So, I will now take questions for myself or Dr. Patel from our two talks. Go ahead. I would suggest that you do a repeat endoscopy. I feel like with hemospray, it tends to be like a temporary hold is kind of what I think of it, especially with tumor bleeding. Do you kind of consistently go back 48 hours later, or do you just wait and hope that it holds? So, I'm a therapeutic endoscopist. I rarely deal with regular run-of-the-mill GI bleeding, but from what I understand in terms of literature and my personal experiences, I actually probably don't re-look in tumoral bleeding. I actually probably don't re-look, because the odds are that their tumor is still going to be bleeding. You probably did nothing other than temporize them, get them stabilized, figure out what tipped them over, and at which point, you know, you want to talk about IR, or you want to talk about radiation therapy in those patients for tumoral bleeding, to be specific. So, if I know that this is not tumoral bleeding, and I have high suspicion that this is a peptic ulcer, then most of the times, I will encourage my colleagues then to take that patient back in 24, 48 hours for a re-look to see if there's any intervenable therapy. But we know from the Lao studies that IVPPI does downgrade lesions after, you know, so those are the patients who IVPPI would be of benefit to downgrade their lesion with regards to endoscopic therapy. Any other questions? So, I think from a guidelines perspective, if I can ask a question. How are you approaching, like, in terms of how are you approaching this 45-50 thing? Like, I mean, a lot of our, so ACP is the, it goes to all the primary care providers and internists who are referring providers, how are people dealing with this, or what are your thoughts there? Yeah. I mean, I would say that the first, the first thing that's really important to keep in mind is that insurance companies are mandated to cover things that have a grade A or B recommendation from the U.S. Preventative Services Task Force. So when you hear of patients who, and that's actually why it was such an important recommendation to come out, is now that a 45-year-old can get a covered screening colonoscopy. So that's one thing to keep in mind. I think the other thing to keep in mind is, I actually think the beauty of lowering the age is that by the time people are 50, you're now going to capture them for screening. So even if the talk is still around 45, I think that's good talk because not every 45-year-old is even in care, right? So most 45-year-olds are pretty healthy. They don't see a primary care doctor. And so it might take them a few years to get their first fit or to get their first colonoscopy. So I think just keeping that language around 45 is good, and then really emphasizing back to patients and to primary care providers that if you would like this, this will be a covered option under your insurance. Any other questions? Is it just along that line for patients between the ages of, oh, yeah. Are you able to hear me now? Okay. So for patients between the ages of 75 to 85, I mean, for example, you're scoping a patient who's like 73, and they've had a history of polyps in the past. What are your recommendations? Yeah. This is actually something I care a lot about and didn't have time to dive into, but I think this is the next big field in colon cancer screening is talking about when we stop. And so back on that table, you'll have all the slides. I did actually still list out the upper ages and what they recommend. The guidance is really mixed. Some societies are recommending stopping completely at 75, like we are done, with regards to primary screening, not surveillance. Other societies say that it's a risk-benefit analysis. So we could talk about President Biden and how he would not be eligible for screening. I think most people are still going to screen him. But so it's the patient in front of you at the end of the day. But what I do is I start to take into account what their history is. So if I have a very healthy 77-year-old who comes in, has never had any sort of colon cancer screening, has a good 10-year life expectancy, I think it's absolutely reasonable to offer them screening. And then in terms of risks, you do just have to go through the fact that there is good literature, that octogenarians, people who are older, have higher comorbidities in terms of risks around the procedure, so falls, PrEP-related injuries, poor PrEP, and then just more complications in general. So it's actually the largest predictor of complication is age. And so it ultimately, I think, is still a risk-benefit analysis, but I think we're going to hopefully get more and more guidance as we have an aging population. I think there's also a paper published by MAH out of Boston that is wonderful in terms of helping us understand that 75-85 risk, and they identify specific risk factors, so the MAH paper from Boston.

follow-up procedures

tumor bleeding

peptic ulcers

screenings

colon cancer