المؤلفون: Arvind J. Trindade, Jianying Zhang, Kara L. Raphael, Jiejing Qiu, John Hauschild, Petros C. Benias

المصدر: Scientific Reports, Vol 12, Iss 1, Pp 1-8 (2022)

مصطلحات موضوعية: Medicine, Science

الوصف: Abstract Guidelines have shifted to now recommend endoscopic eradication therapy for Barrett’s esophagus (BE) with low and high-grade dysplasia. Previously, esophagectomy was the standard therapy for high-grade dysplasia. However, it is unclear to what degree ablation therapy has affected utilization of esophagectomy. In this retrospective observational cohort study of BE patients without cancer from the Premier Healthcare Database, the prevalence of utilization of endoscopic ablation therapy and of esophagectomy in BE were calculated and temporal trends were evaluated. A total of 938, 333 BE cases were included in the study. There was a significantly increasing trend of ablation over the period 2006 to 2010 (Annual Percentage Change (APC); 95% CI 0.56% [0.51%, 0.61%]), a significantly decreasing trend for the period 2011 to 2015 (APC; 95% CI − 0.15% [− 0.20%, − 0.11%]), and a shallow increasing trend for the period 2016 to 2019 (APC; 95% CI 0.09% [0.06%, 0.11%]). For esophagectomy, there was a significantly decreasing trend for the period 2006 to 2009 (APC; 95% CI − 0.03% [− 0.04%, − 0.02%]; P

وصف الملف: electronic resource

Relation: https://doaj.org/toc/2045-2322

URL الوصول: https://doaj.org/article/f5e3db62fd094254932eb986e2c67fdb

المؤلفون: Shruti Mony, Bachir Ghandour, Isaac Raijman, Amar Manvar, Sammy Ho, Arvind J. Trindade, Petros C. Benias, Claudio Zulli, Jérémie Jacques, Yervant Ichkhanian, Tobias Zuchelli, Mouhanna Abu Ghanimeh, Shayan Irani, Andrew Canakis, Omid Sanaei, Daniel Szvarca, Linda Zhang, Michael Bejjani, Venkata Akshintala, Mouen A. Khashab

المصدر: Endoscopy International Open, Vol 10, Iss 06, Pp E898-E904 (2022)

مصطلحات موضوعية: Diseases of the digestive system. Gastroenterology, RC799-869

الوصف: Background and study aims The utility of digital single- operator cholangiopancreatoscopy (D-SOCP) in surgically altered anatomy (SAA) is limited. We aimed to evaluate the technical success and safety of D-SOCP in patients SAA. Patients and methods Patients with SAA who underwent D-SOCP between February 2015 and June 2020 were retrospectively evaluated. Technical success was defined as completing the intended procedure with the use of D-SOCP. Results Thirty-five patients underwent D-SOCP (34 D-SOC, 1 D-SOP). Bilroth II was the most common type of SAA (45.7 %), followed by Whipple reconstruction (31.4 %). Twenty-three patients (65.7 %) patients had prior failed ERCP due to the presence of complex biliary stone (52.2 %). A therapeutic duodenoscope was utilized in the majority of the cases (68.6 %), while a therapeutic gastroscope (22.7 %) or adult colonoscope (8.5 %) were used in the remaining procedures. Choledocholithiasis (61.2 %) and pancreatic duct calculi (3.2 %) were the most common indications for D-SOCP. Technical success was achieved in all 35 patients (100 %) and majority (91.4 %) requiring a single session. Complex interventions included electrohydraulic or laser lithotripsy, biliary or pancreatic stent placement, stricture dilation, and target tissue biopsies. Two mild adverse events occurred (pancreatitis and transient bacteremia). Conclusions In SAA, D-SOCP is a safe and effective modality to diagnose and treat complex pancreatobiliary disorders, especially in cases where standard ERCP attempts may fail.

وصف الملف: electronic resource

Relation: https://doaj.org/toc/2364-3722; https://doaj.org/toc/2196-9736

URL الوصول: https://doaj.org/article/d588eb66753843efaaa93e096dcea9e3

المؤلفون: Anand Kumar, Saurabh Chandan, Babu P. Mohan, Pradeep R. Atla, Evin J. McCabe, David H. Robbins, Arvind J. Trindade, Petros C. Benias

المصدر: Endoscopy International Open, Vol 10, Iss 04, Pp E448-E458 (2022)

مصطلحات موضوعية: Diseases of the digestive system. Gastroenterology, RC799-869

الوصف: Background and study aims Surgical gastroenterostomy (SGE) has been the mainstay treatment for gastric outlet obstruction (GOO). The emergence of endoscopic ultrasound-guided gastroenterostomy (EUS-GE) presents a less invasive alternative for palliation of GOO. We conducted a comprehensive review and meta-analysis to compare the effectiveness and safety of EUS-GE compared to SGE. Methods Multiple electronic databases and conference proceedings up to April 2021 were searched to identify studies that reported on safety and effectiveness of EUS-GE in comparison to SGE. Pooled odds ratios (ORs) of technical success, clinical success, adverse events (AE) and recurrence, and pooled standardized mean difference (SMD) of procedure time and post-procedure length of stay (LOS) were calculated. Study heterogeneity was assessed using I 2 and Cochran Q statistics. Results Seven studies including 625 patients (372 EUS-GE and 253 SGE) were included. EUS-GE had lower pooled odds of technical success compared with SGE (OR 0.19, 95 % confidence interval [CI] 0.06–0.60, I 2 0 %). Among the technically successful cases, EUS-GE was superior in terms of clinical success (OR 4.73, 95 % CI 1.83–12.25, I 2 18 %), lower overall AE (OR 0.20, 95 % CI 0.10–0.37, I 2 39 %), and shorter procedure time (SMD –2.4, 95 % CI –4.1, –0.75, I 2 95 %) and post-procedure LOS (SMD –0.49, 95 % CI –0.94, –0.03, I 2 78%). Rates of severe AE (0.89, 95 % CI 0.11–7.36, I 2 67 %) and recurrence (OR 0.49, 95 % CI 0.18–1.38, I 2 49 %) were comparable. Conclusions Our results suggest EUS-GE is a promising alternative to SGE due to its superior clinical success, overall safety, and efficiency. With further evolution EUS-GE could become the intervention of choice in GOO.

وصف الملف: electronic resource

Relation: https://doaj.org/toc/2364-3722; https://doaj.org/toc/2196-9736

URL الوصول: https://doaj.org/article/d63e1a78230c4799915fcc29a14568ce

المؤلفون: Danny Issa, Petros C. Benias, David L. Carr-Locke

المصدر: Endoscopy International Open, Vol 09, Iss 08, Pp E1222-E1226 (2021)

مصطلحات موضوعية: Diseases of the digestive system. Gastroenterology, RC799-869

وصف الملف: electronic resource

Relation: https://doaj.org/toc/2364-3722; https://doaj.org/toc/2196-9736

URL الوصول: https://doaj.org/article/8be2f147b3b94bf682bbe081ca7ebcff

المؤلفون: Petros C. Benias, Vivek Kumbhari, Nikhil A. Kumta, Amrita Sethi, Lionel S. D’Souza, Amy Tyberg, Olaya Brewer Gutierrez, Larry S. Miller, David L. Carr-Locke, Mouen A. Khashab

المصدر: Endoscopy International Open, Vol 09, Iss 06, Pp E828-E835 (2021)

مصطلحات موضوعية: Diseases of the digestive system. Gastroenterology, RC799-869

الوصف: Background and study aims The rate of gastroesophageal reflux disease (GERD) after per oral endoscopic myotomy (POEM) is concerning. Endoscopic anti-reflux methods, such as Trans Oral Incisionless Fundoplication (TIF), are crucial for the long-term success of POEM, especially if they can be performed in the same session. Methods We completed a proof-of-concept canine pilot study (n = 6) to assess safety and feasibility of POEM and TIF in a single session (POEM-TIF). Subsequently, POEM-TIF was also performed in patients with achalasia (n = 5). Herein, we report on the safety, technical and clinical success of the first-in-human cases with symptom follow-up at 1, 3 and 6 months and pH testing at 6 months. Results POEM was completed successfully in six canines (3 anterior and 3 posterior myotomies), followed by TIF in the same session. Necropsy and extensive testing demonstrated no evidence of mucosal injury and no leaks. The reconstructed valve was 220 to 240 degrees, 3 to 4 cm in length, and resulted in concomitant esophageal lengthening (2–5 cm). Using similar principles, the first-in-human cases were performed without intraprocedural or delayed adverse events. pH testing at 6 months showed that four of five patients had no evidence of GERD (DeMeester > 14.72), and in one case, there was evidence of esophagitis. Conclusions Single session POEM-TIF appears to be safe and feasible. Early clinical human data suggests that it may be able to reduce post POEM GERD, however the additional secondary benefits such as lengthening and straightening of the esophagus, may prove to be equally important for the long-term success of POEM.

وصف الملف: electronic resource

Relation: https://doaj.org/toc/2364-3722; https://doaj.org/toc/2196-9736

URL الوصول: https://doaj.org/article/5e98f478ea9b4442af1a9d86ea223fb8

المؤلفون: Nichol S. Martinez, Sumant Inamdar, Sheila N. Firoozan, Stephanie Izard, Calvin Lee, Petros C. Benias, Arvind J. Trindade, Divyesh V. Sejpal

المصدر: Endoscopy International Open, Vol 09, Iss 06, Pp E888-E894 (2021)

مصطلحات موضوعية: Diseases of the digestive system. Gastroenterology, RC799-869

الوصف: Background and study aims There are conflicting data regarding the risk of post-ERCP pancreatitis (PEP) with self-expandable metallic stents (SEMS) compared to polyethylene stents (PS) in malignant biliary obstructions and limited data related to benign obstructions. Patients and methods A retrospective cohort study was performed of 1136 patients who underwent ERCP for biliary obstruction and received SEMS or PS at a tertiary-care medical center between January 2011 and October 2016. We evaluated the association between stent type (SEMS vs PS) and PEP in malignant and benign biliary obstructions. Results Among the 1136 patients included in our study, 399 had SEMS placed and 737 had PS placed. Patients with PS were more likely to have pancreatic duct cannulation, pancreatic duct stent placement, double guidewire technique, sphincterotomy and sphincteroplasty as compared to the SEMS group. On multivariate analysis, PEP rates were higher in the SEMS group (8.0 %) versus the PS group (4.8 %) (OR 2.27 [CI, 1.22, 4.24]) for all obstructions. For malignant obstructions, PEP rates were 7.8 % and 6.6 % for SEMS and plastic stents, respectively (OR 1.54 [CI, 0.72, 3.30]). For benign obstructions the PEP rate was higher in the SEMS group (8.8 %) compared to the PS group (4.2 %) (OR 3.67 [CI, 1.50, 8.97]). No significant differences between PEP severity were identified based on stent type when stratified based on benign and malignant. Conclusions PEP rates were higher when SEMS were used for benign obstruction as compared to PS. For malignant obstruction, no difference was identified in PEP rates with use of SEMS vs PS.

وصف الملف: electronic resource

Relation: https://doaj.org/toc/2364-3722; https://doaj.org/toc/2196-9736

URL الوصول: https://doaj.org/article/ce4165d13013415fb1dd4ae25cc56123

المؤلفون: Carter C. Somerville, Muhammad Shoaib, Cyrus E. Kuschner, Zarina Brune, Arvind J. Trindade, Petros C. Benias, Lance B. Becker

المصدر: Endoscopy International Open, Vol 09, Iss 05, Pp E701-E705 (2021)

مصطلحات موضوعية: Diseases of the digestive system. Gastroenterology, RC799-869

الوصف: Background and study aims The COVID-19 pandemic has disrupted routine medical care due to uncertainty regarding the risk of viral spread. One major concern for viral transmission to both patients and providers is performing aerosol-generating procedures such as endoscopy. As such, we performed a prospective study to examine the extent of viral contamination present in the local environment before and after endoscopic procedures on COVID-19 positive patients. Materials and methods A total of 82 samples were collected from 23 surfaces in the procedure area of four COVID-positive patients undergoing upper endoscopic procedures. Samples were collected both before and after the procedure. severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA was extracted and quantified using reverse transcription quantitative polymerase chain reaction with primers to detect nucleocapsid RNA, and results reported as the number of viral copies per square centimeter of contaminated surface. Results A total of six positive samples were detected from three of the four patients. The floor beneath the patient bed was the most common site of viral RNA, but RNA was also detected on the ventilator monitor prior to the procedure and the endoscope after the procedure. Conclusions The risk of SARS-CoV-2 transmission associated with upper endoscopy procedures is low based on the low rate of surface contamination. Some surfaces in close proximity to the patient and endoscopist may pose a higher risk for contamination. Patient positioning and oxygen delivery methods may influence the directionality and extent of viral spread. Our results support the use of appropriate personal protection to minimize risk of viral transmission.

وصف الملف: electronic resource

Relation: https://doaj.org/toc/2364-3722; https://doaj.org/toc/2196-9736

URL الوصول: https://doaj.org/article/e007dd2e57e8498381e2d67062051a3d

المؤلفون: Srihari Mahadev, Olga C. Aroniadis, Luis H. Barraza, Emil Agarunov, Michael S. Smith, Adam J. Goodman, Petros C. Benias, Jonathan M. Buscaglia, Seth A. Gross, Franklin Kasmin, Jonathan Cohen, David L. Carr-Locke, David Greenwald, Robin Mendelsohn, Amrita Sethi, Tamas A. Gonda

المصدر: Endoscopy International Open, Vol 08, Iss 12, Pp E1865-E1871 (2020)

مصطلحات موضوعية: Diseases of the digestive system. Gastroenterology, RC799-869

الوصف: Background and study aims The coronavirus disease 2019 (COVID-19), and measures taken to mitigate its impact, have profoundly affected the clinical care of gastroenterology patients and the work of endoscopy units. We aimed to describe the clinical care delivered by gastroenterologists and the type of procedures performed during the early to peak period of the pandemic. Methods Endoscopy leaders in the New York region were invited to participate in an electronic survey describing operations and clinical service. Surveys were distributed on April 7, 2020 and responses were collected over the following week. A follow-up survey was distributed on April 20, 2020. Participants were asked to report procedure volumes and patient characteristics, as well protocols for staffing and testing for COVID-19. Results Eleven large academic endoscopy units in the New York City region responded to the survey, representing every major hospital system. COVID patients occupied an average of 54.5 % (18 – 84 %) of hospital beds at the time of survey completion, with 14.5 % (2 %-23 %) of COVID patients requiring intensive care. Endoscopy procedure volume and the number of physicians performing procedures declined by 90 % (66 %-98 %) and 84.5 % (50 %-97 %) respectively following introduction of restricted practice. During this period the most common procedures were EGDs (7.9/unit/week; 88 % for bleeding; the remainder for foreign body and feeding tube placement); ERCPs (5/unit/week; for cholangitis in 67 % and obstructive jaundice in 20 %); Colonoscopies (4/unit/week for bleeding in 77 % or colitis in 23 %) and least common were EUS (3/unit/week for tumor biopsies). Of the sites, 44 % performed pre-procedure COVID testing and the proportion of COVID-positive patients undergoing procedures was 4.6 % in the first 2 weeks and up to 19.6 % in the subsequent 2 weeks. The majority of COVID-positive patients undergoing procedures underwent EGD (30.6 % COVID +) and ERCP (10.2 % COVID +). Conclusions COVID-19 has profoundly impacted the operation of endoscopy units in the New York region. Our data show the impact of a restricted emergency practice on endoscopy volumes and the proportion of expected COVID positive cases during the peak time of the pandemic.

وصف الملف: electronic resource

Relation: https://doaj.org/toc/2364-3722; https://doaj.org/toc/2196-9736

URL الوصول: https://doaj.org/article/0653f774574b4041960248b54c04ffd7

المؤلفون: Amy Tyberg, Isaac Raijman, Aleksey A. Novikov, Divyesh V. Sejpal, Petros C. Benias, Arvind J. Trindade, Ananya Das, Mankanwal Sachdev, Farhoud Khosravi, Paul Tarnasky, Prashant Kedia, Monica Gaidhane, Michel Kahaleh, Virendra Joshi

المصدر: Endoscopy International Open, Vol 08, Iss 05, Pp E644-E649 (2020)

مصطلحات موضوعية: Diseases of the digestive system. Gastroenterology, RC799-869

الوصف: Background and study aims First-generation optical coherence tomography (OCT) has been shown to increase diagnostic sensitivity for malignant biliary and pancreatic-duct strictures. A newer OCT imaging system, NVision Volumetric Laser Endomicroscopy (VLE), allows for in vivo cross-sectional imaging of the ductal wall at the microstructure level during endoscopic retrograde cholangiopancreatography (ERCP). The aim of this study was to identify and evaluate characteristics on OCT that are predictive of benign and malignant strictures. Patients and methods Consecutive patients from six centers who underwent OCT between September 2016 and September 2017 were included in a dedicated registry. OCT images were analyzed, and nine recurring characteristics were further assessed. Final diagnosis was based on histology and/or surgical pathology. Results 86 patients were included (49 % male, mean age 64.7). OCT was performed in the bile duct in 79 patients and the pancreatic duct in seven. Nine OCT characteristics were identified: dilated hypo-reflective structures (n = 7), onion-skin layering (n = 8), intact layering (n = 17), layering effacement (n = 25), scalloping (n = 20), thickened epithelium (n = 42), hyper-glandular mucosa (n = 13), prominent blood vessels (n = 6), and a hyper-reflective surface (n = 20). Presence of hyper-glandular mucosa, hyper-reflective surface and scalloping significantly increased the odds of malignancy diagnosis by 6 times more (P = 0.0203; 95 % CI 1.3 to 26.5), 4.7 times more (P = 0.0255; 95 % CI 1.2 to 18.0) and 7.9 times more (P = 0.0035; 95 % CI 1.97 to 31.8) respectively. Conclusion By providing in-vivo cross-sectional imaging of the pancreatic and biliary duct wall, OCT technology may improve sensitivity in diagnosing malignant strictures and provide standardizable criteria predictive of malignancy.

وصف الملف: electronic resource

Relation: https://doaj.org/toc/2364-3722; https://doaj.org/toc/2196-9736

URL الوصول: https://doaj.org/article/2f1f07cbc0ec445694b183e59f0a2c1d

المؤلفون: Kara L. Raphael, MD, John Wang, MD, Petros C. Benias, MD, Taisia Vitkovski, MD, Gregory Grimaldi, MD, Arvind J. Trindade, MD

المصدر: VideoGIE, Vol 4, Iss 11, Pp 517-518 (2019)

مصطلحات موضوعية: Diseases of the digestive system. Gastroenterology, RC799-869

وصف الملف: electronic resource

Relation: http://www.sciencedirect.com/science/article/pii/S2468448119301894; https://doaj.org/toc/2468-4481

URL الوصول: https://doaj.org/article/71c7eee5359840e395c0cf6028880291