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Hosni MN, Kassas M, Itani MI, Rahal MA, Al-Zakleet S, El-Jebai M, Abi-Ghanem AS, Moukaddam H, Haidar M, Vinjamuri S, Shaib YH. The Clinical Significance of Incidental GIT Uptake on PET/CT: Radiologic, Endoscopic, and Pathologic Correlation. Diagnostics (Basel) 2023; 13:diagnostics13071297. [PMID: 37046516 PMCID: PMC10093625 DOI: 10.3390/diagnostics13071297] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/17/2023] [Accepted: 03/28/2023] [Indexed: 03/31/2023] Open
Abstract
Incidental gastrointestinal tract (GIT) [18F]-Fluorodeoxyglucose (FDG) uptake in positron emission technology/computed tomography (PET/CT) is an unexpected and often complicated finding for clinicians. This retrospective study reviewed 8991 charts of patients who underwent PET/CT: 440 patients had incidental GIT uptake, of which 80 underwent endoscopy. Patient characteristics, imaging parameters, and endoscopic findings were studied. Of the 80 patients, 31 had cancer/pre-cancer lesions (16 carcinomas; 15 pre-malignant polyps). Compared to patients with benign/absent lesions, patients with cancer/pre-cancer lesions were significantly older (p = 0.01), underwent PET/CT for primary evaluation/staging of cancer (p = 0.03), had focal GIT uptake (p = 0.04), and had lower GIT uptake (p = 0.004). Among patients with focal uptake, an SUVmax of 9.2 had the highest sensitivity (0.76) and specificity (0.885) in detecting cancer/pre-cancerous lesions. Lower GIT uptake was most common in the sigmoid colon, and upper GIT uptake was most frequent in the stomach. In a bivariate analysis, predictors of cancer/pre-cancer were older age, PET/CT indicated for primary evaluation, focal uptake, uptake in the lower GIT, and higher SUVmax. Further endoscopic investigation is warranted for patients with incidental GIT uptake, especially in the elderly or those presenting for primary evaluation with PET/CT, with the following findings on imaging: lower GIT uptake, focal uptake, or high SUVmax.
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Affiliation(s)
- Mohammad N. Hosni
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut 1107-2020, Lebanon
| | - Mutaz Kassas
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut 1107-2020, Lebanon
| | - Mohamad I. Itani
- Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI 48202, USA
| | - Mahmoud A. Rahal
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN 46202-3082, USA
| | - Safaa Al-Zakleet
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut 1107-2020, Lebanon
| | - Malak El-Jebai
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut 1107-2020, Lebanon
| | - Alain S. Abi-Ghanem
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut 1107-2020, Lebanon
| | - Hicham Moukaddam
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut 1107-2020, Lebanon
| | - Mohamad Haidar
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut 1107-2020, Lebanon
- Correspondence: ; Tel.: +961-1-350000 (ext. 7116)
| | - Sobhan Vinjamuri
- Nuclear Medicine, Royal Liverpool and Broadgreen University Hospital, Liverpool L7 8YE, UK
| | - Yasser H. Shaib
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut 1107-2020, Lebanon
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Itani MI, Oberbach A, Salimian KJ, Enderle M, Hahn H, Abbarh S, Kendrick K, Schlichting N, Anders RA, Besharati S, Farha J, Fayad L, Kalloo AN, Badurdeen D, Kumbhari V. Gastric Mucosal Devitalization (GMD): Using the Porcine Model to Develop a Novel Endoscopic Bariatric Approach. Obes Surg 2021; 32:381-390. [PMID: 34797503 DOI: 10.1007/s11695-021-05773-4] [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] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 10/10/2021] [Accepted: 11/03/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS As the pig model has similar gastrointestinal anatomy and physiology to humans, we used pigs to create a gastric mucosal devitalization (GMD) model in preparation for clinical translation of this technique as an endoscopic bariatric therapy (EBT). The aims of this study were to determine the ablation parameters and technique for a successful, safe, and feasible large surface area GMD that produces weight loss. METHODS We performed GMD using argon plasma coagulation (APC) in 3 phases. Phase 1 assessed the ablation energy required to accomplish selective mucosal ablation using ex vivo pig stomachs (n = 2). Phase 2 assessed the optimal percentage of mucosal surface area to be treated and was performed on 10 pigs. Phase 3 assessed feasibility, efficacy, and safety with 8 pigs randomized into GMD (n = 4) or sham (SH, n = 4) and survived for 1 month. Body weights (GMD, n = 4, SH, n = 4) were measured daily in phase 3 for 1 month, and relative body weights were calculated and analyzed using one-tailed Student's t-test. Percent body fat was compared between GMD and SH at baseline and 1 month post-GMD. RESULTS Phase 1 identified the optimal ablation parameters (120 W) that were then used in phase 2. Phase 2 revealed a trend that was suggestive that the optimal percent surface area to ablate was similar to that which is removed at laparoscopic sleeve gastrectomy. In phase 3, GMD was performed over 70% surface area of the greater curvature of the stomach in four pigs. GMD pigs had significantly lower relative body weight increase compared to SH at 1 month (1.375 ± 0.085 vs 1.575 ± 0.047, p = 0.0435). MRI showed a significantly lower body fat mass at 1 month in GMD pigs (5.9 ± 0.4% vs 12.7 ± 2.3%, p = 0.026) compared to SH. CONCLUSIONS GMD resulted in decreased weight gain in the GMD group as evidenced by a lower relative body weight at 1 month. GMD in an animal model appears to show promise as a potential weight loss therapy.
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Affiliation(s)
- Mohamad I Itani
- Department of Internal Medicine, Wayne State University, Detroit, MI, 48201, USA.,Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, 21287, USA
| | - Andreas Oberbach
- Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany
| | - Kevan J Salimian
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD, 21287, USA
| | | | | | - Shahem Abbarh
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, 21287, USA
| | - Katherine Kendrick
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, 21287, USA
| | - Nadine Schlichting
- Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany
| | - Robert A Anders
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD, 21287, USA
| | - Sepideh Besharati
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD, 21287, USA
| | - Jad Farha
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, 21287, USA
| | - Lea Fayad
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, 21287, USA
| | - Anthony N Kalloo
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, 21287, USA
| | - Dilhana Badurdeen
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, 21287, USA
| | - Vivek Kumbhari
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, 21287, USA. .,Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Jacksonville, FL, 32224, USA.
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Farha J, Gebran S, Itani MI, Simsek C, Abbarh S, Lopez A, Haq Z, Koller K, Dunlap M, Adam A, Khashab MA, Oberbach A, Schweitzer M, Badurdeen D, Kumbhari V. Transoral outlet reduction: could additional sutures cause more harm? Endoscopy 2021; 53:1059-1064. [PMID: 33254242 DOI: 10.1055/a-1325-4324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND The double purse-string pattern (DPSP) of transoral outlet reduction (TORe) should conceivably result in a more robust scaffolding for the gastrojejunal anastomosis (GJA). However, there is a paucity of literature pertaining to post-TORe stenosis as an adverse event. Our aim was to determine the rate of stenosis, its potential predictors, and other complications of DPSP TORe. METHODS We performed a retrospective analysis of a prospectively maintained database of 129 consecutive patients who underwent DPSP TORe between December 2015 and August 2019. RESULTS The adverse event rate of TORe was 17.1 % (n = 22), with a 13.3 % (n = 17) rate of stenosis. Stenosis was not significantly associated with any baseline characteristics. GJA diameter pre- and post-TORe, the difference between these values, and procedure duration were not predictive of stenosis. Of patients who developed stenosis, 10 (58.8 %) responded to endoscopic balloon dilation and 7 (41.2 %) required stent placement. CONCLUSION As the DPSP technique is a challenging procedure, with high complication rate and limited benefit, it should not be used for TORe.
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Affiliation(s)
- Jad Farha
- Department of Medicine, Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Selim Gebran
- Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland, United States
| | - Mohamad I Itani
- Department of Medicine, Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Cem Simsek
- Department of Medicine, Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Shahem Abbarh
- Department of Medicine, Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Ariana Lopez
- Department of Medicine, Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Zadid Haq
- Department of Medicine, Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Kristen Koller
- Department of Medicine, Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Margo Dunlap
- Department of Medicine, Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Atif Adam
- Department of Mental Health at The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
| | - Mouen A Khashab
- Department of Medicine, Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Andreas Oberbach
- Department of Medicine, Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, United States.,Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany
| | - Michael Schweitzer
- Department of Surgery, The Johns Hopkins Center for Bariatric Surgery, Baltimore, Maryland, United States
| | - Dilhana Badurdeen
- Department of Medicine, Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Vivek Kumbhari
- Department of Medicine, Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, United States
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Mehta A, Shah S, Dawod E, Hajifathalian K, Kumar R, Igel LI, Saunders KH, Kumbhari V, Farha J, Badurdeen D, Itani MI, Moore RL, Starpoli AA, Carr-Locke DL, Shukla A, Aronne LJ, Sharaiha RZ. Impact of Adjunctive Pharmacotherapy With Intragastric Balloons for the Treatment of Obesity. Am Surg 2021:31348211038579. [PMID: 34384255 DOI: 10.1177/00031348211038579] [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] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND We conducted this study to compare the weight loss outcome of intragastric balloons (IGBs) in conjunction with pharmacotherapy vs IGB and intensive lifestyle changes alone. METHODS This was a multicenter, non-randomized, retrospective study involving 4 academic hospitals. Patients underwent IGB placement with or without concomitant anti-obesity pharmacotherapy. The primary outcome was percent total weight loss (TBWL) after IGB placement at 6 and 12 months. RESULTS This study included 102 patients, with 23 patients (mean age 46.6 years, 82.6% female) treated with IGB/pharmacotherapy and 79 patients (mean age 46.0 years, 88.6% female) treated with IGB/lifestyle modifications. Patients had a 100% follow-up rate at 6 and 12 months. At 6 months following IGB placement, both groups achieved a similar %TBWL. At 12 months, %TBWL was greater in the IGB/pharmacotherapy group (12.6% ± 1.2 vs 9.7% ± 0.7, P = .04). 65.2% of patients achieved ≥10% TBWL at 12 months in the IGB/pharmacotherapy group, compared to 38.0% in the IGB/lifestyle group (P < .05). The proportion of patients that achieved ≥15% weight loss at 12 months was also significantly different between the IGB/pharmacotherapy and IGB/lifestyle groups (30.4% vs 20.3%, P < .05). DISCUSSION IGB with concomitant use of pharmacotherapy did not improve weight loss while the IGB was in place compared to IGB and lifestyle changes. However, patients receiving IGB with pharmacotherapy did have greater weight loss and diminished weight regain after balloon removal compared to those receiving just IGB and lifestyle changes.
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Affiliation(s)
- Amit Mehta
- Division of Gastroenterologyatology, 159947Weill Cornell Medicine, New York, NY, USA
| | - Shawn Shah
- Division of Gastroenterologyatology, 159947Weill Cornell Medicine, New York, NY, USA
| | - Enad Dawod
- Division of Gastroenterologyatology, 159947Weill Cornell Medicine, New York, NY, USA
| | - Kaveh Hajifathalian
- Division of Gastroenterologyatology, 159947Weill Cornell Medicine, New York, NY, USA
| | - Rekha Kumar
- Division of Endocrinology, Diabetes, & Metabolism, 159947Weill Cornell Medicine, New York, NY, USA
| | - Leon I Igel
- Division of Endocrinology, Diabetes, & Metabolism, 159947Weill Cornell Medicine, New York, NY, USA
| | - Katherine H Saunders
- Division of Endocrinology, Diabetes, & Metabolism, 159947Weill Cornell Medicine, New York, NY, USA
| | - Vivek Kumbhari
- Division of Gastroenterology and Hepatology, 156400Mayo Clinic, Jacksonville, FL, USA
| | - Jad Farha
- Division of Gastroenterology and Hepatology, 1501Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dilhana Badurdeen
- Division of Gastroenterology and Hepatology, 1501Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mohamad I Itani
- Division of Gastroenterology and Hepatology, 1501Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | - David L Carr-Locke
- Division of Gastroenterologyatology, 159947Weill Cornell Medicine, New York, NY, USA
| | - Alpana Shukla
- Division of Endocrinology, Diabetes, & Metabolism, 159947Weill Cornell Medicine, New York, NY, USA
| | - Louis J Aronne
- Division of Endocrinology, Diabetes, & Metabolism, 159947Weill Cornell Medicine, New York, NY, USA
| | - Reem Z Sharaiha
- Division of Gastroenterologyatology, 159947Weill Cornell Medicine, New York, NY, USA
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5
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Farha J, McGowan C, Hedjoudje A, Itani MI, Abbarh S, Simsek C, Ichkhanian Y, Vulpis T, James TW, Fayad L, Khashab MA, Oberbach A, Badurdeen D, Kumbhari V. Endoscopic sleeve gastroplasty: suturing the gastric fundus does not confer benefit. Endoscopy 2021; 53:727-731. [PMID: 32777827 DOI: 10.1055/a-1236-9347] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND : There is heterogeneity regarding the technical aspects of endoscopic sleeve gastroplasty (ESG), such as applying fundal sutures. Our aim was to determine whether ESG with fundal suturing (ESG-FS) affects weight loss and the serious adverse event (SAE) rate when compared with ESG with no fundal suturing (ESG-NFS). METHODS: We conducted a two-center retrospective analysis of 247 patients who underwent ESG with or without fundal suturing. The primary outcome was percentage excess weight loss (%EWL) at 3, 6, and 12 months post-ESG. The secondary outcomes included the SAE rate and procedure duration. RESULTS: At 3, 6, and 12-months, ESG-NFS had a significantly greater mean %EWL compared with ESG-FS (38.4 % [standard deviation (SD) 15.3 %] vs. 31.2 % [SD 13.9 %], P = 0.001; 54.7 % [SD 19.2 %] vs. 37.7 % [SD 17.3 %], P < 0.001; 65.3 % [SD 21.1 %] vs. 40.6 % [SD 23.5 %], P < 0.001, respectively). There was no statistically significant difference in the SAE rates for ESG-NFS (n = 2; 2.0 %) and ESG-FS (n = 4; 2.6 %; P > 0.99). The mean procedure time was significantly shorter in the ESG-NFS group at 59.1 minutes (SD 32.7) vs. 93.0 minutes (35.5; P < 0.001), and a lower mean number of sutures were used, with 5.7 (SD 1.1) vs. 8.4 (SD 1.6; P < 0.001). CONCLUSION : ESG-NFS demonstrated greater efficacy and shorter procedure duration. Therefore, fundal suturing should not be performed.
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Affiliation(s)
- Jad Farha
- Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | | | - Abdellah Hedjoudje
- Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Mohamad I Itani
- Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Shahem Abbarh
- Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Cem Simsek
- Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Yervant Ichkhanian
- Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Trish Vulpis
- WakeMed Cary Hospital, Cary, North Carolina, USA
| | - Theodore W James
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Lea Fayad
- Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Andreas Oberbach
- Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Dilhana Badurdeen
- Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Vivek Kumbhari
- Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
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Badurdeen D, Hoff AC, Hedjoudje A, Adam A, Itani MI, Farha J, Abbarh S, Kalloo AN, Khashab MA, Singh VK, Oberbach A, Neto MG, Barrichello S, Kumbhari V. Endoscopic sleeve gastroplasty plus liraglutide versus endoscopic sleeve gastroplasty alone for weight loss. Gastrointest Endosc 2021; 93:1316-1324.e1. [PMID: 33075366 DOI: 10.1016/j.gie.2020.10.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [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: 05/04/2020] [Accepted: 10/11/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Endoscopic sleeve gastroplasty (ESG) has been shown to be effective for inducing weight loss. The efficacy of liraglutide, a glucagon-like peptide-1 agonist, to augment weight loss after ESG is unknown. This study aims to evaluate the efficacy of ESG and liraglutide (ESG-L) compared with ESG alone. METHODS This was a retrospective study of prospectively collected data from patients undergoing ESG at 3 outpatient clinics in Brazil between November 2017 and July 2018. Liraglutide was offered to all patients 5 months after ESG. Patients who opted to take liraglutide (ESG-L) were matched 1:1 to patients who declined it (ESG). The primary outcome was percent total body weight loss (%TBWL), and percent excess weight loss (%EWL) 7 months after initiation of liraglutide (12 months after ESG). The secondary outcome was change in percent body fat 12 months after ESG. ESG technique and postprocedure follow-up were identical at all 3 sites. RESULTS Propensity score matching yielded 26 matched pairs. Adjusted comparisons between the 2 groups showed that patients who opted to take liraglutide had a superior mean %TBWL 7 months after initiation of liraglutide (ESG-L) compared with those who declined it (ESG) (24.72% ± 2.12% vs 20.51% ± 1.68%, respectively; P < .001). ESG-L had a statistically greater reduction in percent body fat compared with ESG (7.85% ± 1.26% vs 10.54% ± 1.88%, respectively; P < .001) at 12 months. CONCLUSIONS Addition of liraglutide at 5 months results in superior weight loss and improved efficacy as demonstrated by decreased body fat 12 months after ESG. Further studies are imperative to determine optimal dose, timing, and duration of liraglutide.
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Affiliation(s)
- Dilhana Badurdeen
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | | | - Abdellah Hedjoudje
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Atif Adam
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Mohamad I Itani
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Jad Farha
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Shahem Abbarh
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Anthony N Kalloo
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Vikesh K Singh
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Andrea Oberbach
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Manoel Galvao Neto
- Division of Gastrointestinal Endoscopy, ABC Medical School, São Paulo, Brazil
| | | | - Vivek Kumbhari
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
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Huang Y, Kruse RL, Ding H, Itani MI, Morrison J, Wang ZZ, Selaru FM, Kumbhari V. Parameters of biliary hydrodynamic injection during endoscopic retrograde cholangio-pancreatography in pigs for applications in gene delivery. PLoS One 2021; 16:e0249931. [PMID: 33909609 PMCID: PMC8081268 DOI: 10.1371/journal.pone.0249931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 03/27/2021] [Indexed: 11/23/2022] Open
Abstract
The biliary system is routinely accessed for clinical purposes via endoscopic retrograde cholangiopancreatography (ERCP). We previously pioneered ERCP-mediated hydrodynamic injection in large animal models as an innovative gene delivery approach for monogenic liver diseases. However, the procedure poses potential safety concerns related mainly to liver or biliary tree injury. Here, we sought to further define biliary hydrodynamic injection parameters that are well-tolerated in a human-sized animal model. ERCP was performed in pigs, and hydrodynamic injection carried out using a novel protocol to reduce duct wall stress. Each pig was subjected to multiple repeated injections to expedite testing and judge tolerability. Different injection parameters (volume, flow rate) and injection port diameters were tested. Vital signs were monitored throughout the procedure, and liver enzyme panels were collected pre- and post-procedure. Pigs tolerated repeated biliary hydrodynamic injections with only occasional, mild, isolated elevation in aspartate aminotransferase (AST), which returned to normal levels within one day post-injection. All other liver tests remained unchanged. No upper limit of volume tolerance was reached, which suggests the biliary tree can readily transmit fluid into the vascular space. Flow rates up to 10 mL/sec were also tolerated with minimal disturbance to vital signs and no anatomic rupture of bile ducts. Measured intrabiliary pressure was up to 150 mmHg, and fluid-filled vesicles were induced in liver histology at high flow rates, mimicking the changes in histology observed in mouse liver after hydrodynamic tail vein injection. Overall, our investigations in a human-sized pig liver using standard clinical equipment suggest that ERCP-guided hydrodynamic injection will be safely tolerated in patients. Future investigations will interrogate if higher flow rates and pressure mediate higher DNA delivery efficiencies.
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Affiliation(s)
- Yuting Huang
- Division of Gastroenterology & Hepatology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Department of Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, Maryland, United States of America
| | - Robert L. Kruse
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Hui Ding
- Division of Gastroenterology & Hepatology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Division of Gastroenterology and Hepatology, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Mohamad I. Itani
- Division of Gastroenterology & Hepatology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Jonathan Morrison
- R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Zack Z. Wang
- Division of Hematology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Florin M. Selaru
- Division of Gastroenterology & Hepatology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- * E-mail: (VK); (FMS)
| | - Vivek Kumbhari
- Division of Gastroenterology & Hepatology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Division of Gastroenterology & Hepatology, Department of Medicine, Mayo Clinic College of Medicine and Science, Jacksonville, Florida, United States of America
- * E-mail: (VK); (FMS)
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8
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Maselli DB, Alqahtani AR, Abu Dayyeh BK, Elahmedi M, Storm AC, Matar R, Nieto J, Teixeira A, Al Khatry M, Neto MG, Kumbhari V, Vargas EJ, Jaruvongvanich V, Mundi MS, Deshmukh A, Itani MI, Farha J, Chapman CG, Sharaiha R. Revisional endoscopic sleeve gastroplasty of laparoscopic sleeve gastrectomy: an international, multicenter study. Gastrointest Endosc 2021; 93:122-130. [PMID: 32473252 DOI: 10.1016/j.gie.2020.05.028] [Citation(s) in RCA: 27] [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: 01/11/2020] [Accepted: 05/07/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Laparoscopic sleeve gastrectomy (LSG) facilitates significant and durable weight loss; however, weight recidivism and need for revisional surgery occur in a subset of patients. Reduction of a dilated LSG using the revisional endoscopic sleeve gastroplasty (R-ESG) approach is an appealing and minimally invasive alternative to surgical revision that is congruent with obesity as a chronic relapsing disease model. In this study, we examine the safety and efficacy of the technique in a large multicenter international cohort. METHODS Prospectively collected data from 9 centers for 82 consecutive adults who underwent R-ESG for weight regain after LSG using the OverStitch device (Apollo Endosurgery, Austin, Tex, USA) from March 2014 to November 2019 were reviewed. Total body weight loss (TBWL) and adverse events were reported up to 12 months. Univariable logistic regression was used to identify predictors of response at 12 months. RESULTS Eighty-two adults (92.7% female) experienced 27.9 ± 20.7 kg weight regain from post-LSG nadir weight, prompting R-ESG (mean age, 42.8 ± 10.4 years) at a mean weight of 128.2 ± 57.5 kg. Mean R-ESG procedure duration was 48.3 ± 20.5 minutes, and the median number of sutures used was 4 (interquartile range, 3-4). After R-ESG, TBWL (follow-up %) was 6.6% ± 3.2% at 1 month (81.7%), 10.6% ± 4.4% at 3 months (74.4%), 13.2% ± 10.1% at 6 months (63.4%), and 15.7% ± 7.6% at 12 months (51.2%). In a per-protocol analysis, ≥10% TBWL was achieved by 37 of 51 patients (72.5%) at 6 months and 34 of 42 patients (81.0%) at 12 months; ≥15% TBWL was achieved by 20 of 46 patients (43.5%) at 6 months and 22 of 42 patients (52.4%) at 12 months. Only 1 moderate adverse event occurred in the form of a narrowed gastroesophageal junction, which resolved after a single endoscopic dilation. CONCLUSIONS R-ESG is a safe and effective means of facilitating weight loss for weight recidivism after LSG, with sustained results at 1 year. R-ESG should be considered before pursuing more-invasive surgical revisional options.
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Affiliation(s)
- Daniel B Maselli
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Aayed R Alqahtani
- Department of Surgery, College of Medicine, King Saud University, and New You Medical Center, Riyadh, Saudi Arabia
| | - Barham K Abu Dayyeh
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohamed Elahmedi
- Department of Surgery, College of Medicine, King Saud University, and New You Medical Center, Riyadh, Saudi Arabia
| | - Andrew C Storm
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Reem Matar
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jose Nieto
- Borland Groover Clinic, Jacksonville, Florida
| | - Andre Teixeira
- Orlando Regional Medical Center, Orlando Health, Orlando, Florida, USA
| | - Maryam Al Khatry
- Department of Gastroenterology, Obaidulla Hospital, Ras Al Khaimah, United Arab Emirates
| | | | - Vivek Kumbhari
- Division of Gastroenterology, Johns Hopkins Medicine, Baltimore, Maryland
| | - Eric J Vargas
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | | | - Mohamad I Itani
- Division of Gastroenterology, Johns Hopkins Medicine, Baltimore, Maryland
| | - Jad Farha
- Division of Gastroenterology, Johns Hopkins Medicine, Baltimore, Maryland
| | - Christopher G Chapman
- University of Chicago Medicine, Center for Endoscopic Research and Therapeutics, Chicago, Illinois
| | - Reem Sharaiha
- Department of Gastroenterology, Weill Cornell Medicine, New York, New York, USA
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9
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Farha J, Abbarh S, Haq Z, Itani MI, Oberbach A, Kumbhari V, Badurdeen D. Endobariatrics and Metabolic Endoscopy: Can We Solve the Obesity Epidemic with Our Scope? Curr Gastroenterol Rep 2020; 22:60. [PMID: 33205261 DOI: 10.1007/s11894-020-00798-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Obesity is a chronic relapsing disease that results in cardiovascular disease, diabetes mellitus, and non-alcoholic fatty liver disease. Currently, surgery represents the most effective treatment. However, the advent of minimally invasive endoscopic bariatric therapy (EBT) has shifted the treatment paradigm to less invasive, cost-effective procedures with minimal complications and recovery time that are preferred by patients. In this review, we will describe current and future EBTs, focusing on outcomes and safety. RECENT FINDINGS The endoscope has provided an incisionless portal into the gastrointestinal tract for placement of space-occupying devices and intraluminal procedures. EBTs are no longer solely manipulating anatomic alterations; instead, they aim to improve metabolic parameters such as glycated hemoglobin, low-density lipoprotein, cholesterol, and hepatic indices by targeting the mucosal layer of the gastrointestinal tract. The endoscope has succeeded in facilitating clinically meaningful weight loss and improvement of metabolic parameters. Future, solutions to the obesity epidemic will likely entail genetic testing, evaluation of the microbiome, and delivery of personalized therapy, utilizing combination endoscopic modalities that change the anatomy and physiology of individual patients, with new targets such as the abnormal metabolic signal.
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Affiliation(s)
- Jad Farha
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Shahem Abbarh
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Zadid Haq
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Mohamad I Itani
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Andreas Oberbach
- Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany
| | - Vivek Kumbhari
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Dilhana Badurdeen
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
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10
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Itani MI, Farha J, Sartoretto A, Abbarh S, Badurdeen D, de Moura DTH, Kumbhari V. Endoscopic sleeve gastroplasty with argon plasma coagulation: A novel technique. J Dig Dis 2020; 21:664-667. [PMID: 32916766 DOI: 10.1111/1751-2980.12939] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/22/2020] [Accepted: 09/08/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The endoscopic sleeve gastroplasty (ESG) is a minimally invasive procedure in which the anterior and posterior aspects of the greater curvature are stitched endoscopically, producing a sleeve-like anatomy mimicking that in a sleeve gastrectomy. However, suture dehiscence and enlargement of the stomach within months of the procedure have been observed. Argon plasma coagulation (APC) is widely used in gastrointestinal endoscopy and is able to induce scarring and fibrosis. We coupled ESG with APC to evaluate its potential to improve durability. METHODS A 46-year-old woman with obesity presented for ESG. Her pre-procedure weight was 117 kg with a body mass index (BMI) of 41.4 kg/m2 . After each plication was complete, APC (60 W, argon flow rate 1.2 L/min) was used to ablate the mucosal surface of the exposed plicated mucosa. APC was applied until the mucosal color was dark brown, indicating adequate and successful mucosal and submucosal ablation. RESULTS The procedure was successful, and the patient recovered without peri- or post-operative complications. The procedure time was 47 minutes. A total of seven sutures were used. At 6-month follow-up the patient had lost 17 kg (37.5 lbs), equivalent to 14.5% total weight loss and had a BMI of 35.4 kg/m2 . Endoscopic follow-up at 6 months revealed enhanced fibrosis along the plications, resulting in a superior, sleeve-like lumen. CONCLUSIONS The combination of ESG with APC may act synergistically to reduce weight without adding significant procedure time. Further investigation is needed to determine whether it should be widely recommended.
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Affiliation(s)
- Mohamad I Itani
- Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Jad Farha
- Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | | | - Shahem Abbarh
- Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Dilhana Badurdeen
- Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Diogo T H de Moura
- Gastroenterology Department, Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Vivek Kumbhari
- Department of Medicine, Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
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11
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Itani MI, Fayad L, El Nahla A, Farha J, Kumbhari V. Gastrogastric fistula as a possible adverse event of transoral gastric outlet reduction. Gastrointest Endosc 2020; 91:1395-1396. [PMID: 31991121 DOI: 10.1016/j.gie.2020.01.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 01/21/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Mohamad I Itani
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Lea Fayad
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | | | - Jad Farha
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Vivek Kumbhari
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
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12
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Ichkhanian Y, Vosoughi K, Aghaie Meybodi M, Jacques J, Sethi A, Patel AA, Aadam AA, Triggs JR, Bapaye A, Dorwat S, Benias P, Chaves DM, Barret M, Law RJ, Browers N, Pioche M, Draganov PV, Kotzev A, Estremera F, Albeniz E, Ujiki MB, Callahan ZM, Itani MI, Brewer OG, Khashab MA. Correction to: Comprehensive analysis of adverse events associated with gastric peroral endoscopic myotomy: an international multicenter study. Surg Endosc 2020; 35:1765. [PMID: 32424623 DOI: 10.1007/s00464-020-07651-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Y Ichkhanian
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, MD, USA
| | - K Vosoughi
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, MD, USA
| | - M Aghaie Meybodi
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, MD, USA
| | - J Jacques
- Gastroenterology Department, Limoges University Hospital, 2 Avenue Martin Luther King, 87042, Rouen, France
| | - A Sethi
- Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, NY, USA
| | - A A Patel
- Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, NY, USA
| | - A A Aadam
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - J R Triggs
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - A Bapaye
- Department of Digestive Diseases & Endoscopy, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India
| | - S Dorwat
- Department of Digestive Diseases & Endoscopy, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India
| | - P Benias
- Division of Gastroenterology, Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, Northwell Health System, New Hyde Park, NY, USA
| | - D M Chaves
- Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - M Barret
- Gastroenterology Unit, Cochin University Hospital, Université Paris Descartes, Paris, France.,Unité INSERM U1016, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - R J Law
- University of Michigan Health Care System, Ann Arbor, USA
| | - N Browers
- University of Michigan Health Care System, Ann Arbor, USA
| | - M Pioche
- Service d'Hépato-gastro-entérologie, Hôpital Edouard Herriot, CHU Lyon, Lyon, France
| | - P V Draganov
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, FL, USA
| | - A Kotzev
- Clinic of Gastroenterology, University Hospital "Alexandrovska", Sofia, Bulgaria
| | - F Estremera
- Clinic of Gastroenterology, University Hospital "Alexandrovska", Sofia, Bulgaria
| | - E Albeniz
- Division of Gastroenterology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - M B Ujiki
- Section of Minimally Invasive Surgery, Department of Surgery, NorthShore University Health System, Evanston, IL, USA
| | - Z M Callahan
- Section of Minimally Invasive Surgery, Department of Surgery, NorthShore University Health System, Evanston, IL, USA
| | - M I Itani
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, MD, USA
| | - O G Brewer
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, MD, USA
| | - M A Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, MD, USA. .,Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Sheikh Zayed Bldg, 1800 Orleans Street, Suite 7125G, Baltimore, MD, 21287, USA.
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13
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Lotfi T, Itani MI, Howeiss P, Kilzar L, Rizk NA, Akl EA. Practice guidelines on migrants' health: assessment of their quality and reporting. Health Qual Life Outcomes 2020; 18:125. [PMID: 32380997 PMCID: PMC7204216 DOI: 10.1186/s12955-020-01363-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 04/14/2020] [Indexed: 02/06/2023] Open
Abstract
Background Migrants may carry with them communicable and non communicable diseases as they move to the host country. Screening migrants may help in improving their health status and in preventing the spread of infections to the host population. Objective To identify and assess the quality of published practice guidelines addressing migrants’ health. Methods We included practice guidelines addressing migrants’ health at the clinical, public health or health systems levels. We searched Medline, Embase, the National Guideline Clearinghouse and the Canadian Medical Association’s Clinical Practice Guidelines Database. Two teams of two reviewers conducted in duplicate and independent manner study selection, data abstraction, assessment of the guideline quality (using the AGREE II instrument), and assessment of the quality of the reporting (using the RIGHT statement). Results Out of 2732 citations captured by the electronic search, we included 24 eligible practice guidelines, all addressing the level of post-arrival to the host country and published between 2011 and 2017. The majority of guidelines (57%) addressed non-communicable diseases, 95% addressed screening, while 52% addressed prevention and treatment respectively. The majority of the guidelines reported their funding sources. 86% used the GRADE approach as part of the development process. The included guidelines scored high on the majority of the items, and low on the following two domains of the AGREE II instrument: rigor of development and applicability. The mean number of the RIGHT checklist items met by the included guidelines was 27, out of a total of 35. Most of the guidelines were based on systematic reviews (95.6%). A minority of the included guidelines (26%) reported considering the values and preferences of the target populations or the costs and resource implications (30%) in the formulation of recommendations. Conclusion We identified 23 practice guidelines addressing migrants’ health, the majority of which addressed screening services. The vast majority of the captured guidelines targeted screening because the population of interest is migrants, meaning that the intention of the guidelines is to deal with additional factors than usual ones, such as prevalence of disease in country of origin, endemic diseases and others. The guidelines suffered limitations on two quality domains (rigor of development and applicability), and have room for improvement of their reporting.
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Affiliation(s)
- Tamara Lotfi
- Clinical Research Institute, American University of Beirut Medical Center, P.O.Box 11-0236, Internal Medicine, Riad El-Solh, Beirut, 1107 2020, Lebanon.,AUB GRADE Center, Clinical Research Institute, American University of Beirut, P.O.Box 11-0236, Internal Medicine, Riad El-Solh, Beirut, 1107 2020, Lebanon.,Department of Internal Medicine, Faculty of Medicine, American University of Beirut, P.O.Box 11-0236, Internal Medicine, Riad El-Solh, Beirut, 1107 2020, Lebanon
| | - Mohamad I Itani
- Clinical Research Institute, American University of Beirut Medical Center, P.O.Box 11-0236, Internal Medicine, Riad El-Solh, Beirut, 1107 2020, Lebanon.,Faculty of Medicine, American University of Beirut, P.O.Box 11-0236, Internal Medicine, Riad El-Solh, Beirut, 1107 2020, Lebanon
| | - Pamela Howeiss
- Department of Internal Medicine, Faculty of Medicine, American University of Beirut, P.O.Box 11-0236, Internal Medicine, Riad El-Solh, Beirut, 1107 2020, Lebanon
| | - Lama Kilzar
- Clinical Research Institute, American University of Beirut Medical Center, P.O.Box 11-0236, Internal Medicine, Riad El-Solh, Beirut, 1107 2020, Lebanon.,Department of Epidemiology & Biostatistics, Faculty of Health Sciences, American University of Beirut, P.O.Box 11-0236, Internal Medicine, Riad El-Solh, Beirut, 1107 2020, Lebanon
| | - Nesrine A Rizk
- Department of Internal Medicine, Faculty of Medicine, American University of Beirut, P.O.Box 11-0236, Internal Medicine, Riad El-Solh, Beirut, 1107 2020, Lebanon
| | - Elie A Akl
- Clinical Research Institute, American University of Beirut Medical Center, P.O.Box 11-0236, Internal Medicine, Riad El-Solh, Beirut, 1107 2020, Lebanon. .,AUB GRADE Center, Clinical Research Institute, American University of Beirut, P.O.Box 11-0236, Internal Medicine, Riad El-Solh, Beirut, 1107 2020, Lebanon. .,Department of Internal Medicine, Faculty of Medicine, American University of Beirut, P.O.Box 11-0236, Internal Medicine, Riad El-Solh, Beirut, 1107 2020, Lebanon. .,Department of Epidemiology & Biostatistics, Faculty of Health Sciences, American University of Beirut, P.O.Box 11-0236, Internal Medicine, Riad El-Solh, Beirut, 1107 2020, Lebanon. .,Department of Health Research Methods, Evidence, and Impact (HE&I), McMaster University, Hamilton, ON, Canada.
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14
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Farha J, Fayad L, Kadhim A, Şimşek C, Badurdeen DS, Ichkhanian Y, Itani MI, Kalloo AN, Khashab MA, Kumbhari V. Gastric Per-Oral Endoscopic Myotomy (G-POEM) for the Treatment of Gastric Stenosis Post-Laparoscopic Sleeve Gastrectomy (LSG). Obes Surg 2020; 29:2350-2354. [PMID: 31001761 DOI: 10.1007/s11695-019-03893-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Laparoscopic sleeve gastrectomy (LSG) has become the most common form of bariatric surgery performed worldwide. However, it is associated with potentially debilitating adverse events such as post-operative stenosis. Finding effective and minimally invasive treatments for such complications is of paramount importance. Gastric per-oral endoscopic myotomy (G-POEM) is a novel procedure developed over the past decade to treat conditions that delay gastric emptying. We present a case demonstrating the use of G-POEM in the successful endoscopic management of post-LSG gastric stenosis.
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Affiliation(s)
- Jad Farha
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, 1800 Orleans St., Sheikh Zayed Tower, Suite 7125B, Baltimore, MD, 21287, USA
| | - Lea Fayad
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, 1800 Orleans St., Sheikh Zayed Tower, Suite 7125B, Baltimore, MD, 21287, USA
| | - Ali Kadhim
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, 1800 Orleans St., Sheikh Zayed Tower, Suite 7125B, Baltimore, MD, 21287, USA
| | - Cem Şimşek
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, 1800 Orleans St., Sheikh Zayed Tower, Suite 7125B, Baltimore, MD, 21287, USA
| | - Dilhana S Badurdeen
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, 1800 Orleans St., Sheikh Zayed Tower, Suite 7125B, Baltimore, MD, 21287, USA
| | - Yervant Ichkhanian
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, 1800 Orleans St., Sheikh Zayed Tower, Suite 7125B, Baltimore, MD, 21287, USA
| | - Mohamad I Itani
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, 1800 Orleans St., Sheikh Zayed Tower, Suite 7125B, Baltimore, MD, 21287, USA
| | - Anthony N Kalloo
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, 1800 Orleans St., Sheikh Zayed Tower, Suite 7125B, Baltimore, MD, 21287, USA
| | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, 1800 Orleans St., Sheikh Zayed Tower, Suite 7125B, Baltimore, MD, 21287, USA
| | - Vivek Kumbhari
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, 1800 Orleans St., Sheikh Zayed Tower, Suite 7125B, Baltimore, MD, 21287, USA.
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15
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Marrache MK, Al-Sabban A, Itani MI, Sartoretto A, Kumbhari V. Endoscopic sleeve gastroplasty by use of a novel suturing pattern, which allays concerns for revisional bariatric surgery. VideoGIE 2020; 5:133-134. [PMID: 32258839 PMCID: PMC7125399 DOI: 10.1016/j.vgie.2019.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Mohamad Kareem Marrache
- Department of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Abdulhameed Al-Sabban
- Department of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Mohamad I Itani
- Department of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | | | - Vivek Kumbhari
- Department of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
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16
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Runge TM, Yang J, Fayad L, Itani MI, Dunlap M, Koller K, Mullin GE, Simsek C, Badurdeen D, Kalloo AN, Khashab MA, Kumbhari V. Correction to: Anatomical Configuration of the Stomach Post-Endoscopic Sleeve Gastroplasty (ESG)-What Are the Sutures Doing? Obes Surg 2020; 30:2061. [PMID: 32157521 DOI: 10.1007/s11695-020-04538-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The name of author Vivek Kumbhari was misspelled in the original article.
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Affiliation(s)
- Thomas M Runge
- Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, 4940 Eastern Avenue, A Building, 5th floor, Baltimore, MD, 21224, USA
| | - Juliana Yang
- Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, 4940 Eastern Avenue, A Building, 5th floor, Baltimore, MD, 21224, USA
| | - Lea Fayad
- Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, 4940 Eastern Avenue, A Building, 5th floor, Baltimore, MD, 21224, USA
| | - Mohamad I Itani
- Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, 4940 Eastern Avenue, A Building, 5th floor, Baltimore, MD, 21224, USA
| | - Margo Dunlap
- Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, 4940 Eastern Avenue, A Building, 5th floor, Baltimore, MD, 21224, USA
| | - Kristen Koller
- Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, 4940 Eastern Avenue, A Building, 5th floor, Baltimore, MD, 21224, USA
| | - Gerard E Mullin
- Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, 4940 Eastern Avenue, A Building, 5th floor, Baltimore, MD, 21224, USA
| | - Cem Simsek
- Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, 4940 Eastern Avenue, A Building, 5th floor, Baltimore, MD, 21224, USA
| | - Dilhana Badurdeen
- Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, 4940 Eastern Avenue, A Building, 5th floor, Baltimore, MD, 21224, USA
| | - Anthony N Kalloo
- Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, 4940 Eastern Avenue, A Building, 5th floor, Baltimore, MD, 21224, USA
| | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, 4940 Eastern Avenue, A Building, 5th floor, Baltimore, MD, 21224, USA
| | - Vivek Kumbhari
- Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, 4940 Eastern Avenue, A Building, 5th floor, Baltimore, MD, 21224, USA.
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17
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Itani MI, Farha J, Marrache MK, Fayad L, Badurdeen D, Kumbhari V. The Effects of Bariatric Surgery and Endoscopic Bariatric Therapies on GERD: An Update. Curr Treat Options Gastroenterol 2020; 18:97-108. [PMID: 31960281 DOI: 10.1007/s11938-020-00278-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Bariatric surgery and endoluminal bariatric therapies (EBTs) form an increasingly utilized therapeutic approach to treat obese patients but may worsen gastroesophageal reflux disease (GERD). In this updated article, we review the evidence on the effects of bariatric procedures on GERD. FINDINGS Recent evidence implicates sleeve gastrectomy with the highest rates of de novo GERD and Barrett's esophagus (BE), whereas malabsorptive-restrictive procedures such as Roux-en-Y gastric bypass (RYGB) and one anastomosis gastric bypass (OAGB) were shown to have significantly lower reported rates. The intragastric balloon (IGB) has been associated with increased likelihood of GERD, whereas insufficient evidence exists linking endoscopic sleeve gastroplasty (ESG) to GERD. SUMMARY Gastroesophageal reflux disease may be treated with some bariatric procedures but is often developed de novo as a result of the change in anatomy. Patients set to undergo bariatric surgery may benefit from pre-procedural endoscopy to choose the more suitable therapy. Further studies with objective measurements of GERD post procedure may provide more insight into the effects of bariatric therapies on reflux, especially more novel ones such as ESG.
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Affiliation(s)
- Mohamad I Itani
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Jad Farha
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Mohamad Kareem Marrache
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Lea Fayad
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Dilhana Badurdeen
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Vivek Kumbhari
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
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Runge TM, Yang J, Fayad L, Itani MI, Dunlap M, Koller K, Mullin GE, Simsek C, Badurdeen D, Kalloo AN, Khashab MA, Kumhbari V. Anatomical Configuration of the Stomach Post-Endoscopic Sleeve Gastroplasty (ESG)—What Are the Sutures Doing? Obes Surg 2019; 30:2056-2060. [DOI: 10.1007/s11695-019-04311-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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