Gastroenterology & Hepatology

April 2023 - Volume 19, Issue 4

Letter From the Editor: Green Endoscopy and Sustainable Care

Gary R. Lichtenstein, MD, AGAF, FACP, FACG

Sustainability is becoming an important concept in medical care, particularly in endoscopy. This month’s issue of Gastroenterology & Hepatology highlights this meaningful and timely topic in an interview with Dr Heiko Pohl in the Advances in Endoscopy column. Dr Pohl provides a thoughtful discussion of the meaning of green endoscopy, the carbon footprint of gastrointestinal endoscopy, and the pillars of sustainable care. He also discusses the recent 5-year strategic plan for environmental sustainability from the major US gastroenterology societies and compares it with the European multisociety position statement for reducing the carbon footprint of endoscopy. Finally, he offers helpful suggestions on how endoscopy departments can be less wasteful and gives examples of how endoscopists can start decreasing the carbon footprint of their units.

One of our review articles this month explores the utility of using botulinum toxin A for the treatment of gastrointestinal disorders. Dr Wasay A. Mohajir, Dr Shruti Khurana, Dr Khushboo Singh, Dr Reubyn William Chong, and Dr Manoop S. Bhutani provide a comprehensive review of the current literature to evaluate the efficacy of botulinum toxin A for the treatment of the gastrointestinal tract from the cricopharyngeal region to the anus. The conditions that are examined include cricopharyngeal dysphagia, achalasia, gastroparesis, sphincter of Oddi disorders, chronic anal fissures, anismus, and postsurgical hemorrhoidectomy pain.

Our other review article this month centers on mesenteric panniculitis, the rare benign condition defined by chronic inflammation and adipose tissue fibrosis, usually involving the small bowel mesentery and occasionally the mesocolon and omentum. Dr Marianny Sulbaran, Dr Frank K. Chen, Dr Francis A. Farraye, and Dr Jana G. Hashash review the epidemiology, pathophysiology, clinical presentation, laboratory and imaging findings, and treatment of this condition. The authors note that data on its treatment are limited, and hope to raise awareness and improve understanding of the disease.

Fecal diversion is explored in our Advances in IBD column. Dr Jean H. Ashburn discusses the use and outcomes of fecal diversion in perianal Crohn’s disease, Crohn’s colitis, diverticulitis, and colon cancer, among other settings. She also discusses how to decide when to divert a patient, whether fecal diversion should be avoided in any situations, and the use of fecal diversion in immunosuppressed patients, along with other issues.

Our NASH in Focus column highlights treatments in development for patients with nonalcoholic steatohepatitis. Professor Vlad Ratziu first discusses the challenges of drug development in this setting and the lessons that have been learned. Other topics of discussion include what is exciting about the 2 drugs furthest in development (obeticholic acid and resmetirom), other drugs in phase 2 and 3 trials, and why combination therapy makes sense.

Finally, I would like to welcome Dr Nancy S. Reau as the new section editor of our monthly Advances in Hepatology column. This month’s column, authored by Dr Tatyana Kushner, covers hepatitis C virus (HCV) during pregnancy. Her discussion includes why the prevalence of HCV in pregnant women has been increasing recently in the United States, the impact of HCV on pregnancy and vice versa, universal HCV screening during pregnancy, and treatment during pregnancy.

I hope that you enjoy these articles and find them interesting and clinically useful.


Gary R. Lichtenstein, MD, AGAF, FACP, FACG

Millennium Medical Publishing, Inc