1
|
Hassan KM, Dawod E, Hassan M, Salgado SM, Mahadev S, Sharaiha RZ, Sampath K. Endoscopic treatment of a hepatic abscess arising from a biliary stricture due to intraductal papillary neoplasm of the bile duct. Endoscopy 2024; 56:E225-E226. [PMID: 38458238 PMCID: PMC10923627 DOI: 10.1055/a-2253-0948] [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: 03/10/2024]
Affiliation(s)
- Kamal M. Hassan
- Gastroenterology and Hepatology, Weill Cornell Medical College, New York, United States
| | - Enad Dawod
- Gastroenterology and Hepatology, Weill Cornell Medical College, New York, United States
| | | | - Sanjay M. Salgado
- Gastroenterology and Hepatology, Weill Cornell Medical College, New York, United States
| | - SriHari Mahadev
- Gastroenterology and Hepatology, Weill Cornell Medical College, New York, United States
| | - Reem Z. Sharaiha
- Gastroenterology and Hepatology, Weill Cornell Medical College, New York, United States
| | - Kartik Sampath
- Gastroenterology and Hepatology, Weill Cornell Medical College, New York, United States
| |
Collapse
|
2
|
Magahis PT, Westerveld D, Simons M, Carr-Locke DL, Sampath K, Sharaiha RZ, Mahadev S. Outcomes of Endoscopic Ultrasound-guided Fine Needle Biopsy Using a Novel Hydrostatic Stylet Tissue Acquisition Technique. J Clin Gastroenterol 2024; 58:407-414. [PMID: 37983811 DOI: 10.1097/mcg.0000000000001934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/28/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) is frequently used to obtain core samples of solid lesions. Here, we describe and evaluate a novel hydrostatic stylet (HS) technique designed to optimize core sample acquisition, reporting diagnostic yield, efficacy, and safety relative to the conventional stylet slow-pull (SP) technique. METHODS A novel HS technique was developed and validated retrospectively. Consecutive patients who underwent EUS-FNB with core biopsy of solid lesions through either the HS or SP technique between January 2020 and April 2022 were included. Exclusion criteria included cystic lesions, nonlesional liver biopsies, and specimens sent for cytologic analysis only. Patient and lesion characteristics, number of passes, sample adequacy, and adverse events were compared between the two techniques. RESULTS A total of 272 patients were included with 138 in the HS group and 134 in the SP group. Lesion size and anatomic distribution were similar in both groups. Compared with the SP approach, the HS technique demonstrated significantly higher sample adequacy (97.8% vs 83.6%, P < 0.001), higher sensitivity (97.1% vs 89.7%, P = 0.03), and lower mean number of passes (1.2 vs 3.3, P < 0.001). Rates and severity of adverse events in the HS group were comparable to the SP group and existing literature. Similar associations were observed in pancreatic and nonpancreatic lesion subanalyses. CONCLUSIONS The novel HS technique demonstrated excellent biopsy sample adequacy and diagnostic yield while requiring fewer passes to obtain diagnostic specimens compared with a conventional EUS-FNB approach. Further prospective evaluation is needed to confirm these pilot findings and optimize EUS-FNB acquisition techniques.
Collapse
Affiliation(s)
| | - Donevan Westerveld
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY
| | - Malorie Simons
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY
| | - David L Carr-Locke
- MD Program, Weill Cornell Medical College
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY
| | - Kartik Sampath
- MD Program, Weill Cornell Medical College
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY
| | - Reem Z Sharaiha
- MD Program, Weill Cornell Medical College
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY
| | - SriHari Mahadev
- MD Program, Weill Cornell Medical College
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY
| |
Collapse
|
3
|
Salgado SM, Hassan KM, Abu-Hammour MN, Carr-Locke DL, Sampath K, Sharaiha RZ, Mahadev S. Endoscopic ultrasound-guided gastrojejunopexy using an improvised T-anchor for successful endoscopic gastrojejunostomy. Endoscopy 2023; 55:E1226-E1227. [PMID: 38081307 PMCID: PMC10713337 DOI: 10.1055/a-2208-5132] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Affiliation(s)
- Sanjay M. Salgado
- Gastroenterology and Hepatology, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, United States
| | - Kamal Maher Hassan
- Gastroenterology and Hepatology, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, United States
| | - Mohamad-Noor Abu-Hammour
- Gastroenterology and Hepatology, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, United States
| | - David L. Carr-Locke
- Gastroenterology and Hepatology, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, United States
| | - Kartik Sampath
- Gastroenterology and Hepatology, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, United States
| | - Reem Z. Sharaiha
- Gastroenterology and Hepatology, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, United States
| | - SriHari Mahadev
- Gastroenterology and Hepatology, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, United States
| |
Collapse
|
4
|
Canakis A, Bomman S, Lee DU, Ross A, Larsen M, Krishnamoorthi R, Alseidi AA, Adam MA, Kouanda A, Sharaiha RZ, Mahadev S, Dawod S, Sampath K, Arain MA, Farooq A, Hasan MK, Kadkhodayan K, de la Fuente SG, Benias PC, Trindade AJ, Ma M, Gilman AJ, Fan GH, Baron TH, Irani SS. Benefits of EUS-guided gastroenterostomy over surgical gastrojejunostomy in the palliation of malignant gastric outlet obstruction: a large multicenter experience. Gastrointest Endosc 2023; 98:348-359.e30. [PMID: 37004816 DOI: 10.1016/j.gie.2023.03.022] [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: 01/14/2023] [Revised: 03/12/2023] [Accepted: 03/14/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND AND AIMS Palliation of malignant gastric outlet obstruction (mGOO) allows resumption of peroral intake. Although surgical gastrojejunostomy (SGJ) provides durable relief, it may be associated with a higher morbidity, interfere with chemotherapy, and require an optimum nutritional status. EUS-guided gastroenterostomy (EUS-GE) has emerged as a minimally invasive alternative. We aimed to conduct the largest comparative series to date between EUS-GE and SGJ for mGOO. METHODS This multicenter retrospective study included consecutive patients undergoing SGJ or EUS-GE at 6 centers. Primary outcomes included time to resumption of oral intake, length of stay (LOS), and mortality. Secondary outcomes included technical and clinical success, reintervention rates, adverse events (AEs), and resumption of chemotherapy. RESULTS A total of 310 patients were included (EUS-GE, n = 187; SGJ, n = 123). EUS-GE exhibited significantly lower time to resumption of oral intake (1.40 vs 4.06 days, P < .001), at lower albumin levels (2.95 vs 3.33 g/dL, P < .001), and a shorter LOS (5.31 vs 8.54 days, P < .001) compared with SGJ; there was no difference in mortality (48.1% vs 50.4%, P = .78). Technical (97.9% and 100%) and clinical (94.1% vs 94.3%) success was similar in the EUS-GE and SGJ groups, respectively. EUS-GE had lower rates of AEs (13.4% vs 33.3%, P < .001) but higher reintervention rates (15.5% vs 1.63%, P < .001). EUS-GE patients exhibited significantly lower interval time to resumption of chemotherapy (16.6 vs 37.8 days, P < .001). Outcomes between the EUS-GE and laparoscopic (n = 46) surgical approach showed that EUS-GE had shorter interval time to initiation/resumption of oral intake (3.49 vs 1.46 days, P < .001), decreased LOS (9 vs 5.31 days, P < .001), and a lower rate of AEs (11.9% vs 17.9%, P = .003). CONCLUSIONS This is the largest study to date showing that EUS-GE can be performed among nutritionally deficient patients without affecting the technical and clinical success compared with SGJ. EUS-GE is associated with fewer AEs while allowing earlier resumption of diet and chemotherapy.
Collapse
Affiliation(s)
- Andrew Canakis
- Division of Gastroenterology and Hepatology, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Shivanand Bomman
- Division of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington, USA
| | - David U Lee
- Division of Gastroenterology and Hepatology, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Andrew Ross
- Division of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Michael Larsen
- Division of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Rajesh Krishnamoorthi
- Division of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington, USA
| | | | | | - Abdul Kouanda
- Division of Gastroenterology and Hepatology, University of California, San Francisco, San Francisco, California, USA
| | - Reem Z Sharaiha
- Division of Gastroenterology and Hepatology, Weill Medical College of Cornell University, New York, New York, USA
| | - SriHari Mahadev
- Division of Gastroenterology and Hepatology, Weill Medical College of Cornell University, New York, New York, USA
| | - Sanad Dawod
- Division of Gastroenterology and Hepatology, Weill Medical College of Cornell University, New York, New York, USA
| | - Kartik Sampath
- Division of Gastroenterology and Hepatology, Weill Medical College of Cornell University, New York, New York, USA
| | | | | | | | | | | | - Petros C Benias
- Division of Gastroenterology, Lenox Hill Hospital, New York, New York, USA
| | - Arvind J Trindade
- Division of Gastroenterology, Long Island Jewish Medical Center, New Hyde Park, New York, USA
| | - Michael Ma
- Division of Gastroenterology, Lenox Hill Hospital, New York, New York, USA
| | - Andrew J Gilman
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Todd H Baron
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Shayan S Irani
- Division of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington, USA.
| |
Collapse
|
5
|
Magahis PT, Westerveld D, Salgado S, Carr-Locke DL, Sampath K, Sharaiha RZ, Mahadev S. Acute worsening of gastric outlet obstruction following EUS-guided gastrojejunal bypass. VideoGIE 2023. [DOI: 10.1016/j.vgie.2023.02.008] [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: 04/08/2023] Open
|
6
|
Magahis PT, Westerveld D, Simons M, Hissong E, Carr-Locke DL, Sampath K, Sharaiha RZ, Mahadev S. EUS-guided liver biopsy using a novel hydrostatic stylet technique. VideoGIE 2023; 8:104-106. [PMID: 36935805 PMCID: PMC10020006 DOI: 10.1016/j.vgie.2022.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Video 1Hydrostatic stylet technique for the performance of EUS-guided liver biopsy.
Collapse
Affiliation(s)
- Patrick T Magahis
- Joan & Sanford I. Weill Medical College of Cornell University, New York, New York
| | - Donevan Westerveld
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Malorie Simons
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Erika Hissong
- Division of Gastrointestinal Pathology, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - David L Carr-Locke
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Kartik Sampath
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Reem Z Sharaiha
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - SriHari Mahadev
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| |
Collapse
|
7
|
Jonica ER, Mahadev S, Gilman AJ, Sharaiha RZ, Baron T, Irani SS. EUS-guided enterocolostomy with lumen-apposing metal stent for palliation of malignant small-bowel obstruction (with video). Gastrointest Endosc 2022; 97:927-933. [PMID: 36572124 DOI: 10.1016/j.gie.2022.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Interventions for malignant small-bowel obstruction (SBO) may be limited by extent of peritoneal disease, rendering surgical or traditional endoscopic methods (ie, luminal stenting or decompressive gastrostomy) unfeasible. We demonstrated the novel use of EUS-guided lumen-apposing metal stent placement for enterocolonic bypass in patients with malignant SBO who were deemed high risk for surgery. METHODS Across 3 tertiary U.S. centers, a retrospective series of consecutive patients underwent attempted EUS-guided enterocolostomy (EUS-EC) for palliation of acute SBO because of malignant causes. Technique and devices used were described, and patient demographics and outcome data were collected. RESULTS Ten patients were included, of whom 9 (90.0%) were men, with a mean age of 64.5 ± 14.0 years and who were 1.5 ± 2.1 years postdiagnosis. Technical success was achieved in 8 of 10 patients (80.0%) and clinical success in 7 of 10 (70.0%), with a single major adverse event (10.0%) of aspiration. Median time until resumption of oral intake was 1.0 day (range, 0-8) after the procedure, with an interval to discharge home of 6.5 days and survival of 57.0 days. CONCLUSIONS EUS-EC is a new alternative for palliation of acute SBO because of advanced malignant disease when conservative measures fail and other surgical or endoscopic options are not possible. Additional larger studies with longer duration of follow-up are needed to further define efficacy and safety of this approach.
Collapse
Affiliation(s)
- Emily R Jonica
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA
| | - SriHari Mahadev
- Division of Gastroenterology & Hepatology, Weill Cornell Medicine, New York, New York, USA
| | - Andrew J Gilman
- Division of Gastroenterology & Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Reem Z Sharaiha
- Division of Gastroenterology & Hepatology, Weill Cornell Medicine, New York, New York, USA
| | - Todd Baron
- Division of Gastroenterology & Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Shayan S Irani
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA
| |
Collapse
|
8
|
Magahis P, Rosenblatt R, Mahadev S. An Unusual Cause of Right Upper Quadrant Pain With Abnormal Liver Enzymes. Gastroenterology 2022; 163:e3-e5. [PMID: 35580657 DOI: 10.1053/j.gastro.2022.04.052] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/20/2022] [Accepted: 04/28/2022] [Indexed: 12/02/2022]
Affiliation(s)
- Patrick Magahis
- Joan & Sanford I. Weill Medical College of Cornell University, New York, New York
| | - Russell Rosenblatt
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - SriHari Mahadev
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York.
| |
Collapse
|
9
|
Di Cocco BL, Westerveld DR, Hajifathalian K, Mahadev S, Sharaiha RZ, Sampath K. Successful minimally invasive management of adverse events following EUS-guided gallbladder drainage in a suboptimal surgical patient. VideoGIE 2022; 7:361-363. [PMID: 36238806 PMCID: PMC9551617 DOI: 10.1016/j.vgie.2022.07.007] [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)
- Bianca L Di Cocco
- Division of Internal Medicine, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - Donevan R Westerveld
- Division of Gastroenterology and Hepatology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - Kaveh Hajifathalian
- Division of Gastroenterology and Hepatology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - SriHari Mahadev
- Division of Gastroenterology and Hepatology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - Reem Z Sharaiha
- Division of Gastroenterology and Hepatology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - Kartik Sampath
- Division of Gastroenterology and Hepatology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| |
Collapse
|
10
|
Mehta A, Hajifathalian K, Shah SL, Mahadev S, Sampath K, Carr-Locke DL, Sharaiha RZ. Quality of Life, Mental Health, and Weight Loss Outcomes Following Endoscopic Sleeve Gastroplasty. J Gastrointest Surg 2022; 26:469-471. [PMID: 34506034 DOI: 10.1007/s11605-021-05137-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 08/21/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Amit Mehta
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital-Weill Cornell Medical Center, New York, NY, 10021, USA
| | - Kaveh Hajifathalian
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital-Weill Cornell Medical Center, New York, NY, 10021, USA
| | - Shawn L Shah
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital-Weill Cornell Medical Center, New York, NY, 10021, USA
| | - SriHari Mahadev
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital-Weill Cornell Medical Center, New York, NY, 10021, USA
| | - Kartik Sampath
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital-Weill Cornell Medical Center, New York, NY, 10021, USA
| | - David L Carr-Locke
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital-Weill Cornell Medical Center, New York, NY, 10021, USA
| | - Reem Z Sharaiha
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital-Weill Cornell Medical Center, New York, NY, 10021, USA.
| |
Collapse
|
11
|
Chhoda A, Dawod S, Grimshaw A, Gunderson C, Mahadev S. Evaluation of diagnostic yield of EUS among patients with asymptomatic common bile duct dilation: systematic review and meta-analysis. Gastrointest Endosc 2021; 94:890-901.e8. [PMID: 34245751 DOI: 10.1016/j.gie.2021.07.002] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 07/02/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Common bile duct (CBD) dilation is a frequent indication for EUS. Among asymptomatic individuals, biliary dilation may not be clinically significant; however, EUS is often relied on for the exclusion of benign and malignant pathology that might require further intervention. The yield of EUS evaluation for this indication is not well characterized and has significant implications for health resource utilization because asymptomatic biliary dilation is prevalent. Through this systematic review, we sought to appraise the yield of EUS evaluation of asymptomatic patients with radiologic evidence of isolated CBD dilation. METHODS A protocolled search (PROSPERO: CRD42020193428) extracted original studies from the Cochrane Library, Ovid Embase, Google Scholar, Ovid Medline, PubMed, Scopus, and Web of Science Core Collection that described diagnostic yield of EUS among asymptomatic patients with biliary dilation. Cumulative EUS diagnostic yield was calculated through meta-analysis of proportions using inverse variance methods and a random-effects model. RESULTS Of 2616 studies, 8 delineated the EUS yield among 224 asymptomatic patients. The cumulative yield of EUS for any pathology was 11.2% (95% confidence interval [CI], 3.6%- 21.6%). The EUS yield for benign etiologies was 9.2% (95% CI, 1.1%-21.9%), of which choledocholithiasis comprised 3.4% (95% CI, 0%-11.2%) and malignant etiologies .5% (95% CI, 0%-3.4%) of cases. CONCLUSIONS EUS in patients with asymptomatic CBD dilation does yield findings of choledocholithiasis and malignancy, albeit at low rates. A cost-effectiveness analysis is warranted to further guide clinical decision-making in this area.
Collapse
Affiliation(s)
- Ankit Chhoda
- Section of Digestive Diseases, Yale School of Medicine, New Haven, Connecticut, USA
| | - Sanad Dawod
- Weill Cornell Medicine, New York, New York USA
| | - Alyssa Grimshaw
- Yale Harvey Cushing/John Hay Whitney Medical Library, New Haven, Connecticut, USA
| | - Craig Gunderson
- Department of Medicine, VA Connecticut Healthcare System, Connecticut, USA
| | | |
Collapse
|
12
|
Mahadev S, Vareedayah AA, Yuen S, Yuen W, Koller KA, Haber GB. Outcomes of a hybrid technique using EMR and endoscopic full-thickness resection for polyps not amenable to standard techniques (with video). Gastrointest Endosc 2021; 94:358-367.e1. [PMID: 33592228 DOI: 10.1016/j.gie.2021.02.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 02/06/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS The full-thickness resection device (FTRD) offers a safe and effective approach for resection of complex colorectal lesions but is limited to lesions <2 cm in size. A hybrid approach-combining EMR with the FTRD-significantly expands the pool of lesions amenable to this technique; however, its safety and efficacy has not been well established. METHODS We report a single-center retrospective study of consecutive patients who underwent full-thickness resection (FTR) of colorectal lesions, either with a standalone FTRD or a hybrid (EMR + FTRD) approach. Outcomes of technical success, clinical success (macroscopically complete resection), R0 resection, and adverse events (AEs) were evaluated. RESULTS Sixty-nine FTR procedures (38 standalone FTR and 31 hybrid EMR + FTR) were performed on 65 patients. The most common indications were nonlifting polyp (43%) or suspected high-grade dysplasia or carcinoma (38%). Hybrid EMR + FTR permitted resection of significantly larger lesions (mean, 39 mm; range, 15-70 mm) compared with standalone FTR (mean, 17 mm; range, 7-25 mm; P < .01). Clinical success (91%), technical success (83%), and R0 resection (81%) rates did not differ between standalone and hybrid groups. Most patients (96%) were discharged home on the day of the procedure. Three AEs occurred, including 2 patients who developed acute appendicitis. CONCLUSIONS A hybrid approach combining EMR and FTRD maintains safety and efficacy while permitting resection of significantly larger lesions than FTRD alone.
Collapse
Affiliation(s)
- SriHari Mahadev
- Division of Gastroenterology & Hepatology, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Ashley A Vareedayah
- Division of Gastroenterology & Hepatology, Department of Medicine, New York University Langone Health, New York, New York, USA
| | - Sofia Yuen
- Division of Gastroenterology & Hepatology, Department of Medicine, New York University Langone Health, New York, New York, USA
| | - William Yuen
- Division of Gastroenterology & Hepatology, Department of Medicine, New York University Langone Health, New York, New York, USA
| | - Kristen A Koller
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Gregory B Haber
- Division of Gastroenterology & Hepatology, Department of Medicine, New York University Langone Health, New York, New York, USA
| |
Collapse
|
13
|
Mahadev S, Aroniadis OS, Barraza L, Agarunov E, Goodman AJ, Benias PC, Buscaglia JM, Gross SA, Kasmin FE, Cohen JJ, Carr-Locke DL, Greenwald DA, Mendelsohn RB, Sethi A, Gonda TA. Impact of the COVID-19 pandemic on endoscopy practice: results of a cross-sectional survey from the New York metropolitan area. Gastrointest Endosc 2020; 92:788-789. [PMID: 32339595 PMCID: PMC7182511 DOI: 10.1016/j.gie.2020.04.047] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 04/19/2020] [Indexed: 02/06/2023]
Affiliation(s)
| | | | - Luis Barraza
- NYP-Columbia University Irving Medical Center, New York, New York, USA
| | - Emil Agarunov
- NYP-Columbia University Irving Medical Center, New York, New York, USA
| | | | | | | | | | | | | | | | | | | | - Amrita Sethi
- NYP-Columbia University Irving Medical Center, New York, New York, USA
| | - Tamas A Gonda
- NYP-Columbia University Irving Medical Center, New York, New York, USA
| |
Collapse
|
14
|
Choi AJ, Mahadev S. Is Tissue Really the Issue? How the Polyp Detection Rate May Be a Good Enough Quality Measure Among Trainees. Dig Dis Sci 2020; 65:2151-2152. [PMID: 32086689 DOI: 10.1007/s10620-020-06151-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Anthony J Choi
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, 1283 York Ave, 9th Floor, New York, NY, 10065, USA
| | - SriHari Mahadev
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, 1283 York Ave, 9th Floor, New York, NY, 10065, USA.
| |
Collapse
|
15
|
Rajan A, Sharaf R, Brown RS, Sharaiha RZ, Lebwohl B, Mahadev S. Association of Search Query Interest in Gastrointestinal Symptoms With COVID-19 Diagnosis in the United States: Infodemiology Study. JMIR Public Health Surveill 2020; 6:e19354. [PMID: 32640418 PMCID: PMC7371406 DOI: 10.2196/19354] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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: 04/14/2020] [Revised: 07/02/2020] [Accepted: 07/08/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Coronavirus disease (COVID-19) is a novel viral illness that has rapidly spread worldwide. While the disease primarily presents as a respiratory illness, gastrointestinal symptoms such as diarrhea have been reported in up to one-third of confirmed cases, and patients may have mild symptoms that do not prompt them to seek medical attention. Internet-based infodemiology offers an approach to studying symptoms at a population level, even in individuals who do not seek medical care. OBJECTIVE This study aimed to determine if a correlation exists between internet searches for gastrointestinal symptoms and the confirmed case count of COVID-19 in the United States. METHODS The search terms chosen for analysis in this study included common gastrointestinal symptoms such as diarrhea, nausea, vomiting, and abdominal pain. Furthermore, the search terms fever and cough were used as positive controls, and constipation was used as a negative control. Daily query shares for the selected symptoms were obtained from Google Trends between October 1, 2019 and June 15, 2020 for all US states. These shares were divided into two time periods: pre-COVID-19 (prior to March 1) and post-COVID-19 (March 1-June 15). Confirmed COVID-19 case numbers were obtained from the Johns Hopkins University Center for Systems Science and Engineering data repository. Moving averages of the daily query shares (normalized to baseline pre-COVID-19) were then analyzed against the confirmed disease case count and daily new cases to establish a temporal relationship. RESULTS The relative search query shares of many symptoms, including nausea, vomiting, abdominal pain, and constipation, remained near or below baseline throughout the time period studied; however, there were notable increases in searches for the positive control symptoms of fever and cough as well as for diarrhea. These increases in daily search queries for fever, cough, and diarrhea preceded the rapid rise in number of cases by approximately 10 to 14 days. The search volumes for these terms began declining after mid-March despite the continued rises in cumulative cases and daily new case counts. CONCLUSIONS Google searches for symptoms may precede the actual rises in cases and hospitalizations during pandemics. During the current COVID-19 pandemic, this study demonstrates that internet search queries for fever, cough, and diarrhea increased prior to the increased confirmed case count by available testing during the early weeks of the pandemic in the United States. While the search volumes eventually decreased significantly as the number of cases continued to rise, internet query search data may still be a useful tool at a population level to identify areas of active disease transmission at the cusp of new outbreaks.
Collapse
Affiliation(s)
- Anjana Rajan
- Department of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, NY, United States
| | - Ravi Sharaf
- Department of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, NY, United States
| | - Robert S Brown
- Department of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, NY, United States
| | - Reem Z Sharaiha
- Department of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, NY, United States
| | - Benjamin Lebwohl
- Division of Digestive and Liver Disease, Columbia University Medical Center, New York, NY, United States
| | - SriHari Mahadev
- Department of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, NY, United States
| |
Collapse
|
16
|
Rutting S, Mahadev S, Tonga KO, Bailey DL, Dame Carroll JR, Farrow CE, Thamrin C, Chapman DG, King GG. Obesity alters the topographical distribution of ventilation and the regional response to bronchoconstriction. J Appl Physiol (1985) 2020; 128:168-177. [DOI: 10.1152/japplphysiol.00482.2019] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Obesity is associated with reduced operating lung volumes that may contribute to increased airway closure during tidal breathing and abnormalities in ventilation distribution. We investigated the effect of obesity on the topographical distribution of ventilation before and after methacholine-induced bronchoconstriction using single-photon emission computed tomography (SPECT)-computed tomography (CT) in healthy subjects. Subjects with obesity ( n = 9) and subjects without obesity ( n = 10) underwent baseline and postbronchoprovocation SPECT-CT imaging, in which Technegas was inhaled upright and followed by supine scanning. Lung regions that were nonventilated (Ventnon), low ventilated (Ventlow), or well ventilated (Ventwell) were calculated using an adaptive threshold method and were expressed as a percentage of total lung volume. To determine regional ventilation, lungs were divided into upper, middle, and lower thirds of axial length, derived from CT. At baseline, Ventnon and Ventlow for the entire lung were similar in subjects with and without obesity. However, in the upper lung zone, Ventnon (17.5 ± 10.6% vs. 34.7 ± 7.8%, P < 0.001) and Ventlow (25.7 ± 6.3% vs. 33.6 ± 5.1%, P < 0.05) were decreased in subjects with obesity, with a consequent increase in Ventwell (56.8 ± 9.2% vs. 31.7 ± 10.1%, P < 0.001). The greater diversion of ventilation to the upper zone was correlated with body mass index ( rs = 0.74, P < 0.001), respiratory system resistance ( rs = 0.72, P < 0.001), and respiratory system reactance ( rs = −0.64, P = 0.003) but not with lung volumes or basal airway closure. Following bronchoprovocation, overall Ventnon increased similarly in both groups; however, in subjects without obesity, Ventnon only increased in the lower zone, whereas in subjects with obesity, Ventnon increased more evenly across all lung zones. In conclusion, obesity is associated with altered ventilation distribution during baseline and following bronchoprovocation, independent of reduced lung volumes. NEW & NOTEWORTHY Using ventilation SPECT-computed tomography imaging in healthy subjects, we demonstrate that ventilation in obesity is diverted to the upper lung zone and that this is strongly correlated with body mass index but is independent of operating lung volumes and of airway closure. Furthermore, methacholine-induced bronchoconstriction only occurred in the lower lung zone in individuals who were not obese, whereas in subjects who were obese, it occurred more evenly across all lung zones. These findings show that obesity-associated factors alter the topographical distribution of ventilation.
Collapse
Affiliation(s)
- S. Rutting
- Department of Respiratory Medicine, Royal North Shore Hospital, St. Leonards, NSW, Australia
- Airway Physiology and Imaging Group, The Woolcock Institute of Medical Research, The University of Sydney, NSW, Australia
| | - S. Mahadev
- Department of Respiratory Medicine, Royal North Shore Hospital, St. Leonards, NSW, Australia
- Airway Physiology and Imaging Group, The Woolcock Institute of Medical Research, The University of Sydney, NSW, Australia
| | - K. O. Tonga
- Department of Respiratory Medicine, Royal North Shore Hospital, St. Leonards, NSW, Australia
- Airway Physiology and Imaging Group, The Woolcock Institute of Medical Research, The University of Sydney, NSW, Australia
- Department of Thoracic and Transplant Medicine, St. Vincent's Hospital, Darlinghurst, NSW, Australia
- Faculty of Medicine & Health, University of Sydney, NSW, Australia
| | - D. L. Bailey
- Faculty of Medicine & Health, University of Sydney, NSW, Australia
- Department of Nuclear Medicine, Royal North Shore Hospital, St. Leonards, NSW, Australia
| | - J. R. Dame Carroll
- Airway Physiology and Imaging Group, The Woolcock Institute of Medical Research, The University of Sydney, NSW, Australia
| | - C. E. Farrow
- Airway Physiology and Imaging Group, The Woolcock Institute of Medical Research, The University of Sydney, NSW, Australia
- Faculty of Medicine & Health, University of Sydney, NSW, Australia
- Department of Respiratory Medicine, Westmead Hospital, Westmead, NSW, Australia
| | - C. Thamrin
- Airway Physiology and Imaging Group, The Woolcock Institute of Medical Research, The University of Sydney, NSW, Australia
| | - D. G. Chapman
- Airway Physiology and Imaging Group, The Woolcock Institute of Medical Research, The University of Sydney, NSW, Australia
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Ultimo, NSW, Australia
| | - G. G. King
- Department of Respiratory Medicine, Royal North Shore Hospital, St. Leonards, NSW, Australia
- Airway Physiology and Imaging Group, The Woolcock Institute of Medical Research, The University of Sydney, NSW, Australia
- NHMRC Centre of Excellence in Severe Asthma, New Lambton Heights, NSW, Australia
| |
Collapse
|
17
|
Laszkowska M, Mahadev S, Sundström J, Lebwohl B, Green PHR, Michaelsson K, Ludvigsson JF. Systematic review with meta-analysis: the prevalence of coeliac disease in patients with osteoporosis. Aliment Pharmacol Ther 2018; 48:590-597. [PMID: 29984519 DOI: 10.1111/apt.14911] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 02/27/2018] [Revised: 03/25/2018] [Accepted: 06/24/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Earlier studies have produced highly varying risk estimates for the prevalence of coeliac disease (CD) in osteoporosis. AIMS To investigate the prevalence of CD among individuals with osteoporosis. METHODS We conducted a systematic review of articles published in PubMed, Medline or EMBASE through May 2017 to identify studies looking at prevalence of CD in patients with osteoporosis. Search terms included "coeliac disease" combined with "fractures", "bone disease", "bone density", "densitometry", "osteoporos*", "osteomal*", "osteodys" or "dexa" or "dxa" or "skelet". Non-English papers with English-language abstracts were included. We used fixed-effects inverse variance-weighted models, and tested heterogeneity through subgroup analysis as well as through meta-regression. RESULTS We identified eight relevant studies, comprising data from 3188 individuals with osteoporosis. Of these, 59 individuals (1.9%) had CD. A weighted pooled analysis demonstrated biopsy-confirmed CD in 1.6% (95% CI = 1.1%-2.0%) of individuals with osteoporosis. The heterogeneity was moderate (I2 = 40.1%), and influenced by the underlying CD prevalence in the general population. After adding four studies (n = 814) with CD defined as positive tissue transglutaminase or endomysial antibodies, the pooled prevalence was comparable (1.6%; 95% CI = 1.2%-2.0%). CONCLUSIONS About 1 in 62 individuals with osteoporosis, or 1.6%, have biopsy-verified CD. This prevalence is comparable to that in the general population. These findings argue against routinely screening patients with osteoporosis for CD, which is contrary to current guideline recommendations. Additional studies are needed to determine the true utility of such screening programs.
Collapse
Affiliation(s)
- M Laszkowska
- Department of Medicine, Celiac Disease Center, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - S Mahadev
- Department of Medicine, Celiac Disease Center, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - J Sundström
- Department of Medical Sciences, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - B Lebwohl
- Department of Medicine, Celiac Disease Center, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - P H R Green
- Department of Medicine, Celiac Disease Center, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - K Michaelsson
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - J F Ludvigsson
- Department of Medicine, Celiac Disease Center, Columbia University College of Physicians and Surgeons, New York, NY, USA.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Paediatrics, Örebro University Hospital, Örebro, Sweden.,Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| |
Collapse
|
18
|
Abstract
Pelvic fluid collections can be challenging and often inaccessible because of their location and close proximity to adjacent organs and spine. This causes an increased risk for morbidity and poor outcomes. Recent advances in endoscopic ultrasound and therapeutic devices provide an effective, safe, and minimally invasive option to surgery or interventional radiology. These devices offer a relatively pain-free method that has shown good outcomes with minimal risk in recent case series, and has increasingly become the first-line treatment of choice. This article summarizes the current literature and the technique and considerations for successful drainage of these collections.
Collapse
Affiliation(s)
- SriHari Mahadev
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Medical Center, 630 West 168th Street, P&S 3-401, New York, NY 10032, USA
| | - David S Lee
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Medical Center, 630 West 168th Street, P&S 3-401, New York, NY 10032, USA.
| |
Collapse
|
19
|
Mahadev S, Murray JA, Green PHR, Adelman DA, Lebwohl B. Editorial: risk factors for persistent villus atrophy in coeliac disease - is it time to reconsider definitions for refractory coeliac disease? Authors' reply. Aliment Pharmacol Ther 2017; 45:1478-1479. [PMID: 28474831 DOI: 10.1111/apt.14086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Affiliation(s)
- S Mahadev
- Celiac Disease Center, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - J A Murray
- Division of Gastroenterology and Hepatology, The Mayo Clinic, Rochester, MN, USA
| | - P H R Green
- Celiac Disease Center, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - D A Adelman
- Division of Allergy/Immunology, Department of Medicine, University of California, San Francisco, CA, USA
| | - B Lebwohl
- Celiac Disease Center, Columbia University College of Physicians and Surgeons, New York, NY, USA
| |
Collapse
|
20
|
Mahadev S, Murray JA, Wu TT, Chandan VS, Torbenson MS, Kelly CP, Maki M, Green PHR, Adelman D, Lebwohl B. Factors associated with villus atrophy in symptomatic coeliac disease patients on a gluten-free diet. Aliment Pharmacol Ther 2017; 45:1084-1093. [PMID: 28220520 DOI: 10.1111/apt.13988] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 10/25/2016] [Accepted: 01/23/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Duodenal injury persists in some coeliac disease patients despite gluten-free diet, and is associated with adverse outcomes. AIM To determine the prevalence and clinical risk factors for persistent villus atrophy among symptomatic coeliac disease patients. METHODS A nested cross-sectional analysis was performed on coeliac disease patients with self-reported moderate or severe symptoms while following a gluten-free diet, who underwent protocol-mandated duodenal biopsy upon enrolment in the CeliAction clinical trial. Demographic factors, symptom type, medication use, and serology were examined to determine predictors of persistent villus atrophy. RESULTS Of 1345 symptomatic patients, 511 (38%, 95% CI, 35-41%) were found to have active coeliac disease with persistent villus atrophy, defined as average villus height to crypt depth ratio ≤2.0. On multivariable analysis, older age (OR, 5.1 for ≥70 vs. 18-29 years, 95% CI, 2.5-10.4) was a risk factor while longer duration on gluten-free diet was protective (OR, 0.37, 95% CI, 0.24-0.55 for 4-5.9 vs. 1-1.9 years). Villus atrophy was associated with use of proton-pump inhibitors (PPIs; OR, 1.6, 95% CI, 1.1-2.3), non-steroidal anti-inflammatory drugs (NSAIDs; OR, 1.64, 95% CI, 1.2-2.2), and selective serotonin reuptake inhibitors (SSRIs; OR, 1.74, 95% CI, 1.2-2.5). Symptoms were not associated with villus atrophy after adjusting for covariates. Conclusions A majority of symptomatic coeliac disease patients did not have active disease on follow-up histology. Symptoms were poorly predictive of persistent mucosal injury. The impact of NSAIDs, PPIs, and SSRIs on mucosal healing in coeliac disease warrants further study.
Collapse
Affiliation(s)
- S Mahadev
- Celiac Disease Center, Columbia University College of Physicians and Surgeons, New York, USA
| | - J A Murray
- Division of Gastroenterology and Hepatology, The Mayo Clinic, Rochester, MN, USA
| | - T-T Wu
- Department of Laboratory Medicine and Pathology, The Mayo Clinic, Rochester, MN, USA
| | - V S Chandan
- Department of Laboratory Medicine and Pathology, The Mayo Clinic, Rochester, MN, USA
| | - M S Torbenson
- Department of Laboratory Medicine and Pathology, The Mayo Clinic, Rochester, MN, USA
| | - C P Kelly
- Celiac Center, Beth Israel Deaconess Medical Center and Celiac Research Program, Harvard Medical School, Boston, MA, USA
| | - M Maki
- Tampere Center for Child Health Research, School of Medicine, University of Tampere and Tampere University Hospital, Finland, Europe
| | - P H R Green
- Celiac Disease Center, Columbia University College of Physicians and Surgeons, New York, USA
| | - D Adelman
- Division of Allergy/Immunology, Department of Medicine, University of California, San Francisco, CA, USA
| | - B Lebwohl
- Celiac Disease Center, Columbia University College of Physicians and Surgeons, New York, USA
| |
Collapse
|
21
|
Jotwani A, Surendran J, Rama mohan R, Chilukuri S, Kalluri S, Premkumar P, Muthu M, Mahadev S, Janardhan N. PO-0692 BLADDER AND RECTUM VOLUME CHANGES DURING PROSTATE IGRT. ARE BOWEL AND BLADDER PREPARATION PROTOCOLS EFFECTIVE? ARE BOWEL AND BLADDER PREPARATION PROTOCOLS EFFECTIVE. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)71025-3] [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: 11/28/2022]
|
22
|
Sudarshan G, Mahadev S. Vinorelbine as radiosensitizer in head and neck and esophageal cancer: A pilot study. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.5562] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
23
|
Abstract
The radiance of most objects seen at a distance through the atmosphere is dominated by scattered light of a blue hue that should make the landscape appear predominately blue. However, common experience shows that people can see colors at a distance. A possible explanation of this paradox is that the visual system splits the light into a haze layer and the background landscape. A straightforward mathematical description of this splitting explains the results of a color matching study in the Great Smoky Mountains National Park. In this study, hues of objects seen through haze were found to be constant with changes in optical depth while colorfulness decreased exponentially.
Collapse
Affiliation(s)
- R C Henry
- Department of Civil Engineering, University of Southern California, Los Angeles 90089-2531, USA
| | | | | | | |
Collapse
|