Digestive System Diseases Commons^™

Comparative Analysis Of Health Outcomes In Gastric Cancer: Robotic Vs. Laparoscopic Gastrectomy, Maftuna Kurbonnazarova

Rowan-Virtua Research Day

Exploring the most effective surgical approach for gastrectomy is crucial for determining superior health outcomes in patients. This research compares robotic and laparoscopic techniques with the aim of pinpointing the optimal method, offering valuable insights for improved postoperative well-being.

Venous Thrombosis Associated With Pancreatic Cancer, Vlad Buică, Camelia Diaconu, Octavian Andronic

Journal of Mind and Medical Sciences

Introduction. Cancer-associated thrombosis is a significant prognostic marker in pancreatic neoplasia, with a venous thromboembolism incidence of 17-34%. This study focuses on cancer-associated thrombosis risk factors, screening scores, and treatment options. Materials and Methods. Comprehensive database searches were conducted across Web of Science, PubMed, Reaxys, ScienceDirect, and Scopus. Results. Of the 37 articles reviewed, findings include splanchnic vein thrombosis correlating with pancreatic complications and survival rates. Gender differences in cancer-associated thrombosis risk were inconclusive, while African Americans showed a higher incidence of pulmonary embolism. Various cancer-associated thrombosis staging scores were evaluated, with ONKOTEV score outperforming Khorana. Direct oral anticoagulants were …

Early Screening Of Colorectal Cancer Using Feature Engineering With Artificial Intelligence-Enhanced Analysis Of Nanoscale Chromatin Modifications, Andrew Chang, Sravya Prabhala, Ali Daneshkhah, Jianan Lin, Hariharan Subramanian, Hemant Kumar Roy, Vadim Backman

Faculty, Staff and Students Publications

Colonoscopy is accurate but inefficient for colorectal cancer (CRC) prevention due to the low (~ 7 to 8%) prevalence of target lesions, advanced adenomas. We leveraged rectal mucosa to identify patients who harbor CRC field carcinogenesis by evaluating chromatin 3D architecture. Supranucleosomal disordered chromatin chains (~ 5 to 20 nm, ~1 kbp) fold into chromatin packing domains (~ 100 to 200 nm, ~ 100 to 1000 kbp). In turn, the fractal-like conformation of DNA within chromatin domains and the folding of the genome into packing domains has been shown to influence multiple facets of gene transcription, including the transcriptional plasticity …

Pancreatic Cancer Tumor Microenvironment Is A Major Therapeutic Barrier And Target, Conner Hartupee, Bolni Marius Nagalo, Chiswili Y. Chabu, Mulu Z. Tesfay, Joycelynn Coleman-Barnett, John T. West, Omeed Moaven

School of Medicine Faculty Publications

Pancreatic Ductal Adenocarcinoma (PDAC) is projected to become the 2nd leading cause of cancer-related deaths in the United States. Limitations in early detection and treatment barriers contribute to the lack of substantial success in the treatment of this challenging-to-treat malignancy. Desmoplasia is the hallmark of PDAC microenvironment that creates a physical and immunologic barrier. Stromal support cells and immunomodulatory cells face aberrant signaling by pancreatic cancer cells that shifts the complex balance of proper repair mechanisms into a state of dysregulation. The product of this dysregulation is the desmoplastic environment that encases the malignant cells leading to a dense, hypoxic …

Reconstitution Of Human Pdac Using Primary Cells Reveals Oncogenic Transcriptomic Features At Tumor Onset, Yi Xu, Michael H Nipper, Angel A Dominguez, Zhenqing Ye, Naoki Akanuma, Kevin Lopez, Janice J Deng, Destiny Arenas, Ava Sanchez, Francis E Sharkey, Colin M Court, Aatur D Singhi, Huamin Wang, Martin E Fernandez-Zapico, Lu-Zhe Sun, Siyuan Zheng, Yidong Chen, Jun Liu, Pei Wang

Faculty, Staff and Student Publications

Animal studies have demonstrated the ability of pancreatic acinar cells to transform into pancreatic ductal adenocarcinoma (PDAC). However, the tumorigenic potential of human pancreatic acinar cells remains under debate. To address this gap in knowledge, we expand sorted human acinar cells as 3D organoids and genetically modify them through introduction of common PDAC mutations. The acinar organoids undergo dramatic transcriptional alterations but maintain a recognizable DNA methylation signature. The transcriptomes of acinar organoids are similar to those of disease-specific cell populations. Oncogenic KRAS alone do not transform acinar organoids. However, acinar organoids can form PDAC in vivo after acquiring the …

Simultaneous Detection Of Helicobacter Pylori Infection Comparing Between White Light And Image-Enhanced Endoscopy, Boonyaorn Chatrangsun, Natsuda Aumpan, Bubpha Pornthisarn, Soonthorn Chonprasertsuk, Sith Siramolpiwat, Patommatat Bhanthumkomol, Pongjarat Nunanan, Navapan Issariyakulkarn, Varocha Mahachai, Yoshio Yamaoka, Ratha-Korn Vilaichone

Faculty, Staff and Students Publications

BACKGROUND: Helicobacter pylori (H. pylori) is associated with gastric cancer. Early and accurate diagnosis of H. pylori infection can reduce risk of gastric cancer. Conventional white light imaging (WLI) and image-enhanced endoscopic (IEE) techniques such as narrow-band imaging (NBI), linked color imaging (LCI) and blue laser imaging (BLI) plays pivotal role in H. pylori diagnosis. This study aimed to determine diagnostic performance of real-time endoscopy between WLI and other IEE techniques for diagnosis of H. pylori infection.

METHODS: This prospective study compared endoscopic images by gastroscopy using WLI and IEE techniques (LCI, Magnifying-BLI, and Magnifying-NBI) at Thammasat University Hospital, Thailand …

Comparing The Ppv Of At-Home Screening Tests With Chronic Anticoagulant And/Or Antiplatelet Therapies, Bradley Gustafson, Nasima Mehraban, Amjad Awan, Michele Mccarroll

North Texas GME Research Forum 2024

BACKGROUND: With the rising incidence and mortality of colorectal cancer (CRC), early diagnosis and treatment is imperative. At-home CRC screening kits are a non-invasive Federal Drug Association (FDA) approved designed to detects either hemoglobin or DNA markers associated for CRC and high-grade polyps. Therefore, therapies that have a propensity to increase rates of gastrointestinal bleeding could theoretically lead to higher false positive rates. The goal of this study was to determine the positive predictive value of at-home screening tests when applied to patients on therapies such as antiplatelet, anticoagulant, non-steroidal anti-inflammatory (NSAID), or a combination of the three. METHODS: The …

Primary Squamous Cell Carcinoma (Scc) Of The Sigmoid Colon: A Rare Location & Histological Subtype Of Colorectal Carcinoma (Crc), Astrid Sacasa, Stachyse Stanis, Mohtashim Naeem

East Florida Division GME Research Day 2024

Introduction. Primary squamous cell carcinoma (SCC) of the colon is a rare histological subtype of CRC with poor prognosis. It most frequently occurs in the right colon, and least commonly in the sigmoid colon. Similar CRC symptoms no matter the subtype can range from asymptomatic to rectal bleeding, abdominal pain, change in bowel habits, and weight loss. Here, we describe a case of primary basaloid SCC of the sigmoid colon.

Case description. A 71-year-old female with no significant past medical history presented with guaiac-positive stools, underwent a colonoscopy revealing an ulcerated mass in the left colon. Histopathology and immunohistochemical results …

Incidence Of Vaginal Stenosis And Sexual Dysfunction After Radiation For Anal And Rectal Cancer, Kalie Goodman

Continental, MidAmerica, & Mountain Divisions GME Research Day 2024

No abstract provided.

Colorectal Cancer Among Veterans In Urban And Rural Veterans: Can An Integral Healthcare Mitigate Disparities?, Minh Anh Le, Po-Hong Liu, Amar Mandalia, Sergio Romero, Ishak A. Mansi, Moheb Boktor

North Florida Division GME Research Day 2024

No abstract provided.

Colon Cancer Symptom Progression In A Non-Adherent Patient: A Case Report, Nasima Mehraban, Bradley Gustafson, Saad Hussain, Amjad Awan

North Texas GME Research Forum 2024

BACKGROUND: Colorectal cancer (CRC) is the second leading cause of cancer mortality and third leading cause of incidence worldwide; accounting for one in ten cancer cases and deaths. Thirty-three percent of people between the age of 50 and 75 are not up to date on screening for colon cancer. Depending on the stage of CRC at the time of presentation, the range of chief complaints that bring patients to seek care for this single etiology is diverse, therefore, a thorough work-up is essential for diagnosis. CASE PRESENTATION: A 55-year-old patient presents to the hospital three times over the course …

Low Grade Appendiceal Mucinous Neoplasm: Intraoperative Diagnosis Of Tumor Origin, Sydney Parker, Caroline Keefer, Robert Markus

Central & West Texas GME Research Day 2024

No abstract provided.

Rare Rectal Lipoma Case Report, Victoria Nguyen, Sean Sojdie, Kunal Elete, Justin Richardson, Long Hoang

North Texas GME Research Forum 2024

INTRODUCTION: Colonic lipomas are rare, benign non-epithelial lesions of the gastrointestinal (GI) tract that predominantly affect elderly females and often found in the ascending colon. They are least common in the rectum, with a prevalence of 3.4%. Lipomas can grow to cause abdominal pain, bleeding, or obstruction. We report an incidental finding of a rectal lipoma in a patient presented with rectal bleeding. CASE: A 70 year-old male with a history of migraines presented to the hospital for two weeks of rectal bleeding and syncopal episode prior to arrival. Patient had visited the emergency department two weeks prior, but hemoglobin …

Primary Resection Of Duodenal Neuroendocrine Tumor With Suspected Lymph Node Metastasis: A Case Report, Raleigh Payton, David Bassa, Furrukh Jabbar, Hassan Ahmed

North Texas GME Research Forum 2024

Introduction: Duodenal neuroendocrine carcinomas are an uncommon variant of Neuroendocrine tumors (NETs) that are typically non-functional with locoregional spread at the time of diagnosis. Management of these tumors is dependent on size, grade, stage, functional status and location.

Summary: A 66-year-old male presented with an incidental finding of low grade 3 centimeter duodenal NET on esophagogastroduodenoscopy (EGD) located in the second segment of the duodenum with evidence of lymphadenopathy on staging scans. In patients with suspected lymph node metastases, the first choice for curative intent is a pancreaticoduodenectomy (PD), also known as Whipple Procedure. We achieved surgical resection with free …

The Utility Of Cologuard In A Real-World Community Setting, Abhinav K. Rao, Shivam Kalra, Danny Tran, Angeli Patel, Ibrahim Al-Saadi, Levi C. Diggins, Ian Whitaker, Shannon Kang, Kunaal Patel, Eyad Gharaibeh, Ali Khalifa, Don C. Rockey, Brett Van Leer-Greensberg

South Atlantic Division GME Research Day 2024

No abstract provided.

Colon Cancer With Ovarian Metastasis Presenting As Syncope And Melena, Raul E. Zambrana Valenzuela, Bryan Kharbanda

Gulf Coast Division GME Research Symposium 2024

No abstract provided.

Colon Adenocarcinoma Mimicking Acute Appendicitis In A 28-Year-Old, Bridget Kowalczyk, Edward Pingenot, Vivek Bansal

Gulf Coast Division GME Research Symposium 2024

No abstract provided.

Screen It Out! Improving Colon Cancer Screening Among Kingwood Clinic Patients, Daniel J. Avila Castillo, Bhavin Patel, Dhruv Patel, Rajeev Raghavan, Zuhair Ali

Gulf Coast Division GME Research Symposium 2024

No abstract provided.

Obstructive Esophageal Mass In A 40-Year Old Female Presenting As Intractable Vomiting And Early Dka: A Case Report, Caroline Andrews, Rachel Hogan

Gulf Coast Division GME Research Symposium 2024

No abstract provided.

Massive Upper Gi Bleeding From Duodenal Invasion Of Hepatocellular Carcinoma Successfully Treated With Embolization And Hemospray®, Patrick Twohig, Erin Walsh, Amy Calderon

Graduate Medical Education Research Journal

Direct invasion of hepatocellular carcinoma (HCC) into the duodenum is a unique and life-threatening complication of HCC that has been rarely reported. A 60-year-old male with known HCC and cirrhosis presented with melena. Computed tomography of the abdomen and pelvis showed a 7cm hepatic mass abutting the duodenum. Esophagogastroduodenoscopy demonstrated a large, actively oozing mass in the duodenum treated with Hemospray® followed by transarterial embolization (TAE). Active upper gastrointestinal bleeding due to duodenal invasion of HCC can be successfully treated with Hemospray® Endoscopic Hemostat and TAE.

Risk Stratification Model For Hepatocellular Cancer In Patients With Cirrhosis, Fasiha Kanwal, Saira Khaderi, Amit G Singal, Jorge A Marrero, Sumeet K Asrani, Christopher I Amos, Aaron P Thrift, Jennifer R Kramer, Xian Yu, Yumei Cao, Michelle Luster, Abeer Al-Sarraj, Jing Ning, Hashem B El-Serag

Faculty, Staff and Students Publications

BACKGROUND & AIMS: The available risk stratification indices for hepatocellular cancer (HCC) have limited applicability. We developed and externally validated an HCC risk stratification index in U.S. cohorts of patients with cirrhosis.

METHODS: We used data from 2 prospective U.S. cohorts to develop the risk index. Patients with cirrhosis were enrolled from 8 centers and followed until development of HCC, death, or December 31, 2021. We identified an optimal set of predictors with the highest discriminatory ability (C-index) for HCC. The predictors were refit using competing risk regression and its predictive performance was evaluated using the area under the receiver-operating …

Colocolic Fistula: A Rare Consequential Presentation Of Cecal Mucinous Adenocarcinoma, Jessica Rutyna, Paige Stratton, Rutwik Pradeep Sharma, Anthony V. Baratta Jr

Advances in Clinical Medical Research and Healthcare Delivery

Colorectal cancer (CRC) is the second most common cause of cancer death in the United States. Relative to a 5-year survival rate, CRC patients diagnosed with localized disease accrue a 90% survival rate while those diagnosed with distant-stage disease maintain 14% survival. Mucinous adenocarcinoma (MAC) is a unique subtype of CRC characterized by the presence of extracellular mucin occupying 50% of tumor expansion. Fistula complications of colonic malignancy have rarely been reported and more commonly occur as complications of diverticulitis. Colocolic fistulae are atypical consequences of colon cancer, which have been rarely reported. We wish to report a unique case …

Significance Of Targeting Rna Polymerase I In Intrahepatic Cholangiocarcinoma, Muhammad A. Bangash, Aun A. Bangash, Haider Ahsan, Sahir Alvi, Mudassier Ahmad, Alejandro Rincon, Samuel Owusu-Mireku, Bilal Hafeez

MEDI 9331 Scholarly Activities Clinical Years

Intrahepatic cholangiocarcinoma (IHCC) is a much-overlooked cancer with a mortality rate that has increased throughout recent years, as stated by the American Cancer Society [1]. In the United States alone, there are an estimated 8,000 adults being diagnosed with IHCC every year, with a five-year survival rate of 9% [2]. Chemotherapy options for the treatment of IHCC include systemic chemotherapy such as gemcitabine, capecitabine, and oxaliplatin. These medications carry a wide array of adverse factors that may warrant discontinuation due to the detriment to the well-being of the patient. Additionally, a broad field of therapy that may also be used, …

A Novel Prediction Model Of The Risk Of Pancreatic Cancer Among Diabetes Patients Using Multiple Clinical Data And Machine Learning, Shih-Min Chen, Phan Thanh Phuc, Phung-Anh Nguyen, Whitney Burton, Shwu-Jiuan Lin, Weei-Chin Lin, Christine Y Lu, Min-Huei Hsu, Chi-Tsun Cheng, Jason C Hsu

Faculty, Staff and Students Publications

INTRODUCTION: Pancreatic cancer is associated with poor prognosis. Considering the increased global incidence of diabetes cases and that individuals with diabetes are considered a high-risk subpopulation for pancreatic cancer, it is critical to detect the risk of pancreatic cancer within populations of person living = with diabetes. This study aimed to develop a novel prediction model for pancreatic cancer risk among patients with diabetes, using = a real-world database containing clinical features and employing numerous artificial intelligent approach algorithms.

METHODS: This retrospective observational study analyzed data on patients with Type 2 diabetes from a multisite Taiwanese EMR database between 2009 …

A Blood-Based Metabolomic Signature Predictive Of Risk For Pancreatic Cancer, Ehsan Irajizad, Ana Kenney, Tiffany Tang, Jody Vykoukal, Ranran Wu, Eunice Murage, Jennifer B Dennison, Marta Sans, James P Long, Maureen Loftus, John A Chabot, Michael D Kluger, Fay Kastrinos, Lauren Brais, Ana Babic, Kunal Jajoo, Linda S Lee, Thomas E Clancy, Kimmie Ng, Andrea Bullock, Jeanine M Genkinger, Anirban Maitra, Kim-Anh Do, Bin Yu, Brian M Wolpin, Sam Hanash, Johannes F Fahrmann

Faculty, Staff and Student Publications

Emerging evidence implicates microbiome involvement in the development of pancreatic cancer (PaCa). Here, we investigate whether increases in circulating microbial-related metabolites associate with PaCa risk by applying metabolomics profiling to 172 sera collected within 5 years prior to PaCa diagnosis and 863 matched non-subject sera from participants in the Prostate, Lung, Colorectal, and Ovarian (PLCO) cohort. We develop a three-marker microbial-related metabolite panel to assess 5-year risk of PaCa. The addition of five non-microbial metabolites further improves 5-year risk prediction of PaCa. The combined metabolite panel complements CA19-9, and individuals with a combined metabolite panel + CA19-9 score in the …

Anesthesia Care Provider Sedation Versus Conscious Sedation For Endoscopic Ultrasound-Guided Tissue Acquisition: A Retrospective Cohort Study, Sneha Shaha, Yinglin Gao, Jiahao Peng, Kendrick Che, John J Kim, Wasseem Skef

Faculty, Staff and Students Publications

BACKGROUND/AIMS: We aimed to study the effects of sedation on endoscopic ultrasound-guided tissue acquisition.

METHODS: We conducted a retrospective study evaluating the role of sedation in endoscopic ultrasound-guided tissue acquisition by comparing two groups: anesthesia care provider (ACP) sedation and endoscopist-directed conscious sedation (CS).

RESULTS: Technical success was achieved in 219/233 (94.0%) in the ACP group and 114/136 (83.8%) in the CS group (p=0.0086). In multivariate analysis, the difference in technical success between the two groups was not significant (adjusted odds ratio [aOR], 0.5; 95% confidence interval [CI], 0.234-1.069; p=0.0738). A successful diagnostic yield was present in 146/196 (74.5%) in …

Spatial Transcriptomics Of Intraductal Papillary Mucinous Neoplasms Of The Pancreas Identifies Nkx6-2 As A Driver Of Gastric Differentiation And Indolent Biological Potential, Marta Sans, Yuki Makino, Jimin Min, Kimal I Rajapakshe, Michele Yip-Schneider, C Max Schmidt, Mark W Hurd, Jared K Burks, Javier A Gomez, Fredrik I Thege, Johannes F Fahrmann, Robert A Wolff, Michael P Kim, Paola A Guerrero, Anirban Maitra

Faculty, Staff and Student Publications

Intraductal Papillary Mucinous Neoplasms (IPMNs) of the pancreas are bona fide precursor lesions of pancreatic ductal adenocarcinoma (PDAC). The most common subtype of IPMNs harbor a gastric foveolar-type epithelium, and these low-grade mucinous neoplasms are harbingers of IPMNs with high-grade dysplasia and cancer. The molecular underpinning of gastric differentiation in IPMNs is unknown, although identifying drivers of this indolent phenotype might enable opportunities for intercepting progression to high-grade IPMN and cancer. We conducted spatial transcriptomics on a cohort of IPMNs, followed by orthogonal and cross species validation studies, which established the transcription factor NKX6-2 as a key determinant of gastric …

Reduction In Racial And Ethnic Disparity In Survival Following Liver Transplant For Hepatocellular Carcinoma In The Direct-Acting Antiviral Era, Anjiya Shaikh, Karthik Goli, Tzu-Hao Lee, Nicole E Rich, Jihane N Benhammou, Stephanie Keeling, Donghee Kim, Aijaz Ahmed, John Goss, Abbas Rana, Amit G Singal, Fasiha Kanwal, George Cholankeril

Faculty, Staff and Students Publications

BACKGROUND & AIMS: Black patients with hepatocellular cancer (HCC), often attributed to hepatitis C virus (HCV) infection, have suboptimal survival following liver transplant (LT). We evaluated the impact of direct-acting antiviral (DAA) availability on racial and ethnic disparities in wait list burden post-LT survival for candidates with HCC.

METHODS: Using the United Network for Organ Sharing registry, we identified patients with HCC who were listed and/or underwent LT from 2009 to 2020. Based on date of LT, patients were categorized into 2 era-based cohorts: the pre-DAA era (LT between 2009 and 2011) and DAA era (LT between 2015 and 2017, …

Two Pediatric Cases Within A Familial Cluster And Hereditary Diffuse Gastric Carcinoma: A Tale Of 2 Sisters, Lacey Falgout, Lawrence L. Gensler

School of Medicine Faculty Publications

Hereditary diffuse gastric cancer is a familial form of poorly differentiated signet ring cell carcinoma (SRCC) caused by a mutation in the CDH1/E-cadherin gene-mediating cell adhesion. CDH1 mutations are inherited in an autosomal dominant fashion and exhibit a high level of penetrance. SRCC diagnosis is exceedingly rare in the pediatric population. We report a case of SRCC in 2 sisters (10 and 15 years) and their father (41 years).

Transcriptional Profiling And Consensus Molecular Subtype Assignment To Understand Response And Resistance To Anti-Epidermal Growth Factor Receptor Therapy In Colorectal Cancer, Saikat Chowdhury, Ria Gupta, Joshua Millstein, Kangyu Lin, Valsala Haridas, Mohammad A Zeineddine, Christine Parseghian, Heinz-Josef Lenz, Scott Kopetz, John Paul Shen

Faculty, Staff and Student Publications

PURPOSE: Activating mutations in KRAS, NRAS, and BRAF are known to cause resistance to anti–epidermal growth factor receptor (EGFR) therapy; however, only approximately 40% of patients with colorectal cancer (CRC) with RASWT tumors respond to anti-EGFR treatment. We sought to discover novel biomarkers to predict response to anti-EGFR antibody treatment in CRC and to understand mechanisms of resistance to anti-EGFR therapy.

MATERIALS AND METHODS: Transcriptomic profiles from three clinical and two preclinical cohorts treated with cetuximab were used to assign consensus molecular subtypes (CMS) to each sample and correlated with outcomes.

RESULTS: Restricting to RASWT patients, …