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Nadeem D, Taye M, Still MD, McShea S, Satterfield D, Dove JT, Wood GC, Addissie BD, Diehl DL, Johal AS, Khara HS, Confer BD, Still CD. Effects of Glucagon-like Peptide-1 Receptor Agonists on Upper Endoscopy in Diabetic and Non-Diabetic Patients. Gastrointest Endosc 2024:S0016-5107(24)03159-6. [PMID: 38692518 DOI: 10.1016/j.gie.2024.04.2900] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 04/15/2024] [Accepted: 04/23/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND AND AIMS Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) promote weight loss by suppressing appetite, enhancing satiety, regulating glucose metabolism and delaying gastric motility. We sought to determine whether GLP-1 RA use could impact sedated medical procedures like esophagogastroduodenoscopy (EGD). METHODS We conducted a retrospective study on 35,183 patients who underwent EGD between 2019 and 2023, 922 of which were using a GLP-1-RA. Data were collected regarding demographics, diabetes status, retained gastric contents during EGD (RGC), incidence of aborted EGD, and necessity for repeat EGD. RESULTS GLP-1 RA use was associated with a fourfold increase in the retention of gastric contents (p<0.0001), fourfold higher rates of aborted EGD (p<0.0001), and twice the likelihood of requiring repeat EGD (p=0.0001), even after stratifying for presence of diabetes. CONCLUSIONS GLP-1 RA use can lead to delayed gastric emptying, affecting EGD adequacy regardless of the presence of diabetes, and may warrant dose adjustment to improve safety and efficacy of these procedures.
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Affiliation(s)
- Danial Nadeem
- Department of Gastroenterology, Hepatology and Nutrition, Geisinger Medical Center.
| | - Mahdi Taye
- Geisinger Commonwealth School of Medicine
| | | | - Shannon McShea
- Department of Gastroenterology, Hepatology and Nutrition, Geisinger Medical Center
| | - Daniel Satterfield
- Department of Gastroenterology, Hepatology and Nutrition, Geisinger Medical Center
| | - James T Dove
- Center for Obesity and Metabolic Research, Geisinger Medical Center
| | - G Craig Wood
- Center for Obesity and Metabolic Research, Geisinger Medical Center
| | - Benyam D Addissie
- Department of Gastroenterology, Hepatology and Nutrition, Geisinger Medical Center
| | - David L Diehl
- Department of Gastroenterology, Hepatology and Nutrition, Geisinger Medical Center
| | - Amitpal S Johal
- Department of Gastroenterology, Hepatology and Nutrition, Geisinger Medical Center
| | - Harshit S Khara
- Department of Gastroenterology, Hepatology and Nutrition, Geisinger Medical Center
| | - Bradley D Confer
- Department of Gastroenterology, Hepatology and Nutrition, Geisinger Medical Center
| | - Christopher D Still
- Department of Gastroenterology, Hepatology and Nutrition, Geisinger Medical Center
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Iqbal U, Li J, Diehl DL, Confer BD. "Two for one": histologic diagnosis of Helicobacter pylori during EUS-guided liver biopsy. Gastrointest Endosc 2024; 99:289-290. [PMID: 37423538 DOI: 10.1016/j.gie.2023.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/05/2023] [Accepted: 07/05/2023] [Indexed: 07/11/2023]
Affiliation(s)
- Umair Iqbal
- Division of Gastroenterology and Hepatology, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Jianhong Li
- Anatomic Pathology, Clinical Pathology, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - David L Diehl
- Division of Gastroenterology and Hepatology, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Bradley D Confer
- Division of Gastroenterology and Hepatology, Geisinger Medical Center, Danville, Pennsylvania, USA
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Hanna D, Makar M, Berger A, Johal AS, Confer BD, Khara HS. Immediate-use strategy is as safe and effective as delayed-use strategy following percutaneous endoscopic gastrostomy tube placement: A retrospective cohort study. JPEN J Parenter Enteral Nutr 2024; 48:120-127. [PMID: 37904600 DOI: 10.1002/jpen.2575] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/19/2023] [Accepted: 10/25/2023] [Indexed: 11/01/2023]
Abstract
BACKGROUND Percutaneous endoscopic gastrostomy (PEG) tube placement is the most common enteral access for long-term feeding. The aim of our study is to assess the feasibility and safety of immediate PEG tube use after initial placement. METHODS We conducted a single-center retrospective cohort study between August 2006 and August 2016. Prior to August 2011, tube feedings were delayed for ≥4 h after initial PEG placement, compared with immediate use (<1 h) after August 2011. Primary outcomes were complication rates within 30 days of placement. Secondary outcomes were impact of morbidity, mortality, length of stay, and need for repeat PEG placement. RESULTS Our study included 1296 patients during the 10-year period, of which 704 underwent delayed use and 592 underwent immediate use (744 inpatient and 552 outpatient). There were no significant differences between the delayed-use and immediate-use PEG with regard to complications (3.4% vs 4.4%; P = 0.76). Subgroup analysis also reflected no significant differences in complications between inpatient and outpatient groups. For inpatients, there were no substantial differences in inpatient mortality (3.9% vs 3.3%; P = 0.70), mortality within 30 days of discharge (13.8% vs 13.1%; P = 0.15), readmissions (38.2% vs 34.3%; P = 0.23), repeat PEG placement (0.7% vs 1.5%; P = 0.46), and length of stay (13.3 vs 13.9 days; P = 0.99). CONCLUSION Patients who received immediate enteral nutrition after PEG tube placement did not have any increased complications, morbidity, or mortality; and it is just as safe when compared with patients who received delayed feeding.
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Affiliation(s)
- David Hanna
- Department of Gastroenterology, Hepatology, and Clinical Nutrition, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Michael Makar
- Department of Gastroenterology, Hepatology, and Clinical Nutrition, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Andrea Berger
- Department of Population Health Sciences, Biostatistics Core, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Amitpal S Johal
- Department of Gastroenterology, Hepatology, and Clinical Nutrition, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Bradley D Confer
- Department of Gastroenterology, Hepatology, and Clinical Nutrition, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Harshit S Khara
- Department of Gastroenterology, Hepatology, and Clinical Nutrition, Geisinger Medical Center, Danville, Pennsylvania, USA
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Iqbal U, Yodice M, Ahmed Z, Lee-Smith W, Adler DG, Confer BD. Efficacy of cap-assisted endoscopy for the visualization of the major duodenal papilla: a systematic review and meta-analysis. Gastrointest Endosc 2023; 98:1004-1008. [PMID: 37544335 DOI: 10.1016/j.gie.2023.07.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 07/30/2023] [Accepted: 07/31/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND AND AIMS The current standard of practice is to use a duodenoscope for the evaluation of the major duodenal papilla (MDP). Recently, cap-assisted endoscopy (CAE), which uses a transparent cap at the tip of a standard front-viewing endoscope, has emerged as an alternative. METHODS A systematic literature search was performed in several databases from inception to January 2023 to identify studies evaluating the efficacy of CAE for the evaluation of the MDP. RESULTS Nine studies including 806 patients met our inclusion criteria. The pooled rate of technical success for CAE was 93.2% (95% confidence interval, 85.6-96.9; I2 = 84.6%). A subgroup analysis comparing CAE with a standard endoscope showed higher odds for the evaluation of the MDP with CAE (but not a duodenoscope, which was better than CAE) with an odds ratio of 57.294 (95% confidence interval, 17.767-184.755; I2 = 45.303%). CONCLUSIONS CAE offers a significant advantage with high rates of complete MDP evaluation compared with standard forward-viewing endoscopy. However, CAE is associated with lower rates of success when compared with side-viewing endoscopes.
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Affiliation(s)
- Umair Iqbal
- Division of Gastroenterology, WellSpan York Hospital, York, Pennsylvania, USA
| | - Michael Yodice
- Division of Internal Medicine, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Zohaib Ahmed
- Department of Gastroenterology, University of Toledo Medical Center, Toledo, Ohio, USA
| | - Wade Lee-Smith
- University Libraries, University of Toledo Medical Center, Toledo, Ohio, USA
| | - Douglas G Adler
- Center for Advanced Therapeutic Endoscopy (CATE), Centura Health, Porter Adventist Hospital, Peak Gastroenterology, Denver, Colorado, USA
| | - Bradley D Confer
- Division of Gastroenterology, Geisinger Medical Center, Danville, Pennsylvania, USA
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Ahmed Z, Ramai D, Merza N, Badal J, Iqbal U, Arif SF, Al-Hillan A, Varughese T, Lee-Smith W, Nawras A, Alastal Y, Khara HS, Confer BD, Diehl DL, Adler DG. Safety and Efficacy of Powered Non-Thermal Endoscopic Resection Device for Removal of Colonic Polyps: A Systematic Review and Meta-Analysis. Gastroenterology Res 2023; 16:254-261. [PMID: 37937229 PMCID: PMC10627355 DOI: 10.14740/gr1638] [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: 05/25/2023] [Accepted: 08/19/2023] [Indexed: 11/09/2023] Open
Abstract
Background Endoscopic mucosal resection is a frequently employed method for removing colonic polyps. Nonetheless, the recurrence of these polyps over a healed submucosal base can complicate the extraction of leftover lesions through standard procedures. EndoRotor®, a non-thermal device specifically designed for endoscopic mucosal resection, has recently been assessed for its utility in removing colonic polyps, non-dysplastic Barrett's esophagus, and pancreatic necrosis. We conducted a systematic review and meta-analysis to ascertain the safety and efficacy of EndoRotor® in resecting scared or recurrence colonic polyps. Methods We conducted an exhaustive review of existing literature using databases such as Medline, Embase, Web of Science, and the Cochrane Library until January 2023. Our aim was to find all studies that assessed the safety of non-thermal endoscopic resection devices in removing colonic polyps. The primary outcome we focused on was the rate of technical success. Secondary outcomes that we considered included the frequency of remaining lesions and instances of adverse events. To analyze these data, we used comprehensive meta-analysis software. Results Our analysis incorporated three studies comprising 54 patients who underwent resection of 60 lesions. The combined technical success rate was 93.9% (95% confidence interval (CI): 77.7-98.6%, I2 = 25.5%). In patients who had another endoscopic examination, 20 were found to have a residual lesion. After the initial session, the combined rate of remaining lesions was 39.8% (95% CI: 15.3-70.8%, I2 = 74.5%). There were eight occurrences of intraoperative bleeding and four instances of bleeding post-procedure. The combined rate of intraoperative bleeding was 13.2% (95% CI: 6.7-24.3%, I2 = 0%), and post-procedure bleeding stood at 8.5% (95% CI: 3.4-19.8%, I2 = 0%). Only one major bleeding event was recorded, and no cases of perforation were reported. Conclusion Our research indicates that the EndoRotor® effectively removes scarred colonic polyps, though the rate of remaining lesions is significant, potentially necessitating several sessions for a thorough removal. There is a need for broader prospective studies, mainly randomized controlled trials, to further assess EndoRotor®'s efficiency and safety in eliminating colonic polyps.
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Affiliation(s)
- Zohaib Ahmed
- Department of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, OH, USA
| | - Daryl Ramai
- Department of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Nooraldin Merza
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH, USA
| | - Joyce Badal
- University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Umair Iqbal
- Department of Gastroenterology and Hepatology, Geisinger Medical Center, Danville, PA, USA
| | | | - Alsadiq Al-Hillan
- Gastroenterology Department, Corewell Health/Willam Beaumont University Hospital, Royal Oak, MI, USA
| | - Tony Varughese
- Department of Internal Medicine, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Wade Lee-Smith
- University of Toledo Libraries, University of Toledo, Toledo, OH, USA
| | - Ali Nawras
- Division of Gastroenterology and Hepatology, University of Toledo, Toledo, OH, USA
| | - Yaseen Alastal
- Division of Gastroenterology and Hepatology, University of Toledo, Toledo, OH, USA
| | - Harshit S. Khara
- Department of Gastroenterology and Hepatology, Geisinger Medical Center, Danville, PA, USA
| | - Bradley D. Confer
- Department of Gastroenterology and Hepatology, Geisinger Medical Center, Danville, PA, USA
| | - David L. Diehl
- Department of Gastroenterology and Hepatology, Geisinger Medical Center, Danville, PA, USA
| | - Douglas G. Adler
- Center for Advanced Therapeutic Endoscopy, Porter Adventist Hospital, Centura Health, Denver, CO, USA
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Makar M, Iqbal U, Sinha A, Berger A, Khara HS, Confer BD, Johal AS, Khurana S, Diehl DL. Changing Trends in Liver Biopsy Practices: A Single-Center Analysis. Cureus 2023; 15:e46424. [PMID: 37927687 PMCID: PMC10621875 DOI: 10.7759/cureus.46424] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction To assess the trends for liver biopsy (LB) indications, technique, and histopathologic diagnosis, we retrospectively evaluated liver biopsies in two one-year periods, separated by a decade. Methods A pathology database query was performed for all parenchymal LB in patients over 18 years (11/2017 to 10/2018) and compared to those performed over a one-year period, a decade ago. We identified 427 parenchymal liver biopsies in the recent group and 166 in the decade-old group. Results Elevated liver enzymes are the most common indication for LB. Non-alcoholic fatty liver disease (NAFLD) has become the most common diagnosis compared to 10 years ago, when it was viral hepatitis. Routes of LB were significantly different between the two groups, endoscopic ultrasound-guided liver biopsy (EUS-LB) (80.3% vs 0; p<0.0001), computed tomography-guided (0 vs 42.8%, p<0.0001), percutaneous by gastroenterologists (0% vs 29.5%, p<0.0001), and transjugular-LB (15.1% vs 17.6%, p<0.0001). The adequacy of the tissue for pathological diagnosis was similar, and there was no difference in adverse events. Conclusion At our institution, practice patterns have changed significantly for liver biopsy. There has been an increase in liver biopsy volume, and EUS guidance has become the most common approach for liver biopsy.
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Affiliation(s)
- Michael Makar
- Gastroenterology and Hepatology, Geisinger Medical Center, Danville, USA
| | - Umair Iqbal
- Internal Medicine, Geisinger Commonwealth School of Medicine, Danville, USA
| | - Ayusa Sinha
- Gastroenterology and Hepatology, Geisinger Medical Center, Danville, USA
| | - Andrea Berger
- Biostatistics, Geisinger Medical Center, Danville, USA
| | - Harshit S Khara
- Gastroenterology and Hepatology, Geisinger Medical Center, Danville, USA
| | - Bradley D Confer
- Gastroenterology and Hepatology, Geisinger Medical Center, Danville, USA
| | - Amitpal S Johal
- Gastroenterology and Nutrition, Geisinger Health System, Danville, USA
| | - Sandeep Khurana
- Gastroenterology and Hepatology, Geisinger Medical Center, Danville, USA
| | - David L Diehl
- Gastroenterology and Hepatology, Geisinger Medical Center, Danville, USA
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Ahmed Z, Iqbal U, Aziz M, Arif SF, Badal J, Farooq U, Lee-Smith W, Gangwani MK, Kamal F, Kobeissy A, Mahmood A, Nawras A, Khara HS, Confer BD, Adler DG. Outcomes and Complications of Radiological Gastrostomy vs. Percutaneous Endoscopic Gastrostomy for Enteral Feeding: An Updated Systematic Review and Meta-Analysis. Gastroenterology Res 2023; 16:79-91. [PMID: 37187550 PMCID: PMC10181338 DOI: 10.14740/gr1593] [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: 01/27/2023] [Accepted: 03/09/2023] [Indexed: 05/17/2023] Open
Abstract
Background Percutaneous endoscopic gastrostomy (PEG) and percutaneous radiological gastrostomy (PRG) are commonly utilized to establish access to enteral nutrition. However, data comparing the outcomes of PEG vs. PRG are conflicting. Therefore, we aimed to conduct an updated systemic review and meta-analysis comparing PRG and PEG outcomes. Methods Medline, Embase, and Cochrane library databases were searched until February 24, 2023. Primary outcomes included 30-day mortality, tube leakage, tube dislodgement, perforation, and peritonitis. Secondary outcomes included bleeding, infectious complications, and aspiration pneumonia. All analyses were conducted using Comprehensive Meta-Analysis Software. Results The initial search revealed 872 studies. Of these, 43 of these studies met our inclusion criteria and were included in the final meta-analysis. Of 471,208 total patients, 194,399 received PRG and 276,809 received PEG. PRG was associated with higher odds of 30-day mortality when compared to PEG (odds ratio (OR): 1.205, 95% confidence interval (CI): 1.015 - 1.430, I2 = 55%). In addition, tube leakage and tube dislodgement were higher in the PRG group than in PEG (OR: 2.231, 95% CI: 1.184 - 4.2 and OR: 2.602, 95% CI: 1.911 - 3.541, respectively). Perforation, peritonitis, bleeding, and infectious complications were higher with PRG than PEG. Conclusion PEG is associated with lower 30-day mortality, tube leakage, and tube dislodgement rates than PRG.
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Affiliation(s)
- Zohaib Ahmed
- Department of Internal Medicine, University of Toledo, Toledo, OH, USA
- Zohaib Ahmed and Umair Iqbal contributed equally and shared the first authorship
- Corresponding Author: Zohaib Ahmed, Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH, USA.
| | - Umair Iqbal
- Division of Gastroenterology and Hepatology, Geisinger Medical Center, Danville, PA, USA
- Zohaib Ahmed and Umair Iqbal contributed equally and shared the first authorship
| | - Muhammad Aziz
- Division of Gastroenterology and Hepatology, University of Toledo, Toledo, OH, USA
| | | | - Joyce Badal
- University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Umer Farooq
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA
| | - Wade Lee-Smith
- University of Toledo Libraries, University of Toledo, Toledo, OH, USA
| | | | - Faisal Kamal
- Division of Gastroenterology, University of California San Francisco, San Francisco, CA, USA
| | - Abdallah Kobeissy
- Division of Gastroenterology and Hepatology, University of Toledo, Toledo, OH, USA
| | - Asif Mahmood
- Department of Internal Medicine, University of Toledo, Toledo, OH, USA
| | - Ali Nawras
- Division of Gastroenterology and Hepatology, University of Toledo, Toledo, OH, USA
| | - Harshit S. Khara
- Division of Gastroenterology and Hepatology, Geisinger Medical Center, Danville, PA, USA
| | - Bradley D. Confer
- Division of Gastroenterology and Hepatology, Geisinger Medical Center, Danville, PA, USA
| | - Douglas G. Adler
- Center for Advanced Therapeutic Endoscopy (CATE), Centura Health, Porter Adventist Hospital, Peak Gastroenterology, Denver, CO, USA
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Iqbal U, Patel PD, Pluskota CA, Berger AL, Khara HS, Confer BD. Outcomes of Acute Gastrointestinal Bleeding in Patients With COVID-19: A Case-Control Study. Gastroenterology Res 2022; 15:13-18. [PMID: 35369679 PMCID: PMC8913019 DOI: 10.14740/gr1483] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 12/21/2021] [Indexed: 11/15/2022] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) patients are at higher risk of acute gastrointestinal bleeding (AGIB) due to higher use of steroids, mechanical ventilation, and use of anticoagulation. We performed this study to compare outcomes of AGIB in COVID-19-positive patients and those without COVID-19 and AGIB. Methods This was a case-control study including patients admitted from March 2020 to February 2021 with the diagnosis of AGIB. Patients were divided into two groups: COVID-19-positive and non-COVID-19 patients. Our primary outcomes were in-hospital or 30 days mortality and length of stay. Secondary outcomes were the rate of rebleeding, the need for intensive care unit (ICU) level of care, and the need for blood transfusion. Results Eighteen COVID-19-positive patients and 54 matched non-COVID-19 patients were included. The COVID-19-positive patients less frequently had endoscopies performed (33.3% vs. 74.1%, P = 0.0059) and had greater steroid use (83.3% vs. 14.8%, P < 0.0001) compared to non-COVID-19 patients. ICU stays were more likely in the COVID-positive patients (odds ratio (OR): 20.41; 95% confidence interval (CI): 2.59 - 160.69; P = 0.004) as was longer hospital length of stay (OR: 1.08; 95% CI: 1.03 - 1.13; P = 0.002). Mortality, readmission within 30 days, need for blood transfusion, and having rebleeding during the admission did not differ for COVID-19 and non-COVID-19 patients. Conclusion COVID-19 patients with AGIB are more likely to require ICU admission and had a longer length of stay. Despite the significantly lower rate of endoscopic procedures performed in patients with COVID-19, need for blood transfusion, mortality and rebleeding were not significantly different.
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Affiliation(s)
- Umair Iqbal
- Department of Gastroenterology and Hepatology, Geisinger Medical Center, Danville, PA, USA
- Corresponding Author: Umair Iqbal, Department of Gastroenterology and Hepatology, Geisinger Medical Center, Danville, PA 17821, USA.
| | - Pooja D. Patel
- Department of Internal Medicine, Geisinger Medical Center, Danville, PA, USA
| | | | - Andrea L. Berger
- Department of Population Health Sciences, Geisinger Medical Center, Danville, PA, USA
| | - Harshit S. Khara
- Department of Gastroenterology and Hepatology, Geisinger Medical Center, Danville, PA, USA
| | - Bradley D. Confer
- Department of Gastroenterology and Hepatology, Geisinger Medical Center, Danville, PA, USA
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Iqbal U, Nawaz A, Ahmed Z, Kamal F, Lee-Smith W, Khan MA, Alastal Y, Confer BD, Khara HS. Safety of endoscopic mucosal resection of large colonic polyps in elderly patients: a systematic review and meta-analysis. Ann Gastroenterol 2022; 35:420-426. [PMID: 35784623 PMCID: PMC9210775 DOI: 10.20524/aog.2022.0727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 04/01/2022] [Indexed: 12/05/2022] Open
Abstract
Background Endoscopic mucosal resection (EMR) is a procedure commonly used for large sessile and flat polyps. However, it may cause bleeding, perforation, and complications related to anesthesia. There are limited data on the safety and efficacy of EMR in the elderly. Therefore, we conducted a comprehensive review and meta-analysis to assess EMR safety in elderly patients. Methods We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Web of Science Core Collection for studies evaluating EMR for large colorectal lesions (>20 mm) in older patients (75+ years). Our primary result was post-polypectomy bleeding and perforation, while our secondary outcome was recurrence or residual polyp. Results The meta-analysis included 6 studies with 2903 patients. The rate of post-polypectomy bleeding was 5.3% (95% confidence interval [CI] 2.3-11.7%), I2=73.7%; and perforation was 1.9% (95%CI 0.9-3.8%), I2=0%, in patients over 75 years old. The pooled risk of post-polypectomy bleeding was 2.4%, 95%CI 1.2-4.8%, I2=0%; and perforation was 2.1%, 95%CI 0.7-5.8%, I2=8.6%, in patients over 80 years old. The risk of post-polypectomy bleeding (odds ratio [OR] 0.922, 95%CI 0.359-2.367, I2=0%); and perforation (OR 1.066, 95%CI 0.188-6.031, I2=0%) did not differ significantly between patients aged over 80 and younger patients. The pooled rate of residual or recurrence of polyps in patients aged over 80 was significantly higher (25%, 95%CI 17-35.3%, I2=59.5%) vs. younger patients (OR 2.234, 95%CI 1.549-3.223, I2=0%). Conclusion EMR is as safe for the elderly as it is for younger patients, and is not associated with a greater risk of bleeding or perforation.
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Affiliation(s)
- Umair Iqbal
- Division of Gastroenterology and Hepatology, Geisinger Medical Center, Pennsylvania (Umair Iqbal, Bradley D.Confer, Harshit S. Khara)
- Correspondence to: Umair Iqbal, MD, Department of Gastroenterology and Hepatology, Geisinger Medical Center, Danville, PA, 17822 USA, e-mail:
| | - Ahmad Nawaz
- Division of Internal Medicine, Yale–New Haven Hospital, Connecticut (Ahmad Nawaz)
| | - Zohaib Ahmed
- Division of Internal Medicine, University of Toledo Medical Center, Ohio (Zohaib Ahmed, Wade Lee-Smith, Yasin Alastal)
| | - Faisal Kamal
- Division of Gastroenterology, University of California, San Francisco, California (Faisal Kamal)
| | - Wade Lee-Smith
- Division of Internal Medicine, University of Toledo Medical Center, Ohio (Zohaib Ahmed, Wade Lee-Smith, Yasin Alastal)
| | - Muhammad Ali Khan
- University of Toledo Libraries, University of Toledo, Toledo, Ohio (Muhammad Ali Khan)
| | - Yasin Alastal
- Division of Internal Medicine, University of Toledo Medical Center, Ohio (Zohaib Ahmed, Wade Lee-Smith, Yasin Alastal)
| | - Bradley D. Confer
- Division of Gastroenterology and Hepatology, Geisinger Medical Center, Pennsylvania (Umair Iqbal, Bradley D.Confer, Harshit S. Khara)
| | - Harshit S. Khara
- Division of Gastroenterology and Hepatology, Geisinger Medical Center, Pennsylvania (Umair Iqbal, Bradley D.Confer, Harshit S. Khara)
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Confer BD. Endoscopic ultrasound-guided fine-needle biopsy: size really does matter! Endoscopy 2021; 53:1130-1131. [PMID: 34344040 DOI: 10.1055/a-1473-5632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Bradley D Confer
- Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, Pennsylvania, USA
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Ching-Companioni RA, Johal AS, Confer BD, Forster E, Khara HS, Diehl DL. Single-pass 1-needle actuation versus single-pass 3-needle actuation technique for EUS-guided liver biopsy sampling: a randomized prospective trial (with video). Gastrointest Endosc 2021; 94:551-558. [PMID: 33771557 DOI: 10.1016/j.gie.2021.03.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 03/14/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Several reports have validated EUS-guided liver biopsy sampling (EUS-LB) as safe and effective. Nineteen-gauge EUS aspiration (FNA) or core (fine-needle biopsy [FNB]) needles are used, but different needle techniques can yield variable outcomes. Some data show that 1 pass (single liver puncture) with 1 actuation (1 to-and-fro needle movement) may be enough to obtain a satisfactory specimen. However, there has not been a head-to-head comparison of single versus multiple needle actuations for EUS-LB. METHODS This was a prospective randomized trial of EUS-LB in 40 patients comparing tissue yields and adequacy using 1 pass, 1 actuation (1:1) versus 1 pass 3 actuations (1:3) of an FNB needle. The primary outcome was number of complete portal triads (CPTs). Secondary outcomes were length of the longest piece, aggregate specimen length, number of cores >9 mm, and adverse events (AEs). Computerized randomization determined selection (either 1:1 or 1:3 with fanning technique). Sample lengths were measured before pathologic processing. RESULTS Both groups had similar demographics and indications for EUS-LB. All biopsy samples were adequate for pathologic interpretation. Compared with 1:1, biopsy sampling with 1:3 yielded more CPTs (mean [standard deviation], 17.25 [6.2] vs 24.5 [9.88]; P < .008) and longer aggregate specimen length (6.89 cm [1.86] vs 12.85 cm [4.02]; P < .001). AEs were not statistically different between the techniques. No severe AEs were noted. CONCLUSIONS EUS-LB using the 1:3 technique produced longer liver cores with more CPTs than the 1:1 technique with an equivalent safety profile. Two needle passes are more likely to provide tissue adequacy according to the American Association for the Study of Liver Diseases guidelines. (Clinical trial registration number: UMIN 000040101.).
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Affiliation(s)
- Rafael A Ching-Companioni
- Department of Gastroenterology, Digestive Diseases Center, Panama City, Florida, USA; Department of Medicine, Gulf Coast Regional Medical Center, Panama City, Florida, USA
| | - Amitpal S Johal
- Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Bradley D Confer
- Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Erin Forster
- Division of Gastroenterology & Hepatology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Harshit S Khara
- Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - David L Diehl
- Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, Pennsylvania, USA
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Confer BD, Iqbal U, Diehl DL. Comparison of pancreatic cystic fluid glucose and carcinoembryonic antigen in the diagnosis of pancreatic mucinous cysts. Gastrointest Endosc 2021; 94:201-202. [PMID: 34148575 DOI: 10.1016/j.gie.2021.02.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 02/23/2021] [Indexed: 02/08/2023]
Affiliation(s)
- Bradley D Confer
- Department of Gastroenterology, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Umair Iqbal
- Department of Gastroenterology, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - David L Diehl
- Department of Gastroenterology, Geisinger Medical Center, Danville, Pennsylvania, USA
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Iqbal U, Anwar H, Siddiqui HU, Khan MA, Kamal F, Confer BD, Khara HS. Acute Gastrointestinal Bleeding in COVID-19 Patients: A Systematic Review and Meta-Analysis. Clin Endosc 2021; 54:534-541. [PMID: 34176255 PMCID: PMC8357590 DOI: 10.5946/ce.2021.071] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 03/24/2021] [Indexed: 12/15/2022] Open
Abstract
Background/Aims More than 100 million people to date have been affected by the coronavirus disease-2019 (COVID-19) pandemic. Patients with COVID-19 have a higher risk of bleeding complications. We performed a systematic review and meta-analysis to evaluate the outcomes of COVID-19 patients with signs and symptoms of acute gastrointestinal bleeding (GIB).
Methods A systematic literature search was carried out for articles published until until November 11, 2020, in the Embase, MEDLINE, Web of Science, and Cochrane Library databases. We included studies on COVID-19 patients with signs and symptoms of GIB.
Results Our search yielded 49 studies, of which eight with a collective 127 patients (86 males and 41 females) met our inclusion criteria. Conservative management alone was performed in 59% of the patients, endoscopic evaluation in 31.5%, and interventional radiology (IR) embolization in 11%. Peptic ulcer disease was the most common endoscopic finding, diagnosed in 47.5% of the patients. Pooled overall mortality was 19.1% (95% confidence interval [CI]; 12.7%-27.6%) and pooled mortality secondary to GIB was 3.5% (95% CI; 1.3%–9.1%). The pooled risk of rebleeding was 11.3% (95% CI; 6.8%–18.4%).
Conclusions The majority of COVID-19 patients with GIB responded to conservative management, with a low mortality rate associated with GIB and the risk of rebleeding. Thus, we suggest limiting endoscopic and IR interventions to those with hemodynamic instability and those for whom conservative management was unsuccessful.
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Affiliation(s)
- Umair Iqbal
- Department of Gastroenterology and Hepatology, Geisinger Medical Center, Danville, PA, USA
| | - Hafsa Anwar
- Department of Internal Medicine, Capital Health Regional Medical Center, Trenton, NJ, USA
| | | | - Muhammad Ali Khan
- Department of Gastroenterology and Hepatology, The University of Texas, MD Anderson Cancer Center Houston, TX, USA
| | - Faisal Kamal
- Department of Gastroenterology and Hepatology, University of Tennessee at Memphis Health Sciences Center, Memphis, TN, USA
| | - Bradley D Confer
- Department of Gastroenterology and Hepatology, Geisinger Medical Center, Danville, PA, USA
| | - Harshit S Khara
- Department of Gastroenterology and Hepatology, Geisinger Medical Center, Danville, PA, USA
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Runge TM, Chiang AL, Kowalski TE, James TW, Baron TH, Nieto J, Diehl DL, Krafft MR, Nasr JY, Kumar V, Khara HS, Irani S, Patel A, Law RJ, Loren DE, Schlachterman A, Hsueh W, Confer BD, Stevens TK, Chahal P, Al-Haddad MA, Mir FF, Pleskow DK, Huggett MT, Paranandi B, Trindade AJ, Brewer-Gutierrez OI, Ichkhanian Y, Dbouk M, Kumbhari V, Khashab MA. Endoscopic ultrasound-directed transgastric ERCP (EDGE): a retrospective multicenter study. Endoscopy 2021; 53:611-618. [PMID: 32882722 DOI: 10.1055/a-1254-3942] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography (ERCP; EDGE) is an alternative to enteroscopy- and laparoscopy-assisted ERCP in patients with Roux-en-Y gastric bypass anatomy. Although short-term results are promising, the long-term outcomes are not known. The aims of this study were: (1) to determine the rates of long-term adverse events after EDGE, with a focus on rates of persistent gastrogastric or jejunogastric fistula; (2) to identify predictors of persistent fistula; (3) to assess the outcomes of endoscopic closure when persistent fistula is encountered. METHODS This was a multicenter retrospective study involving 13 centers between February 2015 and March 2019. Adverse events were defined according to the ASGE lexicon. Persistent fistula was defined as an upper gastrointestinal series or esophagogastroduodenoscopy showing evidence of fistula. RESULTS 178 patients (mean age 58 years, 79 % women) underwent EDGE. Technical success was achieved in 98 % of cases (175/178), with a mean procedure time of 92 minutes. Periprocedural adverse events occurred in 28 patients (15.7 %; mild 10.1 %, moderate 3.4 %, severe 2.2 %). The four severe adverse events were managed laparoscopically. Persistent fistula was diagnosed in 10 % of those sent for objective testing (9/90). Following identification of a fistula, 5 /9 patients underwent endoscopic closure procedures, which were successful in all cases. CONCLUSIONS The EDGE procedure is associated with high clinical success rates and an acceptable risk profile. Persistent fistulas after lumen-apposing stent removal are uncommon, but objective testing is recommended to identify their presence. When persistent fistulas are identified, endoscopic treatment is warranted, and should be successful in closing the fistula.
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Affiliation(s)
- Thomas M Runge
- Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Austin L Chiang
- Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Thomas E Kowalski
- Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Theodore W James
- Division of Gastroenterology and Hepatology, University of North Carolina Hospitals, Chapel Hill, North Carolina, USA
| | - Todd H Baron
- Division of Gastroenterology and Hepatology, University of North Carolina Hospitals, Chapel Hill, North Carolina, USA
| | - Jose Nieto
- Borland Groover Clinic, Advanced Therapeutic Endoscopy Center, Jacksonville, Florida, USA
| | - David L Diehl
- Department of Gastroenterology, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Matthew R Krafft
- Section of Digestive Diseases, Department of Medicine, West Virginia University, Morgantown West Virginia, USA
| | - John Y Nasr
- Section of Digestive Diseases, Department of Medicine, West Virginia University, Morgantown West Virginia, USA
| | - Vikas Kumar
- Department of Gastroenterology, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Harshit S Khara
- Department of Gastroenterology, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Shayan Irani
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Arpan Patel
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Ryan J Law
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
| | - David E Loren
- Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Alex Schlachterman
- Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - William Hsueh
- Section of Digestive Diseases, Department of Medicine, West Virginia University, Morgantown West Virginia, USA
| | - Bradley D Confer
- Department of Gastroenterology, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Tyler K Stevens
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Prabhleen Chahal
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Mohammad A Al-Haddad
- Division of Gastroenterology, Indiana School of Medicine, Indianapolis, Indiana, USA
| | - Fahad Faisal Mir
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconness Medical Center, Boston, Massachusetts, USA
| | - Douglas K Pleskow
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconness Medical Center, Boston, Massachusetts, USA
| | - Matthew T Huggett
- Department of Gastroenterology, St. James' University Hospital, Leeds, UK
| | - Bharat Paranandi
- Department of Gastroenterology, St. James' University Hospital, Leeds, UK
| | - Arvind J Trindade
- Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, Northwell Health, New Hyde Park, New York, USA
| | - Olaya I Brewer-Gutierrez
- Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Yervant Ichkhanian
- Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Mohamad Dbouk
- Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Vivek Kumbhari
- Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
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Khara HS, Confer BD. Beware of the sandman! False "sand dollar sign" can be misleading during EUS-directed transgastric intervention in Roux-en-Y gastric bypass patients. Gastrointest Endosc 2021; 93:264-265. [PMID: 32730823 DOI: 10.1016/j.gie.2020.07.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 07/24/2020] [Indexed: 02/08/2023]
Affiliation(s)
- Harshit S Khara
- Department of Gastroenterology and Hepatology, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Bradley D Confer
- Department of Gastroenterology and Hepatology, Geisinger Medical Center, Danville, Pennsylvania, USA
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Mok SRS, Diehl DL, Confer BD, Johal AS, Khara HS. The 22-gauge core needle is not optimal for endoscopic ultrasound-guided liver biopsy. Endoscopy 2020; 52:157. [PMID: 31991474 DOI: 10.1055/a-1031-9504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Shaffer R S Mok
- Case Western Reserve School of Medicine, Cleveland, Ohio, United States
| | - David L Diehl
- Geisinger Medical Center, Danville, Pennsylvania, United States
| | | | - Amitpal S Johal
- Geisinger Medical Center, Danville, Pennsylvania, United States
| | - Harshit S Khara
- Geisinger Medical Center, Danville, Pennsylvania, United States
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Ching-Companioni RA, Diehl DL, Johal AS, Confer BD, Khara HS. 19 G aspiration needle versus 19 G core biopsy needle for endoscopic ultrasound-guided liver biopsy: a prospective randomized trial. Endoscopy 2019; 51:1059-1065. [PMID: 31342474 DOI: 10.1055/a-0956-6922] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Endoscopic ultrasound-guided liver biopsy (EUS-LB) is a safe and effective method for accomplishing parenchymal liver biopsy. The aim of this study was to compare a 19 G aspiration needle (FNA) with a 19 G Franseen-tip core biopsy needle (FNB) for EUS-LB. METHODS This was a prospective, parallel group, randomized trial comparing the tissue yields and adequacy of a 19 G FNA needle vs. a 19 G FNB needle for EUS-LB. The primary outcome was length of the longest piece of liver core specimen. Secondary outcomes were aggregate specimen length, number of complete portal triads (CPTs), and adverse events. One transgastric pass and one transduodenal pass were performed with the same needle in each patient. Specimen lengths were measured before and after histological processing. RESULTS 40 patients referred for EUS-LB were randomized to either the FNA group (n = 20) or the FNB group (n = 20). Both groups had similar patient characteristics. FNB biopsies yielded longer mean (standard deviation) specimen lengths (pre-processing mean 2.09 cm [0.41] vs. mean 1.47 cm [0.46], and post-processing mean 1.78 cm [0.66] vs. mean 1.05 cm [0.42]; both P < 0.001), a longer aggregate specimen length (pre-processing mean 15.78 cm [5.19] vs. 10.89 cm [4.38]; P = 0.003), and more CPTs (mean 42.6 25 vs 18.1 [9.3]; P < 0.001) compared with the FNA needle. There were no severe adverse events or difference in adverse event rate between the two needles. Post-biopsy pain was noted in 37.5 %. CONCLUSION EUS-LB using the FNB needle delivered longer liver biopsy specimens with more CPTs than the regular (non-core) needle.
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Affiliation(s)
- Rafael A Ching-Companioni
- Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, Pennsylvania, United States
| | - David L Diehl
- Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, Pennsylvania, United States
| | - Amitpal S Johal
- Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, Pennsylvania, United States
| | - Bradley D Confer
- Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, Pennsylvania, United States
| | - Harshit S Khara
- Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, Pennsylvania, United States
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Confer BD, Walker JT, Khurana S, Unzueta A, Khara HS, Johal AS, Diehl DL. EUS-guided liver biopsy: the type of needle matters. Gastrointest Endosc 2019; 90:321-322. [PMID: 31327346 DOI: 10.1016/j.gie.2019.04.207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 04/06/2019] [Indexed: 02/08/2023]
Affiliation(s)
- Bradley D Confer
- Department of Gastroenterology and Hepatology, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - John T Walker
- Department of Gastroenterology and Hepatology, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Sandeep Khurana
- Department of Gastroenterology and Hepatology, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Alberto Unzueta
- Department of Gastroenterology and Hepatology, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Harshit S Khara
- Department of Gastroenterology and Hepatology, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Amitpal S Johal
- Department of Gastroenterology and Hepatology, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - David L Diehl
- Department of Gastroenterology and Hepatology, Geisinger Medical Center, Danville, Pennsylvania, USA
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Mok SRS, Diehl DL, Johal AS, Khara HS, Confer BD, Mudireddy PR, Kovach AH, Diehl MM, Kirchner HL, Chen ZME. Endoscopic ultrasound-guided biopsy in chronic liver disease: a randomized comparison of 19-G FNA and 22-G FNB needles. Endosc Int Open 2019; 7:E62-E71. [PMID: 30648141 PMCID: PMC6327728 DOI: 10.1055/a-0655-7462] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 06/11/2018] [Indexed: 12/19/2022] Open
Abstract
Background and study aims Endoscopic ultrasound-guided liver biopsy uses a 19-gauge (G) needle for parenchymal liver biopsies. We evaluated tissue yields with a 22G fine-needle biopsy (FNB) versus 19G FNA fine-needle aspirate (FNA) device. Patients and methods Biopsies were obtained from 20 patients using the 19G FNA and 22G FNB randomizing each in a cross-over fashion with a blinded outcome assessor. Tissue adequacy for histologic evaluation was the primary outcome, or the proportion of specimens obtaining pathologic diagnosis (portal structures ≥ 5 or length of the longest piece ≥ 15 mm). Additional secondary outcomes included portal and centrilobular inflammation/fibrosis, length of the longest piece, aggregate specimen length, and small (< 5 mm), medium (5 - 8 mm) and large (> 8 mm) fragments. Results were compared in a per needle basis. Patients with cirrhosis were excluded. Results Eighty biopsies (40 each 19G FNA and 22G FNB) were obtained. Tissue adequacy was greater for the 19G FNA (88 %) versus 22G FNB (68 %), ( P = 0.03). There was no difference in total portal structures for the 19G FNA (7.4) and 22G FNB (6.1), ( P = 0.28). There was no difference in pre-processing outcomes. After processing, length of the longest piece was higher for the 19G FNA (9.1 mm) versus 22G FNB (6.6 mm), ( P = 0.02). More total post-processing small fragments 29.9 versus 20.7, ( P = 0.01) and fewer large fragments 1.0 versus 0.4 for the 22G FNB ( P = 0.01) were detected. Conclusions Tissue adequacy was higher for the 19G FNA versus 22G FNB needle. The 22G FNB needle produced samples more prone to fragmentation during specimen processing.
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Affiliation(s)
- Shaffer R. S. Mok
- Geisinger Medical Center, Department of Gastroenterology and Hepatology, Division of Interventional Endoscopy, Danville, Pennsylvania, United States,Corresponding author Shaffer R. S. Mok, MD, MBS Geisinger Medical CenterDepartment of Gastroenterology and HepatologyDivision of Interventional Endoscopy100 North Academy AveDanville, PA, 17822+1-570-271-6852
| | - David L. Diehl
- Geisinger Medical Center, Department of Gastroenterology and Hepatology, Division of Interventional Endoscopy, Danville, Pennsylvania, United States
| | - Amitpal S. Johal
- Geisinger Medical Center, Department of Gastroenterology and Hepatology, Division of Interventional Endoscopy, Danville, Pennsylvania, United States
| | - Harshit S. Khara
- Geisinger Medical Center, Department of Gastroenterology and Hepatology, Division of Interventional Endoscopy, Danville, Pennsylvania, United States
| | - Bradley D. Confer
- Geisinger Medical Center, Department of Gastroenterology and Hepatology, Division of Interventional Endoscopy, Danville, Pennsylvania, United States
| | - Prashant R. Mudireddy
- Geisinger Medical Center, Department of Gastroenterology and Hepatology, Division of Interventional Endoscopy, Danville, Pennsylvania, United States
| | - Alicia H. Kovach
- Geisinger Medical Center, Department of Gastroenterology and Hepatology, Division of Interventional Endoscopy, Danville, Pennsylvania, United States
| | - Mia M. Diehl
- Geisinger Medical Center, Department of Gastroenterology and Hepatology, Division of Interventional Endoscopy, Danville, Pennsylvania, United States
| | - H. Lester Kirchner
- Geisinger Medical Center, Department of Gastroenterology and Hepatology, Division of Interventional Endoscopy, Danville, Pennsylvania, United States
| | - Zong-Ming E. Chen
- Geisinger Medical Center, Department of Gastroenterology and Hepatology, Division of Interventional Endoscopy, Danville, Pennsylvania, United States
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Mok SRS, Diehl DL, Johal AS, Khara HS, Confer BD, Mudireddy PR, Kirchner HL, Chen ZME. A prospective pilot comparison of wet and dry heparinized suction for EUS-guided liver biopsy (with videos). Gastrointest Endosc 2018; 88:919-925. [PMID: 30120956 DOI: 10.1016/j.gie.2018.07.036] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 07/29/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS As EUS-guided liver biopsy sampling (EUS-LB) becomes more widely used, further studies have investigated ways to improve tissue yields. Use of a heparin-primed needle may lead to less clotting of blood within the needle, improve tissue recovery, and decrease fragmentation. The purpose of this study was to prospectively evaluate wet suction using a heparin-primed needle for EUS-LB. METHODS This was a prospective crossover study evaluating wet suction for EUS-LB in parenchymal liver disease. The primary outcome was specimen adequacy, defined by an aggregate specimen length ≥15 mm and ≥5 complete portal tracts (CPTs). Secondary outcomes included number of CPTs, length of the longest piece, aggregate specimen length, and number of small (≤4 mm), medium (5-8 mm), and large (≥9 mm) fragments. Adverse events were tracked at 7 and 30 days. RESULTS One hundred twenty biopsy specimens were collected from 40 participants (3 specimens per patient). Specimen adequacy occurred in 39 wet heparin (98%), 37 dry heparin (93%), and 30 dry needle biopsy samples (80%; 95% confidence interval [CI], .14-.18; P = .01). There was no difference between dry needle techniques. Length of the longest piece was 8.9 mm for wet heparin and 5.8 mm for dry techniques (95% CI, .33-1.53; P = .003). Aggregate specimen length was 49.2 mm for wet heparin and 23.9 mm for dry heparin (95% CI, -46.34 to 44.94; P = .003). Mean CPT count was 7.0 for wet heparin versus 4.0 for dry (95% CI, .74-6.26; P = .01). There were more medium (2.0 vs 1.0; 95% CI, .06-1.24; P = .03) and large (1.0 versus 0.0; 95% CI, .33-1.53; P = .003) fragments with wet suction with no difference in small fragments between groups. CONCLUSIONS The use of wet suction EUS-LB demonstrated improved tissue adequacy compared with dry needle techniques. (Clinical trial registration number: NCT03103997.).
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Affiliation(s)
- Shaffer R S Mok
- Department of Gastroenterology and Hepatology, Division of Interventional Endoscopy, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - David L Diehl
- Department of Gastroenterology and Hepatology, Division of Interventional Endoscopy, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Amitpal S Johal
- Department of Gastroenterology and Hepatology, Division of Interventional Endoscopy, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Harshit S Khara
- Department of Gastroenterology and Hepatology, Division of Interventional Endoscopy, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Bradley D Confer
- Department of Gastroenterology and Hepatology, Division of Interventional Endoscopy, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Prashant R Mudireddy
- Department of Gastroenterology and Hepatology, Division of Interventional Endoscopy, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - H Lester Kirchner
- Department of Gastroenterology and Hepatology, Division of Interventional Endoscopy, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Zong-Ming E Chen
- Department of Gastroenterology and Hepatology, Division of Interventional Endoscopy, Geisinger Medical Center, Danville, Pennsylvania, USA
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Affiliation(s)
- Shaffer R S Mok
- Department of Gastroenterology and Hepatology, Division of Interventional Endoscopy, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Harshit S Khara
- Department of Gastroenterology and Hepatology, Division of Interventional Endoscopy, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Amitpal S Johal
- Department of Gastroenterology and Hepatology, Division of Interventional Endoscopy, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Bradley D Confer
- Department of Gastroenterology and Hepatology, Division of Interventional Endoscopy, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - David L Diehl
- Department of Gastroenterology and Hepatology, Division of Interventional Endoscopy, Geisinger Medical Center, Danville, Pennsylvania, USA
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Esfeh JM, Hanouneh IA, Koval CE, Kovacs C, Dalal DS, Ansari-Gilani K, Confer BD, Eghtesad B, Zein NN, Menon KVN. Impact of pretransplant rifaximin therapy on early post-liver transplant infections. Liver Transpl 2014; 20:544-51. [PMID: 24493238 DOI: 10.1002/lt.23845] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Accepted: 01/27/2014] [Indexed: 12/15/2022]
Abstract
Bacterial and fungal infections are major causes of morbidity and mortality after liver transplantation (LT). The role of intestinal decontamination in the prevention of post-LT infections is controversial. Rifaximin is widely used for the treatment of hepatic encephalopathy. The effect of rifaximin on post-LT infections is unknown. The aim of our study was to determine the effect of rifaximin therapy in the pretransplant period on early bacterial infections (EBIs) and fungal infections within the first 30 days after LT. All adult patients who underwent LT at our institution (January 2009 to July 2011) were included in this retrospective cohort study. Patients receiving antibiotics other than pretransplant protocol antibiotics were excluded. Patients were stratified into 2 groups based on the presence or absence of rifaximin therapy for at least 2 days before LT. Infections were defined by the isolation of any bacterial or fungal organisms within 30 days of LT. Multivariate regression analysis, Student t tests, and Pearson's chi-square tests were used to compare the 2 groups. Two hundred sixty-eight patients were included, and 71 of these patients (26.5%) were on rifaximin at the time of LT. The 2 groups were comparable with respect to age, sex, race, and Model for End-Stage Liver Disease score. There were no significant differences in the rates of EBIs (30% for the non-rifaximin group and 25% for the rifaximin group, P = 0.48) or fungal infections between the 2 groups. There was no increase in antimicrobial resistance among the infecting organisms. There was no difference in survival between the rifaximin and non-rifaximin groups (98% versus 97%, P = 0.36). In conclusion, the use of rifaximin in the pre-LT period was not associated with an increased risk of bacterial or fungal infections in the early post-LT period.
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Affiliation(s)
- Jamak Modaresi Esfeh
- Departments of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH
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Hanouneh IA, Confer BD, Zein NN, Alkhouri N, Eghtesad B. Recurrent upper gastrointestinal bleeding masquerading as gastric variceal bleeding on endoscopy after liver transplantation. Liver Transpl 2013; 19:926-8. [PMID: 23696498 DOI: 10.1002/lt.23674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Accepted: 04/28/2013] [Indexed: 02/07/2023]
Affiliation(s)
- Ibrahim A Hanouneh
- Departments of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH
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Confer BD. Questionable diagnosis of hemolytic anemia? J Am Osteopath Assoc 2008; 108:351-353. [PMID: 18648030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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