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Kahn A, Song K, Dhaliwal L, Thanawala S, Hagen CE, Agarwal S, McDonald NM, Gabre JT, Falk GW, Ginsberg GG, Wolfsen HC, Ramirez FC, Leggett CL, Wang KK, Iyer PG. Long-term outcomes following successful endoscopic treatment of T1 esophageal adenocarcinoma: a multicenter cohort study. Gastrointest Endosc 2023; 98:713-721. [PMID: 37356631 DOI: 10.1016/j.gie.2023.06.012] [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: 04/11/2023] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND AND AIMS Endoscopic eradication therapy (EET) is guideline endorsed for management of early-stage (T1) esophageal adenocarcinoma (EAC). Patients with baseline high-grade dysplasia (HGD) and EAC are at highest risk of recurrence after successful EET, but limited data exist on long-term (>5 year) recurrence outcomes. Our aim was to assess the incidence and predictors of long-term recurrence in a multicenter cohort of patients with T1 EAC treated with EET. METHODS Patients with T1 EAC achieving successful endoscopic cancer eradication with a minimum of 5 years' clinical follow-up were included. The primary outcome was neoplastic recurrence, defined as dysplasia or EAC, and it was characterized as early (<2 years), intermediate (2-5 years), or late (>5 years). Predictors of recurrence were assessed by time to event analysis. RESULTS A total of 84 T1 EAC patients (75 T1a, 9 T1b) with a median 9.1 years (range, 5.1-18.3 years) of follow-up were included. The overall incidence of neoplastic recurrence was 2.0 per 100 person-years of follow-up. Seven recurrences (3 dysplasia, 4 EAC) occurred after 5 years of EAC remission. Overall, 88% of recurrences were treated successfully endoscopically. EAC recurrence-related mortality occurred in 3 patients at a median of 5.2 years from EAC remission. Complete eradication of intestinal metaplasia was independently associated with reduced recurrence (hazard ratio, .13). CONCLUSIONS Following successful EET of T1 EAC, neoplastic recurrence occurred after 5 years in 8.3% of cases. Careful long-term surveillance should be continued in this patient population. Complete eradication of intestinal metaplasia should be the therapeutic end point for EET.
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Affiliation(s)
- Allon Kahn
- Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Kevin Song
- Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Lovekirat Dhaliwal
- Department of Internal Medicine, Louisiana State University Health, Shreveport, Louisiana, USA
| | - Shivani Thanawala
- Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Catherine E Hagen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Siddharth Agarwal
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Nicholas M McDonald
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Joel T Gabre
- Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gary W Falk
- Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gregory G Ginsberg
- Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Herbert C Wolfsen
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Francisco C Ramirez
- Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Cadman L Leggett
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kenneth K Wang
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Prasad G Iyer
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
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2
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Fellows E, Harris J, Kibble T, McDonald NM, Azeem N, Harmon JV. Intraoperative Endoscopic-Guided Bowel Resection for Persistent Gastrointestinal Bleeding Caused by Angiodysplasia: A Case Report and Literature Review. Surg J (N Y) 2023; 9:e112-e117. [PMID: 38031533 PMCID: PMC10586881 DOI: 10.1055/s-0043-1776111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 09/21/2023] [Indexed: 12/01/2023] Open
Abstract
Gastrointestinal angiodysplasia is an uncommon condition often associated with significant gastrointestinal bleeding that is resistant to medical therapy. We report the clinical outcomes of two patients who successfully underwent simultaneous intraoperative endoscopic and surgical interventions for the treatment of angiodysplasia. Intraoperative endoscopic guidance was found to be useful in managing hemorrhage caused by angiodysplasia in both patients. Additionally, we performed an analysis of cases reported in the literature. Our review focused on the anatomic location of the resected bowel and the clinical outcomes of patients ( n = 21) with angiodysplasia managed with intraoperative endoscopy reported in the literature.
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Affiliation(s)
- Emily Fellows
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota
- Division of Gastroenterology, Department of Internal Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Joy Harris
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Tania Kibble
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Nicholas M. McDonald
- Division of Gastroenterology, Department of Internal Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Nabeel Azeem
- Division of Gastroenterology, Department of Internal Medicine, University of Minnesota, Minneapolis, Minnesota
| | - James V. Harmon
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota
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3
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Tappata M, McDonald NM, Abdallah M, Bilal M. Efficacy of wire-guided biopsy forceps for tissue sampling in endoscopic retrograde cholangiopancreatography: a preliminary experience. Clin Endosc 2023:ce.2022.152. [PMID: 36789488 PMCID: PMC10393572 DOI: 10.5946/ce.2022.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 07/06/2022] [Indexed: 02/16/2023] Open
Affiliation(s)
- Manaswita Tappata
- Department of Internal Medicine, University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Nicholas M McDonald
- Division of Gastroenterology and Hepatology, University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Mohamed Abdallah
- Division of Gastroenterology and Hepatology, University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Mohammad Bilal
- Division of Gastroenterology and Hepatology, University of Minnesota Medical Center, Minneapolis, MN, USA.,Division of Gastroenterology and Hepatology, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
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Wilson N, McDonald NM, Abdallah M, Bilal M. Endoscopic full-thickness resection of gastric ulceration with persistent low-grade dysplasia using full-thickness resection device (with video). VideoGIE 2022; 7:410-412. [DOI: 10.1016/j.vgie.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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5
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McDonald NM, Abdallah M, Sunjaya D, Bilal M. Use of modified therapeutic upper endoscope for ERCP in patients post pancreaticoduodenectomy. Endosc Int Open 2022; 10:E905-E909. [PMID: 35692933 PMCID: PMC9187413 DOI: 10.1055/a-1789-0238] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 03/03/2022] [Indexed: 02/07/2023] Open
Affiliation(s)
- Nicholas M. McDonald
- University of Minnesota Medical Center, Division of Gastroenterology, Hepatology, and Nutrition, Minneapolis, Minnesota, United States
| | - Mohamed Abdallah
- University of Minnesota Medical Center, Division of Gastroenterology, Hepatology, and Nutrition, Minneapolis, Minnesota, United States
| | - Dharma Sunjaya
- University of Minnesota Medical Center, Division of Gastroenterology, Hepatology, and Nutrition, Minneapolis, Minnesota, United States,Minneapolis VA Health Care System, Division of Gastroenterology and Hepatology, Minneapolis, Minnesota, United States
| | - Mohammad Bilal
- University of Minnesota Medical Center, Division of Gastroenterology, Hepatology, and Nutrition, Minneapolis, Minnesota, United States,Minneapolis VA Health Care System, Division of Gastroenterology and Hepatology, Minneapolis, Minnesota, United States
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McDonald NM, Amateau SK. Jailbreaking a metal biliary stent through a duodenal stent. VideoGIE 2022; 7:226-228. [PMID: 35686216 PMCID: PMC9171701 DOI: 10.1016/j.vgie.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Video 1.
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Affiliation(s)
- Nicholas M McDonald
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, Minnesota
| | - Stuart K Amateau
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, Minnesota
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7
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Arfeen M, McDonald NM, Bilal M. Endoscopic Ultrasound-Guided Rendezvous for Biliary Obstruction in Patient With Prior Whipple Surgery. J Med Cases 2022; 13:183-187. [PMID: 35464327 PMCID: PMC8993447 DOI: 10.14740/jmc3842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 03/17/2022] [Indexed: 11/15/2022] Open
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered anatomy remains a challenging procedure even for the more experienced endoscopists. We present a unique case of an ERCP performed in a patient with prior Whipple surgery, where biliary access was obtained via an endoscopic ultrasound (EUS)-guided rendezvous technique, and cannulation was ultimately done using a modified therapeutic endoscope with successful biliary drainage.
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Affiliation(s)
- Mohammad Arfeen
- Department of Gastroenterology, Franciscan Health Olympia Fields, Olympia Fields, IL 60461, USA
| | - Nicholas M. McDonald
- Division of Gastroenterology & Hepatology, Minneapolis VA Medical Center, University of Minnesota, Minneapolis, MN 55417, USA
| | - Mohammad Bilal
- Division of Gastroenterology & Hepatology, Minneapolis VA Medical Center, University of Minnesota, Minneapolis, MN 55417, USA
- Corresponding Author: Mohammad Bilal, Division of Gastroenterology & Hepatology, Minneapolis VA Medical Center, University of Minnesota, Minneapolis, MN 55417, USA.
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8
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Ramos GP, Dimopoulos C, McDonald NM, Janssens LP, Hung KW, Proctor D, Ruggiero E, Kane S, Bruining DH, Faubion WA, Raffals LE, Loftus EV, Al-Bawardy B. The Impact of Vedolizumab on Pre-Existing Extraintestinal Manifestations of Inflammatory Bowel Disease: A Multicenter Study. Inflamm Bowel Dis 2021; 27:1270-1276. [PMID: 33165569 DOI: 10.1093/ibd/izaa293] [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: 07/27/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND There are limited data on how vedolizumab (VDZ) impacts extraintestinal manifestations (EIMs) in inflammatory bowel disease (IBD). The aim of this study was to determine the clinical outcomes of EIMs after initiation of VDZ for patients with IBD. METHODS A multicenter retrospective study of patients with IBD who received at least 1 dose of VDZ between January 1, 2014 and August 1, 2019 was conducted. The primary outcome was the rate of worsening EIMs after VDZ. Secondary outcomes were factors associated with worsening EIMs and peripheral arthritis (PA) specifically after VDZ. RESULTS A total of 201 patients with IBD (72.6% with Crohn disease; median age 38.4 years (interquartile range, 29-52.4 years); 62.2% female) with EIMs before VDZ treatment were included. The most common type of EIM before VDZ was peripheral arthritis (PA) (68.2%). Worsening of EIMs after VDZ occurred in 34.8% of patients. There were no statistically significant differences between the worsened EIM (n = 70) and the stable EIM (n = 131) groups in term of age, IBD subtype, or previous and current medical therapy. We found that PA was significantly more common in the worsening EIM group (84.3% vs 59.6%; P < 0.01). Worsening of EIMs was associated with a higher rate of discontinuation of VDZ during study follow-up when compared with the stable EIM group (61.4% vs 44%; P = 0.02). Treatment using VDZ was discontinued specifically because of EIMs in 9.5% of patients. CONCLUSIONS Almost one-third of patients had worsening EIMs after VDZ, which resulted in VDZ discontinuation in approximately 10% of patients. Previous biologic use or concurrent immunosuppressant or corticosteroid therapy did not predict EIM course after VDZ.
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Affiliation(s)
| | - Christina Dimopoulos
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | - Kenneth W Hung
- Section of Digestive Diseases, Yale School of Medicine, New Haven, Connecticut, USA
| | - Deborah Proctor
- Section of Digestive Diseases, Yale School of Medicine, New Haven, Connecticut, USA
| | - Elizabeth Ruggiero
- Section of Digestive Diseases, Yale School of Medicine, New Haven, Connecticut, USA
| | - Sunanda Kane
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - David H Bruining
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - William A Faubion
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Laura E Raffals
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Edward V Loftus
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Badr Al-Bawardy
- Section of Digestive Diseases, Yale School of Medicine, New Haven, Connecticut, USA
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9
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Bilal M, Chandnani M, McDonald NM, Miller CS, Saperia J, Wadhwa V, Singh S, Cohen JM, Berzin TM, Sawhney MS, Pleskow DK. Use of fully covered self-expanding metal biliary stents for managing endoscopic biliary sphincterotomy related bleeding. Endosc Int Open 2021; 9:E667-E673. [PMID: 33937506 PMCID: PMC8062221 DOI: 10.1055/a-1380-3268] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/11/2021] [Indexed: 11/17/2022] Open
Abstract
Background and study aims Endoscopic biliary sphincterotomy (EBS) related-bleeding is a common adverse event related to endoscopic retrograde cholangiopancreatography (ERCP). Traditionally, endoscopic modalities such as epinephrine injection, cauterization, and balloon tamponade have been used for management. Recently, use of a fully covered self-expandable metal stent (FCSEMS) to manage EBS-related bleeding has gained popularity. However, data regarding its use are limited to small case series. Therefore, we aimed to evaluate the safety and efficacy of FCSEMS placement for the treatment of EBS-related bleeding. Patients and methods All patients referred to our center from October 2014 to November 2019 who had an FCSEMS placed for EBS-related bleeding were included. FCSEMS was placed either for primary control of bleeding or after failure of other traditional endoscopic hemostasis techniques at the discretion of the endoscopist. Data was collected regarding patient demographics, procedural characteristics, clinical and technical success rates of FCSEMS, as well as adverse events. Results A total of 97 patients underwent placement of FCSEMS for EBS-related bleeding, of which 76.3 % had immediate bleeding and 23.7 % had delayed bleeding. Mean age was 67.2 years and 47.4 % were males. Seven patients who had immediate EBS-related bleeding at index ERCP underwent other endoscopic therapies prior to placement of FCSEMS for rebleeding. The technical success rate for FCSEMS placement was 100 % and the rebleeding rate was 6.2 %. Four patients with FCSEMS placement developed pancreatitis and four had stent migration. Conclusions Our findings suggest that FCSEMS is a highly effective treatment modality for managing EBS-related bleeding and has an acceptable safety profile.
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Affiliation(s)
- Mohammad Bilal
- Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
| | - Madhuri Chandnani
- Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
| | - Nicholas M. McDonald
- Division of Gastroenterology & Hepatology, University of Minnesota Medical Center, Minneapolis, MN
| | - Corey S. Miller
- Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
| | - James Saperia
- Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
| | - Vaibhav Wadhwa
- Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
| | | | - Jonah M. Cohen
- Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
| | - Tyler M. Berzin
- Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
| | - Mandeep S. Sawhney
- Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
| | - Douglas K. Pleskow
- Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
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10
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McDonald NM, Storm AC. Endoscopic suturing of a jejunal feeding tube extension to prevent recurrent gastric coiling. VideoGIE 2021; 6:122-123. [PMID: 33738360 PMCID: PMC7947371 DOI: 10.1016/j.vgie.2020.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Nicholas M McDonald
- Division of Gastroenterology and Hepatology, University of Minnesota, Minneapolis, Minnesota
| | - Andrew C Storm
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
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11
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McDonald NM, Bilal M, Amin S. Can endoscopic ultrasound-guided gastroenterostomy be used as a first-line modality for endoscopic management of malignant gastric outlet obstruction? Endosc Int Open 2021; 9:E421-E422. [PMID: 33655044 PMCID: PMC7895656 DOI: 10.1055/a-1339-1230] [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: 11/24/2022] Open
Affiliation(s)
- Nicholas M. McDonald
- Division of Gastroenterology and Hepatology, University of Minnesota Medical Center, Minneapolis, Minnesota, United States,Division of Gastroenterology and Hepatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, United States
| | - Mohammad Bilal
- Division of Gastroenterology and Hepatology, University of Minnesota Medical Center, Minneapolis, Minnesota, United States,Division of Gastroenterology and Hepatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, United States
| | - Sunil Amin
- Division of Digestive Health and Liver Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, United States
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12
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Harmon DM, McDonald NM, Beckman TJ. 30-Year-Old Woman With Cough, Dyspnea, and Anosmia. Mayo Clin Proc 2020; 95:1775-1779. [PMID: 32753150 PMCID: PMC7395606 DOI: 10.1016/j.mayocp.2020.05.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/22/2020] [Accepted: 05/26/2020] [Indexed: 12/15/2022]
Affiliation(s)
- David M Harmon
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Nicholas M McDonald
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Thomas J Beckman
- Advisor to residents and Consultant in General Internal Medicine, Mayo Clinic, Rochester, MN.
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13
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Amateau SK, Lim CH, McDonald NM, Arain M, Ikramuddin S, Leslie DB. EUS-Guided Endoscopic Gastrointestinal Anastomosis with Lumen-Apposing Metal Stent: Feasibility, Safety, and Efficacy. Obes Surg 2019; 28:1445-1451. [PMID: 29500673 DOI: 10.1007/s11695-018-3171-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Traditionally, restoration of normal bowel continuity after resection and bypass of a diseased or obstructed gastrointestinal tract can only be achieved through surgery, which can be technically challenging and comes with a risk of adverse events. Here, we describe our institutions' experience with endoscopic-guided gastroenterostomy or enteroenterostomy with lumen-apposing metal stent (LAMS) from March 2015 to August 2016. Ten patients had gastrogastrostomy (gastric pouch to gastric remnant) and three patients had jejunogastrostomy (Roux limb to gastric remnant) for the reversal of Roux-en-Y bariatric surgery. One patient had gastroduodenostomy (stomach to duodenal bulb) post antrectomy and one patient had jejunojejunostomy for distal obstruction following Roux-en-Y reconstruction. Technical and clinical success were achieved in all patients, save for delayed anastomotic stenosis following stent removal in one patient, with a mean follow-up of 126 days (3-318 days) with minimal complications in two patients. Endoscopic gastrointestinal anastomosis therefore may be a safe and feasible technique to re-establish continuity of the digestive system following bypass in the short-term.
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Affiliation(s)
- Stuart K Amateau
- Interventional and Therapeutic Endoscopy, Division of Gastroenterology and Hepatology, Department of Medicine, University of Minnesota Medical Center, MMC 36-420 Delaware St SE, Minneapolis, MN, 55455, USA.
| | - Chin Hong Lim
- Division of Minimally Invasive Gastrointestinal Surgery and Medicine, Department of Surgery, University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Nicholas M McDonald
- Interventional and Therapeutic Endoscopy, Division of Gastroenterology and Hepatology, Department of Medicine, University of Minnesota Medical Center, MMC 36-420 Delaware St SE, Minneapolis, MN, 55455, USA
| | - Mustafa Arain
- Division of Gastroenterology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Sayeed Ikramuddin
- Division of Minimally Invasive Gastrointestinal Surgery and Medicine, Department of Surgery, University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Daniel B Leslie
- Division of Minimally Invasive Gastrointestinal Surgery and Medicine, Department of Surgery, University of Minnesota Medical Center, Minneapolis, MN, USA
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14
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McDonald NM, Piovezani Ramos G, Sweetser S. 60-Year-Old Man With Syncope, Abdominal Pain, and Hematochezia. Mayo Clin Proc 2019; 94:1883-1887. [PMID: 31400905 DOI: 10.1016/j.mayocp.2019.01.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 12/26/2018] [Accepted: 01/08/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Nicholas M McDonald
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | | | - Seth Sweetser
- Advisor to Residents and Consultant in Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.
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15
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Bhat AN, McDonald NM, Eilbott JE, Pelphrey KA. Exploring cortical activation and connectivity in infants with and without familial risk for autism during naturalistic social interactions: A preliminary study. Infant Behav Dev 2019; 57:101337. [PMID: 31450025 DOI: 10.1016/j.infbeh.2019.101337] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 05/09/2019] [Accepted: 07/01/2019] [Indexed: 11/29/2022]
Abstract
Behavioral signs of Autism Spectrum Disorder (ASD) are typically observable by the second year of life and a reliable diagnosis of ASD is possible by 2 to 3 years of age. Studying infants with familial risk for ASD allows for the investigation of early signs of ASD risk within the first year. Brain abnormalities such as hyper-connectivity within the first year may precede the overt signs of ASD that emerge later in life. In this preliminary study, we use functional near-infrared spectroscopy (fNIRS), an infant-friendly neuroimaging tool that is relatively robust against motion artifacts, to examine functional activation and connectivity during naturalistic social interactions in 9 high-risk (HR; older sibling with ASD) and 6 low-risk (LR; no family history of ASD) infants from 6 to 9 months of age. We obtained two 30-second baseline periods and a 5-minute social interaction period. HR infants showed reduced right and left-hemispheric activation compared to LR infants based on oxy (HbO2) and deoxy (HHb) signal trends. HR infants also had greater functional connectivity than LR infants during the pre- and post-social periods and showed a drop in connectivity during the social period. Our findings are consistent with previous work suggesting early differences in cortical activation associated with familial risk for ASD, and highlight the promise of fNIRS in evaluating potential markers of ASD risk during naturalistic social contexts.
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Affiliation(s)
- A N Bhat
- Department of Physical Therapy, University of Delaware, 540 S College Ave., Newark, DE, USA; Department of Psychological & Brain Sciences, University of Delaware, 320 McKinly Lab, Newark, DE, USA; Biomechanics & Movement Science Program, University of Delaware, 540 S College Ave., Newark, DE, USA.
| | - N M McDonald
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, 760 Westwood Plaza, Los Angeles, CA, USA
| | - J E Eilbott
- Yale Child Study Center, Yale University, New Haven, CT, USA
| | - K A Pelphrey
- Department of Neurology, University of Virginia, Charlottesville, VA, USA
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16
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Lim CH, McDonald NM, Freeman ML, Amateau SK. Percutaneous cecostomy with fully covered self-expandable metal stent for initial management of severe malignant colon obstruction. Endoscopy 2017; 49:E313-E315. [PMID: 28992638 DOI: 10.1055/s-0043-119973] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Chin Hong Lim
- Division of Minimally Invasive GI Surgery, University of Minnesota Medical Center, Minnesota, Minneapolis, United States
| | - Nicholas M McDonald
- Division of Gastroenterology and Hepatology, University of Minnesota Medical Center, Minnesota, Minneapolis, United States
| | - Martin L Freeman
- Division of Gastroenterology and Hepatology, University of Minnesota Medical Center, Minnesota, Minneapolis, United States
| | - Stuart K Amateau
- Division of Gastroenterology and Hepatology, University of Minnesota Medical Center, Minnesota, Minneapolis, United States
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McDonald NM, Banton KL, Ikramuddin S, Freeman ML, Amateau SK. Videoconferencing for multidisciplinary evaluation in single-session cholecystectomy and ERCP. Gastrointest Endosc 2016; 84:1055-1056. [PMID: 27327848 DOI: 10.1016/j.gie.2016.05.050] [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] [Received: 04/20/2016] [Accepted: 05/30/2016] [Indexed: 12/11/2022]
Affiliation(s)
- Nicholas M McDonald
- Division of Gastroenterology and Hepatology, University of Minnesota Medical Center, Minneapolis, Minnesota, USA
| | - Kaysie L Banton
- Critical Care and Acute Care Surgery, University of Minnesota Medical Center, Minneapolis, Minnesota, USA
| | - Sayeed Ikramuddin
- Bariatric and Minimally Invasive Surgery, University of Minnesota Medical Center, Minneapolis, Minnesota, USA
| | - Martin L Freeman
- Division of Gastroenterology and Hepatology, University of Minnesota Medical Center, Minneapolis, Minnesota, USA
| | - Stuart K Amateau
- Division of Gastroenterology and Hepatology, University of Minnesota Medical Center, Minneapolis, Minnesota, USA
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Abstract
Osteoinductive demineralized bone matrix results from bone demineralization and is attributed to matrix-associated bone morphogenetic proteins. The osteoinductive potential can vary with donor. Many bioassay methods are available to screen donors, each with its own interpretation, so performance of more than one may be of value. Furthermore, little is known about the relationship between bioassay results and clinical outcomes. A study designed to meaningfully explore these issues would require assay of a large number of donors as well as clinical utilization in a large patient population. A preliminary study was undertaken to gain initial perspective. Using demineralized bone matrix derived from one 33-year-old female donor, 2 methods of bioassay and a clinical case study were performed. The levels of bone morphogenetic proteins 2, 4, and 7 in lyophilized demineralized bone matrix powder were measured (19.65 +/- 0.30 ng/g, 2.49 +/- 0.19 ng/g, and 82.03 +/- 6.89 ng/g, respectively). Also, putty (Osteostim DBM Putty), prepared from powder, was intramuscularly implanted in athymic rats and de novo bone formation quantified (6.7% +/- 3.5% new bone formation with 49% +/- 17% of the implant area associated with new bone formation). The putty, in conjunction with internal fixation, was used in the revision of a medial malleolar nonunion of an obese, 76-year-old woman. Radiographic union with excellent graft incorporation was achieved by 12 weeks postoperatively, with maintenance of an acceptable clinical result during the 14-month follow-up period. These results are interpreted in the broader context of demineralized bone grafting, in general, and an outline for further study is presented.
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Watson DG, Midgley JM, Chen RN, Huang W, Bain GM, McDonald NM, Reid JL, McGhee CN. Analysis of biogenic amines and their metabolites in biological tissues and fluids by gas chromatography-negative ion chemical ionization mass spectrometry (GC-NICIMS). J Pharm Biomed Anal 1990; 8:899-904. [PMID: 2100639 DOI: 10.1016/0731-7085(90)80139-g] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
GC-NICIMS has been employed in the analysis of biogenic amines and their metabolites in human urine and human, bovine and porcine aqueous and vitreous humour. Several new chemical derivatization procedures have been developed in order to analyse these compounds. Concentrations of octopamines and synephrines were determined in urine from treated and untreated hypertensive subjects and normotensive individuals; there were no significant differences in concentrations of these metabolites between these groups. Human urine contained several dihydroxy-phenylethylamines which have not been reported as natural metabolites before and also 5- and 6-hydroxydopamine in relatively large amounts. Aqueous and vitreous humour contained very low quantities of noradrenaline, tyramine and dopamine but measurements were inconsistent because sometimes the levels were below the limits of detection. Metabolites of a number of biogenic amines were readily detected in aqueous and vitreous humour.
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Affiliation(s)
- D G Watson
- Department of Pharmacy, University of Strathclyde, Glasgow, UK
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