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Rengarajan A, Aadam AA. Peroral endoscopic myotomy and its use in non-achalasia disorders. Dis Esophagus 2024:doae014. [PMID: 38458620 DOI: 10.1093/dote/doae014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Indexed: 03/10/2024]
Abstract
The aim of this review is to provide an overview of per-oral endoscopic myotomy (POEM) and its utilization in non-achalasia disorders of the esophagus. POEM, a relatively novel endoscopic technique, involves submucosal tunneling to access esophageal muscle layers, enabling selective myotomy and mitigating the consequences of motor disorders of the esophagus. POEM is an effective treatment modality for diffuse esophageal spasm providing resolution of chest pain and dysphagia in a majority of patients who have refractory symptoms despite medical therapy. The results of POEM are more equivocal compared to esophagogastric junction outflow obstruction (EGJOO). POEM in EGJOO has been shown to have a 93% clinical success rate in 6 months. POEM appears to be more effective in motor disorders that affect the lower esophageal sphincter, such as EGJOO and opioid-induced esophageal dysfunction. While the current data for POEM in other entities such as DES and HE are positive, more supportive data are required to make POEM a consistent recommendation for patients.
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Affiliation(s)
- Arvind Rengarajan
- Division of Gastroenterology, Washington University School of Medicine, Saint Louis, MO, USA
| | - A Aziz Aadam
- Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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2
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Rodrigues TJ, Patel R, Rengarajan A, Booth AL, Abbass M, Aadam AA. Endoscopic submuscular dissection as a rescue for severe fibrosis after incomplete polypectomy. VideoGIE 2024; 9:99-101. [PMID: 38357031 PMCID: PMC10861838 DOI: 10.1016/j.vgie.2023.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
Video 1Endoscopic submuscular dissection as a rescue for severe fibrosis after incomplete polypectomy.
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Affiliation(s)
- Terrance J Rodrigues
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Raeesa Patel
- Department of Radiology, Guy's and St Thomas' Hospital, London, United Kingdom
| | - Arvind Rengarajan
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Adam L Booth
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mohammad Abbass
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - A Aziz Aadam
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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3
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Liu K, Aadam AA. T1b esophageal cancer: Is it time for endoscopic submucosal dissection to enter the stage? Gastrointest Endosc 2022; 96:454-456. [PMID: 35863957 DOI: 10.1016/j.gie.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 05/16/2022] [Indexed: 02/08/2023]
Affiliation(s)
- Kevin Liu
- Department of Medicine, University of Arizona - Banner Medical Center Phoenix, Arizona, USA
| | - A Aziz Aadam
- Department of Medicine, Northwestern University, Chicago, Illinois, USA
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4
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Abstract
With an estimated one million new cases and 769 000 deaths in 2020, gastric cancer is the fifth most frequent cancer and fourth leading cause of cancer death globally. Incidence rates are highest in Asia and Eastern Europe. This manuscript will review the current modalities of diagnosis, staging, and screening of gastric cancer. We will also highlight development of novel diagnostics and advancements in endoscopic detection of early gastric cancer.
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Affiliation(s)
- Jonathan Y Xia
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - A Aziz Aadam
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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5
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Olson D, Liu KC, Merza AP, Tilahun E, Aziz Aadam A. Esophageal tuberculosis induced dysphagia: a case report. BMC Gastroenterol 2022; 22:131. [PMID: 35317747 PMCID: PMC8939207 DOI: 10.1186/s12876-022-02211-2] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 03/14/2022] [Indexed: 11/28/2022] Open
Abstract
Background Patients can present for a wide variety of etiologies for dysphagia, and it is important to consider less common causes once common etiologies have been ruled out. Extrapulmonary Mycobacterium tuberculosis (TB) presentations are rare to see in the western populations due to relative lack of TB exposure and overall less immunocompromised populations, but should be considered for at-risk patients. Gastrointestinal (GI) TB is rare, and the GI tract is considered only the sixth most frequent site of extrapulmonary TB (EPTB).
Case presentation This is a case report of a 35-year-old Ethiopian male presenting with dysphagia and retrosternal odynophagia who was found to have infiltration of mediastinal lymphadenopathy into the esophageal wall secondary to TB. This patient underwent an upper endoscopy, which revealed a linear 2 cm full thickness mucosal defect in the middle esophagus concerning for an infiltrative process with full thickness tear. Computed tomography (CT) of the chest demonstrated a subcarinal soft tissue mass that was inseparable from the esophagus. He was referred to thoracic surgery and underwent an exploratory mediastinal dissection. A mediastinoscopy scope was inserted and the mediastinal dissection was made until the subcarinal nodes were identified and removed. Biopsy results showed necrotizing and non-necrotizing granulomas, and acid-fast bacilli (AFB) culture from the surgically removed lymph node showed Mycobacterium TB complex growth. He had no known TB exposures and did not have any TB risk factors. He then followed up in infectious disease clinic and was managed with anti-tuberculosis treatment (ATT) with complete resolution of symptoms.
Conclusions Our patient was ultimately found to have esophageal TB secondary to mediastinal invasion into the esophageal wall from lymphadenopathy associated with TB. This is an extremely rare presentation in western populations due to diminished exposure rates and overall less immunocompromised populations compared to impoverished countries with increased TB exposure and human immunodeficiency virus (HIV) infection rates. Although TB is not as commonly seen in western populations, it should be considered on the differential for any atypical presentations of GI diseases for patients with clinical or geographic risk factors.
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Affiliation(s)
- Dylan Olson
- Department of Medicine, Northwestern University, Feinberg School of Medicine, 251 E Huron St, Chicago, IL, 60611, USA.
| | - Kevin C Liu
- Division of Gastroenterology and Hepatology, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Anthony P Merza
- Methodist Hospital Chicago, 5025 N Paulina St, Chicago, IL, 60640, USA
| | - Ermias Tilahun
- Methodist Hospital Chicago, 5025 N Paulina St, Chicago, IL, 60640, USA
| | - A Aziz Aadam
- Division of Gastroenterology and Hepatology, Northwestern University, Feinberg School of Medicine, 251 E Huron St, Chicago, IL, 60611, USA
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Vosoughi K, Ichkhanian Y, Benias P, Miller L, Aadam AA, Triggs JR, Law R, Hasler W, Bowers N, Chaves D, Ponte-Neto AM, Draganov P, Yang D, El Halabi M, Sanaei O, Brewer Gutierrez OI, Bulat RS, Pandolfino J, Khashab M. Gastric per-oral endoscopic myotomy (G-POEM) for refractory gastroparesis: results from an international prospective trial. Gut 2022; 71:25-33. [PMID: 33741641 DOI: 10.1136/gutjnl-2020-322756] [Citation(s) in RCA: 56] [Impact Index Per Article: 28.0] [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: 08/07/2020] [Revised: 03/03/2021] [Accepted: 03/08/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Although gastric per-oral endoscopic myotomy (G-POEM) is considered a promising technique for the management of refractory gastroparesis, high-quality evidence is limited. We prospectively investigated the efficacy and safety of G-POEM in unselected patients with refractory gastroparesis. DESIGN In five tertiary centres, patients with symptomatic gastroparesis refractory to standard medical therapy and confirmed by impaired gastric emptying were included. The primary endpoint was clinical success, defined as at least one score decrease in Gastroparesis Cardinal Symptom Index (GCSI) with ≥25% decrease in two subscales, at 12 months. GCSI Score and subscales, adverse events (AEs) and 36-Item Short Form questionnaire of quality of life were evaluated at baseline and 1, 3, 6 and 12 months after G-POEM. Gastric emptying study was performed before and 3 months after the procedure. RESULTS Of 80 enrolled patients, 75 patients (94%) completed 12-month follow-up. Clinical success at 12 months was 56% (95% CI, 44.8 to 66.7). GCSI Score (including subscales) improved moderately after G-POEM (p<0.05). In a regression model, a baseline GCSI Score >2.6 (OR=3.23, p=0.04) and baseline gastric retention >20% at 4 hours (OR=3.65, p=0.03) were independent predictors of clinical success at 12 months, as was early response to G-POEM at 1 month after therapy (OR 8.75, p<0.001). Mild procedure-related AEs occurred in 5 (6%) patients. CONCLUSION G-POEM is a safe procedure, but showed only modest overall effectiveness in the treatment of refractory gastroparesis. Further studies are required to identify the best candidates for G-POEM; unselective use of this procedure should be discouraged. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry NCT02732821.
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Affiliation(s)
- Kia Vosoughi
- Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Yervant Ichkhanian
- Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, Baltimore, Maryland, USA.,Department of Medicine, Henry Ford Health System, Detroit, Michigan, USA
| | - Petros Benias
- Division of Gastroenterology and Hepatology, Northwell Health, New Hyde Park, New York, USA
| | - Larry Miller
- Division of Gastroenterology and Hepatology, Northwell Health, New Hyde Park, New York, USA
| | - A Aziz Aadam
- Division of Gastroenterology and Hepatology, Northwestern Medicine, Chicago, Illinois, USA
| | - Joseph R Triggs
- Division of Gastroenterology and Hepatology, Northwestern Medicine, Chicago, Illinois, USA
| | - Ryan Law
- Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, Michigan, USA
| | - William Hasler
- Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Nicole Bowers
- Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Dalton Chaves
- Division of Gastroenterology and Hepatology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Alberto M Ponte-Neto
- Division of Gastroenterology and Hepatology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Peter Draganov
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida Health, Gainesville, Florida, USA
| | - Dennis Yang
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida Health, Gainesville, Florida, USA
| | - Maan El Halabi
- Department of Medicine, Mount Sinai Saint Luke's Hospital, New York, New York, USA
| | - Omid Sanaei
- Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, Baltimore, Maryland, USA.,Medicine, MedStar Union Memorial Hospital, Baltimore, Maryland, USA
| | | | - Robert Stephen Bulat
- Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - John Pandolfino
- Division of Gastroenterology and Hepatology, Northwestern Medicine, Chicago, Illinois, USA
| | - Mouen Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, Baltimore, Maryland, USA
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7
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Almuhaidb A, Olson D, Aadam AA. Advancements in Endoscopic Biliary Interventions by Gastroenterology. Semin Intervent Radiol 2021; 38:280-290. [PMID: 34393338 DOI: 10.1055/s-0041-1731266] [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] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) is an endoscopic technique in which a specialized side-viewing endoscope is guided into the duodenum, allowing for instruments to access the biliary and pancreatic ducts. ERCP was initially developed as a diagnostic tool as computed tomography was in its infancy during that time. ERCP has evolved since its inception in the 1960s to becoming not only a valuable diagnostic resource but now an effective therapeutic intervention in the treatment of various biliary disorders. The most common biliary interventions performed by ERCP include the management of biliary obstructions for benign and malignant indications. Additionally, endoscopic ultrasound (EUS) has been increasingly utilized in diagnosing and intervening on pancreaticobiliary lesion. This article will discuss the various methods currently available for various endoscopic biliary interventions and future interventional techniques. For the management of biliary strictures, EUS can be utilized with fine need aspiration, while ERCP can be used for the placement of various stents and diagnostic modalities. Another example is radiofrequency ablation, which can be used for the treatment of hilar strictures. Achieving bile duct access can be challenging in patients with complicated clinical scenarios; other techniques that can be used for bile duct access include EUS-guided rendezvous approach, transluminal approach, Choleodochoduodenostomy, and hepatogastrostomy, along with gaining access in complicated anatomy such as in patients with Rou-en-Y anatomy. Another useful endoscopic tool is nonsurgical drainage of the gallbladder, which can be a suitable option when patients are not optimal surgical candidates. There has also been an increase in outpatient utilization of ERCP, which was previously seen as a predominantly inpatient procedure in the past. Possible future evolutions of biliary interventions include robotic manipulation of a duodenoscope and direct infusion of chemotherapeutic or immunomodulatory agents into the pancreaticobiliary tree. These advancements will depend on parallel advancements in other imaging and laboratory as well as breakthrough technology or techniques by other disciplines including interventional radiology and minimally invasive surgery.
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Affiliation(s)
- Aymen Almuhaidb
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Dylan Olson
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - A Aziz Aadam
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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8
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Farina DA, Komanduri S, Aadam AA, Keswani RN. Endoscopic retrograde cholangiopancreatography (ERCP) in critically ill patients is safe and effective when performed in the endoscopy suite. Endosc Int Open 2020; 8:E1165-E1172. [PMID: 32904818 PMCID: PMC7458757 DOI: 10.1055/a-1194-4049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 02/12/2020] [Indexed: 01/30/2023] Open
Abstract
Background and study aims Critically ill patients may require endoscopic retrograde cholangiopancreatography (ERCP) but performing ERCP in the intensive care unit (ICU) poses logistic and technical challenges. There are no data on ICU patients undergoing ERCP in the endoscopy suite. The primary aim of this study was to report outcomes, including safety, when ERCP in critically ill patients is performed in the endoscopy suite. Patients and methods We queried our institutional endoscopy database to identify all ICU patients who underwent ERCP at a single academic medical center from 04/01/2010 to 11/30/2017. Only patients admitted to an ICU prior to ERCP were included. Results Of 7,218 ERCPs performed during the study period, 260 ERCPs (3.6 %) were performed in 231 ICU patients (mean age 61y; 53 % male); nearly all ICU patient ERCPs (n = 258; 99 %) occurred in the endoscopy suite. ERCP indications included cholangitis (50 %), post-liver transplant cholestasis (15 %), and bile leak (10 %). All ERCPs were performed with anesthesiology, most with general anesthesia (60 %) and in the prone position (60 %). Most patients (73 %) had sepsis. Prior to ERCP, 17 % of patients required vasopressors; vasopressors were begun during ERCP in 4 %. The cannulation success rate was 95 % (94 % in native papillae). Adverse events occurred in 9 % (n = 23) of cases with post-ERCP pancreatitis most common. No patients died during or within 24 hours of ERCP. Mortality at 30 days was 16 %, all attributed to underlying disease. Conclusions When advanced ventilatory and hemodynamic support is available, critically ill patients can safely and effectively undergo ERCP in the endoscopy suite.
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Affiliation(s)
- Domenico A. Farina
- Northwestern University, Department of Gastroenterology and Hepatology, Chicago, Illinois, United States
| | - Srinadh Komanduri
- Northwestern University, Department of Gastroenterology and Hepatology, Chicago, Illinois, United States
| | - A. Aziz Aadam
- Northwestern University, Department of Gastroenterology and Hepatology, Chicago, Illinois, United States
| | - Rajesh N. Keswani
- Northwestern University, Department of Gastroenterology and Hepatology, Chicago, Illinois, United States
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Vosoughi K, Ichkhanian Y, Jacques J, Aadam AA, Benias PC, Law R, Hasler WL, Canakis A, Ragi O, Triggs J, Bowers N, Brewer Gutierrez OI, Kumbhari V, Kalloo AN, Bulat RS, Pandolfino JE, Khashab MA. Role of endoscopic functional luminal imaging probe in predicting the outcome of gastric peroral endoscopic pyloromyotomy (with video). Gastrointest Endosc 2020; 91:1289-1299. [PMID: 32035074 DOI: 10.1016/j.gie.2020.01.044] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 01/22/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Endoluminal functional luminal imaging probe (EndoFLIP) is an imaging tool that measures the physiologic characteristics of GI sphincters. In this study, we used EndoFLIP to evaluate the association between the pyloric physiologic measurements and the clinical outcomes of gastric peroral endoscopic myotomy (G-POEM) in patients with refractory gastroparesis. METHODS Thirty-seven patients from 5 centers who underwent G-POEM for management of refractory gastroparesis and had EndoFLIP measurements were evaluated. Cross-sectional area (CSA), balloon pressure, and the distensibility index (DI) of the pylorus were evaluated by EndoFLIP at 40 mL and 50 mL balloon fills before and after G-POEM. One-year clinical success and change in gastric emptying study 3 months after the G-POEM procedure were compared with the EndoFLIP measurements. RESULTS Clinical success was achieved in 26 (70%) patients. Post-G-POEM CSA and DI were significantly higher in the clinical success group with both 40-mL volume distension (CSA: 89.9 ± 64.8 vs 172.5 ± 71.9 mm2, P =.003; DI: 5.8 ± 4.4 vs 8.8 ± 6.1 mm2/mm Hg, P =.043) and 50-mL volume distention (CSA: 140.1 ± 89.9 vs 237.5 ± 80.3 mm2, P =.003; DI: 5.6 ± 3.3 vs 9.9 ± 6.6 mm2/mm Hg, P =.049). CSA using 40-mL volume distention with an area under the curve of 0.83 yielded a specificity of 91% and a sensitivity of 71% at a cutoff point of 154 mm2. CONCLUSIONS Post-G-POEM CSA of the pylorus is associated with clinical success and improvement in a gastric emptying scan after G-POEM. EndoFLIP measurements of the pylorus have the potential to be used as a tool to predict the clinical outcome of G-POEM.
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Affiliation(s)
- Kia Vosoughi
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Yervant Ichkhanian
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Jérémie Jacques
- Gastroenterology Department, Dupuytren University Hospital, Limoges, France
| | - A Aziz Aadam
- Division of Gastroenterology, Northwestern University, Chicago, Illinois, USA
| | - Petros C Benias
- Division of Gastroenterology, Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, Northwell Health System, New Hyde Park, New York, USA
| | - Ryan Law
- Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA
| | - William L Hasler
- Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA
| | - Andrew Canakis
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Olivier Ragi
- Gastroenterology Department, Dupuytren University Hospital, Limoges, France
| | - Joseph Triggs
- Division of Gastroenterology, Northwestern University, Chicago, Illinois, USA
| | - Nicole Bowers
- Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Vivek Kumbhari
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Anthony N Kalloo
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Robert S Bulat
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - John E Pandolfino
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, USA
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10
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Ichkhanian Y, Vosoughi K, Aghaie Meybodi M, Jacques J, Sethi A, Patel AA, Aadam AA, Triggs JR, Bapaye A, Dorwat S, Benias P, Chaves DM, Barret M, Law RJ, Browers N, Pioche M, Draganov PV, Kotzev A, Estremera F, Albeniz E, Ujiki MB, Callahan ZM, Itani MI, Brewer OG, Khashab MA. Correction to: Comprehensive analysis of adverse events associated with gastric peroral endoscopic myotomy: an international multicenter study. Surg Endosc 2020; 35:1765. [PMID: 32424623 DOI: 10.1007/s00464-020-07651-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Y Ichkhanian
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, MD, USA
| | - K Vosoughi
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, MD, USA
| | - M Aghaie Meybodi
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, MD, USA
| | - J Jacques
- Gastroenterology Department, Limoges University Hospital, 2 Avenue Martin Luther King, 87042, Rouen, France
| | - A Sethi
- Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, NY, USA
| | - A A Patel
- Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, NY, USA
| | - A A Aadam
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - J R Triggs
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - A Bapaye
- Department of Digestive Diseases & Endoscopy, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India
| | - S Dorwat
- Department of Digestive Diseases & Endoscopy, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India
| | - P Benias
- Division of Gastroenterology, Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, Northwell Health System, New Hyde Park, NY, USA
| | - D M Chaves
- Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - M Barret
- Gastroenterology Unit, Cochin University Hospital, Université Paris Descartes, Paris, France.,Unité INSERM U1016, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - R J Law
- University of Michigan Health Care System, Ann Arbor, USA
| | - N Browers
- University of Michigan Health Care System, Ann Arbor, USA
| | - M Pioche
- Service d'Hépato-gastro-entérologie, Hôpital Edouard Herriot, CHU Lyon, Lyon, France
| | - P V Draganov
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, FL, USA
| | - A Kotzev
- Clinic of Gastroenterology, University Hospital "Alexandrovska", Sofia, Bulgaria
| | - F Estremera
- Clinic of Gastroenterology, University Hospital "Alexandrovska", Sofia, Bulgaria
| | - E Albeniz
- Division of Gastroenterology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - M B Ujiki
- Section of Minimally Invasive Surgery, Department of Surgery, NorthShore University Health System, Evanston, IL, USA
| | - Z M Callahan
- Section of Minimally Invasive Surgery, Department of Surgery, NorthShore University Health System, Evanston, IL, USA
| | - M I Itani
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, MD, USA
| | - O G Brewer
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, MD, USA
| | - M A Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, MD, USA. .,Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Sheikh Zayed Bldg, 1800 Orleans Street, Suite 7125G, Baltimore, MD, 21287, USA.
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Smith ZL, Park KH, Llano EM, Donboli K, Fayad L, Han S, Kang L, Simril RT, Patel R, Hollander T, Rogers MC, Elmunzer BJ, Siddiqui UD, Aadam AA, Mullady DK, Lang GD, Das KK, Jamil LH, Lo SK, Gaddam S, Chapman CG, Keswani RN, Wani S, Cote GA, Kumbhari V, Kushnir VM. Outcomes of endoscopic treatment of leaks and fistulae after sleeve gastrectomy: results from a large multicenter U.S. cohort. Surg Obes Relat Dis 2019; 15:850-855. [DOI: 10.1016/j.soard.2019.04.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 03/06/2019] [Accepted: 04/06/2019] [Indexed: 02/07/2023]
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Abstract
Advanced pancreaticobiliary malignancy tends to be uncurable at presentation and causes significant morbidity for patients. Palliation for malignant biliary obstruction should be minimally invasive, cost-effective, and aim to improve quality of life of patients. Strategies of endoscopic palliation of malignant biliary obstruction can differ based on sites and degree of biliary obstruction with complex decisions of optimal stent type and placement that involve conscientious planning by a multidisciplinary team.
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Affiliation(s)
- A Aziz Aadam
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kevin Liu
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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14
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Abstract
Endoscopic submucosal dissection (ESD) has evolved into a viable treatment modality for superficial esophageal cancer. ESD offers a distinct advantage given the ability to perform en bloc resection enabling accurate histopathologic assessment. Data from published literature has established ESD as the preferred option in the treatment of superficial squamous cell carcinoma with complete resection rates of 78-100%, and a low rate recurrence of 0-2.6%. En bloc resection for esophageal SCC is curative for tumors with M1 (intrapethelial) or M2 (invasion into the lamina propria) involvement with no lymphovascular invasion. Tumors that contain lymphovascular invasion or submucosal invasion greater than 200 μm should be treated as advanced carcinomas due to the increased risk of lymph node metastasis. In contrast, the role of ESD in Barrett's esophagus is more limited due to the high rate of efficacy of EMR. A randomized control trial comparing EMR and ESD strategies found a higher R0 resection rate for ESD, but no significant difference in complete remission from neoplasia at 3 month follow up. Endoscopic ultrasound (EUS) has a limited role in the evaluation of superficial esophageal cancer. Alternatively, detailed endoscopic assessment along with magnification endoscopy or narrow band imaging, may provide greater utility than EUS. The most common adverse events of ESD in the esophagus include perforation and stricture. Perforation can often be managed by defect closure along with non-operative conservative management. Steroid administration with either topical or local injection can be effective management in stricture prevention. Continued refinement of ESD technique and innovation will overcome some of the current limitations of ESD and enable curative resection of superficial esophageal cancer as an alternative to invasive surgery.
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Affiliation(s)
- A A Aadam
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - S Abe
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
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15
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Abbas AM, Strong AT, Diehl DL, Brauer BC, Lee IH, Burbridge R, Zivny J, Higa JT, Falcão M, El Hajj II, Tarnasky P, Enestvedt BK, Ende AR, Thaker AM, Pawa R, Jamidar P, Sampath K, de Moura EGH, Kwon RS, Suarez AL, Aburajab M, Wang AY, Shakhatreh MH, Kaul V, Kang L, Kowalski TE, Pannala R, Tokar J, Aadam AA, Tzimas D, Wagh MS, Draganov PV. Multicenter evaluation of the clinical utility of laparoscopy-assisted ERCP in patients with Roux-en-Y gastric bypass. Gastrointest Endosc 2018; 87:1031-1039. [PMID: 29129525 DOI: 10.1016/j.gie.2017.10.044] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [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: 07/12/2017] [Accepted: 10/30/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS The obesity epidemic has led to increased use of Roux-en-Y gastric bypass (RYGB). These patients have an increased incidence of pancreaticobiliary diseases, yet standard ERCP is not possible because of surgically altered gastroduodenal anatomy. Laparoscopy-assisted ERCP (LA-ERCP) has been proposed as an option, but supporting data are derived from single-center small case series. Therefore, we conducted a large multicenter study to evaluate the feasibility, safety, and outcomes of LA-ERCP. METHODS This is a retrospective cohort study of adult patients with RYGB who underwent LA-ERCP in 34 centers. Data on demographics, indications, procedure success, and adverse events were collected. Procedure success was defined when all the following were achieved: reaching the papilla, cannulating the desired duct, and providing endoscopic therapy as clinically indicated. RESULTS A total of 579 patients (median age, 51; 84% women) were included. Indication for LA-ERCP was biliary in 89%, pancreatic in 8%, and both in 3%. Procedure success was achieved in 98%. Median total procedure time was 152 minutes (interquartile range [IQR], 109-210), with a median ERCP time of 40 minutes (IQR, 28-56). Median hospital stay was 2 days (IQR, 1-3). Adverse events were 18% (laparoscopy related, 10%; ERCP related, 7%; both, 1%) with the clear majority (92%) classified as mild/moderate, whereas 8% were severe and 1 death occurred. CONCLUSIONS Our large multicenter study indicates that LA-ERCP in patients with RYGB is feasible with a high procedure success rate comparable with that of standard ERCP in patients with normal anatomy. The ERCP-related adverse events rate is comparable with conventional ERCP, but the overall adverse event rate was higher because of the added laparoscopy-related events.
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Affiliation(s)
- Ali M Abbas
- University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | | | - David L Diehl
- Geisinger Medical Center, Danville, Pennsylvania, USA
| | | | - Iris H Lee
- University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | - Jaroslav Zivny
- University of Massachusetts, Worcester, Massachusetts, USA
| | | | - Marcelo Falcão
- Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil
| | - Ihab I El Hajj
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | | | | | - Adarsh M Thaker
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Rishi Pawa
- Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Priya Jamidar
- Yale School of Medicine, New Haven, Connecticut, USA
| | - Kartik Sampath
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | | | | | | | | | - Andrew Y Wang
- University of Virginia, Charlottesville, Virginia, USA
| | | | - Vivek Kaul
- University of Rochester Medical Center, Rochester, New York, USA
| | - Lorna Kang
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | | | | | - Jeffrey Tokar
- Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | | | - Demetrios Tzimas
- Stony Brook University School of Medicine, Stony Brook, New York, USA
| | - Mihir S Wagh
- University of Florida, Gainesville, Florida, USA
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16
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Takamaru H, Saito Y, Aadam AA, Hammoud GM, Sekiguchi M, Yamada M, Abe S, Sakamoto T, Nakajima T, Matsuda T. The role of endoscopic submucosal dissection for Tis/T1 rectal cancer. Ann Laparosc Endosc Surg 2017. [DOI: 10.21037/ales.2017.07.01] [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: 11/06/2022]
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17
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Aadam AA, Wani S, Amick A, Shah JN, Bhat YM, Hamerski CM, Klapman JB, Muthusamy VR, Watson RR, Rademaker AW, Keswani RN, Keefer L, Das A, Komanduri S. A randomized controlled cross-over trial and cost analysis comparing endoscopic ultrasound fine needle aspiration and fine needle biopsy. Endosc Int Open 2016; 4:E497-505. [PMID: 27227104 PMCID: PMC4874800 DOI: 10.1055/s-0042-106958] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [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: 12/12/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Techniques to optimize endoscopic ultrasound-guided tissue acquisition (EUS-TA) in a variety of lesion types have not yet been established. The primary aim of this study was to compare the diagnostic yield (DY) of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) to endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) for pancreatic and non-pancreatic masses. PATIENTS AND METHODS Consecutive patients referred for EUS-TA underwent randomization to EUS-FNA or EUS-FNB at four tertiary-care medical centers. A maximum of three passes were allowed for the initial method of EUS-TA and patients were crossed over to the other arm based on on-site specimen adequacy. RESULTS A total of 140 patients were enrolled. The overall DY was significantly higher with specimens obtained by EUS-FNB compared to EUS-FNA (90.0 % vs. 67.1 %, P = 0.002). While there was no difference in the DY between the two groups for pancreatic masses (FNB: 91.7 % vs. FNA: 78.4 %, P = 0.19), the DY of EUS-FNB was higher than the EUS-FNA for non-pancreatic lesions (88.2 % vs. 54.5 %, P = 0.006). Specimen adequacy was higher for EUS-FNB compared to EUS-FNA for all lesions (P = 0.006). There was a significant rescue effect of crossover from failed FNA to FNB in 27 out of 28 cases (96.5 %, P = 0.0003). Decision analysis showed that the strategy of EUS-FNB was cost saving compared to EUS-FNA over a wide range of cost and outcome probabilities. CONCLUSIONS RESULTS of this RCT and decision analysis demonstrate superior DY and specimen adequacy for solid mass lesions sampled by EUS-FNB.
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Affiliation(s)
- A. Aziz Aadam
- Division of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois, United States
| | - Sachin Wani
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado, United States
| | - Ashley Amick
- Division of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois, United States
| | - Janak N. Shah
- Paul May and Frank Stein Interventional Endoscopy Center, California Pacific Medical Center, San Francisco, California, United States
| | - Yasser M. Bhat
- Paul May and Frank Stein Interventional Endoscopy Center, California Pacific Medical Center, San Francisco, California, United States
| | - Christopher M. Hamerski
- Paul May and Frank Stein Interventional Endoscopy Center, California Pacific Medical Center, San Francisco, California, United States
| | - Jason B. Klapman
- Division of Gastroenterology, Moffitt Cancer Center, Tampa, Florida, United States
| | - V. Raman Muthusamy
- Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, California, United States
| | - Rabindra R. Watson
- Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, California, United States
| | - Alfred W. Rademaker
- Department of Preventative Medicine, Northwestern University, Chicago, Illinois, United States
| | - Rajesh N. Keswani
- Division of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois, United States
| | - Laurie Keefer
- Division of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois, United States
| | - Ananya Das
- Arizona Digestive Health, Gilbert, Arizona, United States
| | - Srinadh Komanduri
- Division of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois, United States,Corresponding author Srinadh Komanduri, MD MS Division of Gastroenterology and HepatologyFeinberg School of MedicineNorthwestern University675 N. St. Clair StreetGalter Pavilion 17-250Chicago, IL 60611
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18
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Keswani RN, Aadam AA, Yang GY. Sessile serrated lesion misdiagnosed as a hyperplastic polyp. Endoscopy 2014; 46 Suppl 1 UCTN:E7-8. [PMID: 24446101 DOI: 10.1055/s-0033-1358928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Rajesh N Keswani
- Division of Gastroenterology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - A Aziz Aadam
- Division of Gastroenterology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Guang-Yu Yang
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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