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
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 Pi*MZ variant increases risk of developing hepatic events in nonalcoholic fatty liver disease patients<sup></sup> 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 Heyde's 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 Hawai'i 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, Crohn's 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 Barrett's 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 Crohn's 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 <em>vs</em> 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 Barrett's 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 Barrett's 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 dia... 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 Crohn's 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:Â 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 Barrett's 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 Crohn's 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 Crohn's 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 Crohn's 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 Barrett's 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 Barrett's 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 Crohn's 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 Barrett's 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 g/dL in haemoglobin and/or ≥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 Crohn's 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 Crohn's 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 Crohn's 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 Crohn's 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 Barrett's 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 antibiotics/immunomodulators? 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 - it's 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 Barrett's 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 Barrett's 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 Crohn's 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 Barrett's 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 A/G 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
Nathan Schmulewitz, Stephan M Wildi, Shyam Varadarajulu, Stacey Roberts, Robert H Hawes, Brenda J Hoffman, Valerie Durkalski, Gerard A Silvestri, Mark I Block, Carolyn Reed, Michael B Wallace Accuracy of EUS criteria and primary tumor site for identification of mediastinal lymph node metastasis from non-small-cell lung cancer CONCLUSIONS: Although tumor location and EUS lymph nodal characteristics are associated with malignant involvement of lymph nodes, the accuracy of these predictors does not obviate the need for cytologic evaluation. EUS with FNA should be performed for all lymph nodes when an abnormal finding will a... 1/28/2004
Stephan M Wildi, Christopher Y Kim, Tammy F Glenn, Harold A Mackey, Gerry E Viator, Michael B Wallace, Robert H Hawes Tele-endoscopy: a way to provide diagnostic quality for remote populations CONCLUSIONS: Upper-GI tele-endoscopy by using telephone lines has good diagnostic quality and is highly sensitive with regard to major findings. The misinterpretation of certain findings (esophageal ring, gastric erosions) may be caused by interobserver variability. The data strongly suggest that en... 1/15/2004
Mohamad A Eloubeidi, Victor K Chen, Isam A Eltoum, Darshana Jhala, David C Chhieng, Nirag Jhala, Selwyn M Vickers, C Mel Wilcox Endoscopic ultrasound-guided fine needle aspiration biopsy of patients with suspected pancreatic cancer: diagnostic accuracy and acute and 30-day complications CONCLUSIONS: EUS-FNA is highly accurate in identifying patients with suspected pancreatic cancer, especially when other modalities have failed. Major complications after EUS-FNA are rare, and minor complications are similar to those reported for upper endoscopy. It seems that follow-up at 1 wk might... 12/23/2003
Shyam Varadarajulu, Radu Tutuian, Christopher Gostout, Richard Kozarek, C Mel Wilcox, Peter B Cotton Efficacy of the Za self-expandable metal stent for palliation of malignant biliary obstruction CONCLUSIONS: The Za-metal stent provided effective palliation for patients with inoperable malignant biliary tumors. Although minor technical problems were encountered with stent deployment, the overall stent patency, efficacy, and safety profile appear satisfactory. 12/18/2003
M A Eloubeidi, D T Iseman, V K Chen, S M Vickers, C M Wilcox Prevalence and significance of periduodenal venous collaterals in patients evaluated for pancreaticobiliary disorders by endosonography CONCLUSIONS: Periduodenal collateral vessels are infrequent in patients with suspected pancreaticobiliary disease, but are relatively common in patients with pancreatic cancer. Transduodenal EUS-FNA can be carried out safely in the majority of cases in the presence of periduodenal collaterals, but c... 12/4/2003
Mahesh S Mokhashi, Stephan M Wildi, Tammy F Glenn, Michael B Wallace, Christian Jost, Bora Gumustop, Christopher Y Kim, Peter B Cotton, Robert H Hawes A prospective, blinded study of diagnostic esophagoscopy with a superthin, stand-alone, battery-powered esophagoscope CONCLUSIONS: Unsedated esophagoscopy with a 3.1-mm, battery-powered, stand-alone esophagoscope is feasible, well tolerated, and accurate in detecting esophageal pathologies. It might be an efficient and cost-effective screening tool for the detection of columnar lined esophagus. 11/26/2003
Shyam Varadarajulu, Tara Noone, Robert H Hawes, Peter B Cotton Pancreatic duct stent insertion for functional smoldering pancreatitis CONCLUSIONS: Smoldering pancreatitis may result from functional obstruction, possibly caused by edema or spasm, of the papillary orifice. Insertion of a stent into the pancreatic duct alleviates pain, enables early resumption of oral intake of food, and facilitates pancreatic duct drainage. It also ... 10/7/2003
Stephan M Wildi, Rana S Hoda, William Fickling, Nathan Schmulewitz, Shyam Varadarajulu, Stacey S Roberts, Brenda Ferguson, Brenda J Hoffman, Robert H Hawes, Michael B Wallace Diagnosis of benign cysts of the mediastinum: the role and risks of EUS and FNA CONCLUSIONS: EUS provides a minimally invasive approach to the diagnosis of benign mediastinal cysts and may be more accurate than CT or other imaging modalities. Aspiration of suspected cysts should be undertaken with caution, given the risk of infection. 10/7/2003
Shyam Varadarajulu, Robert H Hawes, Peter B Cotton Determination of sphincter of Oddi dysfunction in patients with prior normal manometry CONCLUSIONS: A single negative manometry study does not rule out sphincter of Oddi dysfunction. Repeat ERCP with manometry may be warranted for patients with persistent symptoms in whom the clinical suspicion for sphincter of Oddi dysfunction remains high. 10/7/2003
C Mel Wilcox, Jeffrey Linder Prospective evaluation of droperidol on sphincter of Oddi motility CONCLUSIONS: Droperidol alters basal sphincter pressures, which in some patients was clinically significant and would have resulted in misclassification. Although safe and well tolerated, droperidol appears to have subtle but clinically significant effects on the sphincter of Oddi. 10/2/2003
Robert H Hawes Endoscopic management of pseudocysts Endoscopic retrograde cholangiopancreatography (ERCP) has gained acceptance as a treatment of pancreatic pseudocysts in patients suited to this procedure. This article describes a standard approach to the technique. Evaluation prior to endoscopic drainage of pseudocysts should involve review of a hi... 9/23/2003
Jeffrey D Linder, Joshua C Klapow, Sheri D Linder, C Mel Wilcox Incomplete response to endoscopic sphincterotomy in patients with sphincter of Oddi dysfunction: evidence for a chronic pain disorder CONCLUSIONS: Patients found to have SOD who undergo ES are more likely to be improved on long-term follow-up when compared with patients with suspected SOD but normal manometry without ES. However, almost uniformly, despite ES, patients continue to have pain, which is consistent with most chronic pa... 8/9/2003
Desiree E Morgan, J Kevin Smith, Kidaday Hawkins, C Mel Wilcox Endoscopic stent therapy in advanced chronic pancreatitis: relationships between ductal changes, clinical response, and stent patency CONCLUSIONS: Main pancreatic duct caliber after endoscopic stenting was not a good indicator of pain response or stent patency; main pancreatic duct was often larger, and even with stent occlusion, patients' symptoms were frequently improved. Stent-induced strictures were infrequent, compared with v... 5/10/2003
Ravi Madhotra, Mahesh Mokhashi, Ira Willner, Robert H Hawes, Adrian Reuben Prospective evaluation of a 3.1-mm battery-powered esophagoscope in screening for esophageal varices in cirrhotic patients CONCLUSIONS: Unsedated endoscopy with a BPE is safe and well tolerated. The diagnostic accuracy of a BPE for diagnosing EV is the same as by EGD. Esophagoscopy with a BPE is a potential alternative to EGD for EV screening. 5/10/2003
Michael B Wallace, Mark Block, Brenda J Hoffman, Robert H Hawes, Gerard Silvestri, Carolyn E Reed, Michael Mitas, James Ravenel, Mostafa Fraig, Scott Miller, Edward T Jones, Alice Boylan Detection of telomerase expression in mediastinal lymph nodes of patients with lung cancer Mediastinal lymph nodes are the most common site of tumor spread in non-small cell lung cancer (NSCLC). We hypothesized that micrometastatic disease could be detected by reverse transcription-polymerase chain reaction (RT-PCR) for expression of human telomerase reverse transcriptase (hTERT) in media... 3/5/2003
Paul J Nietert, Marc D Silverstein, Mahesh S Mokhashi, Christopher Y Kim, Tammy F Glenn, Vicki A Marsi, Robert H Hawes, Michael B Wallace Cost-effectiveness of screening a population with chronic gastroesophageal reflux CONCLUSIONS: Screening for Barrett's esophagus with ultrathin endoscopy is more cost-effective than standard endoscopy, and both strategies appear to improve quality-adjusted life-years among patients with chronic reflux at costs that are similar to those of other accepted preventive measures. 3/4/2003
Stephan M Wildi, Michael B Wallace, Tammy F Glenn, Mahesh S Mokhashi, Christopher Y Kim, Robert H Hawes Accuracy of esophagoscopy performed by a non-physician endoscopist with a 4-mm diameter battery-powered endoscope CONCLUSION: Esophagoscopy with a battery-powered 4-mm diameter endoscope by a non-physician endoscopist is feasible and accurate in detecting esophageal pathologies. It may be an efficient screening method for the detection of columnar-lined esophagus. There was a distinct underestimate of the prese... 3/4/2003
T O G Kovacs, C M Wilcox, K DeVault, D Miska, W Bochenek, Pantoprozole US Gerd Study Group B Comparison of the efficacy of pantoprazole vs. nizatidine in the treatment of erosive oesophagitis: a randomized, active-controlled, double-blind study CONCLUSIONS: Pantoprazole, at single daily doses of 20 mg and 40 mg for up to 8 weeks, provides more rapid relief of symptoms and superior healing of erosive oesophagitis than nizatidine 150 mg b.d., and is well tolerated. 11/28/2002
Jeffrey D Linder, Wilma Geels, C Mel Wilcox Prevalence of sphincter of Oddi dysfunction: can results from specialized centers be generalized? Recent studies suggest a high prevalence of sphincter of Oddi dysfunction (SOD) in patients referred to specialized centers for sphincter of Oddi manometry (SOM). Whether these results can be generalized to other centers is unknown. From September 1998 to April 2000, patients undergoing SOM were pro... 11/28/2002
Michael B Wallace, Paul J Nietert, Craig Earle, Mark J Krasna, Robert H Hawes, Brenda J Hoffman, Carolyn E Reed An analysis of multiple staging management strategies for carcinoma of the esophagus: computed tomography, endoscopic ultrasound, positron emission tomography, and thoracoscopy/laparoscopy CONCLUSIONS: The combination of PET + EUS-FNA should be the recommended staging procedure for patients with esophageal cancer, unless resources are scarce or PET is unavailable. In these instances, CT + EUS-FNA can be considered the preferred strategy. 10/29/2002
Jeffrey Linder, Rekha Cheruvattath, Christopher Truss, C Mel Wilcox Diagnostic yield and clinical implications of push enteroscopy: results from a nonspecialized center BACKGROUND Push enteroscopy is increasingly used as an investigative tool for the evaluation of gastrointestinal bleeding, and studies from specialized centers have shown an overall diagnostic yield of push enteroscopy in such patients ranging from 38% to 75%. The aim of our study was to characteriz... 10/24/2002
Mohamad A Eloubeidi, Renee Desmond, Miguel R Arguedas, Carolyn E Reed, C Mel Wilcox Prognostic factors for the survival of patients with esophageal carcinoma in the U.S.: the importance of tumor length and lymph node status CONCLUSIONS: Tumor length, the number of involved lymph nodes, and the ratio of positive lymph nodes are important prognostic factors for survival in patients with esophageal carcinoma. A revised TNM classification system for patients with esophageal carcinoma might consider adding tumor length and ... 9/19/2002
David C Chhieng, Darshana Jhala, Nirag Jhala, Isam Eltoum, Victor K Chen, Selwyn Vickers, Martin J Heslin, C Mel Wilcox, Mohamad A Eloubeidi Endoscopic ultrasound-guided fine-needle aspiration biopsy: a study of 103 cases CONCLUSIONS: EUS-FNAB is a safe and accurate diagnostic procedure for the evaluation of intramural and extramural lesions of the gastrointestinal tract. In the majority of cases, it obviates the need for more invasive diagnostic procedures to obtain a tissue diagnosis. 9/5/2002
Mohamad A Eloubeidi, Darshana Jhala, David C Chhieng, Nirag Jhala, Isam Eltoum, C Mel Wilcox Multiple late asymptomatic pancreatic metastases from renal cell carcinoma: diagnosis by endoscopic ultrasound-guided fine needle aspiration biopsy with immunocytochemical correlation We describe a patient who presented with multiple asymptomatic masses detected in the pancreas. Twelve years prior to this presentation, he underwent a left radical nephrectomy for stage I renal cell carcinoma. CT-guided biopsy was unsuccessful. Endoscopic ultrasound guided fine needle aspiration (E... 8/20/2002
W J Coyle, B C Pineau, P R Tarnasky, W L Knapple, L Aabakken, B J Hoffman, J T Cunningham, R H Hawes, P B Cotton Evaluation of unexplained acute and acute recurrent pancreatitis using endoscopic retrograde cholangiopancreatography, sphincter of Oddi manometry and endoscopic ultrasound CONCLUSION: An etiology was identified in the majority of patients with unexplained pancreatitis. SOD represented the most common finding. Moderate to severe chronic pancreatitis was found in over one-fifth of these patients. Bile analysis, SOM, and EUS are useful tools in the evaluation of unexplai... 8/13/2002
Robert H Hawes A clinician's perspective on chronic pancreatitis--2002 The diagnosis and management of chronic pancreatitis represents a significant challenge to clinicians. Progress is being made in our understanding of this disease, especially in the area of genetics and molecular biology. Despite these advances, diagnosis of early-stage disease depends on indirect t... 7/19/2002
Jorgen tenBerge, Brenda J Hoffman, Robert H Hawes, Conny Van Enckevort, Marc Giovannini, Richard A Erickson, Marc F Catalano, Roberto Fogel, Shawn Mallery, Douglas O Faigel, Angelo P Ferrari, Irving Waxman, Larent Palazzo, Tamir Ben-Menachem, Paul S Jowell, Kevin M McGrath, Thomas E Kowalski, Cuong C Nguyen, Wahid Y Wassef, Keiji Yamao, Amitabh Chak, Bruce D Greenwald, Timothy A Woodward, Peter Vilmann, Luis Sabbagh, Michael B Wallace EUS-guided fine needle aspiration of the liver: indications, yield, and safety based on an international survey of 167 cases CONCLUSION: EUS-guided FNA of the liver appears to be a safe procedure with a major complication rate of approximately 1%. EUS-FNA should be considered when a liver lesion is poorly accessible to US-, or CT-guided FNA should be considered when US- or CT-guided FNA fail to make a diagnosis, when a li... 5/25/2002
Miguel R Arguedas, Gustavo H Heudebert, Aaron A Stinnett, C Mel Wilcox Biliary stents in malignant obstructive jaundice due to pancreatic carcinoma: a cost-effectiveness analysis CONCLUSION: Initial endoscopic placement of a metal stent is a cost-saving strategy compared to initial plastic stent placement, particularly in patients expected to survive longer than 6 months. 5/11/2002
Joseph Romagnuolo, John Scott, Robert H Hawes, Brenda J Hoffman, Carolyn E Reed, Guruprasad P Aithal, Niall P Breslin, Robert Y M Chen, Bora Gumustop, Winnie Hennessey, Annette Van Velse, Michael B Wallace Helical CT versus EUS with fine needle aspiration for celiac nodal assessment in patients with esophageal cancer CONCLUSIONS: Despite technological advances, helical CT still appears unreliable, mainly because of insensitivity, for the identification of inoperable T4 or metastatic involvement of celiac lymph node disease in esophageal cancer. 4/30/2002
Joshua C Klapow, C Mel Wilcox, Alison P Mallinger, Robert Marks, Gustavo R Heudebert, Robert M Centor, William Lawrence, Joel Richter Characterization of long-term outcomes after Toupet fundoplication: symptoms, medication use, and health status CONCLUSIONS: Although fundoplication is thought to be a curative procedure, the current findings suggest that many patients take symptomatic therapies and report symptoms and diminished health status up to 2 years after the procedure. These outcomes are associated with physiologic findings. Thus, th... 4/18/2002
B F Thompson, M R Arguedas, C M Wilcox Antibiotic prophylaxis prior to endoscopic retrograde cholangiopancreatography in patients with obstructive jaundice: is it worth the cost? CONCLUSIONS: Antibiotic prophylaxis prior to endoscopic retrograde cholangiopancreatography results in fewer cases of cholangitis and is cost saving when compared to a strategy of no prophylaxis in patients with obstructive jaundice. 4/4/2002
C Mel Wilcox Endoscopic examination with the duodenoscope at ERCP: frequency of lesions and accuracy of detection CONCLUSIONS: Given the frequency of endoscopic lesions, a yield of positive findings similar to that obtained with the forward-viewing endoscope, and the ease of performing endoscopy with the duodenoscope, endoscopic examination of the esophagus, stomach, and duodenum with the duodenoscope should be... 3/30/2002
Robert H Hawes Does virtual colonoscopy have a major role in population-based screening? In summary, technical advances in the performance of VC are occurring at a very rapid pace. These technical improvements will undoubtedly improve the polyp detection rate and reduce false-positive and false-negative examinations. The concept of VC is clearly attractive and the general public is enam... 3/28/2002
Paul R Harris, H Christian Weber, C Mel Wilcox, Robert T Jensen, Phillip D Smith Cytokine gene profile in gastric mucosa in Helicobacter pylori infection and Zollinger-Ellison syndrome CONCLUSIONS: Levels of proinflammatory cytokine mRNA are increased in acid-driven as well as infection-driven gastric inflammation, and the presence of both disease processes appears to have an additive effect on local cytokine message expression. Inflammatory cytokines may mediate both infection- a... 2/28/2002
Tamara K Redman, William J Britt, C Mel Wilcox, Martin F Graham, Phillip D Smith Human cytomegalovirus enhances chemokine production by lipopolysaccharide-stimulated lamina propria macrophages To elucidate the role of mucosal macrophages in intestinal human cytomegalovirus (HCMV) disease, primary lamina propria macrophages (LPM) were isolated from normal human jejunum, infected with HCMV, and studied for their cytokine responses. HCMV infection of LPM was confirmed by the presence of HCMV... 2/28/2002
M B Wallace, G A Silvestri, A V Sahai, R H Hawes, B J Hoffman, V Durkalski, W S Hennesey, C E Reed Endoscopic ultrasound-guided fine needle aspiration for staging patients with carcinoma of the lung CONCLUSIONS: Endoscopic ultrasound with fine needle aspiration identified and histologically confirmed mediastinal disease in more than two thirds of patients with carcinoma of the lung who have abnormal mediastinal CT scans. Although mediastinal disease was more likely in patients with an abnormal ... 1/16/2002
Ika I Peleg, C Mel Wilcox The role of eicosanoids, cyclooxygenases, and nonsteroidal anti-inflammatory drugs in colorectal tumorigenesis and chemoprevention There is mounting evidence from studies on experimental cancer in rodents, interventional studies in patients with familial adenomatous polyposis, and some, but not all, epidemiologic investigations, that suggests a chemopreventive effect of aspirin and nonaspirin nonsteroidal anti-inflammatory drug... 1/10/2002
R H Hawes Perspectives in endoscopic mucosal resection The birth of endoscopic mucosal resection probably can be traced back to the early days of colonoscopy and polypectomy. With the advent of colonoscopy, endoscopists began encountering pedunculated and sessile mass lesions arising from the mucosal surface. The concept of snare polypectomy developed q... 1/10/2002
B C Pineau, W L Knapple, K M Spicer, L Gordon, M Wallace, W S Hennessy, R H Hawes, P B Cotton Cholecystokinin-Stimulated mebrofenin (99mTc-Choletec) hepatobiliary scintigraphy in asymptomatic postcholecystectomy individuals: assessment of specificity, interobserver reliability, and reproducibility CONCLUSIONS: Quantitative CCK-HBS is of poor specificity in asymptomatic postcholecystectomy individuals. Hence, it is of questionable value in excluding sphincter of Oddi dysfunction in patients suspected to suffer from this disorder. 11/28/2001
M R Arguedas, A W Dupont, C M Wilcox Where do ERCP, endoscopic ultrasound, magnetic resonance cholangiopancreatography, and intraoperative cholangiography fit in the management of acute biliary pancreatitis? A decision analysis model CONCLUSIONS: Total costs and cost-effectiveness ratios of these strategies in patients with ABP are highly dependent on the probability of CBDS. 11/6/2001
M B Wallace, T Kennedy, V Durkalski, M A Eloubeidi, R Etamad, K Matsuda, D Lewin, A Van Velse, W Hennesey, R H Hawes, B J Hoffman Randomized controlled trial of EUS-guided fine needle aspiration techniques for the detection of malignant lymphadenopathy CONCLUSIONS: The traditional method of applying suction during EUS-FNA does not improve diagnostic accuracy and worsens specimen bloodiness compared with FNA without suction. The site of FNA within the lymph node does not affect accuracy. When EUS-FNA is necessary, our recommendation is up to 3 FNAs... 9/29/2001
A V Sahai, I D Penman, G Mishra, D Williams, A Pearson, M B Wallace, A van Velse, B J Hoffman, R H Hawes An assessment of the potential value of endoscopic ultrasound as a cost-minimizing tool in dyspeptic patients with persistent symptoms CONCLUSIONS: Patients with persistent dyspepsia may undergo multiple abdominal imaging procedures. Clinical variables do not predict the need for additional testing. An EUS-based strategy may reduce overall costs if it prevents additional testing. 8/8/2001
C M Wilcox, G Heudebert, J Klapow, R Shewchuk, L Casebeer Survey of primary care physicians' approach to gastroesophageal reflux disease in elderly patients CONCLUSIONS: The management of symptomatic GERD in elderly patients appears similar to the management of GERD in other patients. Empiric therapy was frequently recommended in a step-up approach, and diagnostic testing was appropriate. Combination therapy with cisapride and an acid-reducing agent was... 8/7/2001
M A Eloubeidi, M B Wallace, B J Hoffman, M B Leveen, A Van Velse, R H Hawes, C E Reed Predictors of survival for esophageal cancer patients with and without celiac axis lymphadenopathy: impact of staging endosonography CONCLUSIONS: EUS base line findings correlate with long term survival in patients with esophageal cancer. Patients with M1a disease as identified by EUS had a significantly worse postoperative survival when compared with non-M1a patients. This cohort of patients will be ideal for the study of induct... 7/24/2001
M B Wallace, R H Hawes Endoscopic ultrasound in the evaluation and treatment of chronic pancreatitis Endoscopic ultrasound (EUS) was developed in the 1970s specifically for the purpose of improved imaging of the pancreas. The close proximity of the pancreas to the gastric and duodenal lumen allows EUS to obtain high-resolution images, unobstructed by overlying bowel gas. EUS has fewer complications... 7/14/2001
J D Linder, C M Wilcox Acid peptic disease in the elderly GERD and peptic ulcer disease are important diseases in the elderly. GERD presents similarly in the elderly and the young, although elderly patients may have less severe symptoms yet more severe mucosal disease and a higher prevalence of BE. Although the prevalence of H. pylori is falling, the elder... 7/4/2001
C M Wilcox, K F Mönkemüller Wire-assisted minor papilla precut papillotomy CONCLUSIONS: This technique, which uses widely available accessories, facilitates access to the dorsal pancreatic duct for endoscopic therapy. 6/28/2001
M R Arguedas, G Shore, C M Wilcox Congenital vascular lesions of the gastrointestinal tract: blue rubber bleb nevus and Klippel-Trenaunay syndromes We present two cases of hemangiomatosis of the gastrointestinal tract. The first case describes a 59-year-old patient with upper gastrointestinal hemorrhage due to the blue rubber bleb nevus syndrome. The second case illustrates a 26-year-old patient with recurrent rectal bleeding due to Klippel-Tre... 5/3/2001
M R Arguedas, G R Heudebert, C M Wilcox Surveillance colonoscopy or chemoprevention with COX-2 inhibitors in average-risk post-polypectomy patients: a decision analysis CONCLUSION: Chemoprevention with COX-2 inhibitors in 'average-risk' postpolypectomy patients is a more expensive strategy compared to colonoscopic surveillance. 5/1/2001
K Kazbay, P R Tarnasky, R H Hawes, P B Cotton Increased transforming growth factor beta in pure pancreatic juice in pancreatitis Cytokines play an important role in the regulation of inflammation and fibrosis in the development of chronic pancreatitis. In this study, transforming growth factor beta (TGFbeta), interleukin (IL)-6, IL-10, and tumor necrosis factor alpha (TNFalpha) were measured in pure pancreatic juice obtained ... 3/16/2001
M B Wallace, R H Hawes, V Durkalski, A Chak, S Mallery, M F Catalano, M J Wiersema, M S Bhutani, D Ciaccia, M L Kochman, F G Gress, A Van Velse, B J Hoffman The reliability of EUS for the diagnosis of chronic pancreatitis: interobserver agreement among experienced endosonographers CONCLUSIONS: EUS is a reliable method for the diagnosis of chronic pancreatitis with good interobserver agreement among experienced endosonographers. Agreement on the EUS diagnosis of chronic pancreatitis is comparable to other commonly used endoscopic procedures such as bleeding ulcer stigmata and ... 3/7/2001
K E Mönkemüller, C M Wilcox Investigation of diarrhea in AIDS Chronic diarrhea is a common problem in patients with acquired immune deficiency syndrome (AIDS), resulting in significant morbidity and potential mortality. In the early stages of immunodeficiency, human immunodeficiency virus (HIV)-infected patients are susceptible to infection with the same enter... 12/23/2000
T J Savides, A H Fisher, F G Gress, R H Hawes, C J Lightdale 1999 ASGE endoscopic ultrasound survey. ASGE Ad Hoc Endoscopic Ultrasound Committee CONCLUSIONS: EUS in the United States in 1999 is performed mostly by young, academic, interventional endoscopists. Diagnostic upper EUS is most commonly performed. Few new endosonographers are being trained. There is great variability in CPT coding of lower EUS and EUS/fine-needle aspiration procedu... 12/15/2000
N Hadzijahic, M B Wallace, R H Hawes, A VanVelse, M LeVeen, V Marsi, B J Hoffman, A V Sahai CT or EUS for the initial staging of esophageal cancer? A cost minimization analysis CONCLUSION: CT remains as the initial staging test of choice in most clinical settings. However, in referral centers, initial EUS may be reasonable, but individualized model inputs must be obtained before reliable conclusions can be drawn. 12/15/2000
S A Call, G Heudebert, M Saag, C M Wilcox The changing etiology of chronic diarrhea in HIV-infected patients with CD4 cell counts less than 200 cells/mm3 CONCLUSIONS: Over the three years of the study, the incidence of chronic diarrhea in AIDS patients in our clinic did not change. The etiologies of diarrhea did change significantly, with an increased incidence of noninfectious causes and a decreased incidence of opportunistic infectious causes. This... 11/30/2000
N Iqbal, D Salzman, A J Lazenby, C M Wilcox Diagnosis of gastrointestinal graft-versus-host disease Allogeneic bone marrow transplantation is becoming increasingly performed for a variety of disorders but primarily for hematological malignancies. Graft-versus-host disease (GVHD), which often involves the GI tract, is one of the most common complications of this type of transplantation. The diagnos... 11/30/2000
C Y Kim, B Etemad, T F Glenn, H A Mackey, G E Viator, M B Wallace, M S Mokhashi, P B Cotton, R H Hawes Remote clinical assessment of gastrointestinal endoscopy (tele-endoscopy): an initial experience CONCLUSIONS: Overall, our tele-endoscopy setup shows great promise for remote supervision or observation of endoscopic procedures done by nurse endoscopists. Tele-endoscopy is both adequate and feasible for diagnosis of most gastrointestinal lesions. Subtle lesions still may be missed in our current... 11/18/2000
J D Linder, K E Mönkemüller, J V Davis, C M Wilcox Cyclooxygenase-2 inhibitor celecoxib: a possible cause of gastropathy and hypoprothrombinemia Gastrointestinal side effects from nonsteroidal anti-inflammatory drugs (NSAIDs) result mainly from inhibition of the enzyme cyclooxygenase (COX)-1; it is responsible for the synthesis of prostaglandin E2, which leads to increased mucosal blood flow, increased bicarbonate secretion, and mucus produc... 9/27/2000
J D Linder, K E Mönkemüller, I Raijman, L Johnson, A J Lazenby, C M Wilcox Cocaine-associated ischemic colitis Cocaine use can result in various gastrointestinal complications, including gastric ulcerations, retroperitoneal fibrosis, visceral infarction, intestinal ischemia, and gastrointestinal tract perforation. We report cocaine-associated colonic ischemia in three patients and review the literature. Incl... 9/27/2000
M A Eloubeidi, R H Hawes Mucinous tumors of the exocrine pancreas CONCLUSIONS: All mucin-producing cystic tumors of both types require surgical resection because they are frankly malignant or premalignant. Survival rates of both tumors are better than those reported for ductal cell carcinomas. Future studies are needed to improve the accuracy of diagnosing these t... 9/23/2000
K E Mönkemüller, A H Bussian, A J Lazenby, C M Wilcox Special histologic stains are rarely beneficial for the evaluation of HIV-related gastrointestinal infections During a 28-month period, endoscopic mucosal biopsy specimens from all HIV-infected patients were submitted for routine histologic evaluation. Immunoperoxidase staining for cytomegalovirus and herpesvirus antigens (esophagus), mycobacterial and fungal staining, and Gram staining of mucosal biopsy sp... 9/16/2000
K E Mönkemüller, C M Wilcox Diagnosis and treatment of esophagitis in AIDS At least 30% of patients with AIDS experience esophageal symptoms at some point during the course of HIV infection. The aim of this review is to provide a practical approach to the evaluation and therapy of esophagitis in AIDS. 9/14/2000
K E Mönkemüller, C M Wilcox Esophageal ulcer caused by cytomegalovirus: resolution during combination antiretroviral therapy for acquired immunodeficiency syndrome A 36-year-old man with a 5-year history of untreated human immunodeficiency virus (HIV) infection had odynophagia for 14 days. Fifteen days earlier, he had begun taking trimethoprim-sulphamethoxazole and combination antiretroviral therapy that included lamivudine, zidovudine, and nelfinavir. He had ... 8/30/2000
A V Sahai, G Mishra, I D Penman, D Williams, M B Wallace, N Hadzijahic, A Pearson, A Vanvelse, B J Hoffman, R H Hawes EUS to detect evidence of pancreatic disease in patients with persistent or nonspecific dyspepsia CONCLUSIONS: Dyspepsia may be an atypical presentation of pancreatic disease in patients with persistent or nonspecific symptoms. Endosonography may be useful to screen for pancreatic disease in patients with persistent dyspepsia. 8/2/2000
N Chalasani, C M Wilcox Gastrointestinal hemorrhage in patients with AIDS Gastrointestinal (GI) bleeding is a relatively infrequent complication seen in patients with AIDS. As with non-HIV-infected individuals, upper GI bleeding is much more common than lower GI bleeding. In patients with AIDS, upper GI bleeding can result from etiologies related to underlying HIV infecti... 6/8/2000
M B Wallace, B J Hoffman, A S Sahai, H Inoue, A Van Velse, R H Hawes Imaging of esophageal tumors with a water-filled condom and a catheter US probe CONCLUSIONS: Condom C-EUS is a new method of high resolution imaging of the esophagus. This method provides a contained column of water within the esophagus that improves image quality and ease of use and may reduce the risk of aspiration. 5/11/2000
R K Hsu, P Draganov, J W Leung, P R Tarnasky, A S Yu, R H Hawes, J T Cunningham, P B Cotton Therapeutic ERCP in the management of pancreatitis in children CONCLUSIONS: Therapeutic ERCP is safe in pediatric patients with pancreatitis. Significant clinical improvement is achieved in patients with biliary or pancreatic stone disease. Prospective studies with long-term follow-up are needed to determine the impact of endoscopic therapy in patients with chr... 4/1/2000
G R Heudebert, R M Centor, J C Klapow, R Marks, L Johnson, C M Wilcox What is heartburn worth? A cost-utility analysis of management strategies CONCLUSIONS: Empirical treatment seems to be the optimal initial management strategy for patients with heartburn, but the choice between a proton pump inhibitor or histamine2-receptor antagonist depends on the impact of heartburn on quality of life. 3/16/2000
C L Kay, D Kulling, R H Hawes, J W Young, P B Cotton Virtual endoscopy--comparison with colonoscopy in the detection of space-occupying lesions of the colon CONCLUSIONS: Virtual colonoscopy is feasible, well tolerated, and capable of detecting most lesions greater than 10 mm in diameter. This technique is continuing to be developed and warrants further evaluation as a diagnostic and screening tool in colorectal neoplasia. 3/16/2000
M B Wallace, R H Hawes, A V Sahai, A Van Velse, B J Hoffman Dilation of malignant esophageal stenosis to allow EUS guided fine-needle aspiration: safety and effect on patient management CONCLUSION: Dilation of obstructing esophageal tumors allows identification of a large number of patients with advanced stage malignancy. Dilation to 14 to 16 mm is sufficient for complete staging in almost all patients. 3/4/2000
K E Mönkemüller, S A Call, A J Lazenby, C M Wilcox Declining prevalence of opportunistic gastrointestinal disease in the era of combination antiretroviral therapy CONCLUSIONS: GI OD now seem to be an uncommon problem in HIV-infected patients undergoing endoscopy despite a low CD4 lymphocyte count, and this reduction of OD was associated with the use of HAART. 2/24/2000
C M Wilcox Methodology of reprocessing one-time use accessories The current climate of falling reimbursements has prompted evaluation of reusing single use (disposable) endoscopic accessories. A number of different accessories have undergone study of both function and sterility after reuse. These studies, albeit limited in number, do show that selected equipment... 2/22/2000
R H Hawes, Q Xiong, I Waxman, K J Chang, D B Evans, J L Abbruzzese A multispecialty approach to the diagnosis and management of pancreatic cancer This article reviews recent developments in pancreatic cancer research and offers a multispecialty perspective on the diagnosis and management of this challenging disease. Current findings in the molecular biology of the disease and their implications for management are examined, as well as developm... 1/19/2000
R H Hawes Endoscopic ultrasound Endoscopic ultrasound was introduced in the early 1980s. Today, endoscopic ultrasound remains the most accurate modality for local staging of gastrointestinal cancers but the emphasis is now on what findings will impact patient care. At the same time, a new era of interventional endoscopic ultrasoun... 1/5/2000
A V Sahai, D Schembre, P D Stevens, A Chak, G Isenberg, C J Lightdale, M V Sivak, R H Hawes A multicenter U.S. experience with EUS-guided fine-needle aspiration using the Olympus GF-UM30P echoendoscope: safety and effectiveness CONCLUSIONS: The GF-UM30P may be clinically useful for EUS-guided fine-needle aspiration if a curved linear array instrument is unavailable. 11/26/1999
F G Gress, R H Hawes, T J Savides, S O Ikenberry, O Cummings, K Kopecky, S Sherman, M Wiersema, G A Lehman Role of EUS in the preoperative staging of pancreatic cancer: a large single-center experience CONCLUSIONS: EUS is more accurate than CT for staging pancreatic malignancies, including predicting vascular invasion and local resectability. EUS staging was significantly better than CT for T1, T2, and T3 tumors. EUS staging accuracy improved after 100 cases, thus suggesting a correlation between ... 11/26/1999
N Chalasani, T F Imperiale, A Ismail, G Sood, M Carey, C M Wilcox, H Madichetty, P Y Kwo, T D Boyer Predictors of large esophageal varices in patients with cirrhosis CONCLUSIONS: Our data show that clinical predictors could be used to stratify cirrhotic patients for the risk of large esophageal varices and such stratification could be used to improve the cost effectiveness of screening endoscopy. 11/24/1999
K E Mönkemüller, C M Wilcox Diagnosis of esophageal ulcers in acquired immunodeficiency syndrome The esophagus is one of the most common sites of gastrointestinal involvement in human immunodeficiency virus (HIV)-infected patients, with at least 30% of the patients having esophageal symptoms at some point during the course of HIV infection. Esophageal ulcers are commonly caused by infections su... 8/6/1999
G Mishra, A V Sahai, I D Penman, D B Williams, M A Judson, D N Lewin, R H Hawes, B J Hoffman Endoscopic ultrasonography with fine-needle aspiration: an accurate and simple diagnostic modality for sarcoidosis CONCLUSIONS: Mediastinal lymph nodes in patients with sarcoidosis appear to have specific echo characteristics, and EUS-FNA can be used for confirmatory tissue diagnosis. 8/5/1999
M S Mokhashi, R H Hawes The ultraflex stents for malignant esophageal obstruction Ultraflex esophageal stents have contributed to the tremendous success of self-expanding metal stents (SEMS) in the treatment of esophageal cancer because they are easy and safe to insert. With an eye to improving clinical outcome, the Ultraflex stent design has been in a state of constant evolution... 7/2/1999
C M Wilcox Role of endoscopy in the investigation of upper gastrointestinal symptoms in HIV-infected patients Endoscopy plays a pivotal role in the management of patients with the acquired immunodeficiency syndrome (AIDS), because tissue documentation of opportunistic processes is often necessary to establish a definitive diagnosis. With progression of immunodeficiency, endoscopy becomes more important beca... 6/9/1999
D Kulling, J N Vournakis, S Woo, M V Demcheva, D U Tagge, G Rios, S Finkielsztein, R H Hawes Endoscopic injection of bleeding esophageal varices with a poly-N-acetyl glucosamine gel formulation in the canine portal hypertension model CONCLUSIONS: Endoscopic injection of bleeding esophageal varices in this animal model with the use of poly-N-acetyl glucosamine gel was an effective and safe method for stopping the hemorrhage and inducing permanent varix obliteration. 5/27/1999
A Chak, R H Hawes, G S Cooper, B Hoffman, M F Catalano, R C Wong, T E Herbener, M V Sivak Prospective assessment of the utility of EUS in the evaluation of gallstone pancreatitis CONCLUSIONS: EUS can reliably identify cholelithiasis and is more sensitive than transabdominal US in detecting choledocholithiasis in patients with biliary pancreatitis. EUS may be used early in the management of patients with acute pancreatitis to select those who would benefit from endoscopic sto... 5/6/1999
M S Bhutani, B J Hoffman, R H Hawes Diagnosis of pancreas divisum by endoscopic ultrasonography CONCLUSIONS: The absence of a stack sign during pancreatobiliary imaging by EUS may suggest the diagnosis of pancreas divisum. 5/1/1999
D B Williams, A V Sahai, L Aabakken, I D Penman, A van Velse, J Webb, M Wilson, B J Hoffman, R H Hawes Endoscopic ultrasound guided fine needle aspiration biopsy: a large single centre experience CONCLUSIONS: EUS-FNA is safe and can readily obtain tissue specimens adequate for cytopathological diagnoses. Compared with size and sonographic criteria, it is a superior modality for the detection of nodal metastases. While providing accurate diagnosis of pancreatic and perirectal malignancies, re... 4/16/1999
C E Reed, G Mishra, A V Sahai, B J Hoffman, R H Hawes Esophageal cancer staging: improved accuracy by endoscopic ultrasound of celiac lymph nodes CONCLUSIONS: Endoscopic ultrasound with fine-needle aspiration is useful in the detection and confirmation of CLN metastasis. In T3 tumors of the distal esophagus, a negative EUS result does not substantiate absence of CLN disease. Endoscopic ultrasound with fine-needle aspiration may be important i... 4/10/1999
A V Sahai, P D Mauldin, V Marsi, R H Hawes, B J Hoffman Bile duct stones and laparoscopic cholecystectomy: a decision analysis to assess the roles of intraoperative cholangiography, EUS, and ERCP CONCLUSIONS: The least costly strategy for laparoscopic cholecystectomy patients depends primarily on the risk of stones and stone-related symptoms, but procedural costs and operator expertise are also critical. 2/27/1999
C M Wilcox Esophageal strictures complicating ulcerative esophagitis in patients with AIDS CONCLUSION: Esophageal strictures infrequently complicate ulcerative esophagitis caused by opportunistic infections in HIV-infected patients. 2/18/1999
T R Navin, R Weber, D J Vugia, D Rimland, J M Roberts, D G Addiss, G S Visvesvara, S P Wahlquist, S E Hogan, L E Gallagher, D D Juranek, D A Schwartz, C M Wilcox, J M Stewart, S E Thompson, R T Bryan Declining CD4+ T-lymphocyte counts are associated with increased risk of enteric parasitosis and chronic diarrhea: results of a 3-year longitudinal study From January 1991 through September 1994, we observed people who were infected with HIV to assess the impact of enteric parasite-associated diarrhea. Respondents answered comprehensive questionnaires covering clinical and epidemiologic information and provided stool specimens monthly, which were exa... 2/12/1999
C M Wilcox, W S Clark Causes and outcome of upper and lower gastrointestinal bleeding: the Grady Hospital experience CONCLUSIONS: The causes of gastrointestinal bleeding remain little changed over the past several decades, though in our large series the need for surgical therapy and the mortality from both upper and lower GI bleeding were low. 2/5/1999
D Kulling, D R Feldman, C L Kay, B J Hoffman, C E Reed, J W Young, R H Hawes Local staging of esophageal cancer using endoscopic magnetic resonance imaging: prospective comparison with endoscopic ultrasound CONCLUSIONS: Endoscopic magnetic resonance imaging of esophageal cancer diagnoses local staging that is comparable to endosonography. In future, the combination of endoscopic and conventional magnetic resonance scanning may provide comprehensive staging of esophageal cancer. 2/5/1999
M F Vaezi, J E Richter, C M Wilcox, P L Schroeder, S Birgisson, R L Slaughter, R E Koehler, M E Baker Botulinum toxin versus pneumatic dilatation in the treatment of achalasia: a randomised trial CONCLUSIONS: At one year pneumatic dilatation is more effective than botulinum toxin. Symptom improvement parallels objective oesophageal measurements after pneumatic dilatation but not after botulinum toxin treatment for achalasia. 1/23/1999
C M Wilcox, K B Waites, P D Smith No relationship between gastric pH, small bowel bacterial colonisation, and diarrhoea in HIV-1 infected patients CONCLUSIONS: Small bowel bacterial overgrowth is not common in HIV-1 infected patients, regardless of the presence of diarrhoea, and is not associated with hypochlorhydria 12/24/1998
G A Rios, D B Adams, K G Yeoh, P R Tarnasky, J T Cunningham, R H Hawes Outcome of lateral pancreaticojejunostomy in the management of chronic pancreatitis with nondilated pancreatic ducts Lateral pancreaticojejunostomy has demonstrated variable success in the management of chronic pancreatitis associated with ductal dilation, but its role in patients with nondilated ducts is poorly defined. The aim of this study was to assess the outcome of lateral pancreaticojejunostomy in chronic p... 12/8/1998
P R Tarnasky, Y Y Palesch, J T Cunningham, P D Mauldin, P B Cotton, R H Hawes Pancreatic stenting prevents pancreatitis after biliary sphincterotomy in patients with sphincter of Oddi dysfunction CONCLUSIONS: Pancreatic duct stenting protects significantly against post-ERCP pancreatitis in patients with pancreatic sphincter hypertension undergoing biliary sphincterotomy. Stenting of the pancreatic duct should be strongly considered after biliary sphincterotomy for sphincter of Oddi dysfuncti... 12/3/1998
A Chak, A Soweid, B Hoffman, P Stevens, R H Hawes, C J Lightdale, G S Cooper, M I Canto, M V Sivak Clinical implications of endoluminal ultrasonography using through-the-scope catheter probes CONCLUSIONS: Catheter probe-assisted endosonography has a modest effect on diagnostic and therapeutic management, comparable with endoscopic ultrasonography in the same patients. The vast majority of effected changes are toward less invasive management. 12/1/1998
M S Bhutani, B J Hoffman, R H Hawes A swine model for teaching endoscopic ultrasound (EUS) imaging and intervention under EUS guidance CONCLUSIONS: A swine model appears to be useful for hands-on teaching in endoscopic ultrasound imaging and intervention under endoscopic ultrasound guidance. 11/24/1998
C M Wilcox, K E Mönkemüller Diagnosis and management of esophageal disease in the acquired immunodeficiency syndrome CONCLUSIONS: Almost all esophageal infections in patients with AIDS are treatable; therefore, a thorough work-up is indicated. With the widespread use of more effective antiretroviral therapy including the protease inhibitors, there is a general consensus that the incidence of many opportunistic dis... 11/21/1998
R H Hawes Indications for EUS-directed FNA EUS/FNA is an extremely precise method for sampling lesions surrounding the gastrointestinal tract. As experience widens, so do the indications for its use. However, as endoscopists explore ways to use this technique to improve patient care, a basic premise should be kept in mind: the information ob... 10/9/1998
C M Wilcox, K E Mönkemüller Hepatobiliary diseases in patients with AIDS: focus on AIDS cholangiopathy and gallbladder disease Diseases of the biliary tree and gallbladder are being described with increasing frequency among patients with the acquired immunodeficiency syndrome (AIDS). Despite the profound immunosuppressive therapy transplant recipients receive, these patients do not appear to be affected by these disorders; ... 9/10/1998
K E Mönkemüller, C M Wilcox Diagnosis and treatment of colonic disease in AIDS The colon is a frequent site of gastrointestinal complications in patients with HIV infection, and these colonic disorders increase in frequency as immunodeficiency worsens. The most common clinical manifestations of colonic disease in AIDS are diarrhea, lower gastrointestinal bleeding, and abdomina... 9/9/1998
C M Wilcox, W Geels, T H Baron How many times can you reuse a "single-use" sphincterotome? A prospective evaluation CONCLUSIONS: "Single use" sphincterotomes can be safely reused multiple times without compromising their use as a diagnostic or therapeutic device. 7/31/1998
C M Wilcox, N Chalasani, A Lazenby, D A Schwartz Cytomegalovirus colitis in acquired immunodeficiency syndrome: a clinical and endoscopic study CONCLUSIONS: Cytomegalovirus colitis in AIDS appears to have variable but stereotypical clinical and colonoscopic manifestations. Distal colitis associated with ulceration is the most common colonoscopic pattern. 7/31/1998
A V Sahai, M Zimmerman, L Aabakken, P R Tarnasky, J T Cunningham, A van Velse, R H Hawes, B J Hoffman Prospective assessment of the ability of endoscopic ultrasound to diagnose, exclude, or establish the severity of chronic pancreatitis found by endoscopic retrograde cholangiopancreatography CONCLUSIONS: EUS can accurately diagnose, rule out, and establish the severity of chronic pancreatitis found by ERCP. 7/31/1998
J E Craigie, D B Adams, T K Byme, E P Tagge, P R Tarnasky, J T Cunningham, R H Hawes Endoscopic electrohydraulic lithotripsy in the management of pancreatobiliary lithiasis CONCLUSION: Intraoperative pancreatobiliary endoscopy with EHL is safe and effective in the eradication of pancreatic and bile duct stones. This novel technique represents a valuable adjunct in the management of chronic fibrocalcific pancreatitis with ductal lithiasis in the head region and in the o... 5/23/1998
D Kulling, D R Feldman, C L Kay, D E Bohning, B J Hoffman, A K Van Velse, P L Baron, C J Lahr, R H Hawes Local staging of anal and distal colorectal tumors with the magnetic resonance endoscope CONCLUSIONS: For anal and distal colorectal neoplasms, EMR imaging is feasible and provides local staging comparable to endosonography. 3/25/1998
P B Cotton, J E Geenen, S Sherman, J T Cunningham, D A Howell, D L Carr-Locke, N J Nickl, R H Hawes, G A Lehman, A Ferrari, A Slivka, D R Lichtenstein, J Baillie, P S Jowell, L M Lail, H Evangelou, J J Bosco, B L Hanson, B J Hoffman, S M Rahaman, R Male Endoscopic sphincterotomy for stones by experts is safe, even in younger patients with normal ducts CONCLUSION: Sphincterotomy for stones can be performed very safely by experienced endoscopists. 3/6/1998
M S Bhutani, R H Hawes, P L Baron, A Sanders-Cliette, A van Velse, J F Osborne, B J Hoffman Endoscopic ultrasound guided fine needle aspiration of malignant pancreatic lesions CONCLUSIONS: EUS with FNA is useful for detection of malignancy in a pancreatic mass. The procedure appears to have a complication rate of 2%. Impact of this technique on clinical management of patients needs further evaluation. 2/26/1998
N Chalasani, C M Wilcox Etiology and outcome of lower gastrointestinal bleeding in patients with AIDS CONCLUSIONS: LGIB is infrequent in patients with AIDS and is usually caused by opportunistic diseases specifically related to immunodeficiency. Although some of these conditions are potentially treatable medically, in-hospital mortality is high and long-term prognosis is poor because of AIDS-related... 2/19/1998
P R Tarnasky, R H Hawes Endoscopic diagnosis and therapy of unexplained (idiopathic) acute pancreatitis A significant minority of patients with acute pancreatitis show no obvious cause for the attack during a routine evaluation. There is no consensus regarding the appropriate diagnostic and therapeutic approach in this setting. This article reviews the available data, outlines directions for further i... 2/14/1998
D Külling, D R Feldman, C L Kay, B J Hoffman, P B Cotton, R H Hawes Initial experiences with magnetic resonance endoscopy CONCLUSION: These early results demonstrate endoscopic MR to be feasible and to produce comparable local staging to EUS in patients with esophageal and rectal cancer. The ultimate goal will be to combine endoscopic MR with body coil MR imaging (for the assessment of distant metastases) in order to p... 2/12/1998
D B Adams, P R Tarnasky, R H Hawes, J T Cunningham, C Brooker, T E Brothers, P B Cotton Outcome after laparoscopic cholecystectomy for chronic acalculous cholecystitis Patients with typical symptoms of biliary tract disease but no gallstones on ultrasonography may benefit from cholecystectomy for presumed chronic acalculous cholecystitis. We retrospectively analyzed the outcome of 50 patients with a preoperative diagnosis of chronic acalculous cholecystitis based ... 2/11/1998
C M Wilcox, P R Harris, T K Redman, S Kawabata, T Hiroi, H Kiyono, P D Smith High mucosal levels of tumor necrosis factor alpha messenger RNA in AIDS-associated cytomegalovirus-induced esophagitis CONCLUSIONS: Increased macrophage production and high tissue levels of TNF-alpha mRNA are associated with cytomegalovirus-associated esophageal ulcers and probably contribute to the inflammatory response associated with cytomegalovirus-induced gastrointestinal disease. 1/15/1998
P L Baron, L E Aabakken, D J Cole, M B LeVeen, L F Baron, D M Daniel, J T Cunningham, R H Hawes, D B Adams, B J Hoffman Differentiation of benign from malignant pancreatic masses by endoscopic ultrasound CONCLUSIONS: Radial array EUS is helpful in supporting or refuting a diagnosis of cancer in a patient with a pancreatic mass. Although EUS-guided FNA can confirm the diagnosis, a negative FNA should not preclude exploration when clinically indicated. 1/7/1998
D R Feldman, D P Kulling, C L Kay, D J Cole, J T Cunningham, R H Hawes, P R Tarnasky, P B Cotton, P L Baron Magnetic resonance cholangiopancreatography: a novel approach to the evaluation of suspected pancreaticobiliary neoplasms CONCLUSIONS: MRCP can accurately and noninvasively delineate PB ductal anatomy and diagnose PB neoplasms comparably to ERCP. MRCP is an interesting new noninvasive method for evaluating patients with suspected PB neoplasms. 1/7/1998
C M Wilcox, L N Alexander, W S Clark Prospective evaluation of the gastrointestinal tract in patients with iron deficiency and no systemic or gastrointestinal symptoms or signs CONCLUSIONS: Approximately half of patients with iron deficiency in whom gastrointestinal or systemic signs or symptoms are absent have an underlying gastrointestinal lesion. Nevertheless, despite a thorough endoscopic evaluation, some patients will have no etiology found; the prognosis for these pa... 12/31/1997
C M Wilcox Relationship between nonsteroidal anti-inflammatory drug use, Helicobacter pylori, and gastroduodenal mucosal injury With the realization that Helicobacter pylori is the main etiologic factor for peptic ulcer disease, recent studies have explored a potential relationship between H. pylori and nonsteroidal anti-inflammatory drug (NSAID)-related gastroduodenal mucosal injury. Using serology and/or histology to detec... 12/12/1997
M S Bhutani, B J Hoffman, A van Velse, R H Hawes Contrast-enhanced endoscopic ultrasonography with galactose microparticles: SHU508 A (Levovist) CONCLUSION: Intravenous SHU508 A as a contrast agent significantly enhances color Doppler signals during EUS. Vascualar contrast of this sort could potentially have a significant role in improving the accuracy of EUS in diagnosing malignant vascular invasion, the detection of occult pancreatic neopl... 11/14/1997
N Chalasani, W S Clark, C M Wilcox Blood urea nitrogen to creatinine concentration in gastrointestinal bleeding: a reappraisal CONCLUSIONS: Although the BUN/CREAT ratio is higher in UGIB compared with LGIB, the degree of overlap, especially in patients without hematemesis, suggests this value to have poor discriminatory ability. The degree of elevation correlates best with transfusion requirements rather than admission vita... 10/23/1997
C M Wilcox, W S Clark Features associated with painless peptic ulcer bleeding CONCLUSIONS: Approximately half the patients with a bleeding peptic ulcer have no abdominal pain. Large ulcer size, use of tobacco, and age <80 yr seem to be the main determinants of ulcer-related pain in this setting. 8/1/1997
P R Tarnasky, B Hoffman, L Aabakken, W L Knapple, W Coyle, B Pineau, J T Cunningham, P B Cotton, R H Hawes Sphincter of Oddi dysfunction is associated with chronic pancreatitis CONCLUSIONS: Sphincter of Oddi dysfunction is associated with changes of chronic pancreatitis in patients with unexplained pancreaticobiliary pain. Longitudinal follow-up is required to confirm these preliminary findings. 7/1/1997
C M Wilcox, R O Darouiche, L Laine, B L Moskovitz, I Mallegol, J Wu A randomized, double-blind comparison of itraconazole oral solution and fluconazole tablets in the treatment of esophageal candidiasis This multicenter, randomized, double-blind study compared the efficacy and safety of itraconazole oral solution and fluconazole tablets in the treatment of esophageal candidiasis. One hundred twenty-six immunocompromised patients with esophageal candidiasis were treated with itraconazole oral soluti... 7/1/1997
C M Wilcox, K E Mönkemüller Review article: the therapy of gastrointestinal infections associated with the acquired immunodeficiency syndrome Although there have been dramatic strides in the therapy of human immunodeficiency virus infection over the last few years, the number of infected people world-wide is tremendous and, at least in developing countries, continues to expand. Complications which involve the gastrointestinal tract are co... 6/1/1997
M S Bhutani, R H Hawes, B J Hoffman A comparison of the accuracy of echo features during endoscopic ultrasound (EUS) and EUS-guided fine-needle aspiration for diagnosis of malignant lymph node invasion CONCLUSION: Endoscopic ultrasound-guided fine-needle aspiration is an important adjunct for accurate lymph node assessment for malignancy. 6/1/1997
A Chak, M I Canto, T Rösch, H J Dittler, R H Hawes, T L Tio, C J Lightdale, H W Boyce, J Scheiman, S L Carpenter, J Van Dam, M L Kochman, M V Sivak Endosonographic differentiation of benign and malignant stromal cell tumors CONCLUSIONS: Tumor size and certain EUS features are useful for predicting malignancy in stromal cell tumors. Absence of these features indicates benign disease. Agreement among experts in interpreting these EUS features is fair to moderate. 6/1/1997
C M Wilcox, L N Alexander, G A Cotsonis, W S Clark Nonsteroidal antiinflammatory drugs are associated with both upper and lower gastrointestinal bleeding To evaluate the association between nonsteroidal antiinflammatory drug (NSAID) use and upper gastrointestinal bleeding (UGIB) and lower gastrointestinal bleeding (LGIB), we performed a prospective case-control study at a large inner-city hospital over a 28-month period evaluating 461 consecutive pat... 5/1/1997
C M Wilcox, W S Clark Association of nonsteroidal antiinflammatory drugs with outcome in upper and lower gastrointestinal bleeding Although nonsteroidal antiinflammatory drug (NSAID) use is strongly associated with both upper gastrointestinal bleeding (UGIB) and lower gastrointestinal bleeding (LGIB), few data exist regarding the outcome of the bleeding episode for those consuming these drugs. Consecutive patients with UGIB or ... 5/1/1997
D Kulling, D E Bohning, C L Kay, D R Feldman, P B Cotton, R H Hawes Histological correlates to pig gastrointestinal wall layers imaged in vitro with the magnetic resonance endoscope CONCLUSIONS: In vitro imaging with the magnetic resonance endoscope shows three to five wall layers of the porcine gastrointestinal tract depending on the segment scanned. This degree of gut wall resolution suggests that endoscopic magnetic resonance imaging may have potential for local staging of g... 5/1/1997
G R Heudebert, R Marks, C M Wilcox, R M Centor Choice of long-term strategy for the management of patients with severe esophagitis: a cost-utility analysis CONCLUSIONS: Medical therapy is the preferred treatment strategy for most patients with severe erosive esophagitis. Individuals with a long life expectancy are good candidates for LNF if postoperative morbidity is low and GERD symptoms remain abated for many years. 4/1/1997
None Da Silva AJ, SB Slemenda, GS Visvesvara, DA Schwartz, CM Wilcox, S Wallace, NJ Pieniazek Detection of Septata intestinalis (Microsporidia) Cali et al. 1993 Using Polymerase Chain Reaction Primers Targeting the Small Submit Subunit Ribosomal RNA Coding Region Background: The microsporidian Septata intestinalis, recently suggested to be reclassified as Encephalitozoon intestinalis, is probably the second most common microsporidian isolated from AIDS patients after Enterocytozoon bieneusi. S. intestinalis causes a disseminated disease, including infections... 3/1/1997
F G Gress, R H Hawes, T J Savides, S O Ikenberry, G A Lehman Endoscopic ultrasound-guided fine-needle aspiration biopsy using linear array and radial scanning endosonography CONCLUSIONS: EUS-guided FNA appears to be technically feasible, safe, and accurate for obtaining diagnostic tissue of suspicious gastrointestinal and mediastinal lesions and provides important preoperative information. 3/1/1997
L N Alexander, C M Wilcox A prospective trial of thalidomide for the treatment of HIV-associated idiopathic esophageal ulcers Thalidomide appears to be highly effective for oropharyngeal apthous ulcers in HIV-infected patients. However, there are limited data regarding the use of this drug for the treatment of HIV-associated idiopathic esophageal ulcer(s) (IEU). Twelve HIV-infected patients with esophageal symptoms and IEU... 3/1/1997
D R Feldman, D P Kulling, R H Hawes, C L Kay, V R Muckenfuss, P B Cotton, D E Bohning, J W Young MR endoscopy: preliminary experience in human trials The authors performed local staging of esophageal and rectal cancer (without pathologic correlation) with use of a nonferromagnetic magnetic resonance (MR) endoscope with a 3-cm-long receive-only coil embedded in its tip in 16 patients (eight with esophageal cancer and eight with anorectal cancer). ... 3/1/1997
E P Tagge, P R Tarnasky, J Chandler, D U Tagge, C Smith, A Hebra, R H Hawes, P B Cotton, H B Othersen Multidisciplinary approach to the treatment of pediatric pancreaticobiliary disorders A multidisciplinary approach using traditional open surgery, endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic surgery has revolutionized the care of the adult with pancreaticobiliary disease. This study focuses on a similar collaborative effort to diagnose and treat children wi... 2/1/1997
C M Wilcox, L N Alexander, G Cotsonis A prospective characterization of upper gastrointestinal hemorrhage presenting with hematochezia CONCLUSIONS: Hematochezia is common in patients with UGIH, and the presenting features are similar to those of patients with melena. Duodenal ulcer is the most common cause of bleeding associated with hematochezia. Patients with UGIH and hematochezia seem to have a worse prognosis. 2/1/1997
P R Tarnasky, J T Cunningham, R H Hawes, B J Hoffman, R Uflacker, I Vujic, P B Cotton Transpapillary stenting of proximal biliary strictures: does biliary sphincterotomy reduce the risk of postprocedure pancreatitis? CONCLUSION: The risk of pancreatitis following transpapillary biliary stenting is increased in patients with proximal biliary strictures. Such lesions (malignant or benign) may serve as a fulcrum, leading to medial deflection of the stent and compression of the pancreatic orifice. The hypothesis tha... 1/1/1997
C M Wilcox, R F Straub, L N Alexander, W S Clark Etiology of esophageal disease in human immunodeficiency virus-infected patients who fail antifungal therapy CONCLUSIONS: Esophageal ulceration is the most common cause of esophageal symptoms in HIV-infected patients failing empiric antifungal therapy and those developing symptoms while receiving antifungal agents. Given these findings, endoscopy should be the test of choice for these nonresponders, rather... 12/1/1996
R M Bashir, C M Wilcox Symptom-specific use of upper gastrointestinal endoscopy in human immunodeficiency virus-infected patients yields high dividends The yield of upper gastrointestinal endoscopy (esophago-gastroduodenoscopy; EGD) in human immunodeficiency virus (HIV)-infected patients based on presenting symptoms has not been well studied. We studied consecutive patients with documented HIV infection undergoing EGD at a large innercity hospital ... 12/1/1996
C M Wilcox, R F Straub, D A Schwartz Prospective evaluation of biopsy number for the diagnosis of viral esophagitis in patients with HIV infection and esophageal ulcer CONCLUSIONS: At least 10 biopsies may be required to exclude viral esophagitis in HIV-infected patients. If biopsy specimens are adequate and no evidence of viral cytopathic effect has been found, the patient may be treated on the basis of the results of the initial clinical, endoscopic, and patholo... 11/1/1996
N Chalasani, G Cotsonis, C M Wilcox Upper gastrointestinal bleeding in patients with chronic renal failure: role of vascular ectasia CONCLUSIONS: The most common cause of UGIB in patients with CRF is peptic ulcer disease. VE is more frequent in patients with CRF than in those with normal renal function, and its prevalence seems to be related to the duration and severity of renal disease. 11/1/1996
C M Wilcox, K Waites, E S Brookings Use of sterile compared with tap water in gastrointestinal endoscopic procedures CONCLUSIONS: Bacterial growth in the water bottle was infrequent, consisted predominantly of nonpathogenic organisms, and was not associated with clinical complications. Our pilot study suggests that the use of tap water as compared with sterile water may be practical as well as provide cost savings... 10/1/1996
S Sherman, R H Hawes, T J Savides, F G Gress, S O Ikenberry, M T Smith, S Zaidi, G A Lehman Stent-induced pancreatic ductal and parenchymal changes: correlation of endoscopic ultrasound with ERCP CONCLUSION: Short-term pancreatic duct stenting induced both ductal and parenchymal changes in more than 50% of patients. Chronic pancreatitis may be a consequence of pancreatic duct stenting. 9/1/1996
M T Smith, S Sherman, S O Ikenberry, R H Hawes, G A Lehman Alterations in pancreatic ductal morphology following polyethylene pancreatic stent therapy CONCLUSION: Morphologic changes induced by polyethylene pancreatic duct stents occurred in 80% of patients. More than one third of these changes did not resolve during the follow-up period. Because of concern over stent-induced fibrosis, the use of pancreatic stents should remain largely experimenta... 9/1/1996
S Sherman, K Gottlieb, M F Uzer, M T Smith, Q E Khusro, D T Earle, R L Brunelle, R H Hawes, G A Lehman Effects of meperidine on the pancreatic and biliary sphincter CONCLUSION: Meperidine can be used for additional analgesia during sphincter of Oddi manometry if the basal sphincter pressure is the parameter used to determine therapy. 9/1/1996
C M Wilcox, D A Schwartz Endoscopic-pathologic correlates of Candida esophagitis in acquired immunodeficiency syndrome Although Candida esophagitis is one of the most common opportunistic infections in patients with acquired immunodeficiency syndrome (AIDS), there has been no systematic study of the endoscopic and pathologic manifestations of this disease. During a 53-month period, 141 patients with AIDS and Candida... 7/1/1996
I I Peleg, M F Lubin, G A Cotsonis, W S Clark, C M Wilcox Long-term use of nonsteroidal antiinflammatory drugs and other chemopreventors and risk of subsequent colorectal neoplasia Our objective was to study the relationship between dispensed aspirin, nonaspirin nonsteroidal antiinflammatory drugs (NSAIDs), steroidal antiinflammatory drugs (SAIDs), acetaminophen, calcium, psyllium, and multivitamin preparations and the risk for subsequent colorectal adenoma and adenocarcinoma.... 7/1/1996
C M Wilcox, L N Alexander, R F Straub, W S Clark A prospective endoscopic evaluation of the causes of upper GI hemorrhage in alcoholics: a focus on alcoholic gastropathy CONCLUSION: In the actively drinking patient, the most common causes of UGIH are peptic ulcer and disorders related to portal hypertension. Alcoholic gastropathy appears to be a rare and previously overemphasized cause of bleeding. 7/1/1996
C M Wilcox, L N Alexander, W S Clark, S E Thompson Fluconazole compared with endoscopy for human immunodeficiency virus-infected patients with esophageal symptoms CONCLUSIONS: Empirical oral antifungal therapy with fluconazole is highly efficacious, safe, and cost-effective for HIV-infected patients with new-onset esophageal symptoms. 6/1/1996
D M Anwar-Bruni, S E Hogan, D A Schwartz, C M Wilcox, R T Bryan, J L Lennox Atovaquone is effective treatment for the symptoms of gastrointestinal microsporidiosis in HIV-1-infected patients CONCLUSION: Atovaquone demonstrates promise as a symptomatic treatment for intestinal microsporidiosis. A double-blind and placebo-controlled clinical trial is currently in progress. 6/1/1996
G A Silvestri, B J Hoffman, M S Bhutani, R H Hawes, L Coppage, A Sanders-Cliette, C E Reed Endoscopic ultrasound with fine-needle aspiration in the diagnosis and staging of lung cancer CONCLUSIONS: The results showed that EUS/FNA improves the accuracy of computed tomographic scan in the staging of lung cancer. By accessing lymph nodes at levels 5 and 7, EUS/FNA complements mediastinoscopy and is considered the staging modality of choice in these regions. Positive EUS/FNA can obvia... 5/1/1996
N Chalasani, C M Wilcox Etiology, evaluation, and outcome of jaundice in patients with acquired immunodeficiency syndrome Although liver test abnormalities are frequently identified in patients with acquired immunodeficiency syndrome (AIDS), the causes, evaluation, and outcome of jaundice in these patients have not been systematically evaluated. From August 1, 1990 through September 1, 1994, all human immunodeficiency ... 4/1/1996
T J Savides, F G Gress, S A Zaidi, S O Ikenberry, R H Hawes Detection of embryologic ventral pancreatic parenchyma with endoscopic ultrasound CONCLUSION: The ventral anlage is frequently detected during pancreatic EUS, with a significantly lower rate of detection in patients with EUS findings of a pancreatic head mass or diffuse chronic pancreatitis. 1/1/1996
T Yamakawa, R H Hawes Percutaneous choledochoscopy This article reviews the technique and results of the percutaneous application of flexible endoscopy to the biliary tree. Included are some speculations by the authors on future applications. 1/1/1996
F J Rescorla, M Schlatter, R H Hawes, J L Grosfeld Delayed presentation of a penetrating biliary tract injury in a child An 8-year-old child presented with obstruction of the common hepatic duct from a 9-mm bullet that had entered her liver 22 months earlier. Evaluation revealed migration of the bullet with complete obstruction of the common hepatic duct. Surgical removal and reconstruction with hepaticojejunostomy ha... 1/1/1996
C M Wilcox, D A Schwartz, G Cotsonis, S E Thompson Chronic unexplained diarrhea in human immunodeficiency virus infection: determination of the best diagnostic approach CONCLUSIONS: Clinical parameters are helpful in predicting which patients may benefit from endoscopic examination. 1/1/1996
A Chak, M Canto, H Gerdes, C J Lightdale, R H Hawes, M J Wiersema, G Kallimanis, T L Tio, T W Rice, H W Boyce Prognosis of esophageal cancers preoperatively staged to be locally invasive (T4) by endoscopic ultrasound (EUS): a multicenter retrospective cohort study CONCLUSIONS: Endosonography accurately identifies patients with invasive T4 tumors who have a poor prognosis. This prognosis is independent of mode of therapy. 12/1/1995
C M Wilcox, R F Straub, W S Clark Prospective evaluation of oropharyngeal findings in human immunodeficiency virus-infected patients with esophageal ulceration CONCLUSIONS: OP ulceration is uncommon in patients with esophageal ulceration, with the exception of herpes simplex virus esophagitis. OP candidiasis is common in patients with underlying esophageal ulcer, potentially resulting in diagnostic confusion. OP candidiasis appears to be a moderately usefu... 11/1/1995
C S Cutler, D K Rex, R H Hawes, G A Lehman Does routine intravenous glucagon administration facilitate colonoscopy? A randomized trial CONCLUSIONS: Routine use of intravenous glucagon in a dosage of 1 mg does not facilitate colonoscopy by experienced examiners. 10/1/1995
B J Hoffman, R H Hawes Endoscopic ultrasound and clinical competence The last few years have seen substantial growth in technology, research, and performance of endoscopic ultrasound. Unfortunately, opportunities for training in EUS have not kept pace with this growth. To improve the breadth and quality of training in EUS, resources will need to be channeled in two d... 10/1/1995
C M Wilcox, L N Alexander, W S Clark Localization of an obstructing esophageal lesion. Is the patient accurate? There are many options as to the accuracy of a patient's subjective localization of an obstructing esophageal lesion. However, there are few studies specifically examining this issue. Over a 35-month period, all patients evaluated by our gastroenterology service undergoing endoscopy for dysphagia we... 10/1/1995
A L Buchman, C M Wilcox Crohn's disease masquerading as systemic lupus erythematosus We report the case of a 55-year-old woman who was thought to have systemic lupus erythematosus (SLE) for more than 13 years before Crohn's colitis was correctly diagnosed. The differentiation of Crohn's disease from SLE may be difficult, as illustrated by our case. Gastrointestinal symptoms, laborat... 10/1/1995
C M Wilcox, D Gryboski, M Fernandez, W Stahl Computed tomographic findings in pseudomembranous colitis: an important clue to the diagnosis Computed tomography (CT) is increasingly used to evaluate abdominal diseases, including those of the colon. Recent CT studies have documented colonic abnormalities in patients with pseudomembranous colitis; however, these findings are not widely appreciated by primary care physicians. Over a 25-mont... 9/1/1995
G Visvesvara, G J Leitch, N J Pieniazek, A J Da Silva, S Wallace, S B Slemenda, R Weber, D A Schwartz, L Gorelkin, C M Wilcox Short-term in vitro culture and molecular analysis of the microsporidian, Enterocytozoon bieneusi The microsporidium, Enterocytozoon bieneusi, causes a severe, debilitating, chronic diarrhea in patients with the acquired immunodeficiency syndrome. Specific diagnosis of intestinal microsporidiosis, especially due to Enterocytozoon, is difficult and there is no known therapy that can completely er... 9/1/1995
P A Jamidar, G J Beck, B J Hoffman, G A Lehman, R H Hawes, R M Agrawal, P S Ashok, T J Ravi, J T Cunningham, F Troiano Endoscopic retrograde cholangiopancreatography in pregnancy CONCLUSION: Diagnostic and therapeutic ERCP appears reasonably safe and effective in pregnancy. Cautious and selective use of this procedure offers a viable alternative to surgery or observation in patients with emergent pancreaticobiliary problems. 8/1/1995
T J Savides, F G Gress, L J Wheat, S Ikenberry, R H Hawes Dysphagia due to mediastinal granulomas: diagnosis with endoscopic ultrasonography CONCLUSIONS: Based on characteristic EUS findings, mediastinal granulomas are believed to occur in patients with dysphagia who have a midesophageal submucosal mass or stricture on endoscopy and who live in a highly endemic area for histoplasmosis. 8/1/1995
C M Wilcox, D A Schwartz, W S Clark Esophageal ulceration in human immunodeficiency virus infection. Causes, response to therapy, and long-term outcome CONCLUSIONS: Given 1) the broad spectrum of causes of esophageal ulceration, 2) that each of these causes requires specific therapy, and 3) the apparent high response rate, it is important to do endoscopic evaluation with mucosal biopsy in patients with HIV infection so that a diagnosis can be estab... 7/15/1995
T J Howard, E A Wiebke, G Mogavero, K Kopecky, J C Baer, S Sherman, R H Hawes, G A Lehman, R J Goulet, J A Madura Classification and treatment of local septic complications in acute pancreatitis CONCLUSIONS: We conclude that this classification system allows for the stratification of patients into three distinct groups--infected necrosis, sterile necrosis, and pancreatic abscess--and has both therapeutic and prognostic usefulness. 7/1/1995
B J Hoffman, R H Hawes Endoscopic ultrasonography-guided puncture of the lymph nodes: first experience and clinical consequences Endoscopic ultrasonography with fine needle aspiration is indicated for assessment of lymph node metastases as well as malignant tumor diagnosis. This technique has an accuracy of about 80%. There have been no reported complications. Improvement in needles and techniques will improve overall results... 7/1/1995
C M Wilcox, S R Zaki, L M Coffield, P W Greer, D A Schwartz Evaluation of idiopathic esophageal ulceration for human immunodeficiency virus Recent studies suggest human immunodeficiency virus (HIV) may be the cause of HIV-associated idiopathic esophageal ulcer (IEU). However, other causes of esophageal disease in HIV-infected patients have not been evaluated for appropriate comparison. Over a 14-month period 13 patients with IEU as dete... 6/1/1995
D A Schwartz, A Abou-Elella, C M Wilcox, L Gorelkin, G S Visvesvara, S E Thompson, R Weber, R T Bryan The presence of Enterocytozoon bieneusi spores in the lamina propria of small bowel biopsies with no evidence of disseminated microsporidiosis. Enteric Opportunistic Infections Working Group Enterocytozoon bieneusi is the most frequently reported microsporidial infection of humans. In patients with the acquired immunodeficiency syndrome, Enterocytozoon infects the lining epithelial cells of the small intestine, hepatobiliary tract, and gallbladder. Because Enterocytozoon has been though... 5/1/1995
S Kumar, S Sherman, R H Hawes, G A Lehman Success and yield of second attempt ERCP Endoscopic retrograde cholangiopancreatography (ERCP) has been shown to be an accurate and reliable method to evaluate biliary and pancreatic disorders. When an attempt to perform ERCP fails, the managing physician must decide whether to repeat the procedure or rely on other alternatives. We tallied... 5/1/1995
R H Hawes The problem fellow Problems encountered in training GI fellows range from illnesses that affect patient care (impaired physician) to problems in the timely acquisition of the technical, cognitive, and personal skills required to perform endoscopy competently and independently. The key for fellowship programs in addres... 4/1/1995
C M Wilcox, R F Straub, D A Schwartz Cytomegalovirus esophagitis in AIDS: a prospective evaluation of clinical response to ganciclovir therapy, relapse rate, and long-term outcome CONCLUSIONS: CMV esophagitis has a favorable response to induction ganciclovir therapy, and a long-term remission may occur after induction therapy alone. Despite the favorable response to ganciclovir therapy, the long-term survival is poor, reflecting the severe immunodeficiency of these patients. 2/1/1995
G A Lehman, S Sherman, R H Hawes Endoscopic management of recurrent and chronic pancreatitis Endoscopic therapy is now being utilized in the setting of recurrent acute and chronic pancreatitis. This review analyzes the current state of the art of these new applications of endoscopy. Selection of appropriate candidates for the various treatment modalities appears important for optimal result... 1/1/1995
R H Hawes, S Zaidi Endoscopic ultrasonography of the pancreas The pancreas is the most technically demanding area to image with EUS. This technique, however, has found a clinical niche in evaluating patients with pancreatic cancer to determine resectability and likely will play a prominent role in the future in diagnosis through ultrasonographically directed F... 1/1/1995
C M Wilcox, D A Schwartz Comparison of two corticosteroid regimens for the treatment of HIV-associated idiopathic esophageal ulcer CONCLUSIONS: Prednisone therapy is highly efficacious for the treatment of idiopathic esophageal ulcer resulting in a rapid clinical response and endoscopic healing. A 2-wk course of therapy may be associated with a higher relapse rate than a 4-wk regimen. Relapse frequently occurs, usually within 2... 12/1/1994
C M Wilcox, M W Karowe Esophageal infections: etiology, diagnosis, and management With the advent of transplantation and the acquired immunodeficiency syndrome (AIDS), esophageal infections are now a common medical problem. The most common infections involving immunocompromised nonhuman immunodeficiency virus (HIV)-infected patients include viral disease (herpes simplex virus and... 9/1/1994
R F Straub, C M Wilcox, D A Schwartz Variable endoscopic appearance of colonic lymphoid tissue The variable appearance of gut-associated lymphoid tissue at videocolonoscopy has not been well documented. Over a 3-year period all patients undergoing high resolution videcolonoscopy underwent biopsy of any identified abnormalities for correlating histopathologic findings with endoscopic appearanc... 9/1/1994
D B Greenstein, C M Wilcox, K Frontin, J L Clements Nifedipine (Procardia XL) as a cause of false-positive results on barium enema study There are a number of potential causes for false-positive results on a barium enema study. We report three cases in which patients had to have colonoscopy because a nifedipine slow-release tablet (Procardia XL) was misinterpreted as a colonic polyp on a barium enema study. The pill did not move with... 8/1/1994
C M Wilcox, R F Straub, D A Schwartz Prospective endoscopic characterization of cytomegalovirus esophagitis in AIDS Cytomegalovirus (CMV) esophagitis is an important cause of esophageal ulceration in patients with the acquired immunodeficiency syndrome. However, the endoscopic appearance of these lesions has not been well characterized. During a 3-year period, we identified 141 CMV esophageal ulcerations endoscop... 7/1/1994
S Sherman, R H Hawes, S W Rathgaber, M F Uzer, M T Smith, Q E Khusro, W B Silverman, D T Earle, G A Lehman Post-ERCP pancreatitis: randomized, prospective study comparing a low- and high-osmolality contrast agent Diagnostic and therapeutic ERCPs are complicated by pancreatitis in 1% to 10% of patients, and evidence suggests that the contrast agent used for ERCP may be important in the pathogenesis of such pancreatitis. This prospective, double-blind study was undertaken to determine whether the use of a low-... 7/1/1994
C M Wilcox Short report: time course of clinical response with fluconazole for Candida oesophagitis in patients with AIDS CONCLUSIONS: Our study confirms anecdotal experience suggesting that fluconazole results in a rapid clinical response for Candida oesophagitis in patients with AIDS. Given this rapidity, a one-week course of empiric treatment with fluconazole for HIV-infected patients with newly developed esophageal... 6/1/1994
N T Sanghvi, R H Hawes High-intensity focused ultrasound High-intensity focused ultrasound (HIFU) is a technology that permits the use of ultrasound waves used for imaging and then focuses them as one would use a magnifying glass to focus sunlight. The ultrasound energy is absorbed by tissue and converted to heat and can be used to ablate tissue. This art... 4/1/1994
P F Rockley, C M Wilcox, M Moynihan, K Hewan-Lowe, D A Schwartz Splenic infection simulating lymphoma: an unusual presentation of disseminated Pneumocystis carinii infection This report of disseminated pneumocystosis in an HIV-infected patient describes an unusual presentation consisting of splenic disease mimicking lymphoma, absence of typical roentgenographic signs of pulmonary or disseminated pneumocystis, and absence of use of aerosolized pentamidine. Because of the... 4/1/1994
C M Wilcox, D A Schwartz Idiopathic anorectal ulceration in patients with human immunodeficiency virus infection Opportunistic infections and neoplasms of the anorectum have been reported in patients with human immunodeficiency virus (HIV) infection. More recently, idiopathic ulcerative lesions of the colon and rectum have been described. At our center over a 3-yr period, four patients were identified with ulc... 4/1/1994
D K Rex, G A Lehman, T M Ulbright, J J Smith, R H Hawes The yield of a second screening flexible sigmoidoscopy in average-risk persons after one negative examination CONCLUSIONS: These data suggest that the American Cancer Society should consider changing its recommendation for screening flexible sigmoidoscopy in asymptomatic, average-risk persons to 5-year intervals after a negative examination. 3/1/1994
I I Peleg, H T Maibach, S H Brown, C M Wilcox Aspirin and nonsteroidal anti-inflammatory drug use and the risk of subsequent colorectal cancer CONCLUSION: The results of previous experimental animal models, interventional case studies, and some but not all epidemiological investigations and the present data point toward a causal relationship between NSAID use and the prevention of cancer of the large bowel and rectum. Because of the potent... 2/28/1994
T A Ruffolo, S Sherman, G A Lehman, R H Hawes Gallbladder ejection fraction and its relationship to sphincter of Oddi dysfunction Theoretically, relative distal common bile duct obstruction due to sphincter of Oddi dysfunction may be a cause of poor gallbladder evacuation observed on quantitative cholescintigraphy. In this study, the relationship of sphincter of Oddi dysfunction to the gallbladder ejection fraction by quantita... 2/1/1994
C M Wilcox, K A Shalek, G Cotsonis Striking prevalence of over-the-counter nonsteroidal anti-inflammatory drug use in patients with upper gastrointestinal hemorrhage CONCLUSIONS: Over-the-counter NSAID use is frequent in our patient population and exceeds prescription use. Although ulcer-related bleeding was significantly associated with use of these drugs, NSAIDs were commonly used in patients with nonulcer-related upper gastrointestinal hemorrhage as well. Ove... 1/10/1994
K Hewan-Lowe, Y Hammers, J M Lyons, C M Wilcox Polyvinylpyrrolidone storage disease: a source of error in the diagnosis of signet ring cell gastric adenocarcinoma False-positive and false-negative diagnoses of cancer seldom occur during evaluation of gastric mucosal biopsy specimens obtained during flexible fiberoptic endoscopy of the stomach. When they do occur, false-negative diagnoses are usually the result of undersampling of the lesion, whereas false-pos... 1/1/1994
D B Greenstein, C M Wilcox, D A Schwartz Gastric syphilis. Report of seven cases and review of the literature Gastric syphilis had become an uncommon disease, with only 24 cases reported in the English-language literature over the last two decades. However, it may be becoming more frequent. During the last 4 years, seven patients with gastric syphilis have been diagnosed at our institution. The most common ... 1/1/1994
D K Rex, G W Sledge, P A Harper, T M Ulbright, P J Loehrer, D J Helper, J J Smith, M J Wiersema, R H Hawes, G A Lehman Colonic adenomas in asymptomatic women with a history of breast cancer One hundred ninety-three asymptomatic women with a personal history of breast cancer underwent screening colonoscopy. One hundred sixty-eight women had breast cancer as their only potential risk factor for colonic neoplasia, and 25 had a family history of colorectal neoplasia in addition to their pe... 12/1/1993
M Uzer, R H Hawes Endoscopic retrograde cholangiography and laparoscopic cholecystectomy: stones, stents and sphincterotomy Endoscopic retrograde cholangiopancreatography (ERCP) is clearly a useful adjunct in the management of patients undergoing laparoscopic cholecystectomy who have common bile duct stones. Whether endoscopic sphincterotomy plus laparoscopic cholecystectomy is superior to traditional open cholecystectom... 12/1/1993
M J Wiersema, W M Hassig, R H Hawes, M J Wonn Mediastinal lymph node detection with endosonography Eighty-two persons with chronic abdominal pain, submucosal or extrinsic masses, or achalasia and 20 volunteers without symptoms were prospectively examined with endosonography to assess the incidence and features of mediastinal lymphadenopathy. In 99 persons without malignant disease, 86% were found... 11/1/1993
M J Wiersema, R H Hawes, G A Lehman, M L Kochman, S Sherman, K K Kopecky Prospective evaluation of endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography in patients with chronic abdominal pain of suspected pancreatic origin Twenty asymptomatic paid volunteers (13 females, 7 males, mean age 34 years, range 21-52 years), underwent endoscopic ultrasonography (EUS) to assess variation in the appearance of ductular and parenchymal features of the pancreas. Following this investigation, 69 patients with chronic abdominal pai... 11/1/1993
C M Wilcox, M Faibicher, N K Wenger, K A Shalek Prevalence of silent myocardial ischemia and arrhythmias in patients with coronary heart disease undergoing gastrointestinal tract endoscopic procedures CONCLUSIONS: Our data suggest that endoscopic procedures in patients with stable but severe coronary heart disease, when performed with standard medications, monitoring, and techniques, rarely result in silent or symptomatic myocardial ischemia or serious arrhythmias. In addition, although asymptoma... 10/25/1993
R H Hawes New staging techniques. Endoscopic ultrasound Rectal ultrasonography allows detailed images of rectal tumors and provides the most accurate method of staging rectal cancer. Ultrasound assessment of the extent of tumor invasion and lymph node involvement is superior to computed tomography (CT) scan, though CT is still the best method to assess l... 6/15/1993
D K Rex, G A Lehman, T M Ulbright, J J Smith, D C Pound, R H Hawes, D J Helper, M J Wiersema, C D Langefeld, W Li Colonic neoplasia in asymptomatic persons with negative fecal occult blood tests: influence of age, gender, and family history Six hundred twenty-one asymptomatic persons with negative fecal occult blood tests (ages 50-75 yr), including 496 with no known risk factors for colorectal cancer and 125 with a single first-degree relative with a history of colonic neoplasia developed after age 40, underwent screening colonoscopy. ... 6/1/1993
C M Wilcox, D A Schwartz Endoscopic characterization of idiopathic esophageal ulceration associated with human immunodeficiency virus infection Idiopathic esophageal ulcerations (IEUs) associated with human immunodeficiency virus (HIV) infection are now recognized as an important cause of esophageal disease in this population. Limited radiographic and endoscopic reports have almost uniformly described these lesions as solitary and giant. Ov... 4/1/1993
G A Lehman, S Sherman, R Nisi, R H Hawes Pancreas divisum: results of minor papilla sphincterotomy A subpopulation of pancreas divisum patients may have pancreatic pain or pancreatitis as a result of a stenotic minor papilla. This study was undertaken to evaluate the efficacy of minor papilla sphincterotomy in 52 pancreas divisum patients who had disabling chronic pancreatic pain (n = 24), acute ... 1/1/1993
C M Wilcox Serious gastrointestinal disorders associated with human immunodeficiency virus infection Disorders of the gastrointestinal tract are a frequent complication of AIDS. Although the majority of these processes are not life threatening, some diseases will require ICU monitoring. With the increasing longevity of the HIV-infected patient, many more patients may be admitted to the ICU for a va... 1/1/1993
S Sherman, R H Hawes, J A Madura, G A Lehman Comparison of intraoperative and endoscopic manometry of the sphincter of Oddi Despite the potential utility of intraoperative manometry of the sphincter of Oddi, limited data are available validating its use. The current study was undertaken to validate the method of intraoperative sphincter of Oddi manometry by comparing the pressure tracings obtained at operation (transduod... 11/1/1992
C M Wilcox, B L Woods, H T Mixon Prospective evaluation of a peritoneal dialysis catheter system for large volume paracentesis Large volume paracentesis is becoming a popular form of therapy for patients with massive ascites and cirrhosis. Although the physiologic effects of the removal of large amounts of ascitic fluid have been well described, the techniques utilized to perform the procedure are either not well documented... 10/1/1992
D A Schwartz, C M Wilcox Atypical cytomegalovirus inclusions in gastrointestinal biopsy specimens from patients with the acquired immunodeficiency syndrome: diagnostic role of in situ nucleic acid hybridization Cytomegalovirus (CMV) infection of the gastrointestinal tract is a common cause of morbidity and mortality in the acquired immunodeficiency syndrome. The proper recognition of CMV-infected cells in gastrointestinal mucosal biopsies is critical so that effective therapy is not delayed, preventing fur... 9/1/1992
C M Wilcox, D A Schwartz A pilot study of oral corticosteroid therapy for idiopathic esophageal ulcerations associated with human immunodeficiency virus infection CONCLUSIONS: Oral corticosteroid therapy appears to be a highly efficacious and safe therapy for HIV-associated IEU. Further controlled studies will be necessary to conclusively establish efficacy, as well as determine the optimal dose and duration of therapy. 8/1/1992
C M Wilcox, C E Forsmark, T M Darragh, T S Yen, J P Cello Cytomegalovirus peritonitis in a patient with the acquired immunodeficiency syndrome Peritonitis has been reported infrequently in patients with the acquired immunodeficiency syndrome (AIDS). Intestinal or colonic perforation resulting from cytomegalovirus (CMV) enteritis is the most common cause of peritonitis in these patients. We report a patient with CMV peritonitis occurring in... 8/1/1992
W B Silverman, T A Ruffolo, S Sherman, R H Hawes, G A Lehman Correlation of basal sphincter pressures measured from the bile duct and the pancreatic duct in patients with suspected sphincter of Oddi dysfunction If basal sphincter of Oddi pressures measured from the pancreatic duct and the bile duct are essentially equal, then measurement of basal pressures from only one duct would be adequate in evaluating sphincter of Oddi dysfunction. We report a series of 88 patients whom we evaluated with sphincter of ... 7/1/1992
C M Wilcox, D A Schwartz Symptomatic CMV duodenitis. An important clinical problem in AIDS Duodenal disease resulting from cytomegalovirus (CMV) infection is unusual in the absence of other gastrointestinal disease. We report two cases of CMV infection symptomatically isolated to the duodenum. One patient presented with ulcer-type dyspepsia, and the other with severe gastrointestinal blee... 6/1/1992
S Sherman, R H Hawes, F P Troiano, G A Lehman Pancreatitis following bile duct sphincter of Oddi manometry: utility of the aspirating catheter The aspirating sphincter of Oddi manometry (SOM) catheter was shown to reduce the frequency of post-procedure pancreatitis from 31% to 4% following a pancreatic duct evaluation. This study was designed to prospectively evaluate the utility of the aspirating manometry catheter in reducing the frequen... 5/1/1992
C M Wilcox Esophageal disease in the acquired immunodeficiency syndrome: etiology, diagnosis, and management Esophageal disease is a common complication and cause of morbidity in patients with human immunodeficiency virus (HIV) infection. Opportunistic esophageal diseases may occur in patients with long-standing infection or may be the initial manifestation of HIV disease. Although a variety of both opport... 4/1/1992
S Sherman, R H Hawes, R Nisi, G A Lehman Endoscopic sphincterotomy-induced hemorrhage: treatment with multipolar electrocoagulation Multipolar electrocoagulation is an effective therapy for patients with endoscopic evidence of active upper gastrointestinal hemorrhage or a non-bleeding visible vessel in an ulcer crater. The use of this therapy for endoscopic sphincterotomy-induced hemorrhage has not been reported previously. This... 3/1/1992
J H Lipschutz, D F Canal, R H Hawes, T A Ruffolo, M A Besold, G A Lehman Laparoscopic cholecystectomy and ERCP with sphincterotomy in an elderly patient with situs inversus Situs inversus viscerum (transposition of the viscera) is a rare condition with a genetic predisposition that is autosomal recessive. We present a patient with situs inversus, cholelithiasis, and choledocholithiasis who was successfully treated via laparoscopic cholecystectomy and endoscopic retrogr... 2/1/1992
R Weber, R T Bryan, R L Owen, C M Wilcox, L Gorelkin, G S Visvesvara Improved light-microscopical detection of microsporidia spores in stool and duodenal aspirates. The Enteric Opportunistic Infections Working Group CONCLUSIONS: E. bieneusi is an important cause of chronic diarrhea in HIV-infected persons. This new diagnostic technique serves as a practical, noninvasive means to detect microsporidia spores in stool specimens and is also applicable to the examination of duodenal aspirates. 1/16/1992
M J Wiersema, R H Hawes, L C Tao, L M Wiersema, K K Kopecky, D K Rex, S Kumar, G A Lehman Endoscopic ultrasonography as an adjunct to fine needle aspiration cytology of the upper and lower gastrointestinal tract Twenty consecutive patients with either extrinsic or submucosal masses or gastric ulcers suspicious for malignancy with previously negative conventional forceps biopsies and/or brush cytology underwent a combined approach of endoscopic ultrasound (EUS) followed by fine needle aspiration cytology. Di... 1/1/1992
J P Cello, J H Grendell, P Basuk, D Simon, L Weiss, M Wittner, R P Rood, C M Wilcox, C E Forsmark, A E Read Effect of octreotide on refractory AIDS-associated diarrhea. A prospective, multicenter clinical trial CONCLUSION: Patients with AIDS-associated refractory watery diarrhea, especially those without identifiable pathogens, may respond favorably to subcutaneously administered octreotide. This drug deserves further study in a randomized, placebo-controlled trial. 11/1/1991
S Sherman, T A Ruffolo, R H Hawes, G A Lehman Complications of endoscopic sphincterotomy. A prospective series with emphasis on the increased risk associated with sphincter of Oddi dysfunction and nondilated bile ducts Mostly retrospective series with limited use of sphincter of Oddi manometry have indicated that early complications are more common when endoscopic sphincterotomy is performed for sphincter of Oddi dysfunction than for common duct stones. The current study was undertaken to prospectively evaluate th... 10/1/1991
S Sherman, G A Lehman, R H Hawes, T Ponich, L S Miller, L B Cohen, P Kortan, G B Haber Pancreatic ductal stones: frequency of successful endoscopic removal and improvement in symptoms Pancreatic ductal stones may be responsible for attacks of acute pancreatitis (chronic relapsing pancreatitis) or exacerbations of chronic pain in patients with chronic pancreatitis. This study was undertaken to identify those patients with predominantly main pancreatic duct stones most amenable to ... 9/1/1991
G A Boyce, M V Sivak, T Rösch, M Classen, D E Fleischer, H W Boyce, C J Lightdale, J F Botet, R H Hawes, G A Lehman