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Hentschel V, Walter B, Harder N, Arnold F, Seufferlein T, Wagner M, Müller M, Kleger A. Microbial Spectra and Clinical Outcomes from Endoscopically Drained Pancreatic Fluid Collections: A Descriptive Cohort Study. Antibiotics (Basel) 2022; 11:antibiotics11030420. [PMID: 35326883 PMCID: PMC8944472 DOI: 10.3390/antibiotics11030420] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/04/2022] [Accepted: 03/12/2022] [Indexed: 12/10/2022] Open
Abstract
Pancreatic pseudocyst (PC) and walled-off necrosis (WON) are dreaded complications of acute pancreatitis. Standard therapy consists of endoscopic ultrasound-guided transmural placement of stents to expedite resolution through internal drainage of fluids or necrotic material. Either double pigtail plastic stents (DPPS) or lumen-apposing metal stents (LAMS), or a combination of both, are available for this purpose. The objective of this study was to examine the impact of different stent types on infection rates in addition to clinical outcome measures such as periprocedural adverse events. We conducted a retrospective study comprising 77 patients who had undergone endoscopic drainage for PC or WON in a pancreatitis tertiary referral center. Analysis revealed that both bacterial and fungal infections occurred more frequently in patients treated with LAMS with or without DPPS compared to DPPS only. The use of antibiotics and antimycotics followed the same pattern. Furthermore, a prolonged length of hospital stay and a higher likelihood of transfer to an intermediate care unit were observed in patients with LAMS with or without DPPS. These differences were eliminated if only WON patients were analyzed. Our data imply that the clinical course is primarily influenced by the complexity of the pancreatic fluid collection (PFC) itself rather than the stent type. Prospective large-scale cohort studies are mandatory to underpin these findings.
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Affiliation(s)
- Viktoria Hentschel
- Department of Gastroenterology, Clinic of Internal Medicine 1, University Hospital of Ulm, 89081 Ulm, Germany; (V.H.); (B.W.); (N.H.); (F.A.); (T.S.); (M.W.); (M.M.)
- Interdisciplinary Endoscopy Unit, University Hospital of Ulm, 89081 Ulm, Germany
| | - Benjamin Walter
- Department of Gastroenterology, Clinic of Internal Medicine 1, University Hospital of Ulm, 89081 Ulm, Germany; (V.H.); (B.W.); (N.H.); (F.A.); (T.S.); (M.W.); (M.M.)
- Interdisciplinary Endoscopy Unit, University Hospital of Ulm, 89081 Ulm, Germany
| | - Noemi Harder
- Department of Gastroenterology, Clinic of Internal Medicine 1, University Hospital of Ulm, 89081 Ulm, Germany; (V.H.); (B.W.); (N.H.); (F.A.); (T.S.); (M.W.); (M.M.)
| | - Frank Arnold
- Department of Gastroenterology, Clinic of Internal Medicine 1, University Hospital of Ulm, 89081 Ulm, Germany; (V.H.); (B.W.); (N.H.); (F.A.); (T.S.); (M.W.); (M.M.)
| | - Thomas Seufferlein
- Department of Gastroenterology, Clinic of Internal Medicine 1, University Hospital of Ulm, 89081 Ulm, Germany; (V.H.); (B.W.); (N.H.); (F.A.); (T.S.); (M.W.); (M.M.)
- Interdisciplinary Endoscopy Unit, University Hospital of Ulm, 89081 Ulm, Germany
| | - Martin Wagner
- Department of Gastroenterology, Clinic of Internal Medicine 1, University Hospital of Ulm, 89081 Ulm, Germany; (V.H.); (B.W.); (N.H.); (F.A.); (T.S.); (M.W.); (M.M.)
- Interdisciplinary Endoscopy Unit, University Hospital of Ulm, 89081 Ulm, Germany
| | - Martin Müller
- Department of Gastroenterology, Clinic of Internal Medicine 1, University Hospital of Ulm, 89081 Ulm, Germany; (V.H.); (B.W.); (N.H.); (F.A.); (T.S.); (M.W.); (M.M.)
- Interdisciplinary Endoscopy Unit, University Hospital of Ulm, 89081 Ulm, Germany
| | - Alexander Kleger
- Department of Gastroenterology, Clinic of Internal Medicine 1, University Hospital of Ulm, 89081 Ulm, Germany; (V.H.); (B.W.); (N.H.); (F.A.); (T.S.); (M.W.); (M.M.)
- Interdisciplinary Endoscopy Unit, University Hospital of Ulm, 89081 Ulm, Germany
- Correspondence: ; Tel.: +49-731-5000
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Zhou X, Lin H, Su X, Zhang P, Fu C, Kong X, Jin Z, Li Z, Du Y, Zhu H. Metal Versus Plastic Stents for Pancreatic Fluid Collection Drainage: A Systematic Review and Meta-analysis. J Clin Gastroenterol 2021; 55:652-660. [PMID: 33899780 DOI: 10.1097/mcg.0000000000001539] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The therapeutic efficacy of metal stents (MSs) for pancreatic fluid collections (PFCs) is invariably controversial. Here, we conducted a meta-analysis to summarize the results of efficacy of MSs and plastic stents (PSs) in PFC drainage. SUBJECTS AND METHODS We performed a literature search of PubMed/MEDLINE, EMBASE, and COCHRANE for all of the published studies regarding the use of MSs and PSs for endoscopic transmural drainage of PFCs from January, 1 2015 to June 1, 2020. We extracted data from 9 studies (1359 patients) that met the inclusion criteria. The main outcome measures were the rates of treatment success, including technique success and clinical success (CS), adverse events, recurrence, procedure time, and length of hospital stay (LOS). RESULTS There was no difference in overall technique success between patients treated with MSs and PSs for PFCs. However, MSs showed a higher CS rate 92% versus 82% (P<0.01) and a lower overall adverse event rate 20% versus 31% (P<0.01) than PSs. The recurrence rate of PFCs using MSs also had significant advantages over PSs 3% versus 10% (P<0.01) and MSs needed a shorter procedure time than PSs (26.73 vs. 45.40 min, P<0.01). In comparing direct endoscopic necrosectomy use and LOS, there was no difference between MSs and PSs. CONCLUSIONS Bringing together the results of the current study, endoscopic ultrasound-guided drainage of PFCs using MSs may be superior to PSs in terms of CS, adverse events rates and recurrence rate, with similar LOS and direct endoscopic necrosectomy use.
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Affiliation(s)
- Xianzhu Zhou
- Department of Gastroenterology, Changhai Hospital
| | - Han Lin
- Department of Gastroenterology, Changhai Hospital
| | - Xiaoju Su
- Department of Gastroenterology, Changhai Hospital
| | | | - Chunting Fu
- Outpatient Department of Changhai Hospital, Naval Medical University, Shanghai, China
| | - Xiangyu Kong
- Department of Gastroenterology, Changhai Hospital
| | - Zhendong Jin
- Department of Gastroenterology, Changhai Hospital
| | - Zhaoshen Li
- Department of Gastroenterology, Changhai Hospital
| | - Yiqi Du
- Department of Gastroenterology, Changhai Hospital
| | - Huiyun Zhu
- Department of Gastroenterology, Changhai Hospital
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Li J, Yu Y, Li P, Zhang ST. Advancements in the endoscopic treatment of pancreatic fluid collections. Chronic Dis Transl Med 2020; 6:158-164. [PMID: 32885152 PMCID: PMC7451715 DOI: 10.1016/j.cdtm.2020.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Indexed: 12/12/2022] Open
Abstract
Endoscopic drainage of pancreatic fluid collections (PFCs) with fewer complications and less trauma has gradually replaced surgery or percutaneous drainage to become the first-line treatment for PFCs. In recent years, the differential efficacy of various stent techniques to drain different types of PFCs has been controversial. This review summarizes the clinical applications of endoscopic ultrasound-guided stent placement for PFCs drainage.
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Affiliation(s)
- Jing Li
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, Beijing 100050, China
| | - Yang Yu
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, Beijing 100050, China
| | - Peng Li
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, Beijing 100050, China
| | - Shu-Tian Zhang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, Beijing 100050, China
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Ogura T, Nishioka N, Higuchi K. Lumen-apposing metal stent deployment for walled-off necrosis using semi-free hand technique from the intestine. Hepatobiliary Pancreat Dis Int 2020; 19:191-193. [PMID: 31383577 DOI: 10.1016/j.hbpd.2019.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 07/18/2019] [Indexed: 02/05/2023]
Affiliation(s)
- Takeshi Ogura
- 2nd Department of Internal Medicine, Osaka Medical College, 2-7 Daigakuchou, Takatsukishi, Osaka 569-8686, Japan.
| | - Nobu Nishioka
- 2nd Department of Internal Medicine, Osaka Medical College, 2-7 Daigakuchou, Takatsukishi, Osaka 569-8686, Japan
| | - Kazuhide Higuchi
- 2nd Department of Internal Medicine, Osaka Medical College, 2-7 Daigakuchou, Takatsukishi, Osaka 569-8686, Japan
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Weigand K, Mehrl A, Goessmann H, Mueller M, Kandulski A. Endoscopic Necrosectomy of Walled-Off Necrosis following Severe Pancreatitis Using a Hot AxiosTM Stent - A Case Series. Dig Dis 2019; 38:1-4. [PMID: 31726460 DOI: 10.1159/000503991] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 10/08/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Walled-off necrosis is a common complication of severe pancreatitis. Guidelines recommend endoscopic transgastric necrosectomy as therapy of choice. Different endoscopic approaches are possible. METHODS We retrospectively analyzed our series of 9 patients where necrosectomy was performed after application of a lumen-apposing metal stent (LAMS) delivered using a Hot AxiosTM Stent device. RESULTS In all 9 cases, the walled-off necrosis resolved completely. Necrosectomy was performed through the LAMS (mean: 5.7 times). Endoscopic necrosectomy was repeated every 3rd-7th day using 10- or 15-mm snares. There were no major complications. Especially, no early or delayed bleeding was seen. CONCLUSION The Hot AxiosTM Stent device is a safe method for necrosectomy of walled-off necrosis. It enables puncture, drainage, and LAMS insertion in a single delivery, followed by several courses of necrosectomy if needed without stent exchange.
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Affiliation(s)
- Kilian Weigand
- Department of Gastroenterology, University Hospital Regensburg, Regensburg, Germany,
| | - Alexander Mehrl
- Department of Gastroenterology, University Hospital Regensburg, Regensburg, Germany
| | - Holger Goessmann
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Martina Mueller
- Department of Gastroenterology, University Hospital Regensburg, Regensburg, Germany
| | - Arne Kandulski
- Department of Gastroenterology, University Hospital Regensburg, Regensburg, Germany
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Yuste RT, García-Alonso FJ, Sánchez-Ocana R, Cimavilla M, Herrero IP, Carbajo AY, Sanz MDB, Higuera CDLS, Pérez-Miranda M. Safety and clinical outcomes of endoscopic ultrasound-guided gallbladder drainage with lumen-apposing metal stents in patients with dwell time over one year. Ann Gastroenterol 2019; 32:514-521. [PMID: 31474799 PMCID: PMC6686095 DOI: 10.20524/aog.2019.0395] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 05/27/2019] [Indexed: 12/17/2022] Open
Abstract
Background: Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) has proved effective in patients with cholecystitis at high surgical risk. The long-term risks of gallstone-related disease and stent-related adverse events are unknown. Methods: We performed a retrospective evaluation of a case series including subjects who underwent EUS-GBD using lumen-apposing metal stents (LAMS). Patients were identified from a prospective LAMS registry at a single tertiary center. Patients with a stent indwell time <1 year were excluded. Data regarding stent deployment and adverse events were retrieved from the prospective LAMS registry, while emergency room visits, admissions and causes of death were retrieved from electronic medical records. Results: We included 22 patients with a median age of 88.3 years (interquartile range [IQR]: 82.6-92.7), 14 (63.6%) were male. Median follow up was 24.4 months (IQR: 18.2-42.4) and median time to the last available imaging procedure was 607 days (IQR: 463-938). No LAMS-related adverse events were identified beyond the first year of follow up. During follow up, 12 patients (54.5%) visited the emergency room 34 times (1 visit/patient, IQR: 0-3) and a total of 36 hospital admissions were required, with a median of 1 admission/patient (IQR: 0-3). Fourteen (63.6%) patients died during follow up. Only 1 patient (4.5%) required new hospital admissions for gallstone-related disease. Conclusions: There were no adverse events beyond the first year after stent deployment, with only 4.5% of subjects requiring gallstone-related admissions. Permanent EUS-GBD with LAMS may be a definitive treatment for acute cholecystitis in patients ineligible for cholecystectomy.
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Affiliation(s)
- Raúl Torres Yuste
- Gastroenterology Department, Hospital Universitario Río Hortega, Valladolid (Raúl Torres Yuste, Francisco Javier García-Alonso, Ramón Sánchez-Ocana, Ana Yaiza Carbajo, Marina De Benito Sanz, Carlos De la Serna Higuera, Manuel Pérez-Miranda).,Hospital General de Segovia, Segovia (Raúl Torres Yuste)
| | - Francisco Javier García-Alonso
- Gastroenterology Department, Hospital Universitario Río Hortega, Valladolid (Raúl Torres Yuste, Francisco Javier García-Alonso, Ramón Sánchez-Ocana, Ana Yaiza Carbajo, Marina De Benito Sanz, Carlos De la Serna Higuera, Manuel Pérez-Miranda)
| | - Ramón Sánchez-Ocana
- Gastroenterology Department, Hospital Universitario Río Hortega, Valladolid (Raúl Torres Yuste, Francisco Javier García-Alonso, Ramón Sánchez-Ocana, Ana Yaiza Carbajo, Marina De Benito Sanz, Carlos De la Serna Higuera, Manuel Pérez-Miranda)
| | - Marta Cimavilla
- Hospital Río Carrión, Palencia (Marta Cimavilla, Irene Peñas Herrero), Spain
| | - Irene Peñas Herrero
- Hospital Río Carrión, Palencia (Marta Cimavilla, Irene Peñas Herrero), Spain
| | - Ana Yaiza Carbajo
- Gastroenterology Department, Hospital Universitario Río Hortega, Valladolid (Raúl Torres Yuste, Francisco Javier García-Alonso, Ramón Sánchez-Ocana, Ana Yaiza Carbajo, Marina De Benito Sanz, Carlos De la Serna Higuera, Manuel Pérez-Miranda)
| | - Marina De Benito Sanz
- Gastroenterology Department, Hospital Universitario Río Hortega, Valladolid (Raúl Torres Yuste, Francisco Javier García-Alonso, Ramón Sánchez-Ocana, Ana Yaiza Carbajo, Marina De Benito Sanz, Carlos De la Serna Higuera, Manuel Pérez-Miranda)
| | - Carlos De la Serna Higuera
- Gastroenterology Department, Hospital Universitario Río Hortega, Valladolid (Raúl Torres Yuste, Francisco Javier García-Alonso, Ramón Sánchez-Ocana, Ana Yaiza Carbajo, Marina De Benito Sanz, Carlos De la Serna Higuera, Manuel Pérez-Miranda)
| | - Manuel Pérez-Miranda
- Gastroenterology Department, Hospital Universitario Río Hortega, Valladolid (Raúl Torres Yuste, Francisco Javier García-Alonso, Ramón Sánchez-Ocana, Ana Yaiza Carbajo, Marina De Benito Sanz, Carlos De la Serna Higuera, Manuel Pérez-Miranda)
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Saunders R, Ramesh J, Cicconi S, Evans J, Yip VS, Raraty M, Ghaneh P, Sutton R, Neoptolemos JP, Halloran C. A systematic review and meta-analysis of metal versus plastic stents for drainage of pancreatic fluid collections: metal stents are advantageous. Surg Endosc 2019; 33:1412-1425. [PMID: 30191310 PMCID: PMC6484810 DOI: 10.1007/s00464-018-6416-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 08/31/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND The use of fully covered metal stents (FCSEMS) and specifically designed lumen apposing metal stents for transmural drainage of pancreatic fluid collections has become widespread. A systematic review published in 2015 did not support the routine use of metal stents for drainage of pancreatic fluid collections. However, recent studies have shown conflicting data; therefore a systematic review and meta-analysis was performed. METHOD We conducted a database search for original comparative studies between plastic and metal stents. The random effects model was used to calculate pooled risk ratios (RR) with 95% confidence intervals (CI). Outcomes analysed were clinical success, adverse events and requirement of further intervention. RESULTS The search identified 936 studies, 7 studies with 681 (340 metal, 341 plastic) patients met inclusion criteria and were included in the meta-analysis. Clinical success was achieved in 93.8% versus 86.2% in the metal and plastic groups, respectively, RR 1.08 [95% CI 1.02-1.14]; p = 0.009. Adverse events were reduced for metal stents when compared with plastic (10.2% vs. 25.0%), RR 0.42 [95% CI 0.22-0.81]; p = 0.010. Metal stent usage reduced bleeding (2.8% vs. 7.9%), RR 0.37; [95% CI 0.18-0.75]; p = 0.006. Further intervention was required in 12.4% of patients in the metal stent group versus 26.7% for plastic stents, RR 0.54; [95% CI 0.22-1.29]; p = 0.165. CONCLUSIONS The use of metal stents for drainage of pancreatic fluid collections is associated with improved clinical success, fewer adverse events and reduced bleeding compared to plastic stents.
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Affiliation(s)
- Rebecca Saunders
- Pancreatitis Research Group, Royal Liverpool University Hospital, Liverpool, UK
| | - Jayapal Ramesh
- Gastroenterology, Royal Liverpool University Hospital, Liverpool, UK
| | - Silvia Cicconi
- Liverpool Cancer Trials Unit, University of Liverpool, Liverpool, UK
| | - Jonathan Evans
- Radiology, Royal Liverpool University Hospital, Liverpool, UK
| | | | | | - Paula Ghaneh
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Robert Sutton
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - John P Neoptolemos
- General Surgery, Universitatsklinikum Heidelberg Chirurgische Klinik, Heidelberg, Germany
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Abstract
Since the original description of pancreatic fluid collections (PFC) in 1761 by Morgagni, their diagnosis, description, and management have continued to evolve. The mainstay of therapy for symptomatic PFCs has been the creation of a communication between a PFC and the stomach, to enable drainage. Surgical creation of these drainage conduits had been the gold standard of therapy; however, there has been a paradigm shift in recent years with an increasing role of endoscopic drainage. The techniques of endoscopic drainage have evolved from blind fluid aspiration to include endoscopic necrosectomy and the placement of lumen-apposing metal stents.
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Affiliation(s)
- Steven Shamah
- University of Chicago Medical Center, CERT Division, 5700 South Maryland Avenue, MC 8043, Chicago, IL 60637, USA
| | - Patrick I Okolo
- Division of Gastroenterology, Lenox Hill Hospital, 100 East 77th Street, 2nd Floor, New York, NY 10075, USA.
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Amateau SK, Freeman ML. Avoidance, Recognition, and Management of Complications Associated with Lumen-Apposing Metal Stents. Gastrointest Endosc Clin N Am 2018. [PMID: 29519334 DOI: 10.1016/j.giec.2017.11.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The lumen-apposing metal stent has evolved endoscopic transluminal therapies, although it has potential complications, including maldeployment, bleeding, perforation, migration, and several risks specific to necrotizing pancreatitis. Careful planning and technique mitigate these inherent risks of lumen-apposing metal sent deployment; however, setbacks occur even in the most experienced of hands. Therefore, early recognition and management of these complications are critical to alleviating morbidity and avoiding mortality. Management frequently requires multidisciplinary effort, including advanced endoscopic technique and consultation of interventional radiologic and surgical colleagues.
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Affiliation(s)
- Stuart K Amateau
- University of Minnesota Medical Center, Department of Medicine, Division of Gastroenterology and Hepatology, MMC 36 - 420 Delaware Street SE, Minneapolis, MN 55455, USA
| | - Martin L Freeman
- University of Minnesota Medical Center, Department of Medicine, Division of Gastroenterology and Hepatology, MMC 36 - 420 Delaware Street SE, Minneapolis, MN 55455, USA.
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