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Canakis A, Chandan S, Bapaye J, Canakis J, Twery B, Mohan BP, Ramai D, Facciorusso A, Bilal M, Adler DG. Cold Snare Polypectomy in Small (<10 mm) Pedunculated Colorectal Polyps: A Systematic Review and Meta-analysis. J Clin Gastroenterol 2024; 58:370-377. [PMID: 38289665 DOI: 10.1097/mcg.0000000000001848] [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: 10/01/2022] [Accepted: 02/24/2023] [Indexed: 03/17/2024]
Abstract
INTRODUCTION Endoscopic removal techniques for colorectal polyps include cold snare polypectomy (CSP) and hot snare polypectomy (HSP). Although HSP is recommended for pedunculated polyps (PPs) larger than 10 mm, data regarding use of CSP for PPs <10 mm continues to emerge. We aimed to investigate outcomes of these techniques in small (<10 mm) pedunculated colorectal polyps. METHODS Multiple databases were searched till June 2022 to identify studies involving the removal of small PPs with CSP and HSP. Random effects model was used to calculate outcomes and 95% CI. Primary outcome was the pooled rate of successful en-bloc resection. Secondary outcomes were immediate and delayed bleeding with CSP and HSP as well as prophylactic and post resection clip placement. RESULTS Six studies including 1025 patients (1111 polyps with a mean size 4 to 8.5 mm) were analyzed. 116 and 995 polyps were removed with HSP and CSP, respectively. The overall pooled rate of successful en-bloc resection with CSP was 99.7% (CI 99.1-99.9; I2 0%). Pooled immediate and delayed bleeding after CSP was 49.8% (CI 46.8-52.91; I2 98%) and 0% (CI 0.00-0.00; I2 0%), respectively. Delayed bleeding was higher with HSP, relative risk 0.05 (CI 0.01-0.43; I2 0%), P =0.006, whereas immediate bleeding was higher with CSP, relative risk 7.89 (CI 4.36-14.29; I2 0%), P <0.00001. Pooled rates of prophylactic clip placement and post-procedure clip placement (to control immediate bleeding) were 55.3% and 47.2%, respectively. Finally, right colon polyp location significantly correlated with frequency of immediate bleeding. CONCLUSION Our analysis shows that CSP is safe and effective for resection of small PPs.
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Affiliation(s)
- Andrew Canakis
- Division of Gastroenterology & Hepatology, University of Maryland School of Medicine, Baltimore, MD
| | - Saurabh Chandan
- Division of Gastroenterology and Hepatology, Creighton University School of Medicine, Omaha, NE
| | - Jay Bapaye
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY
| | - Justin Canakis
- Department of Internal Medicine, George Washington University School of Medicine, Washington, DC
| | - Benjamin Twery
- Division of Gastroenterology & Hepatology, University of Maryland School of Medicine, Baltimore, MD
| | - Babu P Mohan
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, UT
| | - Daryl Ramai
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, UT
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Surgical and Medical Sciences, University of Foggia, Foggia, Italy
| | - Mohammad Bilal
- Division of Gastroenterology, University of Minnesota and Minneapolis VA Health Care System, Minneapolis, MN
| | - Douglas G Adler
- Center for Advanced Therapeutic Endoscopy (CATE), Centura Health, Porter Adventist Hospital, Denver, CO
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Malik S, Ullah H, Loganathan P, Singh Dahiya D, Chandan S, Mohan BP, Adler DG. Efficacy of Endoscopic Therapy in Symptomatic Pancreatic Divisum: A Systematic Review and Meta-analysis. J Clin Gastroenterol 2024:00004836-990000000-00273. [PMID: 38457418 DOI: 10.1097/mcg.0000000000001986] [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: 08/30/2023] [Accepted: 01/31/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND AND AIMS Pancreas divisum (PD) is a congenital malformation of the pancreas and is implicated as a cause of pancreatitis. The role of endotherapy has been variable in symptomatic PD indicated by recurrent acute pancreatitis (RAP), chronic pancreatitis (CP), or chronic pancreatic-type abdominal pain (PP). The aim of this study was to analyze the pooled data to determine the success of endoscopic intervention for pancreas divisum. METHODS We conducted a comprehensive search of several databases (inception to July 2023) to identify studies reporting on the use of endoscopic therapy in symptomatic pancreatic divisum. The random-effects model was used to calculate the pooled rates and I2% values were used to assess the heterogeneity. RESULTS A total of 27 studies were retrieved that reported endoscopic intervention in pancreatic divisum. The calculated pooled rate of technical success was 92% (95% CI: 87-95; I2=63%). The calculated pooled rate of clinical success was 65% (95% CI: 60-70; I2=60%). The rate of clinical success by PD subtypes was highest in RAP at 71% (95% CI: 65-76; I2=24%). Available studies had significant heterogeneity in defining clinical success. The rate of adverse events was 71% (95% CI: 65-76; I2=24%). CONCLUSIONS The role of endoscopic therapy in pancreatic divisum is variable with the highest success rate in recurrent acute pancreatitis. Endoscopic intervention is associated with a higher-than-usual rate of adverse events, including post-ERCP pancreatitis.
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Affiliation(s)
- Sheza Malik
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY
| | - Hamid Ullah
- Department of Internal Medicine, Hamid Ullah, West Virginia University Priyadarshini Loganathan, UT Health, San Antonio, TX
| | - Priyadarshini Loganathan
- Department of Internal Medicine, Hamid Ullah, West Virginia University Priyadarshini Loganathan, UT Health, San Antonio, TX
| | | | - Saurabh Chandan
- Department of Gastroenterology, CHI Creighton Medical Center, Omaha, NE
| | - Babu P Mohan
- Department of Gastroenterology, Orlando Gastroenterology PA, Orlando, FL
| | - Douglas G Adler
- Gastroenterology & Hepatology,Center for Advanced Therapeutic Endoscopy at Porter Adventist Hospital in Denver, CO
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Hayat U, Al Shabeeb R, Perez P, Hensien J, Dwivedi A, Sakhawat U, Ahmad O, Haseeb M, Siddiqui AA, Adler DG. Safety and adverse events of EUS-guided gallbladder drainage using lumen-apposing metal stents and percutaneous cholecystostomy tubes: a systematic review and meta-analysis. Gastrointest Endosc 2024; 99:444-448.e1. [PMID: 37871846 DOI: 10.1016/j.gie.2023.10.043] [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: 04/03/2023] [Revised: 07/06/2023] [Accepted: 10/18/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND AND AIMS EUS-guided gallbladder drainage using lumen-apposing metal stents (EUS-GBD-LAMSs) and percutaneous cholecystostomy for gallbladder drainage (PTGBD) are the alternative treatment modalities in high-risk surgical patients with acute cholecystitis (AC). The aim of this study was to compare the safety of these procedures for AC in surgically suboptimal candidates. METHODS Six studies compared the 2 groups' early, delayed, and overall adverse events; they also compared length of hospital stay, re-interventions, and re-admissions rate. A random effect model calculated odds ratios (ORs) with a 95% confidence interval (CI). RESULTS The 2 groups had similar early adverse events; however, EUS-GBD-LAMS was associated with a lower rate of delayed (OR, .21; 95% CI, .07-.61; P ≤ .01) and overall (OR, .43; 95% CI, .30-.61; P ≤ .01) adverse events. Patients with EUS-GBD-LAMSs had a shorter hospital stay than PTGBD. CONCLUSIONS EUS-GBD-LAMS is a safer option than PTGBD and is associated with a shorter hospital stay in nonsurgical candidates with AC.
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Affiliation(s)
- Umar Hayat
- Department of Internal Medicine, Division of Gastroenterology, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, Pennsylvania, USA
| | - Reem Al Shabeeb
- Department of Internal Medicine, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
| | - Paola Perez
- University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Jack Hensien
- University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Aanini Dwivedi
- University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Usama Sakhawat
- Department of Internal Medicine, UHS Wilson Medical Center, Binghamton, New York, USA
| | - Oneeb Ahmad
- Department of Internal Medicine, UHS Wilson Medical Center, Binghamton, New York, USA
| | - Muhammad Haseeb
- Hospitalist Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Ali A Siddiqui
- Division of Gastroenterology, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
| | - Douglas G Adler
- Center for Advanced Therapeutic Endoscopy, Porter Adventist Hospital, Denver, Colorado, USA.
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Mohamed R, Tejaswi S, Aabakken L, Ponsioen CY, Bowlus CL, Adler DG, Forbes N, Paulsen V, Voermans RP, Urayama S, Peetermans J, Rousseau MJ, Eksteen B. Per-oral cholangioscopy in patients with primary sclerosing cholangitis: a 12-month follow-up study. Endosc Int Open 2024; 12:E237-E244. [PMID: 38362361 PMCID: PMC10869209 DOI: 10.1055/a-2236-7557] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/22/2023] [Indexed: 02/17/2024] Open
Abstract
Background and study aims Patients with primary sclerosing cholangitis (PSC) have a 9% to 20% lifetime incidence of cholangiocarcinoma (CCA). Per-oral cholangioscopy (POCS) added to endoscopic retrograde cholangiography (ERC) could potentially improve detection of CCA occurrence. We prospectively assessed POCS identification of 12-month CCA incidence in PSC patients undergoing ERC. Patients and methods Consecutive patients with PSC, an indication for ERC, and no prior liver transplantation were enrolled. During the index procedure, POCS preceded planned therapeutic maneuvers. The primary endpoint was ability for POCS visualization with POCS-guided biopsy to identify CCA during 12-month follow-up. Secondary endpoints included ability of ERC/cytology to identify CCA, repeat ERC, liver transplantation, and serious adverse events (SAEs). Results Of 42 patients enrolled, 36 with successful cholangioscope advancement were analyzed. Patients had a mean age 43.5±15.6 years and 61% were male. Three patients diagnosed with CCA had POCS visualization impressions of benign/suspicious/suspicious, and respective POCS-guided biopsy findings of suspicious/positive/suspicious for malignancy at the index procedure. The three CCA cases had ERC visualization impressions of benign/benign/suspicious, and respective cytology findings of atypical/atypical/suspicious for malignancy. No additional patients were diagnosed with CCA during median 11.5-month follow-up. Twenty-three repeat ERCs (5 including POCS) were performed in 14 patients. Five patients had liver transplantation, one after CCA diagnosis and four after benign cytology at the index procedure. Three patients (7.1%) had post-ERC pancreatitis. No SAEs were POCS-related. Conclusions In PSC patients, POCS visualization/biopsy and ERC/cytology each identified three cases of CCA. Some patients had a repeat procedure and none experienced POCS-related SAEs.
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Affiliation(s)
- Rachid Mohamed
- Gastroenterology and Hepatology, University of Calgary, Calgary, Canada
| | - Sooraj Tejaswi
- Division of Gastroenterology & Hepatology, University of California Davis School of Medicine, Sacramento, United States
| | - Lars Aabakken
- Dept of Transplantation Medicine, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Cyriel Y Ponsioen
- Gastroenterology and Hepatology, Amsterdam University Medical Centres, Amsterdam, Netherlands
| | - Christopher L Bowlus
- Division of Gastroenterology & Hepatology, University of California Davis School of Medicine, Sacramento, United States
| | - Douglas G Adler
- Center for Advanced Therapeutic Endoscopy, Adventist Porter Hospital, Denver,
| | - Nauzer Forbes
- Gastroenterology and Hepatology, University of Calgary, Calgary, Canada
| | - Vemund Paulsen
- Dept of Transplantation Medicine, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Rogier P. Voermans
- Gastroenterology and Hepatology, Amsterdam University Medical Centres, Amsterdam, Netherlands
| | - Shiro Urayama
- Division of Gastroenterology & Hepatology, University of California Davis School of Medicine, Sacramento, United States
| | - Joyce Peetermans
- Clinical Endoscopy, Boston Scientific Corporation, Marlborough, United States
| | - Matthew J Rousseau
- Clinical Endoscopy, Boston Scientific Corporation, Marlborough, United States
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Singh S, Mohan BP, Chandan S, Sharma N, Vinayek R, Dutta S, Kantsevoy SV, Le M, Adler DG. Conventional Versus Traction Endoscopic Submucosal Dissection for Colorectal Tumors: A Meta-analysis of Randomized Controlled Trials. J Clin Gastroenterol 2024:00004836-990000000-00258. [PMID: 38252678 DOI: 10.1097/mcg.0000000000001973] [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: 11/01/2023] [Accepted: 12/27/2023] [Indexed: 01/24/2024]
Abstract
INTRODUCTION Compared with conventional endoscopic submucosal dissection (C-ESD) for colorectal lesions, the traction method (T-ESD) allows the lesion to be stabilized with easier dissection. However, randomized controlled trials (RCTs) have reported conflicting results on the clinical outcomes of T-ESD as compared with C-ESD. We conducted a meta-analysis to compile the data. METHODS Multiple databases were searched for RCTs evaluating C-ESD versus T-ESD for colorectal tumors. The end points of interest were procedure time (min), resection speed (mm²/min), R0 resection, en bloc resection, delayed bleeding, and perforation. Standard meta-analysis methods were employed using the random-effects model. RESULTS Six RCTs with a total of 566 patients (C-ESD n=284, T-ESD n=282) were included. The mean age was 67±10 y and 60% were men. As compared with the T-ESD technique, the C-ESD group was associated with longer procedure time (SMD 0.91, 95% CI 0.58 to 1.23, P<0.00001) and lesser resection speed (SMD -1.03, 95% CI -2.01 to -0.06, P=0.04). No significant difference was found in the 2 groups with respect to R0 resection rate (RR 1.00, 95% CI 0.94 to 1.06, P=0.87), en bloc resection (RR 0.99, 95% CI 0.97 to 1.01, P=0.35), delayed bleeding (RR 0.66, 95% CI 0.17 to 2.59, P=0.55) and perforation (RR 2.16, 95% CI 0.75 to 6.27, P=0.16). DISCUSSION On meta-analysis, pooled procedure time was significantly faster with T-ESD compared with C-ESD. The clinical outcomes, however, were comparable.
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Affiliation(s)
- Sahib Singh
- Internal Medicine, Sinai Hospital of Baltimore, Baltimore, MD
| | - Babu P Mohan
- Gastroenterology and Hepatology, Orlando Gastroenterology PA, Orlando, FL
| | - Saurabh Chandan
- Gastroenterology and Hepatology, CHI Creighton Medical Center, Omaha, NE
| | - Neil Sharma
- Gastroenterology and Hepatology, Parkview Health, Fort Wayne, IN
| | - Rakesh Vinayek
- Gastroenterology and Hepatology, Sinai Hospital of Baltimore, Baltimore, MD
| | - Sudhir Dutta
- Gastroenterology and Hepatology, Sinai Hospital of Baltimore, Baltimore, MD
| | | | - Michelle Le
- Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, NE
| | - Douglas G Adler
- Gastroenterology and Hepatology, Peak Gastroenterology Associates, Colorado Springs, CO
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Ali H, Patel P, Lowell JA, Dahiya DS, Singh S, Hammami AS, Poola S, Leland W, Adler DG, Mohan BP. Correction to: Delaying Cardiac Catheterization in Favor of Endoscopy in Non-ST Elevation Myocardial Infarction Patients Is Associated with Worse Outcomes: A Nationwide Analysis. Dig Dis Sci 2024; 69:310. [PMID: 37917213 DOI: 10.1007/s10620-023-08160-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 11/04/2023]
Affiliation(s)
- Hassam Ali
- Department of Gastroenterology, East Carolina University/Brody School of Medicine, Greenville, NC, 27834, USA.
| | - Pratik Patel
- Department of Gastroenterology, Mather Hospital/Hofstra University Zucker School of Medicine, Port Jefferson, NY, 11777, USA
| | - Jeffrey A Lowell
- Department of Internal Medicine, Mather Hospital/Hofstra University Zucker School of Medicine, Port Jefferson, NY, 11777, USA
| | - Dushyant Singh Dahiya
- Department of Internal Medicine, Central Michigan College of Medicine, Saginaw, MI, 48601, USA
| | - Sukhvir Singh
- Department of Internal Medicine, East Carolina University/Brody School of Medicine, Greenville, NC, 27834, USA
| | - Ahmed Sami Hammami
- Department of Internal Medicine, East Carolina University/Brody School of Medicine, Greenville, NC, 27834, USA
| | - Shiva Poola
- Department of Gastroenterology, East Carolina University/Brody School of Medicine, Greenville, NC, 27834, USA
| | - William Leland
- Department of Gastroenterology, East Carolina University/Brody School of Medicine, Greenville, NC, 27834, USA
| | - Douglas G Adler
- Center for Advanced Therapeutic Endoscopy, Porter Adventist Hospital, Centura Health, Denver, CO, USA
| | - Babu P Mohan
- Department of Gastroenterology & Hepatology, University of Utah Health School of Medicine, Salt Lake City, UT, USA
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Ramai D, Smit E, Kani HT, Papaefthymiou A, Warner L, Chandan S, Dhindsa B, Facciorusso A, Gkolfakis P, Ofosu A, Barakat M, Adler DG. Cannulation rates and technical performance evaluation of commericially available single-use duodenoscopes for endoscopic retrograde cholangiopancreatography: A systematic review and meta-analysis. Dig Liver Dis 2024; 56:123-129. [PMID: 37003844 DOI: 10.1016/j.dld.2023.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Single use duodenoscopes were developed to reduce the risk of infection transmission from contaminated reusable duodenoscopes. To this end, we examined various biliary interventions using single use duodenoscopes in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). METHODS Medline, Embase, Scopus, and Cochrane databases were searched from inception through Aug 2022 to identify studies reporting on the performance of single use duodenoscopes for ERCP. RESULTS Seven articles were included in the final analysis that included 642 patients (318 males). The Exalt Model D duodenoscope was used in most cases (88.8%) followed by the aScope Duodeno (11.2%) for ERCP. Most ERCPs had a complexity grade of 2 (n = 303) and 3 (n = 198). The pooled cumulative rate of successful cannulation was 95% (95% Confidence Interval (CI): 93-96%, I2=0%, P = 0.46). Sphincterotomy was successfully performed in all cases. The pooled cumulative rate of PEP was 2% (95% CI: 0.4-3.4%, I2=0%, P = 0.80). The pooled cumulative rate of total adverse events was 7% (95% CI: 4-10%, I2=47%, P = 0.08). CONCLUSIONS The results of this systematic review and meta-analysis show that single use duodenoscopes are associated with high cannulation rates, technical performance, and safety profile.
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Affiliation(s)
- Daryl Ramai
- Gastroenterology & Hepatology, University of Utah Health, Salt Lake City, UT, USA
| | - Eric Smit
- Department of Medicine, Baylor Scott & White Health, Round Rock, TX, USA
| | - Haluk Tarik Kani
- Department of Gastroenterology, School of Medicine, Marmara University, Istanbul, Turkey
| | | | - Lynn Warner
- University of Cincinnati Libraries, Donald C. Harrison Health Sciences Library, Cincinnati, OH, USA
| | - Saurabh Chandan
- Division of Gastroenterology & Hepatology, CHI Health Creighton University Medical Center, Omaha, NE, USA
| | - Banreet Dhindsa
- Gastroenterology & Hepatology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Antonio Facciorusso
- Section of Gastroenterology, Department of Medical Sciences, University of Foggia, 71122 Foggia, Italy
| | - Paraskevas Gkolfakis
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, CUB Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Andrew Ofosu
- Division of Digestive Diseases, University of Cincinnati, Cincinnati, OH, USA
| | - Monique Barakat
- Division of Gastroenterology, Stanford University, California, USA
| | - Douglas G Adler
- Center for Advanced Therapeutic Endoscopy (CATE), Porter Adventist Hospital/PEAK Gastroenterology, Denver, Colorado, USA.
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Stefanovic S, Adler DG, Arlt A, Baron TH, Binmoeller KF, Bronswijk M, Bruno MJ, Chevaux JB, Crinò SF, Degroote H, Deprez PH, Draganov PV, Eisendrath P, Giovannini M, Perez-Miranda M, Siddiqui AA, Voermans RP, Yang D, Hindryckx P. International Consensus Recommendations for Safe Use of LAMS for On- and Off-Label Indications Using a Modified Delphi Process. Am J Gastroenterol 2023:00000434-990000000-00925. [PMID: 37934190 DOI: 10.14309/ajg.0000000000002571] [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: 05/30/2023] [Accepted: 10/02/2023] [Indexed: 11/08/2023]
Abstract
INTRODUCTION The study aimed to develop international consensus recommendations on the safe use of lumen-apposing metal stents (LAMSs) for on- and off-label indications. METHODS Based on the available literature, statements were formulated and grouped into the following categories: general safety measures, peripancreatic fluid collections, endoscopic ultrasound (EUS)-biliary drainage, EUS-gallbladder drainage, EUS-gastroenterostomy, and gastric access temporary for endoscopy. The evidence level of each statement was determined using the Grading of Recommendations Assessment, Development, and Evaluation methodology.International LAMS experts were invited to participate in a modified Delphi process. When no 80% consensus was reached, the statement was modified based on expert feedback. Statements were rejected if no consensus was reached after the third Delphi round. RESULTS Fifty-six (93.3%) of 60 formulated statements were accepted, of which 35 (58.3%) in the first round. Consensus was reached on the optimal learning path, preprocedural imaging, the need for airway protection and essential safety measures during the procedure, such as the use of Doppler, and measurement of the distance between the gastrointestinal lumen and the target structure. Specific consensus recommendations were generated for the different LAMS indications, covering, among others, careful patient selection, the preferred size of the LAMS, the need for antibiotics, the preferred anatomic location of the LAMS, the need for coaxial pigtail placement, and the appropriate management of LAMS-related adverse events. DISCUSSION Through a modified international Delphi process, we developed general and indication-specific experience- and evidence-based recommendations on the safe use of LAMS.
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Affiliation(s)
- Sebastian Stefanovic
- Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium
- Diagnostic Center Bled Group, Bled, Slovenia
| | - Douglas G Adler
- Centura Health, Center for Advanced Therapeutic Endoscopy, Colorado, Englewood, USA
| | - Alexander Arlt
- Department of Internal Medicine and Gastroenterology, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Todd H Baron
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Kenneth F Binmoeller
- Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, California, USA
| | - Michiel Bronswijk
- Gastroenterology and Hepatology, Imelda Hospital Bonheiden and University Hospitals Leuven, Belgium
| | - Marco J Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | | | - Stefano Francesco Crinò
- Department of Medicine, Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University Hospital of Verona, Verona, Italy
| | - Helena Degroote
- Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium
| | - Pierre H Deprez
- Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Department of Hepatogastroenterology, Brussels, Belgium
| | | | - Pierre Eisendrath
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Saint-Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Marc Giovannini
- Digestive Endoscopy Unit, Paoli Calmettes Institute, Marseille Cedex 9, France
| | - Manuel Perez-Miranda
- Gastroenterology Department, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Ali A Siddiqui
- Department of Gastroenterology and Hepatology, Inova Fairfax Hospital, Falls Church, Virginia, USA
| | - Rogier P Voermans
- Amsterdam University Medical Center, Department of Gastroenterology and Hepatology, University of Amsterdam, Amsterdam, Netherlands
| | - Dennis Yang
- Center for Interventional Endoscopy, AdventHealth, Orlando, Florida, USA
| | - Pieter Hindryckx
- Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium
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Iqbal U, Yodice M, Ahmed Z, Lee-Smith W, Adler DG, Confer BD. Efficacy of cap-assisted endoscopy for the visualization of the major duodenal papilla: a systematic review and meta-analysis. Gastrointest Endosc 2023; 98:1004-1008. [PMID: 37544335 DOI: 10.1016/j.gie.2023.07.050] [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: 03/10/2023] [Revised: 07/30/2023] [Accepted: 07/31/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND AND AIMS The current standard of practice is to use a duodenoscope for the evaluation of the major duodenal papilla (MDP). Recently, cap-assisted endoscopy (CAE), which uses a transparent cap at the tip of a standard front-viewing endoscope, has emerged as an alternative. METHODS A systematic literature search was performed in several databases from inception to January 2023 to identify studies evaluating the efficacy of CAE for the evaluation of the MDP. RESULTS Nine studies including 806 patients met our inclusion criteria. The pooled rate of technical success for CAE was 93.2% (95% confidence interval, 85.6-96.9; I2 = 84.6%). A subgroup analysis comparing CAE with a standard endoscope showed higher odds for the evaluation of the MDP with CAE (but not a duodenoscope, which was better than CAE) with an odds ratio of 57.294 (95% confidence interval, 17.767-184.755; I2 = 45.303%). CONCLUSIONS CAE offers a significant advantage with high rates of complete MDP evaluation compared with standard forward-viewing endoscopy. However, CAE is associated with lower rates of success when compared with side-viewing endoscopes.
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Affiliation(s)
- Umair Iqbal
- Division of Gastroenterology, WellSpan York Hospital, York, Pennsylvania, USA
| | - Michael Yodice
- Division of Internal Medicine, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Zohaib Ahmed
- Department of Gastroenterology, University of Toledo Medical Center, Toledo, Ohio, USA
| | - Wade Lee-Smith
- University Libraries, University of Toledo Medical Center, Toledo, Ohio, USA
| | - Douglas G Adler
- Center for Advanced Therapeutic Endoscopy (CATE), Centura Health, Porter Adventist Hospital, Peak Gastroenterology, Denver, Colorado, USA
| | - Bradley D Confer
- Division of Gastroenterology, Geisinger Medical Center, Danville, Pennsylvania, USA
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Malik TF, Mohan BP, Deliwala S, Kassab LL, Chandan S, Sharma NR, Adler DG. Cold Versus Hot Endoscopic Mucosal Resection for Sessile Serrated Colorectal Polyps ≥10 mm: A Systematic Review and Meta-analysis. J Clin Gastroenterol 2023:00004836-990000000-00239. [PMID: 38019045 DOI: 10.1097/mcg.0000000000001951] [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: 07/11/2023] [Accepted: 11/02/2023] [Indexed: 11/30/2023]
Abstract
INTRODUCTION We performed a systematic review and meta-analysis studying the efficacy and safety of cold versus hot endoscopic mucosal resection (EMR) for resection of sessile serrated polyps (SSPs) ≥10 mm. METHODS Multiple databases were searched until January 2023 for studies reporting outcomes of cold versus hot EMR for SSPs ≥10 mm. The primary outcome was the residual SSP rate. Secondary outcomes included technical success rate, R0 resection rate, and adverse events. We used standard meta-analysis methods using the random-effects model, and I2% was used to assess heterogeneity. RESULTS Thirteen studies were included in the final analysis. In all, 1896 SSPs were included with a mean polyp size of 23.7 mm (range, 15.9 to 33). A total of 1452 SSPs were followed up for a median follow-up duration of 15.3 months (range, 6 to 37). The pooled residual SSP rate for cold EMR was 4.5% (95% CI: 1.0-17.4), and 5.1% (95% CI: 2.4-10.4) for hot EMR (P=0.9). The pooled rates of technical success, R0 resection, immediate bleeding, and perforation were comparable. Hot EMR was significantly associated with lower piecemeal resection (59.2% vs. 99.3%, P<0.001), higher en-bloc resection (41.4% vs. 1.4%, P<0.001), and delayed bleeding rate (4% vs. 0.7%, P=0.05) compared to cold EMR. CONCLUSIONS Cold EMR has similar efficacy compared to hot EMR for resection of SSP ≥ 10 mm, despite limitations in piecemeal R0 resection rate reporting. Although hot EMR was associated with a higher rate of en-bloc resection, it also showed an increased risk of delayed bleeding compared to cold EMR.
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Affiliation(s)
- Talia F Malik
- Department of Internal Medicine, Chicago Medical School at Rosalind Franklin University of Medicine and Science, North Chicago, IL
| | - Babu P Mohan
- Department of Gastroenterology & Hepatology, University of Utah School of Medicine, Salt Lake City, UT
| | - Smit Deliwala
- Department of Gastroenterology & Hepatology, Emory University, Atlanta, GA
| | - Lena L Kassab
- Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Saurabh Chandan
- Department of Gastroenterology, CHI Creighton University Medical Center, Omaha, NE
| | - Neil R Sharma
- Department of Gastroenterology, Parkview Cancer Institute, Fort Wayne, IN
| | - Douglas G Adler
- Department of Gastroenterology, Center for Advanced Therapeutic Endoscopy (CATE), Centura Health, Porter Adventist Hospital, Denver, CO
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Adler DG. Top Tips: Gastric Peroral Endoscopic Myotomy. Gastrointest Endosc 2023:S0016-5107(23)03087-0. [PMID: 37993059 DOI: 10.1016/j.gie.2023.11.011] [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: 11/05/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 11/24/2023]
Affiliation(s)
- Douglas G Adler
- Director, Center for Advanced Therapeutic Endoscopy, Porter Adventist Hospital, Denver, Colorado.
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12
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Ali H, Patel P, Malik TF, Pamarthy R, Mohan BP, Asokkumar R, Lopez-Nava G, Adler DG. Endoscopic sleeve gastroplasty reintervention score using supervised machine learning. Gastrointest Endosc 2023; 98:747-754.e5. [PMID: 37263362 DOI: 10.1016/j.gie.2023.05.059] [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: 12/24/2022] [Revised: 04/25/2023] [Accepted: 05/18/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND AND AIMS Reintervention after endoscopic sleeve gastroplasty (ESG) can be indicated because of postprocedural adverse events from various preinterventional or postprocedural comorbidities. We developed and internally validated an ESG reintervention score (ESG-RS) that determines the individualized risk of reintervention within the first 30 days after ESG. METHODS We used data from a sample of 3583 patients who underwent ESG in the Metabolic and Bariatric Surgery Accreditation Quality Improvement Program database (2016-2021). The least absolute shrinkage and selection operator (LASSO)-penalized regression was used to select the most promising predictors of reintervention after ESG within 30 days. The predictive variables extracted by LASSO regression were entered into multivariate analysis to generate an ESG-RS by using the coefficients of the statistically significant variables. The model performance was assessed using receiver-operator curves by 10-fold cross-validation. RESULTS Eleven variables were selected by LASSO regression and used in the final multivariate analysis. The ESG-RS was inferred using 5 factors (history of previous foregut surgery, preoperative anticoagulation use, female gender, American Society of Anesthesiologists class ≥II, and hypertension) weighted by their regression coefficients in the multivariable logistic regression model. The area under the curve of the ESG-RS was .74 (95% confidence interval, .70-.78). For the ESG-RS, the optimal cutpoint was 67.9 (high risk vs low risk), with a sensitivity of .76 and specificity of .71. CONCLUSIONS The ESG-RS aids clinicians in preoperative risk stratification of patients undergoing ESG while clarifying factors contributing to a higher risk of reintervention.
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Affiliation(s)
- Hassam Ali
- Department of Internal Medicine, East Carolina University/Brody School of Medicine, Greenville, North Carolina, USA
| | - Pratik Patel
- Department of Gastroenterology, Mather Hospital/Hofstra University Zucker School of Medicine, Port Jefferson, New York, USA
| | - Talia Farrukh Malik
- Department of Internal Medicine, Chicago Medical School at Rosalind Franklin University of Medicine and Science, Chicago, Illinois, USA
| | - Rahul Pamarthy
- Department of Internal Medicine, East Carolina University/Brody School of Medicine, Greenville, North Carolina, USA
| | - Babu P Mohan
- Gastroenterology & Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Ravishankar Asokkumar
- Gastroenterology & Hepatology, Singapore General Hospital, Duke National University, Singapore
| | - Gontrand Lopez-Nava
- Bariatric Endoscopy, Hospital Universitario Madrid Sanchinarro, Madrid, Spain
| | - Douglas G Adler
- Center for Advanced Therapeutic Endoscopy, Centura Health, Porter Adventist Hospital, Denver, Colorado, USA
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Dahiya DS, Chandan S, Desai A, Ramai D, Mohan BP, Facciorusso A, Bilal M, Sharma NR, Adler DG, Kochhar GS. Risk of Complications After Endoscopic Retrograde Cholangiopancreatography in Pregnancy: A Propensity-Matched Analysis. Dig Dis Sci 2023; 68:4266-4273. [PMID: 37741950 DOI: 10.1007/s10620-023-08112-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 09/11/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND Studies have suggested higher complication rates after endoscopic retrograde cholangiopancreatography (ERCP) in pregnancy. AIMS We performed a propensity-matched cohort analysis to assess the risk of ERCP-related complications among pregnant women in the United States. METHODS The TriNetX database was analyzed to identify pregnant and non-pregnant females between 18 and 50 years of age who underwent ERCP. One-to-one propensity score matching was performed for age and race. Outcomes included risk of post-ERCP pancreatitis (PEP), gastrointestinal (GI) bleeding, perforation within 7 days, and infections within 30 days of ERCP. Subgroup analysis was performed to assess the risk of PEP based on indication for ERCP. RESULTS The risk of PEP was higher in the pregnant cohort compared to controls, 10.3% vs 6.08%, adjusted odds ratio (aOR) 1.77, 95% confidence interval (CI) 1.20-2.61; p = 0.003. We found no difference in the risk of GI bleeding, perforation, and infections between the two cohorts. There was no difference in the risk of PEP in the pregnant cohort compared to controls who underwent ERCP for acute choledocholithiasis (4.2% vs 2.1%, aOR 1.98, 95% CI 0.97-4.03, p = 0.5) or ascending cholangitis (18.6% vs 14.7%, aOR 1.32, 95% CI 0.52-3.39, p = 0.55). There was no difference in the risk of PEP in the pregnant cohort after sensitivity analysis based on age, race, obesity, and indomethacin use. CONCLUSION Pregnant females are at an increased risk of PEP but not GI bleeding, perforation, and infections when compared to non-pregnant controls. Clinicians should be cautious when proceeding with ERCP during pregnancy.
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Affiliation(s)
- Dushyant Singh Dahiya
- Division of Gastroenterology, Hepatology & Motility, The University of Kansas School of Medicine, Kansas City, KS, USA
| | - Saurabh Chandan
- Division of Gastroenterology and Hepatology, Creighton University School of Medicine, 7710 Mercy Road, Suite 200, Omaha, NE, 68124, USA.
| | - Aakash Desai
- Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Daryl Ramai
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Babu P Mohan
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Surgical and Medical Sciences, University of Foggia, Foggia, Italy
| | - Mohammad Bilal
- Division of Gastroenterology, University of Minnesota & Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Neil R Sharma
- Interventional Oncology & Surgical Endoscopy (IOSE) Division, GI Oncology Tumor Site Team, Parkview Cancer Institute, Parkview Health, Fort Wayne, IN, USA
| | - Douglas G Adler
- Center for Advanced Therapeutic Endoscopy (CATE), Centura Health, Porter Adventist Hospital, Denver, CO, USA
| | - Gursimran S Kochhar
- Division of Gastroenterology, Hepatology & Nutrition, Allegheny Health Network, Pittsburgh, PA, USA
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Ahmed Z, Ramai D, Merza N, Badal J, Iqbal U, Arif SF, Al-Hillan A, Varughese T, Lee-Smith W, Nawras A, Alastal Y, Khara HS, Confer BD, Diehl DL, Adler DG. Safety and Efficacy of Powered Non-Thermal Endoscopic Resection Device for Removal of Colonic Polyps: A Systematic Review and Meta-Analysis. Gastroenterology Res 2023; 16:254-261. [PMID: 37937229 PMCID: PMC10627355 DOI: 10.14740/gr1638] [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: 05/25/2023] [Accepted: 08/19/2023] [Indexed: 11/09/2023] Open
Abstract
Background Endoscopic mucosal resection is a frequently employed method for removing colonic polyps. Nonetheless, the recurrence of these polyps over a healed submucosal base can complicate the extraction of leftover lesions through standard procedures. EndoRotor®, a non-thermal device specifically designed for endoscopic mucosal resection, has recently been assessed for its utility in removing colonic polyps, non-dysplastic Barrett's esophagus, and pancreatic necrosis. We conducted a systematic review and meta-analysis to ascertain the safety and efficacy of EndoRotor® in resecting scared or recurrence colonic polyps. Methods We conducted an exhaustive review of existing literature using databases such as Medline, Embase, Web of Science, and the Cochrane Library until January 2023. Our aim was to find all studies that assessed the safety of non-thermal endoscopic resection devices in removing colonic polyps. The primary outcome we focused on was the rate of technical success. Secondary outcomes that we considered included the frequency of remaining lesions and instances of adverse events. To analyze these data, we used comprehensive meta-analysis software. Results Our analysis incorporated three studies comprising 54 patients who underwent resection of 60 lesions. The combined technical success rate was 93.9% (95% confidence interval (CI): 77.7-98.6%, I2 = 25.5%). In patients who had another endoscopic examination, 20 were found to have a residual lesion. After the initial session, the combined rate of remaining lesions was 39.8% (95% CI: 15.3-70.8%, I2 = 74.5%). There were eight occurrences of intraoperative bleeding and four instances of bleeding post-procedure. The combined rate of intraoperative bleeding was 13.2% (95% CI: 6.7-24.3%, I2 = 0%), and post-procedure bleeding stood at 8.5% (95% CI: 3.4-19.8%, I2 = 0%). Only one major bleeding event was recorded, and no cases of perforation were reported. Conclusion Our research indicates that the EndoRotor® effectively removes scarred colonic polyps, though the rate of remaining lesions is significant, potentially necessitating several sessions for a thorough removal. There is a need for broader prospective studies, mainly randomized controlled trials, to further assess EndoRotor®'s efficiency and safety in eliminating colonic polyps.
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Affiliation(s)
- Zohaib Ahmed
- Department of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, OH, USA
| | - Daryl Ramai
- Department of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Nooraldin Merza
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH, USA
| | - Joyce Badal
- University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Umair Iqbal
- Department of Gastroenterology and Hepatology, Geisinger Medical Center, Danville, PA, USA
| | | | - Alsadiq Al-Hillan
- Gastroenterology Department, Corewell Health/Willam Beaumont University Hospital, Royal Oak, MI, USA
| | - Tony Varughese
- Department of Internal Medicine, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Wade Lee-Smith
- University of Toledo Libraries, University of Toledo, Toledo, OH, USA
| | - Ali Nawras
- Division of Gastroenterology and Hepatology, University of Toledo, Toledo, OH, USA
| | - Yaseen Alastal
- Division of Gastroenterology and Hepatology, University of Toledo, Toledo, OH, USA
| | - Harshit S. Khara
- Department of Gastroenterology and Hepatology, Geisinger Medical Center, Danville, PA, USA
| | - Bradley D. Confer
- Department of Gastroenterology and Hepatology, Geisinger Medical Center, Danville, PA, USA
| | - David L. Diehl
- Department of Gastroenterology and Hepatology, Geisinger Medical Center, Danville, PA, USA
| | - Douglas G. Adler
- Center for Advanced Therapeutic Endoscopy, Porter Adventist Hospital, Centura Health, Denver, CO, USA
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15
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Ali H, Patel P, Lowell J, Dahiya DS, Singh S, Hammami AS, Poola S, Leland W, Adler DG, Mohan BP. Delaying Cardiac Catheterization in Favor of Endoscopy in Non-ST Elevation Myocardial Infarction Patients Is Associated with Worse Outcomes: A Nationwide Analysis. Dig Dis Sci 2023; 68:3913-3920. [PMID: 37620712 DOI: 10.1007/s10620-023-08033-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/02/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Non-variceal upper gastrointestinal bleeding (NVUGIB) in non-ST-elevation myocardial infarction (NSTEMI) is associated with substantial morbidity and mortality. We evaluated inpatient outcomes of esophagogastroduodenoscopy (EGD) before cardiac catheterization in patients with NSTEMI and NVUGIB. METHODS We utilized the National Readmission Database (2016-2019) to identify all index hospitalizations with a primary diagnosis of NSTEMI and a secondary diagnosis of NVUGIB that underwent EGD before cardiac catheterization (cases). A matched comparison cohort of similar hospitalizations that undergo EGD after cardiac catheterization were identified (controls) after 1:1 propensity score matching for age, gender, cardiac comorbidities, causes, and severity of bleeding. RESULTS A total of 796 cases were matched with 796 controls. There was a higher median length of hospital stay (8 vs. 5 days, P = 0.01) and median hospital charges ($111,218 vs. $99,115, P = 0.002) for cases compared to controls. There was a higher all-cause inpatient mortality in cases compared to controls (5.5% vs. 3.9%, P = 0.26). Furthermore, there was a higher proportion of patients with ICU admission (7% vs. 3%, P < 0.001), septic shock (7.1% vs. 5.8%, P = 0.41), atrial fibrillation (27.1% vs. 19.8%, P < 0.001) and acute kidney injury (42.8% vs. 29.1%, P < 0.001) for cases compared to controls. CONCLUSION Delaying cardiac catheterization in favor of EGD is associated with increased hospital stay, costs, and cardiac complications. Further studies are warranted to establish our findings.
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Affiliation(s)
- Hassam Ali
- Department of Gastroenterology, East Carolina University/Brody School of Medicine, Greenville, NC, 27834, USA.
| | - Pratik Patel
- Department of Gastroenterology, Mather Hospital/Hofstra University Zucker School of Medicine, Port Jefferson, NY, 11777, USA
| | - Jeffery Lowell
- Department of Internal Medicine, Mather Hospital/Hofstra University Zucker School of Medicine, Port Jefferson, NY, 11777, USA
| | - Dushyant Singh Dahiya
- Department of Internal Medicine, Central Michigan College of Medicine, Saginaw, MI, 48601, USA
| | - Sukhvir Singh
- Department of Internal Medicine, East Carolina University/Brody School of Medicine, Greenville, NC, 27834, USA
| | - Ahmed Sami Hammami
- Department of Internal Medicine, East Carolina University/Brody School of Medicine, Greenville, NC, 27834, USA
| | - Shiva Poola
- Department of Gastroenterology, East Carolina University/Brody School of Medicine, Greenville, NC, 27834, USA
| | - William Leland
- Department of Gastroenterology, East Carolina University/Brody School of Medicine, Greenville, NC, 27834, USA
| | - Douglas G Adler
- Center for Advanced Therapeutic Endoscopy, Porter Adventist Hospital, Centura Health, Denver, CO, USA
| | - Babu P Mohan
- Department of Gastroenterology & Hepatology, University of Utah Health School of Medicine, Salt Lake City, UT, USA
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Adler DG. G-POEM for refractory gastroparesis after gastric pacer placement: moving things forward. Gastrointest Endosc 2023; 98:567-568. [PMID: 37734814 DOI: 10.1016/j.gie.2023.05.053] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 05/12/2023] [Accepted: 05/14/2023] [Indexed: 09/23/2023]
Affiliation(s)
- Douglas G Adler
- Center for Advanced Therapeutic Endoscopy, Centura Health, Porter Adventist Hospital, Denver, Colorado, USA
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17
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Ramai D, Bhandari P, Kewalramani A, Mozell D, Chandan S, Facciorusso A, Gkolfakis P, Swaminath A, Adler DG. Patient adverse events and technical failures with the bravo capsule pH system: insights from the MAUDE database. Esophagus 2023; 20:757-760. [PMID: 37084162 DOI: 10.1007/s10388-023-01007-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 04/14/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND The BRAVO pH monitor system can benefit patients with ongoing GERD symptoms despite treatment and/or atypical symptoms. We aim to investigate the number and type of complications associated with the BRAVO pH capsule. METHODS From April 2016 through February 2021, we analyzed post-marketing surveillance data from the FDA Manufacturer and User Facility Device Experience (MAUDE) database. RESULTS During the study period, approximately 1,651 reports were identified with 2391 cases associated with a device failure, and 254 reporting a patient-related adverse event. Most device complications were due to aspiration n = 153), followed by reported pain (n = 79), injury (unspecified) (n = 63), and additional radiologic imaging (n = 44). Laceration and bleeding accounted for 29 and 19 cases. Furthermore, three patients suffered perforation. Most device failures were due to loss or failure of the Bravo capsule to bond or adhere to the esophageal mucosa as planned (n = 1269), followed by an activation or positioning failure (n = 972), premature detachment of device (n = 284), and failure of the device to record or transmit data (n = 158). CONCLUSIONS Findings from the MAUDE database highlight the risk of aspiration, hemorrhage/bleeding, perforation, injury, and retention as potential complications of BRAVO capsule placement.
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Affiliation(s)
- Daryl Ramai
- Division of Gastroenterology and Hepatology, University of Utah, Salt Lake City, UT, USA
| | - Peter Bhandari
- Department of Internal Medicine, Northwell Health, Lenox Hill Hospital, New York, NY, USA
| | - Anjali Kewalramani
- Department of Internal Medicine, Mathers Hospital, Port Jefferson, NY, USA
| | - Daniel Mozell
- Department of Internal Medicine, Elmhurst Hospital, Queens, NY, USA
| | - Saurabh Chandan
- Division of Gastroenterology & Hepatology, CHI Health Creighton University Medical Center, Omaha, NE, USA
| | - Antonio Facciorusso
- Section of Gastroenterology, Department of Medical Sciences, University of Foggia, 71122, Foggia, Italy
| | - Paraskevas Gkolfakis
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, CUB Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Arun Swaminath
- Division of Gastroenterology, Northwell Health, Lenox Hill Hospital, New York, NY, USA
| | - Douglas G Adler
- Center for Advanced Therapeutic Endoscopy (CATE), Porter Adventist Hospital/PEAK Gastroenterology, Denver, CO, USA.
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Singh AD, Madhu D, Pathiyil MM, Ramai D, Mohan BP, Shah B, Adler DG. Device malfunctions with use of EUS-guided fine-needle biopsy devices: Analysis of the MAUDE database. Endosc Ultrasound 2023; 12:424-427. [PMID: 37969167 PMCID: PMC10631607 DOI: 10.1097/eus.0000000000000016] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/12/2023] [Indexed: 11/17/2023] Open
Abstract
Background The safety of endoscopic ultrasound-guided tissue acquisition through fine-needle biopsy devices is well-established in clinical trials. The real-world experience of using these devices is not known. The authors analyzed the postmarketing surveillance data from the Food and Drug Administration Manufacturer and User Facility Device Experience (MAUDE) database to answer this question. Methods The Food and Drug Administration MAUDE database from January 2012 to June 2022 was accessed to evaluate for device malfunctions and patient-related adverse consequences of these malfunctions. Results There were 344 device-related issues. Most issues were due to detachment or breakage of the device (n = 185 [53.7%]). Seventy-six of the breakages (40.8%) occurred during the procedure, whereas 89 cases (47.8%) occurred while removing the needle from the endoscope. The most common site of tissue biopsy at the time of needle breakage was the pancreas (44 [23.8%]).The common patient-related adverse events were retained foreign body (n = 50 [14.5%]) followed by bleeding (16, 4.6%). Six patients (3.4%) required a second intervention for removal of the retained foreign bodies including surgery in 2 cases. The device breakage damaged the endoscope in 3 cases (1.7%), and there was 1 case of needlestick injury to the nurse. Conclusion The fine-needle biopsy devices can be associated with needle breakage and bending; these adverse events were not previously reported. Needle breakages can result in a retained foreign body that may require additional procedures including surgery. These real-world findings from the MAUDE database may inform clinical decisions and help improve clinical outcomes.
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Affiliation(s)
- Achintya D. Singh
- Gastroenterology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Deepak Madhu
- Gastroenterology, Lisie Institute of Gastroenterology, Lisie Hospital, Kochi, Ernakulam, India
| | | | - Daryl Ramai
- Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, UT, USA
| | - Babu P. Mohan
- Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, UT, USA
| | - Bhavesh Shah
- Gastroenterology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Douglas G. Adler
- Gastroenterology, Center for Advanced Therapeutic Endoscopy, Denver, CO, USA
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19
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Kamal F, Adler DG. Response. Gastrointest Endosc 2023; 98:470-471. [PMID: 37597942 DOI: 10.1016/j.gie.2023.04.2066] [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: 04/07/2023] [Accepted: 04/15/2023] [Indexed: 08/21/2023]
Affiliation(s)
- Faisal Kamal
- Division of Gastroenterology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Douglas G Adler
- Center for Advanced Therapeutic Endoscopy, Porter Adventist Hospital, Denver, Colorado, USA
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20
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Loganathan P, Chandan S, Mohan BP, Saligram S, Adler DG. Comparable Efficacy of Laser-Cut and Braided Self Expanding Metallic Biliary Stent: A Systematic Review and Meta-Analysis. Dig Dis Sci 2023; 68:3756-3764. [PMID: 37439926 DOI: 10.1007/s10620-023-08017-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/18/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND AND AIMS In patients with unresectable malignant biliary obstruction (MBO), endoscopic biliary drainage is the treatment of choice. Self-expanding metallic stents (SEMS) are mainly used for this purpose, and data is limited on the comparative outcomes of laser-cut versus braided SEMS. Herein, we performed the first systematic review and meta-analysis to study the effectiveness and safety of braided and laser-cut SEMS in MBO. METHODS Multiple databases, including Medline, Scopus, and Embase, were searched (in May 2022) using specific terms for studies evaluating the outcomes of braided and laser-cut SEMS in MBO. Outcomes of interest were technical and clinical success, recurrent biliary obstruction, and adverse events. Standard meta-analysis methods were employed using the random-effects model. I2% heterogeneity was used to assess the heterogeneity. RESULTS Seven studies were included in the final analysis. (Laser-cut: 271 patients, 46% females, mean age 70 years; and braided: 282 patients, 47% females, mean age 72 years). The pooled rate of technical success and clinical success with laser-cut SEMS was 99% (95% CI [95-99; I2 = 0%]), 86% [60-96; I2 = 74%], and 98% [96-99; I2 = 0%], 89% [74-95; I2 = 78%] with braided. The pooled rate of recurrent biliary obstruction with laser-cut SEMS was 26% [14-43; I2 = 88%] and 12% [5-27; I2 = 56%) with braided. Pooled total adverse events were 11% [5-21; I2 = 77%] in laser-cut and 12% [6-24; I2 = 63%] in braided. CONCLUSION Our meta-analysis demonstrates similar clinical outcomes with laser-cut and braided SEMS in MBO. Given the comparable performance, a cost-effectiveness analysis might help in choosing one type versus another in patients with MBO.
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Affiliation(s)
| | | | - Babu P Mohan
- Gastroenterology & Hepatology, University of Utah Health, Salt Lake City, UT, USA
| | - Shreyas Saligram
- Gastroenterology, University of Texas Health Science Center, San Antonio, TX, USA
| | - Douglas G Adler
- Gastroenterology, Center for Advanced Therapeutic Endoscopy, Centura Health, Denver, CO, USA.
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21
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Dhindsa BS, Tun KM, Scholten KJ, Deliwala S, Naga Y, Dhaliwal A, Ramai D, Saghir SM, Dahiya DS, Chandan S, Singh S, Adler DG. New Alternative? Self-Assembling Peptide in Gastrointestinal Bleeding: A Systematic Review and Meta-Analysis. Dig Dis Sci 2023; 68:3694-3701. [PMID: 37402986 DOI: 10.1007/s10620-023-08009-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 06/15/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND Gastrointestinal bleeding (GIB) is a common and potentially fatal condition with all-cause mortality ranging from 3 to 10%. Endoscopic therapy traditionally involves mechanical, thermal, and injection therapies. Recently, self-assembling peptide (SAP) has become increasingly available in the United States. When applied to an affected area, this gel forms an extracellular matrix-type structure allowing for hemostasis. This is the first systematic review and meta-analysis to assess the safety and efficacy of this modality in GIB. METHODS We performed a comprehensive literature search of major databases from inception to Nov 2022. The primary outcomes assessed were the success of hemostasis, rebleeding rates, and adverse events. The secondary outcomes assessed were successful hemostasis with monotherapy with SAP and combined therapy, which may include mechanical, injection, and thermal therapies. Pooled estimates were calculated using random-effects models with a 95% confidence interval (CI). RESULTS The analysis included 7 studies with 427 patients. 34% of the patients were on anticoagulation or antiplatelet agents. SAP application was technically successful in all patients. The calculated pooled rate of successful hemostasis was 93.1% (95% confidence interval (CI) 84.7-97.0, I2 = 73.6), and rebleeding rates were 8.9% (95% CI 5.3-14.4, I2 = 55.8). The pooled rates of hemostasis with SAP monotherapy and combined therapy were similar. No adverse events were noted related to SAP. CONCLUSION SAP appears to be a safe and effective treatment modality for patients with GIB. This modality provides an added advantage of improved visualization over the novel spray-based modalities. Further, prospective, or randomized controlled trials are needed to validate our findings.
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Affiliation(s)
- Banreet Singh Dhindsa
- Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, 982000 Nebraska Medical Center, Omaha, NE, 68198-2000, USA
| | - Kyaw Min Tun
- Department of Internal Medicine, University of Nevada Las Vegas School of Medicine, 1701 W Charleston Blvd, Las Vegas, NV, 89102, USA
| | - Kyle J Scholten
- Department of Internal Medicine, University of Nebraska Medical Center, 982000 Nebraska Medical Center, Omaha, NE, 68198-2000, USA
| | - Smit Deliwala
- Division of Gastroenterology and Hepatology, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA, 30322, USA
| | - Yassin Naga
- Department of Internal Medicine, University of South Florida Morsani College of Medicine, 12901 Bruce B Downs Blvd, Tampa, FL, 33612, USA
| | - Amaninder Dhaliwal
- Division of Gastroenterology and Hepatology, McLeod Regional Medical Center, Florence, SC, 29506, USA
| | - Daryl Ramai
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, 30 N 1900 E, Room 4R118, Salt Lake City, UT, 84132, USA
| | - Syed Mohsin Saghir
- Division of Gastroenterology and Hepatology, Creighton University School of Medicine, Omaha, NE, 68124, USA
| | - Dushyant Singh Dahiya
- Division of Internal Medicine, Central Michigan University, 1015 S Washington Ave, Saginaw, MI, 48603, USA
| | - Saurabh Chandan
- Division of Gastroenterology and Hepatology, Creighton University School of Medicine, Omaha, NE, 68124, USA
| | - Shailender Singh
- Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, 982000 Nebraska Medical Center, Omaha, NE, 68198-2000, USA
| | - Douglas G Adler
- Center for Advanced Therapeutic Endoscopy, Professor of Medicine, Centura Health, Denver, CO, USA.
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22
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Naga YSE, Dhindsa BS, Bapaye J, Tun KM, Dhaliwal A, Ramai D, Saghir SM, Chandan S, Adler DG. A Systematic Review and Meta-Analysis: A Prior Appendectomy Does Not Increase the Risk of Severe Clostridioides difficile Infection or Recurrence. Dig Dis Sci 2023; 68:3714-3720. [PMID: 37402978 DOI: 10.1007/s10620-023-07998-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 06/06/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND AND OBJECTIVES There is conflicting evidence regarding the association between a prior appendectomy and severity of Clostridioides difficile infection. The aim of this study was to perform a systematic review and meta-analysis to evaluate this association. PATIENTS AND METHODS Comprehensive review of multiple databases was performed up to May 2022. The primary outcome assessed was the rate of severe Clostridioides difficile infection in patients with a prior appendectomy compared to patients with an appendix. The secondary outcomes assessed were recurrence, mortality, and colectomy rates associated with Clostridioides difficile infection in patients with a prior appendectomy compared to patients with an appendix. RESULTS Eight studies with 666 patients with a prior appendectomy and 3580 patients without an appendectomy were included. The odds ratio of severe Clostridioides difficile infection in patients who underwent prior appendectomy was 1.03 (95% CI 0.6-1.78, p = 0.92). The odds ratio of recurrence in patients who underwent prior appendectomy was 1.29 (95% CI 0.82-2.02, p = 0.28). The odds ratio of colectomy due to Clostridioides difficile infection in patients who underwent prior appendectomy was 2.16 (95% CI 1.27-3.67, p = 0.004). The odds ratio of mortality due to Clostridioides difficile infection in patients with a prior appendectomy was 0.92 (95% CI 0.62-1.37, p = 0.68). CONCLUSION Patients with appendectomy are not at increased risk for developing severe Clostridioides difficile infection or recurrence. Further prospective studies are needed to establish these associations.
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Affiliation(s)
- Yassin Shams Eldien Naga
- Department of Internal Medicine, University of South Florida Morsani College of Medicine, 12901 Bruce B Downs Blvd, Tampa, FL, 33612, USA
| | - Banreet Singh Dhindsa
- Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, 982000 Nebraska Medical Center, Omaha, NE, 68198-2000, USA
| | - Jay Bapaye
- Department of Internal Medicine, Rochester Regional Health, 1425 Portland Avenue, Rochester, NY, 14621, USA
| | - Kyaw Min Tun
- Department of Internal Medicine, University of Nevada Las Vegas School of Medicine, 1701 W Charleston Blvd., Las Vegas, NV, 89102, USA
| | - Amaninder Dhaliwal
- Division of Gastroenterology and Hepatology, McLeod Regional Medical Center, Florence, SC, 29506, USA
| | - Daryl Ramai
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, 30 N 1900 E, Room 4R118, Salt Lake City, UT, 84132, USA
| | - Syed Mohsin Saghir
- Division of Gastroenterology and Hepatology, Creighton University School of Medicine, Omaha, NE, 68124, USA
| | - Saurabh Chandan
- Division of Gastroenterology and Hepatology, Creighton University School of Medicine, Omaha, NE, 68124, USA
| | - Douglas G Adler
- Center for Advanced Therapeutic Endoscopy, Centura Health, Denver, CO, USA.
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Deb A, Moond V, Thongtan T, Deliwala S, Chandan S, Mohan BP, Adler DG. Role of Duodenal Bulb Biopsy in Diagnosing Suspected Celiac Disease in Adult Patients: A Systematic Review and Meta-analysis. J Clin Gastroenterol 2023:00004836-990000000-00203. [PMID: 37646538 DOI: 10.1097/mcg.0000000000001913] [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: 03/06/2023] [Accepted: 07/19/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND AND AIMS Current guidelines recommend multiple biopsies from the first (D1) and second (D2) part of duodenum to establish a diagnosis of celiac disease. In this meta-analysis we aimed to find whether D1 biopsy can increase the diagnostic yield of adult celiac disease. METHODS Literature databases were searched until January 2023 for studies reporting diagnosis of celiac disease in the adult population using D1 biopsy. Meta-analysis was done using a random-effects model. Heterogeneity was assessed by I2% and 95% prediction interval statistics. Measured outcomes were diagnostic yield with D1 and D2 biopsies and from 4 versus 2 biopsy samples. RESULTS A total of 16 studies were included in the final analysis. The pooled diagnostic rate of celiac disease from D1 biopsy was 77.4% [95% CI (64.7-86.5, I2 94%)] and from D2 biopsy was 75.3% [60.8-85.7, I2 96%]. The pooled rate of increase in diagnostic yield with D1 biopsy was 6.9% I [4.6-10.2, I2 66%]. The pooled diagnosis rate with 2 biopsy samples were 77.3% [50-92, I2 93%] and 86.4% I [58.4-96.7, I2 87%] from D1 and D2 respectively, whereas that with 4 biopsy samples were 83.3% [49.8-96.2, I2 76%] and 70.5% I [51-84.6, I2 96%] from D1 and D2, respectively, the difference being non-significant. CONCLUSION Our study demonstrates that taking 4 biopsy samples does not incur any additional diagnostic value over taking 2 biopsy samples from each duodenum segment. Although biopsy from the D1 and D2 has similar diagnostic yield in the adult population, there was an overall increase in diagnostic yield with D1 biopsy, especially in those with a patchy disease distribution.
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Affiliation(s)
- Anasua Deb
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock
| | - Vishali Moond
- Department of Internal Medicine, Saint Peter's University Hospital/Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Thanita Thongtan
- Division of Gastroenterology & Hepatology, The University of Texas Rio Grande Valley, Edinburg, TX
| | - Smit Deliwala
- Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA
| | - Saurabh Chandan
- Division of Gastroenterology & Hepatology, Creighton University School of Medicine, Omaha, NE
| | - Babu P Mohan
- Gastroenterology & Hepatology, University of Utah Health School of Medicine, Salt Lake City, UT
| | - Douglas G Adler
- Director, Center for Advanced Therapeutic Endoscopy, Centura Health, Porter Adventist Hospital, Denver, CO
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Ramai D, Enofe I, Deliwala SS, Mozell D, Facciorusso A, Gkolfakis P, Mohan BP, Chandan S, Previtera M, Maida M, Anderloni A, Adler DG, Ofosu A. Response. Gastrointest Endosc 2023; 98:268-269. [PMID: 37455059 DOI: 10.1016/j.gie.2023.03.027] [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: 03/15/2023] [Accepted: 03/19/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Daryl Ramai
- Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, Utah, USA
| | - Ikponmwosa Enofe
- Department of Gastroenterology and Hepatology, Loyola University Medical Center, Chicago, Illinois, USA
| | - Smit S Deliwala
- Internal Medicine, Hurley Medical Center, Flint, Michigan, USA
| | - Daniel Mozell
- Internal Medicine, Elmhurst Hospital, Elmhurst, New York, USA
| | - Antonio Facciorusso
- Section of Gastroenterology, Department of Medical Sciences, University of Foggia, Foggia, Italy
| | - Paraskevas Gkolfakis
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, CUB Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Babu P Mohan
- Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, Utah, USA
| | - Saurabh Chandan
- Division of Gastroenterology and Hepatology, CHI Health, Creighton University Medical Center, Omaha, Nebraska, USA
| | - Melissa Previtera
- University of Cincinnati Libraries, Donald C. Harrison Health Sciences Library, Cincinnati, Ohio, USA
| | - Marcello Maida
- Gastroenterology and Endoscopy Unit, S. Elia-Raimondi Hospital, Caltanissetta, Italy
| | - Andrea Anderloni
- Digestive Endoscopy Unit, Humanitas Clinical and Research Center, Milano, Italy
| | - Douglas G Adler
- Center for Advanced Therapeutic Endoscopy, Porter Adventist Hospital/PEAK Gastroenterology, Denver, Colorado, USA
| | - Andrew Ofosu
- Division of Digestive Diseases, University of Cincinnati, Cincinnati, Ohio, USA
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25
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Chandan S, Deliwala S, Mohan BP, Ramai D, Dhindsa B, Bapaye J, Kassab LL, Chandan OC, Facciorusso A, Adler DG. Vonoprazan versus lansoprazole in erosive esophagitis - A systematic review and meta-analysis of randomized controlled trials. Indian J Gastroenterol 2023; 42:475-484. [PMID: 37418052 DOI: 10.1007/s12664-023-01384-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/28/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Proton-pump inhibitors (PPIs) are the mainstay of treatment in erosive esophagitis (EE). An alternative to PPIs in EE is Vonoprazan, a potassium competitive acid blocker. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing vonoprazan to lansoprazole. METHODS Multiple databases searched through November 2022. Meta-analysis was performed to assess endoscopic healing at two, four and eight weeks, including for patients with severe EE (Los Angeles C/D). Serious adverse events (SAE) leading to drug discontinuation were assessed. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. RESULTS Four RCTs with 2208 patients were included in the final analysis. Vonoprazan 20 mg once-daily was compared to lansoprazole 30 mg once-daily dosing. Among all patients, at two and eight weeks post-treatment, vonoprazan resulted in significantly higher rates of endoscopic healing as compared to lansoprazole, risk ratios (RR) 1.1, p<0.001 and RR 1.04, p=0.03. The same effect was not observed at four weeks, RR 1.03 (CI 0.99-1.06, I2=0%) following therapy. Among patients with severe EE, vonoprazan resulted in higher rates of endoscopic healing at two weeks, RR 1.3 (1.2-1.4, I2=47%), p=<0.001, at four weeks, RR 1.2 (1.1-1.3, I2=36%), p=<0.001 and at eight weeks post-treatment, RR 1.1 (CI 1.03-1.3, I2=79%), p=0.009. We found no significant difference in the overall pooled rate of SAE and pooled rate of adverse events leading to drug discontinuation. Finally, the overall certainty of evidence for our main summary estimates was rated as high (grade A). CONCLUSION Based on limited number of published non-inferiority RCTs, our analysis demonstrates that among patients with EE, vonoprazan 20 mg once-daily dosing achieves comparable and in those with severe EE, higher endoscopic healing rates as compared to lansoprazole 30 mg once-daily dosing. Both drugs have a comparable safety profile.
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Affiliation(s)
- Saurabh Chandan
- Division of Gastroenterology and Hepatology, Creighton University School of Medicine, Omaha, NE, USA
| | - Smit Deliwala
- Division of Digestive Diseases, Emory University, Atlanta, GA, USA
| | - Babu P Mohan
- Gastroenterology and Hepatology, University of Utah Health School of Medicine, Salt Lake City, UT, USA
| | - Daryl Ramai
- Gastroenterology and Hepatology, University of Utah Health School of Medicine, Salt Lake City, UT, USA
| | - Banreet Dhindsa
- Department of Gastroenterology and Hepatology, University of Nebraska Medical Center|, Omaha, NE, USA
| | - Jay Bapaye
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA
| | - Lena L Kassab
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ojasvini Choudhry Chandan
- Department of Pediatric Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Surgical and Medical Sciences, University of Foggia, Foggia, Italy
| | - Douglas G Adler
- Center for Advanced Therapeutic Endoscopy, Centura Health, Denver, CO, USA.
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Chandan S, Nguyen AK, Mohan BP, Deliwala S, Ramai D, Kassab LL, Muthusamy A, Facciorusso A, Kamal F, Bilal M, Samanta J, Adler DG. EUS-guided therapies for primary and secondary prophylaxis in gastric varices-An updated systematic review and meta-analysis. Endosc Ultrasound 2023; 12:351-361. [PMID: 37795350 PMCID: PMC10547242 DOI: 10.1097/eus.0000000000000017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 04/12/2023] [Indexed: 10/06/2023] Open
Abstract
Background and Objectives Gastric varices (GVs) are associated with a higher risk of uncontrolled bleeding and death when compared with esophageal varices. While endoscopic glue injection therapy has been traditionally used for secondary prophylaxis in GV, data regarding primary prophylaxis continue to emerge. Recently, EUS-guided therapies have been used in GV bleeding. Methods We conducted a comprehensive search of several major databases from inception to June 2022. Our primary goals were to estimate the pooled rates of treatment efficacy, GV obliteration, GV recurrence, and rebleeding with EUS-guided therapy in primary and secondary prophylaxis. Overall adverse events and technical failures were assessed. Random-effects model was used for our meta-analysis, and heterogeneity was assessed using the I2 % statistics. Results Eighteen studies with 604 patients were included. In primary prophylaxis, pooled rate of GV obliteration was 90.2% (confidence interval [CI], 81.1-95.2; I2 = 0). With combination EUS-glue and coil therapy, the rate was 95.4% (CI, 86.7%-98.5%; I2 = 0). Pooled rate of posttherapy GV bleeding was 4.9% (CI, 1.8%-12.4%; I2 = 0). In secondary prophylaxis, pooled rate of treatment efficacy was 91.9% (CI, 86.8%-95.2%; I2 = 12). With EUS-glue, EUS-coil, and combination EUS-glue and coil, the rates were 94.3% (CI, 88.9%-97.1%; I2 = 0), 95.5% (CI, 80.3%-99.1%; I2 = 0), and 88.7% (CI, 76%-95.1%; I2 = 14), respectively. Pooled rate of GV obliteration was 83.6% (CI, 71.5%-91.2%; I2 = 74). With EUS-glue, EUS-coil, and combination EUS-glue and coil, the rates were 84.6% (CI, 75.9%-90.6%; I2 = 31), 92.3% (CI, 81.1%-97.1%; I2 = 0), and 84.5% (CI, 50.8%-96.7%; I2 = 75), respectively. Pooled rates of GV rebleeding and recurrence were 18.1% (CI, 13.1%-24.3%; I2 = 16) and 20.6% (CI, 9.3%-39.5%; I2 = 66), respectively. Conclusion Our analysis shows that EUS-guided therapy for GVs is technically feasible and clinically successful in both primary and secondary prophylaxis of GV.
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Affiliation(s)
- Saurabh Chandan
- Division of Gastroenterology and Hepatology, CHI Creighton University Medical Center, Omaha, NE, USA
| | - Andrew Khoi Nguyen
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Babu P. Mohan
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Smit Deliwala
- Division of Gastroenterology, Emory University, Atlanta, GA, USA
| | - Daryl Ramai
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | | | - Antonio Facciorusso
- Gastroenterology Unit, Department of Surgical and Medical Sciences, University of Foggia, Foggia, Italy
| | - Faisal Kamal
- Department of Gastroenterology, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Mohammad Bilal
- Division of Gastroenterology, University of Minnesota and Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Jayanta Samanta
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Douglas G. Adler
- Center for Advanced Therapeutic Endoscopy (CATE), Centura Health, Porter Adventist Hospital, Denver, CO, USA
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Ali H, Jaber F, Patel P, Dahiya DS, Sarfraz S, Graham S, Farooq MF, Mohan BP, Adler DG. Comparable Short-Term Weight Loss and Safety of Endoscopic Sleeve Gastroplasty in Diabetic and Non-diabetic Patients. Dig Dis Sci 2023; 68:2493-2500. [PMID: 37119378 DOI: 10.1007/s10620-023-07953-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 04/19/2023] [Indexed: 05/01/2023]
Abstract
BACKGROUND Endoscopic sleeve gastroplasty (ESG) is a highly effective endo bariatric procedure. Data on outcomes of ESG in patients with diabetes mellitus (DM) compared to non-diabetics are limited. AIMS We aim to assess differences in clinical outcomes of ESG in DM patients in North America. METHODS We used the Metabolic and Bariatric Surgery Accreditation Quality Improvement Program database from 2016 to 2021 to identify all DM patients who underwent ESG as the primary procedure for weight loss. A 1:1 propensity score matched cohort of non-DM patients served as controls. Patient characteristics, clinical outcomes, and complications were compared and analyzed. Adult patients with Class I obesity and above were included. RESULTS After matching, 310 DM and non-DM patients that underwent ESG were compared. The median % BMI decrease (3.3% vs. 3.1%, P = 0.62) and median total body weight loss (%TBWL) (4.3% vs. 4%, P = 0.75) in 30 days were similar in the DM compared to non-DM cohorts. A similar proportion of patients with major adverse events (AEs) were present after ESG in the DM (1.6% vs. 1.3%, P = 0.74) compared to the non-DM cohort. The DM cohort had more patients with 30-day readmissions (3.2% vs. 1.9%, P = 0.08) than the non-DM cohort. %TBWL was similar in patients with HbA1c < 9% compared to ≥ 9%, (4.3% each, P = 0.33) with comparable AEs. CONCLUSION ESG is a safe procedure in DM patients, without an increase in AEs, and it shows similar short-term weight loss compared to non-DM patients.
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Affiliation(s)
- Hassam Ali
- Department of Gastroenterology, East Carolina University/Brody School of Medicine, Greenville, NC, 27834, USA
| | - Fouad Jaber
- Department of Internal Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, MO, 64108, USA
| | - Pratik Patel
- Department of Gastroenterology, Mather Hospital/Hofstra University Zucker School of Medicine, Port Jefferson, NY, 11777, USA
| | - Dushyant Singh Dahiya
- Department of Internal Medicine, Central Michigan College of Medicine, Saginaw, MI, 48601, USA
| | - Shiza Sarfraz
- Department of Internal Medicine, Quaid-E-Azam Medical College, Punjab, Pakistan
| | - Saeed Graham
- Department of Internal Medicine, East Carolina University/Brody School of Medicine, Greenville, NC, 27834, USA
| | - Muhammad Fahd Farooq
- Department of Gastroenterology, East Carolina University/Brody School of Medicine, Greenville, NC, 27834, USA
| | - Babu P Mohan
- Department of Gastroenterology & Hepatology, University of Utah Health School of Medicine, Salt Lake City, UT, USA
| | - Douglas G Adler
- Center for Advanced Therapeutic Endoscopy, Centura Health, Porter Adventist Hospital, Denver, CO, USA.
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Karna R, S Deliwala S, Ramgopal B, Asawa P, Mishra R, P Mohan B, Jayakrishnan T, Grover D, Kalra T, Bhalla J, Saraswati U, K Gangwani M, Dhawan M, G Adler D. Gastrointestinal treatment-related adverse events of combined immune checkpoint inhibitors: a meta-analysis. Immunotherapy 2023. [PMID: 37190949 DOI: 10.2217/imt-2023-0001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
Introduction: Combined immune checkpoint inhibitors can cause gastrointestinal adverse events. Methods: We performed a meta-analysis of pooled colonic, hepatic and pancreatic treatment-related adverse events of combined ICI. Results: 53 trials reporting treatment-related adverse events in 6581 patients. All grade diarrhea was the most common adverse event seen in 25.4% patients, followed by all grade hepatitis in nearly 13% patients and pancreatitis in nearly 7.5% patients. Conclusion: Our study provides pooled data of treatment-related adverse events from different combination immune checkpoint inhibitors use in solid tumors and demonstrates a high incidence of all grades and ≥3 grade gastrointestinal adverse events. Further studies are required to characterize these adverse events and assess their overall impact on treatment course and outcomes.
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Affiliation(s)
- Rahul Karna
- Internal Medicine, Allegheny Health Network, Pittsburgh, PA, USA
| | - Smit S Deliwala
- Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA, USA
| | - Balasubramanian Ramgopal
- Foundation Fellowship Doctor, University Hospital, Southampton NHS Foundation Trust, Southampton, Hampshire, UK
| | - Palash Asawa
- Internal Medicine, Allegheny Health Network, Pittsburgh, PA, USA
| | - Rahul Mishra
- Postdoctoral research fellow, Cleveland Clinic, OH, USA
| | - Babu P Mohan
- Gastroenterology & Hepatology, University of Utah Health School of Medicine, Salt Lake City, UT, USA
| | | | - Dheera Grover
- Internal Medicine, University of Connecticut, Hartford, CT, USA
| | - Tanisha Kalra
- Internal Medicine, SUNY Downstate Health Science University, NY, USA
| | | | | | - Manesh K Gangwani
- Internal Medicine, University of Toledo Medical Center, Toledo, OH, USA
| | - Manish Dhawan
- Gastroenterology & Hepatology, Allegheny Health Network, Pittsburgh, PA, USA
| | - Douglas G Adler
- Center for Advanced Therapeutic Endoscopy, Centura Health, Denver, CO, USA
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29
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Vohra I, Gopakumar H, Adler DG. G-POEM for gastroparesis: past, present and future. Curr Opin Gastroenterol 2023:00001574-990000000-00074. [PMID: 37265234 DOI: 10.1097/mog.0000000000000950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE OF REVIEW Gastroparesis is a chronic debilitating condition with rising incidence and healthcare burden. As abdominal surgeries, diabetes, viral infections and autoimmune diseases become more prevalent, gastroparesis will continue to upsurge. Conservative treatment options for gastroparesis are limited by their side effects and short-term efficacy. Gastric endoscopic pyloromyotomy (G-POEM) is a novel incisionless endosurgical technique with excellent long-term outcomes. This review is in time, as the demand for G-POEM will continue to escalate. RECENT FINDINGS This review encompasses the conservative and nonconservative treatment options for gastroparesis. G-POEM is a nonconservative treatment option, and the aim of this review is to discuss the variations in technique of G-POEM, short-term and long-term clinical efficacy of G-POEM and adverse events associated with it. SUMMARY G-POEM has high technical and clinical success with minimal adverse events. G-POEM outcomes are similar or superior when compared with other treatment options for refractory gastroparesis. G-POEM is being widely adopted and will become the preferred treatment choice in patients with refractory gastroparesis.
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Affiliation(s)
- Ishaan Vohra
- Department of Gastroenterology and Hepatology, University of Illinois College of Medicine at Peoria, Peoria, Illinois
| | - Harishankar Gopakumar
- Department of Gastroenterology and Hepatology, University of Illinois College of Medicine at Peoria, Peoria, Illinois
| | - Douglas G Adler
- Center for Advanced Therapeutic Endoscopy (CATE), Centura Health-Porter Adventist Hospital, Denver, Colorado, USA
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Mohan BP, Adler DG. Artificial intelligence in colonoscopy: where have we been and where should we go? Transl Gastroenterol Hepatol 2023; 8:23. [PMID: 37601743 PMCID: PMC10432228 DOI: 10.21037/tgh-23-25] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 04/07/2023] [Indexed: 08/22/2023] Open
Affiliation(s)
- Babu P. Mohan
- Division of Gastroenterology & Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Douglas G. Adler
- Center for Advanced Therapeutic Endoscopy (CATE) at Centura Health Porter Adventist Hospital, Denver, Colorado, USA
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Ali H, Mohan BP, Adler DG. Reporting Endoscopic Sleeve Gastroplasty Outcomes Using Bariatric Surgery Accreditation and Quality Improvement Program. Obes Surg 2023:10.1007/s11695-023-06578-3. [PMID: 37016053 DOI: 10.1007/s11695-023-06578-3] [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] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 03/13/2023] [Accepted: 03/28/2023] [Indexed: 04/06/2023]
Affiliation(s)
- Hassam Ali
- Department of Gastroenterology, East Carolina University/Brody School of Medicine, Greenville, NC, 27834, USA
| | - Babu P Mohan
- Department of Gastroenterology & Hepatology, University of Utah Health School of Medicine, Salt Lake City, UT, USA
| | - Douglas G Adler
- Center for Advanced Therapeutic Endoscopy, Centura Health, Porter Adventist Hospital, Denver, CO, USA.
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Ahmed Z, Iqbal U, Aziz M, Arif SF, Badal J, Farooq U, Lee-Smith W, Gangwani MK, Kamal F, Kobeissy A, Mahmood A, Nawras A, Khara HS, Confer BD, Adler DG. Outcomes and Complications of Radiological Gastrostomy vs. Percutaneous Endoscopic Gastrostomy for Enteral Feeding: An Updated Systematic Review and Meta-Analysis. Gastroenterology Res 2023; 16:79-91. [PMID: 37187550 PMCID: PMC10181338 DOI: 10.14740/gr1593] [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: 01/27/2023] [Accepted: 03/09/2023] [Indexed: 05/17/2023] Open
Abstract
Background Percutaneous endoscopic gastrostomy (PEG) and percutaneous radiological gastrostomy (PRG) are commonly utilized to establish access to enteral nutrition. However, data comparing the outcomes of PEG vs. PRG are conflicting. Therefore, we aimed to conduct an updated systemic review and meta-analysis comparing PRG and PEG outcomes. Methods Medline, Embase, and Cochrane library databases were searched until February 24, 2023. Primary outcomes included 30-day mortality, tube leakage, tube dislodgement, perforation, and peritonitis. Secondary outcomes included bleeding, infectious complications, and aspiration pneumonia. All analyses were conducted using Comprehensive Meta-Analysis Software. Results The initial search revealed 872 studies. Of these, 43 of these studies met our inclusion criteria and were included in the final meta-analysis. Of 471,208 total patients, 194,399 received PRG and 276,809 received PEG. PRG was associated with higher odds of 30-day mortality when compared to PEG (odds ratio (OR): 1.205, 95% confidence interval (CI): 1.015 - 1.430, I2 = 55%). In addition, tube leakage and tube dislodgement were higher in the PRG group than in PEG (OR: 2.231, 95% CI: 1.184 - 4.2 and OR: 2.602, 95% CI: 1.911 - 3.541, respectively). Perforation, peritonitis, bleeding, and infectious complications were higher with PRG than PEG. Conclusion PEG is associated with lower 30-day mortality, tube leakage, and tube dislodgement rates than PRG.
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Affiliation(s)
- Zohaib Ahmed
- Department of Internal Medicine, University of Toledo, Toledo, OH, USA
- Zohaib Ahmed and Umair Iqbal contributed equally and shared the first authorship
- Corresponding Author: Zohaib Ahmed, Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH, USA.
| | - Umair Iqbal
- Division of Gastroenterology and Hepatology, Geisinger Medical Center, Danville, PA, USA
- Zohaib Ahmed and Umair Iqbal contributed equally and shared the first authorship
| | - Muhammad Aziz
- Division of Gastroenterology and Hepatology, University of Toledo, Toledo, OH, USA
| | | | - Joyce Badal
- University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Umer Farooq
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA
| | - Wade Lee-Smith
- University of Toledo Libraries, University of Toledo, Toledo, OH, USA
| | | | - Faisal Kamal
- Division of Gastroenterology, University of California San Francisco, San Francisco, CA, USA
| | - Abdallah Kobeissy
- Division of Gastroenterology and Hepatology, University of Toledo, Toledo, OH, USA
| | - Asif Mahmood
- Department of Internal Medicine, University of Toledo, Toledo, OH, USA
| | - Ali Nawras
- Division of Gastroenterology and Hepatology, University of Toledo, Toledo, OH, USA
| | - Harshit S. Khara
- Division of Gastroenterology and Hepatology, Geisinger Medical Center, Danville, PA, USA
| | - Bradley D. Confer
- Division of Gastroenterology and Hepatology, Geisinger Medical Center, Danville, PA, USA
| | - Douglas G. Adler
- Center for Advanced Therapeutic Endoscopy (CATE), Centura Health, Porter Adventist Hospital, Peak Gastroenterology, Denver, CO, USA
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Gleeson FC, Adler DG. In Memoriam: Michael J. Levy, MD: 1964-2023. Gastrointest Endosc 2023; 97:638-639. [PMID: 36958918 DOI: 10.1016/j.gie.2023.01.053] [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: 01/31/2023] [Accepted: 01/31/2023] [Indexed: 03/25/2023]
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Naga YSE, Dhindsa BS, Deliwala S, Tun KM, Dhaliwal A, Ramai D, Bhat I, Singh S, Chandan S, Adler DG. Single-incision needle-knife biopsy for the diagnosis of GI subepithelial tumors: a systematic review and meta-analysis. Gastrointest Endosc 2023; 97:640-645.e2. [PMID: 36460089 DOI: 10.1016/j.gie.2022.11.021] [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: 09/07/2022] [Revised: 11/03/2022] [Accepted: 11/18/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS A histologic diagnosis of GI subepithelial tumors (SETs) is important because of the malignant potential of these lesions. The current modalities of choice, including EUS-guided FNA and biopsy (EUS-FNA/FNB) have demonstrated suboptimal diagnostic success. Single-incision with needle-knife (SINK) biopsy has emerged as an alternative diagnostic approach to increase tissue acquisition and diagnostic success. The aim of this study was to perform a systematic review and meta-analysis to evaluate the technical success, diagnostic success, and adverse events of SINK biopsy. METHODS We searched multiple databases including PubMed, EMBASE, CINAHL, Cochrane, Web of Science, and Google Scholar from inception to July 2022. The primary outcomes assessed were the technical success and diagnostic success of SINK in GI SETs. The secondary outcomes assessed were adverse events and whether immunohistochemical analysis could be successfully performed on tissue samples obtained via SINK. RESULTS Seven studies with a total of 219 SINK biopsy procedures were included in this meta-analysis. The technical success rate was 98.1% (95% CI, 94.9%-99.3%; P = .000; I2 = .0%), and the diagnostic success rate was 87.9% (95% CI, 82.6%-91.7%; P = .000; I2 = .0%). The immunohistochemical success rate was 88.3% (95% CI, 78.7%-93.9%; P = .000; I2 = 3.5%). The rate of adverse events was 7.5% (95% CI, 4.3%-12.7%; P = .00; I2 = 7.2%), and bleeding was the most common adverse event. CONCLUSION SINK biopsy is a safe diagnostic procedure with a high technical and diagnostic success in patients with GI SET. Further randomized controlled trials and direct comparison studies are needed to validate these findings.
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Affiliation(s)
- Yassin Shams Eldien Naga
- Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Banreet Singh Dhindsa
- Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Smit Deliwala
- Division of Gastroenterology and Hepatology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kyaw Min Tun
- Department of Internal Medicine, University of Nevada Las Vegas School of Medicine, Las Vegas, Nevada, USA
| | - Amaninder Dhaliwal
- Division of Gastroenterology and Hepatology, University of South Carolina School of Medicine, Florence, South Carolina, USA
| | - Daryl Ramai
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Ishfaq Bhat
- Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Shailender Singh
- Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Saurabh Chandan
- Division of Gastroenterology and Hepatology, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Douglas G Adler
- Center for Advanced Therapeutic Endoscopy, Centura Health, Denver, Colorado, USA.
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Beran A, Sharma S, Ghazaleh S, Lee-Smith W, Aziz M, Kamal F, Acharya A, Adler DG. Predictors of Fecal Microbiota Transplant Failure in Clostridioides difficile Infection : An Updated Meta-analysis. J Clin Gastroenterol 2023; 57:389-399. [PMID: 35050941 DOI: 10.1097/mcg.0000000000001667] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 08/13/2021] [Accepted: 12/08/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION AND AIM Fecal microbiota transplantation (FMT) is an effective treatment for recurrent/refractory Clostridioides difficile infection (CDI) with a 10% to 20% risk of recurrence after a single FMT. In this meta-analysis, we aimed to evaluate the predictors of FMT failure. METHODS A comprehensive search of MEDLINE, Embase, Cochrane, and Web of Science databases through July 2021 was performed. All studies that evaluated risk factors associated with FMT failure in a multivariate model were included. We calculated pooled odds ratios with 95% confidence intervals for risk factors reported in ≥3 studies using a random-effects model. RESULTS Twenty studies involving 4327 patients (63.6% females) with recurrent/refractory CDI who underwent FMT were included. FMT failed in 705 patients (16.3%) with 2 to 3 months of follow-up in most studies. A total of 12 different risk factors were reported in a multivariate model in ≥3 studies. Meta-analysis showed that advanced age, severe CDI, inflammatory bowel disease, peri-FMT use of non-CDI antibiotics, prior CDI-related hospitalizations, inpatient status, and poor quality of bowel preparation were significant predictors of FMT failure. Charlson Comorbidity Index, female gender, immunosuppressed status, patient-directed donor, and number of CDI recurrences were not associated with FMT failure. CONCLUSIONS Adequate bowel preparation at the time of FMT and optimizing antibiotic stewardship practices in the peri-FMT period can improve the success of FMT. Patients with nonmodifiable risk factors should be counseled about the risk of FMT failure. Our results may help develop a risk stratification model to predict FMT failure in CDI patients.
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Affiliation(s)
| | - Sachit Sharma
- Department of Gastroenterology and Hepatology, Virginia Commonwealth University, Richmond, VA
| | | | - Wade Lee-Smith
- Mulford Health Sciences Library, The University of Toledo, Toledo, OH
| | | | - Faisal Kamal
- Department of Gastroenterology and Hepatology, The University of Tennessee, TN
| | | | - Douglas G Adler
- Center for Advanced Therapeutic Endoscopy (CATE), Centura Health, Denver, CO
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Kamal F, Khan MA, Lee-Smith W, Sharma S, Acharya A, Farooq U, Tarar ZI, Faggen AE, Aziz M, Chandan S, Ahmed Z, Kouanda A, Dai SC, Munroe CA, Adler DG. Efficacy and safety of EUS-guided biliary drainage for benign biliary obstruction - A systematic review and meta-analysis. Endosc Ultrasound 2023; 12:228-236. [PMID: 36751758 PMCID: PMC10237615 DOI: 10.4103/eus-d-22-00077] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 04/17/2022] [Accepted: 10/09/2022] [Indexed: 02/09/2023] Open
Abstract
Background and Objectives ERCP is the first line of treatment for benign and malignant biliary obstruction and EUS-guided biliary drainage (EUS-BD) is usually used for patients who have failed ERCP. Recently, several studies have evaluated the role of EUS-BD in the management of benign biliary obstruction. This meta-analysis evaluates the efficacy and safety of EUS-BD in the management of benign biliary obstruction. Methods We reviewed several databases from inception to July 8, 2022, to identify studies evaluating the efficacy and safety of EUS-BD in the management of benign biliary obstruction. Our outcomes of interest were technical success, clinical success, and adverse events. Pooled rates with 95% confidence intervals (CIs) for all outcomes were calculated using a random effects model. Subgroup analyses were performed including patients with normal anatomy versus surgically altered anatomy (SAA). Heterogeneity was assessed by I2 statistic. Results We included 14 studies with 329 patients. The pooled rate (95% CI) of technical success was 88% (83%, 92%). The pooled rate (95% CI) of technical success for patients with SAA and normal anatomy was 92% (85%, 96%) and 83% (75%, 89%), respectively. The pooled rates (95% CI) of clinical success and adverse events were 89% (83%, 93%) and 19% (13%, 26%), respectively. We found low heterogeneity in most of the analyses. Conclusions EUS-BD is an effective and safe option in patients with benign biliary obstruction and should be considered after a failed attempt at ERCP or when ERCP is not technically possible.
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Affiliation(s)
- Faisal Kamal
- Division of Gastroenterology, University of California-San Francisco, San Francisco, CA, USA
| | - Muhammad Ali Khan
- Department of Gastroenterology, Hepatology and Nutrition, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Wade Lee-Smith
- Mulford Health Sciences Library, University of Toledo, Toledo, OH, USA
| | - Sachit Sharma
- Division of Gastroenterology, Virginia Commonwealth University, Richmond, VA, USA
- Department of Medicine, University of Toledo, Toledo, OH, USA
| | - Ashu Acharya
- Department of Medicine, University of Toledo, Toledo, OH, USA
| | - Umer Farooq
- Department of Medicine, Loyola Medicine/MacNeal Hospital, Berwyn, IL, USA
| | - Zahid Ijaz Tarar
- Department of Medicine, University of Missouri, Columbia, MO, USA
| | - Alec E. Faggen
- Division of Gastroenterology, University of California-San Francisco, San Francisco, CA, USA
| | - Muhammad Aziz
- Division of Gastroenterology, University of Toledo, Toledo, OH, USA
| | - Saurabh Chandan
- Division of Gastroenterology, Creighton University Medical Center, Omaha, NE, USA
| | - Zohaib Ahmed
- Department of Medicine, University of Toledo, Toledo, OH, USA
| | - Abdul Kouanda
- Division of Gastroenterology, University of California-San Francisco, San Francisco, CA, USA
| | - Sun-Chuan Dai
- Division of Gastroenterology, University of California-San Francisco, San Francisco, CA, USA
| | - Craig A. Munroe
- Division of Gastroenterology, University of California-San Francisco, San Francisco, CA, USA
| | - Douglas G. Adler
- Center for Advanced Therapeutic Endoscopy, Porter Adventist Hospital, Denver, Colorado, USA
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Chandan S, Deliwala S, Khan SR, Mohan BP, Dhindsa BS, Bapaye J, Goyal H, Kassab LL, Kamal F, Sayles HR, Kochhar GS, Adler DG. EUS-guided versus percutaneous liver biopsy: A comprehensive review and meta-analysis of outcomes. Endosc Ultrasound 2023; 12:171-180. [PMID: 36204798 PMCID: PMC10237604 DOI: 10.4103/eus-d-21-00268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 04/28/2022] [Indexed: 05/07/2023] Open
Abstract
EUS-guided liver biopsy (EUS-LB) has gained momentum in recent years, especially with availability of newer needle designs. Given the emerging comparative data on EUS-LB with second-generation needles and percutaneous LB (PC-LB), we conducted a systematic review and meta-analysis to compare the safety and efficacy of the two techniques. We searched multiple databases from inception through November 2021 to identify studies comparing outcomes of EUS-LB and PC-LB. Pooled estimates were calculated using a random-effects model, and the results were expressed in terms of pooled proportions and odds ratio (OR) along with relevant 95% confidence intervals (CIs). Five studies with 748 patients were included in the final analysis. EUS-LB was performed in 276 patients and PC-LB in 472 patients. Across all studies, PC-LB had an overall higher diagnostic accuracy than EUS-LB, 98.6% confidence interval (CI: 94.7-99.7) versus 88.3% (49.6-98.3), OR: 1.65, P = 0.04. On assessing data from randomized controlled trials, there was no difference between the two. While pooled diagnostic adequacy and overall adverse events were not significantly different between PC-LB and EUS-LB, the former was superior in terms of the mean number of complete portal tracts (CPT) and total specimen length. PC-LB and EUS-LB produce similar results. PC-LB allows obtaining longer samples and more CPT. Further studies are needed to see if these trends hold up as more providers begin to perform EUS-LB.
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Affiliation(s)
- Saurabh Chandan
- Division of Gastroenterology and Hepatology, CHI Creighton University Medical Center, Omaha, Nebraska, USA
| | - Smit Deliwala
- Department of Internal Medicine, Hurley Medical Center, Flint, Michigan, USA
| | - Shahab R. Khan
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Babu P. Mohan
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Banreet S. Dhindsa
- Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Jay Bapaye
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York, USA
| | - Hemant Goyal
- Department of Gastroenterology, The Wright Center for Graduate Medical Education, Scranton, Pennsylvania, USA
| | - Lena L. Kassab
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Faisal Kamal
- Division of Gastroenterology, University of California-San Francisco, California, USA
| | - Harlan R. Sayles
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Gursimran S. Kochhar
- Division of Gastroenterology, Hepatology and Nutrition, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Douglas G. Adler
- Center for Advanced Therapeutic Endoscopy, Centura Health, Porter Adventist Hospital, Denver, Colorado, USA
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Ramai D, Enofe I, Deliwala SS, Mozell D, Facciorusso A, Gkolfakis P, Mohan BP, Chandan S, Previtera M, Maida M, Anderloni A, Adler DG, Ofosu A. Early (<4 weeks) versus standard (≥4 weeks) endoscopic drainage of pancreatic walled-off fluid collections: a systematic review and meta-analysis. Gastrointest Endosc 2023; 97:415-421.e5. [PMID: 36395824 DOI: 10.1016/j.gie.2022.11.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [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: 08/23/2022] [Revised: 10/19/2022] [Accepted: 11/07/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS Previous studies have demonstrated that the ideal time for drainage of walled-off pancreatic fluid collections is 4 to 6 weeks after their development. However, some pancreatic collections, notably infected pancreatic fluid collections, require earlier drainage. Nevertheless, the optimal timing of the first intervention is unclear, and consensus data are sparse. The aim of this study was to evaluate the clinical efficacy and safety of EUS-guided drainage of pancreatic fluid collections <4 weeks after development compared with ≥4 weeks after development. METHODS Search strategies were developed for PubMed, Embase, and Cochrane Library databases from inception. Outcomes of interest were technical success, defined as successful endoscopic placement of a lumen-apposing metal stent; clinical success, defined as a reduction in cystic collection size; and procedure-related adverse events. A random-effects model was used for analysis, and results are expressed as odds ratio (OR) with 95% confidence interval (CI). RESULTS Six studies (630 patients) were included in our final analysis, in which 182 patients (28.9%) were enrolled in the early drainage cohort and 448 patients (71.1%) in the standard drainage cohort. The mean fluid collection size was 143.4 ± 18.8 mm for the early cohort versus 128 ± 19.7 mm for the standard cohort. Overall, technical success was equal in both cohorts. Clinical success did not favor either standard drainage or early drainage (OR, .39; 95% CI, .13-1.22; P = .11). No statistically significant differences were found in overall adverse events (OR, 1.67; 95% CI, .63-4.45; P = .31) or mortality (OR, 1.14; 95% CI, .29-4.48; P = .85). Hospital stay was longer for patients undergoing early drainage compared with standard drainage (23.7 vs 16.0 days, respectively). CONCLUSIONS Both early (<4 weeks) and standard (≥4 weeks) drainage of walled-off pancreatic fluid collections offer similar technical and clinical outcomes. Patients requiring endoscopic drainage should not be delayed for 4 weeks.
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Affiliation(s)
- Daryl Ramai
- Department of Gastroenterology & Hepatology, University of Utah Health, Salt Lake City, Utah, USA
| | - Ikponmwosa Enofe
- Department of Gastroenterology and Hepatology, Loyola University Medical Center, Chicago, Illinois, USA
| | - Smit S Deliwala
- Department of Internal Medicine, Hurley Medical Center, Flint, Michigan, USA
| | - Daniel Mozell
- Department of Internal Medicine, Elmhurst Hospital, Elmhurst, New York, USA
| | - Antonio Facciorusso
- Section of Gastroenterology, Department of Medical Sciences, University of Foggia, Foggia, Italy
| | - Paraskevas Gkolfakis
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, CUB Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Babu P Mohan
- Department of Gastroenterology & Hepatology, University of Utah Health, Salt Lake City, Utah, USA
| | - Saurabh Chandan
- Division of Gastroenterology & Hepatology, CHI Health Creighton University Medical Center, Omaha, Nebraska, USA
| | - Melissa Previtera
- Donald C. Harrison Health Sciences Library, University of Cincinnati Libraries, Cincinnati, Ohio, USA
| | - Marcello Maida
- Gastroenterology and Endoscopy Unit, S. Elia-Raimondi Hospital, Caltanissetta, Italy
| | - Andrea Anderloni
- Digestive Endoscopy Unit, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | - Douglas G Adler
- Center for Advanced Therapeutic Endoscopy (CATE), Porter Adventist Hospital/PEAK Gastroenterology, Denver, Colorado, USA
| | - Andrew Ofosu
- Division of Digestive Diseases, University of Cincinnati, Cincinnati, Ohio, USA
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Ramai D, Morgan AD, Gkolfakis P, Facciorusso A, Chandan S, Papaefthymiou A, Morris J, Arvanitakis M, Adler DG. Endoscopic management of pancreatic walled-off necrosis. Ann Gastroenterol 2023; 36:123-131. [PMID: 36864934 PMCID: PMC9932860 DOI: 10.20524/aog.2023.0772] [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: 10/30/2022] [Accepted: 11/30/2022] [Indexed: 02/05/2023] Open
Abstract
Pancreatic walled-off necrosis (WON) is a complication of severe pancreatitis. Endoscopic transmural drainage has been recognized as the first-line treatment for pancreatic fluid collections. Endoscopy offers a minimally invasive approach when compared to surgical drainage. Today, endoscopists may choose to use self-expanding metal stents, pigtail stents, or lumen-apposing metal stents to facilitate drainage of fluid collections. Current data suggest that all 3 approaches yield similar outcomes. It was previously thought that drainage should be performed 4 weeks from the initial event of pancreatitis, theoretically allowing the capsule to mature. However, current data show that both early (<4 weeks) and standard (≥4 weeks) endoscopic drainage are comparable. Herein, we provide an up-to-date state-of-the-art review of the indications, techniques, innovations, outcomes, and future perspectives following drainage of pancreatic WON.
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Affiliation(s)
- Daryl Ramai
- Gastroenterology & Hepatology, University of Utah Health, Salt Lake City, UT, USA (Daryl Ramai, John Morris)
| | | | - Paraskevas Gkolfakis
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, CUB Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium (Paraskevas Gkolfakis, Marianna Arvanitakis)
| | - Antonio Facciorusso
- Section of Gastroenterology, Department of Medical Sciences, University of Foggia, Italy (Antonio Facciorusso)
| | - Saurabh Chandan
- Division of Gastroenterology & Hepatology, CHI Health Creighton University Medical Center, Omaha, NE, USA (Saurabh Chandan)
| | - Apostolis Papaefthymiou
- Pancreaticobiliary Medicine Unit, University College London Hospitals (UCLH), London, UK (Apostolis Papaefthymiou)
| | - John Morris
- Gastroenterology & Hepatology, University of Utah Health, Salt Lake City, UT, USA (Daryl Ramai, John Morris)
| | - Marianna Arvanitakis
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, CUB Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium (Paraskevas Gkolfakis, Marianna Arvanitakis)
| | - Douglas G. Adler
- Center for Advanced Therapeutic Endoscopy (CATE), Porter Adventist Hospital/PEAK Gastroenterology, Denver, Colorado, USA (Douglas G. Adler)
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Firpo MA, Boucher KM, Bleicher J, Khanderao GD, Rosati A, Poruk KE, Kamal S, Marzullo L, De Marco M, Falco A, Genovese A, Adler JM, De Laurenzi V, Adler DG, Affolter KE, Garrido-Laguna I, Scaife CL, Turco MC, Mulvihill SJ. Multianalyte Serum Biomarker Panel for Early Detection of Pancreatic Adenocarcinoma. JCO Clin Cancer Inform 2023; 7:e2200160. [PMID: 36913644 PMCID: PMC10530881 DOI: 10.1200/cci.22.00160] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 01/10/2023] [Accepted: 02/03/2023] [Indexed: 03/14/2023] Open
Abstract
PURPOSE We determined whether a large, multianalyte panel of circulating biomarkers can improve detection of early-stage pancreatic ductal adenocarcinoma (PDAC). MATERIALS AND METHODS We defined a biologically relevant subspace of blood analytes on the basis of previous identification in premalignant lesions or early-stage PDAC and evaluated each in pilot studies. The 31 analytes that met minimum diagnostic accuracy were measured in serum of 837 subjects (461 healthy, 194 benign pancreatic disease, and 182 early-stage PDAC). We used machine learning to develop classification algorithms using the relationship between subjects on the basis of their changes across the predictors. Model performance was subsequently evaluated in an independent validation data set from 186 additional subjects. RESULTS A classification model was trained on 669 subjects (358 healthy, 159 benign, and 152 early-stage PDAC). Model evaluation on a hold-out test set of 168 subjects (103 healthy, 35 benign, and 30 early-stage PDAC) yielded an area under the receiver operating characteristic curve (AUC) of 0.920 for classification of PDAC from non-PDAC (benign and healthy controls) and an AUC of 0.944 for PDAC versus healthy controls. The algorithm was then validated in 146 subsequent cases presenting with pancreatic disease (73 benign pancreatic disease and 73 early- and late-stage PDAC cases) and 40 healthy control subjects. The validation set yielded an AUC of 0.919 for classification of PDAC from non-PDAC and an AUC of 0.925 for PDAC versus healthy controls. CONCLUSION Individually weak serum biomarkers can be combined into a strong classification algorithm to develop a blood test to identify patients who may benefit from further testing.
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Affiliation(s)
- Matthew A. Firpo
- Department of Surgery, School of Medicine, University of Utah, Salt Lake City, UT
| | - Kenneth M. Boucher
- Department of Oncological Sciences, School of Medicine, University of Utah, Salt Lake City, UT
| | - Josh Bleicher
- Department of Surgery, School of Medicine, University of Utah, Salt Lake City, UT
| | - Gayatri D. Khanderao
- Department of Surgery, School of Medicine, University of Utah, Salt Lake City, UT
| | - Alessandra Rosati
- BIOUNIVERSA s.r.l., Baronissi, Italy
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana” University of Salerno, Baronissi, Italy
| | - Katherine E. Poruk
- Department of Surgery, School of Medicine, University of Utah, Salt Lake City, UT
| | - Sama Kamal
- Department of Surgery, School of Medicine, University of Utah, Salt Lake City, UT
| | - Liberato Marzullo
- BIOUNIVERSA s.r.l., Baronissi, Italy
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana” University of Salerno, Baronissi, Italy
| | - Margot De Marco
- BIOUNIVERSA s.r.l., Baronissi, Italy
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana” University of Salerno, Baronissi, Italy
| | - Antonia Falco
- BIOUNIVERSA s.r.l., Baronissi, Italy
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana” University of Salerno, Baronissi, Italy
| | - Armando Genovese
- University Hospital “San Giovanni di Dio e Ruggi D'Aragona,” Salerno, Italy
| | - Jessica M. Adler
- Department of Surgery, School of Medicine, University of Utah, Salt Lake City, UT
| | - Vincenzo De Laurenzi
- BIOUNIVERSA s.r.l., Baronissi, Italy
- Department of Medicine and Biotechnology, University G d'Annunzio and CeSI-MeT, Chieti, Italy
| | - Douglas G. Adler
- Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, UT
| | - Kajsa E. Affolter
- Department of Pathology, School of Medicine, University of Utah, Salt Lake City, UT
| | - Ignacio Garrido-Laguna
- Department of Oncological Sciences, School of Medicine, University of Utah, Salt Lake City, UT
| | - Courtney L. Scaife
- Department of Surgery, School of Medicine, University of Utah, Salt Lake City, UT
| | - M. Caterina Turco
- BIOUNIVERSA s.r.l., Baronissi, Italy
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana” University of Salerno, Baronissi, Italy
| | - Sean J. Mulvihill
- Department of Surgery, School of Medicine, University of Utah, Salt Lake City, UT
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Karna R, Deliwala S, Ramgopal B, Mohan BP, Kassab L, Becq A, Dhawan M, Adler DG. Efficacy of topical hemostatic agents in malignancy-related GI bleeding: a systematic review and meta-analysis. Gastrointest Endosc 2023; 97:202-208.e8. [PMID: 35944608 DOI: 10.1016/j.gie.2022.07.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [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: 04/01/2022] [Revised: 07/15/2022] [Accepted: 07/30/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Despite advances in endoscopic therapies, malignancy-related GI bleeding remains difficult to manage with high rates of treatment failure and rebleeding. Topical hemostatic agents (THAs) are easier to apply to the wide bleeding surface of tumors. We conducted this systematic review and meta-analysis to evaluate the efficacy of THAs in malignancy-related GI bleeding. METHODS We conducted a comprehensive search of multiple electronic databases to identify studies reporting on the use of THAs in malignancy-related GI bleeding. The primary outcome was the achievement of hemostasis; secondary outcomes were early rebleeding (≤3 days), delayed rebleeding (>3 days), aggregate rebleeding, all-cause mortality, and GI bleeding-related mortality. A meta-analysis of proportions was done for all outcomes. RESULTS Out of 355 citations, 16 studies with 530 patients were included. Primary hemostasis was achieved in 94.1% (95% confidence interval [CI], 91.5-96.0). Early rebleeding was seen in 13.9% (95% CI, 9.7-19.4) and delayed rebleeding in 11.4% (95% CI, 5.8-21.1). Aggregate rebleeding was seen in 24.2% (95% CI, 18.5-31.0). All-cause mortality was 33.1% (95% CI, 23.7-44.0), whereas GI bleeding-related mortality occurred in 5.9% (95% CI, 2.2%-14.8). CONCLUSIONS THAs are highly effective for achieving primary hemostasis in malignancy-related GI bleeding. It should be considered as an alternative to traditional endotherapy methods in malignancy-related GI bleeding. Future studies should be designed to evaluate its efficacy and safety as a primary method of hemostasis as compared with traditional endotherapy measures.
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Affiliation(s)
- Rahul Karna
- Department of Internal Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Smit Deliwala
- Department of Internal Medicine, Hurley Medical Center, Michigan State University, Flint, Michigan, USA
| | | | - Babu P Mohan
- Department of Gastroenterology & Hepatology, University of Utah Health School of Medicine, Salt Lake City, Utah, USA
| | - Lena Kassab
- Department of Internal Medicine, Mayo College of Medicine, Rochester, Minnesota, USA
| | - Aymeric Becq
- Endoscopy Unit, Sorbonne University, AP-HP, Saint-Antoine Hospital, Paris, France; Gastroenterology Department, UPEC University, AP-HP, Henri Mondor Hospital, Creteil, France
| | - Manish Dhawan
- Division of Gastroenterology and Hepatology, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Douglas G Adler
- Center for Advanced Therapeutic Endoscopy, Centura Health, Denver, Colorado, USA
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Kennington D, Ramai D, Adler DG. Patient-related adverse events and device failures associated with commercially available enteral or duodenal self-expanding metal stents: an analysis of the MAUDE database. Gastrointest Endosc 2023; 97:309-313. [PMID: 36220381 DOI: 10.1016/j.gie.2022.10.008] [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: 08/09/2022] [Revised: 09/24/2022] [Accepted: 10/04/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND AIMS Duodenal stents are widely used to treat patients with malignant gastric outlet obstruction (MGOO), most commonly from pancreatic cancer. The WallFlex (Boston Scientific, Natick, Mass, USA) and Evolution (Cook Endoscopy, Winston-Salem, NC, USA) duodenal stents are in widespread use for treating MGOO. The objective of this study was to analyze device failures and patient-related adverse events reported to the U.S. Food and Drug Administration (FDA) for these 2 stents. METHODS We analyzed postmarketing surveillance data on the WallFlex and Evolution duodenal stents from January 2000 to January 2022 through the FDA's Manufacturer and User Facility Device Experience (MAUDE) database (https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfmaude/search.cfm). RESULTS One hundred fifty-four MAUDE reports were identified and analyzed, from which 176 device failures and 186 patient-related adverse events were identified. Device-related failures for the WallFlex stent were delivery system failure (15.4%) and failure to activate the stent (13.2%). Device failures for the Evolution stent were failure to activate the stent (16.5%) and delivery system failure (15.3%). Patient-related adverse events for the WallFlex stent were perforation (18.9%), death (6.6%), and hemorrhage (3.8%), whereas patient-related adverse events for the Evolution duodenal stent were obstruction (16.3%), perforation (6.3%), aspiration (3.8%), and fragments of broken delivery system left in the patient (3.8%). CONCLUSIONS Both stents are associated with device failures such as failure to activate the stent, stent migration, and occlusion by tumor growth. Despite high success rates, duodenal stents can be associated with serious device failures and patient-related adverse events.
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Affiliation(s)
| | - Daryl Ramai
- Division of Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, Utah, USA
| | - Douglas G Adler
- Center for Advanced Therapeutic Endoscopy (CATE), Porter Adventist Hospital, Centura Health, Denver, Colorado, USA
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Chandan S, Desai A, Dahiya DS, Ramai D, Mohan BP, Facciorusso A, Adler DG, Kochhar GS. Risk of post sphincterotomy bleeding with antiplatelet and anticoagulant use - A propensity-matched analysis of United States Collaborative Network. Gastrointest Endosc 2023; 97:1129-1136.e3. [PMID: 36731579 DOI: 10.1016/j.gie.2023.01.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 12/28/2022] [Accepted: 01/23/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND Gastrointestinal (GI) bleeding following endoscopic retrograde cholangiopancreatography (ERCP) is a serious adverse event and most commonly occurs after endoscopic biliary and/or pancreatic sphincterotomy. While the strength of available evidence for post sphincterotomy GI bleeding risk is high for therapeutic warfarin and heparin, it remains unknown for clopidogrel and prasugrel. We conducted a retrospective United States (US)-based propensity-matched cohort study, to assess the risk of post sphincterotomy bleeding in patients on anticoagulant (AC) and antiplatelet (APT) therapy. METHODS We analyzed the US Collaborative Network in the TriNetX platform through December 27th, 2022, to include patients on APT and AC therapy who underwent ERCP within 7 days of hospitalization. One-to-one propensity-matching was performed. The primary outcome was the incidence of GI bleeding within 7 days of sphincterotomy. Secondary outcomes included need for blood transfusion, intensive care unit (ICU) care, and all-cause mortality within 30 days of bleeding. RESULTS Overall, 2,806 patients (1,806 in the AC and 1000 in APT cohorts) underwent ERCP with sphincterotomy. One-to-one (1:1) propensity score matching was performed for age, BMI >= 30, gender, race, ethnicity, diabetes mellitus, nicotine dependence, presence and severity of chronic kidney disease, cirrhosis, and thrombocytopenia between the cohorts. Patients in both AC and APT cohorts had an increased risk of post sphincterotomy bleeding compared to matched controls, adjusted odds ratio (aOR) 3.6 (95% Confidence Interval (CI) 2.58 - 5.06) and aOR 2.2 (95% CI 1.43 - 3.56), respectively. While heparin bridging therapy and concurrent use of aspirin did not further increase the risk of GI bleeding, resumption of AC within 24 hours post procedure did. Patients in neither cohort were at an increased risk for blood transfusion, ICU care or mortality. CONCLUSION Our database analysis shows that patients on AC and APT are indeed at a higher risk of post sphincterotomy bleeding, compared to matched controls. Appropriate drug cessation period or alternative biliary decompression modalities may be utilized in these patients.
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Affiliation(s)
- Saurabh Chandan
- Division of Gastroenterology and Hepatology, CHI Creighton University Medical Center, Omaha, Nebraska, USA.
| | - Aakash Desai
- Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Dushyant Singh Dahiya
- Department of Internal Medicine, Central Michigan University College of Medicine, Saginaw, Michigan, USA
| | - Daryl Ramai
- Department of Gastroenterology, University of Utah, Salt Lake City, Utah, USA
| | - Babu P Mohan
- Department of Gastroenterology, University of Utah, Salt Lake City, Utah, USA
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Surgical and Medical Sciences, University of Foggia, Foggia, Italy
| | - Douglas G Adler
- Center for Advanced Therapeutic Endoscopy (CATE), Centura Health, Porter Adventist Hospital, Denver, Colorado, USA
| | - Gursimran S Kochhar
- Division of Gastroenterology, Hepatology & Nutrition, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
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Kamal F, Khan MA, Lee-Smith W, Sharma S, Acharya A, Farooq U, Aziz M, Kouanda A, Dai SC, Munroe CA, Arain M, Adler DG. Efficacy and safety of EUS-guided gallbladder drainage for rescue treatment of malignant biliary obstruction: A systematic review and meta-analysis. Endosc Ultrasound 2023; 12:8-15. [PMID: 36861505 PMCID: PMC10134926 DOI: 10.4103/eus-d-21-00206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 04/24/2022] [Indexed: 03/03/2023] Open
Abstract
ERCP is the first line of treatment for malignant biliary obstruction and EUS-guided biliary drainage (EUS-BD) is usually used for patients who have failed ERCP. EUS-guided gallbladder drainage (EUS-GBD) has been suggested as a rescue treatment for patients who fail EUS-BD and ERCP. In this meta-analysis, we have evaluated the efficacy and safety of EUS-GBD as a rescue treatment of malignant biliary obstruction after failed ERCP and EUS-BD. We reviewed several databases from inception to August 27, 2021, to identify studies that evaluated the efficacy and/or safety of EUS-GBD as a rescue treatment in the management of malignant biliary obstruction after failed ERCP and EUS-BD. Our outcomes of interest were clinical success, adverse events, technical success, stent dysfunction requiring intervention, and difference in mean pre- and postprocedure bilirubin. We calculated pooled rates with 95% confidence intervals (CI) for categorical variables and standardized mean difference (SMD) with 95% CI for continuous variables. We analyzed data using a random-effects model. We included five studies with 104 patients. Pooled rates (95% CI) of clinical success and adverse events were 85% (76%, 91%) and 13% (7%, 21%). Pooled rate (95% CI) for stent dysfunction requiring intervention was 9% (4%, 21%). The postprocedure mean bilirubin was significantly lower compared to preprocedure bilirubin, SMD (95% CI): -1.12 (-1.62--0.61). EUS-GBD is a safe and effective option to achieve biliary drainage after unsuccessful ERCP and EUS-BD in patients with malignant biliary obstruction.
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Affiliation(s)
- Faisal Kamal
- Division of Gastroenterology, University of California San Francisco, San Francisco, CA, USA
| | - Muhammad Ali Khan
- Department of Gastroenterology, Hepatology and Nutrition, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Wade Lee-Smith
- Mulford Health Science Library, University of Toledo, Toledo, OH, USA
| | - Sachit Sharma
- Department of Medicine, University of Toledo, Toledo, OH, USA
| | - Ashu Acharya
- Department of Medicine, University of Toledo, Toledo, OH, USA
| | - Umer Farooq
- Department of Medicine, Loyola Medicine MacNeal Hospital, Berwyn, IL, USA
| | - Muhammad Aziz
- Division of Gastroenterology, University of Toledo, Toledo, OH, USA
| | - Abdul Kouanda
- Division of Gastroenterology, University of California San Francisco, San Francisco, CA, USA
| | - Sun-Chuan Dai
- Division of Gastroenterology, University of California San Francisco, San Francisco, CA, USA
| | - Craig A. Munroe
- Division of Gastroenterology, University of California San Francisco, San Francisco, CA, USA
| | - Mustafa Arain
- Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, FL, USA
| | - Douglas G. Adler
- Center for Advanced Therapeutic Endoscopy, Porter Adventist Hospital, Denver, CO, USA
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Mohan BP, Madhu D, Reddy N, Chara BS, Khan SR, Garg G, Kassab LL, Muthusamy AK, Singh A, Chandan S, Facciorusso A, Mangiavillano B, Repici A, Adler DG. Diagnostic accuracy of EUS-guided fine-needle biopsy sampling by macroscopic on-site evaluation: a systematic review and meta-analysis. Gastrointest Endosc 2022; 96:909-917.e11. [PMID: 35932815 DOI: 10.1016/j.gie.2022.07.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 06/22/2022] [Revised: 07/14/2022] [Accepted: 07/22/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Assessment of EUS-guided fine-needle tissue acquisition by macroscopic on-site evaluation (MOSE) is gathering attention. Studies report good diagnostic parameters with MOSE; however, the overall data are limited. We conducted this systematic review and meta-analysis to report on the pooled diagnostic assessment parameters of EUS-guided tissue acquisition by MOSE using fine-needle biopsy sampling (FNB). METHODS Multiple databases were searched (from inception to December 2021), and studies that reported on the diagnostic assessment of EUS-guided tissue acquisition by MOSE were selected. Pooled diagnostic accuracy, sensitivity, specificity, and positive and negative predictive values were calculated by standard meta-analysis methods following the random-effects model. Heterogeneity was assessed by I2 statistics. RESULTS Fourteen studies were included in the analysis, and 1508 lesions were biopsy sampled in 1489 patients undergoing EUS-guided tissue acquisition. MOSE definition included a visible core of tissue with opacity and "wormlike" features of adequate size and length (≥4 mm). The pooled accuracy of FNA and/or FNB specimens in yielding a pathologic diagnosis by MOSE was 91.3% (95% confidence interval [CI], 88.6-93.3; I2 = 66%), pooled sensitivity was 91.5% (95% CI, 88.6-93.6; I2 = 66%), pooled specificity was 98.9% (95% CI, 96.6-99.7; I2 = 80%), pooled positive predictive value was 98.8% (95% CI, 97.4-99.5; I2 = 33%), and pooled negative predictive value was 55.5% (95% CI, 46.9-63.9; I2 = 95%). Subgroup analyses by newer-generation FNB needles demonstrated similar pooled rates, with minimal adverse events (2.5%; 95% CI, 1.5-3.9; I2 = 21%). CONCLUSIONS Excellent pooled diagnostic accuracy parameters were demonstrated in EUS-guided tissue acquisition by FNB using the MOSE method.
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Affiliation(s)
- Babu P Mohan
- Department of Gastroenterology & Hepatology, University of Utah Health, Salt Lake City, Utah, USA
| | - Deepak Madhu
- Department of Gastroenterology, Caritas Hospital, Kottayam, Kerala, India
| | - Nitin Reddy
- Department of Internal Medicine, PSG Institute of Medical Science, Coimbatore, Tamil Nadu, India
| | - Beatriz Sordi Chara
- Department of Medicine, University of Joinville, Joinville, Santa Catarina, Brazil
| | - Shahab R Khan
- Department of Internal Medicine, Brigham's & Children Hospital, Harvard University, Boston, Massachusetts, USA
| | - Gauri Garg
- Department of Gastroenterology & Hepatology, University of Utah Health, Salt Lake City, Utah, USA
| | - Lena L Kassab
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Arun Kumar Muthusamy
- Department of Gastroenterology, Cedar Valley Medical Specialists, Waterloo, Iowa, USA
| | - Achintya Singh
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Saurabh Chandan
- Gastroenterology & Hepatology, CHI Creighton University Medical Center, Omaha, Nebraska, USA
| | | | - Benedetto Mangiavillano
- Department of Gastroenterology, Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Castellanza, Humanitas University, Italy
| | - Alessandro Repici
- Digestive Endoscopy Unit, Humanitas Clinical and Research Center, Milan, Italy
| | - Douglas G Adler
- Department of Gastroenterology, Center for Advanced Therapeutic Endoscopy, Denver, Colorado, USA
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Ramai D, Adler DG. EUS-FNA for solid lesions: An idea whose time has passed? Endosc Ultrasound 2022; 11:429-431. [PMID: 36537382 PMCID: PMC9921979 DOI: 10.4103/eus-d-22-00121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Affiliation(s)
- Daryl Ramai
- Department of Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, UT, USA
| | - Douglas G Adler
- Center for Advanced Therapeutic Endoscopy, Porter Adventist Hospital/PEAK Gastroenterology, Denver, Colorado, USA,Address for correspondence Dr. Douglas G Adler, Center for Advanced Therapeutic Endoscopy, Porter Adventist Hospital, Centura Health Denver, Colorado, USA. E-mail:
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Chandan S, Bapaye J, Khan SR, Deliwala S, Mohan BP, Ramai D, Dhindsa BS, Goyal H, Kassab LL, Aziz M, Kamal F, Facciorusso A, Adler DG. Safety and efficacy of liquid nitrogen spray cryotherapy in Barrett's neoplasia - a comprehensive review and meta-analysis. Endosc Int Open 2022; 10:E1462-E1473. [PMID: 36397870 PMCID: PMC9666080 DOI: 10.1055/a-1906-4967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 07/20/2022] [Indexed: 10/17/2022] Open
Abstract
Background and study aims Barrett's esophagus (BE) is a precursor condition to esophageal adenocarcinoma (EAC), resulting in transformation of the squamous epithelium of distal esophagus to columnar-lined epithelium with intestinal metaplasia (IM). Liquid nitrogen spray cryotherapy (LNSC) is a non-contact method of BE eradication and has been used both as primary and salvage therapy. We conducted a systematic review and meta-analysis to assess the safety and efficacy of LNSC. Methods We searched multiple databases from inception through December 2021 to identify studies on use of LNSC for Barrett's neoplasia. Pooled estimates were calculated using random-effects model and results were expressed in terms of pooled proportions with relevant 95 % confidence intervals (CIs) of complete eradication (CE) of dysplasia(D), high grade dysplasia (HGD) and IM. Results Fourteen studies with 707 patients were included in our final analysis. Overall pooled rates of CE-D, CE-HGD and CE-IM were 80.8 % (CI 77.4-83.8; I 2 62), 90.3 % (CI 85.2-93.7; I 2 33) and 55.8 % (CI 51.7-59.8; I 2 73) with follow up ranging from 4.25 months to 69.7 months. In patients with follow up beyond 24 months, the rates of CE-D and CE-IM were 83.6 % (CI 77.6-88.2; I 2 60) and 54.7 % (CI 47.6-61.6; I 2 81). Among LNSC naïve patients with prior history of endoscopic resection, the rates were 79.9 % (CI 73.3-85.2; I 2 50) and 67.1 % (CI 59.5-73.8; I 2 0). Pooled rate of therapeutic failures, defined as lack of response to LNSC therapy, was 23.6 % (CI 19.4-28.3; I 2 73). Post LNSC strictures and perforation pooled rates were 4 % and 0.8 %, respectively, which are similar to those previously reported for RFA. Conclusions Our analysis suggests that liquid nitrogen spray cryotherapy is an acceptable treatment for BE in both ablation naïve and experienced patients.
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Affiliation(s)
- Saurabh Chandan
- Division of Gastroenterology & Hepatology, CHI Creighton University Medical Center, Omaha, Nebraska, United States
| | - Jay Bapaye
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York, New York, United States
| | - Shahab R. Khan
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Smit Deliwala
- Internal Medicine, Hurley Medical Center, Flint, Michigan, United States
| | - Babu P. Mohan
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, United States
| | - Daryl Ramai
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, United States
| | - Banreet S. Dhindsa
- Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, United States
| | - Hemant Goyal
- Department of Gastroenterology, The Wright Center for Graduate Medical Education, Scranton, Pennsylvania, Unites States
| | - Lena L. Kassab
- Internal Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Muhammad Aziz
- Division of Gastroenterology and Hepatology, University of Toledo, Toledo, Ohio, United States
| | - Faisal Kamal
- Division of Gastroenterology, University of California-San Francisco, California, United States
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Surgical and Medical Sciences, University of Foggia, Foggia, Italy
| | - Douglas G. Adler
- Center for Advanced Therapeutic Endoscopy (CATE), Centura Health, Porter Adventist Hospital, Denver, Colorado, United States
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Kucharski K, Adler DG. Comparison of technical failures and patient-related adverse events associated with 3 widely used mechanical lithotripters for ERCP: insights from the U.S. Food and Drug Administration Manufacturer and User Facility Device Experience database. Gastrointest Endosc 2022; 96:796-800. [PMID: 35718067 DOI: 10.1016/j.gie.2022.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/03/2022] [Accepted: 06/08/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Mechanical lithotripsy is a commonly used, effective method for fragmenting large biliary or pancreatic duct stones. Real-world data on the most commonly reported adverse events and modes of failure associated with mechanical lithotripters are limited. We analyzed the postmarketing surveillance data from the U.S. Food and Drug Administration's Manufacturer and User Facility Device Experience (MAUDE) database for 3 commercially available mechanical lithotripters for use during ERCP. METHODS A search of the MAUDE database from January 2010 to October 2021 was conducted for the following mechanical lithotripters: Trapezoid RX (Boston Scientific, Natick, Mass, USA), LithoCrush (Olympus Endoscopy, Center Valley, Pa, USA), and the Fusion Lithotripsy Extraction Basket (Cook Endoscopy, Winston Salem, NC, USA). Results were compiled and reviewed. RESULTS In total, 1128 medical device reports with 2129 device malfunctions and 205 patient adverse events were identified. Most device malfunctions were because of guidewire port or sheath failure (n = 379, 17.8%), basket entrapment (n = 357, 16.8%), and basket tip separation failure (n = 315, 14.8%). The most commonly reported adverse events to patients were an additional procedure to remove an entrapped basket (170/205, 82.9%), bleeding (15/205, 7.3%), and bowel perforation (5/205, 2.4%). CONCLUSIONS Findings from the MAUDE database highlight device- and patient-related adverse outcomes that should be recognized to improve clinical success and reduce patient risk.
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Affiliation(s)
- Kim Kucharski
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Douglas G Adler
- Center for Advanced Therapeutic Endoscopy, Centura Health, Denver, Colorado, USA
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Chandan S, Deliwala S, Khan SR, Ramai D, Mohan BP, Bilal M, Facciorusso A, Kassab LL, Kamal F, Dhindsa B, Perisetti A, Adler DG. Advanced Endoscopic Resection Techniques in Cirrhosis-A Systematic Review and Meta-Analysis of Outcomes. Dig Dis Sci 2022; 67:4813-4826. [PMID: 34993682 DOI: 10.1007/s10620-021-07364-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 12/08/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND/AIMS While safety and effectiveness of advanced endoscopic resection techniques such as endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) has been well established in general population, data regarding their utility in patients with cirrhosis is limited. METHODS We searched multiple databases from inception through July 2021 to identify studies that reported on outcomes of EMR and/or ESD in patients with cirrhosis. Meta-analysis was performed to determine pooled rates of immediate and delayed bleeding, perforation, death as well as rates of successful en bloc and R0 resection. Pooled relative risk (RR) was calculated for each outcome between patients with and without cirrhosis. RESULTS Ten studies with a total of 3244 patients were included in the final analysis. Pooled rates of immediate & delayed bleeding, perforation, and death during EMR and/or ESD in patients with cirrhosis were 9.5% (CI 4.0-21.1), 6.6% (CI 4.2-10.3), 2.1% (CI 1.1-3.9) and 0.6% (CI 0.2-1.7), respectively. Pooled rates of successful en bloc and R0 resection were 93% (CI 85.9-96.7) and 90.8% (CI 86.5-93.8), respectively. While incidence of immediate bleeding was higher in patients with cirrhosis, there was no statistically significant difference in any of the other outcomes between the patient groups. CONCLUSIONS Our study shows that performing EMR and ESD for gastrointestinal lesions in patients with cirrhosis is both safe and effective. The risks of procedural complications parallel those reported in general population.
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Affiliation(s)
- Saurabh Chandan
- Division of Gastroenterology and Hepatology, CHI Creighton University Medical Center, Omaha, NE, USA
| | - Smit Deliwala
- Internal Medicine, Hurley Medical Center, Flint, MI, USA
| | - Shahab R Khan
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Daryl Ramai
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Babu P Mohan
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Mohammad Bilal
- Division of Gastroenterology, University of Minnesota & Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Surgical and Medical Sciences, University of Foggia, Foggia, Italy
| | | | - Faisal Kamal
- Division of Gastroenterology, University of California-San Francisco, San Francisco, CA, USA
| | - Banreet Dhindsa
- Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Douglas G Adler
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, USA.
- Center for Advanced Therapeutic Endoscopy (CATE), Centura Health, Porter Adventist Hospital, Denver, CO, USA.
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Adler DG. Top tips for endoscopic drainage and debridement of walled-off pancreatic necrosis (with videos). Gastrointest Endosc 2022; 96:675-677. [PMID: 35961840 DOI: 10.1016/j.gie.2022.06.022] [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: 06/03/2022] [Accepted: 06/08/2022] [Indexed: 02/08/2023]
Affiliation(s)
- Douglas G Adler
- Director, Center for Advanced Therapeutic Endoscopy (CATE), Porter Adventist Hospital, PEAK Gastroenterology, Centura Health, Denver, Colorado, USA
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