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Lin N, Lin Y, Xu J, Liu D, Li D, Meng H, Gallant MA, Kubota N, Roy D, Li JS, Gorospe EC, Sherman M, Gish RG, Abou-Alfa GK, Nguyen MH, Taggart DJ, Van Etten RA, Hoshida Y, Li W. A multi-analyte cell-free DNA-based blood test for early detection of hepatocellular carcinoma. Hepatol Commun 2022; 6:1753-1763. [PMID: 35244350 PMCID: PMC9234637 DOI: 10.1002/hep4.1918] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [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: 11/07/2021] [Revised: 01/23/2022] [Accepted: 01/25/2022] [Indexed: 12/25/2022] Open
Abstract
The limited performance of guideline-recommended abdominal ultrasound and serum alpha-fetoprotein (AFP) highlights the urgent, unmet need for new biomarkers for more accurate detection of early hepatocellular carcinoma (HCC). To this end, we have conducted a prospective clinical validation study to evaluate the performance of the HelioLiver Test, a multi-analyte blood test combining cell-free DNA methylation patterns, clinical variables, and protein tumor markers. A blinded, multicenter validation study was performed with 247 subjects, including 122 subjects with HCC and 125 control subjects with chronic liver disease. The performance of the HelioLiver Test was compared with AFP and the GALAD score as established HCC surveillance blood tests. The performance of the HelioLiver Test (area under the receiver operating characteristic curve [AUROC] = 0.944) was superior to both AFP (AUROC = 0.851; p < 0.0001) and GALAD (AUROC = 0.899; p < 0.0001). Using a prespecified diagnostic algorithm, the HelioLiver Test showed sensitivities of 85% (95% confidence interval [CI], 78%-90%) for HCC of any stage and 76% (95% CI, 60%-87%) for early stage (American Joint Committee on Cancer [AJCC] I and II) HCC. In contrast, AFP (≥20 ng/mL) alone and the GALAD score (≥-0.63) showed lower sensitivities of 62% (95% CI, 54%-70%) and 75% (95% CI, 67%-82%) for HCC overall, and 57% (95% CI, 40%-71%) and 65% (95% CI, 49%-79%) for early stage (AJCC I and II) HCC, respectively. The specificities of the HelioLiver Test (91%; 95% CI, 85%-95%), AFP (97%; 95% CI, 92%-99%), and the GALAD score (94%; 95% CI, 88%-97%) were similar for control subjects. The HelioLiver Test showed superior performance for HCC detection compared to with both AFP and the GALAD score and warrants further evaluation in HCC surveillance settings.
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Affiliation(s)
- Nan Lin
- The Third Affiliated Hospital of Sun Yat-sen UniversityGuangzhouChina
| | - Yongping Lin
- The First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
| | | | - Dan Liu
- Laboratory for Advanced Medicine, Inc.BeijingChina
| | - Diange Li
- Guangzhou Youze Biological Pharmaceutical Technology Company LtdGuangzhouGuangdong ProvinceChina
| | - Hongyu Meng
- The Third Affiliated Hospital of Sun Yat-sen UniversityGuangzhouChina
| | | | - Naoto Kubota
- Department of Internal MedicineSimmons Comprehensive Cancer CenterUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | | | - Jason S Li
- Division of Computational BiomedicineDepartment of Biological ChemistrySchool of MedicineUniversity of CaliforniaIrvineCaliforniaUSA
| | | | | | | | | | - Mindie H Nguyen
- Division of Gastroenterology and Hepatology and Department of Epidemiology and Population HealthStanford University Medical CenterStanfordCaliforniaUSA
| | | | - Richard A Van Etten
- Department of MedicineChao Family Comprehensive Cancer CenterUniversity of CaliforniaIrvineCaliforniaUSA
| | - Yujin Hoshida
- Department of Internal MedicineSimmons Comprehensive Cancer CenterUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Wei Li
- Division of Computational BiomedicineDepartment of Biological ChemistrySchool of MedicineUniversity of CaliforniaIrvineCaliforniaUSA
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Affiliation(s)
- Emmanuel C. Gorospe
- PALCARE Program, Manila, Philippines, and School of Public Health, University of Nevada, Las Vegas, Nevada, USA
| | - Agnes B. Bausa
- PALCARE, and Department of Family & Community Medicine, University of the Philippines, Manila, Philippines
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3
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Crews NR, Gorospe EC, Johnson ML, Wong Kee Song LM, Katzka DA, Iyer PG. Comparative quality assessment of esophageal examination with transnasal and sedated endoscopy. Endosc Int Open 2017; 5:E340-E344. [PMID: 28484734 PMCID: PMC5419847 DOI: 10.1055/s-0042-122008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background Unsedated transnasal esophagoscopy (TNE) may offer a less expensive, mobile alternative to sedated esophagogastroduodenoscopy (EGD) for evaluations of reflux related complications. Comparisons of imaging quality by these methods are lacking. Methods Two reviewers evaluated videos of TNE and EGD procedures, performed during a community randomized study comparing endoscopic techniques. Subjects were randomized to EGD, TNE in endoscopy suite, or TNE in mobile research unit. Endoscopic quality was assessed using a validated scoring tool. Results In total, 115 videos (58 EGD, 28 endoscopy suite TNE, and 29 mobile TNE) were reviewed. Overall quality scores for TNE and EGD were excellent without a statistically significant difference (P = 0.30). There were no differences in gastroesophageal junction (GEJ) visualization scores, though EGD scored higher in esophageal passage (P < 0.05) and TNE scored higher in esophageal intubation (P < 0.05). There was no significant difference in any quality score between mobile TNE and gastrointestinal suite TNE. Conclusion Esophageal assessment with TNE or EGD was comparable in overall quality and GEJ visualization. TNE quality was not affected by procedure location. TNE is a feasible option for endoscopic assessment of reflux complications.
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Affiliation(s)
| | - Emmanuel C. Gorospe
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Michele L. Johnson
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | | | - David A. Katzka
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Prasad G. Iyer
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA,Corresponding author Prasad G. Iyer, MD MS Barrett’s Esophagus UnitDivision of Gastroenterology & HepatologyMayo Clinic200 1st St SWRochesterMNUSA+1-507-255-7652
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Goldberg D, Ditah IC, Saeian K, Lalehzari M, Aronsohn A, Gorospe EC, Charlton M. Changes in the Prevalence of Hepatitis C Virus Infection, Nonalcoholic Steatohepatitis, and Alcoholic Liver Disease Among Patients With Cirrhosis or Liver Failure on the Waitlist for Liver Transplantation. Gastroenterology 2017; 152:1090-1099.e1. [PMID: 28088461 PMCID: PMC5367965 DOI: 10.1053/j.gastro.2017.01.003] [Citation(s) in RCA: 430] [Impact Index Per Article: 61.4] [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: 10/10/2016] [Revised: 12/30/2016] [Accepted: 01/04/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Concurrent to development of more effective drugs for treatment of hepatitis C virus (HCV) infection, there has been an increase in the incidence of nonalcoholic fatty liver disease. Data indicate that liver transplantation prolongs survival times of patient with acute hepatitis associated with alcoholic liver disease (ALD). We compared data on disease prevalence in the population with data from liver transplantation waitlists to evaluate changes in the burden of liver disease in the United States. METHODS We collected data on the prevalence of HCV from the 2010 and 2013-2014 cycles of the National Health and Nutrition Examination Survey. We also collected data from the HealthCore Integrated Research Database on patients with cirrhosis and chronic liver failure (CLF) from 2006 through 2014, and data on patients who received transplants from the United Network for Organ Sharing from 2003 through 2015. We determined percentages of new waitlist members and transplant recipients with HCV infection, stratified by indication for transplantation, modeling each calendar year as a continuous variable using the Spearman rank correlation, nonparametric test of trends, and linear regression models. RESULTS In an analysis of data from the National Health and Nutrition Examination Survey (2013-2014), we found that the proportion of patients with a positive HCV antibody who had a positive HCV RNA was 0.5 (95% confidence interval, 0.42-0.55); this value was significantly lower than in 2010 (0.64; 95% confidence interval, 0.59-0.73) (P = .03). Data from the HealthCore database revealed significant changes (P < .05 for all) over time in percentages of patients with compensated cirrhosis (decreases in percentages of patients with cirrhosis from HCV or ALD, but increase in percentages of patients with cirrhosis from nonalcoholic steatohepatitis [NASH]), CLF (decreases in percentages of patients with CLF from HCV or ALD, with an almost 3-fold increase in percentage of patients with CLF from NASH), and hepatocellular carcinoma (HCC) (decreases in percentages of patients with HCC from HCV or ALD and a small increase in HCC among persons with NASH). Data from the United Network for Organ Sharing revealed that among patients new to the liver transplant waitlist, or undergoing liver transplantation, for CLF, there was a significant decrease in the percentage with HCV infection and increases in percentages of patients with nonalcoholic fatty liver disease or ALD. Among patients new to the liver transplant waitlist or undergoing liver transplantation for HCC, proportions of those with HCV infection, nonalcoholic fatty liver disease, or ALD did not change between 2003 and 2015. CONCLUSIONS In an analysis of 3 different databases (National Health and Nutrition Examination Survey, HealthCore, and United Network for Organ Sharing), we found the proportion of patients on the liver transplant waitlist or undergoing liver transplantation for chronic HCV infection to be decreasing and fewer patients to have cirrhosis or CLF. However, the percentages of patients on the waitlist or receiving liver transplants for NASH or ALD are increasing, despite different relative burdens of disease among the entire population of patients with cirrhosis.
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Affiliation(s)
- David Goldberg
- Division of Gastroenterology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania Philadelphia, Pennsylvania.
| | - Ivo C. Ditah
- Division of Gastroenterology and Hepatology, Regions Hospital, St Paul, Minnesota
| | - Kia Saeian
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin
| | - Mona Lalehzari
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin
| | - Andrew Aronsohn
- Division of Gastroenterology and Hepatology, University of Chicago Medical Center, Center for Liver Diseases
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Al-Bawardy B, Gorospe EC, Alexander JA, Bruining DH, Coelho-Prabhu N, Rajan E, Wong Kee Song LM. Outcomes of double-balloon enteroscopy-assisted direct percutaneous endoscopic jejunostomy tube placement. Endoscopy 2016; 48:552-6. [PMID: 26964079 DOI: 10.1055/s-0042-101853] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND STUDY AIMS In a large series, conventional direct percutaneous endoscopic jejunostomy (DPEJ) tube placement with push endoscopes failed in approximately one-third of patients. In a pilot study, double-balloon enteroscopy (DBE)-assisted DPEJ tube placement was successful in all patients in whom attempted conventional DPEJ had failed. The study aim was to assess the technical success of and adverse events related to DBE-DPEJ tube placement in a large cohort of patients. PATIENTS AND METHODS The medical records of all patients who underwent DBE-DPEJ tube placement between July 2010 and November 2013 were reviewed using a prospectively maintained electronic database. Data were abstracted for patient demographics, indications for DPEJ, gut anatomy, technical success rate, causes of failure, and adverse events. RESULTS The study comprised a total of 94 patients (39 men; mean age 56 years; body mass index [BMI] 23 ± 6.4 kg/m(2)). The most common indication for DPEJ was gastroparesis (n = 29). Altered gut anatomy was present in 36 patients (38 %). DBE-DPEJ tube placement was technically successful in 87 patients (93 %). The mean procedure duration was 33 minutes (range 15 - 88). DBE-DPEJ tube placement failed in seven patients (7 %), primarily because of limited instrument advancement in the setting of presumed surgical adhesions. Post-procedural adverse events occurred in eight patients (9 %), with one serious adverse event, which was a gastric interposition requiring surgical repair. CONCLUSIONS Compared with the published outcomes of DPEJ by conventional endoscopy, DBE-DPEJ tube placement was technically successful in a high proportion of patients (93 %) and with a relatively low rate of significant adverse events.
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Affiliation(s)
- Badr Al-Bawardy
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Emmanuel C Gorospe
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeffrey A Alexander
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - David H Bruining
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Elizabeth Rajan
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
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6
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Leggett CL, Gorospe EC, Chan DK, Muppa P, Owens V, Smyrk TC, Anderson M, Lutzke LS, Tearney G, Wang KK. Comparative diagnostic performance of volumetric laser endomicroscopy and confocal laser endomicroscopy in the detection of dysplasia associated with Barrett's esophagus. Gastrointest Endosc 2016; 83:880-888.e2. [PMID: 26344884 PMCID: PMC5554864 DOI: 10.1016/j.gie.2015.08.050] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 08/06/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Probe-based confocal laser endomicroscopy (pCLE) and volumetric laser endomicroscopy (VLE) (also known as frequency domain optical coherence tomography) are advanced endoscopic imaging modalities that may be useful in the diagnosis of dysplasia associated with Barrett's esophagus (BE). We performed pCLE examination in ex-vivo EMR specimens and compared the diagnostic performance of using the current VLE scoring index (previously established as OCT-SI) and a novel VLE diagnostic algorithm (VLE-DA) for the detection of dysplasia. METHODS A total of 27 patients with BE enrolled in a surveillance program at a tertiary-care center underwent 50 clinically indicated EMRs that were imaged with VLE and pCLE and classified into neoplastic (N = 34; high-grade dysplasia, intramucosal adenocarcinoma) and nonneoplastic (N = 16; low-grade dysplasia, nondysplastic BE), based on histology. Image datasets (VLE, N = 50; pCLE, N = 50) were rated by 3 gastroenterologists trained in the established diagnostic criteria for each imaging modality as well as a new diagnostic algorithm for VLE derived from a training set that demonstrated association of specific VLE features with neoplasia. Sensitivity, specificity, and diagnostic accuracy were assessed for each imaging modality and diagnostic criteria. RESULTS The sensitivity, specificity, and diagnostic accuracy of pCLE for detection of BE dysplasia was 76% (95% confidence interval [CI], 59-88), 79% (95% CI, 53-92), and 77% (95% CI, 72-82), respectively. The optimal diagnostic performance of OCT-SI showed a sensitivity of 70% (95% CI, 52-84), specificity of 60% (95% CI, 36-79), and diagnostic accuracy of 67%; (95% CI, 58-78). The use of the novel VLE-DA showed a sensitivity of 86% (95% CI, 69-96), specificity of 88% (95% CI, 60-99), and diagnostic accuracy of 87% (95% CI, 86-88). The diagnostic accuracy of using the new VLE-DA criteria was significantly superior to the current OCT-SI (P < .01). CONCLUSION The use of a new VLE-DA showed enhanced diagnostic performance for detecting BE dysplasia ex vivo compared with the current OCT-SI. Further validation of this algorithm in vivo is warranted.
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Affiliation(s)
- Cadman L Leggett
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Emmanuel C Gorospe
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel K Chan
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Prasuna Muppa
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Victoria Owens
- Division of Gastroenterology and Liver Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Thomas C Smyrk
- Division of Gastroenterology and Liver Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Marlys Anderson
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Lori S Lutzke
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Guillermo Tearney
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kenneth K Wang
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
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7
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Gorospe EC, Wong Kee Song LM. Hybrid endoscopic submucosal dissection in the colon: Cutting corners or trimming fat? Gastrointest Endosc 2016; 83:593-5. [PMID: 26897050 DOI: 10.1016/j.gie.2015.08.059] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 08/26/2015] [Indexed: 02/06/2023]
Affiliation(s)
- Emmanuel C Gorospe
- Prevea Center for Digestive Health & Medical College of Wisconsin-Green Bay Campus, Green Bay, Wisconsin, USA
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8
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Timmer MR, Brankley SM, Gorospe EC, Sun G, Lutzke LS, Iyer PG, Halling KC, Krishnadath KK, Wang KK. Prediction of response to endoscopic therapy of Barrett's dysplasia by using genetic biomarkers. Gastrointest Endosc 2014; 80:984-91. [PMID: 25085335 PMCID: PMC4311726 DOI: 10.1016/j.gie.2014.06.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 06/04/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Endoscopic therapy for the treatment of high-grade dysplasia (HGD) and intramucosal cancer (IMC) in Barrett's esophagus (BE) may not always result in complete remission of dysplasia (CRD). OBJECTIVE To determine whether genetic alterations in the Barrett's mucosa can predict response to endoscopic therapy. DESIGN Retrospective cohort study. SETTING Tertiary-care institution. PATIENTS Selected patients who underwent endoscopic therapy for BE containing HGD/IMC between 2003 and 2010. INTERVENTIONS Endoscopic therapy combining mucosal resection and different ablation modalities was performed based on patient characteristics, endoscopic findings, and technique evolution. Fluorescence in situ hybridization was used to evaluate genetic alterations on baseline endoscopic cytology brushings by using probes directed to loci 8q24 (MYC), 9p21 (CDKN2A; alias P16), 17q12 (ERBB2; alias Her-2/neu), and 20q13.2 (ZNF217). MAIN OUTCOME MEASUREMENTS Genetic biomarkers predicting achievement of CRD after endoscopic therapy. RESULTS A total of 181 patients were included (145 men; 66 ± 10 years of age). There were 130 patients (72%) who responded to endoscopic therapy with CRD. Multiple gains detected by fluorescence in situ hybridization was found to be a negative predictor (hazard ratio 0.57; 95% confidence interval, 0.40-0.82) after adjusting for potential clinical confounders. Similar results were found when analyses were restricted to patients (n = 66) undergoing radiofrequency ablation (hazard ratio 0.58; 95% confidence interval, 0.31-1.09). LIMITATIONS Retrospective study, heterogeneity of treatment modalities. CONCLUSION Patients with multiple gains detected by brush cytology specimens may have a lower response rate to endoscopic therapy. The presence of multiple gains can be an adjunct to standard histology in prognosticating BE patients with HGD/IMC undergoing endoscopic therapy.
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Affiliation(s)
- Margriet R. Timmer
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, United States,Department of Gastroenterology and Hepatology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Shannon M. Brankley
- Department of Laboratory Medicine, Mayo Clinic, 200 First Street SW Rochester, Minnesota 55905, United States
| | - Emmanuel C. Gorospe
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, United States
| | - Gang Sun
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, United States
| | - Lori S. Lutzke
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, United States
| | - Prasad G. Iyer
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, United States
| | - Kevin C. Halling
- Department of Laboratory Medicine, Mayo Clinic, 200 First Street SW Rochester, Minnesota 55905, United States
| | - Kausilia K. Krishnadath
- Department of Gastroenterology and Hepatology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Kenneth K. Wang
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, United States
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Gorospe EC, Desai S, Al-Bawardy B, Baron TH, Wong Kee Song LM. Successful closure of a Billroth II duodenal stump leak with fistulization to the colon by use of stacked over-the-scope clips. Gastrointest Endosc 2014; 80:523-4. [PMID: 25028277 DOI: 10.1016/j.gie.2014.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 06/03/2014] [Indexed: 02/08/2023]
Affiliation(s)
- Emmanuel C Gorospe
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Shiv Desai
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Badr Al-Bawardy
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Todd H Baron
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
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Gorospe EC, Desai S, Al-Bawardy B, Baron TH, Buttar NS, Wong Kee Song LM. Over-the-scope clip closure of pancreaticocolonic fistula caused by severe necrotizing pancreatitis. Gastrointest Endosc 2014; 79:713. [PMID: 24332403 DOI: 10.1016/j.gie.2013.10.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 10/28/2013] [Indexed: 12/11/2022]
Affiliation(s)
- Emmanuel C Gorospe
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Shiv Desai
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Badr Al-Bawardy
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Todd H Baron
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Navtej S Buttar
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
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Leggett CL, Gorospe EC, Calvin AD, Harmsen WS, Zinsmeister AR, Caples S, Somers VK, Dunagan K, Lutzke L, Wang KK, Iyer PG. Obstructive sleep apnea is a risk factor for Barrett's esophagus. Clin Gastroenterol Hepatol 2014; 12:583-8.e1. [PMID: 24035775 PMCID: PMC3952037 DOI: 10.1016/j.cgh.2013.08.043] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 08/01/2013] [Accepted: 08/26/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Common risk factors for obstructive sleep apnea (OSA) and Barrett's esophagus (BE) include obesity and gastroesophageal reflux disease (GERD). The aims of this study were to assess the association between OSA and BE and to determine whether the association is independent of GERD and body mass index (BMI). METHODS Patients who had undergone a diagnostic polysomnogram and esophagogastroduodenoscopy were identified by using Mayo Clinic (Rochester, Minnesota) databases from January 2000-November 2011. They were randomly matched for age, sex, and BMI at time of polysomnogram into the following groups: BE but no OSA (n = 36), OSA but no BE (n = 78), both (n = 74), or neither (n = 74). Clinical and demographic variables were abstracted from medical records. The association between OSA and BE was assessed by using a multiple variable logistic model that incorporated age, sex, BMI, clinical diagnosis of GERD, and smoking history. RESULTS Subjects with OSA had an 80% increased risk for BE compared with subjects without OSA (odds ratio, 1.8; 95% confidence interval, 1.1-3.2; P = .03). These findings were independent of age, sex, BMI, GERD, and smoking history. Increasing severity of OSA, measured by using the apnea-hypopnea index, was associated with an increased risk of BE (odds ratio, 1.2 per 10-unit increase in apnea-hypopnea index; 95% confidence interval, 1.0-1.3; P = .03). CONCLUSIONS In this case-control study, OSA was associated with an increased risk of BE, potentially through BMI and GERD independent mechanisms. Patients with OSA may benefit from evaluation for BE.
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Affiliation(s)
- Cadman L. Leggett
- Division of Gastroenterology and Hepatology, Mayo Clinic Rochester MN
| | | | | | - William S. Harmsen
- Division of Biomedical Statistics and Informatics, Mayo Clinic Rochester MN
| | | | - Sean Caples
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic Rochester MN
| | | | | | - Lori Lutzke
- Division of Gastroenterology and Hepatology, Mayo Clinic Rochester MN
| | - Kenneth K. Wang
- Division of Gastroenterology and Hepatology, Mayo Clinic Rochester MN
| | - Prasad G. Iyer
- Division of Gastroenterology and Hepatology, Mayo Clinic Rochester MN
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Gorospe EC, Oxentenko AS. Anesthesia-Assisted sedation getting notice by Medicare. Mayo Clin Proc 2014; 89:425-6. [PMID: 24582201 DOI: 10.1016/j.mayocp.2013.12.011] [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: 12/02/2013] [Accepted: 12/20/2013] [Indexed: 11/22/2022]
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13
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Al-Bawardy B, Gorospe EC, Leggett C. Malignant mesothelioma presenting as dysphagia diagnosed by endoscopic ultrasound. Ann Gastroenterol 2014; 27:409. [PMID: 25331960 PMCID: PMC4188942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 04/29/2014] [Indexed: 11/27/2022] Open
Affiliation(s)
- Badr Al-Bawardy
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA,
Correspondence to: Badr Al-Bawardy, M.D, Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota, 55905 USA, Tel.: +507 284 9456, e-mail:
| | - Emmanuel C. Gorospe
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Cadman Leggett
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
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Desai SK, Al-Bawardy BF, Leggett C, Gorospe EC. Recurrent bilateral pleural effusions without ascites as an initial presentation of Budd-Chiari syndrome. Ann Gastroenterol 2014; 27:74. [PMID: 24714596 PMCID: PMC3959542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2013] [Accepted: 05/22/2013] [Indexed: 10/28/2022] Open
Affiliation(s)
- Shiv K. Desai
- Division of Gastroenterology and Hepatology, St. Mary’s Hospital, Rochester, Minnesota, USA
| | - Badr F. Al-Bawardy
- Division of Gastroenterology and Hepatology, St. Mary’s Hospital, Rochester, Minnesota, USA
| | - Cadman Leggett
- Division of Gastroenterology and Hepatology, St. Mary’s Hospital, Rochester, Minnesota, USA
| | - Emmanuel C. Gorospe
- Division of Gastroenterology and Hepatology, St. Mary’s Hospital, Rochester, Minnesota, USA,
Correspondence to: Emmanuel C. Gorospe, MD, MPH, CNSC, 1216 Second Street SW, St. Mary’s Hospital, Rochester, Minnesota, 55902 USA, Fax: +507 284 0538, e-mail:
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Leggett CL, Gorospe EC. Application of confocal laser endomicroscopy in the diagnosis and management of Barrett's esophagus. Ann Gastroenterol 2014; 27:193-199. [PMID: 24976007 PMCID: PMC4073013] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 04/21/2014] [Indexed: 11/30/2022] Open
Abstract
Confocal laser endomicroscopy is an advanced endoscopic imaging modality that can be used for the diagnosis of early mucosal dysplasia in various gastrointestinal conditions. It provides histology-like images at 1000-fold magnification. The technology offers potential advantages in the diagnosis of Barrett's esophagus and early esophageal cancer due to the low yield of the current practice of surveillance endoscopy with biopsies. Confocal laser endomicroscopy has the potential to eliminate the need for biopsy, establish diagnosis and facilitate application of endoscopic therapy during the time of actual endoscopy. There are several studies that have demonstrated reasonable diagnostic accuracy in patients undergoing surveillance for Barrett's esophagus from tertiary academic medical centers. However, the application of confocal laser endomicroscopy in routine clinical endoscopy is still in the process of refinement. Its role in the diagnosis and treatment of Barrett's-associated dysplasia will continue to evolve with improvement in technology, criteria for diagnosis and experience among endoscopists in interpreting confocal imaging.
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Affiliation(s)
- Cadman L. Leggett
- Barrett’s Esophagus Unit, Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA,
Correspondence to: Cadman L. Leggett, MD, Department of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota, 55905 USA, Fax: +507 538 5820, e-mail:
| | - Emmanuel C. Gorospe
- Barrett’s Esophagus Unit, Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
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Abstract
The current practice of open-access endoscopy allows primary care and other non-gastroenterology physicians to directly refer patients for routine gastrointestinal endoscopic procedures. Open-access endoscopy is considered to be more cost-effective and time efficient than the traditional practice of referring patients for preprocedural consultation with a gastrointestinal endoscopist. Several studies have evaluated the performance of endoscopic procedures in an open-access environment and the utility of structured referral mechanisms to ensure safe and appropriately indicated procedures. This review focuses on 4 common preprocedural issues in gastrointestinal endoscopy encountered by primary care physicians: management of anticoagulation and antiplatelet therapy, indication for prophylactic antibiotic drug therapy, need for anesthesia-assisted sedation, and management of poor bowel preparation. We summarize the current guidelines that address these 4 common preprocedural issues to facilitate safe and clinically appropriate procedures in open-access endoscopy.
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Affiliation(s)
- Emmanuel C Gorospe
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
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Gupta M, Iyer PG, Lutzke L, Gorospe EC, Abrams JA, Falk GW, Ginsberg GG, Rustgi AK, Lightdale CJ, Wang TC, Fudman DI, Poneros JM, Wang KK. Recurrence of esophageal intestinal metaplasia after endoscopic mucosal resection and radiofrequency ablation of Barrett's esophagus: results from a US Multicenter Consortium. Gastroenterology 2013; 145:79-86.e1. [PMID: 23499759 PMCID: PMC3696438 DOI: 10.1053/j.gastro.2013.03.008] [Citation(s) in RCA: 183] [Impact Index Per Article: 16.6] [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: 10/09/2012] [Revised: 02/16/2013] [Accepted: 03/09/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Radiofrequency ablation (RFA) is an established treatment for dysplastic Barrett's esophagus (BE). Although short-term end points of ablation have been ascertained, there have been concerns about recurrence of intestinal metaplasia (IM) after ablation. We aimed to estimate the incidence and identify factors that predicted the recurrence of IM after successful RFA. METHODS We analyzed data from 592 patients with BE treated with RFA from 2003 through 2011 at 3 tertiary referral centers. Complete remission of intestinal metaplasia (CRIM) was defined as eradication of IM (in esophageal and gastroesophageal junction biopsy specimens), documented by 2 consecutive endoscopies. Recurrence was defined as the presence of IM or dysplasia after CRIM in surveillance biopsies. Two experienced gastrointestinal pathologists confirmed pathology findings. RESULTS Based on histology analysis, before RFA, 71% of patients had high-grade dysplasia or esophageal adenocarcinoma, 15% had low-grade dysplasia, and 14% had nondysplastic BE. Of patients treated, 448 (76%) were assessed after RFA. Fifty-five percent of patients underwent endoscopic mucosal resection before RFA. The median time to CRIM was 22 months, with 56% of patients in CRIM by 24 months. Increasing age and length of BE segment were associated with longer times to CRIM. Twenty-four months after CRIM, the incidence of recurrence was 33%; 22% of all recurrences observed were dysplastic BE. There were no demographic or endoscopic factors associated with recurrence. Complications developed in 6.5% of subjects treated with RFA; strictures were the most common complication. CONCLUSIONS Of patients with BE treated by RFA, 56% were in complete remission after 24 months. However, 33% of these patients had disease recurrence within the next 2 years. Most recurrences were nondysplastic and endoscopically manageable, but continued surveillance after RFA is essential.
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Affiliation(s)
- Milli Gupta
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - Prasad G. Iyer
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - Lori Lutzke
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | | | - Julian A. Abrams
- Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, NY
| | - Gary W. Falk
- Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Gregory G. Ginsberg
- Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Anil K. Rustgi
- Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Charles J. Lightdale
- Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, NY
| | - Timothy C. Wang
- Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, NY
| | - David I. Fudman
- Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, NY
| | - John M. Poneros
- Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, NY
| | - Kenneth K. Wang
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
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Co ML, Gorospe EC. Pediatric case of mesalazine-induced interstitial nephritis with literature review. Pediatr Int 2013; 55:385-7. [PMID: 23782372 DOI: 10.1111/j.1442-200x.2012.03745.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [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: 12/13/2011] [Revised: 02/05/2012] [Accepted: 09/19/2012] [Indexed: 12/12/2022]
Abstract
We present the case of a 14-year-old boy with ulcerative colitis who was diagnosed with mesalazine-induced interstitial nephritis (M-IIN). Improvement in renal function occurred with discontinuation of mesalazine and corticosteroid therapy. We systematically searched the literature for pediatric cases of M-IIN. There were eight cases. Majority of the cases were boys (75%) with ulcerative colitis (75%). Average duration of mesalazine use prior to the diagnosis of interstitial nephritis was 24 ± 18 months. The median dose was 1.5 g/day. M-IIN appears to be an idiosyncratic reaction without any relation to dose or duration of mesalazine use. Although there are no guidelines to recommend routine surveillance of renal function, monitoring of serum creatinine in patients on mesalazine remains an inexpensive and non-invasive test that may lead to early detection and treatment of renal injury.
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Affiliation(s)
- Maridine L Co
- Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan, USA.
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19
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Sun G, Tian J, Gorospe EC, Johnson GB, Hunt CH, Lutzke LS, Leggett CL, Iyer PG, Wang KK. Utility of baseline positron emission tomography with computed tomography for predicting endoscopic resectability and survival outcomes in patients with early esophageal adenocarcinoma. J Gastroenterol Hepatol 2013; 28:975-81. [PMID: 23425230 DOI: 10.1111/jgh.12148] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/29/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIMS Positron emission tomography with computed tomography (PET/CT) has been used to detect metastasis in the diagnosis of esophageal adenocarcinoma (EAC). However, the utility of PET/CT to assess primary tumor for endoscopic resectability and prognosis in early EAC remains unclear. We conducted a retrospective study to determine the association of PET/CT findings with histopathological tumor invasion depth and survival outcomes. METHODS EAC patients who underwent PET/CT followed by endoscopic mucosal resection (EMR) were included. Pathology on EMR and survival outcomes from a prospectively maintained database was retrieved. Two radiologists independently reviewed the PET/CT using the following parameters: detection of malignancy, fluorodeoxyglucose (FDG) uptake intensity, FDG focality, FDG eccentricity, esophageal thickness, maximal standard uptake value (SUVmax), and SUVmax ratio (lesion/liver). RESULTS There were 72 eligible patients: 42 (58.3%) had T1a lesions, and 30 (41.7%) had ≥ T1b. Only SUVmax ratio was associated with tumor invasion depth (odds ratio=2.77, 95% confidence interval 1.26-7.73, P=0.0075). Using a cut-off of 1.48, the sensitivity and specificity of SUVmax ratio for identification of T1a lesions were 43.3% and 80.9%, respectively. Adjusting the SUVmax ratio to 2.14, 16.7% (5/30) of ≥ T1b patients were identified without any false-positive cases. Multivariate analysis showed SUVmax ratio, Charlson comorbidity index, and esophagectomy were independent predictors for survival. CONCLUSIONS SUVmax ratio (lesion/liver) is more accurate in predicting endoscopic resectability and mortality for EAC than other PET/CT parameters and appears promising as a useful adjunct to the current diagnostic work-up.
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Affiliation(s)
- Gang Sun
- Barrett's Esophagus Unit, Division of Gastroenterology and Hepatology, Mayo Clinic, USA
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20
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Abstract
Barrett's esophagus (BE) is the only established precursor lesion in the development of esophageal adenocarcinoma (EAC) and it increases the risk of cancer by 11-fold. It is regarded as a complication of gastroesophageal reflux disease. There is an ever-increasing body of knowledge on the pathogenesis, diagnosis, treatment, and surveillance of BE and its associated dysplasia. In this review, we summarize the latest advances in BE research and clinical practice in the past 2 years. It is critical to understand the molecular underpinnings of this disorder to comprehend the clinical outcomes of the disease. For clinical gastroenterologists, there is also continuous growth of endoscopic approaches which is daunting, and further improvements in the detection and treatment of BE and early EAC are anticipated. In the future, we may see the increased role of biomarkers, both molecular and imaging, in both diagnostic and therapeutic strategies for BE.
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Affiliation(s)
- Subhash Chandra
- Barrett's Esophagus Unit, Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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21
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Gorospe EC, Arora AS. New diagnostic and therapeutic frontiers in eosinophilic esophagitis. MINERVA GASTROENTERO 2013; 59:59-68. [PMID: 23478244] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Eosinophilic esophagitis (EoE) is a relatively new disease that is increasingly recognized as a chronic inflammatory condition with currently evolving diagnostic and therapeutic aspects. There is data to support the rising prevalence of EOE especially in western countries. EoE is an emerging cause of dysphagia and food bolus impaction in adults as well as abdominal pain, feeding disorders, and gastroesophageal reflux-like symptoms in younger patients. EoE is ever more recognized as a separate disease process that is more complicated than eosinophilic infiltration from gastroesophageal reflux disease. Food and environmental antigens both play significant roles in stimulating T-helper (Th-2) inflammatory response. Current therapeutic options include use of proton-pump inhibitors, immunosuppressive drugs, elimination diets, and esophageal dilatation. Simple elimination of food and environmental antigen exposure can be challenging in adults due to the difficulty in accurately identifying triggering antigens and adherence to restrictive diets from a wide range of putative food allergens. Novel therapeutic options are being presented as potential treatments that target chemokines and specific immunologic mechanisms for EoE. This review will aim to summarize the latest and evolving approaches to EoE diagnosis and management. In the future, biomarkers of inflammatory response may help diagnose, treat, and stratify individual patients for better treatment outcomes with this chronic disease.
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Affiliation(s)
- E C Gorospe
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
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22
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Abstract
Endoscopic therapy for Barrett's esophagus is feasible and likely to decrease the future risk of development of esophageal adenocarcinoma. The most commonly used therapy is radiofrequency ablation, which has been shown to produce reproducible superficial injury in the esophagus. Other thermal therapies include multipolar coagulation, argon plasma coagulation, and thermal laser therapy. The other end of the ablative spectrum includes cryotherapy, which involves freezing tissue to produce mucosal necrosis. Photodynamic therapy has been used to photochemically eliminate abnormal mucosa. Endoscopic therapy has been demonstrated to be effective in high-risk situations such as Barrett's esophagus with high-grade dysplasia.
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Affiliation(s)
- Cadman L Leggett
- Barrett's Esophagus Unit, Division of Gastroenterology & Hepatology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
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Gorospe EC, Alexander JA, Bruining DH, Rajan E, Wong Kee Song LM. Performance of double-balloon enteroscopy for the management of small bowel polyps in hamartomatous polyposis syndromes. J Gastroenterol Hepatol 2013. [PMID: 23190124 DOI: 10.1111/jgh.12058] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIM Hamartomatous polyposis syndromes (HPS) are a group of rare inherited autosomal dominant disorders. Small bowel polyposis is one of the manifestations of HPS. Double-balloon enteroscopy (DBE) with polypectomy may obviate repeated small bowel surgeries for polyp intussusception, obstruction, or bleeding. The efficacy and safety of DBE-assisted polypectomy in HPS patients with clinically significant small bowel polyposis were evaluated. METHODS All HPS patients who underwent DBE from January 2007 to April 2011 were identified using a prospectively maintained database. Data on patient demographics, pre-DBE radiological studies, polyp characteristics, procedural outcomes, and complications were abstracted. RESULTS Twenty-two patients underwent a total of 34 DBE procedures. Pre-DBE imaging included computed tomography enterography (n = 15), computed tomography enteroclysis (n = 5), small bowel follow-through (n = 1), and magnetic resonance enterography (n = 1). Any small bowel polyp ≥ 1 cm in size on radiological imaging was referred for DBE-assisted polypectomy. Antegrade and retrograde DBE were successful in reaching and resecting targeted polyps in 90% (18/20) and 71.4% (10/14) of procedures, respectively. The overall success rate for DBE-assisted polypectomy was 82.3% (95% confidence interval: 66.5-91.6%). The median size of resected polyps was 2 cm (range 1-5 cm) and all were hamartomas. Minor adverse events occurred in four (11.8%) procedures, including abdominal pain (n = 2), immediate post-polypectomy bleeding (n = 1), and self-limited hematochezia (n = 1). CONCLUSIONS DBE-assisted polypectomy was successful in over 80% of HPS patients with an acceptable margin of safety. To the knowledge of the authors, this is one of the largest single-center studies to report on the performance and safety of DBE-assisted polypectomy in HPS patients.
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Affiliation(s)
- Emmanuel C Gorospe
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota 55905, USA
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Lomeli LD, Gorospe EC. Successful treatment of portal hypertension from splenic arteriovenous fistula by coil embolization followed by splenectomy. Ann Gastroenterol 2013; 26:257. [PMID: 24714243 PMCID: PMC3959437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Accepted: 01/21/2013] [Indexed: 11/30/2022] Open
Affiliation(s)
- Luis D. Lomeli
- Division of Gastroenterology and Hepatology, St. Mary's Hospital, Rochester, Minnesota, USA
| | - Emmanuel C. Gorospe
- Division of Gastroenterology and Hepatology, St. Mary's Hospital, Rochester, Minnesota, USA,
Correspondence to: Emmanuel C. Gorospe, MD, MPH, CNSC, 1216 Second Street SW St. Mary's Hospital, Rochester, Minnesota, USA 55902, Tel.: +1 507 538 1231, Fax: +1 507 284 0538, e-mail:
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Sun G, Anderson MA, Gorospe EC, Leggett CL, Lutzke LS, Wong Kee Song LM, Levy M, Wang KK. Synergistic effects of photodynamic therapy with HPPH and gemcitabine in pancreatic cancer cell lines. Lasers Surg Med 2012; 44:755-761. [PMID: 23018618 DOI: 10.1002/lsm.v44.9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2012] [Indexed: 05/22/2023]
Abstract
BACKGROUND AND OBJECTIVE Photodynamic therapy (PDT) is a potential treatment for pancreatic cancer. A second-generation photosensitizer, 2-[1-hexyloxyethyl]-2-devinyl pyropheophorbide (HPPH) has a long wavelength absorption, high-tumor selectivity, and shorter duration of skin photosensitivity. We investigated the efficacy of PDT with HPPH and gemcitabine in inducing cell death in multiple pancreatic cancer cell lines. METHODS We used three pancreatic cancer cell lines (PANC-1, MIA PaCa-2, and BXPC-3) incubated with HPPH concentration of 0, 0.005, 0.01, 0.025, 0.05, 0.1, 0.25, and 0.5 µg/ml for 6 hours, followed by photoradiation at a light dose of 60 J/cm(2). Afterwards, each cell line was treated with gemcitabine at concentrations of 0, 1, 10, and 100 µM and incubated for another 96 hours. Cell death was detected with SYTOX green staining. We also assessed the difference in cytotoxicity in adding gemcitabine before and after PDT. RESULTS HPPH-PDT can effectively induce cell death in all cell lines in a dose-dependent manner, with a 100% of cell death at the 0.5 µg/ml HPPH concentration. In contrast, monotherapy with gemcitabine alone (100 µM) only achieved <45% cell death. Combining gemcitabine to HPPH-PDT resulted in synergistic cytotoxic effect with 20-50% more cell death across all cell lines. There was no difference in cytotoxicity in adding gemcitabine before or after PDT. CONCLUSION This is the first study on HPPH-PDT for pancreatic cancer. HPPH-PDT-induced cell death occurs in a dose-dependent manner. HPPH-PDT and gemcitabine have synergistic effects in inducing cell death in multiple pancreatic cancer cell lines.
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Affiliation(s)
- Gang Sun
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA
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26
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Gorospe EC, Leggett CL, Sun G, Anderson MA, Gupta M, Penfield JD, Lutzke L, Lewis JT, Wong Kee Song LM, Wang KK. Diagnostic performance of two confocal endomicroscopy systems in detecting Barrett's dysplasia: a pilot study using a novel bioprobe in ex vivo tissue. Gastrointest Endosc 2012; 76:933-8. [PMID: 22980290 DOI: 10.1016/j.gie.2012.07.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [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: 04/18/2012] [Accepted: 07/01/2012] [Indexed: 02/08/2023]
Abstract
BACKGROUND There are currently 2 existing confocal laser endomicroscopy (CLE) platforms: probe-based CLE (pCLE) and endoscope-based CLE (eCLE) systems, each with its own criteria for identifying dysplasia in Barrett's esophagus (BE). The diagnostic performance of these 2 systems has not been directly compared. DESIGN Preclinical, feasibility study. OBJECTIVES We compared the interrater agreement and diagnostic performance of the pCLE and eCLE systems. In addition, we evaluated a new BE endomicroscopy criteria based on fluorescent glucose intensity uptake. PATIENTS Thirteen patients with Barrett's esophagus and high-grade dysplasia or early cancer undergoing 16 EMR. INTERVENTION CLE imaging was performed using two different probes with 2-[N-(7-nitrobenz-2-oxa-1,3-diaxol-4-yl)amino]-2-deoxyglucose, a fluorescent glucose analog with preferential uptake in dysplastic mucosa to supply contrast. Four quadrants were imaged per specimen with a total of 64 imaged mucosal sites presented to three gastroenterologists. MAIN OUTCOME MEASUREMENTS Interobserver agreement and accuracy for dysplasia was assessed of images classified according to Miami criteria, stacked eCLE images classified using the Mainz criteria and a novel fluorescence intensity criteria. RESULTS The interrater agreements were 0.17, 0.68, and 0.87 for the Miami, Mainz, and the fluorescence intensity criteria, respectively. Overall accuracy in detecting dysplasia was 37% (95% CI, 30.3-43.9), 44.3% (95% CI, 37.3-50.9), and 78.6% (95% CI, 72.2-83.3) for the Miami, Mainz, and the fluorescence intensity criteria, respectively. LIMITATIONS This imaging technique and proposed fluorescence intensity criteria using 2-[N-(7-nitrobenz-2-oxa-1,3-diaxol-4-yl)amino]-2-deoxyglucose in EMR tissue will require in vivo validation and cannot be directly used with the current eCLE and pCLE clinical applications. CONCLUSIONS In this preclinical feasibility study, the use of an eCLE system with a topical fluorescent contrast in ex vivo EMR tissue demonstrated higher interrater agreement and accuracy.
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Gorospe EC, Oxentenko AS. Nutritional consequences of chronic diarrhoea. Best Pract Res Clin Gastroenterol 2012; 26:663-75. [PMID: 23384810 DOI: 10.1016/j.bpg.2012.11.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [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: 09/24/2012] [Revised: 10/24/2012] [Accepted: 11/02/2012] [Indexed: 01/31/2023]
Abstract
There is an undeniable link between gastrointestinal disorders and malnutrition. Chronic diarrhoea is one of the most common gastrointestinal conditions that can impact a patient's nutritional status. The nutritional consequences will depend on the cause of the diarrhoea as well as the location and extent of gastrointestinal involvement. In general, malabsorption plays a central role in the interaction between malnutrition and chronic diarrhoea. Malabsorption can result in both nutritional deficits and diarrhoea. With severe malnutrition, chronic diarrhoea can persist due to impaired immune function and poor mucosal recovery. Food intolerance and an inappropriate diet in the setting of malabsorption may also contribute to chronic diarrhoea. Patients may attribute their gastrointestinal symptoms to specific dietary intake, which can lead to self-imposed indiscriminate dietary restrictions. Therefore, disease-specific treatment in conjunction with appropriate nutritional counselling and intervention is recommended in the prevention and treatment of malnutrition in patients with chronic diarrhoea. Specialized nutritional support through enteral or parenteral administration may be required to treat severe caloric and micronutrient deficiencies. In this review, we aim to summarize the mechanism, diagnosis, and treatment of the nutritional consequences of chronic diarrhoea.
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Affiliation(s)
- Emmanuel C Gorospe
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First St. SW, Rochester, MN, USA
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28
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Sun G, Anderson MA, Gorospe EC, Leggett CL, Lutzke LS, Wong Kee Song LM, Levy M, Wang KK. Synergistic effects of photodynamic therapy with HPPH and gemcitabine in pancreatic cancer cell lines. Lasers Surg Med 2012; 44:755-61. [DOI: 10.1002/lsm.22073] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2012] [Indexed: 12/22/2022]
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Gorospe EC, Lewis JT, Bruining DH. Kayexalate-induced esophageal ulcer in a patient with gastroparesis. Clin Gastroenterol Hepatol 2012; 10:A28. [PMID: 22200687 DOI: 10.1016/j.cgh.2011.12.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Accepted: 12/18/2011] [Indexed: 02/07/2023]
Affiliation(s)
- Emmanuel C Gorospe
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
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Leggett CL, Gorospe EC, Murad MH, Montori VM, Baron TH, Wang KK. Photodynamic therapy for unresectable cholangiocarcinoma: a comparative effectiveness systematic review and meta-analyses. Photodiagnosis Photodyn Ther 2012; 9:189-95. [PMID: 22959798 DOI: 10.1016/j.pdpdt.2012.03.002] [Citation(s) in RCA: 115] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Revised: 03/03/2012] [Accepted: 03/05/2012] [Indexed: 12/17/2022]
Abstract
BACKGROUND Photodynamic therapy (PDT) with placement of a biliary stent may improve bile duct patency in patients with cholangiocarcinoma (CCA). We aimed to determine the effectiveness of biliary stenting with PDT compared to biliary stenting alone in the palliative treatment of CCA. MATERIALS AND METHODS Several databases were searched from inception to December 2011 for prospective studies comparing biliary stenting with PDT vs. biliary stenting only for CCA. Outcomes of interest included patient survival, quality of life (using Karnofsky score), and serum bilirubin levels. The relative risk (RR) for dichotomous outcomes and the weighted mean difference (WMD) for continuous outcomes were estimated using DerSimonian and Laird random-effects model. Inconsistency was quantified using I(2) statistics. The extent of publication bias was ascertained by visual inspection of funnel plots and Egger's test. RESULTS There were six studies that met inclusion criteria. A total of 170 participants received PDT and 157 had biliary stenting only. Compared with biliary stenting, PDT was associated with a statistically significant increase in the length of survival (WMD 265 days; 95% CI: 154-376; p = 0.01; I(2) = 65%), improvement in Karnofsky scores (WMD 7.74; 95% CI: 3.73-11.76; p = 0.01; I(2)= 14%), and a trend for decline in serum bilirubin (WMD -2.92 mg/dL; 95% CI: -7.54 to 1.71; p=0.22; I(2) = 94%). The pooled event rate for biliary sepsis was 15% and was similar between PDT and control groups. CONCLUSION Palliative treatment of CCA with PDT is associated with increased survival benefit, improved biliary drainage, and quality of life. However, the quality of this evidence is low.
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Affiliation(s)
- Cadman L Leggett
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 5590, USA.
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31
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Gorospe EC, Leggett CL, Sun G. Inferior mesenteric arteriovenous malformation: an unusual cause of ischemic colitis. Ann Gastroenterol 2012; 25:165. [PMID: 24714150 PMCID: PMC3959400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Accepted: 01/09/2012] [Indexed: 11/23/2022] Open
Affiliation(s)
- Emmanuel C. Gorospe
- Division of Gastroenterology and Hepatology, St Mary’s Hospital, Rochester, Minnesota, USA,
Correspondence to: Emmanuel C. Gorospe, MD, MPH, CNSC, Alfred-Main Endoscopy, St. Mary’s Hospital, 1216 Second Street SW, Rochester, MN, USA 55902, Tel: +1 507 538 1231, Fax: +1 507 284 0538, e-mail:
| | - Cadman L. Leggett
- Division of Gastroenterology and Hepatology, St Mary’s Hospital, Rochester, Minnesota, USA
| | - Gang Sun
- Division of Gastroenterology and Hepatology, St Mary’s Hospital, Rochester, Minnesota, USA
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Gorospe EC, Leggett CL, Nadkarni NA. Massive biloma presenting as gastric outlet obstruction. Ann Gastroenterol 2012; 25:166. [PMID: 24714259 PMCID: PMC3959387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 12/15/2011] [Indexed: 11/30/2022] Open
Affiliation(s)
- Emmanuel C. Gorospe
- Division of Gastroenterology and Hepatology, St’ Mary’s Hospital, Rochester, Minnesota, USA,
Correspondence to: Emmanuel C. Gorospe, MD, MPH, CNSC, Alfred-Main Endoscopy, St. Mary’s Hospital, 1216 Second Street SW, Rochester, Minnesota, USA 55902, Tel: +1 507 538 1231, Fax: +1 507 284 0538, e-mail:
| | - Cadman L. Leggett
- Division of Gastroenterology and Hepatology, St’ Mary’s Hospital, Rochester, Minnesota, USA
| | - Nikhil A. Nadkarni
- Division of Gastroenterology and Hepatology, St’ Mary’s Hospital, Rochester, Minnesota, USA
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Abstract
Acute liver failure (ALF) is a rare presentation of liver metastases. Although cases of ALF from metastatic disease have been reported, etiologies have been largely confined to lymphoma, metastatic breast, lung, and gastric cancers. ALF from medullary thyroid cancer (MTC) has never been reported. We present a 59-year-old male with newly diagnosed MTC, who was admitted with ALF. He presented with jaundice, hepatic encephalopathy, and synthetic dysfunction. His clinical course was marked by rapid decompensation within 6 days from initial presentation of jaundice to development of hepatic coma. Although liver metastases from medullary thyroid cancer have been reported, to our knowledge, this is the first described case of MTC resulting in acute liver failure.
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Affiliation(s)
- Emmanuel C. Gorospe
- Saint Marys Hospital, Mayo Clinic, 1216 Second Street SW, Rochester, MN 55902, USA
- *Emmanuel C. Gorospe:
| | - Jemilat Badamas
- Saint Marys Hospital, Mayo Clinic, 1216 Second Street SW, Rochester, MN 55902, USA
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34
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Abstract
Acute hepatitis C virus infection is associated with high rates of spontaneous clearance and variable rates of treatment-induced clearance. The benefit of early treatment versus awaiting spontaneous clearance is unknown, as is the optimal timing of treatment.We performed a MEDLINE and EMBASE search for the time period 1950 to October 2008. All English language abstracts using the search terms acute hepatitis C, hepatitis C and acute and hepatitis C and acute disease or acute infection were reviewed. Bibliographies were reviewed.Twenty-two studies including 1075 patients met the inclusion criteria. The sustained virologic response (SVR) rate for treated patients was 78%, significantly higher than 55.1% in untreated patients (OR = 3.08, 95% CI: 1.8-4.8 P value <0.0001). Mean time from diagnosis to spontaneous clearance was 9.7 weeks (SD 6.5). SVR rates varied inversely with time from acute HCV diagnosis. SVR rates for treatment within 12 weeks was 82.5% (95% CI: 75.6-89.3), significantly better than the clearance rates in untreated patients (P < 0.001). Response rates fell to 66.9% for treatment between 12 and 24 weeks, and decreased further to 62.5% for treatment beyond 24 weeks. Rates of viral clearance in treated patients with acute hepatitis C virus infection were significantly higher than that in untreated patients. Treatment rates were highest when treatment was initiated within 12 weeks of diagnosis. Based on these findings, we would advocate a 12 week period of observation for spontaneous clearance before treatment initiation. If no clearance has occurred by 12 weeks, treatment should be initiated.
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Affiliation(s)
- Kathleen E Corey
- Gastrointestinal Unit, Massachusetts General Hospital, Boston, MA
,Harvard Medical School, Boston, MA
| | - Jorge Mendez
- Gastrointestinal Unit, Massachusetts General Hospital, Boston, MA
,National Medical Center “Hospital Especialidades CMN Siglo XXI”, IMSS, Mexico City
| | | | - Hui Zheng
- MGH Biostatistics Center, Massachusetts General Hospital, Boston, MA
,Harvard Medical School, Boston, MA
| | - Raymond T Chung
- Gastrointestinal Unit, Massachusetts General Hospital, Boston, MA
,Harvard Medical School, Boston, MA
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Abstract
Sarcoidosis, a granulomatous disorder of unknown etiology, primarily affects the lungs and lymph nodes. Extrapulmonary disease without any pulmonary involvement is rare. Sarcoidosis with an elevated serum CA-125 level has only been reported five times in the literature. We describe a case of localized hepatosplenic sarcoidosis, confirmed by biopsy, with associated CA-125 elevation. In our review of the current literature, this is the first reported case of localized hepatosplenic sarcoidosis with associated serum CA-125 elevation.
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Affiliation(s)
- Ramin S Herati
- Department of Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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36
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Gorospe EC, Gerstenberger SL. Atypical sources of childhood lead poisoning in the United States: a systematic review from 1966-2006. Clin Toxicol (Phila) 2009; 46:728-37. [PMID: 18608287 DOI: 10.1080/15563650701481862] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Lead poisoning from atypical sources, which excludes the well-established lead-based paint ingestions and exposure in occupational settings, are increasingly reported in medical literature. Our objective is to increase awareness on atypical sources of lead exposure and to formulate recommendations for their detection based on actual reported cases. METHODS We systematically retrieved and reviewed reports on pediatric lead poisoning in the U.S. from atypical sources by searching Medline, Embase, CINAHL, Academic Search Premier, AltHealth, websites of state lead poisoning prevention programs, and the U.S. Consumer Product Safety Commission database for reports published from January 1966 to December 2006. RESULTS We retrieved 28 published reports that met our inclusion criteria. Of these reports, 20 are case reports and 8 case series, documenting a total of 82 incidents of lead poisoning in children from atypical sources. CONCLUSION There are varied sources of atypical lead exposure among U.S. children. The sources were grouped in the following categories based on their utility: fashion accessories, folk remedies, imported condiments & candies, pellets & bullets, and lastly, recreational & domestic items. Based on these findings, we have formulated a questionnaire that may assist in the identification of atypical lead sources in the home.
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Affiliation(s)
- Emmanuel C Gorospe
- University ofNevada Las Vegas, School of Public Health, Department of Environmental & Occupational Health, Las Vegas, Nevada 89154-3064, USA
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37
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Abstract
Intussusception occurs when a proximal bowel segment telescopes into a contiguous distal portion. This report describes a rare case of idiopathic intussusception in a 48-year-old female, complaining of right-sided abdominal pain. The abdominal CT scan presents a classic target lesion, representing the cross-sectional image of the intussusceptum layers inside the outer intussuscipiens.
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Affiliation(s)
- Emmanuel C Gorospe
- Department of Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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38
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Abstract
Hepatic portal venous gas (HPVG) formation is regarded as a sign of serious intra-abdominal process. This report presents an abdominal CT scan of a patient with incidental but rare finding of HPVG after nasogastric intubation. The presence of HPVG should prompt a thorough diagnostic evaluation to immediately rule out a catastrophic intra-abdominal condition.
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Affiliation(s)
- Emmanuel C Gorospe
- Department of Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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39
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Abstract
Hepatic portal venous gas (HPVG) formation is regarded as a sign of serious intra-abdominal process. This report presents an abdominal CT scan of a patient with incidental but rare finding of HPVG after nasogastric intubation. The presence of HPVG should prompt a thorough diagnostic evaluation to immediately rule out a catastrophic intra-abdominal condition.
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Affiliation(s)
- Emmanuel C Gorospe
- Department of Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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40
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Abstract
This article reports the case of a 3-year-old male with an elevated blood lead level. The child had a history of consuming imported lead-contaminated candies resulting in abdominal pains for which he was given a Hispanic folk remedy, called greta, by his mother. The home remedy aggravated the child's symptoms which prompted medical consultation. Analysis of the powdered folk remedy revealed a lead concentration of 140 000 ppm. This case highlights the complexities associated with identifying unfamiliar sources of lead poisoning, and their potential relationships to cultural practices.
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Affiliation(s)
- Elena E Cabb
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada, Las Vegas, NV 89154, USA
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42
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Abstract
Physicians and health care organizations that provide services to low-income patients are valuable partners in improving health care access for the uninsured and medically underserved. In this pilot study, we explored physicians' needs and factors for satisfaction in the Women's Health Connection (WHC), a breast and cervical cancer-screening program for low-income women in Nevada. Of the 126 physicians in the WHC program, 50 physicians completed a needs-and-satisfaction questionnaire. Survey data were subjected to factor analysis using Varimax rotation. The results yielded three components, which accounted for 65% of the variance. The three components or dimensions for physician satisfaction were: (1) appropriate administrative support and documentation, (2) availability of support for medical management, and (3) timeliness of diagnostic reports. Amount of reimbursement was not a significant factor. The respondents serving in this cancer prevention program for low-income women were satisfied in their involvement in the program. Further attention should be given on the identified issues for satisfaction among physicians, which could lead to quality improvement and serve as a model for other programs that serve low-income patients in cancer prevention.
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Affiliation(s)
- Christopher R Cochran
- Department of Health Care Administration & Policy, School of Public Health, University of Nevada Las Vegas, Nevada, USA.
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43
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Abstract
BACKGROUND identification of modifiable risk factors is crucial in the prevention of dementia, given its limited treatment options. Studies on increased body mass index (BMI) as a risk factor for dementia show conflicting results. METHODS we systematically retrieved and reviewed longitudinal population-based studies on increased BMI and dementia using a standard protocol. We searched Medline (1966-2006), Ageline (1978-2006), PsychInfo (1966-2006), CINAHL (1982-2006), and other relevant databases, including the reference lists of the eligible articles for review. Included studies were subjected to a quality assessment protocol. RESULTS we identified eight studies that met our selection criteria. These studies covered 1,688 cases of dementia from 28,697 participants. After adjustment for age, smoking, comorbidities, and other confounders, four studies presented significantly increased risk of dementia with elevated BMI. CONCLUSION this systematic review supports the hypothesis that increased BMI is independently associated with increased risk of dementia. Long-term studies to examine the mechanisms underlying the relationship between obesity and dementia are needed.
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Affiliation(s)
- Emmanuel C Gorospe
- Division of Aging, Brigham and Women's Hospital/Harvard Medical School, 1620 Tremont Street, Boston, USA
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44
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Gorospe EC, Cochran CR, Cabb EE. Factors for satisfaction among providers of ancillary health services in a community-based cancer prevention program: a pilot study in Nevada. ScientificWorldJournal 2006; 6:727-33. [PMID: 16816882 PMCID: PMC5917395 DOI: 10.1100/tsw.2006.151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Providers of ancillary health services are essential members of any health care delivery system. They supply laboratory, radiology, and other diagnostic modalities necessary for quality medical care. Assessment of the providers' factors for satisfaction in participating in cancer prevention programs can contribute to better services and can serve as a model for other community-based health programs.We conducted a pilot survey of providers of ancillary services in the Nevada Women's Health Connection, a community breast and cervical cancer prevention program. Of the 93 participating providers, a total of 44 providers completed the survey. We subjected the survey data to factor analysis using iterative principal axis factoring with Varimax rotation. Three components of satisfaction were identified, comprising satisfaction with the (1) reimbursement process, (2) positive perception of the program, and (3) familiarity with program's requirements. All three components accounted for 72.08% of the total variance before the rotation. Amount of financial gain was not a significant factor for satisfaction among participating providers. Providers of ancillary health services were satisfied in their participation in this community-based cancer prevention program. There were three components of satisfaction identified. Further attention should be given on these issues as they have implications for quality improvement in health services for community-based programs dealing with low income and uninsured patients.
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Affiliation(s)
- Emmanuel C Gorospe
- Department of Health Care Administration and Policy, School of Public Health, University of Nevada Las Vegas, USA.
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45
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Abstract
Nutcracker syndrome is the compression of the left renal vein between the aorta and superior mesenteric artery. It is a rare cause of hematuria which results from the rupture of congested renal veins into the collecting system.
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46
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Abstract
Prenatal calcification of the inferior vena cava (IVC) and renal veins is a rare condition with unclear etiology and prognosis. It occurs with renal vein thrombosis in utero and is associated with congenital anomalies and abnormal prenatal hemodynamic status. We report a rare case of prenatal IVC and renal vein calcification in a normal neonate without any history of compromised prenatal or perinatal condition, or significant deterioration of kidney function.
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Affiliation(s)
- Daniel Ranch
- 1Department of Pediatrics, University of Nevada School of Medicine, Las Vegas, USA.
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47
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Talamayan KS, Springer AE, Kelder SH, Gorospe EC, Joye KA. Prevalence of overweight misperception and weight control behaviors among normal weight adolescents in the United States. ScientificWorldJournal 2006; 6:365-73. [PMID: 16565773 PMCID: PMC5917363 DOI: 10.1100/tsw.2006.70] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Weight perceptions and weight control behaviors have been documented with underweight and overweight adolescents, yet limited information is available on normal weight adolescents. This study investigates the prevalence of overweight misperceptions and weight control behaviors among normal weight adolescents in the U.S. by sociodemographic and geographic characteristics. We examined data from the 2003 Youth Risk Behavior Survey (YRBS). A total of 9,714 normal weight U.S. high school students were included in this study. Outcome measures included self-reported height and weight measurements, overweight misperceptions, and weight control behaviors. Weighted prevalence estimates and odds ratios were computed. There were 16.2% of normal weight students who perceived themselves as overweight. Females (25.3%) were more likely to perceive themselves as overweight than males (6.7%) (p < 0.05). Misperceptions of overweight were highest among white (18.3%) and Hispanic students (15.2%) and lowest among black students (5.8%). Females (16.8%) outnumbered males (6.8%) in practicing at least one unhealthy weight control behavior (use of diet pills, laxatives, and fasting) in the past 30 days. The percentage of students who practiced at least one weight control behavior was similar by ethnicity. There were no significant differences in overweight misperception and weight control behaviors by grade level, geographic region, or metropolitan status. A significant portion of normal weight adolescents misperceive themselves as overweight and are engaging in unhealthy weight control behaviors. These data suggest that obesity prevention programs should address weight misperceptions and the harmful effects of unhealthy weight control methods even among normal weight adolescents.
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Affiliation(s)
- Kathleen S. Talamayan
- Centers for Health Promotion and Prevention Research,
School of Public Health,
University of Texas Health Science Center,
Houston, TX,
USA
| | - Andrew E. Springer
- Centers for Health Promotion and Prevention Research,
School of Public Health,
University of Texas Health Science Center,
Houston, TX,
USA
- *Andrew E. Springer:
| | - Steven H. Kelder
- Centers for Health Promotion and Prevention Research,
School of Public Health,
University of Texas Health Science Center,
Houston, TX,
USA
| | | | - Karen A. Joye
- Centers for Health Promotion and Prevention Research,
School of Public Health,
University of Texas Health Science Center,
Houston, TX,
USA
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48
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Gorospe EC, Bausa AB. Integrating volunteers in palliative care: the Philippine experience. J Palliat Care 2006; 22:297-9. [PMID: 17263058] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
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