Gastroenterology Commons^™

Endoscopic Retrograde Cholangiopancreatography In Cirrhosis - A Systematic Review And Meta-Analysis Focused On Adverse Events, Harmeet Singh Mashiana, Banreet Dhindsa, Ji Won Yoo, Amaninder Singh Dhaliwal, Shailender Singh, Harlan Sayles, Qing Wu, Ali A. Siddiqui, Gordon Ohning, Mohit Girotra, Douglas A. Adler

School of Medicine Faculty Research

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% …

Upper Gastrointestinal Bleed Embolization With Onyx®: The "Tattoo Effect", Driss Raissi, Qian Yu, S. Houssam Mardini

Radiology Faculty Publications

Endoscopic intervention is well validated for the control of upper gastrointestinal bleeding (UGIB). In cases of refractory bleeding, transarterial embolization is a safe and effective alternative. Ethylene vinyl alcohol (EVOH) commonly known as Onyx^® is an inherently black liquid embolic approved for use in cerebrovascular arteriovenous malformations and is increasingly used as an embolic agent in multiple peripheral and visceral territories. Onyx^® has a uniquely undesirable property of causing black color discoloration when used in peripheral applications adjacent to the skin akin to a "tattoo effect." Knowledge of the agents used by the interventional radiologist, clinical correlation, and …

One-Day Oral Polyethylene Glycol Based Cleanout Is Effective For Pre-Colonoscopy Preparation In Children., Ashwath S. Kumar, Brooke L. Beutler, Thomas M. Attard

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: The adequacy of pre-procedure preparation is the principal determinant of the quality of colonoscopy in pediatric as in adult patients. There is a lack of consensus, among providers on a standard pre-procedure regimen. Professional society guidelines include the use of Polyethylene glycol (PEG). Herein we report on the provider-assessed adequacy of a one day, age-categorized dosing, PEG based cleanout regimen in children undergoing colonoscopy in a tertiary institution.

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METHODS: The standard bowel preparation regime at our institution includes an age dependent minimum PEG dosing regimen in addition to clear liquids the day prior to the procedure. We retrospectively …

Comparison Of Outcomes For Supine Vs. Prone Position Ercp: A Systematic Review And Meta-Analysis, Harmeet Singh Mashiana, Mahendran Jayaraj, Babu Pappu Mohan, Gordon Ohning, Douglas G. Adler

School of Medicine Faculty Research

Background While endoscopic retrograde cholangiopancreatography (ERCP) is usually performed in the prone position, some studies have advocated for ERCP in the supine position. Studies comparing the technical success and safety outcomes have shown variable results. We performed a systematic review and meta-analysis of studies reporting the comparison between the two positions for ERCP outcomes. Methods We conducted a search of electronic databases and conference proceedings including PubMed, EMBASE, and Web of Science databases (from inception through October 2016) to identify studies that reported the comparison of technical success and safety outcomes between supine and prone ERCP. The primary outcome was …

A Multi-Institution Consensus On How To Perform Eus-Guided Biliary Drainage For Malignant Biliary Obstruction., Jintao Guo, Marc Giovannini, Anand V. Sahai, Adrian Saftoiu, Christoph F. Dietrich, Erwin Santo, Pietro Fusaroli, Ali Siddiqui, Manoop S. Bhutani, Anthony Yuen Bun Teoh, Atsushi Irisawa, Brenda Lucia Arturo Arias, Chalapathi Rao Achanta, Christian Jenssen, Dong-Wan Seo, Douglas G. Adler, Evangelos Kalaitzakis, Everson Artifon, Fumihide Itokawa, Jan Werner Poley, Girish Mishra, Khek Yu Ho, Hsiu-Po Wang, Hussein Hassan Okasha, Jesse Lachter, Juan J. Vila, Julio Iglesias-Garcia, Kenji Yamao, Kenjiro Yasuda, Kensuke Kubota, Laurent Palazzo, Luis Carlos Sabbagh, Malay Sharma, Mitsuhiro Kida, Mohamed El-Nady, Nam Q. Nguyen, Peter Vilmann, Pramod Kumar Garg, Praveer Rai, Shuntaro Mukai, Silvia Carrara, Sreeram Parupudi, Subbaramiah Sridhar, Sundeep Lakhtakia, Surinder S Rana, Takeshi Ogura, Todd H. Baron, Vinay Dhir, Siyu Sun

Division of Gastroenterology and Hepatology Faculty Papers

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 …

Competence In Endoscopic Ultrasound And Endoscopic Retrograde Cholangiopancreatography, From Training Through Independent Practice., Sachin Wani, Rajesh N. Keswani, Samuel Han, Eva M. Aagaard, Matthew Hall, Violette Simon, Wasif M. Abidi, Subhas Banerjee, Todd H. Baron, Michael Bartel, Erik Bowman, Brian C. Brauer, Jonathan M. Buscaglia, Linda Carlin, Amitabh Chak, Hemant Chatrath, Abhishek Choudhary, Bradley Confer, Gregory A. Coté, Koushik K. Das, Christopher J. Dimaio, Andrew M. Dries, Steven A Edmundowicz, Abdul Hamid El Chafic, Ihab El Hajj, Swan Ellert, Jason Ferreira, Anthony Gamboa, Ian S. Gan, Lisa M. Gangarosa, Bhargava Gannavarapu, Stuart R. Gordon, Nalini M. Guda, Hazem T Hammad, Cynthia Harris, Sujai Jalaj, Paul S. Jowell, Sana Kenshil, Jason Klapman, Michael L. Kochman, Srinadh Komanduri, Gabriel Lang, Linda S. Lee, David E. Loren, Frank J. Lukens, Daniel Mullady, V. Raman Muthusamy, Andrew S. Nett, Mojtaba S. Olyaee, Kavous Pakseresht, Pranith Perera, Patrick Pfau, Cyrus Piraka, John M. Poneros, Amit Rastogi, Anthony Razzak, Brian Riff, Shreyas Saligram, James M. Scheiman, Isaiah Schuster, Raj J. Shah, Rishi Sharma, Joshua P. Spaete, Ajaypal Singh, Muhammad Sohail, Jayaprakash Sreenarasimhaiah, Tyler Stevens, James H. Tabibian, Demetrios Tzimas, Dushant S. Uppal, Shiro Urayama, Domenico Vitterbo, Andrew Y. Wang, Wahid Wassef, Patrick Yachimski, Sergio Zepeda-Gomez, Tobias Zuchelli, Dayna Early

Division of Gastroenterology and Hepatology Faculty Papers

BACKGROUND & AIMS: It is unclear whether participation in competency-based fellowship programs for endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) results in high-quality care in independent practice. We measured quality indicator (QI) adherence during the first year of independent practice among physicians who completed endoscopic training with a systematic assessment of competence.

METHODS: We performed a prospective multicenter cohort study of invited participants from 62 training programs. In phase 1, 24 advanced endoscopy trainees (AETs), from 20 programs, were assessed using a validated competence assessment tool. We used a comprehensive data collection and reporting system to create learning curves …

Surgeon's Perspective On Short Bowel Syndrome: Where Are We?, Ignazio R. Marino, Augusto Lauro

Department of Surgery Faculty Papers

Short bowel syndrome (SBS) is due to a massive loss of small bowel: the reduction of gut function is below the minimum necessary to maintain health (in adults) and growth (in children) so intravenous supplementation is required. Parenteral nutrition represents the milestone of treatment and surgical attempts should be limited only when the residual bowel is sufficient to increase absorption, reducing diarrhea and slowing the transit time of nutrients, water and electrolytes. The surgical techniques lengthen the bowel (tapering it) or reverse a segment of it: developed in children, nowadays are popular also among adults. The issue is mainly represented …

Economical Effect Of Lumen Apposing Metal Stents For Treating Benign Foregut Strictures., Alexander Hallac, Wichit Srikureja, Eashen Liu, Parag Dhumal, Ashish Thatte, Nishant Puri

Articles, Abstracts, and Reports

AIM: To evaluate the clinical and economical efficacy of lumen apposing metal stent (LAMS) in the treatment of benign foregut strictures.

METHODS: A single center retrospective database of patients who underwent endoscopic treatment of benign foregut strictures between January 2014 and May 2017 was analyzed. A control group of non-stented patients who underwent three endoscopic dilations was compared to patients who underwent LAMS placement. Statistical tests performed included independent

RESULTS: Nine hundred and ninety-eight foregut endoscopic dilations were performed between January 2014 and May 2017. 15 patients underwent endoscopic LAMS placement for treatment of benign foregut stricture. Thirty-six patients with …

Over-The-Scope Clip Defect Closure Following Endoscopic Mucosal Resection Throughout The Gastrointestinal Tract: A Case Series, Kyle Kreitman Do, Patrick Hickey Do, Shashin Shah Md, Hiral N. Shah Md

Department of Medicine

No abstract provided.

The Sensitivity Of Cross-Sectional Imaging For Identifying Periampullary Diverticula, Austin Chiang, Md, Mph, Jetmir Vojnika, Md, Alexander Schlachterman, Md, David E. Loren, Md, Thomas E. Kowalski

Division of Gastroenterology and Hepatology Posters

Our aim was to determine the sensitivity of imaging in identifying duodenal diverticula as seen during ERCP.

The Incidental Discovery Of Strongyloidiasis Colitis, Elizabeth Gold Do, Travis Magdaleno Md, Cheryl A. Bloomfield Md

Department of Medicine

No abstract provided.

Real World Experience With Obeticholic Acid For Primary Biliary Cholangitis: A Case Series, Eric Nellis Md, Adam Peyton Do, She-Yan Wong Md

Department of Medicine

No abstract provided.

Role Of Hybrid Argon-Plasma Coagulation (Hybrid Apc) In The Management Of Barrett’S Esophagus: A Case Series Report, Abdul Aleem Md, Kyle Kreitman Do, Shashin Shah Md, Hiral N. Shah Md

Department of Medicine

No abstract provided.

Oral Contraception Woes: Idiosyncratic Drug Induced Liver Injury, Abdul Aleem Md, She-Yan Wong Md

Department of Medicine

No abstract provided.

Benign Colonic Schwann Cell Hamartoma In A Pediatric Patient With Pten Hamartoma Tumor Syndrome (Phts), Naser Tolaymat Md, Adam R. Paul Do

Department of Medicine

No abstract provided.

Pancreatoscopy In Undiagnosed Pancreatic Disease, Travis Magdaleno Md, Shashin Shah Md, Hiral N. Shah Md

Department of Medicine

No abstract provided.

A Proposed Therapeutic Algorithm For Colorectal Cancer Prevention, Based On Endoscopic Polypectomies In Patients With Multiple Colonic Polyps, Septimiu Alexandru, Florin D. Ungureanu, Reka Incze Kutasi, Cosmin Alec Moldovan

Journal of Mind and Medical Sciences

Introduction. Results from single medical centers having large numbers of patients with multiple colonic polyps that have undergone colonoscopy management are rare.

Material and method. The present study is based on 2,000 cases enrolled during 2009 and 2017, including patients that underwent colonoscopy for various reasons in the Department for Upper and Lower Endoscopy of Witting Clinical Hospital, Bucharest, Romania.

Results. Of the 2,000 patients examined during 2009 - 2017, 594 tumor formations were detected; 148 (24.9%) patients had colorectal malignancies, and 446 (75%) polypoid formations in 313 patients who had one or more colon polyps were found.

Discussions. After …

Thrombocytopenia In End-Stage Renal Disease And Chronic Viral Hepatitis B Or C, Olga Hilda Orasan, Laura Urian, George Ciulei, Iulia Breaban, Andreea Maria Stefan, Sorina Cezara Secara, Adela Sitar Taut, Simina Tarmure Sarlea, Vasile Negrean, Dorel Sampelean, Ioan Mihai Patiu, Remus Aurel Orasan, Angela Cozma

Journal of Mind and Medical Sciences

Objectives. We evaluated platelet counts in end-stage renal disease and chronic viral hepatitis.

Materials and Methods. We studied 70 patients with end-stage renal disease and chronic viral hepatitis and compared them to a control group of 45 patients without hepatitis.

Results. The presence of viral hepatitis was associated with a higher prevalence of thrombocytopenia. Correlations between age, C-reactive protein, liver stiffness measurement, and platelet count were observed. C-reactive protein levels > 10 mg/dl were associated with a lower risk of thrombocytopenia in patients with end-stage renal disease and chronic viral hepatitis, yet age > 60 years, dialysis vintage > 10 years, aspartate and …

Era Of Direct Acting Anti-Viral Agents For The Treatment Of Hepatitis C., Monjur Ahmed

Division of Gastroenterology and Hepatology Faculty Papers

Hepatitis C infection is universal and the most common indication of liver transplantation in the United States. The period of less effective interferon therapy with intolerable side effects has gone. Now we have stepped into the era of direct acting anti-viral agents (DAAs) against hepatitis C virus. Treatment of hepatitis C is now extremely effective, tolerable and requires a short duration of intake of oral agents. Less monitoring is required with the current therapy and drug-drug interactions are less than the previous regimen. The current treatment options of chronic hepatitis C with various DAAs are discussed in this article.

None Shall Pass: Migrated Surgical Mesh Causing Gastric Outlet Obstruction With Endoscopic Extraction, Matthew J. Sullivan Do, Shashin Shah Md, Paola Blanco Md

Department of Medicine

No abstract provided.