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Yoo H, Firkins SA, Kwon AG, Imperio-Lagabon K, Bajwa R, Flora B, Simons-Linares CR. Is open-capsule proton pump inhibitor associated with faster healing time for marginal ulceration after Roux-en-Y gastric bypass? Surg Obes Relat Dis 2024; 20:254-260. [PMID: 37996260 DOI: 10.1016/j.soard.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/19/2023] [Accepted: 10/09/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Marginal ulceration (MU) is a significant cause of morbidity after Roux-en-Y gastric bypass (RYGB). Proton pump inhibitors (PPIs) are the primary treatment. Prior limited data suggest that open-capsule PPIs (OC-PPIs) improve MU healing compared with intact-capsule PPIs (IC-PPIs), necessitating further validation. OBJECTIVES We aimed to compare healing times of MU after RYGB when treated with OC-PPIs versus IC-PPIs. SETTING Tertiary academic center, United States. METHODS We retrospectively analyzed patients with prior RYGB diagnosed with MU from 2012 to 2022. Patients requiring mechanical closure without documented healing and without clear PPI prescriptions were excluded. The primary outcome was time to ulcer healing. Log-rank testing and Kaplan-Meier survival curve analyses were performed to compare MU healing times when treated with OC-PPIs versus IC-PPIs. Subgroup analyses further characterized ulcer healing times based on type and dosage of PPI used. RESULTS A total of 108 patients were included for final analysis (38 received OC-PPIs and 70 received IC-PPIs). Treatment with OC-PPIs significantly decreased MU healing time compared with IC-PPIs (146.18 versus 226.14 d; p = .018). However, when stratified by PPI potency, the positive effect of opening the capsule lost significance. CONCLUSION In this study, OC-PPIs significantly improved MU healing times compared with IC-PPIs in RYGB patients, consistent with prior data. However, on subgroup analysis comparing therapy with similar PPI potency, the MU healing time did not differ with respect to administration method. These results highlight the need for a prospective randomized trial to compare the true effect of administration method.
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Affiliation(s)
- Heesoo Yoo
- Internal Medicine Department, Community Care Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Stephen A Firkins
- Gastroenterology, Hepatology and Nutrition Department, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Alvin G Kwon
- Internal Medicine Department, Community Care Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Kristelle Imperio-Lagabon
- Internal Medicine Department, Community Care Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Ramanpreet Bajwa
- Internal Medicine Department, Community Care Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Bailey Flora
- Center for Human Nutrition Department, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - C Roberto Simons-Linares
- Gastroenterology, Hepatology and Nutrition Department, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
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Garg R, Thind K, Bhalla J, Simonson MT, Simons-Linares CR, Singh A, Joyce D, Chahal P. Long-term recurrence after endoscopic versus surgical ampullectomy of sporadic ampullary adenomas: a systematic review and meta-analysis. Surg Endosc 2023:10.1007/s00464-023-10083-0. [PMID: 37221416 DOI: 10.1007/s00464-023-10083-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 04/17/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND AND AIMS Ampullary adenomas are treated both surgically and endoscopically, however, data comparing both techniques are lacking. We aimed to compare long-term recurrence of benign sporadic adenomas after endoscopic (EA) and surgical ampullectomy (SA). METHODS A comprehensive literature search of multiple databases (until December 29, 2020) was performed to identify studies reporting outcomes of EA or SA of benign sporadic ampullary adenomas. The outcome was recurrence rate at 1 year, 2-year, 3 year and 5 years after EA and SA. RESULTS A total of 39 studies with 1753 patients (1468 EA [age 61.1 ± 4.0 years, size 16.1 ± 4.0 mm], 285 SA [mean age 61.6 ± 4.48 years, size 22.7 ± 5.4 mm]) were included in the analysis. At year 1, pooled recurrence rate of EA was 13.0% (95% confidence interval [CI] 10.5-15.9], I2 = 31%) as compared to SA 14.1% (95% CI 9.5-20.3 I2 = 15.8%) (p = 0.82). Two (12.5%, [95% CI, 8.9-17.2] vs. 14.3 [95% CI, 9.1-21.6], p = 0.63), three (13.3%, [95% CI, 7.3-21.6] vs. 12.9 [95% CI, 7.3-21.6], p = 0.94) and 5 years (15.7%, [95% CI, 7.8-29.1] vs. 17.6% [95% CI, 6.2-40.8], p = 0.85) recurrence rate were comparable after EA and SA. On meta-regression, age, size of lesion or enbloc and complete resection were not significant predictors of recurrence. CONCLUSION EA and SA of sporadic adenomas have similar recurrence rates at 1, 2, 3 and 5 years of follow up.
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Affiliation(s)
- Rajat Garg
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, 9500 Euclid Avenue Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Komal Thind
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jaideep Bhalla
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Marian T Simonson
- Cleveland Clinic Alumni Library, Cleveland Clinic, Cleveland, OH, USA
| | - C Roberto Simons-Linares
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, 9500 Euclid Avenue Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Amandeep Singh
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, 9500 Euclid Avenue Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Daniel Joyce
- Department of Hepatopancreaticobiliary Surgery, Digestive Diseases and Surgery Institute Cleveland Clinic, Cleveland, OH, USA
| | - Prabhleen Chahal
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, 9500 Euclid Avenue Cleveland Clinic Foundation, Cleveland, OH, USA.
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Garg R, Mohammed A, Singh A, Siddiki H, Bhatt A, Sanaka MR, Jang S, Simons-Linares CR, Stevens T, Vargo J, Chahal P. Mortality Trends, Outcomes, and Predictors of Portal Vein Thrombosis in Acute Pancreatitis Patients: A Propensity-Matched National Study. Dig Dis Sci 2023; 68:2674-2682. [PMID: 37097368 DOI: 10.1007/s10620-023-07945-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 04/04/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND Portal vein thrombosis (PVT) is a rare complication of acute pancreatitis (AP) and might be associated with worse outcomes. We aimed to study trends, outcomes, and predictors of PVT in AP patients. METHODS The National Inpatient Sample database was utilized to identify the adult patients (≥ 18 years) with primary diagnosis of AP from 2004 to 2013 using International Classification of Disease, Ninth Revision. Patients with and without PVT were entered into propensity matching model based on baseline variables. Outcomes were compared between both groups and predictors of PVT in AP were identified. RESULTS Among the total of 2,389,337 AP cases, 7046 (0.3%) had associated PVT. The overall mortality of AP decreased throughout the study period (p trend ≤ 0.0001), whereas mortality of AP with PVT remained stable (1-5.7%, p trend = 0.3). After propensity matching, AP patients with PVT patients had significantly higher in-hospital mortality (3.3% vs. 1.2%), AKI (13.4% vs. 7.7%), shock (6.9% vs. 2.5%), and need for mechanical ventilation (9.2% vs. 2.5%) along with mean higher cost of hospitalization and length of stay (p < 0.001 for all). Lower age (Odd ratio [OR] 0.99), female (OR 0.75), and gallstone pancreatitis (OR 0.79) were negative predictors, whereas alcoholic pancreatitis (OR 1.51), cirrhosis (OR 2.19), CCI > 2 (OR 1.81), and chronic pancreatitis (OR 2.28) were positive predictors of PVT (p < 0.001 for all) in AP patients. CONCLUSION PVT in AP is associated with significantly higher risk of death, AKI, shock, and need for mechanical ventilation. Chronic and alcoholic pancreatitis is associated with higher risk of PVT in AP.
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Affiliation(s)
- Rajat Garg
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Abdul Mohammed
- Department of Gastroenterology and Hepatology, Advent Health, Orlando, FL, USA
| | - Amandeep Singh
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Hassan Siddiki
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Amit Bhatt
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Madhusudhan R Sanaka
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sunguk Jang
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - C Roberto Simons-Linares
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Tyler Stevens
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - John Vargo
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Prabhleen Chahal
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
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Ragheb JG, Simons-Linares CR, Pluskota C, Confer B, Butler R, Diehl DL, Khara HS, Johal AS, Walsh RM, Chahal P. Utility of endoscopic ultrasound for assessment of locoregional recurrence of pancreatic adenocarcinoma after surgical resection. Endosc Int Open 2023; 11:E401-E408. [PMID: 37102183 PMCID: PMC10125777 DOI: 10.1055/a-2046-4984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 02/20/2023] [Indexed: 04/28/2023] Open
Abstract
Background and study aims Up to 80 % of patients with pancreatic adenocarcinoma develop locoregional recurrence after primary resection. However, the detection of recurrent pancreatic ductal adenocarcinoma (RPDAC) after pancreatic surgery can be challenging because of difficulty distinguishing locoregional recurrence from normal postoperative or post-radiation changes. We sought to evaluate the utility of endoscopic ultrasound (EUS), in detecting pancreatic adenocarcinoma recurrence after surgical resection and its impact on the clinical management of patients. Patients and methods This was a retrospective study of all pancreatic cancer patients who underwent EUS post-resection at two tertiary care centers between January 2004 and June 2019. Results Sixty-seven patients were identified. Of these, 57 (85 %) were diagnosed with RPDAC, resulting in change in clinical management of 46 (72 %) patients. EUS identified masses not seen on computed tomography, magnetic resonance imaging, or positron emission tomography in seven (14 %). Conclusions EUS is useful in detecting RPDAC after pancreatic surgery and can lead to significant impact on clinical management.
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Affiliation(s)
- Jonathan G. Ragheb
- Department of Gastroenterology, Hepatology, and Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic Florida, Weston, Florida, United States
| | - C. Roberto Simons-Linares
- Department of Gastroenterology and Hepatology, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | - Christopher Pluskota
- Department of Gastroenterology, University Hospitals, Elyria, Ohio, United States
| | - Bradley Confer
- Department of Gastroenterology and Nutrition, Geisinger Health, Danville, Pennsylvania, United States
| | - Robert Butler
- Department of Quantitative Sciences, Cleveland Clinic, Cleveland, Ohio, United States
| | - David L. Diehl
- Department of Gastroenterology and Nutrition, Geisinger Health, Danville, Pennsylvania, United States
| | - Harshit S. Khara
- Department of Gastroenterology and Nutrition, Geisinger Health, Danville, Pennsylvania, United States
| | - Amitpal S. Johal
- Department of Gastroenterology and Nutrition, Geisinger Health, Danville, Pennsylvania, United States
| | - R. Matthew Walsh
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | - Prabhleen Chahal
- Department of Gastroenterology and Hepatology, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, United States
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5
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Chittajallu V, Omar YA, Simons-Linares CR, Chahal P. Endoscopic balloon dilation management for benign duodenal stenosis. Surg Endosc 2023; 37:3610-3618. [PMID: 36624215 DOI: 10.1007/s00464-022-09844-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND AIMS Benign duodenal stenosis (BDS) is most commonly caused by peptic ulcer disease (PUD). Endoscopic balloon dilation (EBD) is the recommended initial management despite limited supporting literature. Our study investigated the etiologic spectrum of BDS and its response to endoscopic dilation. METHODS We performed a cohort study of a prospectively maintained database of BDS at our large tertiary academic center between 2002 and 2018. All patients who underwent EBD were analyzed. Dilation was performed using through-the-scope balloons. Technical and clinical successes of initial and repeat EBD were compared. Descriptive statistics, univariate, and multivariate analysis were performed. RESULTS The study included 86 patients with 54.7% female gender. Etiologies included 39 patients with PUD (45.3%), 19 patients with Crohn's disease (22.1%), 23 patients had idiopathic etiologies (26.7%), and 5 patients were listed as other etiologies (5.8%). Proximal stricture location (1st part of duodenum) occurred in 66% of females, whereas distal duodenal involvement was seen in 63.6% of males (p value 0.007). Usage of PPI was associated with 3.6 times higher clinical success rate (p value 0.04). Technical (97.4%) and clinical (77.8%) successes for index dilations in PUD were not significantly better than those of non-PUD patients (p values 0.99, 0.52). CONCLUSION EBD has both a high technical and clinical success for BDS regardless of etiology and should be considered over initial surgical intervention due to low risk profile. Males tend to have more distal duodenal involvement, and PPI usage is an independent predictor for clinical success.
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Affiliation(s)
- Vibhu Chittajallu
- Digestive Health Institute, University Hospitals Cleveland, Cleveland, OH, USA.
| | - Yazan Abu Omar
- Department of Hospital Medicine, Cleveland Clinic, Cleveland, OH, USA
| | | | - Prabhleen Chahal
- Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
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6
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Alkhayyat M, Bachour S, Abou Saleh M, Abureesh M, Almomani A, Simons-Linares CR, Mansoor E, Sandhu D, Bhatt A, Chahal P. The Epidemiology of Annular Pancreas in the United States: A Population-based Study. J Clin Gastroenterol 2022; 56:186-191. [PMID: 33769394 DOI: 10.1097/mcg.0000000000001531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 02/13/2021] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND AIMS Annular pancreas is a rare congenital condition where the second part of the duodenum is encircled by pancreatic tissue. There is a scarcity of data on its natural history therefore, we aimed to evaluate the epidemiology of annular pancreas and identify underlying associations using a large database. METHODS A multi-institutional database (Explorys) was surveyed. A cohort of patients with a Systematized Nomenclature of Medicine-Clinical Terms diagnosis of "MRI, CT, EUS and/or ERCP" between April 2015 and April 2020 was identified. Subsequently a cohort of patients with history of "annular pancreas" was identified. RESULTS There were a total of 40,075,980 individuals in the database with 6,162,600 (15.38%) who had an magnetic resonance imaging, computed tomography, endoscopic retrograde cholangiopancreatography, and/or endoscopic ultrasound. There were 210 (3.4/100,000) had a diagnosis of annular pancreas. When compared with the control group, patients with annular pancreas were more likely to have a history of alcohol use, smoking, acute pancreatitis, chronic pancreatitis, gastritis, duodenitis, jaundice, and gastrointestinal outlet obstruction. CONCLUSIONS This is the largest study evaluating the epidemiology of annular pancreas. We found the estimated prevalence rate of annular pancreas to be 3.4/100,000 in those who had abdominal imaging. Annular pancreas was more likely to be diagnosed in patients with symptoms pertaining to acute or chronic pancreatitis, biliary, and gastric outlet obstruction.
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Affiliation(s)
| | | | | | | | | | | | - Emad Mansoor
- Gastroenterology, Hepatology and Nutrition, Digestive Disease and Surgery Institute, University Hospitals Cleveland Medical Center, Cleveland, OH
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7
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Argueta PP, Salazar M, Vohra I, Corral JE, Lukens FJ, Vargo JJ, Chahal P, Simons-Linares CR. Thirty-Day Readmission Among Patients with Alcoholic Acute Pancreatitis. Dig Dis Sci 2021; 66:4227-4236. [PMID: 33469806 DOI: 10.1007/s10620-020-06765-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 12/06/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND/OBJECTIVES Alcoholic acute pancreatitis (AAP) comprises the second most common cause of acute pancreatitis in the USA, and there is lack of data regarding 30-day specific readmission causes and predictors. We aim to identify 30-day readmission rate, causes, and predictors of readmission. METHODS Retrospective analysis of the 2016 National Readmission Database of adult patients readmitted within 30 days after an index admission for AAP. RESULTS Totally, 76,609 AAP patients were discharged from the hospital in 2016. The 30-day readmission rate was 12%. The main cause of readmission was another episode of AAP. Readmission was not associated with higher mortality (1.3% vs. 1.2%; P = 0.21) or prolonged length of stay (5.2 vs. 5.0 days; P = 0.06). The total health care economic burden was $354 million in charges and $90 million in costs. Independent predictors of readmission were having Medicaid insurance, a Charlson comorbidity index score ≥ 3, use of total parenteral nutrition, opioid abuse disorder, prior pancreatic cyst, chronic alcoholic pancreatitis, and other chronic pancreatitis. Obesity was associated with lower odds of readmission. CONCLUSION Readmission rate for AAP is high and its primary cause are recurrent episodes of AAP. Alcohol and substance abuse pose a high burden on our health care system. Public health strategies should be targeted to provide alcohol abuse disorder rehabilitation and cessation resources to alleviate the burden on readmission, the health care system and to improve patient outcomes.
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Affiliation(s)
- Pedro Palacios Argueta
- Internal Medicine Department, John Stroger Hospital of Cook County, Rush University, Chicago, IL, USA
| | - Miguel Salazar
- Gastroenterology, Hepatology and Nutrition Department, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Ishaan Vohra
- Internal Medicine Department, John Stroger Hospital of Cook County, Rush University, Chicago, IL, USA
| | - Juan E Corral
- Gastroenterology and Hepatology Department, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Frank J Lukens
- Gastroenterology and Hepatology Department, Mayo Clinic Florida, Jacksonville, FL, USA
| | - John J Vargo
- Gastroenterology, Hepatology and Nutrition Department, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Prabhleen Chahal
- Gastroenterology, Hepatology and Nutrition Department, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - C Roberto Simons-Linares
- Gastroenterology, Hepatology and Nutrition Department, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
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8
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Zaver HB, Ghoz H, Stancampiano F, Alnahhal KI, Malviya B, Patel K, Rodriguez AC, Oberoi M, Koralewski A, Crawford MJ, Choudhry A, Mareth K, Werlang ME, Kroner PT, Simons-Linares CR, Lukens F, Bartel MJ, Stark M, Brahmbhatt B. Risk of bleeding following double balloon enteroscopy in patients on continued antiplatelet and/or anticoagulation therapy. Endosc Int Open 2021; 9:E1397-E1403. [PMID: 34466365 PMCID: PMC8382496 DOI: 10.1055/a-1499-6988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 04/25/2021] [Indexed: 11/03/2022] Open
Abstract
Background and study aims Anticoagulation (AC) and antiplatelet (AP) therapy may increase the risk of gastrointestinal bleeding after double balloon enteroscopy (DBE); however, limited data are currently available regarding the incidence. The aim of this study was to assess the incidence and clinical characteristics of post-DBE bleeding in patients on AC and AP therapy. Patients and methods The medical records of patients who underwent DBE between 2009 and 2013 at Mayo Clinic, Florida, were retrospectively reviewed. Patients were divided into three groups: 1) continued AP therapy; 2) AC therapy; and 3) neither AP nor AC at the time of DBE. Follow-up data were collected at 60 days and 1 year. Results A total of 683 patients were identified; 43 on AC, 183 on AP and 457 not on AP or AC therapy. The most common indication for DBE was obscure gastrointestinal bleeding in the groups on and not on AP (85.3 % vs 70.9 %, P < 0.0001). There was no statistical difference in post-DBE bleeding rates in patients on AP vs not on AP at 60 days (11.5 % vs 7.5 %, P = 0.12) or 1 year (19.9 % vs 15.7 %, P = 0.23). Rates of bleeding in patients on AC were 11.6 % within 60 days and 22.5 % within 1 year. Multivariate analysis reflected American Society of Anesthesiologist > 3 and indication for DBE of GI bleeding were independent risk factors for post-DBE bleeding within 1 year. Conclusions Continued antiplatelet use at the time of DBE was not an independent risk factor for bleeding post-DBE at 60 days or 1 year of follow up.
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Affiliation(s)
- Himesh B. Zaver
- Division of Internal Medicine, Mayo Clinic, Jacksonville, Florida, United States
| | - Hassan Ghoz
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, United States
| | | | - Khaled I. Alnahhal
- Division of Vascular Surgery, Mayo Clinic, Jacksonville, Florida, United States
| | - Balkishan Malviya
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, United States
| | - Krupa Patel
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, United States
| | - Andrea C. Rodriguez
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, United States
| | - Mansi Oberoi
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, United States
| | - Andrea Koralewski
- Division of Internal Medicine, Mayo Clinic, Jacksonville, Florida, United States
| | - Matthew J. Crawford
- Division of Internal Medicine, Mayo Clinic, Jacksonville, Florida, United States
| | - Aruj Choudhry
- Division of Gastroenterology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, United States
| | - Karl Mareth
- Division of Internal Medicine, Mayo Clinic, Jacksonville, Florida, United States
| | - Monia E. Werlang
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, United States
| | - Paul T. Kroner
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, United States
| | | | - Frank Lukens
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, United States
| | - Michael J. Bartel
- Division of Gastroenterology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, United States
| | - Mark Stark
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, United States
| | - Bhaumik Brahmbhatt
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, United States
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9
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Alkhayyat M, Saleh MA, Abureesh M, Khoudari G, Qapaja T, Mansoor E, Simons-Linares CR, Vargo J, Stevens T, Rubio-Tapia A, Chahal P. The Risk of Acute and Chronic Pancreatitis in Celiac Disease. Dig Dis Sci 2021; 66:2691-2699. [PMID: 32809104 DOI: 10.1007/s10620-020-06546-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 08/06/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIMS Celiac disease (CD) is a chronic immune-mediated enteropathy that is precipitated by dietary gluten in genetically predisposed individuals. A few studies reported a higher incidence of pancreatitis in the CD population. Using a large US database, we sought to describe the epidemiology, risk, and outcomes of acute pancreatitis (AP) and chronic pancreatitis (CP) in CD patients. METHODS We queried a multiple health system data analytics and research platform (Explorys Inc, Cleveland, OH, USA). A cohort of patients with a diagnosis of CD was identified. Subsequently, individuals who developed a new diagnosis of AP and CP after at least 30 days of being diagnosed with CD were identified. A multivariate regression model was performed to adjust for multiple confounding factors. RESULTS Of the 72,965,940 individuals in the database, 133,400 (0.18%), 362,050 (0.50%), and 95,190 (0.13%) had CD, AP, and CP, respectively. New diagnosis of AP and CP after at least 30 days of CD diagnosis was 1.06%, 0.52%, respectively, compared to non-CD patients with 0.49% for AP and 0.13% for CP, P < .0001. In multivariate regression analysis, patients with CD were at higher risk of developing AP [OR 2.66; 95% CI 2.55-2.77] and CP [OR 2.18; 95% CI 2.04-2.34]. Idiopathic AP was the most common etiology among CD patients [OR 1.54; 95% CI 1.34-1.77]. CONCLUSIONS In this largest US population database and after adjusting for several confounders, patients with CD were at increased risk of developing AP and CP. Celiac disease patients had worse outcomes and higher medical burden compared to non-CD patients. Recurrent abdominal pain that suggests pancreatic etiology, idiopathic pancreatitis, or elevation of pancreatic enzymes should warrant investigation for CD as a potential cause of pancreatic disease.
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Affiliation(s)
- Motasem Alkhayyat
- Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.,Department of Internal Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Mohannad Abou Saleh
- Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.,Gastroenterology, Hepatology and Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue/A30, Cleveland, OH, 44195, USA
| | - Mohammad Abureesh
- Staten Island University Hospital, 475 Seaview Ave, Staten Island, NY, 10305, USA
| | - George Khoudari
- Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Thabet Qapaja
- Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Emad Mansoor
- University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
| | | | - John Vargo
- Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Tyler Stevens
- Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | | | - Prabhleen Chahal
- Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA. .,Gastroenterology, Hepatology and Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
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10
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Abstract
Infectious etiologies are rare cause of acute pancreatitis (AP). We sought to investigate the frequency of viral-attributed AP (VIAP) and describe its natural course and clinical features. Comprehensive review of PubMed and EMBASE in English until December 31, 2019, was performed. AP diagnosis and severity were defined per the Revised Atlanta Classification. Viral infections were diagnosed by serology and/or histology. A diagnosis of viral infection, with a concurrent AP diagnosis, a temporal resolution of both entities, and the attempt to exclude the most common etiologies of AP defined VIAP. Two independent reviewers reviewed eligible publications. Bias risk was assessed with the Murad tool. A total of 209 cases identified in 128 publications met inclusion criteria. Mean age was 38.9 ± 1.28 years. Male-to-female ratio was 2.2:1, and 28% of patients were immunocompromised. Viral hepatitis (A, B, C, D and E) was the most common virus and accounted for 34.4% of cases, followed by coxsackie and echoviruses (14.8%), hemorrhagic fever viruses (12.4%), CMV (12.0%), VZV (10.5%), mumps and measles (3.8%), primary HIV infection (3.8%), HSV (1.9%), EBV (1.9%), and the remainder of cases (2.9%) attributed to adenovirus, influenza H1N1, and multiple viruses. Severity of AP was: 43.1% mild, 11.7% moderately severe, 32.4% severe. Death occurred in 42 (20.1%) patients. A significant portion of VIAP patients were immunocompromised (28.0%) and accounted for 71.4% of mortality cases. Mortality was higher than that reported for AP from other etiologies in the literature.
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Affiliation(s)
- C Roberto Simons-Linares
- Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
| | - Zaid Imam
- Department of Internal Medicine, William Beaumont Hospital, Royal Oak, MI, USA
| | - Prabhleen Chahal
- Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
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11
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Alkhayyat M, Abou Saleh M, Grewal MK, Abureesh M, Mansoor E, Simons-Linares CR, Abelson A, Chahal P. Pancreatic manifestations in rheumatoid arthritis: a national population-based study. Rheumatology (Oxford) 2021; 60:2366-2374. [PMID: 33244600 DOI: 10.1093/rheumatology/keaa616] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 08/21/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES RA is a systemic autoimmune disease characterized by persistent joint inflammation. Extra-articular manifestations of RA can involve different organs including the gastrointestinal (GI) system. Using a large database, we sought to describe the epidemiology of pancreas involvement in RA. METHODS We queried a multicentre database (Explorys Inc, Cleveland, OH, USA), an aggregate of electronic health record data from 26 major integrated US healthcare systems in the US from 1999 to 2019. After excluding patients younger than 18, a cohort of individuals with Systematized Nomenclature of Medicine - Clinical Terms (SNOMED-CT) diagnosis of RA was identified. Within this cohort, patients who developed a SNOMED-CT diagnosis of acute pancreatitis (AP), chronic pancreatitis (CP) and primary pancreatic cancer (PaCa) after at least 30 days of RA diagnosis were identified. Statistical analysis for multivariate model was performed using Statistical Package for Social Sciences (SPSS version 25, IBM Corp) to adjust for several factors. RESULTS Of the 56 183 720 individuals in the database, 518 280 patients had a diagnosis of RA (0.92%). Using a multivariate regression model, patients with RA were more likely to develop AP [odds ratio (OR): 2.51; 95% CI: 2.41, 2.60], CP (OR: 2.97; 95% CI: 2.70, 3.26) and PaC (OR: 1.79; 95% CI: 1.52, 2.10). CONCLUSION In this large database, we found a modest increased risk of AP and CP among patients with RA after adjusting for the common causes of pancreatitis. Further studies are required to better understand this association and the effect of medications used for RA.
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Affiliation(s)
| | - Mohannad Abou Saleh
- Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic Foundation, Cleveland, OH
| | | | - Mohammad Abureesh
- Department of Internal Medicine, Staten Island University Hospital, Staten Island, NY
| | - Emad Mansoor
- Department of Gastroenterology, University Hospitals Cleveland Medical Center
| | - C Roberto Simons-Linares
- Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic Foundation, Cleveland, OH
| | - Abby Abelson
- Department of Rheumatology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Prabhleen Chahal
- Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic Foundation, Cleveland, OH
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12
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Affiliation(s)
| | - Reza Milano
- Section of Gastroenterology, Fox Chase Cancer Center Temple Health, Philadelphia, Pennsylvania
| | - Michael J Bartel
- Section of Gastroenterology, Fox Chase Cancer Center Temple Health, Philadelphia, Pennsylvania
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13
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Aihara H, Kushnir V, Anand GS, Cassani L, Chahal P, Dacha S, Duloy A, Ghassemi S, Huang C, Kowalski TE, Qayed E, Sheth SG, Simons-Linares CR, Taylor JR, Umar SB, Vela SAF, Walsh CM, Williams RL, Wagh MS. Core curriculum for endoscopic ablative techniques. Gastrointest Endosc 2021; 93:305-308. [PMID: 32854937 DOI: 10.1016/j.gie.2020.06.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 06/19/2020] [Indexed: 02/07/2023]
Affiliation(s)
| | - Hiroyuki Aihara
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Vladimir Kushnir
- Division of Gastroenterology, John T. Milliken Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Gobind S Anand
- Division of Gastroenterology, University of California San Diego, San Diego, California, USA
| | - Lisa Cassani
- Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, and Atlanta VA Medical Center, Atlanta, Georgia, USA
| | - Prabhleen Chahal
- Digestive Disease and Surgery Institute, Cleveland Clinic, OH, USA
| | - Sunil Dacha
- Division of Gastroenterology, Department of Internal Medicine, Houston Methodist Hospital and Texas A&M University, Houston, Texas, USA
| | - Anna Duloy
- Division of Gastroenterology, University of Colorado-Denver, Aurora, Colorado, USA
| | - Sahar Ghassemi
- Division of Gastroenterology and Hepatology, Duke University, Durham, North Carolina
| | - Christopher Huang
- Section of Gastroenterology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Thomas E Kowalski
- Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Emad Qayed
- Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sunil G Sheth
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Jason R Taylor
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Saint Louis University, St Louis, Missouri, USA
| | - Sarah B Umar
- Division of Gastroenterology Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Stacie A F Vela
- Gastroenterology Section, Phoenix VA Health Care System, University of Arizona-Phoenix
| | - Catharine M Walsh
- Division of Gastroenterology, Hepatology and Nutrition and the Research and Learning Institutes, Hospital for Sick Children, Department of Paediatrics and the Wilson Centre, University of Toronto, Toronto, Canada
| | - Renee L Williams
- Department of Medicine, Division of Gastroenterology, NYU Grossman School of Medicine, New York, New York, USA
| | - Mihir S Wagh
- Division of Gastroenterology, University of Colorado-Denver, Aurora, Colorado, USA
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14
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Aihara H, Kushnir V, Anand GS, Cassani L, Chahal P, Dacha S, Duloy A, Ghassemi S, Huang C, Kowalski TE, Qayed E, Sheth SG, Simons-Linares CR, Taylor JR, Umar SB, Vela SAF, Walsh CM, Williams RL, Wagh MS. Core curriculum for endoscopic mucosal resection. Gastrointest Endosc 2021; 93:293-296. [PMID: 32843191 DOI: 10.1016/j.gie.2020.06.053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 06/19/2020] [Indexed: 12/11/2022]
Affiliation(s)
| | - Hiroyuki Aihara
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Vladimir Kushnir
- Division of Gastroenterology, John T. Milliken Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Gobind S Anand
- Division of Gastroenterology, University of California San Diego, San Diego, California, USA
| | - Lisa Cassani
- Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, and Atlanta VA Medical Center, Atlanta, Georgia, USA
| | - Prabhleen Chahal
- Digestive Disease and Surgery Institute, Cleveland Clinic, Ohio, USA
| | - Sunil Dacha
- Division of Gastroenterology, Department of Internal Medicine, Houston Methodist Hospital and Texas A&M University, Houston, Texas, USA
| | - Anna Duloy
- Division of Gastroenterology, University of Colorado-Denver, Aurora, Colorado, USA
| | - Sahar Ghassemi
- Division of Gastroenterology and Hepatology, Duke University, Durham, North Carolina
| | - Christopher Huang
- Section of Gastroenterology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Thomas E Kowalski
- Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Emad Qayed
- Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sunil G Sheth
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Jason R Taylor
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Saint Louis University, St Louis, Missouri, USA
| | - Sarah B Umar
- Division of Gastroenterology Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Stacie A F Vela
- Gastroenterology Section, Phoenix VA Health Care System, University of Arizona-Phoenix, Phoenix, Arizona
| | - Catharine M Walsh
- Division of Gastroenterology, Hepatology and Nutrition and the Research and Learning Institutes, Hospital for Sick Children, Department of Paediatrics and the Wilson Centre, University of Toronto, Toronto, Canada
| | - Renee L Williams
- Department of Medicine, Division of Gastroenterology, NYU Grossman School of Medicine, New York, New York, USA
| | - Mihir S Wagh
- Division of Gastroenterology, University of Colorado-Denver, Aurora, Colorado, USA
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15
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Alkhayyat M, Abou Saleh M, Coronado W, Abureesh M, Al-Otoom O, Qapaja T, Mansoor E, Simons-Linares CR, Stevens T, Chahal P. Increasing Prevalence of Anxiety and Depression Disorders After Diagnosis of Chronic Pancreatitis: A 5-Year Population-Based Study. Pancreas 2021; 50:153-159. [PMID: 33565791 DOI: 10.1097/mpa.0000000000001746] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Chronic pancreatitis (CP) is often associated with poor quality of life. Only a few small associative studies have reported the prevalence of mood disorders in CP. Using a large database, we sought to describe the epidemiology and risk association of anxiety and depression in CP and evaluate their outcomes. METHODS A multicenter database (Explorys), an aggregate of electronic health record data from 26 US healthcare systems, was surveyed. A cohort of patients with a diagnosis of CP between 2014 and 2019 was identified. Within this cohort, rates of anxiety and depression were calculated. Demographics, comorbidities, and outcomes were described. RESULTS Of the 30,276,810 individuals in the database (2014-2019), 67,260 patients had a CP diagnosis (0.22%). When compared with patients with no history of CP, patients with CP were more likely to develop anxiety (odds ratio, 6.94; 95% confidence interval, 6.85-7.04) and depression (odds ratio, 5.09; 95% confidence interval, 5.01-5.17). Chronic pancreatitis patients with depression had an increased risk of suicidal ideation compared with controls. CONCLUSIONS Patients with CP are at a higher risk of developing anxiety and depression compared with those without CP, with overall worse outcomes. Clinicians should screen CP patients and make appropriate referral to psychiatry when indicated.
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Affiliation(s)
| | - Mohannad Abou Saleh
- Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic Foundation, Cleveland, OH
| | | | - Mohammad Abureesh
- Department of Internal Medicine, Staten Island University Hospital, New York City, NY
| | | | | | - Emad Mansoor
- Department of Gastroenterology and Hepatology, University Hospitals Cleveland Medical Center, Cleveland, OH
| | | | - Tyler Stevens
- Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic Foundation, Cleveland, OH
| | - Prabhleen Chahal
- Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic Foundation, Cleveland, OH
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16
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Simons-Linares CR, Chittajallu V, Chahal P. Stent gone rogue: endoscopic removal of a 3-year-old embedded cystogastrostomy stent. VideoGIE 2020; 5:548-551. [PMID: 33204913 PMCID: PMC7650305 DOI: 10.1016/j.vgie.2020.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- C Roberto Simons-Linares
- Gastroenterology and Hepatology Department, Digestive Disease and Surgery Institute Cleveland Clinic Foundation, Cleveland, Ohio
| | - Vibhu Chittajallu
- Gastroenterology and Hepatology Department, Digestive Disease and Surgery Institute Cleveland Clinic Foundation, Cleveland, Ohio
| | - Prabhleen Chahal
- Gastroenterology and Hepatology Department, Digestive Disease and Surgery Institute Cleveland Clinic Foundation, Cleveland, Ohio
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17
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Vozzo CF, Simons-Linares CR, Abou Saleh M, Stevens T, Chahal P. Safety of EUS-guided gallbladder drainage using a lumen-apposing metal stent in patients requiring anticoagulation. VideoGIE 2020; 5:500-503.e1. [PMID: 33103010 PMCID: PMC7572616 DOI: 10.1016/j.vgie.2020.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background and Aims EUS-guided gallbladder drainage (EUS-GBD) can be used to treat acute cholecystitis in patients with medical comorbidities that prevent definitive operative management. Historically, nonsurgical management of cholecystitis was achieved by way of percutaneous gallbladder drainage. Methods We examined the periprocedural bleeding rate of EUS-GBD for acute cholecystitis using lumen-apposing metal stents in 5 high-surgical-risk patients requiring anticoagulation. Data on 5 nonoperative candidates with acute cholecystitis who underwent EUS-GBD were studied retrospectively. Results There were no immediate or delayed postprocedure adverse events, including bleeding. Conclusions Although further study is needed, EUS-GBD appears safe in patients who require periprocedural anticoagulation.
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Affiliation(s)
- Catherine Frakes Vozzo
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, Ohio
| | | | - Mohannad Abou Saleh
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Tyler Stevens
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Prabhleen Chahal
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, Ohio
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18
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Imam Z, Simons-Linares CR, Chahal P. Infectious causes of acute pancreatitis: A systematic review. Pancreatology 2020; 20:1312-1322. [PMID: 32938554 DOI: 10.1016/j.pan.2020.08.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/21/2020] [Accepted: 08/24/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Infectious etiologies of acute pancreatitis (AP) are rare and include viruses, bacteria, mycobacteria, parasites, and fungi. We aimed to conduct a comprehensive review on infectious etiologies of AP analyzing the frequency, clinical features, and outcomes of individuals presenting with this condition. METHODS Eligible articles reporting on AP attributed to infectious etiologies were included. A comprehensive literature search of PubMed from time of inception and until September 6,2019 was performed using all relevant MeSH (medical subject heading) keywords. Articles were assessed for eligibility and independently reviewed by two reviewers for clinical features of AP, local complications, and mortality. Methodological quality of included studies was evaluated using the Murad tool. RESULTS A total of 212 articles were included, of which 168 (79.2%) were at high risk of bias. 320 cases of AP were identified. Viruses were the leading etiology of infection attributed AP (65.3%) followed by helminths (19.1%), and bacteria (12.5%). Protozoa, mycobacteria, and fungi accounted for the remaining 3.1% of cases. Mean age was 40.5 ± 18.4 years and M:F ratio was 1.94:1. Mortality occurred in 50 patients. Mortality rate was higher in the virus attributed AP patients than AP from other infectious etiologies (21.8% vs. 7.0%, p < 0.0005). INTERPRETATION Literature quality on infection attributed AP is limited. Virus attributed AP appears to carry a higher mortality than other etiologies of infection attributed AP.
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Affiliation(s)
- Zaid Imam
- Department of Internal Medicine, William Beaumont Hospital, Royal Oak, MI, USA
| | - C Roberto Simons-Linares
- Department of Gastroenterology, Hepatology, and Nutrition; Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Prabhleen Chahal
- Department of Gastroenterology, Hepatology, and Nutrition; Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
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19
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Simons-Linares CR, Yadav D, Lopez R, Bhatt A, Jang S, El-Khider F, Sanaka M, Stevens T, Vargo J, Chahal P. The utility of intracystic glucose levels in differentiating mucinous from non-mucinous pancreatic cysts. Pancreatology 2020; 20:1386-1392. [PMID: 32919884 DOI: 10.1016/j.pan.2020.08.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/21/2020] [Accepted: 08/30/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Differentiating benign non-mucinous from potentially malignant mucinous pancreatic cysts is still a challenge. This study aims to improve this distinction with cyst fluid analysis. METHODS A cohort study of pancreatic cyst undergoing EUS/FNA was performed from a prospectively maintained database between 2014 and 2018 was performed. RESULTS 113 patients were analyzed (40 non-mucinous and 73 mucinous). For differentiating mucinous from non-mucinous cyst: intracyst glucose ≤41 mg/dl had a sensitivity of 92% and a specificity of 92%; positive predictive value (PPV) of 96 and negative predictive value (NPV) of 86. Glucose ≤21 mg/dl had a sensitivity of 88%, specificity of 97%, PPV of 98 and NPV of 81. CEA ≥192 ng/mL had a sensitivity of 50% and a specificity of 92%; PPV of 92 and NPV of 50. Glucose ≤21 mg/dl or CEA ≥192 ng/mL combined had a sensitivity of 93%, specificity of 92%, PPV of 96 and NPV of 87 (Fig. 1, Table 1). CONCLUSION Intra-cyst glucose levels (≤41 mg/dl) outperforms classic CEA testing for differentiation of mucinous from non-mucinous pancreatic cysts. It was found to be an excellent diagnostic test with an AUC of 0.95 (95% CI: 0.81, 0.97).
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Affiliation(s)
- C Roberto Simons-Linares
- Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Divya Yadav
- Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Rocio Lopez
- Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Amit Bhatt
- Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Sunguk Jang
- Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Faris El-Khider
- Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Madhusudan Sanaka
- Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Tyler Stevens
- Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - John Vargo
- Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Prabhleen Chahal
- Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
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20
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Chadalavada P, Simons-Linares CR, Chahal P. Drug-induced acute pancreatitis: Prevalence, Causative agents, and Outcomes. Pancreatology 2020; 20:1281-1286. [PMID: 32878711 DOI: 10.1016/j.pan.2020.07.401] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/20/2020] [Accepted: 07/25/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND We sought to study the causative drugs, prevalence and outcomes of drug-induced acute pancreatitis (DIAP). METHODS Retrospective study of DIAP patients at a tertiary teaching hospital. The diagnosis and severity of pancreatitis were determined based on the Revised Atlanta Classification. The cases were further subclassified using the Badalov et al., 2008 classification, and Naranjo score to evaluate and determine the odds of drug-related adverse reaction as a causative factor for AP. RESULTS Out of 841 AP patients, a total of 31 patients (3.6%) with DIAP were included. The mean age was 52.9 years, 51.6% were male. The most common causative drugs are listed in Table 3. Most cases were mild in severity (87%), moderate AP occurred in 2 patients (6.5%) and severe AP in 2 patients (6.5%). 19.3% had systemic inflammatory response syndrome at presentation, but it persisted beyond 48 h in only 9.6%. 9.6% developed acute kidney injury. One patient with valproate induced DIAP had pancreatic necrosis, splenic vein thrombus, and sub occlusive superior mesenteric vein thrombus on abdominal imaging. Three patients had recurrent AP, and two (6.5%) of them eventually developed chronic pancreatitis. Notably, none of our patients developed complications such as shock, acute respiratory distress syndrome, bacteremia, or death. 1 patient had an acute peripancreatic fluid collection on initial imaging and another patient developed a pseudocyst on follow up imaging. None of them required drainage. CONCLUSION Our study showed a prevalence of DIAP of (3.6%) and hydrochlorothiazide, azathioprine, and doxycycline were the most common culprit drugs.
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Affiliation(s)
- Pravallika Chadalavada
- Gastroenterology and Hepatology Department, Digestive Disease Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - C Roberto Simons-Linares
- Gastroenterology and Hepatology Department, Digestive Disease Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
| | - Prabhleen Chahal
- Gastroenterology and Hepatology Department, Digestive Disease Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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21
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Qayed E, Anand GS, Aihara H, Cassani L, Chahal P, Dacha S, Duloy A, Ghassemi S, Huang C, Kowalski TE, Kushnir V, Sheth SG, Simons-Linares CR, Taylor JR, Umar SB, Vela SAF, Walsh CM, Williams RL, Wagh MS. Core curriculum for endoluminal stent placement. Gastrointest Endosc 2020; 92:463-468. [PMID: 32711868 DOI: 10.1016/j.gie.2020.04.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 04/11/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Emad Qayed
- Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA, USA
| | - Gobind S Anand
- Division of Gastroenterology, University of California San Diego, San Diego, CA, USA
| | - Hiroyuki Aihara
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Lisa Cassani
- Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, and Atlanta VA Medical Center, Atlanta, GA, USA
| | - Prabhleen Chahal
- Digestive Disease and Surgery Institute, Cleveland Clinic, OH, USA; Digestive Disease and Surgery Institute, Cleveland Clinic, OH
| | - Sunil Dacha
- Division of Gastroenterology, Department of Internal Medicine, Houston Methodist Hospital and Texas A&M University, Houston, Texas, USA
| | - Anna Duloy
- Division of Gastroenterology, University of Colorado-Denver, Aurora, CO, USA; Division of Gastroenterology, University of Colorado-Denver, Aurora, CO, USA
| | - Sahar Ghassemi
- Division of Gastroenterology and Hepatology, Duke University, Durham, NC
| | - Christopher Huang
- Section of Gastroenterology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Thomas E Kowalski
- Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Vladimir Kushnir
- Division of Gastroenterology, John T. Milliken Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Sunil G Sheth
- Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | | | - Jason R Taylor
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Saint Louis University, St Louis, Missouri, USA
| | - Sarah B Umar
- Division of Gastroenterology Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Stacie A F Vela
- Gastroenterology Section, Phoenix VA Health Care System, University of Arizona-Phoenix
| | - Catharine M Walsh
- Division of Gastroenterology, Hepatology and Nutrition and the Research and Learning Institutes, Hospital for Sick Children, Department of Paediatrics and the Wilson Centre, University of Toronto, Toronto, Canada
| | - Renee L Williams
- Department of Medicine, Division of Gastroenterology, NYU Grossman School of Medicine, New York, USA
| | - Mihir S Wagh
- Division of Gastroenterology, University of Colorado-Denver, Aurora, CO, USA
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Cassani L, Aihara H, Anand GS, Chahal P, Dacha S, Duloy A, Ghassemi S, Huang C, Kowalski TE, Kushnir V, Qayed E, Sheth SG, Simons-Linares CR, Taylor JR, Umar SB, Vela SAF, Walsh CM, Williams RL, Wagh MS. Core curriculum for EUS. Gastrointest Endosc 2020; 92:469-473. [PMID: 32713612 DOI: 10.1016/j.gie.2020.04.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 04/11/2020] [Indexed: 02/08/2023]
Affiliation(s)
- Lisa Cassani
- Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, and Atlanta VA Medical Center, Atlanta, GA, USA
| | - Hiroyuki Aihara
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Gobind S Anand
- Division of Gastroenterology, University of California San Diego, San Diego, CA, USA
| | - Prabhleen Chahal
- Digestive Disease and Surgery Institute, Cleveland Clinic, OH, USA; Digestive Disease and Surgery Institute, Cleveland Clinic, OH
| | - Sunil Dacha
- Division of Gastroenterology, Department of Internal Medicine, Houston Methodist Hospital and Texas A&M University, Houston, Texas, USA
| | - Anna Duloy
- Division of Gastroenterology, University of Colorado-Denver, Aurora, CO, USA; Division of Gastroenterology, University of Colorado-Denver, Aurora, CO, USA
| | - Sahar Ghassemi
- Division of Gastroenterology and Hepatology, Duke University, Durham, NC
| | - Christopher Huang
- Section of Gastroenterology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Thomas E Kowalski
- Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Vladimir Kushnir
- Division of Gastroenterology, John T. Milliken Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Emad Qayed
- Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA, USA
| | - Sunil G Sheth
- Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | | | - Jason R Taylor
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Saint Louis University, St Louis, Missouri, USA
| | - Sarah B Umar
- Division of Gastroenterology Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Stacie A F Vela
- Gastroenterology Section, Phoenix VA Health Care System, University of Arizona-Phoenix
| | - Catharine M Walsh
- Division of Gastroenterology, Hepatology and Nutrition and the Research and Learning Institutes, Hospital for Sick Children, Department of Paediatrics and the Wilson Centre, University of Toronto, Toronto, Canada
| | - Renee L Williams
- Department of Medicine, Division of Gastroenterology, NYU Grossman School of Medicine, New York, USA
| | - Mihir S Wagh
- Division of Gastroenterology, University of Colorado-Denver, Aurora, CO, USA
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Singh AD, Simons-Linares CR, Chahal P. A Dilated Common Bile Duct with "Atypical" Gallbladder. Gastroenterology 2020; 159:e6-e7. [PMID: 32017905 DOI: 10.1053/j.gastro.2020.01.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 01/17/2020] [Accepted: 01/24/2020] [Indexed: 12/02/2022]
Affiliation(s)
- Achintya D Singh
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio
| | | | - Prabhleen Chahal
- Department of Gastroenterology, Cleveland Clinic, Cleveland, Ohio.
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Duong N, Aby ES, Hathorn KE, Simons-Linares CR, Bilal M. How to Become a Competitive Applicant for Gastroenterology Fellowship: Tips and Tricks for Success Part II. Dig Dis Sci 2020; 65:2172-2175. [PMID: 32356262 DOI: 10.1007/s10620-020-06293-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
In recent years, gastroenterology has become one of the most competitive subspecialties included in the internal medicine fellowship match, which increases the stressful nature of an already potentially nerve-wracking process for the trainee. Though each applicant has unique strengths and thus the process is somewhat individualized, there are some basic principles that can render an applicant more competitive for a gastroenterology fellowship. These include establishing mentorship, achieving scholarly work, building your resume, honing interpersonal and networking skills, and writing a well-planned application. The goal of this article is to outline some basic principles that will help improve the competitiveness of an applicant, and also highlight some practical tips and tricks for applicants with diverse backgrounds, such as international medical graduates, minority applicants, and women in medicine.
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Affiliation(s)
- Nikki Duong
- Department of Internal Medicine, Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC, 20007, USA.
| | - Elizabeth S Aby
- Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, 500 SE Harvard St, Minneapolis, MN, 55455, USA
| | - Kelly E Hathorn
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - C Roberto Simons-Linares
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Mohammad Bilal
- Division of Gastroenterology, Hepatology and Nutrition, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA
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Bazarbashi AN, Simons-Linares CR. COVID-19 and the Gastrointestinal System: What Trainees Need to Know. ACG Case Rep J 2020; 7:e00391. [PMID: 33062773 PMCID: PMC7535659 DOI: 10.14309/crj.0000000000000391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Ahmad Najdat Bazarbashi
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - C Roberto Simons-Linares
- Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH
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Alkhayyat M, Saleh MA, Zmaili M, Sanghi V, Singh T, Rouphael C, Simons-Linares CR, Romero-Marrero C, Carey WD, Lindenmeyer CC. Successful liver transplantation for acute sickle cell intrahepatic cholestasis: A case report and review of the literature. World J Hepatol 2020; 12:108-115. [PMID: 32231764 PMCID: PMC7097501 DOI: 10.4254/wjh.v12.i3.108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 12/28/2019] [Accepted: 02/18/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Sickle cell hepatopathy (SCH) is an inclusive term referring to any liver dysfunction among patients with sickle cell disease. Acute sickle cell intrahepatic cholestasis is one of the rarest and most fatal presentations of SCH. We present the 23rd reported case of liver transplantation (LT) for SCH; a rare case of acute sickle cell intrahepatic cholestasis managed with LT from a hepatitis C virus (HCV) nucleic acid amplification test positive donor.
CASE SUMMARY A 29-year-old male with a past medical history of sickle cell disease presented with vaso-occlusive pain crisis. On examination, he had jaundice and a soft, non-tender abdomen. Initially he was alert and fully oriented; within 24 h he developed new-onset confusion. Laboratory evaluation was notable for hyperbilirubinemia, leukocytosis, anemia, thrombocytopenia, acute kidney injury and elevated international normalized ratio (INR). Imaging by ultrasound and computed tomography scan suggested a cirrhotic liver morphology with no evidence of biliary ductal dilatation. The patient was diagnosed with acute sickle cell intrahepatic cholestasis after excluding competing etiologies of acute liver injury. He underwent LT from an HCV nucleic acid amplification test positive donor 9 d after initial presentation. The liver explant was notable for widespread sinusoidal dilatation with innumerable clusters of sickled red blood cells and cholestasis. On postoperative day 3, HCV RNA was detectable in the patient's peripheral blood and anti-HCV therapy with glecaprevir/pibrentasvir was initiated on postoperative day 23. He subsequently achieved sustained virologic response after completing 3 mo of therapy and has been followed clinically for 12 mo post-transplant.
CONCLUSION This case highlights the utility of LT as a viable treatment option for acute sickle cell intrahepatic cholestasis.
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Affiliation(s)
- Motasem Alkhayyat
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Mohannad Abou Saleh
- Digestive Disease & Surgery Institute, Department of Gastroenterology, Hepatology & Nutrition, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Mohammad Zmaili
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Vedha Sanghi
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Tavankit Singh
- Digestive Disease & Surgery Institute, Department of Gastroenterology, Hepatology & Nutrition, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Carol Rouphael
- Digestive Disease & Surgery Institute, Department of Gastroenterology, Hepatology & Nutrition, Cleveland Clinic, Cleveland, OH 44195, United States
| | - C Roberto Simons-Linares
- Digestive Disease & Surgery Institute, Department of Gastroenterology, Hepatology & Nutrition, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Carlos Romero-Marrero
- Digestive Disease & Surgery Institute, Department of Gastroenterology, Hepatology & Nutrition, Cleveland Clinic, Cleveland, OH 44195, United States
| | - William D Carey
- Digestive Disease & Surgery Institute, Department of Gastroenterology, Hepatology & Nutrition, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Christina C Lindenmeyer
- Digestive Disease & Surgery Institute, Department of Gastroenterology, Hepatology & Nutrition, Cleveland Clinic, Cleveland, OH 44195, United States
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Gad MM, Simons-Linares CR. Is aggressive intravenous fluid resuscitation beneficial in acute pancreatitis? A meta-analysis of randomized control trials and cohort studies. World J Gastroenterol 2020; 26:1098-1106. [PMID: 32206000 PMCID: PMC7081000 DOI: 10.3748/wjg.v26.i10.1098] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/12/2020] [Accepted: 02/21/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There is conflincting evidence on the intravenous fluid (IVF) strategy for acute pancreatitis (AP). We perform a metaanalysis of the available evidence.
AIM To investigate if aggressive IVF therapy in AP patients is beneficial to decrease mortality and improve outcomes.
METHODS Metaanalysis of available randomized controlled trials and cohort studies comparing aggressive IVF vs non-aggressive IVF resuscitation.
RESULTS There was no significant difference in mortality between the aggressive (n = 1229) and non-aggressive IVF (n = 1397) patients. Patients receiving aggressive IVF therapy had higher risk for acute kidney injury and acute respiratory distress syndrome. There also was no significant difference in the overall incidence of systemic inflammatory response syndrome, persistent organ failure, pancreatic necrosis when comparing both study groups.
CONCLUSION Early aggressive IVF therapy did not improve mortality. Moreover, aggressive IVF therapy could potentially increase the risk for acute kidney injury and pulmonary edema leading to respiratory failure and mechanical ventilation. Studies are needed to investigate which subset of AP patients could benefit from aggressive IVF therapy.
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Affiliation(s)
- Mohamed M Gad
- Internal Medicine Department, Medicine Institute, Cleveland Clinic, Cleveland, OH 44195, United States
| | - C. Roberto Simons-Linares
- Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH 44195, United States
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Simons-Linares CR, Gurajala R, Morris-Stiff G, Chahal P. Hybrid Percutaneous-Endoscopic Removal (HPER) of Cholelithiasis. Dig Dis 2020; 38:547-549. [PMID: 32074602 DOI: 10.1159/000506626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 02/14/2020] [Indexed: 02/02/2023]
Abstract
Acute cholecystitis (AC) affects over 20 million Americans annually, leading to annual costs exceeding USD 6 billion. Optimal treatment is early cholecystectomy. However, patients deemed high surgical risk undergo percutaneous cholecystostomy tube (PCT) placement as a bridge to surgery or more commonly as a definitive therapy. We hereby describe our experience with a new procedure named "Hybrid Percutaneous Endoscopic Removal (HPER) of cholelithiasis" that is meant for patients with chronic indwelling PCT. This procedure is an effective alternative to EUS-guided gallbladder drainage in high-risk patients. It does not require special expertise or technology and is simply performed by placing a fully covered metal stent conduit through the existing mature percutaneous tract allowing the endoscopic removal of gallstones through this conduit. This procedure can prevent the recurrence of gallstone-related complications as well as chronic PCT-related costs and adverse events. In our video, we present a case series and long-term follow-up of patients who underwent HPER as an alternative definitive therapy for calculous AC.
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Affiliation(s)
- C Roberto Simons-Linares
- Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Ram Gurajala
- Interventional Radiology Department, Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Gareth Morris-Stiff
- Hepatobiliary Surgery Department, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Prabhleen Chahal
- Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA,
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Kröner PT, Simons-Linares CR, Kesler AM, Abader P, Afsh M, Corral J, Rodriguez J, Vargo JJ, Raimondo M, Chahal P. Acute Pancreatitis in Patients with a History of Bariatric Surgery: Is It Less Severe? Obes Surg 2020; 30:2325-2330. [DOI: 10.1007/s11695-020-04480-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Simons-Linares CR, Romero-Marrero C, Jang S, Bhatt A, Lopez R, Vargo J, Stevens T, Carey W, Chahal P. Clinical outcomes of acute pancreatitis in patients with cirrhosis. Pancreatology 2020; 20:44-50. [PMID: 31734110 DOI: 10.1016/j.pan.2019.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 11/02/2019] [Accepted: 11/06/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND AP outcomes in cirrhotic patients have not yet been studied. We aim to investigate the outcomes of cirrhotics patients with acute pancreatitis. METHODS The National Inpatient Sample (NIS) database (2003-2013) was queried for patients with a discharge diagnosis of AP and liver cirrhosis. Cirrhosis was further classified as compensated and decompensated using the validated Baveno IV criteria. Primary outcome was inpatient mortality. The analysis was adjusted for age, gender, race, Charlson comorbidity index (CCI), median income quartile, and hospital characteristics. RESULTS Over 2.8 million patients with acute pancreatitis were analyzed. Cirrhosis prevalence was 2.8% (80,093). Both compensated and decompensated cirrhosis subjects had significantly higher mortality. Highest odds ratios (OR) were: inpatient mortality (OR 3.4, P < 0.001), Shock (OR 1.5, P = 0.02), Ileus (OR: 1.3, p = 0.02, ARDS (OR 1.2, p = 0.03), upper endoscopy performed (OR 2.0, p < 0.001), blood transfusions (OR 3.1, p < 0.001), gastrointestinal bleed (OR 5.5, p < 0.001), sepsis (OR 1.3, p = 0.005), portal vein thrombosis (PVT) (OR 7.2, p < 0.001), acute cholecystitis (OR 1.3, p < 0.001). Interestingly, cirrhosis patients had lower hospital length of stay, (OR 0.16, p < 0.001), AKI (OR 0.93, p = 0.06), myocardial infarction (OR 0.31, p < 0.001), SIRS (OR 0.62, p < 0.001), parenteral nutrition requirement (OR 0.84, p = 0.002). Decompensated cirrhosis had higher inflation-adjusted hospital charges (+$3896.60; p < 0.001). CONCLUSION AP patients with cirrhosis have higher inpatient mortality, but it is unlikely to be due to AP severity as patients had lower incidence of SIRS and AKI. Higher mortality is possibly related to complications of cirrhosis and portal hypertension itself such as GI bleed, shock, PVT, AC and sepsis.
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Affiliation(s)
- C Roberto Simons-Linares
- Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Carlos Romero-Marrero
- Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Sunguk Jang
- Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Amit Bhatt
- Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Rocio Lopez
- Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - John Vargo
- Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Tyler Stevens
- Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - William Carey
- Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Prabhleen Chahal
- Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
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Simons-Linares CR, Chahal P. Successful EUS-guided Drainage of a Persistent Subdiaphragmatic Fluid Collection in a Patient With Crohn's Disease. Inflamm Bowel Dis 2019; 25:e85-e86. [PMID: 30772910 DOI: 10.1093/ibd/izz018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 01/31/2019] [Indexed: 12/09/2022]
Affiliation(s)
- C Roberto Simons-Linares
- From the Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Prabhleen Chahal
- From the Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Simons-Linares CR, Vargo JJ, Chahal P. Rescue of a delayed spontaneously migrated lumen-apposing metal stent placed to facilitate transluminal ERCP in a patient with acute recurrent pancreatitis and pancreas divisum with Roux-en-Y gastric bypass. VideoGIE 2019; 4:166-168. [PMID: 31020052 PMCID: PMC6470377 DOI: 10.1016/j.vgie.2019.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Simons-Linares CR, Jang S, Sanaka M, Bhatt A, Lopez R, Vargo J, Stevens T, Chahal P. The triad of diabetes ketoacidosis, hypertriglyceridemia and acute pancreatitis. How does it affect mortality and morbidity?: A 10-year analysis of the National Inpatient Sample. Medicine (Baltimore) 2019; 98:e14378. [PMID: 30762737 PMCID: PMC6408121 DOI: 10.1097/md.0000000000014378] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The triad of acute pancreatitis (AP) coexisting with diabetes ketoacidosis (DKA) and hypertriglyceridemia (HTG) has been reported, but no impact on mortality has been found to date. We aim to assess if patients with this triad are at a higher inpatient mortality compared to patients with acute pancreatitis only.Retrospective cohort. The National Inpatient Sample (NIS) database from 2003 to 2013 was queried for patients with a discharge diagnosis of AP and presence of DKA and HTG was ascertained based on International Classification of Diseases, 9th revision (ICD9) codes. Adjusted for age, gender, race, Charlson comorbidity index (CCI), median income quartile, and hospital characteristics.Over 2.8 million AP patients were analyzed. When compared with patients with AP-only, patients with the triad of AP + DKA + HTG had higher inpatient mortality (aOR 2.8, P < .001; CI: 1.9 - 4.2), Acute Kidney Injury (AKI) (aOR 4.1, P < .001; CI: 3.6-4.6), Systemic Inflammatory Response Syndrome (SIRS) (aOR 4.9, P < .001), Shock (aOR 4.3, P < .001), Acute Respiratory Distress Syndrome (ARDS) (aOR 3.0, P < .001), sepsis (aOR 2.6, P < .001), ileus (aOR 2.1, P < .001), parenteral nutrition requirement (aOR 1.8, P < .001), inflation-adjusted hospital charges (US$ 17,704.1), and had longer length of stay (LOS) (aOR 2.0, P < .001; CI 1.8-2.3). Furthermore, when compared to AP-only, patients with AP + HTG had lower mortality, which is different from the current AP knowledge. Finally, it appears that the driving force for the increased in mortality of patients with the triad (AP, DKA, HTG) is the DKA rather than the HTG.Patients with the triad of AP, DKA, and HTG constitute a unique subgroup of patients that has higher inpatient mortality, multi-organ failure, hospital charges, and longer hospital length of stay. Therefore, hospital protocols targeting this subgroup of AP patients could improve mortality and outcomes.
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Affiliation(s)
| | - Sunguk Jang
- Gastroenterology and Hepatology Department, Digestive Disease Institute
| | - Madhusudan Sanaka
- Gastroenterology and Hepatology Department, Digestive Disease Institute
| | - Amit Bhatt
- Gastroenterology and Hepatology Department, Digestive Disease Institute
| | - Rocio Lopez
- Center for Populations Health Research, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - John Vargo
- Gastroenterology and Hepatology Department, Digestive Disease Institute
| | - Tyler Stevens
- Gastroenterology and Hepatology Department, Digestive Disease Institute
| | - Prabhleen Chahal
- Gastroenterology and Hepatology Department, Digestive Disease Institute
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Pang M, Bartel MJ, Brand EC, Brahmbhatt B, Patel K, Simons-Linares CR, Wolfsen HC, Raimondo M, Wallace MB, Woodward TA. Outcome of long benign esophageal strictures undergoing endoscopictherapy: a tertiary center experience. Dis Esophagus 2018; 31:4990672. [PMID: 29718161 DOI: 10.1093/dote/doy040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- M Pang
- Division of Gastroenterology and Hepatology, Mayo Clinic
| | - M J Bartel
- Division of Gastroenterology and Hepatology, Mayo Clinic.,Section of Gastroenterology, Fox Chase Cancer Center, Temple Health, Philadelphia, Pennsylvania
| | - E C Brand
- Division of Gastroenterology and Hepatology, Mayo Clinic.,Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, Netherlands
| | - B Brahmbhatt
- Division of Gastroenterology and Hepatology, Mayo Clinic
| | - K Patel
- Division of Gastroenterology and Hepatology, Mayo Clinic.,University of North Florida, Jacksonville, Florida
| | - C R Simons-Linares
- Division of Gastroenterology and Hepatology, Mayo Clinic.,Department of Medicine, John Stronger Hospital, Cook County, Chicago, Illinois, USA
| | - H C Wolfsen
- Division of Gastroenterology and Hepatology, Mayo Clinic
| | - M Raimondo
- Division of Gastroenterology and Hepatology, Mayo Clinic
| | - M B Wallace
- Division of Gastroenterology and Hepatology, Mayo Clinic
| | - T A Woodward
- Division of Gastroenterology and Hepatology, Mayo Clinic
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Simons-Linares CR, Barkin JA, Wang Y, Jaiswal P, Trick W, Bartel MJ, Barkin JS. Is There an Effect of Cannabis Consumption on Acute Pancreatitis? Dig Dis Sci 2018; 63:2786-2791. [PMID: 29922897 DOI: 10.1007/s10620-018-5169-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 06/12/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM Twenty-percentage of acute pancreatitis (AP) cases is labeled as idiopathic. Cannabis remains the most frequently used illicit drug in the world. The aim of this study was to identify the prevalence of cannabis use among all patients with a first episode of AP, particularly in those labeled as idiopathic etiology, and determine any effect on AP severity. METHODS Retrospective cohort of all consecutive patients admitted with a first episode of AP at a large tertiary referral hospital from 01/2013 through 12/2014. AP was identified by ICD9 code, or lipase ≥ 3 times the upper limit of normal and abdominal pain consistent with AP. Cannabis users (CU) were identified via history or urine toxicology. RESULTS Four hundred and sixty patients were included. 54% were men, with a mean age of 48 years (range 17-89 years). Forty-eight patients (10%) were identified as CU. After adjusting for admission SIRS, age, and gender, cannabis use was not found to be an independent risk factor for persistent SIRS, AKI, ARDS, pancreatic necrosis, mortality, ICU admission, length of stay, in-hospital infections, nor recurrent AP. Of note, AKI was least common among non-CU compared to CU (OR 0.4; p = 0.02; CI 0.2-0.9) and non-CU had a higher admission BISAP score (≥ 2) compared to CU (OR 2.5; p = 0.009; CI 1.2-4.9). CONCLUSION This is the largest study to date examining cannabis use in AP. Cannabis use was found across almost all etiologies of AP with a prevalence of 10% (48 cases), and in 9% (9 cases) of so-called idiopathic AP cases in this cohort, which could account as an association for approximately 2% of all AP cases. Cannabis use did not independently impact AP severity or mortality.
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Affiliation(s)
- C Roberto Simons-Linares
- Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
| | - Jodie A Barkin
- Division of Gastroenterology, Department of Medicine, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Yuchen Wang
- John Stroger Hospital of Cook County, Chicago, IL, USA
| | | | - William Trick
- John Stroger Hospital of Cook County, Chicago, IL, USA
| | - Michael J Bartel
- Section of Gastroenterology, Fox Chase Cancer Center, Temple Health, Philadelphia, PA, USA
| | - Jamie S Barkin
- Division of Gastroenterology, Department of Medicine, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA
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