Journals and Research

Research and education are foundational to the mission of Orlando Health and our Digestive Health Institute. As frequent contributors to leading publications on gastroenterology and endoscopy, our physicians share their research and clinical insights with a national and international community of colleagues.


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Author(s) Title Description Publish Date
Cyrrus M Espino, Chetan Nagaraja, Serena Ortiz, Jacquelyn R Dayton, Akash R Murali, Yanki Ma, Emari L Mann, Snigdha Garlapalli, Ross P Wohlgemuth, Sarah E Brashear, Lucas R Smith, Katherine A Wilkinson, Theanne N Griffith Differential encoding of mammalian proprioception by voltage-gated sodium channels Animals that require purposeful movement for survival are endowed with mechanosensory neurons called proprioceptors that provide essential sensory feedback from muscles and joints to spinal cord circuits, which modulates motor output. Despite the essential nature of proprioceptive signaling in daily... 9/10/2024
Hiram Menezes Nascimento Filho, Angelo So Taa Kum, Alexandre Moraes Bestetti, Pedro Henrique Veras Ayres da Silva, Megui Marilia Mansilla Gallegos, Adérson Omar Mourão Cintra Damião, Udayakumar Navaneethan, Eduardo Guimarães Hourneaux de Moura Patient-Related Factors Associated With Long-Term Outcomes After Successful Endoscopic Balloon Dilation For Crohns Disease-Associated Ileo-Colic Strictures A Systematic Review and Meta-analysis CONCLUSIONS: The use of biologics and endoscopic disease remission at the time of EBD were protective factors against the need for surgery. No previous surgery or use of steroids at the time of EBD was associated with the need for surgery during follow-up. 8/23/2024
American Society for Gastrointestinal Endoscopy Standards of Practice Committee, Swati Pawa, Neil B Marya, Nikhil R Thiruvengadam, Saowanee Ngamruengphong, Todd H Baron, Anthony Yuen Bun Teoh, Christopher K Bent, Wasif Abidi, Omeed Alipour, Stuart K Amateau, Madhav Desai, Jean M Chalhoub, Nayantara Coelho-Prabhu, Natalie Cosgrove, Sherif E Elhanafi, Nauzer Forbes, Larissa L Fujii-Lau, Divyanshoo R Kohli, Jorge D Machicado, Udayakumar Navaneethan, Wenly Ruan, Sunil G Sheth, Nirav C Thosani, Bashar J Qumseya, (ASGE Standards of Practice Committee Chair) TEMPORARY REMOVAL American Society for Gastrointestinal Endoscopy guideline on the role of therapeutic EUS in the management of biliary tract disorders summary and recommendations The publisher regrets that this article has been temporarily removed. A replacement will appear as soon as possible in which the reason for the removal of the article will be specified, or the article will be reinstated. The full Elsevier Policy on Article Withdrawal can be found at https://www.else... 7/30/2024
Hira I Cheema, Benjamin Tharian Big Brother Is Watching Artificial Intelligence in Endoscopy - Hype or Reality Artificial intelligence (AI) has become a part of many image-based specialties, such as radiology and pathology, as well as medical specialties in which "oscopy" is the key to current practice. In gastroenterology, for example, AI is being explored as an aid to endoscopists to visually distinguish p... 2/6/2024
Mark Cromer, C Mel Wilcox, Mohamed Shoreibah Beta-blockers and cirrhosis Striking the right balance Decompensated cirrhosis is associated with a significantly increased risk of mortality. Variceal hemorrhage (VH) further increases the risk of mortality, and of future variceal bleed events. Non-selective beta-blockers (NSBBs) are effective therapy for primary and secondary prophylaxis of VH and hav... 1/23/2024
Sheza Malik, Sruthi Venugopalan, Bettina Gabrielle Tenorio, Shahab R Khan, Priyadarshini Loganathan, Udayakumar Navaneethan, Babu P Mohan Diagnostic accuracy of bowel ultrasonography in patients with inflammatory bowel disease a systematic review and meta-analysis CONCLUSION: The high diagnostic accuracy of BUS in detecting bowel wall inflammation suggests utilizing regular BUS as the primary modality, with subsequent consideration of SICUS if clinically warranted. 1/15/2024
Ji Young Bang, Philippe Willems, Udayakumar Navaneethan, Robert Hawes, Shyam Varadarajulu Impact of Slim Linear Echoendoscope on the Practice of EUS CONCLUSIONS: A very experienced EUS team required SLE in 1.1% of consecutive examinations. Our findings suggest that when used, 95% of patients benefitted as it had a significant impact on their clinical management. 11/20/2023
Ji Young Bang, C Mel Wilcox, Udayakumar Navaneethan, Robert Hawes, Shyam Varadarajulu Orlando Protocol for single session ductal clearance of common bile duct stones at endosopic retrograde cholangiopancreatography CONCLUSIONS: A predetermined protocol optimized outcomes by enabling single-session ductal clearance of CBDS with high technical success and low adverse events. 11/13/2023
Benjamin Morgan, Amal Roy Murali, George Preston, Yidnekachew Ayele Sima, Luis Alberto Marcelo Chamorro, Christos Bourantas, Ryo Torii, Anthony Mathur, Andreas Baumbach, Marc C Jacob, Sergey Karabasov, Rob Krams A physics-based machine learning technique rapidly reconstructs the wall-shear stress and pressure fields in coronary arteries With the global rise of cardiovascular disease including atherosclerosis, there is a high demand for accurate diagnostic tools that can be used during a short consultation. In view of pathology, abnormal blood flow patterns have been demonstrated to be strong predictors of atherosclerotic lesion inc... 10/16/2023
Ji Young Bang, Charles Melbern Wilcox, Udayakumar Navaneethan, Robert Holbrook Hawes, Shyam Varadarajulu Treatment of walled-off necrosis using lumen-apposing metal stents versus plastic stents a systematic review and meta-analysis of data from randomized trials CONCLUSIONS: Except for procedure duration, there is no significant difference in clinical outcomes for patients with WON treated using LAMSs or plastic stents. 9/6/2023
Ruchi Sharma, Weidan Zhao, Yousaf Zafar, Arvind R Murali, Kyle E Brown Serum hepcidin levels in chronic liver disease a systematic review and meta-analysis CONCLUSIONS: Serum hepcidin levels are altered in common forms of CLD albeit not in a consistent direction. Additional study is needed to determine how changes in hepcidin levels are related to dysregulation of iron metabolism in CLD. 8/4/2023
Adam L Edwards, C Mel Wilcox, Mark Beasley, Salpy V Pamboukian, Peter Mannon, Shajan Peter Gastrointestinal bleeding and pro-angiogenic shift in the angiopoietin axis with continuous flow left ventricular assist device implantation CONCLUSION: CF-LVAD recipients demonstrated a shift toward a pro-angiogenic phenotype in the angiopoietin axis that is significantly associated with GIB and may be linked to low pulse pressure. 7/28/2023
Hira Imad Cheema, Benjamin Tharian, Sumant Inamdar, Mauricio Garcia-Saenz-de-Sicilia, Cem Cengiz Recent advances in endoscopic management of gastric neoplasms The development and clinical application of new diagnostic endoscopic technologies such as endoscopic ultrasonography with biopsy, magnification endoscopy, and narrow-band imaging, more recently supplemented by artificial intelligence, have enabled wider recognition and detection of various gastric ... 6/5/2023
Ishani Shah, Andy Silva-Santisteban, Katharine A Germansky, Arvind Trindade, Kara L Raphael, Vladimir Kushnir, Rishi Pawa, Girish Mishra, Jiannis Anastasiou, Sumant Inamdar, Benjamin Tharian, Mohammad Bilal, Mandeep S Sawhney Pancreatic Cancer Screening for At-Risk Individuals Pancreas Scan Study Yield, Harms, and Outcomes From a Prospective Multicenter Study INTRODUCTION: Guidelines endorse pancreatic cancer screening in genetically susceptible individuals. We conducted a prospective, multicenter study to determine yield, harms, and outcomes of pancreatic cancer screening. 5/4/2023
Sameer Prakash, Arvind R Murali Optimal alpha-1 antitrypsin level cutoffs for genotype identification in patients with chronic liver disease BACKGROUND: Controversy exists whether alpha-1 antitrypsin (A1AT) genotype testing should be performed as a first-line screening for A1AT heterozygous variants. 5/3/2023
Vinay Jahagirdar, Jay Bapaye, Saurabh Chandan, Suresh Ponnada, Gursimran S Kochhar, Udayakumar Navaneethan, Babu P Mohan Diagnostic accuracy of convolutional neural network-based machine learning algorithms in endoscopic severity prediction of ulcerative colitis a systematic review and meta-analysis CONCLUSIONS: CNN-based machine learning algorithms demonstrated excellent pooled diagnostic accuracy parameters in the endoscopic severity assessment of UC. Using UCEIS scores in CNN training might offer better results than the MES. Further studies are warranted to establish these findings in real c... 4/24/2023
Ji Young Bang, Charles Mel Wilcox, Udayakumar Navaneethan, Robert Hawes, Shyam Varadarajulu Impact of endoprosthesis type on inflammatory response in patients undergoing endoscopic drainage of pancreatic fluid collections CONCLUSIONS: Use of plastic stents as compared to LAMS was associated with a higher proportion of SIRS and new organ failure that prolonged hospital stay. Therefore, placement of LAMS is recommended in sick patients and those with ≥33% necrosis to minimize inflammatory response. 4/11/2023
Heidi S Ahmed, Nikitha Gangasani, Manju B Jayanna, Michelle T Long, Antonio Sanchez, Arvind R Murali The NAFLD Decompensation Risk Score External Validation and Comparison to Existing Models to Predict Hepatic Events in a Retrospective Cohort Study CONCLUSIONS: In an urban, racially and ethnically diverse population, the Iowa Model performed well to identify NAFLD patients at higher risk for liver-related complications. The model provides the individual probability of developing hepatic events and identifies patients in need of early intervent... 3/23/2023
Basile Njei, Ulrick Sidney Kanmounye, Nancy Seto, Thomas R McCarty, Babu P Mohan, Lydia Fozo, Udayakumar Navaneethan Artificial intelligence in medical imaging for cholangiocarcinoma diagnosis A systematic review with scientometric analysis CONCLUSION: Our results suggest that there is increasing evidence to support the role of AI in the diagnosis of CCA. CNN-based computer vision of cholangioscopy images appears to be the most promising modality for extrahepatic CCA diagnosis. Our social network analysis highlighted an Asian and Ameri... 3/15/2023
Basile Njei, Thomas R McCarty, Babu P Mohan, Lydia Fozo, Udayakumar Navaneethan Artificial intelligence in endoscopic imaging for detection of malignant biliary strictures and cholangiocarcinoma a systematic review CONCLUSIONS: Our results suggest that there is increasing evidence to support a role for AI in the diagnosis of malignant biliary strictures and CCA. CNN-based machine leaning of cholangioscopy images appears to be the most promising, while CNN-EUS has the best clinical performance application. 3/3/2023
Asad Ali, Ye-Jin Lee, Matthew Gosse, Charles Meade, Heather Labath, Arvind R Murali Ileocolonic intussusception presenting as chronic diarrhea in an elderly woman Video 1Colonoscopy findings of cecal mass as a lead point causing intussusception. 2/23/2023
Xiaocen Zhang, Katelin Marie Durham, Alexander Austin Garza, Arvind R Murali Portal vein thrombosis, hepatic decompensation, and survival in patients with porto-sinusoidal vascular disease and portal hypertension CONCLUSIONS: PSVD with PH is not a benign entity. Mortality, PVT and hepatic decompensation are common. Patients with PSVD must be closely monitored, including those who only have non-specific clinical signs (e.g., splenomegaly) of PH. 1/24/2023
Arvind R Murali, Sameer Prakash, Antonio J Sanchez Alpha-1-Antitrypsin PiMZ variant increases risk of developing hepatic events in nonalcoholic fatty liver disease patientssupsup CONCLUSION: Patients with NAFLD and A1AT Pi*MZ variant are at increased risk for developing hepatic decompensation. NAFLD patients should be offered A1AT genotyping for risk stratification, counseling, and multidisciplinary intervention for NAFLD. 12/12/2022
Udayakumar Navaneethan, Dennisdhilak Lourdusamy Endoscopic Stricturotomy and Strictureplasty Strictures in inflammatory bowel disease (IBD) usually occur because of long-standing inflammation and fibrosis causing luminal narrowing. Strictures in the setting of Crohn's disease (CD) can occur de novo, or in the postsurgical setting (anastomotic strictures). Historically these strictures are m... 10/6/2022
Jennifer L Maranki, Steven D Schwaitzberg, Reem Z Sharaiha, Vladimir M Kushnir, Dilhana S Badurdeen, Vivek Kumbhari, Victoria Gómez, Nikhil A Kumta, Jerome D Waye, Jose Nieto, Michael B Ujiki, Petros C Benias, Larry S Miller, Prashant Kedia, Paul Tarnasky, Abraham Mathew, John M Levenick, Sumant Inamdar, Benjamin Tharian, Yanina Nersesova, Lydia Fredell, Sonya Serra, Michael L Kochman Challenges of developing and executing a multi-site registry for a novel device with evolving indications for use CONCLUSIONS: The Prospective Registry for Trans-Orifice Endoscopic Suturing Applications (ES Registry) was an effective Phase 4, postmarketing registry aimed at capturing pragmatic, real-world use of a novel device. These findings serve to solidify the role of endoscopic suturing in clinical practic... 8/3/2022
Hemant Goyal, Sonali Sachdeva, Syed Ali Amir Sherazi, Shweta Gupta, Abhilash Perisetti, Aman Ali, Saurabh Chandan, Benjamin Tharian, Neil Sharma, Nirav Thosani Early prediction of post-ERCP pancreatitis by post-procedure amylase and lipase levels A systematic review and meta-analysis Background and study aims Post-ERCP pancreatitis (PEP) is the most common complication attributed to the procedure, its incidence being approximately 9.7 %. Numerous studies have evaluated the predictive efficacy of post-procedure serum amylase and lipase levels but with varied procedure-to-test ti... 7/18/2022
Hira I Cheema, Saikiran Raghavapuram, Iman Boston, Thomas Augustine, Benjamin Tharian A Case of Duodenal Spot Diagnosis Pseudomelanosis duodeni is a rare finding usually described as a black/brown speckled or tattooed appearance of the intestinal mucosa. Although an incidental finding, it has been associated with different medications and chronic medical conditions such as diabetes mellitus and chronic renal failure.... 7/8/2022
Ravi P Kiran, Gursimran S Kochhar, Revital Kariv, Douglas K Rex, Akira Sugita, David T Rubin, Udayakumar Navaneethan, Tracy L Hull, Huaibin Mabel Ko, Xiuli Liu, Lisa A Kachnic, Scott Strong, Marietta Iacucci, Willem Bemelman, Philip Fleshner, Rachael A Safyan, Paulo G Kotze, André D'Hoore, Omar Faiz, Simon Lo, Jean H Ashburn, Antonino Spinelli, Charles N Bernstein, Sunanda V Kane, Raymond K Cross, Jason Schairer, James T McCormick, Francis A Farraye, Shannon Chang, Ellen J Scherl, David A Schwartz, David H Bruining, Jessica Philpott, Stuart Bentley-Hibbert, Dino Tarabar, Sandra El-Hachem, William J Sandborn, Mark S Silverberg, Darrell S Pardi, James M Church, Bo Shen Management of pouch neoplasia consensus guidelines from the International Ileal Pouch Consortium Surveillance pouchoscopy is recommended for patients with restorative proctocolectomy with ileal pouch-anal anastomosis in ulcerative colitis or familial adenomatous polyposis, with the surveillance interval depending on the risk of neoplasia. Neoplasia in patients with ileal pouches mainly have a g... 7/7/2022
Hira I Cheema, Russell Roark, Seemeen Hassan, Kalyan Chakrala, Benjamin Tharian, Jiannis Anastasiou Comparison Between Intravenous and Intramuscular Octreotide in the Management of Heydes Syndrome Heyde's syndrome is defined as a triad of aortic stenosis, anemia due to angiodysplasia-related bleeding, and von Willebrand syndrome type 2A. It is a rare disease and a diagnostic challenge. Treatment modalities include symptomatic management, blood transfusions, aortic valve replacement, and medic... 7/5/2022
Hemant Goyal, Sara Larsen, Abhilash Perisetti, Nikolaj Birk Larsen, Lotte Klinten Ockert, Sven Adamsen, Benjamin Tharian, Nirav Thosani Gastrointestinal endoscope contamination rates - elevators are not only to blame a systematic review and meta-analysis Background and study aims Duodenoscopes that are contaminated due to inadequate reprocessing are well-documented. However, studies have demonstrated poor reprocessing of other kinds of endoscopes as well, including echoendoscopes, gastroscopes, and colonoscopes. We estimated the contamination rate b... 6/13/2022
Robert H Hawes Basic and Advanced Biliary Cannulation How Do I Do It Successful biliary cannulation of a native papilla is usually the rate-limiting step toward a successful ERCP. Standard cannulation techniques usually succeed, particularly when utilizing the wire-guided technique. There are, however, a myriad of confirmations of the major papilla as well as anatomi... 6/12/2022
Hemant Goyal, Syed Ali Amir Sherazi, Shweta Gupta, Abhilash Perisetti, Ikechukwu Achebe, Aman Ali, Benjamin Tharian, Nirav Thosani, Neil R Sharma Application of artificial intelligence in diagnosis of pancreatic malignancies by endoscopic ultrasound a systemic review CONCLUSION: AI reported a high sensitivity with high specificity and accuracy to diagnose PC, differentiate PC from CP, and differentiate benign from malignant IPMN when used with EUS. 5/5/2022
Shivanand Bomman, Adil Ghafoor, David J Sanders, Mahendran Jayaraj, Shruti Chandra, Rajesh Krishnamoorthi Endoscopic ultrasound-guided gastroenterostomy versus surgical gastrojejunostomy in treatment of malignant gastric outlet obstruction Systematic review and meta-analysis Background and study aims Palliative treatment of malignant gastric outlet obstruction (GOO) has conventionally been with surgical gastrojejunostomy (SGJ). Advent of devices like lumen apposing metal stents has made endoscopic ultrasound-guided gastroenterostomy (EUS-GE) a potential alternative to ... 4/18/2022
Erin Petrie, Nicholas A Hoppmann, C Mel Wilcox, Sameer Al Diffalha, Meagan E Gray Gastric Xanthomatosis Secondary to Lipoprotein X in Primary Biliary Cholangitis Primary biliary cholangitis (PBC) is a rare autoimmune disease characterized by intralobular bile duct destruction. Patients typically present with generalized symptoms including fatigue and pruritis, and less commonly, manifestations of lipid deposition including xanthomas and xanthelasmas. We repo... 4/11/2022
Shorabuddin Syed, Adam Jackson Angel, Hafsa Bareen Syeda, Carole France Jennings, Joseph VanScoy, Mahanazuddin Syed, Melody Greer, Sudeepa Bhattacharyya, Meredith Zozus, Benjamin Tharian, Fred Prior The h-ANN Model Comprehensive Colonoscopy Concept Compilation Using Combined Contextual Embeddings Colonoscopy is a screening and diagnostic procedure for detection of colorectal carcinomas with specific quality metrics that monitor and improve adenoma detection rates. These quality metrics are stored in disparate documents i.e., colonoscopy, pathology, and radiology reports. The lack of integrat... 4/4/2022
Shorabuddin Syed, Adam Jackson Angel, Hafsa Bareen Syeda, Carole Franc Jennings, Joseph VanScoy, Mahanazuddin Syed, Melody Greer, Sudeepa Bhattacharyya, Shaymaa Al-Shukri, Meredith Zozus, Fred Prior, Benjamin Tharian TAX-Corpus Taxonomy based Annotations for Colonoscopy Evaluation Colonoscopy plays a critical role in screening of colorectal carcinomas (CC). Unfortunately, the data related to this procedure are stored in disparate documents, colonoscopy, pathology, and radiology reports respectively. The lack of integrated standardized documentation is impeding accurate report... 3/18/2022
Philip R Foti, Carol M Wilcox, Ralph S Goto Factors Contributing to Snorkel Drowning in Hawaii Causes of the extraordinarily high and increasing incidence of snorkeler drownings in Hawai'i have remained unexplained for years. Defining the mechanisms and factors predisposing to drowning while snorkeling is needed to provide recommendations to substantially mitigate the incidence of this form o... 3/9/2022
Abhilash Perisetti, Hemant Goyal, Rachana Yendala, Saurabh Chandan, Benjamin Tharian, Ragesh Babu Thandassery Sarcopenia in hepatocellular carcinoma Current knowledge and future directions Liver cancer is the second most occurring cancer worldwide and is one of the leading causes of cancer-related deaths. Hepatocellular carcinoma (HCC) is the most common (80%-90%) type among malignant liver cancers. Sarcopenia occurs very early in HCC and can predict and provide an opportunity to impr... 2/7/2022
Fredy Nehme, Hemant Goyal, Abhilash Perisetti, Benjamin Tharian, Neil Sharma, Tony C Tham, Rajiv Chhabra The Evolution of Device-Assisted Enteroscopy From Sonde Enteroscopy to Motorized Spiral Enteroscopy The introduction of capsule endoscopy in 2001 opened the last "black box" of the gastrointestinal tract enabling complete visualization of the small bowel. Since then, numerous new developments in the field of deep enteroscopy have emerged expanding the diagnostic and therapeutic armamentarium again... 1/10/2022
Shivanand Bomman, Munish Ashat, Navroop Nagra, Mahendran Jayaraj, Shruti Chandra, Richard A Kozarek, Andrew Ross, Rajesh Krishnamoorthi Contamination Rates in Duodenoscopes Reprocessed Using Enhanced Surveillance and Reprocessing Techniques A Systematic Review and Meta-Analysis CONCLUSION: While ESRT may improve the disinfection process, a post-ESRT contamination rate of 5% is not negligible. Ongoing efforts to mitigate the rate of contamination by improving disinfection techniques and innovations in duodenoscope design to improve safety are warranted. 1/3/2022
Rupinder Mann, Hemant Goyal, Abhilash Perisetti, Saurabh Chandan, Sumant Inamdar, Benjamin Tharian Endoscopic ultrasound-guided vascular interventions Current insights and emerging techniques Endoscopic ultrasound (EUS) is one of the significant breakthroughs in the field of advanced endoscopy. In the last two decades, EUS has evolved from a diagnostic tool to a real-time therapeutic modality. The luminal gastrointestinal (GI) tract provides a unique opportunity to access multiple vascul... 11/18/2021
Hemant Goyal, Jonathan Kopel, Bojana Ristić, Abhilash Perisetti, Jiannis Anastasiou, Saurabh Chandan, Benjamin Tharian, Sumant Inamdar The pancreas and COVID-19 a clinical conundrum With the progression of the COVID-19 pandemic, the classic manifestations of COVID-19 (e.g., persistent fever, dry cough, pneumonia, and acute respiratory distress syndrome in the severe disease) have expanded to include less common complications of the extrapulmonary organs. Recent evidence has sho... 11/17/2021
Bo Shen, Gursimran S Kochhar, David T Rubin, Sunanda V Kane, Udayakumar Navaneethan, Charles N Bernstein, Raymond K Cross, Akira Sugita, Jason Schairer, Ravi P Kiran, Philip Fleshner, James T McCormick, André D'Hoore, Samir A Shah, Francis A Farraye, Revital Kariv, Xiuli Liu, Joel Rosh, Shannon Chang, Ellen Scherl, David A Schwartz, Paulo Gustavo Kotze, David H Bruining, Jessica Philpott, Bincy Abraham, Jonathan Segal, Rocio Sedano, Maia Kayal, Stuart Bentley-Hibbert, Dino Tarabar, Sandra El-Hachem, Priya Sehgal, Joseph A Picoraro, Séverine Vermeire, William J Sandborn, Mark S Silverberg, Darrell S Pardi Treatment of pouchitis, Crohns disease, cuffitis, and other inflammatory disorders of the pouch consensus guidelines from the International Ileal Pouch Consortium Pouchitis, Crohn's disease of the pouch, cuffitis, polyps, and extraintestinal manifestations of inflammatory bowel disease are common inflammatory disorders of the ileal pouch. Acute pouchitis is treated with oral antibiotics and chronic pouchitis often requires anti-inflammatory therapy, including... 11/14/2021
Hemant Goyal, Syed A A Sherazi, Rupinder Mann, Zainab Gandhi, Abhilash Perisetti, Muhammad Aziz, Saurabh Chandan, Jonathan Kopel, Benjamin Tharian, Neil Sharma, Nirav Thosani Scope of Artificial Intelligence in Gastrointestinal Oncology Gastrointestinal cancers are among the leading causes of death worldwide, with over 2.8 million deaths annually. Over the last few decades, advancements in artificial intelligence technologies have led to their application in medicine. The use of artificial intelligence in endoscopic procedures is a... 11/13/2021
Ji Young Bang, Robert Hawes, Shyam Varadarajulu Endoscopic biliary drainage for malignant distal biliary obstruction Which is better - endoscopic retrograde cholangiopancreatography or endoscopic ultrasound Presently, following endoscopic ultrasound (EUS)-guided biopsy, an endoscopic retrograde cholangiopancreatography (ERCP) with transpapillary stenting is performed for palliation of malignant distal biliary obstruction (MDBO). However, technical failure and postprocedure pancreatitis are limitations ... 11/8/2021
Pauline M C Stassen, Pieter Jan F de Jonge, Marco J Bruno, Arjun D Koch, Arvind J Trindade, Petros C Benias, Divyesh V Sejpal, Uzma D Siddiqui, Christopher G Chapman, Edward Villa, Benjamin Tharian, Sumant Inamdar, Joo Ha Hwang, Monique T Barakat, Iman Andalib, Monica Gaidhane, Avik Sarkar, Haroon Shahid, Amy Tyberg, Kenneth Binmoeller, Rabindra R Watson, Andrew Nett, Christoph Schlag, Mohamed Abdelhafez, Mireen Friedrich-Rust, Alexander Schlachterman, Austin L Chiang, David Loren, Thomas Kowalski, Michel Kahaleh Safety and efficacy of a novel resection system for direct endoscopic necrosectomy of walled-off pancreas necrosis a prospective, international, multicenter trial CONCLUSIONS: The new PED system seems to be a safe and effective treatment tool for WOPN, resulting in fewer interventions and lower hospital duration when compared with published data on using conventional instruments. Randomized controlled trials comparing the PED system with conventional DEN are ... 9/25/2021
Michael Mullarkey, C Mel Wilcox, Adam L Edwards Factitious Gastrointestinal Bleeding A Case Series and Review Factitious gastrointestinal bleeding (GIB) is a manifestation of factitious disorder (FD) wherein patients feign GIB in the absence of external gain. As it can be a challenging diagnosis to make, factitious GIB often leads to multiple tests, exposure to contrast agents and radiation, invasive endosc... 9/23/2021
Shashank Garg, Sumant Inamdar, Benjamin Tharian, Thiruvengadam Muniraj, Harry R Aslanian Education and gastroenterology fellow knowledge about endoscopic mucosal resection of colon adenomas a survey-based study Background and study aims Endoscopic mucosal resection (EMR) is an effective way to remove large (> 2 cm) colon adenomas. Training about it has not been standardized in fellowship programs. This study was aimed at evaluating the education and knowledge of gastroenterology fellows about EMR of color... 8/27/2021
Bo Shen, Gursimran S Kochhar, Revital Kariv, Xiuli Liu, Udayakumar Navaneethan, David T Rubin, Raymond K Cross, Akira Sugita, André D'Hoore, Jason Schairer, Francis A Farraye, Ravi P Kiran, Philip Fleshner, Joel Rosh, Samir A Shah, Shannon Chang, Ellen Scherl, Darrell S Pardi, David A Schwartz, Paulo G Kotze, David H Bruining, Sunanda V Kane, Jessica Philpott, Bincy Abraham, Jonathan Segal, Rocio Sedano, Maia Kayal, Stuart Bentley-Hibbert, Dino Tarabar, Sandra El-Hachem, Priya Sehgal, James T McCormick, Joseph A Picoraro, Mark S Silverberg, Charles N Bernstein, William J Sandborn, Séverine Vermeire Diagnosis and classification of ileal pouch disorders consensus guidelines from the International Ileal Pouch Consortium Restorative proctocolectomy with ileal pouch-anal anastomosis is an option for most patients with ulcerative colitis or familial adenomatous polyposis who require colectomy. Although the construction of an ileal pouch substantially improves patients' health-related quality of life, the surgery is, d... 8/20/2021
Ji Young Bang, C Mel Wilcox, Juan Pablo Arnoletti, Shajan Peter, John Christein, Udayakumar Navaneethan, Robert Hawes, Shyam Varadarajulu Validation of the Orlando Protocol for endoscopic management of pancreatic fluid collections in the era of lumen-apposing metal stents CONCLUSIONS: A structured approach integrating LAMS with selective use of plastic stents improved treatment success in patients with PFCs compared to an approach using only plastic stents. 7/31/2021
Ellyn K Dunbar, Phil J Greer, Stephen T Amann, Samer Alkaade, Peter Banks, Randall Brand, Darwin L Conwell, Christopher E Forsmark, Timothy B Gardner, Nalini M Guda, Michele D Lewis, Jorge D Machicado, Thiruvengadam Muniraj, Georgios I Papachristou, Joseph Romagnuolo, Bimaljit S Sandhu, Stuart Sherman, Adam Slivka, C Mel Wilcox, Dhiraj Yadav, David C Whitcomb, NAPS2 Consortium Pain Experience in Pancreatitis Strong Association of Genetic Risk Loci for Anxiety and PTSD in Patients With Severe, Constant, and Constant-Severe Pain INTRODUCTION: Recurrent acute pancreatitis (RAP) and chronic pancreatitis (CP) are progressive inflammatory syndromes with variable features. Pain is the primary feature that contributes to low physical and mental quality of life with a third of patients reporting severe pain. Pain experience is wor... 7/8/2021
Mark M Aloysius, Hemant Goyal, Niraj J Shah, Kumar Pallav, Nimy John, Mahesh Gajendran, Abhilash Perisetti, Benjamin Tharian Impact of Race and Socioeconomics Disparities on Survival in Young-Onset Colorectal Adenocarcinoma-A SEER Registry Analysis CONCLUSIONS: Survival disparities were found among all races with young-onset colorectal adenocarcinoma. The pattern of SEDH influencing survival was unique to each race. Overall higher income levels, high school education, private insurance, and marital status appeared to be independent factors con... 7/2/2021
Shorabuddin Syed, Benjamin Tharian, Hafsa Bareen Syeda, Meredith Zozus, Melody L Greer, Sudeepa Bhattacharyya, Mahanazuddin Syed, Fred Prior Consolidated EHR Workflow for Endoscopy Quality Reporting Although colonoscopy is the most frequently performed endoscopic procedure, the lack of standardized reporting is impeding clinical and translational research. Inadequacies in data extraction from the raw, unstructured text in electronic health records (EHR) pose an additional challenge to procedure... 5/27/2021
Yassin Naga, Mahendran Jayaraj, Yousif Elmofti, Annie Hong, Gordon Ohning Intraluminal Endovascular Coil Migration A Rare Complication Post-Embolization of the Gastroduodenal Artery for a Previously Bleeding Duodenal Ulcer Transarterial angiographic embolization is a highly effective, safe treatment for non-variceal upper gastrointestinal bleeding refractory to endoscopic intervention. However, intraluminal coil migration is a possible complication. Coil migration, while usually a self-limiting process, can lead to si... 5/27/2021
Saeed Ali, Sameer Prakash, Arvind R Murali Hepatic Manifestations of Nonhepatotropic Infectious Agents Including Severe Acute Respiratory Syndrome Coronavirus-2, Adenovirus, Herpes Simplex Virus, and Coxiella burnetii Nonhepatotropic viruses such as adenovirus, herpes simplex virus, flaviviruses, filoviruses, and human herpes virus, and bacteria such as Coxiella burnetii, can cause liver injury mimicking acute hepatitis. Most of these organisms cause a self-limited infection. However, in immunocompromised patient... 5/24/2021
Shajan Peter, Ji Young Bang, Shyam Varadarajulu Single-use duodenoscopes where are we and where are we going PURPOSE OF REVIEW: Given the growing concerns about infection transmission from use of contaminated reusable duodenoscopes, technological advancements have been made that vary from modifications of existing designs to development of single-use devices. 5/19/2021
Jeska A Fritzsche, Paul Fockens, Marc Barthet, Marco J Bruno, David L Carr-Locke, Guido Costamagna, Gregory A Coté, Pierre H Deprez, Marc Giovannini, Gregory B Haber, Robert H Hawes, Jong Jin Hyun, Takao Itoi, Eisuke Iwasaki, Leena Kylänpaä, Horst Neuhaus, Jeong Youp Park, D Nageshwar Reddy, Arata Sakai, Michael J Bourke, Rogier P Voermans Expert consensus on endoscopic papillectomy using a Delphi process CONCLUSIONS: This is the first step in developing an international consensus-based algorithm for endoscopic management of papillary adenomas. Surprisingly, in many areas consensus could not be achieved. These aspects should be the focus of future studies. 4/22/2021
Bo Shen, Gursimran S Kochhar, Udayakumar Navaneethan, Raymond K Cross, Francis A Farraye, Marietta Iacucci, David A Schwartz, Yago Gonzalez-Lama, Jason Schairer, Ravi P Kiran, Paulo Gustavo Kotze, Taku Kobayashi, Martin Bortlik, Xiuli Liu, Alexander N Levy, Begoña González Suárez, Shou-Jiang Tang, Nayantara Coelho-Prabhu, Martin Lukas, David H Bruining, Sandra El-Hachem, Roger J Charles, Yan Chen, Ajit Sood, Ren Mao, Carme Loras, Parambir S Dulai, Joseph A Picoraro, Michael Chiorean, Milan Lukas, Amandeep Shergill, Mark S Silverberg, William J Sandborn, Charles N Bernstein Endoscopic evaluation of surgically altered bowel in inflammatory bowel disease a consensus guideline from the Global Interventional Inflammatory Bowel Disease Group The majority of patients with Crohn's disease and a proportion of patients with ulcerative colitis will ultimately require surgical treatment despite advances in diagnosis, therapy, and endoscopic interventions. The surgical procedures that are most commonly done include bowel resection with anastom... 4/19/2021
Abhilash Perisetti, Hemant Goyal, Benjamin Tharian The burn of ranitidine recall current insights and mitigation strategies Ranitidine was one of the most commonly used medications for the treatment of gastroesophageal reflux disease. On 1 April 2020, the US Food and Drug Administration requested all manufacturers to immediately withdraw ranitidine from the market because of concern of higher than acceptable levels of N-... 4/19/2021
Saeed Ali, Neelam Khetpal, Evgeny Idrisov, Asad Ur Rahman, Sameen Khalid, Yuan Du, Udayakumar Navaneethan, Shyam Varadarajulu, Robert Hawes, Muhammad Khalid Hasan Endoscopic Mucosal Resection for Colonic Mucosal Neoplasia and Evaluation of Long-Term Recurrence A Single-Center Experience of 500 Cases CONCLUSIONS: EMR is an effective, minimally invasive technique for the treatment of large laterally spreading lesions. Although recurrence is a concern, its risk is low (21.8% on SC1 and 9.8% on SC2) and was managed endoscopically in 96.3% cases on follow-up endoscopy. 3/31/2021
Jesse Xie, Shashank Garg, Abhilash Perisetti, Benjamin Tharian, Mohammad Hassan Murad, Sumant Inamdar Comparison of Biliary Drainage Techniques for Malignant Biliary Obstruction A Systematic Review and Network Meta-analysis CONCLUSIONS: The available evidence did not favor any intervention for drainage of malignant biliary obstruction across all the outcomes assessed. ERCP with or without EUS should be considered first to allow simultaneous tissue acquisition and biliary drainage. 3/29/2021
Hemant Goyal, Rupinder Mann, Zainab Gandhi, Abhilash Perisetti, Zhongheng Zhang, Neil Sharma, Shreyas Saligram, Sumant Inamdar, Benjamin Tharian Application of artificial intelligence in pancreaticobiliary diseases The role of artificial intelligence and its applications has been increasing at a rapid pace in the field of gastroenterology. The application of artificial intelligence in gastroenterology ranges from colon cancer screening and characterization of dysplastic and neoplastic polyps to the endoscopic ... 3/1/2021
Hemant Goyal, Jonathan Kopel, Abhilash Perisetti, Rupinder Mann, Aman Ali, Benjamin Tharian, Shreyas Saligram, Sumant Inamdar Endobariatric procedures for obesity clinical indications and available options Obesity remains a growing public health epidemic that has increased healthcare costs and related comorbidities. Current treatment guidelines encourage a multidisciplinary approach starting from patient selection, interventions, and long-term follow-up to maintain weight loss. However, these conserva... 2/25/2021
Kemmian D Johnson, Abhilash Perisetti, Hemant Goyal, Ragesh Thandassery, Mahesh Gajendran, Mohammad Aziz, Benjamin Tharian, Sumant Inamdar Liver Biopsy in Pregnancy Two Case Reports and Review of the Literature The etiology of most cases of liver diseases in pregnancy can be diagnosed with a thorough history, physical examination, laboratory values, serology, and noninvasive imaging. However, atypical clinical and laboratory presentations of liver diseases/chemistries require a liver biopsy to render an ac... 1/12/2021
Meir Mizrahi, Yazan Fahmawi, Lindsey Merritt, Manoj Kumar, Benjamin Tharian, Salman Ali Khan, Sumant Inamdar, Neil Sharma, Dushant Uppal, Vanessa M Shami, Mahmood Syed Kashif, Moamen Gabr, Douglas Pleskow, Tyler M Berzin, Ted W James, Michael Croglio, Todd H Baron, Douglas G Adler Luminal-apposing stents for benign intraluminal strictures a large United States multicenter study of clinical outcomes CONCLUSIONS: Using LAMS for treatment of short benign GI strictures is safe and effective. Larger LAMS, such as the new 20 mm in diameter, may have a lower stent migration rate compared to smaller diameter LAMS. 1/8/2021
Abhilash Perisetti, Hemant Goyal, Benjamin Tharian, Sumant Inamdar, Jawahar L Mehta Aspirin for prevention of colorectal cancer in the elderly friend or foe Cancer is the leading cause of death among men and women aged 60-79 years. Colorectal cancer is the third most common cancer in males and the second most common in females, with about 0.8 million deaths worldwide per year. Individuals older than 50 years account for 20-50% of colonic adenomas. Sever... 1/8/2021
Yervant Ichkhanian, Mohammed Barawi, Talal Seoud, Shyam Thakkar, Truptesh H Kothari, Maan El Halabi, Asad Ullah, Wedi Edris, Patrick Aepli, Thomas Kowalski, Brianna Shinn, Reem Z Shariaha, Srihari Mahadev, Jeffrey D Mosko, Gianluca Andrisani, Francesco Maria Di Matteo, Heinz Albrecht, Andrew Q Giap, Shou-Jiang Tang, Yehia M Naga, Erwin van Geenen, Shai Friedland, Benjamin Tharian, Shayan Irani, Andrew S Ross, Laith H Jamil, Daniel Lew, Andrew S Nett, Jad Farha, Thomas M Runge, Manol Jovani, Mouen A Khashab Endoscopic full-thickness resection of polyps involving the appendiceal orifice a multicenter international experience CONCLUSIONS: The FTRD is a promising non-surgical alternative for resecting appendiceal lesions, but appendicitis occurs in 1/6 cases. 1/4/2021
Y Hasan, A R Murali, H Gerke Endoscopic mucosal resection for early esophageal carcinoma is effective and safe but necessitates continued surveillance CONCLUSION: EMR is effective and safe for the management of early EC. The risk of cancer recurrence, albeit small, warrants surveillance. Complete eradication of Barrett's should be attempted in all patients after EMR of AC. 11/17/2020
Mark R Pedersen, Garrett Greenan, Sumant Arora, Arvind R Murali, Marlyn J Mayo Ursodeoxycholic Acid Decreases Incidence of Primary Biliary Cholangitis and Biliary Complications After Liver Transplantation A Meta-Analysis After liver transplantation (LT), the role of ursodeoxycholic acid (UDCA) is not well characterized. We examine the effect of UDCA after LT in the prophylaxis of biliary complications (BCs) in all-comers for LT and the prevention of recurrent primary biliary cholangitis (rPBC) in patients transplant... 11/13/2020
Muhammad Aziz, Chandra Shekhar Dasari, Yousaf Zafar, Rawish Fatima, Hossein Haghbin, Zakaria Abdullah Alyousif, Wade Lee-Smith, Abhilash Perisetti, Ali Nawras, Shashank Garg, Sumant Inamdar, Benjamin Tharian Does timing of endoscopy affect outcomes in patients with upper gastrointestinal bleeding a systematic review and meta-analysis CONCLUSION: Given the outcomes and limitations, our meta-analysis did not demonstrate clear benefit of performing EGD within 24 h of presentation for UGIB (particularly NVB). 11/12/2020
Mahesh Gajendran, Abhilash Perisetti, Muhammad Aziz, Saikiran Raghavapuram, Pardeep Bansal, Benjamin Tharian, Hemant Goyal Inflammatory bowel disease amid the COVID-19 pandemic impact, management strategies, and lessons learned The current outbreak of COVID-19 pandemic caused by SARS-CoV-2 has affected nearly 188 countries. Patients with severe COVID-19 are more commonly elderly and suffer from comorbidities such as hypertension, diabetes mellitus, coronary artery disease, chronic pulmonary disease, obesity, and cancer. In... 11/9/2020
Abhilash Perisetti, Mahesh Gajendran, Chandra Shekhar Dasari, Pardeep Bansal, Muhammad Aziz, Sumant Inamdar, Benjamin Tharian, Hemant Goyal Cannabis hyperemesis syndrome an update on the pathophysiology and management Cannabis hyperemesis syndrome (CHS) is a form of functional gut-brain axis disorder characterized by bouts of episodic nausea and vomiting worsened by cannabis intake. It is considered as a variant of cyclical vomiting syndrome seen in cannabis users especially characterized by compulsive hot bathin... 11/9/2020
Kumar Krishnan, Manoop S Bhutani, Harry R Aslanian, Joshua Melson, Udayakumar Navaneethan, Rahul Pannala, Mansour A Parsi, Allison R Schulman, Amrita Sethi, Shelby Sullivan, Guru Trikudanathan, Arvind J Trindade, Rabindra R Watson, John T Maple, (ASGE Technology Committee Chair, 2016-2019), David R Lichtenstein, (ASGE Technology Committee Chair) Enhanced EUS imaging with videos CONCLUSIONS: Elastography and CE-EUS may improve the real-time evaluation of intra- and extraluminal lesions as an adjunct to standard B-mode and Doppler imaging. They are not a replacement for EUS-guided tissue sampling but provide adjunctive diagnostic information in specific clinical situations. ... 11/1/2020
Hemant Goyal, Rupinder Mann, Zainab Gandhi, Abhilash Perisetti, Aman Ali, Khizar Aman Ali, Neil Sharma, Shreyas Saligram, Benjamin Tharian, Sumant Inamdar Scope of Artificial Intelligence in Screening and Diagnosis of Colorectal Cancer Globally, colorectal cancer is the third most diagnosed malignancy. It causes significant mortality and morbidity, which can be reduced by early diagnosis with an effective screening test. Integrating artificial intelligence (AI) and computer-aided detection (CAD) with screening methods has shown pr... 10/20/2020
Ji Young Bang, Thomas Rösch, Hyungjin Myra Kim, Shyam Thakkar, Ernesto Robalino Gonzaga, Benjamin Tharian, Sumant Inamdar, Linda S Lee, Patrick Yachimski, Priya Jamidar, Thiruvengadam Muniraj, Christopher DiMaio, Nikhil Kumta, Amrita Sethi, Peter Draganov, Dennis Yang, Talal Seoud, Abhilash Perisetti, Gayatri Bondi, Sachin Kirtane, Robert Hawes, C Mel Wilcox, Richard Kozarek, D Nageshwar Reddy, Shyam Varadarajulu Prospective evaluation of an assessment tool for technical performance of duodenoscopes CONCLUSIONS: The newly developed assessment tool appears reliable and valid for evaluating the technical performance of duodenoscopes. Registration: ClinicalTrials.gov Identifier: NCT04004533. 10/2/2020
Thomas Augustine, Abhilash Perisetti, Salman Ali Khan, Rodolfo Henrich Lobo, Benjamin Tharian Primary Colonic Lymphoma With Paraneoplastic Hypercalcemia Primary colonic lymphoma is a rare tumor accounting for 0.1%-0.5% of all colorectal malignancies. We describe a 63-year-old man whose initial presentation was altered mental status due to hypercalcemia. Physical examination revealed a hard, right-sided abdominal mass. Abdominal computed tomography s... 9/28/2020
Hemant Goyal, Mahesh Gajendran, Umesha Boregowda, Abhilash Perisetti, Muhammad Aziz, Pardeep Bansal, Sumant Inamdar, Benjamin Tharian Current and future implications of COVID-19 on gastroenterology training and clinical practice The novel coronavirus disease 2019 (COVID-19) pandemic has affected almost every country on the globe, affecting 185 countries with more than 2.6 million cases and 182,000 deaths as of April 22, 2020. The United States (US) has seen an exponential surge in the COVID-19 patients and has become the ep... 9/21/2020
Shajan Peter, Amanda Pendergraft, William VanDerPol, C Mel Wilcox, Kondal R Kyanam Kabir Baig, Casey Morrow, Jacques Izard, Peter J Mannon Mucosa-Associated Microbiota in Barretts Esophagus, Dysplasia, and Esophageal Adenocarcinoma Differ Similarly Compared With Healthy Controls INTRODUCTION: Alterations in the composition of the human gut microbiome and its metabolites have been linked to gut epithelial neoplasia. We hypothesized that differences in mucosa-adherent Barrett's microbiota could link to risk factors, providing risk of progression to neoplasia. 9/21/2020
Ji Young Bang, Robert Hawes, Shyam Varadarajulu Equivalent performance of single-use and reusable duodenoscopes in a randomised trial CONCLUSION: Given the overall safety profile and similar technical performance, single-use duodenoscopes represent an alternative to reusable duodenoscopes for performing low-complexity ERCP procedures in experienced hands. 9/8/2020
Udayakumar Navaneethan, Chad Spencer, Xiang Zhu, John J Vargo, David Grove, Raed A Dweik Volatile organic compounds in bile can distinguish pancreatic cancer from chronic pancreatitis a prospective observational study CONCLUSION: The measurement of VOCs in bile helped to accurately distinguish pancreatic cancer from chronic pancreatitis. 9/7/2020
Saurabh Chandan, Sumant Arora, Babu P Mohan, Shahab R Khan, Ojasvini C Chandan, Lena L Kassab, Arvind R Murali Multimedia based education on bowel preparation improves adenoma detection rate Systematic review amp; meta-analysis of randomized controlled trials CONCLUSION: Pre-colonoscopy patient education using multimedia based platforms seems to improve ADR and the adequacy of bowel preparation. 8/15/2020
Masayuki Kitano, Thomas M Gress, Pramod K Garg, Takao Itoi, Atsushi Irisawa, Hiroyuki Isayama, Atsushi Kanno, Kei Takase, Michael Levy, Ichiro Yasuda, Phillipe Lévy, Shuiji Isaji, Carlos Fernandez-Del Castillo, Asbjørn M Drewes, Andrea R G Sheel, John P Neoptolemos, Tooru Shimosegawa, Marja Boermeester, C Mel Wilcox, David C Whitcomb International consensus guidelines on interventional endoscopy in chronic pancreatitis Recommendations from the working group for the international consensus guidelines for chronic pancreatitis in collaboration with the International Association of Pancreatology, the American Pancreatic Association, the Japan Pancreas Society, and European Pancreatic Club CONCLUSIONS: This international expert consensus guideline provides evidenced-based statements concerning indications and key aspects for interventional endoscopy in the management of patients with chronic pancreatitis. 8/15/2020
Ji Young Bang, C Mel Wilcox, Juan Pablo Arnoletti, Shyam Varadarajulu Importance of Disconnected Pancreatic Duct Syndrome in Recurrence of Pancreatic Fluid Collections Initially Drained Using Lumen-Apposing Metal Stents CONCLUSIONS: In treatment of PFCs with LAMS in patients with DPDS, it is important to replace the LAMS with indwelling plastic stents to minimize PFC recurrence and reduce morbidity. Clinicaltrials.gov no: NCT02422095. 7/20/2020
Ji Young Bang, Charles Mel Wilcox, Robert Hawes, Shyam Varadarajulu Outcomes of a Structured, Stepwise Approach to Endoscopic Necrosectomy CONCLUSIONS: By decreasing the number of necrosectomy sessions, a structured, stepwise approach to endoscopic necrosectomy seems to improve procedural efficiency. 7/14/2020
Vikram Kotwal, Chimezie Mbachi, Yuchen Wang, Bashar Attar, Tejinder Randhawa, Estefania Flores, Julian Robles, Craig Rosenstengle, Melchor Demetria, Oluwatoyin Adeyemi, Gregory Huhn, Arvind R Murali A Novel Score to Predict Esophageal Varices in Patients with Compensated Advanced Chronic Liver Disease CONCLUSION: We propose a new, highly accurate, and easy-to-use scoring system to predict the presence of not only high-risk but any esophageal varices in patients with cACLD. 7/11/2020
William Greenhalf, Philippe Lévy, Thomas Gress, Vinciane Rebours, Randall E Brand, Steve Pandol, Suresh Chari, Maiken Thyregod Jørgensen, Julia Mayerle, Markus M Lerch, Péter Hegyi, Jörg Kleeff, Carlos Fernández-Del Castillo, Shuiji Isaji, Tooru Shimosegawa, Andrea Sheel, Christopher M Halloran, Pramod Garg, Kyoichi Takaori, Marc G Besselink, Chris E Forsmark, C Mel Wilcox, Patrick Maisonneuve, Dhiraj Yadav, David Whitcomb, John Neoptolemos, Working group for the International (IAP – APA – JPS – EPC) Consensus Guidelines for Chronic Pancreatitis International consensus guidelines on surveillance for pancreatic cancer in chronic pancreatitis Recommendations from the working group for the international consensus guidelines for chronic pancreatitis in collaboration with the International Association of Pancreatology, the American Pancreatic Association, the Japan Pancreas Society, and European Pancreatic Club CONCLUSIONS: Patients with inherited PRSS1 mutations should undergo surveillance for pancreatic cancer, but the best methods for cancer detection need further investigation. 7/7/2020
Babu P Mohan, Shahab R Khan, Saurabh Chandan, Lena L Kassab, Suresh Ponnada, Ravishankar Asokkumar, Bo Shen, Marietta Iacucci, Udayakumar Navaneethan Endoscopic resection of colon dysplasia in patients with inflammatory bowel disease a systematic review and meta-analysis CONCLUSIONS: Risk of CRC after dysplasia resection in IBD patients appears to be low, supporting the current strategy of resection and surveillance. 6/28/2020
Mahendran Jayaraj, Ranjit Makar, Gordon Ohning Evaluation and Management of Suspected Early Chronic Pancreatitis ECP PURPOSE OF REVIEW: Chronic pancreatitis in the advanced stages leads to significant health care utilization because of the associated complications. Early-stage diagnosis could prevent the development of these complications by appropriate management. In this article, we reviewed the recent evidence ... 6/28/2020
Aditi Reddy, Divya Ashat, Arvind R Murali Recent insights on the use of topical steroids in eosinophilic esophagitis INTRODUCTION: Eosinophilic Esophagitis (EoE) is an immune-mediated, chronic inflammatory disorder of the esophagus. Topical steroids have been used in the management of EoE for over 15 years. However, there are no Food and Drug Administration (FDA) approved drug therapies for EoE. 6/23/2020
Munish Ashat, Jagpal S Klair, Sydney L Rooney, Sagar J Vishal, Chris Jensen, Nadav Sahar, Arvind R Murali, Rami El-Abiad, Henning Gerke Randomized controlled trial comparing the Franseen needle with the Fork-tip needle for EUS-guided fine-needle biopsy CONCLUSIONS: There was no significant difference in the performance of the Franseen needle versus the Fork-tip needle. Both needles achieved a high yield of histologic tissue samples and high diagnostic accuracy. (Clinical trial registration number: NCT03672032.). 6/12/2020
Chiranjeevi Gadiparthi, Abhilash Perisetti, Hari Sayana, Benjamin Tharian, Sumant Inamdar, Andrew Korman Gastrointestinal Bleeding in Patients with Severe SARS-CoV-2 Gastrointestinal symptoms are common and frequently reported in Coronavirus Disease-2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It is unclear if SARS-CoV-2 is associated with increased risk of gastrointestinal bleeding (GIB). Nevertheless, GIB in... 6/10/2020
Yan Chen, Qiao Yu, Francis A Farraye, Gursimran S Kochhar, Charles N Bernstein, Udayakumar Navaneethan, Kaicun Wu, Jie Zhong, David A Schwartz, Hao Wu, Jing-Jing Zheng, Marietta Iacucci, Ravi P Kiran, Bo Shen Patterns of endoscopy during COVID-19 pandemic a global survey of interventional inflammatory bowel disease practice CONCLUSIONS: Cancellation of elective and emergent endoscopy in IBD care during the pandemic was common. Few respondents reported that their patients' disease conditions worsened due to the cancellation of the endoscopy procedure. Most respondents voiced the need for proper PPE during the procedure ... 6/1/2020
Lindsey C Shipley, David T Steele, Charles M Wilcox, Chad M Burski A Rare Cause of Acute Pancreatitis in a Transgender Female Acute pancreatitis is defined as an acute inflammation of the pancreas and is most commonly caused by gallstones and alcohol followed by elevated triglycerides and medications. Estrogen as a cause of secondary hypertriglyceridemic pancreatitis is a rare but known phenomenon in females on hormonal th... 5/15/2020
Francisco Valverde-López, Eva Julissa Ortega-Suazo, Charles Mel Wilcox, Maria Carmen Fernandez-Cano, Juan Gabriel Martínez-Cara, Eduardo Redondo-Cerezo Endoscopic ultrasound as a diagnostic and predictive tool in idiopathic acute pancreatitis CONCLUSIONS: EUS-directed ERCP/cholecystectomy was associated with lower relapse rates in idiopathic acute pancreatitis. Along with age and gallbladder status, it provides predictive information about recurrence likelihood. 5/9/2020
Mikhail Tikhonov, Shamit Kachru, Daniel S Fisher A model for the interplay between plastic tradeoffs and evolution in changing environments Performance tradeoffs are ubiquitous in both ecological and evolutionary modeling, yet they are usually postulated and built into fitness and ecological landscapes. However, tradeoffs depend on genetic background and evolutionary history and can themselves evolve. We present a simple model capable o... 4/5/2020
Michele D Lewis, Jyothsna Talluri, C Mel Wilcox, Judah N Abberbock, Gong Tang, Darwin L Conwell, Peter A Banks, Gregory A Cote, Stuart Sherman, Samer Alkaade, Timothy B Gardner, Michelle A Anderson, Bimaljit S Sandhu, Thiruvengadam Muniraj, Chris E Forsmark, Nalini Guda, Andres Gelrud, Joseph Romagnuolo, Randall Brand, Jessica LaRusch, Stephen T Amann, Adam Slivka, David C Whitcomb, Dhiraj Yadav Differences in Age at Onset of Symptoms, and Effects of Genetic Variants, in Patients With Early vs Late-Onset Idiopathic Chronic Pancreatitis in a North American Cohort CONCLUSIONS: We confirmed previously reported ages at onset of symptoms for EO-ICP and LO-ICP in a North American cohort. We found differences in clinical features among patients with EO-ICP, LO-ICP, and ACP. Almost half of patients with EO-ICP have genetic variants associated with CP, compared with... 4/3/2020
Kemmian D Johnson, Passisd Laoveeravat, Eric U Yee, Abhilash Perisetti, Ragesh Babu Thandassery, Benjamin Tharian Endoscopic ultrasound guided liver biopsy Recent evidence Liver biopsy (LB) is an essential tool in diagnosing, evaluating and managing various diseases of the liver. As such, histopathological results are critical as they establish or aid in diagnosis, provide information on prognosis, and guide the appropriate selection of medical therapy for patients. I... 3/29/2020
Ji Young Bang, Matthew Hough, Robert H Hawes, Shyam Varadarajulu Use of Artificial Intelligence to Reduce Radiation Exposure at Fluoroscopy-Guided Endoscopic Procedures OBJECTIVES: Exposure to ionizing radiation remains a hazard for patients and healthcare providers. We evaluated the utility of an artificial intelligence (AI)-enabled fluoroscopy system to minimize radiation exposure during image-guided endoscopic procedures. 3/21/2020
Heidi S Ahmed, Natalie Pedersen, Manju Bengaluru Jayanna, Patrick Ten Eyck, Antonio Sanchez, Arvind R Murali Predictive Factors and Time to Development of Hepatic Decompensation in Patients with Non-alcoholic Fatty Liver Disease CONCLUSIONS: A significant proportion of patients with NAFLD developed hepatic decompensation. We have provided a simple, objective model to help identify "at-risk" patients. 3/12/2020
Rajesh Krishnamoorthi, Chandra S Dasari, Viveksandeep Thoguluva Chandrasekar, Harshith Priyan, Mahendran Jayaraj, Joanna Law, Michael Larsen, Richard Kozarek, Andrew Ross, Shayan Irani Effectiveness and safety of EUS-guided choledochoduodenostomy using lumen-apposing metal stents LAMS a systematic review and meta-analysis CONCLUSION: CDD using LAMS/EC-LAMS is an effective and safe technique for biliary decompression in patients who failed ERCP. Further studies are needed to assess CDD using LAMS as primary treatment modality for biliary obstruction. 3/7/2020
Abhilash Perisetti, Passisd Laoveeravat, Sumant Inamdar, Benjamin Tharian, Ragesh Thandassery, Hemant Goyal Hepatitis E virus infection in liver transplant recipients a descriptive literature review Hepatitis E virus infection has been recognized as a rising hepatotropic viral infection in the developing countries but overlooked in the developed countries, due to its lower prevalence. However, hepatitis E virus prevalence is on rise in the liver transplant recipients due to immunosuppression, w... 2/25/2020
Ji Young Bang, Bryce Sutton, Udayakumar Navaneethan, Robert Hawes, Shyam Varadarajulu Efficacy of Single-Operator Cholangioscopy-Guided Lithotripsy Compared With Large Balloon Sphincteroplasty in Management of Difficult Bile Duct Stones in a Randomized Trial CONCLUSIONS: In a randomized trial of patients with difficult bile stones that cannot be cleared by standard maneuvers, SOC-guided lithotripsy leads to duct clearance in a significantly higher proportion of patients than LBS-particularly when stone size exceeds the diameter of the extrahepatic bile ... 2/15/2020
Munish Ashat, Kaartik Soota, Jagpal S Klair, Sarika Gupta, Chris Jensen, Arvind R Murali, Randhir Jesudoss, Rami El-Abiad, Henning Gerke Modified Endoscopic Ultrasound Needle to Obtain Histological Core Tissue Samples A Retrospective Analysis CONCLUSION: EUS-FNB with the modified EUS needle provided histologic tissue cores in the majority of cases and achieved excellent diagnostic accuracy with few needle passes. 2/6/2020
Bo Shen, Gursimran Kochhar, Udayakumar Navaneethan, Francis A Farraye, David A Schwartz, Marietta Iacucci, Charles N Bernstein, Gerald Dryden, Raymond Cross, David H Bruining, Taku Kobayashi, Martin Lukas, Amandeep Shergill, Martin Bortlik, Nan Lan, Milan Lukas, Shou-Jiang Tang, Paulo Gustavo Kotze, Ravi P Kiran, Parambir S Dulai, Sandra El-Hachem, Nayantara Coelho-Prabhu, Shyam Thakkar, Ren Mao, Guodong Chen, Shengyu Zhang, Begoña González Suárez, Yago Gonzalez Lama, Mark S Silverberg, William J Sandborn Practical guidelines on endoscopic treatment for Crohns disease strictures a consensus statement from the Global Interventional Inflammatory Bowel Disease Group Stricture formation is a common complication of Crohn's disease, resulting from the disease process, surgery, or drugs. Endoscopic balloon dilation has an important role in the management of strictures, with emerging techniques, such as endoscopic electroincision and stenting, showing promising resu... 1/20/2020
Basile Njei, Thomas R McCarty, Thiruvengadam Muniraj, Prabin Sharma, Priya A Jamidar, Harry R Aslanian, Shyam Varadarajulu, Udayakumar Navaneethan Comparative effectiveness of pharmacologic and endoscopic interventions for prevention of post-ERCP pancreatitis a network meta-analysis Background and study aims While several interventions may decrease risk of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis, it remains unclear whether one strategy is superior to others. The purpose of this study was to compare the effectiveness of pharmacologic and endoscopi... 1/11/2020
Annie S Hong, Wen Yuan Yu, Jenny M Hong, Chad L Cross, Mohamed Azab, Gordon Ohning, Mahendran Jayaraj Proton pump inhibitor in upper gastrointestinal fecal microbiota transplant A systematic review and analysis CONCLUSIONS: We did not find evidence supporting a clinically significant benefit from routine use of PPIs in FMT protocol. It is possible that the theoretical benefit from improved survival of transplanted microbiota is offset by negative effects on the microbiome. We suggest that routine use of PP... 12/13/2019
Dennis Yang, Hiroyuki Aihara, Yaseen B Perbtani, Andrew Y Wang, Abdul Aziz Aadam, Yutaka Tomizawa, Joo Ha Hwang, Baiming Zou, Nikola S Natov, Amanda Siegel, Milad Pourmousavi Khoshknab, Mouen A Khashab, Saowanee Ngamruengphong, Harshit S Khara, David L Diehl, Thibaut Maniere, Sherif Andrawes, Petros Benias, Nikhil A Kumta, Fariha Ramay, Raymond E Kim, Jason Samarasena, Kenneth Chang, Rintaro Hashimoto, Benjamin Tharian, Sumant Inamdar, Gloria Lan, Amrita Sethi, Michael J Nosler, Abdalaziz Tabash, Mohamed O Othman, Peter V Draganov Safety and efficacy of endoscopic submucosal dissection for rectal neoplasia a multicenter North American experience Background and aims Rectal lesions traditionally represent the first lesions approached during endoscopic submucosal dissection (ESD) training in the West. We evaluated the safety and efficacy of rectal ESD in North America. Methods This is a multicenter retrospective analysis of rectal ESD between ... 12/6/2019
Kemmian D Johnson, Abhilash Perisetti, Benjamin Tharian, Ragesh Thandassery, Priya Jamidar, Hemant Goyal, Sumant Inamdar Endoscopic Retrograde Cholangiopancreatography-Related Complications and Their Management Strategies A Scoping Literature Review Endoscopic retrograde cholangiopancreatography (ERCP) is a well-known procedure with both diagnostic and therapeutic utilities in managing pancreaticobiliary conditions. With the advancements of endoscopic techniques, ERCP has become a relatively safe and effective procedure. However, as ERCP is inc... 12/4/2019
Mohamed Azab, Shishira Bharadwaj, Mahendran Jayaraj, Annie S Hong, Pejman Solaimani, Mohamad Mubder, Hyeyoung Yeom, Ji Won Yoo, Michael L Volk Safety of endoscopic retrograde cholangiopancreatography ERCP in pregnancy A systematic review and meta-analysis CONCLUSIONS: ERCP done by experienced endoscopists is a safe procedure during pregnancy. Radiation-free techniques appear to reduce the rates of nonpregnancy-related complications, but not of fetal and pregnancy-related complications. 11/21/2019
Jagpal S Klair, Munish Ashat, Dane Johnson, Sumant Arora, Nirmal Onteddu, Jose G Machain Palacio, Ronald Samuel, Mohammad Bilal, Avanija Buddam, Ashutosh Gupta, Alan Gunderson, Praveen Guturu, Kaartik Soota, Subhash Chandra, Arvind R Murali Serrated polyp detection rate and advanced adenoma detection rate from a US multicenter cohort CONCLUSION: A significant percentage of endoscopists have either a low SDR or low AADR despite an adequate ADR, justifying the need for separate SDR and AADR benchmarks. Based on our multicenter cohort, endoscopists with adequate ADRs had a median SDR and median AADR of about 8 % and 9 %, respective... 11/19/2019
Subhash Chandra, Arvind R Murali, Maen Masadeh, William B Silverman, Frederick C Johlin Comparison of Biliary Stent versus Biliary Sphincterotomy Alone in the Treatment of Bile Leak CONCLUSION: EBS with or without a biliary stent is highly effective in the management of bile leak. Clinical resolution of the bile leak is quicker with EBS alone, requires fewer interventions, and may cost less. 11/7/2019
Babu P Mohan, Shahab R Khan, Sushruth Trakroo, Suresh Ponnada, Mahendran Jayaraj, Ravishankar Asokkumar, Douglas G Adler Endoscopic ultrasound-guided gallbladder drainage, transpapillary drainage, or percutaneous drainage in high risk acute cholecystitis patients a systematic review and comparative meta-analysis CONCLUSION: EUSGBD demonstrated better clinical success than ETGBD and PCGBD in the management of acute cholecystitis patients at high surgical risk. 10/24/2019
Babu P Mohan, Veeraraghavan Meyyur Aravamudan, Shahab R Khan, Saurabh Chandan, Suresh Ponnada, Ravishankar Asokkumar, Udayakumar Navaneethan, Douglas G Adler Prevalence of colorectal cancer in cryptogenic pyogenic liver abscess patients Do they need screening colonoscopy A systematic review and meta-analysis CONCLUSION: Our study, albeit limited by heterogeneity, demonstrates that patients with cryptogenic PLA are at a 7-fold risk of having CRC. A screening colonoscopy may be considered in population with cryptogenic PLA, especially if positive for K. pneumoniae. Well-conducted studies are needed to ans... 10/12/2019
Haruhiro Inoue, Hironari Shiwaku, Yasutoshi Kobayashi, Philip W Y Chiu, Robert H Hawes, Horst Neuhaus, Guido Costamagna, Stavros N Stavropoulos, Norio Fukami, Stefan Seewald, Manabu Onimaru, Hitomi Minami, Shinwa Tanaka, Yuto Shimamura, Esperanza Grace Santi, Kevin Grimes, Hisao Tajiri Statement for gastroesophageal reflux disease after peroral endoscopic myotomy from an international multicenter experience It has been 10 years since peroral endoscopic myotomy (POEM) was reported for the first time, and POEM has currently become the standard treatment for achalasia and related disorders globally because it is less invasive and has a higher curative effect than conventional therapeutic methods. However,... 9/28/2019
Munish Ashat, Sumant Arora, Jagpal S Klair, Christopher A Childs, Arvind R Murali, Frederick C Johlin Bilateral emvsem unilateral placement of metal stents for inoperable high-grade hilar biliary strictures A systemic review and meta-analysis CONCLUSION: Bilateral biliary drainage had a lower re-intervention rate as compared to unilateral drainage for high grade inoperable malignant biliary strictures, with no significant difference in technical success, and early or late complication rates. 9/28/2019
Jeremias Aguilera Damia, Shamit Kachru, Srinivas Raghu, Gonzalo Torroba Two-Dimensional Non-Fermi-Liquid Metals A Solvable Large-N Limit Significant effort has been devoted to the study of "non-Fermi-liquid" (NFL) metals: gapless conducting systems that lack a quasiparticle description. One class of NFL metals involves a finite density of fermions interacting with soft order parameter fluctuations near a quantum critical point. The p... 9/17/2019
Mohamad Mubder, Mohamed Azab, Mahendran Jayaraj, Chad Cross, Daisy Lankarani, Banreet Dhindsa, Jen-Jung Pan, Gordon Ohning Autoimmune hepatitis in patients with human immunodeficiency virus infection A systematic review of the published literature CONCLUSION: Although rare, but AIH can develop in patients with HIV and physicians should consider it in the differential diagnosis for HIV patients presented with abnormal liver function tests, especially after excluding hepatitis C virus and drug-induced liver injury.Patients with immune deficienc... 9/14/2019
Rajesh Krishnamoorthi, Babu P Mohan, Mahendran Jayaraj, Kenneth K Wang, David A Katzka, Andrew Ross, Douglas G Adler, Prasad G Iyer Risk of progression in Barretts esophagus indefinite for dysplasia a systematic review and meta-analysis CONCLUSION: The estimated incidence of HGD and/or EAC and EAC alone in BE-IND is similar to the previously reported progression risk in BE-LGD. Based on these risk estimates, patients with BE-IND should be placed on active endoscopic surveillance. 8/18/2019
Gregory A Coté, Valerie L Durkalski-Mauldin, Jose Serrano, Erin Klintworth, April W Williams, Zobeida Cruz-Monserrate, Mustafa Arain, James L Buxbaum, Darwin L Conwell, Evan L Fogel, Martin L Freeman, Timothy B Gardner, Erwin van Geenen, J Royce Groce, Sreenivasa S Jonnalagadda, Rajesh N Keswani, Shyam Menon, Dana C Moffatt, Georgios I Papachristou, Andrew Ross, Paul R Tarnasky, Andrew Y Wang, C Mel Wilcox, Frank Hamilton, Dhiraj Yadav, SHARP Consortium SpHincterotomy for Acute Recurrent Pancreatitis Randomized Trial Rationale, Methodology, and Potential Implications CONCLUSIONS: The SHARP trial will determine whether ERCP with miES benefits patients with idiopathic ARP and pancreas divisum. Trial planning has informed the importance of blinded outcome assessors and long-term follow-up. 8/13/2019
ASGE Technology Committee, Harry R Aslanian, Amrita Sethi, Manoop S Bhutani, Adam J Goodman, Kumar Krishnan, David R Lichtenstein, Joshua Melson, Udayakumar Navaneethan, Rahul Pannala, Mansour A Parsi, Allison R Schulman, Shelby A Sullivan, Nirav Thosani, Guru Trikudanathan, Arvind J Trindade, Rabindra R Watson, John T Maple ASGE guideline for endoscopic full-thickness resection and submucosal tunnel endoscopic resection With the development of reliable endoscopic closure techniques and tools, endoscopic full-thickness resection (EFTR) is emerging as a therapeutic option for the treatment of subepithelial tumors and epithelial neoplasia with significant fibrosis. EFTR may be categorized as "exposed" and "nonexposed.... 8/8/2019
Passisd Laoveeravat, Subhanudh Thavaraputta, Sakolwan Suchartlikitwong, Wasawat Vutthikraivit, Thammasak Mingbunjerdsuk, Arunee Motes, Kenneth Nugent, Abhilash Perisetti, Benjamin Tharian, Sameer Islam, Ariwan Rakvit Optimal sequences of same-visit bidirectional endoscopy Systematic review and meta-analysis CONCLUSION: The present study found that the discomfort score was better in the E-C group. However, there was no difference in polyp and adenoma detection. Therefore, the E-C group is the optimal sequence. 8/2/2019
Muhammad K Hasan, Kambiz Kadkhodayan, Evgeny Idrisov, Saeed Ali, Ehsan Rafiq, Dana Ben-Ami Shor, Ala Abdel-Jalil, Uday Navaneethan, Ji Bang, Shyam Varadarajulu, Robert Hawes, Peter Pernicone Endoscopic ultrasound-guided liver biopsy using a 22-G fine needle biopsy needle a prospective study CONCLUSIONS: EUS-LB using a 22-G FNB needle is a safe and viable alternative to the use of larger gauge needles, yielding adequate tissue for evaluation of parenchymal disease in 100 % of the patients. 8/1/2019
Ji Young Bang, Udayakumar Navaneethan, Muhammad Hasan, Bryce Sutton, Robert Hawes, Shyam Varadarajulu Optimizing Outcomes of Single-Operator Cholangioscopy-Guided Biopsies Based on a Randomized Trial CONCLUSIONS: In a prospective comparative study, we found that centers without onsite cytopathology support that analyze 3 single-operator cholangioscopy-guided biopsies of a biliary stricture and process the specimens offsite make the correct diagnosis for 90% of cases. ClinicalTrials.gov, Number: ... 7/28/2019
ASGE technology committee, Mansour A Parsi, Allison R Schulman, Harry R Aslanian, Manoop S Bhutani, Kuman Krishnan, David R Lichtenstein, Joshua Melson, Udayakumar Navaneethan, Rahul Pannala, Amrita Sethi, Guru Trikudanathan, Arvind J Trindade, Rabindra R Watson, John T Maple, ASGE Technology Committee Chair Devices for endoscopic hemostasis of nonvariceal GI bleeding with videos CONCLUSIONS: Endoscopic evaluation and treatment remains a cornerstone in the management of nonvariceal upper- and lower-GI bleeding. A variety of devices is available for hemostasis of bleeding lesions in the GI tract. Other than injection therapy, which should not be used as monotherapy, there are... 7/24/2019
Olha Krechkivska, Callan M Wilcox, Klaas Nauta, Scott H Kable, Timothy W Schmidt Quantum-Induced Symmetry Breaking in the Deuterated Dihydroanthracenyl Radical The hydrogen-atom adduct with anthracene, 9-dihydroanthracenyl radical (C(14)H(11)), and its deuterated analogue have been identified by laser spectroscopy coupled to time-of-flight mass spectrometry, supported by time-dependent density functional theory calculations. The electronic spectrum of 9-di... 7/17/2019
Arvind J Trindade, Petros C Benias, Mohammed Alshelleh, Ahmad N Bazarbashi, Benjamin Tharian, Sumant Inamdar, Neil Sharma, Christina Zelt, Praneet Korrapati, Mohamed Barakat, Divyesh V Sejpal, Marvin Ryou Fine-needle biopsy is superior to fine-needle aspiration of suspected gastrointestinal stromal tumors a large multicenter study Background and study aims There are numerous studies published on the diagnostic yield of the new fine-needle biopsy (FNB) needles in pancreas masses. However, there are limited studies in suspected gastrointestinal stromal tumors (GIST lesions). The aim of this study was to evaluate the diagnostic... 7/16/2019
Mahendran Jayaraj, Babu P Mohan, Harmeet Mashiana, Rajesh Krishnamoorthi, Douglas G Adler Safety and efficacy of combined antegrade and retrograde endoscopic dilation for complete esophageal obstruction a systematic review and meta-analysis CONCLUSIONS: The CARD procedure for CEO has a high technical success rate, but also a high rate of repeat dilations. Given its complexity and associated adverse events, this procedure should be restricted to centers with a high level of expertise. 7/3/2019
Babu P Mohan, Mohammed Shakhatreh, Rajat Garg, Ravishankar Asokkumar, Mahendran Jayaraj, Suresh Ponnada, Udayakumar Navaneethan, Douglas G Adler Comparison of Franseen and fork-tip needles for EUS-guided fine-needle biopsy of solid mass lesions A systematic review and meta-analysis Franseen-tip and Fork-tip needles have been widely used in EUS guided fine-needle biopsy (FNB) of solid organs. There is conflicting data on the performance of these needles and unanswered questions on the ideal number of needle-passes and the requirement of an onsite cytopathologist (ROSE). We cond... 6/29/2019
Ji Young Bang, Charles Melbern Wilcox, Juan Pablo Arnoletti, Shyam Varadarajulu Superiority of endoscopic interventions over minimally invasive surgery for infected necrotizing pancreatitis meta-analysis of randomized trials CONCLUSIONS: An endoscopy-based treatment approach, as compared to minimally invasive surgery, significantly reduces complications in patients with infected necrotizing pancreatitis. 6/21/2019
Udayakumar Navaneethan, Xiang Zhu, Mansour A Parsi, Shyam Varadarajulu Pre-operative biliary drainage is associated with shortened survival time in patients with cholangiocarcinoma CONCLUSIONS: PBD appears negative impact on long-term survival in patients with potentially resectable CCA and should be avoided if possible. 6/21/2019
Elaina Vivian, Leslie Cler, Darwin Conwell, Gregory A Coté, Richard Dickerman, Martin Freeman, Timothy B Gardner, Robert H Hawes, Prashant Kedia, Rajesh Krishnamoorthi, Hellen Oduor, Stephen J Pandol, Georgios I Papachristou, Andrew Ross, Amrita Sethi, Shyam Varadarajulu, Santhi Swaroop Vege, Wahid Wassef, C Mel Wilcox, David C Whitcomb, Bechien U Wu, Dhiraj Yadav, Ashton Ellison, Samar Habash, Sheila Rastegari, Rathan Reddy, Timothy Yen, Mary Rachel Brooks, Paul Tarnasky Acute Pancreatitis Task Force on Quality Development of Quality Indicators for Acute Pancreatitis Management INTRODUCTION: Detailed recommendations and guidelines for acute pancreatitis (AP) management currently exist. However, quality indicators (QIs) are required to measure performance in health care. The goal of the Acute Pancreatitis Task Force on Quality was to formally develop QIs for the management ... 6/18/2019
ASGE Technology Committee, Adam J Goodman, Joshua Melson, Harry R Aslanian, Manoop S Bhutani, Kumar Krishnan, David R Lichtenstein, Udayakumar Navaneethan, Rahul Pannala, Mansour A Parsi, Allison R Schulman, Amrita Sethi, Shelby A Sullivan, Nirav Thosani, Guru Trikudanathan, Arvind J Trindade, Rabindra R Watson, John T Maple Endoscopic simulators CONCLUSIONS: Simulation training is a promising modality that may aid in endoscopic education. However, for widespread incorporation of simulators into gastroenterology training programs to occur, simulators must show a sustained advantage over traditional mentored teaching in a cost-effective manne... 5/25/2019
Babu P Mohan, Ravishankar Asokkumar, Mohammed Shakhatreh, Rajat Garg, Suresh Ponnada, Udayakumar Navaneethan, Douglas G Adler Adverse events with lumen-apposing metal stents in endoscopic gallbladder drainage A systematic review and meta-analysis CONCLUSION: We report an overall AE rate of 13% with LAMS in EUS-GBD. Early AE risk appears to be 6.5% and delayed AE risk appears to be 8%. Our results are analyzed out of good-quality studies, with minimal to zero heterogeneity. 5/23/2019
ASGE Technology Committee, Arvind J Trindade, Udayakumar Navaneethan, Harry R Aslanian, Manoop S Bhutani, Kumar Krishnan, David R Lichtenstein, Joshua Melson, Rahul Pannala, Mansour A Parsi, Allison R Schulman, Amrita Sethi, Guru Trikudanathan, Rabindra R Watson, John T Maple Advances in the diagnosis and surveillance of Barretts esophagus with videos CONCLUSION: Several technologies discussed in this document may improve dysplasia detection in BE in a wide-field manner. Moreover, the addition of different biomarkers may aid in enhanced risk stratification to optimize approaches to surveillance or treatment for patients with BE. 5/23/2019
Ji Young Bang, Shyam Varadarajulu Lumen-apposing metal stents for endoscopic ultrasonography-guided interventions Lumen-apposing metal stents (LAMS) are integrated in a single-step delivery platform and can be deployed under endoscopic ultrasound-guidance for the drainage of intra-abdominal fluid collections, decompression of obstructed ductal systems, establishment of anastomosis or creation of fistulous tract... 5/4/2019
Benjamin Tharian, Konrad Krall, Xiang Zhu, Nayana George, Michael Chambers, Shyam Varadarajulu, Shantel Hebert-Magee Endosonographer-driven dynamic telecytopathology of pancreatic lesions-a pilot study CONCLUSION: An endosonographer with limited training can examine for specimen adequacy, transmit images, and demonstrate representative cell groups. Larger studies are required though preliminary results are encouraging. 5/3/2019
Babu P Mohan, Mahendran Jayaraj, Ravishankar Asokkumar, Mohammed Shakhatreh, Parul Pahal, Suresh Ponnada, Udayakumar Navaneethan, Douglas G Adler Lumen apposing metal stents in drainage of pancreatic walled-off necrosis, are they any better than plastic stents A systematic review and meta-analysis of studies published since the revised Atlanta classification of pancreatic fluid collections Lumen-apposing metal stents (LAMS) are increasingly being used in the drainage of pancreatic walled-off necrosis (WON). Best choice of stent is subject to argument, and studies are varied in the reported outcomes between LAMS and plastic stents (PS) to this end. We conducted a comprehensive search o... 4/23/2019
Abhilash Perisetti, Jonathan Kopel, Abdussalam Shredi, Saikiran Raghavapuram, Benjamin Tharian, Kenneth Nugent Prophylactic pre-esophagogastroduodenoscopy tracheal intubation in patients with upper gastrointestinal bleeding The indications for endotracheal intubation (ETI) during an esophagogastroduodenoscopy (EGD) procedure remain unclear. This study performed a descriptive analysis of patients who underwent prophylactic tracheal intubation during or before an EGD to prevent pulmonary aspiration. We selected patients ... 4/9/2019
Sameen Khalid, Aamer Abbass, Neelam Khetpal, Bo Shen, Udayakumar Navaneethan Endoscopic detection and resection of dysplasia in inflammatory bowel disease-techniques with videos CONCLUSIONS: In this review, we discuss the various techniques for endoscopic resection of dysplasia in patients with inflammatory bowel disease. Further research is required to determine the optimal approach to diagnosis and management of dysplasia in patients with inflammatory bowel disease. 3/12/2019
Shajan Peter, Nipun B Reddy, Mohammed Naseemuddin, Jenine N Zaibaq, Gerald McGwin, C Mel Wilcox Outcomes of use of electromagnetic guidance with responsive insertion technology RIT during colonoscopy a prospective randomized controlled trial Background and study aims Colonoscopy can be technically challenging and cause discomfort in patients. The integrated Scope Guide assist is built in to show that with its use outcomes are improved during colonoscopy. We aimed to test the usefulness of the Magnetic Scope Guide Assist (ScopeGuide ) wi... 2/2/2019
Udayakumar Navaneethan, Jong Ho Moon, Takao Itoi Biliary interventions using single-operator cholangioscopy Cholangioscopy provides an opportunity to directly visualize the bile duct for diagnosing biliary lesions and for therapeutic interventions. Although there are different cholangioscopy techniques available, single-operator cholangioscopy has gained widespread acceptance as the standard technique for... 1/29/2019
Babu P Mohan, Mohammed Shakhatreh, Rajat Garg, Suresh Ponnada, Udayakumar Navaneethan, Douglas G Adler Efficacy and Safety of Endoscopic Ultrasound-guided Choledochoduodenostomy A Systematic Review and Meta-Analysis CONCLUSIONS: On the basis of our analysis EUS-CDD has an adverse event risk of 13.4%, which is lowest reported in literature so far. Reported adverse rates appeared to be lower with the use of lumen-apposing metal stent, except for perforation. 1/26/2019
Jennifer E Tham, Benjamin Tharian, Patrick B Allen, Gary Spence, Tony C Tham Oesophageal Stents for Potentially Curable Oesophageal Cancer - A Bridge to Surgery For oesophageal cancer patients with potentially curative disease, treatment usually comprises neoadjuvant chemoradiotherapy followed by surgery. Several methods are currently used for nutritional support while patients are undergoing neoadjuvant treatment but these do not relieve dysphagia. Stentin... 1/25/2019
Ji Young Bang, Juan Pablo Arnoletti, Bronte A Holt, Bryce Sutton, Muhammad K Hasan, Udayakumar Navaneethan, Nicholas Feranec, C Mel Wilcox, Benjamin Tharian, Robert H Hawes, Shyam Varadarajulu An Endoscopic Transluminal Approach, Compared With Minimally Invasive Surgery, Reduces Complications and Costs for Patients With Necrotizing Pancreatitis CONCLUSIONS: In a randomized trial of 66 patients, an endoscopic transluminal approach for infected necrotizing pancreatitis, compared with minimally invasive surgery, significantly reduced major complications, lowered costs, and increased quality of life. Clinicaltrials.gov no: NCT02084537. 11/20/2018
Udayakumar Navaneethan, Xiang Zhu, Dennisdhilak Lourdusamy, Vennisvasanth Lourdusamy, Bo Shen, Ravi Kiran Colorectal cancer resection rates in patients with inflammatory bowel disease a population-based study CONCLUSIONS: CRC resection rates among IBD patients have continued to decrease annually from 1995 to 2012. There is a population-level decrease in resection of both proximal and distal CRC reflecting a decreasing incidence of IBD-related CRC incidence in the USA. 11/16/2018
ASGE Technology Committee, Rabindra R Watson, Mansour A Parsi, Harry R Aslanian, Adam J Goodman, David R Lichtenstein, Joshua Melson, Udayakumar Navaneethan, Rahul Pannala, Amrita Sethi, Shelby A Sullivan, Nirav C Thosani, Guru Trikudanathan, Arvind J Trindade, John T Maple Biliary and pancreatic lithotripsy devices CONCLUSIONS: Several lithotripsy techniques have been described that vary with respect to ease of use, generalizability, and cost. Overall, lithotripsy is a safe and effective treatment for difficult biliary and pancreatic duct stones. 11/8/2018
Bo Shen, Gursimran Kochhar, Udayakumar Navaneethan, Xiuli Liu, Francis A Farraye, Yago Gonzalez-Lama, David Bruining, Darrell S Pardi, Martin Lukas, Martin Bortlik, Kaicun Wu, Ajit Sood, David A Schwartz, William J Sandborn, Global Interventional Inflammatory Bowel Disease Group Role of interventional inflammatory bowel disease in the era of biologic therapy a position statement from the Global Interventional IBD Group Interventional (or therapeutic) inflammatory bowel disease (IBD) endoscopy has an expanding role in the treatment of disease and surgical adverse events. Endoscopic therapy has been explored and used in the management of strictures, fistulas/abscesses, colitis-associated neoplasia, postsurgical acut... 10/27/2018
Callan M Wilcox, Olha Krechkivska, Klaas Nauta, Timothy W Schmidt, Scott H Kable Jet-Cooled Spectroscopy of ortho-Hydroxycyclohexadienyl Radicals The electronic spectra of the ortho-hydroxycyclohexadienyl radical have been observed following the supersonic expansion of the electric discharge products of phenol and water. Hydrogen atoms, split from water, add to the phenol ring at the ortho position, generating syn and anti rotamers with respe... 10/24/2018
Mahendran Jayaraj, Babu P Mohan, Banreet S Dhindsa, Harmeet S Mashiana, Gowri Radhakrishnan, Vinay Dhir, Arvind J Trindade, Douglas G Adler Periampullary Diverticula and ERCP Outcomes A Systematic Review and Meta-Analysis CONCLUSION: ERCP is technically feasible and increasingly successful when performed by experts in the presence of PAD. The risk of complications such as PEP, bleeding, perforation and cholangitis does not differ between ERCP done in patients with and without PAD. 10/8/2018
Ji Young Bang, Sachin Kirtane, Konrad Krall, Udayakumar Navaneethan, Muhammad Hasan, Robert Hawes, Shyam Varadarajulu In memoriam Fine-needle aspiration, birth Fine-needle biopsy The changing trend in endoscopic ultrasound-guided tissue acquisition CONCLUSION: Given these promising findings, in the future, EUS-guided FNB will likely be the preferred technique for sampling of solid mass lesions. 9/27/2018
Saeed Ali, Robert H Hawes, Kambiz Kadkhodayan, Ehsan Rafiq, Udayakumar Navaneethan, Ji Y Bang, Shyam Varadarajulu, Muhammad K Hasan Utility of rapid onsite evaluation of touch imprint cytology from endoscopic and cholangioscopic forceps biopsy sampling with video CONCLUSIONS: By establishing a rapid onsite diagnosis, ROSE-TIC expedites decision-making on patient management. Prospective studies are needed to confirm these preliminary findings. 9/9/2018
Francisco Valverde-López, C Mel Wilcox, Eduardo Redondo-Cerezo Evaluation and management of acute pancreatitis in Spain INTRODUCTION: The aim of this systematic review is to summarize epidemiological data and areas of future acute pancreatitis research in Spain. 8/29/2018
Ji Young Bang, Bryce Sutton, Robert H Hawes, Shyam Varadarajulu EUS-guided celiac ganglion radiofrequency ablation versus celiac plexus neurolysis for palliation of pain in pancreatic cancer a randomized controlled trial with videos CONCLUSIONS: Compared with EUS-CPN, EUS-RFA provided more pain relief and improved the quality of life for patients with pancreatic cancer. (Clinical trials registration number: NCT03152487.). 8/19/2018
Julia B Greer, Phil Greer, Bimaljit S Sandhu, Samer Alkaade, C Mel Wilcox, Michelle A Anderson, Stuart Sherman, Timothy B Gardner, Michele D Lewis, Nalini M Guda, Thiruvengadam Muniraj, Darwin Conwell, Gregory A Cote, Christopher E Forsmark, Peter A Banks, Gong Tang, Kim Stello, Andres Gelrud, Randall E Brand, Adam Slivka, David C Whitcomb, Dhiraj Yadav Nutrition and Inflammatory Biomarkers in Chronic Pancreatitis Patients CONCLUSIONS: CP patients demonstrated lower levels of selected nutrition and bone metabolism biomarkers than controls. Diabetes and alcohol did not impact biomarkers. Vitamin supplements and pancreatic enzyme replacement therapy improved nutrition biomarkers in CP patients. 8/14/2018
Debdeep Banerjee, Saikiran Raghavapuram, Nayana E George, Soheila Korourian, Faysal A Fedda, Abhilash Perisetti, Benjamin Tharian Cholangiocarcinoma Presenting as Linitis Plastica with Unusual Metastases to the Psoas Muscle and Urinary Bladder Cholangiocarcinoma offers poor prognosis. Infrequent sites of metastasis are poorly described and often diagnostically delayed or missed. Bile duct brush cytologies provide poor diagnostic sensitivity/specificity. We present an unusual case of cholangiocarcinoma in a 34-year-old woman with rare dist... 7/25/2018
Muralidharan Vanuopadath, Nithin Sajeev, Athira Radhamony Murali, Nayana Sudish, Nithya Kangosseri, Ivy Rose Sebastian, Nidhi Dalpatraj Jain, Amit Pal, Dileepkumar Raveendran, Bipin Gopalakrishnan Nair, Sudarslal Sadasivan Nair Mass spectrometry-assisted venom profiling of Hypnale hypnale found in the Western Ghats of India incorporating de novo sequencing approaches Hypnale hypnale (hump-nosed pit viper) is considered to be one among the medically important venomous snake species of India and Sri Lanka. In the present study, venom proteome profiling of a single Hypnale hypnale from Western Ghats of India was achieved using SDS-PAGE based protein separation foll... 7/11/2018
Lubana K Afreen, Ayesha S Bryant, Tetsuzo Nakayama, Timothy J Ness, Keith A Jones, Charity J Morgan, Charles M Wilcox, Mark C Phillips Incidence of Venous Air Embolism During Endoscopic Retrograde Cholangiopancreatography CONCLUSIONS: The high incidence of VAE highlights the need for practitioners to be aware of this potentially serious event. Use of PDU can aid in the detection of VAE during ERCP and should be considered especially during high-risk therapeutic procedures. Detection may allow appropriate intervention... 6/23/2018
Muhammad Ali Khan, Zubair Khan, Claudio R Tombazzi, Chiranjeevi Gadiparthi, Wade Lee, C Mel Wilcox Role of Cholecystectomy After Endoscopic Sphincterotomy in the Management of Choledocholithiasis in High-risk Patients A Systematic Review and Meta-Analysis CONCLUSIONS: Although we found no difference in mortality between the 2 strategies after ES, laparoscopic cholecystectomy should be recommended as it is associated with lower rates of subsequent recurrent cholecystitis, cholangitis, and biliary colic down the road even in high-risk surgical patients... 6/19/2018
Ji Young Bang, Udayakumar Navaneethan, Muhammad K Hasan, Bryce Sutton, Robert Hawes, Shyam Varadarajulu Non-superiority of lumen-apposing metal stents over plastic stents for drainage of walled-off necrosis in a randomised trial CONCLUSION: Except for procedure duration, there was no significant difference in treatment outcomes between LAMS and plastic stents. To minimise adverse events with LAMS, patients should undergo follow-up imaging and stent removal at 3 weeks if WON has resolved. 6/3/2018
David C Whitcomb, Tooru Shimosegawa, Suresh T Chari, Christopher E Forsmark, Luca Frulloni, Pramod Garg, Peter Hegyi, Yoshiki Hirooka, Atsushi Irisawa, Takuya Ishikawa, Shuiji Isaji, Markus M Lerch, Philippe Levy, Atsushi Masamune, Charles M Wilcox, John Windsor, Dhiraj Yadav, Andrea Sheel, John P Neoptolemos, Working Group for the International (IAP – APA – JPS – EPC) Consensus Guidelines for Chronic Pancreatitis International consensus statements on early chronic Pancreatitis Recommendations from the working group for the international consensus guidelines for chronic pancreatitis in collaboration with The International Association of Pancreatology, American Pancreatic Association, Japan Pancreas Society, PancreasFest Working Group and European Pancreatic Club CONCLUSIONS: Morphology based diagnosis of Early CP is not possible without additional information. New approaches to the accurate diagnosis of Early CP will require a mechanistic definition that considers risk factors, biomarkers, clinical context and new models of disease. Such a definition will r... 5/26/2018
Arvind J Trindade, Petros C Benias, Praneet Kurupathi, Benjamin Tharian, Sumant Inamdar, Neil Sharma, Divyesh V Sejpal, Ali A Siddiqui, Douglas G Adler Digital pancreatoscopy in the evaluation of main duct intraductal papillary mucinous neoplasm a multicenter study CONCLUSION: Digital pancreatoscopy should be considered in the diagnostic algorithm of MD-IPMN in patients with a diffusely dilated pancreatic duct and without any focal lesions seen on cross-sectional imaging or EUS. 4/27/2018
Ji Young Bang, Udayakumar Navaneethan, Muhammad Hasan, Robert Hawes, Shyam Varadarajulu Stent placement by EUS or ERCP for primary biliary decompression in pancreatic cancer a randomized trial with videos CONCLUSIONS: Given the similar rates of adverse events and treatment outcomes in this randomized trial, EUS-BD is a practical alternative to ERCP for primary biliary decompression in pancreatic cancer. (Clinical trial registration number: NCT03054987.). 3/26/2018
Ji Young Bang, Udayakumar Navaneethan, Muhammad K Hasan, Robert Hawes, Shyam Varadarajulu Endoscopic Ultrasound-guided Specimen Collection and Evaluation Techniques Affect Diagnostic Accuracy CONCLUSION: In a randomized trial of patients undergoing EUS-FNA for pancreatic masses, samples collected with 22-gauge vs 25-gauge needles performed equally well for offsite specimen evaluation. Use of suction appears to increase number of passes needed and specimen bloodiness. Specimen collection ... 3/15/2018
Ji Young Bang, Shyam Varadarajulu How the Experts Do It Step-by-Step Guide Lumen-apposing metal stents are integrated in a single-step delivery system for draining intra-abdominal fluid collections. The theoretic advantage of lumen-apposing stents is the ability to approximate the wall of the drained cavity or organ to the gastrointestinal tract lumen. The use of lumen-app... 3/10/2018
Abhilash Perisetti, Saikiran Raghavapuram, Benjamin Tharian, Irfan Warraich, Fred Hardwicke, Rubayat Rahman, Edwin Onkendi Pure Squamous Cell Carcinoma of the Gallbladder Masquerading as a Hepatic Mass Gallbladder (GB) carcinomas are adenocarcinomas (AC) in the majority of cases. Adenosquamous carcinoma (ASC) and pure squamous cell carcinoma (SCC) of the gallbladder are rarely encountered and comprise 1-3% of gallbladder cancer cases. Pure squamous cell carcinoma of the gallbladder is rarer with l... 3/9/2018
Brian S Roberts, Andrew A Hardigan, Dianna E Moore, Ryne C Ramaker, Angela L Jones, Meredith B Fitz-Gerald, Gregory M Cooper, C Mel Wilcox, Robert P Kimberly, Richard M Myers Discovery and Validation of Circulating Biomarkers of Colorectal Adenoma by High-Depth Small RNA Sequencing Purpose: Colorectal cancer is the third most common cancer worldwide, causing approximately 700,000 deaths each year. The majority of colorectal cancers begin as adenomas. Definitive screening for colorectal adenomas is currently accomplished through colonoscopy but, owing largely to costs and invas... 3/2/2018
Adam L Edwards, Paul Fitzmorris, Salpy V Pamboukian, James F George, C Mel Wilcox, Shajan Peter Association of Pulsatility with Gastrointestinal Bleeding in a Cohort of HeartMate II Recipients Gastrointestinal bleeding (GIB) is common in patients with continuous-flow left ventricular assist devices (CF-LVADs) possibly because of changes in blood flow. We aimed to test the hypothesis that a low pulsatility index (PI) is associated with an increased hazard of overt GIB in patients with CF-L... 3/1/2018
Mohit Girotra, Kaartik Soota, Amaninder S Dhaliwal, Rtika R Abraham, Mauricio Garcia-Saenz-de-Sicilia, Benjamin Tharian Utility of endoscopic ultrasound and endoscopy in diagnosis and management of hepatocellular carcinoma and its complications What does endoscopic ultrasonography offer above and beyond conventional cross-sectional imaging Hepatocellular carcinoma constitutes over 90% of the primary liver tumors, the rest being cholangiocarcinoma. It has an insidious presentation, which is responsible for the delayed presentation. Hence, the management strategy relies on screening to diagnose it an early stage for curative resection a... 2/23/2018
Tasnia Matin, Mohammed Naseemuddin, Mohamed Shoreibah, Peng Li, Kondal Kyanam Kabir Baig, Charles Mel Wilcox, Shajan Peter Case series on multimodal endoscopic therapy for gastric antral vascular ectasia, a tertiary center experience CONCLUSION: Patients with nodular variant GAVE required multimodal approach more frequently than non-nodular variants. Patients responded well to multimodal therapy and saw decrease in transfusion rates and increase in Hb concentrations. Our findings suggest a multimodal approach may be beneficial i... 1/30/2018
Neil J Reilly, Gabriel da Silva, Callan M Wilcox, Zijun Ge, Damian L Kokkin, Tyler P Troy, Klaas Nauta, Scott H Kable, Michael C McCarthy, Timothy W Schmidt Interconversion of Methyltropyl and Xylyl Radicals A Pathway Unavailable to the Benzyl-Tropyl Rearrangement The products of an electrical discharge containing toluene are interrogated using resonance-enhanced multiphoton ionization and laser-induced fluorescence spectroscopies. A previously unreported electronic spectrum recorded at m/z = 105, with a putative origin band at 26053 cm^(-1), is assigned to m... 1/16/2018
Ji Young Bang, Shantel Hebert-Magee, Udayakumar Navaneethan, Muhammad K Hasan, Robert Hawes, Shyam Varadarajulu Randomized trial comparing the Franseen and Fork-tip needles for EUS-guided fine-needle biopsy sampling of solid pancreatic mass lesions CONCLUSIONS: There was no significant difference between Franseen and Fork-tip needles in yielding histologic tissue. Given their ability to yield diagnostic cell block in greater than 90% of patients, the new-generation fine-needle biopsy needles may obviate the need for ROSE. (Clinical trial regis... 1/7/2018
Nitin Kumar, Barham K Abu Dayyeh, Gontrand Lopez-Nava Breviere, Manoel P Galvao Neto, Nicole P Sahdala, Sohail N Shaikh, Robert H Hawes, Christopher J Gostout, Mahesh K Goenka, Jorge R Orillac, Alonso Alvarado, Pichamol Jirapinyo, Natan Zundel, Christopher C Thompson Endoscopic sutured gastroplasty procedure evolution from first-in-man cases through current technique CONCLUSIONS: Following a methodical procedure development phase, ESG demonstrated safety and short-term efficacy in this trial. The procedure also achieved meaningful weight loss during the follow-up period. 10/28/2017
Kambiz Kadkhodayan, Ehsan Rafiq, Robert H Hawes Endoscopic Evaluation and Management of Gastric Stromal Tumors Purpose of Review Gastrointestinal stromal tumors (GISTs) are both relatively common. Management of these lesions has been challenging with emerging interest in the endoscopic approach for both diagnostic and therapeutic interventions. Recent Findings Although these can be visualized on CT scan, end... 10/28/2017
Abhilash Perisetti, Nayana George, Saikiran Raghavapuram, Abu Baker Sheikh, Mohit Girotra, Benjamin Tharian Endoscopic Dissolution of Gastric Lipoma with Argon Plasma Coagulation A 47-year-old patient presented from outside the hospital for evaluation of iron deficiency anemia (IDA). The endoscopic workup suggested a gastric antral subepithelial lesion with an overlying arteriovenous malformation (AVM). Endoscopic ultrasound (EUS) revealed the lesion to be a lipoma. Given th... 10/5/2017
Ashil J Gosalia, Paul Martin, Patricia D Jones Advances and Future Directions in the Treatment of Hepatocellular Carcinoma Hepatocellular carcinoma (HCC) is the second leading cause of cancer-related deaths worldwide. Liver transplant is considered the gold standard for curative therapy for HCC when patients are not candidates for surgical resection or ablation. Because a subset of patients with HCC have a survival rate... 9/5/2017
Craig E Keller, Charles Mel Wilcox, Gregory D Gudleski, Stacey Branham, Jeffrey M Lackner Beyond Abdominal Pain Pain Beliefs, Pain Affect, and Distress as Determinants of Quality of Life in Patients With Chronic Pancreatitis CONCLUSIONS: The significant predictors of QOL impairment in CP are pain intensity and perceived self-blame for pain. Further research is needed to elucidate this relationship while also evaluating the effectiveness of systematic modification of these variables in an attempt to improve pain and QOL ... 9/1/2017
Udayakumar Navaneethan, Dennisdhilak Lourdusamy, Norma G Gutierrez, Xiang Zhu, John J Vargo, Mansour A Parsi New approach to decrease post-ERCP adverse events in patients with primary sclerosing cholangitis CONCLUSION: Biliary aspiration and avoidance of stenting approach after dilation of strictures during ERCP in PSC patients appears to be associated with decreased risk of cholangitis and overall AEs. Future prospective randomized controlled trials are needed to validate our observation. 8/10/2017
C Mel Wilcox Editorial Management of the Small Asymptomatic Pancreatic Cyst Somehow Along the Way We Forgot About the Patient The incidentally identified pancreatic cyst is an increasing burden for both physicians and patients alike. Although we recognize that most of these lesions are benign and may not progress, a subset of these lesions are premalignant, may have frank cancer, and may progress over time. Most occur in o... 8/3/2017
Rajesh Krishnamoorthi, Mahendran Jayaraj, Richard Kozarek Endoscopic Stents for the Biliary Tree and Pancreas OPINION STATEMENT: PURPOSE OF REVIEW: To review the recently published literature on biliary and pancreatic stents. 7/21/2017
Altaf Dawood, Syed Abdul Basit, Mahendran Jayaraj, Robert G Gish Drugs in Development for Hepatitis B With high morbidity and mortality worldwide, there is great interest in effective therapies for chronic hepatitis B (CHB) virus. There are currently several dozen investigational agents being developed for treatment of CHB. They can be broadly divided into two categories: (1) direct-acting antiviral... 6/30/2017
Darwin L Conwell, Peter A Banks, Bimaljit S Sandhu, Stuart Sherman, Samer Al-Kaade, Timothy B Gardner, Michelle A Anderson, C Mel Wilcox, Michele D Lewis, Thiruvengadam Muniraj, Christopher E Forsmark, Gregory A Cote, Nalini M Guda, Ye Tian, Joseph Romagnuolo, Stephen R Wisniewski, Randall Brand, Andres Gelrud, Adam Slivka, David C Whitcomb, Dhiraj Yadav Validation of Demographics, Etiology, and Risk Factors for Chronic Pancreatitis in the USA A Report of the North American Pancreas Study NAPS Group CONCLUSION: Our data validate the current epidemiologic trends in CP. Alcohol remains the most common physician-defined etiology, while smoking was the most commonly identified TIGAR-O risk factor. Identification of multiple risk factors suggests CP to be a complex disease. 6/11/2017
Arvind R Murali, Ashutosh Gupta, Kyle Brown Systematic review and meta-analysis to determine the impact of iron depletion in dysmetabolic iron overload syndrome and non-alcoholic fatty liver disease CONCLUSIONS: Phlebotomy does not bring about significant improvement in indices of insulin resistance, liver enzymes, or liver histology in patients with DIOS and/or NAFLD compared to lifestyle changes alone. Current evidence does not support the use of phlebotomy in patients with DIOS or NAFLD. 6/9/2017
Udayakumar Navaneethan, Basile Njei, Xiang Zhu, Kiran Kommaraju, Mansour A Parsi, Shyam Varadarajulu Safety of ERCP in patients with liver cirrhosis a national database study Background and aims Given the limited data on the safety of endoscopic retrograde cholangiopancreatography (ERCP) in patients with liver cirrhosis, we attempted to evaluate this question using a large national database. Methods We conducted a matched case - control study using the 2010 National Inpa... 4/11/2017
Arvind R Murali, Sanjeev Patil, Kirk T Phillips, Michael D Voigt Locoregional Therapy With Curative Intent Versus Primary Liver Transplant for Hepatocellular Carcinoma Systematic Review and Meta-Analysis CONCLUSIONS: CLRT-SLT may be offered as first-line therapy to patients with HCC and well-compensated cirrhosis instead of primary LT because it may lead to better utilization of donor liver. However, a large proportion of patients with HCC recurrence after CLRT may not be candidates for SLT. 3/11/2017
Shamit Kachru, Michael Mulligan, Gonzalo Torroba, Huajia Wang Nonsupersymmetric Dualities from Mirror Symmetry We study supersymmetry breaking perturbations of the simplest dual pair of (2+1)-dimensional N=2 supersymmetric field theories-the free chiral multiplet and N=2 super QED with a single flavor. We find dual descriptions of a phase diagram containing four distinct massive phases. The equivalence of th... 1/21/2017
Yunlu Feng, Udayakumar Navaneethan, Xiang Zhu, Shyam Varadarajulu, Ingrid Schwartz, Robert Hawes, Muhammad Hasan, Aiming Yang Prophylactic rectal indomethacin may be ineffective for preventing post-endoscopic retrograde cholangiopancreatography pancreatitis in general patients A meta-analysis CONCLUSION: In a contemporary meta-analysis of available randomized controlled trials of consecutive patients undergoing ERCP, rectal indomethacin did not show significant prevention effect of post-ERCP pancreatitis. 12/4/2016
Glenn Harvin, Eslam Ali, Amit Raina, William Leland, Sabeen Abid, Zahid Vahora, Hossein Movahed, Sumyra Kachru, Rick Tee Patients presenting for colonoscopy A great opportunity to screen for sleep apnea CONCLUSION: Risk for OSA is extremely common in a population presenting for a routine colonoscopy, and screening at the time of a colonoscopy offers an excellent opportunity to identify these patients. 12/3/2016
Ji Young Bang, Shantel Hebert-Magee, Muhammad K Hasan, Udayakumar Navaneethan, Robert Hawes, Shyam Varadarajulu Endoscopic ultrasonography-guided biopsy using a Franseen needle design Initial assessment CONCLUSION: Preliminary data suggest that the Franseen needle yields diagnostic material for ROSE and histology in >95% of patients. 11/24/2016
Byron Cryer, Michael A Barnett, Jennifer Wagner, C Mel Wilcox Overuse and Misperceptions of Nonsteroidal Anti-inflammatory Drugs in the United States CONCLUSIONS: NSAIDs are widely used and often used in a manner that increases the risk of serious side effects. Sufficient knowledge and understanding of NSAIDs is lacking and educational interventions directed to consumers and physicians are needed. 11/21/2016
Ji Young Bang, Charles Melbern Wilcox, Udayakumar Navaneethan, Muhammad K Hasan, Shajan Peter, John Christein, Robert Hawes, Shyam Varadarajulu Impact of Disconnected Pancreatic Duct Syndrome on the Endoscopic Management of Pancreatic Fluid Collections CONCLUSIONS: DPDS has a significant effect on endoscopic management of PFCs as more patients required hybrid treatment, reinterventions, and rescue surgery for achieving optimal clinical outcomes. 11/17/2016
Arvind R Murali, Carlos Romero-Marrero, Charles Miller, Federico Aucejo, Abraham Levitin, Amanjit Gill, Gordon McLennan, Karunakaravel Karuppasamy, Nizar N Zein, Rocio Lopez, K V Narayanan Menon Predictors of Successful Downstaging of Hepatocellular Carcinoma Outside Milan Criteria CONCLUSIONS: Total tumor volume is a good predictor of successful downstaging of HCC. Patients with TTV less than 200 cm may be considered good candidates for downstaging. Further studies with larger cohort of patients are needed to validate this approach in patients with HCC outside Milan. 10/26/2016
Glenn Harvin, Eslam Ali, Amit Raina, William Leland, Sabeen Abid, Zahid Vahora, Hossein Movahed, Sumyra Kachru, Rick Tee Airway observations during upper endoscopy predicting obstructive sleep apnea CONCLUSIONS: The results of our pilot study represent preliminary data regarding the use of upper endoscopy as a potential tool to evaluate patients for obstructive sleep apnea. 10/7/2016
B Njei, T R McCarty, S Varadarajulu, U Navaneethan Systematic review with meta-analysis endoscopic retrograde cholangiopancreatography-based modalities for the diagnosis of cholangiocarcinoma in primary sclerosing cholangitis CONCLUSIONS: Single-operator cholangioscopy with targeted biopsies appears to be the most accurate ERCP-based modality for diagnosing cholangiocarcinoma in primary sclerosing cholangitis. However, future large, well-designed comparative diagnostic studies are warranted to validate these findings. 10/4/2016
Madhusudhan R Sanaka, Ramprasad Jegadeesan, Prashanthi N Thota, Udayakumar Navaneethan, Rocio Lopez, Sudish C Murthy, Siva Raja Two-Person Technique of Peroral Endoscopic Myotomy for Achalasia with an Advanced Endoscopist and a Thoracic Surgeon Initial Experience Background and Aims. We initiated peroral endoscopic myotomy (POEM) utilizing a two-person technique with combination of an advanced endoscopist and a thoracic surgeon with complementary skills. Our aim was to determine the feasibility and outcomes in initial 20 patients. Methods. In this observatio... 9/16/2016
Basile Njei, Thomas R McCarty, Shyam Varadarajulu, Udayakumar Navaneethan Cost utility of ERCP-based modalities for the diagnosis of cholangiocarcinoma in primary sclerosing cholangitis CONCLUSIONS: SOC with biopsy sampling is the most cost-effective diagnostic modality for CCA in PSC strictures. 9/4/2016
Udayakumar Navaneethan, Muhammad K Hasan, Vennisvasanth Lourdusamy, Xiang Zhu, Robert H Hawes, Shyam Varadarajulu Efficacy and safety of endoscopic mucosal resection of non-ampullary duodenal polyps a systematic review CONCLUSION: EMR appears to be a safe and effective therapeutic option for management of sporadic non-ampullary duodenal polyps. Long-term endoscopic surveillance is required to manage and treat recurrent disease. 8/25/2016
Kondal Rao Kyanam Kabir Baig, Charles Melbern Wilcox Translational and clinical perspectives on sphincter of Oddi dysfunction Sphincter of Oddi dysfunction is a complex pathophysiologic entity that is associated with significant morbidity causing abdominal pain, nausea, and vomiting. The purpose of this review is to describe the anatomy and physiology of the sphincter of Oddi, to understand the pathologic mechanisms though... 8/25/2016
Ji Young Bang, Shyam Varadarajulu Endoscopic Treatment of Walled-off Necrosis in Children Clinical Experience and Treatment Outcomes CONCLUSIONS: Endoscopic treatment is effective, safe, and when available should be the first-line modality for the management of WON in children. 8/23/2016
Ramprasad Jegadeesan, Udayakumar Navaneethan, Norma G Gutierrez, Preethi G K Venkatesh, Jeffrey P Hammel, Madhusudhan R Sanaka, Bo Shen Pattern of Inflammation on Surveillance Colonoscopy Does Not Predict Development of Colitis-associated Neoplasia CONCLUSIONS: In patients with UC, colonoscopic features especially on standard-definition white-light colonoscopy did not appear to reliably predict the development of colitis-associated neoplasia. This will leave room for image-enhanced endoscopy technology and molecular markers for the early and a... 8/20/2016
Ji Young Bang, Udayakumar Navaneethan, Muhammad K Hasan, Robert H Hawes, Shyam Varadarajulu EUS correlates of disconnected pancreatic duct syndrome in walled-off necrosis CONCLUSIONS: We report EUS findings indicating the presence of DPDS. These findings may have significant clinical implications for the management of patients with WON. 8/20/2016
Arvind R Murali, Subhash Chandra, Zoe Stewart, Bruce R Blazar, Umar Farooq, M Nedim Ince, Jeffrey Dunkelberg Graft Versus Host Disease After Liver Transplantation in Adults A Case series, Review of Literature, and an Approach to Management CONCLUSIONS: Age older than 50 years and hepatocellular carcinoma appear to be risk factors for GVHD. Hepatitis C may be protective. High-dose steroids and calcineurin inhibitors are ineffective in the treatment of GVHD after LT. CD2-blockers and TNF-α antagonists appear promising. We propose a diag... 8/7/2016
Piyush Somani, Udayakumar Navaneethan Role of ERCP in Patients With Idiopathic Recurrent Acute Pancreatitis Recurrent acute pancreatitis (RAP) is defined based on the occurrence of two or more episodes of acute pancreatitis. RAP is differentiated from chronic pancreatitis based on the presence of a normal morphological appearance of the pancreas between episodes. RAP can be due to a variety of etiologies ... 7/3/2016
Fnu Asad-Ur-Rahman, Aamer Abbass, Umair Majeed, Udayakumar Navaneethan Melanoma Metastasizing to the Small Intestine A Case Report Illustrating Symptomatic and Asymptomatic Involvement Symptomatic gastrointestinal (GI) involvement of melanoma is rare, however, it is a frequent autopsy finding in patients with primary cutaneous melanoma. We present a case of metastatic cutaneous melanoma with initial asymptomatic jejunal involvement as found on a positron emission tomography (PET) ... 6/23/2016
C Mel Wilcox, Toni Seay, Hwasoon Kim, Shyam Varadarajulu Prospective Endoscopic Ultrasound-Based Approach to the Evaluation of Idiopathic Pancreatitis Causes, Response to Therapy, and Long-term Outcome CONCLUSIONS: Following a single idiopathic attack of pancreatitis and a negative EUS examination, relapse was infrequent. Despite endoscopic therapy, patients with multiple attacks, especially those attributed to pancreas divisum and SOD, had high rates of recurrence. EUS may be a useful, minimally ... 6/22/2016
J Gonzales Zamora, A R Murali Rhinoscleroma with Pharyngolaryngeal Involvement Caused by Klebsiella ozaenae Rhinoscleroma is a chronic, slowly progressive granulomatous bacterial infection that is endemic to the tropical world, namely, Central America and Africa. It is occasionally seen in the United States of America (USA). It predominately affects the nasal mucosa but can also involve the rest of the up... 6/14/2016
Ji Young Bang, Muhammad K Hasan, Udayakumar Navaneethan, Bryce Sutton, Wesam Frandah, Sameer Siddique, Robert H Hawes, Shyam Varadarajulu Lumen-apposing metal stents for drainage of pancreatic fluid collections When and for whom CONCLUSIONS: Although there is no difference in clinical outcomes, treating pseudocysts using plastic stents is less expensive. It is also possible that the short procedural duration is a surrogate marker for procedural complexity and this may drive the use of LAMS in sicker patients. 5/21/2016
C Mel Wilcox, Hwasoon Kim Prospective Evaluation of the Clinical Features of Choledocholithiasis Focus on Abdominal Pain CONCLUSIONS: In our study, choledocholithiasis had a characteristic pattern of constant epigastric pain radiating to the back that was associated with nausea. A prior episode was common. The most common laboratory abnormality was transaminase elevation, and the most common imaging finding was common... 5/3/2016
Udayakumar Navaneethan, Vennisvasanth Lourdusamy, Basile Njei, Bo Shen Endoscopic balloon dilation in the management of strictures in Crohns disease a systematic review and meta-analysis of non-randomized trials CONCLUSIONS: EBD appears to be a safe alternative for surgery in the management of Crohn's strictures. Stricture length <4 cm treated with EBD is associated with a significantly decreased risk of surgical intervention. 4/30/2016
Ji Young Bang, Muhammad K Hasan, Bryce Sutton, Bronte A Holt, Udayakumar Navaneethan, Robert Hawes, Shyam Varadarajulu Intraprocedural increase in heart rate during EUS-guided celiac plexus neurolysis Clinically relevant or just a physiologic change CONCLUSIONS: Because patients with an increase in intraprocedural heart rate experienced significant improvement in pain and quality of life components, this observation must be further explored in order to improve the technique and outcomes of EUS-CPN. 4/7/2016
Shyam Varadarajulu, Ji Young Bang, Muhammad K Hasan, Udayakumar Navaneethan, Robert Hawes, Shantel Hebert-Magee Improving the diagnostic yield of single-operator cholangioscopy-guided biopsy of indeterminate biliary strictures ROSE to the rescue with video CONCLUSIONS: Preliminary data suggest that the diagnostic outcomes of SOC-guided biopsies in IDBSs can be significantly improved by using ROSE-TIC. This technique also may benefit centers that rely mainly on fluoroscopy-guided intraductal biopsies. 4/7/2016
Robert H Hawes Lessons Learned from Traditional NOTES A Historical Perspective The idea of natural orifice surgery was conceived by Kantsevoy and Kalloo in the late 1990s. A group of surgeons formed the Apollo Group in 1997. Their vision and mission were to impact the practice of therapeutic endoscopy through innovation in techniques and technologies. The concept of natural or... 4/3/2016
Shyam Varadarajulu, Ji Young Bang Role of Endoscopic Ultrasonography and Endoscopic Retrograde Cholangiopancreatography in the Clinical Assessment of Pancreatic Neoplasms Accurate diagnosis and staging of pancreatic neoplasms is essential for surgical planning and identification of locally advanced and metastatic disease that is incurable by surgery. The ability to position the endoscopic ultrasonography (EUS) transducer close to the pancreas combined with the use of... 3/26/2016
Ji Young Bang, Jayapal Ramesh, Muhammad Hasan, Udayakumar Navaneethan, Bronte A Holt, Robert Hawes, Shyam Varadarajulu Endoscopic ultrasonography is not required for staging malignant esophageal strictures that preclude the passage of a diagnostic gastroscope CONCLUSION: Routine EUS examination may not be required in all patients with ECA as the inability to advance a diagnostic gastroscope past a malignant stricture correlates 100% with locally advanced disease on EUS. 3/23/2016
Udayakumar Navaneethan, Muhammad K Hasan, Kiran Kommaraju, Xiang Zhu, Shantel Hebert-Magee, Robert H Hawes, John J Vargo, Shyam Varadarajulu, Mansour A Parsi Digital, single-operator cholangiopancreatoscopy in the diagnosis and management of pancreatobiliary disorders a multicenter clinical experience with video CONCLUSIONS: SOC has become an integral part of the ERCP armamentarium and has high accuracy in the evaluation of indeterminate biliary strictures. Complete stone clearance was achieved in all but 1 patient with challenging biliary or pancreatic duct stones. ( 3/21/2016
Joseph Romagnuolo, Jyothsna Talluri, Elizabeth Kennard, Bimaljit S Sandhu, Stuart Sherman, Gregory A Cote, Samer Al-Kaade, Timothy B Gardner, Andres Gelrud, Michele D Lewis, Christopher E Forsmark, Nalini M Guda, Darwin L Conwell, Peter A Banks, Thiruvengadam Muniraj, Stephen R Wisniewski, Ye Tian, C Mel Wilcox, Michelle A Anderson, Randall E Brand, Adam Slivka, David C Whitcomb, Dhiraj Yadav Clinical Profile, Etiology, and Treatment of Chronic Pancreatitis in North American Women Analysis of a Large Multicenter Cohort CONCLUSIONS: Most CP cases in women are from nonalcoholic etiologies. In contrast to many other chronic diseases, clinical phenotype of CP is determined by the disease and is independent of sex. 3/12/2016
Ramprasad Jegadeesan, Udayakumar Navaneethan, Shishira Bharadwaj, Jeffrey Hammel, Madhusudhan R Sanaka, Bo Shen Impact of Concurrent Non-IBD Immunological Diseases on the Outcome of Primary Sclerosing Cholangitis CONCLUSIONS: The association of NID in patients with PSC did not seem to affect the need for liver transplantation or transplantation-free survival. The findings suggest that the increased load of autoimmunity, including the presence of IBD or NID, has a minimum impact on the disease outcome of PSC. 3/8/2016
Olha Krechkivska, Callan M Wilcox, Tyler P Troy, Klaas Nauta, Bun Chan, Rebecca Jacob, Scott A Reid, Leo Radom, Timothy W Schmidt, Scott H Kable Hydrogen-atom attack on phenol and toluene is ortho-directed The reaction of H + phenol and H/D + toluene has been studied in a supersonic expansion after electric discharge. The (1 + 1') resonance-enhanced multiphoton ionization (REMPI) spectra of the reaction products, at m/z = parent + 1, or parent + 2 amu, were measured by scanning the first (resonance) l... 3/8/2016
Thanmaya G Reddy, John Knight, Ross P Holmes, Lisa M Harvey, April L E Mitchem, Charles M Wilcox, Klaus E Monkemuller, Dean G Assimos Oxalate Concentrations in Human Gastrointestinal Fluid CONCLUSIONS: Our results suggest that some degree of oxalate secretion in the small intestine may occur in the fasted state while this is less likely in the stomach. Further studies are warranted to provide definitive evidence of gastrointestinal secretion of oxalate. 3/5/2016
Harshad Devarbhavi, Arvind R Murali Safety of Ascitic Paracentesis in Patients with Budd-Chiari Syndrome on Oral Anticoagulation and Elevated International Normalized Ratio CONCLUSIONS: Ascitic paracentesis in patients with BCS on anticoagulation is safe without an increased risk of abdominal wall bleeding or hemoperitoneum. Normal or high FVIII and platelet levels likely mitigate against bleeding risks. 2/23/2016
ASGE Technology Committee, Nirav Thosani, Barham K Abu Dayyeh, Prateek Sharma, Harry R Aslanian, Brintha K Enestvedt, Sri Komanduri, Michael Manfredi, Udayakumar Navaneethan, John T Maple, Rahul Pannala, Mansour A Parsi, Zachary L Smith, Shelby A Sullivan, Subhas Banerjee ASGE Technology Committee systematic review and meta-analysis assessing the ASGE Preservation and Incorporation of Valuable Endoscopic Innovations thresholds for adopting real-time imaging-assisted endoscopic targeted biopsy during endoscopic surveillance of Barretts esophagus CONCLUSIONS: Our meta-analysis indicates that targeted biopsies with acetic acid chromoendoscopy, electronic chromoendoscopy by using narrow-band imaging, and endoscope-based CLE meet the thresholds set by the ASGE PIVI, at least when performed by endoscopists with expertise in advanced imaging tech... 2/15/2016
I Jovanovic, K Vormbrock, C M Wilcox, K Mönkemüller Therapeutic and interventional endoscopy for gastrointestinal bleeding CONCLUSIONS: This is the first review paper dedicated to endoscopic therapy for bleeding involving any part of the luminal GI tract (i.e., esophagus, stomach, small bowel, and colon). Modern endoscopy permits the investigation and treatment of the majority of conditions affecting the entire hollow G... 1/28/2016
Benjamin Tharian, Nayana George, Udayakumar Navaneethan Endoscopy in the Diagnosis and Management of Complications of Inflammatory Bowel Disease The role of endoscopy in inflammatory bowel disease (IBD) has grown over the last decade in both diagnostic and therapeutic realms. It aids in the initial diagnosis of the disease and also in the assessment of the extent and severity of disease. IBD is associated with development of multiple complic... 12/31/2015
Arvind R Murali, Ashutosh Gupta, Bashar M Attar, Venkatesh Ravi, Pramoda Koduru Topical steroids in eosinophilic esophagitis Systematic review and meta-analysis of placebo-controlled randomized clinical trials CONCLUSIONS: Topical corticosteroids seem to be effective in inducing histological remission but may not have similar significant impact in improving clinical symptoms of EoE. Studies with large sample size are needed to uniformly validate symptom improvement in EoE. 12/25/2015
R H Hawes, J C Andrzejowski, I M Goodhart, M C Berthoud, M D Wiles An evaluation of factors influencing the assessment time in a nurse practitioner-led anaesthetic pre-operative assessment clinic Elective patients undergoing anaesthetic pre-operative assessment are usually allocated the same period of time with a nurse practitioner, leading to potential inefficiencies in patient flow through the clinic. We prospectively collected data on 8519 patients attending a pre-operative assessment cli... 12/20/2015
Michelle A Anderson, Venkata Akshintala, Kathryn M Albers, Stephen T Amann, Inna Belfer, Randall Brand, Suresh Chari, Greg Cote, Brian M Davis, Luca Frulloni, Andres Gelrud, Nalini Guda, Abhinav Humar, Rodger A Liddle, Adam Slivka, Rachelle Stopczynski Gupta, Eva Szigethy, Jyothsna Talluri, Wahid Wassef, C Mel Wilcox, John Windsor, Dhiraj Yadav, David C Whitcomb Mechanism, assessment and management of pain in chronic pancreatitis Recommendations of a multidisciplinary study group CONCLUSIONS: Progress is occurring in pain biology and treatment options, but pain in patients with CP remains a major problem that is inadequately understood, measured and managed. The growing body of information needs to be translated into more effective clinical care. 12/2/2015
Ji Young Bang, Robert Hawes, Shyam Varadarajulu A meta-analysis comparing ProCore and standard fine-needle aspiration needles for endoscopic ultrasound-guided tissue acquisition CONCLUSIONS: Current data do not demonstrate a significant difference between the ProCore and standard FNA needles for sample adequacy, diagnostic accuracy or acquisition of a core specimen. However, the ProCore needle establishes the diagnosis with fewer passes. 11/13/2015
C Mel Wilcox, Hwasoon Kim, Toni Seay, Shyam Varadarajulu Choice of plastic or metal stent for patients with jaundice with pancreaticobiliary malignancy using simple clinical tools a prospective evaluation CONCLUSIONS: The decision whether to place a plastic stent or SEMS for patients with distal malignant obstructive jaundice may be based on simple clinical tools resulting in low rates of reintervention. 10/14/2015
Arvind R Murali, Vikram Kotwal, Saurabh Chawla Chronic hepatitis E A brief review Hepatitis E viral infection has traditionally been considered an acute, self-limited, water borne disease similar to hepatitis A, endemic to developing countries. However, over the past decade, zoonotic transmission and progression to chronicity in human patients has been identified, resulting in pe... 9/18/2015
Nevin Yilmaz, Arife Zeybek, Benjamin Tharian, Ugur Eser Yilmaz Efficacy of nonsurgical tigecycline pleurodesis for the management of hepatic hydrothorax in patients with liver cirrhosis Chemical pleurodesis is one of the therapeutic tools to control hepatic hydrothorax. Tetracycline and derivatives have been widely accepted as an effective and safe treatment for the purpose, but availability is the big concern. Tigecycline is an antibiotic derivative of tetracycline, which has demo... 9/15/2015
Alayne D Markland, Kathryn L Burgio, William E Whitehead, Holly E Richter, C Mel Wilcox, David T Redden, Timothy M Beasley, Patricia S Goode Loperamide Versus Psyllium Fiber for Treatment of Fecal Incontinence The Fecal Incontinence Prescription Rx Management FIRM Randomized Clinical Trial CONCLUSIONS: Both loperamide and psyllium improve fecal incontinence. Loperamide was associated with more adverse effects, especially constipation. 9/9/2015
Ioana Smith, Klaus Monkemuller, C Mel Wilcox Incidentally Identified Common Bile Duct Dilatation A Systematic Review of Evaluation, Causes, and Outcome CONCLUSIONS: Incidentally found biliary tract dilatation can be a manifestation of significant biliary tract disease including malignancy. Long-term outcome is not well defined and further prospective studies examining the most cost-effective approach to evaluation are needed. 8/25/2015
Benjamin Tharian, Nayana Elizabeth George, Tony Chiew Keong Tham What is the current role of endoscopy in primary sclerosing cholangitis Endoscopy has important roles in the management of primary sclerosing cholangitis (PSC), ranging from narrowing down the differential diagnoses, screening for complications, determining prognosis and therapy. While the need for a diagnostic endoscopic retrograde cholangiopancreatography (ERCP) may b... 8/13/2015
Ioana Smith, Jayapal Ramesh, Kondal R Kyanam Kabir Baig, Klaus Mönkemüller, C Mel Wilcox Emerging Role of Endoscopic Ultrasound in the Diagnostic Evaluation of Idiopathic Pancreatitis CONCLUSIONS: Given the high incidence of microlithiasis and/or biliary sludge as a cause of idiopathic pancreatitis as well as the safety and high accuracy, EUS should be considered 1st for evaluation of idiopathic pancreatitis if conventional cross-sectional radiography fails to reveal a cause. 8/8/2015
Bronte A Holt, Robert Hawes, Muhammad Hasan, Ashley Canipe, Benjamin Tharian, Udayakumar Navaneethan, Shyam Varadarajulu Biliary drainage role of EUS guidance CONCLUSIONS: In a tertiary-care center, use of advanced ERCP techniques results in a high technical success rate. EUS-guided biliary drainage was required in only 0.6% of native papilla ERCPs, and although a number of excellent indications exist, it should not replace good ERCP technique. 7/29/2015
Brian S Roberts, Andrew A Hardigan, Marie K Kirby, Meredith B Fitz-Gerald, C Mel Wilcox, Robert P Kimberly, Richard M Myers Blocking of targeted microRNAs from next-generation sequencing libraries Highly abundant microRNAs (miRNAs) in small RNA sequencing libraries make it difficult to obtain efficient measurements of more lowly expressed species. We present a new method that allows for the selective blocking of specific, abundant miRNAs during preparation of sequencing libraries. This techni... 7/26/2015
Mohammad Yaghoobi, Qi Pauls, Valerie Durkalski, Joseph Romagnuolo, Evan L Fogel, Paul R Tarnasky, Giuseppe Aliperti, Martin L Freeman, Richard A Kozarek, Priya A Jamidar, Charles M Wilcox, Grace H Elta, Robert H Hawes, April Wood-Williams, Peter B Cotton Incidence and predictors of post-ERCP pancreatitis in patients with suspected sphincter of Oddi dysfunction undergoing biliary or dual sphincterotomy results from the EPISOD prospective multicenter randomized sham-controlled study CONCLUSION: The performance of biliary or dual sphincterotomy does not increase the risk of PEP in patients suspected of SOD. However, the high rate of PEP in patients with suspected SOD, despite pancreatic stenting in expert centers, is confirmed in this prospective study. The combined effect of du... 7/14/2015
Anne K Bartels, Arvind R Murali, Jose Gonzales Zamora Subhepatic Sterile Abscess 10 Years After Laparoscopic Cholecystectomy We present a case of a large, sterile, subhepatic abdominal wall abscess secondary to foreign body reaction to dropped gallstones during laparoscopic cholecystectomy performed 10 years ago. Dropped gallstones are common complications of laparoscopic cholecystectomy, but they rarely result in abscess... 7/10/2015
Ioana B Smith, Juan P Gutierrez, Jayapal Ramesh, C Mel Wilcox, Klaus E Mönkemüller Endoscopic extra-cavitary drainage of pancreatic necrosis with fully covered self-expanding metal stents fcSEMS and staged lavage with a high-flow water jet system CONCLUSION: ED of complex WON with fcSEMS followed by repeated endoscopic extra-cavitary lavage and debridement using a biliary catheter and high-flow water jet system is a minimally invasive, feasible method with high technical and clinical success and minimal complications. 7/3/2015
Kirk B Russ, Mark C Phillips, C Mel Wilcox, Shajan Peter Percutaneous endoscopic gastrostomy in amyotrophic lateral sclerosis CONCLUSIONS: In conclusion, PEG tube placement in patients with ALS seems to be a safe procedure in patients without significant respiratory compromise. In patients with FVC <50%, based on literature review and the results of this study, the authors recommend percutaneous radiologic gastrostomy over... 7/3/2015
Udayakumar Navaneethan, John J Vargo, K V Narayanan Menon, Madhusudhan R Sanaka, Chung-Jyi Tsai Impact of balloon-assisted enteroscopy on the diagnosis and management of suspected and established small-bowel Crohns disease CONCLUSIONS: The use of BAE may help improve management in patients with suspected and established small-bowel CD. 7/3/2015
Matthew Skinner, Juan P Gutierrez, Helmut Neumann, C Mel Wilcox, Chad Burski, Klaus Mönkemüller Over-the-scope clip placement is effective rescue therapy for severe acute upper gastrointestinal bleeding CONCLUSIONS: OTSC use represents an effective, easily performed, and safe endoscopic therapy for various causes of severe acute gastrointestinal bleeding when conventional endoscopic techniques have failed. This therapy should be added to the armamentarium of therapeutic endoscopists. 7/3/2015
Shyam Varadarajulu, Ji Young Bang Digestive Disease Week DDW 2015 Pancreaticobiliary update This update critiques the key abstracts relevant to endoscopic evaluation or interventions in pancreatic and biliary diseases that were presented at Digestive Disease Week (DDW) 2015. We selected 20 abstracts based on their clinical significance, relevance to endoscopic practice and impact on patien... 6/17/2015
Udayakumar Navaneethan, Muhammad K Hasan, Vennisvasanth Lourdusamy, Basile Njei, Shyam Varadarajulu, Robert H Hawes Single-operator cholangioscopy and targeted biopsies in the diagnosis of indeterminate biliary strictures a systematic review CONCLUSIONS: Our study suggests that SpyGlass cholangioscopy with SpyBite biopsies has moderate sensitivity for the diagnosis of malignant biliary strictures. 6/14/2015
Abhijeet Waghray, Arvind R Murali, Kv Narayanan Menon Hepatocellular carcinoma From diagnosis to treatment Hepatocellular carcinoma (HCC) is the sixth most prevalent malignancy worldwide and is a rising cause of cancer related mortality. Risk factors for HCC are well documented and effective surveillance and early diagnosis allow for curative therapies. The majority of HCC appears to be caused by cirrhos... 6/9/2015
Madhusudhan R Sanaka, Tarun Rai, Udaykumar Navaneethan, Tushar D Gohel, Amareshwar Podugu, Prashanthi N Thota, Rocio Lopez, Ravi P Kiran, Carol A Burke Adenoma detection rate in high-risk patients differs from that in average-risk patients CONCLUSIONS: Patients with a PHP have a significantly higher ADR compared with AR patients. Defining a minimum target ADR for individuals with a PHP undergoing surveillance colonoscopy is important. 5/31/2015
C Mel Wilcox Sphincter of Oddi dysfunction Type III New studies suggest new approaches are needed Sphincter of Oddi dysfunction (SOD) has been classified into three types based upon the presence or absence of objective findings including liver test abnormalities and bile duct dilatation. Type III is the most controversial and is classified as biliary type pain in the absence of any these objecti... 5/29/2015
Bronte A Holt, Gareth Hearn, Robert Hawes, Benjamin Tharian, Shyam Varadarajulu Development and evaluation of a 3D printed endoscopic ampullectomy training model with video CONCLUSION: Although further studies are necessary for validation, this novel prototype appears useful for endoscopic ampullectomy training. 5/20/2015
Udayakumar Navaneethan, Steve Eubanks Approach to patients with esophageal Dysphagia Patients frequently present to a physician with complaints of difficulty swallowing. The approach to systematically evaluating these problems can be challenging for those who do not manage this type of patient regularly. The potential for life-threatening malignancies is present and makes this evalu... 5/13/2015
Zubin Arora, Xianrui Wu, Udayakumar Navaneethan, Bo Shen Non-surgical porto-mesenteric vein thrombosis is associated with worse long-term outcomes in inflammatory bowel diseases CONCLUSIONS: IBD patients who were inpatients or receiving corticosteroid therapy had an increased risk of the development of PMVT. The presence of PMVT was associated with poor clinical outcomes in IBD. 4/30/2015
Kunjam Modha, Udayakumar Navaneethan Diagnosis and management of primary sclerosing cholangitis-perspectives from a therapeutic endoscopist Primary sclerosing cholangitis (PSC) is a chronic, cholestatic liver condition characterized by inflammation, fibrosis, and destruction of the intra- and extrahepatic bile ducts. The therapeutic endoscopist plays a key role in the diagnosis and management of PSC. In patients presenting with a choles... 4/28/2015
Vennisvasanth Lourdusamy, Benjamin Tharian, Udayakumar Navaneethan Biomarkers in bile-complementing advanced endoscopic imaging in the diagnosis of indeterminate biliary strictures Biliary strictures present a diagnostic challenge and a conundrum, particularly when an initial work up including abdominal imaging and endoscopic retrograde cholangiopancreatography based sampling are non-diagnostic. Advances in endoscopic imaging have helped us diagnose these strictures better. Ho... 4/23/2015
Olha Krechkivska, Callan M Wilcox, Bun Chan, Rebecca Jacob, Yu Liu, Klaas Nauta, Scott H Kable, Leo Radom, Timothy W Schmidt H and D attachment to naphthalene spectra and thermochemistry of cold gas-phase 1-C10H9 and 1-C10H8D radicals and cations Excitation spectra of the 1H-naphthalene (1-C10H9) and 1D-naphthalene (1-C10H8D) radicals, and their cations, are obtained by laser spectroscopy and mass spectrometry of a skimmed free-jet expansion following an electrical discharge. The spectra are assigned on the basis of density functional theory... 3/11/2015
Udayakumar Navaneethan, Tarun Rai, Preethi Gk Venkatesh, Ravi P Kiran Primary sclerosing cholangitis and the risk of colon neoplasia in patients with Crohns colitis CONCLUSIONS: CC patients with PSC appear not to be at increased risk of developing colon neoplasia. Among patients in our cohort with colon neoplasia and concurrent PSC, the neoplasia occurred in the proximal colon in all cases. 3/1/2015
Arpit Talwar, Nayana George, Benjamin Tharian, James Roberts-Thomson An immunosuppressed man with an aortic rupture secondary to Salmonella aortitis successfully treated with endovascular aortic repair A 75-year-old immunosuppressed man presented with fever and central abdominal pain 3 weeks after having positive blood cultures for Salmonella enteritidis. A computed tomography scan demonstrated a contained perforation of a nonaneurysmal abdominal aorta. Salmonella aortitis was suspected, and given... 2/28/2015
Udayakumar Navaneethan, Mansour A Parsi, Dennisdhilak Lourdusamy, David Grove, Madhusudhan R Sanaka, Jeffrey P Hammel, John J Vargo, Raed A Dweik Volatile Organic Compounds in Urine for Noninvasive Diagnosis of Malignant Biliary Strictures A Pilot Study CONCLUSIONS: Measurement of VOCs in urine may diagnose malignant biliary strictures noninvasively. 2/25/2015
Arvind R Murali, Bashar M Attar, Ariel Katz, Vikram Kotwal, Peter M Clarke Utility of Platelet Count for Predicting Cirrhosis in Alcoholic Liver Disease Model for Identifying Cirrhosis in a US Population CONCLUSIONS: A simple model of platelet count and INR has good diagnostic accuracy for identifying cirrhosis in alcoholics. 2/22/2015
Josna Haritha, C Mel Wilcox Evaluation of Patients Knowledge Regarding Smoking and Chronic Pancreatitis A Pilot Study CONCLUSION: Elaborate studies involving greater number of study population, are necessary to better define measuring tools and to further assess patient's knowledge regarding the relationship between smoking and chronic pancreatitis. Additionally, efforts should be directed towards enhancing physici... 2/17/2015
Tarun Rai, Udayakumar Navaneethan, Tushar Gohel, Amareshwar Podugu, Prashanthi N Thota, Ravi P Kiran, Rocio Lopez, Madhusudhan R Sanaka Effect of quality of bowel preparation on quality indicators of adenoma detection rates and colonoscopy completion rates CONCLUSIONS: Patients with fair and poor standards of preparation have significantly lower colonoscopy completion rates than those with excellent and good preparation. However, there was no difference in ADR between the different grades of preparation. 2/15/2015
Sudha Kodali, Klaus Mönkemüller, Hwasoon Kim, Jayapal Ramesh, Jessica Trevino, Shyam Varadarajulu, C Mel Wilcox ERCP-related perforations in the new millennium A large tertiary referral center 10-year experience CONCLUSIONS: In our study, leaks were much more common than perforations and the majority of patients were successfully managed with conservative therapy alone. We report a very low perforation rate and most perforations can be managed conservatively with a good outcome. 2/6/2015
Shajan Peter, Leona Council, Ji Young Bang, Helmut Neumann, Klaus Mönkemüller, Shyam Varadarajulu, Charles Melbern Wilcox Poor agreement between endoscopists and gastrointestinal pathologists for the interpretation of probe-based confocal laser endomicroscopy findings CONCLUSION: There is a wide discrepancy in the interpretation of pCLE findings between endoscopists and pathologist, particularly for benign and malignant pancreaticobiliary lesions. Further studies are needed to identify the cause of this poor agreement. 12/31/2014
Gursimran Kochhar, Udayakumar Navaneethan, Jose Mari Parungao, Jason Hartman, Ranjan Gupta, Rocio Lopez, Arthur J McCullough, Baljiendra Kapoor, Bo Shen Impact of transjugular intrahepatic portosystemic shunt on post-colectomy complications in patients with ulcerative colitis and primary sclerosing cholangitis CONCLUSION: Patients with PSC and UC who underwent TIPS prior to colectomy had higher rates of complications; however, this was probably due to the greater severity of cirrhosis and PSC in this population. 12/19/2014
Ji Young Bang, Robert Hawes, Albert Bartolucci, Shyam Varadarajulu Efficacy of metal and plastic stents for transmural drainage of pancreatic fluid collections a systematic review CONCLUSIONS: Current evidence does not support routine placement of metal stents for transmural drainage of PFC. Randomized trials are needed to justify the use of metal stents for PFC drainage. 12/18/2014
Udayakumar Navaneethan, Norma G Gutierrez, Ramprasad Jegadeesan, Preethi Gk Venkatesh, Earl Poptic, Madhusudhan R Sanaka, John J Vargo, Mansour A Parsi IgG4 Levels in Bile for Distinguishing IgG4-Associated Cholangiopathy from Other Biliary Disorders A Single Blinded Pilot Study CONCLUSIONS: The results of this pilot study suggest that measurement of biliary IgG4 levels may have clinical value in distinguishing patients with IAC from biliary disorders that can mimic IAC. 12/16/2014
Udayakumar Navaneethan, Mansour A Parsi, Vennisvasanth Lourdusamy, Amit Bhatt, Norma G Gutierrez, David Grove, Madhusudhan R Sanaka, Jeffrey P Hammel, Tyler Stevens, John J Vargo, Raed A Dweik Volatile organic compounds in bile for early diagnosis of cholangiocarcinoma in patients with primary sclerosing cholangitis a pilot study CONCLUSION: The measurement of VOCs in biliary fluid may be useful to diagnose CCA in patients with PSC. A larger study with a longitudinal study design is required to confirm our pilot observations to diagnose CCA early in patients with PSC. ( 12/16/2014
Udayakumar Navaneethan, Basile Njei, Vennisvasanth Lourdusamy, Rajesh Konjeti, John J Vargo, Mansour A Parsi Comparative effectiveness of biliary brush cytology and intraductal biopsy for detection of malignant biliary strictures a systematic review and meta-analysis CONCLUSION: Our study suggests that both brushings and biopsy are comparable and have limited sensitivity for the diagnosis of malignant biliary strictures. A combination of both only modestly increases the sensitivity. 12/3/2014
Udayakumar Navaneethan, Rajesh Konjeti, Vennisvasanth Lourdusamy, Dennisdhilak Lourdusamy, Dhruv Mehta, Madhusudhan R Sanaka, John J Vargo, Mansour A Parsi Precut sphincterotomy efficacy for ductal access and the risk of adverse events CONCLUSIONS: Precut sphincterotomy is effective in achieving ductal access when standard cannulation techniques fail. A successful precut sphincterotomy is not associated with an increased risk of adverse events. 12/3/2014
C Mel Wilcox, Dhiraj Yadav, Tian Ye, Timothy B Gardner, Andres Gelrud, Bimaljit S Sandhu, Michele D Lewis, Samer Al-Kaade, Gregory A Cote, Christopher E Forsmark, Nalini M Guda, Darwin L Conwell, Peter A Banks, Thiruvengadam Muniraj, Joseph Romagnuolo, Randall E Brand, Adam Slivka, Stuart Sherman, Stephen R Wisniewski, David C Whitcomb, Michelle A Anderson Chronic pancreatitis pain pattern and severity are independent of abdominal imaging findings CONCLUSIONS: Mechanisms that determine patterns and severity of pain in patients with chronic pancreatitis are largely independent of structural variants observed by abdominal imaging techniques. Pancreas-relevant quantitative and qualitative pain measures should be included in the evaluation of pat... 11/27/2014
Udayakumar Navaneethan, Preethi Gk Venkatesh, Ramprasad Jegadeesan, Vennisvasanth Lourdusamy, Jeffrey P Hammel, Ravi P Kiran, Bo Shen Comparison of outcomes for patients with primary sclerosing cholangitis associated with ulcerative colitis and Crohns disease CONCLUSIONS: PSC patients with CD appear to be associated with a lower risk of colon neoplasia and colectomy than PSC patients with UC. 10/31/2014
Udayakumar Navaneethan, Vennisvasanth Lourdusamy, Earl Poptic, Jeffrey P Hammel, Madhusudhan R Sanaka, Mansour A Parsi Comparative effectiveness of pyruvate kinase M2 in bile, serum carbohydrate antigen 19-9, and biliary brushings in diagnosing malignant biliary strictures CONCLUSIONS: As a stand-alone factor, none of the markers were able to distinguish benign from malignant biliary strictures with a high sensitivity. However, a combination was highly sensitive in diagnosing malignant biliary strictures. 10/26/2014
J Y Bang, B A Holt, R H Hawes, M K Hasan, J P Arnoletti, J D Christein, C M Wilcox, S Varadarajulu Outcomes after implementing a tailored endoscopic step-up approach to walled-off necrosis in acute pancreatitis CONCLUSION: An algorithmic approach to pancreatic and peripancreatic walled-off necrosis, based on the collection size, location and stepwise response to intervention, resulted in an improved rate of treatment success compared with conventional endoscopic management. 10/22/2014
Ji Young Bang, Shyam Varadarajulu Endoscopic ultrasound-guided management of pancreatic pseudocysts and walled-off necrosis The outcome of endoscopic management of pancreatic fluid collections is dependent on the type of collection being treated. While pseudocysts have an excellent treatment response, the outcomes are modest for walled-off pancreatic necrosis. Recent advances in cross-sectional body imaging have enabled ... 10/18/2014
Ji Young Bang, Shyam Varadarajulu Neoplasia in chronic pancreatitis how to maximize the yield of endoscopic ultrasound-guided fine needle aspiration When performing endoscopic ultrasound-guided fine needle aspiration (EUS-FNA), identifying neoplasia in the setting of chronic pancreatitis can be technically challenging. The morphology of an ill-defined mass on sonography, presence of calcifications or intervening collaterals, reverberation from a... 10/18/2014
Udayakumar Navaneethan, Vennisvasanth Lourdusamy, Preethi Gk Venkatesh, Belinda Willard, Madhusudhan R Sanaka, Mansour A Parsi Bile proteomics for differentiation of malignant from benign biliary strictures a pilot study CONCLUSIONS: Protein biomarkers in bile may differentiate malignant from benign biliary strictures. Larger studies are warranted to validate these observations. 10/12/2014
Adam L Edwards, Klaus Mönkemüller, Salpy V Pamboukian, James F George, C M Wilcox, Shajan Peter Utility of double-balloon enteroscopy in patients with left ventricular assist devices and obscure overt gastrointestinal bleeding Obscure overt gastrointestinal bleeding (OGIB) is a challenge in patients with left ventricular assist devices (LVADs). We evaluated the utility and safety of double-balloon enteroscopy (DBE) in patients with LVADs in an observational consecutive-patient cohort from a single tertiary referral center... 10/8/2014
D Bimczok, J Y Kao, M Zhang, S Cochrun, P Mannon, S Peter, C M Wilcox, K E Mönkemüller, P R Harris, J M Grams, R D Stahl, P D Smith, L E Smythies Human gastric epithelial cells contribute to gastric immune regulation by providing retinoic acid to dendritic cells Despite the high prevalence of chronic gastritis caused by Helicobacter pylori, the gastric mucosa has received little investigative attention as a unique immune environment. Here, we analyzed whether retinoic acid (RA), an important homeostatic factor in the small intestinal mucosa, also contribute... 9/25/2014
Jayapal Ramesh, Ji Young Bang, Shantel Hebert-Magee, Jessica Trevino, Isam Eltoum, Andra Frost, Muhammad K Hasan, Amy Logue, Robert Hawes, Shyam Varadarajulu Randomized Trial Comparing the Flexible 19G and 25G Needles for Endoscopic Ultrasound-Guided Fine Needle Aspiration of Solid Pancreatic Mass Lesions CONCLUSIONS: As there is no significant difference in the performance of flexible 19G and 25G needles, needle choice for sampling pancreatic masses should be based on endoscopist preference and need for histology. 9/19/2014
Jacobo Velázquez-Aviña, Ryan Beyer, Claudia P Díaz-Tobar, Shajan Peter, Kondal R Kyanam Kabir Baig, C Mel Wilcox, Klaus Mönkemüller New method of direct percutaneous endoscopic jejunostomy tube placement using balloon-assisted enteroscopy with fluoroscopy CONCLUSIONS: This new method of inserting a DPEJ using balloon enteroscopy and fluoroscopy was safe and successful. Future comparative studies are now warranted. 9/12/2014
Udayakumar Navaneethan, Basile Njei, Preethi Gk Venkatesh, Vennisvasanth Lourdusamy, Madhusudhan R Sanaka Endoscopic ultrasound in the diagnosis of cholangiocarcinoma as the etiology of biliary strictures a systematic review and meta-analysis CONCLUSIONS: Our study suggests that EUS-FNA is useful in the evaluation of CCA as the etiology of biliary strictures. EUS-FNA may improve the diagnosis of CCA in patients with negative cytology and no mass on cross-sectional imaging. 8/30/2014
Shyam Varadarajulu, Bronte A Holt, Ji Young Bang, Muhammad K Hasan, Amy Logue, Ashutosh Tamhane, Robert H Hawes, Shantel Hebert-Magee Training endosonographers in cytopathology improving the results of EUS-guided FNA CONCLUSIONS: An intensive 2-day program was effective in training endosonographers in the basics of EUS-related cytopathology. Incorporating basic cytopathology in EUS fellowship curriculum will likely improve diagnostic performance of tissue acquisition procedures. 8/16/2014
Arun Kannan, Chithra Poongkunran, Mahendran Jayaraj, Rajesh Janardhanan Role of strain imaging in right heart disease a comprehensive review Advances in the imaging techniques of the heart have fueled the interest in understanding of right heart pathology. Recently, speckle tracking echocardiography has shown to aid in understanding various right heart diseases and better management. Its role is well established in diagnosing right heart... 8/12/2014
Jayapal Ramesh, Nipun Reddy, Hwasoon Kim, Klaus Mönkemüller, Shyam Varadarajulu, Brendan McGuire, Derek DuBay, Devin Eckhoff, C Mel Wilcox Safety and yield of diagnostic ERCP in liver transplant patients with abnormal liver function tests Background. Abnormal liver enzymes postorthotopic liver transplant (OLT) may indicate significant biliary pathology or organ rejection. There is very little known in the literature regarding the current role of diagnostic ERCP in this scenario. Aim. To review the utility of diagnostic ERCP in patien... 8/12/2014
Udayakumar Navaneethan, Ramprasad Jegadeesan, Shishira Nayak, Vennisvasanth Lourdusamy, Madhusudhan R Sanaka, John J Vargo, Mansour A Parsi ERCP-related adverse events in patients with primary sclerosing cholangitis CONCLUSION: Cholangitis appears to be the most common adverse event despite intraprocedural antibiotic use. There was a low risk of adverse events in patients with PSC undergoing ERCP. 8/3/2014
Udayakumar Navaneethan, Vennisvasanth Lourdusamy, Sudhir Duvuru, Dennisdhilak Lourdusamy, Dhruv Mehta, Siva Raja, Sudhish Murthy, Madhusudhan R Sanaka Timing of esophageal stent placement and outcomes in patients with esophageal perforation a single-center experience CONCLUSIONS: Endoscopic stent placement is safe and effective for treating esophageal perforations. However, the timing of stent placement on outcomes remains unclear. 7/19/2014
Shyam Varadarajulu, Ji Young Bang, Bronte A Holt, Muhammad K Hasan, Amy Logue, Robert H Hawes, Shantel Hebert-Magee The 25-gauge EUS-FNA needle Good for on-site but poor for off-site evaluation Results of a randomized trial CONCLUSIONS: The 25-gauge FNA needle yielded a diagnostic cell block in only 81% of patients, irrespective of whether 2 or 4 FNA passes were performed. These findings have important implications for centers without on-site cytopathology services. (Clinical trial registration number NCT01809028.). 6/29/2014
Udayakumar Navaneethan Hepatobiliary manifestations of ulcerative colitis an example of gut-liver crosstalk The interaction between inflammatory bowel disease (IBD) and hepatobiliary manifestations represents a classic example of liver-gut crosstalk. The importance of liver-gut crosstalk in IBD is demonstrated in the pathogenesis and outcome of primary sclerosing cholangitis (PSC) in IBD patients. Immunog... 6/22/2014
Udayakumar Navaneethan, Mansour A Parsi, Norma G Gutierrez, Amit Bhatt, Preethi G K Venkatesh, Dennisdhilak Lourdusamy, David Grove, Jeffrey P Hammel, Sunguk Jang, Madhusudhan R Sanaka, Tyler Stevens, John J Vargo, Raed A Dweik Volatile organic compounds in bile can diagnose malignant biliary strictures in the setting of pancreatic cancer a preliminary observation CONCLUSIONS: The measurement of biliary fluid VOCs may help to distinguish malignant from benign biliary strictures. Further studies are warranted to validate these observations. (Clinical Trial Registration Number NCT01565460.). 6/16/2014
Preethi G K Venkatesh, Basile Njei, Madhusudhan R Sanaka, Udayakumar Navaneethan Risk of comorbidities and outcomes in patients with lower gastrointestinal bleeding - a nationwide study CONCLUSIONS: Comorbidities were associated with increased the risk of mortality and health care utilization in patients with LGIB. Identification of comorbidities and development of risk-adjustment tools may improve the outcome of patients with LGIB. 6/11/2014
Stuart Sherman, Martin L Freeman, Paul R Tarnasky, C Mel Wilcox, Abhijit Kulkarni, Alex M Aisen, David Jacoby, Richard A Kozarek Administration of secretin RG1068 increases the sensitivity of detection of duct abnormalities by magnetic resonance cholangiopancreatography in patients with pancreatitis CONCLUSIONS: Compared with images from MRCP, those from RG1068-stimulated MRCP are improved in many aspects and could aid in diagnosis and clinical decision making for patients with acute, acute recurrent, or chronic pancreatitis. RG1068-enhanced MRCP might also better identify patients in need of t... 6/7/2014
Charles Mel Wilcox, Hwasoon Kim, Jessica Trevino, Jayapal Ramesh, Klaus Monkemuller, Shyam Varadarajulu Prevalence of normal liver tests in patients with choledocholithiasis undergoing endoscopic retrograde cholangiopancreatography CONCLUSIONS: Although rare, liver tests can be normal in patients with CBD stones. Patients most likely to have normal liver tests included older patients and those with abdominal pain. 6/7/2014
Udayakumar Navaneethan, Rajesh Konjeti, Preethi Gk Venkatesh, Madhusudhan R Sanaka, Mansour A Parsi Early precut sphincterotomy and the risk of endoscopic retrograde cholangiopancreatography related complications An updated meta-analysis CONCLUSION: This meta-analysis suggests that pre-cut sphincterotomy and persistent attempts at cannulation are comparable in terms of overall complication rates. Early pre-cut implementation does not increase PEP complications. 6/4/2014
Matthew Skinner, Daniel Popa, Helmut Neumann, C Mel Wilcox, Klaus Mönkemüller ERCP with the overtube-assisted enteroscopy technique a systematic review CONCLUSION: Both endoscopic and ERCP success rates were highest in patients with Billroth II anatomy, followed by those with pancreaticoduodenectomy and Roux-en-Y hepaticojejunostomy; the lowest success rates were in patients with Roux-en-Y gastric bypass. Cannulation rates appeared to be equivalent... 5/20/2014
Ji Young Bang, C Mel Wilcox, Jessica M Trevino, Jayapal Ramesh, Muhammad Hasan, Robert H Hawes, Shyam Varadarajulu Relationship between stent characteristics and treatment outcomes in endoscopic transmural drainage of uncomplicated pancreatic pseudocysts CONCLUSIONS: There appears to be no relationship between the number of interventions required for treatment success and stent characteristics in patients undergoing endoscopic transmural drainage of uncomplicated pancreatic pseudocysts. 5/3/2014
Udayakumar Navaneethan, Norma G Gutierrez, Preethi Gk Venkatesh, Ramprasad Jegadeesan, Renilang Zhang, Sunguk Jang, Madhusudhan R Sanaka, John J Vargo, Mansour A Parsi, Ariel E Feldstein, Tyler Stevens Lipidomic profiling of bile in distinguishing benign from malignant biliary strictures a single-blinded pilot study CONCLUSIONS: The measurement of specific oxPL products may help to distinguish CCA from other biliary strictures. Measurement of these products in bile may enhance the endoscopic diagnosis of indeterminate biliary strictures. 4/9/2014
Kunjam Modha, Udayakumar Navaneethan Advanced therapeutic endoscopist and inflammatory bowel disease dawn of a new role Endoscopy plays a key role in the diagnosis and treatment of patients with inflammatory bowel disease (IBD). Colonoscopy has been traditionally used in the diagnosis of IBD and helps in determination of an important end point in patient management, "mucosal healing". However, the involvement of an a... 4/8/2014
Udayakumar Navaneethan, Dennisdhilak Lourdusamy, Dhruv Mehta, Vennisvasanth Lourdusamy, Preethi G K Venkatesh, Madhusudhan R Sanaka Endoscopic resection of large sporadic non-ampullary duodenal polyps efficacy and long-term recurrence CONCLUSIONS: Endoscopic resection is effective for treating large duodenal adenomas. Adenomas with villous features are more likely to recur. Almost all recurrences can be managed endoscopically. 4/4/2014
Udayakumar Navaneethan, Norma G Gutierrez, Ramprasad Jegadeesan, Preethi Gk Venkatesh, Madhusudhan R Sanaka, John J Vargo, Mansour A Parsi Factors predicting adverse short-term outcomes in patients with acute cholangitis undergoing ERCP A single center experience CONCLUSION: Higher ASA physical classification and delays in ERCP are associated with adverse clinical outcomes and prolonged length of hospital stay in patients with acute cholangitis undergoing ERCP. 3/18/2014
Camille Anne Sommer, C Mel Wilcox Pancreatico-pericardial fistula as a complication of chronic pancreatitis Pancreatico-pericardial fistula is an extremely rare complication of chronic pancreatitis. We present a case of a 58-year-old man who presented with syncope. Transthoracic echocardiogram revealed a pericardial effusion with tamponade physiology. Pericardiocentesis and pericardial fluid analysis demo... 3/15/2014
Jayapal Ramesh, Hwasoon Kim, Kartika Reddy, Shyam Varadarajulu, C Mel Wilcox Impact of pancreatic stent caliber on post-endoscopic retrograde cholangiopancreatogram pancreatitis rates in patients with confirmed sphincter of Oddi dysfunction CONCLUSIONS: There appears to be no relationship between stent characteristics and the risk or severity of PEP in patients with manometrically proven SOD. 3/13/2014
Daniel Popa, Jayapal Ramesh, Shajan Peter, C Mel Wilcox, Klaus Mönkemüller Small Bowel Stent-in-Stent Placement for Malignant Small Bowel Obstruction Using a Balloon-Assisted Overtube Technique Self-expanding metal stents are a useful therapy to palliate malignant and benign luminal gastrointestinal obstruction. Self-expanding metal stents has been widely reported for colonic, esophageal, and gastric obstruction. However, endoscopic delivery and placement to the small bowel is more challen... 2/27/2014
Ashutosh Gupta, Bashar M Attar, Pramoda Koduru, Arvind R Murali, Benjamin T Go, Rajender Agarwal Utility of confocal laser endomicroscopy in identifying high-grade dysplasia and adenocarcinoma in Barretts esophagus a systematic review and meta-analysis Confocal laser endomicroscopy (CLE) is a novel endoscopic technique that has emerged as an important tool in the in-vivo visualization and detailed assessment of the mucosal layer and subcellular structures in Barrett's esophagus. Current guidelines recommend four-quadrant random biopsies for identi... 2/19/2014
Klaus Mönkemüller, Daniel Popa, C Mel Wilcox Endoscopic treatment options for cholangiocarcinomas Cholangiocellular carcinoma (CCC) is a very aggressive tumor, which remains highly resistant to current chemoradiation therapies. Death is usually caused by the tumor burden. However, biliary obstruction, which leads to cholangitis and liver failure, is also a cause of death. Therefore, relief of bi... 2/11/2014
Joseph Romagnuolo, Peter B Cotton, Valerie Durkalski, Qi Pauls, Olga Brawman-Mintzer, Douglas A Drossman, Patrick Mauldin, Kyle Orrell, April W Williams, Evan L Fogel, Paul R Tarnasky, Giuseppe Aliperti, Martin L Freeman, Richard A Kozarek, Priya A Jamidar, C Mel Wilcox, Jose Serrano, Grace H Elta Can patient and pain characteristics predict manometric sphincter of Oddi dysfunction in patients with clinically suspected sphincter of Oddi dysfunction CONCLUSIONS: Patient and pain factors and psychological comorbidity do not predict SOM results at ERCP in suspected type III SOD. ( 1/30/2014
David A Peura, C Mel Wilcox Aspirin and proton pump inhibitor combination therapy for prevention of cardiovascular disease and Barretts esophagus Aspirin, used at low doses (75-325 mg daily), prevents aggregation of platelets and is prescribed for patients as pharmacologic prevention of cardiovascular disease. Despite the well-documented beneficial effects of aspirin, prolonged use is associated with damage to the gastrointestinal (GI) mucosa... 1/8/2014
Helmut Neumann, Mitsuhiro Fujishiro, C Mel Wilcox, Klaus Mönkemüller Present and future perspectives of virtual chromoendoscopy with i-scan and optical enhancement technology Despite being the current gold standard, white-light endoscopy may miss a significant proportion of lesions within the colorectum, thus leading to a misinterpretation of various disease findings. Traditionally, dye-based chromoendoscopy is used to improve both detection and characterization of lesio... 12/31/2013
Udayakumar Navaneethan, Basile Njei, Preethi G K Venkatesh, John J Vargo, Mansour A Parsi Fluorescence in situ hybridization for diagnosis of cholangiocarcinoma in primary sclerosing cholangitis a systematic review and meta-analysis CONCLUSION: Our study suggests that FISH polysomy is highly specific; however, limited sensitivity of FISH highlights that better markers are required for early detection of CCA in PSC. 12/24/2013
Udayakumar Navaneethan, Sudhir Duvuru, Ramprasad Jegadeesan, Preethi G K Venkatesh, Norma G Gutierrez, Jeffrey Hammel, Ravi P Kiran, Madhusudhan R Sanaka Factors associated with 30-day readmission and long-term efficacy of enteral stent placement for malignancy CONCLUSIONS: Early complications following stent placement increase the risk of 30-day readmission. SEMS is efficacious long-term for palliation of malignant gastrointestinal obstruction. 11/16/2013
Shyam Varadarajulu, Robert H Hawes The changing paradigm in EUS-guided tissue acquisition The diagnostic performance of endoscopic ultrasound-guided fine-needle aspiration is strongly dependent on the availability of an onsite cytopathologist. The diagnosis of some rare tumors may require ancillary testing for which a histologic core biopsy is required. There is increasing interest in ev... 11/13/2013
Benjamin Tharian, Grant Caddy, Tony Ck Tham Enteroscopy in small bowel Crohns disease A review Crohn's disease (CD) is a chronic inflammatory condition of the gastrointestinal tract resulting in inflammation, stricturing and fistulae secondary to transmural inflammation. Diagnosis relies on clinical history, abnormal laboratory parameters, characteristic radiologic and endoscopic changes with... 10/23/2013
Ji Young Bang, Shyam Varadarajulu Procore and flexible 19 gauge needle can replace trucut biopsy needle Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is routinely performed for establishing tissue diagnosis in patients with gastrointestinal tumors. The concept of delivering chemotherapy based on molecular markers and the ability to establish a reliable diagnosis in lieu of an onsite cy... 10/22/2013
Ji Young Bang, Shyam Varadarajulu Metal versus Plastic Stent for Transmural Drainage of Pancreatic Fluid Collections The conventional management of pancreatic fluid collections (PFCs) involves surgery or percutaneous drainage. While surgery is associated with significant complications and mortality, percutaneous drainage is associated with prolonged hospitalization and oftentimes the need for other adjunctive trea... 10/22/2013
Guru Trikudanathan, Udayakumar Navaneethan, Basile Njei, John J Vargo, Mansour A Parsi Diagnostic yield of bile duct brushings for cholangiocarcinoma in primary sclerosing cholangitis a systematic review and meta-analysis CONCLUSION: Our study suggests that bile duct brushing is a simple and highly specific technique for detection of CCA in patients with PSC. However, the modest sensitivity from bile duct brushing precludes its utility as a diagnostic tool for early detection of CCA in patients with PSC. 10/22/2013
Preethi G K Venkatesh, Sravanthi Parasa, Basile Njei, Madhusudhan R Sanaka, Udayakumar Navaneethan Increased mortality with peptic ulcer bleeding in patients with both compensated and decompensated cirrhosis CONCLUSION: Both decompensated and compensated cirrhosis are associated with increased mortality in patients with PUB. 10/15/2013
Arvind R Murali, Carlos Romero-Marrero, Federico Aucejo, K V Narayanan Menon Hepatocellular carcinoma options for diagnosing and managing a deadly disease Hepatocellular carcinoma (HCC) is an important cause of death in patients with liver disease, and its incidence appears to be rising in the United States. Because early diagnosis improves the chances of survival, it is important to identify patients who would benefit from surveillance. Once HCC is s... 10/3/2013
Udayakumar Navaneethan, Basile Njei, Preethi G K Venkatesh, Madhusudhan R Sanaka Timing of colonoscopy and outcomes in patients with lower GI bleeding a nationwide population-based study CONCLUSIONS: Early colonoscopy within 24 hours is associated with decreased length of hospital stay and hospitalization costs in patients with LGIB. 9/25/2013
Shyam Varadarajulu, Muhammad K Hasan, Ji Young Bang, Shantel Hebert-Magee, Robert H Hawes Endoscopic ultrasound-guided tissue acquisition Endoscopic ultrasound (EUS) is an indispensable tool for tissue acquisition in patients with gastrointestinal tumors. While fine-needle aspiration (FNA) has been routinely carried out for establishing tissue diagnosis, the emerging concept of tailoring chemotherapeutic agents based on molecular mark... 9/17/2013
Klaus Mönkemüller, Shajan Peter, Basem Alkurdi, Jayapal Ramesh, Daniel Popa, C Mel Wilcox Endoscopic closure of a gastrocolic fistula using the over-the-scope-clip-system Gastrointestinal (GI) defects such as fistulas and leaks can be potentially closed endoscopically using hemoclips and loops. However, hemoclips may not allow for closure of large defects and they do not exert enough tensile force to keep fibrotic defects larger than 5 mm approximated. Herein we pres... 8/17/2013
Udayakumar Navaneethan, Ramprasad Jegadeesan, Norma G Gutierrez, Preethi G K Venkatesh, Jeffrey P Hammel, Bo Shen, Ravi P Kiran Progression of low-grade dysplasia to advanced neoplasia based on the location and morphology of dysplasia in ulcerative colitis patients with extensive colitis under colonoscopic surveillance CONCLUSIONS: The frequency of progression of LGD to AN is low. Flat dysplasia located in the distal colon is associated with a greater risk of progression to AN. 8/7/2013
Ramprasad Jegadeesan, Xiuli Liu, Mangesh R Pagadala, Norma Gutierrez, Mujtaba Butt, Udayakumar Navaneethan Microscopic colitis is it a spectrum of inflammatory bowel disease Lymphocytic and collagenous colitis are forms of microscopic colitis which typically presents in elderly patients as chronic watery diarrhea. The association between microscopic colitis and inflammatory bowel disease is weak and unclear. Lymphocytic colitis progressing to ulcerative colitis has been... 7/19/2013
Klaus Mönkemüller, Shajan Peter, Jay Toshniwal, Daniel Popa, Marzena Zabielski, Richard D Stahl, Jayapal Ramesh, C Mel Wilcox Multipurpose use of the bear claw over-the-scope-clip system to treat endoluminal gastrointestinal disorders CONCLUSIONS: The OTSC system is a useful device in a variety of clinical scenarios including the management of larger GI leaks and fistulas, GI bleeding, full-thickness resection of tumors, and stent anchoring, even in very old and frail patients. 7/17/2013
Ji Young Bang, C Mel Wilcox, Jessica Trevino, Jayapal Ramesh, Shajan Peter, Muhammad Hasan, Robert H Hawes, Shyam Varadarajulu Factors impacting treatment outcomes in the endoscopic management of walled-off pancreatic necrosis CONCLUSIONS: Creating multiple gateways for drainage of necrotic debris improves treatment success, and not removing the transmural stents decreases PFC recurrence in patients undergoing endoscopic drainage of WOPN. 7/9/2013
Udayakumar Navaneethan, Norma G Gutierrez, Ramprasad Jegadeesan, Preethi G K Venkatesh, Earl Poptic, Xiuli Liu, Madhusudhan R Sanaka, Sunguk Jang, John J Vargo, Mansour A Parsi Vascular endothelial growth factor levels in bile distinguishes pancreatic cancer from other etiologies of biliary stricture a pilot study CONCLUSIONS: This study suggests that measurement of biliary VEGF-1 levels distinguishes patients with pancreatic cancer from other etiologies of biliary stricture. This may be particularly relevant in approaching patients with indeterminate biliary stricture. 7/6/2013
Steven D Schwaitzberg, Robert H Hawes, David W Rattner, Michael L Kochman Novel challenges of multi-society investigator-initiated studies a paradigm shift for technique and technology evaluation The introduction of innovative techniques and novel technologies into clinical practice is a challenge that confronts all aspects of healthcare delivery. Upheaval from shrinking research funding and declining healthcare reimbursements now forces patients, doctors, hospitals, payers, regulators, and ... 6/12/2013
Shyam Varadarajulu, Ji Young Bang, Bryce S Sutton, Jessica M Trevino, John D Christein, C Mel Wilcox Equal efficacy of endoscopic and surgical cystogastrostomy for pancreatic pseudocyst drainage in a randomized trial CONCLUSIONS: In a randomized trial comparing endoscopic and surgical cystogastrostomy for pancreatic pseudocyst drainage, none of the patients in the endoscopy group had pseudocyst recurrence during the follow-up period, therefore there is no evidence that surgical cystogastrostomy is superior. Howe... 6/5/2013
Diane Bimczok, Lesley E Smythies, Ken B Waites, Jayleen M Grams, Richard D Stahl, Peter J Mannon, Shajan Peter, C Mel Wilcox, Paul R Harris, Soumita Das, Peter B Ernst, Phillip D Smith Helicobacter pylori infection inhibits phagocyte clearance of apoptotic gastric epithelial cells Increased apoptotic death of gastric epithelial cells is a hallmark of Helicobacter pylori infection, and altered epithelial cell turnover is an important contributor to gastric carcinogenesis. To address the fate of apoptotic gastric epithelial cells and their role in H. pylori mucosal disease, we ... 5/21/2013
Sansrita Nepal, Udayakumar Navaneethan, Ana E Bennett, Bo Shen De novo inflammatory bowel disease and its mimics after organ transplantation Diarrhea is a common symptom after solid organ transplantation or hematopoietic stem cell transplantation, with a reported prevalence up to 72%. One of the uncommon causes for diarrhea in the posttransplant setting is development of de novo inflammatory bowel disease (IBD). The incidence of posttran... 5/10/2013
Udayakumar Navaneethan, Norma G Gutierrez, Ramprasad Jegadeesan, Preethi G K Venkatesh, Mujtaba Butt, Madhusudhan R Sanaka, John J Vargo, Mansour A Parsi Delay in performing ERCP and adverse events increase the 30-day readmission risk in patients with acute cholangitis CONCLUSION: Delays in performing ERCP during the index admission, development of after-ERCP adverse events, and etiology of cholangitis not related to stones increased the risk of 30-day readmissions. 3/27/2013
Udayakumar Navaneethan, Gursimran Kochhar, Preethi G K Venkatesh, Ana E Bennett, Maged Rizk, Bo Shen, Ravi P Kiran Random biopsies during surveillance colonoscopy increase dysplasia detection in patients with primary sclerosing cholangitis and ulcerative colitis CONCLUSIONS: Random biopsies significantly increase the yield of dysplasia in patients with PSC and UC even in the absence of endoscopic features of prior inflammation and significantly impact clinical outcomes. 3/26/2013
C Mel Wilcox, Hwasoon Kim, Jayapal Ramesh, Jessica Trevino, Shyam Varadarajulu Biliary sphincterotomy is not required for bile duct stent placement CONCLUSION: Single bile duct stents, both plastic and metal, can be deployed without EBS. 3/23/2013
J Y Bang, S H Magee, J Ramesh, J M Trevino, S Varadarajulu Randomized trial comparing fanning with standard technique for endoscopic ultrasound-guided fine-needle aspiration of solid pancreatic mass lesions CONCLUSIONS: The fanning technique of FNA was superior to the standard approach because fewer passes were required to establish the diagnosis. If these promising data are confirmed by other investigators, consideration should be given to incorporating the fanning technique into routine practice of E... 3/19/2013
Shajan Peter, Ji Young Bang, Klaus Mönkemuller, Shyam Varardarajulu, C Mel Wilcox Endomicroscopy of the pancreaticobiliary system It is often difficult to accurately differentiate between benign and malignant pancreaticobiliary strictures, and some are interpreted as indeterminate despite ERCP, EUS, or radiological imaging techniques, thereby making it difficult for the clinician to make appropriate management decisions. Probe... 3/12/2013
Preethi G K Venkatesh, Ramprasad Jegadeesan, Norma G Gutierrez, Madhusudhan R Sanaka, Udayakumar Navaneethan Natural history of low grade dysplasia in patients with primary sclerosing cholangitis and ulcerative colitis CONCLUSIONS: One-third of patients with LGD progressed to HGD/CRC in PSC-UC. Most patients progress within the first year of diagnosis of LGD supporting early colectomy in PSC-UC patients with LGD. 2/26/2013
Udayakumar Navaneethan, Ramprasad Jegadeesan, Norma G Gutierrez, Preethi G K Venkatesh, Andrea V Arrossi, Ana E Bennett, Tarun Rai, Feza H Remzi, Bo Shen, Ravi P Kiran Backwash ileitis and the risk of colon neoplasia in ulcerative colitis patients undergoing restorative proctocolectomy CONCLUSIONS: The presence of BWI with extensive colitis was associated with the risk of identifying colon neoplasia but not cancer alone in the proctocolectomy specimen. 2/2/2013
Ji Young Bang, Jayapal Ramesh, Jessica Trevino, Mohamad A Eloubeidi, Shyam Varadarajulu Objective assessment of an algorithmic approach to EUS-guided FNA and interventions CONCLUSION: An algorithmic approach to EUS-FNA/interventions yielded better technical outcomes and cost savings without compromising diagnostic adequacy. 2/2/2013
Stephen T Amann, Dhiraj Yadav, M Micheal Barmada, Michael O'Connell, Elizabeth D Kennard, Michelle Anderson, John Baillie, Stuart Sherman, Joseph Romagnuolo, Robert H Hawes, Samer Alkaade, Randall E Brand, Michele D Lewis, Timothy B Gardner, Andres Gelrud, Mary E Money, Peter A Banks, Adam Slivka, David C Whitcomb Physical and mental quality of life in chronic pancreatitis a case-control study from the North American Pancreatitis Study 2 cohort CONCLUSIONS: The impact of CP on QOL appears substantial. The QOL in CP subjects appears to be worse or similar to the QOL of many other chronic conditions. 1/30/2013
Sravanthi Parasa, Udayakumar Navaneethan, Arun Raghav Mahankali Sridhar, Preethi G K Venkatesh, Kevin Olden End-stage renal disease is associated with worse outcomes in hospitalized patients with peptic ulcer bleeding CONCLUSIONS: ESRD is associated with a significant health care burden in hospitalized patients with PUB. The presence of ESRD contributes to a higher mortality rate, longer hospital stay, and increased need for surgery. 1/30/2013
Guru Trikudanathan, Udayakumar Navaneethan, Mansour A Parsi Endoscopic management of difficult common bile duct stones Endoscopy is widely accepted as the first treatment option in the management of bile duct stones. In this review we focus on the alternative endoscopic modalities for the management of difficult common bile duct stones. Most biliary stones can be removed with an extraction balloon, extraction basket... 1/25/2013
Basil Al-Awabdy, C Mel Wilcox Use of anesthesia on the rise in gastrointestinal endoscopy Conscious sedation has been the standard of care for many years for gastrointestinal endoscopic procedures. As procedures have become more complex and lengthy, additional medications became essential for adequate sedation. Often time's deep sedation is required for procedures such as endoscopic retr... 1/19/2013
Benjamin Tharian, Fotios Tsiopoulos, Nayana George, Salvatore Di Pietro, Fabia Attili, Alberto Larghi Endoscopic ultrasound fine needle aspiration Technique and applications in clinical practice Since its initial report in 1992, endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) has now been incorporated into the diagnostic and staging algorithm for the evaluation of benign and malignant diseases of the gastrointestinal tract and of adjacent organs. Its introduction constitutes a... 1/8/2013
Madhusudhan R Sanaka, Udayakumar Navaneethan, Bennie R Upchurch, Rocio Lopez, Sabrina Vannoy, Milan Dodig, Janice M Santisi, John J Vargo Diagnostic and therapeutic yield is not influenced by the timing of small-bowel enteroscopy morning versus afternoon CONCLUSIONS: The timing of procedure, morning versus afternoon, did not affect the diagnostic and therapeutic efficacy of BE in patients with suspected small-bowel disease. 12/25/2012
Jayapal Ramesh, Ji Young Bang, Jessica Trevino, Shyam Varadarajulu Comparison of outcomes between endoscopic ultrasound-guided transcolonic and transrectal drainage of abdominopelvic abscesses CONCLUSION: Except for patients with diverticular etiology, treatment of abdominopelvic abscess under EUS guidance is highly effective and safe for both routes. 12/11/2012
Guru Trikudanathan, Preethi G K Venkatesh, Udayakumar Navaneethan Diagnosis and therapeutic management of extra-intestinal manifestations of inflammatory bowel disease Extra-intestinal manifestations (EIMs) are reported frequently in patients with inflammatory bowel disease (IBD) and may be diagnosed before, concurrently or after the diagnosis of IBD. EIMs in IBD may be classified based on their association with IBD disease activity. The first group has a direct r... 11/28/2012
Eric M Nelsen, Robert H Hawes, Prasad G Iyer Diagnosis and management of Barretts esophagus Barrett esophagus is characterized by the replacement of squamous mucosa in the esophagus by specialized intestinal metaplasia. Its clinical significance lies in it being the strongest risk factor for and known precursor for esophageal adenocarcinoma. Diagnosis requires endoscopic confirmation of co... 10/3/2012
Preethi G K Venkatesh, Udayakumar Navaneethan, Bo Shen, Arthur J McCullough Increased serum levels of carbohydrate antigen 19-9 and outcomes in primary sclerosing cholangitis patients without cholangiocarcinoma CONCLUSIONS: Thirty-two percent of patients with PSC had elevated serum CA 19-9 in the absence of CCA. There was a trend towards shorter OLT-free survival in PSC patients with elevated CA-19-9. 9/26/2012
Udayakumar Navaneethan, Sravanthi Parasa, Preethi G K Venkatesh, Thimmaiah T Ganapathi, Ravi P Kiran, Bo Shen Impact of inflammatory bowel disease on post-cholecystectomy complications and hospitalization costs a Nationwide Inpatient Sample study CONCLUSIONS: CD patients undergoing cholecystectomy were shown to have a significantly increased risk for postoperative complications, have a longer stay in the hospital, and incur higher hospitalization costs. 9/11/2012
Robert H Hawes, James Clancy, Muhammad K Hasan Endoscopic ultrasound-guided fine needle aspiration in cystic pancreatic lesions Incidental pancreatic cysts are being increasingly recognized recently with incremented concern about health and frequent health check-up. Endoscopic ultrasound (EUS) has emerged as the principal modality for imaging pancreas for various pancreatic diseases including pancreatic cyst. But imaging alo... 8/7/2012
Shyam Varadarajulu, Ji Young Bang, Shantel Hebert-Magee Assessment of the technical performance of the flexible 19-gauge EUS-FNA needle CONCLUSIONS: Preliminary data suggest that the flexible 19-G needle can be used for procuring cytologic aspirates and histologic specimens and to undertake therapeutic interventions even by the transduodenal route. Confirmatory studies are required in a larger cohort of patients with varied patholog... 7/24/2012
A Lanas, J L Goldstein, F K L Chan, C M Wilcox, D A Peura, C Li, G H Sands, J M Scheiman Risk factors associated with a decrease 2 gdL in haemoglobin andor 10 haematocrit in osteoarthritis patients taking celecoxib or a nonselective NSAID plus a PPI in a large randomised controlled trial CONDOR CONCLUSIONS: Monitoring for decreases in haemoglobin should be considered for all OA patients and especially those with an increased age, BMI, history of gastritis and GI intolerance, CRP levels >1 mg/dL and/or positive H. pylori status, as this may affect their clinical management. 7/19/2012
Emmanuel C Obusez, Lei Lian, Zhuo Shao, Udayakumar Navaneethan, Robert O'Shea, Ravi P Kiran, Bo Shen Impact of ileal pouch-anal anastomosis on the surgical outcome of orthotopic liver transplantation for primary sclerosing cholangitis CONCLUSIONS: The presence of the IPAA in OLT for PSC patients appears not to have a negative impact on patient and graft survivals and post-operative complications. 7/14/2012
Jayapal Ramesh, Ji Y Bang, Jessica Trevino, Shyam Varadarajulu Endoscopic ultrasound-guided drainage of pancreatic fluid collections in children CONCLUSIONS: Single-step EUS-guided drainage of PFC in children is technically feasible, safe, clinically effective, and when available, should be the first-line treatment modality. 7/13/2012
Guru Trikudanathan, Udayakumar Navaneethan, Santhi Swaroop Vege Current controversies in fluid resuscitation in acute pancreatitis a systematic review Acute pancreatitis (AP) is a common inflammatory disorder of the pancreas resulting in considerable morbidity and mortality. Aggressive intravenous fluid resuscitation generally is recommended in all patients with AP and remains the cornerstone of management of these patients. However, the optimal r... 7/12/2012
Nathaniel Ranney, Milind Phadnis, Jessica Trevino, Jayapal Ramesh, C Mel Wilcox, Shyam Varadarajulu Impact of biliary stents on EUS-guided FNA of pancreatic mass lesions CONCLUSIONS: The presence or absence of a biliary stent, whether plastic or metal, does not have an impact on the diagnostic yield or technical difficulty of EUS-FNA. 6/26/2012
Narendra B Vadlamudi, Udayakumar Navaneethan, Kirk A Thame, David R Kelly, Reed A Dimmitt, William T Harris Crohns disease with pulmonary manifestations in children 2 case reports and review of the literature Crohn's disease (CD) is a chronic granulomatous disease of unknown etiology that affects primarily the gastrointestinal system but can be associated with extraintestinal manifestations. Latent pulmonary involvement in children with CD has been described, but symptomatic pulmonary disease has rarely ... 6/19/2012
Ji Young Bang, Shantel Hebert-Magee, Jessica Trevino, Jayapal Ramesh, Shyam Varadarajulu Randomized trial comparing the 22-gauge aspiration and 22-gauge biopsy needles for EUS-guided sampling of solid pancreatic mass lesions CONCLUSION: Diagnostic sufficiency, technical performance, and safety profiles of FNA and FNB needles are comparable. There was no significant difference in yield or quality of the histologic core between the 2 needle types. 6/5/2012
Muhammad K Hasan, Robert H Hawes EUS-guided FNA of solid pancreas tumors Although endoscopic ultrasonography (EUS) is considered superior to MRI and CT in detecting pancreatic masses, it is the ability to target and place a needle into suspicious lesions that has made EUS indispensible in the evaluation of patients with solid pancreatic tumors. Endoscopic ultrasound-guid... 5/29/2012
Madhusudhan R Sanaka, Udayakumar Navaneethan, Bhanu Kosuru, Himabindu Yerneni, Rocio Lopez, John J Vargo Antegrade is more effective than retrograde enteroscopy for evaluation and management of suspected small-bowel disease CONCLUSIONS: Antegrade enteroscopy appears to provide a higher diagnostic and therapeutic yield than retrograde enteroscopy in patients with suspected small-bowel disease. 5/22/2012
Udayakumar Navaneethan, Preethi G K Venkatesh, Maria Choudhary, Bo Shen, Ravi P Kiran Elevated immunoglobulin G4 level is associated with reduced colectomy-free survival in patients with primary sclerosing cholangitis and ulcerative colitis CONCLUSIONS: Elevated IgG4 was seen in a small number of PSC patients. Most of these patients had associated UC, were younger at the time of PSC diagnosis, more likely to have backwash ileitis and had reduced colectomy-free survival than patients with normal IgG4. 5/5/2012
Shyam Varadarajulu, Paul Fockens, Robert H Hawes Best practices in endoscopic ultrasound-guided fine-needle aspiration Over the past 2 decades, endoscopic ultrasound-guided fine-needle aspiration has evolved to become an indispensable tool for tissue acquisition in patients with gastrointestinal tumors. The technique is useful for biopsy of mucosal and submucosal lesions in which prior endoscopic biopsies have been ... 4/6/2012
Linda Y Tang, Hui Cai, Udayakumar Navaneethan, James H Boone, Sarah J Rhodes, Lauren Moore, Hyunjin Rho, Carol de La Motte, Elaine Queener, Bo Shen Utility of fecal and serum anti-Saccharomyces cerevisiae antibodies in the diagnosis of Crohns disease-like condition of the pouch CONCLUSIONS: Fecal ASCA appears to be better than serum ASCA in differentiating CDL from other pouch disorders, although this distinction may be of limited clinical utility. 3/21/2012
U Navaneethan, M Choudhary, P G K Venkatesh, B A Lashner, F H Remzi, B Shen, R P Kiran The effects of liver transplantation on the clinical course of colitis in ulcerative colitis patients with primary sclerosing cholangitis CONCLUSIONS: Ulcerative colitis in the presence of primary sclerosing cholangitis remains quiescent, and may improve in most patients after orthotopic liver transplantation. 3/21/2012
U Navaneethan, P G K Venkatesh, B A Lashner, B Shen, R P Kiran The impact of ulcerative colitis on the long-term outcome of patients with primary sclerosing cholangitis CONCLUSIONS: Primary sclerosing cholangitis often is recognised at an early stage in patients with concurrent ulcerative colitis; ulcerative colitis has no impact on long-term prognosis in terms of liver-related outcomes when adjusted for the severity of liver disease. 3/21/2012
Udayakumar Navaneethan, Gursimran Kochhar, Preethi G K Venkatesh, Brian Lewis, Bret A Lashner, Feza H Remzi, Bo Shen, Ravi P Kiran Duration and severity of primary sclerosing cholangitis is not associated with risk of neoplastic changes in the colon in patients with ulcerative colitis CONCLUSION: In this study, the severity of PSC was not significantly associated with the risk of colon neoplasia. Patients with PSC and UC have a high risk of colon neoplasia soon after the coexistence of the two diseases is discovered. Older age at PSC diagnosis increases this risk. 3/13/2012
Udayakumar Navaneethan, Saurabh Mukewar, Preethi G K Venkatesh, Rocio Lopez, Bo Shen Clostridium difficile infection is associated with worse long term outcome in patients with ulcerative colitis CONCLUSIONS: CDI appears to be associated with escalation of medical therapy in the year following infection. CDI and severe disease on endoscopy appear to be associated with an increased risk for subsequent colectomy on long-term follow up. 3/13/2012
Udayakumar Navaneethan, Preethi G K Venkatesh, Bret A Lashner, Rocio Lopez, Ravi P Kiran, Bo Shen Severity of primary sclerosing cholangitis and its impact on the clinical outcome of Crohns disease CONCLUSIONS: In contrast to UC, severe PSC requiring OLT does not appear to impact the clinical outcome of CD. 3/9/2012
Udayakumar Navaneethan, Preethi G K Venkatesh, Bret A Lashner, Feza H Remzi, Bo Shen, Ravi P Kiran Temporal trends in colon neoplasms in patients with primary sclerosing cholangitis and ulcerative colitis CONCLUSIONS: With annual colonoscopic surveillance, dysplasia and cancer in patients with a combined diagnosis of PSC//UC is being diagnosed in patients with a shorter duration of these conditions. The nature and the location of neoplasia have, however, not changed. 3/9/2012
Udayakumar Navaneethan, Gursimran Kochhar, Hardeep Phull, Preethi G K Venkatesh, Feza H Remzi, Ravi P Kiran, Bo Shen Severe disease on endoscopy and steroid use increase the risk for bowel perforation during colonoscopy in inflammatory bowel disease patients CONCLUSIONS: There appears to be a higher risk of colonoscopy-associated perforation in IBD patients with active disease and on steroids. 3/9/2012
Guru Trikudanathan, Udayakumar Navaneethan, Santhi Swaroop Vege Modern treatment of patients with chronic pancreatitis CP remains a challenging disease. Endoscopic and surgical management, along with antioxidants, have helped in reducing chronic pain. Management of exocrine and endocrine insufficiency forms the cornerstone for improving nutrition in these patients. Newer therapeutic targets that will transcend the m... 2/21/2012
Udayakumar Navaneethan, Preethi G K Venkatesh, Erinn Downs-Kelly, Bo Shen Isospora belli superinfection in a patient with eosinophilic gastroenteritis--a diagnostic challenge Isospora belli infection, characterized by peripheral blood eosinophilia, is often seen as an opportunistic infection in patients with acquired immunodeficiency syndrome (AIDS). It is also reported in patients with underlying lymphoproliferative disorders including lymphoma and leukemia. Eosinophil-... 2/14/2012
Shyam Varadarajulu, C Mel Wilcox, Sahibzada Latif, Milind Phadnis, John D Christein Management of pancreatic fluid collections a changing of the guard from surgery to endoscopy The aim of this study was to assess for any trend in management of pancreatic fluid collections (PFCs) and identify impacting factors. The endoscopy and surgical databases were queried for PFC patients. PFCs were categorized as pseudocysts (PP) or complex collections (CC) that included abscess/necro... 1/26/2012
Udayakumar Navaneethan, Preethi G K Venkatesh, Saurabh Mukewar, Bret A Lashner, Feza H Remzi, Arthur J McCullough, Ravi P Kiran, Bo Shen, John J Fung Progressive primary sclerosing cholangitis requiring liver transplantation is associated with reduced need for colectomy in patients with ulcerative colitis CONCLUSIONS: Severe progressive PSC that requires liver transplantation appears to reduce the disease activity of UC and the need for colectomy. 1/17/2012
Udayakumar Navaneethan, Sravanthi Parasa, Preethi G K Venkatesh, Bo Shen Prevalence and risk factors for colonic perforation during colonoscopy in hospitalized end-stage renal disease patients on hemodialysis CONCLUSIONS: There appeared no increased risk of colonic perforation during colonoscopy among inpatients who received HD in our study. Increasing age and female patients appeared to be associated with procedure-related colonic perforation. 12/30/2011
Udayakumar Navaneethan, Bo Shen Pros and cons of medical management of ulcerative colitis Ulcerative colitis (UC) is a chronic inflammatory disease characterized by diffuse mucosal inflammation limited to the colon and rectum. Although a complete medical cure may not be possible, UC can be treated with medications that induce and maintain remission. The medical management of this disease... 12/2/2011
Udayakumar Navaneethan, Anuja Choure, Preethi G K Venkatesh, Jeffrey Hammel, Jingmei Lin, John R Goldblum, Elena Manilich, Ravi P Kiran, Feza H Remzi, Bo Shen Presence of concomitant inflammatory bowel disease is associated with an increased risk of postcholecystectomy complications CONCLUSIONS: IBD patients undergoing cholecystectomy have a significantly increased risk of postoperative complications. Although further studies are warranted to clarify the reason for these differences, caution should be taken to determine the need and timing of cholecystectomy in IBD patients. 11/10/2011
Udayakumar Navaneethan, Xiuli Liu, Ana E Bennett, R Matthew Walsh, Preethi G K Venkatesh, Bo Shen IgG4-associated ampullitis and cholangiopathy in Crohns disease Inflammatory bowel disease (IBD) is reported to be associated with autoimmune pancreatitis and IgG4-related sclerosing disease. We report a case of a 28 year old African American male with a long history of upper gastrointestinal tract Crohn's disease (CD) with multiple surgeries who developed medic... 9/24/2011
Udayakumar Navaneethan, Preethi G K Venkatesh, Mayar Al Mohajer, Andres Gelrud Successful diagnosis and management of biliary cast syndrome in a liver transplant patient using single operator cholangioscopy CONCLUSION: Single operator cholangioscopy provides a safe means of diagnosing and treating patients with biliary cast syndrome. 9/10/2011
Bo Shen, Ana E Bennett, Udayakumar Navaneethan, Lei Lian, Zhuo Shao, Ravi P Kiran, Victor W Fazio, Feza H Remzi Primary sclerosing cholangitis is associated with endoscopic and histologic inflammation of the distal afferent limb in patients with ileal pouch-anal anastomosis CONCLUSIONS: Concurrent PSC appears to be associated with a significant prepouch ileitis on endoscopy and histology in patients with IPAA. Pouch patients with long segment of ileitis should be evaluated for PSC. 8/11/2011
J L Goldstein, F K L Chan, A Lanas, C M Wilcox, D Peura, G H Sands, M F Berger, H Nguyen, J M Scheiman Haemoglobin decreases in NSAID users over time an analysis of two large outcome trials CONCLUSION: IN these two large, independent trials, clinically-meaningful decreases in haemoglobin ≥ 2 g/dL occurred in a relatively similar fashion over time despite differences in trial designs. 8/4/2011
Preethi Gk Venkatesh, Udayakumar Navaneethan, Bo Shen Hepatobiliary disorders and complications of inflammatory bowel disease One of typical examples of liver-gut cross talk is the interaction and impact of inflammatory bowel disease (IBD) and hepatobiliary (HB) abnormalities on each other's disease course. There are several layers of association between IBD and HB diseases: (i) HB diseases and IBD share pathogenetic mecha... 7/28/2011
Shyam Varadarajulu, Ji Young Bang, Milind A Phadnis, John D Christein, C Mel Wilcox Endoscopic transmural drainage of peripancreatic fluid collections outcomes and predictors of treatment success in 211 consecutive patients CONCLUSIONS: Endoscopic therapy is a highly effective technique for the management of patients with non-necrotic peripancreatic fluid collections. 7/26/2011
U Navaneethan, D Schauer, R Giannella Awareness about clostridium difficile infection among internal medicine residents in the United States CONCLUSION: IM residents had suboptimal knowledge of many aspects of the common problem of CDI. Educational efforts should be directed at IM residents, many of whom plan careers as primary care/hospitalists, who will encounter patients with CDI. 7/20/2011
Yang K Chen, Mansour A Parsi, Kenneth F Binmoeller, Robert H Hawes, Douglas K Pleskow, Adam Slivka, Oleh Haluszka, Bret T Petersen, Stuart Sherman, Jacques Devière, Søren Meisner, Peter D Stevens, Guido Costamagna, Thierry Ponchon, Joyce A Peetermans, Horst Neuhaus Single-operator cholangioscopy in patients requiring evaluation of bile duct disease or therapy of biliary stones with videos CONCLUSIONS: Evaluation of bile duct disease and biliary stone therapy can be safely performed with a high success rate by using the SOC system. 7/19/2011
Guru Trikudanathan, Udayakumar Navaneethan, Santhi Swaroop Vege Intra-abdominal fungal infections complicating acute pancreatitis a review Intra-abdominal infections of pancreatic or peripancreatic necrotic tissue complicate the clinical course of severe acute pancreatitis (SAP) and are associated with significant morbidity. Fungal infection of necrotic pancreatic tissue is increasingly being reported. The incidence of intra-abdominal ... 7/7/2011
Udayakumar Navaneethan, Preethi G K Venkatesh, Sumit Kapoor, Ravi P Kiran, Feza H Remzi, Bo Shen Elevated serum IgG4 is associated with chronic antibiotic-refractory pouchitis CONCLUSIONS: Approximately 8% of pouch patients presenting with symptoms of pouch dysfunction to our clinic had elevated serum IgG4. Patients with elevated serum IgG4 were more likely to have CARP. 7/5/2011
Udayakumar Navaneethan, Preethi G K Venkatesh, Elena Manilich, Ravi P Kiran, Feza H Remzi, Bo Shen Prevalence and clinical implications of positive serum anti-microsomal antibodies in symptomatic patients with ileal pouches CONCLUSIONS: Anti-microsomal antibodies were common in pouch patients presenting with symptoms. Patients with positive anti-microsomal antibodies were much more likely to have concurrent AID and PSC. These patients were more likely to require therapy with steroids. 7/1/2011
C Mel Wilcox, Byron L Cryer, Henry J Henk, Victoria Zarotsky, Gergana Zlateva Mortality associated with gastrointestinal bleeding events Comparing short-term clinical outcomes of patients hospitalized for upper GI bleeding and acute myocardial infarction in a US managed care setting CONCLUSIONS: GI bleeding events result in significant mortality similar to that of an AMI after adjusting for the initial hospitalization. 6/23/2011
Udayakumar Navaneethan, Preethi G K Venkatesh, Jiang Wang Cytomegalovirus ileitis in a patient after liver transplantation-differentiating from de novo IBD Cytomegalovirus (CMV) infection of the gastrointestinal (GI) tract has been reported in immunocompromised patients and is seen following liver transplantation. Although CMV infection can affect any part of the GI tract, involvement of the terminal ileum is rarely encountered after liver transplantat... 6/21/2011
Arun Raghav Mahankali Sridhar, Sravanthi Parasa, Udayakumar Navaneethan, Michael D Crowell, Kevin Olden Comprehensive study of cardiovascular morbidity in hospitalized inflammatory bowel disease patients CONCLUSIONS: Our study substantiates the previously reported associations of mesenteric ischemia and venous thrombotic disorders with IBD. Our study also suggests that young females with IBD might have an increased risk for dysrhythmias. 6/21/2011
Nicholas J Shaheen, Bergein F Overholt, Richard E Sampliner, Herbert C Wolfsen, Kenneth K Wang, David E Fleischer, Virender K Sharma, Glenn M Eisen, M Brian Fennerty, John G Hunter, Mary P Bronner, John R Goldblum, Ana E Bennett, Hiroshi Mashimo, Richard I Rothstein, Stuart R Gordon, Steven A Edmundowicz, Ryan D Madanick, Anne F Peery, V Raman Muthusamy, Kenneth J Chang, Michael B Kimmey, Stuart J Spechler, Ali A Siddiqui, Rhonda F Souza, Anthony Infantolino, John A Dumot, Gary W Falk, Joseph A Galanko, Blair A Jobe, Robert H Hawes, Brenda J Hoffman, Prateek Sharma, Amitabh Chak, Charles J Lightdale Durability of radiofrequency ablation in Barretts esophagus with dysplasia CONCLUSIONS: In subjects with dysplastic BE, RFA therapy has an acceptable safety profile, is durable, and is associated with a low rate of disease progression, for up to 3 years. 6/18/2011
Henit Yanai, Geoffrey C Nguyen, Laura Yun, Oscar Lebwohl, Udayakumar Navaneethan, Christian D Stone, Leyla Ghazi, Paul Moayyedi, Jeffrey Brooks, Charles N Bernstein, Shomron Ben-Horin Practice of gastroenterologists in treating flaring inflammatory bowel disease patients with clostridium difficile antibiotics alone or combined antibioticsimmunomodulators CONCLUSIONS: There is significant disagreement among gastroenterologists on whether combination AB+IM or AB alone should be given to IBD patients with CDI-associated flares. Controlled trials are needed to investigate the optimal management approach to this clinical dilemma. 6/16/2011
Shyam Varadarajulu, Milind A Phadnis, John D Christein, C Mel Wilcox Multiple transluminal gateway technique for EUS-guided drainage of symptomatic walled-off pancreatic necrosis CONCLUSION: The EUS-guided MTGT is an effective treatment option for the management of symptomatic walled-off pancreatic necrosis because it obviates the need for surgery and endoscopic necrosectomy and its attendant procedure-related morbidity. Prospective studies are required to confirm these prel... 5/27/2011
Preethi G K Venkatesh, Udayakumar Navaneethan, Santhi Swaroop Vege Intraductal papillary mucinous neoplasm and acute pancreatitis Intraductal papillary mucinous neoplasms (IPMNs) are cystic pancreatic tumors that arise from the pancreatic ducts and are increasingly reported worldwide. Both benign and malignant tumors of the pancreas are thought to contribute to recurrent pancreatitis possibly by pancreatic duct obstruction, an... 5/24/2011
Udayakumar Navaneethan, Sravanthi Parasa, Preethi G K Venkatesh, Guru Trikudanathan, Bo Shen Prevalence and risk factors for colonic perforation during colonoscopy in hospitalized inflammatory bowel disease patients CONCLUSIONS: There appears to be a higher risk of colonoscopy-associated perforation in IBD inpatients than non-IBD controls. In addition, older age, female patients and endoscopic dilations appeared to be associated with an increased risk for perforation. 5/18/2011
Shyam Varadarajulu, John D Christein, Charles Mel Wilcox Frequency of complications during EUS-guided drainage of pancreatic fluid collections in 148 consecutive patients CONCLUSIONS: Complications are rare during EUS-guided drainage of PFC and can be managed successfully in most patients. 5/18/2011
Preethi G K Venkatesh, Udayakumar Navaneethan Azathioprine induced pancreatitis in a patient with co-existing autoimmune pancreatitis and hepatitis CONCLUSIONS: Future studies to investigate the risk of azathioprine induced pancreatitis in the presence of underlying disease of the pancreas including autoimmune pancreatitis are required to further understand the safety of azathioprine in this sub group of patients. 5/7/2011
Ji Young Bang, Shyam Varadarajulu Pediatrics ERCP in children Although endoscopic retrograde cholangiopancreatography (ERCP) is a well-established technique for both the diagnosis and treatment of biliary and pancreatic disorders in adults, indications for some pediatric applications, such as idiopathic and recurrent pancreatitis, remain contentious. This News... 4/14/2011
Xiaohan Cai, Yiding Liu, Xiang Zhou, Udayakumar Navaneethan, Bo Shen, Baochuan Guo An LC-ESI-MS method for the quantitative analysis of bile acids composition in fecal materials In this work, a liquid chromatography coupled with electrospray ionization mass spectrometry (LC-ESI-MS) method was developed and validated for quantification of bile acids in fecal materials. Co-eluting matrix impurities in fecal materials have been shown to greatly suppress the ionization of analy... 4/6/2011
Udayakumar Navaneethan, Elisha Lancaster, Preethi G K Venkatesh, Jiang Wang, Guy W Neff Herpes simplex virus hepatitis - its high time we consider empiric treatment Fulminant hepatitis is an uncommon complication of herpes simplex virus infection. Patients at risk, in particular pregnant women and immunosuppressed patients presenting with fulminant liver failure, receiving delayed acyclovir intervention may lose significant liver parenchyma prompting the need f... 4/1/2011
Christopher Decker, John D Christein, Milind A Phadnis, C Mel Wilcox, Shyam Varadarajulu Biliary metal stents are superior to plastic stents for preoperative biliary decompression in pancreatic cancer CONCLUSIONS: SEMS are superior to plastic stents for preoperative biliary decompression in pancreatic cancer. 3/5/2011
U Navaneethan, V Jayanthi, P Mohan Pathogenesis of cholangitis in obstructive jaundice-revisited Obstructive jaundice produces a number of biochemical and physiologic alterations in the biliary tract. Acute cholangitis occurs in an infected, usually obstructed biliary system, at the level of the common bile duct. The most common cause of obstruction is stones. Bacterial reflux from the biliary ... 3/5/2011
Revital Kariv, Udayakumar Navaneethan, Preethi G K Venkatesh, Rocio Lopez, Bo Shen Impact of Clostridium difficile infection in patients with ulcerative colitis CONCLUSIONS: Recent antibiotic exposure was a risk factor for CDI in UC patients. Interestingly, CDI does not seem to adversely affect short-term adverse clinical outcome (colectomy). 1/29/2011
Dhiraj Yadav, Adam Slivka, Stuart Sherman, Robert H Hawes, Michelle A Anderson, Frank R Burton, Randall E Brand, Michele D Lewis, Timothy B Gardner, Andres Gelrud, James Disario, Stephen T Amann, John Baillie, Christopher Lawrence, Michael O'Connell, Albert B Lowenfels, Peter A Banks, David C Whitcomb Smoking is underrecognized as a risk factor for chronic pancreatitis CONCLUSIONS: Physicians often underrecognize smoking as a CP risk factor. Efforts are needed to raise awareness of the association between smoking and CP. and IAP. 1/19/2011
C Mel Wilcox, Toni Seay, Justin T Arcury, Jean Mohnen, Basil I Hirschowitz Zollinger-Ellison syndrome presentation, response to therapy, and outcome CONCLUSIONS: The clinical presentation of Zollinger-Ellison syndrome was similar to prior reports. Acid hypersecretion was controlled in all patients with variable doses of lansoprazole. Long-term survival was principally related to underlying co-morbidity. 1/4/2011
Udayakumar Navaneethan, Nyingi Kemmer, Guy W Neff Predicting the probable outcome of treatment in HCV patients Hepatitis C virus (HCV) is a major cause of chronic liver disease infecting more than 170 million people worldwide. HCV produces a wide gamut of manifestations varying from mild self-limiting disease to cirrhosis and hepatocellular carcinoma. A variety of viral, environmental and host genetic factor... 12/25/2010
Daniel K Mullady, Dhiraj Yadav, Stephen T Amann, Michael R O'Connell, Michael M Barmada, Grace H Elta, James M Scheiman, Erik-Jan Wamsteker, William D Chey, Meredith L Korneffel, Beth M Weinman, Adam Slivka, Stuart Sherman, Robert H Hawes, Randall E Brand, Frank R Burton, Michele D Lewis, Timothy B Gardner, Andres Gelrud, James DiSario, John Baillie, Peter A Banks, David C Whitcomb, Michelle A Anderson, NAPS2 Consortium Type of pain, pain-associated complications, quality of life, disability and resource utilisation in chronic pancreatitis a prospective cohort study CONCLUSIONS: This is the largest study ever conducted of pain in CP. These findings suggest that the temporal nature of pain is a more important determinant of health-related QOL and healthcare utilisation than pain severity. In contrast to previous studies, the pain associated with CP was not found... 12/15/2010
C Mel Wilcox, Shyam Varadarajulu, Desiree Morgan, John Christein Progress in the management of necrotizing pancreatitis Pancreatic necrosis, a complication of severe pancreatitis, may become infected, resulting in significant morbidity and potential mortality. Infected necrosis was heretofore considered a surgical condition, and despite aggressive operative management, the mortality remained high. With a better under... 11/27/2010
Charles Mel Wilcox, Toni Seay, Justin Arcury, Basil I Hirschowitz Presentation, response to lansoprazole therapy, and outcome of Zollinger-Ellison syndrome-like gastric acid hypersecretors CONCLUSIONS: ZES-like gastric acid hypersecretion presents similarly to the classic syndrome. Lansoprazole titrated to gastric acid output is effective in healing mucosal disease and preventing relapse. 11/16/2010
Udayakumar Navaneethan, Preethi G K Venkatesh Idiopathic hyperammonemia in a patient with total pancreatectomy and islet cell transplantation CONCLUSION: Idiopathic hyperammonemia in the setting of total pancreatectomy and islet cell transplantation has not been reported before. We propose that malnutrition following total pancreatectomy resulting in repressed urea cycle enzyme synthesis may have predisposed for this hyperammonemia. 11/12/2010
Peter B Cotton, Valerie Durkalski, Kyle B Orrell, Olga Brawman-Mintzer, Douglas A Drossman, C Mel Wilcox, Patrick D Mauldin, Grace H Elta, Paul R Tarnasky, Evan L Fogel, Sanjay B Jagganath, Richard A Kozarek, Martin L Freeman, Joseph Romagnuolo, Patricia R Robuck Challenges in planning and initiating a randomized clinical study of sphincter of Oddi dysfunction CONCLUSION: The planning process was challenging, and some changes were needed after initiation. 11/2/2010
Jason A Wilson, Brenda Hoffman, Robert H Hawes, Joseph Romagnuolo EUS in patients with surgically altered upper GI anatomy CONCLUSION: EUS is generally successful and safe in patients with surgically altered anatomy in this tertiary-care setting, and a very low rate of adverse events is possible. Exceptions included imaging the HOP and CBD after Roux-en-Y surgery. After Billroth II surgery, if the afferent limb was intu... 11/2/2010
Gregory A Coté, Dhiraj Yadav, Adam Slivka, Robert H Hawes, Michelle A Anderson, Frank R Burton, Randall E Brand, Peter A Banks, Michele D Lewis, James A Disario, Timothy B Gardner, Andres Gelrud, Stephen T Amann, John Baillie, Mary E Money, Michael O'Connell, David C Whitcomb, Stuart Sherman, North American Pancreatitis Study Group Alcohol and smoking as risk factors in an epidemiology study of patients with chronic pancreatitis CONCLUSIONS: The frequency of alcohol-related CP at tertiary US referral centers is lower than expected. Idiopathic CP and nonalcohol etiologies represent a large subgroup, particularly among women. Smoking is an independent risk factor for idiopathic CP. 10/30/2010
Udayakumar Navaneethan, Preethi Gk Venkatesh, Bo Shen Clostridium difficile infection and inflammatory bowel disease understanding the evolving relationship Clostridium difficile (C. difficile) infection (CDI) is the leading identifiable cause of antibiotic-associated diarrhea. While there is an alarming trend of increasing incidence and severity of CDI in the United States and Europe, superimposed CDI in patients with inflammatory bowel disease (IBD) h... 10/19/2010
Udayakumar Navaneethan, Bo Shen Diagnosis and management of pouchitis and ileoanal pouch dysfunction Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) has become the surgical treatment of choice for patients with medically refractory ulcerative colitis (UC) or UC with dysplasia and for the majority of patients with familial adenomatous polyposis. However, UC patients with IPAA ar... 10/5/2010
N J Shaheen, A F Peery, R H Hawes, R I Rothstein, S J Spechler, J A Galanko, M Campbell, C Carr, B Fowler, J Walsh, A A Siddiqui, A Infantolino, H C Wolfsen, AIM Dysplasia Trial Investigators Quality of life following radiofrequency ablation of dysplastic Barretts esophagus CONCLUSIONS: Inclusion in the treatment group of this randomized, sham-controlled trial of RFA was associated with improvement in disease-specific health-related quality of life. This improvement appears secondary to a perceived decrease in the risk of cancer. 10/2/2010
Daniel Baumann, Anatoly Dymarsky, Shamit Kachru, Igor R Klebanov, Liam McAllister Effects of compactification in D-brane inflation In D3-brane inflation, the inflaton potential receives important contributions from sources in the compact space, such as fluxes, other D-branes, and orientifold planes. Most previous analyses have considered only the effects of sources near to the inflationary D3-brane, but in fact distant sources ... 9/28/2010
Udayakumar Navaneethan, Ralph A Giannella Infectious colitis PURPOSE OF REVIEW: The incidence of gastrointestinal infections continues to increase and infectious colitis contributes to significant morbidity and mortality worldwide. The purpose of this review is to highlight the recent advances in knowledge of pathogens causing infectious colitis. We describe ... 9/22/2010
George B Smallfield, Jeroan Allison, C Mel Wilcox Prospective evaluation of quality of life in patients with Zollinger-Ellison syndrome CONCLUSIONS: Patients with medically managed ZES have norm-based estimates of the mental component scores as measured by the SF-36v2 that approximate normal values, while the physical component scores were decreased with this reduction largely explained by co-morbid illness. 9/9/2010
Venkata Muddana, James Park, Janette Lamb, Dhiraj Yadav, Georgios I Papachristou, Robert H Hawes, Randall Brand, Adam Slivka, David C Whitcomb Are genetic variants in the platelet-derived growth factor beta gene associated with chronic pancreatitis CONCLUSIONS: Known variations in the PDGF-[beta] gene do not have a significant effect on promoting or preventing fibrogenesis in pancreatitis. Further evaluation of this important pathway is warranted. 8/19/2010
Christopher Lawrence, M Faisal Siddiqi, Jonathan N Hamilton, Thomas E Keane, Joseph Romagnuolo, Robert H Hawes, Peter B Cotton Chronic calcific pancreatitis combination ERCP and extracorporeal shock wave lithotripsy for pancreatic duct stones CONCLUSIONS: A multidisciplinary approach, combining ERCP and ESWL, to painful obstructing pancreatic duct stones provided symptomatic improvement and allowed pancreatic surgery to be avoided in the majority of patients. 8/17/2010
Robert H Hawes The evolution of endoscopic ultrasound improved imaging, higher accuracy for fine needle aspiration and the reality of endoscopic ultrasound-guided interventions PURPOSE OF REVIEW: Endoscopic ultrasound (EUS) is one of the fastest growing areas within gastrointestinal endoscopy. Although the growth in the United States has been steady, EUS is exploding in areas of Asia and Eastern Europe. As utilization of EUS is increasing, so is the evolution of the discip... 8/13/2010
Christopher Lawrence, Joseph Romagnuolo, K Mark Payne, Robert H Hawes, Peter B Cotton Low symptomatic premature stent occlusion of multiple plastic stents for benign biliary strictures comparing standard and prolonged stent change intervals CONCLUSION: Multiple plastic biliary stents for benign nonhilar strictures were associated with a low rate of premature symptomatic stent occlusion at more than 6 months and a longer occlusion-free survival. 7/20/2010
C Mel Wilcox, Milind Phadnis, Shyam Varadarajulu Biliary stent placement is associated with post-ERCP pancreatitis CONCLUSIONS: Bile duct stent placement is an independent predictor for pancreatitis, and pancreatitis is not related to performing sphincterotomy before stenting or to stent characteristics. 7/17/2010
Nicholas J Shaheen, Anne F Peery, Bergein F Overholt, Charles J Lightdale, Amitabh Chak, Kenneth K Wang, Robert H Hawes, David E Fleischer, John R Goldblum, AIM Dysplasia Investigators Biopsy depth after radiofrequency ablation of dysplastic Barretts esophagus CONCLUSIONS: In both squamous and columnar tissue, endoscopic biopsy samples after RFA were as likely to demonstrate subepithelium as untreated controls. Almost 80% of all biopsy samples were adequate to evaluate for subsquamous intestinal metaplasia. The primary determinant of biopsy depth is the t... 7/6/2010
Kanwar R Gill, Marwan S Ghabril, Laith H Jamil, Muhammad K Hasan, Rebecca B McNeil, Timothy A Woodward, Massimo Raimondo, Brenda J Hoffman, Robert H Hawes, Joseph Romagnuolo, Michael B Wallace Endosonographic features predictive of malignancy in mediastinal lymph nodes in patients with lung cancer CONCLUSION: Among patients with lung cancer, EUS features of round shape, sharp margins, and short axis of >8.3 mm are significant predictors of malignancy. The probability of malignancy is low when none of the features are present. 6/15/2010
Colin Brown, Venkataraman Subramanian, C Mel Wilcox, Shajan Peter Somatostatin analogues in the treatment of recurrent bleeding from gastrointestinal vascular malformations an overview and systematic review of prospective observational studies CONCLUSIONS: A significant number of patients with bleeding gastrointestinal angiodysplasia respond to treatment with octreotide by reducing the need for blood products. As all the included studies had small sample sizes, multicenter randomized trials are needed to confirm these findings. However, i... 4/16/2010
Tercio L Lopes, C Mel Wilcox Endoscopic retrograde cholangiopancreatography in patients with Roux-en-Y anatomy Bariatric surgery has been increasingly performed in response to the obesity pandemic. During the last decade, Roux-en-Y gastric bypass (RYGB) has become the preferred surgical approach. It is also commonly performed after pylorus preserving pancreaticoduodenectomy and other biliary tract surgeries.... 3/6/2010
Udayakumar Navaneethan, Bo Shen Hepatopancreatobiliary manifestations and complications associated with inflammatory bowel disease Diseases involving the hepatopancreatobiliary (HPB) system are frequently encountered in patients with inflammatory bowel disease (IBD). Hepatobiliary manifestations constitute some of the most common extraintestinal manifestations of IBD. They appear to occur with similar frequency in patients with... 3/4/2010
U Navaneethan, V Jayanthi Nutritional support in acute pancreatitis when to start oral feeds Nutritional support in acute pancreatitis had always been a subject of great controversy in the past. The results of the recently published meta-analysis however have shown improved outcome with enteral feeding when compared to parenteral nutrition in patients with severe acute pancreatitis. However... 3/2/2010
U Navaneethan, J Venkataraman Recent advancements in the pathogenesis of pain in chronic pancreatitis the argument continues Chronic pancreatitis is a state of chronic inflammation characterized by progressive destruction of the pancreas. Pancreatic pain, a cardinal symptom in chronic pancreatitis patients has always been a subject of great interest and controversy. The precise mechanism of pain and its persistence in chr... 3/2/2010
Hong Lu, Lei Lian, Udayakumar Navaneethan, Bo Shen Clinical utility of C-reactive protein in patients with ileal pouch anal anastomosis CONCLUSIONS: Serum CRP levels correlated with endoscopic inflammation in the pouch and afferent limb. Elevated CRP levels might be useful to monitor the degree of inflammatory activity in pouch noninvasively. However, the CRP level as a snapshot had a limited role in distinction between healthy and ... 2/27/2010
B L Cryer, C M Wilcox, H J Henk, G Zlateva, L Chen, V Zarotsky The economics of upper gastrointestinal bleeding in a US managed-care setting a retrospective, claims-based analysis CONCLUSIONS: Patients with UGI bleeds experienced significantly higher (p< 0.0001) 12-month health-resource utilization and costs than patients without UGI bleeds. This study provides empirical evidence of the long-term economic burden associated with UGI bleeding. Interpretation of the results shou... 1/6/2010
Udayakumar Navaneethan, Santhi Swaroop Vege, Suresh T Chari, Todd H Baron Minimally invasive techniques in pancreatic necrosis Traditional open surgical necrosectomy for treatment of infected pancreatic necrosis is associated with high morbidity and mortality, leading to a shift toward minimally invasive endoscopic, radiologic, and laparoscopic approaches. Percutaneous drainage is useful as a temporizing method to control s... 10/27/2009
Tercio L Lopes, Ronald H Clements, C Mel Wilcox Laparoscopy-assisted ERCP experience of a high-volume bariatric surgery center with video CONCLUSION: LAERCP is safe and successful for the diagnosis and therapy of biliopancreatic conditions in patients with RY. It additionally allows the diagnosis and treatment of internal hernias, a known complication of RYGB. 10/23/2009
Udayakumar Navaneethan, Bo Shen Pros and cons of antibiotic therapy for pouchitis Restorative proctocolectomy with ileal pouch-anal anastomosis has become the surgical treatment of choice for patients with medically refractory ulcerative colitis or ulcerative colitis with dysplasia and for the majority of patients with familial adenomatous polyposis. However, pouchitis and other ... 10/13/2009
Tercio L Lopes, Ronald H Clements, C Mel Wilcox Laparoscopy-assisted transjejunal ERCP in a patient with Roux-en-Y reconstruction following partial gastrectomy In this article, we report a patient with a history of partial gastrectomy and Roux-en-Y reconstruction who presented with abdominal pain due to sphincter of Oddi dysfunction. After failed endoscopic retrograde cholangiopancreatography (ERCP) through the anatomic route, the procedure was successfull... 10/2/2009
Udayakumar Navaneethan, Bo Shen Secondary pouchitis those with identifiable etiopathogenetic or triggering factors Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the surgical treatment of choice for the majority of patients with medically refractory ulcerative colitis (UC) or UC with dysplasia, or familial adenomatous polyposis. Various forms of pouchitis frequently occur after surgery. ... 9/17/2009
C M Wilcox, Tercio L Lopes A randomized trial comparing endoscopic stenting to a sham procedure for chronic pancreatitis CONCLUSION: The proposed study represents the first trial of endoscopic stenting for symptomatic CP and ductal strictures with a credible sham procedure, assessment of multiple dimensions of pain, and psychosocial factors. 9/10/2009
Udayakumar Navaneethan, Bo Shen Laboratory tests for patients with ileal pouch-anal anastomosis clinical utility in predicting, diagnosing, and monitoring pouch disorders Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the surgical treatment of choice for patients with medically refractory ulcerative colitis (UC) or UC-associated dysplasia, and for the majority of patients with familial adenomatous polyposis. Pouchitis and other complications ... 7/16/2009
Basil I Hirschowitz, Naomi Fineberg, C Mel Wilcox, Jean Mohnen, Julie Worthington Costs and risks in the management of patients with gastric acid hypersecretion CONCLUSIONS: Relapse is infrequent and generally mild with acid secreting status closely monitored. The ideal strategy to balance costs and testing awaits further study. 7/8/2009
Udayakumar Navaneethan, Jijo V Cherian, Rajesh Prabhu, Jayanthi Venkataraman Distinguishing tuberculosis and Crohns disease in developing countries how certain can you be of the diagnosis Distinguishing tuberculosis and Crohn's disease in patients presenting with chronic abdominal pain and diarrhea is a huge diagnostic challenge, particularly in tuberculosis endemic countries. A large number of patients with Crohn's disease are initially misclassified as having Intestinal tuberculosi... 7/2/2009
Udayakumar Navaneethan, Feza H Remzi, Benjamin Nutter, Victor W Fazio, Bo Shen Risk factors for abnormal liver function tests in patients with ileal pouch-anal anastomosis for underlying inflammatory bowel disease CONCLUSIONS: Abnormal LFTs were common in patients with IPAA in this cohort. The presence of co-existing autoimmune disorder, a family history of IBD, extensive colitis before colectomy, the presence of PSC, and a high BMI appear to be a significant risk factors for abnormal LFTs. Whether abnormal L... 6/25/2009
Dhiraj Yadav, Robert H Hawes, Randall E Brand, Michelle A Anderson, Mary E Money, Peter A Banks, Michele D Bishop, John Baillie, Stuart Sherman, James DiSario, Frank R Burton, Timothy B Gardner, Stephen T Amann, Andres Gelrud, Christopher Lawrence, Beth Elinoff, Julia B Greer, Michael O'Connell, M Michael Barmada, Adam Slivka, David C Whitcomb, North American Pancreatic Study Group Alcohol consumption, cigarette smoking, and the risk of recurrent acute and chronic pancreatitis CONCLUSIONS: Very heavy alcohol consumption and smoking are independent risks for CP. A minority of patients with pancreatitis currently seen at US referral centers report very heavy drinking. 6/10/2009
Burr J Loew, Douglas A Howell, Michael K Sanders, David J Desilets, Paul P Kortan, Gary R May, Raj J Shah, Yang K Chen, Willis G Parsons, Robert H Hawes, Peter B Cotton, Adam A Slivka, Jawad Ahmad, Glen A Lehman, Stuart Sherman, Horst Neuhaus, Brigitte M Schumacher Comparative performance of uncoated, self-expanding metal biliary stents of different designs in 2 diameters final results of an international multicenter, randomized, controlled trial CONCLUSIONS: SEMS occlusions were much more frequent with a 6-mm diameter SEMS and equivalent in the two 10-mm arms despite major differences in stent design, material, and expansion, suggesting that diameter is the critical feature. Malignant tumor ingrowth produced only a minority of the documente... 6/2/2009
Nicholas J Shaheen, Prateek Sharma, Bergein F Overholt, Herbert C Wolfsen, Richard E Sampliner, Kenneth K Wang, Joseph A Galanko, Mary P Bronner, John R Goldblum, Ana E Bennett, Blair A Jobe, Glenn M Eisen, M Brian Fennerty, John G Hunter, David E Fleischer, Virender K Sharma, Robert H Hawes, Brenda J Hoffman, Richard I Rothstein, Stuart R Gordon, Hiroshi Mashimo, Kenneth J Chang, V Raman Muthusamy, Steven A Edmundowicz, Stuart J Spechler, Ali A Siddiqui, Rhonda F Souza, Anthony Infantolino, Gary W Falk, Michael B Kimmey, Ryan D Madanick, Amitabh Chak, Charles J Lightdale Radiofrequency ablation in Barretts esophagus with dysplasia CONCLUSIONS: In patients with dysplastic Barrett's esophagus, radiofrequency ablation was associated with a high rate of complete eradication of both dysplasia and intestinal metaplasia and a reduced risk of disease progression. (ClinicalTrials.gov number, NCT00282672.) 5/29/2009
Nathaniel S Winstead, C Mel Wilcox Clinical trials of pancreatic enzyme replacement for painful chronic pancreatitis--a review Painful chronic pancreatitis is a challenging problem for clinicians and patients. Many patients receive a therapeutic trial of pancreatic enzyme supplementation at some point in the course of their disease, but it is unclear what the expected outcome of such a trial should be and whether or not all... 5/20/2009
Muhammad Shaalan Beg, Udayakumar Navaneethan, Muslim Atiq, Rami Komrokji, Malek Safa Outcome of esophageal carcinoma in the veteran affairs population a comparative analysis from the Veteran Affairs Central Cancer Registry CONCLUSIONS: In nonmetastatic esophageal cancer at the VA, SCC has worse outcome as compared with AC. Blacks with AC have worse outcome than whites. Despite equal access to health care blacks are less likely to undergo surgery, which may contribute to their worse outcome. We recommend further studie... 5/13/2009
C Mel Wilcox, Basil I Hirschowitz Treatment strategies for Zollinger-Ellison syndrome BACKGROUND: Zollinger-Ellison syndrome (ZES) is a rare disorder caused by tumor secretion of the hormone gastrin, which results in gastric acid hypersecretion and secondarily complicated peptic ulcer and diarrhea. Until the development of H(2)-receptor antagonists and later proton pump inhibitors (P... 4/9/2009
Udayakumar Navaneethan, Ralph A Giannella Thinking beyond the colon-small bowel involvement in clostridium difficile infection Small intestinal Clostridium difficile seems to be increasing in incidence. The spectrum of Clostridium difficile infection (CDI) has definitely expanded with small bowel involvement. They are more frequently reported in patients with inflammatory bowel disease (IBD) who have undergone total colecto... 4/3/2009
B Sumathi, S Ramalingam, U Navaneethan, V Jayanthi Risk factors for gastric cancer in South India CONCLUSION: The study showed alcohol and pickled food consumption as independent risk factors for the development of gastric cancer, while consumption of pulses were protective. Cigarette smoking did not predict an increased risk of contracting the disease. 3/20/2009
Wayne Tsuang, Udayakumar Navaneethan, Luis Ruiz, Joseph B Palascak, Andres Gelrud Hypertriglyceridemic pancreatitis presentation and management Hypertriglyceridemia (HTG) is reported to cause 1-4% of acute pancreatitis (AP) episodes. HTG is also implicated in more than half of gestational pancreatitis cases. Disorders of lipoprotein metabolism are conventionally divided into primary (genetic) and secondary causes, including diabetes, hypoth... 3/19/2009
Christopher Lawrence, Joseph Romagnuolo, Peter B Cotton, K Mark Payne, Robert H Hawes Post-ERCP pancreatitis rates do not differ between needle-knife and pull-type pancreatic sphincterotomy techniques a multiendoscopist 13-year experience CONCLUSIONS: The risk of post-ERCP pancreatitis does not differ between EPS techniques when performed at a high-volume pancreaticobiliary referral center when using routine prophylactic pancreatic duct stent placement. 2/28/2009
Shajan Peter, C Mel Wilcox Modern endoscopic therapy of peptic ulcer bleeding Acute upper gastrointestinal bleed (UGIB) remains a challenging clinical problem owing to significant patient morbidity and costs involved with management. Peptic ulcer bleeding (PUB) contributes to the majority of causes of UGIB with a growing concern of its impact on the elderly and the increasing... 2/4/2009
Asif Khalid, Maliha Zahid, Sydney D Finkelstein, Julia K LeBlanc, Neeraj Kaushik, Nuzhat Ahmad, William R Brugge, Steven A Edmundowicz, Robert H Hawes, Kevin M McGrath Pancreatic cyst fluid DNA analysis in evaluating pancreatic cysts a report of the PANDA study CONCLUSIONS: Elevated amounts of pancreatic cyst fluid DNA, high-amplitude mutations, and specific mutation acquisition sequences are indicators of malignancy. The presence of a k-ras mutation is also indicative of a mucinous cyst. DNA analysis should be considered when cyst cytologic examination is... 1/21/2009
B Sumathi, U Navaneethan, V Jayanthi Appropriateness of indications for diagnostic upper gastrointestinal endoscopy in India CONCLUSION: In the south Indian population with dyspepsia, there were more normal and benign lesions at endoscopy. The optimal cut-off ages for detecting malignancy for both genders were also determined. 1/6/2009
Neelima Reddy, C Mel Wilcox Diagnosis amp; management of cytomegalovirus infections in the GI tract Cytomegalovirus (CMV) infection of the GI tract is a common problem in patients immunosuppressed by HIV or organ transplantation. The esophagus and colon are the most common sites of involvement. Recent developments in diagnosis, such as immunohistochemical staining, shell vial assay and PCR, aid in... 12/17/2008
U Navaneethan, N Kemmer, G W Neff Acquired platelet dysfunction with spontaneous intramuscular hematoma and compartment syndrome in cirrhosis Cirrhosis patients are at high risk for bleeding as a result of decreased platelet counts and impaired function, defective production of coagulation factors and abnormalities in clot lysis. The authors report the case of a 58 year-old man with cryptogenic cirrhosis who presented initially with intra... 12/3/2008
H Neumann, Lc Fry, Cm Wilcox, K M O Nkem U Eller Gastrointestinal imaging in HIV Gastrointestinal opportunistic disorders are common in HIV-infection and are often the index AIDS-defining opportunistic illness. Almost 80% of HIV-infected patients experience gastrointestinal (GI) symptoms at some point during the course of their illness, and the incidence of GI disorders increase... 11/29/2008
Lindsay S Robison, Andrew O Westfall, Michael J Mugavero, Mirjam C Kempf, Stephen R Cole, Jeroan J Allison, James H Willig, James L Raper, C Mel Wilcox, Michael S Saag Short-term discontinuation of HAART regimens more common in vulnerable patient populations The durability of HAART regimens is often limited by antiretroviral toxicity and nonadherence, which lead to virologic failure. We sought to determine sociodemographic and psychosocial patient factors predictive of short-term discontinuation of HAART regimens overall and stratified by the reason for... 11/27/2008
Xiuli Liu, Charles Melbern Wilcox, Laurentia Nodit, Audrey J Lazenby Multiple gastrointestinal stromal tumors and lipomatosis In this report, we describe a 36-year-old man with the synchronous occurrence of multiple gastric gastrointestinal stromal tumors and multiple intestinal lipomas. Multiple, small, and well-circumscribed gastric gastrointestinal stromal tumors (3 mm to 2 cm) were present within the gastrectomy specim... 11/4/2008
Charles Mel Wilcox, Meredith Kilgore Cost minimization analysis comparing diagnostic strategies in unexplained pancreatitis CONCLUSIONS: This cost minimization study identifies EUS as the least costly initial test for the diagnostic evaluation of patients with idiopathic pancreatitis with gallbladder in situ. 10/15/2008
Udayakumar Navaneethan, Ralph A Giannella Mechanisms of infectious diarrhea Infectious diarrhea is an important public health problem worldwide. Research has provided new insights into the mechanisms of diarrhea caused by various pathogens that are classified as noninflammatory, inflammatory or invasive. These three groups of organisms cause two diarrheal syndromes--noninfl... 9/25/2008
David C Whitcomb, Dhiraj Yadav, Slivka Adam, Robert H Hawes, Randall E Brand, Michelle A Anderson, Mary E Money, Peter A Banks, Michele D Bishop, John Baillie, Stuart Sherman, James DiSario, Frank R Burton, Timothy B Gardner, Stephen T Amann, Andres Gelrud, Simon K Lo, Mark T DeMeo, William M Steinberg, Michael L Kochman, Babak Etemad, Christopher E Forsmark, Beth Elinoff, Julia B Greer, Michael O'Connell, Janette Lamb, M Michael Barmada, North American Pancreatic Study Group Multicenter approach to recurrent acute and chronic pancreatitis in the United States the North American Pancreatitis Study 2 NAPS2 CONCLUSION: The NAPS2 consortium has successfully completed a prospective ascertainment of 1,000 subjects with RAP and CP from the USA. These data will be useful in elucidating the environmental, metabolic and genetic conditions, and to investigate the complex interactions that underlie RAP and CP. 9/4/2008
Venkata Muddana, Janette Lamb, Julia-B Greer, Beth Elinoff, Robert H Hawes, Peter B Cotton, Michelle A Anderson, Randall E Brand, Adam Slivka, David C Whitcomb Association between calcium sensing receptor gene polymorphisms and chronic pancreatitis in a US population role of serine protease inhibitor Kazal 1type and alcohol CONCLUSION: Our United States-based study confirmed an association of CASR and CP and for the first time demonstrated that CASR R990G is a significant risk factor for CP. We also conclude that the risk of CP with CASR R990G is increased in subjects with moderate to heavy alcohol consumption. 8/6/2008
Udayakumar Navaneethan, Mayar Al Mohajer, Mohamed T Shata Hepatitis E and pregnancy understanding the pathogenesis Hepatitis E virus (HEV) is a single-stranded RNA virus that causes large-scale epidemics of acute viral hepatitis, particularly in developing countries. In men and non-pregnant women, the disease is usually self-limited and has a case-fatality rate of less than <0.1%. However, in pregnant women, par... 7/30/2008
Shyam Varadarajulu, John D Christein, Ashutosh Tamhane, Ernesto R Drelichman, C Mel Wilcox Prospective randomized trial comparing EUS and EGD for transmural drainage of pancreatic pseudocysts with videos CONCLUSIONS: When available, EUS should be considered as the first-line treatment modality for endoscopic drainage of pancreatic pseudocysts given its high technical success rate. 7/22/2008
C Mel Wilcox Should patients undergoing ERCP be placed in the prone or supine position Endoscopic retrograde cholangiopancreatography (ERCP) is generally performed in the prone or semi-prone position. Compared with the supine position, the left lateral and prone positions are believed to carry a lower risk of aspiration, allow easier intubation of the esophagus and provide a more comf... 7/17/2008
Jessica M Trevino, C Mel Wilcox, Shyam Varadarajulu Endoscopic resection of minor papilla adenomas with video CONCLUSIONS: In experienced hands, endoscopic resection of the minor papilla is technically feasible, safe, and is associated with favorable clinical outcomes. 6/28/2008
Shyam Varadarajulu, Tercio L Lopes, C Mel Wilcox, Ernesto R Drelichman, Meredith L Kilgore, John D Christein EUS versus surgical cyst-gastrostomy for management of pancreatic pseudocysts CONCLUSIONS: EUS-guided cyst-gastrostomy should be considered as a first-line treatment approach for patients with uncomplicated pancreatic pseudocysts, because the procedure is cost saving and is associated with a shorter length of a postprocedure hospital stay when compared with surgical cyst-gast... 6/13/2008
C Mel Wilcox, Toni Martin, Milind Phadnis, Jean Mohnen, Julie Worthington, Basil I Hirschowitz Absence of gastrointestinal infections in a cohort of patients with Zollinger-Ellison syndrome and other acid hypersecretors receiving long-term acid suppression with lansoprazole CONCLUSION: In a cohort of patients with gastric acid hypersecretion in whom acid secretion status was monitored on lansoprazole, all were free of significant gastrointestinal infections on long-term follow-up. 5/30/2008
Ganesh Athappan, M Vijay Balaji, Udhayakumar Navaneethan, P Thirumalikolundusubramanian Acute renal failure in snake envenomation a large prospective study Venomous snakebite is a common problem in India. The aim of this study is to assess the prevalence, risk factors and prognostic factors in snakebite induced acute renal failure and to determine their outcome from a tertiary care center in India. A total of 1548 cases of snakebite admitted to adult m... 5/1/2008
Shyam Varadarajulu, Mohamad A Eloubeidi, C Mel Wilcox The concept of bedside EUS CONCLUSIONS: Bedside EUS is technically feasible, safe, facilitates both diagnosis and therapy, and enables the clinical management of patients who are critically ill. 4/22/2008
Mohamad A Eloubeidi, Shyam Varadarajulu, Shilpa Desai, C Mel Wilcox Value of repeat endoscopic ultrasound-guided fine needle aspiration for suspected pancreatic cancer CONCLUSION: Repeat EUS-FNA is warranted in patients with high clinical suspicion for pancreatic cancer despite indeterminate or negative findings at initial EUS-FNA. 4/10/2008
Robert H Hawes Transition from laboratory to clinical practice in NOTES role of NOSCAR The way to move natural orifice translumenal endoscopic surgery (NOTES) from the laboratory to the clinical arena is to do high-quality research in the areas recommended by the NOSCAR working group representing barriers to NOTES procedures. Additionally, good experimental work needs to be done to de... 4/3/2008
U Navaneethan, V Jayanthi Endoscopic management of biliary leaks The answer for the future Bile duct diseases and biliary leaks are not uncommon complications and their management is challenging. Majority of bile leaks occur secondary to trauma, major liver, gallbladder and biliary tract surgeries. Early recognition of bile leaks by imaging combined with a high clinical suspicion is requi... 3/6/2008
Neelima Reddy, C Mel Wilcox, Ashutosh Tamhane, Mohamad A Eloubeidi, Shyam Varadarajulu Protocol-based medical management of post-ERCP pancreatitis CONCLUSIONS: A protocol-based management strategy was associated with less severe pancreatitis, shorter length of hospital stay, need for fewer imaging studies, and use of antibiotics. Prospective validation of these findings is justified. 3/6/2008
Udayakumar Navaneethan, Jayanthi Venkatraman Herbal drugs in liver disease how safe are they A 24-year-old man presented with jaundice to our center and further evaluation revealed the presence of acute hepatitis E infection, an infection common in India. The patient's parents consulted a traditional medicine practitioner for giving him native medications for jaundice, a practice very commo... 2/28/2008
Kazuki Sumiyama, Christopher J Gostout, Elizabeth Rajan, Timothy A Bakken, Mary A Knipschield, Sydney Chung, Peter B Cotton, Robert H Hawes, Anthony N Kalloo, Sergey V Kantsevoy, Pankaj J Pasricha Pilot study of transesophageal endoscopic epicardial coagulation by submucosal endoscopy with the mucosal flap safety valve technique with videos CONCLUSIONS: The SEMF technique allowed endoscopic access to the upper mediastinum, the pericardium, and the epicardium via the esophagus, along with a minimal intervention on the epicardium. 2/26/2008
C M Wilcox, M S Saag Gastrointestinal complications of HIV infection changing priorities in the HAART era It has now been some 25 years since the initial description of AIDS. Following these observations, the epidemiology, natural history and manifestations of this disease have been well characterised. Intense investigation has better characterised HIV, resulting in the development of effective drug the... 1/22/2008
Ii Kwun Chung, Robert H Hawes Advantages and limitations of endoscopic ultrasonography in the evaluation and management of patients with gastrointestinal submucosal tumors a review Conventional endoscopy can assess the location, mucosal appearance, and consistency of a gastrointestinal submucosal tumor but cannot provide enough information to differentiate the tumor from extraluminal compression by an external structure or from a neoplastic lesion or to determine whether the t... 1/15/2008
Shyam Varadarajulu, Mohamad A Eloubeidi, C Mel Wilcox Prospective evaluation of indeterminate ERCP findings by intraductal ultrasound CONCLUSIONS: A technically easy procedure, IDUS offers unique advantages in the evaluation of patients with indeterminate findings at ERCP. 11/23/2007
P Magno, S A Giday, X Dray, S S Chung, P B Cotton, C J Gostout, R H Hawes, A N Kalloo, P J Pasricha, J J White, L Assumpcao, M R Marohn, K L Gabrielson, S V Kantsevoy A new stapler-based full-thickness transgastric access closure results from an animal pilot trial CONCLUSIONS: Gastrotomy closure with a perorally delivered flexible stapling device created a leak-resistant transmural line of staples followed by full-thickness healing of the gastric wall incision. Increasing the length of the instrument and adding device articulation will further facilitate its ... 10/31/2007
C-W Ko, E J Shin, J M Buscaglia, J O Clarke, P Magno, S A Giday, S S C Chung, P B Cotton, C J Gostout, R H Hawes, P J Pasricha, A N Kalloo, S V Kantsevoy Preliminary pneumoperitoneum facilitates transgastric access into the peritoneal cavity for natural orifice transluminal endoscopic surgery a pilot study in a live porcine model CONCLUSIONS: Creation of a preliminary pneumoperitoneum with a Veress needle facilitates gastric wall puncture and entrance into the peritoneal cavity without injury to adjacent organs, and can improve the safety of NOTES. 10/31/2007
Christine S Ritchie, C Mel Wilcox, Elizabeth Kvale Ethical and medicolegal issues related to percutaneous endoscopic gastrostomy placement Enteral nutrition, in many respects more than other medical interventions, has been in the limelight concerning the ethics of withdrawing or withholding nutritional support. This article describes the ethical and legal issues surrounding enteral nutrition, identifies the elements of informed consent... 10/31/2007
Shyam Varadarajulu, C Mel Wilcox, Ashutosh Tamhane, Mohamad A Eloubeidi, Jeanetta Blakely, Cheri L Canon Role of EUS in drainage of peripancreatic fluid collections not amenable for endoscopic transmural drainage CONCLUSIONS: Because a majority of PFCs can be drained by CTD in a shorter duration, with comparable outcomes, EUS-guided drainage should be reserved mainly for PFCs located at the pancreatic tail, because these are unlikely to cause luminal compression or are technically difficult to access. Also, ... 9/26/2007
C Lawrence, P B Cotton, J Romagnuolo, K M Payne, E Rawls, R H Hawes Small prophylactic pancreatic duct stents an assessment of spontaneous passage and stent-induced ductal abnormalities CONCLUSIONS: Nearly 90 % of prophylactic 3-Fr pancreatic duct stents pass spontaneously within 30 days, and these stents were not observed to induce changes in the pancreatic duct. 9/22/2007
N S Winstead, C M Wilcox Erythromycin prior to endoscopy for acute upper gastrointestinal haemorrhage a cost-effectiveness analysis CONCLUSION: Because of the implications for cost saving and increase in QALY, we would recommend giving erythromycin prior to EGD for UGIH. 9/13/2007
P J Pasricha, R Hawari, I Ahmed, J Chen, P B Cotton, R H Hawes, A N Kalloo, S V Kantsevoy, C J Gostout Submucosal endoscopic esophageal myotomy a novel experimental approach for the treatment of achalasia CONCLUSIONS: Endoscopic submucosal esophageal myotomy is feasible, safe, and effective in the short term. It has the potential for being useful in patients with achalasia. The submucosal space is a novel and potentially important field of operation for endoscopic procedures. 8/21/2007
Nathaniel S Winstead, Charles Melbern Wilcox Health-related quality of life, somatization, and abuse in Sphincter of Oddi dysfunction CONCLUSIONS: Health-related quality of life is impaired and abuse histories are common in SOD patients, and similar to patients with recurrent idiopathic pancreatitis. Whether these characteristics are predictors of healthcare seeking remains to be determined. 8/19/2007
Robert H Hawes Advanced endoscopy and endosurgical procedures do we need a new subspecialty On the horizon is a new paradigm in minimally invasive therapy called natural orifice transluminal endoscopic surgery (NOTES). This new approach will most certainly disrupt both those living in the gut lumen with flexible endoscopes as well as those living in the peritoneal cavity using laparoscopes... 7/21/2007
A W DuPont, M R Arguedas, C M Wilcox Aspirin chemoprevention in patients with increased risk for colorectal cancer a cost-effectiveness analysis CONCLUSION: Aspirin chemoprevention combined with colonoscopic surveillance in post-polypectomy patients may be considered a cost-effective strategy. 7/20/2007
Shyam Varadarajulu, Ashutosh Tamhane, C Mel Wilcox Prospective evaluation of adjunctive ketamine on sphincter of Oddi motility in humans CONCLUSIONS: Ketamine at 20 mg did not significantly affect SOM parameters. Further studies are required to confirm our preliminary findings before ketamine can be added to the armamentarium of agents used for performance of sphincter of Oddi manometry. 6/27/2007
Allison Bridges, C Mel Wilcox, Shyam Varadarajulu Endoscopic management of traumatic bile leaks CONCLUSIONS: Consideration should be given to incorporate ERCP as first-line therapy in management of traumatic bile leaks, because endobiliary stent placement provides a successful outcome in a majority of cases, irrespective of the severity of injury. 5/29/2007
Kazuki Sumiyama, Christopher J Gostout, Elizabeth Rajan, Timothy A Bakken, Mary A Knipschield, Sydney Chung, Peter B Cotton, Robert H Hawes, Anthony N Kalloo, Sergey V Kantsevoy, Pankaj J Pasricha Transgastric cholecystectomy transgastric accessibility to the gallbladder improved with the SEMF method and a novel multibending therapeutic endoscope CONCLUSIONS: Transgastric cholecystectomy is technically feasible. Transgastric access to the gallbladder may be improved by using submucosal endoscopy with an offset exit gastrotomy by means of the mucosal flap safety-valve technique and a multibending gastroscope. 5/29/2007
B Hu, A N Kalloo, S S C Chung, P B Cotton, C J Gostout, R H Hawes, P J Pasricha, N V Isakovich, Y Nakajima, K Kawashima, S V Kantsevoy Peroral transgastric endoscopic primary repair of a ventral hernia in a porcine model CONCLUSIONS: Transgastric endoscopic primary repair of ventral hernias in a porcine model is feasible and may be technically simpler than laparoscopic surgery. 5/23/2007
Donald Garrow, Scott Miller, Debajyoti Sinha, Jason Conway, Brenda J Hoffman, Robert H Hawes, Joseph Romagnuolo Endoscopic ultrasound a meta-analysis of test performance in suspected biliary obstruction CONCLUSIONS: There is excellent overall accuracy for EUS in diagnosing choledocholithiasis, with less impressive results for malignancy (when fine-needle aspiration is not used). 5/5/2007
André Kheng Ho Chong, Robert H Hawes, Brenda J Hoffman, David B Adams, David N Lewin, Joseph Romagnuolo Diagnostic performance of EUS for chronic pancreatitis a comparison with histopathology CONCLUSIONS: A threshold of 3 or more EUS criteria provides the best balance of sensitivity and specificity for histologic pancreatic fibrosis. Calcifications seen by EUS but missed by other imaging are common in this group of patients. 5/1/2007
Lindsay S Robison, Shyam Varadarajulu, C Mel Wilcox Safety and success of precut biliary sphincterotomy Is it linked to experience or expertise CONCLUSION: Despite the lack of specific training in this technique, PBS was performed with a high success rate and a complication rate similar to or less than reports from other experienced centers. These results suggest that endoscopic experience and perhaps innate endoscopic skill may play an imp... 5/1/2007
Mohamad A Eloubeidi, Shyam Varadarajulu, Shilpa Desai, Rhett Shirley, Martin J Heslin, Mohit Mehra, Juan P Arnoletti, Isam Eltoum, Charles M Wilcox, Selwyn M Vickers A prospective evaluation of an algorithm incorporating routine preoperative endoscopic ultrasound-guided fine needle aspiration in suspected pancreatic cancer CONCLUSIONS: EUS-FNA is a safe and highly accurate method for tissue diagnosis in suspected pancreatic cancer. This approach allows for preoperative counseling of patients, minimizing surgeon's operative time in cases of unresectable disease, and avoids surgical biopsies in the majority of patients ... 4/19/2007
S Varadarajulu, M A Eloubeidi, A Tamhane, C M Wilcox Prospective randomized trial evaluating ketamine for advanced endoscopic procedures in difficult to sedate patients CONCLUSIONS: Ketamine is a useful adjunct to conscious sedation in patients who are difficult to sedate. Its use Results in better quality and depth of sedation with shorter recovery times than patients sedated using benzodiazepines and meperidine alone. Further prospective studies evaluating the ef... 4/4/2007
Sergey V Kantsevoy, Bing Hu, Sanjay B Jagannath, Nina V Isakovich, Sydney S C Chung, Peter B Cotton, Christopher J Gostout, Robert H Hawes, Pankaj J Pasricha, Yukio Nakajima, Koichi Kawashima, Anthony N Kalloo Technical feasibility of endoscopic gastric reduction a pilot study in a porcine model CONCLUSIONS: Endoscopic gastric reduction is technically feasible on a live porcine model. 2/27/2007
Sergey V Kantsevoy, Sanjay B Jagannath, Hideaki Niiyama, Nina V Isakovich, Sydney S C Chung, Peter B Cotton, Christopher J Gostout, Robert H Hawes, Pankaj J Pasricha, Anthony N Kalloo A novel safe approach to the peritoneal cavity for per-oral transgastric endoscopic procedures CONCLUSIONS: The PEG-like transgastric approach to the peritoneal cavity appears technically simple and safe. 2/27/2007
Jason D Conway, Robert H Hawes The expanding role of endoscopic ultrasound in pancreatic disease Since endoscopic ultrasound (EUS) was first developed in the 1980s, this technology has emerged as the principal modality for imaging the pancreas. When compared with other imaging techniques, EUS can more accurately image solid lesions of the pancreas and determine vascular involvement that might p... 1/17/2007
Kazuki Sumiyama, Christopher J Gostout, Elizabeth Rajan, Timothy A Bakken, Jodie L Deters, Mary A Knipschield, Robert H Hawes, Anthony N Kalloo, Pankaj J Pasricha, Sydney Chung, Sergey V Kantsevoy, Peter B Cotton Pilot study of the porcine uterine horn as an in vivo appendicitis model for development of endoscopic transgastric appendectomy CONCLUSIONS: This preliminary study demonstrated the technical feasibility to create a model for acute appendicitis by using the porcine uterine horn and transgastric appendectomy. 10/24/2006
Shyam Varadarajulu, C Mel Wilcox Randomized trial comparing needle-knife and pull-sphincterotome techniques for pancreatic sphincterotomy in high-risk patients CONCLUSIONS: Pancreatic sphincterotomy is safer in high-risk patients when performed with a needle knife over a pancreatic stent. 10/24/2006
K E Mönkemüller, C M Wilcox Gastrointestinal infections in children Gastrointestinal infections in children are a major cause of morbidity and mortality worldwide. Children living in developing countries are particularly susceptible to infectious diarrhea because of poor standards of hygiene and sanitation. Although the magnitude of diarrheal illnesses in developed ... 10/13/2006
Stephen B Hanauer, William J Sandborn, Nimish Vakil, Philip O Katz, Nicholas J Talley, Douglas K Rex, Robert H Hawes, Nalini M Guda, Martin L Freeman, Emmet B Keeffe, Luis A Balart Best of DDW 2006 Highlights from the 2006 Digestive Disease Week May 20-25, 2006, Los Angeles, CA. In this meeting review, many of our editorial board members report on Digestive Disease Week 2006. They highlight the most noteworthy presentations in their respective areas of expertise, including the latest treatment... 9/8/2006
Shyam Varadarajulu, Meredith L Kilgore, Charles M Wilcox, Mohamad A Eloubeidi Relationship among hospital ERCP volume, length of stay, and technical outcomes CONCLUSIONS: Inpatients who undergo ERCP at high-volume hospitals have shorter LOS and lower procedural failure rates than those undergoing ERCP at low-volume hospitals. These findings have important implications for health care policy decision making and resource utilization. 8/23/2006
Mohamad A Eloubeidi, Renee A Desmond, C Mel Wilcox, Reda J Wilson, Pavan Manchikalapati, Mona M Fouad, Isam Eltoum, Selwyn M Vickers Prognostic factors for survival in pancreatic cancer a population-based study CONCLUSIONS: Survival in patients with pancreatic cancer remains dismal. Tumor characteristics and treatment factors are related directly to survival time in patients with pancreatic cancer. Black patients were less likely to receive therapy but also were more likely to refuse the indicated therapy.... 8/22/2006
B Thompson, D Salzman, J Steinhauer, A J Lazenby, C M Wilcox Prospective endoscopic evaluation for gastrointestinal graft-versus-host disease determination of the best diagnostic approach The best endoscopic diagnostic strategy for gastrointestinal (GI) graft-versus-host disease (GVHD) is unknown. Over a 48-month period, all patients with unexplained diarrhea at risk for acute gastrointestinal GVHD were prospectively identified. Acute GVHD was defined as symptoms and histologic evide... 8/18/2006
Binh V Pham, Gottumukkala S Raju, Ijaz Ahmed, Douglas Brining, Sydney Chung, Peter Cotton, Christopher J Gostout, Robert H Hawes, Anthony N Kalloo, Sergey V Kantsevoy, Pankaj Jay Pasricha Immediate endoscopic closure of colon perforation by using a prototype endoscopic suturing device feasibility and outcome in a porcine model with video CONCLUSIONS: Closure of acute perforation of the colon is feasible with the Eagle Claw endoscopic suturing device in a porcine model. 7/4/2006
Sergey V Kantsevoy, Hideaki Niiyama, Sanjay B Jagannath, Sydney S C Chung, Peter B Cotton, Christopher J Gostout, Robert H Hawes, Pankaj J Pasricha, Carolyn A Magee, Cheryl A Vaughn, David Barlow, Hironobu Kawano, Hideki Shimonaka, Anthony N Kalloo The endoscopic transilluminator an endoscopic device for identification of the proximal jejunum for transgastric endoscopic gastrojejunostomy CONCLUSIONS: The ET is a safe instrument and can be used to identify the proximal jejunum to facilitate endoscopic gastrojejunostomy. 5/31/2006
C Mel Wilcox, Shyam Varadarajulu, Mohamad Eloubeidi Role of endoscopic evaluation in idiopathic pancreatitis a systematic review In approximately 20% of patients with acute pancreatitis, a cause is not established by history, physical examination, routine laboratory testing, and abdominal imaging. For those with a single unexplained attack, the role of invasive evaluation with endoscopic retrograde cholangiopancreatography is... 5/31/2006
Shyam Varadarajulu, C Mel Wilcox Endoscopic management of sphincter of Oddi dysfunction in children CONCLUSIONS: As in adults, pancreatic and dual sphincterotomy, in expert hands, is effective and safe in a subgroup of children with SOD. Prospective, randomized trials with larger number of patients are required to validate the efficacy of endotherapy in children with SOD. 5/19/2006
C Mel Wilcox Gastrointestinal Considerations in Patients with Cardiovascular Disease Using Nonopioid Analgesics for Mild-to-Moderate Pain or Cardioprotection Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most widely used classes of medications worldwide, available both through prescription and over the counter (OTC). Although these drugs are highly effective for pain, gastrointestinal (GI) complications may occur. Risk factors for GI compli... 5/6/2006
David A Sass, Georgios I Papachristou, Janette Lamb, M Michael Barmada, Randall E Brand, Mary E Money, Robert H Hawes, Peter B Cotton, Adam Slivka, David C Whitcomb The MCP-1 -2518 AG polymorphism is not a susceptibility factor for chronic pancreatitis CONCLUSIONS: Although the pro-inflammatory chemokine MCP-1 -2518 G allele is a severity factor for AP, it does not significantly alter susceptibility to CP. 4/26/2006
Mohamad A Eloubeidi, Ashutosh Tamhane, Shyam Varadarajulu, C Mel Wilcox Frequency of major complications after EUS-guided FNA of solid pancreatic masses a prospective evaluation CONCLUSIONS: EUS-FNA of solid pancreatic masses infrequently leads to major complications. Our results can be used by endosonographers to counsel patients before EUS-FNA of solid pancreatic masses. 3/28/2006
S Varadarajulu, M A Eloubeidi, C M Wilcox, R H Hawes, P B Cotton Do all patients with abnormal intraoperative cholangiogram merit endoscopic retrograde cholangiopancreatography CONCLUSIONS: One-third of patients with an abnormal IOC have a normal postoperative ERCP. Elevated liver function tests can help to identify patients who merit further evaluation by ERCP. The use of less invasive methods such as endoscopic ultrasound or magnetic resonance cholangiopancreatography sh... 3/18/2006
C Mel Wilcox, Shyam Varadarajulu Endoscopic therapy for chronic pancreatitis an evidence-based review In the setting of chronic pancreatitis, pancreatic ductal obstruction, and ductal leak, pseudocyst formation and biliary obstruction present many challenges for endoscopists. Although chronic pancreatitis has a variety of clinical manifestations, most commonly patients present with intermittent or c... 3/15/2006
Britt B Drake, Miguel R Arguedas, Meredith L Kilgore, Mary T Hawn, C Mel Wilcox Economical and clinical outcomes of alternative treatment strategies in the management of common bile duct stones in the elderly wait and see or surgery CONCLUSIONS: In patients aged 60 and older, expectant management after ERC-S for CBDS is a reasonable approach, but the economic attractiveness of this strategy is highly dependent on the probability of recurrent symptoms. 2/24/2006
Nechol L Allen, Ruth R Leeth, Kelly R Finan, Darren S Tishler, Selwyn M Vickers, C Mel Wilcox, Mary T Hawn Outcomes of cholecystectomy after endoscopic sphincterotomy for choledocholithiasis Laparoscopic cholecystectomy (LC) for treatment of symptomatic common bile duct stones (CBDS) after endoscopic sphincterotomy (ES) is associated with increased conversion and complications compared with other indications. We examined factors associated with conversion and complications of LC after E... 2/4/2006
S V Kantsevoy, B Hu, S B Jagannath, C A Vaughn, D M Beitler, S S C Chung, P B Cotton, C J Gostout, R H Hawes, P J Pasricha, C A Magee, L J Pipitone, M A Talamini, A N Kalloo Transgastric endoscopic splenectomy is it possible CONCLUSIONS: Transgastric endoscopic splenectomy in a porcine model appears technically feasible. Additional long-term survival experiments are planned. 1/25/2006
C Mel Wilcox, Byron Cryer, George Triadafilopoulos Patterns of use and public perception of over-the-counter pain relievers focus on nonsteroidal antiinflammatory drugs CONCLUSION: OTC analgesics including NSAID are widely used, are frequently taken inappropriately and potentially dangerously, and users are generally unaware of the potential for adverse side effects. Educational intervention directed toward both patients and physicians appears warranted. 11/3/2005
Klaus E Mönkemüller, Gavin C Harewood, Walter H Curioso, Lucia C Fry, C Mel Wilcox, Desiree E Morgan, Todd H Baron Biochemical analysis of pancreatic fluid collections predicts bacterial infection CONCLUSIONS: Biochemical analysis of PFC fluid is clinically helpful in detecting fluid infection in patients with bacteria on Gram stain or positive fluid cultures. Our findings fail to support the utility of fluid analysis in characterizing cyst type, and we caution against its use in distinguishi... 10/26/2005
C Mel Wilcox Gastrointestinal manifestations of AIDS Although gastrointestinal complications have decreased dramatically in patients with acquired immunodeficiency syndrome (AIDS) who received highly active antiretroviral therapy, these disorders still occur in those who do not seek healthcare, those with resistant virus, and those in developing count... 10/11/2005
Isam A Eltoum, Mohamad A Eloubeidi, David C Chhieng, Ashutosh Tamhane, Ralph Crowe, Darshana Jhala, Kay D St John, C Mel Wilcox, Gene P Siegal, Selwyn Vickers, Nirag C Jhala Cytologic grade independently predicts survival of patients with pancreatic adenocarcinoma Our objectives were to devise a cytologic grading system and determine whether it would predict survival of patients with solid-type pancreatic adenocarcinoma. We evaluated 116 consecutive patients from July 2000 to November 2002; they were followed up until September 2003. We scored the following f... 10/6/2005
B Hu, S C S Chung, L C L Sun, J Y W Lau, K Kawashima, T Yamamoto, P B Cotton, C J Gostout, R H Hawes, A N Kalloo, S V Kantsevoy, P J Pasricha Developing an animal model of massive ulcer bleeding for assessing endoscopic hemostatic devices CONCLUSION: This animal model provides reproducible massive hemorrhage suitable for endoscopic studies. Control of gastric bleeding from large arteries by endoscopic suturing is possible. 8/24/2005
Sergey V Kantsevoy, Sanjay B Jagannath, Hideaki Niiyama, Sydney S C Chung, Peter B Cotton, Christopher J Gostout, Robert H Hawes, Pankaj J Pasricha, Carolyn A Magee, Cheryl A Vaughn, David Barlow, Hideki Shimonaka, Anthony N Kalloo Endoscopic gastrojejunostomy with survival in a porcine model CONCLUSIONS: The endoscopic transgastric approach to create a gastrojejunostomy is technically feasible and can be performed, with survival, in a porcine model. 7/28/2005
Bing Hu, S C Sydney Chung, Lawrence C L Sun, Koichi Kawashima, Tetsuya Yamamoto, Peter B Cotton, Christopher J Gostout, Robert H Hawes, Anthony N Kalloo, Sergey V Kantsevoy, Pankaj J Pasricha Eagle Claw II A novel endosuture device that uses a curved needle for major arterial bleeding a bench study CONCLUSIONS: Control of bleeding from large arteries by using endoscopic suturing is possible. Continued refinements of the device are required. 7/28/2005
Shyam Varadarajulu, C Mel Wilcox, Mohamad A Eloubeidi Impact of EUS in the evaluation of pancreaticobiliary disorders in children CONCLUSIONS: EUS and EUS-guided FNA are feasible, safe, and have significant impact that alters subsequent management in the majority of children with PB disorders. Further studies and dissemination of information is required to facilitate its increased application in children. 7/28/2005
Bing Hu, S C Sydney Chung, Lawrence C L Sun, James Y W Lau, Koichi Kawashima, Tetsuya Yamamoto, Peter B Cotton, Christopher J Gostout, Robert H Hawes, Anthony N Kalloo, Sergey V Kantsevoy, Pankaj J Pasricha Endoscopic suturing without extracorporeal knots a laboratory study CONCLUSIONS: The present prototype represents significant improvements in the ease of operation and the security of the suture, bringing the technique closer to clinical use for a variety of applications. 7/28/2005
B Hu, L C Sun, M Karmakar, P B Cotton, C J Gostout, R H Hawes, A N Kalloo, S V Kantsevoy, P J Pasricha, S C Chung Assessing the adequacy of endoscopically tied knots a functional approach CONCLUSIONS: This system is a reliable model for testing intracorporeal knots tied endoscopically. A three-half-hitches square knot with 3/0 nylon, tied using a flexible endoscope and knot-tightening cap, can withstand pressure up to 200 mm Hg. 4/22/2005
B Hu, S C Chung, L C Sun, K Kawashima, T Yamamoto, P B Cotton, C J Gostout, R H Hawes, A N Kalloo, S V Kantsevoy, P J Pasricha Transoral obesity surgery endoluminal gastroplasty with an endoscopic suture device CONCLUSIONS: In a bench model, it is technically possible to accomplish transoral gastroplasty endoscopically with an intraluminal suturing device. Further live animal studies will be needed in order to confirm the efficacy and safety of this procedure before clinical application. 4/22/2005
Shyam Varadarajulu, Tara C Noone, Radu Tutuian, Robert H Hawes, Peter B Cotton Predictors of outcome in pancreatic duct disruption managed by endoscopic transpapillary stent placement CONCLUSIONS: Successful resolution of PD disruption by transpapillary stent insertion depends on the type of disruption and the ability to bridge the disrupted duct with a stent. 4/7/2005
Sanjay B Jagannath, Sergey V Kantsevoy, Cheryl A Vaughn, Sydney S C Chung, Peter B Cotton, Christopher J Gostout, Robert H Hawes, Pankaj J Pasricha, Diana G Scorpio, Carolyn A Magee, Laurie J Pipitone, Anthony N Kalloo Peroral transgastric endoscopic ligation of fallopian tubes with long-term survival in a porcine model CONCLUSIONS: The peroral endoscopic transgastric approach to ligation of the Fallopian tubes with long-term survival is technically feasible and safe in a porcine model. The endoscopic transgastric approach to the peritoneal cavity has potential for a wide array of diagnostic and therapeutic procedu... 3/11/2005
Klaus E Mönkemüller, Audrey J Lazenby, David H Lee, Robert Loudon, C Mel Wilcox Occurrence of gastrointestinal opportunistic disorders in AIDS despite the use of highly active antiretroviral therapy Since the introduction of highly active antiretroviral therapy (HAART), the frequency of opportunistic disorders (ODs) of the gastrointestinal (GI) tract in human immunodeficiency virus (HIV)-infected patients has fallen dramatically. We have found, however, that despite the use of HAART, HIV-infect... 3/5/2005
Nadeem Hussain, Robert H Hawes Principles of endosonography and imaging Accurate interpretation of ultrasound images requires knowledge of the principles of ultrasound and how it interacts with tissue. This article outlines the important principles that every endosonographer should know and provides clinical implications to make the material relevant to endosonographers... 11/24/2004
Elizabeth Rajan, Christopher J Gostout, Arnaldo B Feitoza, Olga N Leontovich, Lori J Herman, Lawrence J Burgart, Sydney Chung, Peter B Cotton, Robert H Hawes, Anthony N Kalloo, Sergey V Kantsevoy, Pankaj J Pasricha Widespread EMR a new technique for removal of large areas of mucosa CONCLUSIONS: Wide EMR appears to be technically feasible for removal of large areas of mucosa. Mucosal strips 5 cm long that included over 50% of the luminal circumference were resected safely. Resection was followed by complete regrowth of the mucosa. However, a second wide EMR to create a circumfe... 10/9/2004
Nirag C Jhala, Darshana Jhala, Isam Eltoum, Selwyn M Vickers, C Mel Wilcox, David C Chhieng, Mohamad A Eloubeidi Endoscopic ultrasound-guided fine-needle aspiration biopsy a powerful tool to obtain samples from small lesions CONCLUSIONS: EUS-FNAB was a highly effective technique to obtain samples from small (< or = 25 mm) and large (> 25 mm) lesions without affecting the sensitivity, specificity, or diagnostic accuracy. 9/16/2004
Charles M Wilcox Efficiency issues in sedation and monitoring Sedation and monitoring are key elements of the endoscopy process. There continues to be intense study of better methods for sedation and monitoring to improve the endoscopic "experience" for both patient and physicians alike. Our current practices will likely change in the future with technologic a... 9/15/2004
S M Wildi, M A Judson, M Fraig, W E Fickling, N Schmulewitz, S Varadarajulu, S S Roberts, P Prasad, R H Hawes, M B Wallace, B J Hoffman Is endosonography guided fine needle aspiration EUS-FNA for sarcoidosis as good as we think CONCLUSIONS: EUS-FNA is an accurate method for diagnosing sarcoidosis in an unselected group of patients with mediastinal lymphadenopathy. The reported sensitivity and specificity must be appreciated in the context of the difficult and often incomplete clinical diagnosis of sarcoidosis. 8/31/2004
Mohamad A Eloubeidi, Frank G Gress, Thomas J Savides, Maurits J Wiersema, Michael L Kochman, Nuzhat A Ahmad, Gregory G Ginsberg, Richard A Erickson, John Dewitt, Jacques Van Dam, Nicholas J Nickl, Michael J Levy, Jonathan E Clain, Amitabh Chak, Michael V Sivak, Richard Wong, Gerard Isenberg, James M Scheiman, Brenna Bounds, Michael B Kimmey, Michael D Saunders, Kenneth J Chang, Ashish Sharma, Phoniex Nguyen, John G Lee, Steven A Edmundowicz, Dayna Early, Riad Azar, Babak Etemad, Yang K Chen, Irving Waxman, Vanessa Shami, Mark F Catalano, C Mel Wilcox Acute pancreatitis after EUS-guided FNA of solid pancreatic masses a pooled analysis from EUS centers in the United States CONCLUSIONS: EUS-guided FNA of solid pancreatic masses is infrequently associated with acute pancreatitis. The procedure appears to be safe when performed by experienced endosonographers. The frequency of post EUS-guided FNA pancreatitis may be underestimated by retrospective analysis. 8/28/2004
Shyam Varadarajulu, C Mel Wilcox, Robert H Hawes, Peter B Cotton Technical outcomes and complications of ERCP in children CONCLUSIONS: When ERCP is performed in children by expert endoscopists, the success rate is high and the complication rate is low, both being comparable with those for ERCP in adult patients. 8/28/2004
Shyam Varadarajulu, Brenda J Hoffman, Robert H Hawes, Mohamad A Eloubeidi EUS-guided FNA of lung masses adjacent to or abutting the esophagus after unrevealing CT-guided biopsy or bronchoscopy CONCLUSIONS: In this study, EUS-guided FNA of lung mass was safe, and it established a diagnosis in all patients with accessible lesions. Given these preliminary data, a prospective evaluation of this new indication for EUS-guided FNA is justified. 7/28/2004
S M Wildi, W E Fickling, T A Day, C D Cunningham, N Schmulewitz, S Varadarajulu, S S Roberts, B Ferguson, B J Hoffman, R H Hawes, M B Wallace Endoscopic ultrasonography in the diagnosis and staging of neoplasms of the head and neck CONCLUSIONS: EUS with FNA provides a viable approach to the diagnosis and staging of tumors in the head and neck region when there is a suggestion of esophageal invasion on CT or MRI, or enlarged mediastinal lymph nodes. EUS with FNA may avoid the need for mediastinoscopy or other more invasive tech... 7/10/2004
C Mel Wilcox, William Rodgers, Audrey Lazenby Prospective comparison of brush cytology, viral culture, and histology for the diagnosis of ulcerative esophagitis in AIDS CONCLUSIONS: Viral culture and cytologic brushings add little to the evaluation of esophageal ulcers in patients with AIDS over multiple biopsy specimens with routine histology. 6/30/2004
Stephan M Wildi, Monty H Cox, Leslie L Clark, Robert Turner, Robert H Hawes, Brenda J Hoffman, Michael B Wallace Assessment of health state utilities and quality of life in patients with malignant esophageal Dysphagia CONCLUSIONS: These results confirm the perceived poor state of health of patients with esophageal cancer and are substantially lower than previous estimates in operated patients. Cost-effectiveness models must take into account significant differences between patients' assessment of their own state ... 6/8/2004
Miguel R Arguedas, Gustavo R Heudebert, Joshua C Klapow, Robert M Centor, Mohamad A Eloubeidi, C Mel Wilcox, Stuart Jon Spechler, VA Cooperative Study Group Re-examination of the cost-effectiveness of surgical versus medical therapy in patients with gastroesophageal reflux disease the value of long-term data collection CONCLUSIONS: Long-term medical therapy with proton pump inhibitors is the preferred strategy for patients with gastroesophageal reflux disease and severe esophagitis. Our study highlights the importance of using primary, patient-derived data rather than expert opinion. 6/8/2004
Mohamad A Eloubeidi, Stefan Seewald, Ashutosh Tamhane, Boris Brand, Victor K Chen, Ichiro Yasuda, Robert J Cerfolio, Salem Omar, Theodoros Topalidis, C Mel Wilcox, Nib Soehendra EUS-guided FNA of the left adrenal gland in patients with thoracic or GI malignancies CONCLUSIONS: EUS-guided FNA of the left adrenal gland is a minimally invasive, safe, and highly accurate method that confirms or excludes malignant adrenal involvement in patients with thoracic or GI malignancies. 4/29/2004
Michael B Wallace, James Ravenel, Mark I Block, Mostafa Fraig, Gerard Silvestri, Stephan Wildi, Nathan Schmulewitz, Shyam Varadarajulu, Stacey Roberts, Brenda J Hoffman, Robert H Hawes, Carolyn E Reed Endoscopic ultrasound in lung cancer patients with a normal mediastinum on computed tomography CONCLUSIONS: Endoscopic ultrasound guided fine needle aspiration can detect advanced mediastinal disease and avoid unnecessary surgical exploration in almost one of four patients who have no evidence of mediastinal disease on CT scan. In addition to previously reported results in patients with enlar... 4/28/2004
S Varadarajulu, M Fraig, N Schmulewitz, S Roberts, S Wildi, R H Hawes, B J Hoffman, M B Wallace Comparison of EUS-guided 19-gauge Trucut needle biopsy with EUS-guided fine-needle aspiration CONCLUSION: The diagnostic accuracy of the new EUS-TNB is comparable to that of EUS-FNA. In our experience, the overall efficacy and safety profile of the Trucut needle appears modest. 4/22/2004
C Mel Wilcox, Jerrold Canakis, Klaus E Mönkemüller, Anthony W Bondora, Wilma Geels Patterns of bleeding after endoscopic sphincterotomy, the subsequent risk of bleeding, and the role of epinephrine injection CONCLUSIONS: The pattern of bleeding following ES may not predict the risk of late bleeding. Abnormal labs are associated with visible bleeding. Epinephrine injection is safe and appears to provide effective hemostasis. 3/30/2004
Stephan M Wildi, Tammy F Glenn, Robert F Woolson, Wei Wang, Robert H Hawes, Michael B Wallace Is esophagoscopy alone sufficient for patients with reflux symptoms CONCLUSIONS: Daily abdominal pain and nausea, in combination with a history of ulcer disease, are strong predictors of major gastric or duodenal disease. Patients with reflux without these predictors are highly unlikely to have a major disease involving the stomach or duodenum, and are suitable cand... 3/5/2004
Shyam Varadarajulu, Nathan Schmulewitz, Stephan M Wildi, Stacey Roberts, James Ravenel, Carolyn E Reed, Mark Block, Brenda J Hoffman, Robert H Hawes, Michael B Wallace Accuracy of EUS in staging of T4 lung cancer CONCLUSIONS: Caution is warranted when unresectability of lung cancer is based solely on tumor invasion into mediastinal soft tissue at EUS. Overstaging occurs when a tumor appears to invade the pleural layer without mediastinal organ invasion. Confirmation of unresectability by other diagnostic mod... 3/5/2004
M R Arguedas, J D Linder, C M Wilcox Suspected sphincter of Oddi dysfunction type II empirical biliary sphincterotomy or manometry-guided therapy CONCLUSIONS: For patients with suspected biliary SOD type II, empirical biliary sphincterotomy performed by experienced endoscopists appears to be cost-saving in comparison with a strategy based on the results of manometry. 2/7/2004