1
|
Gandhi M, Chela HK, Daglilar E, Hammoud G. Mushroom Sign: Complete Esophageal Obstruction After Esophageal Variceal Band Ligation With Successful Removal of Variceal Band. ACG Case Rep J 2023; 10:e01093. [PMID: 37441621 PMCID: PMC10335816 DOI: 10.14309/crj.0000000000001093] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/05/2023] [Indexed: 07/15/2023] [Imported: 08/29/2023] Open
Abstract
Esophageal varices due to portal hypertension are treated with endoscopic variceal band ligation (EVBL), a minimally invasive procedure with potential complications, such as pain, bleeding, and stricture formation. Rarely, complete esophageal obstruction can occur secondary to edema of the mucosa. Most cases can be managed conservatively, but intervention is necessary for severe symptoms with a risk for aspiration and airway compromise. Since EVBL is such a common procedure, it is important for clinicians to be aware of this rare but severe complication. An 80-year-old woman presented with severe dysphagia and chest discomfort after a recent EVBL. Esophagogastroduodenoscopy revealed esophageal mucosal edema and complete obstruction of the esophageal lumen. The band was removed with a loop cutter with subsequent balloon dilation to relieve the obstruction.
Collapse
Affiliation(s)
- Mustafa Gandhi
- Department of Medicine, University of Missouri, Columbia, MO
| | - Harleen Kaur Chela
- Department of Gastroenterology and Hepatology, Charleston Area Medical Center, West Virginia University School of Medicine, Charleston, WV
| | - Ebubekir Daglilar
- Department of Gastroenterology and Hepatology, Charleston Area Medical Center, West Virginia University School of Medicine, Charleston, WV
| | - Ghassan Hammoud
- Department of Medicine, University of Missouri, Columbia, MO
| |
Collapse
|
2
|
Mankoo R, Ali AH, Hammoud GM. Use of artificial intelligence in endoscopic ultrasound evaluation of pancreatic pathologies. Artif Intell Gastrointest Endosc 2021; 2:89-94. [DOI: 10.37126/aige.v2.i3.89] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 06/20/2021] [Accepted: 06/28/2021] [Indexed: 02/06/2023] [Imported: 08/29/2023] Open
Abstract
The application of artificial intelligence (AI) using deep learning and machine learning approaches in modern medicine is rapidly expanding. Within the field of Gastroenterology, AI is being evaluated across a breadth of clinical and diagnostic applications including identification of pathology, differentiation of disease processes, and even automated procedure report generation. Many pancreatic pathologies can have overlapping features creating a diagnostic dilemma that provides a window for AI-assisted improvement in current evaluation and diagnosis, particularly using endoscopic ultrasound. This topic highlight will review the basics of AI, history of AI in gastrointestinal endoscopy, and prospects for AI in the evaluation of autoimmune pancreatitis, pancreatic ductal adenocarcinoma, chronic pancreatitis and intraductal papillary mucinous neoplasm.
Collapse
Affiliation(s)
- Ravinder Mankoo
- Division of Gastroenterology and Hepatology, University of Missouri School of Medicine, Columbia, MO 65212, United States
| | - Ahmad H Ali
- Division of Gastroenterology and Hepatology, University of Missouri School of Medicine, Columbia, MO 65212, United States
| | - Ghassan M Hammoud
- Division of Gastroenterology and Hepatology, University of Missouri School of Medicine, Columbia, MO 65212, United States
| |
Collapse
|
3
|
Mankoo R, Ali AH, Hammoud GM. Use of artificial intelligence in endoscopic ultrasound evaluation of pancreatic pathologies. Artif Intell Gastrointest Endosc 2021. [DOI: 10.37126/aige.v2.i3.88] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] [Imported: 08/29/2023] Open
|
4
|
Pasha SB, Swi A, Hammoud GM. Gastrointestinal and hepatic manifestations of COVID-19 infection: Lessons for practitioners. World J Meta-Anal 2020; 8:348-374. [DOI: 10.13105/wjma.v8.i5.348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/30/2020] [Revised: 09/26/2020] [Accepted: 10/26/2020] [Indexed: 02/06/2023] [Imported: 08/29/2023] Open
Abstract
Originating from Wuhan in China, coronavirus disease 2019 (COVID-19) spread globally within months and was declared a pandemic by World Health Organization in March 2020, making it one of the biggest healthcare calamities of our time. As more data on COVID-19 infection became available, what was initially thought to be a simple respiratory illness was found to be more complex. Many extra-pulmonary manifestations are now frequently reported for COVID-19 in available literature, most commonly gastrointestinal and hepatopancreato-biliary manifestations. Due to early scarcity of data, extra pulmonary manifestations were initially overlooked and may have contributed to nosocomial spread of the infection. Practitioners, especially gastroenterologists, who frequently encounter patients with these symptoms, need to be aware of them. This can not only help minimize the nosocomial spread, ensure safety of provider but also help conserve already stretched-thin healthcare resources. A tremendous amount of COVID-19 related literature is getting added to the growing pool every day, making it difficult for providers to follow. The aim of our review is to summarize the available evidence for gastrointestinal and hepatopancreatobiliary manifestations of COVID-19. We here briefly discussed the possible pathophysiologic mechanism for these manifestations and summarized the recommendations put forward by multiple gastrointestinal societies regarding safe and effective clinical practice during the ongoing pandemic.
Collapse
Affiliation(s)
- Syed B Pasha
- Department of Internal Medicine, University of Missouri, Columbia, MO 65212, United States
| | - Ahmed Swi
- Division of Gastroenterology and Hepatology, University of Missouri School of Medicine, Columbia, MO 65212, United States
| | - Ghassan M Hammoud
- Division of Gastroenterology and Hepatology, University of Missouri School of Medicine, Columbia, MO 65212, United States
| |
Collapse
|
5
|
Ali AH, Panchal S, Rao DS, Gan Y, Al-Juboori A, Samiullah S, Ibdah JA, Hammoud GM. The efficacy and safety of endoscopic ultrasound-guided liver biopsy versus percutaneous liver biopsy in patients with chronic liver disease: a retrospective single-center study. J Ultrasound 2020; 23:157-167. [PMID: 32141043 DOI: 10.1007/s40477-020-00436-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 02/15/2020] [Indexed: 02/06/2023] [Imported: 08/29/2023] Open
Abstract
BACKGROUND AND AIMS There is limited literature on endoscopic ultrasound-guided liver biopsy (EUS-LB), a new method of obtaining liver biopsy (LB). METHODS We conducted a retrospective study of the efficacy and safety of EUS-LB compared to percutaneous liver biopsy (PC-LB) in patients with chronic liver disease at our center between January 2018 and August 2019. RESULTS Thirty patients underwent EUS-LB and 60 patients underwent PC-LB were identified (median follow-up post-LB was 8 days; interquartile range (IQR), 3-5 days). The median number of portal tracts was significantly higher in the PC-LB group (13 vs. 5; P < 0.0001). A histologic diagnosis was established in 93% of the EUS-LB group, compared to 100% in the PC-LB group (P = 0.841). Patients in EUS-LB group had significantly shorter hospital stay (median time of hospital stay was 3 vs. 4.2 h in the EUS-LB vs. PC-LB group, respectively; P = 0.004) and reported less pain compared to PC-LB group (median pain score was 0 vs. 3.5; P = 0.0009). EUS-LB were performed using a 19-gauge (n = 27) or 22-gauge (n = 3); there was a tendency towards higher number of portal tracts in the 22- vs. the 19-gauge needle group (6 vs. 5; P = 0.501). No patient in either group had significant adverse events such as bleeding or death. CONCLUSION EUS-LB is safe and is associated with less pain, shorter hospital stay, and high diagnostic yield (93%) compared to PC-LB. Randomized trials are needed to standardize the utility of EUS-LB.
Collapse
Affiliation(s)
- Ahmad Hassan Ali
- Department of Gastroenterology and Hepatology, University of Missouri-School of Medicine, One Hospital Drive, Columbia, MO, 65212, USA
| | - Sarjukumar Panchal
- Department of Gastroenterology and Hepatology, University of Missouri-School of Medicine, One Hospital Drive, Columbia, MO, 65212, USA
| | - Deepthi S Rao
- Department of Pathology and Anatomical Sciences, University of Missouri-School of Medicine, Columbia, MO, USA
| | - Yujun Gan
- Department of Pathology and Anatomical Sciences, University of Missouri-School of Medicine, Columbia, MO, USA
| | - Alhareth Al-Juboori
- Department of Gastroenterology and Hepatology, University of Missouri-School of Medicine, One Hospital Drive, Columbia, MO, 65212, USA
| | - Sami Samiullah
- Department of Gastroenterology and Hepatology, University of Missouri-School of Medicine, One Hospital Drive, Columbia, MO, 65212, USA
| | - Jamal A Ibdah
- Department of Gastroenterology and Hepatology, University of Missouri-School of Medicine, One Hospital Drive, Columbia, MO, 65212, USA
| | - Ghassan M Hammoud
- Department of Gastroenterology and Hepatology, University of Missouri-School of Medicine, One Hospital Drive, Columbia, MO, 65212, USA.
| |
Collapse
|
6
|
Sathyamurthy A, Choudhary A, Ng D, Okponobi S, Diaz-Arias A, Grewal A, Hammoud GM. Obstructive jaundice due to a rare periampullary tumor. World J Gastrointest Oncol 2013; 5:195-197. [PMID: 24137522 PMCID: PMC3796670 DOI: 10.4251/wjgo.v5.i10.195] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 08/06/2013] [Accepted: 09/04/2013] [Indexed: 02/05/2023] [Imported: 08/29/2023] Open
Abstract
Gangliocytic paraganglioma is a rare neuroendocrine tumor predominantly arising in the second part of the duodenum with rare local recurrence or metastasis to regional lymph nodes. A 92-year-old female presented with obstructive jaundice. On exam she had pale conjunctiva and icteric sclera. Abdominal examination revealed tenderness in the upper abdomen. Laboratory data was consistent with obstructive jaundice. Computed tomography of the abdomen revealed a dilated gall bladder and a common bile duct (CBD) with no evidence of liver lesions or pancreatic head mass. Endoscopic ultrasonography revealed a 1 cm isoechoic submucosal nodule at the periampullary area, dilated CBD (9 mm), a prominent pancreatic duct (4.1 mm) and a hydropic gall bladder with no stones. Endoscopic retrograde cholangiopancreaticography was performed to relieve obstruction and showed a 1 cm periampullary mass which underwent an en-bloc snare resection. Histopathology analyses with immunohistochemical stains were positive for cytokeratin, synaptophysin, S-100 protein, neuron specific enolase and negative for actin and desmin consistent with periampullary gangliocytic paraganglioma. Periampullary gangliocytic paraganglioma is a rare benign tumor of the small bowel. Common presentation includes abdominal pain and obstructive jaundice which should be included in differential diagnosis of obstructive jaundice. Endoscopic resection is a curative therapy in the absence of local invasion or distant metastasis.
Collapse
|
7
|
Abstract
Cephalexin is a well tolerated antimicrobial and hepatic injury is an infrequent occurrence with its use. We here describe a 21-year-old female who presented with jaundice and elevated liver enzymes after 4 weeks completion of 10 day course of cephalexin, prescribed prophylactically after mammoplasty. Extensive work up including all causes of hepatitis was within normal limits and she improved with conservative management. This case highlights the need to suspect drug induced liver injury in cases of jaundice and cephalexin use.
Collapse
Affiliation(s)
- Atul Singla
- Department of Internal Medicine, University of Missouri School of Medicine, One Hospital Drive, Columbia, MO 65212, USA
| | - Hazem T Hammad
- Division of Gastroenterology, Department of Internal Medicine, University of Missouri School of Medicine, One Hospital Drive, Columbia, MO 65212, USA
| | - Ghassan M Hammoud
- Department of Internal Medicine, University of Missouri School of Medicine, One Hospital Drive, Columbia, MO 65212, USA
| |
Collapse
|