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Hanna Y, Dang F, Li S, Kim M, Mosko J, May G, Teshima C. A228 SAFETY AND EFFICACY OF ENDOSCOPIC RESECTION OF NON-AMPULLARY DUODENAL POLYPS AND RISK OF POLYP RECURRENCE. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991326 DOI: 10.1093/jcag/gwac036.228] [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] [Indexed: 03/09/2023] Open
Abstract
Background Non-ampullary duodenal adenomas, which can present sporadically or in the context of a polyposis syndrome, carry a risk of progression to carcinoma in a similar sequence to colorectal adenomas. Complete endoscopic resection is recommended as first line as a less invasive alternative to surgical rsection. Identifying recurrence rates of non-ampullary duodenal polyps after endoscopic resection, and patient and polyp characteristics associated with recurrence is important in determining the best method of resection and guiding endoscopic surveillance. Purpose To determine the technical success rate of endoscopic resection of non-ampullary duodenal polyps, complication rates, rate of residual and recurrent polyps, and identify factors associated with polyp recurrence. Method All adult patients (≥18 years) that underwent endoscopic resection of non-ampullary duodenal polyps at St. Michael’s Hospital, a Canadian tertiary referral center, from January 2010 to June 2021 were retrospectively identified. Descriptive statistics were calculated for variables of interest and Chi-square, t-test or U-Mann Whitney tests were used to compare variables as appropriate. Bi-variate regression analysis was utilized to determine co-variables associated with recurrence. Result(s) A total of 300 patients underwent endoscopic resection of duodenal polyps. Table 1 describes patient demographics, polyp and procedural characteristics and characteristics associated with recurrence. Nearly all cases were technically successful (96%, n=286/299). Clinically significant intraprocedural bleeding occurred in 22% (n=65/300) of patients, and deep mural injury occurred in 3% (n=7/284) of patients. Delayed post-procedural bleeding occurred in 9% of patients (n=26/279). The median time to first surveillance EGD was 4 months. Polyp recurrence occurred in 28% (n=50/180) of patients. Of the patients with polyp recurrence, 82% (n=42/50) were successfully managed endoscopically. On univariate analysis, polyp size (OR 1.03, 95% CI 1.01-1.06), piecemeal resection (OR 1.63, 95% CI 0.17-0.82), intraprocedural bleeding (OR 2.28, 95% CI 1.09-4.74), and high-grade dysplasia (HGD) or intramucosal adenocarcinoma (IMCa) on final histology (OR 3.46, 95% CI 1.64-7.33) were significantly associated with polyp recurrence. On multivariate analysis, only HGD/IMCa on final histology was significant (OR 3.41, 95% CI 1.38-8.47). Image ![]()
Conclusion(s) Endoscopic resection of duodenal polyps can be safely performed with high technical success, however recurrence is a significant concern. Advanced histology was a significant predictor of polyp recurrence and highlights the importance of accurate pre-resection endoscopic characterization to correctly identify lesions at increased risk that may benefit from alternative resection methods such as ESD or hot rather than cold EMR, and which may require closer follow-up. Future work to develop predictive models of recurrence are needed to better stratify patient risk. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared
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Affiliation(s)
- Y Hanna
- Division of Gastroenterology and Hepatology, University of Toronto, Toronto
| | - F Dang
- Division of Gastroenterology and Hepatology, University of Toronto, Toronto
| | - S Li
- Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Canada
| | - M Kim
- Division of Gastroenterology and Hepatology, St. Vincent's Hospital Sydney, Sydney, Australia
| | - J Mosko
- Division of Gastroenterology and Hepatology, University of Toronto, Toronto,The center for Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, Toronto, Canada
| | - G May
- Division of Gastroenterology and Hepatology, University of Toronto, Toronto,The center for Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, Toronto, Canada
| | - C Teshima
- Division of Gastroenterology and Hepatology, University of Toronto, Toronto,The center for Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, Toronto, Canada
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Dang F, Habashi P, Gallinger Z, Nguyen GC. A169 PRICE: PREVENTING READMISSIONS IN IBD CENTRES OF EXCELLENCE. J Can Assoc Gastroenterol 2022. [DOI: 10.1093/jcag/gwab049.168] [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] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Hospital readmission rates are high in the inflammatory bowel disease (IBD) population, with 20% of patients readmitted within the same year. Discharge processes are not routinely standardized and deficiencies in transition of care puts patients at an increased risk of recurrent illness and healthcare costs. In addition, hospitalizations for IBD patients are associated with nosocomial complications such as venous thromboembolism.
Aims
We hypothesize that standardized follow-up by an IBD practice nurse and electronic health outcome monitoring reduces the risk of hospital readmission compared to current approaches of hospital discharge alone.
Methods
This pilot study uses a prospective parallel randomized control design and includes patients admitted with an IBD flare who were discharged without surgical intervention. Patients randomized to the control arm were discharged with usual standard of care (i.e. discharge summary and/or follow-up). In addition to standard of care, those in the intervention group received organized telephone or email follow-up by an IBD practice nurse at 1, 7 and 30 days post-discharge. These patients also received bi-weekly corespondence from an electronic survey tool, NoviSurvey, to determine clinical disease severity and medication adherence. Based on patient interactions and survey responses, the IBD nurse may arrange for expedited ambulatory visit or readmission for high-risk patients.
Results
At present, 41 patients have been enrolled into our study, 4 of which were excluded due to surgical management. 19 patients were randomized to the intervention and 17 to the control group. In the intervention group, the 30-day cumulative rate of readmission [0/19 (0%) vs. 4/17 (24%), p = 0.040] as well as the proportion of patients who failed to taper steroids [0/18 (0%) vs. 5/15 (33%), p = 0.013] was significantly lower when compared to the control group. There were no occurrences of deep vein thrombosis within 30 days post-discharge in either group.
Conclusions
These findings in our pilot study indicate that a nurse led post-discharge intervention may translate to benefits including decreased readmission rates and better medication adherence, warranting a large clinical trial to confirm findings.
Patient Demographics and Clinical Outcomes Between Intervention and Control Groups
Funding Agencies
CAG, CCC
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Affiliation(s)
- F Dang
- Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - P Habashi
- Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Z Gallinger
- Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - G C Nguyen
- Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
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Dang F, Habashi P, Gallinger Z, Nguyen GC. A241 PRICE: PREVENTING READMISSIONS IN IBD CENTRES OF EXCELLENCE. J Can Assoc Gastroenterol 2020. [DOI: 10.1093/jcag/gwz047.240] [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] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Hospital readmission rates are high in the IBD population, with 20% of patients readmitted within the same calendar year. Hospital discharge processes are not routinely standardized and deficiencies in the transition of care after discharge puts patients at increased risk of illness, hospital utilization and healthcare cost. In addition to increased healthcare expenditure, hospitalizations for IBD patients are associated with nosocomial complications such as venous thromboembolism and infection.
Aims
We hypothesize that implementing standardized follow-up by an IBD practice nurse and electronic health outcome monitoring through NoviSurvey can reduce the risk of hospital readmission compared to current approaches of hospital discharge alone.
Methods
This parallel randomized control trial is powered for N=400 and will include patients admitted for an IBD flare without requiring surgical intervention from the gastroenterology service or consulted from general internal medicine. Patients randomized to the control arm are discharged with usual standard of care. Patients in the intervention group will be eligible for usual post-discharge care in addition to organized telephone follow-up by an IBD practice nurse at 1, 7 and 30 days post-discharge. In addition, these patients will receive bi-weekly correspondence from NoviSurvey to complete a short questionnaire on clinical disease severity and medication adherence. Based on telephone interaction and survey scores, the IBD nurse may arrange readmission or expedited ambulatory visit for high-risk patients.
Results
15 patients are currently enrolled into our study, with 7 randomized to the intervention and 8 to the control group. In the control group, 25% of patients were readmitted to hospital within 30 days of discharge and 13% failed to follow their steroid taper. There were no patients in the intervention group who were readmitted to hospital within 30 days and none who failed their steroid taper. In both the control or intervention group, there were no occurrences of deep vein thrombosis within 30 days post-discharge.
Conclusions
The preliminary findings in our small sample study indicate that a nurse led post-discharge intervention may translate to benefits including decreased readmission rates to hospital, better patient satisfaction and better medication adherence.
Funding Agencies
CCC
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Affiliation(s)
- F Dang
- Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - P Habashi
- Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Z Gallinger
- Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - G C Nguyen
- Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
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Bronte-Tinkew DM, Dang F, Hsieh A, McGillis LH, Verapalan I, Murchie R, Capurro M, Greenfield LK, Philpott D, Jones N. A15 VITAMIN D DEFICIENCY PROMOTES INTESTINAL AUTOPHAGY DYSFUNCTION VIA EPIGENETIC REGULATION INVOLVING MIR142-3P IN VITRO AND IN VIVO. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- D M Bronte-Tinkew
- Departments of Paediatrics and Physiology, University of Toronto; Cell Biology Program, Peter Gilgan Centre for Research & Learning and Division of Gastroenterology, Hepatology and Nutrition, Hospital For Sick Children, Toronto, ON, Canada
| | - F Dang
- Departments of Paediatrics and Physiology, University of Toronto; Cell Biology Program, Peter Gilgan Centre for Research & Learning and Division of Gastroenterology, Hepatology and Nutrition, Hospital For Sick Children, Toronto, ON, Canada
| | - A Hsieh
- Departments of Paediatrics and Physiology, University of Toronto; Cell Biology Program, Peter Gilgan Centre for Research & Learning and Division of Gastroenterology, Hepatology and Nutrition, Hospital For Sick Children, Toronto, ON, Canada
| | - L H McGillis
- Departments of Paediatrics and Physiology, University of Toronto; Cell Biology Program, Peter Gilgan Centre for Research & Learning and Division of Gastroenterology, Hepatology and Nutrition, Hospital For Sick Children, Toronto, ON, Canada
| | - I Verapalan
- Departments of Paediatrics and Physiology, University of Toronto; Cell Biology Program, Peter Gilgan Centre for Research & Learning and Division of Gastroenterology, Hepatology and Nutrition, Hospital For Sick Children, Toronto, ON, Canada
| | - R Murchie
- Departments of Paediatrics and Physiology, University of Toronto; Cell Biology Program, Peter Gilgan Centre for Research & Learning and Division of Gastroenterology, Hepatology and Nutrition, Hospital For Sick Children, Toronto, ON, Canada
| | - M Capurro
- Departments of Paediatrics and Physiology, University of Toronto; Cell Biology Program, Peter Gilgan Centre for Research & Learning and Division of Gastroenterology, Hepatology and Nutrition, Hospital For Sick Children, Toronto, ON, Canada
| | - L K Greenfield
- Departments of Paediatrics and Physiology, University of Toronto; Cell Biology Program, Peter Gilgan Centre for Research & Learning and Division of Gastroenterology, Hepatology and Nutrition, Hospital For Sick Children, Toronto, ON, Canada
| | - D Philpott
- Department of Immunology, University of Toronto, Toronto, ON, Canada
| | - N Jones
- Departments of Paediatrics and Physiology, University of Toronto; Cell Biology Program, Peter Gilgan Centre for Research & Learning and Division of Gastroenterology, Hepatology and Nutrition, Hospital For Sick Children, Toronto, ON, Canada
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McGillis LH, Johnson S, Bronte-Tinkew D, Dang F, Philpott D, Jones N. A113 LINKING GENE-ENVIRONMENT INTERACTIONS IN IBD: VITAMIN D-MEDIATED REGULATION OF AUTOPHAGY. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- L H McGillis
- The Hospital for Sick Children, Toronto, ON, Canada
| | - S Johnson
- The Hospital for Sick Children, Toronto, ON, Canada
| | | | - F Dang
- Gastroenterology, The Hospital for Sick Children, Toronto, ON, Canada
| | - D Philpott
- University of Toronto, Toronto, ON, Canada
| | - N Jones
- The Hospital for Sick Children, Toronto, ON, Canada
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Figueiró-Filho EA, Croy BA, Reynolds JN, Dang F, Piro D, Rätsep MT, Forkert ND, Paolozza A, Smith GN, Stroman PW. Diffusion Tensor Imaging of White Matter in Children Born from Preeclamptic Gestations. AJNR Am J Neuroradiol 2017; 38:801-806. [PMID: 28126749 DOI: 10.3174/ajnr.a5064] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 11/06/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Individuals born from pregnancies complicated by preeclampsia have an elevated risk for cognitive impairment. Deviations in maternal plasma angiokines occur for prolonged intervals before clinical signs of preeclampsia. We hypothesized that fetal brain vascular and nervous tissue development become deviated during maternal progression toward preeclampsia and that such deviations would be detectable by MR imaging. MATERIALS AND METHODS In this pilot study, 10 matched (gestational and current ages) pairs (5 boys/5 girls, 7-10 years of age) from preeclampsia or control pregnancies were examined by using diffusion tensor MR imaging. An unbiased voxel-based analysis was conducted on fractional anisotropy and mean diffusivity parametric maps. Six brain ROIs were identified for subsequent analysis by tractography (middle occipital gyrus, caudate nucleus and precuneus, cerebellum, superior longitudinal fasciculus, and cingulate gyrus). RESULTS Statistical differences were present between groups for fractional anisotropy in the caudate nucleus (offspring from preeclamptic gestation > controls), volume of the tract for the superior longitudinal fasciculus (offspring from preeclamptic gestation > controls) and the caudate nucleus (offspring from preeclamptic gestation > controls), and for parallel diffusivity of the cingulate gyrus (offspring from preeclamptic gestation > controls). CONCLUSIONS These novel preliminary results along with previous results from the same children that identified altered cerebral vessel calibers and increased regional brain volumes justify fully powered MR imaging studies to address the impact of preeclampsia on human fetal brain development.
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Affiliation(s)
- E A Figueiró-Filho
- From the Departments of Biomedical and Molecular Sciences (E.A.F.-F., B.A.C., J.N.R., F.D., D.P., N.D.F., G.N.S.) .,Centre for Neuroscience Studies (E.A.F.-F., J.N.R., P.W.S.), Queen's University, Kingston, Ontario, Canada.,Faculty of Medicine (E.A.F.-F.), Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | - B A Croy
- From the Departments of Biomedical and Molecular Sciences (E.A.F.-F., B.A.C., J.N.R., F.D., D.P., N.D.F., G.N.S.)
| | - J N Reynolds
- From the Departments of Biomedical and Molecular Sciences (E.A.F.-F., B.A.C., J.N.R., F.D., D.P., N.D.F., G.N.S.).,Centre for Neuroscience Studies (E.A.F.-F., J.N.R., P.W.S.), Queen's University, Kingston, Ontario, Canada
| | - F Dang
- From the Departments of Biomedical and Molecular Sciences (E.A.F.-F., B.A.C., J.N.R., F.D., D.P., N.D.F., G.N.S.)
| | - D Piro
- From the Departments of Biomedical and Molecular Sciences (E.A.F.-F., B.A.C., J.N.R., F.D., D.P., N.D.F., G.N.S.)
| | - M T Rätsep
- Obstetrics and Gynecology (M.T.R., G.N.S.)
| | - N D Forkert
- From the Departments of Biomedical and Molecular Sciences (E.A.F.-F., B.A.C., J.N.R., F.D., D.P., N.D.F., G.N.S.).,Department of Radiology and Hotchkiss Brain Institute (N.D.F.), University of Calgary, Calgary, Alberta, Canada
| | - A Paolozza
- Laboratory for Infant Studies (A.P.), University of Toronto Scarborough, Scarborough, Ontario, Canada
| | - G N Smith
- From the Departments of Biomedical and Molecular Sciences (E.A.F.-F., B.A.C., J.N.R., F.D., D.P., N.D.F., G.N.S.).,Obstetrics and Gynecology (M.T.R., G.N.S.)
| | - P W Stroman
- Centre for Neuroscience Studies (E.A.F.-F., J.N.R., P.W.S.), Queen's University, Kingston, Ontario, Canada
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Dang F, Zhao D, Guo H, W. Lei K. Novel 24-membered octanuclear manganese(III) metallacrown. B CHEM SOC ETHIOPIA 2014. [DOI: 10.4314/bcse.v28i3.9] [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] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Dang F, Shinohara S, Tabata O, Yamaoka Y, Kurokawa M, Shinohara Y, Ishikawa M, Baba Y. Replica multichannel polymer chips with a network of sacrificial channels sealed by adhesive printing method. Lab Chip 2005; 5:472-478. [PMID: 15791347 DOI: 10.1039/b417398h] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Replica microchips for capillary array electrophoresis containing 10 separation channels (50 microm width, 50 microm depth and 100 microm pitch) and a network of sacrificial channels (100 microm width and 50 microm depth) were successfully fabricated on a poly(methyl methacrylate) (PMMA) substrate by injection molding. The strategy involved development of moving mask deep X-ray lithography to fabricate an array of channels with inclined channel sidewalls. A slight inclination of channel sidewalls, which can not be fabricated by conventional deep X-ray lithography, is highly required to ensure the release of replicated polymer chips from a mold. Moreover, the sealing of molded PMMA multichannel chips with a PMMA cover film was achieved by a novel bonding technique involving adhesive printing and a network of sacrificial channels. An adhesive printing process enables us to precisely control the thickness of an adhesive layer, and a network of sacrificial channels makes it possible to remove air bubbles and an excess adhesive, which are crucial to achieving perfect sealing of replica PMMA chips with well-defined channel and injection structures. A CCD camera equipped with an image intensifier was used to simultaneously monitor electrophoretic separations in ten micro-channels with laser-induced fluorescence detection. High-speed and high-throughput separations of a 100 bp DNA ladder and phi X174 Hae III DNA restriction fragments have been demonstrated using a 10-channel PMMA chip. The current work establishes the feasibility of mass production of PMMA multichannel chips at a cost-effective basis.
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Affiliation(s)
- F Dang
- Single-Molecule Bioanalysis Laboratory, National Institute of Advanced Industrial Science and Technology, Hayashi-cho 2217-14, Takamatsu 761-0395, Japan.
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