1
|
Yousaf MN, Bechtold ML. Unusual to "Bee" in the Colon: A Rare Finding on Screening Colonoscopy. ACG Case Rep J 2024; 11:e01260. [PMID: 38328766 PMCID: PMC10849338 DOI: 10.14309/crj.0000000000001260] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 12/21/2023] [Indexed: 02/09/2024] Open
Affiliation(s)
- Muhammad Nadeem Yousaf
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Missouri, Columbia, MO
| | - Matthew L. Bechtold
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Missouri, Columbia, MO
- Gastroenterology, Harry S. Truman Veterans Administration, Columbia, MO
| |
Collapse
|
2
|
Sharma N, Bechtold ML. To Be a Fly on the Wall: A Mysterious Finding on Colonoscopy. Am J Gastroenterol 2023; 118:1731. [PMID: 37186806 DOI: 10.14309/ajg.0000000000002307] [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: 03/25/2023] [Accepted: 04/21/2023] [Indexed: 05/17/2023]
Affiliation(s)
- Neal Sharma
- Division of Gastroenterology, University of Missouri School of Medicine, Columbia, Missouri, USA
| | | |
Collapse
|
3
|
Bechtold ML, Nepple KG, McCauley SM, Badaracco C, Malone A. Interprofessional implementation of the Global Malnutrition Composite Score quality measure. Nutr Clin Pract 2023; 38:987-997. [PMID: 37431796 DOI: 10.1002/ncp.11033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/14/2023] [Accepted: 05/04/2023] [Indexed: 07/12/2023] Open
Abstract
Malnutrition in hospitalized patients can impact health outcomes, quality of life, and health equity. Quality improvement initiatives and quality measurement can help improve the care of those hospitalized patients with malnutrition. The new Global Malnutrition Composite Score (GMCS) was recently adopted by the Centers for Medicare & Medicaid Services (CMS) as a health equity-focused measure. Beginning in 2024, the GMCS is available for reporting through the CMS Hospital Inpatient Quality Reporting Program. The GMCS provides an opportunity to elevate the importance of patient nutrition status and evidence-based interventions throughout the interdisciplinary hospital decision-making process. To promote this opportunity, the American Society for Parenteral and Enteral Nutrition (ASPEN) held an "Interprofessional implementation of the Global Malnutrition Composite Score" webinar as part of its 2022 Malnutrition Awareness Week programming. This article summarizes the underlying rationale and significance of the GMCS measure and showcases clinical observations about integrating quality improvement and measurement into the acute care setting, as presented during the webinar.
Collapse
Affiliation(s)
- Matthew L Bechtold
- Division of Gastroenterology, Department of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Kenneth G Nepple
- Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | | | | | - Ainsley Malone
- Clinical Practice, The American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland, USA
| |
Collapse
|
4
|
Tarar ZI, Farooq U, Bechtold ML, Ghouri YA. Cap-assisted endoscopy for esophageal foreign bodies: A meta-analysis. World J Meta-Anal 2023; 11:238-246. [DOI: 10.13105/wjma.v11.i5.238] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Esophageal foreign bodies are common around the world. Newer approaches, such as cap-assisted endoscopy, have been introduced as an alternative to conventional methods. Therefore, we performed a meta-analysis ono cap-assisted endoscopy versus conventional endoscopy for removal of esophageal foreign bodies.
AIM To investigated the effectiveness of cap-assisted endoscopy with conventional endoscopy.
METHODS An extensive literature search was performed (December 2021). For esophageal foreign body removal, cap-assisted endoscopy was compared to conventional endoscopy for procedure time, technical success of the procedure, time of foreign body retrieval, en bloc removal, and adverse event rate using odds ratio and mean difference.
RESULTS Six studies met the inclusion criteria (n = 1305). Higher odds of technical success (P = 0.002) and en bloc removal (P < 0.01) and lower odds of adverse events (P = 0.02) and foreign body removal time (P < 0.01) were observed with cap-assisted endoscopy as compared to conventional techniques.
CONCLUSION For esophageal foreign bodies, the technique of cap-assisted endoscopy demonstrated increased en bloc removal and technical success with decreased time and adverse events as compared to conventional techniques.
Collapse
Affiliation(s)
- Zahid Ijaz Tarar
- Department of Internal Medicine, University of Missouri, Columbia, MO 65212, United States
| | - Umer Farooq
- Department of Medicine, Loyola University, Chicago, IL 60153, United States
| | - Matthew L Bechtold
- Department of Medicine, University of Missouri - Columbia, Columbia, MO 65212, United States
| | - Yezaz A Ghouri
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Missouri, Columbia, MO 65212, United States
| |
Collapse
|
5
|
Tarar ZI, Farooq U, Bechtold ML, Ghouri YA. Cap-assisted endoscopy for esophageal foreign bodies: A meta-analysis. World J Meta-Anal 2023; 11:38-46. [DOI: 10.13105/wjma.v11.i1.38] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/11/2022] [Accepted: 12/21/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Esophageal foreign bodies are common around the world. Newer approaches, such as cap-assisted endoscopy, have been introduced as an alternative to conventional methods. Therefore, we performed a meta-analysis ono cap-assisted endoscopy versus conventional endoscopy for removal of esophageal foreign bodies.
AIM To investigated the effectiveness of cap-assisted endoscopy with conventional endoscopy.
METHODS An extensive literature search was performed (December 2021). For esophageal foreign body removal, cap-assisted endoscopy was compared to conventional endoscopy for procedure time, technical success of the procedure, time of foreign body retrieval, en bloc removal, and adverse event rate using odds ratio and mean difference.
RESULTS Six studies met the inclusion criteria (n = 1305). Higher odds of technical success (P = 0.002) and en bloc removal (P < 0.01) and lower odds of adverse events (P = 0.02) and foreign body removal time (P < 0.01) were observed with cap-assisted endoscopy as compared to conventional techniques.
CONCLUSION For esophageal foreign bodies, the technique of cap-assisted endoscopy demonstrated increased en bloc removal and technical success with decreased time and adverse events as compared to conventional techniques.
Collapse
Affiliation(s)
- Zahid Ijaz Tarar
- Department of Internal Medicine, University of Missouri, Columbia, MO 65212, United States
| | - Umer Farooq
- Department of Medicine, Loyola University, Chicago, IL 60153, United States
| | - Matthew L Bechtold
- Department of Medicine, University of Missouri - Columbia, Columbia, MO 65212, United States
| | - Yezaz A Ghouri
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Missouri, Columbia, MO 65212, United States
| |
Collapse
|
6
|
Bechtold ML, Brown PM, Escuro A, Grenda B, Johnston T, Kozeniecki M, Limketkai BN, Nelson KK, Powers J, Ronan A, Schober N, Strang BJ, Swartz C, Turner J, Tweel L, Walker R, Epp L, Malone A. When is enteral nutrition indicated? JPEN J Parenter Enteral Nutr 2022; 46:1470-1496. [PMID: 35838308 DOI: 10.1002/jpen.2364] [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] [Received: 09/29/2021] [Revised: 01/19/2022] [Accepted: 01/21/2022] [Indexed: 11/07/2022]
Abstract
Enteral nutrition (EN) is a vital component of nutrition around the world. EN allows for delivery of nutrients to those who cannot maintain adequate nutrition by oral intake alone. Common questions regarding EN are when to initiate and in what scenarios it is safe. The answers to these questions are often complex and require an evidence-based approach. The Board of Directors of the American Society for Parenteral and Enteral Nutrition (ASPEN) established an Enteral Nutrition Committtee to address the important questions surrounding the indications for EN. Consensus recommendations were established based on eight extremely clinically relevant questions regarding EN indications as deemed by the Enteral Nutrition Committee. These consensus recommendations may act as a guide for clinicians and stakeholders on difficult questions pertaining to indications for EN. This paper was approved by the ASPEN Board of Directors.
Collapse
Affiliation(s)
| | | | | | - Brandee Grenda
- Morrison Healthcare at Atrium Health Navicant, Charlotte, North Carolina, USA
| | - Theresa Johnston
- Nutrition Support Team, Christiana Care Health System, Newark, Delaware, USA
| | | | | | | | - Jan Powers
- Nursing Research and Professional Practice, Parkview Health System, Fort Wayne, Indiana, USA
| | - Andrea Ronan
- Fanconi Anemia Research Fund, Eugene, Oregon, USA
| | - Nathan Schober
- Cancer Treatment Centers of America - Atlanta, Newnan, Georgia, USA
| | | | - Cristina Swartz
- Northwestern Medicine Delnor Cancer Center, Chicago, Illinois, USA
| | - Justine Turner
- Department of Pediatrics, Division of Gastroenterology and Nutrition, University of Alberta, Edmonton, Canada
| | | | - Renee Walker
- Michael E. DeBakey Veteran Affairs Medical Center, Houston, Texas, USA
| | - Lisa Epp
- Mayo Clinic, Rochester, Minnesota, USA
| | - Ainsley Malone
- American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland, USA
| | | |
Collapse
|
7
|
Bechtold ML, Regunath H, Tyler R, Guenter P, Barrocas A, Collins NA. Impact of a nutrition support therapy on hospital-acquired infections: A value analysis. Nutr Clin Pract 2021; 36:1034-1040. [PMID: 34245487 DOI: 10.1002/ncp.10729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Hospital-acquired conditions (HACs) have a direct impact on value, as they decrease quality and increase costs. Numerous interventions have been tried, including nutrition support therapy, with unknown effect on value. Therefore, a value analysis of nutrition support therapy on HACs was performed. METHODS An extensive literature search was performed. Using the Medicare Parts A and B Claims 5% Sample data set, analytic claims modeling was conducted. RESULTS The search identified 1099 studies, with eight meeting the inclusion criteria. All studies were performed on adult critically ill patients and focused on HA infections (HAIs) as the HAC. One study underwent Medicare claims modeling and revealed nutrition therapy has the potential of saving at least $104 million annually in Medicare patients with HAIs. CONCLUSION Nutrition support therapy has the potential to reduce costs of Medicare spending in respect to HAIs.
Collapse
Affiliation(s)
- Matthew L Bechtold
- Department of Medicine, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Hariharan Regunath
- Department of Medicine, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Renay Tyler
- Ambulatory Services, University of Maryland, Baltimore, Maryland
| | - Peggi Guenter
- American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland
| | - Albert Barrocas
- Department of Surgery, Tulane University, New Orleans, Louisiana, USA
| | - Nilsa A Collins
- Clinical Integration Programs, WellStar Clinical Partners, Marietta, Georgia
| |
Collapse
|
8
|
Asif AA, Walayat SK, Bechtold ML, Revanur V, Puli SR. EUS-guided celiac plexus neurolysis for pain in pancreatic cancer patients - a meta-analysis and systematic review. J Community Hosp Intern Med Perspect 2021; 11:536-542. [PMID: 34211665 PMCID: PMC8221153 DOI: 10.1080/20009666.2021.1929049] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background: Endoscopic ultrasound guided celiac plexus neurolysis (EUS- CPN) has been reported to be an effective way to help with pain in pancreatic cancer patient. The aim of our updated meta-analysis is to assess the efficacy of pain relief in patients with pancreatic cancer who underwent EUS guided neurolysis. Methods: Pooled proportions were calculated using both Mantel-Haenszel method (fixed effects model) and DerSimonian Laird method (random effects model). The heterogeneity among studies was tested using Cochran’s Q test based upon inverse variance weights. Results: Initial search identified 176 reference articles, of which 34 were selected and reviewed in detail. Sixteen studies that met the inclusion criteria were included in this analysis. The mean age of patients undergoing neurolysis was 56.31 ± 19.72 years. Number of males, N = 563 (57.4%), was higher than the number of females, N = 417 (42.5%). The pooled proportion of patients who showed pain relief with EUS-guided neurolysis was 71% (95% CI = 68–74). Bias calculated using Begg–Mazumdar was not significant (p = 0.8). In a subgroup analysis, when comparing the central and bilateral techniques, the pooled proportion of patients with pain relief was 66% (95% CI = 61–71) and 57% (95% CI = 48–67), respectively. Conclusions: Our results show that EUS guided CPN could provide relief in as much as 70% of patients with central neurolysis technique having some edge over peripheral neurolysis. Further larger scale randomized controlled trials may further help to elaborate the efficacy of central vs peripheral neurolysis.
Collapse
Affiliation(s)
- Abuzar A Asif
- Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA
| | - Saqib K Walayat
- Department of Gastroenterology and Hepatology, University of Illinois College of Medicine at Peoria, Peoria, IL, USA
| | - Matthew L Bechtold
- Division of Gastroenterology and Hepatology, University of Missouri-Columbia, Columbia, Missouri, USA
| | - Vakya Revanur
- Department of Gastroenterology and Hepatology, University of Illinois College of Medicine at Peoria, Peoria, IL, USA
| | - Srinivas R Puli
- Department of Gastroenterology and Hepatology, University of Illinois College of Medicine at Peoria, Peoria, IL, USA
| |
Collapse
|
9
|
Moosvi Z, Duong JT, Bechtold ML, Nguyen DL. Systematic Review and Meta-Analysis: Preoperative Vedolizumab and Postoperative Complications in Patients with IBD. South Med J 2021; 114:98-105. [PMID: 33537791 DOI: 10.14423/smj.0000000000001214] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The effect of vedolizumab on postoperative outcomes in patients with inflammatory bowel disease (IBD) remains unclear. We aimed to determine the relation between preoperative vedolizumab and early postoperative complications in patients with IBD undergoing abdominal surgery. METHODS A search of databases and abstracts from gastroenterology conferences was performed. Primary outcomes included overall and infectious postoperative complication rates as well as surgical site infections. Studies that compared Crohn disease, ulcerative colitis, or patients with IBD-undefined with preoperative vedolizumab treatment undergoing abdominal surgery with controls with preoperative antitumor necrosis factor-α (anti-TNF-α) treatment or no preoperative biologic treatment were included. A meta-analysis was completed using the Mantel-Haenszel and DerSimonian and Laird models. RESULTS Six studies totaling 1201 patients were included; 281 patients were treated preoperatively with vedolizumab, 327 patients were treated preoperatively with anti-TNF-α agents, and 593 patients were not treated preoperatively with any biologics. There was no significant difference in overall complications (odds ratio [OR] 1.04, 95% confidence interval [CI] 0.48-2.24, P = 0.92, I2 =77%) between the vedolizumab and no-biologic groups. There also was no significant difference in infectious complications (OR 1.00, 95% CI 0.37-2.69, P = 1.00, I2 = 78%), which persisted after sensitivity analysis (OR 0.71, 95% CI 0.31-1.60, P = 0.41, I2 = 46%). Furthermore, there was no significant difference in overall complications (OR 0.77, 95% CI 0.24-2.46, P = 0.66, I2 = 85%) and infectious complications (OR 0.89, 95% CI 0.20-3.94, P = 0.87, I2 = 86%) between the vedolizumab and anti-TNF-α groups. After sensitivity analysis, differences in overall and infectious complications remained insignificant (OR 0.54 and 0.50, 95% CI 0.24-1.17 and 0.22-1.15, P = 0.12 and 0.10, I2 = 39% and 18%, respectively). Vedolizumab was also not associated with a significant increase in surgical site infections compared with the no-biologic (OR 1.45, 95% CI 0.33-6.32, P = 0.62, I2 = 75%) and anti-TNF (OR 1.30, 95% CI 0.22-7.60, P = 0.77, I2 = 81%) groups. CONCLUSIONS Preoperative treatment with vedolizumab in patients with IBD undergoing abdominal surgery is not associated with increases in overall or infectious postoperative complications compared with preoperative anti-TNF-α treatment and no preoperative biologic treatment. Large, prospective studies are needed to further assess the impact of preoperative vedolizumab treatment on postoperative complications, particularly with respect to IBD subtype.
Collapse
Affiliation(s)
- Zain Moosvi
- From the Department of Internal Medicine, University of California Irvine, Orange, California, the Division of Gastroenterology & Hepatology, University of Missouri-Columbia, Columbia, Missouri, and Peak Gastroenterology Associates, Colorado Springs, Colorado
| | - Jacqueline T Duong
- From the Department of Internal Medicine, University of California Irvine, Orange, California, the Division of Gastroenterology & Hepatology, University of Missouri-Columbia, Columbia, Missouri, and Peak Gastroenterology Associates, Colorado Springs, Colorado
| | - Matthew L Bechtold
- From the Department of Internal Medicine, University of California Irvine, Orange, California, the Division of Gastroenterology & Hepatology, University of Missouri-Columbia, Columbia, Missouri, and Peak Gastroenterology Associates, Colorado Springs, Colorado
| | - Douglas L Nguyen
- From the Department of Internal Medicine, University of California Irvine, Orange, California, the Division of Gastroenterology & Hepatology, University of Missouri-Columbia, Columbia, Missouri, and Peak Gastroenterology Associates, Colorado Springs, Colorado
| |
Collapse
|
10
|
Parsa N, Grisham EA, Cockerell CJ, Matteson-Kome ML, Bysani RV, Samiullah S, Nguyen DL, Tahan V, Ghouri YA, Puli SR, Bechtold ML. Split-dose vs same-day bowel preparation for afternoon colonoscopies: A meta-analysis of randomized controlled trials. World J Meta-Anal 2020; 8:462-471. [DOI: 10.13105/wjma.v8.i6.462] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 11/11/2020] [Accepted: 11/21/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Quality of bowel preparation in afternoon colonoscopies has been a struggle. Currently, a choice of same-day preparation (SaD) or split-dose preparation (SpD) exists; however, randomized controlled trials’ results have varied.
AIM To examine the outcomes of SaD and SpD for afternoon colonoscopies.
METHODS An extensive literature search was conducted using multiple databases. Only randomized controlled trials (RCTs) in adults that compared SaD to SpD with Ottawa bowel preparation score (OBPS) were included. Odds ratio (OR) or mean difference was used to analyze outcomes.
RESULTS Eleven RCTs were included (n = 1846). No difference was observed for satisfactory bowel preparation based on OBPS among participants receiving SaD vs SpD (OR 0.77; 95%CI: -0.57-1.03; P = 0.07; I2 = 5%). Subgroup analysis showed no difference in terms of satisfactory bowel preparation based on OBPS between the two groups when receiving same preparation formula (polyethylene glycol) (OR 0.83; 95%CI: 0.51-1.35; P = 0.46; I2 = 39%) as well as receiving same formula and volume (4 L polyethylene glycol) (OR 1.14; 95%CI: 0.65-2.01; P = 0.64; I2 = 0%).
CONCLUSION In patients undergoing afternoon colonoscopies, SaD is comparable with SpD in terms of satisfactory bowel preparation. Further studies are needed to validate these results and determine the optimal formula and dosages.
Collapse
Affiliation(s)
- Nasim Parsa
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Missouri - Columbia, Columbia, MO 65212, United States
| | - Eric A Grisham
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Missouri - Columbia, Columbia, MO 65212, United States
| | - Courtney J Cockerell
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Missouri - Columbia, Columbia, MO 65212, United States
| | - Michelle L Matteson-Kome
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Missouri - Columbia, Columbia, MO 65212, United States
| | - Ramakrishna V Bysani
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Missouri - Columbia, Columbia, MO 65212, United States
| | - Sami Samiullah
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Missouri - Columbia, Columbia, MO 65212, United States
| | - Douglas L Nguyen
- Division of Gastroenterology, Heart of the Rockies Regional Medical Center, Colorado Springs, CO 80907, United States
| | - Veysel Tahan
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Missouri - Columbia, Columbia, MO 65212, United States
| | - Yezaz A Ghouri
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Missouri - Columbia, Columbia, MO 65212, United States
| | - Srinivas R Puli
- Division of Gastroenterology, University of Illinois - Peoria, Peoria, IL 61604, United States
| | - Matthew L Bechtold
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Missouri - Columbia, Columbia, MO 65212, United States
| |
Collapse
|
11
|
Parsa N, Grisham EA, Cockerell CJ, Matteson-Kome ML, Bysani RV, Samiullah S, Nguyen DL, Tahan V, Ghouri YA, Puli SR, Bechtold ML. Split-dose vs same-day bowel preparation for afternoon colonoscopies: A meta-analysis of randomized controlled trials. World J Meta-Anal 2020. [DOI: 10.13105/wjma.v8.i6.461] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
|
12
|
Abstract
Nutrition therapy is a key element in the management of malnourished and critically ill patients. Although many aspects of enteral nutrition (EN) have been well defined by research, with clear recommendations by 3 major society guidelines, EN delivery method remains a topic for debate. The goal of this manuscript is to concisely review gastric vs postpyloric enteral feeding in critically ill adult patients and provide a set of recommendations to individualize EN delivery method based on patient characteristics and specific needs.
Collapse
Affiliation(s)
- Vanessa Kuwajima
- Division of Gastroenterology, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Matthew L Bechtold
- Division of Gastroenterology, University of Missouri School of Medicine, Columbia, Missouri, USA
| |
Collapse
|
13
|
Patel JB, Revanur V, Forcione DG, Bechtold ML, Puli SR. Endoscopic ultrasound-guided fiducial marker placement in pancreatic cancer: A systematic review and meta-analysis. World J Gastrointest Endosc 2020; 12:231-240. [PMID: 32879658 PMCID: PMC7443822 DOI: 10.4253/wjge.v12.i8.231] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 04/02/2020] [Revised: 05/09/2020] [Accepted: 07/19/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pancreatic cancer (PC) mortality remains high despite advances in therapy. Combination chemoradiotherapy offers modest survival benefit over monotherapy with either. Fiducial markers serve as needed landmarks for image-guided radiotherapy (IGRT). Traditionally, these markers were placed surgically or percutaneously with limitations of each. Endoscopic ultrasound-guided placement overcomes these limitations.
AIM To evaluate the safety, efficacy, and feasibility of endoscopic ultrasound (EUS)-guided fiducial placement for PC undergoing IGRT.
METHODS Articles were searched in MEDLINE, PubMed, and Ovid journals. Pooling was conducted by fixed and random effects models. Heterogeneity was assessed using Cochran’s Q test based upon inverse variance weights.
RESULTS Initial search identified 1024 reference articles for EUS-guided fiducial placement in PC. Of these, 261 relevant articles were reviewed. Data was extracted from 11 studies (n = 820) meeting inclusion criteria. Pooled proportion of successful placement was 96.27% (95%CI: 95.35-97.81) with fiducial migration rates low at 4.33% (95%CI: 2.45-6.71). Adverse event rates remained low, with overall pooled proportion of 4.85% (95%CI: 3.04-7.03).
CONCLUSION EUS-guided placement of fiducial markers for IGRT of PC is safe, feasible, and efficacious. The ability to target deep structures under direct visualization while remaining minimally invasive are added benefits. Moreover, the ability to perform fine needle aspiration or celiac plexus neurolysis add value and increase patient-care efficiency. Whether EUS-guided fiducial placement improves outcomes in IGRT or offers any mortality benefits over traditional placement remains unknown and future studies are needed.
Collapse
Affiliation(s)
- Jaymon B Patel
- Department of Gastroenterology, University of Illinois College of Medicine at Peoria, Peoria, IL 61637, United States
| | - Vakya Revanur
- Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL 61637, United States
| | - David G Forcione
- Department of Gastroenterology, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Matthew L Bechtold
- Department of Gastroenterology, University of Missouri, Columbia, MO 65203, United States
| | - Srinivas R Puli
- Department of Gastroenterology, University of Illinois College of Medicine at Peoria, Peoria, IL 61637, United States
| |
Collapse
|
14
|
Zoeller S, Bechtold ML, Burns B, Cattell T, Grenda B, Haffke L, Larimer C, Powers J, Reuning F, Tweel L, Guenter P. Dispelling Myths and Unfounded Practices About Enteral Nutrition. Nutr Clin Pract 2020; 35:196-204. [PMID: 31994794 DOI: 10.1002/ncp.10456] [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: 11/09/2022] Open
Abstract
Many protocols and steps in the process of enteral nutrition (EN) use are not overly supported with strong research and have been done the same way over many years without questioning the use of best-practices evidence. This article reports many of the myths and unfounded practices surrounding EN and attempts to refute those myths with current evidence. These practices include those about enteral access devices, formulas, enteral administration, and complications.
Collapse
Affiliation(s)
| | - Matthew L Bechtold
- Division of Gastroenterology & Hepatology Department of Medicine University Hospital & Clinics, Columbia, Missouri, USA
| | - Berri Burns
- Infusion Pharmacy at Home, Center for Connected Care, Cleveland Clinic, BOC, Independence, Ohio, USA
| | - Theresa Cattell
- Nutrition Support Riverside Methodist Hospital, Columbus, Ohio, USA
| | | | - Lindsey Haffke
- CHI Health at Home - Home Infusion Pharmacy, Omaha, Nebraska, USA
| | - Cara Larimer
- Enteral Nutrition Moog Medical Devices Group, Salt Lake City, Utah, USA
| | - Jan Powers
- Nursing Research and Professional Practice, Parkview Health System, Fort Wayne, Indiana, USA
| | | | - Lauren Tweel
- Chinook Regional Hospital, Alberta Health Services, South Zone, Lethbridge, Alberta, Canada
| | - Peggi Guenter
- American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland, USA
| | -
- Orlando VAMC, Orlando, Florida, USA
| |
Collapse
|
15
|
Tyler R, Barrocas A, Guenter P, Araujo Torres K, Bechtold ML, Chan L, Collier B, Collins NA, Evans DC, Godamunne K, Hamilton C, Hernandez BJD, Mirtallo JM, Nadeau WJ, Partridge J, Perugini M, Valladares A. Value of Nutrition Support Therapy: Impact on Clinical and Economic Outcomes in the United States. JPEN J Parenter Enteral Nutr 2020; 44:395-406. [DOI: 10.1002/jpen.1768] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 11/21/2019] [Accepted: 12/10/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Renay Tyler
- University of Maryland Medical Center Baltimore Maryland USA
| | | | - Peggi Guenter
- Clinical Practice, Quality, and AdvocacyAmerican Society for Parenteral Nutrition Silver Spring Maryland USA
| | | | - Matthew L. Bechtold
- Division of Gastroenterology & HepatologyDepartment of Medicine University Hospital & Clinics Columbia Missouri USA
| | - Lingtak‐Neander Chan
- Department of PharmacyInterdisciplinary FacultyNutritional Sciences ProgramUniversity of Washington Seattle Washington USA
| | - Bryan Collier
- Virginia Tech Carilion School of Medicine Roanoke Virginia USA
| | - Nilsa A. Collins
- Clinical Integration ProgramsWellStar Clinical Partners Marietta Atlanta Georgia USA
| | - David C. Evans
- Ohio Health Trauma and Surgical Services Columbus Ohio USA
| | | | - Cindy Hamilton
- Digestive Disease and Surgery Institute Cleveland Clinic Cleveland Ohio USA
| | | | - Jay M. Mirtallo
- Clinical Practice, Quality, and AdvocacyAmerican Society for Parenteral Nutrition Silver Spring Maryland USA
- The Ohio State UniversityCollege of Pharmacy Columbus Ohio USA
| | | | - Jamie Partridge
- Field Health Economics and Outcomes ResearchBayer Pharmaceuticals Whippany New Jersey USA
| | - Moreno Perugini
- Global Head of Medical Affairs & Marketing AccessNestlé Health Science Bridgewater New Jersey USA
| | | | | |
Collapse
|
16
|
Heath RD, Parsa N, Matteson-Kome ML, Buescher V, Samiullah S, Nguyen DL, Tahan V, Ghouri YA, Puli SR, Bechtold ML. Use of music during colonoscopy: An updated meta-analysis of randomized controlled trials. World J Meta-Anal 2019; 7:428-435. [DOI: 10.13105/wjma.v7.i9.428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 10/02/2019] [Revised: 10/26/2019] [Accepted: 11/15/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Music seems to be beneficial in multiple clinical areas. Colonoscopy is a stressful event for patients, especially with conscious sedation. Music during colonoscopy has been evaluated in multiple randomized controlled trials (RCTs) with varied results. Even meta-analyses on the subject over the years have yielded inconsistent conclusions. Therefore, we conducted an up-to-date meta-analysis regarding music during colonoscopy.
AIM To assess the effects of music played during colonoscopy on patients’ perspectives and sedation requirements.
METHODS Multiple large databases were aggressively searched (November 2018). RCTs comparing music to without music during colonoscopy on adult patients were included. Pooled estimates were calculated for sedative medication doses, total procedure time, and patients’ experience, willingness to repeat procedure, and pain scores using odds ratio (OR) and mean difference (MD) with random effects model.
RESULTS Eleven studies (n = 988) were included. Music during colonoscopy showed a statistically significant reduction in procedure times (MD: -2.3 min; 95%CI: -4.13 to -0.47; P = 0.01) and patients’ pain (MD: -1.26; 95%CI: -2.28 to -0.24; P = 0.02) while improving patients’ experience (MD: -1.11; 95%CI: -1.7 to -0.53; P < 0.01) as compared to no music. No statistically significant differences were observed between music and no music during colonoscopy for midazolam (MD: -0.4 mg; 95%CI: -0.9 to 0.09; P = 0.11), meperidine (MD: -3.06 mg; 95%CI: -10.79 to 4.67; P = 0.44), or patients’ willingness to repeat the colonoscopy (OR: 3.89; 95%CI: 0.76 to 19.97; P = 0.1).
CONCLUSION Music appears to improve overall patient experience while reducing procedure times and patient pain. Therefore, music, being a non-invasive intervention, should be strongly considered during colonoscopy.
Collapse
Affiliation(s)
- Ryan D Heath
- Division of Gastroenterology, University of Missouri School of Medicine, Columbia, MO 65212, United States
| | - Nasim Parsa
- Division of Gastroenterology, University of Missouri School of Medicine, Columbia, MO 65212, United States
| | - Michelle L Matteson-Kome
- Division of Gastroenterology, University of Missouri School of Medicine, Columbia, MO 65212, United States
| | - Victoria Buescher
- Division of Gastroenterology, University of Missouri School of Medicine, Columbia, MO 65212, United States
| | - Sami Samiullah
- Division of Gastroenterology, University of Missouri School of Medicine, Columbia, MO 65212, United States
| | - Douglas L Nguyen
- Division of Gastroenterology, Heart of the Rockies Regional Medical Center, Colorado Springs, CO 80907, United States
| | - Veysel Tahan
- Division of Gastroenterology, University of Missouri School of Medicine, Columbia, MO 65212, United States
| | - Yezaz A Ghouri
- Division of Gastroenterology, University of Missouri School of Medicine, Columbia, MO 65212, United States
| | - Srinivas R Puli
- Division of Gastroenterology, University of Illinois–Peoria, Peoria, IL 61604, United States
| | - Matthew L Bechtold
- Division of Gastroenterology, University of Missouri School of Medicine, Columbia, MO 65212, United States
| |
Collapse
|
17
|
Turse EP, Dailey FE, Bechtold ML. Impact of moderate versus deep sedation on adenoma detection rate in index average-risk screening colonoscopies. Gastrointest Endosc 2019; 90:502-505. [PMID: 31102644 DOI: 10.1016/j.gie.2019.05.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 05/05/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS The debate between moderate sedation versus deep sedation for index average-risk screening colonoscopies is well known to gastroenterologists. Ensuring the best of all metrics to perform quality colonoscopies for colon cancer prevention is paramount for both patients and physicians alike, because colon cancer remains the leading cause of cancer death and is the most-used screening tool in the United States. The aim of this study was to determine if moderate sedation versus deep sedation affects outcomes of adenoma detection rate (ADR) or polyp detection rate (PDR) in index, average-risk colonoscopies for colon cancer screening. METHODS A retrospective, single, tertiary care outpatient center study of 585 healthy average-risk patients who underwent index screening colonoscopy between June 1, 2015 to December 31, 2015 (moderate sedation only) and June 1, 2016,to December 31, 2016 (deep sedation only) was performed after Institutional Review Board approval. Demographic data and polyp details were collected to determine ADR and PDR. Patients who were not average risk were excluded from the study. RESULTS A total of 585 index average-risk screening colonoscopies were included in this study with 57.7% moderate sedation and 42.2% deep sedation. Neither ADR nor PDR was significantly different between the 2 groups (44.1% vs 38.5% [P = .18] and 71.9% vs 67.6% [P = .27], respectively). CONCLUSIONS In index average-risk screening colonoscopies, deep sedation appears to have no benefit compared with moderate sedation for ADR and PDR.
Collapse
Affiliation(s)
- Erica P Turse
- Division of Gastroenterology, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Francis E Dailey
- Division of Gastroenterology, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Matthew L Bechtold
- Division of Gastroenterology, University of Missouri School of Medicine, Columbia, Missouri, USA
| |
Collapse
|
18
|
Mir FA, Boumitri C, Ashraf I, Matteson-Kome ML, Nguyen DL, Puli SR, Bechtold ML. Cap-assisted colonoscopy versus standard colonoscopy: is the cap beneficial? A meta-analysis of randomized controlled trials. Ann Gastroenterol 2017; 30:640-648. [PMID: 29118558 PMCID: PMC5670283 DOI: 10.20524/aog.2017.0180] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 06/21/2017] [Indexed: 12/14/2022] Open
Abstract
Background: In an effort to improve visualization during colonoscopy, a transparent plastic cap or hood may be placed on the end of the colonoscope. Cap-assisted colonoscopy (CAC) has been studied and is thought to improve polyp detection. Numerous studies have been conducted comparing pertinent clinical outcomes between CAC and standard colonoscopy (SC) with inconsistent results. Methods: Numerous databases were searched in November 2016. Only randomized controlled trials (RCTs) involving adult subjects that compared CAC to SC were included. Outcomes of total colonoscopy time, time to cecum, cecal intubation rate, terminal ileum intubation rate, polyp detection rate (PDR), and adenoma detection rate (ADR) were analyzed in terms of odds ratio (OR) or mean difference (MD) with fixed effect and random effects models. Results: Five hundred eighty-nine articles and abstracts were discovered. Of these, 23 RCTs (n=12,947) were included in the analysis. CAC showed statistically significant superiority in total colonoscopy time (MD -1.51 min; 95% confidence interval [CI] -2.67 to -0.34; P<0.01) and time to cecum (MD -0.82 min; 95%CI -1.20 to -0.44; P<0.01) compared to SC. CAC also showed better PDR (OR 1.17; 95%CI 1.06-1.29; P<0.01) but not ADR (OR 1.11; 95%CI 0.95-1.30; P=0.20). In contrast, on sensitivity analysis, ADR was better with CAC. Terminal ileum intubation and cecal intubation rates demonstrated no significant difference between the two groups (P=0.11 and P=0.73, respectively). Conclusions: The use of a transparent cap during colonoscopy improves PDR while reducing procedure times. ADR may improve in cap-assisted colonoscopy but further studies are required to confirm this.
Collapse
Affiliation(s)
- Fazia A Mir
- Department of Medicine, University of Missouri, Columbia (Fazia A. Mir, Christine Boumitri, Imran Ashraf, Michelle L. Matteson-Kome, Matthew L. Bechtold), USA
| | - Christine Boumitri
- Department of Medicine, University of Missouri, Columbia (Fazia A. Mir, Christine Boumitri, Imran Ashraf, Michelle L. Matteson-Kome, Matthew L. Bechtold), USA
| | - Imran Ashraf
- Department of Medicine, University of Missouri, Columbia (Fazia A. Mir, Christine Boumitri, Imran Ashraf, Michelle L. Matteson-Kome, Matthew L. Bechtold), USA
| | - Michelle L Matteson-Kome
- Department of Medicine, University of Missouri, Columbia (Fazia A. Mir, Christine Boumitri, Imran Ashraf, Michelle L. Matteson-Kome, Matthew L. Bechtold), USA
| | - Douglas L Nguyen
- Department of Medicine, University of California, Irvine (Douglas L. Nguyen), USA
| | - Srinivas R Puli
- Department of Medicine, University of Illinois, Peoria (Srinivas R. Puli), USA
| | - Matthew L Bechtold
- Department of Medicine, University of Missouri, Columbia (Fazia A. Mir, Christine Boumitri, Imran Ashraf, Michelle L. Matteson-Kome, Matthew L. Bechtold), USA
| |
Collapse
|
19
|
Kandula M, Bechtold ML, Verma K, Aulakh BS, Taneja D, Puli SR. Is there a difference between 19G core biopsy needle and 22G core biopsy needle in diagnosing the correct etiology? - A meta-analysis and systematic review. World J Meta-Anal 2017; 5:54-62. [DOI: 10.13105/wjma.v5.i2.54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 09/12/2016] [Revised: 09/28/2016] [Accepted: 12/14/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To compare the accuracy of endoscopic ultrasonography (EUS) 19G core biopsies and 22G core biopsies in diagnosing the correct etiology for a solid mass.
METHODS Articles were searched in Medline, PubMed, and Ovid journals. Pooling was conducted by both fixed and random effects models.
RESULTS Initial search identified 4460 reference articles for 19G and 22G, of these 670 relevant articles were selected and reviewed. Data was extracted from 6 studies for 19G (n = 289) and 16 studies for 22G (n = 592) which met the inclusion criteria. EUS 19G core biopsies had a pooled sensitivity of 91.6% (95%CI: 87.1-95.0) and pooled specificity of 95.9% (95%CI: 88.6-99.2), whereas EUS 22G had a pooled sensitivity of 83.3% (95%CI: 79.7-86.6) and pooled specificity of 64.3% (95%CI: 54.7-73.1). The positive likelihood ratio of EUS 19G core biopsies was 9.08 (95%CI: 1.12-73.66) and EUS 22G core biopsies was 1.99 (95%CI: 1.09-3.66). The negative likelihood ratio of EUS 19G core biopsies was 0.12 (95%CI: 0.07-0.24) and EUS 22G core biopsies was 0.25 (95%CI: 0.14-0.41). The diagnostic odds ratio was 84.74 (95%CI: 18.31-392.26) for 19G core biopsies and 10.55 (95% CI: 3.29-33.87) for 22G needles.
CONCLUSION EUS 19G core biopsies have an excellent diagnostic value and seem to be better than EUS 22G biopsies in detecting the correct etiology for a solid mass.
Collapse
|
20
|
Theivanayagam S, Lopez KT, Matteson-Kome ML, Bechtold ML, Asombang AW. ASA Classification Pre-Endoscopic Procedures: A Retrospective Analysis on the Accuracy of Gastroenterologists. South Med J 2017; 110:79-82. [PMID: 28158875 DOI: 10.14423/smj.0000000000000610] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Before an endoscopic procedure, an evaluation to assess the risk of sedation is performed by the gastroenterologist. To risk stratify based on medical problems, the American Society of Anesthesiologists (ASA) classification scores are used routinely in the preprocedure evaluation. The objective of our study was to evaluate among physicians the ASA score accuracy pre-endoscopic procedures. METHODS At a single tertiary-care center an institutional review board-approved retrospective study was performed. Upper endoscopies performed from May 2012 through August 2013 were reviewed; data were collected and recorded. Statistical analysis was performed using descriptive statistics and linear weighted kappa analysis for agreement (≤0.20 is poor agreement, 0.21-0.40 is fair, 0.41-0.60 is moderate, 0.61-0.80 is good, and 0.81-1.00 is very good). RESULTS The mean ASA scores by the gastroenterologist compared with the anesthesiologist were 2.28 ± 0.56 and 2.78 ± 0.60, respectively, with only fair agreement (weighted kappa index 0.223, 95% confidence interval [CI] 0.113-0.333; 48% agreement). The mean ASA scores for gastroenterologists compared with other gastroenterologists were 2.26 ± 0.5 and 2.26 ± 0.44, respectively, with poor agreement (weighted kappa index 0.200, 95% CI 0.108-0.389; 68% agreement). Agreement on ASA scores was only moderate between the gastroenterologist and himself or herself (weighted kappa index 0.464, 95% CI 0.183-0.745; 75% agreement). CONCLUSIONS Gastroenterologists performing preprocedure assessments of ASA scores have fair agreement with anesthesiologists, poor agreement with other gastroenterologists, and only moderate agreement with themselves. Given this level of inaccuracy, it appears that the ASA score pre-endoscopy is of limited significance.
Collapse
Affiliation(s)
- Shoba Theivanayagam
- From the Division of Gastroenterology and Hepatology, University of Illinois, Peoria, Department of Gastroenterology, the Queen's Medical Center, Honolulu, Hawaii, and the Division of Gastroenterology and Hepatology, University of Missouri, Columbia
| | - Kristi T Lopez
- From the Division of Gastroenterology and Hepatology, University of Illinois, Peoria, Department of Gastroenterology, the Queen's Medical Center, Honolulu, Hawaii, and the Division of Gastroenterology and Hepatology, University of Missouri, Columbia
| | - Michelle L Matteson-Kome
- From the Division of Gastroenterology and Hepatology, University of Illinois, Peoria, Department of Gastroenterology, the Queen's Medical Center, Honolulu, Hawaii, and the Division of Gastroenterology and Hepatology, University of Missouri, Columbia
| | - Matthew L Bechtold
- From the Division of Gastroenterology and Hepatology, University of Illinois, Peoria, Department of Gastroenterology, the Queen's Medical Center, Honolulu, Hawaii, and the Division of Gastroenterology and Hepatology, University of Missouri, Columbia
| | - Akwi W Asombang
- From the Division of Gastroenterology and Hepatology, University of Illinois, Peoria, Department of Gastroenterology, the Queen's Medical Center, Honolulu, Hawaii, and the Division of Gastroenterology and Hepatology, University of Missouri, Columbia
| |
Collapse
|
21
|
Moole H, Bechtold ML, Forcione D, Puli SR. A meta-analysis and systematic review: Success of endoscopic ultrasound guided biliary stenting in patients with inoperable malignant biliary strictures and a failed ERCP. Medicine (Baltimore) 2017; 96:e5154. [PMID: 28099327 PMCID: PMC5279072 DOI: 10.1097/md.0000000000005154] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 07/27/2016] [Accepted: 09/25/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND In patients with inoperable malignant biliary strictures, endoscopic retrograde cholangiopancreatography (ERCP) guided biliary stenting fails in 5% to 10% patients due to difficult anatomy/inability to cannulate the papilla. Recently, endoscopic ultrasound guided biliary drainage (EUS-BD) has been described.Primary outcomes were to evaluate the biliary drainage success rates with EUS and compare it to percutaneous transhepatic biliary drainage (PTBD). Secondary outcomes were to evaluate overall procedure related complications. METHODS STUDY SELECTION CRITERIA:: Studies evaluating the efficacy of EUS-BD and comparing EUS-BD versus PTBD in inoperable malignant biliary stricture patients with a failed ERCP were included in this analysis. DATA COLLECTION AND EXTRACTION Articles were searched in Medline, PubMed, and Ovid journals. Two authors independently searched and extracted data. The study design was written in accordance to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Subgroup analyses of prospective studies and EUS-BD versus PTBD were performed. STATISTICAL METHOD Pooled proportions were calculated using fixed and random effects model. I statistic was used to assess heterogeneity among studies. RESULTS Initial search identified 846 reference articles, of which 124 were selected and reviewed. Sixteen studies (N = 528) that met the inclusion criteria were included in this analysis. In the pooled patient population, the percentage of patients that had a successful biliary drainage with EUS was 90.91% (95% CI = 88.10-93.38). The proportion of patients that had overall procedure related complications with EUS-PD was 16.46% (95% CI = 13.20-20.01). The pooled odds ratio for successful biliary drainage in EUS-PD versus PTBD group was 3.06 (95% CI = 1.11-8.43). The risk difference for overall procedure related complications in EUS-PD versus PTBD group was -0.21 (95% CI = -0.35 to -0.06). Relative risk for infectious complications and bile leak in EUS-BD versus PTBD was 0.25 (95% CI = 0.07-0.94) and 0.33 (95% CI = 0.12-0.87), respectively. CONCLUSIONS In patients with inoperable malignant biliary strictures who failed an ERCP guided biliary stenting, EUS-BD seems to be an excellent management option and superior to PTBD with higher successful biliary drainage rates and relatively fewer complications.
Collapse
Affiliation(s)
- Harsha Moole
- Division of General Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL
| | - Matthew L. Bechtold
- Division of Gastroenterology and Hepatology, University of Missouri-Columbia, Columbia, MO
| | - David Forcione
- Interventional Endoscopy Services, Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Srinivas R. Puli
- Division of Gastroenterology and Hepatology, University of Illinois College of Medicine at Peoria, Peoria, IL
| |
Collapse
|
22
|
Affiliation(s)
| | - Fazia A. Mir
- Department of Medicine, University of Missouri, Columbia, Missouri, USA
| | | | - Lena B. Palmer
- Department of Medicine, Loyola University, Chicago, Illinois, USA
| | - David C. Evans
- Department of Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Laszlo N. Kiraly
- Department of Surgery, Oregon Health Sciences University, Portland, Oregon, USA
| | - Douglas L. Nguyen
- Department of Medicine, University of California, Irvine, California, USA
| |
Collapse
|
23
|
Chin M, Karnes W, Jamal MM, Lee JG, Lee R, Samarasena J, Bechtold ML, Nguyen DL. Use of the Endocuff during routine colonoscopy examination improves adenoma detection: A meta-analysis. World J Gastroenterol 2016; 22:9642-9649. [PMID: 27920485 PMCID: PMC5116608 DOI: 10.3748/wjg.v22.i43.9642] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 09/24/2016] [Accepted: 10/19/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To perform meta-analysis of the use of Endocuff during average risk screening colonoscopy. METHODS Scopus, Cochrane databases, MEDLINE/PubMed, and CINAHL were searched in April 2016. Abstracts from Digestive Disease Week, United European Gastroenterology, and the American College of Gastroenterology meeting were also searched from 2004-2015. Studies comparing EC-assisted colonoscopy (EAC) to standard colonoscopy, for any indication, were included in the analysis. The analysis was conducted by using the Mantel-Haenszel or DerSimonian and Laird models with the odds ratio (OR) to assess adenoma detection, cecal intubation rate, and complications performed. RESULTS Nine studies (n = 5624 patients) were included in the analysis. Compared to standard colonoscopy, procedures performed with EC had higher frequencies for adenoma (OR = 1.49, 95%CI: 1.23-1.80; P = 0.03), and sessile serrated adenomas detection (OR = 2.34 95%CI: 1.63-3.36; P < 0.001). There was no significant difference in cecal intubation rates between the EAC group and standard colonoscopy (OR = 1.26, 95%CI: 0.70-2.27, I2 = 0%; P = 0.44). EAC was associated with a higher risk of complications, most commonly being superficial mucosal injury without higher frequency for perforation. CONCLUSION The use of an EC on colonoscopy appears to improve pre-cancerous polyp detection without any difference in cecal intubation rates compared to standard colonoscopy.
Collapse
|
24
|
Abstract
Vitamin D has traditionally been known for its role in bone metabolism, but emerging evidence has suggested a broader role for vitamin D in immune regulation. Vitamin D deficiency has been associated with the pathogenesis of diverse autoimmune disorders and has similarly been implicated as a contributor to inflammatory bowel disease. In this review, we discuss animal, in vitro, genetic, and epidemiologic studies that have linked vitamin D deficiency with inflammatory bowel disease pathogenesis or severity. Nonetheless, we present the caveat in interpreting these studies in the context of reverse causation: Does vitamin D deficiency lead to gastrointestinal disease, or does gastrointestinal disease (with related changes in dietary choices, intestinal absorption, nutritional status, lifestyle) lead to vitamin D deficiency?
Collapse
Affiliation(s)
- Berkeley N Limketkai
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 300 Pasteur Drive, Alway M211, Stanford, CA, 94305, USA.
| | - Matthew L Bechtold
- Division of Gastroenterology and Hepatology, University of Missouri School of Medicine, Columbia, MO, USA
| | - Douglas L Nguyen
- Division of Gastroenterology, University of California, Irvine, CA, USA
| |
Collapse
|
25
|
Moole H, Bechtold ML, Cashman M, Volmar FH, Dhillon S, Forcione D, Taneja D, Puli SR. Covered versus uncovered self-expandable metal stents for malignant biliary strictures: A meta-analysis and systematic review. Indian J Gastroenterol 2016. [PMID: 27566620] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Self-expandable metal stents (SEMS) are used for palliating inoperable malignant biliary strictures. It is unclear if covered metal stents are superior to uncovered metal stents in these patients. We compared clinical outcomes in patients with covered and uncovered stents. Studies using covered and uncovered metallic stents for palliation in patients with malignant biliary stricture were reviewed. Articles were searched in MEDLINE, PubMed, and Ovid journals. Fixed and random effects models were used to calculate the pooled proportions. Initial search identified 1436 reference articles, of which 132 were selected and reviewed. Thirteen studies (n = 2239) for covered and uncovered metallic stents which met the inclusion criteria were included in this analysis. Odds ratio for stent occlusion rates in covered vs. uncovered stents was 0.79 (95 % CI = 0.65 to 0.96). Survival benefit in patients with covered vs. uncovered stents showed the odds ratio to be 1.29 (95 % CI = 0.95 to 1.74). Pooled odds ratio for migration of covered vs. uncovered stents was 9.9 (95 % CI = 4.5 to 22.3). Covered stents seemed to have significantly lesser occlusion rates, increased odds of migration, and increased odds of pancreatitis compared to uncovered stents. There was no statistically significant difference in the survival benefit, overall adverse event rate, and patency period of covered vs. uncovered metal stents in patients with malignant biliary strictures.
Collapse
Affiliation(s)
- Harsha Moole
- Division of General Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA.
| | - Matthew L Bechtold
- Division of Gastroenterology and Hepatology, University of Missouri, Columbia, MO, USA
| | - Micheal Cashman
- Division of Gastroenterology and Hepatology, University of Illinois College of Medicine at Peoria, Peoria, IL, USA
| | - Fritz H Volmar
- Division of Gastroenterology and Hepatology, University of Illinois College of Medicine at Peoria, Peoria, IL, USA
| | - Sonu Dhillon
- Division of Gastroenterology and Hepatology, University of Illinois College of Medicine at Peoria, Peoria, IL, USA
| | - David Forcione
- Interventional Endoscopy Services, Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Deepak Taneja
- Department of Medicine, Division of Pulmonary Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA
| | - Srinivas R Puli
- Division of Gastroenterology and Hepatology, University of Illinois College of Medicine at Peoria, Peoria, IL, USA
| |
Collapse
|
26
|
Sohail U, Harleen C, Mahdi AO, Arif M, Nguyen DL, Bechtold ML. Bleeding risk with clopidogrel and percutaneous endoscopic gastrostomy. World J Gastrointest Endosc 2016; 8:553-557. [PMID: 27621767 PMCID: PMC4997785 DOI: 10.4253/wjge.v8.i16.553] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 04/28/2016] [Revised: 05/27/2016] [Accepted: 06/29/2016] [Indexed: 02/05/2023] Open
Abstract
AIM To compare bleeding within 48 h in patients undergoing percutaneous endoscopic gastrostomy (PEG) with or without clopidogrel.
METHODS After institutional review board approval, a retrospective study involving a single center was conducted on adult patients having PEG (1/08-1/14). Patients were divided into two groups: Clopidogrel group consisting of those patients taking clopidogrel within 5 d of PEG and the non-clopidogrel group including those patients not taking clopidogrel within 5 d of the PEG.
RESULTS Three hundred and nineteen PEG patients were found. One hundred and sixty-eight males and 151 females with mean body mass index 28.47 ± 9.75 kg/m2 and mean age 65.03 ± 16.11 years were identified. Thirty-three patients were on clopidogrel prior to PEG with 286 patients not on clopidogrel. No patients in either group developed hematochezia, melena, or hematemesis within 48 h of percutaneous endoscopic gastrostomy (PEG). No statistical differences were observed between the two groups with 48 h for hemoglobin decrease of > 2 g/dL (2 vs 5 patients; P = 0.16), blood transfusions (2 vs 7 patients; P = 0.24), and repeat endoscopy for possible gastrointestinal bleeding (no patients in either group).
CONCLUSION Based on the results, no significant post-procedure bleeding was observed in patients undergoing PEG with recent use of clopidogrel.
Collapse
|
27
|
Abstract
Colorectal cancer (CRC) is a significant healthcare issue, with substantial morbidity and mortality. Screening for CRC is essential in the prevention and treatment of this disease. The two most common CRC screening modalities are colonoscopy and the stool-based occult blood test, with two types of stool-based occult blood tests: the guaiac-based fecal occult blood test (FOBT) and the immunochemical FOBT. Despite many similarities, these two stool tests are different and often are confused in clinical practice. In an effort to improve awareness of these testing modalities, this review provides extensive information on both of these FOBTs, as well as discusses comparisons in the literature between these stool-based blood tests and other screening modalities such as stool DNA and colonoscopy.
Collapse
Affiliation(s)
- Matthew L Bechtold
- From the Department of Medicine, University of Missouri, Columbia, and the Department of Medicine, University of California, Irvine
| | - Imran Ashraf
- From the Department of Medicine, University of Missouri, Columbia, and the Department of Medicine, University of California, Irvine
| | - Douglas L Nguyen
- From the Department of Medicine, University of Missouri, Columbia, and the Department of Medicine, University of California, Irvine
| |
Collapse
|
28
|
Boumitri C, Mir FA, Ashraf I, Matteson-Kome ML, Nguyen DL, Puli SR, Bechtold ML. Prophylactic clipping and post-polypectomy bleeding: a meta-analysis and systematic review. Ann Gastroenterol 2016; 29:502-508. [PMID: 27708518 PMCID: PMC5049559 DOI: 10.20524/aog.2016.0075] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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: 05/29/2016] [Accepted: 07/01/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Bleeding after polypectomy is a common issue associated with colonoscopy. To help prevent post-polypectomy bleeding, many endoscopists place clips at the site. However, this practice remains controversial. Therefore, we performed a meta-analysis of the efficacy of clip placement in the prevention of post-polypectomy bleeding. METHODS Multiple databases, including Embase, Scopus, MEDLINE/PubMed, CINAHL, Cochrane databases, and recent abstracts from major American meetings were searched in April 2016. Using the DerSimonian and Laird (random effects) model with odds ratio (OR), a meta-analysis was performed of post-polypectomy bleeding with prophylactic clip versus no prophylactic clip. RESULTS Five hundred and thirty potential articles and abstracts were discovered. Thirty-five articles were reviewed, with 12 studies satisfying the inclusion criteria. No statistically significant difference in prophylactic clipping versus no prophylactic clipping for post-polypectomy bleeding in all polyps was found when all studies (OR 1.49; 95% CI: 0.56-4.00; P=0.42), only peer-reviewed studies where abstracts were excluded (OR 0.84; 95% CI: 0.42-1.69; P=0.63), and only randomized controlled trials (OR 1.24; 95% CI: 0.69-2.24; P=0.47) were analyzed. CONCLUSIONS The use of prophylactic clipping for all polypectomies does not seem to prevent post-polypectomy bleeding and should not be a routine practice. However, for large polyps (>2 cm), prophylactic clipping may or may not be beneficial in preventing post-polypectomy bleeding. Further studies are required to fully evaluate this subgroup.
Collapse
Affiliation(s)
- Christine Boumitri
- Department of Medicine, University of Missouri, Columbia (Christine Boumitri, Fazia A. Mir, Imran Ashraf, Michelle L. Matteson-Kome, Matthew L. Bechtold), USA
| | - Fazia A Mir
- Department of Medicine, University of Missouri, Columbia (Christine Boumitri, Fazia A. Mir, Imran Ashraf, Michelle L. Matteson-Kome, Matthew L. Bechtold), USA
| | - Imran Ashraf
- Department of Medicine, University of Missouri, Columbia (Christine Boumitri, Fazia A. Mir, Imran Ashraf, Michelle L. Matteson-Kome, Matthew L. Bechtold), USA
| | - Michelle L Matteson-Kome
- Department of Medicine, University of Missouri, Columbia (Christine Boumitri, Fazia A. Mir, Imran Ashraf, Michelle L. Matteson-Kome, Matthew L. Bechtold), USA
| | - Douglas L Nguyen
- Department of Medicine, University of California, Irvine (Douglas L. Nguyen), USA
| | - Srinivas R Puli
- Department of Medicine, University of Illinois, Peoria (Srinivas R. Puli), USA, USA
| | - Matthew L Bechtold
- Department of Medicine, University of Missouri, Columbia (Christine Boumitri, Fazia A. Mir, Imran Ashraf, Michelle L. Matteson-Kome, Matthew L. Bechtold), USA
| |
Collapse
|
29
|
Rahman R, Nguyen DL, Sohail U, Almashhrawi AA, Ashraf I, Puli SR, Bechtold ML. Pre-endoscopic erythromycin administration in upper gastrointestinal bleeding: an updated meta-analysis and systematic review. Ann Gastroenterol 2016; 29:312-7. [PMID: 27366031 PMCID: PMC4923816 DOI: 10.20524/aog.2016.0045] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 02/19/2015] [Accepted: 04/09/2016] [Indexed: 12/13/2022] Open
Abstract
Background In patients suffering from upper gastrointestinal bleeding (UGIB), adequate visualization is essential during endoscopy. Prior to endoscopy, erythromycin administration has been shown to enhance visualization in these patients; however, guidelines have not fully adopted this practice. Thus, we performed a comprehensive, up-to-date meta-analysis on the issue of erythromycin administration in this patient population. Methods After searching multiple databases (November 2015), randomized controlled trials on adult subjects comparing administration of erythromycin before endoscopy in UGIB patients to no erythromycin or placebo were included. Pooled estimates of adequacy of gastric mucosa visualized, need for second endoscopy, duration of procedure, length of hospital stay, units of blood transfused, and need for emergent surgery using odds ratio (OR) or mean difference (MD) were calculated. Heterogeneity and publication bias were assessed. Results Eight studies (n=598) were found to meet the inclusion criteria. Erythromycin administration showed statistically significant improvement in adequate gastric mucosa visualization (OR 4.14; 95% CI: 2.01-8.53, P<0.01) while reduced the need for a second-look endoscopy (OR 0.51; 95% CI: 0.34-0.77, P<0.01) and length of hospital stay (MD -1.75; 95% CI: -2.43 to -1.06, P<0.01). Duration of procedure (P=0.2), units of blood transfused (P=0.08), and need for emergent surgery (P=0.88) showed no significant differences. Conclusion Pre-endoscopic erythromycin administration in UGIB patients significantly improves gastric mucosa visualization while reducing length of hospital stay and the need for second-look endoscopy.
Collapse
Affiliation(s)
- Rubayat Rahman
- Division of Gastroenterology and Hepatology, University of Missouri Health Sciences Center (Rubayat Rahman, Umair Sohail, Ashraf A. Almashhrawi, Imran Ashraf, Matthew L. Bechtold), USA
| | - Douglas L Nguyen
- Gastroenterology and Hepatology, University of California-Irvine (Douglas L. Nguyen), USA
| | - Umair Sohail
- Division of Gastroenterology and Hepatology, University of Missouri Health Sciences Center (Rubayat Rahman, Umair Sohail, Ashraf A. Almashhrawi, Imran Ashraf, Matthew L. Bechtold), USA
| | - Ashraf A Almashhrawi
- Division of Gastroenterology and Hepatology, University of Missouri Health Sciences Center (Rubayat Rahman, Umair Sohail, Ashraf A. Almashhrawi, Imran Ashraf, Matthew L. Bechtold), USA
| | - Imran Ashraf
- Division of Gastroenterology and Hepatology, University of Missouri Health Sciences Center (Rubayat Rahman, Umair Sohail, Ashraf A. Almashhrawi, Imran Ashraf, Matthew L. Bechtold), USA
| | - Srinivas R Puli
- Gastroenterology and Hepatology, University of Illinois-Peoria (Srinivas R. Puli), USA
| | - Matthew L Bechtold
- Division of Gastroenterology and Hepatology, University of Missouri Health Sciences Center (Rubayat Rahman, Umair Sohail, Ashraf A. Almashhrawi, Imran Ashraf, Matthew L. Bechtold), USA
| |
Collapse
|
30
|
Bechtold ML, Mir F, Puli SR, Nguyen DL. Optimizing bowel preparation for colonoscopy: a guide to enhance quality of visualization. Ann Gastroenterol 2016; 29:137-46. [PMID: 27065725 PMCID: PMC4805732 DOI: 10.20524/aog.2016.0005] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 01/11/2016] [Indexed: 12/15/2022] Open
Abstract
Colonoscopy is an important screening and therapeutic modality for colorectal cancer. Unlike other screening tests, colonoscopy is dependent on pre-procedure bowel preparation. If the bowel preparation is poor, significant pathology may be missed. Many factors are known to improve bowel preparation. This review will highlight those factors that may optimize the bowel preparation, including choice of bowel preparation, grading or scoring of the bowel preparation, special factors that influence preparation, and diet prior to colonoscopy that affects bowel preparation. The aim of the review is to offer suggestions and guide endoscopists on how to optimize the bowel preparation for the patients undergoing colonoscopy.
Collapse
Affiliation(s)
- Matthew L Bechtold
- Departments of Medicine, University of Missouri, Columbia (Matthew L. Bechtold, Fazia Mir), USA
| | - Fazia Mir
- Departments of Medicine, University of Missouri, Columbia (Matthew L. Bechtold, Fazia Mir), USA
| | - Srinivas R Puli
- Departments of Medicine, University of Illinois, Peoria (Srinivas R. Puli), USA
| | - Douglas L Nguyen
- Departments of Medicine, University of California, Irvine (Douglas L. Nguyen), USA
| |
Collapse
|
31
|
Nguyen DL, Jamal MM, Nguyen ET, Puli SR, Bechtold ML. Low-residue versus clear liquid diet before colonoscopy: a meta-analysis of randomized, controlled trials. Gastrointest Endosc 2016; 83:499-507.e1. [PMID: 26460222 DOI: 10.1016/j.gie.2015.09.045] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [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: 03/16/2015] [Accepted: 09/23/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Colonoscopy is extremely important for the identification and removal of precancerous polyps. Bowel preparation before colonoscopy is essential for adequate visualization. Traditionally, patients have been instructed to consume only clear liquids the day before a colonoscopy. However, recent studies have suggested using a low-residue diet, with varying results. We evaluated the outcomes of patients undergoing colonoscopy who consumed a clear liquid diet (CLD) versus low-residue diet (LRD) on the day before colonoscopy by a meta-analysis. METHODS Scopus, PubMed/MEDLINE, Cochrane databases, and CINAHL were searched (February 2015). Studies involving adult patients undergoing colonoscopy examination and comparing LRD with CLD on the day before colonoscopy were included. The analysis was conducted by using the Mantel-Haenszel or DerSimonian and Laird models with the odds ratio (OR) to assess adequate bowel preparations, tolerability, willingness to repeat diet and preparation, and adverse effects. RESULTS Nine studies (1686 patients) were included. Patients consuming an LRD compared with a CLD demonstrated significantly higher odds of tolerability (OR 1.92; 95% CI, 1.36-2.70; P < .01) and willingness to repeat preparation (OR 1.86; 95% CI, 1.34-2.59; P < .01) with no differences in adequate bowel preparations (OR 1.21; 95% CI, 0.64-2.28; P = .58) or adverse effects (OR 0.88; 95% CI, 0.58-1.35; P = .57). CONCLUSION An LRD before colonoscopy resulted in improved tolerability by patients and willingness to repeat preparation with no differences in preparation quality and adverse effects.
Collapse
Affiliation(s)
- Douglas L Nguyen
- Department of Medicine, University of California-Irvine, Irvine, California, USA
| | - M Mazen Jamal
- Department of Medicine, University of California-Irvine, Irvine, California, USA
| | - Emily T Nguyen
- Department of Pharmacy, University of California-Irvine, Irvine, California, USA
| | - Srinivas R Puli
- Department of Medicine, University of Illinois-Peoria, Peoria, Illinois, USA
| | - Matthew L Bechtold
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Missouri-Columbia, Columbia, Missouri, USA
| |
Collapse
|
32
|
Bechtold ML, Nguyen DL, Palmer LB, Kiraly LN, Martindale RG, McClave SA. Nasal bridles for securing nasoenteric tubes: a meta-analysis. Nutr Clin Pract 2015; 29:667-71. [PMID: 25606648 DOI: 10.1177/0884533614536737] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Nasoenteric feeding tubes may easily become dislodged due to patient mental status, transfers, or positional changes. Nasal bridles were introduced to provide a better, more reliable system to secure these tubes. This meta-analysis was performed to evaluate the effectiveness of nasal bridles compared with the traditional method of adhesive tape alone in securing enteral feeding tubes. MATERIALS AND METHODS Multiple databases were searched (October 2013). All studies that evaluated the use of nasal bridles in adult patients were included in the analysis. Meta-analysis for the outcomes from use of a nasal bridle vs the more traditional method of adhesive tape alone for securing nasoenteric tubes was analyzed by calculating pooled estimates of dislodgement, skin complications, and sinusitis. Statistical analysis was performed using RevMan 5.1. RESULTS Six studies (n = 594) met the inclusion criteria. Use of a nasal bridle for securing enteral tubes resulted in a statistically significant reduction in tube dislodgement compared with traditional adhesive tape alone (odds ratio [OR], 0.16; 95% confidence interval [CI], 0.10–0.27; P < .01). The use of nasal bridles was associated with a higher rate of skin complications compared with traditional adhesive tape (OR, 4.27; 95% CI, 1.79–10.23; P < .01). Incidence of sinusitis was no different between the 2 groups (OR, 0.26; 95% CI, 0.03–2.28; P = .22). CONCLUSION Nasal bridles appear to be more effective at securing nasoenteric tubes and preventing dislodgement than traditional use of tape alone.
Collapse
Affiliation(s)
- Matthew L Bechtold
- Division of Gastroenterology & Hepatology, University of Missouri Health Sciences Center, CE405, DC 043.00, Five Hospital Dr, Columbia, MO 65212, USA.
| | | | | | | | | | | |
Collapse
|
33
|
Nguyen DL, Nguyen ET, Bechtold ML. Effect of Immunosuppressive Therapies for the Treatment of Inflammatory Bowel Disease on Response to Routine Vaccinations: A Meta-Analysis. Dig Dis Sci 2015; 60:2446-53. [PMID: 25796579 DOI: 10.1007/s10620-015-3631-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [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: 12/10/2014] [Accepted: 03/11/2015] [Indexed: 12/28/2022]
Abstract
BACKGROUND Several studies have evaluated the effect of immunosuppressive therapy for the treatment of inflammatory bowel disease (IBD) on response to routine vaccinations. The overall effect of specific classes of medications (i.e., immunomodulator vs. biologics) on vaccine response remains undefined. The aim of this study was to determine the effect of each class of immunosuppressive therapy in IBD patients on response to routine vaccinations. METHODS A comprehensive search of PubMed/MEDLINE, Scopus, CINAHL, and Cochrane databases was performed (December 2014). All studies on adults comparing vaccine response among IBD patients on immunosuppression with non-immunosuppressed patients were included. Meta-analysis was performed using the Mantel-Haenszel (fixed effects) model with odds ratio (OR) to assess for adequate vaccine response. RESULTS In the pooled analysis of nine studies (N = 1474), we found that there was nearly a 60 % lower chance of achieving adequate seroprotection in the group that received immunosuppressive therapy compared to the group that was not on any immunosuppressive therapies (OR 0.41 95 % CI 0.30, 0.55, p < 0.001). Specifically, we also demonstrated that patients on immunomodulator monotherapy had a twofold higher probability of achieving adequate immune response to vaccination, compared to patients on anti-tumor necrosis factor (anti-TNF) monotherapy (OR 1.92 95 % CI 1.30, 2.84). CONCLUSION In conclusion, IBD patients on immunosuppressive therapy have a significantly lower response to routine vaccinations. The greatest effect is seen among patients on anti-TNF and combination immunosuppressive therapy. Routine monitoring of vaccine titers post-vaccination is important to ensure that adequate immunologic response has been achieved among IBD patients.
Collapse
Affiliation(s)
- Douglas L Nguyen
- Department of Medicine, UC Irvine School of Medicine, University of California - Irvine, 333 City Blvd. West, Suite 400, Orange, CA, 92868, USA,
| | | | | |
Collapse
|
34
|
Nguyen DL, Palmer LB, Nguyen ET, McClave SA, Martindale RG, Bechtold ML. Specialized enteral nutrition therapy in Crohn's disease patients on maintenance infliximab therapy: a meta-analysis. Therap Adv Gastroenterol 2015; 8:168-75. [PMID: 26136834 PMCID: PMC4480570 DOI: 10.1177/1756283x15578607] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [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] Open
Abstract
OBJECTIVES Many patients with Crohn's disease on infliximab maintenance therapy have recurrent symptoms despite an initial clinical response. Therefore, concomitant therapies have been studied. We conducted a meta-analysis to assess the effect of specialized enteral nutrition therapy with infliximab versus infliximab monotherapy in patients with Crohn's disease. METHODS A comprehensive search of multiple databases was performed. All studies of adult patients with Crohn's disease comparing specialized enteral nutrition therapy (elemental or polymeric diet with low-fat or regular diet) with infliximab versus infliximab monotherapy without dietary restrictions were included. Meta-analysis was performed using the Mantel-Haenszel (fixed effect) model with odds ratio (OR) to assess for clinical remission. RESULTS Four studies (n = 342) met inclusion criteria. Specialized enteral nutrition therapy with infliximab resulted in 109 of 157 (69.4%) patients reaching clinical remission compared with 84 of 185 (45.4%) with infliximab monotherapy [OR 2.73; 95% confidence interval (CI): 1.73-4.31, p < 0.01]. Similarly, 79 of 106 (74.5%) patients receiving enteral nutrition therapy and infliximab remained in clinical remission after one year compared with 62 of 126 (49.2%) patients receiving infliximab monotherapy (OR 2.93; 95% CI: 1.66-5.17, p < 0.01). No publication bias or heterogeneity was noted for either outcome. CONCLUSIONS The use of specialized enteral nutrition therapy in combination with infliximab appears to be more effective at inducing and maintaining clinical remission among patients with Crohn's disease than infliximab monotherapy.
Collapse
Affiliation(s)
- Douglas L. Nguyen
- Department of Medicine, University of California Irvine, Irvine, CA, USA
| | - Lena B. Palmer
- Department of Medicine, Loyola University, Chicago, IL, USA
| | - Emily T. Nguyen
- Department of Pharmacy, University of California – Irvine, CA, USA
| | | | | | - Matthew L. Bechtold
- Division of Gastroenterology & Hepatology, University of Missouri Health Sciences Center, CE405, DC 043.00, Five Hospital Drive, Columbia, MO 65212, USA
| |
Collapse
|
35
|
Abstract
OBJECTIVES Several studies have been performed evaluating the role of perinuclear anti-neutrophil cytoplasmic antibodies (pANCA) to predict early clinical response among patients with inflammatory bowel disease (IBD) who are undergoing infliximab therapy. The results of these studies are variable, however, and the effect of pANCA+ as a predictor of clinical response to infliximab remains largely undefined. The goal of this meta-analysis was to evaluate the role of pANCA in predicting poor responders to infliximab. METHODS A comprehensive search of the PubMed/MEDLINE, Scopus, Cumulative Index of Nursing and Allied Health Literature, Google Scholar, and Cochrane databases was performed in June 2014. All of the studies that evaluated pANCA levels in patients with IBD who were undergoing antitumor necrosis factor-α (anti-TNF-α) therapy and their clinical responses were included. A meta-analysis was performed using the Mantel-Haenszel model with odds ratios to assess for clinical remission. RESULTS In the pooled analysis (N = 415), patients who were pANCA negative had nearly a twofold higher response to anti-TNF-α therapy compared with patients who were pANCA+ (odds ratio 1.87; 95% confidence interval 1.02-3.41). Serologic testing for pANCA+ predicting nonresponse to infliximab therapy showed a sensitivity of 25.2%, a specificity of 85.5%, a positive predictive value of 41.1%, and a negative predictive value of 74.0%. CONCLUSIONS Being more proactive (ie, early dose escalation or accelerated loading regimen) in patients who are pANCA+ may be necessary to improve clinical response.
Collapse
Affiliation(s)
- Douglas L Nguyen
- From the Departments of Medicine and Pharmacy, University of California, Irvine, and the Department of Medicine, University of Missouri, Columbia
| | - Emily T Nguyen
- From the Departments of Medicine and Pharmacy, University of California, Irvine, and the Department of Medicine, University of Missouri, Columbia
| | - Matthew L Bechtold
- From the Departments of Medicine and Pharmacy, University of California, Irvine, and the Department of Medicine, University of Missouri, Columbia
| |
Collapse
|
36
|
Nguyen DL, Flores S, Sassi K, Bechtold ML, Nguyen ET, Parekh NK. Optimizing the use of anti-tumor necrosis factor in the management of patients with Crohn's disease. Ther Adv Chronic Dis 2015; 6:147-54. [PMID: 25954499 PMCID: PMC4416970 DOI: 10.1177/2040622315579621] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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: 12/30/2022] Open
Abstract
Since the approval of the first anti-tumor necrosis factor (anti-TNF) therapy in late 1998, the treatment for Crohn's disease (CD) has been revolutionized. Anti-TNF therapy has been consistently shown in numerous clinical trials to be effective for patients with more aggressive perianal, internal penetrating, and fistulizing CD. However, the loss of clinical remission is frequent and only one-third of patients remain in clinical remission at 1 year. The pharmacokinetics of anti-TNF is highly variable among patients and could be influenced by many factors including serum albumin, gender, body weight, systemic inflammation and route of administration. The main factor impacting anti-TNF pharmacokinetics and efficacy is the development of immunogenicity where antidrug antibodies accelerate anti-TNF drug clearance. In this review paper, we evaluate the role of combination therapy with anti-TNF drugs and immunomodulators, the role of therapeutic drug monitoring, and strategies to recapture loss of clinical response in order to improve both short- and long-term outcomes in CD patients.
Collapse
Affiliation(s)
- Douglas L Nguyen
- Department of Medicine, UC Irvine School of Medicine, 333 City Boulevard West, Suite 400 Orange, CA 92868, USA
| | - Sarah Flores
- Department of Medicine, University of California, Irvine, CA, USA
| | - Kareem Sassi
- Department of Medicine, University of California, Irvine, CA, USA
| | | | - Emily T Nguyen
- Department of Pharmacy, University of California, Irvine, CA, USA
| | | |
Collapse
|
37
|
Kandula M, Moole H, Cashman M, Volmar FH, Bechtold ML, Puli SR. Success of endoscopic ultrasound-guided ethanol ablation of pancreatic cysts: a meta-analysis and systematic review. Indian J Gastroenterol 2015; 34:193-9. [PMID: 26108653 DOI: 10.1007/s12664-015-0575-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 05/14/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND Endoscopic ultrasound (EUS)-guided ethanol ablation has emerged as an efficacious and safe alternative management option for pancreatic cysts. We undertook a meta-analysis and systematic review to assess the overall safety and efficacy of EUS-guided ethanol ablation of pancreatic cysts. METHOD STUDY SELECTION CRITERIA EUS-guided ethanol ablation of pancreatic cysts. DATA COLLECTION EXTRACTION Articles were searched in Medline, Pubmed, and Ovid journals. STATISTICAL METHOD Fixed and random effects models were used to calculate the pooled proportions. RESULTS Initial search identified 1,319 reference articles, in which 120 relevant articles were selected and reviewed. Data was extracted from seven studies (n = 152) of EUS-guided ethanol ablation of pancreatic cysts, which met the inclusion criteria. With EUS-guided ethanol ablation, the pooled proportion of patients with complete cyst resolution was 56.20 % (95 % CI = 48.16 to 64.08) and partial cyst resolution was 23.72 % (95 % CI = 17.24 to 30.89). Postprocedural complications after ablation were significant for abdominal pain in 6.51 % (95 % CI = 3.12 to 11.04) and pancreatitis in 3.90 % (95 % CI = 1.39 to 7.60) of the pooled percentage of patients. Publication bias calculated using Harbord-Egger bias indicator gave a value of -1.09 (95 % CI = 10.21 to 8.03, p = 0.77). The Begg-Mazumdar indicator gave a Kendall's tau b value of 0.05 (p ≥ 0.99). CONCLUSIONS EUS-guided ethanol ablation may be a safe alternative treatment modality for pancreatic cysts, with acceptable intraprocedural and postprocedural complications. However, due to the limited data available, prospective randomized controlled trials with a long follow up period are required in this area.
Collapse
Affiliation(s)
- Manasa Kandula
- Division of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA,
| | | | | | | | | | | |
Collapse
|
38
|
Hinds AM, Ahmad DS, Muenster JE, Berg ZM, Lopez KT, Holly JSL, Matteson-Kome ML, Bechtold ML. Ipilimumab-induced colitis: a rare but serious side effect. Endoscopy 2015; 46 Suppl 1 UCTN:E308-9. [PMID: 25058826 DOI: 10.1055/s-0034-1377209] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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)
- Alisha M Hinds
- Department of Medicine, University of Missouri School of Medicine, Columbia, Missouri, United States of America
| | - Dina S Ahmad
- Department of Medicine, University of Missouri School of Medicine, Columbia, Missouri, United States of America
| | - Joseph E Muenster
- Department of Medicine, University of Missouri School of Medicine, Columbia, Missouri, United States of America
| | - Zachary M Berg
- Department of Medicine, University of Missouri School of Medicine, Columbia, Missouri, United States of America
| | - Kristi T Lopez
- Department of Medicine, University of Missouri School of Medicine, Columbia, Missouri, United States of America
| | - Jason S L Holly
- Department of Anatomical Pathology, University of Missouri School of Medicine, Columbia, Missouri, United States of America
| | - Michelle L Matteson-Kome
- Department of Medicine, University of Missouri School of Medicine, Columbia, Missouri, United States of America
| | - Matthew L Bechtold
- Department of Medicine, University of Missouri School of Medicine, Columbia, Missouri, United States of America
| |
Collapse
|
39
|
Almashhrawi AA, Rahman R, Jersak ST, Asombang AW, Hinds AM, Hammad HT, Nguyen DL, Bechtold ML. Prophylactic tracheal intubation for upper GI bleeding: A meta-analysis. World J Meta-Anal 2015; 3:4-10. [PMID: 25741509 PMCID: PMC4346140 DOI: 10.13105/wjma.v3.i1.4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 11/03/2014] [Accepted: 12/31/2014] [Indexed: 02/05/2023] Open
Abstract
AIM: To evaluate usefulness of prophylactically intubating upper gastrointestinal bleeding (UGIB) patients.
METHODS: UGIB results in a significant number of hospital admissions annually with endoscopy being the key intervention. In these patients, risks are associated with the bleeding and the procedure, including pulmonary aspiration. However, very little literature is available assessing the use of prophylactic endotracheal intubation on aspiration in these patients. A comprehensive search was performed in May 2014 in Scopus, CINAHL, Cochrane databases, PubMed/Medline, Embase, and published abstracts from national gastroenterology meetings in the United States (2004-2014). Included studies examined UGIB patients and compared prophylactic intubation to no intubation before endoscopy. Meta-analysis was conducted using RevMan 5.2 by Mantel-Haenszel and DerSimonian and Laird models with results presented as odds ratio for aspiration, pneumonia (within 48 h), and mortality. Funnel plots were utilized for publication bias and I2 measure of inconsistency for heterogeneity assessments.
RESULTS: Initial search identified 571 articles. Of these articles, 10 relevant peer-reviewed articles in English and two relevant abstracts were selected to review by two independent authors (Almashhrawi AA and Bechtold ML). Of these studies, eight were excluded: Five did not have a control arm, one was a letter the editor, one was a survey study, and one was focused on prevention of UGIB. Therefore, four studies (N = 367) were included. Of the UGIB patients prophylactically intubated before endoscopy, pneumonia (within 48 h) was identified in 20 of 134 (14.9%) patients as compared to 5 of 95 (5.3%) patients that were not intubated prophylactically (P = 0.02). Despite observed trends, no significant differences were found for mortality (P = 0.18) or aspiration (P = 0.11).
CONCLUSION: Pneumonia within 48 h is more likely in UGIB patients who received prophylactic endotracheal intubation prior to endoscopy.
Collapse
|
40
|
Bechtold ML, McClave SA, Palmer LB, Nguyen DL, Urben LM, Martindale RG, Hurt RT. The pharmacologic treatment of short bowel syndrome: new tricks and novel agents. Curr Gastroenterol Rep 2015; 16:392. [PMID: 25052938 DOI: 10.1007/s11894-014-0392-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Short bowel syndrome (SBS) is a manifestation of massive resection of the intestines resulting in severe fluid, electrolyte, and vitamin/mineral deficiencies. Diet and parenteral nutrition play a large role in the management of SBS; however, pharmacologic options are becoming more readily available. These pharmacologic agents focus on reducing secretions and stimulating intestinal adaptation. The choice of medication is highly dependent on the patient's symptoms, remaining anatomy, and risk versus benefit profile for each agent. This article focuses on common and novel pharmacologic medications used in SBS, including expert advice on their indications and use.
Collapse
|
41
|
Nguyen DL, Maithel S, Nguyen ET, Bechtold ML. Does alvimopan enhance return of bowel function in laparoscopic gastrointestinal surgery? A meta-analysis. Ann Gastroenterol 2015; 28:475-80. [PMID: 26423597 PMCID: PMC4585395] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Postoperative ileus (POI) remains a major impediment in patient recovery and leads to longer lengths of stay at the hospital, readmission rates, and hospital costs. Alvimopan, a mu-opioid receptor antagonist, lowers POI incidence following open gastrointestinal surgery, however, little is known about its role on POI prevention among patients undergoing laparoscopic gastrointestinal surgery. METHODS A comprehensive search of PubMed/MEDLINE, Scopus, CINAHL, and Cochrane databases was performed (December 2014). Meta-analysis was performed using the Mantel-Haenszel (fixed effects) model with odds ratio (OR) to assess prevention of POI and hospital readmission. RESULTS Five studies were included in the final analysis. Pooling 4 of 5 studies, there was over a 75% relative risk reduction in POI development when patients were given alvimopan compared to placebo (OR 0.24, 95%CI 0.12-0.51, P=0.02). The number needed to treat with alvimopan to prevent one POI episode was 11 patients. There was a modest reduction in the length of hospitalization between 0.2 and 1.6 days. There did not appear to be a difference in frequency of 30-day readmission rate among the alvimopan group compared to placebo (OR 1.15, 95%CI 0.54-2.45, P=0.62). CONCLUSION Overall, there was a 75% relative risk reduction in POI development among patients undergoing laparoscopic gastrointestinal surgery. However, there did not appear to be a significant reduction in all-cause 30-day readmission rate or length of hospitalization. Future studies will need to address which subset of patients undergoing laparoscopic gastrointestinal surgery will benefit most from alvimopan.
Collapse
Affiliation(s)
- Douglas L. Nguyen
- Department of Medicine, University of California-Irvine, CA (Douglas L. Nguyen, Shelley Maithel), USA,
Correspondence to: Douglas L. Nguyen MD, Assistant Clinical Professor of Medicine, Department of Medicine, UC Irvine School of Medicine, 333 City Blvd. West, Suite 400, Orange, CA 92868, Tel.: +1 714 456 6745, Fax: +1 714 456 7753, e-mail:
| | - Shelley Maithel
- Department of Medicine, University of California-Irvine, CA (Douglas L. Nguyen, Shelley Maithel), USA
| | - Emily T. Nguyen
- Department of Pharmacy, University of California-Irvine, CA (Emily T. Nguyen), USA
| | - Matthew L. Bechtold
- Department of Medicine, University of Missouri-Columbia (Matthew L. Bechtold), USA
| |
Collapse
|
42
|
Lopez KT, Theivanayagam S, Asombang AW, Matteson-Kome ML, Bechtold ML. Airway assessment of patients undergoing endoscopic procedures. South Med J 2014; 107:764-7. [PMID: 25502155 DOI: 10.14423/smj.0000000000000203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES In advance of endoscopic procedures, an evaluation to assess the risk of sedation is performed by the gastroenterologist. Based on regulations, gastroenterologists are required to perform an airway assessment. At this time, data supporting this regulation are limited; therefore, we evaluated airway assessment accuracy by gastroenterologists before endoscopic procedures. METHODS A retrospective, single tertiary care center study was performed from May 2012 through August 2013. Patients who underwent an endoscopy or colonoscopy performed at the University of Missouri-Columbia with documented Mallampati scores were included in the analysis. Three primary cohorts of patients were included in our study: gastroenterologist versus anesthesiologist, gastroenterologist versus other gastroenterologists, and gastroenterologists versus themselves. Data were collected and recorded for patient age, body mass index, and Mallampati score. Statistical analysis was performed using descriptive statistics and linear weighted kappa analysis for agreement. RESULTS For gastroenterologists versus anesthesiologists and versus other gastroenterologists, the agreement on Mallampati scores was poor (weighted kappa index 0.103, 95% confidence interval [CI] -0.0126 to 0.219; percentage of agreement 42% and 0.120, 95% CI -0.0211 to 0.260; percentage of agreement 46%, respectively). For gastroenterologists versus themselves for the same patient, the agreement on Mallampati scores was only moderate (weighted kappa index 0.420, 95% CI 0.119-0.722; percentage of agreement 65%). CONCLUSIONS Gastroenterologists performing a preprocedure assessment using Mallampati scores have poor agreement with anesthesiologists and colleagues and only moderate agreement with themselves.
Collapse
Affiliation(s)
- Kristi T Lopez
- From the Division of Gastroenterology and Hepatology, University of Missouri, Columbia
| | - Shoba Theivanayagam
- From the Division of Gastroenterology and Hepatology, University of Missouri, Columbia
| | - Akwi W Asombang
- From the Division of Gastroenterology and Hepatology, University of Missouri, Columbia
| | | | - Matthew L Bechtold
- From the Division of Gastroenterology and Hepatology, University of Missouri, Columbia
| |
Collapse
|
43
|
Lopez K, Ahmad D, Hinds A, Hammad HT, Godfrey JD, Matteson-Kome ML, Bechtold ML. Pseudoaneurysm eroding into the duodenal bulb: an extremely rare case and treatment modality. Endoscopy 2014; 46 Suppl 1 UCTN:E124-5. [PMID: 24676822 DOI: 10.1055/s-0034-1364944] [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)
- Kristi Lopez
- Department of Internal Medicine, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Dina Ahmad
- Department of Internal Medicine, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Alisha Hinds
- Department of Internal Medicine, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Hazem T Hammad
- Department of Internal Medicine, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Jonathan D Godfrey
- Department of Internal Medicine, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Michelle L Matteson-Kome
- Department of Internal Medicine, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Matthew L Bechtold
- Department of Internal Medicine, University of Missouri School of Medicine, Columbia, Missouri, USA
| |
Collapse
|
44
|
Hinds AM, Ahmad D, Lopez KT, Holly JSL, Matteson-Kome ML, Bechtold ML. Mucinous carcinoma of the eyelid with colonic mass: a rare partnership. Endoscopy 2014; 46 Suppl 1 UCTN:E107-8. [PMID: 24676812 DOI: 10.1055/s-0033-1359239] [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)
- Alisha M Hinds
- Department of Internal Medicine - Gastroenterology, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Dina Ahmad
- Department of Internal Medicine - Gastroenterology, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Kristi T Lopez
- Department of Internal Medicine - Gastroenterology, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Jason S L Holly
- Department of Anatomical Pathology, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Michelle L Matteson-Kome
- Department of Internal Medicine - Gastroenterology, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Matthew L Bechtold
- Department of Internal Medicine - Gastroenterology, University of Missouri School of Medicine, Columbia, Missouri, USA
| |
Collapse
|
45
|
Ashraf I, Ashraf S, Siddique S, Nguyen DL, Choudhary A, Bechtold ML. Hyoscine for polyp detection during colonoscopy: A meta-analysis and systematic review. World J Gastrointest Endosc 2014; 6:549-554. [PMID: 25400869 PMCID: PMC4231494 DOI: 10.4253/wjge.v6.i11.549] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [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: 05/06/2014] [Revised: 08/14/2014] [Accepted: 10/10/2014] [Indexed: 02/05/2023] Open
Abstract
AIM: To assess the role of hyoscine for polyp detection during colonoscopy.
METHODS: Studies (randomized controlled trials or RCTs) that compared the use of hyoscine vs no hyoscine or placebo for polyp detection during colonoscopy were included in our analysis. A search on multiple databases was performed in September 2013 with search terms being “hyoscine and colonoscopy”, “hyoscine and polyp”, “hyoscine and adenoma”, “antispasmotic and colonoscopy”, “antispasmotic and adenoma”, and “antispasmotic and polyp”. Jadad scoring was used to assess the quality of studies. The efficacy of hyoscine was analyzed using Mantel-Haenszel model for polyp and adenoma detection with odds ratio (OR). The I2 measure of inconsistency was used to assess heterogeneity (P < 0.05 or I2 > 50%). Statistical analysis was performed by RevMan 5.1. Funnel plots was used to assess publication bias.
RESULTS: The search of the electronic databases identified 283 articles. Of these articles, eight published RCTs performed at various locations in Europe, Asia, and Australia were included in our meta-analysis, seven published as manuscripts and one published as an abstract (n = 2307). All the studies included patients with a hyoscine and a no hyoscine/placebo group and were of adequate quality (Jadad score ≥ 2). Eight RCTs assessed the polyp detection rate (PDR) (n = 2307). The use of hyoscine demonstrated no statistically significant difference as compared to no hyoscine or placebo for PDR (OR = 1.06; 95%CI: 0.89-1.25; P = 0.51). Five RCTs assessed the adenoma detection rate (ADR) (n = 2015). The use of hyoscine demonstrated no statistically significant difference as compared to no hyoscine or placebo for ADR (OR = 1.12; 95%CI: 0.92-1.37; P = 0.25). Furthermore, the timing of hyoscine administration (given at cecal intubation or pre-procedure) demonstrated no differences in PDR compared to no hyoscine or placebo. Publication bias or heterogeneity was not observed for any of the outcomes.
CONCLUSION: Hyoscine use in patients undergoing colonoscopy does not appear to significantly increase the detection of polyps or adenomas.
Collapse
|
46
|
Matteson-Kome ML, Lopez KT, Sliger AD, Mathews MJ, Bechtold ML. Improving care access for new patients in an outpatient gastroenterology clinic: a novel approach. Mo Med 2014; 111:512-515. [PMID: 25665236 PMCID: PMC6173548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND We performed a quality initiative to improve our gastroenterology clinic access. METHODS A prospective quality improvement initiative was implemented in 12/2012. RESULTS From 10/2011-11/2012, 35.1% new patients were seen < or =10 days. After initiation of the quality improvement initiatives from 12/2012-1/2014, 75.2% new patients were seen < or =10 days (p<0.01). CONCLUSION New patient access to subspecialty clinics can be improved with simple initiatives, staff education, and improved teamwork.
Collapse
|
47
|
Palmer LB, McClave SA, Bechtold ML, Nguyen DL, Martindale RG, Evans DC. Tips and tricks for deep jejunal enteral access: modifying techniques to maximize success. Curr Gastroenterol Rep 2014; 16:409. [PMID: 25183576 DOI: 10.1007/s11894-014-0409-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Endoscopic insertion of enteral feeding tubes is a major advance in the delivery of nutrition therapy. Since the first report of percutaneous endoscopic gastrostomy (PEG) in 1980 (Gauderer et al. J Pediatr Surg. 15:872-5, 1980), insertion techniques and equipment have been refined and improved. Despite this progress, deep jejunal enteral access remains a difficult procedure, and many endoscopists do not have experience with the techniques of nasojejunal (NJ) placement, percutaneous endoscopic gastrojejunostomy (PEGJ), or direct percutaneous endoscopic jejunostomy (DPEJ) (Shike and Latkany, Gastrointest Endosc Clin N Am. 8:569-80, 1998). The difference between an exasperating experience and a rewarding procedure lies in mastering the "tips and tricks" that make insertion easy. While the basic techniques are described elsewhere (McClave and Chang 2011), we review several universal basic principles to enhance deep jejunal access, which should promote a more efficient and successful procedure.
Collapse
Affiliation(s)
- Lena B Palmer
- Department of Medicine, Loyola University Chicago, Maywood, IL, USA,
| | | | | | | | | | | |
Collapse
|
48
|
Hammad HT, Al-Sayyed L, Theivanayagam S, Nguyen V, Rawlings A, Bechtold ML. Impacted bone fragment in a small-bowel diverticulum: an extremely rare cause of obscure gastrointestinal bleeding. Endoscopy 2014; 46 Suppl 1 UCTN:E262. [PMID: 24853449 DOI: 10.1055/s-0034-1365430] [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)
- Hazem T Hammad
- Division of Gastroenterology, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Leen Al-Sayyed
- Division of Gastroenterology, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Shoba Theivanayagam
- Division of Gastroenterology, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Van Nguyen
- Department of Pathology and Anatomical Sciences, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Arthur Rawlings
- Department of Surgery, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Matthew L Bechtold
- Division of Gastroenterology, University of Missouri School of Medicine, Columbia, Missouri, USA
| |
Collapse
|
49
|
Abstract
BACKGROUND There is little information on the frequency of chronic liver disease among hospitalized patients with inflammatory bowel disease (IBD). In this study, we seek to define the common etiologies contributing to chronic liver disease among IBD patients and to identify potential risk factors predictive of increased mortality in this population. METHODS We analyzed the Nationwide Inpatient Sample from 1988 to 2006 to determine the frequency of chronic liver disease among patients with IBD and to determine their in-hospital outcomes. RESULTS From 1988 to 2006, the age-adjusted rate of chronic liver disease among hospitalized patients with IBD has increased from 4.35 per 100,000 persons in 1988-2001 to 7.45 per 100,000 persons in 2004-2006. The most common etiologies contributing to chronic liver disease among IBD patients were: primary sclerosing cholangitis, unspecified chronic hepatitis, chronic hepatitis C, and nonalcoholic fatty liver disease. Compared to IBD patients without liver disease, there was more than a twofold higher rate of inpatient morality among IBD patients with concomitant liver disease (2.7% vs. 1.3%, p < 0.01). The multivariate analysis showed that factors predictive of inpatient mortality include age >50, spontaneous bacterial peritonitis, ascites, hepatic encephalopathy, presence of cirrhosis, malnutrition, Clostridium difficile colitis, and hospital-acquired pneumonia. CONCLUSION There is a higher rate of inpatient mortality among patients with concomitant IBD and chronic liver disease compared to IBD alone. Early recognition and management of complications related to portal hypertension among patients with IBD and chronic liver disease is particularly important in order to reduce inpatient mortality and morbidity.
Collapse
Affiliation(s)
- Douglas L Nguyen
- Division of Gastroenterology and Hepatology, University of California-Irvine , Orange, CA , USA
| | | | | |
Collapse
|
50
|
Hinds AM, Ahmad D, Lopez KT, Matteson-Kome ML, Bechtold ML. Weekday vs weekend endoscopy: Is there a true difference in patient outcomes? A meta-analysis. World J Meta-Anal 2014; 2:29-35. [DOI: 10.13105/wjma.v2.i2.29] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/06/2013] [Revised: 03/05/2014] [Accepted: 04/11/2014] [Indexed: 02/05/2023] Open
Abstract
AIM: To evaluate the “weekend effect” on outcomes in patient admitted on the weekend for upper gastrointestinal bleeding (UGIB).
METHODS: A comprehensive search was performed (March 2014). Studies comparing weekend and weekday endoscopy in patients with UGIB were included. All studies had at least 2 of 3 primary outcomes which included: mortality, need for surgery, time to endoscopy, endoscopy on admission day, and length of hospital stay. Three authors individually extracted data. Meta-analysis was performed using pooled estimates with odds ratio or mean difference by fixed and random effects models.
RESULTS: Eleven studies met the inclusion criteria. Patients admitted with UGIB on the weekend exhibited a statistically significant increase in mortality (OR = 1.13; 95%CI: 1.06-1.20; P < 0.01), need for surgery (OR = 2.46; 95%CI: 1.51-3.99; P < 0.01), and time to endoscopy (MD 2.68; 95%CI: 0.17-5.20; P = 0.04) as compared to patients admitted with UGIB on a weekday. Furthermore, patients with UGIB admitted on weekend experienced statistically significant less endoscopy on day of admission (OR = 0.72; 95%CI: 0.62-0.85; P < 0.01). No difference was noted between the two groups for length of hospital stay (MD -1.29; 95%CI: -3.03-0.45; P = 0.15).
CONCLUSION: A weekend effect seems to be apparent in patients with UGIB with significantly poorer outcomes.
Collapse
|