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Karanfilian B, Tyberg A, Sarkar A, Shahid HM, Simon A, Reinoso K, Bapaye A, Gandhi A, Gadhikar HP, Dorwat S, Raina H, Ansari J, Nieto J, Qadir N, Porfilio MG, Arevalo-Mora M, Puga-Tejada M, Alcivar-Vasquez J, Robles-Medranda C, Ardengh JC, Bareket R, Liao K, Patel R, Pimpinelli S, Gaidhane M, Kahaleh M. Impact of COVID-19 Infection on Pancreato-Biliary Diseases Requiring Endoscopic Retrograde Cholangiopancreatography. Dig Dis Sci 2024:10.1007/s10620-024-08454-1. [PMID: 38713274 DOI: 10.1007/s10620-024-08454-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 04/17/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND Viral infections are known to impact the pancreato-biliary system; however, there are limited data showing that the same is true of COVID-19. Endoscopic retrograde cholangiopancreatography (ERCP) can safely be performed in patients with COVID-19 infection, but outcomes of patients with COVID-19 infections and concomitant pancreatic and biliary disease requiring endoscopic intervention are unknown. AIMS This study aims to evaluate the severity of pancreaticobiliary diseases and post-ERCP outcomes in COVID-19 patients. METHODS Patients with pancreato-biliary disease that required inpatient ERCP from five centers in the United States and South America between January 1, 2020, and October 31, 2020 were included. A representative cohort of patients from each month were randomly selected from each site. Disease severity and post-ERCP outcomes were compared between COVID-19 positive and COVID-19 negative patients. RESULTS A total of 175 patients were included: 95 COVID positive and 80 COVID negative. Mean CTSI score for the patients who had pancreatitis was higher in COVID-positive cohort by 3.2 points (p < .00001). The COVID-positive group had more cases with severe disease (n = 41) versus the COVID-negative group (n = 2) (p < .00001). Mortality was higher in the COVID-19 positive group (19%) compared to COVID-negative group (7.5%) even though the COVID-19-negative group had higher incidence of malignancy (n = 17, 21% vs n = 7, 7.3%) (p = 0.0455). CONCLUSIONS This study shows that patients with COVID infection have more severe pancreato-biliary disease and worse post-ERCP outcomes, including longer length of stay and higher mortality rate. These are important considerations when planning for endoscopic intervention. CLINICALTRIALS gov: (NCT05051358).
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Affiliation(s)
| | - Amy Tyberg
- Endoscopy, Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
| | - Avik Sarkar
- Endoscopy, Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
| | - Haroon M Shahid
- Endoscopy, Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
| | - Alexa Simon
- Endoscopy, Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
| | - Karoline Reinoso
- Endoscopy, Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
| | | | | | | | | | | | | | - Jose Nieto
- Borland Groover Clinic, Jacksonville, FL, USA
| | - Nadim Qadir
- Borland Groover Clinic, Jacksonville, FL, USA
| | | | | | | | | | | | | | - Romy Bareket
- Endoscopy, Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
| | - Kelvin Liao
- Endoscopy, Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
| | - Roohi Patel
- Endoscopy, Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
| | - Sophia Pimpinelli
- Endoscopy, Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
| | - Monica Gaidhane
- Endoscopy, Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
| | - Michel Kahaleh
- Endoscopy, Robert Wood Johnson University Hospital, New Brunswick, NJ, USA.
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Teoh AYB, Kongkam P, Bapaye A, Ratanachu T, Reknimitr R, Lakthakia S, Chan SM, Gadhikar HP, Korrapati SK, Lee YN, Medarapalem J, Ridtitid W, Moon JH. Use of a novel lumen apposing metallic stent for drainage of the bile duct and gallbladder: Long term outcomes of a prospective international trial. Dig Endosc 2021; 33:1139-1145. [PMID: 33284467 DOI: 10.1111/den.13911] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/27/2020] [Accepted: 12/02/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Long-term placement of lumen apposing metal stents (LAMS) with high lumen apposing force may result in adverse events. The aim of the current study was to assess the long-term efficacy and safety of a self-approximating LAMS with lower lumen apposing force for endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) and -gallbladder drainage (EUS-GBD). METHODS Five Asian institutions participated in this study. Consecutive patients suffering from obstructive jaundice with failed ERCP or acute cholecystitis that were at high risk for cholecystectomy were recruited. We evaluated the technical and clinical success rates, adverse events rates, types of interventions through the stent and the patency profile. RESULTS From June 2017 to Oct 2018, a total of 53 patients received EUS-CDS (26) and EUS-GBD (27). The technical and clinical success rates were similar between the two groups (88.5% vs 88.9%, P = 1 and 88.5% vs 88.9%, P = 1 respectively). The differences in 30-day mortality rates [2 (7.7%) vs 2 (7.7%), P = 1] and adverse events [3 (11.5%) vs 3 (11.5%), P = 1] did not reach significance. Regarding long-term outcomes, two patients in each group suffered from adverse events (P = 1). One patient in the EUS-GBD group who was on direct oral anticoagulant suffered from stent induced bleeding. CONCLUSION The self-approximating LAMS with lower lumen apposing force was effective and safe with a low risk of buried stent syndrome and bleeding in the longer term. The ClinicalTrials.gov Identifier was NCT03002051.
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Affiliation(s)
- Anthony Yuen Bun Teoh
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Pradermchai Kongkam
- Division of Gastroenterology, Department of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Amol Bapaye
- Department of Gastroenterology, Deenanath Mangeshkar Hospital, Pune, India
| | | | - Rungsun Reknimitr
- Division of Gastroenterology, Department of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Sundeep Lakthakia
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Shannon Melissa Chan
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Harshal P Gadhikar
- Department of Gastroenterology, Deenanath Mangeshkar Hospital, Pune, India
| | | | - Yun Nah Lee
- Department of Internal Medicine, SoonChunHyang University College of Medicine, Bucheon Hospital, Bucheon, Korea
| | - Jahangeer Medarapalem
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | | | - Jong Ho Moon
- Department of Internal Medicine, SoonChunHyang University College of Medicine, Bucheon Hospital, Bucheon, Korea
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Teoh AYB, Bapaye A, Lakhtakia S, Ratanachu T, Reknimitr R, Chan SM, Choi HJ, Gadhikar HP, Kongkam P, Korrapati SK, Lee YN, Medarapalem J, Ridtitid W, Moon JH. Prospective multicenter international study on the outcomes of a newly developed self-approximating lumen-apposing metallic stent for drainage of pancreatic fluid collections and endoscopic necrosectomy. Dig Endosc 2020; 32:391-398. [PMID: 31343773 DOI: 10.1111/den.13494] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 07/15/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND A novel self-approximating lumen-apposing metallic stent (LAMS; Niti-S Spaxus, Taewoong Medical, Gyeonggi-do, Korea) has recently become available. The aim of the present study was to evaluate the outcomes for drainage of pancreatic fluid collections (PFC). METHODS This was a prospective international multicentered study conducted in six high-volume institutions across Asia. Consecutive patients suffering from pancreatic pseudocyst or walled-off pancreatic necrosis (WOPN) requiring endoscopic ultrasonography-guided drainage were recruited. Outcomes included technical and clinical success, adverse events, procedural events, interventions through the stent and recurrence rates. RESULTS Between August 2016 and November 2017, 59 patients were recruited to this study. Thirty-nine patients (66.1%) had WOPN and mean (SD) size of PFC was 11.5 (5.1) cm. Technical and clinical success rates were 100%. Mean (SD) procedural time was 35.0 (17.2) minutes. Sixteen-millimeter stents were used in 66.1% of the patients. Fifty-four sessions of necrosectomy were carried out with the stent in situ in 17 patients. Stent-related adverse event (AE) rate was 6.8%. Three patients (5.1%) suffered from bleeding after stenting and one required angiographic embolization. Two patients (3.4%) suffered from recurrence during a mean (SD) follow-up time of 325.6 (355.5) days. There were no differences in outcomes between those with pseudocysts or WOPN except for the duration of hospital stay (P = 0.012). CONCLUSION Use of a self-approximating LAMS for drainage of PFC was safe and effective. Endoscopic necrosectomy could be carried out through the stent with ease. The device was associated with a low rate of stent-related AE.
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Affiliation(s)
- Anthony Yuen Bun Teoh
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - Amol Bapaye
- Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Pune, India
| | - Sundeep Lakhtakia
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | | | - Rungsun Reknimitr
- Division of Gastroenterology, Department of Medicine, King Chulalongkorn University, Bangkok, Thailand
| | - Shannon Melissa Chan
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - Hyun Jong Choi
- Department of Internal Medicine, Soon Chun Hyang University College of Medicine, Bucheon Hospital, Bucheon/Seoul, Korea
| | - Harshal P Gadhikar
- Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Pune, India
| | - Pradermchai Kongkam
- Division of Gastroenterology, Department of Medicine, King Chulalongkorn University, Bangkok, Thailand
| | - Sravan Kumar Korrapati
- Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Pune, India
| | - Yun Nah Lee
- Department of Internal Medicine, Soon Chun Hyang University College of Medicine, Bucheon Hospital, Bucheon/Seoul, Korea
| | - Jahangeer Medarapalem
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Wiriyaporn Ridtitid
- Division of Gastroenterology, Department of Medicine, King Chulalongkorn University, Bangkok, Thailand
| | - Jong Ho Moon
- Department of Internal Medicine, Soon Chun Hyang University College of Medicine, Bucheon Hospital, Bucheon/Seoul, Korea
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