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17. Endoscopic ultrasound-directed transgastric ERCP (EDGE): a retrospective multicenter study.

Author

Runge, Thomas M., Chiang, Austin L., Kowalski, Thomas E., James, Theodore W., Baron, Todd H., Nieto, Jose, Diehl, David L., Krafft, Matthew R., Nasr, John Y., Kumar, Vikas, Khara, Harshit S., Irani, Shayan, Patel, Arpan, Law, Ryan J., Loren, David E., Schlachterman, Alex, Hsueh, William, Confer, Bradley D., Stevens, Tyler K., and Chahal, Prabhleen

Subjects
*ENDOSCOPIC retrograde cholangiopancreatography, *GASTRIC bypass, *GASTRIC mucosa, *RESEARCH, *ENDOSCOPIC ultrasonography, *RESEARCH methodology, *RETROSPECTIVE studies, *MEDICAL cooperation, *EVALUATION research, *COMPARATIVE studies, *ENDOSCOPIC gastrointestinal surgery
Abstract

Background: Endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography (ERCP; EDGE) is an alternative to enteroscopy- and laparoscopy-assisted ERCP in patients with Roux-en-Y gastric bypass anatomy. Although short-term results are promising, the long-term outcomes are not known. The aims of this study were: (1) to determine the rates of long-term adverse events after EDGE, with a focus on rates of persistent gastrogastric or jejunogastric fistula; (2) to identify predictors of persistent fistula; (3) to assess the outcomes of endoscopic closure when persistent fistula is encountered.Methods: This was a multicenter retrospective study involving 13 centers between February 2015 and March 2019. Adverse events were defined according to the ASGE lexicon. Persistent fistula was defined as an upper gastrointestinal series or esophagogastroduodenoscopy showing evidence of fistula.Results: 178 patients (mean age 58 years, 79 % women) underwent EDGE. Technical success was achieved in 98 % of cases (175/178), with a mean procedure time of 92 minutes. Periprocedural adverse events occurred in 28 patients (15.7 %; mild 10.1 %, moderate 3.4 %, severe 2.2 %). The four severe adverse events were managed laparoscopically. Persistent fistula was diagnosed in 10 % of those sent for objective testing (9/90). Following identification of a fistula, 5 /9 patients underwent endoscopic closure procedures, which were successful in all cases.Conclusions: The EDGE procedure is associated with high clinical success rates and an acceptable risk profile. Persistent fistulas after lumen-apposing stent removal are uncommon, but objective testing is recommended to identify their presence. When persistent fistulas are identified, endoscopic treatment is warranted, and should be successful in closing the fistula. [ABSTRACT FROM AUTHOR]

Published
2021
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25. 960 MAXIMIZING SUCCESS IN SINGLE-SESSION EDGE - PREDICTIVE FACTORS OF STENT MIGRATION

Author

Shinn, Brianna, Boortalary, Tina, Raijman, Isaac, Nieto, Jose, Khara, Harshit S., Kumar, S Vikas, Confer, Bradley, Diehl, David L., El Halabi, MAAN, Ichkhanian, Yervant, Runge, Thomas M., Kumbhari, Vivek, Khashab, Mouen A., Tyberg, Amy, Shahid, Haroon M., Sarkar, Avik, Gaidhane, Monica, Bareket, Romy, Kahaleh, Michel, Piraka, Cyrus, Zuchelli, Tobias, Law, Ryan, Sondhi, Arjun R., Kedia, Prashant, Robbins, Justin S., Calogero, Cristina, Bakhit, Mena, Chiang, Austin L., Schlachterman, Alexander, Kowalski, Thomas E., and Loren, David E.

Published
2020
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26. 666 WHAT TO DO WHEN HELLER MYOTOMY FAILS? INTERNATIONAL MULTICENTER COMPARATIVE STUDY ON THE OUTCOMES OF REDO HELLER MYOTOMY VS PERORAL ENDOSCOPIC MYOTOMY VS PNEUMATIC DILATATION IN PATIENTS WITH FAILED HELLER MYOTOMY

Author

Parsa, Nasim, Hashimoto, Rintaro, Attaar, Mikhail, Eleftheriadis, Nikolas P., Chung, Chen-Shuan, Hew, Simon, Nieto, Jose, Finati, Elena, Pellegatta, Gaia, Estremera-Arevalo, Fermin, Pawa, Swati, Nett, Andrew S., Kumta, Nikhil A., Tomizawa, Yutaka, Dawod, Qais M., Jovani, Manol, Keane, Geri, Ichkhanian, Yervant, Al Ghamdi, Sarah S., Runge, Thomas M., Meybodi, Mohamad Aghaie, Singh, Sahiljeet, Sharaiha, Reem Z., Carr-Locke, David L., Pawa, Rishi, Albeniz, Eduardo, Maselli, Roberta, Bechara, Robert, Ujiki, Michael, Chang, Kenneth J., and Khashab, Mouen A.

Published
2020
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30. 1026 LIVING ON THE EDGE - SUCCESS, LONG-TERM COMPLICATIONS, AND IMPLICATIONS FOLLOWING EUS-DIRECTED TRANSGASTRIC ERCP: A MULTICENTER STUDY

Author

Runge, Thomas M., Kowalski, Thomas E., Baron, Todd H., Chiang, Austin L., James, Theodore, Schlachterman, Alexander, Loren, David E., Nieto, Jose, Khara, Harshit S., Diehl, David L., Confer, Bradley, Kumar, S Vikas, Irani, Shayan S., Nasr, John, Krafft, Matthew R., Hsueh, William, Law, Ryan, Patel, Arpan H., Stevens, Tyler, Chahal, Prabhleen, Al-Haddad, Mohammad A., Pleskow, Douglas K., Faisal, Mir Fahad, Huggett, Matthew T., Trindade, Arvind, Ichkhanian, Yervant, Vosoughi, Kia, Brewer Gutierrez, Olaya I., Yang, Juliana, Dbouk, Mohamad, Ngamruengphong, Saowanee, Kumbhari, Vivek, Singh, Vikesh, Kalloo, Anthony N., and Khashab, Mouen A.

Published
2019
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31. 471 THE EFFICACY AND SAFETY OF PERORAL ENDOSCOPIC MYOTOMY VERSUS PNEUMATIC DILATION IN THE TREATMENT OF 3,844 ACHALASIA PATIENTS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Author

Ofosu, Andrew, Masadeh, Maen M., John, Febin, Meybodi, Mohamad Aghaie, Ramai, Daryl, Hajiyeva, Gulara, Barakat, Mohamed, Ichkhanian, Yervant, Vosoughi, Kia, Brewer Gutierrez, Olaya I., Yang, Juliana, Runge, Thomas M., Parsa, Nasim, Assis, Daniella, AbiMansour, Jad P., Sloan, Joshua A., Kalloo, Anthony N., Kumbhari, Vivek, and Khashab, Mouen A.

Published
2019
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37. Examining Perceptions of Participation in a Pediatric IBD Collaborative: Analyzing the Integral Features and Activities of ImproveCareNow

Author

Runge, Thomas M.

Abstract

In 2007, pediatric gastroenterologists from ten practice sites across the U.S. created a quality improvement collaborative, now known as ImproveCareNow, to improve the quality of care provided to children with inflammatory bowel disease. Despite the face validity and great potential of quality improvement collaboratives, investigators do not fully understand how improvement happens, including the variables contributing to quality measures and the necessary components needed to sustain quality improvement. The purpose of this project was to explore perceptions of collaborative participants to identify elements of sustainability. We performed qualitative interviews with 16 ImproveCareNow participants as one method in a triangulated strategy of measuring collaborative participants’ perceptions. We selected informants from a diverse list of practice types and geographic locations, and asked open-ended questions, which we then transcribed and coded. For this master’s paper, I analyzed members’ perceptions of value of, and implementation strategies for, collaborative components like previsit planning, patient databases (population management), standardized clinic forms and algorithms, and decision support. I found that collaborative participants value many system-wide features of collaborative participation, but sites have different paths to implementation, and important features are underdeveloped or under-utilized at some sites. Respondents embraced the potential of population management reports, but noted that data entry burdened clinic flow. Previsit planning was cited as moderately successful, and one site had developed a novel modification of the planning to obviate face-to-face meetings. Standardized clinic templates and decision analysis tools met high expectations for mutual benefit from individual innovation and ingenuity. Analyzing in-depth interviews of ICN participants is the first step in understanding what health care providers perceive as the value from, benefits of, and challenges to initiating and sustaining collaborative quality improvement activities

Published
2010
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41. The extremely narrow-caliber esophagus is a treatment-resistant subphenotype of eosinophilic esophagitis.

Author

Eluri, Swathi, Runge, Thomas M., Cotton, Cary C., Burk, Caitlin M., Wolf, W. Asher, Woosley, John T., Shaheen, Nicholas J., and Dellon, Evan S.

Abstract

Background and Aims Some patients with eosinophilic esophagitis (EoE) have an extremely narrow esophagus, but the characteristics of this group have not been extensively described. We aimed to characterize the narrow-caliber phenotype of EoE, determine associated risk factors, and identify differences in treatment response in this subgroup of patients. Methods This retrospective cohort study from 2001 to 2014 included subjects with a new diagnosis of EoE per consensus guidelines. Demographic, endoscopic, histologic, and treatment response data were extracted from medical records. An extremely narrow-caliber esophagus was defined when a neonatal endoscope was required to traverse the esophagus due to the inability to pass an adult endoscope. Patients with and without an extremely narrow-caliber esophagus were compared. Multivariable logistical regression was performed to assess treatment outcomes. Results Of 513 patients with EoE, 46 (9%) had an extremely narrow-caliber esophagus. These patients were older (33 vs 22 years; P < .01), had longer symptom duration (11 vs 3 years; P < .01), more dysphagia (98% vs 66%; P < .01), and food impactions (53% vs 31%; P < .01). Dilation was more common with extreme narrowing (69% vs 17%; P < .01). Patients with a narrow-caliber esophagus were more refractory to steroid treatment, with lower symptom (56% vs 85%), endoscopic (52% vs 76%), and histologic (33% vs 63%) responses ( P < .01 for all), and these differences persisted after multivariate analysis. Conclusion The extremely narrow-caliber esophagus is a more treatment-resistant subphenotype of EoE and is characterized by longer symptom duration and the need for multiple dilations. Recognition of an extremely narrow-caliber esophagus at diagnosis of EoE can provide important prognostic information. [ABSTRACT FROM AUTHOR]

Published
2016
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43. Is two better than one? Alternative techniques for gastric peroral endoscopic myotomy.

Author

Jovani, Manol, Brewer-Gutierrez, Olaya I., Ichkhanian, Yervant, Runge, Thomas M., and Khashab, Mouen A.

Subjects
GASTRIC mucosa, TYPE 1 diabetes, MYOTOMY, ESOPHAGEAL surgery, ESOPHAGOSCOPY, TREATMENT effectiveness, MENTAL health surveys, ENDOSCOPY, ESOPHAGEAL achalasia
Abstract

Because of recent symptom recurrence not relieved by medications and because standard G-POEM had failed, it was decided to perform a double-tunnel G-POEM. 2 Endoscopic image showing submucosal tunnels created both along the greater and the lesser curvature in a 33-year-old woman with severe diabetes-related gastroparesis and symptom recurrence after a previous gastric peroral myotomy procedure. This confirmed our hypothesis that the short distance between muscular fibers may increase the risk of muscle tissue reformation and symptom recurrence, and therefore the need in this case for a more radical myotomy. [Extracted from the article]

Published
2021
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44. Hybrid endoscopic approach for submucosal tunneling septum division for Zenker's diverticulum.

Author

Krishnan, Arunkumar, Ichkhanian, Yervant, Runge, Thomas M., and Khashab, Mouen A.

Subjects
DIVERTICULUM, METHYLENE blue
Abstract

B Video 1 b A symptomatic 71-year-old man with post-surgical fibrosis underwent peroral endoscopic myotomy for Zenker's diverticulum (Z-POEM) using a hybrid approach. 10-1055-a-1164-7569-1551evv01.mp4 The procedure was continued using the Z-POEM technique to ensure complete exposure and dissection of the septum. [Extracted from the article]

Published
2020
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45. Endoscopic ultrasound-guided cholecystoduodenostomy for acute cholecystitis with removal of large (missed) cystic duct stones.

Author

Bakheet, Nader, Ichkhanian, Yervant, Runge, Thomas M., Vosoughi, Kia, and Khashab, Mouen A.

Subjects
ENDOSCOPIC ultrasonography, CHOLECYSTITIS, CALCULI, IDIOPATHIC pulmonary fibrosis
Abstract

1 a Fluoroscopic image showing a guidewire passing through the echoendoscope and coiled inside the gallbladder. b Fluoroscopic image showing the lumen-apposing metal stent (LAMS) passing from the duodenum to the gallbladder with a double-pigtail plastic stent placed coaxially through the LAMS. The cystic duct opening was identified using the gastroscope, and after multiple trials with guidewire manipulation, a stone was seen to exit from the cystic duct into the gallbladder lumen. [Extracted from the article]

Published
2019
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