1
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Trocchia C, Mauer T, Mitchell S, Collard M, Asante-Korang A, Wilsey M. Lymphatic Leakage in Pediatric Heart Transplantation: Early Recognition and Timely Management with Interventional Radiologic and Endoscopic Therapy. JPGN Rep 2023; 4:e381. [PMID: 38034460 PMCID: PMC10684213 DOI: 10.1097/pg9.0000000000000381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/23/2023] [Indexed: 12/02/2023]
Abstract
Protein-losing enteropathy (PLE) is a severe complication of the Fontan procedure that leads to systemic complications owing to enteric protein loss. Hepatoduodenal lymphatic leakage resulting from increased lymphatic pressure is one such complication. We present the case of a pediatric heart transplant patient who experienced refractory PLE symptoms requiring serial albumin infusions and exhibited lymphatic leakage into the duodenum. Using diagnostic lymphangiography and endoscopy, we identified the affected area and treated it successfully with endoscopic sclerotherapy using ethanolamine injection. This treatment allowed for the cessation of lymphatic fluid and may serve as a potential intervention for PLE-associated hepatoduodenal lymphatic leakage. The present case highlights the importance of early recognition and timely intervention with radiology and endoscopic therapy to manage PLE and its associated complications.
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Affiliation(s)
- Carolena Trocchia
- From the Department of Pediatrics, Johns Hopkins All Children’s Hospital, Saint Petersburg, FL
| | - Tian Mauer
- From the Department of Pediatrics, Johns Hopkins All Children’s Hospital, Saint Petersburg, FL
| | - Sally Mitchell
- Department of Interventional Radiology, Johns Hopkins All Children’s Hospital, Saint Petersburg, FL
| | - Michael Collard
- Department of Interventional Radiology, Johns Hopkins All Children’s Hospital, Saint Petersburg, FL
| | - Alfred Asante-Korang
- Division of Pediatric Cardiology, Johns Hopkins All Children’s Hospital, Baltimore, MD
| | - Michael Wilsey
- Department of Pediatric Gastroenterology, Johns Hopkins All Children’s Hospital, Saint Petersburg, FL
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2
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Mauer TL, Trocchia C, Collard M, Chandler NM, Poulos N, Wilsey M. Percutaneous-Endoscopic Rendezvous Procedure in a Pediatric Patient With Biliary Obstruction and Altered Anatomy. J Pediatr Gastroenterol Nutr 2023; 77:e67. [PMID: 37229766 DOI: 10.1097/mpg.0000000000003842] [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] [Indexed: 05/27/2023]
Affiliation(s)
- Tian L Mauer
- From the Department of Pediatrics, Johns Hopkins All Children's Hospital, Saint Petersburg, FL
| | - Carolena Trocchia
- From the Department of Pediatrics, Johns Hopkins All Children's Hospital, Saint Petersburg, FL
| | - Michael Collard
- the Department of Radiology, Johns Hopkins All Children's Hospital, Saint Petersburg, FL
| | - Nicole M Chandler
- the Department of Pediatric Surgery, Johns Hopkins All Children's Hospital, Saint Petersburg, FL
| | - Nicholas Poulos
- AdventHealth Medical Group Pediatric Surgery at Tampa, Tampa, FL
| | - Michael Wilsey
- the Department of Gastroenterology, Nutrition, and Hepatology, Johns Hopkins All Children's Hospital, Saint Petersburg, FL
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3
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Gupta R, Khalaf RT, Morrison J, Amankwah E, Ruan W, Fishman DS, Barth BA, Liu QY, Giefer M, Kim KM, Martinez M, Dall'oglio L, Torroni F, De Angelis P, Faraci S, Bitton S, Dua K, Werlin S, Gugig R, Huang C, Mamula P, Quiros JA, Zheng Y, Piester T, Grover A, Fox VL, Wilsey M, Troendle DM. Impact of Trainee Involvement on Pediatric ERCP Procedures: Results From the Pediatric ERCP Initiative. J Pediatr Gastroenterol Nutr 2023; 77:126-130. [PMID: 36976177 DOI: 10.1097/mpg.0000000000003782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
This study examines the role of trainee involvement with pediatric endoscopic retrograde cholangiopancreatography (ERCP) and whether it affects the procedure's success, post-procedural adverse outcomes, and duration. A secondary analysis of the Pediatric ERCP Database Initiative, an international database, was performed. Consecutive ERCPs on children <19 years of age from 18 centers were entered prospectively into the database. In total 1124 ERCPs were entered into the database, of which 320 (28%) were performed by trainees. The results showed that the presence of trainees did not impact technical success ( P = 0.65) or adverse events rates ( P = 0.43). Rates of post-ERCP pancreatitis, pain, and bleeding were similar between groups ( P > 0.05). Fewer cases involving trainees were in the top quartile (>58 minutes) of procedural time (19% vs 26%; P = 0.02). Overall, our findings indicate trainee involvement in pediatric ERCP is safe.
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Affiliation(s)
- Rekha Gupta
- From the Department of Pediatrics, Johns Hopkins All Children's Hospital, Saint Petersburg, FL
| | - Racha T Khalaf
- the Department of Pediatric Gastroenterology, Hepatology and Nutrition, University of South Florida Morsani College of Medicine, Tampa, FL
| | - John Morrison
- Johns Hopkins All Children's Hospital, Saint Petersburg, FL
| | | | - Wenly Ruan
- Baylor College of Medicine Texas Children's Hospital, Houston, TX
| | - Douglas S Fishman
- From the Department of Pediatrics, Johns Hopkins All Children's Hospital, Saint Petersburg, FL
| | - Bradley A Barth
- the UT Southwestern Medical Center; Children's Health, Children's Medical Center, Dallas, TX
| | - Quin Y Liu
- the Cedars-Sinai Medical Center, Los Angeles, CA
| | - Matthew Giefer
- The University of Queensland, AU-Oschsner Health, New Orleans, LA
| | - Kyung Mo Kim
- University of Ulsan College of Medicine; Asan Medical Center Children's Hospital, Seoul, Republic of Korea
| | - Mercedes Martinez
- Columbia University New York Presbyterian Morgan Stanley Children's Hospital of New York, New York, NY
| | | | | | | | | | - Sam Bitton
- From the Department of Pediatrics, Johns Hopkins All Children's Hospital, Saint Petersburg, FL
| | - Kulwinder Dua
- Medical College of Wisconsin; Children's Wisconsin, Milwaukee, WI
| | - Steven Werlin
- Medical College of Wisconsin; Children's Wisconsin, Milwaukee, WI
| | - Roberto Gugig
- Stanford Children's Health; Lucile Packard Children's Hospital Stanford, Palo Alto, CA
| | | | - Petar Mamula
- Children's Hospital of Philadelphia, Philadelphia, PA
| | | | - Yuhua Zheng
- University of Southern California; Children's Hospital of Los Angeles, Los Angeles, CA
| | - Travis Piester
- University of Southern California; Children's Hospital of Los Angeles, Los Angeles, CA
| | - Amit Grover
- From the Department of Pediatrics, Johns Hopkins All Children's Hospital, Saint Petersburg, FL
| | - Victor L Fox
- From the Department of Pediatrics, Johns Hopkins All Children's Hospital, Saint Petersburg, FL
| | - Michael Wilsey
- Johns Hopkins All Children's Hospital, Saint Petersburg, FL
| | - David M Troendle
- the UT Southwestern Medical Center; Children's Health, Children's Medical Center, Dallas, TX
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4
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Trocchia C, Khalaf R, Amankwah E, Ruan W, Fishman DS, Barth BA, Liu QY, Giefer M, Kim KM, Martinez M, Dall'oglio L, Torroni F, De Angelis P, Faraci S, Bitton S, Werlin SL, Dua K, Gugig R, Huang C, Mamula P, Quiros JA, Zheng Y, Piester T, Grover A, Fox VL, Wilsey M, Troendle DM. Pediatric ERCP in the Setting of Acute Pancreatitis: A Secondary Analysis of an International Multicenter Cohort Study. J Pediatr Gastroenterol Nutr 2023; 76:817-821. [PMID: 36913706 PMCID: PMC10198832 DOI: 10.1097/mpg.0000000000003762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
Previous studies have demonstrated the safety of performing endoscopic retrograde cholangiopancreatography (ERCP) in the pediatric population; however, few have addressed the outcomes of children undergoing ERCP during acute pancreatitis (AP). We hypothesize that ERCP performed in the setting of AP can be executed with similar technical success and adverse event profiles to those in pediatric patients without pancreatitis. Using the Pediatric ERCP Database Initiative, a multi-national and multi-institutional prospectively collected dataset, we analyzed 1124 ERCPs. One hundred and ninety-four (17%) of these procedures were performed in the setting of AP. There were no difference in the procedure success rate, procedure time, cannulation time, fluoroscopy time, or American Society of Anesthesiology class despite patients with AP having higher American Society of Gastrointestinal Endoscopy grading difficulty scores. This study suggests that ERCP can be safely and efficiently performed in pediatric patients with AP when appropriately indicated.
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Affiliation(s)
| | - Racha Khalaf
- University of South Florida Morsani College of Medicine, Tampa, FL
| | - Ernest Amankwah
- From Johns Hopkins All Children's Hospital, St. Petersburg, FL
| | - Wenly Ruan
- Baylor College of Medicine; Texas Children's Hospital, Houston, TX
| | | | - Bradley A Barth
- the UT Southwestern Medical Center; Children's Health Children's Medical Center, Dallas, TX
| | - Quin Y Liu
- the Cedars-Sinai Medical Center, Los Angeles, CA
| | - Matthew Giefer
- The University of Queensland, AU-Oschsner Health, New Orleans, LA
| | - Kyung Mo Kim
- University of Ulsan College of Medicine; Asan Medical Center Children's Hospital, Seoul, The Republic of Korea
| | - Mercedes Martinez
- Columbia University; New York Presbyterian Morgan Stanley Children's Hospital of New York, New York, NY
| | | | | | | | | | - Sam Bitton
- Zucker School of Medicine at Hofstra/Northwell; Cohen Children's Medical Center, Lake Success, NY
| | - Steven L Werlin
- Medical College of Wisconsin; Children's Wisconsin, Milwaukee, WI
| | - Kulwinder Dua
- Medical College of Wisconsin; Children's Wisconsin, Milwaukee, WI
| | - Roberto Gugig
- Stanford Children's Health, Lucile Packard Children's Hospital Stanford, Palo Alto, CA
| | | | - Petar Mamula
- Children's Hospital of Philadelphia, Philadelphia, PA
| | | | - Yuhua Zheng
- University of Southern California; Children's Hospital of Los Angeles, Los Angeles, CA
| | - Travis Piester
- University of Southern California; Children's Hospital of Los Angeles, Los Angeles, CA
| | - Amit Grover
- Harvard Medical School; Boston Children's Hospital, Boston, MA
| | - Victor L Fox
- Harvard Medical School; Boston Children's Hospital, Boston, MA
| | - Michael Wilsey
- From Johns Hopkins All Children's Hospital, St. Petersburg, FL
| | - David M Troendle
- the UT Southwestern Medical Center; Children's Health Children's Medical Center, Dallas, TX
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Barnett GS, Kimsey KM, Shieh HF, Smithers CJ, de Vries JM, Mouch J, Wilsey M. Treatment of Esophageal Perforation: Endoscopic Vacuum-Assisted Closure. JPGN Rep 2023; 4:e314. [PMID: 37200717 PMCID: PMC10187847 DOI: 10.1097/pg9.0000000000000314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 02/20/2023] [Indexed: 05/20/2023]
Abstract
Surgical repair of type C esophageal atresia (EA) with distal tracheoesophageal fistula (TEF) is complicated by an anastomotic leak in 10%-30% of cases with associated morbidity. A novel procedure in the pediatric population, endoscopic vacuum-assisted closure (EVAC), accelerates the healing of esophageal leaks by using the effects of VAC therapy, including fluid removal and stimulation of granulation tissue formation. We report 2 additional cases of chronic esophageal leak treated with EVAC in EA patients. The first is a patient with a previously repaired type C EA/TEF and left congenital diaphragmatic hernia complicated by an infected diaphragmatic hernia patch erosion into the esophagus and colon. Additionally, we discuss a second case using EVAC for early anastomotic leak following type C EA/TEF repair in a patient who was later found to have a distal congenital esophageal stricture.
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Affiliation(s)
- Grafton S. Barnett
- From the Department of Pediatric Gastroenterology and Nutrition, Johns Hopkins All Children’s Hospital, FL
| | - Kathryn M. Kimsey
- From the Department of Pediatric Gastroenterology and Nutrition, Johns Hopkins All Children’s Hospital, FL
| | - Hester F. Shieh
- Department of Surgery, Johns Hopkins All Children’s Hospital, FL
| | | | - Jonathan M. de Vries
- From the Department of Pediatric Gastroenterology and Nutrition, Johns Hopkins All Children’s Hospital, FL
| | - Jack Mouch
- From the Department of Pediatric Gastroenterology and Nutrition, Johns Hopkins All Children’s Hospital, FL
| | - Michael Wilsey
- From the Department of Pediatric Gastroenterology and Nutrition, Johns Hopkins All Children’s Hospital, FL
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6
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Kiskaddon AL, Wilsey M, Gonzalez-Gomez I, Laks J, Miles A, Carapellucci J, Asante-Korang A. Basiliximab therapy for immune-mediated bowel disease in a pediatric heart transplant patient. Pediatr Transplant 2023; 27:e14443. [PMID: 36419214 DOI: 10.1111/petr.14443] [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: 05/01/2022] [Revised: 10/17/2022] [Accepted: 11/13/2022] [Indexed: 11/25/2022]
Abstract
In pediatric patients who undergo heart transplantation, severe immune-mediated bowel disease has been reported. Management is complex, and there are little data discussing the use of basiliximab for immune-mediated bowel disease. This case report discusses a pediatric patient who developed immune-mediated bowel disease following heart transplantation and was successfully managed with basiliximab.
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Affiliation(s)
- Amy L Kiskaddon
- Department of Pharmacy, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA.,Division of Pediatric Cardiology, Department of Pediatrics, Johns Hopkins University School of Medicine, Balitmore, Marlyand, USA
| | - Michael Wilsey
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA
| | - Ignacio Gonzalez-Gomez
- Division of Pathology, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA
| | - Jessica Laks
- Heart Institute, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA
| | - Alyssa Miles
- Department of Pharmacy, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA
| | | | - Alfred Asante-Korang
- Division of Pediatric Cardiology, Department of Pediatrics, Johns Hopkins University School of Medicine, Balitmore, Marlyand, USA.,Heart Institute, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA
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7
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Oliveros L, Rosario M, Wilsey A, Karjoo S, Wilsey M. Gastric Outlet Obstruction Caused by a Foreign Body Ingestion. JPGN Rep 2023; 4:e249. [PMID: 38293319 PMCID: PMC10754611 DOI: 10.1097/pg9.0000000000000249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 07/22/2022] [Indexed: 02/01/2024]
Affiliation(s)
- Lea Oliveros
- Gastroenterology and Hepatology Fellowship, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, Department of Pediatric Gastroenterology, Johns Hopkins All Children's Hospital, Saint Petersburg, Florida, Johns Hopkins All Children's Hospital, Saint Petersburg, Florida
| | - Michelle Rosario
- Gastroenterology and Hepatology Fellowship, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, Department of Pediatric Gastroenterology, Johns Hopkins All Children's Hospital, Saint Petersburg, Florida, Johns Hopkins All Children's Hospital, Saint Petersburg, Florida
| | - Alexander Wilsey
- Gastroenterology and Hepatology Fellowship, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, Department of Pediatric Gastroenterology, Johns Hopkins All Children's Hospital, Saint Petersburg, Florida, Johns Hopkins All Children's Hospital, Saint Petersburg, Florida
| | - Sara Karjoo
- Gastroenterology and Hepatology Fellowship, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, Department of Pediatric Gastroenterology, Johns Hopkins All Children's Hospital, Saint Petersburg, Florida, Johns Hopkins All Children's Hospital, Saint Petersburg, Florida
| | - Michael Wilsey
- Gastroenterology and Hepatology Fellowship, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, Department of Pediatric Gastroenterology, Johns Hopkins All Children's Hospital, Saint Petersburg, Florida, Johns Hopkins All Children's Hospital, Saint Petersburg, Florida
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8
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Peck J, Brown J, Fierstein JL, Nguyen ATH, Amankwah EK, Rehman M, Wilsey M. Comparison of general endotracheal anesthesia versus sedation without endotracheal intubation during initial percutaneous endoscopic gastrostomy insertion for infants: A retrospective cohort study. Paediatr Anaesth 2022; 32:1310-1319. [PMID: 35924407 DOI: 10.1111/pan.14539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 07/13/2022] [Accepted: 07/21/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND Critical airway incidents are a major cause of morbidity and mortality during anesthesia. Delayed management of airway obstruction quickly leads to severe complications due to the reduced apnea tolerance in infants and neonates. The decision of whether to intubate the trachea during anesthesia is therefore of great importance, particularly as an increasing number of procedures are performed outside of the operating room. AIM In this retrospective cohort study, we evaluated airway management for infants below 6 months of age undergoing percutaneous endoscopic gastrostomy insertion. We compared demographic, procedural, and health outcome-related data for infants undergoing percutaneous endoscopic gastrostomy insertion under general endotracheal anesthesia (n = 105) to those receiving monitored anesthesia care (n = 44) without endotracheal intubation. METHODS A retrospective chart review was completed for all infants <6 months of age who underwent percutaneous endoscopic gastrostomy insertion in our institution's endoscopy suite between January 2002 and January 2017. Descriptive statistics summarized numeric variables using medians and corresponding ranges (minimum-maximum), and categorical variables using frequencies and percentages. Differences in study outcomes between patients undergoing general anesthesia or monitored anesthesia care were evaluated with univariate quantile or Firth logistic regression for numerical and categorical outcomes, respectively. Results are presented as β [95% confidence interval] or odds ratio [95% confidence interval] along with corresponding p-values. RESULTS Both groups were similar in distribution of age, race, and gender. However, patients selected for general anesthesia had lower median body weights (3.9 kg [range: 2.0-6.7] vs. 4.4 kg [range: 2.6-6.9]), higher percentages of cardiac (95.2% vs. 84.1%), and/or neurologic comorbidities (74.3% vs. 56.8%) and were more frequently given American Society of Anesthesiologists level IV classifications (41.9% vs. 29.6%) indicating that these infants may have had more severe disease than patients selected for monitored anesthesia care. Three monitored-anesthesia-care patients required intraoperative conversion to general anesthesia. General anesthesia patients experienced greater odds of intraoperative hypoxemia (45.2% vs. 29.0%; odds ratio: 2.0 [0.9-4.3], p-value: .09) and required postoperative airway intervention more frequently than monitored-anesthesia-care patients (13.03% vs. 2.3%; odds ratio: 4.6 [0.8-25.6], p-value: .08). Procedure times were identical in both groups (6 min), but general anesthesia resulted in longer median anesthesia times (44 min [range: 22-292] vs. 12 min [range:19-136]; β:13 [95% 6.9-19.1], p-value: < .001). CONCLUSION Study results suggest that providers selected general anesthesia over monitored anesthesia care for infants and neonates with low body weights, cardiac comorbidities, and neurologic comorbidities. Increased rates of airway intervention, and increased length of stay may be at least partially related to more severe patient comorbidity, as indicated by higher American Society of Anesthesiologists classifications. However, due to the exploratory nature of these analyses, further confirmatory studies are needed to evaluate the impact of airway selection during PEG on postoperative patient outcomes.
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Affiliation(s)
- Jacquelin Peck
- Department of Anesthesia, Mount Sinai Medical Center, Miami Beach, Florida, USA
| | - Jerry Brown
- Office of Medical Education, University of South Florida, Tampa, Florida, USA
| | - Jamie L Fierstein
- Epidemiology and Biostatistics, Johns Hopkins All Children's Clinical and Translational Research Institute, Saint Petersburg, Florida, USA
| | - Anh Thy H Nguyen
- Epidemiology and Biostatistics, Johns Hopkins All Children's Clinical and Translational Research Institute, Saint Petersburg, Florida, USA
| | - Ernest K Amankwah
- Epidemiology and Biostatistics, Johns Hopkins All Children's Clinical and Translational Research Institute, Saint Petersburg, Florida, USA
| | - Mohamed Rehman
- Department of Pediatric Anesthesia, Johns Hopkins All Children's Hospital, Saint Petersburg, Florida, USA
| | - Michael Wilsey
- Department of Pediatric Gastroenterology, Johns Hopkins All Children's Hospital, Saint Petersburg, Florida, USA
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9
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deVries JM, Sidhu S, Kimsey KM, Barnett GS, Wilsey M. No Stone Left Unturned: Pediatric Pancreatic Stones Presenting With Obstructive Jaundice. JPGN Rep 2022; 3:e217. [PMID: 37168618 PMCID: PMC10158305 DOI: 10.1097/pg9.0000000000000217] [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] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 04/27/2022] [Indexed: 05/13/2023]
Abstract
Pancreatic lithiasis, the formation of calcifications in the pancreatic duct, occurs uncommonly in pediatric patients but can occur more frequently with chronic pancreatitis (CP). Cystic fibrosis (CF) is one of the major causes of pancreatic lithiasis in pediatric patients, with mutations in the CF transmembrane conductance regulator (CFTR) gene reported in up to 23% of pediatric CP patients. Mutations in the CFTR gene can lead to mild cases of CF, which may delay diagnosis and treatment. In such cases, pancreatitis can be the presenting symptom in children with CF. We report a unique case of a 10-year-old female with previously undiagnosed and untreated CF presenting with abdominal pain, vomiting, and obstructive jaundice. Her pancreatic lithiasis and biliary obstruction were successfully treated with endoscopic retrograde cholangiopancreatography (ERCP).
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Affiliation(s)
- Jonathan M. deVries
- Department of Pediatric Gastroenterology and Nutrition, Johns Hopkins All Children’s Hospital, St. Petersburg, Florida
| | - Sarah Sidhu
- Department of Pediatric Gastroenterology and Nutrition, Johns Hopkins All Children’s Hospital, St. Petersburg, Florida
| | - Kathryn M. Kimsey
- Department of Pediatric Gastroenterology and Nutrition, Johns Hopkins All Children’s Hospital, St. Petersburg, Florida
| | - Grafton S. Barnett
- Department of Pediatric Gastroenterology and Nutrition, Johns Hopkins All Children’s Hospital, St. Petersburg, Florida
| | - Michael Wilsey
- Department of Pediatric Gastroenterology and Nutrition, Johns Hopkins All Children’s Hospital, St. Petersburg, Florida
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10
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Patricia-Rae Meyer B, Nguyen J, Wilsey M, Karjoo S. Heterotopic Gastric Mucosa Causing Rectal Bleeding in a Young Child. JPGN Rep 2022; 3:e184. [PMID: 37168921 PMCID: PMC10158372 DOI: 10.1097/pg9.0000000000000184] [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] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 02/03/2022] [Indexed: 05/13/2023]
Abstract
Heterotopic gastric mucosa (HGM) in the colon and small bowel is a very rare finding. We report a case of HGM in the rectum of an 8-year-old child with a history of eosinophilic esophagitis after having a colonoscopy to evaluate for inflammatory bowel disease. The colonoscopy was normal except for rectal tissue erythema and edema. Inflammatory bowel disease has been reported in some cases of children with eosinophilic changes of the esophagus. The child had intermittent rectal bleeding thought to be due to constipation. Interestingly, when the patient was placed on a proton pump inhibitor for the treatment of eosinophilic esophagitis, the rectal bleeding decreased. After our patient ceased proton pump inhibitor therapy, he experienced a large amount of rectal bleeding. Histological findings revealed HGM in the colon/rectum. An extensive review of the incidence, diagnosis, and treatment is discussed.
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Affiliation(s)
| | - Johnny Nguyen
- Department of Pathology, Johns Hopkins All Children’s Hospital, St. Petersburg, FL
| | - Michael Wilsey
- Department of Gastroenterology, Johns Hopkins All Children’s Hospital, St. Petersburg, FL
| | - Sara Karjoo
- Department of Gastroenterology, Johns Hopkins All Children’s Hospital, St. Petersburg, FL
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11
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Oliveros L, McIntosh C, Wilsey A, Karjoo S, Wilsey M. “Jingle All the Way!”: Sharp Foreign Bodies Embedded Within the Esophageal Mucosa During the Holiday Season. Cureus 2022; 14:e24493. [PMID: 35651386 PMCID: PMC9134847 DOI: 10.7759/cureus.24493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2022] [Indexed: 11/23/2022] Open
Abstract
Sharp pointed objects in the esophagus are extremely hazardous and can lead to complications such as mucosal ulcerations, perforations, obstruction, abscess, and fistula formation. Patients exhibit symptomatology based on the location within the proximal or distal esophagus. Ingestion of a sharp foreign object warrants emergent endoscopic removal, particularly when lodged in the esophagus. We present two young children, a 30-month-old male and a 10-month-old male, who underwent emergent endoscopic evaluation following the ingestion of a jingle bell and a Christmas ornament hanger, respectively. Types of ingested sharp foreign bodies may vary during the holiday season and present unique diagnostic and therapeutic challenges for pediatric physicians. Additionally, foreign body ingestions are not limited to children including teenagers and should also be considered in infants. Here, we report two young patients who ingested unique holiday ornaments and describe the management of these impacted esophageal foreign bodies.
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13
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Schor B, Blanco P, Rivera-Nieves D, Wilsey M, Karjoo S. Esophageal polyp in a teenage boy with eosinophilic esophagitis. SAGE Open Med Case Rep 2022; 10:2050313X221116954. [PMID: 35991956 PMCID: PMC9382070 DOI: 10.1177/2050313x221116954] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 07/14/2022] [Indexed: 11/19/2022] Open
Abstract
The association of eosinophilic esophagitis and esophageal polyps has been
reported in the literature but remains a rare finding in both adults and
children. The patient in this case report presented with progressively worsening
dysphagia secondary to eosinophilic esophagitis and an esophageal polyp.
Dysphagia is always abnormal, and endoscopic evaluation is essential. Dysphagia
is a well-known symptom in patients with eosinophilic esophagitis. While
esophageal polyps as a whole are less common in the pediatric population, they
should not be overlooked as a possible cause of dysphagia and esophageal
obstruction.
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Affiliation(s)
- Berni Schor
- Department of Pediatrics, Columbia University, NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY, USA
| | - Paola Blanco
- Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Desiree Rivera-Nieves
- Department of Pediatric Gastroenterology, Johns Hopkins All Children’s Hospital, St. Petersburg, FL, USA
| | - Michael Wilsey
- Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
- Department of Pediatric Gastroenterology, Johns Hopkins All Children’s Hospital, St. Petersburg, FL, USA
| | - Sara Karjoo
- Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
- Department of Pediatric Gastroenterology, Johns Hopkins All Children’s Hospital, St. Petersburg, FL, USA
- College of Medicine, Florida State University, Tallahassee, FL, USA
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14
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Dey A, Peck J, Wilsey M, Walter J, Nguyen J, Gonzalez-Gomez I, Karjoo S. The Evolution of Very Early Onset Inflammatory Bowel Disease, Autoimmune Hepatitis, and Primary Sclerosing Cholangitis in a Young Girl. Case Rep Gastroenterol 2021; 15:939-947. [PMID: 34949979 PMCID: PMC8647121 DOI: 10.1159/000520184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 10/12/2021] [Indexed: 11/19/2022] Open
Abstract
Very early onset inflammatory bowel disease, autoimmune hepatitis (AIH), or primary sclerosing cholangitis (PSC) alone is a rare condition in young children. The combination of all 3 autoimmune disorders in a 16-month-old child is even rarer. The onset and etiology of these diseases is multifactorial and typically unknown. However, when the children are diagnosed, the accepted view point is that the inflammation was likely present for months to years prior. This case is unique because the gastrointestinal problems started from infancy, and evolved to the development of Crohn’s disease, AIH, and PSC at a very early age. This case helps bring to light that very early onset autoimmune disorders may in fact present with symptoms of feeding difficulties, growth failure, and formula intolerance. Patients may be diagnosed initially with allergic enterocolitis in infancy. Although few children with these symptoms evolve to develop autoimmune diseases at an older age, clinicians should consider following these children more closely. This case also demonstrates how hard it is to diagnose very early onset autoimmune disorders, as they mimic other illnesses.
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Affiliation(s)
- Aditi Dey
- Department of Pediatrics, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Jacquelin Peck
- Department of Pediatrics, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Michael Wilsey
- Department of Pediatrics, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
- Department of Pediatrics, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Jolan Walter
- Department of Internal Medicine, Allergy and Immunology, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Johnny Nguyen
- Department of Pathology, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Ignacio Gonzalez-Gomez
- Department of Pathology, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Sara Karjoo
- Department of Pediatrics, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
- Department of Pediatrics, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
- Department of Clinical Sciences, Florida State University, Tallahassee, Florida, USA
- *Sara Karjoo,
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15
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Kidder M, Phen C, Brown J, Kimsey K, Oshrine B, Ghazarian S, Mateus J, Amankwah E, Wilsey M. Effectiveness and Complication Rate of Percutaneous Endoscopic Gastrostomy Placement in Pediatric Oncology Patients. Pediatr Gastroenterol Hepatol Nutr 2021; 24:546-554. [PMID: 34796099 PMCID: PMC8593364 DOI: 10.5223/pghn.2021.24.6.546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 11/14/2022] Open
Abstract
PURPOSE Malnutrition is a significant issue for pediatric patients with cancer. We sought to evaluate the effectiveness and complication rate of percutaneous endoscopic gastrostomy (PEG) placement in pediatric oncology patients. METHODS A retrospective chart review was performed on 49 pediatric oncology patients undergoing PEG placement at Johns Hopkins All Children's Hospital between 2000 and 2016. Demographic and clinical characteristics, complications, absolute neutrophil count at time of PEG placement and at time of complications, length of stay, and mortality were identified. Weight-for-age Z-scores were evaluated at time of- and six months post-PEG placement. RESULTS The overall mean weight-for-age Z-score improved by 0.73 (p<0.0001) from pre- (-1.11) to post- (-0.38) PEG placement. Improvement in Z-score was seen in patients who were malnourished at time of PEG placement (1.14, p<0.0001), but not in those who were not malnourished (0.32, p=0.197). Site infections were seen in 12 (24%), buried bumper syndrome in five (10%), and tube dislodgement in one (2%) patient. One patient (2%) with fever was treated for possible peritonitis. There were no cases of other major complications, including gastric perforation, gastrocolic fistula, clinically significant bleeding, or PEG-related death documented. CONCLUSION Consistent with previous studies, our data suggests a relationship between site complications (superficial wound infection, buried bumper syndrome) and neutropenia. Additionally, PEG placement appears to be an effective modality for improving nutritional status in malnourished pediatric oncology patients. However, larger prospective studies with appropriate controls and adjustment for potential confounders are warranted to confirm these findings.
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Affiliation(s)
- Molly Kidder
- Department of Pediatrics, University of South Florida Health, Tampa, FL, USA
| | - Claudia Phen
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jerry Brown
- Department of Pediatric Gastroenterology and Nutrition, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Kathryn Kimsey
- Department of Pediatric Gastroenterology and Nutrition, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Benjamin Oshrine
- Department of Pediatric Hematology/Oncology, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Sharon Ghazarian
- Epidemiology and Biostatistics, Johns Hopkins All Children's Institute for Clinical and Translational Research, St. Petersburg, FL, USA
| | - Jazmine Mateus
- Epidemiology and Biostatistics, Johns Hopkins All Children's Institute for Clinical and Translational Research, St. Petersburg, FL, USA
| | - Ernest Amankwah
- Department of Pediatric Hematology/Oncology, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA.,Epidemiology and Biostatistics, Johns Hopkins All Children's Institute for Clinical and Translational Research, St. Petersburg, FL, USA
| | - Michael Wilsey
- Department of Pediatrics, University of South Florida Health, Tampa, FL, USA.,Department of Pediatric Gastroenterology and Nutrition, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
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16
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Sparks C, Fagen K, Wilsey M, Condino A, Kucera JN. Infantile Adenomyomatosis of the Gallbladder in a 3-Month-Old. JPGN Rep 2021; 2:e140. [PMID: 37206453 PMCID: PMC10191582 DOI: 10.1097/pg9.0000000000000140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 10/04/2021] [Indexed: 05/21/2023]
Abstract
Adenomyomatosis of the gallbladder is an acquired condition of the gallbladder with epithelial, mucosal, and muscular hypertrophy. The result is usually gallbladder wall thickening with associated diverticula known as Rokitansky-Aschoff's sinuses. These mucosal invaginations of the gallbladder wall may extend beyond the muscular layer. The condition is typically asymptomatic and is predominantly diagnosed in adults between 50 and 60 years of age, usually with concomitant cholelithiasis, motility disorders, or chronic inflammation. Few cases within the literature have been described in the pediatric population and even fewer within this subset have been diagnosed in infants. We describe a case of a 3-month-old male with failure to thrive, persistent nonbilious, nonbloody emesis, and elevated transaminases with ultrasound evidence of gallbladder adenomyomatosis. The patient was managed with outpatient laboratory monitoring and follow-up imaging.
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Affiliation(s)
- Chelsea Sparks
- From the Department of Radiology, University of South Florida, Tampa, FL
| | - Kimberly Fagen
- Johns Hopkins All Children’s Hospital, Saint Petersburg, FL
| | - Michael Wilsey
- Johns Hopkins All Children’s Hospital, Saint Petersburg, FL
| | - Adria Condino
- Johns Hopkins All Children’s Hospital, Saint Petersburg, FL
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17
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Fishman DS, Barth B, Man-Wai Tsai C, Giefer MJ, Martinez M, Wilsey M, Khalaf RT, Liu QY, DeAngelis P, Torroni F, Faraci S, Troendle DM. A prospective multicenter analysis from the Pediatric ERCP Database Initiative: predictors of choledocholithiasis at ERCP in pediatric patients. Gastrointest Endosc 2021; 94:311-317.e1. [PMID: 33539907 DOI: 10.1016/j.gie.2021.01.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 01/24/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS The management of suspected choledocholithiasis remains a challenge in pediatric endoscopy. Several recommendations are available for adult patients; however, it is unknown which pediatric patients are most likely to benefit from ERCP for evaluation of choledocholithiasis. The primary aim of this study was to evaluate adult-based criteria in the evaluation of pediatric patients with choledocholithiasis. A secondary aim was to evaluate the role of conjugated (or direct) bilirubin to improve the sensitivity of detecting choledocholithiasis. METHODS This was a prospective multicenter study in pediatric patients as part of the Pediatric ERCP Database Initiative (PEDI) with additional post-hoc analysis of updated guidelines. Patients <19 years of age undergoing ERCP for suspected choledocholithiasis or gallstone pancreatitis were enrolled at participating sites. RESULTS Ninety-five patients were enrolled (69 with choledocholithiasis confirmed at ERCP and 26 with no stones at ERCP). Adverse event rates were similar in both groups. Specificity ranged from 27% to 91% using adult guidelines, but a sensitivity of only 20% to 69%. The were no significant differences between the 2 groups using preprocedure transabdominal US (P = 1.0). Significant differences between groups were identified using either the total or conjugated bilirubin (P = .02). There was also a significant difference between the stone and no-stone groups when conjugated bilirubin was dichotomized to >2 mg/dL (P = .03). CONCLUSIONS Abdominal imaging and laboratory indices may be used to predict pediatric choledocholithiasis with varying sensitivity and specificity. Pediatric-specific guidelines may allow for improved stone prediction compared with existing adult recommendations.
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Affiliation(s)
- Douglas S Fishman
- Section of Pediatric Gastroenterology, Hepatology and Nutrition; Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Brad Barth
- UT Southwestern Department of Pediatrics, Division of Pediatric Gastroenterology Children's Health-Children's Medical Center, Dallas, Texas, USA
| | - Cynthia Man-Wai Tsai
- Section of Pediatric Gastroenterology, Hepatology and Nutrition; Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Matthew J Giefer
- The University of Queensland, Brisbane, Australia; Ochsner Health, New Orleans, Louisianna, USA
| | - Mercedes Martinez
- Department of Pediatrics, Columbia University Medical Center, New York, New York, USA
| | - Michael Wilsey
- Division of Pediatric Gastroenterology, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Racha T Khalaf
- University of South Florida Morsani College of Medicine, Department of Pediatrics, Tampa, Florida, USA
| | - Quin Y Liu
- Cedars-Sinai Medical Center, and David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Paola DeAngelis
- Digestive Surgery and Endoscopy Unit, Bambino Gesu Children's Hospital, Rome, Italy
| | - Filippo Torroni
- Digestive Surgery and Endoscopy Unit, Bambino Gesu Children's Hospital, Rome, Italy
| | - Simona Faraci
- Digestive Surgery and Endoscopy Unit, Bambino Gesu Children's Hospital, Rome, Italy
| | - David M Troendle
- UT Southwestern Department of Pediatrics, Division of Pediatric Gastroenterology Children's Health-Children's Medical Center, Dallas, Texas, USA
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18
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Lee FC, Hattar L, Wesson D, Whitfield Van Buren K, Wilsey M, Fishman DS. Post-Surgical Abnormalities of the Duodenum Leading to Pancreaticobiliary Disease in Children. JPGN Rep 2021; 2:e036. [PMID: 37206947 PMCID: PMC10191589 DOI: 10.1097/pg9.0000000000000036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 11/02/2020] [Indexed: 05/21/2023]
Affiliation(s)
- Frances C. Lee
- From the Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Baylor College of Medicine, Houston, TX
| | - Lana Hattar
- From the Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Baylor College of Medicine, Houston, TX
| | - David Wesson
- Department of Pediatric Surgery, Baylor College of Medicine, Houston, TX
| | - Kristin Whitfield Van Buren
- From the Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Baylor College of Medicine, Houston, TX
- Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Texas Children’s Hospital, Houston, TX
| | - Michael Wilsey
- Department of Pediatric Gastroenterology, Johns Hopkins All Children’s Hospital, St. Petersburg, FL
| | - Douglas S. Fishman
- From the Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Baylor College of Medicine, Houston, TX
- Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Texas Children’s Hospital, Houston, TX
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19
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Peck J, Nguyen ATH, Dey A, Amankwah EK, Rehman M, Wilsey M. Airway Management for Initial PEG Insertion in the Pediatric Endoscopy Unit: A Retrospective Evaluation of 168 Patients. Pediatr Gastroenterol Hepatol Nutr 2021; 24:100-108. [PMID: 33505899 PMCID: PMC7813569 DOI: 10.5223/pghn.2021.24.1.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 09/01/2020] [Accepted: 09/26/2020] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Percutaneous endoscopic gastrostomy (PEG) tube placements are commonly performed pediatric endoscopic procedures. Because of underlying disease, these patients are at increased risk for airway-related complications. This study compares patient characteristics and complications following initial PEG insertion with general endotracheal anesthesia (GETA) vs. anesthesia-directed deep sedation with a natural airway (ADDS). METHODS All patients 6 months to 18 years undergoing initial PEG insertion within the endoscopy suite were considered for inclusion in this retrospective cohort study. Selection of GETA vs. ADDS was made by the anesthesia attending after discussion with the gastroenterologist. RESULTS This study included 168 patients (GETA n=38, ADDS n=130). Cohorts had similar characteristics with respect to sex, race, and weight. Compared to ADDS, GETA patients were younger (1.5 years vs. 2.9 years, p=0.04), had higher rates of severe American Society of Anesthesiologists (ASA) disease severity scores (ASA 4-5) (21% vs. 3%, p<0.001), and higher rates of cardiac comorbidities (39.5% vs. 18.5%, p=0.02). Significant associations were not observed between GETA/ADDS status and airway support, 30-day readmission, fever, or pain medication in unadjusted or adjusted models. GETA patients had significantly increased length of stay (eβ=1.55, 95% confidence interval [CI]=1.11-2.18) after adjusting for ASA class, room time, anesthesia time, fever, and cardiac diagnosis. GETA patients also had increased room time (eβ=1.20, 95% CI=1.08-1.33) and anesthesia time (eβ=1.50, 95% CI=1.30-1.74) in adjusted models. CONCLUSION Study results indicate that younger and higher risk patients are more likely to undergo GETA. Children selected for GETA experienced longer room times, anesthesia times, and hospital length of stay.
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Affiliation(s)
- Jacquelin Peck
- Department of Anesthesiology, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Anh Thy H Nguyen
- Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Aditi Dey
- Office of Medical Education, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Ernest K Amankwah
- Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Mohamed Rehman
- Pediatric Anesthesiology, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Michael Wilsey
- Pediatric Gastroenterology, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
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20
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Laughrey M, Kidder M, Rivera D, Wilsey M, Karjoo S. Development of an esophageal stricture following paradichlorobenzene mothball ingestion. SAGE Open Med Case Rep 2020; 8:2050313X20974210. [PMID: 33240502 PMCID: PMC7675865 DOI: 10.1177/2050313x20974210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 10/26/2020] [Indexed: 11/17/2022] Open
Abstract
A 2-year-old patient presented with a paradichlorobenzene mothball ingestion. The foreign body was removed with a straight Miller blade and a curved Allis clamp. Two weeks following the removal of the mothball, the patient developed solid food dysphagia due to an esophageal stricture. This complication after a short exposure to mothballs is unreported in the literature to date, making this a unique and interesting case. In addition, a comparison of the clinical presentation and treatment of naphthalene and paradichlorobenzene mothballs was reviewed in this article.
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Affiliation(s)
- Marisa Laughrey
- Florida State University College of
Medicine, Sarasota, FL, USA
| | - Molly Kidder
- Morsani College of Medicine, University
of South Florida, Tampa, FL, USA
| | - Desiree Rivera
- Department of Pediatric
Gastroenterology, Johns Hopkins All Children’s Hospital, St. Petersburg, FL,
USA
| | - Michael Wilsey
- Morsani College of Medicine, University
of South Florida, Tampa, FL, USA
- Department of Pediatric
Gastroenterology, Johns Hopkins All Children’s Hospital, St. Petersburg, FL,
USA
| | - Sara Karjoo
- Florida State University College of
Medicine, Sarasota, FL, USA
- Morsani College of Medicine, University
of South Florida, Tampa, FL, USA
- Department of Pediatric
Gastroenterology, Johns Hopkins All Children’s Hospital, St. Petersburg, FL,
USA
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21
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Peck J, Replete N, Melquist S, Flores F, Wilsey M. Adolescent With Acute Liver Failure in the Setting of Ethanol, Cocaine, and Ecstasy Ingestion Treated With a Molecular Adsorbent Recirculating System. Cureus 2020; 12:e9699. [PMID: 32923289 PMCID: PMC7486115 DOI: 10.7759/cureus.9699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Recreational polypharmacy intoxication is a popular trend, particularly among adolescents and young adults. Acute liver failure is an uncommon complication of drug intoxication and has been described separately among patients intoxicated with ethanol, cocaine, and 3,4-methylenedioxy-methamphetamine (MDMA, ecstasy). Many patients with acute liver failure will die without liver transplant, and management of drug-induced acute liver failure is complicated by the fact that polysubstance abuse may be a contraindication for liver transplant, even among young patients. Here we report a case of acute liver failure in an adolescent male secondary to recreational intoxication with ethanol, cocaine, and ecstasy. This patient was not a candidate for liver transplantation. We describe successful treatment using a molecular adsorbent recirculating system (MARS®) or “liver dialysis” and review the literature pertaining to management options for this type of patient.
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Affiliation(s)
- Jacquelin Peck
- Anesthesiology, Mount Sinai Medical Center, Miami Beach, USA
| | - Nina Replete
- Pediatrics, Johns Hopkins All Children's Hospital, St. Petersburg, USA
| | | | - Francisco Flores
- Pediatric Gastroenterology, Cincinnati Children's Hospital Medical Center, Cincinnati, USA
| | - Michael Wilsey
- Pediatrics, University of South Florida College of Medicine, Tampa, USA.,Pediatric Gastroenterology, Johns Hopkins All Children's Hospital, St. Petersburg, USA
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22
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Khalaf RT, Ruan W, Orkin S, Wilsey M, Fishman DS, Mallon D, Pan Z, Hazleton KZ, Kramer RE, Walker T. Gastric injury secondary to button battery ingestions: a retrospective multicenter review. Gastrointest Endosc 2020; 92:276-283. [PMID: 32334020 PMCID: PMC7422336 DOI: 10.1016/j.gie.2020.04.037] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 04/08/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Removal of gastric button batteries (BBs) remains controversial. Our aim was to better define the spectrum of injury and to characterize clinical factors associated with injury from retained gastric BBs. METHODS In this multicenter retrospective cohort study from January 2014 through May 2018, pediatric gastroenterologists from 4 pediatric tertiary care centers identified patients, aged 0 to 18 years, who had a retained gastric BB on radiography and subsequently underwent endoscopic assessment. Demographic and clinical information were abstracted from electronic health records using a standard data collection form. RESULTS Sixty-eight patients with a median age of 2.5 years underwent endoscopic retrieval of a gastric BB. At presentation, 17 (25%) were symptomatic. Duration from ingestion to endoscopic removal was known for 65 patients (median, 9 hours [interquartile range, 5-19]). Median time from ingestion to first radiographic evaluation was 2 hours. At endoscopic removal, 60% of cases had visual evidence of mucosal damage, which correlated with duration of BB retention (P = .0018). Time to retrieval of the BB was not statistically significant between symptomatic and asymptomatic subjects (P = .12). After adjusting for age and symptoms, the likelihood of visualizing gastric damage among patients who had BBs removed 12 hours post ingestion was 4.5 times that compared with those with BB removal within 12 hours of ingestion. CONCLUSIONS In this study, swallowed BBs posed a risk of damage to the stomach, including a single case of impaction and perforation of the gastric wall. Clinicians may want to consider retrieval within 12 hours of ingestion of gastric BBs. Larger prospective studies to assess risk of injury are needed.
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Affiliation(s)
- Racha T. Khalaf
- Digestive Health Institute & Section of Pediatric Gastroenterology, Hepatology and Nutrition Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, CO,Corresponding Author: , Address: 13123 East 16th Avenue PO Box 290, Aurora, CO 80045, Phone: 720-777-6669, Fax: 720-777-7277
| | - Wenly Ruan
- Section of Pediatric Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine; Texas Children’s Hospital, Houston, TX, United States
| | - Sarah Orkin
- Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Michael Wilsey
- Gastroenterology, Hepatology and Nutrition, Johns Hopkins All Children’s Hospital, Saint Petersburg, FL, United States
| | - Douglas S. Fishman
- Section of Pediatric Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine; Texas Children’s Hospital, Houston, TX, United States
| | - Daniel Mallon
- Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Zhaoxing Pan
- Department of Pediatrics, University of Colorado School of Medicine, Biostatistics Core of Children’s Hospital Colorado Research Institute, Aurora, CO
| | - Keith Z. Hazleton
- Digestive Health Institute & Section of Pediatric Gastroenterology, Hepatology and Nutrition Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, CO
| | - Robert E. Kramer
- Digestive Health Institute & Section of Pediatric Gastroenterology, Hepatology and Nutrition Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, CO
| | - Thomas Walker
- Digestive Health Institute & Section of Pediatric Gastroenterology, Hepatology and Nutrition Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, CO
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23
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Peck J, Kimsey KM, Harris E, Monforte H, Wilsey M. Solitary Duodenal Ulcer Causing Biliary Obstruction Requiring Rendezvous Procedure in a Pediatric Patient With Eosinophilic Gastroenteritis. Cureus 2020; 12:e9377. [PMID: 32850245 PMCID: PMC7444993 DOI: 10.7759/cureus.9377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Eosinophilic gastroenteritis (EGE) is an uncommon disease characterized by immune cell-mediated inflammation of the gastrointestinal (GI) tract resulting in vague abdominal symptoms, most commonly nausea, vomiting, diarrhea, and abdominal pain. We report the case of a 16-year-old male presenting with a six-week history of progressive pruritus, jaundice, fatigue, abdominal pain, acholic stools, and dark-colored urine. This patient was diagnosed via endoscopy with biliary obstruction caused by a large, solitary, duodenal ulcer secondary to EGE. This is a severe complication of EGE and to our knowledge, this is the first reported case of biliary obstruction caused by a duodenal ulcer in a pediatric patient with EGE. Additionally, we describe the first pediatric combined percutaneous-endoscopic rendezvous technique after failed therapeutic endoscopic retrograde cholangiography (ERCP) to relieve the biliary obstruction.
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Affiliation(s)
- Jacquelin Peck
- Anesthesiology, Mount Sinai Medical Center, Miami Beach, USA
| | - Kathryn M Kimsey
- Gastroenterology, Johns Hopkins All Children's Hospital, St. Petersburg, USA
| | - Evan Harris
- Vascular and Interventional Radiology, Center for Vien Restoration, Glastonbury, USA
| | - Hector Monforte
- Pathology, Johns Hopkins All Children's Hospital, St. Petersburg, USA
| | - Michael Wilsey
- Gastroenterology, Johns Hopkins All Children's Hospital, St. Petersburg, USA.,Pediatrics, University of South Florida College of Medicine, Tampa, USA
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24
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Abstract
Crohn's disease (CD) is a chronic illness and radiographic evaluation is frequently used. Consequently, pediatric patients with CD who are diagnosed in childhood are at risk for high levels of radiation exposure during their lifetimes. We sought to evaluate the impact of magnetic resonance enterography (MRE) in management of pediatric patients with known or suspected Crohn's disease. A retrospective review of patients with known or suspected CD who underwent MRE for new onset of symptoms was conducted. All demographic data, clinical history, and results of all radiographic, endoscopic, and pathology studies were recorded. Twenty-eight patients with known or suspected CD underwent 31 MRE examinations. MRE showed active disease in 16 (52%), fistula or abscess in seven (22%), and no evidence of active disease in eight (26%). Sixty-five per cent of patients underwent MRE with no other radiation-based imaging used. Surgical intervention was deemed necessary after the MRE in 16 per cent. In all cases, surgical findings were consistent with MRE results. Nearly 60 per cent of patients with CD are managed based on the findings of MRE without additional radiographic evaluation. Based on the results of this retrospective study, we propose a clinical pathway for use of MRE in patients with known or suspected CD with new onset of symptoms.
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Affiliation(s)
- Cristen Litz
- Division of Pediatric Surgery, All Children's Hospital/Johns Hopkins Medicine, St. Petersburg, Florida
| | - Paul D. Danielson
- Division of Pediatric Surgery, All Children's Hospital/Johns Hopkins Medicine, St. Petersburg, Florida
| | - Michael Wilsey
- Division of Pediatric Gastroenterology, All Children's Hospital/Johns Hopkins Medicine, St. Petersburg, Florida
| | - Nicole M. Chandler
- Division of Pediatric Surgery, All Children's Hospital/Johns Hopkins Medicine, St. Petersburg, Florida
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25
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Affiliation(s)
| | | | - Michael Wilsey
- Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Sara Karjoo
- Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
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26
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Brown J, Kidder M, Fabbrini A, deVries J, Robertson J, Chandler N, Wilsey M. Down the Rabbit Hole-Considerations for Ingested Foreign Bodies. Pediatr Gastroenterol Hepatol Nutr 2019; 22:619-623. [PMID: 31777731 PMCID: PMC6856502 DOI: 10.5223/pghn.2019.22.6.619] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 08/31/2019] [Indexed: 01/08/2023] Open
Abstract
We report the case of a seven-year-old boy with an ingested foreign body, which was retained within the appendix for a known duration of ten months, ultimately requiring appendectomy. The ingested foreign body was incidentally discovered by abdominal x-ray at an emergency room visit for constipation. Despite four bowel cleanouts, subsequent x-rays showed persistence of the foreign body in the right lower quadrant. While the patient did not have signs or symptoms of acute appendicitis, laparoscopic appendectomy was performed due to the risk of this foreign body causing appendicitis in the future. A small metallic object was found within the appendix upon removal. This case highlights the unique challenge presented by foreign body ingestions in non-verbal or developmentally challenged children and the importance of further diagnostic workup when concerns arise for potential retained foreign bodies.
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Affiliation(s)
| | - Molly Kidder
- Department of Pediatrics, University of South Florida College of Medicine, Tampa, FL, USA
| | | | | | - Jason Robertson
- Department of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Nicole Chandler
- Department of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Michael Wilsey
- Department of Pediatric Gastroenterology and Nutrition, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
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Sochet AA, Son S, Ryan KS, Roddy M, Barrie E, Wilsey M, McKinley SD, Nakagawa TA. Stress ulcer prophylaxis in children with status asthmaticus receiving systemic corticosteroids: a descriptive study assessing frequency of clinically important bleeding. J Asthma 2019; 57:858-865. [PMID: 31046509 DOI: 10.1080/02770903.2019.1614617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Objective: To determine the frequency of clinically important bleeding (CIB) among children hospitalized for status asthmaticus with and without exposure to stress ulcer prophylaxis (SUP).Methods: We performed a single-center, retrospective cohort in 217 children admitted for asthma exacerbation aged 5-18 years from May 2015 to May 2017. We assessed cohorts with and without exposure to SUP to determine if differences in frequency of CIB exist. Study outcomes included frequency of CIB, gastrointestinal complications (occult bleeding, macroscopic bleeding, gastric perforation, and acquired gastritis), and SUP-related adverse events (ventilator associated pneumonia, C. difficile colitis, necrotizing enterocolitis, and acute thrombocytopenia).Results: Ninety-two (42%) children received SUP of which 82 were admitted to the pediatric intensive care unit (PICU). There were no differences in asthma severity or known risk factors for CIB in children with and without SUP in the PICU subcohort. We observed no CIB or SUP-related adverse events. Two subjects acquired gastritis in the no-SUP cohort and one additional subject experienced occult gastrointestinal bleeding with spontaneous symptom resolution.Conclusion: Children admitted for status asthmaticus with and without SUP had no observed incidence of CIB. In this specific population, we propose a prerequisite assessment for the presence of known stress ulcer related gastrointestinal bleeding risk factors prior to the blanket administration of SUP.
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Affiliation(s)
- Anthony A Sochet
- Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA.,School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Sorany Son
- Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Kelsey S Ryan
- Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA.,College of Medicine, University of South Florida, Tampa, FL, USA
| | - Meghan Roddy
- Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Eddie Barrie
- College of Medicine, University of South Florida, Tampa, FL, USA
| | - Michael Wilsey
- Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA.,School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | | | - Thomas A Nakagawa
- Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA.,School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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Peck J, Sapp K, Wilsey A, Wilsey M. Wire Guided Cannulation Facilitates Endoscopic Management of Buried Bumper Syndrome: A Novel Technique. Pediatr Gastroenterol Hepatol Nutr 2019; 22:86-89. [PMID: 30671378 PMCID: PMC6333583 DOI: 10.5223/pghn.2019.22.1.86] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/10/2018] [Accepted: 05/19/2018] [Indexed: 01/25/2023] Open
Abstract
Buried bumper syndrome is a rare but potentially severe complication of percutaneous endoscopic gastrostomy tube insertion. Though this complication is uncommon, it may lead to pressure necrosis, bleeding, perforation, peritonitis, sepsis, or death. Each case of buried bumper syndrome is unique in terms of patient comorbidities and anatomic positioning of the buried bumper. For this reason, many approaches have been described in the management of buried bumper syndrome. In this case report, we describe the case of an adolescent Caucasian female who developed buried bumper syndrome three years after undergoing percutaneous endoscopic gastrostomy insertion. We review diagnosis and management of buried bumper syndrome and describe a novel technique for bumper removal in which we use a guide wire in combination with external traction to maintain a patent gastrostomy lumen while removing the internal percutaneous endoscopic gastrostomy bumper.
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Affiliation(s)
- Jacquelin Peck
- Department of Pediatric Anesthesia, Johns Hopkins All Children's Hospital, St. Petersburg, United States
| | - Kaitlin Sapp
- Department of Pediatrics, University of South Florida Morsani College of Medicine, Tampa, United States
| | - Alexander Wilsey
- Undergraduate Education, State University, Tallahassee, United States
| | - Michael Wilsey
- Department of Pediatrics, University of South Florida Morsani College of Medicine, Tampa, United States.,Division of Pediatric Gastroenterology, Hepatology and Nutrition, Johns Hopkins All Children's Hospital, St. Petersburg, FL, United States
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29
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Khalaf RT, Green D, Amankwah EK, Peck J, Carr V, Goldenberg NA, Wilsey M. Percutaneous Endoscopic Gastrostomy Tubes May Be Associated With Preservation of Lung Function in Patients With Cystic Fibrosis. Nutr Clin Pract 2018; 34:290-296. [DOI: 10.1002/ncp.10219] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Racha T. Khalaf
- Digestive Health Institute & Section of Pediatric Gastroenterology; Hepatology and Nutrition; Children's Hospital Colorado; University of Colorado School of Medicine; Aurora Colorado USA
- Department of Medical Education; Johns Hopkins All Children's Hospital; St. Petersburg Florida USA
| | - Deanna Green
- Department of Pulmonology; Johns Hopkins All Children's Hospital; St. Petersburg Florida USA
| | - Ernest K. Amankwah
- Health Informatics; Johns Hopkins All Children's Hospital; St. Petersburg Florida USA
| | - Jacquelin Peck
- Department of Anesthesiology; Johns Hopkins All Children's Hospital; St. Petersburg Florida USA
| | - Vanessa Carr
- Department of Nutrition Services; Johns Hopkins All Children's Hospital; St. Petersburg Florida USA
- Medical Nutrition; Kate Farms, Inc; Santa Barbara California USA
| | - Neil A. Goldenberg
- Department of Hematology; Johns Hopkins All Children's Hospital; St. Petersburg Florida USA
| | - Michael Wilsey
- Department of Gastroenterology; Hepatology and Nutrition; Johns Hopkins All Children's Hospital; St. Petersburg Florida USA
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30
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Phen C, Wilsey A, Swan E, Falconer V, Summers L, Wilsey M. Non-Surgical Management of Gastroduodenal Fistula Caused by Ingested Neodymium Magnets. Pediatr Gastroenterol Hepatol Nutr 2018; 21:336-340. [PMID: 30345248 PMCID: PMC6182470 DOI: 10.5223/pghn.2018.21.4.336] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 12/03/2017] [Accepted: 01/08/2018] [Indexed: 12/25/2022] Open
Abstract
Foreign body ingestions pose a significant health risk in children. Neodymium magnets are high-powered, rare-earth magnets that is a serious issue in the pediatric population due to their strong magnetic force and high rate of complications. When multiple magnets are ingested, there is potential for morbidity and mortality, including gastrointestinal fistula formation, obstruction, bleeding, perforation, and death. Many cases require surgical intervention for removal of the magnets and management of subsequent complications. However, we report a case of multiple magnet ingestion in a 19-month-old child complicated by gastroduodenal fistula that was successfully treated by endoscopic removal and supportive care avoiding the need for surgical intervention. At two-week follow-up, the child was asymptomatic and upper gastrointestinal series obtained six months later demonstrated resolution of the fistula.
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Affiliation(s)
- Claudia Phen
- Office of Medical Education, Johns Hopkins All Children's Hospital, St. Petersburg, FL, United States.,College of Arts and Sciences, Florida State University, Tallahassee, FL, United States
| | - Alexander Wilsey
- Office of Medical Education, Johns Hopkins All Children's Hospital, St. Petersburg, FL, United States.,College of Arts and Sciences, Florida State University, Tallahassee, FL, United States
| | - Emily Swan
- College of Arts and Sciences, Florida State University, Tallahassee, FL, United States
| | - Victoria Falconer
- College of Arts and Sciences, University of Florida, Gainesville, FL, United States
| | - Lisa Summers
- Pediatric Gastroenterology, Carolines Healthcare System, Charlotte, NC, United States
| | - Michael Wilsey
- Office of Medical Education, Johns Hopkins All Children's Hospital, St. Petersburg, FL, United States
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31
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Peck J, Khalaf R, Marth R, Phen C, Sosa R, Cordero FB, Wilsey M. Endoscopic Balloon Dilation for Treatment of Congenital Antral Web. Pediatr Gastroenterol Hepatol Nutr 2018; 21:351-354. [PMID: 30345251 PMCID: PMC6182476 DOI: 10.5223/pghn.2018.21.4.351] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 01/12/2018] [Accepted: 02/14/2018] [Indexed: 11/24/2022] Open
Abstract
Congenital antral webs are a rare but relevant cause of gastric outlet obstruction in infants and children. The condition may lead to feeding refusal, vomiting, and poor growth. Due to the relative rarity of the disease, cases of congenital antral web are frequently misdiagnosed or diagnosed with significant delay as physicians favorably pursue diagnoses of pyloric stenosis and gastric ulcer disease, which are more prevalent. We report a case of an eight-month-old female who presented with persistent non-bilious emesis, feeding difficulties, and failure to thrive and was discovered to have an antral web. The web was successfully treated with endoscopic balloon dilation, which resolved her symptoms. Two years later, the patient remains asymptomatic and is thriving with weight at the 75th percentile for her age.
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Affiliation(s)
- Jacquelin Peck
- Pediatric Anesthesiology, Hepatology and Nutrition, Children's Hospital of Colorado, Denver, CO, United States
| | - Racha Khalaf
- Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital of Colorado, Denver, CO, United States
| | - Ryan Marth
- College of Arts and Science, University of South Florida St. Petersburg, St. Petersburg, FL, United States
| | - Claudia Phen
- Office of Medical Education, Johns Hopkins All Children's Hospital, St. Petersburg, FL, United States
| | - Roberto Sosa
- International Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, FL, United States
| | | | - Michael Wilsey
- Pediatric Gastroenterology, Johns Hopkins All Children's Hospital, St. Petersburg, FL, United States
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32
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Cristoforo TA, Rietsma K, Wilsey A, Swan EK, Wilsey M. Herpes Esophagitis With Concomitant Eosinophilic Esophagitis in a Child: A Case Report. Clin Pediatr (Phila) 2018; 57:618-620. [PMID: 28884583 DOI: 10.1177/0009922817730350] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 01/07/2023]
Affiliation(s)
| | | | | | | | - Michael Wilsey
- 3 Johns Hopkins All Children's Hospital, Saint Petersburg, FL, USA
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33
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Khalaf R, Karjoo S, Danielson P, Wilsey M, Shakeel F. Intestinal Hypoganglionosis Leading to Intestinal Failure and the Compassionate Use of Omegaven™. Pediatr Gastroenterol Hepatol Nutr 2017; 20:55-60. [PMID: 28401057 PMCID: PMC5385308 DOI: 10.5223/pghn.2017.20.1.55] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 03/29/2016] [Accepted: 05/07/2016] [Indexed: 11/14/2022] Open
Abstract
Intestinal hypoganglionosis is a rare innervation disorder that provides numerous nutritional, medical and surgical challenges. In this case report, we present a case of a newborn with intestinal hypoganglionosis leading to intestinal failure and intestinal failure-associated liver disease who responded to Omegaven™, a fat emulsion comprised of omega-3 fatty acids. Omegaven™ has been shown to be beneficial in the management of cholestatic liver injury. Clinical success with Omegaven™ was seen in this patient with a clear decrease in aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase and complete resolution of cholestasis with a direct bilirubin of zero within two weeks of initiation of Omegaven™. No current guidelines for the diagnosis and management of hypoganglionosis are available. We recommend a multidisciplinary approach and the use of novel therapies such as fat emulsions composed of omega-3 fatty acids for improved patient outcomes. Appropriate compassionate use protocols should be obtained from the Food and Drug Administration prior to initiation of Omegaven™.
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Affiliation(s)
- Racha Khalaf
- Department of Medical Education, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Sara Karjoo
- Department of Gatroenterology, Hepatology and Nutrition, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Paul Danielson
- Department of Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Michael Wilsey
- Department of Gatroenterology, Hepatology and Nutrition, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Fauzia Shakeel
- Department of Neonatology, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
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34
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Baldwin CL, Wilsey M. Three Year Old Male with Multiple Dieulafoy Lesions Treated with Epinephrine Injections via Therapeutic Endoscopy. Pediatr Gastroenterol Hepatol Nutr 2016; 19:276-280. [PMID: 28090473 PMCID: PMC5234423 DOI: 10.5223/pghn.2016.19.4.276] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 09/05/2016] [Accepted: 09/12/2016] [Indexed: 12/29/2022] Open
Abstract
Dieulafoy lesions, vascular anomalies typically found along the gastrointestinal tract, have been viewed as rare and obscure causes of sudden intestinal bleeding, especially in pediatric patients. Since their discovery in the late 19th century, the reported incidence has increased. This is due to an increased awareness of, and knowledge about, their presentation and to advanced endoscopic diagnosis and therapy. Our patient was a three-year-old male, without a complex medical history. He presented to the emergency department with acute hematemesis with blood clots and acute anemia requiring blood transfusion. Endoscopy revealed four isolated Dieulafoy lesions along the lesser curvature of the stomach, which were treated with an epinephrine injection. The Dieulafoy lesion, although thought to be rare, should be considered when investigating an acute gastrointestinal bleed. These lesions have been successfully treated endoscopically. Appropriate anticipation and preparation for diagnosis and therapy can lead to optimal outcomes for the pediatric patient.
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Affiliation(s)
| | - Michael Wilsey
- Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
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35
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Khalaf R, Phen C, Karjoo S, Wilsey M. Cholestasis beyond the Neonatal and Infancy Periods. Pediatr Gastroenterol Hepatol Nutr 2016; 19:1-11. [PMID: 27066444 PMCID: PMC4821977 DOI: 10.5223/pghn.2016.19.1.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 02/14/2016] [Accepted: 02/16/2016] [Indexed: 02/07/2023] Open
Abstract
Cholestasis results from impairment in the excretion of bile, which may be due to mechanical obstruction of bile flow or impairment of excretion of bile components into the bile canaliculus. When present, cholestasis warrants prompt diagnosis and treatment. The differential diagnosis of cholestasis beyond the neonatal period is broad and includes congenital and acquired etiologies. It is imperative that the clinician differentiates between intrahepatic and extrahepatic origin of cholestasis. Treatment may be supportive or curative and depends on the etiology. Recent literature shows that optimal nutritional and medical support also plays an integral role in the management of pediatric patients with chronic cholestasis. This review will provide a broad overview of the pathophysiology, diagnostic approach, and management of cholestasis beyond the neonatal and infancy periods.
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Affiliation(s)
- Racha Khalaf
- Department of Medical Education, Johns Hopkins All Children's Hospital, St. Petersburg, FL, United States
| | - Claudia Phen
- Department of Medical Education, Johns Hopkins All Children's Hospital, St. Petersburg, FL, United States
| | - Sara Karjoo
- Department of Gastroenterology and Nutrition, Johns Hopkins All Children's Hospital, St. Petersburg, FL, United States
| | - Michael Wilsey
- Department of Gastroenterology and Nutrition, Johns Hopkins All Children's Hospital, St. Petersburg, FL, United States
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36
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Litz C, Danielson PD, Wilsey M, Chandler NM. Impact of magnetic resonance imaging in management of pediatric Crohn's disease. Am Surg 2013; 79:672-675. [PMID: 23815998] [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: 06/02/2023]
Abstract
Crohn's disease (CD) is a chronic illness and radiographic evaluation is frequently used. Consequently, pediatric patients with CD who are diagnosed in childhood are at risk for high levels of radiation exposure during their lifetimes. We sought to evaluate the impact of magnetic resonance enterography (MRE) in management of pediatric patients with known or suspected Crohn's disease. A retrospective review of patients with known or suspected CD who underwent MRE for new onset of symptoms was conducted. All demographic data, clinical history, and results of all radiographic, endoscopic, and pathology studies were recorded. Twenty-eight patients with known or suspected CD underwent 31 MRE examinations. MRE showed active disease in 16 (52%), fistula or abscess in seven (22%), and no evidence of active disease in eight (26%). Sixty-five per cent of patients underwent MRE with no other radiation-based imaging used. Surgical intervention was deemed necessary after the MRE in 16 per cent. In all cases, surgical findings were consistent with MRE results. Nearly 60 per cent of patients with CD are managed based on the findings of MRE without additional radiographic evaluation. Based on the results of this retrospective study, we propose a clinical pathway for use of MRE in patients with known or suspected CD with new onset of symptoms.
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Affiliation(s)
- Cristen Litz
- Division of Pediatric Surgery, All Children's Hospital/Johns Hopkins Medicine, St. Petersburg, Florida 33705, USA
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37
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Irizarry K, Honigbaum S, Demmler-Harrison G, Rippel S, Wilsey M. Successful treatment with oral valganciclovir of primary CMV enterocolitis in a congenitally infected infant. Fetal Pediatr Pathol 2011; 30:437-41. [PMID: 21905765 DOI: 10.3109/15513815.2011.587501] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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: 11/13/2022]
Abstract
Cytomegalovirus (CMV) is the most common congenitally acquired viral infection in the United States and is associated with significant morbidity and mortality. Primary CMV enterocolitis is well documented in immunocompromised patients, but remains rare in congenitally acquired infections. There are no universally accepted recommendations for the treatment of CMV enterocolitis in the pediatric population. Case reports show varied dosing and length of treatment of either intravenously administered ganciclovir, orally administered valganciclovir, or a combination of both. We present a congenitally infected infant with primary CMV enterocolitis who was successfully treated with orally administered valganciclovir.
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Affiliation(s)
- Karina Irizarry
- Department of Pediatrics, University of South Florida, Tampa, Florida 33620, USA
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38
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Perrin JH, Chan P, Wilsey M. Evaluation of an inert, highly protein bound material as a parenteral excipient. Bull Parenter Drug Assoc 1972; 26:182-92. [PMID: 5041144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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