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Bomman S, Klair JS, Canakis A, Muthusamy AK, Nagra N, Chandra S, Shanmugam M, Perisetti A, Aggarwal A, Gavini HK, Krishnamoorthi R. Safety and Efficacy of Endoscopic Full Thickness Resection of Upper Gastrointestinal Lesions Using a Full Thickness Resection Device: A Systematic Review and Meta-analysis. J Clin Gastroenterol 2024; 58:46-52. [PMID: 36730483 DOI: 10.1097/mcg.0000000000001803] [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: 03/18/2022] [Accepted: 10/17/2022] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Endoscopic full-thickness resection (EFTR) is a promising technique that allows for a minimally invasive resection of mucosal and submucosal lesions in the gastrointestinal (GI) tract. The data regarding the efficacy and safety of performing EFTR of upper GI lesions using a full-thickness resection device (FTRD) is limited. Hence, we performed a systematic review and meta-analysis of the studies that evaluated this technique. METHODS We performed a comprehensive systematic search of multiple electronic databases and conference proceedings that reported outcomes of EFTR using the FTRD system. The weighted pooled rates of technical success, complete (R0) resection, adverse events (AE), and residual or recurrent lesions were analyzed with 95% CI using the random effects model. RESULTS Eight studies with a total of 139 patients who underwent EFTR of upper GI lesions were included in the study. The pooled, weighted rate of technical success was 88.2% (95% CI: 81.4-92.7%, I2 : 0). The R0 resection rate was 70.7% (95% CI: 62.5-77.8%, I2 : 0). Overall AE rates were 22.1% (95% CI: 15.8-30.1%, I2 : 0), however, most of the AEs were minor. Of the patients who had follow-up endoscopies, the residual and/or recurrent lesion rate was 6.1% (95% CI: 2.4-14.4%, I2 : 0). Heterogeneity in the analysis was low. CONCLUSIONS EFTR using the FTRD seems to be effective and safe with acceptable R0 resection rates and low recurrence rates. Further prospective studies are required to validate our results and to compare various modalities of endoscopic resection with this single-step EFTR device.
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Affiliation(s)
| | - Jagpal S Klair
- Center for Digestive Health, Virginia Mason Franciscan Health
| | - Andrew Canakis
- Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD
| | | | - Navroop Nagra
- Division of Gastroenterology and Hepatology, University of Louisville School of Medicine, Louisville, KY
| | - Shruti Chandra
- Division of Gastroenterology, Mayo Clinic, Rochester, MN
| | | | | | - Avin Aggarwal
- Division of Gastroenterology and Hepatology, University of Arizona, Tucson, AZ
| | - Hemanth K Gavini
- Division of Gastroenterology and Hepatology, University of Arizona, Tucson, AZ
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Nagra N, Kozarek RA, Burman BE. Therapeutic Advances in Viral Hepatitis A-E. Adv Ther 2022; 39:1524-1552. [PMID: 35220557 DOI: 10.1007/s12325-022-02070-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/31/2022] [Indexed: 11/25/2022]
Abstract
Viral hepatitis remains a significant global health problem. All forms of viral hepatitis A through E (A-E) can lead to acute symptomatic infection, while hepatitis B and C can lead to chronic infection associated with significant morbidity and mortality related to progression to cirrhosis, end-stage-liver disease, and liver cancer. Viral hepatitis occurs worldwide, though certain regions are disproportionately affected. We now, remarkably, have highly effective curative regimens for hepatitis C, and safe and tolerable medications to suppress hepatitis B activity, and to prevent liver damage and slow disease progression. We have effective vaccines for hepatitis A and B which provide long-lasting immunity, while improved sanitation and awareness can curb outbreaks of hepatitis A and E. However, more effective and available preventive and curative strategies are needed to achieve global eradication of viral hepatitis. This review provides an overview of the epidemiology, transmission, diagnosis, and clinical features of each viral hepatitis with a primary focus on current and future therapeutic and curative options.
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Affiliation(s)
- Navroop Nagra
- Department of Gastroenterology, University of Louisville, Louisville, KY, 40202, USA
| | - Richard A Kozarek
- Center for Digestive Health, Virginia Mason Franciscan Health, 1100 9th Ave., Seattle, WA, 98101, USA
| | - Blaire E Burman
- Center for Digestive Health, Virginia Mason Franciscan Health, 1100 9th Ave., Seattle, WA, 98101, USA.
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Nagra N, Klair JS, Jayaraj M, Murali AR, Singh D, Law J, Larsen M, Irani S, Kozarek R, Ross A, Krishnamoorthi R. Biliary Sphincterotomy Alone versus Biliary Stent with or without Biliary Sphincterotomy for the Management of Post-Cholecystectomy Bile Leak: A Systematic Review and Meta-Analysis. Dig Dis 2022; 40:810-815. [PMID: 35130543 DOI: 10.1159/000522328] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 01/31/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Endoscopic therapy with endoscopic retrograde cholangiopancreatography is considered the first-line treatment in the management of post-cholecystectomy bile leak (PCBL). Currently, there is no consensus on the most effective endoscopic intervention for PCBL. Hence, we performed a systematic review and meta-analysis to compare the effectiveness and safety of the two interventional groups (biliary sphincterotomy [BS] alone vs. biliary stent ± BS) in management of PCBL. METHODS We conducted a comprehensive search of multiple electronic databases and conference proceedings (from inception through January 2021). The primary outcome was to compare the pooled rate of clinical success between the 2 groups. The secondary outcome was to estimate the pooled rate of adverse events. RESULTS The pooled rate of clinical success with BS alone (5 studies, 299 patients) was 88% (95% confidence interval (CI): 84-92%, I2: 0%) and for biliary stent ± BS (5 studies, 864 patients) was 97% (CI: 93-100%, I2: 79%). The rate of clinical success in biliary stent ± BS group was significantly higher than BS alone group (OR: 3.91 95% CI: 2.29-6.69, p < 0.001, I2: 13%). The rate of adverse events was numerically lower in biliary stent ± BS group compared to BS alone (3 studies; OR: 0.65 95% CI: 0.41-1.03, p = 0.07) without statistical significance. Low heterogeneity was noted in the analysis. CONCLUSIONS Biliary stent ± BS is more effective in endoscopic management of PCBL compared to BS alone. This may be related to inter-endoscopist variation in completeness of sphincterotomy and post-sphincterotomy edema, which can influence the preferential trans-papillary flow of bile.
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Affiliation(s)
- Navroop Nagra
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Jagpal Singh Klair
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA,
| | - Mahendran Jayaraj
- Division of Gastroenterology and Hepatology, University of Nevada School of Medicine, Las Vegas, Nevada, USA
| | - Arvind R Murali
- Division of Gastroenterology and Hepatology, University of Iowa Hospitals and Clinics, Iowa, Iowa, USA
| | - Dhruv Singh
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Joanna Law
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Michael Larsen
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Shayan Irani
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Richard Kozarek
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Andrew Ross
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Rajesh Krishnamoorthi
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA
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Bomman S, Ashat M, Nagra N, Jayaraj M, Chandra S, Kozarek RA, Ross A, Krishnamoorthi R. Contamination Rates in Duodenoscopes Reprocessed Using Enhanced Surveillance and Reprocessing Techniques: A Systematic Review and Meta-Analysis. Clin Endosc 2022; 55:33-40. [PMID: 34974676 PMCID: PMC8831410 DOI: 10.5946/ce.2021.212] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 08/03/2021] [Accepted: 08/26/2021] [Indexed: 11/28/2022] Open
Abstract
Background/Aims Multiple outbreaks of multidrug-resistant organisms have been reported worldwide due to contaminated duodenoscopes. In 2015, the United States Food and Drug Administration recommended the following supplemental enhanced surveillance and reprocessing techniques (ESRT) to improve duodenoscope disinfection: (1) microbiological culture, (2) ethylene oxide sterilization, (3) liquid chemical sterilant processing system, and (4) double high-level disinfection. A systematic review and meta-analysis was performed to assess the impact of ESRT on the contamination rates. Methods A thorough and systematic search was performed across several databases and conference proceedings from inception until January 2021, and all studies reporting the effectiveness of various ESRTs were identified. The pooled contamination rates of post-ESRT duodenoscopes were estimated using the random effects model.
Results A total of seven studies using various ESRTs were incorporated in the analysis, which included a total of 9,084 post-ESRT duodenoscope cultures. The pooled contamination rate of the post-ESRT duodenoscope was 5% (95% confidence interval [CI]: 2.3%–10.8%, inconsistency index [I2]=97.97%). Pooled contamination rates for high-risk organisms were 0.8% (95% CI: 0.2%–2.7%, I2=94.96).
Conclusions While ESRT may improve the disinfection process, a post-ESRT contamination rate of 5% is not negligible. Ongoing efforts to mitigate the rate of contamination by improving disinfection techniques and innovations in duodenoscope design to improve safety are warranted.
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Affiliation(s)
- Shivanand Bomman
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA
| | - Munish Ashat
- Indiana University Health, Indianapolis, IN, USA
| | - Navroop Nagra
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA
| | | | | | - Richard A Kozarek
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA
| | - Andrew Ross
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA
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Nagra N, Penna R, La Selva D, Coy D, Siddique A, Burman B. Tagging incidental finding of fatty liver on ultrasound: A novel intervention to improve early detection of liver fibrosis. J Clin Transl Res 2021; 7:641-647. [PMID: 34778594 PMCID: PMC8580527] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 09/08/2021] [Accepted: 09/09/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND It is not uncommon to see that a large proportion of patients with cirrhosis due to nonalcoholic steatohepatitis never had any prior evaluation or diagnosis of liver disease, and most of the times their first clinical presentation is decompensated cirrhosis. Acknowledging incidental finding of fatty liver on abdominal imaging and identifying patients at risk of having advanced liver fibrosis may help in preventing its progression to cirrhosis. AIM We aimed to increase acknowledgement and improve evaluation of steatosis through radiology recommendation to consider hepatology referral, and to identify the predictors of hepatology referral and significant fibrosis. METHODS We performed a retrospective study of 812 patients with hepatic steatosis tagged on ultrasound (US), over 18 months, at a single center. Patients with secondary causes of fatty liver were excluded from the study. We evaluated the yield of this intervention and factors correlated with hepatology referral and presence of significant fibrosis. RESULTS Diagnosis of fatty liver was acknowledged for 69% of patients with tagged US, although only 29% were ultimately seen by hepatology. Patients who had US ordered by a primary care provider (PCP) were more likely to have hepatology evaluation (64.8% vs. 56.9%, P = 0.0183). Sixty-six percent of patients seen by hepatology had elevated alanine transaminase (ALT) compared to 52% not seen by hepatology (P < 0.0005). Among patients further evaluated, 53% underwent staging, and 18% had ≥stage 2 (F2) fibrosis. Type II diabetes correlated with significant to advanced fibrosis (43.5% vs. 21.4%, P = 0.0357), while ALT and Body Mass Index did not. CONCLUSIONS Tagging US reports led to clinical acknowledgement of fatty liver in 7 of 10 patients, although fewer than 1 in 3 had further hepatology evaluation. Of those who underwent staging for incidentally noted steatosis, 18% had significant fibrosis, suggesting that we are failing to evaluate patients with potentially advanced liver disease. RELEVANCE FOR PATIENTS Identifying incidental finding of fatty liver on US provides a unique opportunity in diagnosing liver fibrosis at an early stage and can help prevent its progression to cirrhosis. PCP should consider using noninvasive scoring systems on a regular basis to assess the risk of fibrosis in patients with fatty liver, and timely referral to hepatology should be provided in patients at high risk of having advanced fibrosis.
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Affiliation(s)
- Navroop Nagra
- 1Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA 98101, United States,Corresponding author: Navroop Nagra Digestive Disease Institute, Virginia Mason Medical Center, 1100 Ninth Ave, Seattle, WA 98101, United States Tel: 530-701-5116 E-mail:
| | - Rubal Penna
- 2Department of Radiology, Virginia Mason Medical Center, Seattle, WA 98101, United States
| | - Danielle La Selva
- 1Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA 98101, United States
| | - David Coy
- 2Department of Radiology, Virginia Mason Medical Center, Seattle, WA 98101, United States
| | - Asma Siddique
- 1Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA 98101, United States
| | - Blaire Burman
- 1Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA 98101, United States
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Klair JS, Zafar Y, Nagra N, Murali AR, Jayaraj M, Singh D, Rustagi T, Krishnamoorthi R. Outcomes of Radiofrequency Ablation versus Endoscopic Surveillance for Barrett's Esophagus with Low-Grade Dysplasia: A Systematic Review and Meta-Analysis. Dig Dis 2021; 39:561-568. [PMID: 33503615 DOI: 10.1159/000514786] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 07/21/2020] [Accepted: 01/22/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Endoscopic therapy using radiofrequency ablation (RFA) is a recommended treatment for Barrett's esophagus with high-grade dysplasia (BE-HGD) without a visible lesion which is managed by resection. However, currently, there is no consensus on the management of BE with low-grade dysplasia (BE-LGD) - RFA versus endoscopic surveillance. Hence, we performed a systematic review and meta-analysis of these comparative studies to compare the risk of progression to HGD or esophageal adenocarcinoma (EAC) among patients with BE-LGD treated with RFA versus endoscopic surveillance. METHODS The primary outcome was to compare the risk of progression to HGD or EAC among patients with BE-LGD treated with RFA versus endoscopic surveillance. RESULTS Four comparative studies reporting a total of 543 patients with BE-LGD were included in the meta-analysis (234 in RFA and 309 in endoscopic surveillance). The progression of BE-LGD to either HGD or EAC was significantly lower in patients treated with RFA compared to endoscopic surveillance (OR: 0.17, 95% confidence interval [CI]: 0.04-0.65, p = 0.01). The progression to HGD alone was significantly lower in patients treated with RFA versus endoscopic surveillance (OR: 0.23, 95% CI: 0.08-0.61, p = 0.003). The progression to EAC alone was numerically lower in RFA than endoscopic surveillance without statistical significance (OR: 0.44, 95% CI: 0.17-1.16, p = 0.09). Moderate heterogeneity was noted in the analysis. CONCLUSIONS Based on our meta-analysis, there was a significant reduction in the risk of progression to HGD or EAC among patients with BE-LGD treated with RFA compared with those undergoing endoscopic surveillance. Endoscopic eradication therapy with RFA should be the preferred management approach for BE-LGD.
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Affiliation(s)
- Jagpal Singh Klair
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Yousaf Zafar
- Department of Internal Medicine, Naples Community Healthcare, University of Central Florida, Orlando, Florida, USA
| | - Navroop Nagra
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Arvind R Murali
- Division of Gastroenterology and Hepatology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Mahendran Jayaraj
- Division of Gastroenterology and Hepatology, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Dhruv Singh
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Tarun Rustagi
- Division of Gastroenterology and Hepatology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Rajesh Krishnamoorthi
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA
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Lee HS, Nagra N, La Selva D, Kozarek RA, Ross A, Weigel W, Beecher R, Chiorean M, Gluck M, Boden E, Venu N, Krishnamoorthi R, Larsen M, Lin OS. Nurse-Administered Propofol Continuous Infusion Sedation for Gastrointestinal Endoscopy in Patients Who Are Difficult to Sedate. Clin Gastroenterol Hepatol 2021; 19:180-188. [PMID: 32931961 DOI: 10.1016/j.cgh.2020.09.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 09/06/2020] [Accepted: 09/09/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Patients who chronically use alcohol, marijuana, or opioids, or suffer from post-traumatic stress disorder (PTSD), can be difficult to sedate with midazolam and fentanyl, and often are referred for monitored anesthesia care during endoscopy. Nurse-administered propofol continuous infusion sedation (NAPCIS), which confers the benefit of propofol-based sedation without the added expense of anesthesia, is effective and safe for sedation of healthy patients. We investigated whether NAPCIS also is effective for patients who are difficult to sedate. METHODS We performed a retrospective study of patients who underwent upper endoscopy or colonoscopy with NAPCIS at a single center from January 2018 through April 2018. We reviewed records from patients who were heavy users of alcohol (n = 105), daily users of marijuana (n = 267) or opioids (n = 178), had a diagnosis of PTSD (n = 91), or were none of these (controls, n = 786). We compared mean fentanyl and propofol doses (adjusted for body weight), procedure and recovery times, procedure success rates, and adverse events. RESULTS Compared with the controls, the marijuana group required higher mean adjusted sedative doses for colonoscopies (0.6 vs 0.4 mcg/kg fentanyl and 5.0 vs 4.7 mg/kg propofol; P ≤ .025 for both) and upper endoscopies (0.8 vs 0.3 mcg/kg fentanyl and 3.7 vs 3.2 mg/kg propofol; P ≤ .021 for both), the PTSD group required a higher dose of fentanyl for colonoscopies (0.6 vs 0.4 mcg/kg; P = .009), and the alcohol group required a higher dose of fentanyl for upper endoscopies (0.7 vs 0.3 mcg/kg; P < .001). Procedure success rates were high (95.1%-100%) and did not differ significantly between the difficult-to-sedate groups and controls; mean procedure times (7.0-9.0 minutes for upper endoscopies, 21.1-22.9 minutes for colonoscopies) and recovery times (22.5-29.6 minutes) also were similar among groups. Upper endoscopies were associated with lower sedative doses and shorter procedure and recovery times than colonoscopies. Sedation-related adverse events were rare in all groups (only 26 cases total), and there were no serious complications or deaths. CONCLUSIONS NAPCIS seems to be a safe and effective means of providing sedation for endoscopy to patients who may be difficult to sedate owing to alcohol, marijuana, or opioid use, or PTSD.
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Affiliation(s)
- Hyun Seok Lee
- Digestive Disease Institute; Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | | | | | | | | | - Wade Weigel
- Department of Anesthesia, Virginia Mason Medical Center, Seattle, Washington
| | - Ryan Beecher
- Department of Anesthesia, Virginia Mason Medical Center, Seattle, Washington
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Aly R, Gupta S, Gupta S, Nagra N, Goyal A, Singh B. Primary Gastric Adenosquamous Carcinoma: A Case Report. Gastroenterology Res 2020; 13:155-157. [PMID: 32864027 PMCID: PMC7433371 DOI: 10.14740/gr1307] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 07/29/2020] [Indexed: 11/11/2022] Open
Abstract
Gastric adenosquamous carcinoma (GASC) is a rare variant of gastric cancer; the limited data available suggest that these tumors are more aggressive and have a worse outcome in comparison to gastric adenocarcinoma. Currently, the management of GASC is similar to adenocarcinoma. We report a case of GASC that progressed rapidly despite treatment.
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Affiliation(s)
- Ragia Aly
- Danbury Hospital, 24 Hospital Ave, Danbury, CT 06810, USA
| | - Sachin Gupta
- Tower Health Reading Hospital, POBox16052, Reading, PA 19612-6052, USA
| | - Sorab Gupta
- Hematology Oncology, Einstein Healthcare Network, 5501 Old York, Philadelphia, PA 19141, USA
| | - Navroop Nagra
- Hepatology, Virgina Mason Medical Center, Seattle, WA, USA
| | - Abhinav Goyal
- Gastroenterology, Einstein Healthcare Network, 5501 Old York, Philadelphia, PA 19141, USA
| | - Balraj Singh
- Hematology Oncology, St. Joseph’s University Medical Center, 703 Main St, Paterson, NJ 07503, USA
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Nagra N, Burman B, Gault CR, Dorer R, Siddique A. Amyloidosis Masquerading as Alcohol-Related Cirrhosis. Cureus 2020; 12:e8976. [PMID: 32775058 PMCID: PMC7402442 DOI: 10.7759/cureus.8976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Amyloidosis can affect multiple organs, and involvement of the heart is the most common cause of death. Signs and symptoms vary depending upon the organ system affected by amyloid. Liver involvement is often seen, but symptoms are usually mild and nonspecific in isolated hepatic amyloidosis. None of the laboratory markers and imaging is characteristic of this condition; therefore, diagnosis is often delayed. Tissue biopsy is required for definitive diagnosis. Herein, we report a case where the patient's symptoms had been attributed to alcohol-related cirrhosis; however, further workup ultimately led to a diagnosis of systemic amyloidosis with multi-organ involvement.
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Affiliation(s)
- Navroop Nagra
- Gastroenterology, Virginia Mason Medical Center, Seattle, USA
| | - Blaire Burman
- Hepatology, Virginia Mason Medical Center, Seattle, USA
| | | | - Russell Dorer
- Pathology, Virginia Mason Medical Center, Seattle, USA
| | - Asma Siddique
- Hepatology, Virginia Mason Medical Center, Seattle, USA
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Nagra N, Tolentino L, Singhvi G. Esophageal Melanosis: A Rare Condition of Undetermined Significance. Clin Gastroenterol Hepatol 2020; 18:e59. [PMID: 30902599 DOI: 10.1016/j.cgh.2019.03.025] [Citation(s) in RCA: 2] [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] [Received: 03/07/2019] [Accepted: 03/10/2019] [Indexed: 02/07/2023]
Affiliation(s)
- Navroop Nagra
- Peacehealth Southwest Medical Center, Vancouver, Washington
| | | | - Gaurav Singhvi
- UCLA David Geffen School of Medicine, Los Angeles, California
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Nagra N, Singhvi AR, Singhvi G. Mucosa-associated Lymphoid Tissue Lymphoma of Colon: A Case Report and Literature Review of Rare Entity. Cureus 2020; 12:e7438. [PMID: 32351818 PMCID: PMC7186103 DOI: 10.7759/cureus.7438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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