1
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Elford AT, Ardalan Z, Simkin P, Christensen B. Comprehensive review and update of stricturing Crohn's disease. Indian J Gastroenterol 2024; 43:64-77. [PMID: 38277070 DOI: 10.1007/s12664-023-01508-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 12/17/2023] [Indexed: 01/27/2024]
Abstract
Up to 50% of patients with Crohn's disease develop a stricture within 10 years of diagnosis. Crohn's strictures can compose of inflammation, fibrosis or smooth muscle expansion and usually a combination of these. There have been numerous new developments in imaging modalities in determining the composition of Crohn's strictures. Magnetic resonance imaging remains the best upfront imaging modality to characterize Crohn's strictures. Gastrointestinal ultrasound (GIUS) has an increasing role in clinical practice, particularly for monitoring stricture response as a treat-to-target tool. Novel imaging techniques to differentiate between fibrosis and inflammatory strictures have been developed including contrast-enhanced GIUS, strain or shear wave elastography with GIUS and multiple new magnetic resonance imaging (MRI) protocols, including diffusion weighted, delayed contrast enhancement and magnetization transfer MR protocols. However, these techniques require further validation and standardization. Regarding therapeutics, anti-tumor necrosis agents with a treat-to-target strategy have the highest quality evidence in treating strictures and can lead to stricture regression in some cases. Endoscopic balloon dilatation remains a mainstay in the treatment algorithm of treating predominantly fibrostenotic Crohn's strictures, particularly those which are symptomatic, < 5 cm in length and not causing prestenotic dilatation. Endoscopic balloon dilatation has greater effectiveness in anastomotic strictures. Surgery remains an important treatment option in Crohn's strictures, with segmental resection and stricturoplasty having their own advantages and disadvantages. Kono-S anastomosis may be superior to conventional anastomosis for endoscopic recurrence; however, further high-quality studies are required to confirm this. Using risk stratification models such as the BACARDI risk model is important to guide management decisions between a medical and surgical approach. Early post-operative medical prophylaxis with an advanced therapy is an important consideration to prevent disease recurrence. This review expands on the above topics, highlights research gaps and provides a suggested investigation and management pathway in stricturing Crohn's disease.
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Affiliation(s)
- Alexander T Elford
- Gastroenterology Department, Royal Melbourne Hospital, Melbourne, Australia.
- Faculty of Medicine, Melbourne University, Melbourne, Australia.
- Edinburgh Inflammatory Bowel Diseases Unit, Western General Hospital, Edinburgh, UK.
| | - Zaid Ardalan
- Gastroenterology Department, Royal Melbourne Hospital, Melbourne, Australia
- Faculty of Medicine, Melbourne University, Melbourne, Australia
- Faculty of Medicine, Monash University, Melbourne, Australia
- Gastroenterology Department, Alfred Health, Melbourne, Australia
| | - Paul Simkin
- Radiology Department, Royal Melbourne Hospital, Melbourne, Australia
| | - Britt Christensen
- Gastroenterology Department, Royal Melbourne Hospital, Melbourne, Australia
- Faculty of Medicine, Melbourne University, Melbourne, Australia
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2
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Kutaiba N, Varcoe JG, Barnes P, Succar N, Lau E, Patwala K, Low E, Ardalan Z, Gow P, Goodwin M. Radiation exposure from radiological procedures in liver transplant candidates with hepatocellular carcinoma. Eur J Radiol 2023; 158:110656. [PMID: 36542933 DOI: 10.1016/j.ejrad.2022.110656] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 10/25/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Candidates for liver transplantation (LT) with hepatocellular carcinoma (HCC) undergo a large number of diagnostic and interventional radiology procedures. A significant proportion of such procedures involve ionizing radiation with increased lifetime risk of cancer. The objective of our study was to review LT candidates with HCC to quantify ionizing radiation doses from different radiology procedures performed at a single transplant center. METHOD We retrospectively reviewed 179 adult patients with HCC (median age 58.6 years [IQR, 55-62]; 155 [86.6%] males) who were accepted for LT between April 2010 and Dec 2018. Radiology procedures and radiation doses were retrieved and the total and median radiation effective dose in millisieverts (mSv) were calculated for different procedures. Exposure to ionizing radiation was categorized based on previously reported thresholds. RESULTS We assessed 9,986 radiology procedures for our cohort. Patients had a median effective dose prior to transplantation of 254 mSv (IQR, 130-421) with an annualized rate of 152 mSv (IQR, 92-266). Patient median dose increased to 316 mSv (IQR, 159-478) when including exposures post-LT within the study period. 85% of overall exposure was in the extremely high exposure category (>100 mSv). Interventional procedures represented 13% of procedures with substantial radiation and contributed to 45% of radiation exposure while abdominal CTs represented 39% of total procedures and contributed to 45% of radiation exposure. CONCLUSIONS Patients with HCC considered for LT undergo radiology procedures with significant cumulative radiation exposure. Attempts to reduce radiation exposure are suggested by minimizing unnecessary procedures and utilizing ones without ionizing radiation. Improving interventional techniques to reduce radiation doses is needed without compromising treatment delivery.
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Affiliation(s)
- Numan Kutaiba
- Radiology Department, Austin Health, Melbourne, Victoria, Australia; The University of Melbourne, Victoria, Australia.
| | - Joshua G Varcoe
- Australian Radiation Protection and Nuclear Safety Agency, Melbourne, Victoria, Australia; Medical Physics, Austin Health, Melbourne, Victoria, Australia
| | - Peter Barnes
- Medical Physics, Austin Health, Melbourne, Victoria, Australia
| | - Natalie Succar
- Radiology Department, Austin Health, Melbourne, Victoria, Australia
| | - Eddie Lau
- Radiology Department, Austin Health, Melbourne, Victoria, Australia; The University of Melbourne, Victoria, Australia; Molecular Imaging and Therapy, Austin Health, Melbourne, Victoria, Australia
| | - Kurvi Patwala
- Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia
| | - Elizabeth Low
- Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia
| | - Zaid Ardalan
- Department of Gastroenterology, Alfred Health and Monash University, Melbourne, Victoria, Australia
| | - Paul Gow
- The University of Melbourne, Victoria, Australia; Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia
| | - Mark Goodwin
- Radiology Department, Austin Health, Melbourne, Victoria, Australia; The University of Melbourne, Victoria, Australia
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3
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Segal JP, Kayal M, Ardalan Z, Garg M, Sparrow M, Barnes E. Acute pouchitis: the condition that time forgot about. Therap Adv Gastroenterol 2022; 15:17562848221124057. [PMID: 36171809 PMCID: PMC9511291 DOI: 10.1177/17562848221124057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
| | - Maia Kayal
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Zaid Ardalan
- Department of Gastroenterology, Alfred Health, Melbourne, VIC, Australia
| | - Mayur Garg
- Department of Gastroenterology, Northern Hospital Epping, Melbourne, VIC, Australia
- Department of Clinical Medicine, University of Melbourne, Parkville, VIC, Australia
| | - Miles Sparrow
- Department of Gastroenterology, Alfred Health, Melbourne, VIC, Australia
| | - Edward Barnes
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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4
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Vaughan R, Murphy E, Nalder M, Gibson RN, Ardalan Z, Boussioutas A, Christensen B. Infliximab Trough Levels Are Associated With Transmural Sonographic Healing in Inflammatory Bowel Disease. Inflamm Bowel Dis 2022:6696163. [PMID: 36094156 DOI: 10.1093/ibd/izac186] [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: 06/15/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND Mucosal healing improves clinical outcomes in patients with inflammatory bowel disease (IBD) and is associated with higher infliximab trough levels (ITLs). Transmural healing, assessed by intestinal ultrasound (IUS), is emerging as an objective target in Crohn's disease (CD) and ulcerative colitis (UC). This study explores the correlation between maintenance ITLs and sonographic transmural healing. METHODS Patients on maintenance infliximab therapy were prospectively enrolled to undergo paired IUS examination and serum ITL. Infliximab trough levels were compared between patients with and without sonographic markers of inflammation using the Mann-Whitney U test. RESULTS A prospective cohort of 103 patients (51% male; 79 CD; 24 UC; median duration of disease 8 years) underwent IUS and serum ITL testing. Forty-one percent of CD and 66% of UC patients demonstrated sonographic healing (bowel wall thickening ≤3 mm with no increase in color Doppler signal). Crohn's disease patients with sonographic healing had higher median ITL compared with those with sonographic inflammation (4.8 μg/mL vs 3.1 μg/mL; P = .049). Additionally, the presence of hyperemia on Doppler was independently associated with lower ITL compared with those without hyperemia (2.1 μg/mL vs 4.2 μg/mL, respectively; P = .003). There was no significant association between ITL and other sonographic markers of inflammation. In UC, lower ITL was associated with hyperemia on Doppler imaging (P = .04). There was no association between ITL and sonographic healing or any other individual sonographic parameter of inflammation. CONCLUSIONS Lower maintenance infliximab levels are associated with sonographic parameters of inflammation in UC and CD. Further studies are needed to determine whether targeting higher infliximab levels can increase sonographic healing.
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Affiliation(s)
- Rose Vaughan
- Department of Gastroenterology, The Royal Melbourne Hospital, Melbourne, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - Elise Murphy
- Department of Gastroenterology, The Royal Melbourne Hospital, Melbourne, Australia.,Pharmacy, The Royal Melbourne Hospital, Melbourne, Australia
| | - Michelle Nalder
- Pharmacy, The Royal Melbourne Hospital, Melbourne, Australia
| | - Robert N Gibson
- Department of Radiology, The Royal Melbourne Hospital and The University of Melbourne, Melbourne, Australia
| | - Zaid Ardalan
- Department of Gastroenterology, The Royal Melbourne Hospital, Melbourne, Australia
| | - Alex Boussioutas
- Department of Gastroenterology, The Royal Melbourne Hospital, Melbourne, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - Britt Christensen
- Department of Gastroenterology, The Royal Melbourne Hospital, Melbourne, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Australia
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5
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Mitreski G, McGill J, Nikolovski Z, Jamel W, Al-Kaisey Y, Kam NM, Con D, Ardalan Z, Kutaiba N. Value of computed tomography scores in complicated acute diverticulitis. ANZ J Surg 2022; 92:2935-2941. [PMID: 35866354 DOI: 10.1111/ans.17913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 05/28/2022] [Accepted: 07/03/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Diverticular disease remains one of the most common conditions in the western world. Up to 25% of patients with diverticular disease require hospitalization, 15-30% of those of which require surgical intervention. CT scoring systems have been proposed as means to drive assessment and stratify patients necessitating hospital intervention. To assess and correlate CT scoring systems with clinical and surgical outcomes. METHODS Retrospective cohort analysis at a single institution. Single institutional assessment with patients presenting to emergency with a CT diagnosed episode of acute diverticulitis. One hundred and eighty-nine patients were included in the study, 61% of which were male. Patient demographics, comorbidities, medications, biochemistry and inflammatory markers, type of complication following acute diverticulitis, operative/procedural intervention, hospital outcome and mortality were measured. CT scoring systems assessed included modified Hinchey, modified Neff, World Society of Emergency Surgery (WSES) and modified Siewert scoring systems. RESULTS Majority of patients had left-sided diverticulitis (91%) with localized air (88%) and pericolic abscess (49%) the most common radiological findings. 28% of patients required radiological and/or surgical management with 12% requiring intensive care unit (ICU) admission. There was a general trend for surgical/radiological intervention as the scores increased in severity. The four scoring systems were found to be statistically significant predictors of any intervention and of ICU admission with minimal statistical differences across the different scoring systems. CONCLUSION Radiological CT scores for complicated diverticulitis are at best, moderate predictors of clinical and surgical outcomes and may serve to guide management with minimal statistical differences across different scores.
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Affiliation(s)
- Goran Mitreski
- Department of Radiology, Austin Health, Melbourne, Victoria, Australia
| | - Jeannette McGill
- Department of Medicine, Austin Health, Melbourne, Victoria, Australia
| | - Zoran Nikolovski
- Department of Medicine, Austin Health, Melbourne, Victoria, Australia
| | - Wael Jamel
- Department of Surgery, Austin Health, Melbourne, Victoria, Australia
| | - Yasir Al-Kaisey
- Department of Surgery, Austin Health, Melbourne, Victoria, Australia
| | - Ning Mao Kam
- Department of Radiology, St Vincent's Health, Melbourne, Victoria, Australia
| | - Danny Con
- Department of Gastroenterology, Eastern Health, Melbourne, Victoria, Australia
| | - Zaid Ardalan
- Department of Gastroenterology, Alfred Health and Monash University, Melbourne, Victoria, Australia
| | - Numan Kutaiba
- Department of Radiology, Austin Health, Melbourne, Victoria, Australia
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6
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Vaughan R, Tjandra D, Patwardhan A, Mingos N, Gibson R, Boussioutas A, Ardalan Z, Al‐Ani A, Gibson PR, Christensen B. Toward transmural healing: Sonographic healing is associated with improved long-term outcomes in patients with Crohn's disease. Aliment Pharmacol Ther 2022; 56:84-94. [PMID: 35343603 PMCID: PMC9313877 DOI: 10.1111/apt.16892] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 02/09/2022] [Accepted: 03/04/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND AIMS Transmural healing has emerged as a treatment target in Crohn's disease (CD). We investigated whether transmural healing assessed with intestinal ultrasound (IUS) is associated with improved clinical outcomes in patients with CD in clinical remission. METHODS Patients with CD in clinical remission at baseline (HBI <4) having IUS between August 2017 and June 2020 with at least 6-months' follow-up were retrospectively studied. Time to medication escalation, corticosteroid use and CD-related hospitalisation or surgery were compared by the presence or absence of sonographic healing, defined as bowel wall thickness ≤3 mm without hyperemia on color Doppler, inflammatory fat, or disrupted bowel wall stratification. Factors associated with survival were analyzed by Kaplan-Meier analysis using Cox proportional-hazard model. RESULTS Of 202 consecutive patients (50% male), sonographic inflammation was present in 61%. During median follow-up of 19 (IQR 13-27) months, medication escalation occurred in 52%, corticosteroid use in 23%, hospitalisation in 21%, and CD-related surgery in 13%. Sonographic healing was significantly associated with a reduced risk of medication escalation (p = 0.0018), corticosteroid use (p = 0.0247), hospitalisation (p = 0.0102), and surgery (p = 0.083). On multivariable analysis, sonographic healing was significantly associated with an increased odds of medication escalation-free survival (hazard ratio [HR]:1.94; 95% CI 1.23-3.06; p = 0.004) and corticosteroid-free survival (HR:2.41; 95% CI 1.24-4.67; p = 0.009), but not with hospitalisation or surgery. CONCLUSION In patients with CD in clinical remission, sonographic healing is associated with improved clinical outcomes. Further studies are needed to determine whether sonographic healing should be a treatment target.
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Affiliation(s)
- Rose Vaughan
- Department of GastroenterologyRoyal Melbourne HospitalMelbourneAustralia
| | - Douglas Tjandra
- Department of GastroenterologyRoyal Melbourne HospitalMelbourneAustralia
| | - Ashwin Patwardhan
- Department of GastroenterologyRoyal Melbourne HospitalMelbourneAustralia
| | - Nicholas Mingos
- Department of GastroenterologyRoyal Melbourne HospitalMelbourneAustralia
| | - Robert Gibson
- Department of RadiologyRoyal Melbourne HospitalMelbourneAustralia
| | - Alex Boussioutas
- Department of GastroenterologyRoyal Melbourne HospitalMelbourneAustralia
| | - Zaid Ardalan
- Department of GastroenterologyRoyal Melbourne HospitalMelbourneAustralia
| | - Aysha Al‐Ani
- Department of GastroenterologyRoyal Melbourne HospitalMelbourneAustralia
| | - Peter R. Gibson
- Department of GastroenterologyAlfred Hospital and Monash UniversityMelbourneAustralia
| | - Britt Christensen
- Department of GastroenterologyRoyal Melbourne HospitalMelbourneAustralia
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7
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Lu S, Archard R, Mcleod L, Banh A, Con D, Ardalan Z, Kutaiba N. Portal Venous Pulsatility Index as a predictor of fibrosis in patients with non‐alcoholic fatty liver disease. Australas J Ultrasound Med 2021; 25:36-41. [DOI: 10.1002/ajum.12286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Shisheng Lu
- Department of Radiology Austin Health Melbourne Victoria Australia
| | - Robyn Archard
- Department of Radiology Austin Health Melbourne Victoria Australia
| | - Linda Mcleod
- Department of Radiology Austin Health Melbourne Victoria Australia
| | - Angus Banh
- Department of Radiology Austin Health Melbourne Victoria Australia
| | - Danny Con
- Department of General Medicine Eastern Health Melbourne Victoria Australia
| | - Zaid Ardalan
- Department of Gastroenterology Austin Health Melbourne Victoria Australia
- Department of Gastroenterology Alfred Health and Monash University Melbourne Victoria Australia
| | - Numan Kutaiba
- Department of Radiology Austin Health Melbourne Victoria Australia
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8
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Al‐Ani AH, Prentice RE, Rentsch CA, Johnson D, Ardalan Z, Heerasing N, Garg M, Campbell S, Sasadeusz J, Macrae FA, Ng SC, Rubin DT, Christensen B. Review article: prevention, diagnosis and management of COVID-19 in the IBD patient. Aliment Pharmacol Ther 2020; 52:54-72. [PMID: 32348598 PMCID: PMC7267115 DOI: 10.1111/apt.15779] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [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: 04/13/2020] [Revised: 04/15/2020] [Accepted: 04/17/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND The current COVID-19 pandemic, caused by SARS-CoV-2, has emerged as a public health emergency. All nations are seriously challenged as the virus spreads rapidly across the globe with no regard for borders. The primary management of IBD involves treating uncontrolled inflammation with most patients requiring immune-based therapies. However, these therapies may weaken the immune system and potentially place IBD patients at increased risk of infections and infectious complications including those from COVID-19. AIM To summarise the scale of the COVID-19 pandemic, review unique concerns regarding IBD management and infection risk during the pandemic and assess COVID-19 management options and drug interactions in the IBD population. METHODS A literature review on IBD, SARS-CoV-2 and COVID-19 was undertaken and relevant literature was summarised and critically examined. RESULTS IBD patients do not appear to be more susceptible to SARS-CoV-2 infection and there is no evidence of an association between IBD therapies and increased risk of COVID-19. IBD medication adherence should be encouraged to prevent disease flare but where possible high-dose systemic corticosteroids should be avoided. Patients should exercise social distancing, optimise co-morbidities and be up to date with influenza and pneumococcal vaccines. If a patient develops COVID-19, immune suppressing medications should be withheld until infection resolution and if trial medications for COVID-19 are being considered, potential drug interactions should be checked. CONCLUSIONS IBD patient management presents a challenge in the current COVID-19 pandemic. The primary focus should remain on keeping bowel inflammation controlled and encouraging medication adherence.
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Affiliation(s)
- Aysha H. Al‐Ani
- Department of GastroenterologyThe Royal Melbourne HospitalMelbourneVic.Australia
| | - Ralley E. Prentice
- Department of GastroenterologyThe Royal Melbourne HospitalMelbourneVic.Australia
| | - Clarissa A. Rentsch
- Department of GastroenterologyThe Royal Melbourne HospitalMelbourneVic.Australia
| | - Doug Johnson
- Victorian Infectious Diseases UnitThe Royal Melbourne HospitalMelbourneVic.Australia
| | - Zaid Ardalan
- Department of GastroenterologyThe Royal Melbourne HospitalMelbourneVic.Australia
| | - Neel Heerasing
- Department of GastroenterologyThe Royal Melbourne HospitalMelbourneVic.Australia
| | - Mayur Garg
- Department of GastroenterologyThe Royal Melbourne HospitalMelbourneVic.Australia
| | - Sian Campbell
- Victorian Infectious Diseases UnitThe Royal Melbourne HospitalMelbourneVic.Australia
| | - Joe Sasadeusz
- Victorian Infectious Diseases UnitThe Royal Melbourne HospitalMelbourneVic.Australia
| | - Finlay A. Macrae
- Department of GastroenterologyThe Royal Melbourne HospitalMelbourneVic.Australia
| | - Siew C. Ng
- Department of Medicine and TherapeuticsInstitute of Digestive DiseaseState Key Laboratory of Digestive DiseasesLi Ka Shing Institute of Health ScienceThe Chinese University of Hong KongHong Kong Special Administrative RegionChina
| | - David T. Rubin
- Inflammatory Bowel Disease CenterUniversity of Chicago MedicineChicagoILUSA
| | - Britt Christensen
- Department of GastroenterologyThe Royal Melbourne HospitalMelbourneVic.Australia
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9
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Kutaiba N, Ardalan Z, Rotella J. Fatty liver as a radiological incidental finding in the emergency department: An opportunity to lessen a growing burden on the health care system. Emerg Med Australas 2020; 32:528-529. [DOI: 10.1111/1742-6723.13506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 01/17/2020] [Accepted: 01/30/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Numan Kutaiba
- Radiology DepartmentAustin Health Melbourne Victoria Australia
| | - Zaid Ardalan
- Gastroenterology DepartmentAustin Health Melbourne Victoria Australia
- Gastroenterology DepartmentAlfred Health and Monash University Melbourne Victoria Australia
| | - Joe‐Anthony Rotella
- Emergency DepartmentAustin Health Melbourne Victoria Australia
- Division of Medicine, Dentistry and Health Sciences, The University of Melbourne Melbourne Victoria Australia
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10
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Kutaiba N, Rotella JA, Ardalan Z, Testro A. Incidental hepatic steatosis in radiology reports: a survey of emergency department clinicians' perspectives and current practice. J Med Imaging Radiat Oncol 2019; 63:573-579. [PMID: 31385415 DOI: 10.1111/1754-9485.12938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 03/25/2019] [Revised: 06/02/2019] [Accepted: 07/14/2019] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Hepatic steatosis is a relatively common incidental finding on computed tomography (CT) studies performed for patients in the emergency department (ED). The aim of our survey was to explore the preferences and perspectives of emergency physicians regarding reporting of incidental findings with a focus on hepatic steatosis. METHODS A prospective web-based questionnaire was conducted and distributed electronically to emergency clinicians with anonymous collection of responses. RESULTS A total of 236 responses were received. The true response rate could not be determined due to different methods of electronic distribution. However, there was an estimated representation of 8.3% for ED physicians and 2.5% for trainees. The median time spent on the survey was less than 3 minutes. Seventy-seven per cent answered yes to giving an incidental finding more significance if mentioned in the conclusion section. More than half of respondents (60.2%) reported that they would like hepatic steatosis to be mentioned in a CT report while 30% reported that it was irrelevant in the emergency setting and 10% reported that they did not want it mentioned in the report. The majority (83.1%) reported that they would include this finding in the discharge summary for GP follow-up and less than half (44.1%) would mention it to patients. CONCLUSION Our survey highlights the importance of clear communication between radiologists and ED physicians when incidental findings are encountered. Radiologists play an important role in alerting ED physicians and clinicians who have access to patients' radiology reports to the presence of incidental findings including hepatic steatosis.
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Affiliation(s)
- Numan Kutaiba
- Radiology Department, Austin Health, Melbourne, Victoria, Australia
| | - Joe-Anthony Rotella
- Emergency Department, Austin Health, Melbourne, Victoria, Australia.,The University of Melbourne, Melbourne, Victoria, Australia
| | - Zaid Ardalan
- Gastroenterology Department, Austin Health, Melbourne, Victoria, Australia.,Gastroenterology Department, Alfred Health and Monash University, Melbourne, Victoria, Australia
| | - Adam Testro
- The University of Melbourne, Melbourne, Victoria, Australia.,Gastroenterology Department, Austin Health, Melbourne, Victoria, Australia
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11
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Kutaiba N, Richmond D, Morey M, Brennan D, Rotella JA, Ardalan Z, Goodwin M. Incidental hepatic steatosis on unenhanced computed tomography performed for suspected renal colic: Gaps in reporting and documentation. J Med Imaging Radiat Oncol 2019; 63:431-438. [PMID: 30874372 DOI: 10.1111/1754-9485.12873] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 02/17/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Hepatic steatosis is a common incidental finding on computed tomography (CT) in patients presenting to the emergency department (ED). The aims of our study were to assess the prevalence of hepatic steatosis in ED patients with suspected renal colic and to assess documentation in radiology reports and medical charts correlated with alanine transaminase (ALT) levels. METHODS Over 18 months from January 2016 to June 2017, all unenhanced CTs performed for suspected renal colic were reviewed. Quantitative assessment measuring hepatic and splenic attenuation in Hounsfield Units was performed. Hepatic steatosis was defined using multiple CT criteria including liver/spleen (L/S) ratio. Radiology reports, medical charts and ALT levels, if collected within 24 h of CT, were reviewed. RESULTS A total of 1290 patients were included with a median age 52.5 years (range 16-98) and male predominance (835 [64.7%]). A total of 336 (26%) patients had hepatic steatosis measured by L/S ratio of ≤ 1.0. Ninety-four patients (28%) had radiology reports noting steatosis. Documentation in medical charts was noted in 18 of the 94 patients (19.1%) for whom steatosis was reported. Liver enzymes were available for 704 (54.6%) patients. There was a significantly higher mean ALT level in patients with hepatic steatosis (42.2 U/L; 95% CI 38.4-46.0) compared to patients without (28.8 U/L; 95% CI 25.7-31.9) (P < 0.0001). CONCLUSION Our findings highlight multiple gaps in the reporting and evaluation of hepatic steatosis among radiologists and emergency clinicians alike. Recognising and reporting this incidental finding may impact health outcomes.
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Affiliation(s)
- Numan Kutaiba
- Radiology Department, Austin Health, Melbourne, Victoria, Australia
| | | | - Matthew Morey
- Radiology Department, Austin Health, Melbourne, Victoria, Australia
| | - Daniel Brennan
- Radiology Department, Austin Health, Melbourne, Victoria, Australia
| | - Joe-Anthony Rotella
- Emergency Department, Austin Health, Melbourne, Victoria, Australia.,The University of Melbourne, Melbourne, Victoria, Australia
| | - Zaid Ardalan
- Gastroenterology Department, Austin Health, Melbourne, Victoria, Australia.,Gastroenterology Department, Alfred Health and Monash University, Melbourne, Victoria, Australia
| | - Mark Goodwin
- Radiology Department, Austin Health, Melbourne, Victoria, Australia.,The University of Melbourne, Melbourne, Victoria, Australia
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12
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Vasudevan A, Ardalan Z, Gow P, Angus P, Testro A. Efficacy of outpatient continuous terlipressin infusions for hepatorenal syndrome. Hepatology 2016; 64:316-8. [PMID: 26524479 DOI: 10.1002/hep.28325] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 09/02/2015] [Accepted: 09/12/2015] [Indexed: 12/07/2022]
Affiliation(s)
| | - Zaid Ardalan
- Liver Transplant Unit Victoria, Austin Health, Melbourne, Australia
| | - Paul Gow
- Liver Transplant Unit Victoria, Austin Health, Melbourne, Australia
| | - Peter Angus
- Liver Transplant Unit Victoria, Austin Health, Melbourne, Australia
| | - Adam Testro
- Liver Transplant Unit Victoria, Austin Health, Melbourne, Australia
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13
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Vasudevan A, Ardalan Z, Angus P. Liver Failure Complicating a Febrile Illness in a Middle-Aged Man. Gastroenterology 2016; 150:1542-1544. [PMID: 27151259 DOI: 10.1053/j.gastro.2016.01.044] [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: 01/01/2016] [Revised: 01/19/2016] [Accepted: 01/29/2016] [Indexed: 12/02/2022]
Affiliation(s)
- Abhinav Vasudevan
- Department of Gastroenterology and Liver Transplantation, Austin Hospital, Heidelberg, Victoria, Australia
| | - Zaid Ardalan
- Department of Gastroenterology and Liver Transplantation, Austin Hospital, Heidelberg, Victoria, Australia
| | - Peter Angus
- Department of Gastroenterology and Liver Transplantation, Austin Hospital, Heidelberg, Victoria, Australia
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