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Magahis PT, Westerveld D, Simons M, Carr-Locke DL, Sampath K, Sharaiha RZ, Mahadev S. Outcomes of Endoscopic Ultrasound-guided Fine Needle Biopsy Using a Novel Hydrostatic Stylet Tissue Acquisition Technique. J Clin Gastroenterol 2024; 58:407-414. [PMID: 37983811 DOI: 10.1097/mcg.0000000000001934] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 06/15/2023] [Accepted: 09/28/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) is frequently used to obtain core samples of solid lesions. Here, we describe and evaluate a novel hydrostatic stylet (HS) technique designed to optimize core sample acquisition, reporting diagnostic yield, efficacy, and safety relative to the conventional stylet slow-pull (SP) technique. METHODS A novel HS technique was developed and validated retrospectively. Consecutive patients who underwent EUS-FNB with core biopsy of solid lesions through either the HS or SP technique between January 2020 and April 2022 were included. Exclusion criteria included cystic lesions, nonlesional liver biopsies, and specimens sent for cytologic analysis only. Patient and lesion characteristics, number of passes, sample adequacy, and adverse events were compared between the two techniques. RESULTS A total of 272 patients were included with 138 in the HS group and 134 in the SP group. Lesion size and anatomic distribution were similar in both groups. Compared with the SP approach, the HS technique demonstrated significantly higher sample adequacy (97.8% vs 83.6%, P < 0.001), higher sensitivity (97.1% vs 89.7%, P = 0.03), and lower mean number of passes (1.2 vs 3.3, P < 0.001). Rates and severity of adverse events in the HS group were comparable to the SP group and existing literature. Similar associations were observed in pancreatic and nonpancreatic lesion subanalyses. CONCLUSIONS The novel HS technique demonstrated excellent biopsy sample adequacy and diagnostic yield while requiring fewer passes to obtain diagnostic specimens compared with a conventional EUS-FNB approach. Further prospective evaluation is needed to confirm these pilot findings and optimize EUS-FNB acquisition techniques.
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Affiliation(s)
| | - Donevan Westerveld
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY
| | - Malorie Simons
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY
| | - David L Carr-Locke
- MD Program, Weill Cornell Medical College
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY
| | - Kartik Sampath
- MD Program, Weill Cornell Medical College
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY
| | - Reem Z Sharaiha
- MD Program, Weill Cornell Medical College
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY
| | - SriHari Mahadev
- MD Program, Weill Cornell Medical College
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY
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2
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Canakis A, Dawod SM, Dawod E, Simons M, Di Cocco B, Westerveld DR, Trasolini RP, Berzin TM, Marshall CA, Abdelfattah AM, Marya NB, Smallfield GB, Kaspar M, Campos GM, Skef W, Kedia P, Smith TA, Aihara H, Moyer MT, Sampath K, Mahadev S, Carr-Locke DL, Sharaiha RZ. Efficacy, Feasibility, and Safety of the X-Tack Endoscopic HeliX Tacking System: A Multicenter Experience. J Clin Gastroenterol 2024:00004836-990000000-00261. [PMID: 38277501 DOI: 10.1097/mcg.0000000000001977] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/04/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND AND AIMS The application of endoscopic suturing has revolutionized defect closures. Conventional over-the-scope suturing necessitates removal of the scope, placement of the device, and reinsertion. A single channel, single sequence, through-the-scope suturing device has been developed to improve this process. This study aims to describe the efficacy, feasibility, and safety of a through-the-scope suturing device for gastrointestinal defect closure. METHODS This was a retrospective multicenter study involving 9 centers of consecutive adult patients who underwent suturing using the X-Tack Endoscopic HeliX Tacking System (Apollo Endosurgery). The primary outcomes were technical success and long-term clinical success. Secondary outcomes included adverse events, recurrence, and reintervention rates. RESULTS In all, 56 patients (mean age 53.8, 33 women) were included. Suturing indications included fistula repair (n=22), leak repair (n=7), polypectomy defect closure (n=12), peroral endoscopic myotomy (POEM) site closure (n=7), perforation repair (n=6), and ulcers (n=2). Patients were followed at a mean duration of 74 days. Overall technical and long-term clinical success rates were 92.9% and 75%, respectively. Both technical and clinical success rates were 100% for polypectomies, POEM-site closures, and ulcers. Success rates were lower for the repair of fistulas (95.5% technical, 54.5% clinical), leaks (57.1%, 28.6%), and perforations (100%, 66.7%). No immediate adverse events were noted. CONCLUSION This novel, through-the-scope endoscopic suturing system, is a safe and feasible method to repair defects that are ≤3 cm. The efficacy of this device may be better suited for superficial defects as opposed to full-thickness defects. Larger defects will need more sutures and probably a double closure technique to provide a reinforcement layer.
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Affiliation(s)
- Andrew Canakis
- Department of Gastroenterology, University of Maryland Medical Center, Baltimore, MD
| | - Sanad Maher Dawod
- Department of Gastroenterology, Weill Cornell Medical Center, New York, NY
| | - Enad Dawod
- Department of Gastroenterology, Weill Cornell Medical Center, New York, NY
| | - Malorie Simons
- Department of Gastroenterology, Weill Cornell Medical Center, New York, NY
| | - Bianca Di Cocco
- Department of Gastroenterology, Weill Cornell Medical Center, New York, NY
| | | | | | - Tyler M Berzin
- Department of Gastroenterology, Beth Israel Deaconess Medical Center, Boston
| | | | | | - Neil B Marya
- Department of Gastroenterology, UMass Memorial Medical Center, Worcester, MA
| | - George B Smallfield
- Department of Gastroenterology, Virginia Commonwealth University, Richmond, VA
| | - Matthew Kaspar
- Department of Gastroenterology, Virginia Commonwealth University, Richmond, VA
| | - Guilherme M Campos
- Department of Gastroenterology, Virginia Commonwealth University, Richmond, VA
| | - Wasseem Skef
- Department of Gastroenterology, Loma Linda University Medical Center, Loma Linda, CA
| | - Prashant Kedia
- Department of Gastroenterology, Methodist Dallas Medical Center, Dallas, TX
| | - Terrence A Smith
- Department of Gastroenterology, Vanderbilt University Medical Center, Nashville, TN
| | - Hiroyuki Aihara
- Department of Gastroenterology, Brigham and Women's Hospital
| | - Matthew T Moyer
- Department of Gastroenterology, Penn State Health Milton S Hershey Medical Center. Hershey, PA
| | - Kartik Sampath
- Department of Gastroenterology, Weill Cornell Medical Center, New York, NY
| | - Srihari Mahadev
- Department of Gastroenterology, Weill Cornell Medical Center, New York, NY
| | - David L Carr-Locke
- Department of Gastroenterology, Weill Cornell Medical Center, New York, NY
| | - Reem Z Sharaiha
- Department of Gastroenterology, Weill Cornell Medical Center, New York, NY
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Carr-Locke DL. ERCP: a very personal history. Clin Liver Dis (Hoboken) 2023; 22:211-218. [PMID: 38143813 PMCID: PMC10745235 DOI: 10.1097/cld.0000000000000028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 01/23/2023] [Indexed: 12/26/2023] Open
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4
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Salgado SM, Hassan KM, Abu-Hammour MN, Carr-Locke DL, Sampath K, Sharaiha RZ, Mahadev S. Endoscopic ultrasound-guided gastrojejunopexy using an improvised T-anchor for successful endoscopic gastrojejunostomy. Endoscopy 2023; 55:E1226-E1227. [PMID: 38081307 PMCID: PMC10713337 DOI: 10.1055/a-2208-5132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Affiliation(s)
- Sanjay M. Salgado
- Gastroenterology and Hepatology, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, United States
| | - Kamal Maher Hassan
- Gastroenterology and Hepatology, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, United States
| | - Mohamad-Noor Abu-Hammour
- Gastroenterology and Hepatology, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, United States
| | - David L. Carr-Locke
- Gastroenterology and Hepatology, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, United States
| | - Kartik Sampath
- Gastroenterology and Hepatology, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, United States
| | - Reem Z. Sharaiha
- Gastroenterology and Hepatology, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, United States
| | - SriHari Mahadev
- Gastroenterology and Hepatology, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, United States
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Issa D, Mahadev S, Sharaiha RZ, Carr-Locke DL, Sampath K. Response. Gastrointest Endosc 2023; 98:1039. [PMID: 37977665 DOI: 10.1016/j.gie.2023.08.009] [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] [Received: 08/17/2023] [Accepted: 08/17/2023] [Indexed: 11/19/2023]
Affiliation(s)
- Danny Issa
- Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Srihari Mahadev
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, New York, USA
| | - Reem Z Sharaiha
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, New York, USA
| | - David L Carr-Locke
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, New York, USA
| | - Kartik Sampath
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, New York, USA
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Magahis PT, Salgado S, Westerveld D, Dawod E, Carr-Locke DL, Sampath K, Sharaiha RZ, Mahadev S. Preferred techniques for endoscopic ultrasound-guided gastroenterostomy: a survey of expert endosonographers. Endosc Int Open 2023; 11:E1035-E1045. [PMID: 37954107 PMCID: PMC10635781 DOI: 10.1055/a-2185-6426] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/15/2023] [Indexed: 11/14/2023] Open
Abstract
Background and study aims Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is an emerging procedure that lacks technical standardization with limited adoption beyond expert centers. We surveyed high-volume endosonographers about the technical aspects of EUS-GE to describe how the procedure is currently performed at expert centers and identify targets for standardization. Methods Invitations to complete an electronic survey were distributed to 21 expert EUS practitioners at 19 U.S. centers. Respondents were surveyed about technical aspects of EUS-GE, indications, efficacy, safety, and attitudes toward the procedure. Results All 21 (100%) invited expert endoscopists completed the survey. Nine (42.9%) reported performing >10 EUS-GEs in the last 12 months. About half (47.6%, 10/21) puncture the target loop prior to lumen-apposing metal stent (LAMS) introduction, most often to confirm the loop is jejunum. No respondents reported guidewire placement prior to LAMS introduction. Most (71.4%, 15/21) do not use a guidewire at any time, while 28.6% (6/21) reported wire placement after distal flange deployment to secure the tract during apposition. Eight (38.1%, 8/21) reported at least one major adverse event, most commonly intraperitoneal LAMS deployment (87.5%, 7/8). Factors most often reported as advantageous for EUS-GE over enteral stenting included lack of papilla interference (33.3%, 7/21) and decreased occlusion risk (23.8%, 5/21). Conclusions Significant variation in performance technique for EUS-GE exists among expert US endoscopists, which may hinder widespread adoption and contribute to inconsistencies in reported patient outcomes. The granularity provided by these survey results may identify areas to focus standardization efforts and guide future studies on developing an ideal EUS-GE protocol.
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Affiliation(s)
| | - Sanjay Salgado
- Division of Gastroenterology and Hepatology, NewYork-Presbyterian Weill Cornell Medical Center, New York, United States
| | - Donevan Westerveld
- Division of Gastroenterology and Hepatology, NewYork-Presbyterian Weill Cornell Medical Center, New York, United States
| | - Enad Dawod
- Division of Gastroenterology and Hepatology, NewYork-Presbyterian Weill Cornell Medical Center, New York, United States
| | - David L. Carr-Locke
- Division of Gastroenterology and Hepatology, NewYork-Presbyterian Weill Cornell Medical Center, New York, United States
| | - Kartik Sampath
- Division of Gastroenterology and Hepatology, NewYork-Presbyterian Weill Cornell Medical Center, New York, United States
| | - Reem Z. Sharaiha
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, United States
| | - Srihari Mahadev
- Division of Gastroenterology and Hepatology, NewYork-Presbyterian Weill Cornell Medical Center, New York, United States
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Issa D, Sharaiha RZ, Abdelfattah T, Htway Z, Tabibian JH, Thiruvengadam S, Dawod QM, Wangrattanapranee P, Dawod E, Mukewar S, Mahadev S, Carr-Locke DL, Sampath K. Clinical outcomes and learning curve for ERCP during advanced endoscopy training: a comparison of supine versus prone positioning. Gastrointest Endosc 2023; 98:629-633.e1. [PMID: 37385547 DOI: 10.1016/j.gie.2023.06.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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] [Received: 02/28/2023] [Revised: 05/31/2023] [Accepted: 06/10/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND AND AIMS No studies have evaluated trainees' outcomes when learning ERCP with patients in the supine and prone positions simultaneously. We aimed to assess whether patient position impacts procedural outcomes and learning curve. METHODS We prospectively evaluated patients undergoing ERCP by a supervised advanced endoscopy trainee (AET) at a tertiary care center. Adult patients with native papillae were included. The AET was universally given 5 attempts per cannulation. Outcomes were evaluated quarterly. RESULTS Successful cannulation was achieved in 44 supine (69%) and 17 prone (68%) patients (P = .95). Although mean time to reach the papilla was shorter in the supine patient position, time to biliary cannulation (7.8 vs 9.4 minutes, P = .53) and number of attempts were similar. A stepwise increase was seen in cannulation rates throughout the academic year (P < .01) and increased more in supine patients (P = .01). Procedure and total room times were shorter in supine patients. CONCLUSIONS Shorter procedure and room turnover times and a comparable cannulation rate were found for supine versus prone ERCP.
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Affiliation(s)
| | - Reem Z Sharaiha
- Division of Gastroenterology & Hepatology, Weill Cornell Medicine, New York, New York, USA
| | - Thaer Abdelfattah
- Division of Gastroenterology & Hepatology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Zin Htway
- Department of Epidemiology, California State University Channel Islands, Walden University, Camarillo, California, USA
| | - James H Tabibian
- Division of Gastroenterology, Olive View Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | | | - Qais M Dawod
- Division of Gastroenterology & Hepatology, Weill Cornell Medicine, New York, New York, USA
| | | | - Enad Dawod
- Division of Gastroenterology & Hepatology, Weill Cornell Medicine, New York, New York, USA
| | - Saurabh Mukewar
- Division of Gastroenterology & Hepatology, Weill Cornell Medicine, New York, New York, USA
| | - Srihari Mahadev
- Division of Gastroenterology & Hepatology, Weill Cornell Medicine, New York, New York, USA
| | - David L Carr-Locke
- Division of Gastroenterology & Hepatology, Weill Cornell Medicine, New York, New York, USA
| | - Kartik Sampath
- Division of Gastroenterology & Hepatology, Weill Cornell Medicine, New York, New York, USA
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Magahis PT, Westerveld D, Salgado S, Carr-Locke DL, Sampath K, Sharaiha RZ, Mahadev S. Acute worsening of gastric outlet obstruction following EUS-guided gastrojejunal bypass. VideoGIE 2023. [DOI: 10.1016/j.vgie.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
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9
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Magahis PT, Westerveld D, Simons M, Hissong E, Carr-Locke DL, Sampath K, Sharaiha RZ, Mahadev S. EUS-guided liver biopsy using a novel hydrostatic stylet technique. VideoGIE 2023; 8:104-106. [PMID: 36935805 PMCID: PMC10020006 DOI: 10.1016/j.vgie.2022.11.012] [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] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Video 1Hydrostatic stylet technique for the performance of EUS-guided liver biopsy.
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Affiliation(s)
- Patrick T Magahis
- Joan & Sanford I. Weill Medical College of Cornell University, New York, New York
| | - Donevan Westerveld
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Malorie Simons
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Erika Hissong
- Division of Gastrointestinal Pathology, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - David L Carr-Locke
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Kartik Sampath
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Reem Z Sharaiha
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - SriHari Mahadev
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York
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Gudenkauf FJ, Mehta A, Ferri L, Aihara H, Draganov PV, Yang DJ, Jue TL, Munroe CA, Boparai ES, Mehta NA, Bhatt A, Kumta NA, Othman MO, Mercado M, Javaid H, Aadam AA, Siegel A, James TW, Grimm IS, DeWitt JM, Novikov A, Schlachterman A, Kowalski T, Samarasena J, Hashimoto R, Chehade NEH, Lee JG, Chang K, Su B, Ujiki MB, Sharaiha RZ, Carr-Locke DL, Chen A, Chen M, Chen YI, Tomizawa Y, von Renteln D, Kumbhari V, Khashab MA, Bechara R, Karasik M, Patel NJ, Fukami N, Nishimura M, Hanada Y, Song LMWK, Laszkowska M, Wang AY, Hwang JH, Friedland S, Sethi A, Ngamruengphong S. Factors Associated With Advanced Histological Diagnosis and Upstaging After Endoscopic Submucosal Dissection of Superficial Gastric Neoplasia. Techniques and Innovations in Gastrointestinal Endoscopy 2023; 25:2-10. [DOI: 10.1016/j.tige.2022.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/25/2023]
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Mehta A, Hajifathalian K, Shah SL, Mahadev S, Sampath K, Carr-Locke DL, Sharaiha RZ. Quality of Life, Mental Health, and Weight Loss Outcomes Following Endoscopic Sleeve Gastroplasty. J Gastrointest Surg 2022; 26:469-471. [PMID: 34506034 DOI: 10.1007/s11605-021-05137-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 08/21/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Amit Mehta
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital-Weill Cornell Medical Center, New York, NY, 10021, USA
| | - Kaveh Hajifathalian
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital-Weill Cornell Medical Center, New York, NY, 10021, USA
| | - Shawn L Shah
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital-Weill Cornell Medical Center, New York, NY, 10021, USA
| | - SriHari Mahadev
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital-Weill Cornell Medical Center, New York, NY, 10021, USA
| | - Kartik Sampath
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital-Weill Cornell Medical Center, New York, NY, 10021, USA
| | - David L Carr-Locke
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital-Weill Cornell Medical Center, New York, NY, 10021, USA
| | - Reem Z Sharaiha
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital-Weill Cornell Medical Center, New York, NY, 10021, USA.
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Mehta A, Shah S, Dawod E, Hajifathalian K, Kumar R, Igel LI, Saunders KH, Kumbhari V, Farha J, Badurdeen D, Itani MI, Moore RL, Starpoli AA, Carr-Locke DL, Shukla A, Aronne LJ, Sharaiha RZ. Impact of Adjunctive Pharmacotherapy With Intragastric Balloons for the Treatment of Obesity. Am Surg 2021:31348211038579. [PMID: 34384255 DOI: 10.1177/00031348211038579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND We conducted this study to compare the weight loss outcome of intragastric balloons (IGBs) in conjunction with pharmacotherapy vs IGB and intensive lifestyle changes alone. METHODS This was a multicenter, non-randomized, retrospective study involving 4 academic hospitals. Patients underwent IGB placement with or without concomitant anti-obesity pharmacotherapy. The primary outcome was percent total weight loss (TBWL) after IGB placement at 6 and 12 months. RESULTS This study included 102 patients, with 23 patients (mean age 46.6 years, 82.6% female) treated with IGB/pharmacotherapy and 79 patients (mean age 46.0 years, 88.6% female) treated with IGB/lifestyle modifications. Patients had a 100% follow-up rate at 6 and 12 months. At 6 months following IGB placement, both groups achieved a similar %TBWL. At 12 months, %TBWL was greater in the IGB/pharmacotherapy group (12.6% ± 1.2 vs 9.7% ± 0.7, P = .04). 65.2% of patients achieved ≥10% TBWL at 12 months in the IGB/pharmacotherapy group, compared to 38.0% in the IGB/lifestyle group (P < .05). The proportion of patients that achieved ≥15% weight loss at 12 months was also significantly different between the IGB/pharmacotherapy and IGB/lifestyle groups (30.4% vs 20.3%, P < .05). DISCUSSION IGB with concomitant use of pharmacotherapy did not improve weight loss while the IGB was in place compared to IGB and lifestyle changes. However, patients receiving IGB with pharmacotherapy did have greater weight loss and diminished weight regain after balloon removal compared to those receiving just IGB and lifestyle changes.
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Affiliation(s)
- Amit Mehta
- Division of Gastroenterologyatology, 159947Weill Cornell Medicine, New York, NY, USA
| | - Shawn Shah
- Division of Gastroenterologyatology, 159947Weill Cornell Medicine, New York, NY, USA
| | - Enad Dawod
- Division of Gastroenterologyatology, 159947Weill Cornell Medicine, New York, NY, USA
| | - Kaveh Hajifathalian
- Division of Gastroenterologyatology, 159947Weill Cornell Medicine, New York, NY, USA
| | - Rekha Kumar
- Division of Endocrinology, Diabetes, & Metabolism, 159947Weill Cornell Medicine, New York, NY, USA
| | - Leon I Igel
- Division of Endocrinology, Diabetes, & Metabolism, 159947Weill Cornell Medicine, New York, NY, USA
| | - Katherine H Saunders
- Division of Endocrinology, Diabetes, & Metabolism, 159947Weill Cornell Medicine, New York, NY, USA
| | - Vivek Kumbhari
- Division of Gastroenterology and Hepatology, 156400Mayo Clinic, Jacksonville, FL, USA
| | - Jad Farha
- Division of Gastroenterology and Hepatology, 1501Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dilhana Badurdeen
- Division of Gastroenterology and Hepatology, 1501Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mohamad I Itani
- Division of Gastroenterology and Hepatology, 1501Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | - David L Carr-Locke
- Division of Gastroenterologyatology, 159947Weill Cornell Medicine, New York, NY, USA
| | - Alpana Shukla
- Division of Endocrinology, Diabetes, & Metabolism, 159947Weill Cornell Medicine, New York, NY, USA
| | - Louis J Aronne
- Division of Endocrinology, Diabetes, & Metabolism, 159947Weill Cornell Medicine, New York, NY, USA
| | - Reem Z Sharaiha
- Division of Gastroenterologyatology, 159947Weill Cornell Medicine, New York, NY, USA
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Ngamruengphong S, Ferri L, Aihara H, Draganov PV, Yang DJ, Perbtani YB, Jue TL, Munroe CA, Boparai ES, Mehta NA, Bhatt A, Kumta NA, Othman MO, Mercado M, Javaid H, Aadam AA, Siegel A, James TW, Grimm IS, DeWitt JM, Novikov A, Schlachterman A, Kowalski T, Samarasena J, Hashimoto R, Chehade NEH, Lee J, Chang K, Su B, Ujiki MB, Mehta A, Sharaiha RZ, Carr-Locke DL, Chen A, Chen M, Chen YI, Pourmousavi Khoshknab M, Wang R, Kerdsirichairat T, Tomizawa Y, von Renteln D, Kumbhari V, Khashab MA, Bechara R, Karasik M, Patel NJ, Fukami N, Nishimura M, Hanada Y, Wong Kee Song LM, Laszkowska M, Wang AY, Hwang JH, Friedland S, Sethi A, Kalloo AN. Efficacy of Endoscopic Submucosal Dissection for Superficial Gastric Neoplasia in a Large Cohort in North America. Clin Gastroenterol Hepatol 2021; 19:1611-1619.e1. [PMID: 32565290 DOI: 10.1016/j.cgh.2020.06.023] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 06/07/2020] [Accepted: 06/11/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Endoscopic submucosal dissection (ESD) is a widely accepted treatment option for superficial gastric neoplasia in Asia, but there are few data on outcomes of gastric ESD from North America. We aimed to evaluate the safety and efficacy of gastric ESD in North America. METHODS We analyzed data from 347 patients who underwent gastric ESD at 25 centers, from 2010 through 2019. We collected data on patient demographics, lesion characteristics, procedure details and related adverse events, treatment outcomes, local recurrence, and vital status at the last follow up. For the 277 patients with available follow-up data, the median interval between initial ESD and last clinical or endoscopic evaluation was 364 days. The primary endpoint was the rate of en bloc and R0 resection. Secondary outcomes included curative resection, rates of adverse events and recurrence, and gastric cancer-related death. RESULTS Ninety patients (26%) had low-grade adenomas or dysplasia, 82 patients (24%) had high-grade dysplasia, 139 patients (40%) had early gastric cancer, and 36 patients (10%) had neuroendocrine tumors. Proportions of en bloc and R0 resection for all lesions were 92%/82%, for early gastric cancers were 94%/75%, for adenomas and low-grade dysplasia were 93%/ 92%, for high-grade dysplasia were 89%/ 87%, and for neuroendocrine tumors were 92%/75%. Intraprocedural perforation occurred in 6.6% of patients; 82% of these were treated successfully with endoscopic therapy. Delayed bleeding occurred in 2.6% of patients. No delayed perforation or procedure-related deaths were observed. There were local recurrences in 3.9% of cases; all occurred after non-curative ESD resection. Metachronous lesions were identified in 14 patients (6.9%). One of 277 patients with clinical follow up died of metachronous gastric cancer that occurred 2.5 years after the initial ESD. CONCLUSIONS ESD is a highly effective treatment for superficial gastric neoplasia and should be considered as a viable option for patients in North America. The risk of local recurrence is low and occurs exclusively after non-curative resection. Careful endoscopic surveillance is necessary to identify and treat metachronous lesions.
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Affiliation(s)
| | - Lorenzo Ferri
- Division of Thoracic Surgery, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Hiroyuki Aihara
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts
| | - Peter V Draganov
- Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida
| | - Dennis J Yang
- Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida
| | - Yaseen B Perbtani
- Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida
| | - Terry L Jue
- Division of Gastroenterology, Kaiser Permanente San Francisco, San Francisco, California
| | - Craig A Munroe
- Division of Gastroenterology, Kaiser Permanente San Francisco, San Francisco, California
| | - Eshandeep S Boparai
- Division of Gastroenterology, Kaiser Permanente San Francisco, San Francisco, California
| | - Neal A Mehta
- Department of Gastroenterology and Hepatology, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - Amit Bhatt
- Department of Gastroenterology and Hepatology, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - Nikhil A Kumta
- Division of Gastroenterology, Mount Sinai Hospital, New York, New York
| | - Mohamed O Othman
- Division of Gastroenterology and Hepatology, Baylor University Medical Center, Houston, Texas
| | - Michael Mercado
- Division of Gastroenterology and Hepatology, Baylor University Medical Center, Houston, Texas
| | - Huma Javaid
- Division of Gastroenterology and Hepatology, Baylor University Medical Center, Houston, Texas
| | - Abdul Aziz Aadam
- Division of Gastroenterology and Hepatology, Northwestern University Medical Center, Chicago, Illinois
| | - Amanda Siegel
- Division of Gastroenterology and Hepatology, Northwestern University Medical Center, Chicago, Illinois
| | - Theodore W James
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ian S Grimm
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - John M DeWitt
- Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, Indiana
| | - Aleksey Novikov
- Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Alexander Schlachterman
- Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Thomas Kowalski
- Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Jason Samarasena
- Division of Gastroenterology and Hepatology, University of California, Irvine, Irvine, California
| | - Rintaro Hashimoto
- Division of Gastroenterology and Hepatology, University of California, Irvine, Irvine, California
| | - Nabil El Hage Chehade
- Division of Gastroenterology and Hepatology, University of California, Irvine, Irvine, California
| | - John Lee
- Division of Gastroenterology and Hepatology, University of California, Irvine, Irvine, California
| | - Kenneth Chang
- Division of Gastroenterology and Hepatology, University of California, Irvine, Irvine, California
| | - Bailey Su
- Department of Surgery, NorthShore University Health System, Evanston, Illinois
| | - Michael B Ujiki
- Department of Surgery, NorthShore University Health System, Evanston, Illinois
| | - Amit Mehta
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, New York
| | - Reem Z Sharaiha
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, New York
| | - David L Carr-Locke
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, New York
| | - Alex Chen
- Division of Thoracic Surgery, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Michael Chen
- Division of Thoracic Surgery, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Yen-I Chen
- Division of Gastroenterology and Hepatology, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | | | - Rui Wang
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland
| | | | - Yutaka Tomizawa
- Division of Gastroenterology and Hepatology, University of Washington, Seattle, Washington
| | - Daniel von Renteln
- Division of Gastroenterology, University of Montreal Hospital Research Centre, University of Montreal Hospital Centre, Montreal, Quebec, Canada
| | - Vivek Kumbhari
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Mouen A Khashab
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Robert Bechara
- Division of Gastroenterology, Queen's University, Kingston, Ontario, Canada
| | - Michael Karasik
- Department of Gastroenterology, Hartford Hospital, Hartford, Connecticut
| | - Neej J Patel
- Division of Gastroenterology and Hepatology, Mayo Clinic Arizona, Phoenix, Arizona
| | - Norio Fukami
- Division of Gastroenterology and Hepatology, Mayo Clinic Arizona, Phoenix, Arizona
| | - Makoto Nishimura
- Gastroenterology and Nutrition Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Yuri Hanada
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | | | - Monika Laszkowska
- Division of Digestive and Liver Diseases, Columbia University Irving Medical Center, New York, New York
| | - Andrew Y Wang
- Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, Virginia
| | - Joo Ha Hwang
- Department of Gastroenterology, Stanford University School of Medicine, Stanford, California
| | - Shai Friedland
- Department of Gastroenterology, Hartford Hospital, Hartford, Connecticut
| | - Amrita Sethi
- Division of Digestive and Liver Diseases, Columbia University Irving Medical Center, New York, New York
| | - Antony N Kalloo
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland
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Issa D, Benias PC, Carr-Locke DL. Achalasia and gastroparesis: Coexisting entities or consequence of therapy? Endosc Int Open 2021; 9:E1222-E1226. [PMID: 34447868 PMCID: PMC8383087 DOI: 10.1055/a-1492-2487] [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] [Received: 10/31/2020] [Accepted: 02/03/2021] [Indexed: 11/11/2022] Open
Affiliation(s)
- Danny Issa
- Division of Digestive Diseases, David Geffen School of Medicine, University of California Los Angele, California, United States
| | - Petros C. Benias
- Department of Medicine, Division of Gastroenterology, Zucker School of Medicine at Hofstra/Northwell, New York, United States
| | - David L. Carr-Locke
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital and Weill Cornell Medical Center, New York, New York, United States
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15
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Issa D, Irani S, Law R, Shah S, Bhalla S, Mahadev S, Hajifathalian K, Sampath K, Mukewar S, Carr-Locke DL, Khashab MA, Sharaiha RZ. Endoscopic ultrasound-guided gallbladder drainage as a rescue therapy for unresectable malignant biliary obstruction: a multicenter experience. Endoscopy 2021; 53:827-831. [PMID: 32898918 DOI: 10.1055/a-1259-0349] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Endoscopic retrograde cholangiopancreatography (ERCP) is often unsuccessful in patients with duodenal stenosis or malignant ampullary infiltration. While endoscopic ultrasound-guided biliary drainage (EUS-BD) has been proposed as an alternative, EUS-guided gallbladder drainage (EUS-GBD) is an attractive option when both approaches fail. We aimed to assess the effectiveness and safety of EUS-GBD as rescue therapy for malignant distal bile duct obstruction. METHODS A multicenter retrospective study was performed on patients with unresectable malignant distal bile duct obstruction who underwent EUS-GBD between 2014 and 2019 after unsuccessful ERCP and EUS-BD. Clinical success was defined as a decrease in serum bilirubin of > 50 % within 2 weeks. RESULTS 28 patients were included, with a lumen-apposing metal stent used in 26 (93 %) and a self-expandable metal stent in two (7 %). The technical success rate was 100 %. The clinical success rate was 93 %, with an improvement in bilirubin (7.3 [SD 5.4] pre-procedure vs. 2.8 [SD 1.1] post-procedure; P = 0.001). Delayed adverse events included food impaction of the stent (n = 3), with a further two patients developing cholecystitis and bleeding. CONCLUSION This study demonstrates the feasibility of gallbladder drainage to relieve malignant distal bile duct obstruction in patients with failed ERCP and EUS-BD.
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Affiliation(s)
- Danny Issa
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital and Weill Cornell Medical Center, New York, New York, USA
| | - Shayan Irani
- Division of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Ryan Law
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Shawn Shah
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital and Weill Cornell Medical Center, New York, New York, USA
| | - Sean Bhalla
- Division of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Srihari Mahadev
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital and Weill Cornell Medical Center, New York, New York, USA
| | - Kaveh Hajifathalian
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital and Weill Cornell Medical Center, New York, New York, USA
| | - Kartik Sampath
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital and Weill Cornell Medical Center, New York, New York, USA
| | - Saurabh Mukewar
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital and Weill Cornell Medical Center, New York, New York, USA
| | - David L Carr-Locke
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital and Weill Cornell Medical Center, New York, New York, USA
| | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Reem Z Sharaiha
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital and Weill Cornell Medical Center, New York, New York, USA
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16
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Barakat M, Ramai D, Cheung D, Abdelfatah MM, Othman MO, Carr-Locke DL, Adler DG. Management of early gastric cancer meeting criteria for endoscopic resection: US population-based study. Endosc Int Open 2021; 9:E989-E993. [PMID: 34222618 PMCID: PMC8211475 DOI: 10.1055/a-1478-3281] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 12/02/2020] [Accepted: 03/08/2021] [Indexed: 11/26/2022] Open
Abstract
Background and study aims The goal of this study was to assess surgical resection (SR) of early gastric cancer (EGC) fitting Japanese Gastric Cancer Association (JGCA) endoscopic resection (ER) criteria. Patients and methods We analyzed EGC data from the national Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2015. Results A total of 2219 EGC cases were identified (1074 T1a and 1145 T1b). Of them, 409 met absolute criteria, 219 met expanded 1, 529 expanded 2, and 229 expanded 3. 259 lesions were treated endoscopically while 1007 were surgically resected (20.5 % vs 79.5 %, P = 0.0001). Temporal analysis showed that the frequency of ER steadily increased while SR proportionally decreased during the study period. Cox proportion regression analysis adjusting for confound variables (including age, gender, and race) showed no significant difference in the risk of mortality following either surgery or endoscopy. Conclusions EGC can be safely treated with ER. However, EGC meeting JGCA ER criteria is largely treated with SR in the United States.
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Affiliation(s)
- Mohamed Barakat
- Division of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Brooklyn, New York, United States
| | - Daryl Ramai
- Department of Internal Medicine, The Brooklyn Hospital Center, Brooklyn, New York, United States
| | - Derrick Cheung
- Division of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Brooklyn, New York, United States
| | - Mohamed M. Abdelfatah
- Division of Gastroenterology and Hepatology, University of Alabama, Birmingham, Alabama, United States
| | - Mohamed O. Othman
- Division of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, United States
| | - David L. Carr-Locke
- Division of Gastroenterology and Hepatology, New York Presbyterian, New York, New York, United States
| | - Douglas G. Adler
- Division of Gastroenterology and Hepatology, Utah University, Salt Lake City, Utah, United States
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17
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Benias PC, Kumbhari V, Kumta NA, Sethi A, D’Souza LS, Tyberg A, Brewer Gutierrez O, Miller LS, Carr-Locke DL, Khashab MA. Single session per oral endoscopic myotomy and trans oral incisionless fundoplication - can we prevent reflux in patients with achalasia? Endosc Int Open 2021; 9:E828-E835. [PMID: 34079863 PMCID: PMC8159615 DOI: 10.1055/a-1395-5667] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 09/18/2020] [Accepted: 11/12/2020] [Indexed: 12/19/2022] Open
Abstract
Background and study aims The rate of gastroesophageal reflux disease (GERD) after per oral endoscopic myotomy (POEM) is concerning. Endoscopic anti-reflux methods, such as Trans Oral Incisionless Fundoplication (TIF), are crucial for the long-term success of POEM, especially if they can be performed in the same session. Methods We completed a proof-of-concept canine pilot study (n = 6) to assess safety and feasibility of POEM and TIF in a single session (POEM-TIF). Subsequently, POEM-TIF was also performed in patients with achalasia (n = 5). Herein, we report on the safety, technical and clinical success of the first-in-human cases with symptom follow-up at 1, 3 and 6 months and pH testing at 6 months. Results POEM was completed successfully in six canines (3 anterior and 3 posterior myotomies), followed by TIF in the same session. Necropsy and extensive testing demonstrated no evidence of mucosal injury and no leaks. The reconstructed valve was 220 to 240 degrees, 3 to 4 cm in length, and resulted in concomitant esophageal lengthening (2-5 cm). Using similar principles, the first-in-human cases were performed without intraprocedural or delayed adverse events. pH testing at 6 months showed that four of five patients had no evidence of GERD (DeMeester > 14.72), and in one case, there was evidence of esophagitis. Conclusions Single session POEM-TIF appears to be safe and feasible. Early clinical human data suggests that it may be able to reduce post POEM GERD, however the additional secondary benefits such as lengthening and straightening of the esophagus, may prove to be equally important for the long-term success of POEM.
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Affiliation(s)
- Petros C. Benias
- Division of Gastroenterology, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Manhasset, New York, United States
| | - Vivek Kumbhari
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, United States.
| | - Nikhil A. Kumta
- Division of Gastroenterology and Hepatology, Mount Sinai, New York, New York, United States.
| | - Amrita Sethi
- Division of Gastroenterology, Columbia University Medical Center, New York, New York.
| | - Lionel S. D’Souza
- Division of Gastroenterology and hepatology, Stony Brook School of Medicine, East Setauket, New York, United States
| | - Amy Tyberg
- Department of Gastroenterology, Rutgers Robert Wood Johnson University Hospital, New Brunswick, New Jersey, United States.
| | - Olaya Brewer Gutierrez
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, United States.
| | - Larry S. Miller
- Division of Gastroenterology, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Manhasset, New York, United States
| | - David L. Carr-Locke
- Division of Gastroenterology and Hepatology, Weil Cornell School of Medicine, New York Hospital, New York, New York, United States
| | - Mouen A. Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, United States.
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18
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Belykh E, Preul MC, Carr-Locke DL, Nguyen QT. Editorial: Applications of Fluorescence in Surgery and Interventional Diagnostics. Front Surg 2021; 8:624124. [PMID: 33912583 PMCID: PMC8074625 DOI: 10.3389/fsurg.2021.624124] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 03/02/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- Evgenii Belykh
- Department of Neurosurgery, New Jersey Medical School, Rutgers University, Newark, NJ, United States
| | - Mark C Preul
- Center for Advanced Digestive Care, Weill Cornell Medicine, New York, NY, United States
| | - David L Carr-Locke
- Departments of Surgery and Pharmacology, University of California, San Diego, San Diego, CA, United States
| | - Quyen T Nguyen
- The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States
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19
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Mahadev S, Aroniadis OC, Barraza LH, Agarunov E, Smith MS, Goodman AJ, Benias PC, Buscaglia JM, Gross SA, Kasmin F, Cohen J, Carr-Locke DL, Greenwald D, Mendelsohn R, Sethi A, Gonda TA. Gastrointestinal endoscopy during the coronavirus pandemic in the New York area: results from a multi-institutional survey. Endosc Int Open 2020; 8:E1865-E1871. [PMID: 33269322 PMCID: PMC7695511 DOI: 10.1055/a-1264-7599] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 06/25/2020] [Accepted: 08/20/2020] [Indexed: 02/07/2023] Open
Abstract
Background and study aims The coronavirus disease 2019 (COVID-19), and measures taken to mitigate its impact, have profoundly affected the clinical care of gastroenterology patients and the work of endoscopy units. We aimed to describe the clinical care delivered by gastroenterologists and the type of procedures performed during the early to peak period of the pandemic. Methods Endoscopy leaders in the New York region were invited to participate in an electronic survey describing operations and clinical service. Surveys were distributed on April 7, 2020 and responses were collected over the following week. A follow-up survey was distributed on April 20, 2020. Participants were asked to report procedure volumes and patient characteristics, as well protocols for staffing and testing for COVID-19. Results Eleven large academic endoscopy units in the New York City region responded to the survey, representing every major hospital system. COVID patients occupied an average of 54.5 % (18 - 84 %) of hospital beds at the time of survey completion, with 14.5 % (2 %-23 %) of COVID patients requiring intensive care. Endoscopy procedure volume and the number of physicians performing procedures declined by 90 % (66 %-98 %) and 84.5 % (50 %-97 %) respectively following introduction of restricted practice. During this period the most common procedures were EGDs (7.9/unit/week; 88 % for bleeding; the remainder for foreign body and feeding tube placement); ERCPs (5/unit/week; for cholangitis in 67 % and obstructive jaundice in 20 %); Colonoscopies (4/unit/week for bleeding in 77 % or colitis in 23 %) and least common were EUS (3/unit/week for tumor biopsies). Of the sites, 44 % performed pre-procedure COVID testing and the proportion of COVID-positive patients undergoing procedures was 4.6 % in the first 2 weeks and up to 19.6 % in the subsequent 2 weeks. The majority of COVID-positive patients undergoing procedures underwent EGD (30.6 % COVID +) and ERCP (10.2 % COVID +). Conclusions COVID-19 has profoundly impacted the operation of endoscopy units in the New York region. Our data show the impact of a restricted emergency practice on endoscopy volumes and the proportion of expected COVID positive cases during the peak time of the pandemic.
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Affiliation(s)
- Srihari Mahadev
- NYP-Weill Cornell Medicine, New York, New York, United States
| | | | - Luis H. Barraza
- NYP-Columbia University Irving Medical Center, New York, United States
| | - Emil Agarunov
- NYP-Columbia University Irving Medical Center, New York, United States
| | | | | | | | | | - Seth A. Gross
- NYU Langone Health, New York, New York, United States
| | | | | | | | | | - Robin Mendelsohn
- Memorial Sloan Kettering Hospital, New York, New York, United States
| | - Amrita Sethi
- NYP-Columbia University Irving Medical Center, New York, United States
| | - Tamas A. Gonda
- NYP-Columbia University Irving Medical Center, New York, United States
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20
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Hajifathalian K, Ichkhanian Y, Dawod Q, Meining A, Schmidt A, Glaser N, Vosoughi K, Diehl DL, Grimm IS, James T, Templeton AW, Samarasena JB, Chehade NEH, Lee JG, Chang KJ, Mizrahi M, Barawi M, Irani S, Friedland S, Korc P, Aadam AA, Al-Haddad M, Kowalski TE, Smallfield G, Ginsberg GG, Fukami N, Lajin M, Kumta NA, Tang SJ, Naga Y, Amateau SK, Kasmin F, Goetz M, Seewald S, Kumbhari V, Ngamruengphong S, Mahdev S, Mukewar S, Sampath K, Carr-Locke DL, Khashab MA, Sharaiha RZ. Full-thickness resection device (FTRD) for treatment of upper gastrointestinal tract lesions: the first international experience. Endosc Int Open 2020; 8:E1291-E1301. [PMID: 33015330 PMCID: PMC7508667 DOI: 10.1055/a-1216-1439] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 03/03/2020] [Accepted: 06/29/2020] [Indexed: 02/08/2023] Open
Abstract
Background and study aims The Full-Thickness Resection Device (FTRD) provides a novel treatment option for lesions not amenable to conventional endoscopic resection techniques. There are limited data on the efficacy and safety of FTRD for resection of upper gastrointestinal tract (GIT) lesions. Patients and methods This was an international multicenter retrospective study, including patients who had an endoscopic resection of an upper GIT lesion using the FTRD between January 2017 and February 2019. Results Fifty-six patients from 13 centers were included. The most common lesions were mesenchymal neoplasms (n = 23, 41 %), adenomas (n = 7, 13 %), and hamartomas (n = 6, 11 %). Eighty-four percent of lesions were located in the stomach, and 14 % in the duodenum. The average size of lesions was 14 mm (range 3 to 33 mm). Deployment of the FTRD was technically successful in 93 % of patients (n = 52) leading to complete and partial resection in 43 (77 %) and 9 (16 %) patients, respectively. Overall, the FTRD led to negative histological margins (R0 resection) in 38 (68 %) of patients. A total of 12 (21 %) mild or moderate adverse events (AEs) were reported. Follow-up endoscopy was performed in 31 patients (55 %), on average 88 days after the procedure (IQR 68-138 days). Of these, 30 patients (97 %) did not have any residual or recurrent lesion on endoscopic examination and biopsy, with residual adenoma in one patient (3 %). Conclusions Our results suggest a high technical success rate and an acceptable histologically complete resection rate, with a low risk of AEs and early recurrence for FTRD resection of upper GIT lesions.
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Affiliation(s)
- Kaveh Hajifathalian
- Weill Cornell Medicine, Division of Gastroenterology and Hepatology, Department of Medicine, New York, NY
| | - Yervant Ichkhanian
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Qais Dawod
- Weill Cornell Medicine, Division of Gastroenterology and Hepatology, Department of Medicine, New York, NY
| | - Alexander Meining
- Interventional and Experimental Endoscopy, Department of Internal Medicine I, Ulm University, Ulm, Germany
| | - Arthur Schmidt
- Department of Medicine II, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Nicholas Glaser
- Department of Medicine II, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Kia Vosoughi
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - David L. Diehl
- Interventional and Experimental Endoscopy, Department of Internal Medicine I, Ulm University, Ulm, Germany
| | - Ian S. Grimm
- Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, Pennsylvania, United States
| | - Theodore James
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Adam W. Templeton
- Department of Gastroenterology, University of Washington, Seattle, Washington, United States
| | - Jason B. Samarasena
- H. H. Chao Comprehensive Digestive Disease Center, Division of Gastroenterology and Hepatology, University of California, Irvine, Orange, California, United States
| | - Nabil El Hage Chehade
- H. H. Chao Comprehensive Digestive Disease Center, Division of Gastroenterology and Hepatology, University of California, Irvine, Orange, California, United States
| | - John G. Lee
- H. H. Chao Comprehensive Digestive Disease Center, Division of Gastroenterology and Hepatology, University of California, Irvine, Orange, California, United States
| | - Kenneth J. Chang
- H. H. Chao Comprehensive Digestive Disease Center, Division of Gastroenterology and Hepatology, University of California, Irvine, Orange, California, United States
| | - Meir Mizrahi
- Department of Internal Medicine, Division of Gastroenterology, Center for Advanced Endoscopy, University of South Alabama, Mobile, Alabama, United States
| | - Mohammed Barawi
- Division of Gastroenterology and Hepatology, Ascension St. John hospital, Detroit, Michigan, United States
| | - Shayan Irani
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, United Stats
| | - Shai Friedland
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, United States
| | - Paul Korc
- Department of Medicine, Division of Gastroenterology, Hoag Hospital, Newport Beach, California, United States
| | - Abdul Aziz Aadam
- Division of Gastroenterology, Northwestern University, Chicago, Illinois, United States
| | - Mohammad Al-Haddad
- Indiana University School of Medicine, Department of Medicine, Division of Gastroenterology, Indianapolis, Indiana, United States
| | | | - George Smallfield
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, Richmond, Virginia United States
| | - Gregory G. Ginsberg
- Gastroenterology Division, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, United States
| | - Norio Fukami
- Division of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Arizona, United States
| | - Michael Lajin
- SHARP Grossmont Hospital, La Mesa, California, United States
| | - Nikhil A. Kumta
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Shou-jiang Tang
- Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, United States
| | - Yehia Naga
- Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, United States
| | - Stuart K. Amateau
- Division of Gastroenterology, University of Minnesota, Minneapolis, Minnesota, United States
| | - Franklin Kasmin
- Division of Gastroenterology, Lenox Hill Hospital, Northwell Health, New York, New York, United States
| | - Martin Goetz
- Innere Medizin I, Universitätsklinikum Tübingen, Tuebingen, Germany
| | - Stefan Seewald
- Centre of Gastroenterology, Klinik Hirslanden, Zurich, Switzerland
| | - Vivek Kumbhari
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | | | - Srihari Mahdev
- Weill Cornell Medicine, Division of Gastroenterology and Hepatology, Department of Medicine, New York, NY
| | - Saurabh Mukewar
- Weill Cornell Medicine, Division of Gastroenterology and Hepatology, Department of Medicine, New York, NY
| | - Kartik Sampath
- Weill Cornell Medicine, Division of Gastroenterology and Hepatology, Department of Medicine, New York, NY
| | - David L. Carr-Locke
- Weill Cornell Medicine, Division of Gastroenterology and Hepatology, Department of Medicine, New York, NY
| | - Mouen A. Khashab
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Reem Z. Sharaiha
- Weill Cornell Medicine, Division of Gastroenterology and Hepatology, Department of Medicine, New York, NY
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Mahadev S, Aroniadis OS, Barraza L, Agarunov E, Goodman AJ, Benias PC, Buscaglia JM, Gross SA, Kasmin FE, Cohen JJ, Carr-Locke DL, Greenwald DA, Mendelsohn RB, Sethi A, Gonda TA. Impact of the COVID-19 pandemic on endoscopy practice: results of a cross-sectional survey from the New York metropolitan area. Gastrointest Endosc 2020; 92:788-789. [PMID: 32339595 PMCID: PMC7182511 DOI: 10.1016/j.gie.2020.04.047] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 04/19/2020] [Indexed: 02/06/2023]
Affiliation(s)
| | | | - Luis Barraza
- NYP-Columbia University Irving Medical Center, New York, New York, USA
| | - Emil Agarunov
- NYP-Columbia University Irving Medical Center, New York, New York, USA
| | | | | | | | | | | | | | | | | | | | - Amrita Sethi
- NYP-Columbia University Irving Medical Center, New York, New York, USA
| | - Tamas A Gonda
- NYP-Columbia University Irving Medical Center, New York, New York, USA
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22
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Affiliation(s)
- David L. Carr-Locke
- New York Presbyterian Hospital, Division of Gastroenterology & Hepatology, Weill Cornell Medicine, New York, New York, USA
| | - Roy Soetikno
- Division of Gastroenterology and Hepatology, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Reem Z. Sharaiha
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, New York, USA
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23
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Sethi A, Swaminath A, Latorre M, Behin DS, Jodorkovsky D, Calo D, Aroniadis O, Mone A, Mendelsohn RB, Sharaiha RZ, Gonda TA, Khanna LG, Bucobo JC, Nagula S, Ho S, Carr-Locke DL, Robbins DH. Donning a New Approach to the Practice of Gastroenterology: Perspectives From the COVID-19 Pandemic Epicenter. Clin Gastroenterol Hepatol 2020; 18:1673-1681. [PMID: 32330565 PMCID: PMC7194523 DOI: 10.1016/j.cgh.2020.04.032] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 04/20/2020] [Indexed: 02/07/2023]
Abstract
The COVID-19 pandemic seemingly is peaking now in New York City and has triggered significant changes to the standard management of gastrointestinal diseases. Priorities such as minimizing viral transmission, preserving personal protective equipment, and freeing hospital beds have driven unconventional approaches to managing gastroenterology (GI) patients. Conversion of endoscopy units to COVID units and redeployment of GI fellows and faculty has profoundly changed the profile of most GI services. Meanwhile, consult and procedural volumes have been reduced drastically. In this review, we share our collective experiences regarding how we have changed our practice of medicine in response to the COVID surge. Although we review our management of specific consults and conditions, the overarching theme focuses primarily on noninvasive measures and maximizing medical therapies. Endoscopic procedures have been reserved for those timely interventions that are most likely to be therapeutic. The role of multidisciplinary discussion, although always important, now has become critical. The support of our faculty and trainees remains essential. Local leadership can encourage well-being by frequent team check-ins and by fostering trainee development through remote learning. Advancing a clear vision and a transparent process for how to organize and triage care in the recovery phase will allow for a smooth transition to our new normal.
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Affiliation(s)
- Amrita Sethi
- New York Presbyterian-Columbia University Irving Medical Center, New York, New York.
| | - Arun Swaminath
- Lenox Hill Hospital, Northwell Health, New York, New York
| | | | - Daniel S Behin
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Daniela Jodorkovsky
- New York Presbyterian-Columbia University Irving Medical Center, New York, New York
| | - Delia Calo
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Anjali Mone
- Lenox Hill Hospital, Northwell Health, New York, New York
| | | | | | - Tamas A Gonda
- New York Presbyterian-Columbia University Irving Medical Center, New York, New York
| | | | | | - Satish Nagula
- Mount Sinai Hospital/Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sammy Ho
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
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Kröner PT, Bilal M, Samuel R, Umar S, Abougergi MS, Lukens FJ, Raimondo M, Carr-Locke DL. Use of ERCP in the United States over the past decade. Endosc Int Open 2020; 8:E761-E769. [PMID: 32490161 PMCID: PMC7247893 DOI: 10.1055/a-1134-4873] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 09/26/2019] [Accepted: 02/12/2020] [Indexed: 12/12/2022] Open
Abstract
Abstract
Background and study aims With newer imaging modalities, indications for use of endoscopic retrograde cholangiopancreatography (ERCP) have changed in the last decade. Despite advances in ERCP, paucity in recent literature regarding utilization and outcomes of ERCP exists. Thus, the aim of this study was to assess the inpatient use of ERCP, outcomes, and most common indications.
Patients and methods Retrospective-cohort study using the Nationwide Inpatient Sample 2007–2016. All patients with ICD9–10CM procedural codes for ERCP were included. The primary outcome was the use of ERCP. Secondary outcomes included determining procedural specifics (stenting, sphincterotomy and dilation), complications (post-ERCP pancreatitis [PEP], bile duct perforation), hospital length of stay, total hospital costs and charges. Multivariate regression analysis was used to adjust for confounders.
Results A total of 1,606,850 patients underwent inpatient ERCP. The mean age was 59 years (60 % female). The total number of ERCPs increased over the last decade. Patients undergoing ERCP in 2016 had greater odds of undergoing bile duct stent placement, pancreatic duct (PD) stenting, biliary dilation, pancreatic sphincterotomy, PEP and biliary perforation. Inpatient mortality decreased. Hospital charges increased, while length of stay (LOS) decreased.
Conclusions The number of ERCPs increased in the past decade. Odds of therapeutic interventions and complications increased. The most common principal diagnoses were choledocholithiasis and gallstone-related AP. Hence, physicians must be aware to promptly diagnose and treat complications. These findings may reflect the increased case complexity and fact that ERCP continues to evolve into an increasingly interventional tool, contrasting from its former role as a predominantly diagnostic and gallstone extraction tool.
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Affiliation(s)
- Paul T. Kröner
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, United States
| | - Mohammad Bilal
- Division of Gastroenterology and Hepatology Beth Israel Deaconess Medical Center, Boston, Massachusetts, United State
| | - Ronald Samuel
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, Texas, United States
| | - Shifa Umar
- Division of Gastroenterology, Allegheny Health Network, Pittsburgh, Pennsylvania, United States
| | - Marwan S. Abougergi
- Division of Gastroenterology, Palmetto Health, Columbia, South Carolina, United States
| | - Frank J. Lukens
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, United States
| | - Massimo Raimondo
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, United States
| | - David L. Carr-Locke
- Division of Gastroenterology, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, United States
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Affiliation(s)
- Guido Costamagna
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy.,Università Cattolica del Sacro Cuore, Centre for Endoscopic Research Therapeutics and Training (CERTT), Roma, Italy
| | - David L Carr-Locke
- The Center for Advanced Digestive Care, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, United States
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26
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Barakat M, Seif M, Abdelfatah MM, Ofosu A, Carr-Locke DL, Othman MO. Endoscopic submucosal dissection for early neoplastic lesions in the surgically altered stomach: a systematic review and meta-analysis. Surg Endosc 2019; 33:2381-2395. [PMID: 30963259 DOI: 10.1007/s00464-019-06778-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 10/15/2018] [Accepted: 04/04/2019] [Indexed: 12/18/2022]
Abstract
INTRODUCTION AND AIM Endoscopic submucosal dissection (ESD) for early gastric cancer is highly effective and well established. Performing ESD in the surgically altered stomach (SAS) is challenging. The aim of this meta-analysis is to assess the safety and efficacy of ESD for patients with early neoplastic lesions occurring in the SAS with a subgroup analysis of lesions occurring on the suture line compared to non-suture line lesions and outcomes in the remnant stomach compared to the gastric tube. METHODS We performed a literature search of the PubMed, Embase, and CINAHL electronic databases from January 2000 to November 2017 for articles reporting the safety and efficacy of ESD in the surgically altered stomach. SAS was defined as the remnant stomach following gastrectomy and gastric tube following esophagectomy. Meta-analysis was performed using Review Manager version 5.3 software. RESULTS A total of 21 articles, with 903 lesions occurring in the remnant stomach or gastric tube, were included in this study. There was no significant difference between en bloc (RR 0.99, 95% CI 0.91-1.08), curative resection (RR 1.03, 95% CI 0.84-1.26), or bleeding rates (RR 1.40, 95% CI 0.18-10.72) between lesions in the remnant stomach and gastric tube. However, perforation was significantly higher in the gastric tube (RR 5.19, 95% 1.27-21.25). Suture line lesions had a significantly higher risk of perforation (RR 4.55, 95% CI 2.13-9.74). CONCLUSION ESD for early neoplastic lesions occurring in the SAS is a safe and efficacious with similar en bloc and curative resection rates compared to the anatomically normal stomach. ESD for lesions on the suture line or in the gastric tube is associated with an increased risk of perforation which can be managed endoscopically.
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Affiliation(s)
- Mohamed Barakat
- Division of Gastroenterology, The Brooklyn Hospital Center, 121 De Kalb Ave, Brooklyn, NY, 11201, USA.
| | | | | | - Andrew Ofosu
- Division of Gastroenterology, The Brooklyn Hospital, Brooklyn, NY, USA
| | | | - Mohamed O Othman
- Division of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, TX, USA
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27
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Saumoy M, Madanat L, Carr-Locke DL, Sharaiha RZ. Tissue ingrowth within lumen-apposing metal stents. How long is long term? Endoscopy 2018; 50:E284-E285. [PMID: 30089327 DOI: 10.1055/a-0631-7854] [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: 12/10/2022]
Affiliation(s)
- Monica Saumoy
- Weill Cornell Medicine, New York Presbyterian Hospital, New York, United States
| | - Luai Madanat
- Weill Cornell Medicine, New York Presbyterian Hospital, New York, United States
| | - David L Carr-Locke
- Weill Cornell Medicine, New York Presbyterian Hospital, New York, United States
| | - Reem Z Sharaiha
- Weill Cornell Medicine, New York Presbyterian Hospital, New York, United States
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28
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D'Souza LS, Trindade AJ, Markowitz B, Carr-Locke DL, Benias PC. Novel endoscopic approach to resection of large symptomatic duplication cysts. Endoscopy 2018; 50:E208-E209. [PMID: 29895057 DOI: 10.1055/a-0605-2630] [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: 12/10/2022]
Affiliation(s)
| | | | | | - David L Carr-Locke
- New York Presbyterian/Weill Cornell Medical Center, New York, United States
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29
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Benias PC, D’Souza L, Lan G, Gluckman C, Inamdar S, Trindade AJ, Miller LS, Carr-Locke DL. Initial experience with a novel resection and plication (RAP) method for acid reflux: a pilot study. Endosc Int Open 2018; 6:E443-E449. [PMID: 29607397 PMCID: PMC5876037 DOI: 10.1055/s-0044-101453] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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: 10/21/2017] [Accepted: 12/27/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND AND STUDY AIMS Current endoscopic therapies for gastroesophageal reflux disorder (GERD) are limited by technical complexity, and/or cost. We sought to evaluate the success of a novel resection and plication (RAP) anti-reflux procedure. PATIENTS AND METHODS RAP was performed on 10 patients with GERD refractory to proton pump inhibitor (PPI) therapy. RAP consists of semi-circumferential mucosectomy along with full-thickness plication of the lower esophageal sphincter (LES) and cardia. We assessed the technical success and safety as well as followed GERD-Health Related Quality of Life (GERD-HRQL) scores and medication usage. RESULTS All patients underwent RAP without adverse events and were discharged on the same day. Only half of the patients required general anesthesia. Follow-up ranged from 5 to 24 months (median 9 months) and all patients had a significant improvement in their GERD-HRQL scores ( P < 0.0001, 95 % CI 19.3 - 25.3). 8 of 10 eliminated their daily PPI dependence. CONCLUSIONS The RAP method has potential as an effective anti-reflux option. Its main advantages include a short procedure time, simple approach using readily available equipment, and possible avoidance of general anesthesia.
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Affiliation(s)
- Petros C. Benias
- Zucker School of Medicine at Hofstra/Northwell,Corresponding author Petros C. Benias Director of Endoscopic SurgeryAssistant Professor of MedicineDivision of GastroenterologyHofstra University, Northwell Health System+1-516-387-3990
| | | | - Gloria Lan
- Mount Sinai Beth Israel, New York, New York
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30
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Cho JY, Baron TH, Carr-Locke DL, Chapman WC, Costamagna G, de Santibanes E, Dominguez Rosado I, Garden OJ, Gouma D, Lillemoe KD, Angel Mercado M, Mullady DK, Padbury R, Picus D, Pitt HA, Sherman S, Shlansky-Goldberg R, Tornqvist B, Strasberg SM. Proposed standards for reporting outcomes of treating biliary injuries. HPB (Oxford) 2018; 20:370-378. [PMID: 29397335 DOI: 10.1016/j.hpb.2017.10.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 10/06/2017] [Accepted: 10/21/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND There is no standard nor widely accepted way of reporting outcomes of treatment of biliary injuries. This hinders comparison of results among approaches and among centers. This paper presents a proposal to standardize terminology and reporting of results of treating biliary injuries. METHODS The proposal was developed by an international group of surgeons, biliary endoscopists and interventional radiologists. The method is based on the concept of "patency" and is similar to the approach used to create reporting standards for arteriovenous hemodialysis access. RESULTS The group considered definitions and gradings under the following headings: Definition of Patency, Definition of Index Treatment Periods, Grading of Severity of Biliary Injury, Grading of Patency, Metrics, Comparison of Surgical to Non Surgical Treatments and Presentation of Case Series. CONCLUSIONS A standard procedure for reporting outcomes of treating biliary injuries has been produced. It is applicable to presenting results of treatment by surgery, endoscopy, and interventional radiology.
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Affiliation(s)
- Jai Young Cho
- Department of Surgery, Seoul National University, Bundang Hospital, Seoul National University College of Medicine, Seongnam, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si 13620, Republic of Korea
| | - Todd H Baron
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, 130 Mason Farm Road CB 7080, Chapel Hill, NC 27599, USA
| | - David L Carr-Locke
- The Center for Advanced Digestive Care, Weill Cornell Medicine, New York Presbyterian Hospital, 1305 York Avenue, 4th Floor, New York, NY 10021, USA
| | - William C Chapman
- Section of Transplantation, Department of Surgery, Washington University in St Louis, 1 Barnes Hospital Plaza, St Louis, MO 63110, USA
| | - Guido Costamagna
- Digestive Endoscopy Unit, Catholic University of the Sacred Heart, Gemelli Hospital, Largo Agostino Gemelli, 8, Roma, RM 00168, Italy
| | - Eduardo de Santibanes
- Department of Surgery, Hospital Italiano de Buenos Aires, Juan D. Peron 4190, C1181ACH CABA, Buenos Aires, Argentina
| | - Ismael Dominguez Rosado
- Department of Surgery, National Institute of Medical Sciences and Nutrition, Vasco de Quiroga 15 Col. Seccion XVI, Tlalpan C.P. 14000, Mexico City, Mexico
| | - O James Garden
- Clinical Surgery, University of Edinburgh, Royal Infirmary, 51 Little France Crescent, Edinburgh EH16 4SA, UK
| | - Dirk Gouma
- Department of Surgery, Faculty of Medicine AMC, University of Amsterdam, Sweelincklaan 15, 1217 CK, Hilversum, The Netherlands
| | - Keith D Lillemoe
- Department of Surgery, White 506, 55 Fruit Street, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Miguel Angel Mercado
- Department of Surgery, National Institute of Medical Sciences and Nutrition, Vasco de Quiroga 15 Col. Seccion XVI, Tlalpan C.P. 14000, Mexico City, Mexico
| | - Daniel K Mullady
- Washington University in St Louis, Department of Medicine, Division of Gastroenterology, Campus Box 8124 660 S Euclid Ave, St Louis, MO 63110, USA
| | - Robert Padbury
- Department of Surgery, Flinders Medical Centre and Flinders University, Flinders Dr, Bedford Park SA 5042, Australia
| | - Daniel Picus
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Blvd, St Louis, MO 63110, USA
| | - Henry A Pitt
- Department of Surgery, Lewis Katz School of Medicine at Temple University, 3509 N. Broad Street, Boyer Pavilion, E 938, Philadelphia, PA 19140, USA
| | - Stuart Sherman
- Department of Medicine, Division of Digestive and Liver Disorders, Indiana University Health-University Hospital, 550 North University Blvd, Suite 1634, Indianapolis, IN 46202, USA
| | - Richard Shlansky-Goldberg
- Division of Interventional Radiology, Perelman School of Medicine at the University of Pennsylvania, Hospital of the University of Pennsylvania, Silverstein 1st floor, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Bjorn Tornqvist
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Steven M Strasberg
- Section of HPB Surgery, Washington University in St Louis, 1 Barnes Hospital Plaza, St Louis, MO 63110, USA.
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Affiliation(s)
| | - Andrew Korman
- Mount Sinai Beth Israel Medical Center, New York, USA
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32
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Affiliation(s)
| | - Andrew Korman
- Mount Sinai Beth Israel Medical Center, New York, USA
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33
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Carr-Locke DL. Endoscopic papillectomy for adenoma: To inject or not to inject? That is no longer the question. Gastrointest Endosc 2017; 85:756-757. [PMID: 28317689 DOI: 10.1016/j.gie.2016.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 10/03/2016] [Indexed: 12/11/2022]
Affiliation(s)
- David L Carr-Locke
- Division of Digestive Diseases, Mount Sinai Beth Israel Medical Center, New York, New York, USA
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34
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Yang D, Amin S, Gonzalez S, Mullady D, Edmundowicz SA, DeWitt JM, Khashab MA, Wang AY, Nagula S, Buscaglia JM, Bucobo JC, Wagh MS, Draganov PV, Stevens T, Vargo JJ, Khara HS, Diehl DL, Keswani RN, Komanduri S, Yachimski PS, Prabhu A, Kwon RS, Watson RR, Goodman AJ, Benias P, Carr-Locke DL, DiMaio CJ. Clinical outcomes of EUS-guided drainage of debris-containing pancreatic pseudocysts: a large multicenter study. Endosc Int Open 2017; 5:E130-E136. [PMID: 28210709 PMCID: PMC5305425 DOI: 10.1055/s-0042-121666] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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] [Indexed: 02/06/2023] Open
Abstract
Background and study aims Data on clinical outcomes of endoscopic drainage of debris-free pseudocysts (PDF) versus pseudocysts containing solid debris (PSD) are very limited. The aims of this study were to compare treatment outcomes between patients with PDF vs. PSD undergoing endoscopic ultrasound (EUS)-guided drainage via transmural stents. Patients and methods Retrospective review of 142 consecutive patients with pseudocysts who underwent EUS-guided transmural drainage (TM) from 2008 to 2014 at 15 academic centers in the United States. Main outcome measures included TM technical success, treatment outcomes (symptomatic and radiologic resolution), need for endoscopic re-intervention at follow-up, and adverse events (AEs). Results TM was performed in 90 patients with PDF and 52 with PSD. Technical success: PDF 87 (96.7 %) vs. PSD 51 (98.1 %). There was no difference in the rates for endoscopic re-intervention (5.5 % in PDF vs. 11.5 % in PSD; P = 0.33) or AEs (12.2 % in PDF vs. 19.2 % in PSD; P = 0.33). Median long-term follow-up after stent removal was 297 days (interquartile range [IQR]: 59 - 424 days) for PDF and 326 days (IQR: 180 - 448 days) for PSD (P = 0.88). There was a higher rate of short-term radiologic resolution of PDF (45; 66.2 %) vs. PSD (21; 51.2 %) (OR = 0.30; 95 % CI: 0.13 - 0.72; P = 0.009). There was no difference in long-term symptomatic resolution (PDF: 70.4 % vs. PSD: 66.7 %; P = 0.72) or radiologic resolution (PDF: 68.9 % vs. PSD: 78.6 %; P = 0.72) Conclusions There was no difference in need for endoscopic re-intervention, AEs or long-term treatment outcomes in patients with PDF vs. PSD undergoing EUS-guided drainage with transmural stents. Based on these results, the presence of solid debris in pancreatic fluid collections does not appear to be associated with a poorer outcome.
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Affiliation(s)
- Dennis Yang
- Division of Gastroenterology, University of Florida College of Medicine, Gainesville, Florida, United Sates
| | - Sunil Amin
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Susana Gonzalez
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Daniel Mullady
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, United States
| | - Steven A. Edmundowicz
- Division of Gastroenterology, University of Colorado, Aurora, Colorado, United States
| | - John M. DeWitt
- Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana, United States
| | - Mouen A. Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Andrew Y. Wang
- Division of Gastroenterology and Hepatology, University of Virginia Health System, Charlottesville, Virginia, United States
| | - Satish Nagula
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Jonathan M. Buscaglia
- Division of Gastroenterology and Hepatology, Stony Brook University School of Medicine, Stony Brook, New York, United States
| | - Juan Carlos Bucobo
- Division of Gastroenterology and Hepatology, Stony Brook University School of Medicine, Stony Brook, New York, United States
| | - Mihir S. Wagh
- Division of Gastroenterology, University of Colorado, Aurora, Colorado, United States
| | - Peter V. Draganov
- Division of Gastroenterology, University of Florida College of Medicine, Gainesville, Florida, United Sates
| | - Tyler Stevens
- Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | - John J. Vargo
- Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | - Harshit S. Khara
- Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, Pennsylvania, United States
| | - David L. Diehl
- Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, Pennsylvania, United States
| | - Rajesh N. Keswani
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Srinadh Komanduri
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Patrick S. Yachimski
- Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Anoop Prabhu
- Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, Michigan, United States
| | - Richard S. Kwon
- Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, Michigan, United States
| | - Rabindra R. Watson
- Division of Digestive Diseases, University of California at Los Angeles School of Medicine, Los Angeles, California, United States
| | - Adam J. Goodman
- Division of Gastroenterology, New York University School of Medicine, New York, New York, United States
| | - Petros Benias
- Division of Digestive Diseases, Beth Israel Medical Center, New York, New York, United States
| | - David L. Carr-Locke
- Division of Digestive Diseases, Beth Israel Medical Center, New York, New York, United States
| | - Christopher J. DiMaio
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, United States,Corresponding author Christopher J. DiMaio, MD Dr. Henry D. Janowitz Division of GastroenterologyIcahn School of Medicine at Mount SinaiOne Gustave L. Levy Place, Box 1069New York, NY 10029+1-212-241-7535
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Sharaiha RZ, Tyberg A, Khashab MA, Kumta NA, Karia K, Nieto J, Siddiqui UD, Waxman I, Joshi V, Benias PC, Darwin P, DiMaio CJ, Mulder CJ, Friedland S, Forcione DG, Sejpal DV, Gonda TA, Gress FG, Gaidhane M, Koons A, DeFilippis EM, Salgado S, Weaver KR, Poneros JM, Sethi A, Ho S, Kumbhari V, Singh VK, Tieu AH, Parra V, Likhitsup A, Womeldorph C, Casey B, Jonnalagadda SS, Desai AP, Carr-Locke DL, Kahaleh M, Siddiqui AA. Endoscopic Therapy With Lumen-apposing Metal Stents Is Safe and Effective for Patients With Pancreatic Walled-off Necrosis. Clin Gastroenterol Hepatol 2016; 14:1797-1803. [PMID: 27189914 DOI: 10.1016/j.cgh.2016.05.011] [Citation(s) in RCA: 162] [Impact Index Per Article: 20.3] [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: 03/02/2016] [Revised: 04/29/2016] [Accepted: 05/03/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Endoscopic ultrasound-guided transmural drainage and necrosectomy have become the standard treatment for patients with pancreatic walled-off necrosis (WON). Lumen-apposing metal stents (LAMS) have shown success in the management of pancreatic fluid collections. However, there are few data on their specific roles in management of WON. We investigated the efficacy and safety of LAMS in treatment of WON. METHODS We performed a retrospective multicenter case series of 124 patients with WON who underwent endoscopic transmural drainage by using LAMS at 17 tertiary care centers from January 2014 through May 2015. Patients underwent endoscopic ultrasound-guided cystogastrostomy or cystoenterostomy with placement of an LAMS into the WON collection. At the discretion of the endoscopist, we performed direct endoscopic necrosectomy, irrigation with hydrogen peroxide, and/or nasocystic drain placement. We performed endoscopic retrograde cholangiopancreatography with pancreatic duct stent placement when indicated. Concomitant therapies included direct endoscopic debridement (n = 78), pancreatic duct stent placement for leak (n = 19), hydrogen peroxide-assisted necrosectomy (n = 38), and nasocystic irrigation (n = 22). We collected data for a median time of 4 months (range, 1-34 months) after the LAMS placement. The primary outcomes were rates of technical success (successful placement of the LAMS), clinical success (resolution of WON, on the basis of image analysis, without need for further intervention via surgery or interventional radiology), and adverse events. RESULTS The median size of the WON was 9.5 cm (range, 4-30 cm). Eight patients had 2 LAMS placed for multiport access, all with technical success (100%). Clinical success was achieved in 107 patients (86.3%) after 3 months of follow-up. Thirteen patients required a percutaneous drain, and 3 required a surgical intervention to manage their WON. The stents remained patent in 94% of patients (117 of 124) and migrated in 5.6% of patients (7 of 124). The median number of endoscopic interventions was 2 (range, 1-9 interventions). CONCLUSIONS On the basis of a retrospective analysis of 124 patients, endoscopic therapy of WON by using LAMS is safe and effective. Creation of a large and sustained cystogastrostomy or cystoenterostomy tract is effective in the drainage and treatment of WON.
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Affiliation(s)
- Reem Z Sharaiha
- Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, New York.
| | - Amy Tyberg
- Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, New York
| | - Mouen A Khashab
- Gastroenterology and Hepatology, Johns Hopkins Medical Institute, Baltimore, Maryland
| | - Nikhil A Kumta
- Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, New York
| | - Kunal Karia
- Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, New York
| | - Jose Nieto
- Department of Gastroenterology and Hepatology, Borland Groover Clinic, Jacksonville, Florida
| | - Uzma D Siddiqui
- Center for Endoscopic Research and Therapeutics (CERT), University of Chicago Medicine and Biological Sciences, Chicago, Illinois
| | - Irving Waxman
- Center for Endoscopic Research and Therapeutics (CERT), University of Chicago Medicine and Biological Sciences, Chicago, Illinois
| | - Virendra Joshi
- Gastroenterology and Hepatology, Ochsner Health System, New Orleans, Louisiana
| | - Petros C Benias
- Gastroenterology and Hepatology, Beth Israel Mt Sinai, New York, New York
| | - Peter Darwin
- Gastroenterology and Hepatology, University of Maryland, Baltimore, Maryland
| | | | - Christopher J Mulder
- Gastroenterology and Hepatology, Brooke Army Medical Center, Fort Sam Houston, Texas
| | - Shai Friedland
- Gastroenterology and Hepatology, Stanford Hospital and Clinics, Palo Alto, California
| | - David G Forcione
- Gastroenterology and Hepatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Divyesh V Sejpal
- Gastroenterology and Hepatology, North Shore-Long Island Jewish Health System, New York, New York
| | - Tamas A Gonda
- Gastroenterology and Hepatology, Columbia University Medical Center, New York, New York
| | - Frank G Gress
- Gastroenterology and Hepatology, Columbia University Medical Center, New York, New York
| | - Monica Gaidhane
- Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, New York
| | - Ann Koons
- Center for Endoscopic Research and Therapeutics (CERT), University of Chicago Medicine and Biological Sciences, Chicago, Illinois
| | - Ersilia M DeFilippis
- Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, New York
| | - Sanjay Salgado
- Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, New York
| | - Kristen R Weaver
- Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, New York
| | - John M Poneros
- Gastroenterology and Hepatology, Columbia University Medical Center, New York, New York
| | - Amrita Sethi
- Gastroenterology and Hepatology, Columbia University Medical Center, New York, New York
| | - Sammy Ho
- Gastroenterology and Hepatology, Montefiore, New York, New York
| | - Vivek Kumbhari
- Gastroenterology and Hepatology, Johns Hopkins Medical Institute, Baltimore, Maryland
| | - Vikesh K Singh
- Gastroenterology and Hepatology, Johns Hopkins Medical Institute, Baltimore, Maryland
| | - Alan H Tieu
- Gastroenterology and Hepatology, Johns Hopkins Medical Institute, Baltimore, Maryland
| | - Viviana Parra
- Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, New York
| | - Alisa Likhitsup
- Gastroenterology and Hepatology, University of Missouri Kansas City, Kansas City, Missouri
| | - Craig Womeldorph
- Gastroenterology and Hepatology, Brooke Army Medical Center, Fort Sam Houston, Texas
| | - Brenna Casey
- Gastroenterology and Hepatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sreeni S Jonnalagadda
- Gastroenterology and Hepatology, University of Missouri Kansas City, Kansas City, Missouri
| | - Amit P Desai
- Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, New York
| | - David L Carr-Locke
- Gastroenterology and Hepatology, Beth Israel Mt Sinai, New York, New York
| | - Michel Kahaleh
- Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, New York
| | - Ali A Siddiqui
- Gastroenterology and Hepatology, Jefferson University, Philadelphia, Pennsylvania
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Benias PC, D'Souza LS, Papafragkakis H, Kim J, Harshan M, Theise ND, Carr-Locke DL. Needle-based confocal endomicroscopy for evaluation of malignant lymph nodes - a feasibility study. Endoscopy 2016; 48:923-8. [PMID: 27434768 DOI: 10.1055/s-0042-109775] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIMS Current modalities for lymph node staging in cancer can be limited. We sought to evaluate the feasibility of needle-based confocal laser endomicroscopy (nCLE) at the time of endoscopic ultrasound (EUS) and to describe the nCLE features that distinguish between benign, malignant, and inflammatory lymph nodes. METHODS We collected data on 28 consecutive patients during EUS staging of malignancy or assessment of enlarged lymph nodes. Patients underwent nCLE at the time of EUS followed by fine needle biopsy. nCLE images were correlated with the patients' final histopathology. RESULTS All 28 patients successfully underwent nCLE during EUS without adverse events. There were 17 cases of carcinoma, 4 lymphoid malignancies, and 7 benign lymph nodes. We characterized the various nCLE features of the lymph node capsule and cortex. Features of carcinoma, such as clusters of dark pleomorphic tumor cells, were identified and found to correlate well with the final pathology. Lymphoid malignancies often had enlarged follicles, but this was inconsistent. CONCLUSIONS nCLE of lymph nodes at the time of EUS is feasible and appears to be safe. Dark pleomorphic cells were readily identified in all of the malignant lymph nodes and correlated with tumor cells seen on histology.
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Affiliation(s)
- Petros C Benias
- Division of Digestive Diseases, Mount Sinai Beth Israel Medical Center, New York, New York, USA
| | - Lionel S D'Souza
- Division of Digestive Diseases, Mount Sinai Beth Israel Medical Center, New York, New York, USA
| | - Haris Papafragkakis
- Division of Gastroenterology, The Brooklyn Hospital Center, Brooklyn, New York, USA
| | - Joseph Kim
- Division of Gastroenterology, Doylestown Hospital, Doylestown, Pennsylvania, USA
| | - Manju Harshan
- Department of Surgical Pathology, Mount Sinai Beth Israel Medical Center, New York, New York, USA
| | - Neil D Theise
- Division of Digestive Diseases, Mount Sinai Beth Israel Medical Center, New York, New York, USA
| | - David L Carr-Locke
- Division of Digestive Diseases, Mount Sinai Beth Israel Medical Center, New York, New York, USA
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Yang D, Amin S, Gonzalez S, Mullady D, Hasak S, Gaddam S, Edmundowicz SA, Gromski MA, DeWitt JM, El Zein M, Khashab MA, Wang AY, Gaspar JP, Uppal DS, Nagula S, Kapadia S, Buscaglia JM, Bucobo JC, Schlachterman A, Wagh MS, Draganov PV, Jung MK, Stevens T, Vargo JJ, Khara HS, Huseini M, Diehl DL, Keswani RN, Law R, Komanduri S, Yachimski PS, DaVee T, Prabhu A, Lapp RT, Kwon RS, Watson RR, Goodman AJ, Chhabra N, Wang WJ, Benias P, Carr-Locke DL, DiMaio CJ. Transpapillary drainage has no added benefit on treatment outcomes in patients undergoing EUS-guided transmural drainage of pancreatic pseudocysts: a large multicenter study. Gastrointest Endosc 2016; 83:720-9. [PMID: 26548849 DOI: 10.1016/j.gie.2015.10.040] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 10/29/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS The need for transpapillary drainage (TPD) in patients undergoing transmural drainage (TMD) of pancreatic fluid collections (PFCs) remains unclear. The aims of this study were to compare treatment outcomes between patients with pancreatic pseudocysts undergoing TMD versus combined (TMD and TPD) drainage (CD) and to identify predictors of symptomatic and radiologic resolution. METHODS This is a retrospective review of 375 consecutive patients with PFCs who underwent EUS-guided TMD from 2008 to 2014 at 15 academic centers in the United States. Main outcome measures included TMD and CD technical success, treatment outcomes (symptomatic and radiologic resolution) at follow-up, and predictors of treatment outcomes on logistic regression. RESULTS A total of 375 patients underwent EUS-guided TMD of PFCs, of which 174 were pseudocysts. TMD alone was performed in 95 (55%) and CD in 79 (45%) pseudocysts. Technical success was as follows: TMD, 92 (97%) versus CD, 35 (44%) (P = .0001). There was no difference in adverse events between the TMD (15%) and CD (14%) cohorts (P = .23). Median long-term (LT) follow-up after transmural stent removal was 324 days (interquartile range, 72-493 days) for TMD and 201 days (interquartile range, 150-493 days) (P = .37). There was no difference in LT symptomatic resolution (TMD, 69% vs CD, 62%; P = .61) or LT radiologic resolution (TMD, 71% vs CD, 67%; P = .79). TPD attempt was negatively associated with LT radiologic resolution of pseudocyst (odds ratio, 0.11; 95% confidence interval, 0.02-0.8; P = .03). CONCLUSIONS TPD has no benefit on treatment outcomes in patients undergoing EUS-guided TMD of pancreatic pseudocysts and negatively affects LT resolution of PFCs.
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Affiliation(s)
- Dennis Yang
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sunil Amin
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Susana Gonzalez
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Daniel Mullady
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Stephen Hasak
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Srinivas Gaddam
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Steven A Edmundowicz
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Mark A Gromski
- Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - John M DeWitt
- Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Mohamad El Zein
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Andrew Y Wang
- Division of Gastroenterology and Hepatology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Jonathan P Gaspar
- Division of Gastroenterology and Hepatology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Dushant S Uppal
- Division of Gastroenterology and Hepatology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Satish Nagula
- Division of Gastroenterology and Hepatology, Stony Brook University School of Medicine, Stony Brook, New York, USA
| | - Samir Kapadia
- Division of Gastroenterology and Hepatology, Stony Brook University School of Medicine, Stony Brook, New York, USA
| | - Jonathan M Buscaglia
- Division of Gastroenterology and Hepatology, Stony Brook University School of Medicine, Stony Brook, New York, USA
| | - Juan Carlos Bucobo
- Division of Gastroenterology and Hepatology, Stony Brook University School of Medicine, Stony Brook, New York, USA
| | - Alex Schlachterman
- Division of Gastroenterology, University of Florida, Gainesville, Florida, USA
| | - Mihir S Wagh
- Division of Gastroenterology, University of Florida, Gainesville, Florida, USA
| | - Peter V Draganov
- Division of Gastroenterology, University of Florida, Gainesville, Florida, USA
| | - Min Kyu Jung
- Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Tyler Stevens
- Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - John J Vargo
- Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Harshit S Khara
- Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Mustafa Huseini
- Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - David L Diehl
- Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Rajesh N Keswani
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ryan Law
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Srinadh Komanduri
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Patrick S Yachimski
- Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Tomas DaVee
- Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Anoop Prabhu
- Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Robert T Lapp
- Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Richard S Kwon
- Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Rabindra R Watson
- Division of Digestive Diseases, University of California at Los Angeles School of Medicine, Los Angeles, California, USA
| | - Adam J Goodman
- Division of Gastroenterology, New York University School of Medicine, New York, New York, USA
| | - Natasha Chhabra
- Division of Gastroenterology, New York University School of Medicine, New York, New York, USA
| | - Wallace J Wang
- Division of Digestive Diseases, Beth Israel Medical Center, New York, New York, USA
| | - Petros Benias
- Division of Digestive Diseases, Beth Israel Medical Center, New York, New York, USA
| | - David L Carr-Locke
- Division of Digestive Diseases, Beth Israel Medical Center, New York, New York, USA
| | - Christopher J DiMaio
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Pinn DM, D'Souza LS, Mannan AASR, Benias P, Carr-Locke DL. A rare case of non-Epstein-Barr virus-associated lymphoepithelioma-like carcinoma of the esophagus treated with endoscopic submucosal dissection. Gastrointest Endosc 2016; 83:471-2; discussion 472. [PMID: 26297869 DOI: 10.1016/j.gie.2015.08.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 08/13/2015] [Indexed: 12/11/2022]
Affiliation(s)
- David M Pinn
- Department of Medicine, Mount Sinai Beth Israel Medical Center, New York, New York, USA
| | - Lionel S D'Souza
- Division of Digestive Diseases, Mount Sinai Beth Israel Medical Center, New York, New York, USA
| | | | - Petros Benias
- Division of Digestive Diseases, Mount Sinai Beth Israel Medical Center, New York, New York, USA
| | - David L Carr-Locke
- Division of Digestive Diseases, Mount Sinai Beth Israel Medical Center, New York, New York, USA
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Wang KK, Carr-Locke DL, Singh SK, Neumann H, Bertani H, Galmiche JP, Arsenescu RI, Caillol F, Chang KJ, Chaussade S, Coron E, Costamagna G, Dlugosz A, Ian Gan S, Giovannini M, Gress FG, Haluszka O, Ho KY, Kahaleh M, Konda VJ, Prat F, Shah RJ, Sharma P, Slivka A, Wolfsen HC, Zfass A. Use of probe-based confocal laser endomicroscopy (pCLE) in gastrointestinal applications. A consensus report based on clinical evidence. United European Gastroenterol J 2015; 3:230-54. [PMID: 26137298 DOI: 10.1177/2050640614566066] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [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: 07/29/2014] [Accepted: 11/17/2014] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Probe-based confocal laser endomicroscopy (pCLE) provides microscopic imaging during an endoscopic procedure. Its introduction as a standard modality in gastroenterology has brought significant progress in management strategies, affecting many aspects of clinical care and requiring standardisation of practice and training. OBJECTIVE This study aimed to provide guidance on the standardisation of its practice and training in Barrett's oesophagus, biliary strictures, colorectal lesions and inflammatory bowel diseases. METHODS Initial statements were developed by five group leaders, based on the available clinical evidence. These statements were then voted and edited by the 26 participants, using a modified Delphi approach. After two rounds of votes, statements were validated if the threshold of agreement was higher than 75%. RESULTS Twenty-six experts participated and, among a total of 77 statements, 61 were adopted (79%) and 16 were rejected (21%). The adoption of each statement was justified by the grade of evidence. CONCLUSION pCLE should be used to enhance the diagnostic arsenal in the evaluation of these indications, by providing microscopic information which improves the diagnostic performance of the physician. In order actually to implement this technology in the clinical routine, and to ensure good practice, standardised initial and continuing institutional training programmes should be established.
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Affiliation(s)
- Kenneth K Wang
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - David L Carr-Locke
- Division of Digestive Diseases, Beth Israel Medical Center, New York City, NY, USA
| | - Satish K Singh
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Helmut Neumann
- The Ludwig Demling Endoscopy Center of Excellence, Erlangen, Germany
| | - Helga Bertani
- Endoscopy Unit, Nuovo Ospedale Civile S. Agostino Estense, Modena, Italy
| | | | | | - Fabrice Caillol
- Endoscopy Unit, Paoli-Calmettes Institute, Marseille, France
| | - Kenneth J Chang
- H.H. Chao Comprehensive Digestive Disease Center, University of California, Irvine, CA, USA
| | - Stanislas Chaussade
- Division of Gastroenterology, Hopital Cochin and Paris-Descartes University, Paris, France
| | - Emmanuel Coron
- Division of Gastroenterology and Hepatology, Nantes CHU, Rouen, France
| | | | - Aldona Dlugosz
- Karolinska Institutet, Department of Medicine, Division of Gastroenterology and Hepatology, Karolinska University Hospital, Stockholm, Sweden
| | - S Ian Gan
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA
| | - Marc Giovannini
- Endoscopy Unit, Paoli-Calmettes Institute, Marseille, France
| | - Frank G Gress
- Division of Digestive and Liver disease, Columbia University Medical Center, New York City, NY, USA
| | - Oleh Haluszka
- Department of Medicine, Temple University School of Medicine, Philadelphia, PA, USA
| | - Khek Y Ho
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Michel Kahaleh
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York City, NY, USA
| | - Vani J Konda
- Center for Endoscopic Research and Therapeutics, Department of Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Frederic Prat
- Division of Gastroenterology, Hopital Cochin and Paris-Descartes University, Paris, France
| | - Raj J Shah
- University of Colorado School of Medicine, Aurora, CO, USA
| | - Prateek Sharma
- Department of Gastroenterology and Hepatology, Veterans Affairs Medical Center, Kansas City, MI, USA ; Department of Gastroenterology and Hepatology, The University of Kansas Medical Center, Kansas City, KS, USA
| | - Adam Slivka
- Division of Gastroenterology & Hepatology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Alvin Zfass
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University Medical Center, Richmond, VA, USA
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Benias PC, Matin A, Ascunce GI, Carr-Locke DL. Esophageal obstruction as a result of isolated eosinophilic gastroenteritis. Gastroenterol Hepatol (N Y) 2013; 9:607-610. [PMID: 24729774 PMCID: PMC3983982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Petros C Benias
- Division of Digestive Diseases, Beth Israel Medical Center, New York, New York
| | - Ayaz Matin
- Division of Digestive Diseases, Beth Israel Medical Center, New York, New York
| | - Gil Ignacio Ascunce
- Division of Digestive Diseases, Beth Israel Medical Center, New York, New York
| | - David L Carr-Locke
- Division of Digestive Diseases, Beth Israel Medical Center, New York, New York
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41
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Affiliation(s)
- Brian R Boulay
- Section of Gastroenterology & Nutrition, University of Illinois Medical Center, Chicago, Illinois, USA
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Telford JJ, Carr-Locke DL, Baron TH, Poneros JM, Bounds BC, Kelsey PB, Schapiro RH, Huang CS, Lichtenstein DR, Jacobson BC, Saltzman JR, Thompson CC, Forcione DG, Gostout CJ, Brugge WR. A randomized trial comparing uncovered and partially covered self-expandable metal stents in the palliation of distal malignant biliary obstruction. Gastrointest Endosc 2010; 72:907-14. [PMID: 21034891 DOI: 10.1016/j.gie.2010.08.021] [Citation(s) in RCA: 170] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Accepted: 08/16/2010] [Indexed: 02/08/2023]
Abstract
BACKGROUND The most common complication of uncovered biliary self-expandable metal stents (SEMSs) is tumor ingrowth. The addition of an impenetrable covering may prolong stent patency. OBJECTIVE To compare stent patency between uncovered and partially covered SEMSs in malignant biliary obstruction. DESIGN Multicenter randomized trial. SETTING Four teaching hospitals. PATIENTS Adults with inoperable distal malignant biliary obstruction. INTERVENTIONS Uncovered or partially covered SEMS insertion. MAIN OUTCOME MEASURES Time to recurrent biliary obstruction, patient survival, serious adverse events, and mechanism of recurrent biliary obstruction. RESULTS From October 2002 to May 2008, 129 patients were randomized. Recurrent biliary obstruction was observed in 11 of 61 uncovered SEMSs (18%) and 20 of 68 partially covered SEMSs (29%). The median times to recurrent biliary obstruction were 711 days and 357 days for the uncovered and partially covered SEMS groups, respectively (P = .530). Median patient survival was 239 days for the uncovered SEMS and 227 days for the partially covered SEMS groups (P = .997). Serious adverse events occurred in 27 (44%) and 42 (62%) patients in the uncovered and partially covered SEMS groups, respectively (P = .046). None of the uncovered and 8 (12%) of the partially covered SEMSs migrated (P = .0061). LIMITATIONS Intended sample size was not reached. Allocation to treatment groups was unequal. CONCLUSIONS There was no significant difference in time to recurrent biliary obstruction or patient survival between the partially covered and uncovered SEMS groups. Partially covered SEMSs were associated with more serious adverse events, particularly migration.
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Omata F, Deshpande G, Tokuda Y, Takahashi O, Ohde S, Carr-Locke DL, Jacobs JL, Mine T, Fukui T. Meta-analysis: somatostatin or its long-acting analogue, octreotide, for prophylaxis against post-ERCP pancreatitis. J Gastroenterol 2010; 45:885-95. [PMID: 20373114 DOI: 10.1007/s00535-010-0234-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [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: 12/18/2009] [Accepted: 03/03/2010] [Indexed: 02/04/2023]
Abstract
BACKGROUND Acute pancreatitis is a most serious complication following endoscopic retrograde cholangiopancreatography (ERCP). Previous meta-analyses and randomized controlled trials have shown conflicting results regarding the preventive efficacy of somatostatin or octreotide for this complication. The aim of this study was to resolve these conflicts. METHODS A standardized comprehensive literature search was performed through September 2009. Depending on heterogeneity of outcomes, either random-effects model (REM) or fixed-effects model (FEM) was applied to calculate pooled estimates of drug efficacy. RESULTS Seventeen studies, including 3818 participants, met the inclusion criteria. Analysis of somatostatin and octreotide trials showed that these drugs prevented post-ERCP pancreatitis (pooled risk ratio [95% confidence interval; CI], 0.63 [0.42-0.96] in REM. Pooled risk ratios [95% CI] of each subgroup were: 0.52 [0.30-0.90] for somatostatin in REM; 0.30 [0.17-0.53] for high-dose somatostatin infused over 12 h in FEM; 0.27 [0.13-0.52] for bolus somatostatin in FEM; 0.35 [0.15-0.82] for pancreatic duct (PD) injection with somatostatin in FEM; 0.33 [0.16-0.70] for biliary sphincterotomy (BS) with somatostatin in FEM; 0.53 [0.24-1.17] for intention-to-treat (ITT) analysis with somatostatin in REM; 0.42 [0.20-0.90] for high-dose octreotide in FEM; 0.61 [0.27-1.35] for PD injection with octreotide in FEM; 0.64 [0.32-1.29] for BS with octreotide in FEM; and 0.83 [0.34-2.03] for ITT analysis with octreotide in REM. CONCLUSIONS Somatostatin and high-dose octreotide may prevent post-ERCP pancreatitis. The preventive efficacy of somatostatin is more prominent in cases of PD injection, or BS, or high-dose administration over 12 h, or bolus injection.
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Affiliation(s)
- Fumio Omata
- St. Luke's International Hospital, 9-1 Akashichyo, Chuoku, Tokyo 104-8560, Japan.
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Fernández-Esparrach G, Matthes EL, Maurice D, Enderlé M, Thompson CC, Carr-Locke DL. A novel device for endoscopic submucosal dissection that combines water-jet submucosal hydrodissection and elevation with electrocautery: initial experience in a porcine model. Gastrointest Endosc 2010; 71:615-8. [PMID: 20189522 DOI: 10.1016/j.gie.2009.10.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2009] [Accepted: 10/08/2009] [Indexed: 02/08/2023]
Abstract
BACKGROUND Endoscopic submucosal dissection requires a high degree of endoscopic skill and specifically designed dissecting instruments. OBJECTIVE To describe the technique for endoscopic submucosal dissection when using the ERBE Hybrid Knife, which combines an ultrafine high-pressure water jet with an electrocautery needle. DESIGN Descriptive study (ex vivo and in vivo porcine esophagus, stomach, and colon). INTERVENTIONS The only instrument used for the dissection was the ERBE Hybrid Knife. The high-pressure water jet was used at a pressure between 45 and 60 bar for creating submucosal fluid elevation. After this, circumferential mucosal incisions and submucosal dissection were performed with the FORCED COAG and ENDOCUT D modes of the same device. The water jet was used intermittently during the dissection process. MAIN OUTCOME MEASUREMENTS At the end of the in vivo experiments, animals were killed and the organs removed for evaluation. RESULTS Multiple endoscopic submucosal dissection procedures were successfully performed. It was possible to create submucosal fluid cushions rapidly. Repeated fluid injections during dissection were easily facilitated with the same device. All ex vivo gastric endoscopic submucosal dissections of 50 x 40-mm lesions were completed within 10 minutes. In the in vivo studies, the mean size of the gastric and colonic specimens was 3.7 +/- 2.1 x 2.3 +/- 1 cm, and the dissections were completed within 8 minutes. No thermal injury was observed on the serosa, and no perforations were detected. CONCLUSIONS Endoscopic submucosal dissection can be safely and effectively achieved in a porcine model with the ERBE Hybrid Knife and should be considered a suitable device for this procedure in humans.
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Piesman M, Kozarek RA, Brandabur JJ, Pleskow DK, Chuttani R, Eysselein VE, Silverman WB, Vargo JJ, Waxman I, Catalano MF, Baron TH, Parsons WG, Slivka A, Carr-Locke DL. Improved oral intake after palliative duodenal stenting for malignant obstruction: a prospective multicenter clinical trial. Am J Gastroenterol 2009; 104:2404-11. [PMID: 19707192 DOI: 10.1038/ajg.2009.409] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES We sought to test the hypothesis that placement of a new nitinol duodenal self-expandable metallic stent (SEMS) for palliation of malignant gastroduodenal obstruction is effective and safe in allowing patients to tolerate an oral diet. METHODS In a prospective multicenter study, SEMSs (Duodenal WallFlex, Boston Scientific) were placed to alleviate gastroduodenal obstruction in inoperable patients without the ability to tolerate solid food. The primary study end point was improvement in oral intake monitored according to the 4-point Gastric Outlet Obstruction Scoring System (GOOSS) up to 24 weeks after stent placement. RESULTS Forty-three patients received SEMSs, which were successfully deployed on the first attempt in 41 cases (95%) and the second attempt in two (5%). Within 1 day and 7 days after SEMS placement, 52% and 75% of patients, respectively, benefited from a GOOSS increase > or =1. Resumption of solid food intake (GOOSS 2-3) was attained by 56% of patients within 7 days and 80% by 28 days. Of the patients attaining GOOSS 2-3, 48% remained on solid food until death or last follow-up. Device-related adverse events included stent occlusion/malfunction in 9% of patients and perforation in 5% of patients. CONCLUSIONS Duodenal WallFlex stent placement promptly improves oral intake in a majority of inoperable patients with malignant gastroduodenal obstruction. In approximately half the patients achieving GOOSS 2-3, the capacity for solid food intake endures until death or last follow-up.
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Affiliation(s)
- Michael Piesman
- Endoscopy Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
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Mullady DK, Carr-Locke DL. Traumatic biliary stricture. Medscape J Med 2008; 10:114. [PMID: 18596943 PMCID: PMC2438481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Daniel K Mullady
- Division of Gastroenterology, Harvard Medical School, Boston, Massachusetts, USA.
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Pai RD, Carr-Locke DL, Thompson CC. Endoscopic evaluation of the defunctionalized stomach by using ShapeLock technology (with video). Gastrointest Endosc 2007; 66:578-81. [PMID: 17725949 DOI: 10.1016/j.gie.2007.02.062] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [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: 11/08/2006] [Accepted: 02/19/2007] [Indexed: 02/06/2023]
Abstract
BACKGROUND Patients with Roux-en-Y gastric bypass (RYGB) present a unique problem if they require diagnostic or therapeutic interventions for which the pancreatobiliary limb or the defunctionalized stomach must be accessed. Novel shape-locking guides have been reported in the literature to reduce looping during colonoscopy, and a new guide is now available to assist with enteroscopy. OBJECTIVE To use ShapeLock technology to permit evaluation of the defunctionalized stomach. DESIGN Observational case series. SETTING Tertiary-care center. PATIENTS Nine patients with a history of RYGB referred for repeat endoscopic evaluation after initial enteroscopy failed to reach the excluded stomach. INTERVENTIONS After achieving appropriate levels of sedation, a standard enteroscope was back-loaded with the ShapeLock enteroscopy guide and was inserted through the mouth. The device was moved through the gastrojejunal (GJ) anastomosis, along the Roux limb, and into the distal pancreatobiliary limb. The device was then locked, which allowed the enteroscope to be advanced to the defunctionalized stomach. RESULTS The ShapeLock guide was able to be advanced to the excluded stomach and perform a thorough examination of the pancreatobiliary limb in 8 of 9 patients, without complications. In 1 patient, the diameter of the GJ anastomosis prevented passage of the device. CONCLUSIONS The ShapeLock enteroscopy guide can allow access to the upper-GI tract in patients after RYGB, provided the GJ anastomosis is of adequate diameter. This study suggested that the technique is safe and has the potential to allow therapeutic interventions in the defunctionalized stomach and duodenum, including ERCP.
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Affiliation(s)
- Reina D Pai
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
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Liu JJ, Glickman JN, Li X, Maurer R, Ashley SW, Brooks DC, Carr-Locke DL, Saltzman JR. Smooth muscle remodeling of the gastroesophageal junction after endoluminal gastroplication. Gastrointest Endosc 2007; 65:1023-7. [PMID: 17324412 DOI: 10.1016/j.gie.2006.06.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [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: 03/07/2006] [Accepted: 06/05/2006] [Indexed: 01/30/2023]
Abstract
BACKGROUND Endoluminal gastroplication has been shown to reduce symptoms of gastroesophageal reflux disease and to induce focal hypertrophy of the gastroesophageal junction (GEJ) muscularis propria. Despite suture loss, some patients have persistent symptomatic resolution. OBJECTIVE This study was designed to examine the durability of smooth muscle hypertrophy after suture removal. DESIGN Seven pigs underwent upper endoscopy with endoscopic ultrasonography (EGD/EUS) at baseline to evaluate GEJ muscularis propria layer. Endoluminal gastroplication was performed at week 1 with placement of 2 sutures at the GEJ. Repeat EGD/EUS was performed at week 3 and week 5. Three of the 7 pigs were killed for histologic analysis. The remaining 4 pigs had sutures removed and survived for 9, 11, and 13 weeks; serial weekly EGD/EUS was performed until the animal was killed. RESULTS The GEJ muscularis propria thickness by EUS was 1.1+/-0.1 mm at baseline, 4.7+/-1.9 mm at week 3, and 4.4+/-1.1 mm at week 5. The muscularis propria thickness by histologic examination in the 3 animals with sutures intact were 6.2+/-0.3 mm near the suture site and 4.7+/-0.5 mm at the opposing wall to the suture site. For the 4 animals with sutures removed, the measurements were 6.9+/-0.2 mm (suture site) and 4.7+/-0.5 mm (opposing wall), respectively. CONCLUSIONS The GEJ smooth muscle cell hypertrophy induced by endoluminal gastroplication persisted after removal of mucosal sutures. These changes may be responsible for persistent symptomatic response despite suture loss in patients.
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Affiliation(s)
- Julia J Liu
- Division of Gastroenterology, Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA
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Grover S, Hamilton MJ, Carr-Locke DL. Refractory Clostridium difficile-associated diarrhea. MedGenMed 2007; 9:46. [PMID: 17955101 PMCID: PMC1994858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- Shilpa Grover
- Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts, USA
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