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Patel S, Kiker D, Mondal U, Sayana H, Saligram S, Rosenkranz L, Han S. Safety Parameters for the Use of Holmium:YAG Laser in the Treatment of Biliary Calculi: The Ex-Vivo Model. Medicina (Kaunas) 2024; 60:346. [PMID: 38399633 PMCID: PMC10889936 DOI: 10.3390/medicina60020346] [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: 01/23/2024] [Revised: 02/13/2024] [Accepted: 02/17/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: While studies have demonstrated the efficacy of cholangioscopy-guided Holmium-Yttrium aluminum garnet (Ho:YAG) laser lithotripsy for the treatment of refractory bile duct stones, data regarding the safety of the operating parameters for laser lithotripsy are lacking. The aim of this study was to determine safe, yet effective, energy settings for Ho:YAG laser in the ex-vivo model. Materials and Methods: This ex vivo experimental study utilized the Ho:YAG laser on porcine bile duct epithelium and human gallstones. Ho:YAG laser lithotripsy was applied in different power settings from 8 to 15 Watts (W) to six explanted porcine bile ducts. Settings that appeared safe were then utilized to fragment seventy-three human gallstones. Results: The median bile duct perforation times with the Ho:YAG laser between 8-15 W were: >60 s (8 W); 23 s (9 W); 29 s (10 W); 27 s (12 W); 12 s (14 W); and 8 s (15 W). Statistically significant differences in the median perforation times were noted between 8 W vs. 15 W, 9 W vs. 15 W, 10 W vs. 15 W, and 12 W vs. 15 W (p < 0.05). When using a 365 µm Ho:YAG laser probe at 8-12 W, the fragmentation rates on various size stones were: 100% (<1.5 cm); 80-100% (1.6-2.0 cm) and 0-32% (>2.0 cm). Optimal fragmentation was seen utilizing 12 W with high energy (2.4 J) and low frequency (5 Hz) settings. Using a larger 550 µm probe at these settings resulted in 100% fragmentation of stones larger than 2 cm. Conclusions: The Ho:YAG laser appears to be safe and effective in the treatment of large bile duct stones when used between 8-12 W in 5 s bursts in an ex vivo model utilizing porcine bile ducts and human gallstones.
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Affiliation(s)
- Sandeep Patel
- Division of Gastroenterology and Nutrition, UT Health San Antonio, San Antonio, TX 78229, USA
| | - Dustin Kiker
- Division of Gastroenterology and Nutrition, UT Health San Antonio, San Antonio, TX 78229, USA
| | - Utpal Mondal
- Division of Gastroenterology and Nutrition, UT Health San Antonio, San Antonio, TX 78229, USA
| | - Hari Sayana
- Division of Gastroenterology and Nutrition, UT Health San Antonio, San Antonio, TX 78229, USA
| | - Shreyas Saligram
- Division of Gastroenterology and Nutrition, UT Health San Antonio, San Antonio, TX 78229, USA
| | - Laura Rosenkranz
- Division of Gastroenterology and Nutrition, UT Health San Antonio, San Antonio, TX 78229, USA
| | - Samuel Han
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
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Boregowda U, Echavarria J, Umapathy C, Rosenkranz L, Sayana H, Patel S, Saligram S. Endoscopy versus early surgery for the management of chronic pancreatitis: a systematic review and meta-analysis. Surg Endosc 2022; 36:8753-8763. [PMID: 35922602 DOI: 10.1007/s00464-022-09425-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 06/29/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND AIM Endoscopic stone removal and stenting of pancreatic strictures are the initial treatment for treating chronic pancreatitis-related pain. Surgery is considered when endoscopic interventions fail to improve symptoms. In this meta-analysis, we have compared early surgery versus endoscopic interventions. METHODS The study was performed as per the PRISMA statement. The literature search was conducted on online databases to identify studies that compared endoscopy and surgery for the management of chronic pancreatitis symptoms. Primary outcomes of interest were pain relief, complications, and exocrine/endocrine insufficiency. Secondary outcomes were mean length of stay and mean number of procedures. Pooled odds ratio (OR) was calculated using random-effects model with 95% confidence interval (CI). RESULTS Of a total of 9880 articles that were screened, three randomized controlled trials and two retrospective studies with 602 patients (71.4% males) were found to be eligible. Endoscopic interventions were performed in 317 patients and 285 patients underwent early surgery. Early surgery provided significantly better pain relief compared to endoscopy (OR 0.46; 95%CI 0.27-0.80; p = 0.01; I2 = 17.65%) and required less number of procedures (Mean difference 1.66; 95%CI 0.9-2.43; p = 0.00; I2 = 96.46%). There was no significant difference in procedure-related complication (OR 0.91; 95%CI 0.51-1.61; p = 0.74; I2 = 38.8%), endocrine (OR 1.18; 95%CI 0.63-2.20; p = 0.61; I2 = 28.24%), or exocrine insufficiency (OR 1.78; 95%CI 0.66-4.79; p = 0.25; I2 = 30.97%) or the length of stay (Mean difference 1.21; 95%CI -7.12 to 4.70; p = 0.69). CONCLUSION Compared to endoscopy, early surgery appears to be better in controlling chronic pancreatitis-related pain, with no significant difference in procedure-related complications. However, larger randomized controlled trials are needed to ascertain their efficacy.
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Affiliation(s)
- Umesha Boregowda
- Division of Gastroenterology, Hepatology, and Nutrition, University of Texas Health, San Antonio, TX, 78229, USA
| | - Juan Echavarria
- Division of Gastroenterology, Hepatology, and Nutrition, University of Texas Health, San Antonio, TX, USA
| | - Chandraprakash Umapathy
- Division of Gastroenterology, Hepatology, and Nutrition, University of Texas Health, San Antonio, TX, USA
| | - Laura Rosenkranz
- Division of Gastroenterology, Hepatology, and Nutrition, University of Texas Health, San Antonio, TX, USA
| | - Hari Sayana
- Division of Gastroenterology, Hepatology, and Nutrition, University of Texas Health, San Antonio, TX, USA
| | - Sandeep Patel
- Division of Gastroenterology, Hepatology, and Nutrition, University of Texas Health, San Antonio, TX, USA
| | - Shreyas Saligram
- Division of Gastroenterology, Hepatology, and Nutrition, University of Texas Health, San Antonio, TX, USA.
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Abstract
Introduction: Both breast and pancreatic cancers have high mortality rates. Breast cancer is the second leading cause of cancer death in females, while pancreatic ductal adenocarcinoma (PDAC) is the fourth most common cause of cancer death. Almost 4-16 % of individuals with pancreatic cancer have a family history of the disease. Intra-ductal papillary mucinous neoplasms (IPMNs) are cystic lesions that received more attention lately due to their associations with PDAC and other solid organ tumors, such as breast cancer. Aim: The purpose of this article is to discuss the association of the familiar pancreatic cancer (FPC), sporadic pancreatic cancer, and IPMNs with the breast cancer. Results: Mutations in BRCA2, BRCA1, p16 and PALB2 play a major role in the genetic etiologies of familial pancreatic cancer. In familial and sporadic pancreatic cancers, mutations in BRCA2 are associated with a high incidence of PDAC, while mutations in BRCA1have shown inconsistent results. Data is insufficient to prove an association between IPMNs and breast cancer. Conclusion: The familial clustering of PDAC is not well understood. Further studies are required for greater comprehension of the genetic basis of PDAC and the association between IPMNs and breast cancer.
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Affiliation(s)
- Mary Barbara
- Department of Medicine, UT Health San Antonio, San Antonio, TX, USA
| | - Adrianne Tsen
- Department of Medicine, UT Health San Antonio, San Antonio, TX, USA
| | - Laura Tenner
- Department of Hematology and Oncology, UT Health San Antonio, San Antonio, Tx, USA
| | - Laura Rosenkranz
- Department of Gastroenterology, UT Health San Antonio San Antonio, TX, USA
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Abstract
Carbohydrate antigen 19-9 (CA 19-9) is a tumor marker which has been extensively evaluated and widely utilized primarily in diagnosing and prognosticating pancreaticobiliary malignancies. Levels may be significantly influenced and elevated in cases of benign biliary conditions however, especially in obstructive jaundice, thereby posing difficulty in distinguishing between benign and malignant cholestasis. A myriad of studies have focused on elucidating proper use and interpretation of CA 19-9 in pancreatic cancer as well as in the setting of cholestasis. These studies have demonstrated that many factors influence CA 19-9 values and various methods for interpreting CA 19-9 in obstructive jaundice have been proposed. With improvements in diagnostic imaging, advancements in endoscopic modalities, and likelihood that management will not change based on the results of the test, clinicians should be cautious when ordering CA 19-9 and consider the reasons for measuring the tumor marker.
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Affiliation(s)
- Adrianne Tsen
- University of Texas Health Science Center at San Antonio, 5623 Hamilton Wolfe, #712, San Antonio, TX 78240, USA.
| | - Mary Barbara
- Department of Internal Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Laura Rosenkranz
- Department of Gastroenterology and Advanced Therapeutic Endoscopy, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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Wani S, Keswani R, Hall M, Han S, Ali MA, Brauer B, Carlin L, Chak A, Collins D, Cote GA, Diehl DL, DiMaio CJ, Dries A, El-Hajj I, Ellert S, Fairley K, Faulx A, Fujii-Lau L, Gaddam S, Gan SI, Gaspar JP, Gautamy C, Gordon S, Harris C, Hyder S, Jones R, Kim S, Komanduri S, Law R, Lee L, Mounzer R, Mullady D, Muthusamy VR, Olyaee M, Pfau P, Saligram S, Piraka C, Rastogi A, Rosenkranz L, Rzouq F, Saxena A, Shah RJ, Simon VC, Small A, Sreenarasimhaiah J, Walker A, Wang AY, Watson RR, Wilson RH, Yachimski P, Yang D, Edmundowicz S, Early DS. A Prospective Multicenter Study Evaluating Learning Curves and Competence in Endoscopic Ultrasound and Endoscopic Retrograde Cholangiopancreatography Among Advanced Endoscopy Trainees: The Rapid Assessment of Trainee Endoscopy Skills Study. Clin Gastroenterol Hepatol 2017; 15. [PMID: 28625816 PMCID: PMC7042954 DOI: 10.1016/j.cgh.2017.06.012] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS On the basis of the Next Accreditation System, trainee assessment should occur on a continuous basis with individualized feedback. We aimed to validate endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) learning curves among advanced endoscopy trainees (AETs) by using a large national sample of training programs and to develop a centralized database that allows assessment of performance in relation to peers. METHODS ASGE recognized training programs were invited to participate, and AETs were graded on ERCP and EUS exams by using a validated competency assessment tool that assesses technical and cognitive competence in a continuous fashion. Grading for each skill was done by using a 4-point scoring system, and a comprehensive data collection and reporting system was built to create learning curves by using cumulative sum analysis. Individual results and benchmarking to peers were shared with AETs and trainers quarterly. RESULTS Of the 62 programs invited, 20 programs and 22 AETs participated in this study. At the end of training, median number of EUS and ERCP performed/AET was 300 (range, 155-650) and 350 (125-500), respectively. Overall, 3786 exams were graded (EUS, 1137; ERCP-biliary, 2280; ERCP-pancreatic, 369). Learning curves for individual end points and overall technical/cognitive aspects in EUS and ERCP demonstrated substantial variability and were successfully shared with all programs. The majority of trainees achieved overall technical (EUS, 82%; ERCP, 60%) and cognitive (EUS, 76%; ERCP, 100%) competence at conclusion of training. CONCLUSIONS These results demonstrate the feasibility of establishing a centralized database to report individualized learning curves and confirm the substantial variability in time to achieve competence among AETs in EUS and ERCP. ClinicalTrials.gov: NCT02509416.
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Affiliation(s)
- Sachin Wani
- University of Colorado Anschutz Medical Campus, Aurora, Colorado.
| | | | - Matt Hall
- University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Samuel Han
- University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Meer Akbar Ali
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Brian Brauer
- University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Linda Carlin
- Colorado Clinical and Translational Sciences Institute, Aurora, Colorado
| | - Amitabh Chak
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Dan Collins
- Carolinas Medical Center, Charlotte, North Carolina
| | - Gregory A. Cote
- Medical University of South Carolina, Charleston, South Carolina
| | | | | | - Andrew Dries
- Carolinas Medical Center, Charlotte, North Carolina
| | | | - Swan Ellert
- Colorado Clinical and Translational Sciences Institute, Aurora, Colorado
| | | | - Ashley Faulx
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | | | - Srinivas Gaddam
- Washington University School of Medicine, St Louis, Missouri
| | - Seng-Ian Gan
- Virginia Mason Medical Center, Seattle, Washington
| | | | | | - Stuart Gordon
- Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | | | - Sarah Hyder
- Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Ross Jones
- Carolinas Medical Center, Charlotte, North Carolina
| | - Stephen Kim
- University of California, Los Angeles, Los Angeles, California
| | | | - Ryan Law
- Northwestern University, Chicago, Illinois
| | - Linda Lee
- Brigham and Women’s Hospital, Boston, Massachusetts
| | - Rawad Mounzer
- University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Daniel Mullady
- Washington University School of Medicine, St Louis, Missouri
| | | | | | | | | | | | | | | | - Fadi Rzouq
- University of Kansas, Kansas City, Kansas
| | | | - Raj J. Shah
- University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | | | - Aaron Small
- Virginia Mason Medical Center, Seattle, Washington
| | | | | | - Andrew Y. Wang
- University of Virginia Health System, Charlottesville, Virginia
| | | | - Robert H. Wilson
- University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | | | - Dennis Yang
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Dayna S. Early
- Washington University School of Medicine, St Louis, Missouri
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Mondal U, Schindler A, Rosenkranz L. Recurrent hematochezia in a patient with chronic constipation. Gastroenterology 2015; 149:1343-4. [PMID: 26409665 DOI: 10.1053/j.gastro.2015.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 08/10/2015] [Indexed: 12/02/2022]
Affiliation(s)
- Utpal Mondal
- Division of Gastroenterology and Nutrition, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Amy Schindler
- Division of Gastroenterology and Nutrition, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Laura Rosenkranz
- Division of Gastroenterology and Nutrition, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
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Raijman I, Tarnasky PR, Patel S, Fishman DS, Surapaneni SN, Rosenkranz L, Talreja JP, Nguyen D, Gaidhane M, Kahaleh M. Endoscopic drainage of pancreatic fluid collections using a fully covered expandable metal stent with antimigratory fins. Endosc Ultrasound 2015; 4:213-8. [PMID: 26374579 PMCID: PMC4568633 DOI: 10.4103/2303-9027.163000] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Endoscopic drainage is the first consideration in treating pancreatic fluid collections (PFCs). Recent data suggests it may be useful in complicated PFCs as well. Most of the available data assess the use of plastic stents, but scarce data exists on metal stent management of PFCs. The aim of our study to evaluate the efficacy and safety of a metal stent in the management of PFCs. PATIENTS AND METHODS Data were collected prospectively on 47 patients diagnosed with PFCs from March 2007 to August 2011 at 3 tertiary care centers. These patients underwent endoscopic transmural placement of a fully covered self-expanding metal stent (FCSEMS) with antimigratory fins of 10 mm diameter. RESULTS The stent was successfully placed in all patients, and left in place an average of 13 weeks (range 0.4-36 weeks). Etiology of the PFC was biliary pancreatitis (23), pancreas divisum (2), trauma (4), hyperlipidemia (3), alcoholic (8), smoking (2), idiopathic (4), and medication-induced (1). PFCs resolved in 36 patients, for an overall success rate of 77%. Complications included fever (3), stent migration (2) and abdominal pain (1). CONCLUSIONS The use of FCSEMS is successful in the majority of patients with low complication rates. A large sample-sized RCT is needed to confirm if the resolution of PFCs is long-standing.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Michel Kahaleh
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, USA
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8
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Mondal U, Henkes N, Henkes D, Rosenkranz L. Cavernous hemangioma of adult pancreas: A case report and literature review. World J Gastroenterol 2015; 21:9793-9802. [PMID: 26361427 PMCID: PMC4562964 DOI: 10.3748/wjg.v21.i33.9793] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Revised: 05/29/2015] [Accepted: 06/26/2015] [Indexed: 02/06/2023] Open
Abstract
Pancreatic hemangioma is a rare type of benign vascular tumor. Low clinical suspicion and inability of current cross sectional imaging techniques to differentiate it from other pancreatic lesions, contribute to the difficulty in making the correct diagnosis. Without a definitive diagnosis, and due to concern for malignancy, in many instances, surgery is performed. We report a case of pancreas cavernous hemangioma in an 18-year-old female. The patient presented with three-month history of epigastric pain. Physical examination and routine blood tests were normal. Abdominal Computed Tomography scan revealed a 5 cm × 6 cm complex non-enhancing cystic mass in the head of pancreas. Magnetic resonance imaging, endoscopic ultrasonography (EUS) and EUS guided fine needle aspiration cytology were non-diagnostic. Because of uncontrolled symptoms, the patient underwent surgical resection. Histopathology and Immunohistochemical staining confirmed the diagnosis of cavernous hemangioma of pancreas.
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9
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Al-Haddad MA, Kowalski T, Siddiqui A, Mertz HR, Mallat D, Haddad N, Malhotra N, Sadowski B, Lybik MJ, Patel SN, Okoh E, Rosenkranz L, Karasik M, Golioto M, Linder J, Catalano MF. Integrated molecular pathology accurately determines the malignant potential of pancreatic cysts. Endoscopy 2015; 47:136-42. [PMID: 25314329 DOI: 10.1055/s-0034-1390742] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [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: 02/08/2023]
Abstract
BACKGROUND AND STUDY AIMS Current diagnostic testing is inadequate to determine the malignant potential of pancreatic cysts, resulting in overcautious patient management. Integrated molecular pathology (IMP) testing combines molecular analysis with first-line test results (cytology, imaging, and fluid chemistry) to assess the malignant potential of pancreatic cysts. This multicenter study aimed to determine the diagnostic accuracy of IMP for pancreatic adenocarcinoma, and the utility of IMP testing under current guideline recommendations for managing pancreatic cysts. PATIENTS AND METHODS Patients who had undergone previous IMP testing as prescribed by their physician and for whom clinical outcomes were available from retrospective record review were included (n = 492). Performance was determined by correlation between clinical outcome and previous IMP diagnosis ("benign"/"statistically indolent" vs. "statistically higher risk [SHR]"/ "aggressive") or an International Consensus Guideline (Sendai 2012) criteria model for "surveillance" vs. "surgery." The Cox proportional hazards model determined hazard ratios for malignancy. RESULTS Benign and statistically indolent IMP diagnoses had a 97 % probability of benign follow-up for up to 7 years and 8 months from initial IMP testing. SHR and aggressive diagnoses had relative hazard ratios for malignancy of 30.8 and 76.3, respectively (both P < 0.0001). Sendai surveillance criteria had a 97 % probability of benign follow-up for up to 7 years and 8 months, but for surgical criteria the hazard ratio was only 9.0 (P < 0.0001). In patients who met Sendai surgical criteria, benign and statistically indolent IMP diagnoses had a > 93 % probability of benign follow-up, with relative hazard ratios for SHR and aggressive IMP diagnoses of 16.1 and 50.2, respectively (both P < 0.0001). CONCLUSION IMP more accurately determined the malignant potential of pancreatic cysts than a Sendai 2012 guideline management criteria model. IMP may improve patient management by justifying more relaxed observation in patients meeting Sendai surveillance criteria. IMP can more accurately differentiate between the need for surveillance or surgery in patients meeting Sendai surgical criteria.
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Affiliation(s)
| | - Thomas Kowalski
- Department of Medicine, Jefferson Digestive Disease Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ali Siddiqui
- Department of Medicine, Jefferson Digestive Disease Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Damien Mallat
- Premier Gastroenterology of Texas, Dallas, Texas, USA
| | - Nadim Haddad
- Division of Gastroenterology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Nidhi Malhotra
- Division of Gastroenterology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Brett Sadowski
- Division of Gastroenterology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Mark J Lybik
- Northside Gastroenterology, Indianapolis, Indiana, USA
| | - Sandeep N Patel
- Department of Medicine, University of Texas San Antonio, San Antonio, Texas, USA
| | - Emuejevoke Okoh
- Department of Medicine, University of Texas San Antonio, San Antonio, Texas, USA
| | - Laura Rosenkranz
- Department of Medicine, University of Texas San Antonio, San Antonio, Texas, USA
| | | | | | - Jeffrey Linder
- Digestive Health Associates of Texas, Dallas, Texas, USA
| | - Marc F Catalano
- Wisconsin Center for Advanced Research, St. Luke's Medical Center, Milwaukee, Wisconsin, USA
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Patel SN, Rosenkranz L, Hooks B, Tarnasky PR, Raijman I, Fishman DS, Sauer BG, Kahaleh M. Holmium-yttrium aluminum garnet laser lithotripsy in the treatment of biliary calculi using single-operator cholangioscopy: a multicenter experience (with video). Gastrointest Endosc 2014; 79:344-8. [PMID: 24268531 DOI: 10.1016/j.gie.2013.07.054] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 07/29/2013] [Indexed: 12/13/2022]
Affiliation(s)
- Sandeep N Patel
- Division of Gastroenterology and Nutrition, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Laura Rosenkranz
- Division of Gastroenterology and Nutrition, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Bennett Hooks
- Division of Gastroenterology and Nutrition, University of Texas Health Science Center, San Antonio, Texas, USA
| | | | - Isaac Raijman
- Digestive Associates of Houston, St Luke's Hospital, Houston, Texas, USA
| | | | - Bryan G Sauer
- Division of Gastroenterology and Hepatology, Department of Medicine, Weil Cornell Medical College, New York, New York, USA
| | - Michel Kahaleh
- Division of Gastroenterology and Hepatology, Department of Medicine, Weil Cornell Medical College, New York, New York, USA
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11
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Torres V, Martinez N, Lee G, Almeda J, Gross G, Patel S, Rosenkranz L. How do we manage post-OLT redundant bile duct? World J Gastroenterol 2013; 19:2501-2506. [PMID: 23674851 PMCID: PMC3646140 DOI: 10.3748/wjg.v19.i16.2501] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 04/08/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To address endoscopic outcomes of post-Orthotopic liver transplantation (OLT) patients diagnosed with a “redundant bile duct” (RBD).
METHODS: Medical records of patients who underwent OLT at the Liver Transplant Center, University Texas Health Science Center at San Antonio Texas were retrospectively analyzed. Patients with suspected biliary tract complications (BTC) underwent endoscopic retrograde cholangiopancreatography (ERCP). All ERCP were performed by experienced biliary endoscopist. RBD was defined as a looped, sigmoid-shaped bile duct on cholangiogram with associated cholestatic liver biomarkers. Patients with biliary T-tube placement, biliary anastomotic strictures, bile leaks, bile-duct stones-sludge and suspected sphincter of oddi dysfunction were excluded. Therapy included single or multiple biliary stents with or without sphincterotomy. The incidence of RBD, the number of ERCP corrective sessions, and the type of endoscopic interventions were recorded. Successful response to endoscopic therapy was defined as resolution of RBD with normalization of associated cholestasis. Laboratory data and pertinent radiographic imaging noted included the pre-ERCP period and a follow up period of 6-12 mo after the last ERCP intervention.
RESULTS: One thousand two hundred and eighty-two patient records who received OLT from 1992 through 2011 were reviewed. Two hundred and twenty-four patients underwent ERCP for suspected BTC. RBD was reported in each of the initial cholangiograms. Twenty-one out of 1282 (1.6%) were identified as having RBD. There were 12 men and 9 women, average age of 59.6 years. Primary indication for ERCP was cholestatic pattern of liver associated biomarkers. Nineteen out of 21 patients underwent endoscopic therapy and 2/21 required immediate surgical intervention. In the endoscopically managed group: 65 ERCP procedures were performed with an average of 3.4 per patient and 1.1 stent per session. Fifteen out of 19 (78.9%) patients were successfully managed with biliary stenting. All stents were plastic. Selection of stent size and length were based upon endoscopist preference. Stent size ranged from 7 to 11.5 Fr (average stent size 10 Fr); Stent length ranged from 6 to 15 cm (average length 9 cm). Concurrent biliary sphincterotomy was performed in 10/19 patients. Single ERCP session was sufficient in 6/15 (40.0%) patients, whereas 4/15 (26.7%) patients needed two ERCP sessions and 5/15 (33.3%) patients required more than two (average of 5.4 ERCP procedures). Single biliary stent was sufficient in 5 patients; the remaining patients required an average of 4.9 stents. Four out of 19 (21.1%) patients failed endotherapy (lack of resolution of RBD and recurrent cholestasis in the absence of biliary stent) and required either choledocojejunostomy (2/4) or percutaneous biliary drainage (2/4). Endoscopic complications included: 2/65 (3%) post-ERCP pancreatitis and 2/10 (20%) non-complicated post-sphincterotomy bleeding. No endoscopic related mortality was found. The medical records of the 15 successful endoscopically managed patients were reviewed for a period of one year after removal of all biliary stents. Eleven patients had continued resolution of cholestatic biomarkers (73%). One patient had recurrent hepatitis C, 2 patients suffered septic shock which was not associated with ERCP and 1 patient was transferred care to an outside provider and records were not available for our review.
CONCLUSION: Although surgical biliary reconstruction techniques have improved, RBD represents a post-OLT complication. This entity is rare however, endoscopic management of RBD represents a reasonable initial approach.
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Abstract
Stones in biliary and pancreatic ducts are entities that plague hundreds of thousands of patients worldwide every year. Symptoms can be mild (pain) to life threatening (cholangitis, severe acute pancreatitis). In the last few decades, management of these stones has transitioned from exclusively surgical to now predominantly endoscopic techniques. This article reviews the evolution of endoscopic techniques used in the management of stones in the common bile duct and pancreatic duct.
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Affiliation(s)
- Laura Rosenkranz
- Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA.
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13
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14
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Rosenkranz L, Schroeder C. Recurrent malignant melanoma following a 46-year disease-free interval. N Y State J Med 1985; 85:95. [PMID: 3857481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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15
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Abstract
Two patients with hypothermia were noted to have pancytopenia. Bone marrow examination showed failure of all marrow elements in both patients. Although a wide variety of hematologic abnormalities have been found in patients with hypothermia, bone marrow failure has not been previously reported.
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16
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Rosenkranz L, Schell AR. Carotid body tumor as reversible cause of recurrent syncope. N Y State J Med 1984; 84:38-9. [PMID: 6583549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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17
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Rosenkranz L, Cataletto MM. Metatarsalgia caused by an increase in circulating platelets: a case report. Foot Ankle 1984; 4:216-7. [PMID: 6714865 DOI: 10.1177/107110078400400414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
A patient with a year-long history of metatarsalgia was found to have an elevated platelet count due to essential thrombocythemia, a benign myeloproliferative disease. Reduction of the platelet count with chemotherapy eliminated the foot pain. The authors recommended that a platelet count be part of the work-up of patients with metatarsalgia when the etiology of the foot pain is unclear.
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Rosenkranz L. Aseptic necrosis of bone and chronic alcoholism. J Fam Pract 1983; 17:323-326. [PMID: 6875490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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19
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