Gastroenterology Commons^™

Persistent Risk For New, Subsequent New And Recurrent Hepatocellular Carcinoma Despite Successful Anti-Hepatitis B Virus Therapy And Tumor Ablation: The Need For Hepatitis B Virus Cure., Brianna J. Shinn, Aaron Martin, Robert M. Coben, Mitchell I. Conn, Jorge Prieto, Howard Kroop, Anthony J. Dimarino, Hie-Won Hann

Division of Gastroenterology and Hepatology Faculty Papers

Hepatitis B virus (HBV) is one of the most significant hepatocarcinogens. The ultimate goal of anti-HBV treatment is to prevent the development of hepatocellular carcinoma (HCC). During the last two decades, with the use of currently available anti-HBV therapies (lamivudine, entecavir and tenofovir disoproxil fumatate), there has been a decrease in the incidence of HBV-associated HCC (HBV-HCC). Furthermore, several studies have demonstrated a reduction in recurrent or new HCC development after initial HCC tumor ablation. However, during an observation period spanning 10 to 20 years, several case reports have demonstrated the development of new, subsequent new and recurrent HCC even …

Denture Misadventure: The Tooth About Your Colon., Rajesh Essrani Md, Patrick Hickey Do, Hiral N. Shah Md

Department of Medicine

Foreign body ingestion occurs mainly in a mentally impaired person, but rarely in healthy adults. A 48-year-old male was admitted with a recurrence of previously diagnosed right knee septic arthritis and accidentally ingested his dental bridge which was removed from a proximal ascending colon with a colonoscopy.

Volumetric Laser Endomicroscopy And Its Application To Barrett's Esophagus: Results From A 1,000 Patient Registry., M. S. Smith, B. Cash, V. Konda, A. J. Trindade, S. Gordon, S. Demeester, V. Joshi, C. Lee, D. V. Sejpal, K. Chang, +38 Additional Authors

Journal Articles

Volumetric laser endomicroscopy (VLE) uses optical coherence tomography (OCT) for real-time, microscopic cross-sectional imaging. A US-based multi-center registry was constructed to prospectively collect data on patients undergoing upper endoscopy during which a VLE scan was performed. The objective of this registry was to determine usage patterns of VLE in clinical practice and to estimate quantitative and qualitative performance metrics as they are applied to Barrett's esophagus (BE) management. All procedures utilized the NvisionVLE Imaging System (NinePoint Medical, Bedford, MA) which was used by investigators to identify the tissue types present, along with focal areas of concern. Following the VLE procedure, …

Lumen Apposing Metal Stents Are Superior To Plastic Stents In Pancreatic Walled-Off Necrosis: A Large International Multicenter Study., Y. Chen, J. Yang, S. Friedland, I. Holmes, R. Law, A. Hosmer, D. V. Sejpal, S. Inamdar, A. J. Trindade, M. A. Khashab, +30 Additional Authors

Journal Articles

Background and study aims  The use of lumen apposing metal stents (LAMS) during EUS-guided transmural drainage (EUS-TD) of pancreatic walled-off necrosis (WON) has gained popularity. Data supporting their use in WON over plastic stents (PS), however, remain scarce. The aim of this study was to compare the clinical efficacy of LAMS (Axios, Boston Scientific) with PS in WON. Patients and methods  This was a multicenter, retrospective study involving 14 centers. Consecutive patients who underwent EUS-TD of WON (2012 - 2016) were included. The primary end point was clinical success defined as WON size ≤ 3 cm within a 6-month period …

Devices For Endoscopic Hemostasis Of Nonvariceal Gi Bleeding (With Videos), M. A. Parsi, A. R. Schulman, H. R. Aslanian, M. S. Bhutani, K. Krishnan, D. R. Lichtenstein, J. Melson, U. Navaneethan, A. J. Trindade, J. T. Maple, +4 Additional Authors

Journal Articles

© 2019 American Society for Gastrointestinal Endoscopy Background: Endoscopic intervention is often the first line of therapy for GI nonvariceal bleeding. Although some of the devices and techniques used for this purpose have been well studied, others are relatively new, with few available outcomes data. Methods: In this document, we review devices and techniques for endoscopic treatment of nonvariceal GI bleeding, the evidence regarding their efficacy and safety, and financial considerations for their use. Results: Devices used for endoscopic hemostasis in the GI tract can be classified into injection devices (needles), thermal devices (multipolar/bipolar probes, hemostatic forceps, heater probe, argon …

Fine-Needle Biopsy Is Superior To Fine-Needle Aspiration Of Suspected Gastrointestinal Stromal Tumors: A Large Multicenter Study., A. J. Trindade, P. C. Benias, M. Alshelleh, A. N. Bazarbashi, B. Tharian, S. Inamdar, N. Sharma, C. Zelt, D. V. Sejpal, M. Ryou, +2 Additional Authors

Journal Articles

Background and study aims  There are numerous studies published on the diagnostic yield of the new fine-needle biopsy (FNB) needles in pancreas masses. However, there are limited studies in suspected gastrointestinal stromal tumors (GIST lesions). The aim of this study was to evaluate the diagnostic yield of a new fork-tip FNB needle. Patients and methods  This was a multicenter retrospective study of consecutive patients from prospectively maintained databases comparing endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) versus endoscopic ultrasound-guided FNB (EUS-FNB) using the fork-tip needle. Outcomes measured were cytopathology yield (ability to obtain tissue for analysis of cytology), ability to analyze the …

Asge Guideline For Endoscopic Full-Thickness Resection And Submucosal Tunnel Endoscopic Resection, H. R. Aslanian, A. Sethi, M. S. Bhutani, A. J. Goodman, K. Krishnan, D. R. Lichtenstein, J. Melson, U. Navaneethan, A. J. Trindade, J. T. Maple, +7 Additional Authors

Journal Articles

© 2019 American Society for Gastrointestinal Endoscopy With the development of reliable endoscopic closure techniques and tools, endoscopic full-thickness resection (EFTR) is emerging as a therapeutic option for the treatment of subepithelial tumors and epithelial neoplasia with significant fibrosis. EFTR may be categorized as “exposed” and “nonexposed.” In exposed EFTR, the full-thickness resection is undertaken with a tunneled or nontunneled technique, with subsequent closure of the defect. In nonexposed EFTR, a secure serosa-to-serosa apposition is achieved before full-thickness resection of the isolated lesion. This document reviews current techniques and devices used for EFTR and reviews clinical applications and outcomes.

Changes In Vedolizumab Utilization Across Us Academic Centers And Community Practice Are Associated With Improved Effectiveness And Disease Outcomes., J. L. Koliani-Pace, S. Singh, M. Luo, R. Hirten, S. Aniwan, G. Kochhar, S. Chang, Y. Gao, A. Swaminath, P. S. Dulai, +25 Additional Authors

Journal Articles

BACKGROUND:Vedolizumab effectiveness estimates immediately after Food and Drug Administration (FDA) approval for ulcerative colitis (UC) and Crohn's disease (CD) are limited by use in refractory populations. We aimed to compare treatment patterns and outcomes of vedolizumab in 2 time frames after FDA approval. METHODS:We used 2 data sets for time trend analysis, an academic multicenter vedolizumab consortium (VICTORY) and the Truven MarketScan database, and 2 time periods, May 2014-June 2015 (Era 1) and July 2015-June 2017 (Era 2). VICTORY cumulative 12-month clinical remission, corticosteroid-free remission, and mucosal healing rates, and Truven 12-month hospitalization and surgery rates, were compared between Eras …

Gastrointestinal Bleeding In Patients With Acute Respiratory Distress Syndrome: A National Database Analysis., F. Siddiqui, M. Ahmed, S. Abbasi, A. Avula, A. H. Siddiqui, J. Philipose, H. M. Khan, T. M. Khan, L. Deeb, M. Chalhoub

Journal Articles

Background:The goal of our study was to determine the impact of gastrointestinal bleeding (GIB) on in-hospital outcomes among acute respiratory distress syndrome (ARDS) patients, and subsequently determine the potential risk factors for the development of GIB. Methods:ARDS patients with and without GIB were identified using the National Inpatient Sample (2002 - 2012). Linear regression analysis was used to assess impact of GIB on in-hospital mortality, length of stay and total charges. Univariate logistic regression was used to determine associated odds ratios (OR) for causes of ARDS and common comorbid conditions. Results:We identified 149,190 ARDS patients. The incidence of GIB was …

Digital Cholangioscopy Can Detect Residual Biliary Stones Missed By Occlusion Cholangiogram In Ercp: A Prospective Tandem Study., D. V. Sejpal, A. J. Trindade, C. Lee, L. S. Miller, P. C. Benias, S. Inamdar, G. Singh, M. Stewart, B. J. George, A. K. Vegesna

Journal Articles

Background and study aims  After stone removal in endoscopic retrograde cholangiopancreatography (ERCP), an occlusion cholangiogram (OC) is performed to confirm bile duct clearance. OC can miss residual stones that can lead to recurrent biliary symptoms. The aim of this study was to assess if digital peroral cholangioscopy (POC) increased the diagnostic yield of residual biliary stones that are missed with OC. Patients and methods  Patients having ERCP performed for choledocholithiasis were enrolled into the study only if they had one of the following criteria: dilated bile duct ≥ 12 mm and/or if lithotripsy was being performed. An OC was performed …

Mutational Load May Predict Risk Of Progression In Patients With Barrett's Oesophagus And Indefinite For Dysplasia: A Pilot Study, A. J. Trindade, M. J. Mckinley, M. Alshelleh, G. Levi, M. Stewart, K. J. Quinn, R. M. Thomas

Journal Articles

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. Background and aims Mutational load (ML) has been shown to help risk-stratify those that may progress from non-dysplastic Barrett's oesophagus (BE) to dysplastic disease. Management of patients with BE and indefinite for dysplasia (BE-IND) is challenging and risk stratification tools are lacking. The aim of this pilot study is to evaluate the utility of ML for risk stratification in patients with BE-IND. Methods This is a single-centre, retrospective pilot study evaluating ML quantification in patients with BE-IND. Histology at …

Pooled Analysis Of The Efficacy And Safety Of Video Capsule Endoscopy In Patients With Implantable Cardiac Devices, R. Tabet, N. Nassani, B. Karam, Y. Shammaa, P. Akhrass, L. Deeb

Journal Articles

© 2019 Rabih Tabet et al. Background. To date, video capsule endoscopy (VCE) is still contraindicated by the FDA and the main manufacturers of Cardiac Implantable Electronic Devices (CIED) in patients with CIED, given a theoretical electromagnetic interference and possible device malfunction. Objectives. The objective of this study was to assess the safety profile and efficacy of VCE in patients with implantable cardiac devices through analyzing the risk of mutual interference. Methods. A systematic review of PubMed, Web of Science, and Embase databases was conducted. Peer-reviewed original articles, published in the English language and containing "capsule endoscopy" AND "pacemaker", "defibrillator" …

Acute Esophageal Necrosis: A View In The Dark, H. Khan, M. Ahmed, M. Daoud, J. Philipose, S. Ahmed, L. Deeb

Journal Articles

© 2019 The Author(s). Published by S. Karger AG, Basel. Acute esophageal necrosis (AEN), also known as Gurvits syndrome, black esophagus, or acute necrotizing esophagitis, is a rare clinical entity and an unusual reason for upper gastrointestinal bleeding. It is typically described in critically ill patients with multiple medical conditions, arising from a combination of ischemic insult to the esophageal mucosa due to low-flow vascular states, corrosive injury caused by reflux of acid and pepsin, and decreased function of the mucosal barrier systems and reparative mechanisms as occurs in malnourished and debilitated physical states. Patients with AEN tend to be …

Direct Oral Anticoagulants In Cirrhotic Patients: Current Evidence And Clinical Observations, S. Elhosseiny, H. Al Moussawi, J. M. Chalhoub, J. Lafferty, L. Deeb

Journal Articles

© 2019 Sherif Elhosseiny et al. The introduction of Direct Oral Anticoagulants (DOACs) to the pharmaceutical market provided patients and clinicians with novel convenient and safe options of anticoagulation. The use of this class of medications is currently limited to venous thromboembolic therapy and prophylaxis, in addition to stroke prophylaxis in patients with nonvalvular atrial fibrillation. Despite their altered hemostasis, patients with cirrhosis are thought to be in a procoagulant state and thus prone to thrombus formation. Patients with cirrhosis might benefit from the convenience of DOACs; however, the medical literature includes limited data on the efficacy and safety of …

Endoscopic Identification Of Endoluminal Esophageal Landmarks For Radial And Longitudinal Orientation And Lesion Location, F. Emura, R. Gomez-Esquivel, C. Rodriguez-Reyes, P. Benias, J. Preciado, M. Wallace, L. Giraldo-Cadavid

Journal Articles

© The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved. AIM To characterize esophageal endoluminal landmarks to permit radial and longitudinal esophageal orientation and accurate lesion location. METHODS Distance from the incisors and radial orientation were estimated for the main left bronchus and the left atrium landmarks in 207 consecutive patients using white light examination. A sub-study was also performed using white light followed by endoscopic ultrasound (EUS) in 25 consecutive patients to confirm the findings. The scope orientation throughout the exam was maintained at the natural axis, where the left esophageal quadrant corresponds to the area …

The Role Of Vitamin D In Elderly Inflammatory Bowel Disease Patients, D. Kagolanu, I. Levine, S. Katz

Journal Articles

© 2019 Gastro-Hep Communications Inc. All rights reserved. The role of vitamin D has long been discussed in many chronic diseases, and its significance in inflammatory bowel disease has recently gained attention. This article reviews vitamin D homeostasis, the involvement of vitamin D in the pathophysiol-ogy of inflammatory bowel disease, and vitamin D deficiency as a result of inflammatory bowel disease. In addition, this article explores the possibility of age, specifically in the elderly population, as a risk factor for developing vitamin D deficiency in patients with inflammatory bowel disease.

Advanced Imaging In Surveillance Of Barrett's Esophagus: Is The Juice Worth The Squeeze?, S. A. Cerrone, A. J. Trindade

Journal Articles

No abstract provided.

Ileal Adenocarcinoma With Liver Metastasis In Patient With Crohn's Disease: A 9-Year Survival., J. P. Kothadia, D. H. Nagaraju, S. Katz, H. Bruckner, S. H. Itzkowitz, M. Schwartz

Journal Articles

Small bowel adenocarcinoma is a rare but well-known complication of Crohn's disease. The diagnosis of small bowel adenocarcinoma remains difficult since its presentation is highly variable and mimics active or obstructive Crohn's disease. The diagnosis is often delayed and typically detected only at surgery in an advanced stage with a poor prognosis. We report a case of metastatic ileal adenocarcinoma in a patient with Crohn's disease with prolonged survival. Our case describes serial promising treatment options of these advanced malignancies and raises a possible role for checkpoint immunotherapy.

Comparative Performances Of Machine Learning Methods For Classifying Crohn Disease Patients Using Genome-Wide Genotyping Data, A. Romagnoni, S. Jégou, K. Van Steen, G. Wainrib, J. P. Hugot, L. Peyrin-Biroulet, M. Chamaillard, J. F. Colombel, S. Katz, Y. Sharma, +84 Additional Authors

Journal Articles

© 2019, The Author(s). Crohn Disease (CD) is a complex genetic disorder for which more than 140 genes have been identified using genome wide association studies (GWAS). However, the genetic architecture of the trait remains largely unknown. The recent development of machine learning (ML) approaches incited us to apply them to classify healthy and diseased people according to their genomic information. The Immunochip dataset containing 18,227 CD patients and 34,050 healthy controls enrolled and genotyped by the international Inflammatory Bowel Disease genetic consortium (IIBDGC) has been re-analyzed using a set of ML methods: penalized logistic regression (LR), gradient boosted trees …

Shorter Disease Duration Is Associated With Higher Rates Of Response To Vedolizumab In Patients With Crohn's Disease But Not Ulcerative Colitis., D. M. Faleck, A. Winters, S. Chablaney, P. Shashi, J. Meserve, A. Weiss, V. Kesar, K. Sultan, A. Swaminath, R. Ungaro, +24 Additional Authors

Journal Articles

BACKGROUND & AIMS: Patients with Crohn's disease (CD), but not ulcerative colitis (UC), of shorter duration have higher rates of response to tumor necrosis factor (TNF) antagonists than patients with longer disease duration. Little is known about the association between disease duration and response to other biologic agents. We aimed to evaluate response of patients with CD or UC to vedolizumab, stratified by disease duration.

METHODS: We analyzed data from a retrospective, multicenter, consortium of patients with CD (n = 650) or UC (n = 437) treated with vedolizumab from May 2014 through December 2016. Using time to event analyses, …