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Robles-Medranda C, Alcivar-Vasquez J, Raijman I, Kahaleh M, Puga-Tejada M, Del Valle R, Alvarado H, Cifuentes-Gordillo C, Binmoeller KF, Baptista AJ, Barreto-Perez J, Rodriguez J, Egas-Izquierdo M, Cunto D, Calle-Loffredo D, Lukashok H, Baquerizo-Burgos J, Tabacelia D. Accurate and safe diagnosis and treatment of neoplastic biliary lesions using a novel 9F and 11F digital single-operator cholangioscope. Endosc Int Open 2024; 12:E498-E506. [PMID: 38585021 PMCID: PMC10997424 DOI: 10.1055/a-2282-6678] [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: 09/11/2023] [Accepted: 02/15/2024] [Indexed: 04/09/2024] Open
Abstract
Background and study aims Digital single-operator cholangioscopy (DSOC) allows the diagnosis of biliary duct disorders and treatment for complicated stones. However, these technologies have limitations such as the size of the probe and working channel, excessive cost, and low image resolution. Recently, a novel DSOC system (eyeMAX, Micro-Tech, Nanjing, China) was developed to address these limitations. We aimed to evaluate the usefulness and safety of a novel 9F and 11F DSOC system in terms of neoplastic diagnostic accuracy based on visual examination, ability to evaluate tumor extension and to achieve complete biliary stone clearance, and procedure-related adverse events (AEs). Patients and methods Data from ≥ 18-year-old patients who underwent DSOC from July 2021 to April 2022 were retrospectively recovered and divided into a diagnostic and a therapeutic cohort. Results A total of 80 patients were included. In the diagnostic cohort (n = 49/80), neovascularity was identified in 26 of 49 patients (46.9%). Biopsy was performed in 65.3% patients with adequate tissue sample obtained in 96.8% of cases. Biopsy confirmed neoplasia in 23 of 32 cases. DSOC visual impression achieved 91.6% sensitivity and 87.5% specificity in diagnosing neoplasms. In the therapeutic cohort (n = 43/80), 26 of 43 patients required lithotripsy alone. Total stone removal was achieved in 71% patients in the first session. Neither early nor late AEs were documented in either the diagnostic or therapeutic cohort. Conclusions The novel DSOC device has excellent diagnostic accuracy in distinguishing neoplastic biliary lesions as well as therapeutic benefits in the context of total stone removal, with no documented AEs.
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Affiliation(s)
- Carlos Robles-Medranda
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas - IECED, Guayaquil, Ecuador
| | - Juan Alcivar-Vasquez
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas - IECED, Guayaquil, Ecuador
| | - Isaac Raijman
- Gastroenterology, Digestive Associates of Houston, Houston, United States
| | - Michel Kahaleh
- Gastroenterology, Robert Wood Johnson Medical School, New Brunswick, United States
| | - Miguel Puga-Tejada
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas - IECED, Guayaquil, Ecuador
| | - Raquel Del Valle
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas - IECED, Guayaquil, Ecuador
| | - Haydee Alvarado
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas - IECED, Guayaquil, Ecuador
| | | | | | | | - Jonathan Barreto-Perez
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas - IECED, Guayaquil, Ecuador
| | - Jorge Rodriguez
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas - IECED, Guayaquil, Ecuador
| | - Maria Egas-Izquierdo
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas - IECED, Guayaquil, Ecuador
| | - Domenica Cunto
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas - IECED, Guayaquil, Ecuador
| | - Daniel Calle-Loffredo
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas - IECED, Guayaquil, Ecuador
| | - Hannah Lukashok
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas - IECED, Guayaquil, Ecuador
| | - Jorge Baquerizo-Burgos
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas - IECED, Guayaquil, Ecuador
| | - Daniela Tabacelia
- Gastroenterology, Elias Emergency University Hospital, Bucuresti, Romania
- Gastroenterology, Carol Davila University of Medicine and Pharmacy, Bucuresti, Romania
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Kim M, Parekh D, Kahaleh M. Ablation Therapy of the Biliary Tree: Status and Comprehensive Review. J Clin Gastroenterol 2024; 58:317-323. [PMID: 38252680 DOI: 10.1097/mcg.0000000000001965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 12/13/2023] [Indexed: 01/24/2024]
Abstract
Malignant biliary obstruction is typically referred to endoscopists for palliation. A curative resection is indeed rarely an option in this condition. Photodynamic therapy and radiofrequency ablation are 2 modalities that can be offered in those patients. Many studies have demonstrated improved stent patency and survival after ablation. Photodynamic therapy is unfortunately very expensive and is associated with photosensitivity; however, it transmits to the entire biliary tree. Radiofrequency ablation is more affordable and easier to apply but requires contact with the tumor to be efficient. This review explores both modalities in terms of their safety and efficacy for bile duct cancer palliation.
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Affiliation(s)
- Marina Kim
- University of Massachusetts, Worcester, MA
| | - Darshan Parekh
- Thane Institute of Gastroenterology, Thane, Maharashtra, India
| | - Michel Kahaleh
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
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Mitsuhashi S, Kamal F, Shinn BJ, Chalikonda D, Tyberg A, Shahid H, Sarkar A, Kahaleh M, Chiang A, Kumar A, Schlachterman A, Loren D, Kowalski T. Colonic-enteric lumen-apposing metal stents: a promising and safe alternative for endoscopic management of small-bowel obstruction. Gastrointest Endosc 2024; 99:606-613. [PMID: 37951278 DOI: 10.1016/j.gie.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/03/2023] [Accepted: 11/06/2023] [Indexed: 11/13/2023]
Abstract
BACKGROUND AND AIMS Lumen-apposing metal stents (LAMSs) have revolutionized the treatment of various gastroenterologic conditions that previously required surgery. The use of LAMSs for the management of small-bowel obstruction (SBO) involves EUS-guided coloenterostomy (EUS-CE) between the colon and a dilated loop of the small intestine proximal to the point of obstruction. This procedure is potentially beneficial for patients with malignant SBO who are poor surgical candidates. METHODS A retrospective cohort study was conducted at 2 tertiary care hospitals. Patients who underwent EUS-CE for SBO were identified, and data regarding patient demographics, indication for the procedure, location of the obstruction, procedural details, and adverse events were collected. The primary outcome was technical success of the procedure. Secondary outcomes were clinical success, resolution of symptoms, ability to tolerate enteral nutrition, and adverse events. RESULTS Twenty-six patients who underwent the EUS-CE procedure were included. Technical success was achieved in all 26 patients, clinical success (resolution of obstructive symptoms) was achieved in 92.3% of patients (24/26), and the ability to resume enteral nutrition in 84.6% (22/26). Adverse events occurred in 4 patients (15.4%) and included bleeding (1/26), diarrhea (2/26), and postprocedure sepsis (1/26). Patients were followed for a mean of 54.8 days (range, 2-190). CONCLUSIONS This study highlights that EUS-CE with LAMSs can be performed with high technical and clinical success for the management of SBO, particularly in patients with malignant obstructions who are not suitable candidates for surgical interventions. Further research with larger sample sizes will be essential to substantiate its efficacy and safety.
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Affiliation(s)
- Shuji Mitsuhashi
- Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Faisal Kamal
- Department of Medicine, Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Brianna J Shinn
- Department of Medicine, Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Divya Chalikonda
- Department of Medicine, Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Amy Tyberg
- Department of Medicine, Division of Gastroenterology and Hepatology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Haroon Shahid
- Department of Medicine, Division of Gastroenterology and Hepatology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Avik Sarkar
- Department of Medicine, Division of Gastroenterology and Hepatology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Michel Kahaleh
- Department of Medicine, Division of Gastroenterology and Hepatology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Austin Chiang
- Department of Medicine, Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Anand Kumar
- Department of Medicine, Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Alex Schlachterman
- Department of Medicine, Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - David Loren
- Department of Medicine, Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Thomas Kowalski
- Department of Medicine, Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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Badaoui A, Teles de Campos S, Fusaroli P, Gincul R, Kahaleh M, Poley JW, Sosa Valencia L, Czako L, Gines A, Hucl T, Kalaitzakis E, Petrone MC, Sadik R, van Driel L, Vandeputte L, Tham T. Curriculum for diagnostic endoscopic ultrasound training in Europe: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 2024; 56:222-240. [PMID: 38065561 DOI: 10.1055/a-2224-8704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
The European Society of Gastrointestinal Endoscopy (ESGE) has recognized the need to formalize and enhance training in diagnostic endoscopic ultrasound (EUS). This manuscript represents the outcome of a formal Delphi process resulting in an official Position Statement of the ESGE and provides a framework to develop and maintain skills in diagnostic EUS. This curriculum is set out in terms of the prerequisites prior to training; the recommended steps of training to a defined syllabus; the quality of training; and how competence should be defined and evidenced before independent practice. 1: Trainees should have achieved competence in upper gastrointestinal endoscopy before training in diagnostic EUS. 2: The development of diagnostic EUS skills by methods that do not involve patients is advisable, but not mandatory, prior to commencing formal training in diagnostic EUS. 3: A trainee's principal trainer should be performing adequate volumes of diagnostic EUSs to demonstrate maintenance of their own competence. 4: Training centers for diagnostic EUS should offer expertise, as well as a high volume of procedures per year, to ensure an optimal level of quality for training. Under these conditions, training centers should be able to provide trainees with a sufficient wealth of experience in diagnostic EUS for at least 12 months. 5: Trainees should engage in formal training and supplement this with a range of learning resources for diagnostic EUS, including EUS-guided fine-needle aspiration and biopsy (FNA/FNB). 6: EUS training should follow a structured syllabus to guide the learning program. 7: A minimum procedure volume should be offered to trainees during diagnostic EUS training to ensure that they have the opportunity to achieve competence in the technique. To evaluate competence in diagnostic EUS, trainees should have completed a minimum of 250 supervised EUS procedures: 80 for luminal tumors, 20 for subepithelial lesions, and 150 for pancreaticobiliary lesions. At least 75 EUS-FNA/FNBs should be performed, including mostly pancreaticobiliary lesions. 8: Competence assessment in diagnostic EUS should take into consideration not only technical skills, but also cognitive and integrative skills. A reliable valid assessment tool should be used regularly during diagnostic EUS training to track the acquisition of competence and to support trainee feedback. 9: A period of supervised practice should follow the start of independent activity. Supervision can be delivered either on site if other colleagues are already practicing EUS or by maintaining contacts with the training center and/or other EUS experts. 10: Key performance measures including the annual number of procedures, frequency of obtaining a diagnostic sample during EUS-FNA/FNB, and adverse events should be recorded within an electronic documentation system and evaluated.
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Affiliation(s)
- Abdenor Badaoui
- Department of Gastroenterology and Hepatology, CHU UCL NAMUR, Université catholique de Louvain, Yvoir, Belgium
| | - Sara Teles de Campos
- Department of Gastroenterology, Digestive Unit, Champalimaud Foundation, Lisbon, Portugal
| | - Pietro Fusaroli
- Unit of Gastroenterology, University of Bologna, Hospital of Imola, Imola, Italy
| | - Rodica Gincul
- Department of Gastroenterology, Jean Mermoz Private Hospital, Lyon, France
| | - Michel Kahaleh
- Division of Gastroenterology, Rutgers University, New Brunswick, New Jersey, USA
| | - Jan-Werner Poley
- Department of Gastroenterology and Hepatology, Maastricht UMC+, Maastricht, The Netherlands
| | - Leonardo Sosa Valencia
- IHU Strasbourg - Institute of Image-Guided Surgery - Université de Strasbourg, Strasbourg, France
| | - Laszlo Czako
- Division of Gastroenterology, Department of Medicine, University of Szeged, Szeged, Hungary
| | - Angels Gines
- Endoscopy Unit, Gastroenterology Department, ICMDM, Hospital Clínic, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Tomas Hucl
- Department of Gastroenterology and Hepatology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Evangelos Kalaitzakis
- Department of Gastroenterology, University Hospital of Heraklion, University of Crete, Heraklion, Greece
| | - Maria Chiara Petrone
- Division of Pancreatobiliary Endoscopy and Endosonography, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Riadh Sadik
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
| | - Lydi van Driel
- Department of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, The Netherlands
| | - Lieven Vandeputte
- Department of Gastroenterology and Hepatology, AZ Sint-Jan Brugge-Oostende AV, Bruges, Belgium
| | - Tony Tham
- Department of Gastroenterology and Hepatology, Ulster Hospital, Dundonald, Northern Ireland
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Fugazza A, Colombo M, Kahaleh M, Muthusamy VR, Benjamin B, Laleman W, Barbera C, Fabbri C, Nieto J, Al-Lehibi A, Ramchandani M, Tyberg A, Shahid H, Sarkar A, Ehrlich D, Sherman S, Binda C, Spadaccini M, Iannone A, Khalaf K, Reddy N, Anderloni A, Repici A. The outcomes and safety of patients undergoing endoscopic retrograde cholangiopancreatography combining a single-use cholangioscope and a single-use duodenoscope: A multicenter retrospective international study. Hepatobiliary Pancreat Dis Int 2024; 23:71-76. [PMID: 37100688 DOI: 10.1016/j.hbpd.2023.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 04/06/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Duodenoscope-related multidrug-resistant organism (MDRO) infections raise concerns. Disposable duodenoscopes have been recently introduced in the market and approved by regulatory agencies with the aim to reduce the risk of endoscopic retrograde cholangiopancreatography (ERCP) associated infections. The aim of this study was to evaluate the outcome of procedures performed with single-use duodenoscopes in patients with clinical indications to single-operator cholangiopancreatoscopy. METHODS This is a multicenter international, retrospective study combining all patients who underwent complex biliopancreatic interventions using the combination of a single-use duodenoscope and a single-use cholangioscope. The primary outcome was technical success defined as ERCP completion for the intended clinical indication. Secondary outcomes were procedural duration, rate of cross-over to reusable duodenoscope, operator-reported satisfaction score (1 to 10) on performance rating of the single-use duodenoscope, and adverse event (AE) rate. RESULTS A total of 66 patients (26, 39.4% female) were included in the study. ERCP was categorized according to ASGE ERCP grading system as 47 (71.2%) grade 3 and 19 (28.8%) grade 4. The technical success rate was 98.5% (65/66). Procedural duration was 64 (interquartile range 15-189) min, cross-over rate to reusable duodenoscope was 1/66 (1.5%). The satisfaction score of the single-use duodenoscope classified by the operators was 8.6 ± 1.3 points. Four patients (6.1%) experienced AEs not directly related to the single-use duodenoscope, namely 2 post-ERCP pancreatitis (PEP), 1 cholangitis and 1 bleeding. CONCLUSIONS Single-use duodenoscope is effective, reliable and safe even in technically challenging procedures with a non-inferiority to reusable duodenoscope, making these devices a viable alternative to standard reusable equipment.
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Affiliation(s)
- Alessandro Fugazza
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital - IRCCS, Via Manzoni 56, 20089, Rozzano, Milano, Italy.
| | - Matteo Colombo
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital - IRCCS, Via Manzoni 56, 20089, Rozzano, Milano, Italy
| | - Michel Kahaleh
- Gastroenterology, Rutgers Robert Wood Johnson; New Brunswick, New Jersey, USA
| | - V Raman Muthusamy
- Vatche and Tamar Manoukian Division of Digestive Diseases, University of California, Los Angeles School of Medicine at UCLA, Los Angeles, California, USA
| | - Bick Benjamin
- Division of Digestive and Liver Disorders; Indiana University School of Medicine, Indianapolis, IN, USA
| | - Wim Laleman
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, 3000 Leuven, Belgium
| | - Carmelo Barbera
- U.O.C. di Gastroenterologia ed Endoscopia Digestiva, Ospedale Giuseppe Mazzini, ASL Teramo, Italy
| | - Carlo Fabbri
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena, Italy
| | - Jose Nieto
- Borland Groover Clinic, Jacksonville, Florida, USA
| | - Abed Al-Lehibi
- Department of Gastroenterology and Hepatology, King Fahad Medical City, Riyadh, Saudi Arabia
| | | | - Amy Tyberg
- Gastroenterology, Rutgers Robert Wood Johnson; New Brunswick, New Jersey, USA
| | - Haroon Shahid
- Gastroenterology, Rutgers Robert Wood Johnson; New Brunswick, New Jersey, USA
| | - Avik Sarkar
- Gastroenterology, Rutgers Robert Wood Johnson; New Brunswick, New Jersey, USA
| | - Dean Ehrlich
- Vatche and Tamar Manoukian Division of Digestive Diseases, University of California, Los Angeles School of Medicine at UCLA, Los Angeles, California, USA
| | - Stuart Sherman
- Division of Digestive and Liver Disorders; Indiana University School of Medicine, Indianapolis, IN, USA
| | - Cecilia Binda
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena, Italy
| | - Marco Spadaccini
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital - IRCCS, Via Manzoni 56, 20089, Rozzano, Milano, Italy
| | - Andrea Iannone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy
| | - Kareem Khalaf
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
| | | | - Andrea Anderloni
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital - IRCCS, Via Manzoni 56, 20089, Rozzano, Milano, Italy
| | - Alessandro Repici
- Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital - IRCCS, Via Manzoni 56, 20089, Rozzano, Milano, Italy; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
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6
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Elfert K, Malik M, Aboursheid T, Mohamed M, Elfert Y, Beran A, Jaber F, Elromisy E, Al-Taee A, Kahaleh M. Impact of COVID-19 infection on patients admitted with nonvariceal upper gastrointestinal bleeding: an analysis from the National Inpatient Sample. Proc AMIA Symp 2023; 37:36-41. [PMID: 38174004 PMCID: PMC10761015 DOI: 10.1080/08998280.2023.2260280] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 09/07/2023] [Indexed: 01/05/2024] Open
Abstract
Background Nonvariceal upper gastrointestinal bleeding (NVUGIB) is a medical emergency that has significant morbidity and mortality. The available data about the impact of COVID-19 infection on mortality in patients with NVUGIB is limited. Methods We identified all hospitalizations with a principal diagnosis of NVUGIB in 2020. The baseline characteristics and clinical outcomes of patients with COVID-19 infection were compared to those without COVID-19 infection. Results NVUGIB patients with COVID-19 infection had higher mortality (5% vs 2%, P < 0.0001), a longer mean length of stay (6.85 vs 4.48 days, P < 0.0001), and a lower rate of esophagogastroduodenoscopy utilization (40% vs 51%, P < 0.0001) than those without COVID-19 infection. Multivariate logistic regression analysis showed that COVID-19 infection was associated with a higher mortality rate (odds ratio 2.2, 95% confidence interval, 1.4-3.4). Conclusions COVID-19 infection is an independent predictor of mortality in adults hospitalized with NVUGIB.
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Affiliation(s)
- Khaled Elfert
- Department of Internal Medicine, SBH Health System, New York, New York, USA
| | - Mushrin Malik
- Department of Internal Medicine, SBH Health System, New York, New York, USA
| | - Tarek Aboursheid
- Department of Internal Medicine, Ascension Saint Francis Hospital, Evanston, Illinois, USA
| | - Mouhand Mohamed
- Department of Internal Medicine, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Yomna Elfert
- Department of Pediatrics, UH Cleveland Medical Center, Cleveland, Ohio, USA
| | - Azizullah Beran
- Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, Indiana, USA
| | - Fouad Jaber
- Department of Internal Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Esraa Elromisy
- Tanta University Faculty of Medicine, Tanta, Gharbiyah, Egypt
| | - Ahmad Al-Taee
- Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Urbana, Illinois, USA
| | - Michel Kahaleh
- Division of Gastroenterology, Department of Medicine, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
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7
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Shah-Khan SM, Elfert K, Sarkar A, Shahid H, Tyberg A, Kahaleh M. Tips and tricks for endoscopic ultrasound-guided hepaticogastrostomy. Endoscopy 2023; 55:E643-E644. [PMID: 37084779 PMCID: PMC10121325 DOI: 10.1055/a-2057-0460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
Affiliation(s)
- Sardar M Shah-Khan
- Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, United States
| | - Khaled Elfert
- Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, United States
| | - Avik Sarkar
- Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, United States
| | - Haroon Shahid
- Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, United States
| | - Amy Tyberg
- Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, United States
| | - Michel Kahaleh
- Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, United States
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8
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Tyberg A, Sarkar A, Shahid HM, Shah-Khan SM, Gaidhane M, Simon A, Eisenberg IA, Lajin M, Karagyozov P, Liao K, Patel R, Zhao E, Martínez MG, Artifon EL, Lino AD, Vanella G, Arcidiacono PG, Kahaleh M. EUS-Guided Biliary Drainage Versus ERCP in Malignant Biliary Obstruction Before Hepatobiliary Surgery: An International Multicenter Comparative Study. J Clin Gastroenterol 2023; 57:962-966. [PMID: 36730114 DOI: 10.1097/mcg.0000000000001795] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 10/07/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Endoscopic ultrasound-guided biliary drainage (EUS-BD) is the procedure of choice for patients who cannot undergo endoscopic retrograde cholangiopancreatography (ERCP). The outcomes of patients undergoing surgery after EUS-BD for malignancy are unknown. METHODS We conducted an international, multicenter retrospective comparative study of patients who underwent hepatobiliary surgery after having undergone EUS-BD or ERCP from 6 tertiary care centers. Patient demographics, procedural data, and follow-up care were collected in a registry. RESULTS One hundred forty-five patients were included: EUS-BD n=58 (mean age 66, 45% male), ERCP n=87 (mean age 68, 53% male). The majority of patients had pancreatic cancer, cholangiocarcinoma, or gallbladder malignancy. In the EUS-BD group, 29 patients had hepaticogastrostomy, 24 had choledochoduodenostomy, and 5 had rendezvous technique done. The most common surgery was Whipple in both groups (n=41 EUS-BD, n=56 ERCP) followed by partial hepatectomy (n=7 EUS-BD, n=14 ERCP) and cholecystectomy (n=2 EUS-BD, n=2 ERCP). Endoscopy clinical success was comparable in both groups (98% EUS-BD, 94% ERCP). Adverse event rates were similar in both groups: EUS-BD (n=10, 17%) and ERCP (n=23, 26%). Surgery technical success and clinical success were significantly higher in the EUS-BD group compared with the ERCP group (97% vs. 83%, 97% vs. 75%). Total Hospital stay from surgery to discharge was significantly higher in the ERCP group (19 d vs. 10 d, P =0.0082). DISCUSSION Undergoing EUS-BD versus ERCP before hepatobiliary surgery is associated with fewer repeat endoscopic interventions, shorter duration between endoscopy and surgical intervention, higher rates of surgical clinical success, and shorter length of hospital stay after surgery.
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Affiliation(s)
- Amy Tyberg
- Gastroenterology, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Avik Sarkar
- Gastroenterology, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Haroon M Shahid
- Gastroenterology, Robert Wood Johnson Medical School, New Brunswick, NJ
| | | | - Monica Gaidhane
- Gastroenterology, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Alexa Simon
- Gastroenterology, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Ian A Eisenberg
- Gastroenterology, Robert Wood Johnson Medical School, New Brunswick, NJ
| | | | | | - Kelvin Liao
- Gastroenterology, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Roohi Patel
- Gastroenterology, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Eric Zhao
- Gastroenterology, Robert Wood Johnson Medical School, New Brunswick, NJ
| | | | | | - André D Lino
- Universidade de Sao Paulo Faculdade de Medicina, Sao Paulo, Brazil
| | | | | | - Michel Kahaleh
- Gastroenterology, Robert Wood Johnson Medical School, New Brunswick, NJ
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9
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Shahid HM, Bareket R, Tyberg A, Sarkar A, Simon A, Gurram K, Gress FG, Bhenswala P, Chalikonda D, Loren DE, Kowalski TE, Kumar A, Vareedayah AA, Abhyankar PR, Parker K, Gabr MM, Nieto J, De Latour R, Zolotarevsky M, Barber J, Zolotarevsky E, Vazquez-Sequeiros E, Gaidhane M, Andalib I, Kahaleh M. Comparing the Safety and Efficacy of Two Commercially Available Single-Use Duodenoscopes: A Multicenter Study. J Clin Gastroenterol 2023; 57:798-803. [PMID: 35997700 DOI: 10.1097/mcg.0000000000001752] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 07/07/2022] [Indexed: 12/10/2022]
Abstract
INTRODUCTION Single-use disposable duodenoscopes (SDD) have been developed to mitigate infectious risks related to reusable duodenoscopes. The aim of this study is to compare the safety and efficacy of the two available SDDs in the United States. METHODS We conducted a comparative study of 2 SDD in consecutive ERCP procedures performed by expert endoscopists from 9 academic centers. Performance ratings, procedure details, and adverse events were collected. RESULTS A total of 201 patients were included: 129 patients underwent ERCP with Exalt (mean age 63, Males- 66 (51%), 72 with aScope Duodeno (mean age 65, males=30 (42%). A majority of endoscopists had performed >2000 ERCPs in both groups (71% Exalt, 93% aScope Duodeno). Technical success was 92% in both groups (n=119 Exalt-group, n=66 aScope-Duodeno-group). The procedural complexity for the ERCP cases performed were: Grade 1: 35 cases (18%), Grade 2: 83 cases (41%), Grade 3: 65 cases (32%), and Grade 4: 18 cases (9%). Thirteen patients (10%) from the Exalt group and 16 patients (22%) from the aScope Duodeno group required conversion to a reusable duodenoscope. On a scale of 1 to 5, Exalt and aScope Duodeno, respectively, were rated: 2.31 versus 2.60 for location and visualization quality, 1.38 versus 1.57 for maneuverability based on papillary orientation, 1.48 versus 1.15 for suction/air control, and 2.31 versus 2.34 for elevator efficiency. None of the adverse events were related to the SDDs. CONCLUSIONS The 2 SDDs were comparable. Further ongoing enhancements to these devices will improve maneuverability and clinical effectiveness.
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Affiliation(s)
- Haroon M Shahid
- Endoscopy, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Romy Bareket
- Endoscopy, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Amy Tyberg
- Endoscopy, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Avik Sarkar
- Endoscopy, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Alexa Simon
- Endoscopy, Robert Wood Johnson Medical School, New Brunswick, NJ
| | | | | | | | | | | | | | - Anand Kumar
- Thomas Jefferson University, Philadelphia, PA
| | | | | | | | | | - Jose Nieto
- Borland Groover Clinic, Jacksonville, FL
| | | | | | | | | | | | - Monica Gaidhane
- Endoscopy, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Iman Andalib
- Elmhurst Mount Sinai, Icahn School of Medicine New York
| | - Michel Kahaleh
- Endoscopy, Robert Wood Johnson Medical School, New Brunswick, NJ
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10
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Kahaleh M, Tyberg A, Sameera S, Sarkar A, Shahid HM, Abdelqader A, Gjeorgjievski M, Gaidhane M, Muniraj T, Jamidar PA, Aslanian HR, Abraham M, Lajin M, Kedia P, Nieto J, Parsa N, Andalib I, Bashir M, Kowalski TE, Loren DE, Kumar A, Schlachterman A, Chiang A, Holmes I, Mendoza Ladd AH, Oleas R, Zolotarevsky E, Robles-Medranda C, Barthet M. EUS-guided Gastroenterostomy: A Multicenter International Study Comparing Benign and Malignant Diseases. J Clin Gastroenterol 2023:00004836-990000000-00204. [PMID: 37646532 DOI: 10.1097/mcg.0000000000001903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 07/14/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Endoscopic ultrasound (EUS)-guided gastroenterostomy (EUS-GE) is a minimally invasive therapy for patients with gastric outlet obstruction without the risks of surgical bypass and the limited long-term efficacy of enteral self-expanding metal stent placement. However, due to its novelty, there is a lack of significant data comparing long-term outcomes of patients with EUS-GE, based on the underlying disease. In this study, we compare outcomes of EUS-GE on benign versus malignant indications. METHODS Consecutive patients from 12 international, tertiary care centers who underwent EUS-GE over 3 years were extracted in a retrospective registry. Demographic characteristics, procedure-related information and follow-up data was collected. Primary outcome was the rate of adverse events associated with EUS-GE and the comparison of the rate of adverse events in benign versus malignant diseases. Secondary outcomes included technical and clinical success as well as hospitalization admission. RESULTS A total of 103 patients were included: 72 malignant and 31 benign. The characteristics of the patients undergoing EUS-GE is shown in Table 1. The mean age of the cohort was 68 years and 58 years for malignant and benign etiology. Gender distribution was 57% and 39% being females in malignant and benign etiology group, respectively. Clinical success, technical success, average procedure time, and hospital length of stay were similar in both groups. Patients with benign underlying etiology had significantly higher number of surgically altered midgut anatomy (P=0.0379). CONCLUSION EUS-GE is equally efficient regardless of the underlying etiology (malignant vs. benign), and the adverse events both groups were comparable.
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Affiliation(s)
- Michel Kahaleh
- Department of Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Amy Tyberg
- Department of Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Sohini Sameera
- Department of Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Avik Sarkar
- Department of Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Haroon M Shahid
- Department of Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Abdelhai Abdelqader
- Department of Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Mihajlo Gjeorgjievski
- Department of Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Monica Gaidhane
- Department of Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, NJ
| | | | | | | | - Mathew Abraham
- Penn State Health Milton S. Hershey Medical Center, Hershey, PA
| | | | | | - Jose Nieto
- Borland Groover Clinic, PA, Jacksonville, FL
| | | | - Iman Andalib
- South Nassau Communities Hospital, Oceanside, NY
| | | | | | | | - Anand Kumar
- Thomas Jefferson University, Philadelphia, PA
| | | | | | - Ian Holmes
- Thomas Jefferson University, Philadelphia, PA
| | | | - Roberto Oleas
- Ecuadorian Institute of Digestive Diseases (IECED), Guayaquil, Guayas, Ecuador
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11
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Robles-Medranda C, Baquerizo-Burgos J, Alcivar-Vasquez J, Kahaleh M, Raijman I, Kunda R, Puga-Tejada M, Egas-Izquierdo M, Arevalo-Mora M, Mendez JC, Tyberg A, Sarkar A, Shahid H, del Valle-Zavala R, Rodriguez J, Merfea RC, Barreto-Perez J, Saldaña-Pazmiño G, Calle-Loffredo D, Alvarado H, Lukashok HP. Artificial intelligence for diagnosing neoplasia on digital cholangioscopy: development and multicenter validation of a convolutional neural network model. Endoscopy 2023; 55:719-727. [PMID: 36781156 PMCID: PMC10374349 DOI: 10.1055/a-2034-3803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 02/13/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND We aimed to develop a convolutional neural network (CNN) model for detecting neoplastic lesions during real-time digital single-operator cholangioscopy (DSOC) and to clinically validate the model through comparisons with DSOC expert and nonexpert endoscopists. METHODS In this two-stage study, we first developed and validated CNN1. Then, we performed a multicenter diagnostic trial to compare four DSOC experts and nonexperts against an improved model (CNN2). Lesions were classified into neoplastic and non-neoplastic in accordance with Carlos Robles-Medranda (CRM) and Mendoza disaggregated criteria. The final diagnosis of neoplasia was based on histopathology and 12-month follow-up outcomes. RESULTS In stage I, CNN2 achieved a mean average precision of 0.88, an intersection over the union value of 83.24 %, and a total loss of 0.0975. For clinical validation, a total of 170 videos from newly included patients were analyzed with the CNN2. Half of cases (50 %) had neoplastic lesions. This model achieved significant accuracy values for neoplastic diagnosis, with a 90.5 % sensitivity, 68.2 % specificity, and 74.0 % and 87.8 % positive and negative predictive values, respectively. The CNN2 model outperformed nonexpert #2 (area under the receiver operating characteristic curve [AUC]-CRM 0.657 vs. AUC-CNN2 0.794, P < 0.05; AUC-Mendoza 0.582 vs. AUC-CNN2 0.794, P < 0.05), nonexpert #4 (AUC-CRM 0.683 vs. AUC-CNN2 0.791, P < 0.05), and expert #4 (AUC-CRM 0.755 vs. AUC-CNN2 0.848, P < 0.05; AUC-Mendoza 0.753 vs. AUC-CNN2 0.848, P < 0.05). CONCLUSIONS The proposed CNN model distinguished neoplastic bile duct lesions with good accuracy and outperformed two nonexpert and one expert endoscopist.
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Affiliation(s)
- Carlos Robles-Medranda
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
| | - Jorge Baquerizo-Burgos
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
| | - Juan Alcivar-Vasquez
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
| | - Michel Kahaleh
- Gastroenterology, Robert Wood Johnson Medical School Rutgers University, New Brunswick, New Jersey, United States
| | - Isaac Raijman
- Houston Methodist Hospital, Houston, Texas, United States
- Baylor Saint Luke’s Medical Center, Houston, Texas, United States
| | - Rastislav Kunda
- Department of Advanced Interventional Endoscopy, Universitair Ziekenhuis Brussel (UZB)/Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Miguel Puga-Tejada
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
| | - Maria Egas-Izquierdo
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
| | - Martha Arevalo-Mora
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
| | - Juan C. Mendez
- mdconsgroup, Artificial Intelligence Department, Guayaquil, Ecuador
| | - Amy Tyberg
- Gastroenterology, Robert Wood Johnson Medical School Rutgers University, New Brunswick, New Jersey, United States
| | - Avik Sarkar
- Gastroenterology, Robert Wood Johnson Medical School Rutgers University, New Brunswick, New Jersey, United States
| | - Haroon Shahid
- Gastroenterology, Robert Wood Johnson Medical School Rutgers University, New Brunswick, New Jersey, United States
| | - Raquel del Valle-Zavala
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
| | - Jorge Rodriguez
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
| | - Ruxandra C. Merfea
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
| | - Jonathan Barreto-Perez
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
| | | | - Daniel Calle-Loffredo
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
| | - Haydee Alvarado
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
| | - Hannah P. Lukashok
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
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12
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Eisenberg I, Gaidhane M, Kahaleh M, Tyberg A. Drainage Approach for Malignant Biliary Obstruction: A Changing Paradigm. J Clin Gastroenterol 2023; 57:546-552. [PMID: 37079870 DOI: 10.1097/mcg.0000000000001854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) is the standard of care in the management of unresectable malignant biliary obstruction. However, endoscopic ultrasound (EUS)-guided biliary drainage has become widely accepted over the past several years for complicated biliary drainage in cases when ERCP is unsuccessful or not feasible. Recent emerging evidence suggests EUS-guided hepaticogastrostomy and EUS-guided choledochoduodenostomy are noninferior, and possibly even superior to conventional ERCP for primary palliation of malignant biliary obstruction. This article reviews the procedural techniques and considerations of the different techniques as well as comparative literature on safety and efficacy between techniques.
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Affiliation(s)
- Ian Eisenberg
- Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD
| | - Monica Gaidhane
- Department of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Michel Kahaleh
- Department of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Amy Tyberg
- Department of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
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13
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Gjeorgjievski M, Bareket R, Bhurwal A, Abdelqader A, Shahid H, Sarkar A, Tyberg A, Kahaleh M. Endoscopic vacuum therapy: 2 methods of successful endosponge placement for treatment of anastomotic leak in the upper GI tract. VideoGIE 2023; 8:257-259. [PMID: 37456215 PMCID: PMC10339126 DOI: 10.1016/j.vgie.2023.03.007] [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] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Video 1Presentation of 2 methods of successful endosponge placement for treatment of anastomotic leak in the upper GI tract.
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Affiliation(s)
- Mihajlo Gjeorgjievski
- Department of Gastroenterology and Hepatology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Romy Bareket
- Department of Gastroenterology and Hepatology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Abhishek Bhurwal
- Department of Gastroenterology and Hepatology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Abdelhai Abdelqader
- Department of Gastroenterology and Hepatology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Haroon Shahid
- Department of Gastroenterology and Hepatology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Avik Sarkar
- Department of Gastroenterology and Hepatology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Amy Tyberg
- Department of Gastroenterology and Hepatology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Michel Kahaleh
- Department of Gastroenterology and Hepatology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
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14
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Papaefthymiou A, Kahaleh M, Lemmers A, Sferrazza S, Barret M, Yamamoto K, Deprez P, Marín-Gabriel JC, Tribonias G, Ouyang H, Barbaro F, Kiosov O, Seewald S, Patil G, Elkholy S, Coumaros D, Vuckovic C, Banks M, Haidry R, Mavrogenis G. Performance of endoscopic submucosal dissection for undifferentiated early gastric cancer: a multicenter retrospective cohort. Endosc Int Open 2023; 11:E673-E678. [PMID: 37744471 PMCID: PMC10513782 DOI: 10.1055/a-2105-1934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 05/31/2023] [Indexed: 09/26/2023] Open
Abstract
Background and study aims Undifferentiated early gastric cancer (UD-EGC) represents an extended indication for endoscopic submucosal dissection (ESD) based on the existing guidelines. This study evaluated the prevalence of UD-EGC recurrence after ESD, and potentially implicated risk factors. Patients and methods Data from 17 centers were collected retrospectively including demographics, endoscopic and pathological findings, and follow-up data from UD-EGC cases treated by ESD. Patients with incomplete resection or advanced disease were excluded. Descriptive statistics quantified variables and calculated the incidence of recurrence. Chi-square test was applied to assess any link between independent variables and relapse; significantly associated variables were inserted to a multivariable regression model. Results Seventy-one patients were eligible, with 2:1 female to male ratio and age of 65.8 ± 11.8 years. Mean lesion size was 33.5 ± 18.8 mm and the most frequent histological subtype was signet ring-cells UGC (2:1). Patients were followed-up every 5.6 ± 3.7 months with a mean surveillance period of 29.3 ± 15.3 months until data collection. Four patients (5.6%) developed local recurrence 8.8 ± 6.5 months post-ESD, with no lymph node or distal metastases been reported. Lesion size was not associated with recurrence ( P = 0.32), in contrast to lymphovascular and perineural invasion which were independently associated with local recurrence ( P = 0.006 and P < 0.001, respectively). Conclusions ESD could be considered as the initial step to manage UD-EGC, providing at least an "entire-lesion" biopsy to guide therapeutic strategy. When histology confirms absence of lymphovascular and perineural invasion, this modality could be therapeutic, providing low recurrence rates.
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Affiliation(s)
- Apostolis Papaefthymiou
- Endoscopy Unit, University College London Hospitals NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Michel Kahaleh
- Gastroenterology, Rutgers Robert Wood Johnson Medical School New Brunswick, New Brunswick, United States
| | - Arnaud Lemmers
- Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles (ULB), Bruxelles, Belgium
| | - Sandro Sferrazza
- Department of Gastroenterology and Digestive Endoscopy, APSS Trento, Trento, Italy
| | - Maximilien Barret
- Gastroenterology and Digestive Oncology, Hopital Cochin, Paris, France
| | - Katsumi Yamamoto
- Department of Gastroenterology, Japan Community Healthcare Organization Osaka Hospital, Osaka, Japan
| | - Pierre Deprez
- Cliniques Universitaires St-Luc, Université Catholique de Louvain, Louvain Medical ASBL, Bruxelles, Belgium
| | | | - George Tribonias
- Gastroenterology, General Hospital of Nikaia Peiraia Agios Panteleimon, Athens, Greece
| | - Hong Ouyang
- Endoscopy, The People's Hospital of Linan City, hangzhou, China
| | - Federico Barbaro
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Oleksandr Kiosov
- University Clinical, Zaporizhzhia State Medical University, Zaporozhye, Ukraine
| | - Stefan Seewald
- Center for Gastroenterology, Hirlanden Clinic Zurich, Zurich, Switzerland
| | | | - Shaimaa Elkholy
- Gastroenterology Division, Internal Medicine Department, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt
| | - Dimitri Coumaros
- Gastroenterology Department, Clinique Sainte Barbe, Strasbourg, France
| | - Clemence Vuckovic
- Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles (ULB), Bruxelles, Belgium
| | - Matthew Banks
- Gastroenterology, University College London Hospitals NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Rehan Haidry
- Gastroenterology, University College London Medical School, London, United Kingdom of Great Britain and Northern Ireland
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15
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Tyberg A, Duarte-Chavez R, Shahid HM, Sarkar A, Simon A, Shah-Khan SM, Gaidhane M, Mohammad TF, Nosher J, Wise SS, Needham V, Kheng M, Lajin M, Sojitra B, Wey B, Dorwat S, Raina H, Ansari J, Gandhi A, Bapaye A, Shah-Khan SM, Krafft MR, Thakkar S, Singh S, Bane JR, Nasr JY, Lee DP, Kedia P, Arevalo-Mora M, Del Valle RS, Robles-Medranda C, Puga-Tejada M, Vanella G, Ardengh JC, Bilal M, Giuseppe D, Arcidiacono PG, Kahaleh M. Endoscopic Ultrasound-Guided Gallbladder Drainage Versus Percutaneous Drainage in Patients With Acute Cholecystitis Undergoing Elective Cholecystectomy. Clin Transl Gastroenterol 2023; 14:e00593. [PMID: 37141073 PMCID: PMC10299765 DOI: 10.14309/ctg.0000000000000593] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 04/18/2023] [Indexed: 05/05/2023] Open
Abstract
INTRODUCTION Cholecystectomy (CCY) is the gold standard treatment of acute cholecystitis (AC). Nonsurgical management of AC includes percutaneous transhepatic gallbladder drainage (PT-GBD) and endoscopic ultrasound-guided gallbladder drainage (EUS-GBD). This study aims to compare outcomes of patients who undergo CCY after having received EUS-GBD vs PT-GBD. METHODS A multicenter international study was conducted in patients with AC who underwent EUS-GBD or PT-GBD, followed by an attempted CCY, between January 2018 and October 2021. Demographics, clinical characteristics, procedural details, postprocedure outcomes, and surgical details and outcomes were compared. RESULTS One hundred thirty-nine patients were included: EUS-GBD in 46 patients (27% male, mean age 74 years) and PT-GBD in 93 patients (50% male, mean age 72 years). Surgical technical success was not significantly different between the 2 groups. In the EUS-GBD group, there was decreased operative time (84.2 vs 165.4 minutes, P < 0.00001), time to symptom resolution (4.2 vs 6.3 days, P = 0.005), and length of stay (5.4 vs 12.3 days, P = 0.001) compared with the PT-GBD group. There was no difference in the rate of conversion from laparoscopic to open CCY: 5 of 46 (11%) in the EUS-GBD arm and 18 of 93 (19%) in the PT-GBD group ( P value 0.2324). DISCUSSION Patients who received EUS-GBD had a significantly shorter interval between gallbladder drainage and CCY, shorter surgical procedure times, and shorter length of stay for the CCY compared with those who received PT-GBD. EUS-GBD should be considered an acceptable modality for gallbladder drainage and should not preclude patients from eventual CCY.
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Affiliation(s)
- Amy Tyberg
- Endoscopy, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA;
| | | | - Haroon M. Shahid
- Endoscopy, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA;
| | - Avik Sarkar
- Endoscopy, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA;
| | - Alexa Simon
- Endoscopy, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA;
| | - Sardar M. Shah-Khan
- Endoscopy, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA;
| | - Monica Gaidhane
- Endoscopy, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA;
| | - Tayyaba F. Mohammad
- Endoscopy, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA;
| | - John Nosher
- Endoscopy, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA;
| | - Susannah S. Wise
- Endoscopy, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA;
| | - Victoria Needham
- Endoscopy, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA;
| | - Marin Kheng
- Endoscopy, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA;
| | | | - Badal Sojitra
- Endoscopy, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA;
| | - Bryan Wey
- Endoscopy, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA;
| | | | | | | | | | | | | | | | - Shyam Thakkar
- West Virginia University, Morgantown, West Virginia, USA
| | | | - Janele R. Bane
- West Virginia University, Morgantown, West Virginia, USA
| | - John Y. Nasr
- West Virginia University, Morgantown, West Virginia, USA
| | - David P. Lee
- Methodist Dallas Medical Center, Dallas, Texas, USA
| | | | | | | | | | | | | | | | - Mohammad Bilal
- Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
| | | | | | - Michel Kahaleh
- Endoscopy, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA;
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16
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Kedia P, Shah-Khan S, Tyberg A, Gaidhane M, Sarkar A, Shahid H, Zhao E, Thakkar S, Winkie M, Krafft M, Singh S, Zolotarevsky E, Barber J, Zolotarevsky M, Greenberg I, Eke D, Lee D, Gress F, Andalib I, Bills G, Carey P, Gabr M, Lajin M, Vazquez-Sequeiros E, Pleskow D, Mehta N, Schulman A, Kwon R, Platt K, Nasr J, Kahaleh M. Endoscopic ultrasound-directed transgastric ERCP (EDGE): A multicenter US study on long-term follow-up and fistula closure. Endosc Int Open 2023; 11:E529-E537. [PMID: 37251793 PMCID: PMC10219784 DOI: 10.1055/a-2057-5984] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 03/09/2023] [Indexed: 05/31/2023] Open
Abstract
Background and study aims Endoscopic ultrasound-directed transgastric ERCP (EDGE) is a safe and efficacious procedure to treat pancreaticobiliary diseases in Roux-en-Y gastric bypass (RYGB). This multicenter study aimed to determine the long-term outcomes of EDGE focusing on fistula persistence rates and post-procedure weight change. Patients and methods Information about patients with Roux-en-Y gastric bypass anatomy who underwent EDGE between 2015 and 2021 from 10 institutions was captured in a registry. Patient demographics, procedural details, and clinical outcomes were analyzed. Results One hundred seventy-two patients were included in the study (mean age 60, 25 % male). Technical success of lumen-apposing metal stent (LAMS) placement was 171 of 172 (99.4 %) while clinical success of intervention was 95%. The mean procedure time was 65 minutes. The most commonly reported complication was stent dislodgement/migration (n = 29, 17). Mean length of time of LAMS duration was 69 days. Mean follow-up time was 6 months. Endoscopic fistula closure was performed in 40 % of patients (69/172) at the time of LAMS removal. Persistence of fistula was observed in 19 of 62 patients (31 %) assessed. Length of LAMS indwell time (days) was a predictor of persistent fistula. The average weight gain while the LAMS was in place was 12 lb in 63 patients (36.6 %); 59.4 % of patients gained < 5 lb. Conclusions EDGE is a safe and efficacious procedure for RYGB patients requiring ERCP. Post-procedure evaluation and management of the enteral fistula varies widely among centers currently and would benefit from further standardization. Fistula persistence appears to be uncommon and can be managed endoscopically but may be related to length of indwell times of the LAMS.
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Affiliation(s)
- Prashant Kedia
- Methodist Dallas Medical Center – Gastroenterology, Dallas, Texas, United States
| | - Sardar Shah-Khan
- Rutgers Robert Wood Johnson Medical School – Gastroenterology, New Brunswick, New Jersey, United States
| | - Amy Tyberg
- Weill Cornell Medical College – Gastroenterology & Hepatology, New York, New York, United States
| | - Monica Gaidhane
- Methodist Dallas Medical Center – Gastroenterology, Dallas, Texas, United States
| | - Avik Sarkar
- Methodist Dallas Medical Center – Gastroenterology, Dallas, Texas, United States
| | - Haroon Shahid
- Methodist Dallas Medical Center – Gastroenterology, Dallas, Texas, United States
| | - Eric Zhao
- Methodist Dallas Medical Center – Gastroenterology, Dallas, Texas, United States
| | - Shyam Thakkar
- West Virginia University – Gastroenterology, New Brunswick, New Jersey, United States
| | - Mason Winkie
- West Virginia University – Gastroenterology, New Brunswick, New Jersey, United States
| | - Matthew Krafft
- Ruby Memorial Hospital – Digestive Diseases, Morgantown, West Virginia, United States
| | - Shailendra Singh
- Ruby Memorial Hospital – Digestive Diseases, Morgantown, West Virginia, United States
| | - Eugene Zolotarevsky
- Spectrum Health Butterworth Hospital – Advanced Endoscopy/Gastroenterology, Grand Rapids, Michigan, United States
| | - Jeremy Barber
- Spectrum Health Butterworth Hospital – Advanced Endoscopy/Gastroenterology, Grand Rapids, Michigan, United States
| | - Mitchelle Zolotarevsky
- Spectrum Health Butterworth Hospital – Advanced Endoscopy/Gastroenterology, Grand Rapids, Michigan, United States
| | - Ian Greenberg
- Methodist Dallas Medical Center – Gastroenterology, Dallas, Texas, United States
| | - Dhiemeziem Eke
- Methodist Dallas Medical Center – Gastroenterology, Dallas, Texas, United States
| | - David Lee
- Methodist Dallas Medical Center – Gastroenterology, Dallas, Texas, United States
| | - Frank Gress
- Icahn School of Medicine at Mount Sinai – Gastroenterology, New York, New York, United States
| | - Iman Andalib
- Robert Wood Johnson Health System – Gastroenterology, New Brunswick, New Jersey, United States
| | - Gregory Bills
- University of Kentucky Medical Center – Gastroenterology, New Brunswick, Kentucky, United States
| | - Patrick Carey
- University of Kentucky Medical Center – Gastroenterology, New Brunswick, Kentucky, United States
| | - Moamen Gabr
- Tanta University Faculty of Medicine – Gastroenterology and Hepatology – Internal Medicine, Tanta, Egypt
| | - Michael Lajin
- Sharp Grassmont Hospital – Gastroenterology/Internal Medicine, Mesa, California, United States
| | | | - Douglas Pleskow
- Beth Israel Deaconess Medical Center – Gastroenterology, Boston, Massachusetts, United States
| | - Neal Mehta
- Beth Israel Deaconess Medical Center – Gastroenterology, Boston, Massachusetts, United States
| | - Allison Schulman
- University of Michigan Medicine – Gastroenterology, New Brunswick, Michigan, United States
| | - Richard Kwon
- University of Michigan Health System – Gastroenterology, Ann Arbor, Michigan, United States
| | - Kevin Platt
- University of Michigan Michigan Medicine – Internal Medicine, Ann Arbor, Michigan, United States
| | - John Nasr
- West Virginia University – Gastroenterology, New Brunswick, New Jersey, United States
| | - Michel Kahaleh
- Rutgers Robert Wood Johnson Medical School – Gastroenterology, New Brunswick, New Jersey, United States
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17
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Duarte-Chavez R, Tyberg A, Sarkar A, Shahid HM, Vemulapalli B, Shah-Khan S, Gaidhane M, Kahaleh M. Invasive CO 2 monitoring with arterial line compared to end tidal CO 2 during peroral endoscopic myotomy. Endosc Int Open 2023; 11:E468-E473. [PMID: 37180312 PMCID: PMC10169232 DOI: 10.1055/a-2048-1312] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 02/10/2022] [Indexed: 05/16/2023] Open
Abstract
Background and study aims Peroral endoscopic myotomy (POEM) has become a recognized treatment for achalasia. The technique requires CO 2 insufflation. It is estimated that the partial pressure of CO 2 (PaCO 2 ) is 2 to 5 mm Hg higher than the end tidal CO 2 (etCO 2 ), and etCO 2 is used as a surrogate for PaCO 2 because PaCO 2 requires an arterial line. However, no study has compared invasive and noninvasive CO 2 monitoring during POEM. Patients and methods Seventy-one patients who underwent POEM were included in a prospective comparative study. PaCO 2 plus etCO 2 was measured in 32 patients (invasive group) and etCO 2 only in 39 matched patients (noninvasive group). Pearson correlation coefficient (PCC) and Spearman's Rho were used to calculate the correlation between PaCO 2 and ETCO 2 . Results PaCO 2 and ETCO 2 were strongly correlated: PCC R value: 0.8787 P ≤ 0.00001, Spearman's Rho R value: 0.8775, P ≤ 0.00001. Within the invasive group, the average difference between PaCO 2 and ETCO 2 was 3.39 mm Hg (median 3, standard deviation 3.5), within the 2- to 5-mm Hg range. The average procedure time (scope in to scope out) was increased 17.7 minutes ( P = 0.044) and anesthesia duration was 46.3 minutes. Adverse events (AEs) included three hematomas and one nerve injury in the invasive group and one pneumothorax in the noninvasive group. There were no differences in AE rates between the groups (13 % vs 3 % P = 0.24). Conclusions Universal PaCO 2 monitoring contributes to increased procedure and anesthesia times without any decrease in AEs in patients undergoing POEM. CO 2 monitoring with an arterial line should only be performed in patients with major cardiovascular comorbidities; in all other patients, ETCO 2 is an appropriate tool.
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Affiliation(s)
- Rodrigo Duarte-Chavez
- Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, United States
| | - Amy Tyberg
- Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, United States
| | - Avik Sarkar
- Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, United States
| | - Haroon M. Shahid
- Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, United States
| | - Bhargav Vemulapalli
- Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, United States
| | - Sardar Shah-Khan
- Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, United States
| | - Monica Gaidhane
- Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, United States
| | - Michel Kahaleh
- Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, United States
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18
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Sameera S, Mohammad T, Liao K, Shahid H, Sarkar A, Tyberg A, Kahaleh M. Management of Pancreatic Fluid Collections: An Evidence-based Approach. J Clin Gastroenterol 2023; 57:346-361. [PMID: 36040932 DOI: 10.1097/mcg.0000000000001750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Managing pancreatic fluid collections (PFCs) remains a challenge for many clinicians. Recently, significant progress has been made in the therapy of PFCs, including improvements in technology and devices, as well as in the development of minimally invasive endoscopic techniques, many of which are proven less traumatic when compared with surgical options and more efficacious when compared with percutaneous techniques. This review will explore latest developments in the management of PFCs and how they incorporate into the current treatment algorithm.
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Affiliation(s)
- Sohini Sameera
- Department of Gastroenterology & Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
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19
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Gjeorgjievski M, Bhurwal A, Chouthai AA, Abdelqader A, Gaidhane M, Shahid H, Tyberg A, Sarkar A, Kahaleh M. Percutaneous endoscopic necrosectomy (PEN) for treatment of necrotizing pancreatitis: a systematic review and meta-analysis. Endosc Int Open 2023; 11:E258-E267. [PMID: 36968976 PMCID: PMC10036203 DOI: 10.1055/a-1935-4738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 08/10/2022] [Indexed: 03/25/2023] Open
Abstract
Background and study aims
Endoscopic necrosectomy is limited by the proximity of necrosis to the gastrointestinal tract. Percutaneous endoscopic necrosectomy (PEN) is a minimally invasive endoscopic method of percutaneous debridement. Studies regarding its efficacy and safety are lacking. The purpose of this study was to assess the efficacy and safety of PEN in necrotizing pancreatitis.
Methods
Pubmed, Ovid, Cochrane, Scopus and Web of Science Database were searched from inception through February 2021. Dual extraction and quality assessment of studies using Cochrane risk of bias tool were performed independently by two authors. The primary outcome was defined as clinical success of PEN. Secondary outcomes included periprocedural morbidity, mortality, and long-term morbidity and mortality.
Results
Sixteen observational studies including 282 subjects were analyzed. The average reported age of the participants was 50.3 years. Patients with reported gender included 39 % females and 61 % males. The success rate as defined by complete resolution of necrosis and removal of drainage catheters/stents was 82 % (95 % confidence interval 77–87). The mean size of pancreatic necrosis was 14.86 cm (5–54 cm). The periprocedural morbidity rate was 10 %, while there was no reported periprocedural mortality. The long-term morbidity rate was reported as 23 % and mortality at follow-up was 16 %.
Conclusions
PEN is a novel method of endoscopic management of pancreatic necrosis. Based on our meta-analysis of retrospective studies, it represents a safe treatment modality with high rates of clinical success and low rates of perioperative morbidity and mortality. This study supports the use of PEN when conventional endoscopic therapy is not feasible.
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Affiliation(s)
- Mihajlo Gjeorgjievski
- Division of Gastroenterology, Rutgers, Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
| | - Abishek Bhurwal
- Division of Gastroenterology, Rutgers, Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
| | - Abhishek A. Chouthai
- Division of Gastroenterology, Rutgers, Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
| | - Abdelhai Abdelqader
- Division of Gastroenterology, Rutgers, Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
| | - Monica Gaidhane
- Division of Gastroenterology, Rutgers, Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
| | - Haroon Shahid
- Division of Gastroenterology, Rutgers, Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
| | - Amy Tyberg
- Division of Gastroenterology, Rutgers, Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
| | - Avik Sarkar
- Division of Gastroenterology, Rutgers, Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
| | - Michel Kahaleh
- Division of Gastroenterology, Rutgers, Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
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20
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Shah-Khan SM, Patel A, Shah-Khan SM, Shahid H, Tyberg A, Kahaleh M, Sarkar A. EUS of a submucosal lesion at the appendiceal orifice using a double-balloon endoluminal intervention platform. VideoGIE 2023; 8:124-126. [PMID: 36935804 PMCID: PMC10020377 DOI: 10.1016/j.vgie.2022.11.004] [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] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Video 1Video demonstrating the use of a DEIP to facilitate both radial and linear EUS in the proximal colon.
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Affiliation(s)
- Sardar Momin Shah-Khan
- Section of Gastroenterology and Hepatology, West Virginia University, Morgantown, West Virginia
| | - Ankoor Patel
- Division of Gastroenterology, Rutgers Robert Wood Johnson Hospital, New Brunswick, New Jersey
| | - Sardar Musa Shah-Khan
- Division of Gastroenterology, Rutgers Robert Wood Johnson Hospital, New Brunswick, New Jersey
| | - Haroon Shahid
- Division of Gastroenterology, Rutgers Robert Wood Johnson Hospital, New Brunswick, New Jersey
| | - Amy Tyberg
- Division of Gastroenterology, Rutgers Robert Wood Johnson Hospital, New Brunswick, New Jersey
| | - Michel Kahaleh
- Division of Gastroenterology, Rutgers Robert Wood Johnson Hospital, New Brunswick, New Jersey
| | - Avik Sarkar
- Division of Gastroenterology, Rutgers Robert Wood Johnson Hospital, New Brunswick, New Jersey
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21
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Kim M, Duarte-Chavez R, Kahaleh M. Device-assisted submucosal tunneling endoscopic resection for rectal gastrointestinal stromal tumor. Endoscopy 2022; 54:E763-E764. [PMID: 35561988 DOI: 10.1055/a-1824-4691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Marina Kim
- Department of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Rodrigo Duarte-Chavez
- Department of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Michel Kahaleh
- Department of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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22
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Pimpinelli M, Makar M, Kahaleh M. Endoscopic management of benign and malignant hilar stricture. Dig Endosc 2022; 35:443-452. [PMID: 36453003 DOI: 10.1111/den.14487] [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: 04/21/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022]
Abstract
Management of hilar strictures pose a significant challenge for endoscopists. Several strategies have been demonstrated in the last decade beyond decompression, however, there remains controversy and minimal consensus in the literature. This review seeks to summarize the current literature and discuss emerging therapies, such as photodynamic therapy and radiofrequency ablation.
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Affiliation(s)
- Marcella Pimpinelli
- Department of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, USA
| | - Michael Makar
- Department of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, USA
| | - Michel Kahaleh
- Department of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, USA
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23
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Elfert K, Zeid E, Duarte-Chavez R, Kahaleh M. Endoscopic ultrasound guided access procedures following surgery. Best Pract Res Clin Gastroenterol 2022; 60-61:101812. [PMID: 36577531 DOI: 10.1016/j.bpg.2022.101812] [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: 11/01/2022] [Accepted: 11/13/2022] [Indexed: 11/17/2022]
Abstract
EUS-guided therapeutic procedures have emerged in the recent years as a minimally invasive option for the management of complex hepatobiliary disorders. Gastrointestinal surgeries, e.g., pancreaticoduodenectomy, Roux-en-Y Gastric Bypass, Roux-en-Y hepaticojejunostomy, and partial gastrectomy with different reconstructions are commonly performed for a wide range of indications that include tumour resections and weight loss. Conventional endoscopic procedures are challenging in those patients due to inaccessible or unreachable ampulla. Patients with surgically altered anatomy are good candidates for EUS-guided access procedures that have shown good technical and clinical success rates. This category of procedures includes EUS-guided biliary drainage, EUS-guided pancreatic drainage, EUS-directed transgastric ERCP (EDGE) and EUS-guided Gastroenterostomy. Studies have shown that these procedures have comparable or better results than traditional endoscopic, interventional radiology-guided and surgical procedures. This article discusses the indications, technique and outcome of the different EUS-guided access procedures in patients with surgically altered anatomy.
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Affiliation(s)
- Khaled Elfert
- Department of Medicine, SBH Health System, Bronx, NY, USA.
| | - Ebrahim Zeid
- Department of Surgery, Kafr El Zayat General Hospital, Kafr EL Zayat, Gharbiyah, Egypt.
| | - Rodrigo Duarte-Chavez
- Gastroenterology Division, Department of Medicine, St Luke's University Health Network, Bethlehem, PA, USA.
| | - Michel Kahaleh
- Gastroenterology Division, Department of Medicine, Robert Wood Johnson University Hospital, New Brunswick, NJ, USA.
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24
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Kahaleh M, Bhagat V, Dellatore P, Tyberg A, Sarkar A, Shahid HM, Andalib I, Alkhiari R, Gaidhane M, Kedia P, Nieto J, Kumta NA, Dixon RE, Salameh H, Mavrogenis G, Bassioukas S, Abe S, Arentes VN, Morita FH, Sakai P, de Moura EG. Subepithelial tumors: How does endoscopic full-thickness resection & submucosal tunneling with endoscopic resection compare with laparoscopic endoscopic cooperative surgery? Endosc Int Open 2022; 10:E1491-E1496. [PMID: 36397865 PMCID: PMC9666078 DOI: 10.1055/a-1922-7890] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 08/10/2022] [Indexed: 10/15/2022] Open
Abstract
Background and study aims Endoscopic techniques are rapidly emerging for resection of subepithelial tumors (SETs). Submucosal tunneling for endoscopic resection (STER), endoscopic full-thickness resection (EFTR) and laparoscopic endoscopic cooperative surgery (LECS) are current alternatives to open surgery. In this study, we aimed to compare the three endoscopic techniques. Patients and methods Consecutive patients who underwent resection of a submucosal esophageal or gastric lesion at several tertiary care centers were included in a dedicated registry over 3 years. Demographics, size and location of resected lesion, histology of specimen, length of procedure, adverse events (AEs), duration of hospital stay, and follow-up data were collected. Results Ninety-six patients were included (47.7 % male, mean age 62): STER n = 34, EFTR n = 34, LECS n = 280. The lesions included leiomyoma, gastrointestinal stromal tumors (GISTs) and other. The mean lesion size was 28 mm (STD 16, range 20-72 mm). The majority of lesions in the EFTR and laparoscopic-assisted resection group were GISTs. There was no significant difference in clear resection margins, post-procedure complication rates, recurrence rate and total follow-up duration between the groups. However, the LECS group had a procedure time at least 30 minutes longer than STER or EFTR ( P < 0.01). Total hospital stay for the laparoscopic-assisted resection group was also longer when compared to STER (1.5) and EFTR (1.8) ( P < 0.01). Conclusions STER, EFTR, and laparoscopic-assisted resection are efficacious approaches for resection of SETs with similar R0 resection rates, complication rates, and AE rates. Laparoscopic assisted resection appears more time-consuming and is associated with a longer hospital stay.
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Affiliation(s)
- Michel Kahaleh
- Gastroenterology, Robert Wood Johnson University, New Brunswick, New Jersey, United States
| | - Vicky Bhagat
- Gastroenterology, Robert Wood Johnson University, New Brunswick, New Jersey, United States
| | - Peter Dellatore
- Gastroenterology, Robert Wood Johnson University, New Brunswick, New Jersey, United States
| | - Amy Tyberg
- Gastroenterology, Robert Wood Johnson University, New Brunswick, New Jersey, United States
| | - Avik Sarkar
- Gastroenterology, Robert Wood Johnson University, New Brunswick, New Jersey, United States
| | - Haroon M. Shahid
- Gastroenterology, Robert Wood Johnson University, New Brunswick, New Jersey, United States
| | - Iman Andalib
- Gastroenterology, Robert Wood Johnson University, New Brunswick, New Jersey, United States
| | - Resheed Alkhiari
- Gastroenterology, Robert Wood Johnson University, New Brunswick, New Jersey, United States
| | - Monica Gaidhane
- Gastroenterology, Robert Wood Johnson University, New Brunswick, New Jersey, United States
| | - Prashant Kedia
- Gastroenterology, Methodist Hospital, Dallas, Texas, United States
| | - Jose Nieto
- Borland-Groover Clinic, Jacksonville, Florida, United States
| | - Nikhil A. Kumta
- Gastroenterology, Mount Sinai Hospital, New York, New York, United States
| | - Rebekah E. Dixon
- Gastroenterology, Mount Sinai Hospital, New York, New York, United States
| | - Habeeb Salameh
- Gastroenterology, Mount Sinai Hospital, New York, New York, United States
| | | | | | - Seiichiro Abe
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | | | - Flavio H. Morita
- Gastroenterology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Paulo Sakai
- Gastroenterology, University of Sao Paulo Medical School, Sao Paulo, Brazil
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25
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Duarte Chavez R, Marino D, Kahaleh M, Tyberg A. Endoscopic Treatment of Reflux: A Comprehensive Review. J Clin Gastroenterol 2022; 56:831-843. [PMID: 36040930 DOI: 10.1097/mcg.0000000000001757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
The last decade has seen the rise of multiple novel endoscopic techniques to treat gastroesophageal reflux disease, many of which are efficacious when compared with traditional surgical options and allow relief from long-term dependence on antacid medications. This review will explore the latest endoscopic treatment options for gastroesophageal reflux disease including a description of the technique, review of efficacy and safety, and future directions.
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Affiliation(s)
- Rodrigo Duarte Chavez
- Department of Gastroenterology, Robert Wood Johnson Medical Center, New Brunswick, NJ
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26
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Duarte-Chavez R, Elfert K, Kahaleh M. Lost in the tunnel: Submucosal tunneling endoscopic resection guided by endoscopic ultrasound coils. Endoscopy 2022; 55:E161-E162. [PMID: 36307070 PMCID: PMC9829770 DOI: 10.1055/a-1944-8973] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Rodrigo Duarte-Chavez
- Department of Gastroenterology & Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Khaled Elfert
- Department of Gastroenterology & Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Michel Kahaleh
- Department of Gastroenterology & Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
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27
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Gjeorgjievski M, Sarkar A, Shahid H, Tyberg A, Kahaleh M. Endoscopic full-thickness resection with reconstruction of the rectal wall. Endoscopy 2022; 55:E133-E134. [PMID: 36307071 PMCID: PMC9829778 DOI: 10.1055/a-1948-2007] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Mihajlo Gjeorgjievski
- Department of Gastroenterology & Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Avik Sarkar
- Department of Gastroenterology & Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Haroon Shahid
- Department of Gastroenterology & Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Amy Tyberg
- Department of Gastroenterology & Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Michel Kahaleh
- Department of Gastroenterology & Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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Abstract
Malignant biliary obstruction often presents with challenges requiring the endoscopist to assess the location of the lesion, the staging of the disease, the eventual resectability and patient preferences in term of biliary decompression. This review will focus on the different modalities available in order to offer the most appropriate palliation, such as conventional endoscopic retrograde cholangiopancreatography, endoscopic ultrasound guided biliary drainage as well as ablative therapies including photodynamic therapy or radiofrequency ablation.
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Affiliation(s)
- Andrew Canakis
- Department of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD 21201, United States
| | - Michel Kahaleh
- Department of Gastroenterology and Hepatology, Robert Wood Johnson Medical Center, New Brunswick, NJ 08901, United States
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Gjeorgjievski M, Abdelqader A, Sarkar A, Shahid H, Tyberg A, Kahaleh M. Transurethral endoscopic retrograde pancreatography: a novel endoscopic technique to treat complications after pancreas transplantation. Endoscopy 2022; 54:E470-E471. [PMID: 34571560 DOI: 10.1055/a-1625-2628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Mihajlo Gjeorgjievski
- Department of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Abdelhai Abdelqader
- Department of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Avik Sarkar
- Department of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Haroon Shahid
- Department of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Amy Tyberg
- Department of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Michel Kahaleh
- Department of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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Tyberg A, Raijman I, Gaidhane M, Trindade AJ, Shahid H, Sarkar A, Samarasena J, Andalib I, Diehl DL, Pleskow DK, Woods KE, Gordon SR, Pannala R, Kedia P, Draganov PV, Tarnasky PR, Sejpal DV, Kumta NA, Parasher G, Adler DG, Patel K, Yang D, Siddiqui U, Kahaleh M, Joshi V. First interobserver agreement of optical coherence tomography in the bile duct: A multicenter collaborative study. Endosc Int Open 2022; 10:E1065-E1072. [PMID: 35979031 PMCID: PMC9377829 DOI: 10.1055/a-1779-5027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 02/22/2022] [Indexed: 11/26/2022] Open
Abstract
Background and study aims Optical coherence tomography (OCT) is a new technology available for evaluation of indeterminate biliary strictures. It allows under-the-surface visualization and preliminary studies have confirmed standardized characteristics associated with malignancy. The aim of this study is to evaluate the first interobserver agreement in identifying previously agreed upon OCT criteria and diagnosing of malignant versus benign disease. Patients and methods Fourteen endoscopists were asked to review an atlas of reference clips and images of eight criteria derived from expert consensus A total of 35 de-identified video clips were then evaluated for presence of the eight criteria and for final diagnosis of malignant versus benign using the atlas as reference Intraclass correlation (ICC) analysis was done to evaluate interrater agreement. Results Clips of 23 malignant lesions and 12 benign lesions were scored. Excellent interobserver agreement was seen with dilated hypo-reflective structures (0.85) and layering effacement (0.89); hyper-glandular mucosa (0.76), intact layering (0.81), and onion-skin layering (0.77); fair agreement was seen with scalloping (0.58), and thickened epithelium (0.4); poor agreement was seen with hyper-reflective surface (0.36). The diagnostic ICC for both neoplastic (0.8) and non-neoplastic (0.8) was excellent interobserver agreement. The overall diagnostic accuracy was 51 %, ranging from 43 % to 60 %. Conclusions Biliary OCT is a promising new modality for evaluation of indeterminate biliary strictures. Interobserver agreement ranged from fair to almost perfect on eight previously identified criteria. Interobserver agreement for malignancy diagnosis was substantial (0.8). Further studies are needed to validate this data.
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Affiliation(s)
- Amy Tyberg
- Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, United States
| | - Isaac Raijman
- Baylor St Lukes Medical Center, Houston, Texas, United States
| | - Monica Gaidhane
- Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, United States
| | - Arvind J. Trindade
- Long Island Jewish Medical Center, New Hyde Park, New York, United States
| | - Haroon Shahid
- Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, United States
| | - Avik Sarkar
- Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, United States
| | - Jason Samarasena
- University of California Irvine, Irvine, California, United States
| | - Iman Andalib
- Mount Sinai South Nassau, Oceanside, New York, United States
| | - David L. Diehl
- Geisinger Medical Center, Danville, Pennsylvania, United States
| | - Douglas K. Pleskow
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
| | - Kevin E. Woods
- Southeastern Regional Medical Center, Lumberton, North Carolina, United States
| | - Stuart R. Gordon
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, United States
| | - Rahul Pannala
- Mayo Clinic Phoenix, Phoenix, Arizona, United States
| | - Prashant Kedia
- Methodist Dallas Medical Center, Dallas, Texas, United States
| | - Peter V. Draganov
- University of Florida, Gainesville, Gainesville, Florida, United States
| | | | | | | | - Gulshan Parasher
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico, United States
| | - Douglas G. Adler
- University of Utah School of Medicine, Salt Lake City, Utah, United States
| | - Kalpesh Patel
- Baylor College of Medicine, Houston, Texas, United States
| | - Dennis Yang
- University of Florida, Gainesville, Gainesville, Florida, United States
| | - Uzma Siddiqui
- University of Chicago, Chicago, Illinois, United States
| | - Michel Kahaleh
- Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, United States
| | - Viren Joshi
- Ochsner Medical Center, New Orleans, Louisiana, United States
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Shah-Khan SM, Zhao E, Tyberg A, Sarkar S, Shahid HM, Duarte-Chavez R, Gaidhane M, Kahaleh M. Endoscopic Ultrasound-Directed Transgastric ERCP (EDGE) Utilization of Trends Among Interventional Endoscopists. Dig Dis Sci 2022; 68:1167-1177. [PMID: 35947304 DOI: 10.1007/s10620-022-07650-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 05/19/2022] [Accepted: 07/29/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND Endoscopic ultrasound-directed transgastric ERCP (EDGE) has become standard-of-care therapy at many centers for pancreaticobiliary disease in patients with Roux-en-Y Gastric Bypass. In this study, we aimed to evaluate the opinions and practices of endoscopists who perform EDGE. METHODS A 22-question utilization of EDGE survey was sent to 36 advanced endoscopists at tertiary care centers in the United States. The two-section survey included questions regarding advanced endoscopy volume and training at the respective facilities, and questions on specific details of EDGE utilization. RESULTS Among 36 interventional endoscopists (IE) surveyed, 14 (39%) reported performing > 1000 ERCPs annually. Thirty (83%) offered EDGE as an option for Roux-en-Y gastric bypass patients with previous cholecystectomy. Other options offered included: 19 (53%) offered Laparoscopy-assisted ERCP (LA-ERCP), 7 (19%) offered Single-Balloon ERCP (SBE), and 10 (28%) offered percutaneous drainage (PTC). Twenty (56%) IE performed 10 or less EDGE procedures, while 16 (44%) performed 11 or more. Single-session EDGE was performed by 7 (19%) IE, while 15 (42%) performed dual session, and 13 (36%) performed both. 19 (53%) actively closed fistulas while 17 (47%) let them close spontaneously. Thirty one (86%) reported a technical success rate of 91% to 100%. The most frequently reported immediate adverse event post-procedurally was abdominal pain, reported by 17 IE (47%). Weight gain was reported by 2 IE (6%). CONCLUSION EDGE continues to gain in popularity as an option for Roux-en-Y gastric bypass patients requiring pancreaticobiliary interventions, with 24/36 IE (67%) believing that it should be the new standard. In addition, most report a low frequency of post-procedural weight gain. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT05041608.
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Affiliation(s)
- Sardar M Shah-Khan
- Department of Gastroenterology, Rutgers Robert Wood Johnson Medical School, Robert Wood Johnson University Hospital, New Brunswick, NJ, 08901, USA
| | - Eric Zhao
- Department of Gastroenterology, Rutgers Robert Wood Johnson Medical School, Robert Wood Johnson University Hospital, New Brunswick, NJ, 08901, USA
| | - Amy Tyberg
- Department of Gastroenterology, Rutgers Robert Wood Johnson Medical School, Robert Wood Johnson University Hospital, New Brunswick, NJ, 08901, USA
| | - Sardar Sarkar
- Department of Gastroenterology, Rutgers Robert Wood Johnson Medical School, Robert Wood Johnson University Hospital, New Brunswick, NJ, 08901, USA
| | - Haroon M Shahid
- Department of Gastroenterology, Rutgers Robert Wood Johnson Medical School, Robert Wood Johnson University Hospital, New Brunswick, NJ, 08901, USA
| | - Rodrigo Duarte-Chavez
- Department of Gastroenterology, Rutgers Robert Wood Johnson Medical School, Robert Wood Johnson University Hospital, New Brunswick, NJ, 08901, USA
| | - Monica Gaidhane
- Department of Gastroenterology, Rutgers Robert Wood Johnson Medical School, Robert Wood Johnson University Hospital, New Brunswick, NJ, 08901, USA
| | - Michel Kahaleh
- Department of Gastroenterology, Rutgers Robert Wood Johnson Medical School, Robert Wood Johnson University Hospital, New Brunswick, NJ, 08901, USA.
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Abstract
Third space endoscopy (TSE), a type of natural orifice transluminal endoscopic surgery, was first introduced a decade ago, and since then, has revolutionized the field of therapeutic endoscopy. TSE involves tunneling into the submucosal space between the intestinal mucosa and the muscularis propria. By accessing this "third space," endoscopists can perform minimally invasive myotomies, resections, and dissections while maintaining the mucosa and preventing full-thickness perforation. TSE procedures can be used to treat motility disorders as well as neoplasms throughout the gastrointestinal tract, which were traditionally conditions that would require open or laparoscopic surgery. The main TSE procedures include peroral endoscopic myotomy, gastric peroral endoscopic myotomy, Zenker peroral endoscopic myotomy, submucosal tunneling for endoscopic resection, endoscopic submucosal tunnel dissection, peroral endoscopic tunneling for restoration of the esophagus, and per-rectal endoscopic myotomy. Some of those procedures have now been accepted as viable alternative to surgical techniques due to their limited invasiveness, safety and cost. This review will explore the different techniques recently added to our arsenal while describing their potential efficacy and limitations.
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Affiliation(s)
- Briette Karanfilian
- Division of Gastroenterology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
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Sarkar A, Tawadros A, Andalib I, Shahid HM, Tyberg A, Alkhiari R, Gaidhane M, Kedia P, John ES, Bushe B, Martinez GM, Zamarripa F, Carames MC, Carames JC, Casarodriguez F, Bove V, Costamagna G, Boskoski I, Kahaleh M. Safety and efficacy of endoscopic sleeve gastroplasty for obesity management in new bariatric endoscopy programs: a multicenter international study. Ther Adv Gastrointest Endosc 2022; 15:26317745221093883. [PMID: 35694412 PMCID: PMC9178997 DOI: 10.1177/26317745221093883] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 03/21/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Endoscopic sleeve gastroplasty (ESG) is an incisionless procedure that reduces the size of the gastric cavity. In prior studies, it has been proven to be a safe and effective treatment for obesity. In this study, we performed a collaborative study to evaluate the effectiveness of ESG among new endobariatric programs. Methods: This was an international, multicenter study reviewing the outcomes of ESG in centers starting ESG programs. Total body weight loss, change of body mass index (BMI), excess body weight loss (EBWL), technical success, duration of hospitalization, and immediate and delayed adverse events and complications at 24 h, 1 week, and 1, 3, and 6 months post-procedure were evaluated. Results: A total of 91 patients (35 males) from six centers were included. The patients’ mean BMI before the procedure was 38.7 kg/m2. BMI reduction at 3 months was 7.3 (p < 0.000), at 6 months 9.3 (p < 0.000), and at 12 months 8.6 (p < 0.000) from baseline. EBWL was 17.3% at 1 month (p < 0.000), 29.2% at 3 months (p < 0.000), and 35.6% at 6 months (p < 0.000). The mean procedure duration was 85.1 min. The mean length of hospital stay post-procedure was 27 h. Conclusion: ESG provides EBWL percentage sustained up to 12 months. These results are equivalent among the new ESG centers compared to previous studies by expert centers. Lay title Endoscopic sleeve gastroplasty in new bariatric endoscopy programs: Plain Language Summary This article is the result of a collaborative international study on new endoscopic programs offering endoscopic sleeve gastroplasty. The minimally invasiveness and increasing accessibility of this technique makes it very attractive for patients with obesity while being poor candidate for surgery or refusing surgery. This study will also provide valuable information regarding this rising technique of endobariatric treatment.
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Affiliation(s)
- Avik Sarkar
- Gastroenterology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Augustine Tawadros
- Gastroenterology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Iman Andalib
- Gastroenterology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Haroon M. Shahid
- Gastroenterology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Amy Tyberg
- Gastroenterology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Resheed Alkhiari
- Gastroenterology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Monica Gaidhane
- Gastroenterology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | | | | | - Bryce Bushe
- Gastroenterology, Methodist Hospital, Dallas, TX, USA
| | | | | | | | | | | | - Vincenzo Bove
- Gastroenterology, Fondazione Policlinico A. Gemelli, Roma, Italy
| | - Guido Costamagna
- Gastroenterology, Fondazione Policlinico A. Gemelli, Roma, Italy
| | - Ivo Boskoski
- Gastroenterology, Fondazione Policlinico A. Gemelli, Roma, Italy
| | - Michel Kahaleh
- Department of Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, NJ 08901, USA
- Gastroenterology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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Kim M, Bareket R, Kahaleh M. Endoscopic submucosal dissection of a duodenal GI stromal tumor assisted by endoloops. Endoscopy 2022; 54:E316-E317. [PMID: 34243199 DOI: 10.1055/a-1526-0199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Marina Kim
- Department of Gastroenterology, Robert Wood Johnson Medical Center, New Brunswick, New Jersey, USA
| | - Romy Bareket
- Department of Gastroenterology, Robert Wood Johnson Medical Center, New Brunswick, New Jersey, USA
| | - Michel Kahaleh
- Department of Gastroenterology, Robert Wood Johnson Medical Center, New Brunswick, New Jersey, USA
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Duarte-Chavez R, Kim M, Marino D, Kahaleh M. Traction-assisted endoscopic submucosal dissection with submucosal tunneling for Barrett's esophagus nodularity. Endoscopy 2022; 54:E275-E276. [PMID: 34144614 DOI: 10.1055/a-1499-6267] [Citation(s) in RCA: 1] [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: 12/10/2022]
Affiliation(s)
- Rodrigo Duarte-Chavez
- Department of Gastroenterology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
| | - Marina Kim
- Department of Gastroenterology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
| | - Daniel Marino
- Department of Gastroenterology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
| | - Michel Kahaleh
- Department of Gastroenterology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
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Mohammad T, Kahaleh M. Comparing palliative treatment options for cholangiocarcinoma: photodynamic therapy vs. radiofrequency ablation. Clin Endosc 2022; 55:347-354. [PMID: 35578751 PMCID: PMC9178148 DOI: 10.5946/ce.2021.274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 01/06/2022] [Indexed: 11/24/2022] Open
Abstract
Referral to an endoscopist is often done once curative resection is no longer an option for cholangiocarcinoma management. In such cases, palliation has become the main objective of the treatment. Photodynamic therapy and radiofrequency ablation can be performed to achieve palliation, with both procedures associated with improved stent patency and survival. Despite the greatly increased cost and association with photosensitivity, photodynamic therapy allows transmission to the entire biliary tree. In contrast, radiofrequency ablation is cheaper and faster to apply, but requires intraductal contact. This paper reviews both modalities and compares their efficacy and safety for bile duct cancer palliation.
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Affiliation(s)
- Tayyaba Mohammad
- Division of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Michel Kahaleh
- Division of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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Abstract
Endoscopic ultrasound (EUS) has been continuously evolving for the past three decades and has become widely used for both diagnostic and therapeutic purposes. The efficacy of therapeutic EUS (TEUS) has proven to be superior and better tolerated than conventional percutaneous or surgical techniques. TEUS has allowed the performance of multiple procedures including gallbladder, pancreatic duct and biliary drainage as well as gastrointestinal anastomoses. TEUS procedures generally require the following critical steps: needle access, guidewire placement, fistula creation and stent deployment. The indications and contraindication for TEUS procedures vary with different procedures but common contraindications include hemodynamic instability, severe coagulopathy unable to be reversed, large volume ascites or the inability to obtain access to the target site. Proficiency and high volume in endoscopic retrograde cholangiopancreatography (ERCP) and diagnostic EUS procedures are required for training in TEUS. The complexity of the cases performed can be seen as a pyramid with drainage of pancreatic fluid collections at the base, pancreaticobiliary decompression in the middle, and creation of digestive anastomosis at the top. The mastery of each level is crucial prior to reaching the next level of complexity. TEUS has been incorporated in our arsenal and is impacting on a daily basis the way we offer minimally invasive therapy.
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Affiliation(s)
- Rodrigo Duarte-Chavez
- Department of Internal Medicine, St. Luke’s University Health Network, Bethlehem, PA, USA
| | - Michel Kahaleh
- Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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Kim M, Bareket R, Eleftheriadis NP, Kedia P, Seewald S, Groth S, Nieto J, Kumta NA, Deshmukh AA, Katz J, Suresh S, Zamarripa F, Martínez MG, Liu-Burdowski J, Gaidhane M, Sarkar A, Shahid HM, Tyberg A, Kahaleh M. Endoscopic Submucosal Dissection (ESD) Offers a Safer and More Cost-effective Alternative to Transanal Endoscopic Microsurgery (TEM): An International Collaborative Study. J Clin Gastroenterol 2022; 57:486-489. [PMID: 35470283 DOI: 10.1097/mcg.0000000000001708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 03/15/2022] [Indexed: 12/10/2022]
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) and transanal endoscopic microsurgery (TEM) are minimally invasive procedures that treat early rectal cancer (ERC). Both are effective treatments, yet there are very few studies comparing them. The aim of our study was to identify ideal candidates for each procedure. MATERIALS AND METHODS Between January 2016 and November 2019, 204 ERC patients were managed with either ESD (n=101) or TEM (n=103) at 7 international centers. Data analyzed included clinical success, tumor characteristics, procedure info, and recurrence rates. RESULTS Median tumor size was 40 mm±23.9 in the ESD group and 56 mm±27.9 in the TEM group, significantly larger in the latter (P<0.00001). Average procedure time was 131.5±67.9 minutes in ESD group and 104.9±28.4 minutes in TEM group (P=0.000347). Average hospital stay was 3.3±2.6 days in the ESD group and 4.7±0.7 days in the TEM group (P<0.00001). Adverse event rate was 6.8% in the ESD group and 24% in the TEM group. There were no significant difference in the rate of en bloc resection, technical success, tumor location, necessity of additional procedures, and tumor recurrence rates. CONCLUSION Compared with TEM, ESD is a safer procedure with shorter hospital stay and should be offered for patients who have ERC.
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Affiliation(s)
- Marina Kim
- Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Romy Bareket
- Robert Wood Johnson University Hospital, New Brunswick, NJ
| | | | | | | | | | | | | | | | - Jordan Katz
- Robert Wood Johnson University Hospital, New Brunswick, NJ
| | | | | | | | | | | | - Avik Sarkar
- Robert Wood Johnson University Hospital, New Brunswick, NJ
| | | | - Amy Tyberg
- Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Michel Kahaleh
- Robert Wood Johnson University Hospital, New Brunswick, NJ
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Mohamadnejad M, Anushiravani A, Kasaeian A, Sorouri M, Djalalinia S, Kazemzadeh Houjaghan A, Gaidhane M, Kahaleh M. Endoscopic or surgical treatment for necrotizing pancreatitis: Comprehensive systematic review and meta-analysis. Endosc Int Open 2022; 10:E420-E428. [PMID: 35433210 PMCID: PMC9010078 DOI: 10.1055/a-1783-9229] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 11/10/2021] [Indexed: 11/18/2022] Open
Abstract
Background and study aims Treatment of necrotizing pancreatitis is changed over the past two decades with the availability of endoscopic, and minimally invasive surgical approaches. The aim of this systematic review was to assess outcomes of endoscopic drainage, and different types of surgical drainage approaches in necrotizing pancreatitis. Methods Medline, Embase, Scopus, and Web of Science were searched from 1998 to 2020 to assess outcomes in endoscopic drainage and various surgical drainage procedures. The assessed variables consisted of mortality, development of pancreatic or enteric fistula, new onset diabetes mellitus, and exocrine pancreatic insufficiency. Results One hundred seventy studies comprising 11,807 patients were included in the final analysis. The pooled mortality rate was 22 % (95 % confidence interval [CI]: 19%-26 %) in the open surgery (OS), 8 % (95 %CI:5 %-11 %) in minimally invasive surgery (MIS), 13 % (95 %CI: 9 %-18 %) in step-up approach, and 3 % (95 %CI:2 %-4 %) in the endoscopic drainage (ED). The pooled rate of fistula formation was 35 % (95 %CI:28 %-41 %) in the OS, 17 % (95 %CI: 12%-23 %) in MIS, 17 % (95 %CI: 9 %-27 %) in step-up approach, and 2 % (95 %CI: 0 %-4 %) in ED. There were 17 comparative studies comparing various surgical drainage methods with ED. The mortality rate was significantly lower in ED compared to OS (risk ratio [RR]: 30; 95 %CI: 0.20-0.45), and compared to MIS (RR: 0.40; 95 %CI: 0.26-0.6). Also, the rate of fistula formation was lower in ED compared to all other surgical drainage approaches. Conclusions This systematic review demonstrated lower rate of fistula formation with ED compared to various surgical drainage methods. A lower rate of mortality with ED was also observed in observational studies. PROSPERO Identifier: CRD42020139354.
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Affiliation(s)
- Mehdi Mohamadnejad
- Liver and Pancreaticobiliary Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Anushiravani
- Liver and Pancreaticobiliary Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Kasaeian
- Liver and Pancreaticobiliary Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran,Hematology, Oncology and Stem Cell Transplantation Research Center, Research Institute for Oncology, Hematology and Cell Therapy, Tehran University of Medical Sciences, Tehran, Iran,Inflammation Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Majid Sorouri
- Liver and Pancreaticobiliary Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shirin Djalalinia
- Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
| | - Amirmasoud Kazemzadeh Houjaghan
- Liver and Pancreaticobiliary Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Monica Gaidhane
- Division of Gastroenterology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
| | - Michel Kahaleh
- Division of Gastroenterology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
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Reja M, Mishra A, Tyberg A, Andalib I, Martínez GM, Zamarripa F, Gaidhane M, Nieto J, Kahaleh M. Gastric Peroral Endoscopic Myotomy: A Specific Learning Curve. J Clin Gastroenterol 2022; 56:339-342. [PMID: 34009842 DOI: 10.1097/mcg.0000000000001537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 02/18/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Gastric peroral endoscopic pyloromyotomy (G-POEM) is a novel option for patients with gastroparesis. It involves submucosal tunneling across the pylorus, followed by pyloromyotomy, and subsequent closure of the endoscopic tunnel. The aim of this study was to determine the learning curve for G-POEM. METHODS Consecutive patients undergoing G-POEM by a single operator were included from a prospective registry over 2 years. Demographics, procedure info, postprocedure follow-up data, and adverse events were collected. Nonlinear regression and cumulative sum control chart analyses were conducted for the learning curve. Clinical outcomes were improvement in Gastroparesis Cardinal Symptom Index score and gastric emptying scintigraphy. RESULTS Thirty-six patients were included (16.7% M, mean age 46 y). The majority had idiopathic gastroparesis (n=16, 44%), with the remaining having diabetes (n=5, 17%), postsurgical (n=10, 28%), or other (n=4, 11%). Technical success was achieved in 35 of 36 (97%). There was a significant reduction in the total Gastroparesis Cardinal Symptom Index score (2.09 units, P<0.00001) and a significant reduction in postoperative gastric emptying scintigraphy (82.44 mins, P<0.00001). Mean follow-up was 15 months (SD, 1.05). Median procedure time was 60.5 minutes (range, 35 to 136). Cumulative sum control chart shows 60-minute procedure was achieved at the 18th procedure. Procedure durations further reduced with consequent procedures with the last 3 being 45 minutes, thus demonstrating continued improvement with ongoing experience (nonlinear regression P<0.0001). CONCLUSION Endoscopists experienced in G-POEM are expected to achieve a reduction in procedure time over successive cases, with efficiency reached at 60.5 minutes and a learning rate of 18 cases with continuing improvement.
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Affiliation(s)
- Mishal Reja
- Rutgers Robert Wood Johnson Medical School, New Brunswick
| | | | - Amy Tyberg
- Rutgers Robert Wood Johnson Medical School, New Brunswick
| | - Iman Andalib
- Ichan School of Medicine, Mount Sinai, New York, NY
| | | | | | | | | | - Michel Kahaleh
- Rutgers Robert Wood Johnson Medical School, New Brunswick
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Gjeorgjievski M, Abdelqader A, Sarkar A, Shahid H, Tyberg A, Kahaleh M. Endoscopic coloenterostomy for treatment of malignant small-bowel obstruction: troubleshooting and management of complications. Endoscopy 2022; 54:E176-E177. [PMID: 33910247 DOI: 10.1055/a-1463-2495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Mihajlo Gjeorgjievski
- Department of Gastroenterology and Hepatology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Abdelhai Abdelqader
- Department of Gastroenterology and Hepatology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Avik Sarkar
- Department of Gastroenterology and Hepatology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Haroon Shahid
- Department of Gastroenterology and Hepatology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Amy Tyberg
- Department of Gastroenterology and Hepatology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Michel Kahaleh
- Department of Gastroenterology and Hepatology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
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Kahaleh M, Mahpour NY, Tyberg A, Bareket R, Shahid HM, Sarkar A, Abdelqader A, Gjeorgjievski M, Marino D, Kats D, Gaidhane M, Greenberg I, Lee DP, Bushe B, Eke C, Sun H, Kedia P, Méndez ALM, Lambroza A, Barret M, Hallit R, Eleftheriadis NP, Nieto J, Oleas R, Robles-Medranda C, Bapaye A. Per Oral Endoscopic Myotomy for Zenker's Diverticulum: A Novel and Superior Technique Compared With Septotomy? J Clin Gastroenterol 2022; 56:224-227. [PMID: 34183618 DOI: 10.1097/mcg.0000000000001579] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 05/26/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Endoscopic management of Zenker diverticuli (ZD) has traditionally been via septotomy technique. The recent development of tunneling technique has shown to be both efficacious and safe. The aim of this study is to evaluate the tunneling technique using per oral endoscopic myotomy (Z-POEM) versus septotomy. METHODS Patients who underwent endoscopic management of ZD either by Z-POEM or septotomy from March 2017 until November 2020 from 9 international academic centers were included. Demographics, clinical data preprocedure and postprocedure, procedure time, adverse events, and hospital length of stay were analyzed. RESULTS A total of 101 patients (mean age 74.9 y old, 55.4% male) were included: septotomy (n=49), Z-POEM (n=52). Preprocedure Functional Oral Intake Scale score and Eckardt score was 5.3 and 5.4 for the septotomy group and 5.9 and 5.15 for the Z-POEM group. Technical success was achieved in 98% of the Z-POEM group and 100% of the septotomy group. Clinical success was achieved in 84% and 92% in the septotomy versus Z-POEM groups. Adverse events occurred in 30.6% (n=15) in septotomy group versus 9.6% (n=5) in the Z-POEM group (P=0.017). Reintervention for ongoing symptoms occurred in 7 patients in the septotomy group and 3 patients in the Z-POEM group. Mean hospital length of stay was shorter for the Z-POEM group, at 1.5 versus 1.9 days. CONCLUSIONS A tunneling technique via the Z-POEM procedure is an efficacious and safe endoscopic treatment for ZD. Z-POEM is a safer procedure with a statistically significant reduction in adverse events compared with traditional septotomy technique.
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Affiliation(s)
- Michel Kahaleh
- Department of Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Noah Y Mahpour
- Department of Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Amy Tyberg
- Department of Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Romy Bareket
- Department of Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Haroon M Shahid
- Department of Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Avik Sarkar
- Department of Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Abdelhai Abdelqader
- Department of Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Mihajlo Gjeorgjievski
- Department of Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Daniel Marino
- Department of Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Daniel Kats
- Department of Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Monica Gaidhane
- Department of Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, NJ
| | | | | | | | | | | | | | | | | | | | | | | | | | - Roberto Oleas
- Gastroenterology and Endoscopy Division, Ecuadorian Institute of Digestive Diseases (IECED), Guayaquil, Ecuador
| | - Carlos Robles-Medranda
- Gastroenterology and Endoscopy Division, Ecuadorian Institute of Digestive Diseases (IECED), Guayaquil, Ecuador
| | - Amol Bapaye
- Deenanath Mangeshkar Hospital and Research Center, Pune, India
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Kim M, Bareket R, Reja M, Sarkar A, Shahid H, Tyberg A, Kahaleh M. Ultimate salvation: feasibility of NOTES for complications of ERCP and endoscopic ultrasound-guided procedures. Endoscopy 2022; 54:E100-E101. [PMID: 33784748 DOI: 10.1055/a-1394-5872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Marina Kim
- Department of Gastroenterology & Hepatology, Rutgers Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Romy Bareket
- Department of Gastroenterology & Hepatology, Rutgers Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Mishal Reja
- Department of Gastroenterology & Hepatology, Rutgers Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Avik Sarkar
- Department of Gastroenterology & Hepatology, Rutgers Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Haroon Shahid
- Department of Gastroenterology & Hepatology, Rutgers Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Amy Tyberg
- Department of Gastroenterology & Hepatology, Rutgers Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Michel Kahaleh
- Department of Gastroenterology & Hepatology, Rutgers Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
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Stassen PMC, de Jonge PJF, Bruno MJ, Koch AD, Trindade AJ, Benias PC, Sejpal DV, Siddiqui UD, Chapman CG, Villa E, Tharian B, Inamdar S, Hwang JH, Barakat MT, Andalib I, Gaidhane M, Sarkar A, Shahid H, Tyberg A, Binmoeller K, Watson RR, Nett A, Schlag C, Abdelhafez M, Friedrich-Rust M, Schlachterman A, Chiang AL, Loren D, Kowalski T, Kahaleh M. Safety and efficacy of a novel resection system for direct endoscopic necrosectomy of walled-off pancreas necrosis: a prospective, international, multicenter trial. Gastrointest Endosc 2022; 95:471-479. [PMID: 34562471 DOI: 10.1016/j.gie.2021.09.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 09/10/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Direct endoscopic necrosectomy (DEN) of walled-off pancreatic necrosis (WOPN) lacks dedicated instruments and requires repetitive and cumbersome procedures. This study evaluated the safety and efficacy of a new powered endoscopic debridement (PED) system designed to simultaneously resect and remove solid debris within WOPN. METHODS This was a single-arm, prospective, multicenter, international device trial conducted from November 2018 to August 2019 at 10 sites. Patients with WOPN ≥6 cm and ≤22 cm and with >30% solid debris were enrolled. The primary endpoint was safety through 21 days after the last DEN procedure. Efficacy outcomes included clearance of necrosis, procedural time, adequacy of debridement, number of procedures until resolution, hospital stay duration, and quality of life. RESULTS Thirty patients (mean age, 55 years; 60% men) underwent DEN with no device-related adverse events. Of 30 patients, 15 (50%) achieved complete debridement in 1 session and 20 (67%) achieved complete debridement within 2 or fewer sessions. A median of 1.5 interventions (range, 1-7) were required. Median hospital stay was 10 days (interquartile range, 22). There was an overall reduction of 91% in percent necrosis within WOPN from baseline to follow-up and 85% in collection volume. Baseline WOPN volume was positively correlated with the total number of interventions (ρ = .363, P = .049). CONCLUSIONS The new PED system seems to be a safe and effective treatment tool for WOPN, resulting in fewer interventions and lower hospital duration when compared with published data on using conventional instruments. Randomized controlled trials comparing the PED system with conventional DEN are needed. (Clinical trial registration number: NCT03694210.).
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Affiliation(s)
- Pauline M C Stassen
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Pieter Jan F de Jonge
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marco J Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Arjun D Koch
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Arvind J Trindade
- Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Long Island Jewish Medical Center, New Hyde Park, New York, USA
| | - Petros C Benias
- Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Long Island Jewish Medical Center, New Hyde Park, New York, USA
| | - Divyesh V Sejpal
- Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Long Island Jewish Medical Center, New Hyde Park, New York, USA
| | - Uzma D Siddiqui
- The Center for Endoscopic Research and Therapeutics (CERT), University of Chicago Medicine, Chicago, Illinois, USA
| | - Christopher G Chapman
- The Center for Endoscopic Research and Therapeutics (CERT), University of Chicago Medicine, Chicago, Illinois, USA
| | - Edward Villa
- Division of Gastroenterology and Hepatology, University of Illinois at Chicago Medical Center, Chicago, Illinois, USA
| | - Benjamin Tharian
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Sumant Inamdar
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Joo Ha Hwang
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford University, Stanford, California, USA
| | - Monique T Barakat
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford University, Stanford, California, USA
| | - Iman Andalib
- Division of Gastroenterology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Monica Gaidhane
- Division of Gastroenterology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Avik Sarkar
- Division of Gastroenterology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Haroon Shahid
- Division of Gastroenterology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Amy Tyberg
- Division of Gastroenterology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Kenneth Binmoeller
- Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, California, USA
| | - Rabindra R Watson
- Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, California, USA
| | - Andrew Nett
- Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, California, USA
| | - Christoph Schlag
- Medical Department, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Mohamed Abdelhafez
- Medical Department, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Mireen Friedrich-Rust
- Department of Internal Medicine 1, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Alexander Schlachterman
- Department of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Austin L Chiang
- Department of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - David Loren
- Department of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Thomas Kowalski
- Department of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Michel Kahaleh
- Division of Gastroenterology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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Kahaleh M, Gaidhane M, Shahid HM, Tyberg A, Sarkar A, Ardengh JC, Kedia P, Andalib I, Gress F, Sethi A, Gan SI, Suresh S, Makar M, Bareket R, Slivka A, Widmer JL, Jamidar PA, Alkhiari R, Oleas R, Kim D, Robles-Medranda CA, Raijman I. Digital single-operator cholangioscopy interobserver study using a new classification: the Mendoza Classification (with video). Gastrointest Endosc 2022; 95:319-326. [PMID: 34478737 DOI: 10.1016/j.gie.2021.08.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 08/14/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Digital single-operator cholangioscopy (DSOC) allows direct visualization of the biliary tree for evaluation of biliary strictures. Our objective was to assess the interobserver agreement (IOA) of DSOC interpretation for indeterminate biliary strictures using newly refined criteria. METHODS Fourteen endoscopists were asked to review an atlas of reference clips and images of 5 criteria derived from expert consensus. They then proceeded to score 50 deidentified DSOC video clips based on the visualization of tortuous and dilated vessels, irregular nodulations, raised intraductal lesions, irregular surface with or without ulcerations, and friability. The endoscopists then diagnosed the clips as neoplastic or non-neoplastic. Intraclass correlation (ICC) analysis was done to evaluate inter-rater agreement for both criteria sets and final diagnosis. RESULTS Clips of 41 malignant lesions and 9 benign lesions were scored. Three of 5 revised criteria had almost perfect agreement. ICC was almost perfect for presence of tortuous and dilated vessels (.86), raised intraductal lesions (.90), and presence of friability (.83); substantial agreement for presence of irregular nodulations (.71); and moderate agreement for presence of irregular surface with or without ulcerations (.44). The diagnostic ICC was almost perfect for neoplastic (.90) and non-neoplastic (.90) diagnoses. The overall diagnostic accuracy using the revised criteria was 77%, ranging from 64% to 88%. CONCLUSIONS The IOA and accuracy rate of DSOC using the new Mendoza criteria shows a significant increase of 16% and 20% compared with previous criteria. The reference atlas helps with formal training and may improve diagnostic accuracy. (Clinical trial registration number: NCT02166099.).
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Affiliation(s)
- Michel Kahaleh
- Department of Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Monica Gaidhane
- Department of Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Haroon M Shahid
- Department of Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Amy Tyberg
- Department of Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Avik Sarkar
- Department of Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | | | | | - Iman Andalib
- Mount Sinai South Nassau, Oceanside, New York, USA
| | - Frank Gress
- Mount Sinai South Nassau, Oceanside, New York, USA
| | - Amrita Sethi
- Columbia University Medical Center, New York, New York, USA
| | - S Ian Gan
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Michael Makar
- Department of Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Romy Bareket
- Department of Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Adam Slivka
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | | | | | - Resheed Alkhiari
- Department of Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA; Department of Medicine, Qassim University, Saudi Arabia
| | - Roberto Oleas
- Instituto Ecuatoriano de Enfermedades Digestivas, Guayaquil, Ecuador
| | - Dongchoon Kim
- Soon Chun Hyang University Hospital, Seoul, Republic of Korea
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Bhagat V, Alkhiari R, Kahaleh M. The light at the end of the tunnel: tunnel bleeding following per-oral endoscopic myotomy. Endoscopy 2021; 53:E464-E465. [PMID: 33540432 DOI: 10.1055/a-1346-7802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Vicky Bhagat
- Department of Gastroenterology, Robert Wood Johnson Medical Center, New Brunswick, New Jersey, United States
| | - Resheed Alkhiari
- Department of Gastroenterology, Robert Wood Johnson Medical Center, New Brunswick, New Jersey, United States
| | - Michel Kahaleh
- Department of Gastroenterology, Robert Wood Johnson Medical Center, New Brunswick, New Jersey, United States
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Abdelqader A, Sarkar A, Shahid H, Tyberg A, Sameera S, Gjeorgjievski M, Escobedo K, Simon A, Bareket R, He P, Zhao E, Gaidhane M, Kahaleh M. Impact of the SARS-CoV-2 pandemic on turnover time and revenue in the endoscopy unit: single-center experience. Endosc Int Open 2021; 9:E1680-E1685. [PMID: 34790530 PMCID: PMC8589563 DOI: 10.1055/a-1546-8302] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 06/17/2021] [Indexed: 11/15/2022] Open
Abstract
Background and study aims The SARS-CoV-2 pandemic heavily impacted the New York metro area causing most institutions to either reduce case volume or fully close remaining open units incorporated specific guidelines for procedures lockdown potentially leading to a greater turn-over time. We analyzed the quantitative and financial impact of this lost time on our tertiary care center's endoscopy unit. Patients and methods This single-center, retrospective study included demographics, procedure details and turn-over times (TOT) from all endoscopic procedures between December 1, 2019 to June 30, 2020. Cases were categorized as pre-COVID-19 group from December 1, 2019 to March 15, 2020 and during COVID-19 (lockdown) group from March 16, 2020 to June 30, 2020. The financial impact was assessed using national averages for reimbursement of outpatient endoscopic procedures provided by Center for Medicare and Medicaid Services. Results A total of 3622 procedures were performed during the study period: 2297 in the pre-COVID-19 period, 1325 in the COVID-19 period, representing a 42.32 % decrease. In the COVID-19 lockdown group, there was a significant increase in TOT in both the general endoscopy cases (18.11 minutes, P = 0.000) and advanced endoscopy cases (17.7 minutes, P = 0.000). The 42.3 % decrease in volume equated to at least $1.6 million USD in lost revenue during the lockdown. Conclusions COVID-19 pandemic led to an increase in TOT with overall reduced procedure volume and a negative effect on revenue. Providing continued endoscopic management during a pandemic avoids delays in reopening the endoscopy unit and hampers the post-pandemic surge of delayed cases and its financial impact.
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Affiliation(s)
- Abdelhai Abdelqader
- Department of Medicine, Division of Gastroenterology, Robert Wood Johnson Medical Center, New Brunswick, New Jersey, United States
| | - Avik Sarkar
- Department of Medicine, Division of Gastroenterology, Robert Wood Johnson Medical Center, New Brunswick, New Jersey, United States
| | - Haroon Shahid
- Department of Medicine, Division of Gastroenterology, Robert Wood Johnson Medical Center, New Brunswick, New Jersey, United States
| | - Amy Tyberg
- Department of Medicine, Division of Gastroenterology, Robert Wood Johnson Medical Center, New Brunswick, New Jersey, United States
| | - Sohini Sameera
- Department of Medicine, Division of Gastroenterology, Robert Wood Johnson Medical Center, New Brunswick, New Jersey, United States
| | - Mihajlo Gjeorgjievski
- Department of Medicine, Division of Gastroenterology, Robert Wood Johnson Medical Center, New Brunswick, New Jersey, United States
| | - Karoline Escobedo
- Department of Medicine, Division of Gastroenterology, Robert Wood Johnson Medical Center, New Brunswick, New Jersey, United States
| | - Alexa Simon
- Department of Medicine, Division of Gastroenterology, Robert Wood Johnson Medical Center, New Brunswick, New Jersey, United States
| | - Romy Bareket
- Department of Medicine, Division of Gastroenterology, Robert Wood Johnson Medical Center, New Brunswick, New Jersey, United States
| | - Ping He
- Department of Medicine, Division of Gastroenterology, Robert Wood Johnson Medical Center, New Brunswick, New Jersey, United States
| | - Eric Zhao
- Department of Medicine, Division of Gastroenterology, Robert Wood Johnson Medical Center, New Brunswick, New Jersey, United States
| | - Monica Gaidhane
- Department of Medicine, Division of Gastroenterology, Robert Wood Johnson Medical Center, New Brunswick, New Jersey, United States
| | - Michel Kahaleh
- Department of Medicine, Division of Gastroenterology, Robert Wood Johnson Medical Center, New Brunswick, New Jersey, United States
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Pioppo L, Reja D, Gaidhane M, Bareket R, Tawadros A, Madrigal Méndez AL, Nieto J, Zamarripa F, Martínez MG, Carames MC, Carames JC, Liu-Burdowski J, Kim M, Deshmukh AA, Suresh S, Alkhiari R, Andalib I, Shahid HM, Sarkar A, Tyberg A, Kahaleh M. Gastric per-oral endoscopic myotomy versus pyloromyotomy for gastroparesis: An international comparative study. J Gastroenterol Hepatol 2021; 36:3177-3182. [PMID: 34170565 DOI: 10.1111/jgh.15599] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/11/2021] [Accepted: 06/15/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIM Gastroparesis is a potentially debilitating gastric motility disorder with limited treatment options. Highest efficacy treatments include gastric per-oral endoscopic myotomy (GPOEM) and surgical pyloromyotomy. This study compares the efficacy and safety of GPOEM versus laparoscopic pyloromyotomy for refractory gastroparesis. METHODS Patients who underwent GPOEM or laparoscopic pyloromyotomy for refractory gastroparesis from four centers across the USA and Latin America were included in a dedicated registry. Data collected included patient demographics, imaging, laboratory values, clinical success, gastroparesis cardinal symptom index, procedure time, pre-op and post-op gastric emptying times, adverse events, and hospital length of stay. RESULTS A total of 102 patients were included (mean age 47; 32.4% male): GPOEM n = 39, surgical pyloromyotomy n = 63.Technical success was 100% in both groups. Clinical success was 92.3% in the GPOEM group and 82.5% in the surgery group (P = 0.164). The GPOEM group had a significantly higher post-op GSCI score reduction by 1.3 units (P < 0.00001), post-op retention reduction at 2 h by 18% (P < 0.00001), post-op retention reduction at 4 h by 25% (P < 0.00001) and a lower procedure time by 20 min (P < 0.00001) as compared with surgery. GPOEM also had a lower hospital length of stay by 2.8 days (P < 0.00001). Adverse events were significantly fewer in the GPOEM group (13%) compared with surgery group (33.3%; P = 0.021). Mean blood loss in the GPOEM group was only 3.6 mL compared with 866 mL in the surgery group. CONCLUSIONS The GPOEM may be a less invasive, safer, and more efficacious procedural treatment for refractory gastroparesis as compared with surgical pyloromyotomy.
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Affiliation(s)
- Lauren Pioppo
- Department of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Debashis Reja
- Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Monica Gaidhane
- Department of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Romy Bareket
- Department of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Augustine Tawadros
- Department of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Ana L Madrigal Méndez
- Department of Gastroenterology, Costa Rican Social Security Fund, San José, Costa Rica
| | - Jose Nieto
- Department of Gastroenterology, Borland-Groover Clinic, Miami, Florida, USA
| | - Felipe Zamarripa
- Department of Gastroenterology, Juarez Hospital, Ciudad Juarez, Mexico
| | | | - Mine C Carames
- Department of Gastroenterology, Santander Hospital, Reynosa, Mexico
| | - Juan C Carames
- Department of Gastroenterology, Santander Hospital, Reynosa, Mexico
| | - Jennifer Liu-Burdowski
- Department of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Marina Kim
- Department of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Ameya A Deshmukh
- Department of Gastroenterology, Costa Rican Social Security Fund, San José, Costa Rica
| | - Supriya Suresh
- Department of Gastroenterology, Weill Cornell Medical College, New York, New York, USA
| | - Resheed Alkhiari
- Department of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | | | - Haroon M Shahid
- Department of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Avik Sarkar
- Department of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Amy Tyberg
- Department of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Michel Kahaleh
- Department of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
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Alkhiari R, Kahaleh M. Therapeutic endoscopic ultrasound: Between reducing the cost and detection of early complications. Saudi J Gastroenterol 2021; 27:259-260. [PMID: 34596592 PMCID: PMC8555773 DOI: 10.4103/sjg.sjg_483_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Resheed Alkhiari
- Department of Medicine, College of Medicine, Qassim University, Qassim, Saudi Arabia,Address for correspondence: Dr. Resheed Alkhiari, Department of Medicine, College of Medicine, Qassim University, Qassim, Saudi Arabia. E-mail:
| | - Michel Kahaleh
- Division of Gastroenterology, Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
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Shinn B, Boortalary T, Raijman I, Nieto J, Khara HS, Kumar SV, Confer B, Diehl DL, El Halabi M, Ichkhanian Y, Runge T, Kumbhari V, Khashab M, Tyberg A, Shahid H, Sarkar A, Gaidhane M, Bareket R, Kahaleh M, Piraka C, Zuchelli T, Law R, Sondhi A, Kedia P, Robbins J, Calogero C, Bakhit M, Chiang A, Schlachterman A, Kowalski T, Loren D. Maximizing success in single-session EUS-directed transgastric ERCP: a retrospective cohort study to identify predictive factors of stent migration. Gastrointest Endosc 2021; 94:727-732. [PMID: 33957105 DOI: 10.1016/j.gie.2021.04.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 01/18/2021] [Accepted: 04/27/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS EUS-directed transgastric ERCP (the EDGE procedure) is a simplified method of performing ERCP in Roux-en-Y gastric bypass patients. The EDGE procedure involves placement of a lumen-apposing metal stent (LAMS) into the excluded stomach to serve as a conduit for passage of the duodenoscope for pancreatobiliary intervention. Originally a multistep process, urgent indications for ERCP have led to the development of single-session EDGE (SS-EDGE) with LAMS placement and ERCP performed in the same session. The goal of this study was to identify predictive factors of intraprocedural LAMS migration in SS-EDGE. METHODS We conducted a multicenter retrospective review that included 9 tertiary medical centers across the United States. Data were collected and analyzed from 128 SS-EDGE procedures. The primary outcome was intraprocedural LAMS migration. Secondary outcomes were other procedural adverse events such as bleeding and perforation. RESULTS Eleven LAMS migrations were observed in 128 procedures (8.6%). Univariate analysis of clinically relevant variables was performed, as was a binary logistic regression analysis of stent diameter and stent dilation. This revealed that use of a smaller (15 mm) diameter LAMS was an independent predictor of intraprocedural stent migration (odds ratio, 5.36; 95% confidence interval, 1.29-22.24; P = .021). Adverse events included 3 patients who required surgery and 2 who experienced intraprocedural bleeding. CONCLUSIONS Use of a larger-diameter LAMS is a predictive factor for a nonmigrated stent and improved procedural success in SS-EDGE. Although larger patient cohorts are needed to adequately assess these findings, performance of LAMS dilation and fixation may also decrease risk of intraprocedural LAMS migration and improve procedural success.
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Affiliation(s)
- Brianna Shinn
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Tina Boortalary
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | | | - Jose Nieto
- Borland Groover Clinic, Jacksonville, Florida, USA
| | | | - S Vikas Kumar
- Geisinger Health System, Danville, Pennsylvania, USA
| | | | - David L Diehl
- Geisinger Health System, Danville, Pennsylvania, USA
| | - Maan El Halabi
- Johns Hopkins University Hospital, Baltimore, Maryland, USA
| | | | - Thomas Runge
- Johns Hopkins University Hospital, Baltimore, Maryland, USA
| | - Vivek Kumbhari
- Johns Hopkins University Hospital, Baltimore, Maryland, USA
| | - Mouen Khashab
- Johns Hopkins University Hospital, Baltimore, Maryland, USA
| | - Amy Tyberg
- Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Haroon Shahid
- Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Avik Sarkar
- Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Monica Gaidhane
- Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Romy Bareket
- Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Michel Kahaleh
- Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Cyrus Piraka
- Henry Ford Health System, Detroit, Michigan, USA
| | | | - Ryan Law
- University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - Arjun Sondhi
- University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | | | - Justin Robbins
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Cristina Calogero
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Mena Bakhit
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Austin Chiang
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | | | - Thomas Kowalski
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - David Loren
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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