1
|
Ortega AJ, Bashashati M, Robles A, Davis B, Sarosiek I, Elhanafi S, McCallum R. EndoFLIP and Interstitial Cells of Cajal in Refractory Gastroparesis. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00561-x] [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: 01/28/2023]
|
2
|
Maegawa FB, Ahmad M, Aguirre K, Elhanafi S, Chiba S, Philipovskiy A, Tyroch AH, Konstantinidis IT. The impact of minimally invasive surgery and frailty on post-hepatectomy outcomes. HPB (Oxford) 2022; 24:1577-1584. [PMID: 35459620 DOI: 10.1016/j.hpb.2022.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 01/19/2022] [Accepted: 03/29/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND The impact of patient frailty on post-hepatectomy outcomes is not well studied. We hypothesized that patient frailty is a strong predictor of 30-day post-hepatectomy complications. METHODS The liver-targeted National Surgical Quality Improvement Program (NSQIP) database for 2014-2019 was reviewed. A validated modified frailty index (mFI) was used. RESULTS A total of 24,150 hepatectomies were reviewed. Worsening frailty was associated with increased incidence of Clavien-Dindo grade IV complications (mFI 0, 1, 2, 3, 4 was 3.9%, 6.3%, 10%, 8.1%, 50% respectively; p < 0.001). Minimally invasive hepatectomies had a lower rate of Clavien-Dindo grade IV complications for non-frail (Laparoscopic: 1%, Robotic: 2.6%, Open: 4.6%; p < 0.001) and frail patients (Laparoscopic: 3%, Robotic: 2.3%, Open: 7.7%; p < 0.001). Frail patients experienced higher incidence of post-hepatectomy liver failure (5.4% vs 4.1% for non-frail; p < 0.001) and grade C liver failure (28% vs 21.1% for non-frail; p = 0.03). Incorporating mFI to Albumin-Bilirubin score (ALBI) improved its ability to predict Clavien-Dindo grade IV complications (AUC improved from 0.609 to 0.647; p < 0.001) and 30-day mortality (AUC improved from 0.663 to 0.72; p < 0.001). CONCLUSION Worsening frailty correlates with increased incidence of Clavien-Dindo grade IV complications post-hepatectomy, whereas minimally invasive approaches decrease this risk. Incorporating frailty assessment to ALBI improves its ability to predict major postoperative complications and 30-day mortality.
Collapse
Affiliation(s)
- Felipe B Maegawa
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Maria Ahmad
- Department of Surgery, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Katherine Aguirre
- Department of Surgery, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Sherif Elhanafi
- Department of Gastroenterology, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Shintaro Chiba
- Department of Surgery, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Alexander Philipovskiy
- Department of Medical Oncology, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Alan H Tyroch
- Department of Surgery, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | | |
Collapse
|
3
|
Krill JT, Szafron D, Elhanafi S, Hussein MS, Patel K, Raijman I, Fisher W, El Serag HB, Othman MO. Endoscopic Ultrasound Finding of Diffuse Echogenicity in the Pancreas, Is It Relevant? Dig Dis Sci 2022; 67:3244-3251. [PMID: 34350519 DOI: 10.1007/s10620-021-07181-1] [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: 06/01/2020] [Accepted: 07/16/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND/OBJECTIVES Diffuse echogenicity of the pancreas, a commonly discovered finding on endoscopic ultrasound (EUS), is often of undetermined significance. The goal of this study was to characterize the clinical picture and pancreatic function in patients who incidentally present with this endosonographic finding. METHODS This was a case-control study comparing consecutive adult patients with diffuse echogenicity of the pancreas found on EUS to those who did not have known pancreas disease. Demographic and clinical data were extracted from the electronic medical record. The primary endpoint was exocrine pancreatic insufficiency (EPI) defined as fecal elastase (FE-1) < 200 μg/g. RESULTS A total of 166 patients were included in this study. There were 89 patients who had diffuse echogenicity of the pancreas on EUS and FE-1 testing. There were 77 control patients with chronic diarrhea who did not have known pancreas disease but did have FE-1 testing. EPI was significantly more likely in the fatty pancreas group compared to the control group (47% vs 6%, p < 0.001). There was also a significantly greater proportion of smokers in the fatty pancreas group compared to the control group (42% vs 17%, p = 0.002). There were no other differences in baseline characteristics between the two groups, including prevalence of chronic pancreatitis by Rosemont classification. On multiple logistic regression analysis controlling for multiple variables, smoking (OR 2.26, 95% CI 1.15-4.43) and NAFLD (OR 3.99, 95% CI 1.09-14.70) had significant associations with EPI. CONCLUSIONS This study found a significantly greater amount of patients who had diffuse echogenicity of the pancreas on EUS to also have EPI. This is compared to a control group of patients without known pancreas disease. This prevalence was found in the absence of a significant association with chronic pancreatitis on EUS based on Rosemont classification. Future controlled studies are required to further investigate this relationship.
Collapse
Affiliation(s)
- Joseph T Krill
- Division of Gastroenterology, Baylor College of Medicine, Houston, TX, USA
| | - David Szafron
- Department of Internal Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Sherif Elhanafi
- Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, AZ, USA
| | - Mohammed S Hussein
- Division of Gastroenterology, Baylor College of Medicine, Houston, TX, USA.,Department of Internal Medicine, Al-Azhar University, Cairo, Egypt
| | - Kalpesh Patel
- Division of Gastroenterology, Baylor College of Medicine, Houston, TX, USA
| | | | - William Fisher
- Department of General Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Hashem B El Serag
- Division of Gastroenterology, Baylor College of Medicine, Houston, TX, USA
| | - Mohamed O Othman
- Division of Gastroenterology, Baylor College of Medicine, Houston, TX, USA. .,Chief of Gastroenterology Section, Baylor St Luke's Medical Center, 7200 Cambridge St. STE 10C, Houston, TX, 77030, USA.
| |
Collapse
|
4
|
Mazal S, Najmi M, Ahmad M, Aguirre K, Elhanafi S, Philipovskiy A, Gaur S, Konstantinidis I. Gastrointestinal melanoma: Outcomes of surgery and immunotherapy. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e16224] [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
e16224 Background: Most knowledge on gastrointestinal (GI) melanoma is limited to anal melanoma. Our aim is to examine the impact of surgical treatment and the utility of immunotherapy on GI (other than anal) melanoma. Methods: The National Cancer Database (2004-2016) was reviewed for patients who were treated for GI melanoma. Kaplan-Meier method and log-rank test were used to make survival comparisons. Results: We analyzed data from 731 patients with gastrointestinal melanoma (esophageal:97, gastric:57, small bowel:87, colonic:31, rectal:459). A minority of patients had metastatic disease at the time of diagnosis (esophageal:14.4%, gastric:17.5%, small bowel:4.6%, colonic:19.4%, rectal: 16.3%) and small proportion received immunotherapy (esophageal:16.5%, gastric:15.8%, small bowel:15%, colonic:6.5%, rectal:20.3%). Patients who had resection with negative margins had an improved survival irrespectively of the magnitude of surgery (for example rectal melanoma: OS: no surgery:7.9mo, local excision:23.3mo, partial proctectomy:23.5mo, total proctectomy:18.4mo; p < 0.001 and OS for R0 margins:29.4mo vs R1:13.5mo vs R2:5mo;p < 0.001). The use of immunotherapy was associated with improved survival in metastatic disease for rectal melanoma (OS:10.8mo vs 5.7mo; p = 0.01). Conclusions: Excision with negative margins is associated with improved outcomes in gastrointestinal melanoma. The use of immunotherapy should be considered in the presence of metastatic disease.
Collapse
Affiliation(s)
- Sarah Mazal
- Texas Tech University Health Sciences Center El Paso, Paul L Foster School of Medicine, El Paso, TX
| | - Maleka Najmi
- Texas Tech University Health Sciences Center El Paso, Paul L Foster School of Medicine, El Paso, TX
| | - Maria Ahmad
- Texas Tech University Health Sciences Center El Paso, Department of Surgery, El Paso, TX
| | - Katherine Aguirre
- Texas Tech University Health Sciences Center El Paso, Department of Surgery, El Paso, TX
| | - Sherif Elhanafi
- Texas Tech University Health Sciences Center El Paso, Department of Internal Medicine, El Paso, TX
| | - Alexander Philipovskiy
- Texas Tech Universtiy Health Sciences Center, Department of Internal Medicine, Lubbock, TX
| | - Sumit Gaur
- Texas Tech University Health Science Center, El Paso, TX
| | - Ioannis Konstantinidis
- Texas Tech University Health Sciences Center El Paso, Department of Surgery, El Paso, TX
| |
Collapse
|
5
|
Ebrahim Nakhli R, Shanker A, Sarosiek I, Boschman J, Espino K, Sigaroodi S, Al Bayati I, Elhanafi S, Sadeghi A, Sarosiek J, Zuckerman MJ, Rezaie A, McCallum RW, Schmulson MJ, Bashashati A, Bashashati M. Gastrointestinal symptoms and the severity of COVID-19: Disorders of gut-brain interaction are an outcome. Neurogastroenterol Motil 2022; 34:e14368. [PMID: 35383423 PMCID: PMC9115309 DOI: 10.1111/nmo.14368] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 02/24/2022] [Accepted: 03/17/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Many of the studies on COVID-19 severity and its associated symptoms focus on hospitalized patients. The aim of this study was to investigate the relationship between acute GI symptoms and COVID-19 severity in a clustering-based approach and to determine the risks and epidemiological features of post-COVID-19 Disorders of Gut-Brain Interaction (DGBI) by including both hospitalized and ambulatory patients. METHODS The study utilized a two-phase Internet-based survey on: (1) COVID-19 patients' demographics, comorbidities, symptoms, complications, and hospitalizations and (2) post-COVID-19 DGBI diagnosed according to Rome IV criteria in association with anxiety (GAD-7) and depression (PHQ-9). Statistical analyses included univariate and multivariate tests. RESULTS Five distinct clusters of symptomatic subjects were identified based on the presence of GI symptoms, loss of smell, and chest pain, among 1114 participants who tested positive for SARS-CoV-2. GI symptoms were found to be independent risk factors for severe COVID-19; however, they did not always coincide with other severity-related factors such as age >65 years, diabetes mellitus, and Vitamin D deficiency. Of the 164 subjects with a positive test who participated in Phase-2, 108 (66%) fulfilled the criteria for at least one DGBI. The majority (n = 81; 75%) were new-onset DGBI post-COVID-19. Overall, 86% of subjects with one or more post-COVID-19 DGBI had at least one GI symptom during the acute phase of COVID-19, while 14% did not. Depression (65%), but not anxiety (48%), was significantly more common in those with post-COVID-19 DGBI. CONCLUSION GI symptoms are associated with a severe COVID-19 among survivors. Long-haulers may develop post-COVID-19 DGBI. Psychiatric disorders are common in post-COVID-19 DGBI.
Collapse
Affiliation(s)
- Ramin Ebrahim Nakhli
- School of Biomedical EngineeringUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Aaron Shanker
- Division of GastroenterologyDepartment of MedicineTexas Tech University Health Sciences Center El PasoEl PasoTexasUSA
| | - Irene Sarosiek
- Division of GastroenterologyDepartment of MedicineTexas Tech University Health Sciences Center El PasoEl PasoTexasUSA
| | - Jeffrey Boschman
- School of Biomedical EngineeringUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Karina Espino
- Division of GastroenterologyDepartment of MedicineTexas Tech University Health Sciences Center El PasoEl PasoTexasUSA
| | - Solmaz Sigaroodi
- Division of GastroenterologyDepartment of MedicineTexas Tech University Health Sciences Center El PasoEl PasoTexasUSA
| | - Ihsan Al Bayati
- Division of GastroenterologyDepartment of MedicineTexas Tech University Health Sciences Center El PasoEl PasoTexasUSA
| | - Sherif Elhanafi
- Division of GastroenterologyDepartment of MedicineTexas Tech University Health Sciences Center El PasoEl PasoTexasUSA
| | - Amin Sadeghi
- Qatar Computing Research InstituteHamad bin Khalifa UniversityDohaQatar
| | - Jerzy Sarosiek
- Division of GastroenterologyDepartment of MedicineTexas Tech University Health Sciences Center El PasoEl PasoTexasUSA
| | - Marc J. Zuckerman
- Division of GastroenterologyDepartment of MedicineTexas Tech University Health Sciences Center El PasoEl PasoTexasUSA
| | - Ali Rezaie
- Division of GastroenterologyDepartment of MedicineGI Motility ProgramCedars‐SinaiLos AngelesCaliforniaUSA
| | - Richard W. McCallum
- Division of GastroenterologyDepartment of MedicineTexas Tech University Health Sciences Center El PasoEl PasoTexasUSA
| | - Max J. Schmulson
- Laboratory of Liver, Pancreas and Motility (HIPAM)Unit of Research in Experimental MedicineFaculty of Medicine‐Universidad Nacional Autónoma de México (UNAM)Mexico CityMexico
| | - Ali Bashashati
- School of Biomedical EngineeringUniversity of British ColumbiaVancouverBritish ColumbiaCanada,Department of Pathology and Laboratory Medicine, of the University of British ColumbiaVancouverBritish ColumbiaCanada
| | - Mohammad Bashashati
- Division of GastroenterologyDepartment of MedicineTexas Tech University Health Sciences Center El PasoEl PasoTexasUSA
| |
Collapse
|
6
|
Abstract
Acute variceal bleeding is a complication of portal hypertension, usually due to cirrhosis, with high morbidity and mortality. There are 3 scenarios for endoscopic treatment of esophageal varices: prevention of first variceal bleed, treatment of active variceal bleed, and prevention of rebleeding. Patients with cirrhosis should be screened for esophageal varices. Recommended endoscopic therapy for acute variceal bleeding is endoscopic variceal banding. Although banding is the first-choice treatment, sclerotherapy may have a role. Treatment with Sengstaken-Blakemore tube or self-expanding covered metallic esophageal stent can be used for acute variceal bleeding refractory to standard pharmacologic and endoscopic therapy.
Collapse
Affiliation(s)
- Marc J Zuckerman
- Division of Gastroenterology and Hepatology, Texas Tech University Health Sciences Center, 4800 Alberta Avenue, El Paso, TX 79905, USA.
| | - Sherif Elhanafi
- Division of Gastroenterology and Hepatology, Texas Tech University Health Sciences Center, 4800 Alberta Avenue, El Paso, TX 79905, USA
| | - Antonio Mendoza Ladd
- Division of Gastroenterology and Hepatology, Texas Tech University Health Sciences Center, 4800 Alberta Avenue, El Paso, TX 79905, USA
| |
Collapse
|
7
|
Al Bayati I, Badhiwala V, Al Obaidi S, Didia C, Zuckerman MJ, Elhanafi S. Endoscopic Treatment of Black Esophagus With Fully Covered Metallic Stent. J Investig Med High Impact Case Rep 2022; 10:23247096221084540. [PMID: 35313735 PMCID: PMC8943450 DOI: 10.1177/23247096221084540] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/25/2022] [Accepted: 02/07/2022] [Indexed: 12/02/2022] Open
Abstract
Acute esophageal necrosis (AEN) is a condition characterized by black appearance and inflammation of the esophagus. Our patient developed AEN presenting in the setting of alcohol intoxication and extensive inferior vena cava thrombosis. Esophagogastroduodenoscopy showed blood and black discoloration of the middle and lower esophagus with oozing. To control bleeding, a self-expandable fully covered metallic esophageal stent was placed. Multiple studies and reviews agree that the initial management for AEN is supportive care, resuscitation, and proton pump inhibitors to protect the esophageal mucosa from injury from acid reflux. Our case highlights the benefits of esophageal stent placement to manage AEN with active bleeding.
Collapse
Affiliation(s)
| | | | | | - Claudia Didia
- Texas Tech University Health Sciences Center,
El Paso, USA
| | | | | |
Collapse
|
8
|
Das KK, Hasak S, Elhanafi S, Visrodia KH, Ginsberg GG, Ahmad NA, Hollander T, Lang G, Kushnir VM, Mullady DK, Abu Dayyeh BK, Buttar NS, Wong Kee Song LM, Kochman ML, Chandrasekhara V. Performance and Predictors of Migration of Partially and Fully Covered Esophageal Self-Expanding Metal Stents for Malignant Dysphagia. Clin Gastroenterol Hepatol 2021; 19:2656-2663.e2. [PMID: 32898705 DOI: 10.1016/j.cgh.2020.09.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 05/22/2020] [Revised: 08/24/2020] [Accepted: 09/02/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Self-expanding metal stents (SEMS) are routinely used to palliate malignant dysphagia. However esophageal SEMS can migrate or obstruct due to epithelial hyperplasia. The aim of this study was to evaluate the rates and factors predicting migration and obstruction, and the nutritional outcomes in partially covered (pc) vs. fully covered (fc) SEMS vs. fcSEMS with antimigration fins (AF) placed for malignant dysphagia. METHODS A retrospective review of consecutive patients undergoing SEMS placement for malignant dysphagia at three academic medical centers. RESULTS Among 357 patients, there were 55 (15.4%) stent migrations, 45 (12.6%) obstructions from epithelial hyperplasia, and 20 (5.6%) food impactions. Median overall survival was 79 days (IQR 41,199). The percent weight change/change in albumin at 30 and 60 days after SEMS placement were -2.24%/-0.544 g/dL and -2.98%/-0.55 g/dL, respectively. Stent migration occurred significantly more often with fcSEMS than pcSEMS (25.3% vs 10.9%; P < .003), but there was no difference when either group was compared to fcSEMS-AF (19.3%). The overall rate of epithelial hyperplasia resulting in stent obstruction was low (12.6%) and not different between stent types. Factors associated with increased risk of SEMS migration on multivariable logistic regression included stricture traversability with a diagnostic endoscope (OR, 2.37; 95% CI, 1.29-4.35) and use of fcSEMS (OR, 2.56; 1.31-5.00) or fcSEMS-AF (OR, 2.30, 1.03-5.14). CONCLUSIONS Traversability of a malignant esophageal stenosis predicts SEMS migration. In these patients with a limited overall survival, pcSEMS are associated with lower rates of stent migration and similar rates of obstruction compared to fcSEMS.
Collapse
Affiliation(s)
- Koushik K Das
- Division of Gastroenterology, Washington University, St. Louis, Missouri.
| | - Stephen Hasak
- Division of Gastroenterology, Washington University, St. Louis, Missouri
| | - Sherif Elhanafi
- Division of Gastroenterology, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Kavel H Visrodia
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts
| | - Gregory G Ginsberg
- Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Nuzhat A Ahmad
- Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Thomas Hollander
- Division of Gastroenterology, Washington University, St. Louis, Missouri
| | - Gabriel Lang
- Division of Gastroenterology, Washington University, St. Louis, Missouri
| | - Vladimir M Kushnir
- Division of Gastroenterology, Washington University, St. Louis, Missouri
| | - Daniel K Mullady
- Division of Gastroenterology, Washington University, St. Louis, Missouri
| | - Barham K Abu Dayyeh
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Navtej S Buttar
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | | | - Michael L Kochman
- Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | |
Collapse
|
9
|
Ahmad M, Maegawa FB, Aguirre K, Elhanafi S, Chiba S, Philipovskiy A, Konstantinidis I, Tyroch AH. The Impact of Minimally Invasive Surgery and Frailty on Hepatectomy Outcomes. J Am Coll Surg 2021. [DOI: 10.1016/j.jamcollsurg.2021.07.283] [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: 11/29/2022]
|
10
|
Le E, Maegawa FB, Aguirre K, Elhanafi S, Philipovskiy A, Chiba S, Tyroch AH, Konstantinidis IT. Gastrointestinal Stromal Tumors with Liver Metastases: How Aggressive Should Treatment Be? J Am Coll Surg 2021. [DOI: 10.1016/j.jamcollsurg.2021.08.294] [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: 10/20/2022]
|
11
|
Chandrasekhara V, Elhanafi S, Storm AC, Takahashi N, Lee NJ, Levy MJ, Kaura K, Wang L, Majumder S, Vege SS, Law RJ, Abu Dayyeh BK. Predicting the Need for Step-Up Therapy After EUS-Guided Drainage of Pancreatic Fluid Collections With Lumen-Apposing Metal Stents. Clin Gastroenterol Hepatol 2021; 19:2192-2198. [PMID: 33965573 DOI: 10.1016/j.cgh.2021.05.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [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: 12/30/2020] [Revised: 04/12/2021] [Accepted: 05/03/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS A significant proportion of individuals with pancreatic fluid collections (PFCs) require step-up therapy after endoscopic drainage with lumen-apposing metal stents. The aim of this study is to identify factors associated with PFCs that require step-up therapy. METHODS A retrospective cohort study of patients undergoing endoscopic ultrasound-guided drainage of PFCs with lumen-apposing metal stents from April 2014 to October 2019 at a single center was performed. Step-up therapy included direct endoscopic necrosectomy, additional drainage site (endoscopic or percutaneous), or surgical intervention after the initial drainage procedure. Multivariable logistic regression was performed using a backward stepwise approach with a P ≤ .2 threshold for variable retention to identify factors predictive for the need for step-up therapy. RESULTS One hundred thirty-six patients were included in the final study cohort, of whom 69 (50.7%) required step-up therapy. Independent predictors of step-up therapy included: collection size measuring ≥10 cm (odds ratio [OR], 8.91; 95% confidence interval [CI], 3.36-23.61), paracolic extension of the PFC (OR, 4.04; 95% CI, 1.60-10.23), and ≥30% solid necrosis (OR, 4.24; 95% CI, 1.48-12.16). In a sensitivity analysis of 81 patients with walled-off necrosis, 51 (63.0%) required step-up therapy. Similarly, factors predictive of the need for step-up therapy for walled-off necrosis included: collection size measuring ≥10 cm (OR, 6.94; 95% CI, 1.76-27.45), paracolic extension of the PFC (OR, 3.79; 95% CI, 1.18-12.14), and ≥30% solid necrosis (OR, 7.10; 95% CI, 1.16-43.48). CONCLUSIONS Half of all patients with PFCs drained with lumen-apposing metal stents required step-up therapy, most commonly direct endoscopic necrosectomy. Individuals with PFCs ≥10 cm in size, paracolic extension, or ≥30% solid necrosis are more likely to require step-up therapy and should be considered for early endoscopic reintervention.
Collapse
Affiliation(s)
| | - Sherif Elhanafi
- Division of Gastroenterology, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Andrew C Storm
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | | | - Nam Ju Lee
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Michael J Levy
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Karan Kaura
- Department of Internal Medicine, East Carolina University, Greenville, North Carolina
| | - Lillian Wang
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Shounak Majumder
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Santhi S Vege
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Ryan J Law
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Barham K Abu Dayyeh
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
12
|
Gajendran M, Umapathy C, Perisetti A, Loganathan P, Dwivedi A, Alvarado LA, Zuckerman MJ, Goyal H, Elhanafi S. Nationwide analysis of incidence and predictors of 30-day readmissions in patients with decompensated cirrhosis. Frontline Gastroenterol 2021; 13:295-302. [PMID: 35722599 PMCID: PMC9186038 DOI: 10.1136/flgastro-2021-101850] [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: 03/22/2021] [Accepted: 06/08/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Cirrhosis is the number one cause of non-cancer deaths among gastrointestinal diseases and is responsible for significant morbidity and healthcare utilisation. The objectives were to measure the 30-day readmissions rate following index hospitalisation, to determine the predictors of readmission, and to estimate the cost of 30-day readmission in patients with decompensated cirrhosis. METHODS We performed a retrospective cohort study of patients with decompensated cirrhosis using 2014 Nationwide Readmission Database from January to November. Decompensated cirrhosis was identified based on the presence of at least one of the following: ascites, hepatic encephalopathy, variceal bleeding, spontaneous bacterial peritonitis and hepatorenal syndrome. We excluded patients less than 18 years of age, pregnant patients, patients with missing length of stay data, and those who died during the index admission. RESULTS Among 57 305 unique patients with decompensated cirrhosis, the 30-day readmission rate was 23.2%. The top three predictors of 30-day readmission were leaving against medical advice (AMA), ascites and acute kidney injury, which increased the risk of readmission by 47%, 22% and 20%, respectively. Index admission for variceal bleeding was associated with a lower 30-day readmission rate by 18%. The estimated total cost associated with 30-day readmission in our study population was US$234.4 million. CONCLUSION In a nationwide population study, decompensated cirrhosis is associated with a 30-day readmission rate of 23%. Leaving AMA, ascites and acute kidney injury are positively associated with readmission. Targeted interventions and quality improvement efforts should be directed toward these potential risk factors to reduce readmissions.
Collapse
Affiliation(s)
- Mahesh Gajendran
- Paul L Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA,Gastroenterology, UT Health San Antonio Long School of Medicine, San Antonio, Texas, USA
| | - Chandraprakash Umapathy
- Gastroenterology and Nutrition, UT Health San Antonio Long School of Medicine, San Antonio, Texas, USA
| | - Abhilash Perisetti
- Department of Gastroenterology and Hepatology, UAMS, Little Rock, Arkansas, USA
| | - Priyadarshini Loganathan
- Department of Medicine, Texas Tech University Health Sciences Center El Paso Paul L Foster School of Medicine, El Paso, Texas, USA
| | - Alok Dwivedi
- Biostatistics and Epidemiology, Texas Tech University Health Sciences Center El Paso Paul L Foster School of Medicine, El Paso, Texas, USA
| | - Luis A Alvarado
- Biostatistics and Epidemiology, Texas Tech University Health Sciences Center El Paso Paul L Foster School of Medicine, El Paso, Texas, USA
| | - Marc J Zuckerman
- Paul L Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA
| | - Hemant Goyal
- Gastroenterology, Wright Center for Graduate Medical Education, Scranton, Pennsylvania, USA
| | - Sherif Elhanafi
- Paul L Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA
| |
Collapse
|
13
|
Wang L, Elhanafi S, Storm AC, Topazian MD, Majumder S, Abu Dayyeh BK, Levy MJ, Petersen BT, Martin JA, Chari ST, Vege SS, Chandrasekhara V. Impact of disconnected pancreatic duct syndrome on endoscopic ultrasound-guided drainage of pancreatic fluid collections. Endoscopy 2021; 53:603-610. [PMID: 32629484 DOI: 10.1055/a-1213-1489] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 12/13/2022]
Abstract
BACKGROUND Endoscopic intervention for pancreatic fluid collections (PFCs) with disconnected pancreatic duct syndrome (DPDS) has been associated with failures and increased need for additional endoscopic and non-endoscopic interventions. The primary aim of this study was to determine the outcomes of endoscopic ultrasound (EUS)-guided transmural drainage of PFCs in patients with DPDS. METHODS In patients undergoing EUS-guided drainage of PFCs from January 2013 to January 2018, demographic profiles, procedural indications and details, adverse events, outcomes, and subsequent interventions were retrospectively collected. Overall treatment success was determined by PFC resolution on follow-up imaging or stent removal without recurrence. RESULTS EUS-guided drainage of PFCs was performed in 141 patients. DPDS was present in 57 of them (40 %) and walled-off necrosis was the most frequent type of PFC (55 %). DPDS was not associated with lower clinical success, increased number of repeat interventions, or increased time to PFC resolution. Patients with DPDS were more likely to be treated with permanent transmural plastic double-pigtail stents (odds ratio [OR] 6.4; 95 % confidence interval [CI] 2.5 - 16.5; P < 0.001). However, when stents were removed, DPDS was associated with increased PFC recurrence after stent removal (OR 8.0; 95 %CI 1.2 - 381.8; P = 0.04). CONCLUSIONS DPDS frequently occurs in patients with PFCs but does not negatively impact successful resolution. DPDS is associated with increased PFC recurrence after stent removal.
Collapse
Affiliation(s)
- Lillian Wang
- Division of Gastroenterology and Hepatology, Mayo Clinic at Rochester, Rochester, Minnesota, USA
| | - Sherif Elhanafi
- Division of Gastroenterology, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Andrew C Storm
- Division of Gastroenterology and Hepatology, Mayo Clinic at Rochester, Rochester, Minnesota, USA
| | - Mark D Topazian
- Division of Gastroenterology and Hepatology, Mayo Clinic at Rochester, Rochester, Minnesota, USA
| | - Shounak Majumder
- Division of Gastroenterology and Hepatology, Mayo Clinic at Rochester, Rochester, Minnesota, USA
| | - Barham K Abu Dayyeh
- Division of Gastroenterology and Hepatology, Mayo Clinic at Rochester, Rochester, Minnesota, USA
| | - Michael J Levy
- Division of Gastroenterology and Hepatology, Mayo Clinic at Rochester, Rochester, Minnesota, USA
| | - Bret T Petersen
- Division of Gastroenterology and Hepatology, Mayo Clinic at Rochester, Rochester, Minnesota, USA
| | - John A Martin
- Division of Gastroenterology and Hepatology, Mayo Clinic at Rochester, Rochester, Minnesota, USA
| | - Suresh T Chari
- Division of Gastroenterology and Hepatology, Mayo Clinic at Rochester, Rochester, Minnesota, USA
| | - Santhi S Vege
- Division of Gastroenterology and Hepatology, Mayo Clinic at Rochester, Rochester, Minnesota, USA
| | - Vinay Chandrasekhara
- Division of Gastroenterology and Hepatology, Mayo Clinic at Rochester, Rochester, Minnesota, USA
| |
Collapse
|
14
|
Jauregui A, Gajendran M, Loganathan P, Padilla A, Qiao J, Elhanafi S. Rare Distal Metastasis of Endometrial Adenocarcinoma Impersonating as Primary Colon Cancer. J Investig Med High Impact Case Rep 2021; 9:23247096211039943. [PMID: 34414815 PMCID: PMC8381418 DOI: 10.1177/23247096211039943] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/19/2021] [Accepted: 07/28/2021] [Indexed: 11/16/2022] Open
Abstract
An 89-year-old Caucasian female with a recent diagnosis of endometrial adenocarcinoma status post hysterectomy and acute deep vein thrombosis on anticoagulation presented with hematochezia. Colonoscopy revealed sigmoid colon stricture with the biopsy findings of metastatic endometrial adenocarcinoma based on positive immunohistochemistry staining for cytokeratin 7, paired box gene 8, and estrogen receptor. The oncologist referral was given to the patient for consideration of chemotherapy, but she decided to go with palliative care. Thus far, only 2 similar cases have been published in the literature. Our case exemplifies the potential for an unconventional pattern of metastasis of primary endometrial adenocarcinoma to the colon.
Collapse
Affiliation(s)
- Alexia Jauregui
- Texas Tech University Health Sciences Center,
El Paso, TX, USA
| | | | | | | | - Jesse Qiao
- Texas Tech University Health Sciences Center,
El Paso, TX, USA
| | - Sherif Elhanafi
- Texas Tech University Health Sciences Center,
El Paso, TX, USA
| |
Collapse
|
15
|
Jia Y, Michael M, Bashashati M, Elhanafi S, Dodoo C, Dwivedi AK, Carrion AF, Othman MO, Zuckerman MJ. Evaluation of the diagnostic and therapeutic utility of retrograde through-the-scope balloon enteroscopy and single-balloon enteroscopy. World J Gastrointest Endosc 2020; 12:459-468. [PMID: 33269055 PMCID: PMC7677883 DOI: 10.4253/wjge.v12.i11.459] [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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/26/2020] [Accepted: 10/26/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Retrograde single balloon enteroscopy (SBE) is a minimally invasive procedure which is less frequently performed compared with antegrade SBE. There are few studies on the retrograde through-the-scope enteroscopy (TTSE), a novel technique for evaluation of the small bowel. AIM To compare the clinical utility and safety of retrograde TTSE with retrograde SBE. METHODS Clinical data and complications of retrograde TTSE (2014-2018) and retrograde SBE (2011-2018) performed in a community hospital were reviewed and presented as mean ± SD or frequency (%) and compared using proper statistical tests. Technical success was defined as insertion of the enteroscope > 20 cm beyond ileocecal valve. RESULTS Data obtained from 54 retrograde SBE in 49 patients and 27 retrograde TTSE in 26 patients were studied. The most common indication for retrograde enteroscopy was iron deficiency anemia (41 patients) followed by gastrointestinal bleeding (37 patients), and chronic diarrhea (7 patients). The duration of retrograde SBE procedure (91.9 ± 34.2 min) was significantly longer compared with retrograde TTSE (70.5 ± 30.7 min) (P = 0.04). Technical success was comparable in TTSE [23/27 (85.2%)] and SBE [41/54 (75.9%) (P = 0.33)]. The mean depth of insertion beyond the ileocecal valve in retrograde SBE (92.5 ± 70.0 cm) tended to be longer compared with retrograde TTSE (64.6 ± 49.0 cm) (P = 0.08). No complication was observed in this study. CONCLUSION Both retrograde TTSE and retrograde SBE are feasible and safe. Retrograde TTSE takes a shorter time and has a comparable technical success with SBE. TTSE has a lower capacity of small bowel insertion.
Collapse
Affiliation(s)
- Yi Jia
- Division of Gastroenterology, Department of Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX 79905, United States
| | - Majd Michael
- Division of Gastroenterology, Department of Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX 79905, United States
| | - Mohammad Bashashati
- Division of Gastroenterology, Department of Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX 79905, United States
| | - Sherif Elhanafi
- Division of Gastroenterology, Department of Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX 79905, United States
| | - Christopher Dodoo
- Biostatistics and Epidemiology Consulting Lab, Office of Research Resources and Division of Biostatistics and Epidemiology, Department of Molecular and Translational Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX 79905, United States
| | - Alok K Dwivedi
- Biostatistics and Epidemiology Consulting Lab, Office of Research Resources and Division of Biostatistics and Epidemiology, Department of Molecular and Translational Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX 79905, United States
| | - Andres F Carrion
- Division of Gastroenterology and Hepatology, University of Miami Miller School of Medicine, Miami, FL 33136, United States
| | - Mohamed O Othman
- Department of Internal Medicine, Baylor College of Medicine, Houston, TX 77082, United States
| | - Marc J Zuckerman
- Division of Gastroenterology, Department of Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX 79905, United States
| |
Collapse
|
16
|
Abstract
Coronaviruses have caused three global outbreaks in the last 20 years, which include Severe Acute Respiratory Syndrome (SARS) caused by SARS-CoV (SARS-CoV-1), Middle East Respiratory Syndrome (MERS) by MERS-CoV and Coronavirus Disease-2019 (COVID-19) due to SARS-CoV-2. These outbreaks share many similarities, including clinical presentation, transmission, and management. Although respiratory manifestations are responsible for most of the morbidity and mortality in these conditions, extra-pulmonary manifestations such as gastrointestinal symptoms are also increasingly recognized as important symptoms. Important gastrointestinal symptoms include nausea, vomiting, anorexia, diarrhea, and abdominal pain. Hepatic manifestations such as abnormal aminotransferases are also noted in these patients. Early identification of GI symptoms is crucial as some patients can present only with GI manifestations in the absence of pulmonary symptoms. Furthermore, patients with diarrhea have tested positive for viral RNA in the stool. This has been reported even after the resolution of respiratory symptoms and can extend up to many days from the onset of symptoms. Because of this phenomenon, there is a theoretical risk of fecal-oral transmission and the potential spread of the disease. Though GI symptoms are frequently observed, understanding the pathogenesis of these symptoms is crucial, as it can not only of public health importance but could also identify infected patients early in the spread. Understanding the different GI and hepatic manifestations with underlying mechanisms of symptoms can assist in the therapeutic management of these patients. In this article, we summarize various GI and hepatic manifestations with their prevalence, underlying pathophysiology with emphasis on stool positivity.
Collapse
Affiliation(s)
- Abhilash Perisetti
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
| | - Mahesh Gajendran
- Department of Internal Medicine, Texas Tech University, Paul L Foster School of Medicine, El Paso, Texas 79905, USA.
| | - Rupinder Mann
- Department of Internal Medicine, Saint Agnes Medical Center, 1303 E Herndon Ave, Fresno, CA 93730, USA.
| | - Sherif Elhanafi
- Division of Gastroenterology and Hepatology, Texas Tech University, Paul L Foster School of Medicine, El Paso, Texas 79905, USA.
| | - Hemant Goyal
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, The Wright Center of Graduate Medical Education, Scranton, Pennsylvania, USA.
| |
Collapse
|
17
|
Elhanafi S, Mahmud N, Vergara N, Kochman ML, Das KK, Ginsberg GG, Rajala M, Chandrasekhara V. Comparison of endoscopic ultrasound tissue acquisition methods for genomic analysis of pancreatic cancer. J Gastroenterol Hepatol 2019; 34:907-913. [PMID: 30422342 PMCID: PMC6497552 DOI: 10.1111/jgh.14540] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [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: 09/04/2018] [Revised: 10/11/2018] [Accepted: 11/04/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIM Tumor genotyping may allow for improved prognostication and targeted therapy for pancreatic ductal adenocarcinoma (PDAC). We aimed to compare endoscopic ultrasonography (EUS) with fine needle aspiration (FNA) to fine needle biopsy (FNB) for obtaining sufficient tissue for genomic analysis and theranostic potential. METHODS A retrospective cohort study of patients that underwent EUS-FNA or EUS-FNB with either positive or suspicious cytology for PDAC between March 2016 and December 2017. Demographic, procedural, and cytology data were recorded. Genetic alterations were recorded, and Kaplan-Meier survival curves were calculated. RESULTS The study included 167 patients: 145 patients had FNA and 22 patients underwent FNB. Overall, 117 samples (70.1%) were sufficient for targeted next-generation sequencing. FNB resulted in a higher proportion of patients with sufficient samples compared with FNA (90.9% vs 66.9%; P = 0.02). In multivariable modeling, only FNB (odds ratio 4.95, 95% confidence interval 1.11-22.05, P = 0.04) was associated with sufficient sampling for genomic testing. FNB was more likely to obtain sufficient tissue from tumors ≤ 3 cm (100% vs 68.4%, P = 0.017) and tumors located in the head/neck of the pancreas (100% vs 63.1%, P = 0.03) compared with FNA. The most commonly identified alterations were in KRAS (88%), TP53 (68%), and SMAD4 (16%). CONCLUSIONS Endoscopic ultrasonography can reliably obtain sufficient tissue from PDAC for targeted genomic sequencing for prognostication and theranostics. FNB should be considered when tumor genotyping is requested, especially for tumors ≤ 3 cm or tumors located in the head/neck of the pancreas.
Collapse
Affiliation(s)
- Sherif Elhanafi
- Division of Gastroenterology, Department of Medicine, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Nadim Mahmud
- Division of Gastroenterology, Department of Medicine, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Norge Vergara
- Department of Clinical Pathology and Laboratory Medicine, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Michael L Kochman
- Division of Gastroenterology, Department of Medicine, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Koushik K Das
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, Massachusetts, USA
| | - Gregory G Ginsberg
- Division of Gastroenterology, Department of Medicine, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Michael Rajala
- Division of Gastroenterology, Department of Medicine, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Vinay Chandrasekhara
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
18
|
Al-Bayati I, Saadi M, Elhanafi S, McCallum RW. Effectiveness of Bulking Agent (Solesta) Therapy in Fecal Incontinence in Patients Refractory to Conventional Therapies. Am J Med Sci 2017; 354:476-479. [DOI: 10.1016/j.amjms.2017.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 08/28/2017] [Accepted: 09/03/2017] [Indexed: 01/14/2023]
|
19
|
Abdelfatah MM, Elhanafi S, Zuckerman MJ, Othman MO. Correlation between adenoma detection rate and novel quality indicators for screening colonoscopy. A proposal for quality measures tool kit. Scand J Gastroenterol 2017. [PMID: 28643529 DOI: 10.1080/00365521.2017.1339827] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Adenoma detection rate (ADR) is the most validated quality indicator for colonoscopy. Calculating ADR may not yield information in regards to advanced adenoma detection rate (advanced ADR). In addition, calculating ADR for individual endoscopists cannot distinguish between those who find only one versus more than one adenoma per colonoscopy. Several novel quality indictors were recently proposed to ensure adequate assessment of quality during colonoscopy. Our study aims to determine the correlation between ADR and novel quality indicators. METHODS A retrospective cohort study of patients undergoing screening colonoscopy in a university hospital setting. Patient characteristics and colonoscopy findings were combined and analyzed to calculate the correlation of ADR with novel quality indicators using Spearman's rank-order correlation were used. RESULTS A total of 1433 patients out of 2116 patients met the inclusion criteria. There was a significant positive correlation between ADR correlated with [advanced-ADR-2, nonadvanced-ADR, adenoma per colonoscopy, Multiplicity detection rate and ADR-Plus] r = (0.82, 0.99, 0.99, 0.07 and 0.85), respectively. However, ADR did not correlate with advanced-ADR and adenomas per positive participant. CONCLUSION Adding advanced-ADR and adenomas per positive participant to ADR may create a more comprehensive quality indicators tool kit, which is sensitive and difficult to game. Future studies are needed to investigate the impact of the tool kit on the interval cancers and adenoma missing rate.
Collapse
Affiliation(s)
- Mohamed M Abdelfatah
- a Division of Gastroenterology, Department of Internal Medicine , East Carolina University , Greenville , NC , USA
| | - Sherif Elhanafi
- b Gastroenterology and Hepatology Section , University of Pennsylvania , Philadelphia , PA , USA
| | - Marc J Zuckerman
- c Division of Gastroenterology, Department of Internal Medicine, Paul L. Foster School of Medicine , Texas Tech University Health Sciences Center , El Paso , TX , USA
| | - Mohamed O Othman
- d Gastroenterology and Hepatology Section , Baylor College of Medicine , Houston , TX , USA
| |
Collapse
|
20
|
Yandrapu H, Elhanafi S, Chowdhury F, Liu J, Onate EJ, Dwivedi A, Othman MO. Impact of introduction of endoscopic ultrasound on volume, success, and complexity of endoscopic retrograde cholangiopancreatography in a tertiary referral center. Endosc Ultrasound 2017; 6:252-256. [PMID: 28663529 PMCID: PMC5579911 DOI: 10.4103/2303-9027.190922] [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: 11/04/2022] Open
Abstract
Background and Objectives: Endoscopic ultrasound (EUS) is commonly used to examine pancreaticobiliary disorders. We hypothesize that the introduction of EUS service may change the pattern and the complexity of endoscopic retrograde cholangiopancreatographies (ERCPs) performed. The aim of this study is to assess the impact of introducing EUS on the volume, success, and complexity of ERCP. Materials and Methods: This is a single-center retrospective data review of ERCP procedures done “before” and “after” the introduction of EUS (before EUS and after EUS). Patients' demographics, ERCP indications, types of sedation, therapeutic interventions, outcomes, complications, and complexity of ERCP were collected. The categorical and continuous variables were compared using Fisher's exact test and the unpaired t-test, respectively. Multivariable logistic regression analysis was used to compare ERCP outcomes. Results: A total of 945 ERCPs performed over a 3-year period between January 2010 and January 2013 (411 and 534 in the “before EUS” and “after EUS” time periods, respectively) were included in this study. There was a 30% relative increase in the volume of ERCPs after the introduction of EUS. ERCP success rate was higher after the introduction of EUS, even after adjusting the complexity grade [odds ratio (OR) = 4.54, P = 0.001]. Significant increase in the complexity of ERCP was observed after the introduction of EUS service. The OR of performing grade 4 ERCP was 4.44 (P = 0.0005) after the introduction of EUS. Conclusions: The introduction of a new EUS service in our tertiary referral university medical center is associated with an increase in the volume, success, and complexity of ERCP procedures. EUS expertise may be valuable for better ERCP outcomes.
Collapse
Affiliation(s)
- Harathi Yandrapu
- Department of Internal Medicine, Texas Tech University of Health Sciences, El Paso, Texas, USA
| | - Sherif Elhanafi
- Department of Internal Medicine, Texas Tech University of Health Sciences, El Paso, Texas, USA
| | - Farhanaz Chowdhury
- Department of Internal Medicine, Texas Tech University of Health Sciences, El Paso, Texas, USA
| | - Jiayang Liu
- Department of Internal Medicine, Texas Tech University of Health Sciences, El Paso, Texas, USA
| | - Eduardo J Onate
- Department of Internal Medicine, Texas Tech University of Health Sciences, El Paso, Texas, USA
| | - Alok Dwivedi
- Department of Internal Medicine, Texas Tech University of Health Sciences, El Paso, Texas, USA
| | - Mohamed O Othman
- Department of Internal Medicine, Texas Tech University of Health Sciences, El Paso; Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine, Houston, Texas, USA
| |
Collapse
|
21
|
Mendoza Ladd A, Jia Y, Yu C, Elhanafi S, Dwivedi A, Liu J, Song G, Hall M, Zuckerman MJ. Demographic and Clinical Characteristics of a Predominantly Hispanic Population with Inflammatory Bowel Disease on the US-Mexico Border. South Med J 2017; 109:792-797. [PMID: 27911976 DOI: 10.14423/smj.0000000000000571] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Information regarding Hispanics with inflammatory bowel disease (IBD) is scarce. In this study we aimed to describe a predominantly Hispanic population with IBD in a city located along the US-Mexico border and to identify clinical or demographic differences between Hispanics and non-Hispanics. METHODS Retrospective cohort analysis of patients with IBD between 2003 and 2013 at a tertiary care center. Information collected included age, sex, ethnicity, diagnosis, diagnosis status (new vs old), endoscopic extent of disease (EOD), extraintestinal manifestations, medical treatment, and surgeries performed. Continuous and categorical variables were compared using a two-sided unpaired t test/Wilcoxon rank sum test and the Fisher exact test, respectively. Results with P ≤ 5% were considered statistically significant. RESULTS Hispanics accounted for 71% of the population sample. A total of 141 patients (68%) were diagnosed as having ulcerative colitis (UC) and 67 (32%) as having Crohn disease (CD). The only statistically significant differences between Hispanics and non-Hispanics were older age at diagnosis and a higher proportion of new diagnoses in Hispanics with CD (P = 0.008 and 0.009, respectively) The most common EOD in patients with UC was extensive colitis, whereas isolated colonic disease predominated in CD, regardless of ethnicity. Immunomodulators and biologics were used in 3% and 1% of cases, respectively. Treatment regimens were similar in both ethnic groups. Patients with CD were more likely than those with UC to have undergone surgery (27% vs 11%, P = 0.004). Surgery rates did not differ between Hispanics and non-Hispanics. CONCLUSIONS In our population, UC was more common than CD, and the EOD of both conditions differed from the one previously described in other Hispanic populations in the United States. The use of immunomodulators and biologics is the lowest reported to date in the country. No clinically relevant differences were seen between Hispanics and non-Hispanics.
Collapse
Affiliation(s)
- Antonio Mendoza Ladd
- From the Department of Medicine, Division of Gastroenterology, the Division of Biostatistics & Epidemiology, and the Division of Biostatistics, Texas Tech University Health Sciences Center at El Paso, and the Paul L. Foster School of Medicine, Texas Tech University, El Paso
| | - Yi Jia
- From the Department of Medicine, Division of Gastroenterology, the Division of Biostatistics & Epidemiology, and the Division of Biostatistics, Texas Tech University Health Sciences Center at El Paso, and the Paul L. Foster School of Medicine, Texas Tech University, El Paso
| | - Christine Yu
- From the Department of Medicine, Division of Gastroenterology, the Division of Biostatistics & Epidemiology, and the Division of Biostatistics, Texas Tech University Health Sciences Center at El Paso, and the Paul L. Foster School of Medicine, Texas Tech University, El Paso
| | - Sherif Elhanafi
- From the Department of Medicine, Division of Gastroenterology, the Division of Biostatistics & Epidemiology, and the Division of Biostatistics, Texas Tech University Health Sciences Center at El Paso, and the Paul L. Foster School of Medicine, Texas Tech University, El Paso
| | - Alok Dwivedi
- From the Department of Medicine, Division of Gastroenterology, the Division of Biostatistics & Epidemiology, and the Division of Biostatistics, Texas Tech University Health Sciences Center at El Paso, and the Paul L. Foster School of Medicine, Texas Tech University, El Paso
| | - Jiayang Liu
- From the Department of Medicine, Division of Gastroenterology, the Division of Biostatistics & Epidemiology, and the Division of Biostatistics, Texas Tech University Health Sciences Center at El Paso, and the Paul L. Foster School of Medicine, Texas Tech University, El Paso
| | - Giangqing Song
- From the Department of Medicine, Division of Gastroenterology, the Division of Biostatistics & Epidemiology, and the Division of Biostatistics, Texas Tech University Health Sciences Center at El Paso, and the Paul L. Foster School of Medicine, Texas Tech University, El Paso
| | - Mark Hall
- From the Department of Medicine, Division of Gastroenterology, the Division of Biostatistics & Epidemiology, and the Division of Biostatistics, Texas Tech University Health Sciences Center at El Paso, and the Paul L. Foster School of Medicine, Texas Tech University, El Paso
| | - Marc J Zuckerman
- From the Department of Medicine, Division of Gastroenterology, the Division of Biostatistics & Epidemiology, and the Division of Biostatistics, Texas Tech University Health Sciences Center at El Paso, and the Paul L. Foster School of Medicine, Texas Tech University, El Paso
| |
Collapse
|
22
|
Sumayin Ngamdu K, El Mallah W, Dwivedi A, Mohsin R, Elhanafi S, Jia Y, Alvarado LA, Mukherjee D, Zuckerman MJ. One-Year Survival is Not Affected by Gastrointestinal Bleeding After Percutaneous Coronary Interventions. Am J Med Sci 2017; 353:381-386. [DOI: 10.1016/j.amjms.2017.01.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 01/21/2017] [Accepted: 01/30/2017] [Indexed: 10/20/2022]
|
23
|
Othman MO, Abdelfatah MM, Padilla O, Hussinat M, Elhanafi S, Eloliby M, Torabi A, Hakim N, Boman DA. The cellularity yield of three different 22-gauge endoscopic ultrasound fine needle aspiration needles. Diagn Cytopathol 2017; 45:426-432. [PMID: 28261978 DOI: 10.1002/dc.23689] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 02/02/2017] [Accepted: 02/06/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Endoscopic ultrasound (EUS) fine needle aspiration (FNA) is an integral part in the diagnosis of pancreatic, intestinal and extra-intestinal masses or lesions. There is no clear data on the superiority of the core biopsy needle over standard 22-gauge needles. The aim of this study is to prospectively compare the cellularity yield of three commonly used 22-gauge FNA needles available in the US market. METHODS This is a prospective, randomized study comparing the cellularity yield of three commercially available EUS needles (two standard FNA needles and core biopsy needle). Two blinded pathologists evaluated the cytology specimens based on an already agreed upon cytology score. We included adult patients (18-80 years old) who presented to our endoscopy unit for FNA of pancreatic or extrapancreatic masses. RESULTS 109 patients (57 F, 52 M) were recruited to the study, 88 lesions were pancreatic lesions. 39 patients were recruited in the EZ Shot 2™ group, 36 in the Procore® group and 34 in the Expect™ group. The average cellularity score and the mean number of passes (SD) were not different between the three needles; P = 0.91 and P = 0.16, respectively. There was no difference between the three needles in obtaining an onsite diagnosis (P = 0.627) and no difference in reported adverse events between the three groups. CONCLUSION The cellularity yields, the mean number of passes and reported adverse events were similar in the three compared 22-gauge needles. Diagn. Cytopathol. 2017;45:426-432. © 2017 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Mohamed O Othman
- Gastroenterology and Hepatology Section, Baylor College of Medicine, Houston, Texas
| | - Mohamed M Abdelfatah
- Division of Gastroenterology, Department of Internal Medicine, East Carolina University, Greenville, North Carolina
| | - Osvaldo Padilla
- Department of Pathology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Maha Hussinat
- Gastroenterology and Hepatology Section, Baylor College of Medicine, Houston, Texas
| | - Sherif Elhanafi
- Division of Gastroenterology, Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Mohamed Eloliby
- Division of Gastroenterology, Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Alireza Torabi
- Division of Gastroenterology, Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Nawar Hakim
- Division of Gastroenterology, Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Darius A Boman
- Division of Gastroenterology, Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
| |
Collapse
|
24
|
Elhanafi S, Chhana R, Mallawaarachchi I, Lou W, Rangel G, Fang H, Patel R, Dwivedi AK, Zuckerman MJ, Othman MO. Effects of Starting a Gastroenterology Fellowship Training Program on Quality Measures of Colonoscopy. South Med J 2017; 110:200-206. [DOI: 10.14423/smj.0000000000000614] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
25
|
Othman MO, Zhang D, Elhanafi S, Eloliby M, Davis B, Guererro R, Alvarado L, Sanchez L, Dwivedi A, Zuckerman MJ. Cap-Assisted Colonoscopy Increases Detection of Advanced Adenomas and Polyps. Am J Med Sci 2017; 353:367-373. [PMID: 28317624 DOI: 10.1016/j.amjms.2017.01.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 01/29/2017] [Accepted: 01/30/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Cap-assisted colonoscopy (CAC) has been reported to increase the adenoma detection rate (ADR) in Asian population. However, CAC trials in non-Asian population have had conflicting results. Studies in North America have shown an improvement in ADRs with the use of CAC, but it mainly included white and African American patients. Given the lack of prospective studies of CAC in Hispanics, we conducted this randomized controlled trial. MATERIALS AND METHODS This is a randomized controlled trial comparing CAC with standard colonoscopy (SC) in patients undergoing screening or surveillance colonoscopy. Our primary outcome was the ADR. Secondary outcomes were polyp detection rate, mean polyp and ADR, advanced ADR (AADR) and detection rates based on polyp morphology and location. RESULTS A total of 440 patients were included in the study (88.5% Hispanic). Cecal and terminal ileum intubation rates were similar in both groups (CAC: 97% and 86% versus SC: 99% and 81%, respectively). CAC did not improve ADR in comparison with SC (0.65 versus 0.52; P = 0.079); however, CAC had a higher AADR in comparison with SC (9.9% versus 4.6%; P = 0.049). CAC detected significantly more pedunculated polyps as compared with flat and sessile polyps (P = 0.011). Complication rates were similar in the CAC and SC groups (0.9% versus 0%). CONCLUSIONS In a predominantly Hispanic population, no difference was seen in the mean ADR with the use of CAC. However, CAC, when compared with SC, resulted in an increased AADR and mean polyp detection rate.
Collapse
Affiliation(s)
- Mohamed O Othman
- Department of Medicine, Baylor College of Medicine, Houston, Texas.
| | - Daniel Zhang
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Sherif Elhanafi
- Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Mohamed Eloliby
- Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Brian Davis
- Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Richard Guererro
- Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Luis Alvarado
- Department of Biomedical Sciences, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Linda Sanchez
- Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Alok Dwivedi
- Department of Biomedical Sciences, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Marc J Zuckerman
- Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
| |
Collapse
|
26
|
Affiliation(s)
- Sherif Elhanafi
- Division of Gastroenterology, University of Pennsylvania, Philadelphia, PA, USA
| | - Vinay Chandrasekhara
- Division of Gastroenterology, University of Pennsylvania, Philadelphia, PA, USA.,Wilmott-Barna Center for Endoscopic Education, Innovation, & Training, University of Pennsylvania, Philadelphia, PA, USA
| | - James H Tabibian
- Division of Gastroenterology, University of Pennsylvania, Philadelphia, PA, USA.,Wilmott-Barna Center for Endoscopic Education, Innovation, & Training, University of Pennsylvania, Philadelphia, PA, USA.,Division of Gastroenterology and Hepatology, UC Davis Medical Center, Sacramento, CA
| |
Collapse
|
27
|
Moraveji S, Bashashati M, Elhanafi S, Sunny J, Sarosiek I, Davis B, Torabi A, McCallum RW. Depleted interstitial cells of Cajal and fibrosis in the pylorus: Novel features of gastroparesis. Neurogastroenterol Motil 2016; 28:1048-54. [PMID: 26940535 DOI: 10.1111/nmo.12806] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [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: 10/22/2015] [Accepted: 01/27/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Depletion and ultrastructural changes of interstitial cells of Cajal (ICC) in the gastric body and antrum have been observed in gastroparesis. This research was performed to investigate the ICC population in the muscularis propria and fibrosis of the muscular layer of the pylorus in gastroparesis. METHODS Full thickness pyloric and antral biopsies were obtained from 17 gastroparetic and 6 non-gastroparetic controls. Biopsies were stained with C-Kit for ICC and Trichrome for collagen fibrosis. Interstitial cells of Cajal depletion in the antrum was defined as mean ICC count <10 per 20 high power fields (HPF) based on established data. KEY RESULTS The average pyloric ICC count was ≥10/HPF in the control patients. Twelve (70.5%) gastroparetic patients had pyloric ICC loss. Only five patients (29.4%) had ICC loss in the antrum. Gastric emptying (GE) was not significantly different in patients with depleted vs normal pyloric ICC. However, GE at 2 h was slower in patients with antral ICC <10/HPF compared to those with normal antral ICC populations. Collagen fibrosis was observed in the pylorus of 14 (82.3%) patients. Inclusion bodies in the muscularis propria of the pylorus were identified in four patients, all with diabetic gastroparesis. CONCLUSIONS & INFERENCES In gastroparetic patients, ICC loss in the pylorus is twice as common as in the antrum and fibrosis in the pyloric smooth muscle is nearly three times more common than the antrum. These findings can provide one explanation for pyloric dysfunction which is a contributing factor to the pathophysiology of gastroparesis.
Collapse
Affiliation(s)
- S Moraveji
- Department of Internal Medicine, Texas Tech University Health Sciences Center/Paul L. Foster School of Medicine, El Paso, TX, USA
| | - M Bashashati
- Division of Gastroenterology, Department of Internal Medicine, Texas Tech University Health Sciences Center/Paul L. Foster School of Medicine, El Paso, TX, USA
| | - S Elhanafi
- Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - J Sunny
- Division of Gastroenterology, Department of Internal Medicine, Texas Tech University Health Sciences Center/Paul L. Foster School of Medicine, El Paso, TX, USA
| | - I Sarosiek
- Division of Gastroenterology, Department of Internal Medicine, Texas Tech University Health Sciences Center/Paul L. Foster School of Medicine, El Paso, TX, USA
| | - B Davis
- Department of Surgery, Texas Tech University Health Sciences Center/Paul L. Foster School of Medicine, El Paso, TX, USA
| | - A Torabi
- Department of Pathology, Texas Tech University Health Sciences Center/Paul L. Foster School of Medicine, El Paso, TX, USA
| | - R W McCallum
- Division of Gastroenterology, Department of Internal Medicine, Texas Tech University Health Sciences Center/Paul L. Foster School of Medicine, El Paso, TX, USA
| |
Collapse
|
28
|
Othman MO, Guerrero R, Elhanafi S, Davis B, Hernandez J, Houle J, Mallawaarachchi I, Dwivedi AK, Zuckerman MJ. A prospective study of the risk of bacteremia in directed cholangioscopic examination of the common bile duct. Gastrointest Endosc 2016; 83:151-7. [PMID: 26116469 DOI: 10.1016/j.gie.2015.05.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 05/06/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS The frequency of bacteremia during ERCP with cholangioscopy has not been well studied. There are no formal guidelines regarding antibiotic prophylaxis before ERCP with cholangioscopy. The aim was to estimate the frequency of bacteremia and subsequent infectious adverse events after ERCP with cholangioscopy. METHODS This prospective nonrandomized study performed in a single tertiary referral center included adult patients who were undergoing ERCP with cholangioscopic examination of the common bile duct. Blood cultures were drawn from patients before the procedure and 5 and 30 minutes after the procedure. Antibiotics were not given before or after the procedure. Patients were followed up after 24 hours and 1 week after the procedure for infectious adverse events. The primary outcome was bacteremia rate, and secondary outcomes were cholangitis rate and adverse events. RESULTS Fifty-seven patients were enrolled in the study with 60 procedures performed. The first procedure from each patient was considered in the analysis, and thus we included 57 patients with 57 procedures in this study analysis. Postprocedure bacteremia was seen in 5 of 57 procedures (8.8%; 95% confidence interval, 2.9%-19.3%). Four patients were readmitted with cholangitis (7.0%). Bacteremia was more common in patients who had cholangioscopy with biopsy sampling compared with patients who had cholangioscopy without biopsy sampling (P = .011). Cholangitis was significantly more common in patients with bacteremia than in those patients with a negative blood culture (P = .035). CONCLUSION ERCP with cholangioscopy is associated with a bacteremia rate of 8.8% and a cholangitis rate of 7.0%. Preprocedural antibiotics may be considered before cholangioscopy, especially if tissue acquisition with biopsy sampling is expected. ( CLINICAL TRIAL REGISTRATION NUMBER NCT01673269.).
Collapse
Affiliation(s)
- Mohamed O Othman
- Gastroenterology and Hepatology Section, Department of Internal Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Richard Guerrero
- Division of Gastroenterology, Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Sherif Elhanafi
- Division of Gastroenterology, Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Brian Davis
- Division of Gastroenterology, Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Jesus Hernandez
- Division of Gastroenterology, Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Jennifer Houle
- Division of Gastroenterology, Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Indika Mallawaarachchi
- Division of Biostatistics & Epidemiology, Department of Biomedical Sciences, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Alok Kumar Dwivedi
- Division of Biostatistics & Epidemiology, Department of Biomedical Sciences, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Marc J Zuckerman
- Division of Gastroenterology, Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| |
Collapse
|
29
|
Jia Y, Dwivedi A, Elhanafi S, Ortiz A, Othman M, Zuckerman M. Low risk of bacteremia after endoscopic variceal therapy for esophageal varices: a systematic review and meta-analysis. Endosc Int Open 2015; 3:E409-17. [PMID: 26528494 PMCID: PMC4612236 DOI: 10.1055/s-0034-1392552] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 12/29/2014] [Accepted: 05/07/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND STUDY AIMS Endoscopic variceal ligation (EVL) and endoscopic variceal sclerotherapy (EVS) are the main therapeutic procedures for the emergency treatment and secondary prophylaxis of esophageal varices in cirrhotics. Post-endoscopic bacteremia has been reported after EVS and EVL, but data on the frequency of bacteremia are conflicting. This study aims to provide incidences of bacteremia after EVS and EVL in different settings through meta-analysis. METHODS Only prospective or randomized studies were included in this meta-analysis. Binomial distribution was used to compute variance for each study. Random effects models were used as the final model for estimating the effect size and 95 % confidence interval. Adjusted effects were obtained using meta-regression analysis. RESULTS Nineteen prospective studies involving 1001 procedures in 587 patients were included in the meta-analysis on the risk of bacteremia after EVS or EVL in cirrhotics with esophageal varices. The frequency of bacteremia after endoscopic variceal therapy was 13 %. The frequency of bacteremia after EVS (17 %) was higher than after EVL (6 %) with no statistically significant difference (P = 0.106). The frequency of bacteremia after elective EVS (14 %) was significantly less than after emergency EVS (22 %) (P < 0.001). The frequency of bacteremia after elective EVL (7.6 %) was not significantly different from after emergency EVL (3.2 %) (P = 0.850). CONCLUSIONS The incidence of bacteremia is low in patients with cirrhosis and varices after esophageal variceal therapy. These results are consistent with our current guidelines that antibiotic prophylaxis before endoscopic variceal therapy is only necessary for bleeding patients.
Collapse
Affiliation(s)
- Yi Jia
- Division of Gastroenterology, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Alok Dwivedi
- Division of Biostatistics & Epidemiology, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Sherif Elhanafi
- Division of Gastroenterology, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Arleen Ortiz
- Division of Gastroenterology, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Mohamed Othman
- Division of Gastroenterology, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Marc Zuckerman
- Division of Gastroenterology, Texas Tech University Health Sciences Center, El Paso, Texas, USA,Corresponding author Marc J. Zuckerman, MD Division of GastroenterologyTexas Tech University Health Sciences Center4800 Alberta AvenueEl PasoTexas 79905USA+1-915-545-6634
| |
Collapse
|
30
|
Abstract
Patients with pre-diabetes have a tenfold higher risk of developing Type 2 DM and a twofold higher risk of developing coronary heart disease compared to non-diabetics. Interventions targeted at those in an early stage of impaired glucose metabolism can delay or prevent diabetes. Effects of these interventions on cardiovascular outcome are unknown. This article aims to review current and available data on lifestyle intervention, specifically physical activity, on cardiovascular outcomes in populations at risk for diabetes. We searched PubMed database from 1990 to present with focus on more recent literature published over the last 2 years. Various permutations of keywords used included glucose intolerance, pre-diabetes, diabetes, lifestyle modifications, physical activity, and cardiovascular disease. Intensive glycemic control, specific medications, and lifestyle intervention including increase in physical activity have been evaluated in diabetes and pre-diabetes. Most studies we reviewed showed that these interventions prevented progression of pre-diabetes to diabetes and improved cardiovascular risk surrogate measures. Direct decrease in cardiovascular mortality, non-fatal stroke, and non-fatal myocardial infarctions was shown in one recent trial. Increase in physical activity has a positive effect on decreasing cardiovascular risk by modifying several important risk factors and may decrease risk of events in pre-diabetics. More randomized high power trials are needed to verify and characterize these effects.
Collapse
Affiliation(s)
- Maryna Popp Switzer
- Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, 79905, USA
| | | | | |
Collapse
|
31
|
Elhanafi S, Saadi M, Lou W, Mallawaarachchi I, Dwivedi A, Zuckerman M, Othman MO. Gastric polyps: Association with Helicobacter pylori status and the pathology of the surrounding mucosa, a cross sectional study. World J Gastrointest Endosc 2015; 7:995-1002. [PMID: 26265993 PMCID: PMC4530333 DOI: 10.4253/wjge.v7.i10.995] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 04/22/2015] [Accepted: 07/08/2015] [Indexed: 02/05/2023] Open
Abstract
AIM: To assess the endoscopic characteristics of gastric polyps and their association with Helicobacter pylori (H. pylori) status in a predominantly Hispanic population.
METHODS: We conducted a retrospective study of all esophagogastroduodenoscopies performed at our institution. Demographic, endoscopic and histopathological data were reviewed. Categorization of patients into Hispanic and Non-Hispanic was based on self-identification. Patients without resection/biopsy were not included in the analysis. Identification of polyps type was based on histological examination. One way analysis of variance was used to compare continuous variables among different polyp types and Fisher’s exact test was used compare categorical variables among polyp types. Unadjusted and adjusted comparisons of demographic and clinical characteristics were performed according to the H. pylori status and polyp type using logistic regressions.
RESULTS: Of 7090 patients who had upper endoscopy, 335 patients had gastric polyps (4.7%). Resection or biopsy of gastric polyps was performed in 296 patients (88.4%) with a total of 442 polyps removed or biopsied. Of 296 patients, 87 (29%) had hyperplastic polyps, 82 (28%) had fundic gland polyps and 5 (1.7%) had adenomatous polyps. Hyperplastic polyps were significantly associated with positive H. pylori status compared with fundic gland polyps (OR = 4.621; 95%CI: 1.92-11.13, P = 0.001). Hyperplastic polyps were also found to be significantly associated with portal hypertensive gastropathy compared with fundic gland polyps (OR = 6.903; 95%CI: 1.41-33.93, P = 0.0174). Out of 296 patients, 30 (10.1%) had a follow-up endoscopy with a mean duration of 26 ± 16.3 mo. Interval development of cancer was not noted in any of the patients during follow up period.
CONCLUSION: Gastric hyperplastic polyps were significantly associated with positive H. pylori status and portal hypertensive gastropathy as compared with fundic gland polyps.
Collapse
|
32
|
Rambod M, Elhanafi S, Mukherjee D. Response to: Brugada phenocopy: morphological classification and importance of provocative testing. Ann Noninvasive Electrocardiol 2014; 19:606. [PMID: 25267162 DOI: 10.1111/anec.12201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Mehdi Rambod
- Division of Cardiology, University of Vermont College of Medicine, Burlington, VT
| | | | | |
Collapse
|
33
|
Abstract
Brugada phenocopy describes conditions with Brugada-like ECG pattern but without true congenital Brugada syndrome. We report a case of 44-year-old man with no known medical history who presented with loss of consciousness. Toxicology screening was positive for opiates and high serum alcohol level. His initial ECG showed Brugada type 1 pattern which resolved after several hours of observation and treatment with continuous naloxone infusion. Patient regained his consciousness and disclosed heroin abuse and drinking alcohol. This case highlights the heroin overdose as a possible cause of Brugada phenocopy.
Collapse
Affiliation(s)
- Mehdi Rambod
- Division of Cardiology, Department of Internal Medicine, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, El Paso, Texas
| | | | | |
Collapse
|
34
|
Cooper CJ, Teleb M, Elhanafi S, Ajmal S, Hernandez GT. Bird fanciers' lung induced by exposure to duck and goose feathers. Am J Case Rep 2014; 15:155-8. [PMID: 24753784 PMCID: PMC3992218 DOI: 10.12659/ajcr.890184] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 12/20/2013] [Indexed: 11/09/2022]
Abstract
PATIENT Female, 60 FINAL DIAGNOSIS: Bird fanciers' lung Symptoms: Cough productive • hypoxia • short of breath • substernal chest pain MEDICATION - Clinical Procedure: - Specialty: - OBJECTIVE Rare disease. BACKGROUND Hypersensitivity pneumonitis (HP) is a group of inflammatory interstitial lung diseases caused by hypersensitivity reactions from repeated insults of inhalation of fine particulate organic dusts derived from environmental sources. Bird fanciers' lung (BFL) is the most common form of HP, with an estimated prevalence of 0.5-7.5% and is observed in individuals who develop a hypersensitivity response to avian droppings or antigens on bird feathers. CASE REPORT A 60-year-old woman presented to our care with shortness of breath with exertion. She was hypoxic with oxygen saturation of 70% on room air. The CTA of the chest revealed a diffuse bilateral ground glass density in the lung parenchyma with a mosaic attenuation pattern. On further questioning she explained that she collected many duck and goose feathers she found on the ranch and placed them in a vase at home. Transbronchial lung biopsy revealed non-caseating granulomas, aggregates of epithelioid macrophages, and patchy mononuclear cell infiltration with lymphocytes and fibrotic tissue. The patient clinically improved and was discharged home on the 6(th) hospital day with prednisone 20 mg daily, with clinical improvement noted on subsequent follow up visits. CONCLUSIONS There is no specific clinical manifestation; abnormal laboratory test results help establish a definitive diagnosis. The best diagnostic tool is the correlation of symptom onset with the environmental exposure. The prognosis is excellent after a single episode of HP, but continuous re-exposure carries the risk of progressive pulmonary impairment.
Collapse
Affiliation(s)
- Chad J Cooper
- Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, TX, U.S.A
| | - Mohamed Teleb
- Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, TX, U.S.A
| | - Sherif Elhanafi
- Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, TX, U.S.A
| | - Shajeea Ajmal
- Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, TX, U.S.A
| | - German T Hernandez
- Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, TX, U.S.A
| |
Collapse
|
35
|
Elhanafi S, Othman M, Sunny J, Said S, Cooper CJ, Alkhateeb H, Quansah R, McCallum R. Esophageal perforation post pneumatic dilatation for achalasia managed by esophageal stenting. Am J Case Rep 2013; 14:532-5. [PMID: 24349606 PMCID: PMC3862140 DOI: 10.12659/ajcr.889637] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 12/09/2013] [Accepted: 09/02/2013] [Indexed: 01/14/2023]
Abstract
Patient: Female, 82 Final Diagnosis: Achalasia Symptoms: Nocturnal regurgtation • weight loss Medication: — Clinical Procedure: Esophageal stenting Specialty: Gastroenterology • Hepatology Objective: Unusual or unexpected effect of treatment
Collapse
Affiliation(s)
- Sherif Elhanafi
- Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, U.S.A
| | - Mohamed Othman
- Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, U.S.A
| | - Joseph Sunny
- Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, U.S.A
| | - Sarmad Said
- Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, U.S.A
| | - Chad J Cooper
- Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, U.S.A
| | - Haider Alkhateeb
- Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, U.S.A
| | - Raphael Quansah
- Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, U.S.A
| | - Richard McCallum
- Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, U.S.A
| |
Collapse
|
36
|
Said S, Cooper CJ, Alkhateeb H, Elhanafi S, Bizet J, Gosavi S, Abedin Z. Pyridostigmine-induced high grade SA-block in a patient with myasthenia gravis. Am J Case Rep 2013; 14:359-61. [PMID: 24046803 PMCID: PMC3775617 DOI: 10.12659/ajcr.889484] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 07/16/2013] [Indexed: 11/09/2022]
Abstract
Patient: Female, 70 Final Diagnosis: SA block induced by pyridostigmine Symptoms: Asymptomatic Medication: Pyridostigmine Clinical Procedure: Pacemaker insertion Specialty: Electrophysiology
Collapse
Affiliation(s)
- Sarmad Said
- Department of Internal Medicine, Paul L. Foster School of Medicine,Texas Tech University Health Sciences Center, El Paso, TX, U.S.A
| | | | | | | | | | | | | |
Collapse
|