1
|
Khirfan K, Tavangar A, Samarasena J, Chang KJ. Gastric peroral endoscopic myotomy using a novel bipolar blade and the navigational tunnel technique. VideoGIE 2024; 9:12-13. [PMID: 38261857 PMCID: PMC10793600 DOI: 10.1016/j.vgie.2023.09.013] [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] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
Video 1Demonstration of gastric peroral endoscopic myotomy using a novel bipolar blade and the navigational tunnel technique.
Collapse
Affiliation(s)
- Khaldoon Khirfan
- Digestive Health Institute, University of California, Irvine Medical Center, Orange, California
| | - Amirali Tavangar
- Digestive Health Institute, University of California, Irvine Medical Center, Orange, California
| | - Jason Samarasena
- Digestive Health Institute, University of California, Irvine Medical Center, Orange, California
| | - Kenneth J Chang
- Digestive Health Institute, University of California, Irvine Medical Center, Orange, California
| |
Collapse
|
2
|
Samarasena J, Yang D, Berzin TM. AGA Clinical Practice Update on the Role of Artificial Intelligence in Colon Polyp Diagnosis and Management: Commentary. Gastroenterology 2023; 165:1568-1573. [PMID: 37855759 DOI: 10.1053/j.gastro.2023.07.010] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 06/06/2023] [Accepted: 07/17/2023] [Indexed: 10/20/2023]
Abstract
DESCRIPTION The purpose of this American Gastroenterological Association (AGA) Institute Clinical Practice Update (CPU) is to review the available evidence and provide expert commentary on the current landscape of artificial intelligence in the evaluation and management of colorectal polyps. METHODS This CPU was commissioned and approved by the AGA Institute Clinical Practice Updates Committee (CPUC) and the AGA Governing Board to provide timely guidance on a topic of high clinical importance to the AGA membership and underwent internal peer review by the CPUC and external peer review through standard procedures of Gastroenterology. This Expert Commentary incorporates important as well as recently published studies in this field, and it reflects the experiences of the authors who are experienced endoscopists with expertise in the field of artificial intelligence and colorectal polyps.
Collapse
Affiliation(s)
- Jason Samarasena
- Division of Gastroenterology, University of California Irvine, Orange, California
| | - Dennis Yang
- Center for Interventional Endoscopy, AdventHealth, Orlando, Florida.
| | - Tyler M Berzin
- Center for Advanced Endoscopy, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
3
|
Choi AY, Li X, Guo W, Chandan VS, Samarasena J, Lee JG, Chang KJ, Hu KQ. Performance of Endoscopic Ultrasound-Guided Versus Percutaneous Liver Biopsy in Diagnosing Stage 3-4 Fibrosis. Dig Dis Sci 2023; 68:3774-3780. [PMID: 37540389 DOI: 10.1007/s10620-023-08019-8] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 06/21/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND Percutaneous liver biopsy (P-bx) is the gold standard for diagnosing advanced fibrosis. Despite the proven technical feasibility of EUS-guided liver bx (EUS-bx) as a novel alternative way of liver biopsy, the clinical applicability remains to be determined. AIMS The primary aim of this study is to evaluate if EUS-bx, compared to P-bx, can effectively and safely obtain adequate specimen and accurately predict hepatic fibrosis. METHODS This is a single center, retrospective chart review among patients with liver diseases at a tertiary endoscopy center from February 2011 to March 2020. We assessed the EUS-bx versus P-bx outcomes by success rate, performance, and safety profile. The primary outcome was the association between EUS-bx clinical variables and the presence of histologic liver fibrosis stage ≥ 3. The secondary outcomes were the associations between EUS-bx and variables indicative of fibrosis. RESULTS Fifty-nine patients underwent EUS-bx; and 59, P-bx. All EUS-bx procedures were successfully completed. All 56/56 (100%) of EUS-bx vs. 50/52 (96.2%) P-bx were considered adequate samples. Tissue lengths were significantly longer in the EUS-bx cohort (p < 0.0001) with a trend towards a greater number of portal tracts. 46/56 (82.1%) cases of EUS-bx vs. 32/52 (61.5%) of P-bx had > 10 portal tracts; 21/56 (37.5%) cases of EUS-bx vs. 14/52 (26.9%) of P-bx had > 15 portal tracts. There were 6 (10.2%) EUS-bx vs. 1 (1.7%) P-bx related complication leading to a phone call (p = 0.061). CONCLUSIONS EUS-bx can safely performed and accurately predict liver fibrosis stage as the standard P-bx without being influenced by procedure-related factors.
Collapse
Affiliation(s)
- Alyssa Y Choi
- Division of Gastroenterology/Hepatology, University of California, Irvine, School of Medicine, Orange, CA, USA
| | - Xiaodong Li
- Department of Pathology, University of California, Irvine, School of Medicine, Orange, CA, USA
| | - Wenchang Guo
- Department of Pathology, University of California, Irvine, School of Medicine, Orange, CA, USA
| | - Vishal S Chandan
- Department of Pathology, University of California, Irvine, School of Medicine, Orange, CA, USA
| | - Jason Samarasena
- Division of Gastroenterology/Hepatology, University of California, Irvine, School of Medicine, Orange, CA, USA
| | - John G Lee
- Division of Gastroenterology/Hepatology, University of California, Irvine, School of Medicine, Orange, CA, USA
| | - Kenneth J Chang
- Division of Gastroenterology/Hepatology, University of California, Irvine, School of Medicine, Orange, CA, USA
| | - Ke-Qin Hu
- Division of Gastroenterology/Hepatology, University of California, Irvine, School of Medicine, Orange, CA, USA.
| |
Collapse
|
4
|
Farha J, Ramberan H, Aihara H, Zhang LY, Mehta A, Hage C, Schlachterman A, Kumar A, Shinn B, Canakis A, Kim RE, DʼSouza LS, Buscaglia JM, Storm AC, Samarasena J, Chang K, Friedland S, Draganov PV, Qumseya BJ, Jawaid S, Othman MO, Hasan MK, Yang D, Khashab MA, Ngamruengphong S. A novel through-the-scope helix tack-and-suture device for mucosal defect closure following colorectal endoscopic submucosal dissection: a multicenter study. Endoscopy 2023; 55:571-577. [PMID: 36323330 DOI: 10.1055/a-1970-5528] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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] [Indexed: 11/07/2022]
Abstract
BACKGROUND Complete closure of large mucosal defects following colorectal endoscopic submucosal dissection (ESD) with through-the-scope (TTS) clips is oftentimes not possible. We aimed to report our early experience of using a novel TTS suturing system for the closure of large mucosal defects after colorectal ESD. METHODS We performed a retrospective multicenter cohort study of consecutive patients who underwent attempted prophylactic defect closure using the TTS suturing system after colorectal ESD. The primary outcome was technical success in achieving complete defect closure, defined as a < 5 mm residual mucosal defect in the closure line using TTS suturing, with or without adjuvant TTS clips. RESULTS 82 patients with a median defect size of 30 (interquartile range 25-40) mm were included. Technical success was achieved in 92.7 % (n = 76): TTS suturing only in 44 patients (53.7 %) and a combination of TTS suturing to approximate the widest segment followed by complete closure with TTS clips in 32 (39.0 %). Incomplete/partial closure, failure of appropriate TTS suture deployment, and the need for over-the-scope salvage closure methods were observed in 7.3 % (n = 6). One intraprocedural bleed, one delayed bleed, and three intraprocedural perforations were observed. There were no adverse events related to placement of the TTS suture. CONCLUSION The TTS suture system is an effective and safe tool for the closure of large mucosal defects after colorectal ESD and is an alternative when complete closure with TTS clips alone is not possible.
Collapse
Affiliation(s)
- Jad Farha
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Hemchand Ramberan
- Division of Gastroenterology and Hepatology, Riverside Regional Medical Center, Newport News, Virginia, USA
| | - Hiroyuki Aihara
- Division of Gastroenterology and Hepatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Linda Y Zhang
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Amit Mehta
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Camille Hage
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Alexander Schlachterman
- Department of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Anand Kumar
- Department of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Brianna Shinn
- Department of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Andrew Canakis
- Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Raymond E Kim
- Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Lionel S DʼSouza
- Division of Gastroenterology and Hepatology, Stony Brook University Hospital, Stony Brook, New York, USA
| | - Jonathan M Buscaglia
- Division of Gastroenterology and Hepatology, Stony Brook University Hospital, Stony Brook, New York, USA
| | - Andrew C Storm
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jason Samarasena
- H. H. Chao Comprehensive Digestive Disease Center, University of California, Department of Medicine, Irvine Medical Center, Orange, California, USA
| | - Kenneth Chang
- H. H. Chao Comprehensive Digestive Disease Center, University of California, Department of Medicine, Irvine Medical Center, Orange, California, USA
| | - Shai Friedland
- Division of Gastroenterology and Hepatology, Stanford University, Redwood City, California, USA
- Veterans Affairs Palo Alto Health System, Palo Alto, California, USA
| | - Peter V Draganov
- Division of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, Florida, USA
| | - Bashar J Qumseya
- Division of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, Florida, USA
| | - Salmaan Jawaid
- Division of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA
| | - Mohamed O Othman
- Division of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA
| | - Muhammad K Hasan
- Division of Gastroenterology and Hepatology, Advent Health, Orlando, Florida, USA
| | - Dennis Yang
- Division of Gastroenterology and Hepatology, Advent Health, Orlando, Florida, USA
| | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Saowanee Ngamruengphong
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| |
Collapse
|
5
|
Shah S, Park N, Chehade NEH, Chahine A, Monachese M, Tiritilli A, Moosvi Z, Ortizo R, Samarasena J. Effect of computer-aided colonoscopy on adenoma miss rates and polyp detection: A systematic review and meta-analysis. J Gastroenterol Hepatol 2023; 38:162-176. [PMID: 36350048 DOI: 10.1111/jgh.16059] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [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: 04/21/2022] [Revised: 10/16/2022] [Accepted: 10/31/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND AIM Multiple computer-aided techniques utilizing artificial intelligence (AI) have been created to improve the detection of polyps during colonoscopy and thereby reduce the incidence of colorectal cancer. While adenoma detection rates (ADR) and polyp detection rates (PDR) are important colonoscopy quality indicators, adenoma miss rates (AMR) may better quantify missed lesions, which can ultimately lead to interval colorectal cancer. The purpose of this systematic review and meta-analysis was to determine the efficacy of computer-aided colonoscopy (CAC) with respect to AMR, ADR, and PDR in randomized controlled trials. METHODS A comprehensive, systematic literature search was performed across multiple databases in September of 2022 to identify randomized, controlled trials that compared CAC with traditional colonoscopy. Primary outcomes were AMR, ADR, and PDR. RESULTS Fourteen studies totaling 10 928 patients were included in the final analysis. There was a 65% reduction in the adenoma miss rate with CAC (OR, 0.35; 95% CI, 0.25-0.49, P < 0.001, I2 = 50%). There was a 78% reduction in the sessile serrated lesion miss rate with CAC (OR, 0.22; 95% CI, 0.08-0.65, P < 0.01, I2 = 0%). There was a 52% increase in ADR in the CAC group compared with the control group (OR, 1.52; 95% CI, 1.39-1.67, P = 0.04, I2 = 47%). There was 93% increase in the number of adenomas > 10 mm detected per colonoscopy with CAC (OR 1.93; 95% CI, 1.18-3.16, P < 0.01, I2 = 0%). CONCLUSIONS The results of the present study demonstrate the promise of CAC in improving AMR, ADR, PDR across a spectrum of size and morphological lesion characteristics.
Collapse
Affiliation(s)
- Sagar Shah
- Department of Internal Medicine, University of California Los Angeles Ronald Reagan Medical Center, Los Angeles, California, USA
| | - Nathan Park
- H. H. Chao Comprehensive Digestive Disease Center, University of California Irvine Medical Center, Orange, California, USA
| | - Nabil El Hage Chehade
- Division of Internal Medicine, Case Western Reserve University MetroHealth Medical Center, Cleveland, Ohio, USA
| | - Anastasia Chahine
- H. H. Chao Comprehensive Digestive Disease Center, University of California Irvine Medical Center, Orange, California, USA
| | - Marc Monachese
- H. H. Chao Comprehensive Digestive Disease Center, University of California Irvine Medical Center, Orange, California, USA
| | - Amelie Tiritilli
- H. H. Chao Comprehensive Digestive Disease Center, University of California Irvine Medical Center, Orange, California, USA
| | - Zain Moosvi
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ronald Ortizo
- H. H. Chao Comprehensive Digestive Disease Center, University of California Irvine Medical Center, Orange, California, USA
| | - Jason Samarasena
- H. H. Chao Comprehensive Digestive Disease Center, University of California Irvine Medical Center, Orange, California, USA
| |
Collapse
|
6
|
Gudenkauf FJ, Mehta A, Ferri L, Aihara H, Draganov PV, Yang DJ, Jue TL, Munroe CA, Boparai ES, Mehta NA, Bhatt A, Kumta NA, Othman MO, Mercado M, Javaid H, Aadam AA, Siegel A, James TW, Grimm IS, DeWitt JM, Novikov A, Schlachterman A, Kowalski T, Samarasena J, Hashimoto R, Chehade NEH, Lee JG, Chang K, Su B, Ujiki MB, Sharaiha RZ, Carr-Locke DL, Chen A, Chen M, Chen YI, Tomizawa Y, von Renteln D, Kumbhari V, Khashab MA, Bechara R, Karasik M, Patel NJ, Fukami N, Nishimura M, Hanada Y, Song LMWK, Laszkowska M, Wang AY, Hwang JH, Friedland S, Sethi A, Ngamruengphong S. Factors Associated With Advanced Histological Diagnosis and Upstaging After Endoscopic Submucosal Dissection of Superficial Gastric Neoplasia. Techniques and Innovations in Gastrointestinal Endoscopy 2023; 25:2-10. [DOI: 10.1016/j.tige.2022.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/25/2023]
|
7
|
Tyberg A, Raijman I, Gaidhane M, Trindade AJ, Shahid H, Sarkar A, Samarasena J, Andalib I, Diehl DL, Pleskow DK, Woods KE, Gordon SR, Pannala R, Kedia P, Draganov PV, Tarnasky PR, Sejpal DV, Kumta NA, Parasher G, Adler DG, Patel K, Yang D, Siddiqui U, Kahaleh M, Joshi V. First interobserver agreement of optical coherence tomography in the bile duct: A multicenter collaborative study. Endosc Int Open 2022; 10:E1065-E1072. [PMID: 35979031 PMCID: PMC9377829 DOI: 10.1055/a-1779-5027] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 02/22/2022] [Indexed: 11/26/2022] Open
Abstract
Background and study aims Optical coherence tomography (OCT) is a new technology available for evaluation of indeterminate biliary strictures. It allows under-the-surface visualization and preliminary studies have confirmed standardized characteristics associated with malignancy. The aim of this study is to evaluate the first interobserver agreement in identifying previously agreed upon OCT criteria and diagnosing of malignant versus benign disease. Patients and methods Fourteen endoscopists were asked to review an atlas of reference clips and images of eight criteria derived from expert consensus A total of 35 de-identified video clips were then evaluated for presence of the eight criteria and for final diagnosis of malignant versus benign using the atlas as reference Intraclass correlation (ICC) analysis was done to evaluate interrater agreement. Results Clips of 23 malignant lesions and 12 benign lesions were scored. Excellent interobserver agreement was seen with dilated hypo-reflective structures (0.85) and layering effacement (0.89); hyper-glandular mucosa (0.76), intact layering (0.81), and onion-skin layering (0.77); fair agreement was seen with scalloping (0.58), and thickened epithelium (0.4); poor agreement was seen with hyper-reflective surface (0.36). The diagnostic ICC for both neoplastic (0.8) and non-neoplastic (0.8) was excellent interobserver agreement. The overall diagnostic accuracy was 51 %, ranging from 43 % to 60 %. Conclusions Biliary OCT is a promising new modality for evaluation of indeterminate biliary strictures. Interobserver agreement ranged from fair to almost perfect on eight previously identified criteria. Interobserver agreement for malignancy diagnosis was substantial (0.8). Further studies are needed to validate this data.
Collapse
Affiliation(s)
- Amy Tyberg
- Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, United States
| | - Isaac Raijman
- Baylor St Lukes Medical Center, Houston, Texas, United States
| | - Monica Gaidhane
- Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, United States
| | - Arvind J. Trindade
- Long Island Jewish Medical Center, New Hyde Park, New York, United States
| | - Haroon Shahid
- Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, United States
| | - Avik Sarkar
- Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, United States
| | - Jason Samarasena
- University of California Irvine, Irvine, California, United States
| | - Iman Andalib
- Mount Sinai South Nassau, Oceanside, New York, United States
| | - David L. Diehl
- Geisinger Medical Center, Danville, Pennsylvania, United States
| | - Douglas K. Pleskow
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
| | - Kevin E. Woods
- Southeastern Regional Medical Center, Lumberton, North Carolina, United States
| | - Stuart R. Gordon
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, United States
| | - Rahul Pannala
- Mayo Clinic Phoenix, Phoenix, Arizona, United States
| | - Prashant Kedia
- Methodist Dallas Medical Center, Dallas, Texas, United States
| | - Peter V. Draganov
- University of Florida, Gainesville, Gainesville, Florida, United States
| | | | | | | | - Gulshan Parasher
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico, United States
| | - Douglas G. Adler
- University of Utah School of Medicine, Salt Lake City, Utah, United States
| | - Kalpesh Patel
- Baylor College of Medicine, Houston, Texas, United States
| | - Dennis Yang
- University of Florida, Gainesville, Gainesville, Florida, United States
| | - Uzma Siddiqui
- University of Chicago, Chicago, Illinois, United States
| | - Michel Kahaleh
- Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, United States
| | - Viren Joshi
- Ochsner Medical Center, New Orleans, Louisiana, United States
| |
Collapse
|
8
|
Sowa P, Kolb J, Samarasena J, Chang KJ. EUS-guided blood patch delivery during liver biopsy: nature's gel foam. VideoGIE 2021; 6:487-488. [PMID: 34765837 PMCID: PMC8573651 DOI: 10.1016/j.vgie.2021.06.006] [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] [Indexed: 11/29/2022] Open
Abstract
Video 1Case 1 EUS liver biopsy with FNA needle complicated by persistent blood flow within biopsy tract, which is successfully treated with blood patch technique. Case 2 EUS liver biopsy with FNA needle complicated by persistent blood flow within biopsy tract, which is successfully treated with blood patch technique.
Collapse
Affiliation(s)
- Piotr Sowa
- Digestive Health Institute, Chao Family Comprehensive Digestive Disease Center, University of California, Irvine
| | - Jennifer Kolb
- Digestive Health Institute, Chao Family Comprehensive Digestive Disease Center, University of California, Irvine
| | - Jason Samarasena
- Digestive Health Institute, Chao Family Comprehensive Digestive Disease Center, University of California, Irvine
| | - Kenneth J Chang
- Digestive Health Institute, Chao Family Comprehensive Digestive Disease Center, University of California, Irvine
| |
Collapse
|
9
|
Abstract
Background and Aims Gastric peroral endoscopic pyloromyotomy (G-POEM) is emerging as a treatment option for patients with gastroparesis. The most technically difficult part of the procedure is creating a submucosal tunnel in the gastric antrum, which can be directionally challenging. We describe a novel navigational tunneling method that guides submucosal dissection in the direction of the pylorus and helps to identify the pyloric landmarks. Methods Consecutive patients from September to December 2020 who underwent G-POEM for symptomatic gastroparesis were included. All cases were confirmed by prolonged gastric emptying study. The navigational tunnel technique was performed as follows: (1) mucosal cautery markings were made to outline the tunnel starting 3 to 4 cm proximal to the pylorus, (2) submucosal injection was done at the level of the pylorus and extended backward to the incision point, and (3) submucosal dissection was carried out after the prior submucosal injection straight to the pylorus. Results Six patients with gastroparesis underwent G-POEM with the navigational tunneling technique. The average time for submucosal injection was 2 minutes and 42 seconds, and the average tunnel time was 15 minutes and 36 seconds. There were no adverse events. All patients reported significant improvement (50%-85%) in symptoms. Conclusions This novel navigational tunneling technique appears to guide and facilitate G-POEM by providing a visual path for submucosal dissection straight to the pylorus. It may increase efficiency, decreasing the need to repeatedly exit the tunnel to check direction and preventing nonproductive wandering. It may also help identify the pyloric ring within the tunnel.
Collapse
Affiliation(s)
- Jennifer M Kolb
- Division of Gastroenterology, Digestive Health Institute, University of California Irvine, Irvine, California, USA
| | - Piotr Sowa
- Division of Gastroenterology, Digestive Health Institute, University of California Irvine, Irvine, California, USA
| | - Jason Samarasena
- Division of Gastroenterology, Digestive Health Institute, University of California Irvine, Irvine, California, USA
| | - Kenneth J Chang
- Division of Gastroenterology, Digestive Health Institute, University of California Irvine, Irvine, California, USA
| |
Collapse
|
10
|
Ngamruengphong S, Ferri L, Aihara H, Draganov PV, Yang DJ, Perbtani YB, Jue TL, Munroe CA, Boparai ES, Mehta NA, Bhatt A, Kumta NA, Othman MO, Mercado M, Javaid H, Aadam AA, Siegel A, James TW, Grimm IS, DeWitt JM, Novikov A, Schlachterman A, Kowalski T, Samarasena J, Hashimoto R, Chehade NEH, Lee J, Chang K, Su B, Ujiki MB, Mehta A, Sharaiha RZ, Carr-Locke DL, Chen A, Chen M, Chen YI, Pourmousavi Khoshknab M, Wang R, Kerdsirichairat T, Tomizawa Y, von Renteln D, Kumbhari V, Khashab MA, Bechara R, Karasik M, Patel NJ, Fukami N, Nishimura M, Hanada Y, Wong Kee Song LM, Laszkowska M, Wang AY, Hwang JH, Friedland S, Sethi A, Kalloo AN. Efficacy of Endoscopic Submucosal Dissection for Superficial Gastric Neoplasia in a Large Cohort in North America. Clin Gastroenterol Hepatol 2021; 19:1611-1619.e1. [PMID: 32565290 DOI: 10.1016/j.cgh.2020.06.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 12/10/2019] [Revised: 06/07/2020] [Accepted: 06/11/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Endoscopic submucosal dissection (ESD) is a widely accepted treatment option for superficial gastric neoplasia in Asia, but there are few data on outcomes of gastric ESD from North America. We aimed to evaluate the safety and efficacy of gastric ESD in North America. METHODS We analyzed data from 347 patients who underwent gastric ESD at 25 centers, from 2010 through 2019. We collected data on patient demographics, lesion characteristics, procedure details and related adverse events, treatment outcomes, local recurrence, and vital status at the last follow up. For the 277 patients with available follow-up data, the median interval between initial ESD and last clinical or endoscopic evaluation was 364 days. The primary endpoint was the rate of en bloc and R0 resection. Secondary outcomes included curative resection, rates of adverse events and recurrence, and gastric cancer-related death. RESULTS Ninety patients (26%) had low-grade adenomas or dysplasia, 82 patients (24%) had high-grade dysplasia, 139 patients (40%) had early gastric cancer, and 36 patients (10%) had neuroendocrine tumors. Proportions of en bloc and R0 resection for all lesions were 92%/82%, for early gastric cancers were 94%/75%, for adenomas and low-grade dysplasia were 93%/ 92%, for high-grade dysplasia were 89%/ 87%, and for neuroendocrine tumors were 92%/75%. Intraprocedural perforation occurred in 6.6% of patients; 82% of these were treated successfully with endoscopic therapy. Delayed bleeding occurred in 2.6% of patients. No delayed perforation or procedure-related deaths were observed. There were local recurrences in 3.9% of cases; all occurred after non-curative ESD resection. Metachronous lesions were identified in 14 patients (6.9%). One of 277 patients with clinical follow up died of metachronous gastric cancer that occurred 2.5 years after the initial ESD. CONCLUSIONS ESD is a highly effective treatment for superficial gastric neoplasia and should be considered as a viable option for patients in North America. The risk of local recurrence is low and occurs exclusively after non-curative resection. Careful endoscopic surveillance is necessary to identify and treat metachronous lesions.
Collapse
Affiliation(s)
| | - Lorenzo Ferri
- Division of Thoracic Surgery, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Hiroyuki Aihara
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts
| | - Peter V Draganov
- Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida
| | - Dennis J Yang
- Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida
| | - Yaseen B Perbtani
- Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida
| | - Terry L Jue
- Division of Gastroenterology, Kaiser Permanente San Francisco, San Francisco, California
| | - Craig A Munroe
- Division of Gastroenterology, Kaiser Permanente San Francisco, San Francisco, California
| | - Eshandeep S Boparai
- Division of Gastroenterology, Kaiser Permanente San Francisco, San Francisco, California
| | - Neal A Mehta
- Department of Gastroenterology and Hepatology, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - Amit Bhatt
- Department of Gastroenterology and Hepatology, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - Nikhil A Kumta
- Division of Gastroenterology, Mount Sinai Hospital, New York, New York
| | - Mohamed O Othman
- Division of Gastroenterology and Hepatology, Baylor University Medical Center, Houston, Texas
| | - Michael Mercado
- Division of Gastroenterology and Hepatology, Baylor University Medical Center, Houston, Texas
| | - Huma Javaid
- Division of Gastroenterology and Hepatology, Baylor University Medical Center, Houston, Texas
| | - Abdul Aziz Aadam
- Division of Gastroenterology and Hepatology, Northwestern University Medical Center, Chicago, Illinois
| | - Amanda Siegel
- Division of Gastroenterology and Hepatology, Northwestern University Medical Center, Chicago, Illinois
| | - Theodore W James
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ian S Grimm
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - John M DeWitt
- Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, Indiana
| | - Aleksey Novikov
- Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Alexander Schlachterman
- Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Thomas Kowalski
- Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Jason Samarasena
- Division of Gastroenterology and Hepatology, University of California, Irvine, Irvine, California
| | - Rintaro Hashimoto
- Division of Gastroenterology and Hepatology, University of California, Irvine, Irvine, California
| | - Nabil El Hage Chehade
- Division of Gastroenterology and Hepatology, University of California, Irvine, Irvine, California
| | - John Lee
- Division of Gastroenterology and Hepatology, University of California, Irvine, Irvine, California
| | - Kenneth Chang
- Division of Gastroenterology and Hepatology, University of California, Irvine, Irvine, California
| | - Bailey Su
- Department of Surgery, NorthShore University Health System, Evanston, Illinois
| | - Michael B Ujiki
- Department of Surgery, NorthShore University Health System, Evanston, Illinois
| | - Amit Mehta
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, New York
| | - Reem Z Sharaiha
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, New York
| | - David L Carr-Locke
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, New York
| | - Alex Chen
- Division of Thoracic Surgery, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Michael Chen
- Division of Thoracic Surgery, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Yen-I Chen
- Division of Gastroenterology and Hepatology, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | | | - Rui Wang
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland
| | | | - Yutaka Tomizawa
- Division of Gastroenterology and Hepatology, University of Washington, Seattle, Washington
| | - Daniel von Renteln
- Division of Gastroenterology, University of Montreal Hospital Research Centre, University of Montreal Hospital Centre, Montreal, Quebec, Canada
| | - Vivek Kumbhari
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Mouen A Khashab
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Robert Bechara
- Division of Gastroenterology, Queen's University, Kingston, Ontario, Canada
| | - Michael Karasik
- Department of Gastroenterology, Hartford Hospital, Hartford, Connecticut
| | - Neej J Patel
- Division of Gastroenterology and Hepatology, Mayo Clinic Arizona, Phoenix, Arizona
| | - Norio Fukami
- Division of Gastroenterology and Hepatology, Mayo Clinic Arizona, Phoenix, Arizona
| | - Makoto Nishimura
- Gastroenterology and Nutrition Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Yuri Hanada
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | | | - Monika Laszkowska
- Division of Digestive and Liver Diseases, Columbia University Irving Medical Center, New York, New York
| | - Andrew Y Wang
- Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, Virginia
| | - Joo Ha Hwang
- Department of Gastroenterology, Stanford University School of Medicine, Stanford, California
| | - Shai Friedland
- Department of Gastroenterology, Hartford Hospital, Hartford, Connecticut
| | - Amrita Sethi
- Division of Digestive and Liver Diseases, Columbia University Irving Medical Center, New York, New York
| | - Antony N Kalloo
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland
| |
Collapse
|
11
|
Abadir AP, Park N, Eng D, El Hage N, Sowa P, Samarasena J. Successful use of a novel dynamic rigidizing overtube in a patient with looping during colonoscopy. VideoGIE 2021; 6:236-238. [PMID: 34027258 PMCID: PMC8119879 DOI: 10.1016/j.vgie.2020.12.011] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Alexander Philip Abadir
- Division of Gastroenterology and Hepatology, University of California - Irvine, Irvine, California
| | - Nathan Park
- Division of Gastroenterology and Hepatology, University of California - Irvine, Irvine, California
| | - David Eng
- Division of Gastroenterology and Hepatology, University of California - Irvine, Irvine, California
| | - Nabil El Hage
- Division of Gastroenterology and Hepatology, University of California - Irvine, Irvine, California
| | - Piotr Sowa
- Division of Gastroenterology and Hepatology, University of California - Irvine, Irvine, California
| | - Jason Samarasena
- Division of Gastroenterology and Hepatology, University of California - Irvine, Irvine, California
| |
Collapse
|
12
|
Neumann H, Latorre M, Zimmerman T, Lang G, Samarasena J, Gross S, Brahmbhatt B, Pazwash H, Kushnir V. A multicenter, prospective, inpatient feasibility study to evaluate the use of an intra-colonoscopy cleansing device to optimize colon preparation in hospitalized patients: the REDUCE study. BMC Gastroenterol 2021; 21:232. [PMID: 34022813 PMCID: PMC8140575 DOI: 10.1186/s12876-021-01817-2] [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: 01/27/2021] [Accepted: 05/13/2021] [Indexed: 01/19/2023] Open
Abstract
Background High quality bowel preparation prior to colonoscopy can be difficult to achieve in the inpatient setting. Hospitalized patients are at risk for extended hospital stays and low diagnostic yield due to inadequate bowel preparation.
The Pure-Vu System is a novel device intended to fit over existing colonoscopes to improve intra-colonoscopy bowel preparation. The objective of the REDUCE study was to conduct the first inpatient study to evaluate optimization of bowel preparation quality following overnight preparation when using the Pure-Vu System during colonoscopy. Methods This multicenter, prospective feasibility study enrolled hospitalized subjects undergoing colonoscopy. Subjects recorded the clarity of their last bowel movement using a 5-point scale prior to colonoscopy. After one night of preparation, all enrolled subjects underwent colonoscopy utilizing the Pure-Vu System. The primary endpoint was improvement of colon cleanliness from baseline to post-cleansing with the Pure-Vu System as assessed by the improvement in Boston Bowel Preparation Scale (BBPS). An exploratory analysis was conducted to assess whether the clarity of the last bowel movement could predict inadequate bowel preparation. Results Ninety-four subjects were included. BBPS analyses showed significant improvements in bowel preparation quality across all evaluable colon segments after cleansing with Pure-Vu, including left colon (1.74 vs 2.89; p < 0.0001), transverse colon (1.74 vs 2.91; p < 0.0001), and the right colon (1.41 vs 2.88; p < 0.0001). Prior to Pure-Vu, adequate cleansing (BBPS scores of ≥ 2) were reported in 60%, 62%, and 47% for the left colon, transverse colon, and right colon segments, respectively. After intra-colonoscopy cleansing with the Pure-Vu System, adequate colon preparation was reported in 100%, 99%, and 97% of the left colon, transverse colon, and right colon segments, respectively. Subjects with lower bowel movement clarity scores were more likely to have inadequate bowel preparation prior to cleansing with Pure-Vu. Conclusions In this feasibility study, the Pure-Vu System appears to be effective in significantly improving bowel preparation quality in hospitalized subjects undergoing colonoscopy. Clarity of last bowel movement may be useful indicator in predicting poor bowel preparation. Larger studies powered to evaluate clinical outcomes, hospital costs, and blinded BBPS assessments are required to evaluate the significance of these findings. Trial registration Evaluation of the Bowel Cleansing in Hospitalized Patients Using Pure-Vu System (NCT03503162).
Collapse
Affiliation(s)
- Helmut Neumann
- Department of Gastroenterology and Hepatology, University Medical Center Mainz, Mainz, Germany
| | - Melissa Latorre
- Division of Gastroenterology and Hepatology, New York University Langone Medical Center, New York City, NY, USA
| | - Tim Zimmerman
- Department of Gastroenterology and Hepatology, University Medical Center Mainz, Mainz, Germany
| | - Gabriel Lang
- Division of Gastroenterology, Washington University in St. Louis, 660 South Euclid Avenue, Campus Box 8124, St. Louis, MO, 63110, USA
| | - Jason Samarasena
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California, Irvine, Orange, CA, USA
| | - Seth Gross
- Division of Gastroenterology and Hepatology, New York University Langone Medical Center, New York City, NY, USA
| | - Bhaumik Brahmbhatt
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
| | - Haleh Pazwash
- Division of Gastroenterology, Valley Hospital, Ridgewood, NJ, USA
| | - Vladimir Kushnir
- Division of Gastroenterology, Washington University in St. Louis, 660 South Euclid Avenue, Campus Box 8124, St. Louis, MO, 63110, USA.
| |
Collapse
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
Alvarez JB, Bibault JE, Burgun A, Cai J, Cao Z, Chang K, Chen JH, Chen WC, Cho M, Cho PJ, Cornish TC, Costa A, Dekker A, Drukker K, Dunn J, Eminaga O, Erickson BJ, Fournier L, Gambhir SS, Gennatas ED, Giger ML, Halilaj I, Harrison AP, He B, Hong JC, Jin D, Jin MC, Jochems A, Kalpathy-Cramer J, Kapp DS, Karimzadeh M, Karnes W, Lambin P, Langlotz CP, Lee J, Li H, Liao JC, Lin AL, Lin RY, Liu Y, Lu L, Magnus D, McIntosh C, Miao S, Min JK, Neill DB, Oermann EK, Ouyang D, Peng L, Phene S, Poirot MG, Quon JL, Ranti D, Rao A, Raskar R, Rombaoa C, Rubin DL, Samarasena J, Seekins J, Seetharam K, Shearer E, Sibley A, Singh K, Singh P, Sordo M, Suraweera D, Valliani AAA, van Wijk Y, Vepakomma P, Wang B, Wang G, Wang N, Wang Y, Warner E, Welch M, Wong K, Wu Z, Xing F, Xing L, Yan K, Yan P, Yang L, Yeom KW, Zachariah R, Zeng D, Zhang L, Zhang L, Zhang X, Zhou L, Zou J. List of contributors. Artif Intell Med 2021. [DOI: 10.1016/b978-0-12-821259-2.00035-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
15
|
Canto MI, Trindade AJ, Abrams J, Rosenblum M, Dumot J, Chak A, Iyer P, Diehl D, Khara HS, Corbett FS, McKinley M, Shin EJ, Waxman I, Infantolino A, Tofani C, Samarasena J, Chang K, Wang B, Goldblum J, Voltaggio L, Montgomery E, Lightdale CJ, Shaheen NJ. Multifocal Cryoballoon Ablation for Eradication of Barrett's Esophagus-Related Neoplasia: A Prospective Multicenter Clinical Trial. Am J Gastroenterol 2020; 115:1879-1890. [PMID: 33156107 DOI: 10.14309/ajg.0000000000000822] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Ablation of Barrett's esophagus (BE) is the preferred approach for the treatment of neoplasia without visible lesions. Limited data on cryoballoon ablation (CBA) suggest its potential clinical utility. We evaluated the safety and efficacy of CBA in a multicenter study of patients with neoplastic BE. METHODS In a prospective clinical trial, 11 academic and community centers recruited consecutive patients with BE of 1-6 cm length and low-grade dysplasia, high-grade dysplasia (HGD), or intramucosal adenocarcinoma (ImCA) confirmed by central pathology. Patients with symptomatic pre-existing strictures or visible BE lesions had dilation or endoscopic mucosal resection (EMR), respectively, before enrollment. A nitrous oxide cryoballoon focal ablation system was used to treat all visible columnar mucosa in up to 5 sessions. Study end points included complete eradication of all dysplasia (CE-D) and intestinal metaplasia (CE-IM) at 1 year. RESULTS One hundred twenty patients with BE with ImCA (20%), HGD (56%), or low-grade dysplasia (23%) were enrolled. In the intention-to-treat analysis, the CE-D and CE-IM rates were 76% and 72%, respectively. In the per-protocol analysis (94 patients), the CE-D and CE-IM rates were 97% and 91%, respectively. Postablation pain was mild and short lived. Fifteen subjects (12.5%) developed strictures requiring dilation. One patient (0.8%) with HGD progressed to ImCA, which was successfully treated with EMR. Another patient (0.8%) developed gastrointestinal bleeding associated with clopidogrel use. One patient (0.8%) had buried BE with HGD in 1 biopsy, not confirmed by subsequent EMR. DISCUSSION In patients with neoplastic BE, CBA was safe and effective. Head-to-head comparisons between CBA and other ablation modalities are warranted (clinicaltrials.gov registration NCT02514525).
Collapse
Affiliation(s)
- Marcia Irene Canto
- Department of Medicine (Gastroenterology), Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Arvind J Trindade
- Division of Gastroenterology at the Zucker School of Medicine of Hofstra/Northwell, Long Island Jewish Medical Center, Northwell Health System, New Hyde Park, New York, USA
| | - Julian Abrams
- Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Michael Rosenblum
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, USA
| | - John Dumot
- Division of Gastroenterology at University Hospitals of Cleveland Medical Center, Cleveland, Ohio, USA
| | - Amitabh Chak
- Division of Gastroenterology at University Hospitals of Cleveland Medical Center, Cleveland, Ohio, USA
| | - Prasad Iyer
- Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota, USA
| | - David Diehl
- Division of Gastroenterology, Geisinger Medical Center, Danby Pennsylvania, USA
| | - Harshit S Khara
- Division of Gastroenterology, Geisinger Medical Center, Danby Pennsylvania, USA
| | - F Scott Corbett
- Florida Digestive Health Specialists, Sarasota, Florida, USA
| | - Matthew McKinley
- Division of Gastroenterology at the Zucker School of Medicine of Hofstra/Northwell, Long Island Jewish Medical Center, Northwell Health System, New Hyde Park, New York, USA
| | - Eun Ji Shin
- Department of Medicine (Gastroenterology), Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Irving Waxman
- Division of Gastroenterology, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Anthony Infantolino
- Division of Gastroenterology, Jefferson Medical Center, Philadelphia, Pennsylvania, USA
| | - Christina Tofani
- Division of Gastroenterology, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Jason Samarasena
- Division of Gastroenterology, University of California Irvine Medical Center, Irvine, California, USA
| | - Kenneth Chang
- Division of Gastroenterology, University of California Irvine Medical Center, Irvine, California, USA
| | - Bingkai Wang
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, USA
| | - John Goldblum
- Department of Pathology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Lysandra Voltaggio
- Department ofPathology, Johns Hopkins Medical Institutions Baltimore Maryland, USA
| | - Elizabeth Montgomery
- Department ofPathology, Johns Hopkins Medical Institutions Baltimore Maryland, USA
| | - Charles J Lightdale
- Division of Gastroenterology at the Zucker School of Medicine of Hofstra/Northwell, Long Island Jewish Medical Center, Northwell Health System, New Hyde Park, New York, USA
| | - Nicholas J Shaheen
- Division of Gastroenterology, University of North Carolina, Chapel Hill, North Carolina, USA
| |
Collapse
|
16
|
Affiliation(s)
- Andrea Anderloni
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Milan, Italy
| | - Francesco Auriemma
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Milan, Italy,Digestive Endoscopy Unit, Humanitas Mater Domini, Castellanza, Italy
| | - Jason Samarasena
- Division of Gastroenterology and Hepatology, University of California Irvine Medical Center, Orange, California, United States
| |
Collapse
|
17
|
Eluri S, Kaul V, Sharma NR, Gordon SR, Kachaamy T, Smallfield G, Samarasena J, Trindade A, Kothari S, Weber J, Chang KJ, Benias P, McKinley MJ, Shaheen N. Efficacy of palliative liquid nitrogen spray cryotherapy in curbing progression of dysphagia in esophageal cancer. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.4_suppl.400] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
400 Background: Progressive dysphagia in locally advanced esophageal cancer worsens quality of life (QOL). Endoscopic cryoablation may effectively palliate dysphagia. Aim: To study the effect of palliative cryoablation with trūFreeze Spray Cryotherapy (SCT) in patients with esophageal cancer. Methods: This is an interim analysis of a multi-center prospective study of esophageal cancer patients who are non-surgical candidates, not on active systemic therapy, without esophageal stents, or prior SCT. SCT is an endoscopic ablation modality using liquid nitrogen (LN2) delivered by catheter. SCT occurred at 6 week intervals or as indicated at a dose of 2x30 or 3x30 secs/treatment site. Dysphagia and esophageal symptoms were assessed at baseline and after treatment with a 5-point Dysphagia score and the EORTC-QLQ-OES18 (higher score = more symptoms). Results: 39 subjects (mean age 74.4 ±12.2; 87% men, Table) had 182 treatment sessions over a mean follow-up of 206.9 days, and received a median 3 SCT sessions with an average dose of 90 (3x30) secs/site. There was 1 procedure related SAE (2.6% of patients and 0.5% procedures). Mean follow-up dysphagia score was 1.6 ±0.8 and 90% had same or improved dysphagia score after SCT treatment, p<0.01. On average, treated patients maintained the same or improved levels of dysphagia for 117 days. Esophageal QOL was maintained with improvement in “eating problems” (24.4 before treatment to 18.2 after, p=0.01). Only 4 subjects needed an esophageal stent (n=2) or gastrostomy tube (n=2) for nutrition. Conclusions: SCT for palliation of esophageal cancer was effective in limiting progression of dysphagia, while maintaining esophageal QOL. Only 10% required either esophageal stenting or feeding tube at >6 month follow-up. Clinical trial information: NCT03243734. [Table: see text]
Collapse
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
| |
Collapse
|
18
|
Zachariah R, Samarasena J, Luba D, Duh E, Dao T, Requa J, Ninh A, Karnes W. Prediction of Polyp Pathology Using Convolutional Neural Networks Achieves "Resect and Discard" Thresholds. Am J Gastroenterol 2020; 115:138-144. [PMID: 31651444 DOI: 10.14309/ajg.0000000000000429.prediction] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
OBJECTIVES Reliable in situ diagnosis of diminutive (≤5 mm) colorectal polyps could allow for "resect and discard" and "diagnose and leave" strategies, resulting in $1 billion cost savings per year in the United States alone. Current methodologies have failed to consistently meet the Preservation and Incorporation of Valuable endoscopic Innovations (PIVIs) initiative thresholds. Convolutional neural networks (CNNs) have the potential to predict polyp pathology and achieve PIVI thresholds in real time. METHODS We developed a CNN-based optical pathology (OP) model using Tensorflow and pretrained on ImageNet, capable of operating at 77 frames per second. A total of 6,223 images of unique colorectal polyps of known pathology, location, size, and light source (white light or narrow band imaging [NBI]) underwent 5-fold cross-training (80%) and validation (20%). Separate fresh validation was performed on 634 polyp images. Surveillance intervals were calculated, comparing OP with true pathology. RESULTS In the original validation set, the negative predictive value for adenomas was 97% among diminutive rectum/rectosigmoid polyps. Results were independent of use of NBI or white light. Surveillance interval concordance comparing OP and true pathology was 93%. In the fresh validation set, the negative predictive value was 97% among diminutive polyps in the rectum and rectosigmoid and surveillance concordance was 94%. DISCUSSION This study demonstrates the feasibility of in situ diagnosis of colorectal polyps using CNN. Our model exceeds PIVI thresholds for both "resect and discard" and "diagnose and leave" strategies independent of NBI use. Point-of-care adenoma detection rate and surveillance recommendations are potential added benefits.
Collapse
Affiliation(s)
- Robin Zachariah
- Department of Gastroenterology and Department of Internal Medicine, University of California Irvine Medical Center, Orange, California, USA
| | - Jason Samarasena
- Department of Gastroenterology and Department of Internal Medicine, University of California Irvine Medical Center, Orange, California, USA
- Docbot, Irvine, California, USA
| | - Daniel Luba
- Monterey Bay GI Consultants Medical Group, Monterey, California, USA
| | - Erica Duh
- Department of Gastroenterology and Department of Internal Medicine, University of California Irvine Medical Center, Orange, California, USA
| | | | | | - Andrew Ninh
- Monterey Bay GI Consultants Medical Group, Monterey, California, USA
| | - William Karnes
- Department of Gastroenterology and Department of Internal Medicine, University of California Irvine Medical Center, Orange, California, USA
| |
Collapse
|
19
|
Yang D, Aihara H, Perbtani YB, Wang AY, Aadam AA, Tomizawa Y, Hwang JH, Zou B, Natov NS, Siegel A, Khoshknab MP, Khashab MA, Ngamruengphong S, Khara HS, Diehl DL, Maniere T, Andrawes S, Benias P, Kumta NA, Ramay F, Kim RE, Samarasena J, Chang K, Hashimoto R, Tharian B, Inamdar S, Lan G, Sethi A, Nosler MJ, Tabash A, Othman MO, Draganov PV. Safety and efficacy of endoscopic submucosal dissection for rectal neoplasia: a multicenter North American experience. Endosc Int Open 2019; 7:E1714-E1722. [PMID: 31803823 PMCID: PMC6887644 DOI: 10.1055/a-1010-5663] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 06/09/2019] [Accepted: 08/16/2019] [Indexed: 02/07/2023] Open
Abstract
Background and aims Rectal lesions traditionally represent the first lesions approached during endoscopic submucosal dissection (ESD) training in the West. We evaluated the safety and efficacy of rectal ESD in North America. Methods This is a multicenter retrospective analysis of rectal ESD between January 2010 and September 2018 in 15 centers. End points included: rates of en bloc resection, R0 resection, adverse events, comparison of pre- and post-ESD histology, and factors associated with failed resection. Results In total, 171 patients (median age 63 years; 56 % men) underwent rectal ESD (median size 43 mm). En bloc resection was achieved in 141 cases (82.5 %; 95 %CI 76.8-88.2), including 24 of 27 (88.9 %) with prior failed endoscopic mucosal resection (EMR). R0 resection rate was 74.9 % (95 %CI 68.4-81.4). Post-ESD bleeding and perforation occurred in 4 (2.3 %) and 7 (4.1 %), respectively. Covert submucosal invasive cancer (SMIC) was identified in 8.6 % of post-ESD specimens. There was one case (1/120; 0.8 %) of recurrence at a median follow-up of 31 weeks; IQR: 19-76 weeks). Older age and higher body mass index (BMI) were predictors of failed R0 resection, whereas submucosal fibrosis was associated with a higher likelihood of both failed en bloc and R0 resection. Conclusion Rectal ESD in North America is safe and is associated with high en bloc and R0 resection rates. The presence of submucosal fibrosis was the main predictor of failed en bloc and R0 resection. ESD can be considered for select rectal lesions, and serves not only to establish a definitive tissue diagnosis but also to provide curative resection for lesions with covert advanced disease.
Collapse
Affiliation(s)
- Dennis Yang
- Division of Gastroenterology and Hepatology, University of Florida, Gainesville, FL, USA,Corresponding author Dennis Yang, MD 1329 SW 16th StreetRoom #5252GainesvilleFL 32608USA+1-352-627-9002
| | - Hiroyuki Aihara
- Division of Gastroenterology and Hepatology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Yaseen B. Perbtani
- Division of Gastroenterology and Hepatology, University of Florida, Gainesville, FL, USA
| | - Andrew Y. Wang
- Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, VA, USA
| | - Abdul Aziz Aadam
- Division of Gastroenterology and Hepatology, Northwestern University Medical Center, Chicago, IL, USA
| | - Yutaka Tomizawa
- Division of Gastroenterology and Hepatology, University of Washington, Seattle, WA, USA
| | - Joo Ha Hwang
- Division of Gastroenterology and Hepatology, University of Washington, Seattle, WA, USA
| | - Baiming Zou
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | - Nikola S. Natov
- Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, VA, USA
| | - Amanda Siegel
- Division of Gastroenterology and Hepatology, Northwestern University Medical Center, Chicago, IL, USA
| | | | - Mouen A. Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, Baltimore, MD, USA
| | | | - Harshit S. Khara
- Division of Gastroenterology and Hepatology, Geisinger Health System, Danville, PA, USA
| | - David L. Diehl
- Division of Gastroenterology and Hepatology, Geisinger Health System, Danville, PA, USA
| | - Thibaut Maniere
- Division of Gastroenterology and Hepatology, Universite de Sherbrooke, Sherbrook, QC, Canada
| | - Sherif Andrawes
- Division of Gastroenterology and Hepatology, Northwell Health, Staten Island, NY, USA
| | - Petros Benias
- Division of Gastroenterology and Hepatology, Northwell Health, Staten Island, NY, USA
| | - Nikhil A. Kumta
- Division of Gastroenterology, Mount Sinai Hospital, New York, NY, USA
| | - Fariha Ramay
- Division of Gastroenterology and Hepatology, University of Maryland, Baltimore, MD, USA
| | - Raymond E. Kim
- Division of Gastroenterology and Hepatology, University of Maryland, Baltimore, MD, USA
| | - Jason Samarasena
- Division of Gastroenterology and Hepatology, University of California Irvine, Irvine, CA, USA
| | - Kenneth Chang
- Division of Gastroenterology and Hepatology, University of California Irvine, Irvine, CA, USA
| | - Rintaro Hashimoto
- Division of Gastroenterology and Hepatology, University of California Irvine, Irvine, CA, USA
| | - Benjamin Tharian
- Division of Gastroenterology and Hepatology, University of Arkansas Medical Sciences, Little Rock, AR, USA
| | - Sumant Inamdar
- Division of Gastroenterology and Hepatology, University of Arkansas Medical Sciences, Little Rock, AR, USA
| | - Gloria Lan
- Division of Gastroenterology and Hepatology, New York Presbyterian Hospital, New York, NY, USA
| | - Amrita Sethi
- Division of Gastroenterology and Hepatology, New York Presbyterian Hospital, New York, NY, USA
| | | | - Abdalaziz Tabash
- Division of Gastroenterology and Hepatology, Baylor University Medical Center, Houston, TX, USA
| | - Mohamed O. Othman
- Division of Gastroenterology and Hepatology, Baylor University Medical Center, Houston, TX, USA
| | - Peter V. Draganov
- Division of Gastroenterology and Hepatology, University of Florida, Gainesville, FL, USA
| |
Collapse
|
20
|
|
21
|
Smith MS, Cash B, Konda V, Trindade AJ, Gordon S, DeMeester S, Joshi V, Diehl D, Ganguly E, Mashimo H, Singh S, Jobe B, McKinley M, Wallace M, Komatsu Y, Thakkar S, Schnoll-Sussman F, Sharaiha R, Kahaleh M, Tarnasky P, Wolfsen H, Hawes R, Lipham J, Khara H, Pleskow D, Navaneethan U, Kedia P, Hasan M, Sethi A, Samarasena J, Siddiqui UD, Gress F, Rodriguez R, Lee C, Gonda T, Waxman I, Hyder S, Poneros J, Sharzehi K, Di Palma JA, Sejpal DV, Oh D, Hagen J, Rothstein R, Sawhney M, Berzin T, Malik Z, Chang K. Volumetric laser endomicroscopy and its application to Barrett's esophagus: results from a 1,000 patient registry. Dis Esophagus 2019; 32:5481776. [PMID: 31037293 PMCID: PMC6853704 DOI: 10.1093/dote/doz029] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 10/22/2018] [Revised: 02/08/2019] [Indexed: 12/11/2022]
Abstract
Volumetric laser endomicroscopy (VLE) uses optical coherence tomography (OCT) for real-time, microscopic cross-sectional imaging. A US-based multi-center registry was constructed to prospectively collect data on patients undergoing upper endoscopy during which a VLE scan was performed. The objective of this registry was to determine usage patterns of VLE in clinical practice and to estimate quantitative and qualitative performance metrics as they are applied to Barrett's esophagus (BE) management. All procedures utilized the NvisionVLE Imaging System (NinePoint Medical, Bedford, MA) which was used by investigators to identify the tissue types present, along with focal areas of concern. Following the VLE procedure, investigators were asked to answer six key questions regarding how VLE impacted each case. Statistical analyses including neoplasia diagnostic yield improvement using VLE was performed. One thousand patients were enrolled across 18 US trial sites from August 2014 through April 2016. In patients with previously diagnosed or suspected BE (894/1000), investigators used VLE and identified areas of concern not seen on white light endoscopy (WLE) in 59% of the procedures. VLE imaging also guided tissue acquisition and treatment in 71% and 54% of procedures, respectively. VLE as an adjunct modality improved the neoplasia diagnostic yield by 55% beyond the standard of care practice. In patients with no prior history of therapy, and without visual findings from other technologies, VLE-guided tissue acquisition increased neoplasia detection over random biopsies by 700%. Registry investigators reported that VLE improved the BE management process when used as an adjunct tissue acquisition and treatment guidance tool. The ability of VLE to image large segments of the esophagus with microscopic cross-sectional detail may provide additional benefits including higher yield biopsies and more efficient tissue acquisition. Clinicaltrials.gov NCT02215291.
Collapse
Affiliation(s)
- M S Smith
- Mount Sinai West & Mount Sinai St. Luke's Hospitals, New York, New York,Address correspondence to: Michael S. Smith, M.D., M.B.A., Chief of Gastroenterology and Hepatology, Mount Sinai West & Mount Sinai St. Luke's Hospitals, Ambulatory Care Center, Floor 13, 440 W. 114th Street, New York, NY 10025, USA.
| | - B Cash
- University of Texas Health Science Center at Houston, Houston, Texas
| | - V Konda
- Baylor University Medical Center, Dallas, Texas
| | - A J Trindade
- Zucker School of Medicine at Hofstra/Northwell, Northwell Health System Manhasset, New York
| | - S Gordon
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | | | - V Joshi
- University Medical Center at LSU, New Orleans, Louisiana
| | - D Diehl
- Geisinger Medical Center, Danville, Pennsylvania
| | - E Ganguly
- University of Vermont Medical Center, Burlington, Vermont
| | - H Mashimo
- VA Boston Health Care System, Boston, Massachusetts
| | - S Singh
- VA Boston Health Care System, Boston, Massachusetts
| | - B Jobe
- Allegheny Health Network, Pittsburgh, Pennsylvania
| | - M McKinley
- Zucker School of Medicine at Hofstra/Northwell, Northwell Health System Manhasset, New York,ProHEALTHcare Associates, Lake Success, New York, New York
| | | | - Y Komatsu
- Allegheny Health Network, Pittsburgh, Pennsylvania
| | - S Thakkar
- Allegheny Health Network, Pittsburgh, Pennsylvania
| | | | - R Sharaiha
- Weill Cornell Medicine, New York, New York
| | - M Kahaleh
- Robert Wood Johnson University Hospital, New Brunswick, New Jersey
| | | | | | - R Hawes
- Florida Hospital, Orlando, Florida
| | - J Lipham
- University of Southern California, Keck School of Medicine, Los Angeles, California
| | - H Khara
- Geisinger Medical Center, Danville, Pennsylvania
| | - D Pleskow
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | - P Kedia
- Methodist Health System, Dallas, Texas
| | - M Hasan
- Florida Hospital, Orlando, Florida
| | - A Sethi
- Columbia University Medical Center, New York, New York
| | | | | | - F Gress
- Columbia University Medical Center, New York, New York
| | - R Rodriguez
- University of South Alabama, Mobile, Alabama
| | - C Lee
- Zucker School of Medicine at Hofstra/Northwell, Northwell Health System Manhasset, New York
| | - T Gonda
- Columbia University Medical Center, New York, New York
| | - I Waxman
- Chicago Medicine, Chicago, Illinois
| | - S Hyder
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - J Poneros
- Columbia University Medical Center, New York, New York
| | - K Sharzehi
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - J A Di Palma
- University of Texas Health Science Center at Houston, Houston, Texas
| | - D V Sejpal
- Zucker School of Medicine at Hofstra/Northwell, Northwell Health System Manhasset, New York
| | - D Oh
- University of Southern California, Keck School of Medicine, Los Angeles, California
| | - J Hagen
- University of Southern California, Keck School of Medicine, Los Angeles, California
| | - R Rothstein
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - M Sawhney
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - T Berzin
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Z Malik
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - K Chang
- UC Irvine Medical Center, Irvine, California
| |
Collapse
|
22
|
Yoon WJ, Park DH, Choi JH, Jang S, Samarasena J, Lee TH, Paik WH, Oh D, Song TJ, Choi JH, Hara K, Iwashita T, Perez-Miranda M, Lee JG, Vazquez-Sequeiros E, Naitoh I, Vila JJ, Brugge WR, Takenaka M, Lee SS, Seo DW, Lee SK, Kim MH. The underutilization of EUS-guided biliary drainage: Perception of endoscopists in the East and West. Endosc Ultrasound 2019; 8:188-193. [PMID: 30719996 PMCID: PMC6590002 DOI: 10.4103/eus.eus_57_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background and Objectives EUS-guided biliary drainage (EUS-BD) is increasingly utilized to manage unresectable malignant biliary obstruction after a failed ERCP. However, there is no data on how endoscopists perceive EUS-BD. The aim of this study was to investigate the perception of endoscopists on EUS-BD. Patients and Methods A survey questionnaire of six topics with 22 survey statements was developed. A total of 17 pancreatobiliary endoscopists (10 from East and 7 from West) were invited to survey. The participants were asked to answer the multiple choice questionnaire and give comments. The opinions of the participants for individual survey statements were assessed using 5-point Likert scale. Results All participants completed the survey. The endoscopists had a trend to perceive EUS-BD as a procedure indicated after a failed ERCP. Various EUS-BD methods were regarded as having different efficacy and safety. The superiority of EUS-BD over percutaneous transhepatic BD (PTBD) with regard to efficacy, procedure-related adverse events, and unscheduled re-intervention was not in agreement. Conclusions EUS-BD was not yet perceived as the initial procedure to relieve the unresectable malignant biliary obstruction. Various EUS-BD methods were regarded as having different efficacy and safety. The superiority of EUS-BD over PTBD was not in agreement. Refining the procedure, developing dedicated devices, and gaining expertise in the procedure are necessary to popularize EUS-BD.
Collapse
Affiliation(s)
- Won Jae Yoon
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, South Korea
| | - Do Hyun Park
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jun Ho Choi
- Department of Internal Medicine, Dankook University College of Medicine, South Korea
| | - Sunguk Jang
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA
| | - Jason Samarasena
- Department of Medicine, University of California-Irvine, Orange, CA, USA
| | - Tae Hoon Lee
- Department of Internal Medicine, Soonchunhyang University School of Medicine, Cheonan, South Korea
| | - Woo Hyun Paik
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Dongwook Oh
- Department of Gastroenterology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea
| | - Tae Jun Song
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Joon Hyuk Choi
- Department of Internal Medicine, Inje University College of Medicine, Busan, South Korea
| | - Kazuo Hara
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Takuji Iwashita
- First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan
| | - Manuel Perez-Miranda
- Department of Gastroenterology and Hepatology, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - John G Lee
- Department of Medicine, University of California-Irvine, Orange, CA, USA
| | - Enrique Vazquez-Sequeiros
- Department of Gastroenterology and Hepatology, University Hospital Ramon Y Cajal, IRYCIS, Madrid, Spain
| | - Itaru Naitoh
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Juan J Vila
- Endoscopy Unit, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - William R Brugge
- Division of Gastroenterology, Mount Auburn Hospital, Cambridge, MA, USA
| | - Mamoru Takenaka
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Sang Soo Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Dong-Wan Seo
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sung Koo Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Myung-Hwan Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| |
Collapse
|
23
|
Basar O, Yuksel O, Yang DJ, Samarasena J, Forcione D, DiMaio CJ, Wagh MS, Chang K, Casey B, Fernandez-Del Castillo C, Pitman MB, Brugge WR. Feasibility and safety of microforceps biopsy in the diagnosis of pancreatic cysts. Gastrointest Endosc 2018; 88:79-86. [PMID: 29510146 DOI: 10.1016/j.gie.2018.02.039] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [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: 09/22/2017] [Accepted: 02/20/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS The tissue acquisition and diagnostic yield of cyst fluid cytology is low-to-moderate and rarely provides a specific diagnosis. The aim of this study was to compare the tissue acquisition and diagnostic tissue yield of microforceps biopsy (MFB) with cyst fluid cytology. METHODS In this multicenter study, data of 42 patients who had cysts both aspirated by EUS-guided FNA (EUS-FNA) and biopsy specimens were then obtained with an MFB device, were collected. Cytology analysis of cyst fluid and histologic analysis of biopsy specimens were done. Acquisition yield was defined as percentage of patients with tissue present in the aspirate or biopsy. Diagnostic tissue yield was evaluated at 3 levels: the ability of differentiation between mucinous and/or nonmucinous cysts, detection of high risk for malignancy, and specific cyst type diagnosis. RESULTS The mean patient age was 69 years. Sixteen pancreatic cysts (38.1%) were located in the head, 17 (40.5%) in the body, and 9 (21.4%) in the tail. The mean cyst size was 28.2 mm (12-60 mm); 25 of 42 (60%) were septated. The EUS-FNA tissue (fluid) acquisition yield was 88.1% (37/42). The MFB tissue acquisition yield was 90.4% (38/42). The diagnostic cytology yield to differentiate between mucinous and/or nonmucinous cysts was 47.6% (20/42), and the MFB histologic yield to differentiate between mucinous and/or nonmucinous cysts was 61.9% (26/42) (P = .188). The percentage of cysts at high risk for malignancy by cytology was 54.7% (23/42), and MFB was 71.5% (30/42) (P = .113). However, the ability of MFB to provide a specific cyst type diagnosis was 35.7% (15/42), and that for cytology was 4.8% (2/42) (P = .001). Surgical histology was concordant with that of MFB in 6 of 7 patients (85%), and with that of cytology in 1 of 7 patients (15%). CONCLUSION The cyst tissue acquisition yield for MFBs was 90%. Although cytology of cyst fluid and MFB were comparable in distinguishing mucinous and nonmucinous cysts and detecting cysts at high risk for malignancy, MFB was far superior to cytology for providing a specific cyst diagnosis.
Collapse
Affiliation(s)
- Omer Basar
- Pancreas Biliary Center, Gastrointestinal Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Osman Yuksel
- Department of Gastroenterology, Eryaman Private Hospital, Ankara, Turkey
| | - Dennis J Yang
- Division of Gastroenterology, University of Florida Health, Gainesville, Florida
| | - Jason Samarasena
- Division of Gastroenterology and Hepatology, University of California, Aurora, California
| | - David Forcione
- Pancreas Biliary Center, Gastrointestinal Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Mihir S Wagh
- Division of Gastroenterology and Hepatology, University of Colorado, Denver, Colorado, USA
| | - Kenneth Chang
- Division of Gastroenterology and Hepatology, University of California, Aurora, California
| | - Brenna Casey
- Pancreas Biliary Center, Gastrointestinal Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Martha B Pitman
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - William R Brugge
- Pancreas Biliary Center, Gastrointestinal Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| |
Collapse
|
24
|
Affiliation(s)
- Jason Samarasena
- H. H. Chao Comprehensive Digestive Disease Center, University of California, Irvine, CA, USA
| | - Kenneth J Chang
- H. H. Chao Comprehensive Digestive Disease Center, University of California, Irvine, CA, USA
| |
Collapse
|
25
|
Santos-Fernandez J, Paiji C, Shakhatreh M, Becerro-Gonzalez I, Sanchez-Ocana R, Yeaton P, Samarasena J, Perez-Miranda M. Lumen-apposing metal stents for benign gastrointestinal tract strictures: An international multicenter experience. World J Gastrointest Endosc 2017; 9:571-578. [PMID: 29290912 PMCID: PMC5740102 DOI: 10.4253/wjge.v9.i12.571] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 07/22/2017] [Accepted: 09/15/2017] [Indexed: 02/05/2023] Open
Abstract
AIM To investigate technical feasibility, outcomes and adverse events of the lumen-apposing metal stent (LAMS) for benign gastrointestinal (GI) tract strictures.
METHODS Between July 2015 and January 2017, patients undergoing treatment by LAMS for benign GI strictures at three tertiary referral centers were included in this study. Primary outcomes included technical success, short-term clinical success, long-term clinical success, and adverse events. Short-term clinical success was defined as symptom resolution at 30 d after stent placement. Long-term clinical success was defined by symptom resolution at 60 d in patients who continued to have indwelling stent, or continued symptom resolution at 30 d after elective stent removal.
RESULTS A total of 21 patients (mean age 62.6 years, 47.6% males) underwent placement of LAMS for benign GI strictures. A 15 mm × 10 mm LAMS was placed in 16 patients, a 10 mm × 10 mm LAMS was placed in 2 patients, and a 16 mm × 30 mm LAMS was placed in 3 patients. Technical success was obtained in all cases. Short-term clinical success was achieved in 19 out of 21 cases (90.5%), and long-term clinical success was achieved in 12 out of 18 (66.7%). Mean (range) stent indwell time was 107.2 (28-370) d. After a mean (range) dwell time of 104.3 (28-306) d, 9 LAMSs were removed due to the following complications: ulceration at stent site (n = 1), angulation (n = 2), migration (n = 4) and stricture overgrowth (n = 2). Migration occurred in 4 cases (19.0%), and it was associated with stricture resolution in one case. Median (range) follow-up period was 119 (31-422) d.
CONCLUSION Utilization of LAMS for benign strictures has shown to be technically feasible and safe, but adverse events highlight the need for further study of its indications.
Collapse
Affiliation(s)
| | - Christopher Paiji
- Division of Gastroenterology and Hepatology, University of California - Irvine, Orange, CA 92697, United States
| | - Mohammad Shakhatreh
- Section of Gastroenterology and Hepatology, Virginia Tech Carilion School of Medicine and Research Institute, Roanoke, VI 24016, United States
| | - Irene Becerro-Gonzalez
- Gastroenterology Department, Hospital Universitario Rio Hortega, Valladolid 47012, Spain
| | - Ramon Sanchez-Ocana
- Gastroenterology Department, Hospital Universitario Rio Hortega, Valladolid 47012, Spain
| | - Paul Yeaton
- Section of Gastroenterology and Hepatology, Virginia Tech Carilion School of Medicine and Research Institute, Roanoke, VI 24016, United States
| | - Jason Samarasena
- Division of Gastroenterology and Hepatology, University of California - Irvine, Orange, CA 92697, United States
| | - Manuel Perez-Miranda
- Gastroenterology Department, Hospital Universitario Rio Hortega, Valladolid 47012, Spain
| |
Collapse
|
26
|
Samarasena J, Chen CL, Chin M, Chang K, Lee J. Successful closure of a cryotherapy-induced bleeding jejunal perforation with the over-the-scope clip system. Gastrointest Endosc 2017; 85:451. [PMID: 27866906 DOI: 10.1016/j.gie.2016.10.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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: 04/22/2016] [Accepted: 10/31/2016] [Indexed: 02/08/2023]
Affiliation(s)
| | - Chien-Lin Chen
- University of California, Irvine, Orange, California, USA
| | - Matthew Chin
- University of California, Irvine, Orange, California, USA
| | - Kenneth Chang
- University of California, Irvine, Orange, California, USA
| | - John Lee
- University of California, Irvine, Orange, California, USA
| |
Collapse
|
27
|
Jalali F, Samarasena J, Lee JG. Endoscopic ultrasound-guided transgastric drainage of a complex multiloculated peritoneal fluid collection as rare complication of lupus peritonitis. Endoscopy 2016; 48 Suppl 1 UCTN:E39. [PMID: 26829196 DOI: 10.1055/s-0042-100807] [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)
- Farid Jalali
- H. H. Chao Comprehensive Digestive Disease Center, Division of Gastroenterology, Department of Medicine, Irvine Medical Center, University of California, Orange, California, United States
| | - Jason Samarasena
- H. H. Chao Comprehensive Digestive Disease Center, Division of Gastroenterology, Department of Medicine, Irvine Medical Center, University of California, Orange, California, United States
| | - John G Lee
- H. H. Chao Comprehensive Digestive Disease Center, Division of Gastroenterology, Department of Medicine, Irvine Medical Center, University of California, Orange, California, United States
| |
Collapse
|
28
|
Chin M, Karnes W, Jamal MM, Lee JG, Lee R, Samarasena J, Bechtold ML, Nguyen DL. Use of the Endocuff during routine colonoscopy examination improves adenoma detection: A meta-analysis. World J Gastroenterol 2016; 22:9642-9649. [PMID: 27920485 PMCID: PMC5116608 DOI: 10.3748/wjg.v22.i43.9642] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 09/24/2016] [Accepted: 10/19/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To perform meta-analysis of the use of Endocuff during average risk screening colonoscopy. METHODS Scopus, Cochrane databases, MEDLINE/PubMed, and CINAHL were searched in April 2016. Abstracts from Digestive Disease Week, United European Gastroenterology, and the American College of Gastroenterology meeting were also searched from 2004-2015. Studies comparing EC-assisted colonoscopy (EAC) to standard colonoscopy, for any indication, were included in the analysis. The analysis was conducted by using the Mantel-Haenszel or DerSimonian and Laird models with the odds ratio (OR) to assess adenoma detection, cecal intubation rate, and complications performed. RESULTS Nine studies (n = 5624 patients) were included in the analysis. Compared to standard colonoscopy, procedures performed with EC had higher frequencies for adenoma (OR = 1.49, 95%CI: 1.23-1.80; P = 0.03), and sessile serrated adenomas detection (OR = 2.34 95%CI: 1.63-3.36; P < 0.001). There was no significant difference in cecal intubation rates between the EAC group and standard colonoscopy (OR = 1.26, 95%CI: 0.70-2.27, I2 = 0%; P = 0.44). EAC was associated with a higher risk of complications, most commonly being superficial mucosal injury without higher frequency for perforation. CONCLUSION The use of an EC on colonoscopy appears to improve pre-cancerous polyp detection without any difference in cecal intubation rates compared to standard colonoscopy.
Collapse
|
29
|
Samarasena J, Borgaonkar M. Development of hepatocellular carcinoma in a patient with Crohn's disease treated with azathioprine. Dig Dis Sci 2007; 52:2748-50. [PMID: 17404860 DOI: 10.1007/s10620-006-9613-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [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: 08/08/2006] [Accepted: 09/12/2006] [Indexed: 12/09/2022]
Affiliation(s)
- Jason Samarasena
- Memorial University of Newfoundland, Faculty of Medicine, Department of Internal Medicine, St. John's, Newfoundland, Canada, A1B 3V6.
| | | |
Collapse
|
30
|
Samarasena J, Winsor W, Lush R, Duggan P, Xie Y, Borgaonkar M. Individuals homozygous for the H63D mutation have significantly elevated iron indexes. Dig Dis Sci 2006; 51:803-7. [PMID: 16615007 DOI: 10.1007/s10620-006-3210-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [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: 02/12/2005] [Accepted: 04/08/2005] [Indexed: 01/28/2023]
Abstract
Our objective was to assess the iron indexes of patients with one or more mutations of the HFE gene with a specific interest in studying the effect of the H63D/H63D genotype. Eight hundred twenty subjects who underwent HFE mutational testing for C282Y and H63D mutations were retrospectively identified. Data collected included age, gender, HFE genotype, and values for serum ferritin, iron saturation, aspartate aminotransferase (AST), and alanine aminotransferase (ALT). Compared to the Wild/Wild genotype (0.34 +/- 0.17), genotypes H63D/C282Y (0.44 +/- 0.14 P < 0.01), H63D/H63D (0.51 +/- 0.21 P < 0.01), and C282Y/C282Y (0.64 +/- 0.20 P < 0.01) had significantly higher transferrin saturation levels and were independent predictors of higher iron saturation in multivariate regression analysis. Compared to the Wild/Wild genotype, no abnormal HFE genotypes had significantly higher ferritin levels, although the genotype H63D/H63D was an independent predictor of higher serum ferritin (P = 0.02) in regression analysis. There was no significant difference in the proportion of patients with abnormally elevated AST (P = 0.64) or ALT (P = 0.80) between groups. H63D homozygotes have elevated transferrin saturation compared to the Wild genotype, comparable to that of C282Y homozygotes and compound heterozygotes. The clinical significance of this finding is unclear but warrants further study.
Collapse
Affiliation(s)
- Jason Samarasena
- Memorial University of Newfoundland, Faculty of Medicine, St. John's, Newfoundland, Canada A1B 3V6.
| | | | | | | | | | | |
Collapse
|