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Visrodia K, Dobashi A, Bazerbachi F, Poneros J, Sethi A. Endoscopic Submucosal Dissection Facilitating Techniques Among Non-experts: A Systematic Literature Review. Dig Dis Sci 2023; 68:2561-2584. [PMID: 37024739 DOI: 10.1007/s10620-022-07784-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 11/30/2022] [Indexed: 04/08/2023]
Abstract
BACKGROUND AND AIMS The dissemination of endoscopic submucosal dissection (ESD) has been limited by its technical complexity and safety profile, particularly among non-experts. Various techniques and devices have facilitated the performance of ESD, but their yield and role in the path to learning ESD remain unclear. METHODS We performed a systematic review by querying MEDLINE, EMBASE, Web of Science, and Japan Medical Abstracts Society specifically for comparative studies investigating the impact of assigned ESD techniques vs. conventional techniques among non-experts in ESD (< 50 ESD procedures). Procedural outcomes of efficacy, efficiency, and safety were assessed. RESULTS We identified 46 studies evaluating 54 cohorts in which a total 237 non-experts performed 2461 ESDs conventionally, and 1953 ESDs using an assigned ESD technique (knives, countertraction, miscellaneous techniques). The majority of studies were from East Asia (67%), single-center (96%), observational in design (61%), in an animal model (57%), and gastric location (63%). The most studied techniques were countertraction techniques (48% cohorts) and scissor knives (15% cohorts), both of which commonly enhanced efficiency of ESD, and less so efficacy or safety. Techniques found to be beneficial in experts were more likely to be beneficial in non-experts (70% concordance) than vice versa (47% concordance). CONCLUSION Based on the currently available literature, countertraction techniques and scissor knives should be considered for early incorporation into ESD training by non-experts. Several aspects of ESD training remain understudied, including techniques in Western non-experts, educational resources, and several commonly cited techniques. These areas should guide future investigation to enhance the pathway to learning ESD.
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Affiliation(s)
- Kavel Visrodia
- Division of Digestive and Liver Diseases, Columbia University Irving Medical Center-New York Presbyterian Hospital, 161 Fort Washington Ave, 8th Fl, Ste 852A, New York, NY, 10032, USA.
| | - Akira Dobashi
- Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
| | - Fateh Bazerbachi
- CentraCare, Interventional Endoscopy Program, St Cloud Hospital, St Cloud, MN, USA
| | - John Poneros
- Division of Digestive and Liver Diseases, Columbia University Irving Medical Center-New York Presbyterian Hospital, 161 Fort Washington Ave, 8th Fl, Ste 852A, New York, NY, 10032, USA
| | - Amrita Sethi
- Division of Digestive and Liver Diseases, Columbia University Irving Medical Center-New York Presbyterian Hospital, 161 Fort Washington Ave, 8th Fl, Ste 852A, New York, NY, 10032, USA
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Rizvi A, Sethi A, Poneros J, Visrodia KH. Does incidentally detected common bile duct dilation need evaluation? Cleve Clin J Med 2022; 89:315-319. [PMID: 35649563 DOI: 10.3949/ccjm.89a.21029] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Anam Rizvi
- Division of Gastroenterology and Hepatology, North Shore University Hospital-Long Island Jewish Medical Center, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Manhasset, NY
| | - Amrita Sethi
- Associate Professor of Medicine, Director of Interventional Endoscopy, Division of Digestive and Liver Diseases, Department of Medicine, Columbia University, New York, NY
| | - John Poneros
- Associate Professor of Medicine, Division of Digestive and Liver Diseases, Department of Medicine, Columbia University, New York, NY
| | - Kavel H Visrodia
- Assistant Professor of Medicine, Division of Digestive and Liver Diseases, Department of Medicine, Columbia University, New York, NY
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Dong J, Grant C, Vuong B, Nishioka N, Gao AH, Beatty M, Baldwin G, Bailargeon A, Bablouzian A, Grahmann P, Bhat N, Ryan E, Barrios A, Giddings S, Ford T, Beaulieu-Ouellet E, Hosseiny SH, Lerman I, Trasischker W, Reddy R, Singh K, Gora M, Hyun D, Queneherve L, Wallace M, Wolfsen H, Sharma P, Wang KK, Leggett CL, Poneros J, Abrams JA, Lightdale C, Leeds S, Rosenberg M, Tearney G. Feasibility and Safety of Tethered Capsule Endomicroscopy in Patients With Barrett's Esophagus in a Multi-Center Study. Clin Gastroenterol Hepatol 2022; 20:756-765.e3. [PMID: 33549871 PMCID: PMC8715859 DOI: 10.1016/j.cgh.2021.02.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 02/02/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Tethered capsule endomicroscopy (TCE) involves swallowing a small tethered pill that implements optical coherence tomography (OCT) imaging, procuring high resolution images of the whole esophagus. Here, we demonstrate and evaluate the feasibility and safety of TCE and a portable OCT imaging system in patients with Barrett's esophagus (BE) in a multi-center (5-site) clinical study. METHODS Untreated patients with BE as per endoscopic biopsy diagnosis were eligible to participate in the study. TCE procedures were performed in unsedated patients by either doctors or nurses. After the capsule was swallowed, the device continuously obtained 10-μm-resolution cross-sectional images as it traversed the esophagus. Following imaging, the device was withdrawn through mouth, and disinfected for subsequent reuse. BE lengths were compared to endoscopy findings when available. OCT-TCE images were compared to volumetric laser endomicroscopy (VLE) images from a patient who had undergone VLE on the same day as TCE. RESULTS 147 patients with BE were enrolled across all sites. 116 swallowed the capsule (79%), 95/114 (83.3%) men and 21/33 (63.6%) women (P = .01). High-quality OCT images were obtained in 104/111 swallowers (93.7%) who completed the procedure. The average imaging duration was 5.55 ± 1.92 minutes. The mean length of esophagus imaged per patient was 21.69 ± 5.90 cm. A blinded comparison of maximum extent of BE measured by OCT-TCE and EGD showed a strong correlation (r = 0.77-0.79). OCT-TCE images were of similar quality to those obtained by OCT-VLE. CONCLUSIONS The capabilities of TCE to be used across multiple sites, be administered to unsedated patients by either physicians or nurses who are not expert in OCT-TCE, and to rapidly and safely evaluate the microscopic structure of the esophagus make it an emerging tool for screening and surveillance of BE patients. Clinical trial registry website and trial number: NCT02994693 and NCT03459339.
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Affiliation(s)
- Jing Dong
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA,Harvard Medical School, MA
| | - Catriona Grant
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA
| | - Barry Vuong
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA,Harvard Medical School, MA
| | - Norman Nishioka
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA,Harvard Medical School, MA
| | - Anna Huizi Gao
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA
| | - Matthew Beatty
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA
| | - Grace Baldwin
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA
| | - Aaron Bailargeon
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA
| | - Ara Bablouzian
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA
| | - Patricia Grahmann
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA
| | - Nitasha Bhat
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA
| | - Emily Ryan
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA
| | - Amilcar Barrios
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA
| | - Sarah Giddings
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA
| | - Timothy Ford
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA,Harvard Medical School, MA
| | | | | | - Irene Lerman
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA
| | - Wolfgang Trasischker
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA,Harvard Medical School, MA
| | - Rohith Reddy
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA,Harvard Medical School, MA
| | - Kanwarpal Singh
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA,Harvard Medical School, MA
| | - Michalina Gora
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA,Harvard Medical School, MA,ICube Laboratory, CNRS, Strasbourg University, France
| | - Daryl Hyun
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA
| | - Lucille Queneherve
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA,Harvard Medical School, MA
| | - Michael Wallace
- Division of Gastroenterology and Hepatology, Mayo Clinic Jacksonville, FL
| | - Herbert Wolfsen
- Division of Gastroenterology and Hepatology, Mayo Clinic Jacksonville, FL
| | - Prateek Sharma
- Department of Gastroenterology, Kansas City Veterans Administration and University of Kansas School of Medicine, MO
| | - Kenneth K. Wang
- Division of Gastroenterology and Hepatology,, Mayo Clinic Rochester, MN
| | - Cadman L. Leggett
- Division of Gastroenterology and Hepatology,, Mayo Clinic Rochester, MN
| | | | | | | | | | - Mireille Rosenberg
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA,Harvard Medical School, MA
| | - Guillermo Tearney
- Wellman Center for Photomedicine, Massachusetts General Hospital, MA,Harvard Medical School, MA,Department of Pathology, Massachusetts General Hospital, MA,Harvard-MIT Division of Health Science and Technology (HST)
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Abrams JA, Del Portillo A, Hills C, Compres G, Friedman RA, Cheng B, Poneros J, Lightdale CJ, De La Rue R, di Pietro M, Fitzgerald RC, Sepulveda A, Wang TC. Randomized Controlled Trial of the Gastrin/CCK 2 Receptor Antagonist Netazepide in Patients with Barrett's Esophagus. Cancer Prev Res (Phila) 2021; 14:675-682. [PMID: 33782049 DOI: 10.1158/1940-6207.capr-21-0050] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/15/2021] [Accepted: 03/23/2021] [Indexed: 11/16/2022]
Abstract
Hypergastrinemia has been associated with high-grade dysplasia and adenocarcinoma in patients with Barrett's esophagus, and experimental studies suggest proinflammatory and proneoplastic effects of gastrin on Barrett's esophagus. This is of potential concern, as patients with Barrett's esophagus are treated with medications that suppress gastric acid production, resulting in increased physiologic levels of gastrin. We aimed to determine whether treatment with the novel gastrin/CCK2 receptor antagonist netazepide reduces expression of markers associated with inflammation and neoplasia in Barrett's esophagus. This was a randomized, double-blind, placebo-controlled trial of netazepide in patients with Barrett's esophagus without dysplasia. Subjects were treated for 12 weeks, with endoscopic assessment at baseline and at end of treatment. The primary outcome was within-individual change in cellular proliferation as assessed by Ki67. Secondary analyses included changes in gene expression, assessed by RNA-sequencing, and safety and tolerability. A total of 20 subjects completed the study and were included in the analyses. There was no difference between arms in mean change in cellular proliferation (netazepide: +35.6 Ki67+ cells/mm2, SD 620.7; placebo: +307.8 Ki67+ cells/mm2, SD 640.3; P = 0.35). Netazepide treatment resulted in increased expression of genes related to gastric phenotype (TFF2, MUC5B) and certain cancer-associated markers (REG3A, PAX9, MUC1), and decreased expression of intestinal markers MUC2, FABP1, FABP2, and CDX1 No serious adverse events related to study drug occurred. The gastrin/CCK2 receptor antagonist netazepide did not reduce cellular proliferation in patients with nondysplastic Barrett's esophagus. Further research should focus on the biological effects of gastrin in Barrett's esophagus.Prevention Relevance: Treatment of patients with Barrett's esophagus with a gastrin/CCK2 receptor antagonist did not have obvious chemopreventive effects.
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Affiliation(s)
- Julian A Abrams
- Department of Medicine, Columbia University Irving Medical Center, New York, New York. .,Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York
| | - Armando Del Portillo
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York
| | - Caitlin Hills
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York
| | - Griselda Compres
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Richard A Friedman
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York.,Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York
| | - Bin Cheng
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
| | - John Poneros
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Charles J Lightdale
- Department of Medicine, Columbia University Irving Medical Center, New York, New York.,Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York
| | - Rachel De La Rue
- MRC Cancer Unit, Hutchison-MRC Research Centre, University of Cambridge, Cambridge, United Kingdom
| | - Massimiliano di Pietro
- MRC Cancer Unit, Hutchison-MRC Research Centre, University of Cambridge, Cambridge, United Kingdom
| | - Rebecca C Fitzgerald
- MRC Cancer Unit, Hutchison-MRC Research Centre, University of Cambridge, Cambridge, United Kingdom
| | - Antonia Sepulveda
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York.,Department of Pathology, George Washington University, Washington, D.C
| | - Timothy C Wang
- Department of Medicine, Columbia University Irving Medical Center, New York, New York.,Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York
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5
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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.
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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
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6
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Brooks C, Gausman V, Kokoy-Mondragon C, Munot K, Amin SP, Desai A, Kipp C, Poneros J, Sethi A, Gress FG, Kahaleh M, Murty VV, Sharaiha R, Gonda TA. Role of Fluorescent In Situ Hybridization, Cholangioscopic Biopsies, and EUS-FNA in the Evaluation of Biliary Strictures. Dig Dis Sci 2018; 63:636-644. [PMID: 29353443 DOI: 10.1007/s10620-018-4906-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [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: 07/11/2017] [Accepted: 10/22/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIMS Our goal was to compare the diagnostic accuracy of FISH in the detection of malignancy compared with other standard diagnostic modalities, including brush cytology and biopsy specimens over a 10-year period of prospective data collection. METHODS We conducted a review of all consecutive biliary strictures evaluated between 2006 and 2016. Patients with a final pathologic diagnosis or conclusive follow-up were included. We evaluated the performance of FISH polysomy (CEP 3, 7, and 17) and 9p21 deletion as well as cholangioscopic biopsy (CBx) and EUS-FNA. Statistical analysis was performed with the Mann-Whitney U and Fisher's exact tests. RESULTS Of 382 patients with indeterminate strictures, 281 met inclusion criteria. Forty-nine percent were malignant. Cytology, FISH polysomy, and FISH polysomy/9p21 showed a specificity of 99.3%. FISH polysomy/9p21 as a single modality was the most sensitive at 56% (p < 0.001). The sensitivity of FISH polysomy/9p21 and cytology was significantly higher than cytology alone at 63 versus 35% (p < 0.05). EUS-FNA for distal strictures and CBx for proximal strictures increased sensitivity from 33 to 93% (p < 0.001) and 48-76% (p = 0.05) in cytology-negative strictures. CONCLUSIONS The high specificity of FISH polysomy/9p21 suggests that a positive result is sufficient for diagnosing malignancy in indeterminate strictures. The significantly higher sensitivity of FISH polysomy/9p21 compared to cytology supports the use of FISH in all non-diagnostic cases. Although both EUS-FNA and CBx were complimentary, our results suggest that distal strictures should be evaluated by EUS initially. Proximal strictures may be evaluated by FISH first and then by CBx if inconclusive.
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Affiliation(s)
- Christian Brooks
- Division of Digestive and Liver Diseases, Columbia University Medical Center-NYP, New York, NY, USA
| | - Valerie Gausman
- Department of Medicine, NYU Langone Medical Center, New York, NY, USA
| | - Chanthel Kokoy-Mondragon
- Division of Digestive and Liver Diseases, Columbia University Medical Center-NYP, New York, NY, USA
| | - Khushboo Munot
- Section of Gastroenterology and Hepatology, Baylor College of Medicine Medical Center, Houston, TX, USA
| | - Sunil P Amin
- Division of Digestive and Liver Diseases, Columbia University Medical Center-NYP, New York, NY, USA
| | - Amit Desai
- Division of Digestive and Liver Diseases, Columbia University Medical Center-NYP, New York, NY, USA
| | - Claudine Kipp
- Division of Digestive and Liver Diseases, Columbia University Medical Center-NYP, New York, NY, USA
| | - John Poneros
- Division of Digestive and Liver Diseases, Columbia University Medical Center-NYP, New York, NY, USA
| | - Amrita Sethi
- Division of Digestive and Liver Diseases, Columbia University Medical Center-NYP, New York, NY, USA
| | - Frank G Gress
- Division of Digestive and Liver Diseases, Columbia University Medical Center-NYP, New York, NY, USA
| | - Michel Kahaleh
- Division of Gastroenterology and Hepatology, Weill Cornell Medical Center-NYP, New York, NY, USA
| | - Vundavalli V Murty
- Department of Pathology, Columbia University Medical Center-NYP, New York, NY, USA
| | - Reem Sharaiha
- Division of Gastroenterology and Hepatology, Weill Cornell Medical Center-NYP, New York, NY, USA
| | - Tamas A Gonda
- Division of Digestive and Liver Diseases, Columbia University Medical Center-NYP, New York, NY, USA.
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7
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Ngamruengphong S, Sharaiha R, Sethi A, Siddiqui A, DiMaio CJ, Gonzalez S, Rogart J, Jagroop S, Widmer J, Im J, Hasan RA, Laique S, Gonda T, Poneros J, Desai A, Wong K, Villgran V, Brewer Gutierrez O, Bukhari M, Chen YI, Hernaez R, Hanada Y, Sanaei O, Agarwal A, Kalloo AN, Kumbhari V, Singh V, Khashab MA. Fully-covered metal stents with endoscopic suturing vs. partially-covered metal stents for benign upper gastrointestinal diseases: a comparative study. Endosc Int Open 2018; 6:E217-E223. [PMID: 29404384 PMCID: PMC5797316 DOI: 10.1055/s-0043-125363] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 09/26/2017] [Accepted: 12/18/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND STUDY AIMS Self-expandable metallic stents (SEMS) have been increasingly used in benign conditions (e. g. strictures, fistulas, leaks, and perforations). Fully covered SEMS (FSEMS) were introduced to avoid undesirable consequences of partially covered SEMS (PSEMS), but come with higher risk of stent migration. Endoscopic suturing (ES) for stent fixation has been shown to reduce migration of FSEMS. Our aim was to compare the outcomes of FSEMS with ES (FS/ES) versus PSEMS in patients with benign upper gastrointestinal conditions. PATIENTS AND METHODS We retrospectively identified all patients who underwent stent placement for benign gastrointestinal conditions at seven US tertiary-care centers. Patients were divided into two groups: FSEMS with ES (FS/ES group) and PSEMS (PSEMS group). Clinical outcomes between the two groups were compared. RESULTS A total of 74 (FS/ES 46, PSEMS 28) patients were included. On multivariable analysis, there was no significant difference in rate of stent migration between FS/ES (43 %) and PSEMS (15 %) (adjusted odds ratio 0.56; 95 % CI 0.15 - 2.00). Clinical success was similar [68 % vs. 64 %; P = 0.81]. Rate of adverse events (AEs) was higher in PSEMS group [13 (46 %) vs. 10 (21 %); P = 0.03). Difficult stent removal was higher in the PSEMS group (n = 5;17 %) vs. 0 % in the FS/ES group; P = 0.005. CONCLUSIONS The proportion of stent migration of FS/ES and PSEMS are similar. Rates of other stent-related AEs were higher in the PSEMS group. PSEMS was associated with tissue ingrowth or overgrowth leading to difficult stent removal, and secondary stricture formation. Thus, FSEMS with ES for stent fixation may be the preferred modality over PSEMS for the treatment of benign upper gastrointestinal conditions.
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Affiliation(s)
| | - Reem Sharaiha
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, United States
| | - Amrita Sethi
- Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, New York, United States
| | - Ali Siddiqui
- Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
| | - Christopher J. DiMaio
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Susana Gonzalez
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Jason Rogart
- Capital Health Center for Digestive Health, Pennington, New Jersey, United States
| | - Sophia Jagroop
- North Shore University Hospital/ Long Island Jewish Medical Center, Forest Hills, New York, United States
| | - Jessica Widmer
- North Shore University Hospital/ Long Island Jewish Medical Center, Forest Hills, New York, United States
| | - Jennifer Im
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Raza Abbas Hasan
- Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
| | - Sobia Laique
- Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
| | - Tamas Gonda
- Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, New York, United States
| | - John Poneros
- Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, New York, United States
| | - Amit Desai
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, United States
| | - Katherine Wong
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Vipin Villgran
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Olaya Brewer Gutierrez
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Majidah Bukhari
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Yen-I Chen
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Ruben Hernaez
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas, United States
| | - Yuri Hanada
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Omid Sanaei
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Amol Agarwal
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Anthony N. Kalloo
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Vivek Kumbhari
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Vikesh Singh
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Mouen A. Khashab
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, United States,Corresponding author Mouen Khashab, MD Associate Professor of MedicineJohns Hopkins HospitalDivision of Gastroenterology and Hepatology1800 Orleans Street, Sheikh Zayed Bldg. Suite 7125GBaltimore, MD 21287+1-443-683-8335
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Ngamruengphong S, Sharaiha RZ, Sethi A, Siddiqui AA, DiMaio CJ, Gonzalez S, Im J, Rogart JN, Jagroop S, Widmer J, Hasan RA, Laique S, Gonda T, Poneros J, Desai A, Tyberg A, Kumbhari V, El Zein M, Abdelgelil A, Besharati S, Hernaez R, Okolo PI, Singh V, Kalloo AN, Kahaleh M, Khashab MA. Endoscopic suturing for the prevention of stent migration in benign upper gastrointestinal conditions: a comparative multicenter study. Endoscopy 2016; 48:802-8. [PMID: 27356125 DOI: 10.1055/s-0042-108567] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [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] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND STUDY AIMS Fully covered self-expandable metal stents (FCSEMSs) have increasingly been used in benign upper gastrointestinal (UGI) conditions; however, stent migration remains a major limitation. Endoscopic suture fixation (ESF) may prevent stent migration. The aims of this study were to compare the frequency of stent migration in patients who received endoscopic suturing for stent fixation (ESF group) compared with those who did not (NSF group) and to assess the impact of ESF on clinical outcome. PATIENTS AND METHODS This was a retrospective study of patients who underwent FCSEMS placement for benign UGI diseases. Patients were divided into either the NSF or ESF group. Outcome variables, including stent migration, clinical success (resolution of underlying pathology), and adverse events, were compared. RESULTS A total of 125 patients (44 in ESF group, 81 in NSF group; 56 benign strictures, 69 leaks/fistulas/perforations) underwent 224 stenting procedures. Stent migration was significantly more common in the NSF group (33 % vs. 16 %; P = 0.03). Time to stent migration was longer in the ESF group (P = 0.02). ESF appeared to protect against stent migration in patients with a history of stent migration (adjusted odds ratio [OR] 0.09; P = 0.002). ESF was also significantly associated with a higher rate of clinical success (60 % vs. 38 %; P = 0.03). Rates of adverse events were similar between the two groups. CONCLUSIONS Endoscopic suturing for stent fixation is safe and associated with a decreased migration rate, particularly in patients with a prior history of stent migration. It may also improve clinical response, likely because of the reduction in stent migration.
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Affiliation(s)
| | - Reem Z Sharaiha
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA
| | - Amrita Sethi
- Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, New York, USA
| | - Ali A Siddiqui
- Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Christopher J DiMaio
- Division of Gastroenterology and Hepatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Susana Gonzalez
- Division of Gastroenterology and Hepatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jennifer Im
- Division of Gastroenterology and Hepatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jason N Rogart
- Capital Health Center for Digestive Health, Pennington, New Jersey, USA
| | - Sophia Jagroop
- North Shore University Hospital/ Long Island Jewish Medical Center, Forest Hills, New York, USA
| | - Jessica Widmer
- North Shore University Hospital/ Long Island Jewish Medical Center, Forest Hills, New York, USA
| | - Raza Abbas Hasan
- Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Sobia Laique
- Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Tamas Gonda
- Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, New York, USA
| | - John Poneros
- Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, New York, USA
| | - Amit Desai
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA
| | - Amy Tyberg
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA
| | - Vivek Kumbhari
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Mohamad El Zein
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Ahmed Abdelgelil
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Sepideh Besharati
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Ruben Hernaez
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Patrick I Okolo
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Vikesh Singh
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Anthony N Kalloo
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Michel Kahaleh
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA
| | - Mouen A Khashab
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
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9
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Ngamruengphong S, Sharaiha RZ, Sethi A, Siddiqui AA, DiMaio CJ, Gonzalez S, Im J, Rogart JN, Jagroop S, Widmer J, Hasan RA, Laique S, Gonda T, Poneros J, Desai A, Tyberg A, Kumbhari V, El Zein M, Abdelgelil A, Besharati S, Hernaez R, Okolo PI, Singh V, Kalloo AN, Kahaleh M, Khashab MA. Endoscopic suturing for the prevention of stent migration in benign upper gastrointestinal conditions: a comparative multicenter study. Endoscopy 2016; 48:808. [PMID: 27494452 DOI: 10.1055/s-0042-113997] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
| | - Reem Z Sharaiha
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA
| | - Amrita Sethi
- Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, New York, USA
| | - Ali A Siddiqui
- Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Christopher J DiMaio
- Division of Gastroenterology and Hepatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Susana Gonzalez
- Division of Gastroenterology and Hepatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jennifer Im
- Division of Gastroenterology and Hepatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jason N Rogart
- Capital Health Center for Digestive Health, Pennington, New Jersey, USA
| | - Sophia Jagroop
- North Shore University Hospital/ Long Island Jewish Medical Center, Forest Hills, New York, USA
| | - Jessica Widmer
- North Shore University Hospital/ Long Island Jewish Medical Center, Forest Hills, New York, USA
| | - Raza Abbas Hasan
- Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Sobia Laique
- Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Tamas Gonda
- Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, New York, USA
| | - John Poneros
- Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, New York, USA
| | - Amit Desai
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA
| | - Amy Tyberg
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA
| | - Vivek Kumbhari
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Mohamad El Zein
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Ahmed Abdelgelil
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Sepideh Besharati
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Ruben Hernaez
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Patrick I Okolo
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Vikesh Singh
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Anthony N Kalloo
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Michel Kahaleh
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA
| | - Mouen A Khashab
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
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10
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Chen X, Lagana SM, Poneros J, Kato T, Remotti F, He H, Kaminsky D, Hamele-Bena D. Cytological diagnosis of angiosarcoma arising in an immunosuppressed patient 6 years after multi-visceral transplantation. Diagn Cytopathol 2013; 42:884-9. [DOI: 10.1002/dc.23068] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 10/03/2013] [Accepted: 10/10/2013] [Indexed: 11/12/2022]
Affiliation(s)
- Xiaowei Chen
- Department of Pathology and Cell Biology; Columbia University Medical Center; New York New York
| | - Stephen M. Lagana
- Department of Pathology and Cell Biology; Columbia University Medical Center; New York New York
| | - John Poneros
- Department of Medicine; Columbia University Medical Center; New York New York
| | - Tomoaki Kato
- Department of Surgery; Columbia University Medical Center; New York New York
| | - Fabrizio Remotti
- Department of Pathology and Cell Biology; Columbia University Medical Center; New York New York
| | - Huangjun He
- Department of Pathology and Cell Biology; Columbia University Medical Center; New York New York
| | - Dmitry Kaminsky
- Department of Pathology and Cell Biology; Columbia University Medical Center; New York New York
| | - Diane Hamele-Bena
- Department of Pathology and Cell Biology; Columbia University Medical Center; New York New York
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11
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Horowitz DP, Halmos B, Poneros J, Sonett J, Remotti H, Burri RJ. Management of Esophageal Squamous Cell Carcinoma with Definitive Chemoradiotherapy in a Patient with Scleroderma: Case Report and Review of the Literature. J Gastrointest Cancer 2012; 43 Suppl 1:S156-60. [PMID: 22585471 DOI: 10.1007/s12029-012-9393-2] [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] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- David P Horowitz
- Department of Radiation Oncology, Columbia University Medical Center-New York Presbyterian Hospital, New York, NY, USA
| | - Balazs Halmos
- Department of Medicine, Columbia University Medical Center-New York Presbyterian Hospital, New York, NY, USA
| | - John Poneros
- Department of Medicine, Columbia University Medical Center-New York Presbyterian Hospital, New York, NY, USA
| | - Joshua Sonett
- Department of Surgery, Columbia University Medical Center-New York Presbyterian Hospital, New York, NY, USA
| | - Helen Remotti
- Department of Pathology, Columbia University Medical Center-New York Presbyterian Hospital, New York, NY, USA
| | - Ryan J Burri
- Winter Park Cancer Center, Winter Park, FL, USA.
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13
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Abstract
BACKGROUND The extrahepatic portal vein is inaccessible to direct catheterization. METHODS Because EUS can readily image the portal vein, the feasibility of EUS-guided portal vein catheterization by using a 22-gauge needle was studied in 7 normal pigs and 14 pigs in which portal hypertension was induced (7/14 anticoagulated). RESULTS Catheterization was not possible by EUS or transhepatic methods in, respectively, 3 and 5 animals. One anticoagulated animal had a small amount of periduodenal bleeding as a result of EUS catheterization. The mean normal portal vein pressure (1 standard deviation) as determined by EUS and transhepatic methods was, respectively, 20.3 (4) mm Hg and 20.4 (2) mm Hg. Injection of polyvinyl alcohol particles increased the portal vein pressure by 10.2 (11.59) mm Hg. There was a close correlation under all conditions between the mean portal vein pressures obtained by EUS and transhepatic catheterization (r=0.91). CONCLUSIONS EUS-guided portal vein catheterization appears to be feasible in an animal model and provides accurate pressure measurements.
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Affiliation(s)
- Lawrence Lai
- Caritas Medical Center Hong Kong, Brigham and Women's Hospital, Vascular Radiology and GI Unit, Massachusetts General Hospital, Boston 02114, USA
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