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Mohamed R, Tejaswi S, Aabakken L, Ponsioen CY, Bowlus CL, Adler DG, Forbes N, Paulsen V, Voermans RP, Urayama S, Peetermans J, Rousseau MJ, Eksteen B. Per-oral cholangioscopy in patients with primary sclerosing cholangitis: a 12-month follow-up study. Endosc Int Open 2024; 12:E237-E244. [PMID: 38362361 PMCID: PMC10869209 DOI: 10.1055/a-2236-7557] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/22/2023] [Indexed: 02/17/2024] Open
Abstract
Background and study aims Patients with primary sclerosing cholangitis (PSC) have a 9% to 20% lifetime incidence of cholangiocarcinoma (CCA). Per-oral cholangioscopy (POCS) added to endoscopic retrograde cholangiography (ERC) could potentially improve detection of CCA occurrence. We prospectively assessed POCS identification of 12-month CCA incidence in PSC patients undergoing ERC. Patients and methods Consecutive patients with PSC, an indication for ERC, and no prior liver transplantation were enrolled. During the index procedure, POCS preceded planned therapeutic maneuvers. The primary endpoint was ability for POCS visualization with POCS-guided biopsy to identify CCA during 12-month follow-up. Secondary endpoints included ability of ERC/cytology to identify CCA, repeat ERC, liver transplantation, and serious adverse events (SAEs). Results Of 42 patients enrolled, 36 with successful cholangioscope advancement were analyzed. Patients had a mean age 43.5±15.6 years and 61% were male. Three patients diagnosed with CCA had POCS visualization impressions of benign/suspicious/suspicious, and respective POCS-guided biopsy findings of suspicious/positive/suspicious for malignancy at the index procedure. The three CCA cases had ERC visualization impressions of benign/benign/suspicious, and respective cytology findings of atypical/atypical/suspicious for malignancy. No additional patients were diagnosed with CCA during median 11.5-month follow-up. Twenty-three repeat ERCs (5 including POCS) were performed in 14 patients. Five patients had liver transplantation, one after CCA diagnosis and four after benign cytology at the index procedure. Three patients (7.1%) had post-ERC pancreatitis. No SAEs were POCS-related. Conclusions In PSC patients, POCS visualization/biopsy and ERC/cytology each identified three cases of CCA. Some patients had a repeat procedure and none experienced POCS-related SAEs.
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Affiliation(s)
- Rachid Mohamed
- Gastroenterology and Hepatology, University of Calgary, Calgary, Canada
| | - Sooraj Tejaswi
- Division of Gastroenterology & Hepatology, University of California Davis School of Medicine, Sacramento, United States
| | - Lars Aabakken
- Dept of Transplantation Medicine, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Cyriel Y Ponsioen
- Gastroenterology and Hepatology, Amsterdam University Medical Centres, Amsterdam, Netherlands
| | - Christopher L Bowlus
- Division of Gastroenterology & Hepatology, University of California Davis School of Medicine, Sacramento, United States
| | - Douglas G Adler
- Center for Advanced Therapeutic Endoscopy, Adventist Porter Hospital, Denver,
| | - Nauzer Forbes
- Gastroenterology and Hepatology, University of Calgary, Calgary, Canada
| | - Vemund Paulsen
- Dept of Transplantation Medicine, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Rogier P. Voermans
- Gastroenterology and Hepatology, Amsterdam University Medical Centres, Amsterdam, Netherlands
| | - Shiro Urayama
- Division of Gastroenterology & Hepatology, University of California Davis School of Medicine, Sacramento, United States
| | - Joyce Peetermans
- Clinical Endoscopy, Boston Scientific Corporation, Marlborough, United States
| | - Matthew J Rousseau
- Clinical Endoscopy, Boston Scientific Corporation, Marlborough, United States
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Tejaswi S, Parikh M, Fananapazir G, Olson K, Gui D. Intra-ampullary papillary-tubular neoplasm. VideoGIE 2023; 8:277-282. [PMID: 37456221 PMCID: PMC10338961 DOI: 10.1016/j.vgie.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Video 1Cholangioscopic examination of the ampullary channel and extrahepatic bile duct.
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Affiliation(s)
- Sooraj Tejaswi
- Division of Gastroenterology & Hepatology, University of California, Davis School of Medicine, Sacramento, California
| | - Mili Parikh
- Department of Internal Medicine, University of California, Davis School of Medicine, Sacramento, California
| | - Ghaneh Fananapazir
- Department of Radiology, University of California, Davis School of Medicine, Sacramento, California
| | - Kristin Olson
- Department of Pathology and Laboratory Medicine, University of California, Davis School of Medicine, Sacramento, California
| | - Dorina Gui
- Department of Pathology and Laboratory Medicine, University of California, Davis School of Medicine, Sacramento, California
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Tejaswi S, Singh A, Manglekar S, Ambikathanaya UK, Shetty S. Evaluation of dentinal crack propagation, amount of gutta percha remaining and time required during removal of gutta percha using two different rotary instruments and hand instruments - An In vitro study. Niger J Clin Pract 2022; 25:524-530. [PMID: 35439914 DOI: 10.4103/njcp.njcp_1838_21] [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] [Indexed: 11/04/2022]
Abstract
Background One of the most important goal of non surgical endodontic retreatment is the successful removal of gutta percha and sealers from the root canal system. A variety of techniques have been recommended for retreatment procedures for the removal of gutta-percha and sealers with or without the help of adjunctive chemical solvents, by using stainless steel hand files or nickel-titanium rotary files, gate glidden burs, heated instruments, ultrasonic instruments, and lasers 1,3. The current advancements in the design of NiTi instruments have proved efficacious in the removal of filling materials from the root canal wall and various studies have also confirmed their cleaning ability and efficacy 4,5. Nevertheless, the use of rotary instrumentation can lead to the formation of dentinal cracks in the root canal dentin. Many researchers have reported the incidence of crack formation and propagation after the procedure with manual, rotary and reciprocating instruments. The behavior of rotary instruments in the generation of defects have been the point of greatest interest during many years 6. These dentinal cracks can be defined as defects with a complete crack line extending from inner root canal space up to the outer surface of the root when the tensile stress in the root canal wall exceeds the tensile stress of dentin 7. Aim This study was conducted to investigate and to compare the amount of dentinal microcracks formation with various new instrumentation methods and conventional hand filing method. It also looks into amount of gutta-percha removed after retreatment from the canal and the time required for all the instrumentation technique. Methodology Sixty extracted human maxillary first molars with curved roots were mounted on addition silicone impression material incorporated in an aluminium hollow block, then instrumented using step-back preparation with 35 size K files. Obturation was done using gutta-percha with AH plus sealer. These were stored for 14 days and divided into three groups Mani GPR, Endostar Re Endo and H file and were subjected to retreatment procedures. Retreatment was considered complete when no filling material was observed on the canal wall and the canal was smooth and free of visible debris. The samples were examined under scanning electron microscope and the number of cracks were calculated. The percentage of root canal filling material and time taken was recorded. Statistical Analysis The data obtained were analyzed by using descriptive statistics, ANOVA (Analysis of Variance), chi-square test and Scheffe's post hoc test through SPSS for window (version 22.0). Result All the techniques showed similar amount of crack propagation, with no statistical difference between the group. Retreatment done using H Files required more time and removed less material. The coronal third showed less amount of gutta-percha remnants than the apical third in all groups. Conclusion All the groups showed a similar amount of crack propagation. Less number of cracks were observed in the coronal one third and more amount of cracks were found at the apical third. Endostar RE Endo rotary instrument proved to be most effective and least time-consuming. Hedstrom Files required more time and removed less material.
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Affiliation(s)
- S Tejaswi
- Department of Conservative Dentistry and Endodontics, JSS Dental College and Hospita, Mysore, Karnataka, India
| | - A Singh
- Department of Conservative Dentistry and Endodontics, JSS Dental College and Hospita, Mysore, Karnataka, India
| | - S Manglekar
- Department of Periodontology, Bharti Vidyapeeth Deemed University, Pune, Maharashtra, India
| | - U K Ambikathanaya
- Department of Conservative Dentistry and Endodontics, JSS Dental College and Hospita, Mysore, Karnataka, India
| | - S Shetty
- Department of Conservative Dentistry and Endodontics, JSS Dental College and Hospita, Mysore, Karnataka, India
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Tejaswi S, Louie J, Loehfelm TW, Jenner ZB, Reichert S, Mitra AD, Gholami S, Pillai RM. Cholangiocarcinoma obscured by a large paraesophageal hernia causing traction compression of the common hepatic duct ultimately diagnosed with percutaneous cholangioscopy. VideoGIE 2022; 7:95-98. [PMID: 35287357 PMCID: PMC8917337 DOI: 10.1016/j.vgie.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
| | - Justin Louie
- UC Davis School of Medicine, Sacramento, California
| | | | | | | | | | | | - Rex M Pillai
- UC Davis School of Medicine, Sacramento, California
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Tejaswi S, Loehfelm TW, Olson KA. Cholangioscopy in primary sclerosing cholangitis: a case series of benign features. VideoGIE 2021; 6:431-437. [PMID: 34527845 PMCID: PMC8430051 DOI: 10.1016/j.vgie.2021.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background and Aims Cholangioscopy is useful in establishing a visual diagnosis of cholangiocarcinoma (CCA), but this is harder to achieve in primary sclerosing cholangitis (PSC) because of the stricture-forming nature of the disease. Furthermore, it can be harder to differentiate malignant from benign features of the underlying inflammation. This case series demonstrates the varied features of nonmalignant inflammatory findings in PSC. Methods A single experienced endoscopist performed cholangioscopy for PSC cases referred for ERCP. Results Cholangioscopy in these 5 cases without CCA demonstrated the features of acute and chronic inflammation, acute inflammatory mass, dominant stricture, acute cholangitis in a duct with features of chronic inflammation with a large pigmented stone, and fibrostenotic disease. Cholangioscopic maneuvers such as advancement across strictures after balloon dilation, targeted mucosal biopsy, and electrohydraulic lithotripsy (EHL) of impacted stones are demonstrated. The relevant radiographic and histopathologic features of the disease accompany each case description. Regarding long-term prognosis, 1 case of acute inflammatory mass and a case of worsening liver function required a liver transplant evaluation, whereas the other 3 cases remain stable. Conclusions Cholangioscopic features of benign disease in PSC are varied. Knowledge of these features is essential in differentiating between benign and malignant findings. These features, combined with biopsy and cytology evaluation, can help in tailoring management in patients with benign PSC.
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Key Words
- ALP, alkaline phosphatase
- ALT, alanine aminotransferase
- AST, aspartate aminotransferase
- CBD, common bile duct
- CCA, cholangiocarcinoma
- CHD, common hepatic duct
- EHL, electrohydraulic lithotripsy
- FISH, fluorescent in situ hybridization
- LFTs, liver function tests
- MRI, magnetic resonance imaging
- PSC, primary sclerosing cholangitis
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Affiliation(s)
- Sooraj Tejaswi
- Division of Gastroenterology & Hepatology, University of California Davis School of Medicine, Sacramento, California
| | - Thomas W Loehfelm
- Department of Radiology, University of California Davis School of Medicine, Sacramento, California
| | - Kristin A Olson
- Department of Pathology and Laboratory Medicine, University of California Davis School of Medicine, Sacramento, California
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Tejaswi S, Pillai RM, Grandhe S, Patel D, Jenner ZB. Disposable digital percutaneous cholangioscope-aided retrieval of a plastic biliary stent after failed retrieval at ERCP. VideoGIE 2021; 6:413-415. [PMID: 34527840 PMCID: PMC8430274 DOI: 10.1016/j.vgie.2021.05.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/29/2022] Open
Affiliation(s)
- Sooraj Tejaswi
- Division of Gastroenterology & Hepatology, University of California Davis School of Medicine, Sacramento, California
| | - Rex M Pillai
- Division of Interventional Radiology, University of California Davis School of Medicine, Sacramento, California
| | - Sirisha Grandhe
- Division of Gastroenterology & Hepatology, University of California Davis School of Medicine, Sacramento, California
| | - Dhairyasheel Patel
- Division of Interventional Radiology, University of California Davis School of Medicine, Sacramento, California
| | - Zachary B Jenner
- Division of Interventional Radiology, University of California Davis School of Medicine, Sacramento, California
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Brewer Gutierrez OI, Godoy Brewer G, Zulli C, Tejaswi S, Pawa R, Jamidar P, Robles-Medranda C, Pawa S, Camilion JV, Oleas R, Parsa N, Runge T, Miaw D, Ichkhanian Y, Khashab MA. Multicenter experience with digital single-operator cholangioscopy in pregnant patients. Endosc Int Open 2021; 9:E116-E121. [PMID: 33532547 PMCID: PMC7834694 DOI: 10.1055/a-1320-0084] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 10/19/2020] [Indexed: 02/06/2023] Open
Abstract
Background and study aims The use of fluoroscopy during pregnancy should be minimized given that a clear-cut safe radiation dose in pregnancy is unknown. The role of digital single-operator cholangioscopy (D-SOC) as an alternative to standard enodoscopic retrograde cholangiopancreatography (ERCP) in pregnant patients has not been comprehensively studied. This study assessed 1 Technical success defined as performance of ERCP with D-SOC without the use of fluoroscopy in pregnant patients; 2 safety of D-SOC in pregnancy; and 3 maternal and neonatal outcomes after D-SOC during/after pregnancy. Patients and methods This was an international, multicenter, retrospective study at 6 tertiary centers. Pregnant patients who underwent D-SOC for the treatment of bile duct stones and/or strictures were included. Results A total of 10 patients underwent D-SOC. Indications for ERCP were choledocholithiasis, strictures, previous stent removal, and choledocholithiasis/stent removal. Bile duct cannulation without fluoroscopy was achieved in 10 of 10 patients (100 %). Moreover, 50 % of patients (5/10) completed a fluoroless ERCP with D-SOC. Mean fluoroscopy dose and fluoroscopy time were 3.4 ± 7.2 mGy and 0.5 ± 0.8 min, respectively. One case of mild bleeding and one case of moderate post-ERCP pancreatitis occurred. The mean gestational age at delivery was 36.2 ± 2.6 weeks. Median birth weight was 2.5 kg [IQR: 2.2-2.8]. No birth defects were noted. Conclusion ERCP guided by D-SOC appears to be a feasible and effective alternative to standard ERCP in pregnant patients. It enables avoidance of radiation in half of cases.
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Affiliation(s)
- Olaya I. Brewer Gutierrez
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, United States
| | - Gala Godoy Brewer
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, United States
| | - Claudio Zulli
- Division of Gastroenterology, University Hospital G. Fucito, Ruggi d’Aragona, Salermo, Italy
| | - Sooraj Tejaswi
- Division of Gastroenterology & Hepatology, University of California Davis School of Medicine, Sacramento California, United States
| | - Rishi Pawa
- Division of Gastroenterology, Wake Forest Baptist Medical Center, Winston Salem, NC
| | - Priya Jamidar
- Division of Digestive Diseases, Yale University School of Medicine, New Haven, Connecticut, United States
| | - Carlos Robles-Medranda
- Division of Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas, Guayaquil, Ecuador
| | - Swati Pawa
- Division of Gastroenterology, Wake Forest Baptist Medical Center, Winston Salem, NC
| | - Jose V. Camilion
- Nova Southeastern College of Ostheopathic Medicine, Davie, Florida, United States
| | - Roberto Oleas
- Division of Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas, Guayaquil, Ecuador
| | - Nasim Parsa
- Division of Gastroenterology and Hepatology, University of Missouri, Columbia, MO
| | - Thomas Runge
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, United States
| | - Diana Miaw
- Division of Gynecology & Obstetrics, Johns Hopkins Medical Institution, Baltimore, Maryland, United States
| | - Yervant Ichkhanian
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, United States
| | - Mouen A. Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, United States
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Perry LM, Loehfelm T, Pillai R, Pan DY, Tejaswi S, Gholami S. Shifting the Treatment Paradigm for Pancreaticoportal Fistula Causing Hepatic Necrosis. Dig Dis Sci 2020; 65:1955-1959. [PMID: 31919639 DOI: 10.1007/s10620-020-06045-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Lauren M Perry
- Division of Surgical Oncology, Department of Surgery, University of California, 2279 45th Street, Davis, Sacramento, CA, 95817, USA
| | - Thomas Loehfelm
- Division of Abdominal Imaging, Department of Radiology, University of California, Davis, USA
| | - Rex Pillai
- Division of Interventional Radiology, Department of Radiology, University of California, Davis, USA
| | - Dana Y Pan
- Division of Gastroenterology, Department of Internal Medicine, University of California, Davis, USA
| | - Sooraj Tejaswi
- Division of Gastroenterology, Department of Internal Medicine, University of California, Davis, USA
| | - Sepideh Gholami
- Division of Surgical Oncology, Department of Surgery, University of California, 2279 45th Street, Davis, Sacramento, CA, 95817, USA.
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Affiliation(s)
- Justin Louie
- Division of Gastroenterology and Hepatology, University of California Davis School of Medicine, Sacramento, California
| | - Sooraj Tejaswi
- Division of Gastroenterology and Hepatology, University of California Davis School of Medicine, Sacramento, California
| | - Karen Matsukuma
- Division of Pathology, University of California Davis School of Medicine, Sacramento, California
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Fung BM, Fejleh MP, Tejaswi S, Tabibian JH. Cholangioscopy and its Role in Primary Sclerosing Cholangitis. Eur Med J Hepatol 2020; 8:42-53. [PMID: 32714560 PMCID: PMC7380688] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Primary sclerosing cholangitis (PSC) is a cholestatic liver disease characterised by chronic inflammation and fibro-obliteration of the intrahepatic and/or extrahepatic bile ducts. It is associated with numerous hepatobiliary complications including an increased risk of malignancy (in particular, cholangiocarcinoma) and biliary tract stone formation. The evaluation of biliary strictures in patients with PSC is especially challenging, with imaging and endoscopic methods having only modest sensitivity for the diagnosis of cholangiocarcinoma, and treatment of biliary strictures poses a similarly significant clinical challenge. In recent years, peroral cholangioscopy has evolved technologically and increased in popularity as an endoscopic tool that can provide direct intraductal visualisation and facilitate therapeutic manipulation of the biliary tract. However, the indications for and effectiveness of its use in patients with PSC remain uncertain, with only a few studies performed on this small but important subset of patients. In this review, the authors discuss the available data regarding the use of peroral cholangioscopy in patients with PSC, with a focus on its use in the evaluation and management of biliary strictures and stones.
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Affiliation(s)
- Brian M. Fung
- Department of Medicine, Olive View-UCLA Medical Center, Los Angeles, California, USA
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - M. Phillip Fejleh
- Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Sooraj Tejaswi
- Division of Gastroenterology & Hepatology, University of California, UC Davis Health, Sacramento, California, USA
| | - James H. Tabibian
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Division of Gastroenterology, Department of Medicine, Olive View-UCLA Medical Center, Los Angeles, California, USA
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Spiewak TA, Yan SL, Tejaswi S. Impact of EMR Automated Results Routing Tool Implementation on Notification of Inpatient Endoscopy Biopsy Results. Jt Comm J Qual Patient Saf 2020; 46:321-325. [PMID: 32402762 DOI: 10.1016/j.jcjq.2020.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 02/28/2020] [Accepted: 03/04/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Mucosal biopsies are often obtained during inpatient endoscopies to aid diagnosis. Up to 75% of patients are reported to have pending test results at discharge. Incomplete result communication to patients can lead to patient anxiety and poor outcomes. This study aimed to evaluate the impact of a systemwide electronic medical record (EMR) update on result communication. METHODS The researchers retrospectively reviewed 100 inpatient endoscopies pending histopathology results at discharge to see if finalized results were communicated to the patients within 30 days. The same metric was studied after implementation of an EMR update that automatically routed results to the supervising endoscopist, by reviewing another 100 inpatient endoscopies during which biopsies were obtained. Follow-up rate pre- and post-EMR update was compared. RESULTS Prior to the update, 47/77 (61.0%) histopathology results were communicated to the patients. Of the 30 nonreported cases, 17 showed nonspecific/chronic inflammation, 8 had no abnormal findings, 3 showed hyperplastic colon polyps, and 2 had colonic tubular adenomas. Following the EMR update, 65/71 (91.5%) of pathology results were communicated, demonstrating an increase of 30.5 percentage points in the rate of follow-up (95% confidence interval [CI] = 17.7-43.0, p < 0.0001). CONCLUSION This study observed that 39.0% of inpatient endoscopic mucosal biopsy results in one health care system were not communicated to the patients. Implementation of a systemwide EMR intervention reduced this to 8.5% by shifting the responsibility of result communication to the endoscopy team. Similar EMR enhancements can be applied to other pending test results in health care systems with similar issues.
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Marsano J, Johnson S, Yan S, Alli-Akintade L, Wilson M, Al-Juburi A, Stondell J, Tejaswi S. Comparison of colon adenoma detection rates using cap-assisted and Endocuff-assisted colonoscopy: a randomized controlled trial. Endosc Int Open 2019; 7:E1585-E1591. [PMID: 31788539 PMCID: PMC6877415 DOI: 10.1055/a-0996-7891] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 12/15/2018] [Accepted: 04/10/2019] [Indexed: 12/13/2022] Open
Abstract
Objectives and study aim Colonoscopy prevents colorectal cancer by removing adenomatous polyps, but missed adenomas lead to interval cancers. Different devices have been used to increase adenoma detection rates (ADR). Two such devices of interest are the transparent cap (Olympus) and Endocuff (ARC Medical). Our study aimed to compare differences in ADR between Endocuff-assisted colonoscopy (EAC), cap-assisted colonoscopy (CAC) and standard colonoscopy (SC). Patients and methods A sample size of 126 subjects was calculated to determine an effect size of 30 %. Patients undergoing screening or surveillance colonoscopy between March 2016 and January 2017 were randomized to SC, CAC or EAC groups. Three experienced endoscopists performed all colonoscopies. Patient demographics, procedure indication, Boston Bowel Prep Score (BBPS), withdrawal time, polyp size, location, histopathology, were analyzed. Results There was no difference in ADR (52 %, 40 % and 54 %) in the SC, CAC and EAC groups respectively ( P = 0.4). Similar findings were also observed for proximal ADR (45 %, 35 %, and 50 %, P = 0.4) and SSA detection rate (16 %, 14 %, and 23 %, P = 0.5). EAC detected higher mean ADR per colonoscopy compared to CAC (1.70 vs 0.76, P = 0.01). However, there was no significant difference in mean ADR per positive colonoscopy (2.08, 1.63, and 2.59, P = 0.21). Conclusion In a randomized controlled trial comparing AC to CAC and SC, neither device conferred additional benefits in ADR among high detectors. When comparing each device, EAC may be better than CAC at detecting more total adenomas.
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Affiliation(s)
- Joseph Marsano
- Division of Gastroenterology and Hepatology, University of California Davis School of Medicine, Sacramento, California, United States
| | - Sheeva Johnson
- Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, California, United States
| | - Stephanie Yan
- Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, California, United States
| | - Latifat Alli-Akintade
- Division of Gastroenterology and Hepatology, University of California Davis School of Medicine, Sacramento, California, United States
| | - Machelle Wilson
- Department of Public Health Sciences, Division of Biostatistics, University of California Davis School of Medicine, Sacramento, California, United States
| | - Amar Al-Juburi
- Division of Gastroenterology and Hepatology, University of California Davis School of Medicine, Sacramento, California, United States
| | - Jesse Stondell
- Division of Gastroenterology and Hepatology, University of California Davis School of Medicine, Sacramento, California, United States
| | - Sooraj Tejaswi
- Division of Gastroenterology and Hepatology, University of California Davis School of Medicine, Sacramento, California, United States,Corresponding author Sooraj Tejaswi, MD, MSPH University of California DavisDepartment of Internal MedicineDivision of Gastroenterology and Hepatology4150 V Street, Suite 3500Sacramento, California 95817USA+1- 916-734-7908
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Yan S, Tejaswi S. Clinical impact of digital cholangioscopy in management of indeterminate biliary strictures and complex biliary stones: a single-center study. Ther Adv Gastrointest Endosc 2019; 12:2631774519853160. [PMID: 31218297 PMCID: PMC6563398 DOI: 10.1177/2631774519853160] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 05/03/2019] [Indexed: 12/23/2022] Open
Abstract
Aims: Endoscopic management of indeterminate strictures and complex stones remains a challenge, for which the latest generation single-operator digital cholangioscope (SpyGlass DS) has shown promising results. We aimed to study the clinical impact of single-operator digital cholangioscope at our tertiary academic center. Methods: We retrospectively reviewed all digital cholangioscopies performed from June 2015 to May 2018. Patient characteristics, procedure characteristics, and post-procedural patient outcomes were recorded. Results: A total of 50 patients (26 men, average age 61.4 years) underwent 67 procedures. Indications were biliary stones (21/50, 42%), strictures and primary sclerosing cholangitis surveillance (22/50, 46%), and miscellaneous (7/50, 14%). The average procedure time was 82 ± 29 min (99.5 min for stones and 74.2 min for strictures). Stone clearance was achieved in 19/21 (90.47%) cases, with electrohydraulic lithotripsy employed in 16/21 and repeat cholangioscopy necessary in 9/21. Malignant strictures (10) were differentiated from benign (12) in all cases both in patients with primary sclerosing cholangitis (9) and in those without (13), based on visual cholangioscopic features (sensitivity and specificity 100%), single-operator digital cholangioscope–directed biopsies (sensitivity 60% and specificity 100%), and brush cytology (sensitivity 37.5% and specificity 100%). Complications included one post-sphincterotomy bleeding and one post-procedural cholangitis despite antibiotic prophylaxis, but no procedure-related mortality. Conclusion: Single-operator digital cholangioscope had a high success rate and a low rate of complications for management of indeterminate strictures and difficult biliary stones. Visual cholangioscopic features of biliary strictures had excellent diagnostic accuracy, and targeted biopsies outperformed brush cytology. Early implementation of cholangioscopy for select indications leads to successful patient outcomes and reduces diagnostic delays, cost, and risks of repeat endoscopic retrograde cholangiopancreatographies.
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Affiliation(s)
- Stephanie Yan
- Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Sooraj Tejaswi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, CA, USA
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Kipper B, Jairam A, Tejaswi S, Vu C. 03:00 PM Abstract No. 306 The biliary rendezvous: a quality improvement initiative. J Vasc Interv Radiol 2019. [DOI: 10.1016/j.jvir.2018.12.373] [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] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Shahedi K, Tejaswi S. Abdominal Wall Bile Staining Without Jaundice. Clin Gastroenterol Hepatol 2016; 14:A33-4. [PMID: 26972980 DOI: 10.1016/j.cgh.2016.03.010] [Citation(s) in RCA: 2] [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: 01/27/2016] [Revised: 03/02/2016] [Accepted: 03/03/2016] [Indexed: 02/07/2023]
Affiliation(s)
- Kamyar Shahedi
- Department of Internal Medicine, Division of Gastroenterology, University of California-Davis Health System, Sacramento, California
| | - Sooraj Tejaswi
- Department of Internal Medicine, Division of Gastroenterology, University of California-Davis Health System, Sacramento, California
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Kumar CV, Kumar MP, Tejaswi S, Shivaraj. Spectroscopic, crystallographic, and docking studies of 3,4-dimethyl-N-((thiophen-2-yl)methylene)isoxazol-5-amine Schiff base. CRYSTALLOGR REP+ 2014. [DOI: 10.1134/s1063774514060169] [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] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Tejaswi S. Increase in proximal adenoma detection rate after transition from air to water method for screening colonoscopy in a community-based setting in the United States. J Interv Gastroenterol 2013. [DOI: 10.7178/jig.121] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Walter RJ, Attar BM, Rafiq A, Delimata M, Tejaswi S. Two avirulent, lentogenic strains of Newcastle disease virus are cytotoxic for some human pancreatic tumor lines in vitro. JOP 2012; 13:502-13. [PMID: 22964957 DOI: 10.6092/1590-8577/977] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
CONTEXT Pancreatic cancer is the fourth leading cause of cancer death in the U.S. Highly infectious Newcastle disease virus (NDV) strains are known to be very cytotoxic for an array of human tumor cell types in vitro and in vivo but the effects of these and avirulent NDV strains on pancreatic neoplasms are little known. OBJECTIVE Here, the direct cytolytic effects of the avirulent Hitchner-B1 (B1) and Ulster (U) NDV strains on 7 human pancreatic tumor cell lines and 4 normal human cell lines were studied. METHODS Cytotoxicity assays used serially diluted NDV to determine minimum cytotoxic plaque forming unit (PFU) doses. RESULTS For NDV-B1, normal human cells were killed only by relatively high doses (range: 471-3,724 PFU) whereas NDV-U killed these cells at low PFU (range: 0.32-1.60 PFU). Most pancreatic cancer cell types were killed by much lower NDV-B1 doses (range: 0.40-2.60 PFU) while NDV-U killed Capan-1 and SU.86.86 cultures at very low doses (0.00041 PFU and 0.0034 PFU, respectively). CONCLUSIONS On average, 1,555 times more NDV-B1 was needed to kill normal cells than most pancreatic tumor cells and 558 times more NDV-U to kill the two most sensitive pancreatic cancer lines. These innately-targeted lentogenic viruses may have meaningful potential in treating pancreatic cancer.
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Affiliation(s)
- Robert J Walter
- Division of Gastroenterology/Hepatology, Cook County-John H. Stroger Hospital, Chicago, IL, USA.
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Walter RJ, Attar BM, Rafiq A, Tejaswi S, Delimata M. Newcastle disease virus LaSota strain kills human pancreatic cancer cells in vitro with high selectivity. JOP 2012; 13:45-53. [PMID: 22233946] [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] [Subscribe] [Scholar Register] [Received: 11/12/2011] [Revised: 12/14/2011] [Accepted: 12/12/2011] [Indexed: 05/31/2023]
Abstract
CONTEXT Pancreatic cancer is highly resistant to treatment. Previously, we showed that Newcastle disease virus (NDV) strain 73-T was highly cytotoxic to a range of tumor types in vitro and in vivo but the effects of NDV on pancreatic tumors are unknown. We determined the cytotoxicity of the lentogenic LaSota strain of NDV (NDV-LS) toward 7 different human pancreatic tumor cell lines and 4 normal human cell lines (keratinocytes, fibroblasts, pancreatic ductal cells, and vascular endothelial cells). METHODS Cytotoxicity assays used serially diluted NDV incubated for 96 hours post-infection. Cells were fixed, stained, and minimum cytotoxic plaque forming unit (PFU) doses were determined (n = 10-24/cell line). RESULTS Normal cells were killed only by high doses of NDV-LS. The cytotoxic doses for pancreatic ductal cells, fibroblasts, and vascular endothelial cells were 729, 626, and 1,217 plaque forming units, respectively. In contrast, most pancreatic cancer cells were killed by much lower doses. The doses for PL45, Panc 10.05, PANC-1, BxPC3, SU.86.86, Capan-1 and CFPAC-1 were 0.15, 0.41, 0.43, 0.55, 1.30, 17.1 and 153 plaque forming units, respectively. CONCLUSIONS Most pancreatic tumor cells were more than 700 times more sensitive to NDV-LS killing than normal cells. Such avirulent, lentogenic NDV strains may have therapeutic potential in the treatment of pancreatic cancers.
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Affiliation(s)
- Robert J Walter
- Division of Gastroenterology and Hepatology, Cook County-John H Stroger Hospital, Chicago, IL 60612, USA.
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Abstract
In a case control study, we assessed the prevalence of bacterial urinary tract infections (UTI) and renal scarring in 155 consecutive type 1 (n=102) and type 2 (n=53) diabetic individuals and 128 healthy controls. Subjects who received antibiotics during the past 6 months, pregnant women and those with overt renal failure were excluded. In all subjects, urine culture and 99m Technetium (Tc) dimercapto-succinic acid renal scan was performed. UTI was diagnosed if two consecutive urine cultures grew the same organism with at least 10(5) colony forming unit (cfu)/ml in asymptomatic and at least 10(4) cfu/ml in symptomatic subjects, respectively. Renal scan was considered abnormal if focal or multiple tracer uptake defects and/or break in cortical outline were observed. The prevalence of UTI in diabetes mellitus was higher, when compared to that in controls (9% vs. 0.78%, P=0.005). Escherichia coli was the most commonly grown organism (64.3%), followed by Staphyloccocus aureus (21.4%) and Klebsiella pneumoniae (14.3%). Prevalence of renal scarring was higher in patients with diabetes (28/155, 18.0%), when compared to that of controls (7/128, 5.4%, P=0.002). Fifty percent of patients with diabetes and UTI had renal scarring. The prevalence in diabetics with no UTI was also higher, when compared to controls (14.8 vs. 5.5%, P<0.01). The prevalence of UTI as well as renal scarring was significantly higher in females, when compared to male diabetics. No significant difference in vascular events, hypertension, proteinuria, renal function tests and HbA1 was observed in patients with and without renal scar. Thus, patients with diabetes mellitus have 10- and 3-folds increased risk of UTI and renal scarring, respectively. The results could help prioritize protocols for management of UTI among patients with diabetes mellitus.
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Affiliation(s)
- R Goswami
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi 110 029, India
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Goswami R, Dadhwal V, Tejaswi S, Datta K, Paul A, Haricharan RN, Banerjee U, Kochupillai NP. Species-specific prevalence of vaginal candidiasis among patients with diabetes mellitus and its relation to their glycaemic status. J Infect 2000; 41:162-6. [PMID: 11023762 DOI: 10.1053/jinf.2000.0723] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.3] [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
OBJECTIVES Non- C. albicans Candida species are increasingly being recognized as the cause of vulvo-vaginal candidiasis. These species are often less susceptible to antifungal agents. Patients with diabetes mellitus are at risk for vulvo-vaginal candidasis. We assessed the species-specific prevalence rate and risk of candidiasis in patients with diabetes mellitus and healthy controls. METHODS Genital tract examination, direct microscopy and fungal cultures of discharge collected by high vaginal swab were undertaken among 78 consecutive patients with diabetes mellitus (mean (+/-sd) age 32+/-12 years and body mass index (BMI) 22.3+/-5.5kg/m(2)) and 88 age- and BMI-matched healthy females. Glycaemic control in the diabetic cohort was assessed by measuring total glycosylated haemoglobin. RESULTS Candida species were isolated in 36 of 78 (46%) subjects with diabetes mellitus and in 21 of 88 (23%) healthy subjects (Chi-squared 9.11, P=0.0025). The predominant Candida species isolated in diabetics with vulvo-vaginal candidiasis were Candida glabrata (39%), C. albicans (26%) and C. tropicalis (17%). In contrast, in the control group, C. albicans, C. glabrata and C. hemulonii comprised 30% each, with none having C. tropicalis infection (for C. tropicalis: diabetic vs. control; 17% vs. nil, P=0. 05). Among the diabetic group, subjects with vulvo-vaginal candidiasis had significantly higher mean HbA1 when compared to those who had no such infection (12.8+/-2.6% vs. 9.7+/-1.7% respectively, P=0.001). The overall accuracy of direct microscopy and clinical examination for predicting vulvo-vaginal candidiasis was only 77% and 51%, respectively, in the diabetic group, and 83% and 65% in the control group. CONCLUSIONS Patients with diabetes mellitus had a high prevalence rate (46%) of vulvo-vaginal candidiasis with relative risk of 2.45. The non- C. albicans species such as C. glabrata and C. tropicalis were the predominant species isolated among them. There seems to be a significant link between hyperglycaemia and vulvo-vaginal candidiasis.
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Affiliation(s)
- R Goswami
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi 110029, India
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