Qazi Corner, Edition 7: ERCP Timing, GLP-1 RA Considerations, Seronegative Villous Atrophy

Taha Qazi, MD

Credit: Cleveland Clinic

It's my pleasure to present the third iteration of Qazi Corner for the 2024 year. In this installment, we highlight research from our fellows and from our team, as well as poignant topics in gastroenterology that we believe are very important and relevant for clinicians.

The first article is written by Rajat Garg, MD, who reviewed a retrospective cohort study looking at early versus late complications in patients who have liver transplantation and are sent to ERCP. It's a very poignant article looking at what the risk factors are and the complication rates in these patients who have an ERCP earlier versus later. What he came up with through this review of the coronary center at the Cleveland Clinic is that patients who have an earlier ERCP, ideally within 30 days of their liver transplantation, have a higher risk for bleeding compared to patients who have ERCP later than 30 days post-transplant, and without any change in technical success or clinical success for the procedure itself.

This provides a little bit of a pause as we're sort of rushing into our procedures and evaluating. Obviously, there are reasons why we sometimes have to do our procedures in a more timely fashion, but I think it does provide that situation where a patient may be able to wait for a delay prior to that procedure without necessarily changing your technical level of success or clinical success.

The second article is by David Long, DO, a current second-year GI fellow at Cleveland Clinic, who summarizes the use of GLP-1 receptor agonists in the context of endoscopic management and how we evaluate these new medications with their ubiquitous use and gaining popularity, as well as how we sort of try and utilize techniques that can minimize complications with these agents that are designed to delay gastric emptying, delay gastric utility, impair peristalsis, and actually potentially result in poor preps and higher risk for aspirations. I think he provides a very good summary of the data that is out there, but also the current updates and practice guidelines.

Lastly, our final article is by Chiara Maruggi, MD, a graduated third-year GI fellow, currently in practice at Scripps in San Diego, and she provides her research on the diagnosis of seronegative celiac disease in patients with villous atrophy found on endoscopy. I think the bigger thing that we need to sort of realize is that in most of these situations where we look and we find patients who have villous atrophy on endoscopy, the more common things that we're often finding is the patient does have seronegative celiac disease. The blood testing can be negative, but they do have evidence suggesting that they have celiac disease, and the differential can be wide, potentially including things like HIV, CVID, Crohn's disease, and medication-induced. So I think the big sort of telltale sign is to keep the differential broad, always review whether it truly is celiac disease by implementing a gluten challenge, but really evaluate what we can do to address this sort of condition and really come with a good diagnosis or a diagnostic skill to create the best differential possible.