1 Kao D, Gomez SZ, Tandon P, et al. Managing the post-liver transplant anastomotic stricture: multiple plastic versus metal stents-a systematic review. Gastrointest Endosc 2013;77:679-91. Water immersion colonoscopy Colonoscopy is performed with the patient in the left lateral position. The air pump is turned off before colonoscopy. During endoscope insertion, residual air in lumen is suctioned and 37°C water is infused with a peristaltic pump through the biopsy channel to obtain

visualization. Turbid fluid is suctioned and replaced with clean water until colon lumen is clearly visualized again and the endoscope is advanced under water. Water immersion colonoscopy for unsedated patients with prior abdomino-pelvic surgery In the small

study by Luo et al,1 the probability of reaching the cecum was enhanced using the water immersion technique. Other factors noted were a decrease Protein Tyrosine Kinase inhibitor in the need for variable scope stiffness, application of abdominal pressure and the use of patient position change. Adenoma detection was not studied, nor were all the patients included in the study being screened for the first time. Cecal intubation time was similar in the two study groups. The role of water immersion colonoscopy technique in patients who receive sedation is unclear. BMS-354825 manufacturer Whether similar benefits could be seen with the use of CO2 insufflation and pediatric colonoscopes is an open question. All but 1 of the 11 patients that could not be studied with air insufflation had complete examinations with sedation. However, in special situations such as the scenario presented above where sedation is not an option, the water immersion technique may facilitate a complete examination.1 Take-home point: Consider water immersion colonoscopy in unsedated patients

Temsirolimus cost with prior abdominal or pelvic surgery. 1 Luo H, Zhang L, Liu X et al. Water exchange enhanced cecal intubation in potentially difficult colonoscopy. Unsedated patients with prior abdominal or pelvic surgery: a prospective randomized, controlled trial. Gastrointest Endosc 2013;77:767-73. The GIE: Gastroinintestinal Endoscopy CME Activity can now be completed entirely on-line. To complete do the following: 1 Read the CME articles in this issue carefully and complete the activity: Barkun AN, Moosavi S, Martel M. Topical hemostatis agents: a systematic review with particular emphasis on endoscopic application in GI bleeding. Gastrointest Endosc 2013;77:692-700. Oh HC, Brugge WR. EUS-guided pancreatic cyst ablation: a critical review (with video). Gastrointest Endosc 2013;77:526-33. Kao D, Gomez SZ, Tandon P, et al. Managing the post-liver transplant anastomotic stricture: multiple plastic versus metal stents—a systematic review. Gastrointest Endosc 2013;77:679-91. Luo H, Zhang L, Liu X et al. Water exchange enhanced cecal intubation in potentially difficult colonoscopy.