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Hartpence J, Zolotarevsky E. Which Stones Are Best Left Unturned? Maybe the Small Ones. Dig Dis Sci 2023; 68:4292-4293. [PMID: 37891438 DOI: 10.1007/s10620-023-08138-2] [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] [Received: 09/08/2023] [Accepted: 09/29/2023] [Indexed: 10/29/2023]
Affiliation(s)
- Jesse Hartpence
- Division of Gastroenterology and Hepatology Chicago, University of Illinois at Chicago, 840 South Wood Street CSB Suite 718E (MC 716), Chicago, IL, 60612, USA
| | - Eugene Zolotarevsky
- Division of Gastroenterology and Hepatology, CoreWell Health, 4100 Lake Drive, Grand Rapids, MI, 49546, USA.
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Shahid HM, Bareket R, Tyberg A, Sarkar A, Simon A, Gurram K, Gress FG, Bhenswala P, Chalikonda D, Loren DE, Kowalski TE, Kumar A, Vareedayah AA, Abhyankar PR, Parker K, Gabr MM, Nieto J, De Latour R, Zolotarevsky M, Barber J, Zolotarevsky E, Vazquez-Sequeiros E, Gaidhane M, Andalib I, Kahaleh M. Comparing the Safety and Efficacy of Two Commercially Available Single-Use Duodenoscopes: A Multicenter Study. J Clin Gastroenterol 2023; 57:798-803. [PMID: 35997700 DOI: 10.1097/mcg.0000000000001752] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 04/14/2022] [Accepted: 07/07/2022] [Indexed: 12/10/2022]
Abstract
INTRODUCTION Single-use disposable duodenoscopes (SDD) have been developed to mitigate infectious risks related to reusable duodenoscopes. The aim of this study is to compare the safety and efficacy of the two available SDDs in the United States. METHODS We conducted a comparative study of 2 SDD in consecutive ERCP procedures performed by expert endoscopists from 9 academic centers. Performance ratings, procedure details, and adverse events were collected. RESULTS A total of 201 patients were included: 129 patients underwent ERCP with Exalt (mean age 63, Males- 66 (51%), 72 with aScope Duodeno (mean age 65, males=30 (42%). A majority of endoscopists had performed >2000 ERCPs in both groups (71% Exalt, 93% aScope Duodeno). Technical success was 92% in both groups (n=119 Exalt-group, n=66 aScope-Duodeno-group). The procedural complexity for the ERCP cases performed were: Grade 1: 35 cases (18%), Grade 2: 83 cases (41%), Grade 3: 65 cases (32%), and Grade 4: 18 cases (9%). Thirteen patients (10%) from the Exalt group and 16 patients (22%) from the aScope Duodeno group required conversion to a reusable duodenoscope. On a scale of 1 to 5, Exalt and aScope Duodeno, respectively, were rated: 2.31 versus 2.60 for location and visualization quality, 1.38 versus 1.57 for maneuverability based on papillary orientation, 1.48 versus 1.15 for suction/air control, and 2.31 versus 2.34 for elevator efficiency. None of the adverse events were related to the SDDs. CONCLUSIONS The 2 SDDs were comparable. Further ongoing enhancements to these devices will improve maneuverability and clinical effectiveness.
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Affiliation(s)
- Haroon M Shahid
- Endoscopy, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Romy Bareket
- Endoscopy, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Amy Tyberg
- Endoscopy, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Avik Sarkar
- Endoscopy, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Alexa Simon
- Endoscopy, Robert Wood Johnson Medical School, New Brunswick, NJ
| | | | | | | | | | | | | | - Anand Kumar
- Thomas Jefferson University, Philadelphia, PA
| | | | | | | | | | - Jose Nieto
- Borland Groover Clinic, Jacksonville, FL
| | | | | | | | | | | | - Monica Gaidhane
- Endoscopy, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Iman Andalib
- Elmhurst Mount Sinai, Icahn School of Medicine New York
| | - Michel Kahaleh
- Endoscopy, Robert Wood Johnson Medical School, New Brunswick, NJ
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3
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Kahaleh M, Tyberg A, Sameera S, Sarkar A, Shahid HM, Abdelqader A, Gjeorgjievski M, Gaidhane M, Muniraj T, Jamidar PA, Aslanian HR, Abraham M, Lajin M, Kedia P, Nieto J, Parsa N, Andalib I, Bashir M, Kowalski TE, Loren DE, Kumar A, Schlachterman A, Chiang A, Holmes I, Mendoza Ladd AH, Oleas R, Zolotarevsky E, Robles-Medranda C, Barthet M. EUS-guided Gastroenterostomy: A Multicenter International Study Comparing Benign and Malignant Diseases. J Clin Gastroenterol 2023:00004836-990000000-00204. [PMID: 37646532 DOI: 10.1097/mcg.0000000000001903] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 07/14/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Endoscopic ultrasound (EUS)-guided gastroenterostomy (EUS-GE) is a minimally invasive therapy for patients with gastric outlet obstruction without the risks of surgical bypass and the limited long-term efficacy of enteral self-expanding metal stent placement. However, due to its novelty, there is a lack of significant data comparing long-term outcomes of patients with EUS-GE, based on the underlying disease. In this study, we compare outcomes of EUS-GE on benign versus malignant indications. METHODS Consecutive patients from 12 international, tertiary care centers who underwent EUS-GE over 3 years were extracted in a retrospective registry. Demographic characteristics, procedure-related information and follow-up data was collected. Primary outcome was the rate of adverse events associated with EUS-GE and the comparison of the rate of adverse events in benign versus malignant diseases. Secondary outcomes included technical and clinical success as well as hospitalization admission. RESULTS A total of 103 patients were included: 72 malignant and 31 benign. The characteristics of the patients undergoing EUS-GE is shown in Table 1. The mean age of the cohort was 68 years and 58 years for malignant and benign etiology. Gender distribution was 57% and 39% being females in malignant and benign etiology group, respectively. Clinical success, technical success, average procedure time, and hospital length of stay were similar in both groups. Patients with benign underlying etiology had significantly higher number of surgically altered midgut anatomy (P=0.0379). CONCLUSION EUS-GE is equally efficient regardless of the underlying etiology (malignant vs. benign), and the adverse events both groups were comparable.
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Affiliation(s)
- Michel Kahaleh
- Department of Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Amy Tyberg
- Department of Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Sohini Sameera
- Department of Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Avik Sarkar
- Department of Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Haroon M Shahid
- Department of Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Abdelhai Abdelqader
- Department of Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Mihajlo Gjeorgjievski
- Department of Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Monica Gaidhane
- Department of Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, NJ
| | | | | | | | - Mathew Abraham
- Penn State Health Milton S. Hershey Medical Center, Hershey, PA
| | | | | | - Jose Nieto
- Borland Groover Clinic, PA, Jacksonville, FL
| | | | - Iman Andalib
- South Nassau Communities Hospital, Oceanside, NY
| | | | | | | | - Anand Kumar
- Thomas Jefferson University, Philadelphia, PA
| | | | | | - Ian Holmes
- Thomas Jefferson University, Philadelphia, PA
| | | | - Roberto Oleas
- Ecuadorian Institute of Digestive Diseases (IECED), Guayaquil, Guayas, Ecuador
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Kedia P, Shah-Khan S, Tyberg A, Gaidhane M, Sarkar A, Shahid H, Zhao E, Thakkar S, Winkie M, Krafft M, Singh S, Zolotarevsky E, Barber J, Zolotarevsky M, Greenberg I, Eke D, Lee D, Gress F, Andalib I, Bills G, Carey P, Gabr M, Lajin M, Vazquez-Sequeiros E, Pleskow D, Mehta N, Schulman A, Kwon R, Platt K, Nasr J, Kahaleh M. Endoscopic ultrasound-directed transgastric ERCP (EDGE): A multicenter US study on long-term follow-up and fistula closure. Endosc Int Open 2023; 11:E529-E537. [PMID: 37251793 PMCID: PMC10219784 DOI: 10.1055/a-2057-5984] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 09/08/2022] [Accepted: 03/09/2023] [Indexed: 05/31/2023] Open
Abstract
Background and study aims Endoscopic ultrasound-directed transgastric ERCP (EDGE) is a safe and efficacious procedure to treat pancreaticobiliary diseases in Roux-en-Y gastric bypass (RYGB). This multicenter study aimed to determine the long-term outcomes of EDGE focusing on fistula persistence rates and post-procedure weight change. Patients and methods Information about patients with Roux-en-Y gastric bypass anatomy who underwent EDGE between 2015 and 2021 from 10 institutions was captured in a registry. Patient demographics, procedural details, and clinical outcomes were analyzed. Results One hundred seventy-two patients were included in the study (mean age 60, 25 % male). Technical success of lumen-apposing metal stent (LAMS) placement was 171 of 172 (99.4 %) while clinical success of intervention was 95%. The mean procedure time was 65 minutes. The most commonly reported complication was stent dislodgement/migration (n = 29, 17). Mean length of time of LAMS duration was 69 days. Mean follow-up time was 6 months. Endoscopic fistula closure was performed in 40 % of patients (69/172) at the time of LAMS removal. Persistence of fistula was observed in 19 of 62 patients (31 %) assessed. Length of LAMS indwell time (days) was a predictor of persistent fistula. The average weight gain while the LAMS was in place was 12 lb in 63 patients (36.6 %); 59.4 % of patients gained < 5 lb. Conclusions EDGE is a safe and efficacious procedure for RYGB patients requiring ERCP. Post-procedure evaluation and management of the enteral fistula varies widely among centers currently and would benefit from further standardization. Fistula persistence appears to be uncommon and can be managed endoscopically but may be related to length of indwell times of the LAMS.
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Affiliation(s)
- Prashant Kedia
- Methodist Dallas Medical Center – Gastroenterology, Dallas, Texas, United States
| | - Sardar Shah-Khan
- Rutgers Robert Wood Johnson Medical School – Gastroenterology, New Brunswick, New Jersey, United States
| | - Amy Tyberg
- Weill Cornell Medical College – Gastroenterology & Hepatology, New York, New York, United States
| | - Monica Gaidhane
- Methodist Dallas Medical Center – Gastroenterology, Dallas, Texas, United States
| | - Avik Sarkar
- Methodist Dallas Medical Center – Gastroenterology, Dallas, Texas, United States
| | - Haroon Shahid
- Methodist Dallas Medical Center – Gastroenterology, Dallas, Texas, United States
| | - Eric Zhao
- Methodist Dallas Medical Center – Gastroenterology, Dallas, Texas, United States
| | - Shyam Thakkar
- West Virginia University – Gastroenterology, New Brunswick, New Jersey, United States
| | - Mason Winkie
- West Virginia University – Gastroenterology, New Brunswick, New Jersey, United States
| | - Matthew Krafft
- Ruby Memorial Hospital – Digestive Diseases, Morgantown, West Virginia, United States
| | - Shailendra Singh
- Ruby Memorial Hospital – Digestive Diseases, Morgantown, West Virginia, United States
| | - Eugene Zolotarevsky
- Spectrum Health Butterworth Hospital – Advanced Endoscopy/Gastroenterology, Grand Rapids, Michigan, United States
| | - Jeremy Barber
- Spectrum Health Butterworth Hospital – Advanced Endoscopy/Gastroenterology, Grand Rapids, Michigan, United States
| | - Mitchelle Zolotarevsky
- Spectrum Health Butterworth Hospital – Advanced Endoscopy/Gastroenterology, Grand Rapids, Michigan, United States
| | - Ian Greenberg
- Methodist Dallas Medical Center – Gastroenterology, Dallas, Texas, United States
| | - Dhiemeziem Eke
- Methodist Dallas Medical Center – Gastroenterology, Dallas, Texas, United States
| | - David Lee
- Methodist Dallas Medical Center – Gastroenterology, Dallas, Texas, United States
| | - Frank Gress
- Icahn School of Medicine at Mount Sinai – Gastroenterology, New York, New York, United States
| | - Iman Andalib
- Robert Wood Johnson Health System – Gastroenterology, New Brunswick, New Jersey, United States
| | - Gregory Bills
- University of Kentucky Medical Center – Gastroenterology, New Brunswick, Kentucky, United States
| | - Patrick Carey
- University of Kentucky Medical Center – Gastroenterology, New Brunswick, Kentucky, United States
| | - Moamen Gabr
- Tanta University Faculty of Medicine – Gastroenterology and Hepatology – Internal Medicine, Tanta, Egypt
| | - Michael Lajin
- Sharp Grassmont Hospital – Gastroenterology/Internal Medicine, Mesa, California, United States
| | | | - Douglas Pleskow
- Beth Israel Deaconess Medical Center – Gastroenterology, Boston, Massachusetts, United States
| | - Neal Mehta
- Beth Israel Deaconess Medical Center – Gastroenterology, Boston, Massachusetts, United States
| | - Allison Schulman
- University of Michigan Medicine – Gastroenterology, New Brunswick, Michigan, United States
| | - Richard Kwon
- University of Michigan Health System – Gastroenterology, Ann Arbor, Michigan, United States
| | - Kevin Platt
- University of Michigan Michigan Medicine – Internal Medicine, Ann Arbor, Michigan, United States
| | - John Nasr
- West Virginia University – Gastroenterology, New Brunswick, New Jersey, United States
| | - Michel Kahaleh
- Rutgers Robert Wood Johnson Medical School – Gastroenterology, New Brunswick, New Jersey, United States
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Eluri S, Kaul V, Sharma NR, Gordon SR, Kachaamy T, Smallfield G, Samarasena J, Trindade A, Willingham FF, Zolotarevsky E, Barber J, Kothari S, Weber J, Chang KJ, Benias P, McKinley MJ, Shaheen N. Palliative endoscopic spray cryotherapy to prevent worsening of dysphagia and improve quality of life in esophageal cancer. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.3_suppl.219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
219 Background: Patients with locally advanced esophageal cancer can have progressive dysphagia and associated worsening quality of life (QOL). Maintenance of esophageal patency by reducing intraluminal tumor burden can improve QOL by palliating dysphagia and delay or prevent the need for feeding tubes and esophageal stents. We aimed to assess the effect of endoscopic palliative cryoablation with trūFreeze Spray Cryotherapy (SCT) on dysphagia burden, QOL, and survival in patients with esophageal cancer. Methods: This is a multi-center prospective study of esophageal cancer patients at 10 sites in the United States. Subjects are 18-89 years old with luminal esophageal cancer, non-surgical candidates, not receiving systemic therapy, without esophageal stents, or history of prior SCT for esophageal cancer. SCT is an endoluminal ablation modality using non-contact medical grade liquid nitrogen (LN2) reaching a temperature of -1960 C delivered by a catheter. SCT was performed at 6 week intervals or as clinically indicated at a dose of 2x30 or 3x30 seconds per every 2-3 cm treatment site. Dysphagia and QOL were assessed with the 5-point Dysphagia score and EORTC QLQ 30 and OES18 esophageal module. Results: Of 49 subjects, mean age is 74.2 ± 11.8, 88% are men, 92% have esophageal adenocarcinoma and 19% have prior esophageal surgery or esophagectomy. 75% had a history of chemotherapy and/or radiation, and 58% (n=21) had a tumor stage >2. Subjects had a total of 258 treatment sessions over a mean follow-up of 329.7 ± 219.1 days, and received a median of 4 (IQR:2-7) SCT sessions with an average dose of 90 (3x30 sec) seconds/treatment site. There were 19 procedure related adverse events (20.4% of patients and 7.4% of procedures), all of which were mild (n=13) or moderate (n=6) in severity. Mean baseline dysphagia score was 1.7 ± 0.9 and 89% maintained (72%) or improved (17%) their baseline dysphagia score after initial SCT, p<0.05, and maintained this degree of symptom burden with ongoing SCT for a mean 239 ± 198 days. 28.6% (n=14) needed an esophageal stent after a mean 168 ± 169 days and 8% (n=4) had a feeding tube placed after a mean 145 ± 76 days after initial treatment. There was improvement in global health status (61.9 ± 23.3 vs 67.7 ± 19.7) and social functioning (73.9 ± 24.7 vs 81.2 ± 28.0) with decreased dysphagia (OES18: 21.5 vs. 16.7) and eating problems (26.1 vs. 20.6), p<0.05 for all. During the follow-up period, 49% of this palliative group survived and median survival was 386 days. Factors associated with survival with SCT were earlier cancer stage (69% stage 1 or 2 were survivors vs. 20% non-survivors; p=0.03) and ≤25% of luminal obstruction by tumor (62% vs. 36%; p=0.06). Conclusions: Liquid nitrogen SCT is an effective option to curb dysphagia progression in palliation of esophageal cancer and improves overall quality of life. Degree of luminal obstruction and tumor stage predicted survival. Clinical trial information: NCT03243734.
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Affiliation(s)
- Swathi Eluri
- University of North Carolina School of Medicine, Chapel Hill, NC
| | - Vivek Kaul
- University of Rochester Medical Center, Rochester, NY
| | | | | | | | | | - Jason Samarasena
- University of California Irvine Medical Center, Orange County, CA
| | - Arvind Trindade
- Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Manhasset, NY
| | | | | | | | | | - Jeffrey Weber
- Western Regional Medical Center, Cancer Treatment Centers of America, Goodyear, AZ
| | | | - Petros Benias
- Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Manhasset, NY
| | - Matthew J. McKinley
- North Shore-LIJ Health System, ProHEALTH Care Associates, Syosset, Lake Success, NY
| | - Nicholas Shaheen
- University of North Carolina School of Medicine, Chapel Hill, NC
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Hawa F, Sako Z, Nguyen T, Catanzaro AT, Zolotarevsky E, Bartley AN, Gunaratnam NT. The band and slough technique is effective for management of diminutive type 1 gastric and duodenal neuroendocrine tumors. Endosc Int Open 2020; 8:E717-E721. [PMID: 32490154 PMCID: PMC7247896 DOI: 10.1055/a-1119-6698] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 11/03/2019] [Accepted: 02/03/2020] [Indexed: 02/08/2023] Open
Abstract
Background and study aims Endoscopic resection is recommended as initial treatment for early-stage gastric and duodenal neuroendocrine tumors (G-NETs and D-NETs). However, it can cause serious adverse events. We aimed to evaluate the efficacy and safety of the band and slough (BAS) technique as a novel and less aggressive endoscopic therapy for management of such tumors. Four patients, three diagnosed with < 10-mm D-NET and one with 10-mm type I G-NET, were treated with the BAS technique without endoscopic resection. Initial follow-up endoscopy at 3 months was done to assess for residual tumor. Subsequent endoscopic surveillance was performed. After one session of banding, all patients achieved complete remission at 3-month follow-up. No tumor recurrence was detected on repeat biopsy at 12-month surveillance endoscopy. None of the patients developed any adverse events including bleeding or perforation. The BAS technique may prove to be a safe and effective endoscopic therapy for diminutive, non-metastatic type 1 G-NETs and D-NETs. Studies of larger scale and longer follow-up periods are needed to corroborate these findings.
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Affiliation(s)
- Fadi Hawa
- Department of Internal Medicine, St. Joseph Mercy Ann Arbor Hospital, Ypsilanti, Michigan, United States
| | - Zeyad Sako
- Department of Hematology and Oncology, Ascension St. John Hospital, Detroit, Michigan, United States
| | - Than Nguyen
- Department of Gastroenterology and Hepatology, Kaiser Permanente Vacaville Medical Center, Vacaville, California, United States
| | - Andrew T. Catanzaro
- Department of Gastroenterology and Hepatology, Huron Gastroenterology Associates, St. Joseph Mercy Ann Arbor Hospital, Ypsilanti, Michigan, United States
| | - Eugene Zolotarevsky
- Department of Gastroenterology and Hepatology, Spectrum Health Hospitals, Grand Rapids, Michigan, United States
| | - Angela N. Bartley
- Department of Pathology, St. Joseph Mercy Ann Arbor Hospital, Ypsilanti, Michigan, United States
| | - Naresh T. Gunaratnam
- Department of Gastroenterology and Hepatology, Huron Gastroenterology Associates, St. Joseph Mercy Ann Arbor Hospital, Ypsilanti, Michigan, United States
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Al Natour RH, Catanzaro A, Zolotarevsky E, DeBenedet AT, Gunaratnam NT. Endoscopic therapy for Barrett's high grade dysplasia and intramucosal esophageal cancer is effective in community clinical practice by advanced endoscopists following multidisciplinary approach. Dis Esophagus 2018; 31:1-6. [PMID: 29087500 DOI: 10.1093/dote/dox126] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 02/07/2017] [Accepted: 09/19/2017] [Indexed: 12/11/2022]
Abstract
Barrett's esophagus with high-grade dysplasia (BEHGD) and intramucosal esophageal adenocarcinoma (IMC) can be treated by radiofrequency ablation (RFA) and endoscopic mucosal resection (EMR). Efficacy of RFA and EMR in academic medical centers has been demonstrated in previous studies. However, the clinical effectiveness of this approach in community clinical practice is not fully established.All patients with biopsy-proven BEHGD and IMC (T1a), who were treated endoscopically between 2007 and 2014, were prospectively enrolled. Treatment algorithms were determined by consensus opinion after presentation at gastrointestinal tumor board. Patients underwent EMR and/or RFA until eradication-of-dysplasia and complete remission of intestinal metaplasia (CRIM) was achieved. Patients were then enrolled in an endoscopic surveillance program.A total of 60 patients underwent endoscopic therapy for BEHGD (32) or IMC (28). Median length BE was 4 cm. Forty-six patients had EMR. Median treatment interval was nine months. Median follow-up was 33 months (Interquartile range: 16-50). Fifty-five (92%) patients achieved eradication-of-dysplasia and 52(87%) CRIM. One patient with BEHGD did not achieve any benefit six months into treatment. Nine (15%) patients relapsed after CRIM with nondysplastic-BE (6), BE with low-grade dysplasia (1), and BEHGD (2). After retreatment, eradication-of-intestinal metaplasia was achieved in five patients. BE length was a negative predictor for achieving CRIM (OR 0.81; P = 0.04). There were no procedure-related severe complications. Eleven patients with prior EMR developed symptomatic strictures, which were all successfully dilated.Endoscopic management of BEHGD and IMC can be safely and effectively performed in a community clinical practice similarly to high-volume academic medical centers when performed by advanced endoscopists following multidisciplinary approach.
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Affiliation(s)
- Riad H Al Natour
- Surgery Department, St Joseph Mercy Health System, 5333 McAuley Drive, Suite RHB-2115, Ann Arbor, MI 48197, USA
| | - A Catanzaro
- Huron Gastro Center for Digestive Disease, St Joseph Mercy Health System, 5300 Elliott Dr., Ann Arbor, MI 48197, USA
| | - E Zolotarevsky
- Huron Gastro Center for Digestive Disease, St Joseph Mercy Health System, 5300 Elliott Dr., Ann Arbor, MI 48197, USA
| | - Anthony T DeBenedet
- Huron Gastro Center for Digestive Disease, St Joseph Mercy Health System, 5300 Elliott Dr., Ann Arbor, MI 48197, USA
| | - Naresh T Gunaratnam
- Huron Gastro Center for Digestive Disease, St Joseph Mercy Health System, 5300 Elliott Dr., Ann Arbor, MI 48197, USA
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Koritala T, Tworek J, Schapiro B, Zolotarevsky E. Paraneoplastic cutaneous lupus secondary to esophageal squamous cell carcinoma. J Gastrointest Oncol 2015; 6:E61-5. [PMID: 26029469 DOI: 10.3978/j.issn.2078-6891.2015.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 01/21/2015] [Indexed: 11/14/2022] Open
Abstract
Sporadic subacute cutaneous lupus erythematosus (SCLE) in an elderly man does not fit a typical demographic for the disease process. Using the McLean's criteria we were able to establish a temporal relationship between the patient's diagnosis of esophageal squamous cell carcinoma (SCC) and his dermatosis, both of which responded to cytotoxic chemotherapy. The clinical presentation and progression of the clinical illness is supportive of a very unusual and not previously reported paraneoplastic SCLE secondary to esophageal SCC.
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Affiliation(s)
- Thoyaja Koritala
- 1 Department of Internal Medicine, Mayo Clinic, Fairmont, MN, USA ; 2 Department of Pathology, 3 Huron Gastroenterology, St. Joseph Mercy Hospital, Ypsilanti, MI, USA
| | - Joseph Tworek
- 1 Department of Internal Medicine, Mayo Clinic, Fairmont, MN, USA ; 2 Department of Pathology, 3 Huron Gastroenterology, St. Joseph Mercy Hospital, Ypsilanti, MI, USA
| | - Brian Schapiro
- 1 Department of Internal Medicine, Mayo Clinic, Fairmont, MN, USA ; 2 Department of Pathology, 3 Huron Gastroenterology, St. Joseph Mercy Hospital, Ypsilanti, MI, USA
| | - Eugene Zolotarevsky
- 1 Department of Internal Medicine, Mayo Clinic, Fairmont, MN, USA ; 2 Department of Pathology, 3 Huron Gastroenterology, St. Joseph Mercy Hospital, Ypsilanti, MI, USA
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9
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Anderson MA, Zolotarevsky E, Cooper KL, Sherman S, Shats O, Whitcomb DC, Lynch HT, Ghiorzo P, Rubinstein WS, Vogel KJ, Sasson AR, Grizzle WE, Ketcham MA, Lee SY, Normolle D, Plonka CM, Mertens AN, Tripon RC, Brand RE. Alcohol and tobacco lower the age of presentation in sporadic pancreatic cancer in a dose-dependent manner: a multicenter study. Am J Gastroenterol 2012; 107:1730-9. [PMID: 22929760 PMCID: PMC3923585 DOI: 10.1038/ajg.2012.288] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [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: 12/11/2022]
Abstract
OBJECTIVES The objective of this study was to examine the association between tobacco and alcohol dose and type and the age of onset of pancreatic adenocarcinoma (PancCa). METHODS Prospective data from the Pancreatic Cancer Collaborative Registry were used to examine the association between age of onset and variables of interest including: gender, race, birth country, educational status, family history of PancCa, diabetes status, and tobacco and alcohol use. Statistical analysis included logistic and linear regression, Cox proportional hazard regression, and time-to-event analysis. RESULTS The median age to diagnosis for PancCa was 66.3 years (95% confidence intervals (CIs), 64.5-68.0). Males were more likely than females to be smokers (77% vs. 69%, P=0.0002) and heavy alcohol and beer consumers (19% vs. 6%, 34% vs. 19%, P<0.0001). In univariate analysis for effects on PancCa presentation age, the following were significant: gender, alcohol and tobacco use (amount, status and type), family history of PancCa, and body mass index. Both alcohol and tobacco had dose-dependent effects. In multivariate analysis, alcohol status and dose were independently associated with increased risk for earlier PancCa onset with greatest risk occurring in heavy drinkers (HR 1.62, 95% CI 1.04-2.54). Smoking status had the highest risk for earlier onset pancreatic cancer with a HR of 2.69 (95% CI, 1.97-3.68) for active smokers and independent effects for dose (P=0.019). The deleterious effects for alcohol and tobacco appear to resolve after 10 years of abstinence. CONCLUSIONS Alcohol and tobacco use are associated with a dose-related increased risk for earlier age of onset of PancCa. Although beer drinkers develop pancreatic cancer at an earlier age than nondrinkers, alcohol type did not have a significant effect after controlling for alcohol dose.
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Affiliation(s)
- Michelle A. Anderson
- Division of Gastroenterology, Department of Internal
Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Eugene Zolotarevsky
- Division of Gastroenterology, Department of Internal
Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Kristine L. Cooper
- Department of Biostatistics, University of Pittsburgh,
Pittsburgh, Pennsylvania, USA
| | - Simon Sherman
- Eppley Institute for Research in Cancer, University of
Nebraska Medical Center, Omaha, Nebraska, USA
| | - Oleg Shats
- Eppley Institute for Research in Cancer, University of
Nebraska Medical Center, Omaha, Nebraska, USA
| | - David C. Whitcomb
- Division of Gastroenterology, University of Pittsburgh
Medical Center, Pittsburgh, Pennsylvania, USA
| | - Henry T. Lynch
- Department of Preventive Medicine, Creighton University
School Medicine, Omaha, Nebraska, USA
| | - Paola Ghiorzo
- Department of Internal Medicine and Medical Specialties,
University of Genoa, Genoa, Italy
| | - Wendy S. Rubinstein
- Department of Medicine, Northshore University Health
Systems, Evanston, Illinois, USA,University of Chicago Pritzker School of Medicine, Chicago,
Illinois, USA
| | - Kristen J. Vogel
- Department of Medicine, Northshore University Health
Systems, Evanston, Illinois, USA
| | - Aaron R. Sasson
- Department of Surgery, University of Nebraska Medical
Center, Omaha, Nebraska, USA
| | - William E. Grizzle
- Department of Pathology, University of Alabama at
Birmingham, Birmingham, Alabama, USA
| | - Marsha A. Ketcham
- Eppley Institute for Research in Cancer, University of
Nebraska Medical Center, Omaha, Nebraska, USA
| | - Shih-Yuan Lee
- Department of Biostatistics, University of Michigan
School of Public Health, Ann Arbor, Michigan, USA
| | - Daniel Normolle
- Department of Biostatistics, University of Pittsburgh
Medical Center, Pittsburgh, Pennsylvania, USA
| | - Caitlyn M. Plonka
- Division of Gastroenterology, Department of Internal
Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Amy N. Mertens
- Division of Gastroenterology, Department of Internal
Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Renee C. Tripon
- Division of Gastroenterology, Department of Internal
Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Randall E. Brand
- Division of Gastroenterology, University of Pittsburgh
Medical Center, Pittsburgh, Pennsylvania, USA
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10
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Zolotarevsky E, Kurtz RC. Pancreatic tumor: when is it not pancreatic adenocarcinoma? Gastroenterol Hepatol (N Y) 2011; 7:838-840. [PMID: 22347826 PMCID: PMC3280419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Eugene Zolotarevsky
- Gastroenterology and Nutrition Service Department of Medicine Memorial Sloan-Kettering Cancer Center New York, New York
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11
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Li C, Zolotarevsky E, Thompson I, Anderson MA, Simeone DM, Casper JM, Mullenix MC, Lubman DM. A multiplexed bead assay for profiling glycosylation patterns on serum protein biomarkers of pancreatic cancer. Electrophoresis 2011; 32:2028-35. [PMID: 21732554 DOI: 10.1002/elps.201000693] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Revised: 01/19/2011] [Accepted: 01/23/2011] [Indexed: 01/05/2023]
Abstract
A multiplexed bead-based immunoassay was developed to simultaneously profile glycosylation patterns of serum proteins to investigate their usefulness as biomarkers for pancreatic cancer. The multiplex assay utilized protein-specific capture antibodies chemically coupled individually to beads labeled with specific amounts of fluorescent dye. Captured proteins were detected based on the extent and specific type of glycosylation as determined by successive binding of fluorescent lectin probes. Advantages to this technique include the fact that antibodies coupled to the beads had minimal nonspecific binding to the lectins ConA/SNA, avoiding the step of chemically blocking the antibody glycans and the bead assays were performed in a 96-well filter plate enabling high-throughput screening applications with improved reproducibility. The assay was tested with ConA and SNA lectins to examine the glycosylation patterns of α-1-β glycoprotein (A1BG) and serum amyloid p (SAP) component for use as potential biomarkers for the detection of pancreatic cancer based on the results from prior biomarker studies. The results showed that the SNA response on the captured A1BG protein could distinguish chronic pancreatitis samples from pancreatic cancer with a p-value of 0.035 and for the SAP protein with SNA, a p-value of 0.026 was found between the signal of normal controls and the pancreatic cancer samples. For the ConA response, a decline in the signal for both proteins in the serum samples was found to distinguish pancreatic cancer from normal controls and renal cell carnoma samples (A1BG, p<0.05; and SAP, p<0.0001).
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Affiliation(s)
- Chen Li
- Department of Chemistry, The University of Michigan, Ann Arbor, MI 48109, USA
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12
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Zolotarevsky E, Fehmi SM, Anderson MA, Schoenfeld PS, Elmunzer BJ, Kwon RS, Piraka CR, Wamsteker EJ, Scheiman JM, Korsnes SJ, Normolle DP, Kim HM, Elta GH. Prophylactic 5-Fr pancreatic duct stents are superior to 3-Fr stents: a randomized controlled trial. Endoscopy 2011; 43:325-30. [PMID: 21455872 PMCID: PMC3514442 DOI: 10.1055/s-0030-1256305] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [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: 02/07/2023]
Abstract
BACKGROUND Temporary prophylactic pancreatic duct stenting effectively reduces post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) in high-risk patients, but the optimal stent remains unclear. We compared rate of spontaneous passage, and technical difficulty of placement for 3-Fr and 5-Fr stents. METHODS A randomized controlled trial at a single academic medical center. Patients deemed high risk for PEP randomly received 5-Fr or 3-Fr pancreatic duct stents. Primary outcome was spontaneous stent passage by 2 weeks. Secondary outcomes were ease and time for stent placement, and number of guide wires required for the entire procedure. RESULTS Patients (69 female [89 %]; mean age 44.9 years, standard deviation [SD] 16.8) were randomly assigned to receive 5-Fr (n = 38) and 3-Fr (n = 40) stents. Indications for stenting were similar. Seven patients in the 3-Fr group actually received a 5-Fr stent, and two in the 5-Fr group had a 3-Fr stent. Spontaneous passage or non-passage was confirmed in 64 (83 %). No statistically significant difference in spontaneous passage rates was seen (5-Fr group, 68.4 %; 3-Fr group 75.0 %; P = 0.617). Non-passage rates were 10.5 % (5-Fr group) and 10.0 % (3-Fr group) ( P = 1.00). The study was stopped after a futility analysis for the primary end point. Placement of 5-Fr stents was rated easier, at a mean score of 1.8 (5-Fr) vs. 3.4 (3-Fr), P < 0.001, with a trend towards being faster, 9.2 vs. 11.1 minutes ( P = 0.355). Fewer guide wires were required for 5-Fr stent placement, 1.5 vs. 1.9 ( P = 0.002). PEP rates did not differ ( P = 0.519). CONCLUSION Placement of 5-Fr compared to 3-Fr pancreatic duct stents for PEP prophylaxis is easier, faster, and requires fewer wires. No statistically significant difference in spontaneous passage was found between the two sizes.
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Affiliation(s)
- E. Zolotarevsky
- University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - S. M. Fehmi
- University of Michigan Medical Center, Ann Arbor, Michigan, USA,University of California, San Diego Medical Center, California, USA
| | - M. A. Anderson
- University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | | | - B. J. Elmunzer
- University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - R. S. Kwon
- University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - C. R. Piraka
- University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - E.-J. Wamsteker
- University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - J. M. Scheiman
- University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - S. J. Korsnes
- University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - D. P. Normolle
- University of Michigan Medical Center, Ann Arbor, Michigan, USA,University of Pittsburgh Medical Center, Pennsylvania, USA
| | - H. Myra Kim
- University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - G. H. Elta
- University of Michigan Medical Center, Ann Arbor, Michigan, USA
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13
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Brand RE, Greer JB, Zolotarevsky E, Brand R, Du H, Simeone D, Zisman A, Gorchow A, Lee SY(C, Roy HK, Anderson MA. Pancreatic cancer patients who smoke and drink are diagnosed at younger ages. Clin Gastroenterol Hepatol 2009; 7:1007-12. [PMID: 19560558 PMCID: PMC2736339 DOI: 10.1016/j.cgh.2009.06.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [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] [Received: 01/27/2009] [Revised: 06/12/2009] [Accepted: 06/17/2009] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Cigarette smoking is an established risk factor for pancreatic cancer, but there is conflicting evidence regarding the effects of alcohol consumption. The effects of cigarettes and alcohol on age of sporadic pancreatic cancer diagnosis have not been examined; we evaluated the independent and synergistic effects of lifetime cigarette smoking and alcohol consumption on age at pancreatic cancer diagnosis in the United States. METHODS We analyzed data on cigarette smoking and alcohol consumption from the IMPAC Services, Inc Cancer Information Resource File (CIRF), collected from June 1, 1993, to December 31, 2003, for 29,239 reported, histologically confirmed cases of pancreatic adenocarcinoma. We also analyzed data on cigarette smoking and alcohol consumption for 820 histologically confirmed cases of pancreatic adenocarcinoma from the University of Michigan Pancreatic Cancer Registry (UMPCR), collected from January 2004 to October 2007. RESULTS Current cigarette smokers were diagnosed at significantly younger ages than never smokers, according to data from the CIRF and UMPCR (8.3 and 6.3 y, respectively); the UMPCR data indicated dose effects. Past and current alcohol consumption were associated with younger age at diagnosis in both databases. Current smokers who were current drinkers were diagnosed significantly earlier (CIRF, 10.2 y; UMPCR, 8.6 y) than abstainers. Past cigarette smoking was associated modestly with younger diagnosis age. CONCLUSIONS Cigarette smoking and alcohol consumption were associated with younger age at pancreatic cancer presentation and have a combined effect on diagnosis age. Past cigarette smoking is less influential. Smoking cessation programs could help prevent pancreatic cancer.
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Affiliation(s)
| | | | | | | | | | | | - Anna Zisman
- Evanston Northwestern Healthcare, University of Chicago Hospital System
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