Jonathan Cohen, M.D.

Computers for colonoscopy training: where do they fit in?
Cohen, Jonathan
2010 Feb;71(2):308-311, Gastrointestinal endoscopy
— id: 107282, year: 2010, vol: 71, page: 308, stat: Journal Article,

A novel device for rapid cleaning of poorly prepared colons
Moshkowitz, M; Hirsch, Y; Carmel, I; Duvdevany, T; Fabian, I; Willenz, E P; Cohen, J
2010 Oct;42(10):834-836, Endoscopy
BACKGROUND: Adequate colon preparation is essential for the quality and accuracy of colonoscopy and has a significant influence on related costs. The aim of this study was to assess the efficacy and safety of a novel attachable colon-cleaning device used during colonoscopies in porcine colon. METHODS: The ClearPath device consists of a multilumen extruded tube with channels for water irrigation and evacuation designed to allow the break up and removal of stool remnants during colonoscopy. Seven female domestic swine underwent several series of experiments in which partial bowel preparation followed by a sedated colonoscopy using the new device was performed. RESULTS: Between February 2008 and October 2008, a total of 57 colonoscopic procedures were conducted. The device enabled rapid cleaning of the partially prepared porcine colon with no immediate or delayed adverse consequences. CONCLUSIONS: Use of the ClearPath device was found to be a simple, reliable, and safe method for intraprocedural cleaning of partly prepared porcine colon. These experiments support a potential role for ClearPath in cleaning the colon in unprepared or poorly prepared human patients
— id: 133809, year: 2010, vol: 42, page: 834, stat: Journal Article,

Optical contrast endoscopy: is it ready for routine use?
Cohen, Jonathan
2009 Jan;136(1):52-55, Gastroenterology
— id: 92686, year: 2009, vol: 136, page: 52, stat: Journal Article,

Identifying cognitive mechanisms targeted for treatment development in schizophrenia: An overview of the first meeting of the cognitive neuroscience treatment research to improve cognition in schizophrenia initiative
Carter, Cameron S; Barch, Deanna M; Buchanan, Robert W; Bullmore, Ed; Krystal, John H; Cohen, Jonathan; Geyer, Mark; Green, Michael; Nuechterlein, Keith H; Robbins, Trevor; Silverstein, Steven; Smith, Edward E; Strauss, Milton; Wykes, Til; Heinssen, Robert
2008 ;64(1):4-10, Biological psychiatry
This overview describes the generation and development of the ideas that led to the Cognitive Neuroscience Treatment Research to Improve Cognition in Schizophrenia (CNTRICS) initiative. It also describes the organization, process, and products of the first meeting. The CNTRICS initiative involves a series of three conferences that will systematically address barriers to translating paradigms developed in the basic animal and human cognitive neuroscience fields for use in translational research aimed at developing novel treatments for cognitive impairments in schizophrenia. The articles in this special section report on the results of the first conference, which used a criterion-based consensus-building process to develop a set of cognitive constructs to be targeted for translation efforts.
— id: 101369, year: 2008, vol: 64, page: 4, stat: Journal Article,

Simulation training in endoscopy
Cohen J.
2008 ;4(1):25-27, Gastroenterology & Hepatology
— id: 76784, year: 2008, vol: 4, page: 25, stat: Journal Article,

Evaluation of surgical outcomes and gallbladder characteristics in patients with biliary dyskinesia
Sabbaghian, M Shirin; Rich, Barrie S; Rothberger, Gary D; Cohen, Jonathan; Batash, Steven; Kramer, Elissa; Pachter, H Leon; Marcus, Stuart G; Shamamian, Peter
2008 Aug;12(8):1324-1330, Journal of gastrointestinal surgery
INTRODUCTION: This study was designed to compare symptomatic outcomes following cholecystectomy in patients with biliary dyskinesia. MATERIALS AND METHODS: From 1999 to 2006 at New York University Medical Center, 197 adults underwent hepatobiliary scintigraphy with cholecystokinin administration to evaluate gallbladder ejection fraction (GBEF). Biliary dyskinesia was demonstrated in 120 patients based on decreased GBEF of </=35%. Forty-four patients underwent cholecystectomy, and data from chart review and telephone questionnaires were available for 42 patients. Patients reported symptomatic improvement whether gallstones were present (25/27, 92.6%) or absent (13/15, 86.7%) prior to cholecystectomy (p = 0.90). The most common pathologic findings were chronic cholecystitis and cholesterolosis, regardless of the presence of gallstones. Additional data from 101 of the 120 patients with decreased GBEF demonstrated 74/101 (73.2%) patients were diagnosed with gastroesophageal reflux disease (GERD), and 59/101 (58.4%) patients were diagnosed with gastritis. RESULTS: The results of this study suggest that biliary dyskinesia should be considered as part of the spectrum of symptomatic gallbladder disease that can be successfully treated with cholecystectomy and that biliary dyskinesia is associated with GERD and gastritis
— id: 93321, year: 2008, vol: 12, page: 1324, stat: Journal Article,

Adenoma detection using high definition endoscopy - Does narrow band imaging increase the yield? Commentary
Cohen J.
2007 ;8(4):79-80, Evidence-Based Gastroenterology
— id: 74691, year: 2007, vol: 8, page: 79, stat: Journal Article,

Does Simulator Training in Colonoscopy Reduce Procedure-Related Complications?
Matthes K.; Cohen J.
2007 ;9(4):242-245, Techniques in Gastrointestinal Endoscopy
Training in colonoscopy occurs in the traditional mentoring method, wherein trainees are exposed to procedures under the guidance of an experienced teacher. This teaching experience is unstructured and dictated by the random admission of patients rather than a consistent exposure to fundamental medical problems in an organized programmatic fashion. Evidence shows that a higher incidence of complications is observed in procedures performed by trainees in comparison to experienced endoscopists. Colonoscopy simulator training is without the involvement of patient risk and might lead to improved quality of patient care without any additional risk. Virtual reality simulators provide the ability of feedback of patient discomfort and could increase the awareness of trainees causing discomfort. This increased vigilance could potentially lead to a decreased rate of colon perforation. Training on ex-vivo simulators may lead to better performance of interventional procedures, such as polypectomy and endoscopic mucosal resection, with the possibility of decreasing the incidence of intraoperative and postoperative bleeding. Data shows that with the use of structured simulator training with ample feedback from tutors, fellows advance faster to more proficient skill levels. Reaching a more advanced level of expertise by simulator training in the early phase of training could potentially lead to increased patient comfort and thus less requirement of sedation, which has been shown to decrease the rate of unexpected cardiopulmonary events. However, clinical evidence of simulator training in colonoscopy in reducing procedure-related complications is currently not available and subject to further investigation. Given the low rate of complications associated with colonoscopy, studies to provide this evidence may be difficult to conduct. copyright 2007 Elsevier Inc. All rights reserved
— id: 75220, year: 2007, vol: 9, page: 242, stat: Journal Article,

Multicenter, randomized, controlled trial of virtual-reality simulator training in acquisition of competency in colonoscopy
Cohen, Jonathan; Cohen, Seth A; Vora, Kinjal C; Xue, Xiaonan; Burdick, J Steven; Bank, Simmy; Bini, Edmund J; Bodenheimer, Henry; Cerulli, Maurice; Gerdes, Hans; Greenwald, David; Gress, Frank; Grosman, Irwin; Hawes, Robert; Mullin, Gerard; Schnoll-Sussman, Felice; Starpoli, Anthony; Stevens, Peter; Tenner, Scott; Villanueva, Gerald
2006 Sep;64(3):361-368, Gastrointestinal endoscopy
BACKGROUND: The GI Mentor is a virtual reality simulator that uses force feedback technology to create a realistic training experience. OBJECTIVE: To define the benefit of training on the GI Mentor on competency acquisition in colonoscopy. DESIGN: Randomized, controlled, blinded, multicenter trial. SETTING: Academic medical centers with accredited gastroenterology training programs. PATIENTS: First-year GI fellows. INTERVENTIONS: Subjects were randomized to receive 10 hours of unsupervised training on the GI Mentor or no simulator experience during the first 8 weeks of fellowship. After this period, both groups began performing real colonoscopies. The first 200 colonoscopies performed by each fellow were graded by proctors to measure technical and cognitive success, and patient comfort level during the procedure. MAIN OUTCOME MEASUREMENTS: A mixed-effects model comparison between the 2 groups of objective and subjective competency scores and patient discomfort in the performance of real colonoscopies over time. RESULTS: Forty-five fellows were randomized from 16 hospitals over 2 years. Fellows in the simulator group had significantly higher objective competency rates during the first 100 cases. A mixed-effects model demonstrated a higher objective competence overall in the simulator group (P < .0001), with the difference between groups being significantly greater during the first 80 cases performed. The median number of cases needed to reach 90% competency was 160 in both groups. The patient comfort level was similar. CONCLUSIONS: Fellows who underwent GI Mentor training performed significantly better during the early phase of real colonoscopy training
— id: 68508, year: 2006, vol: 64, page: 361, stat: Journal Article,

Preface: endoscopy simulators for training and assessing skill
Greenwald D; Cohen J
2006 ;16(3):xv-xvi Jul, Gastrointestinal endoscopy clinics of North America
— id: 69402, year: 2006, vol: 16, page: xv, stat: Journal Article,

The Neo-Papilla: a new modification of porcine ex vivo simulators for ERCP training (with videos)
Matthes, K; Cohen, J
2006 OCT ;64(4):570-576, Gastrointestinal endoscopy
Background: Computer simulators, live pigs, and ex vivo porcine simulators are used for training in ERCP The location of the porcine biliary orifice in the proximal duodenum is dissimilar to human anatomy, making the endoscopy experience less realistic. In addition, in native porcine anatomy, the pancreatic duct enters the duodenum distal to the biliary orifice, limiting the teaching of pancreatic techniques and selective duct cannulation. Objective: To overcome these limitations, we aimed to construct a Neo-Papilla that could be incorporated into an ex vivo model. Design: We attached chicken heart tissue to the porcine duodenum, with integrated porcine arteries that resembled an artificial common bile duct and a pancreatic duct. Setting: The simulator was presented and evaluated at 2 major GI endoscopy conferences. Main Outcome Measurements: The feasibility and the realism of this prototype was tested by 9 recognized ERCP experts who rated this model in comparison to other teaching models for ERCP by recollection of prior experience. Results: The Neo-Papilla was more prominent and more distally located than the native porcine papilla. The experts rated this modification superior to existing models in its usefulness as an educational tool. Limitations: Pilot study. Conclusions: We demonstrated the technical feasibility of a real-tissue Neo-Papilla modification of porcine ex vivo simulators, more closely approximating the natural anatomy This new model should facilitate ERCP training. Formal validation studies are warranted
— id: 68957, year: 2006, vol: 64, page: 570, stat: Journal Article,

Training with the compactEASIE biologic endoscopy simulator significantly improves hemostatic technical skill of gastroenterology fellows: a randomized controlled comparison with clinical endoscopy training alone
Hochberger, J; Matthes, K; Maiss, J; Koehnick, C; Hahn, EG; Cohen, J
2005 FEB ;61(2):204-215, Gastrointestinal endoscopy
Background: The Erlangen Active Simulator for interventional Endoscopy (EASIE) was introduced in 1997 for interventional endoscopy training. compactEASIE developed in 1998 is a modified, light-weight version of the original model. Objective evidence of the benefits of training with these models is limited. A randomized controlled study, therefore, was conducted to compare the effects of intensive 7-month, hands-on training in hemostatic techniques by using the compactEASIE model (in addition to clinical endoscopic training) vs. pure clinical training in endoscopic hemostatic methods. Methods: Thirty-seven fellows in gastroenterology in New York City area training programs were enrolled. Baseline skills were assessed on the simulator for the following techniques: manual skills, injection and electrocoagulation, hemoclip application, and variceal ligation. Twenty-eight fellows were then randomized into two comparable groups. Those randomized to Group A received purely clinical training in endoscopic hemostatic techniques at their hospitals. Those in Group B, in addition, were trained by experienced tutors in 3 full-day hemostasis workshops over 7 months. Both groups underwent a final evaluation on the compactEASIE simulator conducted by their tutors and additional evaluators who were blinded to the method of training. Initial and final evaluation scores were compared for each group and between groups. Outcomes of actual clinical hemostatic procedures performed during the study period also were analyzed. Results: Ten of 14 fellows randomized to Group A (standard training) and 13 of 14 in Group B (intensive training) returned for the final evaluation. For Group B, scores for all techniques were significantly improved. In Group A, a significant improvement was noted for variceal ligation alone. Conclusions: compactEASIE simulator training (3 sessions over 7 months), together with clinical endoscopic training resulted in objective improvement in the performance by fellows of all 4 endoscopic hemostatic techniques, whereas significant improvement was noted for variceal ligation alone for fellows who had standard clinical training. In clinical practice, fellows who had intensive simulator/clinical training had a significantly higher success rate and a nonsignificant reduction in the frequency of occurrence of complications
— id: 48948, year: 2005, vol: 61, page: 204, stat: Journal Article,

Efficacy and costs of a one-day hands-on EASIE endoscopy simulator train-the-trainer workshop
Matthes, K; Cohen, J; Kochman, ML; Cerulli, MA; Vora, KC; Hochherger, J
2005 DEC ;62(6):921-927, Gastrointestinal endoscopy
Background: The efficacy of an intensive hands-on training in endoscopic hemostasis on the compactEASIE simulator has been previously demonstrated in a randomized prospective trial. In the current study, we evaluated how quickly and effectively new tutors, without simulator training experience, are able to acquire teaching skills in endoscopic hemostasis. Methods: Five tutors with prior Erlangen Active Simulator for Interventional Endoscopy (EASIE) teaching experience instructed 7 endoscopists without prior EASIE experience on how to teach when using the model. These new tutors then independently conducted a workshop for 8 fellows in 4 hemostasis techniques. Results were compared with a historical control trained similarly by experienced tutors. Two one-day workshops in endoscopic hemostasis on the compactEASIE ex vivo endoscopy simulator were conducted in a category A hospital in New York City, New York. Skill scores at the end of training were compared with baseline skills assessments, and qualitative ratings of the new tutors were obtained from both the trainees and the experienced tutors. Results: Significant improvement was achieved by the fellows in all 4 skills areas. Both the expert tutors and the trainees consistently rated the teaching skill of the new tutors highly. Fellows' skill acquisition using new tutors was of similar magnitude to that achieved in the prior EASIE trial using experienced trainers teaching the fellows. Conclusions: It is feasible to conduct an effective EASIE train-the-trainer course in one day. Tutors trained in this manner are able to provide a similar educational experience with objective improvement in trainee skill to experts who have conducted many hands-on workshops
— id: 60203, year: 2005, vol: 62, page: 921, stat: Journal Article,

The impact of tissue sampling on endoscopy efficiency
Cohen, Jonathan
2004 Oct;14(4):725-34, x, Gastrointestinal endoscopy clinics of North America
Much of the time spent in gastrointestinal endoscopy is devoted to tissue sampling. For this reason, efforts to facilitate tissue diagnosis can greatly influence the overall efficiency of endoscopy. This overview reviews the steps involved in tissue sampling and highlights potential ways to achieve increased efficiency in tissue sampling. Both potential improvements in process and innovations in technology are considered
— id: 47849, year: 2004, vol: 14, page: 725, stat: Journal Article,

Endoscopic treatment compared with medical therapy for the prevention of recurrent ulcer hemorrhage in patients with adherent clots
Bini, Edmund J; Cohen, Jonathan
2003 Nov;58(5):707-714, Gastrointestinal endoscopy
BACKGROUND: Two recent randomized, controlled trials have demonstrated efficacy for combination endoscopic therapy in the management of bleeding peptic ulcer with adherent clot. The aim of this study was to determine the effectiveness of this technique in a clinical practice setting. METHODS: Medical records of consecutive patients, seen from January 1992 through December 1999, with severe ulcer hemorrhage and non-bleeding adherent clots resistant to target irrigation were reviewed. The decision for combination endoscopic therapy (epinephrine injection, removal of adherent clot, treatment of underlying stigmata) or medical therapy was left to the discretion of the endoscopist. RESULTS: Of 244 patients with adherent clots, 138 (56.6%) had endoscopic therapy and 106 (43.4%) were managed with medical therapy alone. The baseline characteristics of the two groups were similar, except for older age in the endoscopic therapy group. Recurrence of bleeding within 7 days of endoscopy was significantly less frequent in the endoscopic therapy group than the medical therapy group (respectively, 8.7% vs. 27.4%; adjusted odds ratio 0.07 95% CI [0.02, 0.22], p<0.001). Median hospital stay (6.0 vs. 8.0 days; p<0.001), median number of red blood cell transfusions after endoscopy (2.0 vs. 3.0 units; p=0.01), the need for repeat endoscopy (9.4% vs. 26.4%; p<0.001), and recurrent bleeding within 30 days (10.1% vs. 28.3%; p<0.001) were significantly lower in the endoscopic therapy group. In addition, the need for ulcer surgery (5.8% vs. 9.4%; p=0.28) and 30-day mortality (3.6% vs. 7.5%; p=0.18) were lower in the endoscopic therapy group, although these differences were not statistically significant. Endoscopic complications were uncommon (1.4% vs. 0.9%; p=1.00). CONCLUSIONS: Combination endoscopic treatment of ulcers with an adherent clot was associated with a significant reduction in recurrent ulcer hemorrhage compared with medical therapy alone. These findings confirm that the efficacy of combination endoscopic therapy demonstrated in carefully designed, randomized, controlled clinical trials can be reproduced when this technique is applied in a clinical practice setting. However, combination therapy did not significantly reduce the need for ulcer surgery or 30-day mortality
— id: 39006, year: 2003, vol: 58, page: 707, stat: Journal Article,

Diagnostic yield of capsule endoscopy in patients with severe GI bleeding of obscure origin, subsequent recommendations, and outcomes
Jensen DM; Dulai G; Lousuebsakul V; Cave D; Bini EJ; Firoozi B; Cohen J; Kimmey M
2002 ;55:AB127-AB127 abstract #M1954, Gastrointestinal endoscopy
— id: 32915, year: 2002, vol: 55, page: AB127, stat: Journal Article,

Laryngeal mask airway - a novel method of airway protection during ER
Osborn, IP; Cohen, J; Soper, RJ; Roth, LA
2002 JUL ;56(1):122-128, Gastrointestinal endoscopy
Background: ERCP sometimes requires deep sedation and rarely general anesthesia with airway protection. The laryngeal mask airway device is placed perorally to create a seal over the larynx. Unlike endotracheal intubation, no tube traverses the vocal cords, thus reducing airway stimulation and obviating the need to administer muscle relaxants. The feasibility of using the laryngeal mask airway during ERCP was evaluated and recovery times compared for patients undergoing ERCP with the laryngeal mask airway versus endotracheal intubation. Methods: In this retrospective cohort study, anesthesia records were reviewed for anesthesiologist-assisted ERCP procedures performed during a 30-month period. Demographics, procedure duration, and time from endoscope removal to extubation were abstracted. Either propofol or inhalation agents were used for anesthesia in all patients. Observations: Anesthesiologists administered sedation for 41 ERCPs. The airway was managed in 12 patients with endotracheal intubation and the laryngeal mask airway in 20 patients. Six patients underwent laryngeal mask airway insertion and removal while prone. A therapeutic duodenoscope was passed beyond the laryngeal mask airway with little or no resistance In all cases. Repositioning the laryngeal mask airway during the procedure was required in 1 case. Laryngeal mask airway use was associated with shorter extubation time compared with endotracheal intubation (7.2 vs. 12 min.; p = 0.004). There were no airway complications. Conclusion: ERCP can be performed while using the laryngeal mask airway for airway protection. The laryngeal mask airway can be placed with the patient prone, obviating the need to change position. Laryngeal mask airway shortens extubation time compared with endotracheal intubation
— id: 55302, year: 2002, vol: 56, page: 122, stat: Journal Article,

Infectious diarrhea in human immunodeficiency virus
Cohen J; West AB; Bini EJ
2001 Sep;30(3):637-664, Gastroenterology clinics of North America
Chronic HIV-associated diarrhea is currently a field in flux. Improved noninvasive diagnostic tests, improved pathogen-specific regimens, and better empiric therapies may change some of the assumptions used to select algorithms for diagnostic evaluation and management. Any shift in the cause of diarrhea from pathogen-associated to idiopathic or a reduction in the overall incidence of diarrhea would have considerable impact. It is unclear how significant the problem of pathogen relapse in previous responders will become. Existing studies reviewed in this article show that the high diagnostic yield of endoscopy when stool tests are negative, coupled with significantly better outcomes when pathogens are identified, support the current practice of routine endoscopic evaluation. There currently are scant data on the economic impact of HIV-associated diarrhea as it relates to pathogen-specific and empiric therapy in the era of protease inhibitors. Such data would be integral to future evaluation of the impact of diagnostic and therapeutic strategies
— id: 26529, year: 2001, vol: 30, page: 637, stat: Journal Article,

Laryngeal mask airway (LMA) vs ETT for airway protection in ERCP
Cohen, J; Osborn, IP; Soper, RJ; Roth, LA
2001 APR ;53(5):AB80-AB80, Gastrointestinal endoscopy
— id: 55075, year: 2001, vol: 53, page: AB80, stat: Journal Article,

Impact of protease inhibitors on the outcome of human immunodeficiency virus-infected patients with chronic diarrhea
Bini EJ; Cohen J
1999 Dec;94(12):3553-3559, American journal of gastroenterology
OBJECTIVE: The effect of protease inhibitors on the outcome of chronic HIV-related diarrhea is unknown. The aim of this study was to compare the response to treatment of chronic HIV-related diarrhea, recurrence of diarrhea, and survival in a large cohort of individuals taking protease inhibitors to the outcome in similar patients not receiving protease inhibitors. METHODS: We reviewed the medical records of all patients referred between October 1993 and October 1996 at Bellevue Hospital for endoscopic evaluation of chronic HIV-related diarrhea after negative stool examination. Only patients presenting after December 1995 received protease inhibitor therapy. Follow-up data were obtained from chart review and direct telephone contact. The success of antidiarrheal therapy was compared between protease inhibitor and nonprotease inhibitor groups for patients receiving pathogen-specific therapy and for those with no pathogens found on endoscopy. RESULTS: Two hundred eighty-two of 307 patients evaluated for chronic diarrhea were followed for a mean of 69.9+/-34.1 weeks. Patients receiving protease inhibitors had a significantly higher rate of successful response to antidiarrheal therapy (62.0% vs 33.5%, p < 0.001). Protease inhibitors were associated with a significant decrease in stool frequency (4.8+/-4.5 vs 3.4+/-4.6 bowel movements per day, p = 0.01), an increase in weight (2.4+/-5.9 vs -1.6+/-6.2 kg, p < 0.001), a decrease in recurrence of diarrhea (34.8% vs 15.3%, p = 0.02), and a longer mean survival (148 vs 118 weeks, p = 0.002). CONCLUSIONS: Protease inhibitors significantly improve the outcome of antidiarrheal therapy and survival in patients with chronic HIV-associated diarrhea
— id: 17558, year: 1999, vol: 94, page: 3553, stat: Journal Article,

Do stigmata of hemorrhage have the same clinical importance in patients with bleeding duodenal and gastric ulcers?
Bini, EJ; Cohen, J
1999 APR ;49(4):AB162-AB162, Gastrointestinal endoscopy
— id: 54038, year: 1999, vol: 49, page: AB162, stat: Journal Article,

Endoscopic treatment of adherent clots significantly reduces early rebleeding in patients with peptic ulcer disease
Bini, EJ; Cohen, J
1999 ;49(4):432-432, Gastrointestinal endoscopy
— id: 108260, year: 1999, vol: 49, page: 432, stat: Journal Article,

Stigmata of hemorrhage in patients with duodenal ulcers without overt bleeding on presentation: Prevalence and prognostic significance
Bini, EJ; Cohen, J
1999 APR ;49(4):AB163-AB163, Gastrointestinal endoscopy
— id: 54039, year: 1999, vol: 49, page: AB163, stat: Journal Article,

Intrinsic common bile duct stricture: an unusual presentation of retroperitoneal fibrosis
Lascarides CE; Bini EJ; Newman E; Gordon RB; Sidhu GS; Cohen J
1999 Jul;50(1):102-105, Gastrointestinal endoscopy
— id: 6147, year: 1999, vol: 50, page: 102, stat: Journal Article,

Diagnostic yield and cost-effectiveness of endoscopy in chronic human immunodeficiency virus-related diarrhea
Bini EJ; Cohen J
1998 Oct;48(4):354-361, Gastrointestinal endoscopy
BACKGROUND: Endoscopy is commonly performed in patients with chronic human immunodeficiency virus (HIV)-related diarrhea after negative stool studies. The aim of this study was to determine the diagnostic yield and cost-effectiveness of endoscopy in this setting. METHODS: Consecutive HIV-infected patients with chronic unexplained diarrhea who were referred for diagnostic endoscopy were identified. Patient charts, pathology reports, and endoscopy records were reviewed. RESULTS: A total of 479 endoscopic procedures were performed in 307 patients. A pathogen was identified in 147 patients (47.9%); cytomegalovirus was the most frequent organism found (21.5%). The average cost of identifying a pathogen by endoscopy was $3822.94. Colonoscopy had a greater diagnostic yield than flexible sigmoidoscopy (38.7% vs. 22.4%, p = 0.009) and was more cost-effective. The yield of upper endoscopy was 29.6%. In patients with a CD4 count of less than 100/mm3, endoscopy had a higher diagnostic yield (62.8% vs. 8.3%, p < 0.0001) and a lower cost of identifying a pathogen ($2943.92 vs. $21,583.51) than in those with higher CD4 counts. CONCLUSIONS: Endoscopy frequently identifies a pathogen in HIV-related chronic diarrhea. Colonoscopy is the most cost-effective procedure. Endoscopic evaluation has a significantly higher diagnostic yield and is considerably more cost-effective in patients with a CD4 count of less than 100/mm3 than in those with higher CD4 counts
— id: 7500, year: 1998, vol: 48, page: 354, stat: Journal Article,

Effect of protease inhibitors on the outcome of therapy for chronic HIV-related diarrhea
Bini, EJ; Cohen, J
1998 APR 15 ;114(4):A933-A933, Gastroenterology
— id: 53466, year: 1998, vol: 114, page: A933, stat: Journal Article,

Predictive value of hemorrhage for the diagnosis of occult malignancy in patients with benign-appearing gastric ulcers
Bini, EJ; Rieber, JM; Cohen, J
1998 APR 15 ;114(4):A4-A4, Gastroenterology
— id: 53463, year: 1998, vol: 114, page: A4, stat: Journal Article,

Prevalence and prognostic significance of stigmata of bleeding in patients with gastric ulcers without overt hemorrhage on presentation
Bini, EJ; Rieber, JM; Cohen, J
1998 APR ;47(4):AB80-AB80, Gastrointestinal endoscopy
— id: 53507, year: 1998, vol: 47, page: AB80, stat: Journal Article,

Predictors of gastrointestinal hemorrhage in 893 patients with benign-appearing gastric ulcers
Bini, EJ; Unger, JS; Cohen, J
1998 APR 15 ;114(4):A5-A5, Gastroenterology
— id: 53464, year: 1998, vol: 114, page: A5, stat: Journal Article,

Long duration high-dose interferon therapy for hepatitis C is associated with a high sustained response rate
Pasternak, BA; Cohen, J; Weber, SA; Teperman, L; Tobias, H
1998 APR 15 ;114(4):A1320-A1321, Gastroenterology
— id: 53474, year: 1998, vol: 114, page: A1320, stat: Journal Article,

Outcome following transplantation for autoimmune hepatitis
Valdes, MT; Zakai, MD; Cohen, J; Tobias, H; Talal, A; John, D; Teperman, L
1998 APR 15 ;114(4):A1358-A1358, Gastroenterology
— id: 53475, year: 1998, vol: 114, page: A1358, stat: Journal Article,

Cost-effectiveness of endoscopy in HIV-positive patients with chronic diarrhea
Bini, EJ; Cohen, J
1997 ;45(4):82-82, Gastrointestinal endoscopy
— id: 108263, year: 1997, vol: 45, page: 82, stat: Journal Article,