status postorthotopic liver transplant from a donation after cardiac death. His posttransplant course was complicated by the development of a biliary anastomotic stricture, ischemic cholangiopathy, biloma, recurrent cholangitis, and intrahepatic stones. Through the use of antegrade cholangioscopy with a single-operator cholangioscope (SpyGlass 2; Boston Scientific, Boston, MA) passed through a percutaneous sheath, we were able to visualize impacted stones within the left intrahepatic system and treat them using electrohydraulic lithotripsy for stone fragmentation and removal.

OBJECTIVES: Colorectal cancer (CRC) screening has increased in the United States during the past 20 years, resulting in an increased demand for colonoscopy. We tested the hypothesis that such increase resulted in longer wait times for colonoscopy and influenced CRC diagnosis. METHODS: A total of 36,623 consecutive colonoscopies performed at the University of Wisconsin from April 8, 2013, until December 31, 2016, were included in the analysis. Wait times for colonoscopy were stratified by consecutive 6-month periods and indications of screening/surveillance vs diagnostic colonoscopy. RESULTS: Despite unchanged number of endoscopists, more colonoscopies were performed in 2015–2016 than in 2013–2014 (20,897 vs 15,726, respectively, P = 0.004). The mean wait time for colonoscopy increased from 68 days in 2013–2014 to 111 days in 2015–2016 (P < 0.0001), with most change affecting screening/surveillance colonoscopy. In 170 patients with a newly diagnosed CRC, the wait time did not significantly change between 2013–2014 and 2015–2016 (21 vs 27 days, respectively, P = 0.2206). DISCUSSION: An increase in screening/surveillance colonoscopies resulted in a substantial rise in the number of procedures between 2013 and 2016. This increase was associated with longer wait times for screening/surveillance but not diagnostic colonoscopy. Longer wait times did not result in later CRC stage at diagnosis.