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3. Burden of Ionizing Radiation in the Diagnosis and Management of Necrotizing Pancreatitis.

Author

Thiruvengadam, Nikhil R, Miranda, Janille, Kim, Christopher, Behr, Spencer, Corvera, Carlos, Dai, Sun-Chuan, Kirkwood, Kimberly, Harris, Hobart W, Hirose, Kenzo, Nakakura, Eric, Ostroff, James W, Kochman, Michael L, and Arain, Mustafa A

Subjects
Clinical Sciences
Abstract

IntroductionA step-up endoscopic or percutaneous approach improves outcomes in necrotizing pancreatitis (NP). However, these require multiple radiographic studies and fluoroscopic procedures, which use low-dose ionizing radiation. The cumulative radiation exposure for treatment of NP has not been well defined.MethodsWe conducted a retrospective study of consecutive patients with NP admitted to University of California San Francisco Medical Center from January 2011 to June 2019. We calculated effective doses for fluoroscopic procedures using the dose area product and used the National Cancer Institute tool for computed tomography studies. The primary outcome was the cumulative effective dose (CED). Multivariable logistic regression was used to evaluate risk factors of high exposure (CED > 500 mSv).ResultsOne hundred seventy-one patients with NP (mean follow-up 40 ± 18 months) underwent a median of 7 (interquartile range [IQR] 5-11) computed tomography scans and 7 (IQR 5-12) fluoroscopic procedures. The median CED was 274 mSv (IQR 177-245) and 30% (51) of patients received high exposure. Risk factors of high exposure include multiorgan failure (aOR 3.47, 95%-CI: 1.53-9.88, P = 0.003), infected necrosis (adjusted odds ratio [aOR] 3.89 95%-CI:1.53-9.88, P = 0.005), and step-up endoscopic approach (aOR 1.86, 95%-CI: 1.41-1.84, P = 0.001) when compared with step-up percutaneous approach.DiscussionPatients with NP were exposed to a substantial amount of ionizing radiation (257 mSv) as a part of their treatment, and 30% received more than 500 mSv, which corresponds with a 5% increase in lifetime cancer risk. Severity of NP and a step-up endoscopic approach were associated with CED > 500 mSv. Further studies are needed to help develop low-radiation treatment protocols for NP, particularly in patients receiving endoscopic therapy.

Published
2021

8. Competence in Endoscopic Ultrasound and Endoscopic Retrograde Cholangiopancreatography, From Training Through Independent Practice

Author

Wani, Sachin, Keswani, Rajesh N, Han, Samuel, Aagaard, Eva M, Hall, Matthew, Simon, Violette, Abidi, Wasif M, Banerjee, Subhas, Baron, Todd H, Bartel, Michael, Bowman, Erik, Brauer, Brian C, Buscaglia, Jonathan M, Carlin, Linda, Chak, Amitabh, Chatrath, Hemant, Choudhary, Abhishek, Confer, Bradley, Coté, Gregory A, Das, Koushik K, DiMaio, Christopher J, Dries, Andrew M, Edmundowicz, Steven A, El Chafic, Abdul Hamid, El Hajj, Ihab, Ellert, Swan, Ferreira, Jason, Gamboa, Anthony, Gan, Ian S, Gangarosa, Lisa M, Gannavarapu, Bhargava, Gordon, Stuart R, Guda, Nalini M, Hammad, Hazem T, Harris, Cynthia, Jalaj, Sujai, Jowell, Paul S, Kenshil, Sana, Klapman, Jason, Kochman, Michael L, Komanduri, Srinadh, Lang, Gabriel, Lee, Linda S, Loren, David E, Lukens, Frank J, Mullady, Daniel, Muthusamy, V Raman, Nett, Andrew S, Olyaee, Mojtaba S, Pakseresht, Kavous, Perera, Pranith, Pfau, Patrick, Piraka, Cyrus, Poneros, John M, Rastogi, Amit, Razzak, Anthony, Riff, Brian, Saligram, Shreyas, Scheiman, James M, Schuster, Isaiah, Shah, Raj J, Sharma, Rishi, Spaete, Joshua P, Singh, Ajaypal, Sohail, Muhammad, Sreenarasimhaiah, Jayaprakash, Stevens, Tyler, Tabibian, James H, Tzimas, Demetrios, Uppal, Dushant S, Urayama, Shiro, Vitterbo, Domenico, Wang, Andrew Y, Wassef, Wahid, Yachimski, Patrick, Zepeda-Gomez, Sergio, Zuchelli, Tobias, and Early, Dayna

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Biomedical Imaging, Clinical Research, Digestive Diseases, Cholangiopancreatography, Endoscopic Retrograde, Clinical Competence, Endosonography, Humans, Learning Curve, Prospective Studies, Quality Indicators, Health Care, Quality Indicators, Advanced Endoscopy Training, Learning Curves, The EUS and ERCP Skills Assessment Tool, Neurosciences, Paediatrics and Reproductive Medicine, Gastroenterology & Hepatology, Clinical sciences, Nutrition and dietetics
Abstract

Background & aimsIt is unclear whether participation in competency-based fellowship programs for endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) results in high-quality care in independent practice. We measured quality indicator (QI) adherence during the first year of independent practice among physicians who completed endoscopic training with a systematic assessment of competence.MethodsWe performed a prospective multicenter cohort study of invited participants from 62 training programs. In phase 1, 24 advanced endoscopy trainees (AETs), from 20 programs, were assessed using a validated competence assessment tool. We used a comprehensive data collection and reporting system to create learning curves using cumulative sum analysis that were shared with AETs and trainers quarterly. In phase 2, participating AETs entered data into a database pertaining to every EUS and ERCP examination during their first year of independent practice, anchored by key QIs.ResultsBy the end of training, most AETs had achieved overall technical competence (EUS 91.7%, ERCP 73.9%) and cognitive competence (EUS 91.7%, ERCP 94.1%). In phase 2 of the study, 22 AETs (91.6%) participated and completed a median of 136 EUS examinations per AET and 116 ERCP examinations per AET. Most AETs met the performance thresholds for QIs in EUS (including 94.4% diagnostic rate of adequate samples and 83.8% diagnostic yield of malignancy in pancreatic masses) and ERCP (94.9% overall cannulation rate).ConclusionsIn this prospective multicenter study, we found that although competence cannot be confirmed for all AETs at the end of training, most meet QI thresholds for EUS and ERCP at the end of their first year of independent practice. This finding affirms the effectiveness of training programs. Clinicaltrials.gov ID NCT02509416.

Published
2018

14. Assessment of the Psychosocial Impact of Pancreatic Cancer Surveillance in High-Risk Individuals

Author

Anez-Bruzual, Isabel, primary, Coughlin, Sarah, additional, Clay, Daniel, additional, Heiman, Jordan, additional, Dungan, Michaela, additional, Weber, Marina, additional, Almario, Christopher V., additional, Leung, Galen, additional, Ahmad, Nuzhat A., additional, Ginsberg, Gregory G., additional, Kochman, Michael L., additional, Valverde, Kathleen D., additional, Long, Jessica M., additional, and Katona, Bryson W., additional

Published
2023
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20. The Clinical Impact and Cost-Effectiveness of Surveillance of Incidentally Detected Gastric Intestinal Metaplasia: A Microsimulation Analyses

Author

Thiruvengadam, Nikhil R., primary, Gupta, Shashank, additional, Buller, Seth, additional, Awad, Imad, additional, Gandhi, Devika, additional, Ibarra, Allison, additional, Latorre, Gonzalo, additional, Riquelme, Arnoldo, additional, Kochman, Michael L., additional, Cote, Gregory, additional, Shah, Shailja C., additional, and Saumoy, Monica, additional

Published
2023
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22. Assessment of the Psychosocial Impact of Pancreatic Cancer Surveillance in High-Risk Individuals.

Author

Anez-Bruzual, Isabel, Coughlin, Sarah, Clay, Daniel, Heiman, Jordan, Dungan, Michaela, Weber, Marina, Almario, Christopher V., Leung, Galen, Ahmad, Nuzhat A., Ginsberg, Gregory G., Kochman, Michael L., Valverde, Kathleen D., Long, Jessica M., and Katona, Bryson W.

Subjects
PANCREATIC tumors, PUBLIC health surveillance, EARLY detection of cancer, PATIENTS' attitudes, SURVEYS, SELF-efficacy, DESCRIPTIVE statistics, RESEARCH funding, LOGISTIC regression analysis, EMOTIONS
Abstract

Simple Summary: This study explores the psychosocial impact of pancreatic cancer (PC) surveillance in individuals at high-risk (HRIs) of developing PC. The primary objective was to understand the attitudes and beliefs of HRIs undergoing PC surveillance and assess the immediate and sustained psychosocial effects. By investigating factors such as perceived benefits, self-efficacy, and emotions before and after surveillance, the study aims to shed light on the overall experience of PC surveillance. The findings suggest that PC surveillance can yield lasting psychosocial benefits for HRIs. This insight not only enhances our understanding of the social and psychological aspects of surveillance, but also has implications for how the medical community approaches and supports individuals in high-risk PC surveillance programs. Objectives: Pancreatic cancer (PC) surveillance of high-risk individuals (HRIs) downstages PC and improves survival. However, it remains less clear whether PC surveillance has a positive psychosocial impact on HRIs. Herein, we aimed to define the attitudes and beliefs of HRIs undergoing PC surveillance, and the immediate and sustained psychosocial impact of PC surveillance in HRIs. Methods: 100 HRIs undergoing PC surveillance by endoscopic ultrasound (EUS) completed three surveys addressing different components of the psychosocial impact of PC surveillance. Logistic regression analyses were performed to identify predictive factors relating to these components. Results: Most HRIs reported increased perceived benefits of PC surveillance, self-efficacy, and perceived severity of PC. HRIs reported few negative emotions prior to surveillance and frequent positive emotions after surveillance. Compared to prior to surveillance, there was a 53.5% decrease in the level of distress reported by HRIs after surveillance, which was sustained for 4–6 weeks post-surveillance. Family history of PC and lower self-reported mental health were identified as predictors for increased perceived susceptibility to PC (p < 0.01) and greater change in distress pre- to post-surveillance (p < 0.01), respectively. Conclusions: Our findings suggest that PC surveillance can lead to sustained psychosocial benefits in HRIs. [ABSTRACT FROM AUTHOR]

Published
2024
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28. Evaluating Patient-Centered Outcomes in Clinical Trials of Procedural Sedation, Part 2 Safety: Sedation Consortium on Endpoints and Procedures for Treatment, Education, and Research Recommendations

Author

Ward, Denham S., Williams, Mark R., Berkenbosch, John W., Bhatt, Maala, Carlson, Douglas, Chappell, Phillip, Clark, Randall M., Constant, Isabelle, Conway, Aaron, Cravero, Joseph, Dahan, Albert, Dexter, Franklin, Dionne, Raymond, Dworkin, Robert H., Gan, Tong J., Gozal, David, Green, Steven, Irwin, Michael G., Karan, Suzanne, Kochman, Michael, Lerman, Jerrold, Lightdale, Jenifer R., Litman, Ronald S., Mason, Keira P., Miner, James, O’Connor, Robert E., Pandharipande, Pratik, Riker, Richard R., Roback, Mark G., Sessler, Daniel I., Sexton, Anne, Tobin, Joseph R., Turk, Dennis C., Twersky, Rebecca S., Urman, Richard D., Weiss, Mark, Wunsch, Hannah, and Zhao-Wong, Anna

Published
2018
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29. Reply

Author

Thiruvengadam, Nikhil R., primary and Kochman, Michael L., additional

Published
2022
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35. Reply

Author

Lieberman, David, Rex, Douglas, Kochman, Michael, and Tokar, Jeffrey

Published
2016
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38. EUS-based Pancreatic Cancer Surveillance in BRCA1/BRCA2/PALB2/ATM Carriers Without a Family History of Pancreatic Cancer

Author

Katona, Bryson W., primary, Long, Jessica M., additional, Ahmad, Nuzhat A., additional, Attalla, Sara, additional, Bradbury, Angela R., additional, Carpenter, Erica L., additional, Clark, Dana F., additional, Constantino, Gillain, additional, Das, Koushik K., additional, Domchek, Susan M., additional, Dudzik, Christina, additional, Ebrahimzadeh, Jessica, additional, Ginsberg, Gregory G., additional, Heiman, Jordan, additional, Kochman, Michael L., additional, Maxwell, Kara N., additional, McKenna, Danielle B., additional, Powers, Jacquelyn, additional, Shah, Payal D., additional, Wangensteen, Kirk J., additional, and Rustgi, Anil K., additional

Published
2021
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43. Reply

Author

Thiruvengadam, Nikhil R. and Kochman, Michael L.

Published
2023
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