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Khan MZ, Suresh S, Ichkhanian Y, Jou J, Nagirimadugu A, Ghanimeh MA, Zuchelli T. Use of endoscopic plication to repair a dysfunctional gastric conduit. VideoGIE 2024; 9:78-81. [PMID: 38357021 PMCID: PMC10861837 DOI: 10.1016/j.vgie.2023.09.019] [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: 02/16/2024]
Abstract
Video 1Full length video showing the use of endoscopic plication to repair a dysfunctional gastric conduit.
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Affiliation(s)
- Muhammad Zarrar Khan
- Department of Gastroenterology and Hepatology, Henry Ford Health, Detroit, Michigan
| | - Suraj Suresh
- Department of Gastroenterology and Hepatology, Henry Ford Health, Detroit, Michigan
| | | | - Jessica Jou
- Department of Gastroenterology and Hepatology, Henry Ford Health, Detroit, Michigan
| | - Ankita Nagirimadugu
- Department of Gastroenterology and Hepatology, Henry Ford Health, Detroit, Michigan
| | | | - Tobias Zuchelli
- Department of Gastroenterology and Hepatology, Henry Ford Health, Detroit, Michigan
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Ichkhanian Y, Nimri F, Salman MF, Harris K, Taha A, Fahad H, Zuchelli T. A challenging case of pancreaticogastric anastomotic stricture in a patient with surgically altered anatomy. VideoGIE 2023; 8:410-415. [PMID: 37849772 PMCID: PMC10577586 DOI: 10.1016/j.vgie.2023.06.004] [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: 10/19/2023]
Abstract
Video 1EUS-guided gastro-jejunostomy using a lumen-apposing metal stent to access the surgical pancreaticogastric anastomotic site and perform EUS-guided de novo pancreatico-gastrostomy for the management of a postsurgical pancreaticogastric anastomotic stricture with pancreatic insufficiency.
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Affiliation(s)
| | - Faisal Nimri
- Division of Gastroenterology and Hepatology, Henry Ford Hospital, Detroit, Michigan
| | | | - Kevin Harris
- Division of Gastroenterology and Hepatology, Henry Ford Hospital, Detroit, Michigan
| | - Ashraf Taha
- Division of Gastroenterology and Hepatology, Henry Ford Hospital, Detroit, Michigan
| | - Hamna Fahad
- Division of Gastroenterology and Hepatology, Henry Ford Hospital, Detroit, Michigan
| | - Tobias Zuchelli
- Division of Gastroenterology and Hepatology, Henry Ford Hospital, Detroit, Michigan
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Ichkhanian Y, Al-Haddad MA, Jacobs CC, Schlachterman A, Yang J, Canakis A, Kim R, Guerson-Gil A, D'Souza LS, Alsheik E, Ginnebaugh BD, Khashab MA, Zuchelli T, McFarlin K, Piraka C. Gastric peroral endoscopic myotomy for management of refractory gastroparesis in patients with gastric neurostimulator devices: a multicenter retrospective case control study. Gastrointest Endosc 2023; 98:559-566.e1. [PMID: 37121364 DOI: 10.1016/j.gie.2023.04.2079] [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: 01/26/2023] [Revised: 03/28/2023] [Accepted: 04/19/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND AND AIMS Gastric neurostimulation (GNS) and gastric peroral myotomy (G-POEM), therapies for refractory gastroparesis, are associated with suboptimal outcomes. We studied the role of G-POEM as a salvage therapy in patients with refractory symptoms after GNS implantation. METHODS This was a multicenter, retrospective, matched case-control study. Consecutive patients with a GNS device and who underwent G-POEM as a salvage therapy for clinical failure (cases) and patients without GNS implantation and who underwent G-POEM for refractory gastroparesis (control) between October 2018 and August 2021 were included. The primary outcome was clinical success after G-POEM. RESULTS A total of 123 patients (mean age 45.7 ± 14.7 years; 88 female subjects [72%]) underwent G-POEM therapy during the study: 41 cases and 82 controls. Clinical success was achieved in 66% in the case group and 65% in the control group (P = .311), during a median total clinical follow-up time of 11.8 (interquartile range, 2.4-6.3) months. In the case group, the mean Gastroparesis Cardinal Symptom Index score decreased from 2.8 ± 1.8 to 1.5 ± 1.9 (P = .024), and gastric retention at 4 hours improved from 45% ± 25.8% to 16.6% ± 13.1% (P = .06). The mean delta improvement in the subscales of nausea/vomiting (1.3 ± .6 vs .9 ± 1.1, P = .044) and bloating (1.6 ± 1.3 vs 1.2 ± 1.4, P = .041) were significantly higher in cases than in controls. CONCLUSIONS Among patients with refractory symptoms after GNS, G-POEM can be a reasonable salvage therapy to provide further symptomatic relief with evidence of a potential additive effect of both G-POEM and GNS.
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Affiliation(s)
| | - Mohammad A Al-Haddad
- Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, Indiana, USA
| | - Chelsea C Jacobs
- Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, Indiana, USA
| | - Alexander Schlachterman
- Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Juliana Yang
- Division of Gastroenterology and Hepatology, Vanderbilt University, Nashville, Tennessee, USA
| | - Andrew Canakis
- Division of Gastroenterology and Hepatology, University of Maryland, Baltimore, Maryland, USA
| | - Raymond Kim
- Division of Gastroenterology and Hepatology, University of Maryland, Baltimore, Maryland, USA
| | - Arcelia Guerson-Gil
- Division of Gastroenterology and Hepatology, Stony Brook University Hospital, Stony Brook, New York, USA
| | - Lionel S D'Souza
- Division of Gastroenterology and Hepatology, Stony Brook University Hospital, Stony Brook, New York, USA
| | | | | | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, Baltimore, Maryland, USA (10)Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
| | | | - Kellie McFarlin
- Department of Surgery, Henry Ford Hospital, Detroit, Michigan, USA
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Ichkhanian Y, Jovani M. Use of lumen apposing metal stents in patients with altered gastrointestinal anatomy. Curr Opin Gastroenterol 2023; 39:348-355. [PMID: 37530730 DOI: 10.1097/mog.0000000000000965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
PURPOSE OF REVIEW Lumen apposing metal stents (LAMS) have been increasingly used to manage patients with surgically altered anatomy (SAA), who would have otherwise required percutaneous or surgical interventions. Via the creation of de-novo anastomoses, LAMS provides a conduit to access distal parts of the gastrointestinal tract to perform various interventions. RECENT FINDINGS Pancreatobiliary (PB) and non-PB interventions are challenging in patients with SAA. Endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography (ERCP) (EDGE) and endoscopic ultrasound (EUS)-directed transenteric ERCP (EDEE) are effective procedures that are being increasingly utilized to perform ERCP in patient with Roux-en-Y gastric bypass (RYGB) and non-RYGB SAA, respectively. Furthermore, EUS-directed trans-gastric intervention (EDGI) is a collective term for the non-PB procedures that could be performed in patients with SAA. EDGE/EDEE/EDGI are considered relatively safe procedures, however, intra-procedural stent misdeployement, and long-term ramifications of persistent fistula and stent migration could require endoscopic or, in rare instances, surgical management. SUMMARY The advent of LAMS has revolutionized the therapeutic capabilities of EUS, by allowing the creation of new gastrointestinal anastomoses. With the growing body of literature, it is expected that such techniques will be more commonly performed in the community, providing less invasive and more effective treatment options for patients with SAA.
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Affiliation(s)
| | - Manol Jovani
- Division of Gastroenterology and Hepatology, Maimonides Medical Center
- SUNY Downstate University, Brooklyn, New York, USA
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Obri M, Ichkhanian Y, Brown P, Almajed MR, Nimri F, Taha A, Agha Y, Jesse M, Singla S, Piraka C, Zuchelli TE. Full-thickness resection device for management of lesions involving the appendiceal orifice: Systematic review and meta-analysis. Endosc Int Open 2023; 11:E899-E907. [PMID: 37810898 PMCID: PMC10558260 DOI: 10.1055/a-2131-4891] [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] [Received: 01/29/2023] [Accepted: 07/11/2023] [Indexed: 10/10/2023] Open
Abstract
Background and study aims Endoscopic resection of lesions involving the appendiceal orifice is technically challenging and is commonly referred for surgical resection. However, post-resection appendicitis is a concern. Many studies have varying rates of post-procedure appendicitis. We aim to report the rate of post-resection appendicitis by performing a systematic review and meta-analysis. Methods Studies that involved the use of a full-thickness resection device (FTRD) for management of appendiceal polyps were included. The primary outcome was appendicitis after FTRD and a subgroup analysis was performed on studies that only included FTRD performed at the appendiceal orifice. Results Appendicitis was encountered in 15% (95%CI: [11-21]) of the patients with 61% (95% CI: [44-76]) requiring surgical management. Pooled rates of technical success, histologic FTR, and histologic R0 resection in this sub-group (n=123) were 92% (95% CI: [85-96]), 98% (95% CI: [93-100]), and 72% (95% CI: [64-84%]), respectively. Post-resection histopathological evaluation revealed a mean resected specimen size of 16.8 ± 5.4 mm, with non-neoplastic pathology in 9 (7%), adenomas in 103 (84%), adenomas + high-grade dysplasia (HGD) in nine (7%), and adenocarcinoma in two (2%). The pooled rate for non-appendicitis-related surgical management (technical failure and/or high-risk lesions) was 11 % (CI: 7-17). Conclusions FTRD appears to be an effective method for managing appendiceal lesions. However, appendicitis post-resection occurs in a non-trivial number of patients and the R0 resection rate in appendiceal lesions is only 72%. Therefore, caution should be employed in the use of this technique, considering the relative risks of surgical intervention in each patient.
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Affiliation(s)
- Mark Obri
- Internal Medicine, Henry Ford Health System, Detroit, United States
| | | | - Patrick Brown
- Division of Gastroenterology, Henry Ford Health System, Detroit, United States
| | | | - Faisal Nimri
- Division of Gastroenterology, Henry Ford Health System, Detroit, United States
| | - Ashraf Taha
- Division of Gastroenterology, Henry Ford Health System, Detroit, United States
| | - Yasmine Agha
- Division of Gastroenterology, Henry Ford Health System, Detroit, United States
| | - Michelle Jesse
- Internal Medicine, Henry Ford Health System, Detroit, United States
| | - Sumit Singla
- Gastroenterology and Hepatology, Henry Ford Hospital, Detroit, United States
| | - Cyrus Piraka
- Gastroenterology and Hepatology, Henry Ford Hospital, Detroit, United States
| | - Tobias E. Zuchelli
- Gastroenterology and Hepatology, Henry Ford Hospital, Detroit, United States
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6
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Obri MS, Youssef RM, Alluri S, Vemulapalli K, Ichkhanian Y, Todter EN, Jesse MT, Salgia R. Disparities in Referrals to End-of-Life Care in Eligible Hepatocellular Carcinoma Patients. Dig Dis Sci 2023:10.1007/s10620-023-07992-4. [PMID: 37289417 DOI: 10.1007/s10620-023-07992-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 05/30/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Hepatocellular Carcinoma (HCC) is a malignancy with increasing incidence and morbidity. For patients with a poor prognosis, engagement with advanced care planning and end-of life (EOL) services (I.e., palliative care, hospice) can address physical, financial, and social complications of a terminal diagnosis. Minimal data exist on the demographics of the patients being referred to and enrolling in EOL services for HCC. AIMS We aim to report the relationship between demographics and EOL service referral. METHODS Retrospective review of a prospectively maintained high-volume liver center registry of patients diagnosed with HCC from 2004 to 2022. EOL services eligible patients were defined as BCLC stage C or D, evidence of metastases, and/or transplant ineligible. RESULTS Black patients were more likely to be referred than white patients (OR 1.47 (1.03, 2.11)). Once referred, patients were significantly more likely to be enrolled if they had insurance coverage, though no other factors in models were significant. There were no significant differences in survival among those referred who did or did not enroll, after controlling for other factors. CONCLUSION Black patients were more likely to be referred compared to white patients and patients who were insured were more likely to be enrolled. Whether this is indicative of black patients being appropriately referred at a higher rate, being offered EOL care instead of aggressive treatment, or other unknown factors warrants further study.
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Affiliation(s)
- Mark S Obri
- Division of Internal Medicine, Henry Ford Health, 2799 West Grand Boulevard, Detroit, MI, 48202, USA.
| | - Rami M Youssef
- Division of Internal Medicine, Henry Ford Health, 2799 West Grand Boulevard, Detroit, MI, 48202, USA
| | - Spandana Alluri
- Division of Internal Medicine, Henry Ford Health, 2799 West Grand Boulevard, Detroit, MI, 48202, USA
| | - Krishna Vemulapalli
- Division of Internal Medicine, Henry Ford Health, 2799 West Grand Boulevard, Detroit, MI, 48202, USA
| | - Yervant Ichkhanian
- Division of Internal Medicine, Henry Ford Health, 2799 West Grand Boulevard, Detroit, MI, 48202, USA
| | - Erika N Todter
- Public Health Sciences, Henry Ford Health, Detroit, MI, USA
| | - Michelle T Jesse
- Division of Internal Medicine, Henry Ford Health, 2799 West Grand Boulevard, Detroit, MI, 48202, USA
- Transplant Institute, Henry Ford Health, Detroit, MI, USA
| | - Reena Salgia
- Division of Gastroenterology and Hepatology, Henry Ford Health, Detroit, USA
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7
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Ghandour B, Keane MG, Shinn B, Dawod QM, Fansa S, El Chafic AH, Irani SS, Pawa R, Gutta A, Ichkhanian Y, Paranandi B, Pawa S, Al-Haddad MA, Zuchelli T, Huggett MT, Sharaiha RZ, Kowalski TE, Khashab MA, Shrigiriwar A, Zhang L, Mony S, Khan A, Loren DE, Chiang A, Schlachterman A, Kumar A, Saab O, Blake B, Obri MS. Factors predictive of persistent fistulas in EUS-directed transgastric ERCP: a multicenter matched case-control study. Gastrointest Endosc 2023; 97:260-267. [PMID: 36228699 DOI: 10.1016/j.gie.2022.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 09/16/2022] [Accepted: 09/26/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND AIMS EUS-directed transgastric ERCP (EDGE) is an established method for managing pancreaticobiliary pathology in Roux-en-Y gastric bypass patients, with high rates of technical success and low rates of serious adverse events (AEs). However, widespread adoption of the technique has been limited because of concerns about the development of persistent gastrogastric or jejunogastric fistulas. Gastrogastric and jejunogastric fistulas have been reported in up to 20% of cases in some series, but predictive risk factors and long-term management and outcomes are lacking. Therefore, our aims were to assess factors associated with the development of persistent fistulas and the technical success of endoscopic fistula closure. METHODS This is a case-control study involving 9 centers (8 USA, 1 Europe) from February 2015 to September 2021. Cases of persistent fistulas were defined as endoscopic or imaging evidence of fistula more than 8 weeks after lumen-apposing metal stent (LAMS) removal. Control subjects were defined as endoscopic or imaging confirmation of no fistula more than 8 weeks after LAMS removal. AEs were defined and graded according to the American Society for Gastrointestinal Endoscopy lexicon. RESULTS Twenty-five patients identified to have evidence of a persistent fistula on follow-up surveillance (cases) were matched with 50 patients with no evidence of a persistent fistula on follow-up surveillance (control subjects) based on age and sex. Mean LAMS dwell time was 74.7 ± 106.2 days. After LAMS removal, argon plasma coagulation (APC) ablation of the fistula was performed in 46 patients (61.3%). Primary closure of the fistula was performed in 26.7% of patients (20: endoscopic suturing in 17, endoscopic tacking in 2, and over-the-scope clips + endoscopic suturing in 1). When comparing cases with control subjects, there was no difference in baseline demographics, fistula site, LAMS size, or primary closure frequency between the 2 groups (P > .05). However, in the persistent fistula group, the mean LAMS dwell time was significantly longer (127 vs 48 days, P = .02) and more patients had ≥5% total body weight gain (33.3% vs 10.3%, P = .03). LAMS dwell time was a significant predictor of persistent fistula (odds ratio, 4.5 after >40 days in situ, P = .01). The odds of developing a persistent fistula increased by 9.5% for every 7 days the LAMS was left in situ. In patients with a persistent fistula, endoscopic closure was attempted in 19 (76%) with successful resolution in 14 (73.7%). CONCLUSIONS Longer LAMS dwell time was found to be associated with a higher risk of persistent fistulas in EDGE patients. APC or primary closure of the fistula on LAMS removal was not found to be protective against developing a persistent fistula, which, if present, can be effectively managed through endoscopic closure in most cases.
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Affiliation(s)
- Bachir Ghandour
- Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Margaret G Keane
- Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Brianna Shinn
- Division of Gastroenterology and Hepatology, Thomas Jefferson Hospital, Philadelphia, Pennsylvania, USA
| | - Qais M Dawod
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, New York, USA
| | - Sima Fansa
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Abdul Hamid El Chafic
- Division of Gastroenterology and Hepatology, Ochsner Medical Center-New Orleans, New Orleans, Louisiana, USA
| | - Shayan S Irani
- Division of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Rishi Pawa
- Division of Gastroenterology and Hepatology, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Aditya Gutta
- Division of Gastroenterology and Hepatology, Indiana University Medical Center, Indianapolis, Indiana, USA
| | - Yervant Ichkhanian
- Division of Gastroenterology and Hepatology, Henry Ford Health System, Detroit, Michigan, USA
| | - Bharat Paranandi
- Division of Gastroenterology and Hepatology, Leeds Teaching Hospitals NHS Trust, Leeds, Leeds, UK
| | - Swati Pawa
- Division of Gastroenterology and Hepatology, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Mohammad A Al-Haddad
- Division of Gastroenterology and Hepatology, Indiana University Medical Center, Indianapolis, Indiana, USA
| | - Tobias Zuchelli
- Division of Gastroenterology and Hepatology, Henry Ford Health System, Detroit, Michigan, USA
| | - Matthew T Huggett
- Division of Gastroenterology and Hepatology, Leeds Teaching Hospitals NHS Trust, Leeds, Leeds, UK
| | - Reem Z Sharaiha
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, New York, USA
| | - Thomas E Kowalski
- Division of Gastroenterology and Hepatology, Thomas Jefferson Hospital, Philadelphia, Pennsylvania, USA
| | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, Baltimore, Maryland, USA
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Facciorusso A, Ramai D, Ichkhanian Y, Yadlapati R, Annese V, Wani S, Khashab MA. Peroral Endoscopic Myotomy for the Treatment of Esophageal Diverticula: A Systematic Review and Meta-analysis. J Clin Gastroenterol 2022; 56:853-862. [PMID: 34608024 PMCID: PMC8977395 DOI: 10.1097/mcg.0000000000001622] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 09/04/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND There is limited evidence on the efficacy of peroral endoscopic myotomy (POEM) in patients with esophageal diverticula. AIMS This meta-analysis aimed to assess the efficacy and safety profile of POEM in patients with Zenker (ZD) and epiphrenic diverticula. METHODS With a literature search through August 2020, we identified 12 studies (300 patients) assessing POEM in patients with esophageal diverticula. The primary outcome was treatment success. Results were expressed as pooled rates and 95% confidence intervals. RESULTS Pooled rate of technical success was 95.9% (93.4%-98.3%) in ZD patients and 95.1% (88.8%-100%) in patients with epiphrenic diverticula. Pooled rate of treatment success was similar for ZD (90.6%, 87.1%-94.1%) and epiphrenic diverticula (94.2%, 87.3%-100%). Rates of treatment success were maintained at 1 year (90%, 86.4%-97.4%) and 2 years (89.6%, 82.2%-96.9%) in ZD patients. Pooled rate of symptom recurrence was 2.6% (0.9%-4.4%) in ZD patients and 0% in patients with epiphrenic diverticula. Pooled rates of adverse events and severe adverse events were 10.6% (4.6%-16.6%) and 3.5% (0%-7.4%) in ZD and 8.4% (0%-16.8%) and 8.4% (0%-16.8%) in epiphrenic diverticula, respectively. CONCLUSION POEM represents an effective and safe therapy for the treatment of esophageal diverticula.
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Affiliation(s)
| | - Daryl Ramai
- Department of Medicine, The Brooklyn Hospital Center, Brooklyn, New York
| | - Yervant Ichkhanian
- Division of Gastroenterology and Hepatology, John Hopkins University Hospital, Baltimore
| | - Rena Yadlapati
- Division of Gastroenterology, University of California San Diego, La Jolla, California
| | - Vito Annese
- Valiant Clinic & American Hospital, Dubai, United Arab Emirates
| | - Sachin Wani
- University of Colorado Anschutz Medical Campus, Aurora, Colorado, U.S.A
| | - Mouen A. Khashab
- Division of Gastroenterology and Hepatology, John Hopkins University Hospital, Baltimore
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9
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Ichkhanian Y, Fahad H, Ghanimeh MA, Zuchelli T. EUS-guided jejuno-enterostomy in a patient with total gastrectomy with Roux-en-Y esophagojejunostomy to facilitate cholangioscopy with electrohydraulic lithotripsy. VideoGIE 2022; 8:30-34. [PMID: 36644248 PMCID: PMC9832221 DOI: 10.1016/j.vgie.2022.08.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Video 1EUS-guided jejuno-jejunostomy in a 67-year-old male patient with total gastrectomy with Roux-en-Y esophagojejunostomy to facilitate cholangioscopy with electrohydraulic lithotripsy.
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Affiliation(s)
| | - Hamna Fahad
- Division of Gastroenterology and Hepatology, Henry Ford Hospital, Detroit, Michigan
| | - Mouhanna Abu Ghanimeh
- Division of Gastroenterology and Hepatology, Stanford Health, Sioux Falls, South Dakota
| | - Tobias Zuchelli
- Division of Gastroenterology and Hepatology, Henry Ford Hospital, Detroit, Michigan
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10
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Ghandour B, Shinn B, Dawod QM, Fansa S, El Chafic AH, Irani SS, Pawa R, Gutta A, Ichkhanian Y, Paranandi B, Pawa S, Al-Haddad MA, Zuchelli T, Huggett MT, Bejjani M, Sharaiha RZ, Kowalski TE, Khashab MA. EUS-directed transgastric interventions in Roux-en-Y gastric bypass anatomy: a multicenter experience. Gastrointest Endosc 2022; 96:630-638. [PMID: 35623383 DOI: 10.1016/j.gie.2022.05.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [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: 03/09/2022] [Accepted: 05/14/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Placement of a lumen-apposing metal stent (LAMS) between the gastric pouch and the excluded stomach allows for EUS-guided transgastric interventions (EDGIs) in patients with Roux-en-Y gastric bypass (RYGB). Although EUS-guided transgastric ERCP (EDGE) outcomes have been reported, data are scant on other endoscopic interventions. We aimed to evaluate the outcomes and safety of EDGIs. METHODS This retrospective study involved 9 centers (United States, 8; Europe, 1) and included patients with RYGB who underwent EDGIs between June 2015 and September 2021. The primary outcome was the technical success of EDGIs. Secondary outcomes were adverse events (AEs), length of hospital stay, and fistula follow-up and management. RESULTS Fifty-four EDGI procedures were performed in 47 patients (mean age, 61 years; 72% women), most commonly for the evaluation of a pancreatic mass (n = 16) and management of pancreatic fluid collections (n = 10). A 20-mm LAMS was used in 26 patients and a 15-mm LAMS in 21, creating a gastrogastrostomy in 37 patients and jejunogastrostomy in 10. Most patients (n = 30, 64%) underwent a dual-session EDGI, with a median interval of 17 days between the 2 procedures. Single-session EDGI was performed in 17 patients, of whom 10 (59%) had anchoring of the LAMS. The most common interventions were diagnostic EUS (with or without FNA or fine-needle biopsy sampling; n = 28) and EUS-guided cystgastrostomy (n = 8). The mean procedural time was 97.6 ± 78.9 minutes. Technical success was achieved in 52 patients (96%). AEs occurred in 5 patients (10.6%), of which only 1 AE (2.1%) was graded as severe. Intraprocedural LAMS migration was the most common AE, occurring in 3 patients (6.4%), whereas delayed spontaneous LAMS migration occurred in 2 (4.3%). Four of the 5 LAMS migration events were managed endoscopically, and 1 required surgical repair. LAMS anchoring was found to be protective against LAMS migration (P = .001). The median duration of hospital stay was 2.1 ± 3.7 days. Of the 17 patients who underwent objective fistula assessment endoscopically or radiologically after LAMS removal, 2 (11.7%) were found to have persistent fistulas. In 1 case the fistula was intentionally left open to assist with weight gain. The other fistula was successfully closed endoscopically. CONCLUSIONS EDGI is effective and safe for the diagnosis and management of pancreaticobiliary and foregut disorders in RYGB patients. It is associated with high rates of technical success and low rates of severe AEs. LAMS migration is the most common AE with evidence that anchoring can be protective against its occurrence. Persistent fistulas may occur, but endoscopic closure seems to be effective.
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Affiliation(s)
- Bachir Ghandour
- Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Brianna Shinn
- Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Qais M Dawod
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, New York, USA
| | - Sima Fansa
- Department of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Abdul Hamid El Chafic
- Division of Gastroenterology and Hepatology, Ochsner Medical Center-New Orleans, New Orleans, Louisiana, USA
| | - Shayan S Irani
- Division of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Rishi Pawa
- Division of Gastroenterology and Hepatology, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Aditya Gutta
- Division of Gastroenterology and Hepatology, Indiana University Medical Center, Indianapolis, Indiana, USA
| | - Yervant Ichkhanian
- Division of Gastroenterology and Hepatology, Henry Ford Health System, Detroit, Michigan, USA
| | - Bharat Paranandi
- Division of Gastroenterology and Hepatology, Leeds Teaching Hospitals NHS Trust, Leeds, Leeds, UK
| | - Swati Pawa
- Division of Gastroenterology and Hepatology, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Mohammad A Al-Haddad
- Division of Gastroenterology and Hepatology, Indiana University Medical Center, Indianapolis, Indiana, USA
| | - Tobias Zuchelli
- Division of Gastroenterology and Hepatology, Henry Ford Health System, Detroit, Michigan, USA
| | - Matthew T Huggett
- Division of Gastroenterology and Hepatology, Leeds Teaching Hospitals NHS Trust, Leeds, Leeds, UK
| | - Michael Bejjani
- Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Reem Z Sharaiha
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, New York, USA
| | - Thomas E Kowalski
- Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, Baltimore, Maryland, USA
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11
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Ichkhanian Y, Brewer Gutierrez O, Roman S, Yoo IK, Canakis A, Pawa R, Koch K, Su B, Ujiki M, Alsheik E, Zuchelli T, Piraka C, Ghandour B, Zhang L, Sloan JA, Khashab MA. Role of functional luminal imaging probe in the management of postmyotomy clinical failure. Gastrointest Endosc 2022; 96:9-17.e3. [PMID: 35149045 DOI: 10.1016/j.gie.2022.02.002] [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: 10/22/2021] [Accepted: 02/01/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS A small percentage of patients with esophageal dysmotility disorders (EDDs) fail to improve or relapse after management by laparoscopic Heller myotomy (LHM) and peroral endoscopic myotomy (POEM). In this study, we aimed to describe the role of functional luminal imaging probe (FLIP) in identifying patients who might benefit from lower esophageal sphincter (LES)-directed retreatment. METHODS This was a retrospective study at 6 tertiary care centers (United States, 4; Europe, 1; Asia, 1) between January 2015 and April 2021 involving patients with prior failed myotomy. The primary outcome was the impact of the use of FLIP on the management of patients with prior failed myotomy. RESULTS One hundred twenty-three patients (62 women [50%]; mean age, 53 ± 21.1 years) who underwent LHM (n = 53, 43%) or POEM (n = 70, 57%) for the management of achalasia (n = 98) or other EDDs (n = 25) had clinical failure at a median time of 10.8 months (interquartile range, .8-17.3) postprocedure. Twenty-nine patients had apposing "abnormal" diagnoses in terms of integrated relaxation pressure (IRP) >15 mm Hg on HRM and distensibility index (DI) <2.8 mm2/mm Hg on FLIP, with ultimate change in management noted in 15 patients (10 directed toward conservative management, 5 directed toward LES-directed retreatment). The impact of FLIP on both diagnosis and management was noted in 15 of 29 patients (52%). In the subgroup analysis of 44 patients who underwent LES-directed retreatment, clinical success was highest among patients with both abnormal IRP and DI (21/25 [84%]) versus patients with only abnormal IRP (8/14 [57%]) or only abnormal DI (3/5 [60%], P = .04), with DI at 40-mL distension volume on FLIP identified as an independent predictor of clinical success (odd ratio, 1.51; 95% confidence interval, 1.02-2.1; P = .03). CONCLUSIONS The finding of this study further suggests the important role of using FLIP in addition to HRM in evaluating patients with clinical failure postmyotomy.
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Affiliation(s)
- Yervant Ichkhanian
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA; Department of Medicine, Henry Ford Hospital, Detroit, Michigan, USA
| | - Olaya Brewer Gutierrez
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA
| | - Sabine Roman
- Department of Gastroenterology, Edouard Herriot Hospital, Hospices Civils de Lyon and Lyon University, Lyon, France
| | - In Kyung Yoo
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Andrew Canakis
- Division of Gastroenterology & Hepatology, University of Maryland Medical Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Rishi Pawa
- Division of Gastroenterology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Kenneth Koch
- Division of Gastroenterology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Bailey Su
- Department of Surgery, NorthShore University Health System, Evanston, Illinois, USA
| | - Michael Ujiki
- Department of Surgery, NorthShore University Health System, Evanston, Illinois, USA
| | - Eva Alsheik
- Division of Gastroenterology and Hepatology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Tobias Zuchelli
- Division of Gastroenterology and Hepatology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Cyrus Piraka
- Division of Gastroenterology and Hepatology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Bachir Ghandour
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA
| | - Linda Zhang
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA
| | - Joshua A Sloan
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA; Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA
| | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA
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12
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Mony S, Ghandour B, Raijman I, Manvar A, Ho S, Trindade AJ, Benias PC, Zulli C, Jacques J, Ichkhanian Y, Zuchelli T, Ghanimeh MA, Irani S, Canakis A, Sanaei O, Szvarca D, Zhang L, Bejjani M, Akshintala V, Khashab MA. An international experience with single-operator cholangiopancreatoscopy in patients with altered anatomy. Endosc Int Open 2022; 10:E898-E904. [PMID: 35692911 PMCID: PMC9187392 DOI: 10.1055/a-1794-0331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background and study aims The utility of digital single- operator cholangiopancreatoscopy (D-SOCP) in surgically altered anatomy (SAA) is limited. We aimed to evaluate the technical success and safety of D-SOCP in patients SAA. Patients and methods Patients with SAA who underwent D-SOCP between February 2015 and June 2020 were retrospectively evaluated. Technical success was defined as completing the intended procedure with the use of D-SOCP. Results Thirty-five patients underwent D-SOCP (34 D-SOC, 1 D-SOP). Bilroth II was the most common type of SAA (45.7 %), followed by Whipple reconstruction (31.4 %). Twenty-three patients (65.7 %) patients had prior failed ERCP due to the presence of complex biliary stone (52.2 %). A therapeutic duodenoscope was utilized in the majority of the cases (68.6 %), while a therapeutic gastroscope (22.7 %) or adult colonoscope (8.5 %) were used in the remaining procedures. Choledocholithiasis (61.2 %) and pancreatic duct calculi (3.2 %) were the most common indications for D-SOCP. Technical success was achieved in all 35 patients (100 %) and majority (91.4 %) requiring a single session. Complex interventions included electrohydraulic or laser lithotripsy, biliary or pancreatic stent placement, stricture dilation, and target tissue biopsies. Two mild adverse events occurred (pancreatitis and transient bacteremia). Conclusions In SAA, D-SOCP is a safe and effective modality to diagnose and treat complex pancreatobiliary disorders, especially in cases where standard ERCP attempts may fail.
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Affiliation(s)
- Shruti Mony
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Bachir Ghandour
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Isaac Raijman
- Greater Houston Gastroenterology, Houston, Texas, United States
| | - Amar Manvar
- Division of Gastroenterology and Hepatology, Montefiore Medical Center, New York City, New York, United States
| | - Sammy Ho
- Division of Gastroenterology and Hepatology, Montefiore Medical Center, New York City, New York, United States
| | - Arvind J. Trindade
- Division of Gastroenterology and Hepatology, Hofstra-Northwell School of Medicine, Manhasset, New York, United States
| | - Petros C. Benias
- Division of Gastroenterology and Hepatology, Hofstra-Northwell School of Medicine, Manhasset, New York, United States
| | - Claudio Zulli
- Division of Gastroenterology and Hepatology, Hospital of Salerno, G. Fucito Center, Mercato San Severino, Italy
| | - Jérémie Jacques
- Department of Endoscopy and Gastroenterology, Limoges Dupuytren Hospital, Lyon, France
| | - Yervant Ichkhanian
- Division of Gastroenterology, Henry Ford Hospital, Detroit, Michigan, United States
| | - Tobias Zuchelli
- Division of Gastroenterology, Henry Ford Hospital, Detroit, Michigan, United States
| | | | - Shayan Irani
- Digestive Disease Institute at Virginia Mason Medical Center, Seattle, Washington, United States
| | - Andrew Canakis
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, United States
| | - Omid Sanaei
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Daniel Szvarca
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Linda Zhang
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Michael Bejjani
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Venkata Akshintala
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Mouen A. Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
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13
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Ichkhanian Y, Hwang JH, Ofosu A, Li AA, Szvarca D, Draganov PV, Yang D, Alsheik E, Zuchelli T, Piraka C, Mony S, Khashab MA. Role of gastric per-oral endoscopic myotomy (G-POEM) in post-lung transplant patients: a multicenter experience. Endosc Int Open 2022; 10:E832-E839. [PMID: 35692909 PMCID: PMC9187381 DOI: 10.1055/a-1797-9587] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 11/25/2021] [Accepted: 02/17/2022] [Indexed: 11/17/2022] Open
Abstract
Background and study aims Gastroparesis post-lung transplant (LTx) can lead to increased risk of gastroesophageal reflux (GER) and accelerated graft dysfunction. We aimed to evaluate the efficacy and safety of gastric per-oral endoscopic myotomy (G-POEM), a promising tool in patients with refractory gastroparesis, for managing refractory gastroparesis and GER in post-LTx patients. Patents and methods This was a multicenter retrospective study on post-LTx patients who underwent G-POEM for management of gastroparesis and GER that were refractory to standard medical therapy. The primary outcome was clinical success post-G-POEM. Secondary outcomes included the rate of post-G-POEM objective esophageal pH exam normalization, rate of gastric emptying scintigraphy (GES) normalization, technical success, and adverse events. Results A total of 20 patients (mean age 54.7 ± 14.1 years, Female 50 %) underwent G-POEM at a median time of 13 months (interquartile range 6.5-13.5) post-LTx. All G-POEM procedures were technically successful. Clinical success was achieved in 17 (85 %) patients during a median follow-up time of 8.9 (IQR: 3-17) months post-G-POEM. Overall GCSI and two of its subscales (bloating and postprandial fullness/early satiety) improved significantly following G-POEM. Two patients (10 %) developed post-procedural AEs (delayed bleeding 1, pyloric stenosis 1, both moderate in severity). Post-G-POEM GES improvement was achieved in 12 of 16 patients (75 %). All 20 patients were on proton pump inhibitors pre-G-POEM, as opposed to five post-G-POEM. Post-G-POEM PH study normalization was noted in nine of 10 patients (90 %) who underwent both pre- and post-G-poem pH testing. Conclusions G-POEM is a promising noninvasive therapeutic tool for management of refractory gastroparesis and GER post-LTx.
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Affiliation(s)
- Yervant Ichkhanian
- Henry Ford Health System, Department of Internal Medicine, Detroit, Michigan, United States
| | - Joo Ha Hwang
- Divisions of Gastroenterology and Hepatology, Stanford University, School of Medicine, Stanford, California, United States
| | - Andrew Ofosu
- Divisions of Gastroenterology and Hepatology, Stanford University, School of Medicine, Stanford, California, United States
| | - Andrew A Li
- Divisions of Gastroenterology and Hepatology, Stanford University, School of Medicine, Stanford, California, United States
| | - Daniel Szvarca
- Johns Hopkins Hospital, Department of Internal Medicine, Baltimore, Maryland, United States
| | - Peter V. Draganov
- Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida, United States
| | - Dennis Yang
- Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida, United States
| | - Eva Alsheik
- Henry Ford Health System, Division of Gastroenterology and Hepatology, Michigan, United States
| | - Tobias Zuchelli
- Henry Ford Health System, Division of Gastroenterology and Hepatology, Michigan, United States
| | - Cyrus Piraka
- Henry Ford Health System, Division of Gastroenterology and Hepatology, Michigan, United States
| | - Shruti Mony
- Johns Hopkins Hospital, Division of Gastroenterology and Hepatology, Baltimore, Maryland, United States
| | - Mouen A. Khashab
- Johns Hopkins Hospital, Division of Gastroenterology and Hepatology, Baltimore, Maryland, United States
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14
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Al Ghamdi SS, Farha J, Moran RA, Pioche M, Moll F, Yang DJ, Hernández Mondragón OV, Ujiki M, Wong H, Tantau A, Sedarat A, Fejleh MP, Chang K, Lee DP, Nieto JM, Andrawes S, Ginsberg GG, Saumoy M, Bapaye A, Dashatwar P, Aghaie Meybodi M, Lopez AC, Sanaei O, Yousaf MN, Jovani M, Ichkhanian Y, Brewer Gutierrez OI, Kumbhari V, O'Rourke AK, Lentsch EJ, Elmunzer BJ, Khashab MA. Zenker's peroral endoscopic myotomy, or flexible or rigid septotomy for Zenker's diverticulum: a multicenter retrospective comparison. Endoscopy 2022; 54:345-351. [PMID: 34198355 DOI: 10.1055/a-1518-7223] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [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] [Indexed: 12/13/2022]
Abstract
BACKGROUND Treatment of Zenker's diverticulum has evolved from open surgery to endoscopic techniques, including flexible and rigid endoscopic septotomy, and more recently, peroral endoscopic myotomy (Z-POEM). This study compared the effectiveness of flexible and rigid endoscopic septotomy with that of Z-POEM. METHODS Consecutive patients who underwent endoscopic septotomy (flexible/rigid) or Z-POEM for Zenker's diverticulum between 1/2016 and 9/2019 were included. Primary outcomes were clinical success (decrease in Dakkak and Bennett dysphagia score to ≤ 1), clinical failure, and clinical recurrence. Secondary outcomes included technical success and rate/severity of adverse events. RESULTS 245 patients (110 females, mean age 72.63 years, standard deviation [SD] 12.37 years) from 12 centers were included. Z-POEM was the most common management modality (n = 119), followed by flexible (n = 86) and rigid (n = 40) endoscopic septotomy. Clinical success was 92.7 % for Z-POEM, 89.2 % for rigid septotomy, and 86.7 % for flexible septotomy (P = 0.26). Symptoms recurred in 24 patients (15 Z-POEM during a mean follow-up of 282.04 [SD 300.48] days, 6 flexible, 3 rigid [P = 0.47]). Adverse events occurred in 30.0 % rigid septotomy patients, 16.8 % Z-POEM patients, and 2.3 % flexible septotomy patients (P < 0.05). CONCLUSIONS There was no difference in outcomes between the three treatment approaches for symptomatic Zenker's diverticulum. Rigid endoscopic septotomy was associated with the highest rate of complications, while flexible endoscopic septotomy appeared to be the safest. Recurrence following Z-POEM was similar to flexible and rigid endoscopic septotomy. Prospective studies with long-term follow-up are required.
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Affiliation(s)
- Sarah S Al Ghamdi
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Jad Farha
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Robert A Moran
- Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina, United States
| | - Mathieu Pioche
- Gastroenterology, Edouard Herriot Hospital, Lyon, France
| | - Frédéric Moll
- Gastroenterology, Edouard Herriot Hospital, Lyon, France
| | - Dennis J Yang
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, United States
| | | | - Michael Ujiki
- Division of Minimally Invasive Surgery, NorthShore's Grainger Center for Simulation and Innovation, Evanston, Illinois, United States
| | - Harry Wong
- Division of Minimally Invasive Surgery, NorthShore's Grainger Center for Simulation and Innovation, Evanston, Illinois, United States
| | - Alina Tantau
- Department of Gastroenterology, the 4th Medical Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Alireza Sedarat
- Ronald Reagan UCLA Medical Center, UCLA Medical Center, Los Angeles, California, United States
| | - M Phillip Fejleh
- Ronald Reagan UCLA Medical Center, UCLA Medical Center, Los Angeles, California, United States
| | - Kenneth Chang
- H.H. Chao Comprehensive Digestive Disease Center, University of California, Irvine Medical Center, Irvine, California, United States
| | - David P Lee
- H.H. Chao Comprehensive Digestive Disease Center, University of California, Irvine Medical Center, Irvine, California, United States
| | - Jose M Nieto
- Borland Groover Clinic Advance Therapeutic Endoscopy Center and Baptist Medical Center, Jacksonville, Florida, United States
| | - Sherif Andrawes
- Division of Gastroenterology and Hepatology, Staten Island University Hospital - Northwell Health, Staten Island, New York, United States
| | - Gregory G Ginsberg
- Endoscopic Services, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, United States
| | - Monica Saumoy
- Endoscopic Services, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, United States
| | - Amol Bapaye
- Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Pune, India
| | - Parag Dashatwar
- Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Pune, India
| | - Mohamad Aghaie Meybodi
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Ariana C Lopez
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Omid Sanaei
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | | | - Manol Jovani
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Yervant Ichkhanian
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Olaya I Brewer Gutierrez
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Vivek Kumbhari
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Ashli K O'Rourke
- Department of Otolaryngology, Medical University of South Carolina, Charleston, South Carolina, United States
| | - Eric J Lentsch
- Department of Otolaryngology, Medical University of South Carolina, Charleston, South Carolina, United States
| | - B Joseph Elmunzer
- Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina, United States
| | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
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15
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Vosoughi K, Ichkhanian Y, Benias P, Miller L, Aadam AA, Triggs JR, Law R, Hasler W, Bowers N, Chaves D, Ponte-Neto AM, Draganov P, Yang D, El Halabi M, Sanaei O, Brewer Gutierrez OI, Bulat RS, Pandolfino J, Khashab M. Gastric per-oral endoscopic myotomy (G-POEM) for refractory gastroparesis: results from an international prospective trial. Gut 2022; 71:25-33. [PMID: 33741641 DOI: 10.1136/gutjnl-2020-322756] [Citation(s) in RCA: 56] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 03/03/2021] [Accepted: 03/08/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Although gastric per-oral endoscopic myotomy (G-POEM) is considered a promising technique for the management of refractory gastroparesis, high-quality evidence is limited. We prospectively investigated the efficacy and safety of G-POEM in unselected patients with refractory gastroparesis. DESIGN In five tertiary centres, patients with symptomatic gastroparesis refractory to standard medical therapy and confirmed by impaired gastric emptying were included. The primary endpoint was clinical success, defined as at least one score decrease in Gastroparesis Cardinal Symptom Index (GCSI) with ≥25% decrease in two subscales, at 12 months. GCSI Score and subscales, adverse events (AEs) and 36-Item Short Form questionnaire of quality of life were evaluated at baseline and 1, 3, 6 and 12 months after G-POEM. Gastric emptying study was performed before and 3 months after the procedure. RESULTS Of 80 enrolled patients, 75 patients (94%) completed 12-month follow-up. Clinical success at 12 months was 56% (95% CI, 44.8 to 66.7). GCSI Score (including subscales) improved moderately after G-POEM (p<0.05). In a regression model, a baseline GCSI Score >2.6 (OR=3.23, p=0.04) and baseline gastric retention >20% at 4 hours (OR=3.65, p=0.03) were independent predictors of clinical success at 12 months, as was early response to G-POEM at 1 month after therapy (OR 8.75, p<0.001). Mild procedure-related AEs occurred in 5 (6%) patients. CONCLUSION G-POEM is a safe procedure, but showed only modest overall effectiveness in the treatment of refractory gastroparesis. Further studies are required to identify the best candidates for G-POEM; unselective use of this procedure should be discouraged. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry NCT02732821.
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Affiliation(s)
- Kia Vosoughi
- Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Yervant Ichkhanian
- Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, Baltimore, Maryland, USA.,Department of Medicine, Henry Ford Health System, Detroit, Michigan, USA
| | - Petros Benias
- Division of Gastroenterology and Hepatology, Northwell Health, New Hyde Park, New York, USA
| | - Larry Miller
- Division of Gastroenterology and Hepatology, Northwell Health, New Hyde Park, New York, USA
| | - A Aziz Aadam
- Division of Gastroenterology and Hepatology, Northwestern Medicine, Chicago, Illinois, USA
| | - Joseph R Triggs
- Division of Gastroenterology and Hepatology, Northwestern Medicine, Chicago, Illinois, USA
| | - Ryan Law
- Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, Michigan, USA
| | - William Hasler
- Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Nicole Bowers
- Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Dalton Chaves
- Division of Gastroenterology and Hepatology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Alberto M Ponte-Neto
- Division of Gastroenterology and Hepatology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Peter Draganov
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida Health, Gainesville, Florida, USA
| | - Dennis Yang
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida Health, Gainesville, Florida, USA
| | - Maan El Halabi
- Department of Medicine, Mount Sinai Saint Luke's Hospital, New York, New York, USA
| | - Omid Sanaei
- Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, Baltimore, Maryland, USA.,Medicine, MedStar Union Memorial Hospital, Baltimore, Maryland, USA
| | | | - Robert Stephen Bulat
- Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - John Pandolfino
- Division of Gastroenterology and Hepatology, Northwestern Medicine, Chicago, Illinois, USA
| | - Mouen Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, Baltimore, Maryland, USA
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16
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Ichkhanian Y, Barawi M, Seoud T, Thakkar S, Kothari TH, Halabi ME, Ullah A, Edris W, Aepli P, Kowalski T, Shinn B, Shariaha RZ, Mahadev S, Mosko JD, Andrisani G, Di Matteo FM, Albrecht H, Giap AQ, Tang SJ, Naga YM, van Geenen E, Friedland S, Tharian B, Irani S, Ross AS, Jamil LH, Lew D, Nett AS, Farha J, Runge TM, Jovani M, Khashab MA. Endoscopic full-thickness resection of polyps involving the appendiceal orifice: a multicenter international experience. Endoscopy 2022; 54:16-24. [PMID: 33395714 DOI: 10.1055/a-1345-0044] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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] [Indexed: 12/15/2022]
Abstract
BACKGROUND Endoscopic resection of lesions involving the appendiceal orifice remains a challenge. We aimed to report outcomes with the full-thickness resection device (FTRD) for the resection of appendiceal lesions and identify factors associated with the occurrence of appendicitis. METHODS This was a retrospective study at 18 tertiary-care centers (USA 12, Canada 1, Europe 5) between November 2016 and August 2020. Consecutive patients who underwent resection of an appendiceal orifice lesion using the FTRD were included. The primary outcome was the rate of R0 resection in neoplastic lesions, defined as negative lateral and deep margins on post-resection histologic evaluation. Secondary outcomes included the rates of: technical success (en bloc resection), clinical success (technical success without need for further surgical intervention), post-resection appendicitis, and polyp recurrence. RESULTS 66 patients (32 women; mean age 64) underwent resection of colonic lesions involving the appendiceal orifice (mean [standard deviation] size, 14.5 (6.2) mm), with 40 (61 %) being deep, extending into the appendiceal lumen. Technical success was achieved in 59/66 patients (89 %), of which, 56 were found to be neoplastic lesions on post-resection pathology. Clinical success was achieved in 53/66 (80 %). R0 resection was achieved in 52/56 (93 %). Of the 58 patients in whom EFTR was completed who had no prior history of appendectomy, appendicitis was reported in 10 (17 %), with six (60 %) requiring surgical appendectomy. Follow-up colonoscopy was completed in 41 patients, with evidence of recurrence in five (12 %). CONCLUSIONS The FTRD is a promising non-surgical alternative for resecting appendiceal lesions, but appendicitis occurs in 1/6 cases.
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Affiliation(s)
- Yervant Ichkhanian
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA.,Department of Medicine, Henry Ford Hospital, Detroit, Michigan, USA
| | - Mohammed Barawi
- Division of Gastroenterology and Hepatology, Ascension St. John Hospital, Detroit, Michigan, USA
| | - Talal Seoud
- Center for Advanced Endoscopy, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Shyam Thakkar
- Center for Advanced Endoscopy, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Truptesh H Kothari
- Division of Gastroenterology and Hepatology, University of Rochester Medical Center, Rochester, New York, USA
| | - Maan El Halabi
- Department of Internal Medicine, Mount Sinai West, New York, New York, USA
| | - Asad Ullah
- Department of Gastroenterology, Gastrointestinal Oncology and Interventional Endoscopy, Sana Klinikum, Offenbach, Germany
| | - Wedi Edris
- Department of Gastroenterology, Gastrointestinal Oncology and Interventional Endoscopy, Sana Klinikum, Offenbach, Germany
| | - Patrick Aepli
- Department of Gastroenterology and Hepatology, Luzerner Kantonsspital, Luzerne, Switzerland
| | - Thomas Kowalski
- Division of Gastroenterology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Brianna Shinn
- Division of Gastroenterology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Reem Z Shariaha
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine/New York, Presbyterian Hospital, New York, New York, USA
| | - Srihari Mahadev
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine/New York, Presbyterian Hospital, New York, New York, USA
| | - Jeffrey D Mosko
- The Center for Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Gianluca Andrisani
- Digestive Endoscopy Unit, Campus Bio-Medico, University of Rome, Rome, Italy
| | | | - Heinz Albrecht
- Department of Medicine, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Andrew Q Giap
- Department of Gastroenterology, Kaiser Permanente, Anaheim, California, USA
| | - Shou-Jiang Tang
- Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Yehia M Naga
- Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | | | - Shai Friedland
- Division of Gastroenterology, Department of Medicine, Stanford University, Stanford, California, USA
| | - Benjamin Tharian
- Department of Gastroenterology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Shayan Irani
- Division of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Andrew S Ross
- Division of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Laith H Jamil
- Section of Gastroenterology and Hepatology, Beaumont Health-Royal Oak, Royal Oak, Michigan, USA.,Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
| | - Daniel Lew
- Pancreatic and Biliary Diseases Program, Cedars-Sinai Medical Center, West Hollywood, California, USA
| | - Andrew S Nett
- Division of Gastroenterology, Sutter Health, Sacramento, California, USA
| | - Jad Farha
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA
| | - Thomas M Runge
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA.,Division of Gastroenterology and Hepatology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Manol Jovani
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA
| | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA
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17
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AbiMansour JP, Ichkhanian Y, Minami H, Familiari P, Landi R, Costamagna G, Seewald S, Callahan ZM, Ujiki MB, Pioche M, Ponchon T, Roman S, Cho JY, Yoo IK, Sippey M, Marks JM, Eleftheriadis N, Khumbari V, Gutierrez OIB, Khashab MA. Durability of per-oral endoscopic myotomy beyond 6 years. Endosc Int Open 2021; 9:E1595-E1601. [PMID: 34790520 PMCID: PMC8589554 DOI: 10.1055/a-1553-9846] [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: 08/03/2020] [Accepted: 04/26/2021] [Indexed: 12/02/2022] Open
Abstract
Background and study aims The aim of this study was to assess long-term clinical outcomes beyond 6 years in patients who underwent per-oral endoscopic myotomy (POEM) for the treatment of achalasia. Patients and methods Patients with achalasia who underwent POEM between 2010 and 2012 and had follow-up of at least 6 years were retrospectively identified at eight tertiary care centers. The primary outcome evaluated was clinical success defined by an Eckardt symptom score (ESS) ≤ 3 for the duration of the follow-up period. The clinical success cohort was compared to failure (ESS > 3 at any time during follow-up) in order to identify characteristics associated with symptom relapse. The incidence of patient-reported gastroesophageal reflux (GER) was also evaluated. Results Seventy-three patients with 6-year follow-up data were identified. Sustained clinical remission was noted in 89 % (65/73) at 6-years. Mean ESS decreased from 7.1 ± 2.3 pre-procedure to 1.1 ± 1.1 at 6 years ( P < 0.001). Symptomatic reflux was reported by 27 of 72 patients (37.5 %). Type I achalasia (OR 10.8, P = 0.04) was found to be associated with clinical failure on logistic regression analysis. Conclusions In patients with achalasia, POEM provides high initial clinical success with excellent long-term outcomes. There are high rates of patient-reported gastroesophageal reflux post-procedure which persist at long-term follow-up.
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Affiliation(s)
- Jad P. AbiMansour
- Division of Gastroenterology and Hepatology Johns Hopkins Hospital, Baltimore, USA
| | - Yervant Ichkhanian
- Division of Gastroenterology and Hepatology Johns Hopkins Hospital, Baltimore, USA
| | - Hitomi Minami
- Department of Gastroenterology and Hepatology Nagasaki University Hospital Nagasaki, Japan
| | - Pietro Familiari
- Digestive Endoscopy Unit Fondazione Policlinico Universitario Agostino Gemelli IRCCS Rome, Italy
| | - Rosario Landi
- Digestive Endoscopy Unit Fondazione Policlinico Universitario Agostino Gemelli IRCCS Rome, Italy
| | - Guido Costamagna
- Digestive Endoscopy Unit Fondazione Policlinico Universitario Agostino Gemelli IRCCS Rome, Italy
| | - Stefan Seewald
- Center of Gastroenterology Hirslanden Private Clinic Group Zürich, Switzerland
| | | | - Michael B. Ujiki
- Department of Surgery NorthShore University HealthSystem Evanston, USA
| | - Mathieu Pioche
- Gastroenterology Unit/Unit of Functional Disease and Digestive Physiology Edouard Herriot Hospital Lyon, France
| | - Thierry Ponchon
- Gastroenterology Unit/Unit of Functional Disease and Digestive Physiology Edouard Herriot Hospital Lyon, France
| | - Sabine Roman
- Gastroenterology Unit/Unit of Functional Disease and Digestive Physiology Edouard Herriot Hospital Lyon, France
| | - Joo Young Cho
- Department of Gastroenterology, Cha Bundang Medical Center, Cha University College of Medicine, Seongnam-si, Korea
| | - In Kyung Yoo
- Department of Gastroenterology, Cha Bundang Medical Center, Cha University College of Medicine, Seongnam-si, Korea
| | - Megan Sippey
- Case Western/University Hospitals Cleveland Medical Center, Cleveland, USA
| | - Jeffrey M. Marks
- Case Western/University Hospitals Cleveland Medical Center, Cleveland, USA
| | | | - Vivek Khumbari
- Division of Gastroenterology and Hepatology Johns Hopkins Hospital, Baltimore, USA
| | | | - Mouen A. Khashab
- Division of Gastroenterology and Hepatology Johns Hopkins Hospital, Baltimore, USA
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18
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Ichkhanian Y, Zuchelli T, Watson A, Piraka C. Evolving management of colorectal polyps. Ther Adv Gastrointest Endosc 2021; 14:26317745211047010. [PMID: 34604745 PMCID: PMC8485258 DOI: 10.1177/26317745211047010] [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] [Received: 05/01/2021] [Accepted: 08/31/2021] [Indexed: 11/16/2022] Open
Abstract
Advances in endoscopic technology have led to increased success in colorectal cancer (CRC) screening and polyp management, with reduction of CRC incidence and mortality. Despite these advances, CRC is still one of the leading causes of cancer deaths, and half of all CRC develops from lesions that were missed during colonoscopy while one-fifth of CRC arise from prior incomplete resection. Techniques to improve polyp detection are needed, along with optimization of complete resection of any abnormal lesions that are found. This article will review the currently available endoscopic resection techniques and will discuss where they fit in the management of polyps of different sizes and types, such as pedunculated versus nonpedunculated, and those with or without suspected invasion.
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Affiliation(s)
| | - Tobias Zuchelli
- Division of Gastroenterology and Hepatology, Henry Ford Hospital, Detroit, MI, USA
| | - Andrew Watson
- Division of Gastroenterology and Hepatology, Henry Ford Hospital, Detroit, MI, USA
| | - Cyrus Piraka
- Section Chief-Advanced Therapeutic Endoscopy, Division of Gastroenterology and Hepatology, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI 48202, USA
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19
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Ichkhanian Y, Assis D, Familiari P, Ujiki M, Su B, Khan SR, Pioche M, Draganov PV, Cho JY, Eleftheriadis N, Barret M, Haji A, Velanovich V, Tantau M, Marks JM, Bapaye A, Sedarat A, Albeniz E, Bechara R, Kumta NA, Costamagna G, Perbtani YB, Patel M, Sippey M, Korrapati SK, Jain R, Estremera F, El Zein MH, Brewer Gutierrez OI, Khashab MA. Management of patients after failed peroral endoscopic myotomy: a multicenter study. Endoscopy 2021; 53:1003-1010. [PMID: 33197943 DOI: 10.1055/a-1312-0496] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Although peroral endoscopic myotomy (POEM) is highly effective for the management of achalasia, clinical failures may occur. The optimal management of patients who fail POEM is not well known. This study aimed to compare the outcomes of different management strategies in patients who had failed POEM. METHODS This was an international multicenter retrospective study at 16 tertiary centers between January 2012 and November 2019. All patients who underwent POEM and experienced persistent or recurrent symptoms (Eckardt score > 3) were included. The primary outcome was to compare the rates of clinical success (Eckardt score ≤ 3) between different management strategies. RESULTS : 99 patients (50 men [50.5 %]; mean age 51.4 [standard deviation (SD) 16.2]) experienced clinical failure during the study period, with a mean (SD) Eckardt score of 5.4 (0.3). A total of 29 patients (32.2 %) were managed conservatively and 70 (71 %) underwent retreatment (repeat POEM 33 [33 %], pneumatic dilation 30 [30 %], and laparoscopic Heller myotomy (LHM) 7 [7.1 %]). During a median follow-up of 10 (interquartile range 3 - 20) months, clinical success was highest in patients who underwent repeat POEM (25 /33 [76 %]; mean [SD] Eckardt score 2.1 [2.1]), followed by pneumatic dilation (18/30 [60 %]; Eckardt score 2.8 [2.3]), and LHM (2/7 [29 %]; Eckardt score 4 [1.8]; P = 0.12). A total of 11 patients in the conservative group (37.9 %; mean Eckardt score 4 [1.8]) achieved clinical success. CONCLUSION : This study comprehensively assessed an international cohort of patients who underwent management of failed POEM. Repeat POEM and pneumatic dilation achieved acceptable clinical success, with excellent safety profiles.
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Affiliation(s)
- Yervant Ichkhanian
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA
| | - Daniella Assis
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA
| | - Pietro Familiari
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Michael Ujiki
- Department of Surgery, Northshore University Health System, Chicago, Illinois, USA
| | - Baily Su
- Department of Surgery, University of Chicago Medicine, Chicago, Illinois, USA
| | - Sarah R Khan
- Department of Medicine, Saint Agnes Hospital, Baltimore, Maryland, USA
| | - Mathieu Pioche
- Department of Endoscopy and Gastroenterology, Pavillon L Edouard Herriot Hospital, Lyon, France
| | | | - Joo Young Cho
- CHA Bundang Medical Center, Seongnam, Republic of Korea
| | | | | | - Amyn Haji
- King's College NHS Foundation Trust, London, UK
| | | | - Marcel Tantau
- Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - Jeffrey M Marks
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | | | | | - Eduardo Albeniz
- Gastroenterology Department, Complejo Hospitalario de Navarra, Navarro, Spain
| | | | - Nikhil A Kumta
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Guido Costamagna
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Mehul Patel
- King's College NHS Foundation Trust, London, UK
| | - Megan Sippey
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | | | | | - Fermín Estremera
- Gastroenterology Department, Complejo Hospitalario de Navarra, Navarro, Spain
| | - Mohamad H El Zein
- Division of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, Ohio, USA
| | - Olaya I Brewer Gutierrez
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA
| | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA
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20
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Shinn B, Boortalary T, Raijman I, Nieto J, Khara HS, Kumar SV, Confer B, Diehl DL, El Halabi M, Ichkhanian Y, Runge T, Kumbhari V, Khashab M, Tyberg A, Shahid H, Sarkar A, Gaidhane M, Bareket R, Kahaleh M, Piraka C, Zuchelli T, Law R, Sondhi A, Kedia P, Robbins J, Calogero C, Bakhit M, Chiang A, Schlachterman A, Kowalski T, Loren D. Maximizing success in single-session EUS-directed transgastric ERCP: a retrospective cohort study to identify predictive factors of stent migration. Gastrointest Endosc 2021; 94:727-732. [PMID: 33957105 DOI: 10.1016/j.gie.2021.04.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 01/18/2021] [Accepted: 04/27/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS EUS-directed transgastric ERCP (the EDGE procedure) is a simplified method of performing ERCP in Roux-en-Y gastric bypass patients. The EDGE procedure involves placement of a lumen-apposing metal stent (LAMS) into the excluded stomach to serve as a conduit for passage of the duodenoscope for pancreatobiliary intervention. Originally a multistep process, urgent indications for ERCP have led to the development of single-session EDGE (SS-EDGE) with LAMS placement and ERCP performed in the same session. The goal of this study was to identify predictive factors of intraprocedural LAMS migration in SS-EDGE. METHODS We conducted a multicenter retrospective review that included 9 tertiary medical centers across the United States. Data were collected and analyzed from 128 SS-EDGE procedures. The primary outcome was intraprocedural LAMS migration. Secondary outcomes were other procedural adverse events such as bleeding and perforation. RESULTS Eleven LAMS migrations were observed in 128 procedures (8.6%). Univariate analysis of clinically relevant variables was performed, as was a binary logistic regression analysis of stent diameter and stent dilation. This revealed that use of a smaller (15 mm) diameter LAMS was an independent predictor of intraprocedural stent migration (odds ratio, 5.36; 95% confidence interval, 1.29-22.24; P = .021). Adverse events included 3 patients who required surgery and 2 who experienced intraprocedural bleeding. CONCLUSIONS Use of a larger-diameter LAMS is a predictive factor for a nonmigrated stent and improved procedural success in SS-EDGE. Although larger patient cohorts are needed to adequately assess these findings, performance of LAMS dilation and fixation may also decrease risk of intraprocedural LAMS migration and improve procedural success.
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Affiliation(s)
- Brianna Shinn
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Tina Boortalary
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | | | - Jose Nieto
- Borland Groover Clinic, Jacksonville, Florida, USA
| | | | - S Vikas Kumar
- Geisinger Health System, Danville, Pennsylvania, USA
| | | | - David L Diehl
- Geisinger Health System, Danville, Pennsylvania, USA
| | - Maan El Halabi
- Johns Hopkins University Hospital, Baltimore, Maryland, USA
| | | | - Thomas Runge
- Johns Hopkins University Hospital, Baltimore, Maryland, USA
| | - Vivek Kumbhari
- Johns Hopkins University Hospital, Baltimore, Maryland, USA
| | - Mouen Khashab
- Johns Hopkins University Hospital, Baltimore, Maryland, USA
| | - Amy Tyberg
- Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Haroon Shahid
- Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Avik Sarkar
- Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Monica Gaidhane
- Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Romy Bareket
- Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Michel Kahaleh
- Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Cyrus Piraka
- Henry Ford Health System, Detroit, Michigan, USA
| | | | - Ryan Law
- University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - Arjun Sondhi
- University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | | | - Justin Robbins
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Cristina Calogero
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Mena Bakhit
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Austin Chiang
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | | | - Thomas Kowalski
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - David Loren
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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21
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Sanaei O, Ichkhanian Y, Mondragón OVH, Nieto J, Krishnan A, Tantau M, Tantau A, Desai PN, Ginsberg GG, Saumoy M, Deshmukh A, Attaar M, Farha J, Jovani M, Al-Ghamdi SS, Ujiki M, Khashab MA. Impact of prior treatment on feasibility and outcomes of Zenker's peroral endoscopic myotomy (Z-POEM). Endoscopy 2021; 53:722-726. [PMID: 33096576 DOI: 10.1055/a-1276-0219] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Zenker's peroral endoscopic myotomy (Z-POEM) is a novel procedure for the management of symptomatic Zenker's diverticulum. This study aims to report the technical feasibility and outcomes of Z-POEM in the management of Zenker's diverticulum after prior failed interventions. METHODS Patients with persistent or recurrent symptoms after prior endoscopic and/or surgical intervention for Zenker's diverticulum were retrospectively included. The primary outcome was clinical success, defined as complete or near complete resolution of dysphagia (dysphagia score of 0 or 1) without the need for repeat endoscopic or surgical intervention during follow-up. RESULTS Z-POEM was technically successful in 30/32 patients (93.8 %). Clinical success was achieved in 29/30 patients (96.7 %), and Z-POEM significantly reduced the median (interquartile range [IQR]) dysphagia score of patients from 2 (1 - 2) to 0 (0) (P < 0.001) over a median duration of follow up of 166 days (IQR 39 - 566). Four patients (12.5 %) had adverse events (two inadvertent mucosotomies and two leaks found on post-procedural esophagrams). CONCLUSION Z-POEM is feasible, safe, and effective in the majority of patients with recurrent symptoms after prior surgical or endoscopic interventions.
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Affiliation(s)
- Omid Sanaei
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.,Department of Medicine, MedStar Health System, Baltimore, Maryland, USA
| | - Yervant Ichkhanian
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | | | - Jose Nieto
- Division of Gastroenterology and Hepatology, Borland Groover Clinic, Jacksonville, Florida, USA
| | - Arunkumar Krishnan
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Marcel Tantau
- Gastroenterology and Hepatology Medical Center, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Alina Tantau
- Gastroenterology and Hepatology Medical Center, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - Gregory G Ginsberg
- Endoscopic Services, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Monica Saumoy
- Endoscopic Services, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Ameya Deshmukh
- Division of Gastroenterology and Hepatology, Borland Groover Clinic, Jacksonville, Florida, USA
| | - Mikhail Attaar
- Department of Surgery, Grainger Center of Simulation and Innovation, NorthShore University Health System, Evanston, Illinois, USA
| | - Jad Farha
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Manol Jovani
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Sarah S Al-Ghamdi
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Michael Ujiki
- Department of Surgery, Grainger Center of Simulation and Innovation, NorthShore University Health System, Evanston, Illinois, USA
| | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
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22
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Farha J, McGowan C, Hedjoudje A, Itani MI, Abbarh S, Simsek C, Ichkhanian Y, Vulpis T, James TW, Fayad L, Khashab MA, Oberbach A, Badurdeen D, Kumbhari V. Endoscopic sleeve gastroplasty: suturing the gastric fundus does not confer benefit. Endoscopy 2021; 53:727-731. [PMID: 32777827 DOI: 10.1055/a-1236-9347] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND : There is heterogeneity regarding the technical aspects of endoscopic sleeve gastroplasty (ESG), such as applying fundal sutures. Our aim was to determine whether ESG with fundal suturing (ESG-FS) affects weight loss and the serious adverse event (SAE) rate when compared with ESG with no fundal suturing (ESG-NFS). METHODS: We conducted a two-center retrospective analysis of 247 patients who underwent ESG with or without fundal suturing. The primary outcome was percentage excess weight loss (%EWL) at 3, 6, and 12 months post-ESG. The secondary outcomes included the SAE rate and procedure duration. RESULTS: At 3, 6, and 12-months, ESG-NFS had a significantly greater mean %EWL compared with ESG-FS (38.4 % [standard deviation (SD) 15.3 %] vs. 31.2 % [SD 13.9 %], P = 0.001; 54.7 % [SD 19.2 %] vs. 37.7 % [SD 17.3 %], P < 0.001; 65.3 % [SD 21.1 %] vs. 40.6 % [SD 23.5 %], P < 0.001, respectively). There was no statistically significant difference in the SAE rates for ESG-NFS (n = 2; 2.0 %) and ESG-FS (n = 4; 2.6 %; P > 0.99). The mean procedure time was significantly shorter in the ESG-NFS group at 59.1 minutes (SD 32.7) vs. 93.0 minutes (35.5; P < 0.001), and a lower mean number of sutures were used, with 5.7 (SD 1.1) vs. 8.4 (SD 1.6; P < 0.001). CONCLUSION : ESG-NFS demonstrated greater efficacy and shorter procedure duration. Therefore, fundal suturing should not be performed.
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Affiliation(s)
- Jad Farha
- Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | | | - Abdellah Hedjoudje
- Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Mohamad I Itani
- Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Shahem Abbarh
- Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Cem Simsek
- Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Yervant Ichkhanian
- Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Trish Vulpis
- WakeMed Cary Hospital, Cary, North Carolina, USA
| | - Theodore W James
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Lea Fayad
- Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Andreas Oberbach
- Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Dilhana Badurdeen
- Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Vivek Kumbhari
- Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
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23
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Ofosu A, Mohan BP, Ichkhanian Y, Masadeh M, Febin J, Barakat M, Ramai D, Chandan S, Haiyeva G, Khan SR, Aghaie Meybodi M, Facciorusso A, Repici A, Wani S, Thosani N, Khashab MA. Peroral endoscopic myotomy (POEM) vs pneumatic dilation (PD) in treatment of achalasia: A meta-analysis of studies with ≥ 12-month follow-up. Endosc Int Open 2021; 9:E1097-E1107. [PMID: 34222636 PMCID: PMC8216779 DOI: 10.1055/a-1483-9406] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 07/22/2020] [Accepted: 11/23/2020] [Indexed: 02/07/2023] Open
Abstract
Background and study aims Peroral endoscopic myotomy (POEM) is increasingly being used as the preferred treatment option for achalasia. The aim of this systematic review and meta-analysis was to compare the efficacy and safety of POEM versus pneumatic balloon dilation (PD). Methods We performed a comprehensive review of studies that reported clinical outcomes of POEM and PD for the treatment of achalasia. Measured outcomes included clinical success (improvement of symptoms based on a validated scale including an Eckardt score ≤ 3), adverse events, and post-treatment gastroesophageal reflux disease (GERD). Results Sixty-six studies (6268 patients) were included in the final analysis, of which 29 studies (2919 patients) reported on POEM and 33 studies (3050 patients) reported on PD and 4 studies (299 patients) compared POEM versus PD. Clinical success with POEM was superior to PD at 12, 24, and 36 months (92.9 %, vs 76.9 % P = 0.001; 90.6 % vs 74.8 %, P = 0.004; 88.4 % vs 72.2 %, P = 0.006, respectively). POEM was superior to PD in type I, II and III achalasia (92.7 % vs 61 %, P = 0.01; 92.3 % vs 80.3 %, P = 0.01; 92.3 %v 41.9 %, P = 0.01 respectively) Pooled OR of clinical success at 12 and 24 months were significantly higher with POEM (8.97; P = 0.001 & 5.64; P = 0.006). Pooled OR of GERD was significantly higher with POEM (by symptoms: 2.95, P = 0.02 and by endoscopic findings: 6.98, P = 0.001). Rates of esophageal perforation (0.3 % vs 0.6 %, P = 0.8) and significant bleeding (0.4 % vs 0.7 %, P = 0.56) were comparable between POEM and PD groups. Conclusions POEM is more efficacious than PD in the treatment of patients with achalasia during short-term and long-term follow-up, albeit with higher risk of abnormal esophageal acid exposure.
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Affiliation(s)
- Andrew Ofosu
- Gastroenterology and Hepatology, Stanford University, Stanford, California, United States
| | - Babu P. Mohan
- Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, Utah, United States
| | - Yervant Ichkhanian
- Internal Medicine, Henry Ford University Medical Center, Detroit, Michigan, United States
| | - Maen Masadeh
- Kaiser Permanente Northern California, California, United States
| | - John Febin
- Gastroenterology and Hepatology, Stanford University, Stanford, California, United States
| | - Mohamed Barakat
- Gastroenterology and Hepatology, Stanford University, Stanford, California, United States
| | - Daryl Ramai
- Gastroenterology and Hepatology, Stanford University, Stanford, California, United States
| | - Saurabh Chandan
- Gastroenterology and Hepatology, University of Nebraska, United States
| | - Gulara Haiyeva
- Beneficts Hospital Inc., Great Falls, Montana, United States
| | - Shahab R. Khan
- Gastroenterology, Rush University Medical Center, Chicago, Illinois, United States
| | - Mohamad Aghaie Meybodi
- Gastroenterology and Hepatology, John Hopkins University Hospital, Baltimore, Maryland, United States
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy
| | - Alessandro Repici
- Humanitas Research Hospital, Humanitas University, Rozzano, Milan, Italy
| | - Sachin Wani
- Gastroenterology, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Nirav Thosani
- Gastroenterology, Hepatology and Nutrition, University of Texas Health Science Center at Houston, Houston, Texas, United States
| | - Mouen A. Khashab
- Gastroenterology and Hepatology, John Hopkins University Hospital, Baltimore, Maryland, United States
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Runge TM, Chiang AL, Kowalski TE, James TW, Baron TH, Nieto J, Diehl DL, Krafft MR, Nasr JY, Kumar V, Khara HS, Irani S, Patel A, Law RJ, Loren DE, Schlachterman A, Hsueh W, Confer BD, Stevens TK, Chahal P, Al-Haddad MA, Mir FF, Pleskow DK, Huggett MT, Paranandi B, Trindade AJ, Brewer-Gutierrez OI, Ichkhanian Y, Dbouk M, Kumbhari V, Khashab MA. Endoscopic ultrasound-directed transgastric ERCP (EDGE): a retrospective multicenter study. Endoscopy 2021; 53:611-618. [PMID: 32882722 DOI: 10.1055/a-1254-3942] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [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] [Indexed: 02/07/2023]
Abstract
BACKGROUND Endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography (ERCP; EDGE) is an alternative to enteroscopy- and laparoscopy-assisted ERCP in patients with Roux-en-Y gastric bypass anatomy. Although short-term results are promising, the long-term outcomes are not known. The aims of this study were: (1) to determine the rates of long-term adverse events after EDGE, with a focus on rates of persistent gastrogastric or jejunogastric fistula; (2) to identify predictors of persistent fistula; (3) to assess the outcomes of endoscopic closure when persistent fistula is encountered. METHODS This was a multicenter retrospective study involving 13 centers between February 2015 and March 2019. Adverse events were defined according to the ASGE lexicon. Persistent fistula was defined as an upper gastrointestinal series or esophagogastroduodenoscopy showing evidence of fistula. RESULTS 178 patients (mean age 58 years, 79 % women) underwent EDGE. Technical success was achieved in 98 % of cases (175/178), with a mean procedure time of 92 minutes. Periprocedural adverse events occurred in 28 patients (15.7 %; mild 10.1 %, moderate 3.4 %, severe 2.2 %). The four severe adverse events were managed laparoscopically. Persistent fistula was diagnosed in 10 % of those sent for objective testing (9/90). Following identification of a fistula, 5 /9 patients underwent endoscopic closure procedures, which were successful in all cases. CONCLUSIONS The EDGE procedure is associated with high clinical success rates and an acceptable risk profile. Persistent fistulas after lumen-apposing stent removal are uncommon, but objective testing is recommended to identify their presence. When persistent fistulas are identified, endoscopic treatment is warranted, and should be successful in closing the fistula.
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Affiliation(s)
- Thomas M Runge
- Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Austin L Chiang
- Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Thomas E Kowalski
- Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Theodore W James
- Division of Gastroenterology and Hepatology, University of North Carolina Hospitals, Chapel Hill, North Carolina, USA
| | - Todd H Baron
- Division of Gastroenterology and Hepatology, University of North Carolina Hospitals, Chapel Hill, North Carolina, USA
| | - Jose Nieto
- Borland Groover Clinic, Advanced Therapeutic Endoscopy Center, Jacksonville, Florida, USA
| | - David L Diehl
- Department of Gastroenterology, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Matthew R Krafft
- Section of Digestive Diseases, Department of Medicine, West Virginia University, Morgantown West Virginia, USA
| | - John Y Nasr
- Section of Digestive Diseases, Department of Medicine, West Virginia University, Morgantown West Virginia, USA
| | - Vikas Kumar
- Department of Gastroenterology, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Harshit S Khara
- Department of Gastroenterology, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Shayan Irani
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Arpan Patel
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Ryan J Law
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
| | - David E Loren
- Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Alex Schlachterman
- Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - William Hsueh
- Section of Digestive Diseases, Department of Medicine, West Virginia University, Morgantown West Virginia, USA
| | - Bradley D Confer
- Department of Gastroenterology, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Tyler K Stevens
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Prabhleen Chahal
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Mohammad A Al-Haddad
- Division of Gastroenterology, Indiana School of Medicine, Indianapolis, Indiana, USA
| | - Fahad Faisal Mir
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconness Medical Center, Boston, Massachusetts, USA
| | - Douglas K Pleskow
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconness Medical Center, Boston, Massachusetts, USA
| | - Matthew T Huggett
- Department of Gastroenterology, St. James' University Hospital, Leeds, UK
| | - Bharat Paranandi
- Department of Gastroenterology, St. James' University Hospital, Leeds, UK
| | - Arvind J Trindade
- Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, Northwell Health, New Hyde Park, New York, USA
| | - Olaya I Brewer-Gutierrez
- Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Yervant Ichkhanian
- Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Mohamad Dbouk
- Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Vivek Kumbhari
- Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
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25
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Zhang LY, Runge TM, Ichkhanian Y, Kumbhari V, Khashab MA. Percutaneous transcystic cholangioscopy-assisted rendezvous ERCP in a hostile abdomen. VideoGIE 2021; 6:215-218. [PMID: 34027251 PMCID: PMC8117940 DOI: 10.1016/j.vgie.2021.01.012] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Video 1Percutaneous transcystic cholangioscopy-assisted rendezvous ERCP in a hostile abdomen.
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Affiliation(s)
- Linda Y Zhang
- Division of Gastroenterology & Hepatology, Johns Hopkins Medicine, Baltimore, Maryland
| | - Thomas M Runge
- Division of Gastroenterology & Hepatology, Johns Hopkins Medicine, Baltimore, Maryland.,Division of Gastroenterology, Hepatology & Nutrition, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Yervant Ichkhanian
- Division of Gastroenterology & Hepatology, Johns Hopkins Medicine, Baltimore, Maryland
| | - Vivek Kumbhari
- Division of Gastroenterology & Hepatology, Johns Hopkins Medicine, Baltimore, Maryland
| | - Mouen A Khashab
- Division of Gastroenterology & Hepatology, Johns Hopkins Medicine, Baltimore, Maryland
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26
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Ichkhanian Y, Abimansour JP, Pioche M, Vosoughi K, Eleftheriadis N, Chiu PWY, Minami H, Ogihara K, Sanaei O, Jovani M, Khashab MA. Outcomes of anterior versus posterior peroral endoscopic myotomy 2 years post-procedure: prospective follow-up results from a randomized clinical trial. Endoscopy 2021; 53:462-468. [PMID: 32572862 DOI: 10.1055/a-1204-4242] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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] [Indexed: 12/28/2022]
Abstract
BACKGROUND Peroral endoscopic myotomy (POEM) is considered a primary treatment modality for achalasia. It can be performed using either the anterior or posterior approach. A previous randomized clinical trial (RCT) showed that the posterior approach was noninferior to the anterior approach at 1 year post-POEM in terms of clinical success, rate of adverse event, and risk of gastroesophageal reflux disease (GERD). The aim of this post-RCT study was to compare outcomes at ≥ 2 years post-POEM. METHODS Patients who previously completed the 1-year follow-up were contacted and their Eckardt, dysphagia, and GERD questionnaire (GERDQ) scores and frequency of proton pump inhibitor use were recorded. Clinical success was defined as an Eckardt score < 3. RESULTS 150 patients were initially randomized and 138 completed the 1-year follow-up. Of the 138, 111 (anterior group 54, posterior group 57) also completed ≥ 2 years of follow-up, with an overall clinical success decrease from 89 % to 82 %. At ≥ 2 years post-POEM, clinical success was achieved in 46/54 (85 %) and 45/57 (79 %) in the anterior and posterior groups, respectively (P = 0.43). A similar decrease in clinical success was noted in both groups at ≥ 2 years (anterior: 90 % to 85 %; posterior 89 % to 79 %; P = 0.47). GERDQ score was 6 (interquartile range 6 - 8; P = 0.08) in both treatment groups. CONCLUSIONS The anterior and posterior POEM techniques remained equally effective at 2 years and decreases in efficacy were similar between the two approaches over time. GERD outcomes were also similar in both groups during medium-term follow-up.
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Affiliation(s)
- Yervant Ichkhanian
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, United States
| | - Jad P Abimansour
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, United States
| | - Mathieu Pioche
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Lyon, France
| | - Kia Vosoughi
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, United States
| | - Nicholas Eleftheriadis
- Endoscopy Department, Gastroenterology Unit, Metropolitan Hospital Athens, Athens, Greece.,Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Philip Wai Yan Chiu
- Division of Upper GI and Metabolic Surgery, Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Hitomi Minami
- Department of Gastroenterology and Hepatology, Nagazaki University Hospital, Nagazaki, Japan
| | - Kumi Ogihara
- Department of Gastroenterology and Hepatology, Nagazaki University Hospital, Nagazaki, Japan
| | - Omid Sanaei
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, United States
| | - Manol Jovani
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, United States
| | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, United States
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27
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Jovani M, Brewer-Gutierrez OI, Ichkhanian Y, Runge TM, Khashab MA. Is two better than one? Alternative techniques for gastric peroral endoscopic myotomy. Endoscopy 2021; 53:556-557. [PMID: 32818990 DOI: 10.1055/a-1226-6271] [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: 12/10/2022]
Affiliation(s)
- Manol Jovani
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | | | - Yervant Ichkhanian
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Thomas M Runge
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, USA
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28
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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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29
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Reddy CA, Tavakkoli A, Abdul-Hussein M, Almazan E, Vosoughi K, Ichkhanian Y, Al-Hawary M, Chang AC, Chen JW, Korsnes S, Elmunzer BJ, Khashab MA, Law R. Clinical impact of routine esophagram after peroral endoscopic myotomy. Gastrointest Endosc 2021; 93:102-106. [PMID: 32504702 PMCID: PMC8783294 DOI: 10.1016/j.gie.2020.05.046] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 05/08/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS It is unclear whether the common practice of postoperative day (POD) 1 esophagram impacts clinical care or reliably identifies significant adverse events (AEs) related to peroral endoscopic myotomy (POEM). Therefore, we aimed to correlate the most clinically relevant esophagram findings with postoperative outcomes after POEM. METHODS Patients were retrospectively reviewed and included if they underwent POEM at 1 of the 3 study institutions between 2014 and 2018. Patient outcomes were assessed in relation to relevant POD 1 esophagram findings such as esophageal dissection or leak. RESULTS One hundred seventy post-POEM contrast esophagrams (139 fluoroscopy-based vs 31 CT-based) performed on POD 1 were included. Most esophagrams (n = 98) contained abnormal findings but only 5 showed esophageal leak or dissection. Confirmed postoperative AEs of leak or dissection occurred in 4 patients. In 2 patients, POD 1 esophagram appropriately identified the leak or dissection, but in the other 2 patients the initial esophagram was negative, and the AEs were not recognized before clinical deterioration. One patient had a false-positive leak and dissection noted on esophagram leading to an unremarkable endoscopy. CONCLUSIONS Despite the low AE rate after POEM, follow-up esophagram on POD 1 frequently shows expected, unremarkable postprocedural findings and occasionally fails to diagnose serious AEs. This results in pitfalls in accuracy regarding agreement between esophagram versus clinical and endoscopic findings. Relying exclusively on esophagram for post-POEM clinical decision-making can lead to unnecessary additional testing or missed AEs.
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Affiliation(s)
| | - Anna Tavakkoli
- Division of Gastroenterology, UT Southwestern, Dallas, Texas, USA
| | - Mustafa Abdul-Hussein
- Division of Gastroenterology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Erik Almazan
- Division of Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kia Vosoughi
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Yervant Ichkhanian
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Mahmoud Al-Hawary
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Andrew C. Chang
- Section of Thoracic Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Joan W. Chen
- Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA
| | - Sheryl Korsnes
- Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA
| | - B. Joseph Elmunzer
- Division of Gastroenterology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Mouen A. Khashab
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Ryan Law
- Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA
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30
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Ichkhanian Y, Yang J, Khashab MA. Response. Gastrointest Endosc 2021; 93:279-280. [PMID: 33353631 DOI: 10.1016/j.gie.2020.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 08/15/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Yervant Ichkhanian
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland; Department of Medicine, Henry Ford Hospital, Detroit, Michigan
| | - Juliana Yang
- Division of Gastroenterology and Hepatology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA
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31
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Sloan JA, Triggs JR, Pandolfino JE, Dbouk M, Brewer Gutierrez OI, El Zein M, Quader F, Ichkhanian Y, Gyawali CP, Rubenstein JH, Khashab MA. Treatment experience with a novel 30-mm hydrostatic balloon in esophageal dysmotility: a multicenter retrospective analysis. Gastrointest Endosc 2020; 92:1251-1257. [PMID: 32417296 DOI: 10.1016/j.gie.2020.04.076] [Citation(s) in RCA: 12] [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: 02/27/2020] [Accepted: 04/19/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS The newest addition in the management of achalasia and esophagogastric junction outflow obstruction (EGJOO) is a 30-mm hydrostatic balloon dilator that uses impedance planimetry technology. It allows for the measurement of the diameter and cross-sectional area to determine effective dilation. We aimed to (1) determine the clinical success (defined as a decrease in Eckardt score to ≤3) in the treatment of esophageal motility disorders and (2) report the safety (rate/severity of adverse events). METHODS This retrospective multicenter study involved 4 centers. Patients with esophageal motility disorders who underwent hydrostatic balloon dilation between January 2015 and October 2018 were included. RESULTS Fifty-one patients (mean age, 54.1 years; women, 49%) underwent hydrostatic dilation for achalasia (n = 37) or EGJOO (n = 14) during the study period. Forty-seven patients had a median baseline Eckardt score of 5 (range, 3-8; achalasia, n = 35, 6 [range, 3-8]; EGJOO, n = 12, 4 [range, 3.25-6.5]). Clinical success was achieved in 60% of cases (achalasia vs EGJOO: 68.4% vs 33.3%, P = .18). Dilation resulted in a significant decrease in the median Eckardt score from 5 (range, 3-8) to 1.5 (range, 1-4.75; P < .001). Patients with achalasia had a decrease in Eckardt score from 6 (range, 3-8) to 1 (range, 1-4; P < .001), whereas those with EGJOO experienced no significant change. One patient had mild postprocedure chest pain. CONCLUSIONS The hydrostatic balloon dilator is a new tool in our armamentarium to treat esophageal motility disorders. This is the first multicenter study showing the device to be safe and moderately efficacious.
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Affiliation(s)
- Joshua A Sloan
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Joseph R Triggs
- Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - John E Pandolfino
- Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Mohamad Dbouk
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Olaya I Brewer Gutierrez
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mohamad El Zein
- Division of Gastroenterology, University of Toledo, Toledo, Ohio, USA
| | - Farhan Quader
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Yervant Ichkhanian
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - C Prakash Gyawali
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Joel H Rubenstein
- Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA
| | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Affiliation(s)
- Arunkumar Krishnan
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Yervant Ichkhanian
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Thomas M Runge
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, USA
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Hajifathalian K, Ichkhanian Y, Dawod Q, Meining A, Schmidt A, Glaser N, Vosoughi K, Diehl DL, Grimm IS, James T, Templeton AW, Samarasena JB, Chehade NEH, Lee JG, Chang KJ, Mizrahi M, Barawi M, Irani S, Friedland S, Korc P, Aadam AA, Al-Haddad M, Kowalski TE, Smallfield G, Ginsberg GG, Fukami N, Lajin M, Kumta NA, Tang SJ, Naga Y, Amateau SK, Kasmin F, Goetz M, Seewald S, Kumbhari V, Ngamruengphong S, Mahdev S, Mukewar S, Sampath K, Carr-Locke DL, Khashab MA, Sharaiha RZ. Full-thickness resection device (FTRD) for treatment of upper gastrointestinal tract lesions: the first international experience. Endosc Int Open 2020; 8:E1291-E1301. [PMID: 33015330 PMCID: PMC7508667 DOI: 10.1055/a-1216-1439] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 03/03/2020] [Accepted: 06/29/2020] [Indexed: 02/08/2023] Open
Abstract
Background and study aims The Full-Thickness Resection Device (FTRD) provides a novel treatment option for lesions not amenable to conventional endoscopic resection techniques. There are limited data on the efficacy and safety of FTRD for resection of upper gastrointestinal tract (GIT) lesions. Patients and methods This was an international multicenter retrospective study, including patients who had an endoscopic resection of an upper GIT lesion using the FTRD between January 2017 and February 2019. Results Fifty-six patients from 13 centers were included. The most common lesions were mesenchymal neoplasms (n = 23, 41 %), adenomas (n = 7, 13 %), and hamartomas (n = 6, 11 %). Eighty-four percent of lesions were located in the stomach, and 14 % in the duodenum. The average size of lesions was 14 mm (range 3 to 33 mm). Deployment of the FTRD was technically successful in 93 % of patients (n = 52) leading to complete and partial resection in 43 (77 %) and 9 (16 %) patients, respectively. Overall, the FTRD led to negative histological margins (R0 resection) in 38 (68 %) of patients. A total of 12 (21 %) mild or moderate adverse events (AEs) were reported. Follow-up endoscopy was performed in 31 patients (55 %), on average 88 days after the procedure (IQR 68-138 days). Of these, 30 patients (97 %) did not have any residual or recurrent lesion on endoscopic examination and biopsy, with residual adenoma in one patient (3 %). Conclusions Our results suggest a high technical success rate and an acceptable histologically complete resection rate, with a low risk of AEs and early recurrence for FTRD resection of upper GIT lesions.
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Affiliation(s)
- Kaveh Hajifathalian
- Weill Cornell Medicine, Division of Gastroenterology and Hepatology, Department of Medicine, New York, NY
| | - Yervant Ichkhanian
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Qais Dawod
- Weill Cornell Medicine, Division of Gastroenterology and Hepatology, Department of Medicine, New York, NY
| | - Alexander Meining
- Interventional and Experimental Endoscopy, Department of Internal Medicine I, Ulm University, Ulm, Germany
| | - Arthur Schmidt
- Department of Medicine II, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Nicholas Glaser
- Department of Medicine II, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Kia Vosoughi
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - David L. Diehl
- Interventional and Experimental Endoscopy, Department of Internal Medicine I, Ulm University, Ulm, Germany
| | - Ian S. Grimm
- Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, Pennsylvania, United States
| | - Theodore James
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Adam W. Templeton
- Department of Gastroenterology, University of Washington, Seattle, Washington, United States
| | - Jason B. Samarasena
- H. H. Chao Comprehensive Digestive Disease Center, Division of Gastroenterology and Hepatology, University of California, Irvine, Orange, California, United States
| | - Nabil El Hage Chehade
- H. H. Chao Comprehensive Digestive Disease Center, Division of Gastroenterology and Hepatology, University of California, Irvine, Orange, California, United States
| | - John G. Lee
- H. H. Chao Comprehensive Digestive Disease Center, Division of Gastroenterology and Hepatology, University of California, Irvine, Orange, California, United States
| | - Kenneth J. Chang
- H. H. Chao Comprehensive Digestive Disease Center, Division of Gastroenterology and Hepatology, University of California, Irvine, Orange, California, United States
| | - Meir Mizrahi
- Department of Internal Medicine, Division of Gastroenterology, Center for Advanced Endoscopy, University of South Alabama, Mobile, Alabama, United States
| | - Mohammed Barawi
- Division of Gastroenterology and Hepatology, Ascension St. John hospital, Detroit, Michigan, United States
| | - Shayan Irani
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, United Stats
| | - Shai Friedland
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, United States
| | - Paul Korc
- Department of Medicine, Division of Gastroenterology, Hoag Hospital, Newport Beach, California, United States
| | - Abdul Aziz Aadam
- Division of Gastroenterology, Northwestern University, Chicago, Illinois, United States
| | - Mohammad Al-Haddad
- Indiana University School of Medicine, Department of Medicine, Division of Gastroenterology, Indianapolis, Indiana, United States
| | | | - George Smallfield
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, Richmond, Virginia United States
| | - Gregory G. Ginsberg
- Gastroenterology Division, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, United States
| | - Norio Fukami
- Division of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Arizona, United States
| | - Michael Lajin
- SHARP Grossmont Hospital, La Mesa, California, United States
| | - Nikhil A. Kumta
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Shou-jiang Tang
- Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, United States
| | - Yehia Naga
- Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, United States
| | - Stuart K. Amateau
- Division of Gastroenterology, University of Minnesota, Minneapolis, Minnesota, United States
| | - Franklin Kasmin
- Division of Gastroenterology, Lenox Hill Hospital, Northwell Health, New York, New York, United States
| | - Martin Goetz
- Innere Medizin I, Universitätsklinikum Tübingen, Tuebingen, Germany
| | - Stefan Seewald
- Centre of Gastroenterology, Klinik Hirslanden, Zurich, Switzerland
| | - Vivek Kumbhari
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | | | - Srihari Mahdev
- Weill Cornell Medicine, Division of Gastroenterology and Hepatology, Department of Medicine, New York, NY
| | - Saurabh Mukewar
- Weill Cornell Medicine, Division of Gastroenterology and Hepatology, Department of Medicine, New York, NY
| | - Kartik Sampath
- Weill Cornell Medicine, Division of Gastroenterology and Hepatology, Department of Medicine, New York, NY
| | - David L. Carr-Locke
- Weill Cornell Medicine, Division of Gastroenterology and Hepatology, Department of Medicine, New York, NY
| | - Mouen A. Khashab
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Reem Z. Sharaiha
- Weill Cornell Medicine, Division of Gastroenterology and Hepatology, Department of Medicine, New York, NY
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Parsa N, Runge T, Ichkhanian Y, Gutierrez OB, Khashab MA. EUS-guided hepaticogastrostomy to facilitate cholangioscopy and electrohydraulic lithotripsy of massive intraductal stones after Roux-en-Y hepaticojejunostomy. VideoGIE 2020; 5:418-420. [PMID: 32954104 PMCID: PMC7482416 DOI: 10.1016/j.vgie.2020.05.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/31/2022] Open
Affiliation(s)
- Nasim Parsa
- University of Missouri Health System, Columbia, Missouri
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Ichkhanian Y, Sanaei O, Canakis A, Vosoughi K, Almazan E, Ghandour B, Khashab MA. Esophageal peroral endoscopic myotomy (POEM) for treatment of esophagogastric junction outflow obstruction: results from the first prospective trial. Endosc Int Open 2020; 8:E1137-E1143. [PMID: 32904698 PMCID: PMC7458721 DOI: 10.1055/a-1198-4643] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 05/11/2020] [Indexed: 12/16/2022] Open
Abstract
Background and study aims Esophagogastric junction outflow obstruction (EGJOO) is a rare esophageal dysmotility disease that is characterized by elevated integrated relaxation pressuse (IRP) with evidence of preserved peristalsis. The role of peroral endoscopic myotomy (POEM) in management of EGJOO is currently unknown. Patients and methods This is a prospective trial conducted in a single US tertiary care center from June 2015 to June 2019. Symptomatic patients, diagnosed with EGJOO on both HRM and endoluminal functional lumen imaging probe (EndoFLIP), who were eligible for POEM were recruited. Primary outcome was clinical success, defined as Eckardt score (ES) ≤ 3, at 6 months post-POEM. Other outcomes included dysphagia score, quality of life as measured by 36-item Short Form health survey scales (SF-36), post-POEM HRM, EndoFLIP, and pH measurements, and adverse events. Results A total of 15 patients (51.8 yr. 9 F) with EGJOO underwent POEM. Pre-POEM mean IRP on HRM and Distensibility index (DI) on EndoFLIP were 24.3 ± 2.2 mmHg and 1.1 ± 0.6 mm 2 /mmHg, respectively. Clinical success was achieved in 93 % at 6 months post-POEM. There was significant decrease in IRP (-17.6 mmHg) post-POEM. There was significant improvement at 6 months in two of the SF-36 subscales. Ten patients underwent post-POEM pH testing, seven of whom had abnormal DeMeester score. Seven patients underwent EGD evaluation revealing esophagitis in five (2 Los Angeles grade A and 3 grade B). Conclusions POEM offers a high clinical success rate for patients with EGJOO confirmed by impedance planimetry.
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Affiliation(s)
- Yervant Ichkhanian
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, United States
| | - Omid Sanaei
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, United States
| | - Andrew Canakis
- Department of Internal Medicine, Boston Medical Center, Boston, Massachusetts, United States
| | - Kia Vosoughi
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, United States
| | - Erik Almazan
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, United States
| | - Bachir Ghandour
- American University of Beirut School of Medicine, Beirut, Lebanon
| | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, United States
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El-Rayess H, Khamis AM, Haddad S, Ghaddara HA, Hakoum M, Ichkhanian Y, Bejjani M, Akl EA. Assessing concordance of financial conflicts of interest disclosures with payments' databases: a systematic survey of the health literature. J Clin Epidemiol 2020; 127:19-28. [PMID: 32622901 DOI: 10.1016/j.jclinepi.2020.06.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 06/21/2020] [Accepted: 06/28/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The objective of the study is to review the literature for studies that assessed the concordance of financial conflicts of interest disclosures with payments' databases and evaluate their methods. STUDY DESIGN AND SETTING We conducted a systematic survey of the health literature to identify eligible studies. We searched both Medline and EMBASE up to February 2017. We conducted study selection, data abstraction, and methodological quality assessment in duplicate and independently using standardized forms. We subcategorized 'nonconcordant disclosures' as either 'partially nonconcordant' or 'completely nonconcordant'. The main outcome was the percentage of authors with 'nonconcordant' disclosures. We summarized results by three levels of analysis: authors, companies, and studies. RESULTS We identified 27 eligible journal articles. The top two types of documents assessed were published articles (n = 13) and published guidelines (n = 9). The most commonly used payment database was the Open Payments Database (n = 16). The median percentage of authors with 'nonconcordant' disclosures was 81%; the median percentage was 43% for 'completely nonconcordant' disclosures. The percentage of 'nonconcordant' conflict of interest (COI) reporting by companies varied between 23% and 85%. The methods of concordance assessment, as well as the labeling and definitions of assessed outcomes varied widely across the included studies. We judged three of the included studies as high-quality studies. CONCLUSION Underreporting of health science researchers' financial COIs is pervasive. Studies assessing COI underreporting suffer from a number of limitations that could have overestimated their findings.
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Affiliation(s)
- Hebah El-Rayess
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Assem M Khamis
- Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Sara Haddad
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hussein Abou Ghaddara
- Department of Internal Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Maram Hakoum
- Department of Family Medicine, Cornerstone Care Teaching Health Center, Morgantown, WV, USA
| | - Yervant Ichkhanian
- Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Michael Bejjani
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Elie A Akl
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon; Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon; Faculty of Medicine, American University of Beirut, Beirut, Lebanon; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
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Repici A, Spadaccini M, Belletrutti PJ, Galtieri PA, Fugazza A, Anderloni A, Carrara S, Di Leo M, Pellegatta G, Cappello A, Castoro C, Ichkhanian Y, Khashab MA, Maselli R. Peroral endoscopic septotomy for short-septum Zenker's diverticulum. Endoscopy 2020; 52:563-568. [PMID: 32185781 DOI: 10.1055/a-1127-3304] [Citation(s) in RCA: 12] [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] [Indexed: 12/10/2022]
Abstract
BACKGROUND Treatments of Zenker's diverticulum aim to dissect the cricopharyngeal muscle, removing the underlying source of dysfunction. This is difficult in patients with a short-septum (≤ 20 mm) diverticulum because the limited anatomical space restricts the operating area for either rigid or flexible endoscopic approaches. The aim of this study was to investigate the efficacy and safety of a novel third-space approach, peroral endoscopic septotomy (POES), for treating symptomatic patients with short-septum Zenker's diverticulum. METHODS All patients with short-septum Zenker's diverticulum who were referred for endoscopic repair from September 2017, were considered for the study. Outcomes included procedure-related adverse events and symptom improvement. The Dakkak - Bennett score was used to quantify dysphagia. RESULTS 20 patients (men 12, women 8; mean age 67.9 years [SD 14.3]) underwent POES. All procedures were performed with patients under deep sedation. Mean size of Zenker's diverticulum was 17.5 mm (SD 3.0) and mean dysphagia score was 2.7 (SD 0.5). Average procedure time was 13.8 minutes (SD 5.1). No intra- or post- procedural adverse events occurred. Septal myotomy was successfully completed in all patients. Dysphagia significantly improved in 19 out of 20 patients. Dakkak - Bennett score improved to 0.3 (SD 0.5), P < 0.0001). No recurrences were reported in a mean follow-up time of 12.0 months (SD 3.7, range 6 - 20). CONCLUSIONS POES may be considered as a potential alternative for the treatment of short-septum Zenker's diverticulum. Further data are required to validate this technique and compare it with already available rigid and flexible approaches.
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Affiliation(s)
- Alessandro Repici
- Department of Gastroenterology, Digestive Endoscopy Unit, Humanitas Clinical and Research Center, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Rozzano, Italy
| | - Marco Spadaccini
- Department of Gastroenterology, Digestive Endoscopy Unit, Humanitas Clinical and Research Center, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Rozzano, Italy
| | | | - Piera Alessia Galtieri
- Department of Gastroenterology, Digestive Endoscopy Unit, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Alessandro Fugazza
- Department of Gastroenterology, Digestive Endoscopy Unit, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Andrea Anderloni
- Department of Gastroenterology, Digestive Endoscopy Unit, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Silvia Carrara
- Department of Gastroenterology, Digestive Endoscopy Unit, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Milena Di Leo
- Department of Biomedical Sciences, Humanitas University, Rozzano, Italy
| | - Gaia Pellegatta
- Department of Gastroenterology, Digestive Endoscopy Unit, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Annalisa Cappello
- Department of Gastroenterology, Digestive Endoscopy Unit, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Carlo Castoro
- Department of Biomedical Sciences, Humanitas University, Rozzano, Italy
| | - Yervant Ichkhanian
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, United States
| | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, United States
| | - Roberta Maselli
- Department of Gastroenterology, Digestive Endoscopy Unit, Humanitas Clinical and Research Center, Rozzano, Italy
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Ichkhanian Y, Runge T, Gutierrez OIB, Khashab MA. Simultaneous double gastrojejunostomy for afferent and efferent limb syndromes. VideoGIE 2020; 5:294-295. [PMID: 32642616 PMCID: PMC7332759 DOI: 10.1016/j.vgie.2020.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Vosoughi K, Ichkhanian Y, Jacques J, Aadam AA, Benias PC, Law R, Hasler WL, Canakis A, Ragi O, Triggs J, Bowers N, Brewer Gutierrez OI, Kumbhari V, Kalloo AN, Bulat RS, Pandolfino JE, Khashab MA. Role of endoscopic functional luminal imaging probe in predicting the outcome of gastric peroral endoscopic pyloromyotomy (with video). Gastrointest Endosc 2020; 91:1289-1299. [PMID: 32035074 DOI: 10.1016/j.gie.2020.01.044] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [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: 09/12/2019] [Accepted: 01/22/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Endoluminal functional luminal imaging probe (EndoFLIP) is an imaging tool that measures the physiologic characteristics of GI sphincters. In this study, we used EndoFLIP to evaluate the association between the pyloric physiologic measurements and the clinical outcomes of gastric peroral endoscopic myotomy (G-POEM) in patients with refractory gastroparesis. METHODS Thirty-seven patients from 5 centers who underwent G-POEM for management of refractory gastroparesis and had EndoFLIP measurements were evaluated. Cross-sectional area (CSA), balloon pressure, and the distensibility index (DI) of the pylorus were evaluated by EndoFLIP at 40 mL and 50 mL balloon fills before and after G-POEM. One-year clinical success and change in gastric emptying study 3 months after the G-POEM procedure were compared with the EndoFLIP measurements. RESULTS Clinical success was achieved in 26 (70%) patients. Post-G-POEM CSA and DI were significantly higher in the clinical success group with both 40-mL volume distension (CSA: 89.9 ± 64.8 vs 172.5 ± 71.9 mm2, P =.003; DI: 5.8 ± 4.4 vs 8.8 ± 6.1 mm2/mm Hg, P =.043) and 50-mL volume distention (CSA: 140.1 ± 89.9 vs 237.5 ± 80.3 mm2, P =.003; DI: 5.6 ± 3.3 vs 9.9 ± 6.6 mm2/mm Hg, P =.049). CSA using 40-mL volume distention with an area under the curve of 0.83 yielded a specificity of 91% and a sensitivity of 71% at a cutoff point of 154 mm2. CONCLUSIONS Post-G-POEM CSA of the pylorus is associated with clinical success and improvement in a gastric emptying scan after G-POEM. EndoFLIP measurements of the pylorus have the potential to be used as a tool to predict the clinical outcome of G-POEM.
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Affiliation(s)
- Kia Vosoughi
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Yervant Ichkhanian
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Jérémie Jacques
- Gastroenterology Department, Dupuytren University Hospital, Limoges, France
| | - A Aziz Aadam
- Division of Gastroenterology, Northwestern University, Chicago, Illinois, USA
| | - Petros C Benias
- Division of Gastroenterology, Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, Northwell Health System, New Hyde Park, New York, USA
| | - Ryan Law
- Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA
| | - William L Hasler
- Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA
| | - Andrew Canakis
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Olivier Ragi
- Gastroenterology Department, Dupuytren University Hospital, Limoges, France
| | - Joseph Triggs
- Division of Gastroenterology, Northwestern University, Chicago, Illinois, USA
| | - Nicole Bowers
- Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Vivek Kumbhari
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Anthony N Kalloo
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Robert S Bulat
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - John E Pandolfino
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, USA
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Fayad L, Simsek C, Oleas R, Ichkhanian Y, Fayad GE, Ngamreungphong S, Schweitzer M, Oberbach A, Kalloo AN, Khashab MA, Kumbhari V. Safety and Efficacy of Endoscopically Secured Fully Covered Self-Expandable Metallic Stents (FCSEMS) for Post-Bariatric Complex Stenosis. Obes Surg 2020; 29:3484-3492. [PMID: 31254212 DOI: 10.1007/s11695-019-04021-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND The use of fully covered self-expandable metallic stents (FCSEMS) has opened the door to treat stenosis in the post-bariatric stomach. We hypothesized that endoscopically securing a FCSEMS would be technically feasible, effective, and safe for > 30-day dwell time. OBJECTIVES To assess the technical feasibility, clinical efficacy, and safety of endoscopically secured FCSEMS in the stomach for > 30 days. METHODS A retrospective review (September 2016 to April 2018) of consecutive patients who underwent FCSEMS suturing in the stomach at a single academic institution was reviewed. Technical success, stent dwell time, symptoms, and adverse events were recorded. RESULTS Fifteen patients (median age of 49 (31-70)) were included. Stents were inserted for gastrojejunal (GJ) stricture or gastric stenosis in 9/15 and 6/15 of patients, respectively. All procedures were technically successful (100%). Immediate and short-term clinical success (prior to stent removal) was 100% in patients who did not have stent migration. Stent migration was seen in 3 cases (20%) after a median dwell time of 211 days. However, 2/3 (66.6%) had not attended their scheduled removal. Recurrence of symptoms after stent removal was seen in 53.3% of patients with 40% undergoing repeat stenting. Median stent dwell was 117 (30-342) days. Sixty percent and 33% of patients had stent dwell of at least 90 and 180 days, respectively. CONCLUSIONS A FCSEMS, if secured, may be safe and effective for even > 90-day dwell time in the post-bariatric stomach and may result in long-term clinical success for GJ stricture after stent removal.
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Affiliation(s)
- Lea Fayad
- Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Cem Simsek
- Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Roberto Oleas
- Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Yervant Ichkhanian
- Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Georges E Fayad
- Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | | | - Michael Schweitzer
- Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Andreas Oberbach
- Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Anthony N Kalloo
- Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Mouen A Khashab
- Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Vivek Kumbhari
- Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
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Ichkhanian Y, Vosoughi K, Aghaie Meybodi M, Jacques J, Sethi A, Patel AA, Aadam AA, Triggs JR, Bapaye A, Dorwat S, Benias P, Chaves DM, Barret M, Law RJ, Browers N, Pioche M, Draganov PV, Kotzev A, Estremera F, Albeniz E, Ujiki MB, Callahan ZM, Itani MI, Brewer OG, Khashab MA. Correction to: Comprehensive analysis of adverse events associated with gastric peroral endoscopic myotomy: an international multicenter study. Surg Endosc 2020; 35:1765. [PMID: 32424623 DOI: 10.1007/s00464-020-07651-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Y Ichkhanian
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, MD, USA
| | - K Vosoughi
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, MD, USA
| | - M Aghaie Meybodi
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, MD, USA
| | - J Jacques
- Gastroenterology Department, Limoges University Hospital, 2 Avenue Martin Luther King, 87042, Rouen, France
| | - A Sethi
- Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, NY, USA
| | - A A Patel
- Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, NY, USA
| | - A A Aadam
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - J R Triggs
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - A Bapaye
- Department of Digestive Diseases & Endoscopy, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India
| | - S Dorwat
- Department of Digestive Diseases & Endoscopy, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India
| | - P Benias
- Division of Gastroenterology, Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, Northwell Health System, New Hyde Park, NY, USA
| | - D M Chaves
- Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - M Barret
- Gastroenterology Unit, Cochin University Hospital, Université Paris Descartes, Paris, France.,Unité INSERM U1016, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - R J Law
- University of Michigan Health Care System, Ann Arbor, USA
| | - N Browers
- University of Michigan Health Care System, Ann Arbor, USA
| | - M Pioche
- Service d'Hépato-gastro-entérologie, Hôpital Edouard Herriot, CHU Lyon, Lyon, France
| | - P V Draganov
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, FL, USA
| | - A Kotzev
- Clinic of Gastroenterology, University Hospital "Alexandrovska", Sofia, Bulgaria
| | - F Estremera
- Clinic of Gastroenterology, University Hospital "Alexandrovska", Sofia, Bulgaria
| | - E Albeniz
- Division of Gastroenterology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - M B Ujiki
- Section of Minimally Invasive Surgery, Department of Surgery, NorthShore University Health System, Evanston, IL, USA
| | - Z M Callahan
- Section of Minimally Invasive Surgery, Department of Surgery, NorthShore University Health System, Evanston, IL, USA
| | - M I Itani
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, MD, USA
| | - O G Brewer
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, MD, USA
| | - M A Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, MD, USA. .,Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Sheikh Zayed Bldg, 1800 Orleans Street, Suite 7125G, Baltimore, MD, 21287, USA.
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El Halabi M, Bou Daher H, Rustom LBO, Marrache M, Ichkhanian Y, Kahil K, El Sayed M, Sharara AI. Characteristics and outcome of patients presenting with acute Pancreatitis: A one-year descriptive study from a tertiary care center in Lebanon. Arab J Gastroenterol 2020; 21:106-110. [PMID: 32409259 DOI: 10.1016/j.ajg.2020.04.015] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/03/2020] [Accepted: 04/19/2020] [Indexed: 12/16/2022]
Abstract
AIM To determine the aetiology, hospital course, and outcome of patients diagnosed with acute pancreatitis (AP) presenting to the Emergency Department (ED) of a tertiary care center in Lebanon. PATIENTS AND METHODS Using a retrospective cross-sectional study design, records of all patients presenting to the ED with elevated lipase over one calendar year (2016) were reviewed. Patients diagnosed with AP according to the revised Atlanta classification were identified. RESULTS Over one year, a total of 24,133 adult patients visited the ED and 4,976 had serum lipase determination. Of those, 75 patients (mean age 59.4 ± 16.1; range 20-95; M:F 2.1) had confirmed AP accounting for 0.3% of adult ED visits. The most common etiologies were biliary (36%), idiopathic (16%), drugs (13%), and alcohol (11%). Intake of drugs known to be associated with AP was identified in 26% of patients. Alcoholic pancreatitis was more common in males, while biliary pancreatitis was more common in females (p less than 0.05 in both). 63 patients (84%) required regular hospital admission and only 1 (1.3%) required intensive care unit admission and passed away after multiorgan failure. Mean hospital stay was 4.0 ± 4.0 days (range 0-23) with mean hospital charges of $6,637 ± 8,496. CONCLUSION Acute pancreatitis accounts for a relatively small number of emergency visits in Lebanon. Leading etiologies are biliary and drugs, with a low contribution of alcohol compared to the West. The economic burden of AP is important, but outcomes appear largely favorable with an overall mortality of less than 2%.
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Affiliation(s)
- Maan El Halabi
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Halim Bou Daher
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon; Division of Gastroenterology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Luma Basma O Rustom
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon; Division of Gastroenterology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Majd Marrache
- School of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Yervant Ichkhanian
- School of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Karine Kahil
- School of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mazen El Sayed
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ala I Sharara
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon; Division of Gastroenterology, American University of Beirut Medical Center, Beirut, Lebanon.
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Al Ghamdi SS, Farha J, Runge TM, Ichkhanian Y, Khashab MA. No pouch, no problem: successful endoscopic division of a symptomatic cricopharyngeal bar using a modified peroral endoscopic myotomy technique for Zenker's diverticulum. VideoGIE 2020; 5:281-282. [PMID: 32642611 PMCID: PMC7332726 DOI: 10.1016/j.vgie.2020.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Sarah S Al Ghamdi
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Jad Farha
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Thomas M Runge
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Yervant Ichkhanian
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD
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Runge TM, Ichkhanian Y, Khashab MA. POEM for achalasia: endoscopic myotomy enters its golden age, and we are taking NOTES. Gastrointest Endosc 2020; 91:1045-1049.e1. [PMID: 32327117 DOI: 10.1016/j.gie.2020.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 01/06/2020] [Indexed: 02/08/2023]
Affiliation(s)
- Thomas M Runge
- Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Yervant Ichkhanian
- Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
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Ichkhanian Y, Yang J, James TW, Baron TH, Irani S, Nasr J, Sharaiha RZ, Law R, Wannhoff A, Khashab MA. EUS-directed transenteric ERCP in non-Roux-en-Y gastric bypass surgical anatomy patients (with video). Gastrointest Endosc 2020; 91:1188-1194.e2. [PMID: 31917168 DOI: 10.1016/j.gie.2019.12.043] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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: 09/04/2019] [Accepted: 12/26/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Enteroscopy-assisted ERCP is challenging in patients with surgically altered upper GI anatomy. This study evaluated a novel procedure, EUS-directed transenteric ERCP (EDEE), in the de novo creation of an enteroenteric anastomosis for the performance of ERCP in non-Roux-en Y gastric bypass (RYGB) patients. METHODS This was a multicenter retrospective study involving 7 centers between January 2014 and October 2018. Primary outcome was clinical success (completion of EDEE and ERCP with intended interventions), and secondary outcomes were technical success and rate/severity of adverse events. RESULTS Eighteen patients (mean age, 63 years; 13 women) were included. The most common type of surgical anatomy was Whipple (10/18) and Roux-en-Y hepaticojejunostomy (6/18). Technical success rate of EUS-guided lumen-apposing metal stent (LAMS) placement was 100% and of ERCP was 94.44% (17/18). Fourteen patients underwent separate-session EDEE with a median of 21 days (interquartile range [IQR], 11.5-36) between the 2 procedures. Median total procedure time was 111 minutes (IQR, 81-192). Clinical success and adverse events occurred in 17 (94.4%) and 1 (5.6%; abdominal pain) patients, respectively, during a median follow-up of 88 days (IQR, 54-142). CONCLUSIONS This study suggests that EDEE using LAMSs is feasible and safe in patients with non-RYGB surgical anatomy and complex pancreaticobiliary pathologies.
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Affiliation(s)
- Yervant Ichkhanian
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA
| | - Juliana Yang
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA
| | - Theodore W James
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Todd H Baron
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Shayan Irani
- Division of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington, USA
| | - John Nasr
- Section of Digestive Diseases, West Virginia University, Morgantown, West Virginia, USA
| | - Reem Z Sharaiha
- Division of Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, New York, USA
| | - Ryan Law
- Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA
| | - Andreas Wannhoff
- Department of Gastroenterology, Hospital Ludwigsburg, Ludwigsburg, Germany
| | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA
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Brewer Gutierrez OI, Moran RA, Familiari P, Dbouk MH, Costamagna G, Ichkhanian Y, Seewald S, Bapaye A, Cho JY, Barret M, Eleftheriadis N, Pioche M, Hayee BH, Tantau M, Ujiki M, Landi R, Invernizzi M, Yoo IK, Roman S, Haji A, Hedberg HM, Parsa N, Mion F, Fayad L, Kumbhari V, Agarwalla A, Ngamruengphong S, Sanaei O, Ponchon T, Khashab MA. Long-term outcomes of per-oral endoscopic myotomy in achalasia patients with a minimum follow-up of 4 years: a multicenter study. Endosc Int Open 2020; 8:E650-E655. [PMID: 32355884 PMCID: PMC7165007 DOI: 10.1055/a-1120-8125] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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: 04/25/2019] [Accepted: 01/27/2020] [Indexed: 12/15/2022] Open
Abstract
Background and study aims Per-oral endoscopic myotomy (POEM) is associated with a short-term clinical response of 82 % to 100 % in treatment of patients with achalasia. Data are limited on the long-term durability of the clinical response in these patients. The aim of this study was to determine the long-term outcomes of patients undergoing POEM for management of achalasia. Methods This was a retrospective multicenter cohort study of consecutive patients who underwent POEM for management of achalasia. Patients had a minimum of 4 years follow-up. Clinical response was defined by an Eckardt score ≤ 3. Results A total of 146 patients were included from 11 academic medical centers. Mean (± SD) age was 49.8 (± 16) years and 79 (54 %) were female. The most common type of achalasia was type II, seen in 70 (47.9 %) patients, followed by type I seen in 41 (28.1 %) patients. Prior treatments included: pneumatic dilation in 29 (19.9 %), botulinum toxin injection in 13 (8.9 %) and Heller myotomy in seven patients (4.8 %). Eight adverse events occurred (6 mucosotomies, 2 pneumothorax) in eight patients (5.5 %). Median follow-up duration was 55 months (IQR 49.9-60.6). Clinical response was observed in 139 (95.2 %) patients at follow-up of ≥ 48 months. Symptomatic reflux after POEM was seen in 45 (32.1 %) patients, while 35.3 % of patients were using daily PPI at 48 months post POEM. Reflux esophagitis was noted in 16.8 % of patients who underwent endoscopy. Conclusion POEM is a durable and safe procedure with an acceptably low adverse event rate and an excellent long-term clinical response.
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Affiliation(s)
| | - Robert A. Moran
- Department of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina, United States
| | - Pietro Familiari
- Digestive Endoscopy Unit – Gemelli University Hospital,Rome, Italy
| | - Mohamad H. Dbouk
- Division of gastroenterology and hepatology Johns Hopkins Hospital, Baltimore, United States
| | - Guido Costamagna
- Digestive Endoscopy Unit – Gemelli University Hospital,Rome, Italy
| | - Yervant Ichkhanian
- Division of gastroenterology and hepatology Johns Hopkins Hospital, Baltimore, United States
| | - Stefan Seewald
- Center of Gastroenterolgy Hirslanden Private Clinic Group Witellikerstrasse 40, 8032 Zürich
| | - Amol Bapaye
- Shivanand Desai Centre for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Centre, Pune, India
| | - Joo Young Cho
- Digestive Endoscopy Center, CHA Bundang Hospital, South Korea
| | | | | | - Mathieu Pioche
- Gastroenterology unit/unit of functional disease and digestive physiology, Edouard Herriot hospital, Lion, France
| | - Bu' Hussain Hayee
- Institute of Therapeutic Endoscopy, Kingʼs College Hospital NHS Foundation Trust, London, UK
| | - Marcel Tantau
- Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Michael Ujiki
- NorthShore University HealthSystem/University of Chicago Medical Center, Chicago, United States
| | - Rosario Landi
- Digestive Endoscopy Unit – Gemelli University Hospital,Rome, Italy
| | - Martina Invernizzi
- Center of Gastroenterolgy Hirslanden Private Clinic Group Witellikerstrasse 40, 8032 Zürich
| | - In Kyung Yoo
- Digestive Endoscopy Center, CHA Bundang Hospital, South Korea
| | - Sabine Roman
- Gastroenterology unit/unit of functional disease and digestive physiology, Edouard Herriot hospital, Lion, France
| | - Amyn Haji
- Institute of Therapeutic Endoscopy, Kingʼs College Hospital NHS Foundation Trust, London, UK
| | - H. Mason Hedberg
- NorthShore University HealthSystem/University of Chicago Medical Center, Chicago, United States
| | - Nasim Parsa
- Division of gastroenterology and hepatology Johns Hopkins Hospital, Baltimore, United States
| | - Francois Mion
- Gastroenterology unit/unit of functional disease and digestive physiology, Edouard Herriot hospital, Lion, France
| | - Lea Fayad
- Division of gastroenterology and hepatology Johns Hopkins Hospital, Baltimore, United States
| | - Vivek Kumbhari
- Division of gastroenterology and hepatology Johns Hopkins Hospital, Baltimore, United States
| | - Anant Agarwalla
- Division of gastroenterology and hepatology Johns Hopkins Hospital, Baltimore, United States
| | - Saowanee Ngamruengphong
- Division of gastroenterology and hepatology Johns Hopkins Hospital, Baltimore, United States
| | - Omid Sanaei
- Division of gastroenterology and hepatology Johns Hopkins Hospital, Baltimore, United States
| | - Thierry Ponchon
- Gastroenterology unit/unit of functional disease and digestive physiology, Edouard Herriot hospital, Lion, France
| | - Mouen A. Khashab
- Division of gastroenterology and hepatology Johns Hopkins Hospital, Baltimore, United States
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Farha J, Fayad L, Kadhim A, Şimşek C, Badurdeen DS, Ichkhanian Y, Itani MI, Kalloo AN, Khashab MA, Kumbhari V. Gastric Per-Oral Endoscopic Myotomy (G-POEM) for the Treatment of Gastric Stenosis Post-Laparoscopic Sleeve Gastrectomy (LSG). Obes Surg 2020; 29:2350-2354. [PMID: 31001761 DOI: 10.1007/s11695-019-03893-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Laparoscopic sleeve gastrectomy (LSG) has become the most common form of bariatric surgery performed worldwide. However, it is associated with potentially debilitating adverse events such as post-operative stenosis. Finding effective and minimally invasive treatments for such complications is of paramount importance. Gastric per-oral endoscopic myotomy (G-POEM) is a novel procedure developed over the past decade to treat conditions that delay gastric emptying. We present a case demonstrating the use of G-POEM in the successful endoscopic management of post-LSG gastric stenosis.
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Affiliation(s)
- Jad Farha
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, 1800 Orleans St., Sheikh Zayed Tower, Suite 7125B, Baltimore, MD, 21287, USA
| | - Lea Fayad
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, 1800 Orleans St., Sheikh Zayed Tower, Suite 7125B, Baltimore, MD, 21287, USA
| | - Ali Kadhim
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, 1800 Orleans St., Sheikh Zayed Tower, Suite 7125B, Baltimore, MD, 21287, USA
| | - Cem Şimşek
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, 1800 Orleans St., Sheikh Zayed Tower, Suite 7125B, Baltimore, MD, 21287, USA
| | - Dilhana S Badurdeen
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, 1800 Orleans St., Sheikh Zayed Tower, Suite 7125B, Baltimore, MD, 21287, USA
| | - Yervant Ichkhanian
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, 1800 Orleans St., Sheikh Zayed Tower, Suite 7125B, Baltimore, MD, 21287, USA
| | - Mohamad I Itani
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, 1800 Orleans St., Sheikh Zayed Tower, Suite 7125B, Baltimore, MD, 21287, USA
| | - Anthony N Kalloo
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, 1800 Orleans St., Sheikh Zayed Tower, Suite 7125B, Baltimore, MD, 21287, USA
| | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, 1800 Orleans St., Sheikh Zayed Tower, Suite 7125B, Baltimore, MD, 21287, USA
| | - Vivek Kumbhari
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, 1800 Orleans St., Sheikh Zayed Tower, Suite 7125B, Baltimore, MD, 21287, USA.
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Ichkhanian Y, Vosoughi K, Aghaie Meybodi M, Jacques J, Sethi A, Patel AA, Aadam AA, Triggs JR, Bapaye A, Dorwat S, Benias P, Chaves DM, Barret M, Law RJ, Browers N, Pioche M, Draganov PV, Kotzev A, Estremera F, Albeniz E, Ujiki MB, Callahan ZM, Itani MI, Brewer OG, Khashab MA. Comprehensive Analysis of Adverse Events Associated with Gastric Peroral Endoscopic Myotomy: An International Multicenter Study. Surg Endosc 2020; 35:1755-1764. [DOI: 10.1007/s00464-020-07570-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 04/15/2020] [Indexed: 02/08/2023]
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Abstract
Background and Aims Accessing the pancreatobiliary region in patients with a history of Roux-en-Y gastric bypass (RYGB) can be challenging. Traditionally, techniques such as percutaneous biliary drainage, enteroscopy-assisted ERCP, and laparoscopy-assisted ERCP have been used. However, each technique has its limitations. EUS–directed transgastric ERCP (EDGE) using a lumen-apposing metal stent (LAMS) has emerged as a novel endoscopic technique for ERCP in patients who have undergone RYGB. The aim of this case series was to highlight LAMS-related shortcomings and adverse events during the periprocedural period. Methods This was a retrospective review of 4 patients with RYGB anatomy who underwent EDGE for the management of pancreaticobiliary disease and experienced LAMS-related adverse events. Techniques for managing and avoiding these events are discussed. Results Four patients underwent EDGE with both technical and clinical success. Slight LAMS migration with partial mucosal overgrowth was encountered in 1 case and was managed by LAMS removal. A large, bleeding, distal marginal ulcer after the EDGE procedure was encountered in the second case and was managed with proton pump inhibitor and removal of the LAMS, with fistula treatment with argon plasma coagulation used to enhance closure. The third case was complicated by moderate intraprocedural bleeding after LAMS dilation, which was managed by applying balloon tamponade and placing a through-the-scope esophageal stent across the LAMS. Last, preferential food passage to the excluded stomach was noted in the fourth case and resulted in symptomatic distention. The symptomatic distention was managed by another de novo jejunogastrostomy using a LAMS for drainage. Conclusions Despite its feasibility and acceptable safety profile, the use of LAMSs during EDGE could be associated with several procedure-specific adverse events, which can be avoided or managed endoscopically with no further consequence.
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Affiliation(s)
- Yervant Ichkhanian
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Thomas Runge
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Manol Jovani
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Kia Vosoughi
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland
| | | | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland
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50
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Brewer Gutierrez OI, Akshintala VS, Ichkhanian Y, Brewer GG, Hanada Y, Truskey MP, Agarwal A, Hajiyeva G, Kumbhari V, Kalloo AN, Khashab MA, Ngamruengphong S. Endoscopic full-thickness resection using a clip non-exposed method for gastrointestinal tract lesions: a meta-analysis. Endosc Int Open 2020; 8:E313-E325. [PMID: 32118105 PMCID: PMC7035039 DOI: 10.1055/a-1073-7593] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 11/13/2018] [Accepted: 11/18/2019] [Indexed: 02/08/2023] Open
Abstract
Background and study aims Endoscopic full-thickness resection (EFTR) allows for treatment of epithelial and sub-epithelial lesions (SELs) unsuitable to conventional resection techniques. This meta-analysis aimed to assess the efficacy and safety of clip-assisted method for non-exposed EFTR using FTRD or over-the-scope clip of gastrointestinal tumors. Methods A comprehensive literature search was performed. The primary outcome of interest was the rate of histologic complete resection (R0). Secondary outcomes of interest were the rate of enbloc resection, FTR, adverse events, and post-EFTR surgery. Random-effects model was used to calculate pooled estimates and generate forest plots. Results Eighteen studies with 730 patients and 733 lesions were included in the analyses. Indications for EFTR were difficult/residual colorectal adenoma, adenoma at a diverticulum or appendiceal orifice and early cancer (n = 634), colorectal SELs (n = 42), and upper gastrointestinal lesions (n = 51), other colonic lesions (n = 6). Median size of lesions was 13.5 mm. There were 22 failed EFTR attempts. Pooled overall R0 resection rate was 82 % (95 % CI: 75, 89). The pooled overall FTR rate was 83 % (95 % CI: 77, 89). The pooled overall enbloc resection rate was 95 (95 % CI: 92, 96). The pooled estimates for perforation and bleeding were < 0.1 % and 2 %, respectively. Following EFTR, a total of 110 patients underwent surgery for any reason [pooled rate 7 % (95 % 2, 14). The pooled rates for post-EFTR surgery due to invasive cancer, for non-curative endoscopic resection and for adverse events were 4 %, < 0.1 % and < 0.1 %, respectively. No mortality related to EFTR was noted. Conclusions EFTR appears to be safe and effective for gastrointestinal lesions that are not amenable to conventional endoscopic resection. This technique should be considered as an alternative to surgery in selected cases.
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Affiliation(s)
- Olaya I. Brewer Gutierrez
- Division of Gastroenterology and hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Venkata S. Akshintala
- Division of Gastroenterology and hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Yervant Ichkhanian
- Division of Gastroenterology and hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Gala G. Brewer
- Division of Gastroenterology and hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Yuri Hanada
- Department of Internal Medicine, Johns Hopkins Hospital Baltimore, Maryland, United States
| | - Maria P. Truskey
- William H. Welch Medical Library, Johns Hopkins Medical Institutions, Baltimore, Maryland, United States
| | - Amol Agarwal
- Department of Internal Medicine, Johns Hopkins Hospital Baltimore, Maryland, United States
| | - Gulara Hajiyeva
- Department of Internal Medicine, Johns Hopkins Hospital Baltimore, Maryland, United States
| | - Vivek Kumbhari
- Division of Gastroenterology and hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Anthony N. Kalloo
- Division of Gastroenterology and hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Mouen A. Khashab
- Division of Gastroenterology and hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Saowanee Ngamruengphong
- Division of Gastroenterology and hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
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