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Rajadurai A, Zorron Cheng Tao Pu L, Cameron R, Tagkalidis P, Holt B, Bassan M, Gupta S, Croagh D, Swan M, Saxena P, Efthymiou M, Vaughan R, Chandran S. Endoscopic ultrasound-guided gallbladder and bile duct drainage with lumen apposing metal stent: A large multicenter cohort (with videos). J Gastroenterol Hepatol 2022; 37:179-189. [PMID: 34562319 DOI: 10.1111/jgh.15688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Received: 06/15/2021] [Revised: 09/09/2021] [Accepted: 09/11/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM Cholecystectomy and endoscopic retrograde cholangiopancreatography are the gold standard for managing acute cholecystitis and malignant biliary obstruction, respectively. Recent advances in therapeutic endoscopic ultrasound (EUS) have provided alternatives for managing patients in whom these approaches fail, namely, EUS-guided gallbladder drainage (EUS-GB) and EUS-guided bile duct drainage (EUS-BD). We aimed to assess the technical and clinical success of these techniques in the largest multicenter cohort published to date. METHODS A retrospective, multicenter, observational study involving 17 centers across Australia and New Zealand was conducted. All patients who had EUS-GB or EUS-BD performed in a participating center using a lumen apposing metal stent between 2016 and 2020 were included. Primary outcome was technical success, defined as intra-procedural successful drainage. Secondary outcomes included clinical success and 30-day mortality. RESULTS One hundred and fifteen patients underwent EUS-GB (n = 49) or EUS-BD (n = 66). EUS-GB was technically successful in 47 (95.9%) while EUS-BD was successful in 60 (90.9%). All failed cases were due to maldeployment of the distal flange outside of the targeted lumen. Clinical success of EUS-GB was achieved in 39 (79.6%). No patients required subsequent cholecystectomy. Clinical success of EUS-BD was achieved in 52 (78.8 %). Thirty-day mortality was 14.3% for EUS-GB and 12.1% for EUS-BD. CONCLUSIONS EUS-guided gallbladder drainage and EUS-BD are promising alternatives for managing nonsurgical candidates with cholecystitis and malignant biliary obstruction following failed endoscopic retrograde pancreatography. Both techniques delivered high technical success with acceptable clinical success. Further research is needed to investigate the gap between technical and clinical success.
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Affiliation(s)
- Anton Rajadurai
- Department of Gastroenterology and Hepatology, Austin Health, Heidelberg, Victoria, Australia
| | | | - Rees Cameron
- Department of Gastroenterology and Hepatology, Austin Health, Heidelberg, Victoria, Australia
| | - Peter Tagkalidis
- Department of Gastroenterology and Hepatology, Austin Health, Heidelberg, Victoria, Australia
| | - Bronte Holt
- Department of Gastroenterology and Hepatology, Austin Health, Heidelberg, Victoria, Australia
| | - Milan Bassan
- Department of Gastroenterology and Hepatology, Austin Health, Heidelberg, Victoria, Australia
| | - Saurabh Gupta
- Department of Gastroenterology and Hepatology, Austin Health, Heidelberg, Victoria, Australia
| | - Daniel Croagh
- Department of Gastroenterology and Hepatology, Austin Health, Heidelberg, Victoria, Australia
| | - Michael Swan
- Department of Gastroenterology and Hepatology, Austin Health, Heidelberg, Victoria, Australia
| | - Payal Saxena
- Department of Gastroenterology and Hepatology, Austin Health, Heidelberg, Victoria, Australia
| | - Marios Efthymiou
- Department of Gastroenterology and Hepatology, Austin Health, Heidelberg, Victoria, Australia
| | - Rhys Vaughan
- Department of Gastroenterology and Hepatology, Austin Health, Heidelberg, Victoria, Australia
| | - Sujievvan Chandran
- Department of Gastroenterology and Hepatology, Austin Health, Heidelberg, Victoria, Australia
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- Department of Gastroenterology and Hepatology, Austin Health, Heidelberg, Victoria, Australia
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Zorron Cheng Tao Pu L, Raval M, Terbah R, Singh G, Rajadurai A, Vaughan R, Efthymiou M, Chandran S. Video consultations during the coronavirus disease 2019 pandemic are associated with high satisfaction for both doctors and patients. JGH Open 2021; 5:542-548. [PMID: 34013052 PMCID: PMC8114984 DOI: 10.1002/jgh3.12547] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/31/2021] [Indexed: 12/11/2022]
Abstract
Background and Aim Telehealth has become the standard of care during the COVID-19 outbreak. This study aimed to assess doctor and patient satisfaction of endoscopy-related telehealth clinics with video consultations. Methods A prospective observational study of patients consecutively booked to attend two endoscopy-related telehealth clinics at an ambulatory tertiary care setting was conducted from July to October 2020. Data collected from our previously published study using phone consultations (data collected in April-May 2020) were used as a control arm. The primary outcome (satisfaction) was assessed through the six-question score (6Q_score) as per previous research. Secondary outcomes included failure-to-attend (FTA) rate and perceived necessity of physical examination/in-person follow-up appointment. Results There were 962 endoscopy clinic appointments between July and October, of which 157 were conducted through video. Data on 127 doctor questionnaires and 94 patient questionnaires were analyzed. The median age (years) of patients reviewed via video [57, interquartile range (IQR) 48-66] was lower than those reviewed via phone (65, IQR 55-74, P < 0.01). Patient average 6Q_score was higher with video compared to phone (85.1% vs 78.4%, P = 0.01), as was doctors' 6Q_score (97.5% vs 91.9%, P = 0.02). FTA rates remained similar between the two assessments (6.4% in April/May and 4.4% between July/October, P = 0.12). The requirement for in-person follow-up/physical examination was identified in two video consultations (1.6%). Conclusion Video consultations during the COVID-19 outbreak demonstrated higher patient and doctor satisfaction compared to phone consultations. There was no significant difference in FTA rates and need for in-person follow-up consultations/physical examination between the telehealth two modalities.
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Affiliation(s)
| | - Manjri Raval
- Department of Gastroenterology and Hepatology, Austin HealthHeidelbergVictoriaAustralia
| | - Ryma Terbah
- Department of Gastroenterology and Hepatology, Austin HealthHeidelbergVictoriaAustralia
- University of Melbourne, ParkvilleMelbourneVictoriaAustralia
| | - Gurpreet Singh
- Department of Gastroenterology and Hepatology, Austin HealthHeidelbergVictoriaAustralia
| | - Anton Rajadurai
- Department of Gastroenterology and Hepatology, Austin HealthHeidelbergVictoriaAustralia
| | - Rhys Vaughan
- Department of Gastroenterology and Hepatology, Austin HealthHeidelbergVictoriaAustralia
- University of Melbourne, ParkvilleMelbourneVictoriaAustralia
| | - Marios Efthymiou
- Department of Gastroenterology and Hepatology, Austin HealthHeidelbergVictoriaAustralia
- University of Melbourne, ParkvilleMelbourneVictoriaAustralia
| | - Sujievvan Chandran
- Department of Gastroenterology and Hepatology, Austin HealthHeidelbergVictoriaAustralia
- University of Melbourne, ParkvilleMelbourneVictoriaAustralia
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Zorron Cheng Tao Pu L, Singh G, Rajadurai A, Terbah R, De Silva R, Vaughan R, Efthymiou M, Chandran S. Benefits of phone consultation for endoscopy-related clinics in the COVID-19 pandemic. J Gastroenterol Hepatol 2021; 36:1064-1080. [PMID: 33037824 PMCID: PMC7675268 DOI: 10.1111/jgh.15292] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 07/30/2020] [Revised: 09/17/2020] [Accepted: 09/28/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM During COVID-19 outbreak, restrictions to in-person consultations were introduced with a rise in telehealth. An indirect benefit of telehealth could be better attendance. This study aimed to assess "failure-to-attend" (FTA) rate and satisfaction for two endoscopy-related compulsory telehealth clinics during the COVID-19 outbreak. METHODS Consecutive patients booked for endoscopy-related telehealth clinics at a tertiary hospital were prospectively assessed. In-person clinic control data were assessed retrospectively. Sample size was calculated to detect an anticipated increase in attendance of 8%. Secondary outcomes included FTA differences between clinics and evaluation of patients and doctors satisfaction. Satisfaction was assessed based on six Likert scale questions used in previous telehealth research and asked to both patients and doctors (6Q_score). This study was exempt from IRB review after institutional IRB review. RESULTS There were 691 patients booked for appointments in our endoscopy clinics during the study periods (373 in 2020). FTA rates were lowered by half during the compulsory telehealth clinics (12.6% to 6.4%, P < 0.01). The patient 6Q_score was higher for the advanced endoscopy clinic (84.6% vs 73.8%, P < 0.01), while the doctor 6Q_score was similar between both advanced clinics and post endoscopy clinics (91.1% vs 92.5% respectively, P = 0.80). An in-person follow-up consultation was suggested for 3.5% of the appointments, while the necessity of physical examination was flagged in 5.1%. CONCLUSIONS The use of phone consultations in endoscopy-related clinics during the COVID-19 outbreak has improved FTA rates while demonstrating high satisfaction rates. The need for in-person follow-up consultations and physical examination were low.
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Affiliation(s)
| | - Gurpreet Singh
- Department of Gastroenterology and HepatologyAustin HealthHeidelbergVictoriaAustralia
| | - Anton Rajadurai
- Department of Gastroenterology and HepatologyAustin HealthHeidelbergVictoriaAustralia
| | - Ryma Terbah
- Department of Gastroenterology and HepatologyAustin HealthHeidelbergVictoriaAustralia
| | - Rahil De Silva
- Department of Gastroenterology and HepatologyAustin HealthHeidelbergVictoriaAustralia
| | - Rhys Vaughan
- Department of Gastroenterology and HepatologyAustin HealthHeidelbergVictoriaAustralia,University of MelbourneParkville, MelbourneVictoriaAustralia
| | - Marios Efthymiou
- Department of Gastroenterology and HepatologyAustin HealthHeidelbergVictoriaAustralia,University of MelbourneParkville, MelbourneVictoriaAustralia
| | - Sujievvan Chandran
- Department of Gastroenterology and HepatologyAustin HealthHeidelbergVictoriaAustralia,University of MelbourneParkville, MelbourneVictoriaAustralia
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Efthymiou M, Chandran S, Zorron Cheng Tao Pu L, Collins A, Rajadurai A, Nikfarjam M, Vaughan R. Outcomes of endoscopic ultrasound as a one-off pancreatic cancer screening tool for 122 high- and moderate-risk patients. JGH Open 2020; 4:1217-1223. [PMID: 33319059 PMCID: PMC7731834 DOI: 10.1002/jgh3.12432] [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] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 09/26/2020] [Indexed: 11/06/2022]
Abstract
Background and Aim Pancreatic cancer (PC) carries a poor prognosis and is often detected at later stages. Screening programs for moderate- and high-risk people are still under debate. We present the results from a prospective study on endoscopic ultrasound (EUS) as a one-off screening tool for pancreatic cancer screening. Methods Asymptomatic patients with moderate- or high-risk of PC were invited to participate. Moderate risk consisted of one first-degree and at least one second-degree relative with PC and no PC-associated genetic mutations. High risk consisted of >1 first-degree relatives with PC or PC-associated mutations (i.e. BRCA2, Lynch Syndrome, Familial Atypical Multiple Mole Melanoma Syndrome, STK11, or PALB2). All included patients had genetic counseling and a screening EUS done. Primary outcome was the detection of PC on EUS. Secondary outcomes assessed the evolution of psychological symptoms based on the Impact of Events Scale (IES) and Personal Consequences Questionnaire (PCQ) before and after the screening took place. Results A total of 122 patients had a screening EUS performed between 2013 and 2019; 60 were male, 55.8 years was the mean age, 78 were at high risk for PC, and 25 had PC-associated mutations. No pancreatic cancers were identified at the one-off EUS screening. Overall, patients' IES/PCQ scores did not change after screening and feedback of no malignancy, with the exception of females (less concerned about PC after screening EUS). Conclusions EUS did not detect any PCs in either a moderate- or high-risk population as a one-off screening method. The EUS procedure and genetic counseling improved psychological symptoms for the female subset of this population.
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Affiliation(s)
- Marios Efthymiou
- Endoscopy Unit, Department of Gastroenterology and Hepatology Austin Health Melbourne Victoria Australia.,University of Melbourne Parkville Melbourne Victoria Australia
| | - Sujievvan Chandran
- Endoscopy Unit, Department of Gastroenterology and Hepatology Austin Health Melbourne Victoria Australia.,University of Melbourne Parkville Melbourne Victoria Australia
| | | | - Allison Collins
- Institute for Breathing and Sleep Austin Health Melbourne Victoria Australia
| | - Anton Rajadurai
- Endoscopy Unit, Department of Gastroenterology and Hepatology Austin Health Melbourne Victoria Australia
| | - Mehrdad Nikfarjam
- University of Melbourne Parkville Melbourne Victoria Australia.,Department of Hepatobiliary Surgery Austin Health Melbourne Victoria Australia
| | - Rhys Vaughan
- Endoscopy Unit, Department of Gastroenterology and Hepatology Austin Health Melbourne Victoria Australia.,University of Melbourne Parkville Melbourne Victoria Australia
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Shaughnessy M, La Muraglia G, Rajadurai A, Kumar R, Olson C, Jiang B, Gray N, Tsao H. 705 Cyclin-dependent kinase 9 (CDK9) as a therapeutic target in uveal and triple-wild type melanoma. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.03.781] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Roh MR, Kumar R, Rajadurai A, Njauw C, Ryoo UH, Chung KY, Tsao H. Beta-catenin causes fibrotic changes in the extracellular matrix via upregulation of collagen I transcription. Br J Dermatol 2017; 177:312-315. [PMID: 27639179 DOI: 10.1111/bjd.15079] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- M R Roh
- Wellman Center for Photomedicine, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, U.S.A.,Department of Dermatology, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - R Kumar
- Wellman Center for Photomedicine, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, U.S.A
| | - A Rajadurai
- Wellman Center for Photomedicine, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, U.S.A
| | - C Njauw
- Wellman Center for Photomedicine, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, U.S.A
| | - U H Ryoo
- Department of Biological Sciences, Korea Advanced Institute of Science and Technology, Daejeon, Korea
| | - K Y Chung
- Department of Dermatology, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - H Tsao
- Wellman Center for Photomedicine, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, U.S.A
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Boulos D, Ngian GS, Rajadurai A, Elford K, Stevens W, Proudman S, Owen C, Roddy J, Nikpour M, Youssef P, Hill C, Sahhar J. Long-term efficacy and tolerability of mycophenolate mofetil therapy in diffuse scleroderma skin disease. Int J Rheum Dis 2017; 20:481-488. [DOI: 10.1111/1756-185x.13035] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Daniel Boulos
- Department of Rheumatology; Monash Health; Melbourne Victoria Australia
| | - Gene-Siew Ngian
- Department of Rheumatology; Monash Health; Melbourne Victoria Australia
| | - Anton Rajadurai
- Department of Rheumatology; Monash Health; Melbourne Victoria Australia
| | - Kathleen Elford
- Department of Rheumatology; Monash Health; Melbourne Victoria Australia
| | - Wendy Stevens
- Department of Rheumatology; St Vincent's Health; Melbourne Victoria Australia
| | - Susanna Proudman
- Department of Rheumatology; Royal Adelaide Hospital; Adelaide South Australia Australia
- Discipline of Medicine; University of Adelaide; Adelaide South Australia Australia
| | - Claire Owen
- Department of Rheumatology; Austin Health; Melbourne Victoria Australia
- Department of Medicine; University of Melbourne; Melbourne Victoria Australia
| | - Janet Roddy
- Department of Rheumatology; Royal Perth Hospital; Perth Western Australia Australia
| | - Mandana Nikpour
- Department of Rheumatology; St Vincent's Health; Melbourne Victoria Australia
- Department of Medicine; University of Melbourne; Melbourne Victoria Australia
| | - Peter Youssef
- Department of Rheumatology; Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - Catherine Hill
- Discipline of Medicine; University of Adelaide; Adelaide South Australia Australia
- Department of Rheumatology; Queen Elizabeth Hospital; Adelaide South Australia Australia
| | - Joanne Sahhar
- Department of Rheumatology; Monash Health; Melbourne Victoria Australia
- Department of Medicine; Monash University; Melbourne Victoria Australia
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Boulos D, Rajadurai A, Ngian G, Elford K, Stevens W, Proudman S, Roddy J, Nikpour M, Youssef P, Hill C, Sahhar J. FRI0266 Long-Term Efficacy and Tolerability of Mycophenolate Mofetil Therapy in Diffuse Scleroderma Skin Disease. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3372] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Roh M, Rajadurai A, Kumar R, Chung K, Tsao H. 726 Role of β-catenin in collagen I production in keloid pathogenesis. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.02.769] [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] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Murali G, Gopal M, Rajadurai A. Effect of Circular and Rectangular Drawbeads in Hemispherical Cup Forming: Finite Element Analysis and Experimental Validation. Arab J Sci Eng 2012. [DOI: 10.1007/s13369-012-0276-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kuppan P, Narayanan S, Rajadurai A. Experimental investigations into electrical discharge deep hole drilling of Inconel 718 using copper-tungsten electrode. ACTA ACUST UNITED AC 2012. [DOI: 10.1504/ijmms.2012.049969] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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