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Chen V, Hara R, Siddiqui AA, Omar HN, Nazareth A, Lightdale-Miric N, Phan A, Wren TAL, Goldstein RY. Dedicated Early Morning Orthopaedic Trauma Operating Room Is Associated With Shorter Time to Surgery and Decreased Length of Hospital Stay for Children Undergoing Surgical Treatment of Supracondylar Humerus Fractures: A Retrospective Cohort Study. J Am Acad Orthop Surg 2024; 32:383-389. [PMID: 37755393 DOI: 10.5435/jaaos-d-20-00929] [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: 08/07/2020] [Accepted: 08/24/2023] [Indexed: 09/28/2023] Open
Abstract
INTRODUCTION The purpose of this study was to investigate whether the use of a dedicated early morning orthopaedic trauma operating room (OR) resulted in shorter wait times, decreased surgical times, decreased length of stay (LOS), and decreased complications in children treated with urgent surgical intervention for supracondylar humerus fractures. METHODS This retrospective comparative cohort study at a level I pediatric trauma center included patients younger than 12 years with supracondylar humerus fractures urgently treated with closed or open reduction and percutaneous pinning. Index surgical cases from April 28, 2013, to February 26, 2020, were included. Patients with prior humerus fracture, concomitant injuries, open fracture, pulseless supracondylar fracture, or missing data were excluded. Patients were analyzed based on the type of OR: dedicated early morning orthopaedic trauma OR or typical daytime orthopaedic OR. The primary outcome was time from presentation to surgery. Secondary outcomes included surgical time, complications, and LOS. RESULTS A total of 401 patients with a mean age of 5 ± 2 (range: 1 to 11) years and a mean follow-up of 2.0 ± 2.1 (range: 0.5 to 25.0) months were included, of whom 137 patients (34%) underwent surgery in the early morning dedicated orthopaedic trauma OR. The dedicated early morning orthopaedic OR group had significantly less time from presentation to surgery (7.5 versus 9.4 hours; P = 0.0002) and shorter LOS (21.0 versus 24.0 hours; P = 0.004) compared with children treated in the typical daytime orthopaedic OR. Surgical time (31.1 versus 32.6 minutes; P = 0.40) and complication rates (5.8% versus 4.9%; P = 0.65) were similar between the groups. No revision surgery was required in either group. DISCUSSION Surgical wait times were diminished with use of the dedicated early morning OR, as was LOS. Surgical times and complication rates were similar between groups. Institutions may consider adopting a dedicated early morning orthopaedic trauma OR to improve surgical wait times and decrease LOS. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Vivian Chen
- From the Jackie and Gene Autry Orthopedic Center, Children's Hospital Los Angeles, Los Angeles, CA (Chen, Hara, Siddiqui, Omar, Nazareth, Lightdale-Miric, Phan, Wren, and Goldstein) and the Department of Orthopaedic Surgery, Harbor-UCLA Medical Center, Torrance, CA (Nazareth)
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Siddiqui AA, Troyer WD, Bango J, Mustafa MS, Buckner JF, Shi GG, Haupt ET. Lateralizing calcaneal osteotomy performed with a percutaneous burr results in a significantly lower increase in tarsal tunnel pressure. Eur J Orthop Surg Traumatol 2024; 34:1865-1870. [PMID: 38431895 DOI: 10.1007/s00590-024-03865-2] [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] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 02/16/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE Tarsal tunnel syndrome is well documented following lateralizing calcaneal osteotomy to manage varus hindfoot deformity. Traditionally, calcaneal osteotomy is performed with an oscillating saw. No studies have investigated the effect of alternative surgical techniques on postoperative tarsal tunnel pressure. The purpose of this study was to investigate the difference in tarsal tunnel pressures following lateralizing calcaneal osteotomy performed using a high-torque, low-speed "minimally invasive surgery" (MIS) Shannon burr versus an oscillating saw. METHODS Lateralizing calcaneal osteotomy was performed on 10 below-knee cadaveric specimens. This was conducted on 5 specimens each using an oscillating saw (Saw group) or MIS burr (Burr group). The calcaneal tuberosity was translated 1 cm laterally and transfixed using 2 Kirschner wires. Tarsal tunnel pressure was measured before and after osteotomy via ultrasound-guided percutaneous needle barometer. Mean pre/post-osteotomy pressures were compared between groups. Differences were analyzed using Student's t test. RESULTS The mean pre-procedure tarsal tunnel pressure was 25.8 ± 5.1 mm Hg in the Saw group and 26.4 ± 4.3 mm Hg in the Burr group (p = 0.85). The mean post-procedure pressure was 63.4 ± 5.1 in the Saw group and 47.8 ± 4.3 in the Burr group (p = 0.01). Change in tarsal tunnel pressure was significantly lower in the Burr group (21.4 ± 4.5) compared to the Saw group (37.6 ± 12.5) (p = 0.03). The increase in tarsal tunnel pressure was 43% lower in the Burr group. CONCLUSION In this cadaveric study, tarsal tunnel pressure increase after lateralizing calcaneal osteotomy was significantly lower when using a burr versus a saw. This is likely because the increased width ("kerf") of the 3 mm MIS burr, compared to the submillimeter saw blade width, causes calcaneal shortening. Given the smaller increase in tarsal tunnel pressure, using the MIS burr for lateralizing calcaneal osteotomy may decrease the risk of postoperative tarsal tunnel syndrome. Future research in vivo should explore this.
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Affiliation(s)
- Ali A Siddiqui
- Department of Orthopaedic Surgery and Rehabilitation, University of Florida College of Medicine Jacksonville, Jacksonville, FL, USA.
- Department of Orthopaedic Surgery, Mayo Clinic Florida, Jacksonville, FL, USA.
| | - Wesley D Troyer
- Department of Orthopaedic Surgery, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Jugert Bango
- Department of Orthopaedic Surgery and Rehabilitation, University of Florida College of Medicine Jacksonville, Jacksonville, FL, USA
- Department of Orthopaedic Surgery, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Moawiah S Mustafa
- Department of Orthopaedic Surgery and Rehabilitation, University of Florida College of Medicine Jacksonville, Jacksonville, FL, USA
- Department of Orthopaedic Surgery, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Jeannie F Buckner
- Department of Orthopaedic Surgery and Rehabilitation, University of Florida College of Medicine Jacksonville, Jacksonville, FL, USA
- Department of Orthopaedic Surgery, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Glenn G Shi
- Department of Orthopaedic Surgery, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Edward T Haupt
- Department of Orthopaedic Surgery, Mayo Clinic Florida, Jacksonville, FL, USA
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Stefanovic S, Adler DG, Arlt A, Baron TH, Binmoeller KF, Bronswijk M, Bruno MJ, Chevaux JB, Crinò SF, Degroote H, Deprez PH, Draganov PV, Eisendrath P, Giovannini M, Perez-Miranda M, Siddiqui AA, Voermans RP, Yang D, Hindryckx P. International Consensus Recommendations for Safe Use of LAMS for On- and Off-Label Indications Using a Modified Delphi Process. Am J Gastroenterol 2024; 119:671-681. [PMID: 37934190 DOI: 10.14309/ajg.0000000000002571] [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: 05/30/2023] [Accepted: 10/02/2023] [Indexed: 11/08/2023]
Abstract
INTRODUCTION The study aimed to develop international consensus recommendations on the safe use of lumen-apposing metal stents (LAMSs) for on- and off-label indications. METHODS Based on the available literature, statements were formulated and grouped into the following categories: general safety measures, peripancreatic fluid collections, endoscopic ultrasound (EUS)-biliary drainage, EUS-gallbladder drainage, EUS-gastroenterostomy, and gastric access temporary for endoscopy. The evidence level of each statement was determined using the Grading of Recommendations Assessment, Development, and Evaluation methodology.International LAMS experts were invited to participate in a modified Delphi process. When no 80% consensus was reached, the statement was modified based on expert feedback. Statements were rejected if no consensus was reached after the third Delphi round. RESULTS Fifty-six (93.3%) of 60 formulated statements were accepted, of which 35 (58.3%) in the first round. Consensus was reached on the optimal learning path, preprocedural imaging, the need for airway protection and essential safety measures during the procedure, such as the use of Doppler, and measurement of the distance between the gastrointestinal lumen and the target structure. Specific consensus recommendations were generated for the different LAMS indications, covering, among others, careful patient selection, the preferred size of the LAMS, the need for antibiotics, the preferred anatomic location of the LAMS, the need for coaxial pigtail placement, and the appropriate management of LAMS-related adverse events. DISCUSSION Through a modified international Delphi process, we developed general and indication-specific experience- and evidence-based recommendations on the safe use of LAMS.
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Affiliation(s)
- Sebastian Stefanovic
- Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium
- Diagnostic Center Bled Group, Bled, Slovenia
| | - Douglas G Adler
- Centura Health, Center for Advanced Therapeutic Endoscopy, Colorado, Englewood, USA
| | - Alexander Arlt
- Department of Internal Medicine and Gastroenterology, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Todd H Baron
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Kenneth F Binmoeller
- Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, California, USA
| | - Michiel Bronswijk
- Gastroenterology and Hepatology, Imelda Hospital Bonheiden and University Hospitals Leuven, Belgium
| | - Marco J Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | | | - Stefano Francesco Crinò
- Department of Medicine, Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University Hospital of Verona, Verona, Italy
| | - Helena Degroote
- Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium
| | - Pierre H Deprez
- Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Department of Hepatogastroenterology, Brussels, Belgium
| | | | - Pierre Eisendrath
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Saint-Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Marc Giovannini
- Digestive Endoscopy Unit, Paoli Calmettes Institute, Marseille Cedex 9, France
| | - Manuel Perez-Miranda
- Gastroenterology Department, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Ali A Siddiqui
- Department of Gastroenterology and Hepatology, Inova Fairfax Hospital, Falls Church, Virginia, USA
| | - Rogier P Voermans
- Amsterdam University Medical Center, Department of Gastroenterology and Hepatology, University of Amsterdam, Amsterdam, Netherlands
| | - Dennis Yang
- Center for Interventional Endoscopy, AdventHealth, Orlando, Florida, USA
| | - Pieter Hindryckx
- Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium
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Hayat U, Ashfaq MZ, Haseeb M, Farhan ML, Kamal MU, Talib KA, Khan HMA, Siddiqui AA. Adjuvant Radiofrequency Ablation Along With Stenting Versus Stenting Alone for Biliary Tree Drainage in Patients With Malignant Biliary Strictures: A Systemic Review and Meta-analysis. J Clin Gastroenterol 2024; 58:297-306. [PMID: 37039475 DOI: 10.1097/mcg.0000000000001851] [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: 10/24/2022] [Accepted: 03/09/2023] [Indexed: 04/12/2023]
Abstract
OBJECTIVE This metanalysis aims to assess the efficacy and safety of biliary stenting along with radiofrequency ablation compared with stents alone to treat malignant biliary obstruction (MBO) due to extrahepatic biliary strictures secondary to cholangiocarcinoma, pancreatic cancer, and metastatic cancer. METHODS A systemic search of major databases through April 2022 was done. All original studies were included comparing radiofrequency ablation with stenting versus stenting alone for treating malignant biliary strictures. The primary outcomes of interest were the difference in the mean stent patency and overall survival (OS) days between the 2 groups. The secondary outcome was to compare the adverse events of the 2 groups. The mean difference in the stent patency and OS days was pooled by using a random-effect model. We calculated the odds ratio to compare the adverse events between the 2 groups. RESULTS A total of 13 studies with 1339 patients were identified. The pooled weighted mean difference in stent patency was 43.50 days (95% CI, 25.60-61.41), favoring the RFA plus stenting. Moreover, the pooled weighted mean difference in OS was 90.53 days (95% CI, 49.00-132.07), showing improved survival in the RFA group. Our analysis showed no statistically significant difference in adverse events between the 2 groups OR 1.13 (95% CI, 0.90-1.42). CONCLUSION Our analysis showed that RFA, along with stent, is safe and is associated with improved stent patency and overall patient survival in malignant biliary strictures. More robust prospective studies should assess this association further.
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Affiliation(s)
- Umar Hayat
- Department of Internal Medicine, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA
| | | | | | | | | | | | - Hafiz M A Khan
- Department of Gastroenterology, Suny Upstate Medical University, Syracuse, NY
| | - Ali A Siddiqui
- Department of Gastroenterology and Hepatology, Inova Fairfax Hospital, VA
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Hayat U, Al Shabeeb R, Perez P, Hensien J, Dwivedi A, Sakhawat U, Ahmad O, Haseeb M, Siddiqui AA, Adler DG. Safety and adverse events of EUS-guided gallbladder drainage using lumen-apposing metal stents and percutaneous cholecystostomy tubes: a systematic review and meta-analysis. Gastrointest Endosc 2024; 99:444-448.e1. [PMID: 37871846 DOI: 10.1016/j.gie.2023.10.043] [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: 04/03/2023] [Revised: 07/06/2023] [Accepted: 10/18/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND AND AIMS EUS-guided gallbladder drainage using lumen-apposing metal stents (EUS-GBD-LAMSs) and percutaneous cholecystostomy for gallbladder drainage (PTGBD) are the alternative treatment modalities in high-risk surgical patients with acute cholecystitis (AC). The aim of this study was to compare the safety of these procedures for AC in surgically suboptimal candidates. METHODS Six studies compared the 2 groups' early, delayed, and overall adverse events; they also compared length of hospital stay, re-interventions, and re-admissions rate. A random effect model calculated odds ratios (ORs) with a 95% confidence interval (CI). RESULTS The 2 groups had similar early adverse events; however, EUS-GBD-LAMS was associated with a lower rate of delayed (OR, .21; 95% CI, .07-.61; P ≤ .01) and overall (OR, .43; 95% CI, .30-.61; P ≤ .01) adverse events. Patients with EUS-GBD-LAMSs had a shorter hospital stay than PTGBD. CONCLUSIONS EUS-GBD-LAMS is a safer option than PTGBD and is associated with a shorter hospital stay in nonsurgical candidates with AC.
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Affiliation(s)
- Umar Hayat
- Department of Internal Medicine, Division of Gastroenterology, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, Pennsylvania, USA
| | - Reem Al Shabeeb
- Department of Internal Medicine, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
| | - Paola Perez
- University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Jack Hensien
- University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Aanini Dwivedi
- University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Usama Sakhawat
- Department of Internal Medicine, UHS Wilson Medical Center, Binghamton, New York, USA
| | - Oneeb Ahmad
- Department of Internal Medicine, UHS Wilson Medical Center, Binghamton, New York, USA
| | - Muhammad Haseeb
- Hospitalist Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Ali A Siddiqui
- Division of Gastroenterology, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
| | - Douglas G Adler
- Center for Advanced Therapeutic Endoscopy, Porter Adventist Hospital, Denver, Colorado, USA.
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Illingworth KD, Siddiqui AA, Skaggs DL, Andras LM. Deformity angular ratio is associated with neuromonitoring changes without a vertebral column resection: spinal deformity is more influential than type of surgery. Spine Deform 2023; 11:951-956. [PMID: 36930440 PMCID: PMC10261247 DOI: 10.1007/s43390-023-00669-y] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 02/18/2023] [Indexed: 03/18/2023]
Abstract
PURPOSE The purpose of this study is to investigate the effect of the deformity angular ratio (DAR) on intra-operative neuromonitoring (IONM) signal changes during posterior spinal fusion (PSF) without vertebral column resection (VCR). METHODS Retrospective review of severe pediatric spinal deformity patients treated with PSF without VCR or three-column osteotomy from 2008 to 2018. Exclusion criteria were prior instrumentation, lack of IONM, and incomplete radiographic data. Coronal DAR (C-DAR), sagittal DAR (S-DAR), and total DAR (T-DAR) were calculated and compared between patients with IONM signal loss and those without. RESULTS Two hundred and fifty-three patients met inclusion criteria. Forty-seven of two hundred and fifty-three (19%) patients had IONM signal loss. Intra-operative wake-up test was performed in seven cases; three of seven (43%) had a neurological deficit on wake-up test. All neurological deficits resolved at a mean of 41 days postop. IONM loss was associated with increased kyphosis (p = 0.003) and was not associated with Cobb angle (p = 0.16). S-DAR (p = 0.03) and T-DAR (p = 0.005) were associated with IONM signal loss but C-DAR was not (p = 0.06). Increased incidence of IONM signal loss was seen with S-DAR > 7 (p = 0.02) or T-DAR > 27 (p = 0.02). Twenty-four of ninety-two (26%) patients with S-DAR > 7 had IONM signal loss compared to twenty-three of one hundred and sixty-one (14%) with S-DAR ≤ 7 (OR, 2.1; 95% CI, 1.1-4.0). Seven of sixteen (44%) patients with T-DAR > 27 had signal loss compared to forty of two hundred and thirty-seven (17%) patients with T-DAR ≤ 27 (OR, 3.8; 95% CI, 1.3-10.9). CONCLUSION Patients with S-DAR > 7 or T-DAR > 27 have a higher risk of IONM loss during pediatric PSF even in the absence of a VCR or three-column osteotomies. LEVEL OF EVIDENCE II
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Affiliation(s)
| | - Ali A Siddiqui
- Jackie and Gene Autry Orthopedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd, MS#69, Los Angeles, CA, 90027, USA
- Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
- University of FL College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - David L Skaggs
- Department of Orthopaedics, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Lindsay M Andras
- Jackie and Gene Autry Orthopedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd, MS#69, Los Angeles, CA, 90027, USA.
- Keck School of Medicine of University of Southern California, Los Angeles, CA, USA.
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Whitmarsh-Brown MA, Christ AB, Lin AJ, Siddiqui AA, Herman RY, Allison DC, Goldstein RY. Modernizing Our Understanding of Total Hip Arthroplasty in the Pediatric and Young Adult Patient: A Single-center Experience. J Pediatr Orthop 2023; 43:e290-e298. [PMID: 36727975 DOI: 10.1097/bpo.0000000000002316] [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: 11/04/2021] [Accepted: 10/17/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Pediatric hip disorders represent a broad range of pathology and remain a significant source of morbidity for children and young adults. Surgical intervention is often required for joint preservation, but when salvage is not possible, joint replacement may be indicated to eliminate pain and preserve function. Although there have been significant updates in the management of both pediatric hip disease and the field of total hip arthroplasty (THA), there is a paucity of literature reflecting advancements in the area of pediatric and young adult (PYA) arthroplasty. No study has investigated the impact of approach on outcomes after PYA THA. The purpose of this study is to describe the indications, techniques, and early outcomes of THA in the PYA population in a modern practice setting. METHODS We performed a retrospective descriptive analysis of all patients undergoing primary THA performed at a tertiary care children's hospital from 2004 to 2019. Ninety-three hips in 76 patients were evaluated. Demographics, intraoperative variables, postoperative pain and function ratings, and complication and revision rates were collected. RESULTS Eighty-five hips in 69 patients were included. Patients were aged 12 to 23 years old, with males and females represented equally (33 vs. 36, respectively). The most common cause of hip pain was avascular necrosis (AVN, 56/85, 66%), most commonly due to slipped capital femoral epiphysis (13/56, 23%) idiopathic AVN (12/56, 21%), and chemotherapy (12/56, 21%). Half of all hips had been previously operated before THA (43/85). Thirty-six procedures were performed via the posterolateral approach (36/85, 42%), 33 were performed via direct anterior approach (33/85, 39%), and 16 were performed via the lateral approach (LAT, 16/85, 19%). At final follow-up, 98% (83/85) of patients had complete resolution of pain, 82% (70/85) had no notable limp, and 95% (81/85) had returned to all activities. There were 6 complications and 1 early revision. Average Hip disability and Osteoarthritis Outcomes Score for Joint Replacement scores increased by 37 points from 56 to 93. The overall revision-free survival rate for PYA THA was 98.8% (at average 19-mo follow-up). CONCLUSIONS Modern PYA THA is dissimilar in indications and surgical techniques to historic cohorts, and conclusions from prior studies should not be generalized to modern practice. In our practice, PYA patients most commonly carry a diagnosis of AVN, and THA can be performed with modern cementless fixation with large cup and head sizes and ceramic-on-cross-linked polyethylene bearings utilizing any approach. Further study is required to better characterize middle-term and long-term results and patient-reported outcomes. LEVEL OF EVIDENCE Therapeutic Level IV-retrospective case series.
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Affiliation(s)
- Meghan A Whitmarsh-Brown
- Department of Orthopaedics and Rehabilitation, University of New Mexico School of Medicine, Albuquerque, NM
| | - Alexander B Christ
- Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA
| | - Adrian J Lin
- Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA
| | - Ali A Siddiqui
- Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA
| | - Renee Y Herman
- Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA
| | - Daniel C Allison
- Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA
| | - Rachel Y Goldstein
- Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA
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Hayat U, Siddiqui AA, Farhan ML, Haris A, Hameed N. Genome Editing and Fatty Liver. Advances in Experimental Medicine and Biology 2023; 1396:191-206. [DOI: 10.1007/978-981-19-5642-3_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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Hayat U, Ashfaq MZ, Johnson L, Ford R, Wuthnow C, Kadado K, El Jurdi K, Okut H, Kilgore WR, Assi M, Siddiqui AA. The Association of Metabolic-Associated Fatty Liver Disease with Clinical Outcomes of COVID-19: A Systematic Review and Meta-Analysis. Kans J Med 2022; 15:241-246. [PMID: 35899064 PMCID: PMC9311786 DOI: 10.17161/kjm.vol15.16522] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/16/2022] [Indexed: 02/06/2023] Open
Abstract
Introduction Metabolic-associated fatty liver disease (MAFLD) is a hepatic manifestation of metabolic syndrome (MS). MAFLD patients have a higher prevalence of COVID-19. MAFLD also is associated with worse clinical outcomes of COVID-19, such as disease severity, intensive care unit (ICU) admission rate, and higher mortality rates. However, this evidence has not been well characterized in the literature. This meta-analysis aimed to determine the clinical outcomes of COVID-19 among MAFLD patients compared to the non-MAFLD group. Methods A comprehensive search was conducted in the Cumulative Index of Nursing and Allied Health (CINAHL), PubMed/Medline, and Embase for studies reporting MAFLD prevalence among COVID-19 patients and comparing clinical outcomes such as severity, ICU admission, and mortality among patients with and without MAFLD. The pooled prevalence of MAFLD among COVID-19 patients and the pooled odds ratios (OR) with 95% confidence intervals (CI) for clinical outcomes of COVID-19 were calculated. Results Sixteen observational studies met inclusion criteria involving a total of 11,484 overall study participants, including 1,746 MAFLD patients. The prevalence of COVID-19 among MAFLD patients was 0.29 (95% CI: 0.19–0.40). MAFLD was associated with the COVID-19 disease severity OR 3.07 (95% CI: 2.30–4.09). Similarly, MAFLD was associated with an increased risk of ICU admission compared to the non-MAFLD group OR 1.46 (95% CI: 1.12–1.91). Lastly, the association between MAFLD and COVID-19 mortality was not statistically significant OR 1.45 (95% CI: 0.74–2.84). Conclusions In this study, a high percentage of COVID-19 patients had MAFLD. Moreover, MAFLD patients had an increased risk of COVID-19 disease severity and ICU admission rate.
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Affiliation(s)
- Umar Hayat
- Department of Internal Medicine, University of Kansas School of Medicine-Wichita, Wichita, KS
| | | | - Luke Johnson
- Department of Internal Medicine, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Ryan Ford
- Department of Internal Medicine, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Chelsea Wuthnow
- Department of Internal Medicine, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Kevin Kadado
- Department of Internal Medicine, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Katia El Jurdi
- Department of Internal Medicine, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Hayrettin Okut
- Office of Research, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - William Ransom Kilgore
- Department of Internal Medicine, University of Kansas School of Medicine-Wichita, Wichita, KS.,Ascension Medical Group, Wichita, KS
| | - Maha Assi
- Department of Internal Medicine, University of Kansas School of Medicine-Wichita, Wichita, KS.,Infectious Diseases Consultants, Wichita, KS
| | - Ali A Siddiqui
- Division of Gastroenterology, Centura Healthcare, Denver, CO
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Higgins MC, Siddiqui AA, Kosowsky T, Unan L, Mete M, Rowe S, Marchalik D. Burnout, Professional Fulfillment, Intention to Leave, and Sleep-Related Impairment among Radiology Trainees across the United States (US): A Multisite Epidemiologic Study. Acad Radiol 2022; 29 Suppl 5:S118-S125. [PMID: 35241358 DOI: 10.1016/j.acra.2022.01.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 01/28/2022] [Accepted: 01/31/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To examine the prevalence of burnout among radiology trainees in the United States, and to study the relationships between burnout and professional fulfillment (PF), intent-to-leave (ITL), sleep-related impairment and self-compassion by gender. METHODS This cross-sectional study was conducted via an anonymous electronic survey sent to 11 large academic medical centers (Physician Wellness Academic Consortium) between January 2017 and September 2018. The survey included the Professional Fulfillment Index (PFI) and an abbreviated form of the PROMIS Sleep-related impairment (SRI) scale. Two-sample t-tests and chi-square exact tests were used for analysis (p < 0.05). RESULTS Two hundred forty-seven radiology residents responded to the survey. Out of these, 36.2% reported burnout, 37.4% endorsed PF, 64.8% reported sleep-related impairment, 7.6% expressed ITL. There were no significant differences between genders. Burnout was associated with reduced PF, increased sleep-impairment (p < 0.001 for both) and increased ITL (p = 0.02). Lower PF, peer support, perceived appreciation for and meaningfulness in work, alignment of organizational and personal values, self-compassion, and higher sleep impairment were associated with burnout (p < 0.001 for all). Burnout was associated with perceptions of less support from department leaders (p = 0.003), control over schedules (p = 0.001) and helpfulness of electronic health record systems (p = 0.01). ITL was associated with reduced PF, perceived work appreciation, and leadership support (p = 0.03, p = 0.04, and p = 0.007, respectively). DISCUSSION Burnout is prevalent among radiology residents. Many demonstrate sleep-impairment and reduced professional fulfillment, with a lesser fraction desiring to leave their institution. Key factors to burnout included peer and organizational support, electronic health record systems helpfulness, and personal factors like self-compassion and work appreciation.
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Hayat U, Siddiqui AA, Okut H, Afroz S, Tasleem S, Haris A. The effect of coffee consumption on the non-alcoholic fatty liver disease and liver fibrosis: A meta-analysis of 11 epidemiological studies. Ann Hepatol 2021; 20:100254. [PMID: 32920163 DOI: 10.1016/j.aohep.2020.08.071] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 08/24/2020] [Accepted: 08/24/2020] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND OBJECTIVES Non-alcoholic fatty liver disease (NAFLD) is a widespread chronic liver disease. It is considered a multifactorial disorder that can progress to liver fibrosis and cause a worldwide public health concern. Coffee consumption may have a protective impact on NAFLD and liver fibrosis. However, the evidence from the previous studies is inconsistent. This meta-analysis summarizes available literature. MATERIALS AND METHODS This study comprises two meta-analyses. The first meta-analysis summarizes the effect of coffee consumption on NAFLD in those who did or did not drink coffee. The second analysis compares the risk of liver fibrosis development between NAFLD patients who did or did not drink coffee. Pooled risk ratios (RR) and confidence intervals (CI) of observational studies were estimated. RESULTS Of the total collected 321 articles, 11 met our eligibility criteria to be included in the analysis. The risk of NAFLD among those who drank coffee compared to those who did not was significantly lower with a pooled RR value of 0.77 (95% CI 0.60-0.98). Moreover, we also found a significantly reduced risk of liver fibrosis in those who drink coffee than those who did not drink in the NAFLD patients with the relative risk (RR) of 0.68 (95% CI 0.68-0.79). CONCLUSIONS Regular coffee consumption is significantly associated with a reduced risk of NAFLD. It is also significantly associated with decreased risk of liver fibrosis development in already diagnosed NAFLD patients. Although coffee consumption may be considered an essential preventive measure for NAFLD, this subject needs further epidemiological studies.
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Affiliation(s)
- Umar Hayat
- Department of Population Health, University of Kansas School of Medicine, Wichita, KA, USA.
| | - Ali A Siddiqui
- Department of Gastroenterology, Loma Linda University Hospital, Loma Linda, CA, USA
| | - Hayrettin Okut
- Department of Population Health, University of Kansas School of Medicine, Wichita, KA, USA
| | - Saba Afroz
- Hospital Medicine, Wesley Medical Center, Wichita, KA, USA
| | - Syed Tasleem
- Department of Gastroenterology, Baylor College of Medicine, Houston, USA
| | - Ahmed Haris
- Hospital Medicine, Wesley Medical Center, Wichita, KA, USA
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Lin AJ, Siddiqui AA, Lai LM, Goldstein RY. An Inverted Acetabular Labrum Is Predictive of Pavlik Harness Treatment Failure in Children With Developmental Hip Dysplasia. J Pediatr Orthop 2021; 41:479-482. [PMID: 34267151 DOI: 10.1097/bpo.0000000000001916] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The failure rate of Pavlik harness treatment for developmental dysplasia of the hip (DDH) has been reported as high as 55%. The purpose of this study is to investigate the effect of an inverted acetabular labrum on outcomes of Pavlik harness treatment for DDH. METHODS A retrospective review was conducted on DDH patients at a tertiary care pediatric hospital from 2004 to 2016. DDH patients that underwent index treatment with Pavlik harness and had minimum 12 months follow-up were included. Medical charts were reviewed for demographics, treatment, and outcomes. Outcomes were compared between patients with an inverted labrum versus those without an inverted labrum. RESULTS A total of 156 patients with 229 dysplastic hips were included. The mean age at initiation of Pavlik harness treatment was 1.9±1.4 months and mean follow-up was 37.7±23.0 months. Bilateral DDH was diagnosed in 46% (73/156) of patients. In all, 37% (75/229) of hips failed Pavlik harness index treatment. Second-line treatment was rigid hip abduction bracing in 91% (68/75) of hips, closed reduction in 5% (4/75) of hips, and open reduction in 4% (3/75) of hips. An inverted labrum was present in 10% (22/229) of all hips. The incidence of Pavlik harness treatment failure was 91% (20/22) in the inverted labrum group compared with 27% (55/207) in the control group (P<0.001). Closed or open reduction was required in 86% (15/22) of the inverted labrum group compared with 3% (7/207) of hips in the control group (P<0.001). The incidence of avascular necrosis was 18% (4/22) in hips with an inverted labrum compared with 0.4% (1/207) in the control group (P<0.001). CONCLUSIONS In children with DDH undergoing index treatment in a Pavlik harness, the presence of an inverted acetabular labrum is strongly predictive of treatment failure. Dysplastic hips with an inverted labrum also have a significantly higher risk of requiring closed or open reduction and developing avascular necrosis compared with those without an inverted labrum. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
| | - Ali A Siddiqui
- Department of Radiology, Children's Hospital Los Angeles, Los Angeles, CA
| | - Lillian M Lai
- University of Florida College of Medicine at Jacksonville, Jacksonville, FL
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Siddiqui AA, Salar M, Bell A. Surgical Management of a Displaced Posterior Column Pelvic Fracture Involving the Triradiate Cartilage in a 15-Year-Old Adolescent Boy: A Case Report. JBJS Case Connect 2021; 11:01709767-202109000-00060. [PMID: 35102038 DOI: 10.2106/jbjs.cc.20.00659] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
CASE A 15-year-old adolescent boy sustained a displaced acetabular fracture involving the ilioischial physis of the triradiate cartilage after a ground-level fall. The patient was managed operatively with open reduction and internal fixation and was followed for 9 months postoperatively. At 4 months postoperatively, the patient had resumed full weight bearing on the injured extremity and was participating in sports with no difficulties. CONCLUSION Pediatric pelvic fractures through the triradiate cartilage are rare, and no consensus exists on the treatment of these injuries. Previous authors largely described nonoperative management with suboptimal outcomes. We present the case of a patient treated with initial operative fixation who successfully returned to full activities.
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Affiliation(s)
- Ali A Siddiqui
- Department of Orthopaedic Surgery and Rehabilitation, University of Florida-Jacksonville, Jacksonville, Florida
| | - Mohamed Salar
- Department of Orthopaedic Surgery and Rehabilitation, University of Florida-Jacksonville, Jacksonville, Florida
| | - Anthony Bell
- Mercy Orthopaedic Trauma Clinic, Springfield, Missouri
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Abstract
EUS has opened a new frontier in endoscopic techniques for accessing pancreatic ducts in patients with failed ERCP. The major indications of EUS-guided pancreatic duct intervention (EUS-PDI) are main pancreatic duct (MPD) strictures due to chronic pancreatitis or strictures of pancreaticojejunal or pancreaticogastric anastomosis after Whipple resection, which lead to recurrent acute pancreatitis. EUS-guided pancreaticogastro or duodenostomy offers an alternative to surgery when transpapillary drainage fails or is not possible. We provide an expert commentary and a brief overview on this relatively novel technique utilizing EUS-PDI creation in patients with impaired drainage of the MPD who have failed other conventional endoscopic techniques for MPD drainage and either are poor surgical candidates or are reluctant to undergo surgery.
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Affiliation(s)
- Zarak Khan
- Department of Internal Medicine, St. Mary Mercy Hospital, Livonia, MI, USA
| | - Umar Hayat
- Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, MN, USA
| | - Sharareh Moraveji
- Division of Gastroenterology, Hepatology and Nutrition, Stanford University, Palo Alto, CA, USA
| | - Douglas G Adler
- Division of Gastroenterology, Hepatology and Nutrition, University of Utah, Salt Lake City, UT, USA
| | - Ali A Siddiqui
- Division of Gastroenterology and Hepatology, Loma Linda University Health, Loma Linda, CA, USA
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Siddiqui AA, Andras LM, Obana KK, Murgai R, Illingworth KD, Tolo VT, Mariscal M, Ponrartana S, Skaggs DL. Using a dedicated spine radiology technologist is associated with reduced fluoroscopy time, radiation dose, and surgical time in pediatric spinal deformity surgery. Spine Deform 2021; 9:85-89. [PMID: 32780303 DOI: 10.1007/s43390-020-00183-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 08/01/2020] [Indexed: 11/24/2022]
Abstract
STUDY DESIGN Retrospective comparative study OBJECTIVES: The goal of this study was to investigate fluoroscopy time and radiation exposure during pediatric spine surgery using a dedicated radiology technologist with extensive experience in spine operating rooms. Repetitive use of intraoperative fluoroscopy during posterior spinal fusion (PSF) exposes the patient, surgeon, and staff to radiation. METHODS Retrospective review was conducted on patients with posterior spinal fusion (PSF) of ≥ 7 levels for adolescent idiopathic scoliosis (AIS) at a pediatric hospital from 2015 to 2019. Cases covered by the dedicated radiology technologist (dedicated group) were compared to all other cases (non-dedicated group). Surgical and radiologic variables were compared between groups. RESULTS 230 patients were included. 112/230 (49%) were in the dedicated group and 118/230 (51%) were in the non-dedicated group. Total fluoroscopy time was significantly reduced in cases with the dedicated technologist (46 s) compared to those without (69 s) (p = 0.001). Radiation dose area product (DAP) and air kerma (AK) were reduced by 43% (p < 0.001) and 42% (p < 0.001) in the dedicated group, respectively. The dedicated group also had reduced total surgical time (4.1 vs. 3.5 h; p < 0.001) and estimated blood loss (447 vs. 378 cc (; p = 0.02). Multivariate regression revealed that using a dedicated radiology technologist was independently associated with decreased fluoroscopy time (p = 0.001), DAP (p < 0.001), AK (p < 0.001), surgical time (p < 0.001), and EBL (p = 0.02). CONCLUSIONS In AIS patients undergoing PSF, using a dedicated radiology technologist was independently associated with significant reductions in fluoroscopy time, radiation exposure, surgical time, and EBL. This adds to the growing body of research demonstrating that the experience level of the team-not just that of the surgeon-is necessary for optimal outcomes. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Ali A Siddiqui
- Keck School of Medicine at University of Southern California, Los Angeles, CA, USA.,Children's Orthopaedic Center, Children's Hospital of Los Angeles, 4650 Sunset Blvd, MS#69, Los Angeles, CA, 90027, USA.,University of FL College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - Lindsay M Andras
- Keck School of Medicine at University of Southern California, Los Angeles, CA, USA.,Children's Orthopaedic Center, Children's Hospital of Los Angeles, 4650 Sunset Blvd, MS#69, Los Angeles, CA, 90027, USA
| | - Kyle K Obana
- Children's Orthopaedic Center, Children's Hospital of Los Angeles, 4650 Sunset Blvd, MS#69, Los Angeles, CA, 90027, USA.,University of Hawaii, Honolulu, HI, USA
| | - Rajan Murgai
- Keck School of Medicine at University of Southern California, Los Angeles, CA, USA.,Children's Orthopaedic Center, Children's Hospital of Los Angeles, 4650 Sunset Blvd, MS#69, Los Angeles, CA, 90027, USA.,University of Miami, Miami, FL, USA
| | - Kenneth D Illingworth
- Keck School of Medicine at University of Southern California, Los Angeles, CA, USA.,Children's Orthopaedic Center, Children's Hospital of Los Angeles, 4650 Sunset Blvd, MS#69, Los Angeles, CA, 90027, USA
| | - Vernon T Tolo
- Keck School of Medicine at University of Southern California, Los Angeles, CA, USA.,Children's Orthopaedic Center, Children's Hospital of Los Angeles, 4650 Sunset Blvd, MS#69, Los Angeles, CA, 90027, USA
| | - Michael Mariscal
- Children's Orthopaedic Center, Children's Hospital of Los Angeles, 4650 Sunset Blvd, MS#69, Los Angeles, CA, 90027, USA
| | - Skorn Ponrartana
- Keck School of Medicine at University of Southern California, Los Angeles, CA, USA.,Children's Orthopaedic Center, Children's Hospital of Los Angeles, 4650 Sunset Blvd, MS#69, Los Angeles, CA, 90027, USA
| | - David L Skaggs
- Keck School of Medicine at University of Southern California, Los Angeles, CA, USA. .,Children's Orthopaedic Center, Children's Hospital of Los Angeles, 4650 Sunset Blvd, MS#69, Los Angeles, CA, 90027, USA.
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Illingworth KD, Siddiqui AA, Abousamra O, Meisel EM, Kay RM. Response to comment on Siddiqui et al: 'Femoral shaft fractures in children with non-ambulatory neuromuscular disorders can be effectively treated using flexible intramedullary nails'. J Child Orthop 2020; 14:243-244. [PMID: 32582394 PMCID: PMC7302417 DOI: 10.1302/1863-2548.14.200108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- Kenneth D. Illingworth
- Children’s Orthopedic Center, Children’s Hospital Los Angeles, Los Angeles, California, USA,Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Ali A. Siddiqui
- Children’s Orthopedic Center, Children’s Hospital Los Angeles, Los Angeles, California, USA,Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Oussama Abousamra
- Children’s Orthopedic Center, Children’s Hospital Los Angeles, Los Angeles, California, USA,Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Erin M. Meisel
- Children’s Orthopedic Center, Children’s Hospital Los Angeles, Los Angeles, California, USA,Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Robert M. Kay
- Children’s Orthopedic Center, Children’s Hospital Los Angeles, Los Angeles, California, USA,Keck School of Medicine of University of Southern California, Los Angeles, California, USA,Correspondence should be sent to Robert M. Kay, Children’s Orthopaedic Center, Children’s Hospital Los Angeles, 4650 Sunset Blvd, MS#69, Los Angeles, CA 90027, USA. E-mail:
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Siddiqui AA, Illingworth KD, Abousamra OA, Meisel EM, Kay RM. Femoral shaft fractures in children with non-ambulatory neuromuscular disorders can be effectively treated using flexible intramedullary nails. J Child Orthop 2020; 14:132-138. [PMID: 32351626 PMCID: PMC7184642 DOI: 10.1302/1863-2548.14.190154] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE There is little information in the literature regarding flexible intramedullary nails (FIN) for treating femur fractures in children with neuromuscular disorders. The purpose of this study is to investigate the outcomes of FIN for femoral shaft fractures in non-ambulatory children with neuromuscular disorders. METHODS A retrospective review was conducted on patients with femur fractures at a paediatric hospital between 2004 and 2018. Inclusion criteria were femoral shaft fracture treated with FIN. Outcomes were compared between patients with neuromuscular disorders (NM group) and a control group of those without neuromuscular disorders. RESULTS A total of 37 patients with 37 femoral shaft fractures were studied (12 patients in the NM group and 25 in the control group). All NM group patients were non-ambulatory at baseline. Fractures were length stable in all 25 patients in the control group and in 2/12 (17%) patients in the NM group. All fractures healed in both groups. Three complications (all nail migrations) requiring reoperation before fracture union occurred in the NM group, yielding a major complication rate of 25% (3/12) in the NM group versus 0% (0/25) in controls (p = 0.03). Angular deformity occurred in 5/12 (42%) NM group patients and 1/25 (4%) control group patient (p = 0.009); none required reoperation. CONCLUSION Femur fractures in non-ambulatory children with neuromuscular disorders can be successfully treated with FIN. Angular deformities are common in this population, but had no functional impact in the non-ambulatory NM group patients. Surgeons must also be vigilant for implant prominence and skin breakdown in these patients. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Ali A. Siddiqui
- Children’s Orthopaedic Center, Children’s Hospital Los Angeles, USA,Keck School of Medicine of University of Southern California, USA
| | - Kenneth D. Illingworth
- Children’s Orthopaedic Center, Children’s Hospital Los Angeles, USA,Keck School of Medicine of University of Southern California, USA
| | - Oussama A. Abousamra
- Children’s Orthopaedic Center, Children’s Hospital Los Angeles, USA,Keck School of Medicine of University of Southern California, USA
| | - Erin M. Meisel
- Children’s Orthopaedic Center, Children’s Hospital Los Angeles, USA,Keck School of Medicine of University of Southern California, USA
| | - Robert M. Kay
- Children’s Orthopaedic Center, Children’s Hospital Los Angeles, USA,Keck School of Medicine of University of Southern California, USA,Correspondence should be sent to Robert M. Kay, Children’s Orthopaedic Center, Children’s Hospital Los Angeles, 4650 Sunset Blvd, MS#69, Los Angeles, CA 90027, USA. E-mail:
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18
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Obana KK, Siddiqui AA, Broom AM, Barrett K, Andras LM, Millis MB, Goldstein RY. Slipped Capital Femoral Epiphysis in Children without Obesity. J Pediatr 2020; 218:192-197.e1. [PMID: 31955882 DOI: 10.1016/j.jpeds.2019.11.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 08/26/2019] [Revised: 11/11/2019] [Accepted: 11/22/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To evaluate rates and characteristics of slipped capital femoral epiphysis (SCFE) in children who are not obese to prevent missed diagnoses and subsequent complications. STUDY DESIGN A multicenter, retrospective review identified all patients with SCFE from January 1, 2003 to December 31, 2012. Patients were excluded if they received previous surgery at an outside institution, had no recorded height and weight, or had medical co-morbidity associated with increased risk of SCFE. Body mass index (BMI) percentile for age was calculated and categorized for each patient (patients without obesity vs with obesity). RESULTS In total, 275 patients met inclusion criteria. Average BMI was 91.2 percentile (range: 8.4-99.7). Thirteen percent (34 patients) were considered "normal weight" (BMI 5%-85%), 17% (48 patients) were considered "overweight" (BMI 85%- 95%), and 70% (193 patients) were considered "obese" (BMI >95%). Average BMI percentile was higher in male than female patients (93.2 ± 12.7 vs 88.5 ± 21.4, P = .034). Patients without obesity were older compared with patients with obesity (12.2 ± 1.7 vs 11.7 ± 1.6 years, P = .015). Fewer patients without obesity were seen at the hospital in the southwest. The southwest had fewer patients without obesity than the northeast (18.3% vs 36.1%, P = .002). Patients without obesity were more likely to present with a severe slip as graded by Wilson percent displacement (27.2% vs 11.4%, P = .007) and an unstable slip (32.9% vs 14.7%, P = .001). CONCLUSION Rates of nonobese SCFE in this study are higher than reported in the previous literature. Normal weight patients with SCFE are more likely to be older, female, and present with a severe and unstable SCFE.
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Affiliation(s)
- Kyle K Obana
- Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA
| | - Ali A Siddiqui
- Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA
| | - Alexander M Broom
- Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA
| | - Kody Barrett
- Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA
| | - Lindsay M Andras
- Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA
| | | | - Rachel Y Goldstein
- Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA.
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Guo J, Sahai AV, Teoh A, Arcidiacono PG, Larghi A, Saftoiu A, Siddiqui AA, Arturo Arias BL, Jenssen C, Adler DG, Lakhtakia S, Seo DW, Itokawa F, Giovannini M, Mishra G, Sabbagh L, Irisawa A, Iglesias-Garcia J, Poley JW, Vila JJ, Jesse L, Kubota K, Kalaitzakis E, Kida M, El-Nady M, Mukai SU, Ogura T, Fusaroli P, Vilmann P, Rai P, Nguyen NQ, Ponnudurai R, Achanta CR, Baron TH, Yasuda I, Wang HP, Hu J, Duan B, Bhutani MS, Sun S. An international, multi-institution survey on performing EUS-FNA and fine needle biopsy. Endosc Ultrasound 2020; 9:319-328. [PMID: 32883921 PMCID: PMC7811723 DOI: 10.4103/eus.eus_56_20] [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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background and Objectives Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) and fine needle biopsy (FNB) are effective techniques that are widely used for tissue acquisition. However, it remains unclear how to obtain high-quality specimens. Therefore, we conducted a survey of EUS-FNA and FNB techniques to determine practice patterns worldwide and to develop strong recommendations based on the experience of experts in the field. Methods This was a worldwide multi-institutional survey among members of the International Society of EUS Task Force (ISEUS-TF). The survey was administered by E-mail through the SurveyMonkey website. In some cases, percentage agreement with some statements was calculated; in others, the options with the greatest numbers of responses were summarized. Another questionnaire about the level of recommendation was designed to assess the respondents' answers. Results ISEUS-TF members developed a questionnaire containing 17 questions that was sent to 53 experts. Thirty-five experts completed the survey within the specified period. Among them, 40% and 54.3% performed 50-200 and more than 200 EUS sampling procedures annually, respectively. Some practice patterns regarding FNA/FNB were recommended. Conclusion This is the first worldwide survey of EUS-FNA and FNB practice patterns. The results showed wide variations in practice patterns. Randomized studies are urgently needed to establish the best approach for optimizing the FNA/FNB procedures.
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Affiliation(s)
- Jintao Guo
- Department of Gastroenterology, Sheng Jing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Anand V Sahai
- Center Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Anthony Teoh
- Department of Surgery, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China
| | - Paolo Giorgio Arcidiacono
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Larghi
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Adrian Saftoiu
- Department of Endoscopy, University of Medicine and Pharmacy, Craiova, Romania
| | - Ali A Siddiqui
- Endoscopy Center, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Brenda Lucia Arturo Arias
- Endoscopy Center, Medical Research Group University of Manizales, SES University Hospital of Caldas, Caldas, Colombia
| | - Christian Jenssen
- Department of Medical, Krankenhaus Märkisch Oderland Strausberg, Wriezen, Germany
| | - Douglas G Adler
- Department of Gastroenterology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Sundeep Lakhtakia
- Endoscopy Center, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Dong-Wan Seo
- Department of Gastroenterology, University of Ulsan College of Medicine, Seoul, South Korea
| | - Fumihide Itokawa
- Department of Gastroenterology and Hepatology, Tokyo Adventist Hospital, Tokyo, Japan
| | - Marc Giovannini
- Department of Gastroenterology, Institute Paoli-Calmettes, Marseille, France
| | - Girish Mishra
- Department of Gastroenterology, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Luis Sabbagh
- Department of Gastroenterology, Sanitas University Foundation, Clinica Reina Sofia, Bogota, Colombia
| | - Atsushi Irisawa
- Fukushima Medical University Aizu Medical Center, Aizuwakamatsu, Japan
| | - Julio Iglesias-Garcia
- Endoscopy Center, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Jan Werner Poley
- Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Juan J Vila
- Department of Gastroenterology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Lachter Jesse
- Department of Gastroenterology, Rambam Healthcare Campus, Haifa, Israel
| | - Kensuke Kubota
- Department of Gastroenterology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Evangelos Kalaitzakis
- Department of Gastroenterology, University Hospital of Heraklion, University of Crete, Heraklion, Greece
| | - Mitsuhiro Kida
- Department of Gastroenterology, Kitasato University East Hospital, Sagamihara, Japan
| | - Mohamed El-Nady
- Department of Gastroenterology, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Sh Untaro Mukai
- Department of Gastroenterology, Tokyo Medical University, Tokyo, Japan
| | - Takeshi Ogura
- Department of Gastroenterology, Osaka Medical College, Osaka, Japan
| | - Pietro Fusaroli
- Department of Gastroenterology, University of Bologna, Bologna, Italy
| | - Peter Vilmann
- Department of Gastroenterology, GastroUnit, Herlev and Gentofte Hospital, Copenhagen University, Copenhagen, Denmark
| | - Praveer Rai
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Nam Q Nguyen
- Department of Gastroenterology, Royal Adelaide Hospital, North Terrace, Adelaide, Australia
| | | | - Chalapathi Rao Achanta
- Department of Gastroenterology, KIMS Icon Hospital, Visakhapatnam, Andhra Pradesh, India
| | - Todd H Baron
- Department of Gastroenterology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ichiro Yasuda
- Department of Gastroenterology, Teikyo University Mizonokuchi Hospital, Kawasaki, Japan
| | - Hsiu-Po Wang
- Department of Gastroenterology, National Taiwan University Hospital, Taipei, Taiwan, China
| | - Jinlong Hu
- Department of Gastroenterology, Sheng Jing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Bowen Duan
- Department of Gastroenterology, Sheng Jing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Manoop S Bhutani
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Siyu Sun
- Department of Gastroenterology, Sheng Jing Hospital of China Medical University, Shenyang, Liaoning Province, China
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Schur M, Andras LM, Murgai R, Siddiqui AA, Gonsalves NR, Sponseller PD, Emans JB, Vitale MG, Skaggs DL. Pelvic Obliquity Correction in Distraction-Based Growth Friendly Implants. Spine Deform 2019; 7:985-991. [PMID: 31732012 DOI: 10.1016/j.jspd.2019.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 05/21/2018] [Revised: 02/25/2019] [Accepted: 03/15/2019] [Indexed: 11/17/2022]
Abstract
DESIGN Multicenter retrospective review. OBJECTIVE To evaluate radiographic outcomes and complication rates of patients treated with distraction based implants and pelvic fixation with either screws (sacral-alar-iliac [SAI] screws or iliac screws) or hooks (S hook iliac fixation). SUMMARY OF BACKGROUND DATA Multiple options exist for pelvic fixation in distraction-based growing rod systems; however, limited comparative data are available. METHODS Early-onset scoliosis (EOS) patients of all diagnoses with distraction-based implants that had pelvic fixation from 2000 to 2013 were reviewed from two EOS multicenter databases. Patients were divided into two groups by type of pelvic fixation: (1) screw group (SAI screws or iliac screws) or (2) S hooks. Exclusion criteria were as follows: index instrumentation ≥10 years old and follow up <2 years. A total of 153 patients met the inclusion criteria. Mean age at index surgery was 6.1 years (range 1.0-9.9 years) and mean follow-up was 4.9 years. RESULTS Pelvic fixation in the 153 patients was as follows: screw group = 42 and S hook group = 111. When comparing patients with >20° of initial pelvic obliquity, the screw group had significantly more correction; mean 26° ± 13° for the screw group versus mean 17° ± 7° in the S hook group (p = .039). There was no significant difference in change in T1-S1 length (40 vs. 39 mm, p = .89) or correction of Cobb angle (30° vs. 24°, p = .24). The total complication rate for the screw group was 14% (6/42) versus 25% (28/111) in the S hook group, though this did not achieve significance (p = .25). The most common complications were device migration (13), implant failure (8), and implant prominence (4) for S hooks and implant failure (3), implant prominence (2), and device migration (1) for the screw group. CONCLUSION In distraction-based growth-friendly constructs, pelvic fixation with screws achieved better correction of pelvic obliquity than S hooks. Complications were almost twice as common with S hooks than screws, though this did not reach statistical significance.
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Affiliation(s)
- Mathew Schur
- Children's Orthopaedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027, USA
| | - Lindsay M Andras
- Children's Orthopaedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027, USA
| | - Rajan Murgai
- Children's Orthopaedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027, USA
| | - Ali A Siddiqui
- Children's Orthopaedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027, USA
| | - Nicholas R Gonsalves
- Children's Orthopaedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027, USA
| | - Paul D Sponseller
- Division of Pediatric Orthopaedics, Johns Hopkins Children's Center, 1800 Orleans St, Baltimore, MD 21287, USA
| | - John B Emans
- Department of Orthopaedic Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Michael G Vitale
- Columbia University Medical Center, Morgan Stanley Children's Hospital of New York - Presbyterian, 3959 Broadway, New York, NY 10032, USA
| | - David L Skaggs
- Children's Orthopaedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027, USA.
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21
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Thomas S, Siddiqui AA, Taylor LJ, Parbhu S, Cao C, Loren D, Kowalski T, Adler DG. Fully-covered esophageal stent migration rates in benign and malignant disease: a multicenter retrospective study. Endosc Int Open 2019; 7:E751-E756. [PMID: 31157292 PMCID: PMC6524992 DOI: 10.1055/a-0890-3284] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 10/26/2018] [Accepted: 02/26/2019] [Indexed: 01/18/2023] Open
Abstract
Background and study aims Stent migration is a common complication of fully-covered self-expanding metal stents (FCSEMS), but the rate of clinically relevant migration as defined by stent migration followed by reintervention via endoscopy for stent replacement is unknown. The goal of this study is to gain insight into the total migration rate and clinically relevant migration rate of different types of FCSEMS placed within benign and malignant strictures with specific attention paid to stent manufacturer, diameter, and length. Patients and methods Multicenter retrospective analysis of endoscopic data from patients with FCSEMS placed within benign or malignant strictures. FCSEMS used included a variety of sizes and manufacturers. Results A total of 369 patients were included, 161 of whom had benign strictures and 208 of whom had malignant strictures. The total migration rate and clinically relevant migration rate in benign strictures were 30 % and 17 %, respectively. For benign strictures, Wallflex stents had a clinically relevant migration rate of 15 %, compared to Endomaxx stents with 19 %, and Evolution stents with 25 % ( P = 0.52). The total migration rate and clinically relevant migration rates in malignant strictures were 23 % and 14 %, respectively. Evolution stents had a significantly higher clinically relevant migration rate (29 %) than the Wallflex stents (7 %) and the endomaxx stents (12 %), P = 0.003. Conclusion This study is the largest to investigate migration rates for FCSEMS in benign and malignant strictures. Clinically relevant migration is a relatively common occurrence with all stent types studied and better anti-migration features are needed.
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Affiliation(s)
- Samuel Thomas
- Department of Gastroenterology and Hepatology, University of Utah - Huntsman Cancer Center, Salt Lake City, Utah, United States
| | - Ali A. Siddiqui
- Department of Gastroenterology and Hepatology, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, United States
| | - Linda Jo Taylor
- Department of Gastroenterology and Hepatology, University of Utah - Huntsman Cancer Center, Salt Lake City, Utah, United States
| | - Sheeva Parbhu
- Department of Gastroenterology and Hepatology, University of Utah - Huntsman Cancer Center, Salt Lake City, Utah, United States
| | - Christopher Cao
- Department of Gastroenterology and Hepatology, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, United States
| | - David Loren
- Department of Gastroenterology and Hepatology, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, United States
| | - Thomas Kowalski
- Department of Gastroenterology and Hepatology, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, United States
| | - Douglas G. Adler
- Department of Gastroenterology and Hepatology, University of Utah - Huntsman Cancer Center, Salt Lake City, Utah, United States,Corresponding author Douglas G. Adler, MD, FACG, AGAF, FASGE Professor of MedicineDirector of Therapeutic EndoscopyDirector, GI Fellowship ProgramGastroenterology and HepatologyUniversity of Utah School of MedicineHuntsman Cancer Center30N 1900E 4R118Salt Lake City, Utah 84132+1-801-581-8007
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Adler DG, Shah J, Nieto J, Binmoeller K, Bhat Y, Taylor LJ, Siddiqui AA. Placement of lumen-apposing metal stents to drain pseudocysts and walled-off pancreatic necrosis can be safely performed on an outpatient basis: A multicenter study. Endosc Ultrasound 2019; 8:36-42. [PMID: 29770780 PMCID: PMC6400089 DOI: 10.4103/eus.eus_30_17] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Backgrounds and Objectives: No study on the use of lumen-apposing fully covered self-expanding metal stent (LAMS) to drain pancreatic fluid collections (PFCs) has evaluated outcomes of patients in the outpatient setting. The objective of this multicenter study was to evaluate the clinical outcomes, success rate, and adverse events of the LAMS for endoscopic ultrasound (EUS)-guided transmural drainage of patients with symptomatic PFCs on an inpatient versus an outpatient basis. Methods: This was a multicenter, retrospective study conducted at 4 tertiary care centers. Results: We identified eighty patients with PFCs in whom EUS-guided transmural drainage using the LAMS was performed. The mean age of the patients was 53.1 years old. Mean size of the PFC was 11.8 ± 5.1 cm. A total of 33 patients had PFCs drained in an outpatient setting while 47 patients underwent PFC drainage as inpatients. The overall technical success (ability to access and drain a PFC by placement of transmural stents) was 98.7% (79 patients). There was no statistically significant difference in the technical success rate between the inpatient and outpatient groups (100% vs. 98%, respectively, P = 1). There was no significant difference in resolution of PFCs in the inpatient and outpatient groups (91% vs. 87% respectively; P = 1). The number of procedures required for PFC resolution was significantly lower in the inpatient group as compared to the outpatients (2.3 vs. 3.1 respectively, P = 0.025). Procedure-related adverse events were significantly lower in the inpatient group compared to the outpatient group (P < 0.01). There was no significant difference in the 2 groups in terms of development of adverse events requiring endoscopic reintervention within 30 days of initial stent placement (P = 0.69). Conclusion: This study shows that LAMS placement for PFCs can be performed safely on an outpatient basis with overall technical and clinical outcomes that are comparable to those seen in inpatients.
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Affiliation(s)
- Douglas G Adler
- Division of Gastroenterology and Hepatology, University of Utah Hospital, Salt Lake City, UT, USA
| | - Janak Shah
- Division of Gastroenterology, California Pacific Medical Center, San Francisco, CA, USA
| | - Jose Nieto
- Department of Gastroenterology, Borland-Groover Clinic, Jacksonville, FL, USA
| | - Kenneth Binmoeller
- Division of Gastroenterology, California Pacific Medical Center, San Francisco, CA, USA
| | - Yasser Bhat
- Division of Gastroenterology, California Pacific Medical Center, San Francisco, CA, USA
| | - Linda Jo Taylor
- Division of Gastroenterology and Hepatology, University of Utah Hospital, Salt Lake City, UT, USA
| | - Ali A Siddiqui
- Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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Yan L, Dargan A, Nieto J, Shariaha RZ, Binmoeller KF, Adler DG, DeSimone M, Berzin T, Swahney M, Draganov PV, Yang DJ, Diehl DL, Wang L, Ghulab A, Butt N, Siddiqui AA. Direct endoscopic necrosectomy at the time of transmural stent placement results in earlier resolution of complex walled-off pancreatic necrosis: Results from a large multicenter United States trial. Endosc Ultrasound 2019; 8:172-179. [PMID: 29882517 PMCID: PMC6590004 DOI: 10.4103/eus.eus_108_17] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background and Objectives EUS-guided drainage, and direct endoscopic necrosectomy (DEN) of walled-off necrosis (WON) using a lumen-apposing metal stent (LAMS) is safe and effective. Early debridement of WON may improve overall clinical outcomes. The aim of this study is to perform a multicenter retrospective study to compare the clinical outcomes and predictors of success for endoscopic drainage of WON with LAMS followed by immediate or delayed DEN performed at standard intervals. Methods Patients with WON managed by EUS-guided drainage with LAMS were divided into 2 groups: (1) those that underwent immediate DEN at the time of stent placement and (2) those that underwent delayed DEN 1 week after stent placement. DEN was subsequently performed every 1-2 week (s). Technical success (successful placement of LAMS), adverse events (AEs), and clinical success (complete resolution of the WON) were evaluated. Results Totally, 271 patients underwent WON drainage with LAMS: 69 who underwent immediate DEN and 202 who underwent delayed DEN. The technical success for LAMS placement was 100% in both groups. There was no significant difference in the overall procedural AEs between the immediate and delayed DEN groups (P = 7.2% vs. 9.4%; P = 0.81). Stent dislodgement during index endoscopy occurred in three patients in the immediate DEN group compared to zero in the delayed DEN group (P = 0.016); all three dislodgements occurred during necrosectomy. Clinical success for WON resolution in the immediate DEN group was 91.3% compared to 86.1% in the delayed DEN group (P = 0.3). The mean number of necrosectomy sessions for WON resolution was significantly lower in the immediate DEN group compared to the delayed DEN group (3.1 vs. 3.9, P < 0.001). Performing DEN at the time of stent placement was an independent predictor for resolution of WON with lesser number of DEN sessions (odds ratio 2.3; P = 0.004). Conclusions DEN at the time of initial stent placement reduces the number of necrosectomy sessions required for successful clinical resolution of WON.
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Affiliation(s)
- Linda Yan
- Division of Gastroenterlogy, Department of Internal Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Andrew Dargan
- Division of Gastroenterlogy, Department of Internal Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jose Nieto
- Division of Gastroenterlogy, Borland Groover Clinic, Jacksonville, FL, USA
| | - Reem Z Shariaha
- Division of Gastroenterlogy, Department of Internal Medicine, Weill Cornell Medical Center, New York City, NY, USA
| | - Kenneth F Binmoeller
- Division of Gastroenterlogy, Department of Internal Medicine, California Pacific Medical Center, San Francisco, CA, USA
| | - Douglas G Adler
- Division of Gastroenterlogy, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Michael DeSimone
- Division of Gastroenterlogy, Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Tyler Berzin
- Division of Gastroenterlogy, Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Mandeep Swahney
- Division of Gastroenterlogy, Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Peter V Draganov
- Division of Gastroenterlogy, Department of Internal Medicine, University of Florida, Gainesville, FL, USA
| | - Dennis J Yang
- Division of Gastroenterlogy, Department of Internal Medicine, University of Florida, Gainesville, FL, USA
| | - David L Diehl
- Division of Gastroenterlogy, Department of Internal Medicine, Geisinger Health System, Danville, PA, USA
| | - Lillian Wang
- Division of Gastroenterlogy, Department of Internal Medicine, Geisinger Health System, Danville, PA, USA
| | - Asma Ghulab
- Division of Gastroenterlogy, Department of Internal Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Nausharwan Butt
- Division of Gastroenterlogy, Department of Internal Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ali A Siddiqui
- Division of Gastroenterlogy, Department of Internal Medicine, Thomas Jefferson University, Philadelphia, PA, USA
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Mashiana HS, Dhaliwal AS, Sayles H, Dhindsa B, Yoo JW, Wu Q, Singh S, Siddiqui AA, Ohning G, Girotra M, Adler DG. Endoscopic retrograde cholangiopancreatography in cirrhosis - a systematic review and meta-analysis focused on adverse events. World J Gastrointest Endosc 2018; 10:354-366. [PMID: 30487946 PMCID: PMC6247096 DOI: 10.4253/wjge.v10.i11.354] [Citation(s) in RCA: 12] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 07/17/2018] [Accepted: 08/21/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate indications and outcomes of endoscopic retrograde cholangiopancreatography (ERCP) in cirrhotics, especially adverse events. Patients with cirrhosis undergoing ERCP are believed to have increased risk. However, there is a paucity of literature describing the indications and outcomes of ERCP procedures in patients with cirrhosis, especially focusing on adverse events. METHODS We performed a systematic appraisal of major literature databases, including PubMed and EMBASE, with a manual search of literature from their inception until April 2017. RESULTS A total of 6,505 patients from 15 studies were analyzed (male ratio 59%, mean age 59 years), 11% with alcoholic and 89% with non-alcoholic cirrhosis, with 56.2% Child-Pugh class A, and 43.8% class B or C. Indications for ERCP included choledocholithiasis 60.9%, biliary strictures 26.2%, gallstone pancreatitis 21.1% and cholangitis 15.5%. Types of interventions included endoscopic sphincterotomy 52.7%, biliary stenting 16.7% and biliary dilation 4.6%. Individual adverse events included hemorrhage in 4.58% (95%CI: 2.77-6.75%, I 2 = 85.9%), post-ERCP pancreatitis (PEP) in 3.68% (95%CI: 1.83-6.00%, I 2 = 89.5%), cholangitis in 1.93% (95%CI: 0.63-3.71%, I 2 = 87.1%) and perforation in 0.00% (95%CI: 0.00-0.23%, I 2 = 37.8%). Six studies were used for comparison of ERCP-related complications in cirrhosis vs non-cirrhosis, which showed higher overall rates of complications in cirrhosis patients with pooled OR of 1.63 (95%CI: 1.27-2.09, I 2 = 65%): higher rates of hemorrhage with OR of 2.05 (95%CI: 1.62-2.58, I 2 = 2.1%) and PEP with OR of 1.33 (95%CI: 1.04-1.70, I 2=65%), but similar cholangitis rates with OR of 1.23 (95%CI: 0.67-2.26, I 2 = 44.3%). CONCLUSION There is an overall higher rate of adverse events related to ERCP in patients with cirrhosis, especially hemorrhage and PEP. A thorough risk/benefit assessment should be performed prior to undertaking ERCP in patients with cirrhosis.
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Affiliation(s)
- Harmeet Singh Mashiana
- Department of Internal Medicine, University of Nevada Las Vegas School of Medicine, Las Vegas, NV 89102, United States
| | - Amaninder Singh Dhaliwal
- Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, 982000 Nebraska Medical Center, Omaha, NE 68198-2000, United States
| | - Harlan Sayles
- Department of Biostatistics, University of Nebraska Medical Center, 982000 Nebraska Medical Center, Omaha, NE 68198-2000, United States
| | - Banreet Dhindsa
- Department of Internal Medicine, University of Nevada Las Vegas School of Medicine, Las Vegas, NV 89102, United States
| | - Ji Won Yoo
- Department of Internal Medicine, University of Nevada Las Vegas School of Medicine, Las Vegas, NV 89102, United States
| | - Qing Wu
- Nevada Institute of Personalized Medicine, Department of Environmental and Occupational Health, School of Community Health Sciences, University of Nevada, Las Vegas, NV 89154-4009, United States
| | - Shailender Singh
- Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, 982000 Nebraska Medical Center, Omaha, NE 68198-2000, United States
| | - Ali A Siddiqui
- Division of Gastroenterology, Jefferson Medical College, Philadelphia, PA 19107, United States
| | - Gordon Ohning
- Division of Gastroenterology, University of Nevada Las Vegas School of Medicine, Las Vegas, NV 89102, United States
| | - Mohit Girotra
- Division of Gastroenterology, University of Miami Miller School of Medicine, Miami, FL 33136, United States
| | - Douglas G Adler
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Huntsman Cancer Center, Salt Lake City, UT 84132, United States
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Mishra BK, Shukla P, Aslam M, Siddiqui AA, Madhu SV. Prevalence of double diabetes in youth onset diabetes patients from east Delhi and neighboring NCR region. Diabetes Metab Syndr 2018; 12:839-842. [PMID: 28899639 DOI: 10.1016/j.dsx.2017.08.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 08/04/2017] [Accepted: 08/20/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND It is being increasingly reported that some of the youth onset diabetes patients cannot be classified clearly as type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) based on usual criteria and the term double diabetes (DD) coined for these cases. AIM The objective of the study was to find out the prevalence of DD in youth onset diabetes patients from east Delhi and neighboring NCR region. METHODS A total of 200 patients with youth onset diabetes below 25 years of age were recruited from a tertiary care hospital in East Delhi. Clinical history, family history of diabetes and anthropometry of patients were recorded. Fasting serum C-peptide, Anti-IA2-antibody and Anti-GAD-antibody were measured in all patients. Patients positive for Anti-GAD-antibody (>1.05U/ml) and C-peptide level >0.3nmol/l were characterized as DD patients. Patients negative for Anti-GAD-antibody and C-peptide >0.3nmol/l were kept under the category of T2DM. Patients with low C-peptide level along with one of the following, positive Anti-GAD-antibody, positive Anti-IA2-antibody and diabetic ketoacidosis (DKA) were considered as T1DM. Remaining patients were kept under the unknown category. RESULTS Mean age of study subjects was 18.2±7.1years. Seven percent (7%) of the subjects were classified as DD, 51% as T1DM, 13% as T2DM and 29% were kept under the unknown category. Mean age of subjects with 22.2±9.7, 16.9±6.7, 20.6±7.7 and 19.4±7.4 years in DD, T1DM, T2DM and unknown category respectively. Mean BMI of subjects with DD, T1DM, T2DM and unknown category was 19.8±5.7, 16.6±3.7, 19.3±4.1 and 18.0±4.6 kg/m2 respectively. CONCLUSION Double diabetes is an important occurrence among youth onset diabetes subjects. Only half of the subjects with youth onset of diabetes had T1DM.
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Affiliation(s)
- B K Mishra
- Department of Endocrinology, Centre for Diabetes Endocrinology & Metabolism, University College of Medical Sciences & Guru Teg Bahadur Hospital, Delhi, India
| | - P Shukla
- Department of Endocrinology, Centre for Diabetes Endocrinology & Metabolism, University College of Medical Sciences & Guru Teg Bahadur Hospital, Delhi, India
| | - M Aslam
- Department of Endocrinology, Centre for Diabetes Endocrinology & Metabolism, University College of Medical Sciences & Guru Teg Bahadur Hospital, Delhi, India
| | - A A Siddiqui
- Department of Endocrinology, Centre for Diabetes Endocrinology & Metabolism, University College of Medical Sciences & Guru Teg Bahadur Hospital, Delhi, India
| | - S V Madhu
- Department of Endocrinology, Centre for Diabetes Endocrinology & Metabolism, University College of Medical Sciences & Guru Teg Bahadur Hospital, Delhi, India.
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Trindade AJ, Benias PC, Kurupathi P, Tharian B, Inamdar S, Sharma N, Sejpal DV, Siddiqui AA, Adler DG. Digital pancreatoscopy in the evaluation of main duct intraductal papillary mucinous neoplasm: a multicenter study. Endoscopy 2018; 50:1095-1098. [PMID: 29698989 DOI: 10.1055/a-0596-7374] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The aim of this study was to investigate the outcomes of digital pancreatoscopy in main duct intraductal papillary mucinous neoplasm (MD-IPMN). METHODS This was a multicenter retrospective study. Outcomes analyzed were safety, incremental pathology yield compared with previous cross-sectional/endoscopic ultrasound (EUS) imaging, and whether the surgical procedure was dictated by the pancreatoscopy. RESULTS A total of 31 patients were enrolled from six tertiary care centers. Overall, 42 % of cases had findings on pancreatoscopy that were not seen on cross-sectional imaging or EUS. Digital pancreatoscopy dictated the type of surgery performed in 13 patients (42 %) who underwent surgery. However, in patients with a diffusely dilated pancreatic duct (> 10 mm), the pancreatoscopy dictated the type of surgery in 77 % of cases vs. 17 % of cases in the focally dilated pancreatic duct group (10/13 vs. 3/18; P = 0.001). CONCLUSION Digital pancreatoscopy should be considered in the diagnostic algorithm of MD-IPMN in patients with a diffusely dilated pancreatic duct and without any focal lesions seen on cross-sectional imaging or EUS.
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Affiliation(s)
- Arvind J Trindade
- Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Division of Gastroenterology, Department of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York, United States
| | - Petros C Benias
- Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Division of Gastroenterology, Department of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York, United States.,Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, New York, United States
| | - Praneet Kurupathi
- Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, New York, United States
| | - Benjamin Tharian
- Division of Gastroenterology, University of Arkansas, Little Rock, Arkansas, United States
| | - Sumant Inamdar
- Division of Gastroenterology, University of Arkansas, Little Rock, Arkansas, United States
| | - Neil Sharma
- Parkview Health System, Wayne, Indiana, United States
| | - Divyesh V Sejpal
- Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Division of Gastroenterology, Department of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York, United States
| | - Ali A Siddiqui
- Division of Gastroenterology, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - Douglas G Adler
- University of Utah School of Medicine, Division of Gastroenterology and Hepatology, Salt Lake City, Utah, United States
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Witt BL, Factor RE, Chadwick BE, Caron J, Siddiqui AA, Adler DG. Evaluation of the SharkCore ® needle for EUS-guided core biopsy of pancreatic neuroendocrine tumors. Endosc Ultrasound 2018; 7:323-328. [PMID: 29623910 PMCID: PMC6199904 DOI: 10.4103/eus.eus_51_17] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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: 11/01/2016] [Accepted: 07/03/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND AND OBJECTIVES EUS guided core biopsy was once rarely performed but is now entering mainstream practice. Neuroendocrine tumors often warrant core biopsy as sufficient tissue must be obtained to allow for special staining to ensure a correct diagnosis. Traditionally these lesions were sampled with FNA needles. We performed a retrospective pilot study to evaluate the clinical value and efficacy of the a new EUS core needle biopsy needle as compared to a standard EUS FNA needle in the evaluation of patients with known or suspected neuroendocrine tumors. METHODS A retrospective analysis of the first 10 patients (between January 2015 and April 2016) to undergo EUS-FNA with the SharkCore® needle at the University of Utah School of Medicine/Huntsman Cancer Center with neuroendocrine tumors. Each case was retrospectively reviewed by a board certified cytopathologist (BLW) for the following cytologic parameters on the aspirate smears or touch/squash preparations: overall cellularity [1 (low) to 3 (high)], percentage of obtained cells that were lesional/representative (<25%, 26%-50%, and >50%), relative ease of interpretation [1 (difficult) to 3 (easy)]. Pathologic material and reporting records were also reviewed for each case to confirm the number of needle passes to achieve diagnostic adequacy, the presence or absence diagnostic material on H&E slide (from cell block, if prepared), whether a definitive diagnosis was able to be rendered, and the presence or absence of a true core/core fragments (within the cell block, if prepared). RESULTS A total of 20 patients underwent EUS-FNA for suspected neuroendocrine lesions. Ten patients underwent either transgastric or transduodenal EUS-FNA with the 22 gauge SharkCore® needle. The comparison cohort of 10 patients underwent either transgastric or transduodenal EUS-FNA with the standard 22 gauge Echotip® needle. The SharkCore® needle required a fewer mean number of needle passes to obtain diagnostic adequacy than the Echotip® (P=0.0074). For cases with cell blocks, the SharkCore® needle produced diagnostic material in 100% of cases, whereas Echotip® produced diagnostic material in 60% of cases. There was no significant difference between specimen cellularity, percentage of lesional material, or ease of interpretation between the two needle types. CONCLUSION Our pilot investigation targeting patients with known or suspected pancreatic NETs indicates that the SharkCore® needle shows promise in obtaining suitable tissue for ancillary testing that can allow for more definitive pathologic interpretations on EUS FNA specimens. Fewer passes were needed with the core needle when compared to a standard needle.
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Affiliation(s)
- Benjamin L. Witt
- Department of Pathology, School of Medicine, ARUP Laboratories, University of Utah, Salt Lake City, UT, USA
| | - Rachel E. Factor
- Department of Pathology, School of Medicine, ARUP Laboratories, University of Utah, Salt Lake City, UT, USA
| | - Barbara E. Chadwick
- Department of Pathology, School of Medicine, ARUP Laboratories, University of Utah, Salt Lake City, UT, USA
| | - Justin Caron
- Department of Pathology, School of Medicine, ARUP Laboratories, University of Utah, Salt Lake City, UT, USA
| | - Ali A. Siddiqui
- Division of Gastroenterology, School of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Douglas G. Adler
- Division of Gastroenterology, School of Medicine, University of Utah, Salt Lake City, UT, USA
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Aslam M, Siddiqui AA, Sandeep G, Madhu SV. High prevalence of obesity among nursing personnel working in tertiary care hospital. Diabetes Metab Syndr 2018; 12:313-316. [PMID: 29287842 DOI: 10.1016/j.dsx.2017.12.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 11/18/2017] [Accepted: 12/19/2017] [Indexed: 11/30/2022]
Abstract
AIM To find out the prevalence of obesity and glucose intolerance among nurses working in tertiary care hospital. METHODS Study was conducted in 496 apparently healthy females comprising two groups. Group B had 290 nurses and control group A had 206 age matched female subjects of general population. Detailed performa was filled which included anthropometry, systemic examination and other details. Fasting plasma glucose was done followed by oral glucose tolerance test (OGTT). Subjects with body mass index ≥23 kg/m2 were categorized as 'overweight' and ≥25 kg/m2 as 'obese' as per criteria for Asian Indians. Women with waist circumference of ≥80 cm were categorized as 'centrally obese'. RESULTS Mean age of subjects in groups A and B was 40.45 ± 8.64 years and 40.50 ± 6.96 years respectively. Significantly higher number of nurses (80%) were overweight or obese compared to controls (59.71%,P = < .001). Similarly, central obesity was significantly higher in nurses (82.07%) compared to controls (67.96%,P = <.001). The prevalence of glucose intolerance (prediabetes and newly detected diabetes) was significantly higher in controls compared to nurses (45.63% vs 29.66%, P < .001). CONCLUSION Every four out of five nurses working in tertiary care hospital have overweight/obesity and central obesity. Despite this they have lower rates of glucose intolerance.
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Affiliation(s)
- M Aslam
- Department of Endocrinology, Centre for Diabetes Endocrinology & Metabolism, University College of Medical Sciences (University of Delhi) & GTB Hospital, Delhi 110095, India
| | - A A Siddiqui
- Department of Endocrinology, Centre for Diabetes Endocrinology & Metabolism, University College of Medical Sciences (University of Delhi) & GTB Hospital, Delhi 110095, India
| | - G Sandeep
- Department of Endocrinology, Centre for Diabetes Endocrinology & Metabolism, University College of Medical Sciences (University of Delhi) & GTB Hospital, Delhi 110095, India
| | - S V Madhu
- Department of Endocrinology, Centre for Diabetes Endocrinology & Metabolism, University College of Medical Sciences (University of Delhi) & GTB Hospital, Delhi 110095, India.
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Mudireddy PR, Sethi A, Siddiqui AA, Adler DG, Nieto J, Khara H, Trindade A, Ho S, Benias PC, Draganov PV, Yang D, Mok S, Confer B, Diehl DL. EUS-guided drainage of postsurgical fluid collections using lumen-apposing metal stents: a multicenter study. Gastrointest Endosc 2018; 87:1256-1262. [PMID: 28843581 DOI: 10.1016/j.gie.2017.08.011] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [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: 04/18/2017] [Accepted: 08/06/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Postsurgical fluid collections (PSFCs) are traditionally drained either percutaneously or surgically. Endoscopic drainage offers several advantages compared with either percutaneous or surgical approaches, including avoiding repeat surgery or the need to have a percutaneous drain in place for weeks. There are very little data regarding the use of lumen-apposing metal stents (LAMSs) in the drainage of PSFCs. We aim to study the technical and clinical success and adverse events (AEs) of using LAMSs in the drainage of PSFCs. METHODS Collaborators from 8 centers retrospectively reviewed their endoscopic databases to find procedures using LAMSs for drainage of PSFCs. Technical success (successful placement of LAMSs into the fluid collection), clinical success (complete resolution of the fluid collection on repeat imaging or endoscopy), and intraprocedure and postprocedure AEs were measured. RESULTS Forty-seven patients were identified with PSFCs after various surgeries. Thirteen patients had failed previous percutaneous or surgical drainage attempts. Fluid collections averaged 78.6 mm (range, 47-150 mm) in size. The most common site of stent placement was transgastric, followed by rectum and duodenum. Technical success rate was 93.6% and clinical success rate 89.3%. The intraprocedural AE rate was 4.25% and postprocedural AE rate 6.4%. There was 1 death unrelated to the procedure. CONCLUSIONS The use of LAMSs to drain PSFCs has a high technical and clinical success rate with low AEs. For collections that are favorably located adjacent to the stomach, duodenum, or rectum, LAMS placement is a viable alternative to repeat surgery or percutaneous drainage.
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Affiliation(s)
- Prashant R Mudireddy
- Department of Gastroenterology, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Amrita Sethi
- Department of Gastroenterology, Columbia University Medical Center, New York, New York, USA
| | - Ali A Siddiqui
- Department of Gastroenterology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Douglas G Adler
- Department of Gastroenterology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Jose Nieto
- Department of Gastroenterology, Borland-Groover Clinic, Jacksonville, Florida, USA
| | - Harshit Khara
- Department of Gastroenterology, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Arvind Trindade
- Department of Gastroenterology, Long Island Jewish Medical Center, Northwell Health System, New Hyde Park, New York, USA
| | - Sammy Ho
- Department of Gastroenterology, Montefiore Medical Center, Bronx, New York, USA
| | - Petros C Benias
- Department of Gastroenterology, Long Island Jewish Medical Center, Northwell Health System, New Hyde Park, New York, USA
| | - Peter V Draganov
- Department of Gastroenterology, University of Florida, Gainesville, Florida, USA
| | - Dennis Yang
- Department of Gastroenterology, University of Florida, Gainesville, Florida, USA
| | - Shaffer Mok
- Department of Gastroenterology, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Bradley Confer
- Department of Gastroenterology, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - David L Diehl
- Department of Gastroenterology, Geisinger Medical Center, Danville, Pennsylvania, USA
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Guo J, Giovannini M, Sahai AV, Saftoiu A, Dietrich CF, Santo E, Fusaroli P, Siddiqui AA, Bhutani MS, Bun Teoh AY, Irisawa A, Arturo Arias BL, Achanta CR, Jenssen C, Seo DW, Adler DG, Kalaitzakis E, Artifon E, Itokawa F, Poley JW, Mishra G, Ho KY, Wang HP, Okasha HH, Lachter J, Vila JJ, Iglesias-Garcia J, Yamao K, Yasuda K, Kubota K, Palazzo L, Sabbagh LC, Sharma M, Kida M, El-Nady M, Nguyen NQ, Vilmann P, Garg PK, Rai P, Mukai S, Carrara S, Parupudi S, Sridhar S, Lakhtakia S, Rana SS, Ogura T, Baron TH, Dhir V, Sun S. A multi-institution consensus on how to perform EUS-guided biliary drainage for malignant biliary obstruction. Endosc Ultrasound 2018; 7:356-365. [PMID: 30531022 PMCID: PMC6289007 DOI: 10.4103/eus.eus_53_18] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background and Objectives: EUS-guided biliary drainage (EUS-BD) was shown to be useful for malignant biliary obstruction (MBO). However, there is lack of consensus on how EUS-BD should be performed. Methods: This was a worldwide multi-institutional survey among members of the International Society of EUS conducted in February 2018. The survey consisted of 10 questions related to the practice of EUS-BD. Results: Forty-six endoscopists of them completed the survey. The majority of endoscopists felt that EUS-BD could replace percutaneous transhepatic biliary drainage after failure of ERCP. Among all EUS-BD methods, the rendezvous stenting technique should be the First choice. Self-expandable metal stents (SEMSs) were recommended by most endoscopists. For EUS-guided hepaticogastrostomy (HGS), superiority of partially-covered SEMS over fully-covered SEMS was not in agreement. 6-Fr cystotomes were recommended for fistula creation. During the HGS approach, longer SEMS (8 or 10 cm) was recommended. During the choledochoduodenostomy approach, 6-cm SEMS was recommended. During the intrahepatic (IH) approach, the IH segment 3 was recommended. Conclusion: This is the first worldwide survey on the practice of EUS-BD for MBO. There were wide variations in practice, and randomized studies are urgently needed to establish the best approach for the management of this condition.
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Affiliation(s)
- Jintao Guo
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Marc Giovannini
- Pathology Unit (Flora Poizat), Institute Paoli-Calmettes, Marseille, France
| | - Anand V Sahai
- Center Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Adrian Saftoiu
- Department of Endoscopy, University of Medicine and Pharmacy, Craiova, Romania
| | | | - Erwin Santo
- Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Pietro Fusaroli
- Department of Medical and Surgical Sciences, Gastroenterology Unit, Hospital of Imola, University of Bologna, Bologna, Italy
| | - Ali A Siddiqui
- Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Manoop S Bhutani
- Department of Gastroenterology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anthony Yuen Bun Teoh
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Atsushi Irisawa
- Department of Gastroenterology, Dokkyo Medical University, Mibu, Japan
| | | | | | | | - Dong-Wan Seo
- Department of Internal Medicine, Division of Gastroenterology, University of Ulsan College of Medicine, Seoul, South Korea
| | - Douglas G Adler
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Evangelos Kalaitzakis
- Division of Endoscopy, Gastro Unit, Copenhagen University Hospital Herlev, Copenhagen, Denmark
| | - Everson Artifon
- Department of Surgery, University of Sao Paulo, Sao Paulo, Brazil
| | - Fumihide Itokawa
- Department of Gastroenterology and Hepatology, Tokyo Adventist Hospital, Tokyo, Japan
| | - Jan Werner Poley
- Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Girish Mishra
- Department of Gastroenterology, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Khek Yu Ho
- Department of Medicine, National University of Singapore, Singapore, Singapore
| | - Hsiu-Po Wang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, China
| | | | | | - Juan J Vila
- Endoscopy Unit, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Julio Iglesias-Garcia
- Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, Spain
| | | | - Kenjiro Yasuda
- Department of Gastroenterology, Kyoto Second Red Cross Hospital, Kyoto, Japan
| | - Kensuke Kubota
- Department of Endoscopy, Yokohama City University School of Medicine, Yokohama, Japan
| | | | | | - Malay Sharma
- Department of Gastroenterology, Jaswant Rai Specialty Hospital, Meerut, Uttar Pradesh, India
| | - Mitsuhiro Kida
- Department of Gastroenterology, Kitasato University East Hospital, Sagamihara, Japan
| | - Mohamed El-Nady
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nam Q Nguyen
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, North Terrace, Adelaide, Australia
| | - Peter Vilmann
- Division of Endoscopy, Gastro Unit, Copenhagen University Hospital Herlev, Copenhagen, Denmark
| | - Pramod Kumar Garg
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Praveer Rai
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Shuntaro Mukai
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Silvia Carrara
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Milan, Italy
| | | | - Subbaramiah Sridhar
- Section of Gastroenterology/Hepatology, Augusta University, Augusta, GA, USA
| | - Sundeep Lakhtakia
- Asian Institute of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Surinder S Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Takeshi Ogura
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Todd H Baron
- Division of Gastroenterology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Vinay Dhir
- Department of Gastroenterology, SL Raheja Hospital, Mumbai, Maharashtra, India
| | - Siyu Sun
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
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Naveed M, Siddiqui AA, Kowalski TE, Loren DE, Khalid A, Soomro A, Mazhar SM, Yoo J, Hasan R, Yalamanchili S, Tarangelo N, Taylor LJ, Adler DG. A Multicenter comparative trial of a novel EUS-guided core biopsy needle (SharkCore ™) with the 22-gauge needle in patients with solid pancreatic mass lesions. Endosc Ultrasound 2018; 7:34-40. [PMID: 29451167 PMCID: PMC5838725 DOI: 10.4103/eus.eus_27_17] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background and Objectives: The ability to obtain adequate tissue of solid pancreatic lesions by EUS-guided remains a challenge. The aim of this study was to compare the performance characteristics and safety of EUS-FNA for evaluating solid pancreatic lesions using the standard 22-gauge needle versus a novel EUS biopsy needle. Methods: This was a multicenter retrospective study of EUS-guided sampling of solid pancreatic lesions between 2009 and 2015. Patients underwent EUS-guided sampling with a 22-gauge SharkCore (SC) needle or a standard 22-gauge FNA needle. Technical success, performance characteristics of EUS-FNA, the number of needle passes required to obtain a diagnosis, diagnostic accuracy, and complications were compared. Results: A total of 1088 patients (mean age = 66 years; 49% female) with pancreatic masses underwent EUS-guided sampling with a 22-gauge SC needle (n = 115) or a standard 22-gauge FNA needle (n = 973). Technical success was 100%. The frequency of obtaining an adequate cytology by EUS-FNA was similar when using the SC and the standard needle (94.1% vs. 92.7%, respectively). The sensitivity, specificity, and diagnostic accuracy of EUS-FNA for tissue diagnosis were not significantly different between two needles. Adequate sample collection leading to a definite diagnosis was achieved by the 1st, 2nd, and 3rd pass in 73%, 92%, and 98% of procedures using the SC needle and 20%, 37%, and 94% procedures using the standard needle (P < 0.001), respectively. The median number of passes to obtain a tissue diagnosis using the SC needle was significantly less as compared to the standard needle (1 and 3, respectively; P < 0.001). Conclusions: The EUS SC biopsy needle is safe and technically feasible for EUS-FNA of solid pancreatic mass lesions. Preliminary results suggest that the SC needle has a diagnostic yield similar to the standard EUS needle and significantly reduces the number of needle passes required to obtain a tissue diagnosis.
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Affiliation(s)
- Mariam Naveed
- Division of Gastroenterology and Hepatology, University of Iowa, Iowa City, IA, USA
| | - Ali A Siddiqui
- Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Thomas E Kowalski
- Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, PA, USA
| | - David E Loren
- Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ammara Khalid
- Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ayesha Soomro
- Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Syed M Mazhar
- Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Joseph Yoo
- Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Raza Hasan
- Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Silpa Yalamanchili
- Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Nicholas Tarangelo
- Division of Gastroenterology and Hepatology, University of Utah, Salt Lake City, UT, USA
| | - Linda J Taylor
- Division of Gastroenterology and Hepatology, University of Utah, Salt Lake City, UT, USA
| | - Douglas G Adler
- Division of Gastroenterology and Hepatology, University of Utah, Salt Lake City, UT, USA
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Xu MM, Yin S, Siddiqui AA, Salem RR, Schrope B, Sethi A, Poneros JM, Gress FG, Genkinger JM, Do C, Brooks CA, Chabot JA, Kluger MD, Kowalski T, Loren DE, Aslanian H, Farrell JJ, Gonda TA. Comparison of the diagnostic accuracy of three current guidelines for the evaluation of asymptomatic pancreatic cystic neoplasms. Medicine (Baltimore) 2017; 96:e7900. [PMID: 28858107 PMCID: PMC5585501 DOI: 10.1097/md.0000000000007900] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Asymptomatic pancreatic cysts are a common clinical problem but only a minority of these cases progress to cancer. Our aim was to compare the accuracy to detect malignancy of the 2015 American Gastroenterological Association (AGA), the 2012 International Consensus/Fukuoka (Fukuoka guidelines [FG]), and the 2010 American College of Radiology (ACR) guidelines.We conducted a retrospective study at 3 referral centers for all patients who underwent resection for an asymptomatic pancreatic cyst between January 2008 and December 2013. We compared the accuracy of 3 guidelines in predicting high-grade dysplasia (HGD) or cancer in resected cysts. We performed logistic regression analyses to examine the association between cyst features and risk of HGD or cancer.A total of 269 patients met inclusion criteria. A total of 228 (84.8%) had a benign diagnosis or low-grade dysplasia on surgical pathology, and 41 patients (15.2%) had either HGD (n = 14) or invasive cancer (n = 27). Of the 41 patients with HGD or cancer on resection, only 3 patients would have met the AGA guideline's indications for resection based on the preoperative cyst characteristics, whereas 30/41 patients would have met the FG criteria for resection and 22/41 patients met the ACR criteria. The sensitivity, specificity, positive predictive value, negative predictive value of HGD, and/or cancer of the AGA guidelines were 7.3%, 88.2%, 10%, and 84.1%, compared to 73.2%, 45.6%, 19.5%, and 90.4% for the FG and 53.7%, 61%, 19.8%, and 88% for the ACR guidelines. In multivariable analysis, cyst size >3 cm, compared to ≤3 cm, (odds ratio [OR] = 2.08, 95% confidence interval [CI] = 1.11, 4.2) and each year increase in age (OR = 1.07, 95% CI = 1.03, 1.11) were positively associated with risk of HGD or cancer on resection.In patients with asymptomatic branch duct-intraductal papillary mucinous neoplasms or mucinous cystic neoplasms who underwent resection, the prevalence rate of HGD or cancer was 15.2%. Using the 2015 AGA criteria for resection would have missed 92.6% of patients with HGD or cancer. The more "inclusive" FG and ACR had a higher sensitivity for HGD or cancer but lower specificity. Given the current deficiencies of these guidelines, it will be important to determine the acceptable rate of false-positives in order to prevent a single true-positive.
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Affiliation(s)
- Ming-ming Xu
- Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, NY
| | - Shi Yin
- Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, NY
| | - Ali A. Siddiqui
- Division of Gastroenterology and Hepatology, Thomas Jefferson University Medical Center, Philadelphia, PA
| | - Ronald R. Salem
- Section of Surgical Oncology, Division of Surgery, Yale University School of Medicine, New Haven, CT
| | | | - Amrita Sethi
- Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, NY
| | - John M. Poneros
- Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, NY
| | - Frank G. Gress
- Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, NY
| | - Jeanine M. Genkinger
- Department of Epidemiology, Mailman School of Public Health
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY
| | - Catherine Do
- Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, NY
| | - Christian A. Brooks
- Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, NY
| | | | | | - Thomas Kowalski
- Division of Gastroenterology and Hepatology, Thomas Jefferson University Medical Center, Philadelphia, PA
| | - David E. Loren
- Division of Gastroenterology and Hepatology, Thomas Jefferson University Medical Center, Philadelphia, PA
| | - Harry Aslanian
- Section of Digestive Disease, Yale University School of Medicine, New Haven, CT, USA
| | - James J. Farrell
- Section of Digestive Disease, Yale University School of Medicine, New Haven, CT, USA
| | - Tamas A. Gonda
- Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, NY
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Affiliation(s)
- Douglas G Adler
- Department of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Ali A Siddiqui
- Department of Gastroenterology and Hepatology, Jefferson University School of Medicine, Philadelphia, Pennsylvania, USA
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Adler DG, Papachristou GI, Taylor LJ, McVay T, Birch M, Francis G, Zabolotsky A, Laique SN, Hayat U, Zhan T, Das R, Slivka A, Rabinovitz M, Munigala S, Siddiqui AA. Clinical outcomes in patients with bile leaks treated via ERCP with regard to the timing of ERCP: a large multicenter study. Gastrointest Endosc 2017; 85:766-772. [PMID: 27569859 DOI: 10.1016/j.gie.2016.08.018] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [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: 04/06/2016] [Accepted: 08/17/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Postsurgical or traumatic bile duct leaks (BDLs) can be safely and effectively managed by endoscopic therapy via ERCP. The early diagnosis of BDL is important because unrecognized leaks can lead to serious adverse events (AEs). Our aim was to evaluate the relationship between timing of endotherapy after BDL and the clinical outcomes, AEs, and long-term results of endoscopic therapy. METHODS We conducted a multicenter, retrospective study on patients with BDLs who underwent ERCP between 2006 and 2014. Data were assembled on patient demographics, etiology of BDL, and procedural details. Endotherapy for BDLs were classified a priori into 3 groups based on timing of ERCP from time of biliary injury: within 1 day of BDL, on day 2 or 3 after BDL, and greater than 3 days after BDL. The relationship among timing of ERCP after BDL injury and outcomes, procedure-related AEs, and patient AEs and mortality were evaluated. RESULTS From February 2006 to June 2014, 518 patients (50% male; mean age, 51.7 years) underwent ERCP for therapy of BDLs. The etiology of the BDL was laparoscopic cholecystectomy (70.7%), post-liver transplantation (11.2%), liver resection (14.1%), trauma (2.5%), and other causes (1.5%). Endotherapy was performed by placing a transpapillary stent alone (73.5%) or with a sphincterotomy (26.5%). The timing of ERCPs was as follows: ≤1 day = 57 patients, day 2 or 3 = 140 patients, and >3 days = 321 patients. There was no statistical difference in patient demographics, etiology/site of BDL, or type of endotherapy performed among the 3 groups. On multivariate analysis there was no statistically significant difference in BDL success rate for ERCPs performed within 1 day compared with those performed on day 2 or 3 or after 3 days of bile duct injury (91.2%, 90%, and 88.5%, respectively; P = .77). Similarly, there was no significant difference in the overall patient AE rate among the 3 groups (21.1%, 22.9%, and 24.6%, respectively; P = .81). AEs in men occurred significantly more frequently when compared with women, even after adjusting for age, BDL etiology, and location of leak (27.6% vs 19.9%; OR, 1.53; P = .04). Patients whose BDL was due to a cholecystectomy had a lower AE and mortality rate compared with those who had biliary injury from other etiologies (OR, .42; P < .001). CONCLUSIONS The overall success rates and AEs after ERCP were not dependent on the timing of the procedure relative to the discovery of the bile leak. This suggests that ERCP in these patients can usually be performed in an elective, rather than an urgent, manner.
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Affiliation(s)
- Douglas G Adler
- Department of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Georgios I Papachristou
- Division of Gastroenterology and Hepatology, Jefferson University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Linda Jo Taylor
- Department of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Tyler McVay
- Department of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Madeleine Birch
- Department of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Gloria Francis
- Division of Gastroenterology and Hepatology, Jefferson University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Andrew Zabolotsky
- Division of Gastroenterology and Hepatology, Jefferson University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Sobia N Laique
- Division of Gastroenterology and Hepatology, Jefferson University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Umar Hayat
- Division of Gastroenterology and Hepatology, Jefferson University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Tingting Zhan
- Division of Biostatistics, Jefferson University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Rohit Das
- Division of Gastroenterology and Hepatology, Jefferson University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Adam Slivka
- Division of Gastroenterology and Hepatology, Jefferson University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Mordechai Rabinovitz
- Division of Gastroenterology and Hepatology, Jefferson University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Satish Munigala
- Division of Biostatistics, Jefferson University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Ali A Siddiqui
- Division of Gastroenterology and Hepatology, Jefferson University School of Medicine, Philadelphia, Pennsylvania, USA
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Yang J, Siddiqui AA, Kowalski TE, Loren DE, Khalid A, Soomro A, Mazhar SM, Rosé J, Isby L, Kahaleh M, Kalra A, Sarkisian AM, Kumta NA, Nieto J, Sharaiha RZ. Erratum to: Esophageal stent fixation with endoscopic suturing device improves clinical outcomes and reduces complications in patients with locally advanced esophageal cancer prior to neoadjuvant therapy: a large multicenter experience. Surg Endosc 2017; 31:1420. [DOI: 10.1007/s00464-016-5259-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Silon B, Siddiqui AA, Taylor LJ, Arastu S, Soomro A, Adler DG. Endoscopic Management of Esophagorespiratory Fistulas: A Multicenter Retrospective Study of Techniques and Outcomes. Dig Dis Sci 2017; 62:424-431. [PMID: 28012101 DOI: 10.1007/s10620-016-4390-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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: 08/02/2016] [Accepted: 11/22/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIMS Esophagorespiratory fistulas (ERF) are a devastating complication of benign and malignant etiologies. ERF are associated with high mortality, short survival, and poor quality of life. We performed a multicenter analysis of patients with ERF undergoing endoscopic treatment. METHODS Multicentre retrospective study. RESULTS We analyzed 25 patients undergoing 35 procedures over an 8-year period. Our data showed high technical success rates (97.1% of procedures) and with good, but not ideal, clinical success rates (60% of procedures, 80% of patients), which were defined as fistula closure confirmed by radiographic or repeat endoscopic evaluation and/or a lack of recurrent episodes of clinical aspiration to focus on durable ERF closure as opposed to only initial success. Proximal ERF were the most difficult to manage with the lowest overall clinical success rates, highest rates of recurrent aspiration despite endoscopic therapy, highest adverse events, and shortest survival times. Adverse events occurred in 40.0% of our patients and were all minor. Treatment allowed for diet advancement in 75% of patients. CONCLUSION This represents the largest recent collection of US data and the first multicenter study evaluating the clinical success of multiple treatment modalities while stratifying data by fistula etiology and esophageal location. The endoscopic approaches detailed in this study offer a minimally invasive and safe choice for intervention with the potential to improve quality of life despite overall suboptimal clinical success and survivorship rates for in with ERF.
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Affiliation(s)
- Bryan Silon
- Gastroenterology and Hepatology, Huntsman Cancer Center, University of Utah School of Medicine, 30N 1900E 4R118, Salt Lake City, UT, 84132, USA
| | - Ali A Siddiqui
- Gastroenterology and Hepatology, Jefferson University School of Medicine, Philadelphia, PA, USA
| | - Linda Jo Taylor
- Gastroenterology and Hepatology, Huntsman Cancer Center, University of Utah School of Medicine, 30N 1900E 4R118, Salt Lake City, UT, 84132, USA
| | - Sanaa Arastu
- Gastroenterology and Hepatology, Jefferson University School of Medicine, Philadelphia, PA, USA
| | - Ammara Soomro
- Gastroenterology and Hepatology, Jefferson University School of Medicine, Philadelphia, PA, USA
| | - Douglas G Adler
- Gastroenterology and Hepatology, Huntsman Cancer Center, University of Utah School of Medicine, 30N 1900E 4R118, Salt Lake City, UT, 84132, USA.
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Yoo J, Yan L, Hasan R, Somalya S, Nieto J, Siddiqui AA. Feasibility, safety, and outcomes of a single-step endoscopic ultrasonography-guided drainage of pancreatic fluid collections without fluoroscopy using a novel electrocautery-enhanced lumen-apposing, self-expanding metal stent. Endosc Ultrasound 2017; 6:131-135. [PMID: 28440239 PMCID: PMC5418966 DOI: 10.4103/2303-9027.204814] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND AND OBJECTIVES There are currently limited data available regarding the safety of endoscopic ultrasound (EUS)-guided drainage of pancreatic fluid collections (PFCs) using the lumen-apposing metal stent without fluoroscopic guidance. This study aims to evaluate clinical outcomes and safety of EUS-guided drainage of PFC using the electrocautery-enhanced lumen-apposing metal stents (EC-LAMSs) without fluoroscopic guidance. METHODS We conducted a retrospective study on patients with symptomatic PFC who underwent EUS-guided drainage using EC-LAMS without fluoroscopy. All patients were followed clinically until resolution of their PFC. Technical success (successful placement of EC-LAMS), number of patients who achieved complete resolution of PFC without additional intervention and adverse events were noted. RESULTS We evaluated 25 patients, including three with pancreatic pseudocysts and 22 with walled-off necrosis (WON). The etiology of the patient's pancreatitis was gallstones (42%), alcohol (27%), and other causes (31%). The mean cyst size was 82 mm (range, 60-170 mm). The indications for endoscopic drainage were abdominal pain, infected WON, or gastric outlet obstruction. Technical success with placement of the EC-LAMS was achieved in all 25 patients. There were no procedure-related complications. The mean patient follow-up was 7.8 months. PFCs resolved in 24 (96%) patients; the one failure was in a patient with WON. Stent occlusion was seen in one patient. There was a spontaneous migration of one stent into the enteral lumen after resolution of WONs. The EC-LAMS were successfully removed using a snare in all the remaining patients. The median number of endoscopy sessions to achieve PFCs resolution was 2 (range, 2-6). CONCLUSIONS Single-step EUS-guided drainage of PFCs without fluoroscopic guidance using the novel EC-LAMS is a safe and effective endoscopic technique for drainage of PFCs with excellent technical and clinical success rates and no complications. Due to its ease of use, EC-LAMS may simplify and streamline EUS-guided management of PFC and help in its widespread adoption as an alternative to surgery.
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Affiliation(s)
- Joseph Yoo
- Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Linda Yan
- Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Raza Hasan
- Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Saana Somalya
- Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jose Nieto
- Division of Gastroenterology, Borland Groover Clinic, Jacksonville, FL, USA
| | - Ali A Siddiqui
- Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, PA, USA
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Wyse JM, Battat R, Sun S, Saftoiu A, Siddiqui AA, Leong AT, Arturo Arias BL, Fabbri C, Adler DG, Santo E, Kalaitzakis E, Artifon E, Mishra G, Okasha HH, Poley JW, Guo J, Vila JJ, Lee LS, Sharma M, Bhutani MS, Giovannini M, Kitano M, Eloubeidi MA, Khashab MA, Nguyen NQ, Saxena P, Vilmann P, Fusaroli P, Garg PK, Ho S, Mukai S, Carrara S, Sridhar S, Lakhtakia S, Rana SS, Dhir V, Sahai AV. Practice guidelines for endoscopic ultrasound-guided celiac plexus neurolysis. Endosc Ultrasound 2017; 6:369-375. [PMID: 29251270 PMCID: PMC5752758 DOI: 10.4103/eus.eus_97_17] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [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: 12/17/2022] Open
Abstract
Objectives: The objective of guideline was to provide clear and relevant consensus statements to form a practical guideline for clinicians on the indications, optimal technique, safety and efficacy of endoscopic ultrasound guided celiac plexus neurolysis (EUS-CPN). Methods: Six important clinical questions were determined regarding EUS-CPN. Following a detailed literature review, 6 statements were proposed attempting to answer those questions. A group of expert endosonographers convened in Chicago, United States (May 2016), where the statements were presented and feedback provided. Subsequently a consensus group of 35 expert endosonographers voted based on their individual level of agreement. A strong recommendation required 80% voter agreement. The modified GRADE (Grading of Recommendations Assessment, Development, and Evaluation) criteria were used to rate the strength of recommendations and the quality of evidence. Results: Eighty percent agreement was reached on 5 of 6 consensus statements, 79.4% agreement was reached on the remaining one. Conclusions: EUS-CPN is efficacious, should be integrated into the management of pancreas cancer pain, and can be considered early at the time of diagnosis of inoperable disease. Techniques may still vary based on operator experience. Serious complications exist, but are rare.
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Affiliation(s)
- Jonathan M Wyse
- Division of Gastroenterology, Jewish General Hospital, McGill University, Montreal, Canada
| | - Robert Battat
- Division of Gastroenterology, Jewish General Hospital, McGill University, Montreal, Canada
| | - Siyu Sun
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Adrian Saftoiu
- Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy, Craiova, Romania
| | - Ali A Siddiqui
- Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Ang Tiing Leong
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
| | | | - Carlo Fabbri
- Unit of Gastroenterology and Digestive Endoscopy, AUSL Bologna Bellaria-Maggiore Hospital, Bologna, Italy
| | - Douglas G Adler
- Department of Internal Medicine, Division of Gastroenterology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Erwin Santo
- Department of Gastroenterology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | - Everson Artifon
- Department of Surgery, Ana Costa Hospital, Sao Paulo, Brazil
| | - Girish Mishra
- Department of Gastroenterology, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | | | - Jan Werner Poley
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jintao Guo
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Juan J Vila
- Endoscopy Unit, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Linda S Lee
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, USA
| | - Malay Sharma
- Department of Gastroenterology, Jaswant Rai Specialty Hospital, Meerut, Uttar Pradesh, India
| | - Manoop S Bhutani
- Department of Gastroenterology, Hepatology and Nutrition, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Marc Giovannini
- Endoscopic Unit, Institut Paoli-Calmettes, Marseille, France
| | - Masayuki Kitano
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Mohamad Ali Eloubeidi
- Division of Gastroenterology, Northeast Alabama Regional Medical Center, Anniston, AL, USA
| | - Mouen A Khashab
- Department of Medicine and Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Nam Q Nguyen
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, North Terrace, Adelaide, Australia
| | - Payal Saxena
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Peter Vilmann
- Department of Gastroenterology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Pietro Fusaroli
- Department of Medical and Surgical Science, Gastroenterology Unit, Hospital of Imola, University of Bologna, Bologna, Italy
| | - Pramod Kumar Garg
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Sammy Ho
- Division of Gastroenterology and Liver Diseases, Montefiore Medical Center, Bronx, New York, USA
| | - Shuntaro Mukai
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Silvia Carrara
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Milan, Italy
| | - Subbaramiah Sridhar
- Section of Gastroenterology/Hepatology, Augusta University, Augusta, GA, USA
| | - Sundeep Lakhtakia
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Surinder S Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vinay Dhir
- Baldota Institute of Digestive Sciences, Global Hospitals, Mumbai, Maharashtra, India
| | - Anand V Sahai
- Division of Gastroenterology, Center Hospitalier de l'Université de Montréal, Montreal, Canada
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Guo J, Saftoiu A, Vilmann P, Fusaroli P, Giovannini M, Mishra G, Rana SS, Ho S, Poley JW, Ang TL, Kalaitzakis E, Siddiqui AA, De La Mora-Levy JG, Lakhtakia S, Bhutani MS, Sharma M, Mukai S, Garg PK, Lee LS, Vila JJ, Artifon E, Adler DG, Sun S. A multi-institutional consensus on how to perform endoscopic ultrasound-guided peri-pancreatic fluid collection drainage and endoscopic necrosectomy. Endosc Ultrasound 2017; 6:285-291. [PMID: 29063871 PMCID: PMC5664848 DOI: 10.4103/eus.eus_85_17] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [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] [Indexed: 12/13/2022] Open
Abstract
There is a lack of consensus on how endoscopic ultrasound (EUS)-guided pseudocyst drainage and endoscopic necrosectomy should be performed. This survey was carried out amongst members of the EUS Journal Editorial Board to describe their practices in performing this procedure. This was a worldwide multi-institutional survey amongst members of the EUS Journal Editorial Board in May 2017. The responses to a 22-question survey with respect to the practice of EUS-guided pseudocyst drainage and endoscopic necrosectomy were obtained. Twenty-two endoscopists responded to the questionnaire as follows: 72.7% (16/22) were of the opinion that lumen-apposing metal stents (LAMS) should be the standard of care for the creation of an endoscopic cystenterostomy in patients with pancreatic walled-off necrosis (WON); 95.5% (21/22) recommended large diameter (d=15 mm) LAMS for drainage in patients with WON; 54.5% (12/22) would not dilate LAMS after placement into the WOPN; 86.4% (19/22) would not perform endoscopic necrosectomy during the same procedure as the creation of the cystenterostomy; 45.5% (10/22) recommend that agents, such as diluted hydrogen peroxide, should be used to lavage the peri-pancreatic fluid collection (PFC) cavity in patients with WON; and 45.5% (10/22) considered a naso-cystic or other tube to be necessary for lavage of WON after initial drainage. The mean optimal interval recommended for endoscopic necrosectomy procedures after EUS-guided drainage was 6.23 days. The mean optimal interval recommended for repeat imaging in patients undergoing endoscopic necrosectomy was 12.32 days. The mean time recommended for LAMS removal was 4.59 weeks. This is the first worldwide survey on the practice of EUS-guided pseudocyst drainage and endoscopic necrosectomy. There were wide variations in practice and randomized studies are urgently needed to establish the best approach for management of this condition. There is also a pressing need to establish a best practice consensus.
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Affiliation(s)
- Jintao Guo
- Endoscopy Center, Sheng Jing Hospital of Medical University, Shenyang, China
| | - Adrian Saftoiu
- Department of Endoscopy, University of Medicine and Pharmacy, Craiova, Romania
| | - Peter Vilmann
- Endoscopy Department, GastroUnit, Copenhagen University Hospital, Copenhagen, Denmark
| | - Pietro Fusaroli
- Gastroenterology Unit, University of Bologna, Bologna, Italy
| | - Marc Giovannini
- Pathology Unit (Flora Poizat), Institute Paoli-Calmettes, Marseille, France
| | | | - Surinder S Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sammy Ho
- Montefiore Medical Center, New York, USA
| | - Jan-Werner Poley
- Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Tiing Leong Ang
- Gastroenterology Department, Changi General Hospital, Singapore
| | - Evangelos Kalaitzakis
- Endoscopy Unit, Digestive Disease Center, Copenhagen University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Ali A Siddiqui
- Division of Digestive and Liver Diseases, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | | | - Sundeep Lakhtakia
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, USA
| | - Manoop S Bhutani
- MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - Malay Sharma
- Department of Gastroenterology, Jaswant Rai Specialty Hospital, Meerut, Uttar Pradesh, USA
| | - Shuntaro Mukai
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Pramod Kumar Garg
- Department of Gastroenterology, All Institute of Medical Sciences, New Delhi, India
| | - Linda S Lee
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, MA, USA
| | - Juan J Vila
- Endoscopy Unit, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Everson Artifon
- Department of Surgery, Ana Costa Hospital, Sao Paulo, Brazil
| | - Douglas G Adler
- Division of Gastroenterology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Siyu Sun
- Endoscopy Center, Sheng Jing Hospital of Medical University, Shenyang, China
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Adler DG, Taylor LJ, Hasan R, Siddiqui AA. A retrospective study evaluating endoscopic ultrasound-guided drainage of pancreatic fluid collections using a novel lumen-apposing metal stent on an electrocautery enhanced delivery system. Endosc Ultrasound 2017; 6:389-393. [PMID: 29251273 PMCID: PMC5752761 DOI: 10.4103/eus.eus_4_17] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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] [Indexed: 02/07/2023] Open
Abstract
Objectives: To report the safety and clinical efficacy with the novel lumen-apposing metal stent (LAMS) with an electrocautery enhanced delivery system for the drainage of pancreatic fluid collections (PFCs). Methods: This was a retrospective analysis of all consecutive patients with PFCs who underwent endoscopic ultrasound (EUS)-guided drainage using the LAMS with an electrocautery enhanced delivery system in 2 US centers. Results: Thirteen patients with PFCs (69% with walled-off necrosis [WON]) underwent drainage using the study device. Successful stent placement was accomplished in all patients. Direct endoscopic necrosectomy was carried out in all nine patients with WON complete resolution of the PFC was obtained in all 13 cases, with no recurrence during follow-up. There was one procedure-related adverse event. In one patient, the LAMS was dislodged immediately after deployment, falling into the stomach where it was removed. A second electrocautery enhanced LAMS was placed in this patient immediately afterward. Conclusions: EUS-guided drainage using the LAMS with the electrocautery-enhanced delivery system is a safe, easily performed, and a highly effective for the drainage of PFCs.
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Affiliation(s)
- Douglas G Adler
- Department of Internal Medicine, Division of Gastroenterology, University of Utah Hospital, Salt Lake City, UT, USA
| | - Linda Jo Taylor
- Department of Internal Medicine, Division of Gastroenterology, University of Utah Hospital, Salt Lake City, UT, USA
| | - Raza Hasan
- Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Ali A Siddiqui
- Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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Yoo J, Yan LH, Siddiqui AA. Can contrast harmonic endoscopic ultrasonography replace endoscopic ultrasonography-guided fine-needle aspiration in patients with solid pancreatic lesions? An American perspective. Endosc Ultrasound 2017; 6:1-3. [PMID: 28218193 PMCID: PMC5331836 DOI: 10.4103/2303-9027.190930] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Joseph Yoo
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Linda H Yan
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Ali A Siddiqui
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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Affiliation(s)
- Douglas G Adler
- Department of Internal Medicine, Division of Gastroenterology, University of Utah Hospital, Salt Lake City, Utah, USA
| | - Ali A Siddiqui
- Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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Yoo J, Kistler CA, Yan L, Dargan A, Siddiqui AA. Endoscopic ultrasound in pancreatic cancer: innovative applications beyond the basics. J Gastrointest Oncol 2016; 7:1019-1029. [PMID: 28078128 PMCID: PMC5177581 DOI: 10.21037/jgo.2016.08.07] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 05/30/2016] [Accepted: 07/06/2016] [Indexed: 12/16/2022] Open
Abstract
Endoscopic ultrasound (EUS) has become a mainstay in assisting in the diagnosis and staging of pancreatic cancer. In addition, EUS provides a modality to treat chronic pain through celiac plexus neurolysis. Currently, there is growing data and utilization of EUS in more diverse and innovative applications aimed at providing more sophisticated diagnostic, prognostic and therapeutic options for patients with pancreatic cancer. EUS delivery of chemotherapy, viral and biological vectors and fiducial markers may eventually revolutionize the way clinicians approach the care of a patient with pancreatic cancer.
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Affiliation(s)
- Joseph Yoo
- Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - C. Andrew Kistler
- Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA
- Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Linda Yan
- Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Andrew Dargan
- Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Ali A. Siddiqui
- Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA
- Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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Sharaiha RZ, Tyberg A, Khashab MA, Kumta NA, Karia K, Nieto J, Siddiqui UD, Waxman I, Joshi V, Benias PC, Darwin P, DiMaio CJ, Mulder CJ, Friedland S, Forcione DG, Sejpal DV, Gonda TA, Gress FG, Gaidhane M, Koons A, DeFilippis EM, Salgado S, Weaver KR, Poneros JM, Sethi A, Ho S, Kumbhari V, Singh VK, Tieu AH, Parra V, Likhitsup A, Womeldorph C, Casey B, Jonnalagadda SS, Desai AP, Carr-Locke DL, Kahaleh M, Siddiqui AA. Endoscopic Therapy With Lumen-apposing Metal Stents Is Safe and Effective for Patients With Pancreatic Walled-off Necrosis. Clin Gastroenterol Hepatol 2016; 14:1797-1803. [PMID: 27189914 DOI: 10.1016/j.cgh.2016.05.011] [Citation(s) in RCA: 162] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 04/29/2016] [Accepted: 05/03/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Endoscopic ultrasound-guided transmural drainage and necrosectomy have become the standard treatment for patients with pancreatic walled-off necrosis (WON). Lumen-apposing metal stents (LAMS) have shown success in the management of pancreatic fluid collections. However, there are few data on their specific roles in management of WON. We investigated the efficacy and safety of LAMS in treatment of WON. METHODS We performed a retrospective multicenter case series of 124 patients with WON who underwent endoscopic transmural drainage by using LAMS at 17 tertiary care centers from January 2014 through May 2015. Patients underwent endoscopic ultrasound-guided cystogastrostomy or cystoenterostomy with placement of an LAMS into the WON collection. At the discretion of the endoscopist, we performed direct endoscopic necrosectomy, irrigation with hydrogen peroxide, and/or nasocystic drain placement. We performed endoscopic retrograde cholangiopancreatography with pancreatic duct stent placement when indicated. Concomitant therapies included direct endoscopic debridement (n = 78), pancreatic duct stent placement for leak (n = 19), hydrogen peroxide-assisted necrosectomy (n = 38), and nasocystic irrigation (n = 22). We collected data for a median time of 4 months (range, 1-34 months) after the LAMS placement. The primary outcomes were rates of technical success (successful placement of the LAMS), clinical success (resolution of WON, on the basis of image analysis, without need for further intervention via surgery or interventional radiology), and adverse events. RESULTS The median size of the WON was 9.5 cm (range, 4-30 cm). Eight patients had 2 LAMS placed for multiport access, all with technical success (100%). Clinical success was achieved in 107 patients (86.3%) after 3 months of follow-up. Thirteen patients required a percutaneous drain, and 3 required a surgical intervention to manage their WON. The stents remained patent in 94% of patients (117 of 124) and migrated in 5.6% of patients (7 of 124). The median number of endoscopic interventions was 2 (range, 1-9 interventions). CONCLUSIONS On the basis of a retrospective analysis of 124 patients, endoscopic therapy of WON by using LAMS is safe and effective. Creation of a large and sustained cystogastrostomy or cystoenterostomy tract is effective in the drainage and treatment of WON.
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Affiliation(s)
- Reem Z Sharaiha
- Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, New York.
| | - Amy Tyberg
- Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, New York
| | - Mouen A Khashab
- Gastroenterology and Hepatology, Johns Hopkins Medical Institute, Baltimore, Maryland
| | - Nikhil A Kumta
- Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, New York
| | - Kunal Karia
- Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, New York
| | - Jose Nieto
- Department of Gastroenterology and Hepatology, Borland Groover Clinic, Jacksonville, Florida
| | - Uzma D Siddiqui
- Center for Endoscopic Research and Therapeutics (CERT), University of Chicago Medicine and Biological Sciences, Chicago, Illinois
| | - Irving Waxman
- Center for Endoscopic Research and Therapeutics (CERT), University of Chicago Medicine and Biological Sciences, Chicago, Illinois
| | - Virendra Joshi
- Gastroenterology and Hepatology, Ochsner Health System, New Orleans, Louisiana
| | - Petros C Benias
- Gastroenterology and Hepatology, Beth Israel Mt Sinai, New York, New York
| | - Peter Darwin
- Gastroenterology and Hepatology, University of Maryland, Baltimore, Maryland
| | | | - Christopher J Mulder
- Gastroenterology and Hepatology, Brooke Army Medical Center, Fort Sam Houston, Texas
| | - Shai Friedland
- Gastroenterology and Hepatology, Stanford Hospital and Clinics, Palo Alto, California
| | - David G Forcione
- Gastroenterology and Hepatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Divyesh V Sejpal
- Gastroenterology and Hepatology, North Shore-Long Island Jewish Health System, New York, New York
| | - Tamas A Gonda
- Gastroenterology and Hepatology, Columbia University Medical Center, New York, New York
| | - Frank G Gress
- Gastroenterology and Hepatology, Columbia University Medical Center, New York, New York
| | - Monica Gaidhane
- Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, New York
| | - Ann Koons
- Center for Endoscopic Research and Therapeutics (CERT), University of Chicago Medicine and Biological Sciences, Chicago, Illinois
| | - Ersilia M DeFilippis
- Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, New York
| | - Sanjay Salgado
- Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, New York
| | - Kristen R Weaver
- Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, New York
| | - John M Poneros
- Gastroenterology and Hepatology, Columbia University Medical Center, New York, New York
| | - Amrita Sethi
- Gastroenterology and Hepatology, Columbia University Medical Center, New York, New York
| | - Sammy Ho
- Gastroenterology and Hepatology, Montefiore, New York, New York
| | - Vivek Kumbhari
- Gastroenterology and Hepatology, Johns Hopkins Medical Institute, Baltimore, Maryland
| | - Vikesh K Singh
- Gastroenterology and Hepatology, Johns Hopkins Medical Institute, Baltimore, Maryland
| | - Alan H Tieu
- Gastroenterology and Hepatology, Johns Hopkins Medical Institute, Baltimore, Maryland
| | - Viviana Parra
- Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, New York
| | - Alisa Likhitsup
- Gastroenterology and Hepatology, University of Missouri Kansas City, Kansas City, Missouri
| | - Craig Womeldorph
- Gastroenterology and Hepatology, Brooke Army Medical Center, Fort Sam Houston, Texas
| | - Brenna Casey
- Gastroenterology and Hepatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sreeni S Jonnalagadda
- Gastroenterology and Hepatology, University of Missouri Kansas City, Kansas City, Missouri
| | - Amit P Desai
- Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, New York
| | - David L Carr-Locke
- Gastroenterology and Hepatology, Beth Israel Mt Sinai, New York, New York
| | - Michel Kahaleh
- Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, New York
| | - Ali A Siddiqui
- Gastroenterology and Hepatology, Jefferson University, Philadelphia, Pennsylvania
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Bostan N, Amen N, Safdar W, Adam T, Durrani AA, Shakoor A, Ahmed H, Siddiqui AA, Javed S, Mahmood T. Risk factors involved in spread of HCV in patients from sub urban Rawalpindi and their association with existing genotypes. Trop Biomed 2016; 33:652-662. [PMID: 33579061] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The current epidemiological study was designed to trace the involved risk factors in Hepatitis C Virus (HCV) spread and to identify any association between HCV genotypes and risk factors. Blood samples were taken from 400 participants and viral genotyping was performed in order to find any possible relationship between the risk factors and genotypes. Major genotypes included 3, 1, 4 and several untypeable ones with prevalence rates 65%, 22.5%, 2.75% and 9.75% respectively. Surgery and dental procedure were strongly related to the spread of genotype 3b, while genotype 1b was strongly related to blood transfusion and dental procedures as a single combination risk factor. On the other hand genotypes 1a, 3a, 4 and the untypeable genotypes, were equally affected by all reported risk factors. The probability of occurrence of genotype 3a with reference to dental procedures was 11%. Dental procedures, unsafe injection and surgical procedures are the main risk factors while the blood transfusion in combination with dental procedures has emerged as a potent risk factor in the transmission of HCV.
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Affiliation(s)
- N Bostan
- Department of Biosciences, COMSATS Institute of Information Technology (CIIT), Islamabad, Pakistan
| | - N Amen
- Department of Biosciences, COMSATS Institute of Information Technology (CIIT), Islamabad, Pakistan
| | - W Safdar
- Department of Biochemistry and Biotechnology, Jiangnan University,Wuxi, China
| | - T Adam
- Department of Gastroenterology, Pakistan Institute of Medical Sciences Islamabad, Pakistan
| | - A A Durrani
- Department of Gastroenterology, Fauji Foundation Hospital, Rawalpindi, Pakistan
| | - A Shakoor
- Department of Statistics, PMAS University of Arid Agriculture, Rawalpindi, Pakistan
| | - H Ahmed
- Department of Biosciences, COMSATS Institute of Information Technology (CIIT), Islamabad, Pakistan
| | - A A Siddiqui
- Department of Biological and Biomedical Science, The Aga Khan Health University, Stadium Road, Karachi, Pakistan
| | - S Javed
- Department of Biosciences, COMSATS Institute of Information Technology (CIIT), Islamabad, Pakistan
| | - T Mahmood
- Department of Plant Sciences, Faculty of Biological Sciences, Quaid-e-Azam University, Islamabad, Pakistan
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Yan L, Siddiqui AA, Laique SN, Saumoy M, Kahaleh M, Yoo J, Kalra A, Mathew A, Sterling J, Rao R, Lieberman M, Cosgrove N, Sharaiha RZ. A large multicenter study of recurrence after surgical resection of branch-duct intraductal papillary mucinous neoplasm of the pancreas. Minerva Gastroenterol (Torino) 2016; 63:50-54. [PMID: 27824244 DOI: 10.23736/s1121-421x.16.02341-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 11/08/2022]
Abstract
BACKGROUND Surgery for pancreatic branch-duct intraductal papillary mucinous neoplasm (BD-IPMN) is indicated for therapy of symptomatic patients and to prevent development of invasive cancer. There is currently no consensus on management of BD-IPMN patients after surgical resection. The aim of this retrospective multicenter study was to determine the recurrence and long-term survival after surgical resection of BD-IPMN and to determine the predictive factors of recurrence. METHODS All patients who underwent surgery for BD-IPMN from 2005 to 2011 at 2 centers were identified. The diagnosis of BD-IPMN was based upon imaging and endosonographic analysis, and was confirmed by pathological analysis. The lesions were classified into 4 categories according to the WHO classification. Data on cyst characteristics, operative procedure, recurrence, and follow-up were evaluated. Recurrence was defined as the presence of BD-IPMN or mass in the remnant pancreas after surgery as seen on follow-up imaging. Recurrence suspected on imaging was confirmed via histological analysis when possible. RESULTS A number of 271 patients (67% female; mean age 63.4 yrs) with BD-IPMN underwent surgical resection. The mean size of the cyst was 24.2mm (range, 12-80). There were 34 (12.5%) patients with an associated mass. 82 (30.3%) patients had worrisome features in the cyst on pre-operative EUS, included mural nodules (N.=25), solid component (N.=27), debris (N.=25), and a dilated major pancreatic duct (N.=5). 144(53%) patients had a pancreaticoduodenectomy for head lesions, 125 (46%) had distal pancreatectomy for tail/body lesions, and 1 (1%) underwent a total pancreatectomy. Histology showed 86% with noninvasive IPMN (adenoma 31%, moderate dysplasia 24%, severe dysplasia or carcinoma in situ 31%) and 14% with invasive IPMN. The mean patient follow-up was 28 months (range, 10-180 months). Recurrence in the remnant pancreas occurred in 34 (12.5%) patients. Of the patients with recurrence, 3/34 had invasive carcinoma and 31/34 had noninvasive cystic lesions; all patients with invasive carcinoma recurrence were those with a previous invasive IPMN. On MVA, risk factors for cyst recurrence were severe dysplasia/intraductal carcinoma in situ and invasive IPMN even after adjusting for elevated CEA (>193 ng/mL), type of surgery, and cyst size (OR 2.8, 95% CI=1.1-7.3; P=0.028). 3 patients who had invasive IPMN and 1 who had severe dysplasia patient with recurrence died, all because of recurrent cancer, with the mean time from recurrence to death being 36 months. CONCLUSIONS The risk of BD-IPMN recurrence after resection depends upon the histological type, with the highest-risk groups being those with severe dysplasia/intraductal carcinoma in situ and invasive IPMN. Even after negative resection margins, the pancreatic remnant still harbors a risk of recurrence which requires long-term surveillance.
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Affiliation(s)
- Linda Yan
- Gastroenterology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ali A Siddiqui
- Gastroenterology, Thomas Jefferson University, Philadelphia, PA, USA -
| | - Sobia N Laique
- Gastroenterology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Monica Saumoy
- Gastroenterology, Weill Cornell Medical Center, New York, NY, USA
| | - Michel Kahaleh
- Gastroenterology, Weill Cornell Medical Center, New York, NY, USA
| | - Joseph Yoo
- Gastroenterology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ankush Kalra
- Gastroenterology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Arun Mathew
- Gastroenterology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jessica Sterling
- Gastroenterology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Rema Rao
- Gastroenterology, Weill Cornell Medical Center, New York, NY, USA
| | | | - Natalie Cosgrove
- Gastroenterology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Reem Z Sharaiha
- Gastroenterology, Weill Cornell Medical Center, New York, NY, USA
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47
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Ngamruengphong S, Sharaiha RZ, Sethi A, Siddiqui AA, DiMaio CJ, Gonzalez S, Im J, Rogart JN, Jagroop S, Widmer J, Hasan RA, Laique S, Gonda T, Poneros J, Desai A, Tyberg A, Kumbhari V, El Zein M, Abdelgelil A, Besharati S, Hernaez R, Okolo PI, Singh V, Kalloo AN, Kahaleh M, Khashab MA. Endoscopic suturing for the prevention of stent migration in benign upper gastrointestinal conditions: a comparative multicenter study. Endoscopy 2016; 48:802-8. [PMID: 27356125 DOI: 10.1055/s-0042-108567] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [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] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND STUDY AIMS Fully covered self-expandable metal stents (FCSEMSs) have increasingly been used in benign upper gastrointestinal (UGI) conditions; however, stent migration remains a major limitation. Endoscopic suture fixation (ESF) may prevent stent migration. The aims of this study were to compare the frequency of stent migration in patients who received endoscopic suturing for stent fixation (ESF group) compared with those who did not (NSF group) and to assess the impact of ESF on clinical outcome. PATIENTS AND METHODS This was a retrospective study of patients who underwent FCSEMS placement for benign UGI diseases. Patients were divided into either the NSF or ESF group. Outcome variables, including stent migration, clinical success (resolution of underlying pathology), and adverse events, were compared. RESULTS A total of 125 patients (44 in ESF group, 81 in NSF group; 56 benign strictures, 69 leaks/fistulas/perforations) underwent 224 stenting procedures. Stent migration was significantly more common in the NSF group (33 % vs. 16 %; P = 0.03). Time to stent migration was longer in the ESF group (P = 0.02). ESF appeared to protect against stent migration in patients with a history of stent migration (adjusted odds ratio [OR] 0.09; P = 0.002). ESF was also significantly associated with a higher rate of clinical success (60 % vs. 38 %; P = 0.03). Rates of adverse events were similar between the two groups. CONCLUSIONS Endoscopic suturing for stent fixation is safe and associated with a decreased migration rate, particularly in patients with a prior history of stent migration. It may also improve clinical response, likely because of the reduction in stent migration.
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Affiliation(s)
| | - Reem Z Sharaiha
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA
| | - Amrita Sethi
- Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, New York, USA
| | - Ali A Siddiqui
- Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Christopher J DiMaio
- Division of Gastroenterology and Hepatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Susana Gonzalez
- Division of Gastroenterology and Hepatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jennifer Im
- Division of Gastroenterology and Hepatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jason N Rogart
- Capital Health Center for Digestive Health, Pennington, New Jersey, USA
| | - Sophia Jagroop
- North Shore University Hospital/ Long Island Jewish Medical Center, Forest Hills, New York, USA
| | - Jessica Widmer
- North Shore University Hospital/ Long Island Jewish Medical Center, Forest Hills, New York, USA
| | - Raza Abbas Hasan
- Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Sobia Laique
- Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Tamas Gonda
- Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, New York, USA
| | - John Poneros
- Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, New York, USA
| | - Amit Desai
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA
| | - Amy Tyberg
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA
| | - Vivek Kumbhari
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Mohamad El Zein
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Ahmed Abdelgelil
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Sepideh Besharati
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Ruben Hernaez
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Patrick I Okolo
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Vikesh Singh
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Anthony N Kalloo
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Michel Kahaleh
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA
| | - Mouen A Khashab
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
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48
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Ngamruengphong S, Sharaiha RZ, Sethi A, Siddiqui AA, DiMaio CJ, Gonzalez S, Im J, Rogart JN, Jagroop S, Widmer J, Hasan RA, Laique S, Gonda T, Poneros J, Desai A, Tyberg A, Kumbhari V, El Zein M, Abdelgelil A, Besharati S, Hernaez R, Okolo PI, Singh V, Kalloo AN, Kahaleh M, Khashab MA. Endoscopic suturing for the prevention of stent migration in benign upper gastrointestinal conditions: a comparative multicenter study. Endoscopy 2016; 48:808. [PMID: 27494452 DOI: 10.1055/s-0042-113997] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 12/13/2022]
Affiliation(s)
| | - Reem Z Sharaiha
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA
| | - Amrita Sethi
- Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, New York, USA
| | - Ali A Siddiqui
- Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Christopher J DiMaio
- Division of Gastroenterology and Hepatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Susana Gonzalez
- Division of Gastroenterology and Hepatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jennifer Im
- Division of Gastroenterology and Hepatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jason N Rogart
- Capital Health Center for Digestive Health, Pennington, New Jersey, USA
| | - Sophia Jagroop
- North Shore University Hospital/ Long Island Jewish Medical Center, Forest Hills, New York, USA
| | - Jessica Widmer
- North Shore University Hospital/ Long Island Jewish Medical Center, Forest Hills, New York, USA
| | - Raza Abbas Hasan
- Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Sobia Laique
- Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Tamas Gonda
- Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, New York, USA
| | - John Poneros
- Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, New York, USA
| | - Amit Desai
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA
| | - Amy Tyberg
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA
| | - Vivek Kumbhari
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Mohamad El Zein
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Ahmed Abdelgelil
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Sepideh Besharati
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Ruben Hernaez
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Patrick I Okolo
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Vikesh Singh
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Anthony N Kalloo
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Michel Kahaleh
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA
| | - Mouen A Khashab
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
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49
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Tang SJ, Vilmann AS, Saftoiu A, Wang W, Streba C, Fink PP, Griswold M, Wu R, Dietrich CF, Jenssen C, Hocke M, Kantowski M, Pohl J, Fockens P, Annema JT, van der Heijden EH, Havre RF, Pham KDC, Kunda R, Deprez PH, Mariana J, Vazquez-Sequeiros E, Larghi A, Buscarini E, Fusaroli P, Lahav M, Puri R, Garg PK, Sharma M, Maluf-Filho F, Sahai A, Brugge WR, Lee LS, Aslanian HR, Wang AY, Shami VM, Markowitz A, Siddiqui AA, Mishra G, Scheiman JM, Isenberg G, Siddiqui UD, Shah RJ, Buxbaum J, Watson RR, Willingham FF, Bhutani MS, Levy MJ, Harris C, Wallace MB, Nolsøe CP, Lorentzen T, Bang N, Sørensen SM, Gilja OH, D’Onofrio M, Piscaglia F, Gritzmann N, Radzina M, Sparchez ZA, Sidhu PS, Freeman S, McCowan TC, de Araujo CR, Patel A, del Ali MA, Campbell G, Chen E, Vilmann P. EUS Needle Identification Comparison and Evaluation study (with videos). Gastrointest Endosc 2016; 84:424-433.e2. [PMID: 26873530 PMCID: PMC5570521 DOI: 10.1016/j.gie.2016.01.068] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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: 11/24/2015] [Accepted: 01/29/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS EUS-guided FNA or biopsy sampling is widely practiced. Optimal sonographic visualization of the needle is critical for image-guided interventions. Of the several commercially available needles, bench-top testing and direct comparison of these needles have not been done to reveal their inherent echogenicity. The aims are to provide bench-top data that can be used to guide clinical applications and to promote future device research and development. METHODS Descriptive bench-top testing and comparison of 8 commonly used EUS-FNA needles (all size 22 gauge): SonoTip Pro Control (Medi-Globe); Expect Slimline (Boston Scientific); EchoTip, EchoTip Ultra, EchoTip ProCore High Definition (Cook Medical); ClearView (Conmed); EZ Shot 2 (Olympus); and BNX (Beacon Endoscopic), and 2 new prototype needles, SonoCoat (Medi-Globe), coated by echogenic polymers made by Encapson. Blinded evaluation of standardized and unedited videos by 43 EUS endoscopists and 17 radiologists specialized in GI US examination who were unfamiliar with EUS needle devices. RESULTS There was no significant difference in the ratings and rankings of these needles between endosonographers and radiologists. Overall, 1 prototype needle was rated as the best, ranking 10% to 40% higher than all other needles (P < .01). Among the commercially available needles, the EchoTip Ultra needle and the ClearView needle were top choices. The EZ Shot 2 needle was ranked statistically lower than other needles (30%-75% worse, P < .001). CONCLUSIONS All FNA needles have their inherent and different echogenicities, and these differences are similarly recognized by EUS endoscopists and radiologists. Needles with polymeric coating from the entire shaft to the needle tip may offer better echogenicity.
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Affiliation(s)
- Shou-jiang Tang
- Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | | | - Adrian Saftoiu
- Gastro Unit, Copenhagen University Hospital Herlev, Copenhagen, Denmark
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology Craiova, Craiova, Romania
| | - Wanmei Wang
- Center of Biostatistics & Bioinformatics, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Costin Streba
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology Craiova, Craiova, Romania
| | | | - Michael Griswold
- Center of Biostatistics & Bioinformatics, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Ruonan Wu
- Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | | | | | | | | | - Jürgen Pohl
- Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | | | | | | | | | | | | | | | - Jinga Mariana
- University of Medicine and Pharmacy, Bucharest, Romania
| | | | | | | | - Pietro Fusaroli
- Department of Medical and Surgical Sciences, University of Bologna/Hospital of Imola, Italy
| | | | - Rajesh Puri
- Institute of Digestive and Hepatobiliary Sciences, Gurgaon, India
| | | | - Malay Sharma
- Jaswant Rai Speciality Hospital, Uttar Pradersh, India
| | | | - Anand Sahai
- Centre Hospitalier de l’Universite de Montreal, Canada
| | | | - Linda S. Lee
- Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | | | - Andrew Y. Wang
- University of Virginia Health System, Division of Gastroenterology and Hepatology, Charlottesville, Virginia, USA
| | - Vanessa M. Shami
- University of Virginia Health System, Division of Gastroenterology and Hepatology, Charlottesville, Virginia, USA
| | | | - Ali A. Siddiqui
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Girish Mishra
- Wake Forest University Hospital, Winston-Salem, North Carolina, USA
| | | | | | | | - Raj J. Shah
- University of Colorado Hospital, Denver, Colorado, USA
| | - James Buxbaum
- University of Southern California Keck School of Medicine, California, USA
| | | | | | | | | | | | | | | | - Torben Lorentzen
- Gastro Unit, Copenhagen University Hospital Herlev, Copenhagen, Denmark
| | - Niels Bang
- Aarhus University Hospital, Aarhus, Denmark
| | | | - Odd Helge Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, and Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | | | - Fabio Piscaglia
- Department of Medical and Surgical Sciences, University of Bologna/Hospital of Imola, Italy
| | | | - Maija Radzina
- Paula Stradina Clinical University Hospital, Riga, Latvia
| | - Zeno Adrian Sparchez
- 3rd Medical Department, University of Medicine and Pharmacy, Institute for Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | | | | | | | | | - Akash Patel
- University of Mississippi Medical Center, Jackson, Mississippi, USA
| | | | - Garth Campbell
- University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Edward Chen
- UT Southwestern Medical Center, Dallas, Texas, USA
| | - Peter Vilmann
- Gastro Unit, Copenhagen University Hospital Herlev, Copenhagen, Denmark
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50
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Affiliation(s)
- Douglas G Adler
- Division of Gastroenterology and Hepatology, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Ali A Siddiqui
- Division of Gastroenterology and Hepatology, Jefferson Medical College, Philadelphia, PA, USA
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