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Objectives: Patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) face excess mortality compared with the general population. Mortality in clinical epidemiology research is often examined using death certificate diagnosis codes; however, the sensitivity of such codes in AAV is unknown., Methods: We performed a retrospective cohort study using the Mass General Brigham AAV Cohort, including patients with AAV who died between 2002 and 2019. Causes of death were determined by electronic health record (EHR) review (reference gold standard) and via cause of death diagnosis codes on death certificates. We calculated the sensitivity of death certificate diagnosis codes for AAV., Results: Of 684 patients in the registry, 184 died, 92 (52 %) of whom had adequate EHR data available determine cause of death and 72 (40 %) of whom had both EHR and death certificate data available. Death due to AAV, infection, cardiovascular disease, and cancer occurred in 8 %, 29 %, 5 %, and 18 %, respectively, when ascertained by manual review, as opposed to 0 %, 11 %, 25 %, and 21 %, as determined by death certificates. The sensitivity of AAV diagnosis codes for AAV was 16.6 % (95 % CI: 10.5, 22.6) among all patients with death certificate data available., Conclusion: In a contemporary cohort of patients with AAV, infection was the most common cause of death, while death due to AAV itself was rare. We found a high degree of discordance between causes of death determined by manual review and death certificate diagnosis codes. Mortality research on AAV should include linkage to medical records data to reduce potential bias., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Guy Katz reports financial support was provided by Rheumatology Research Foundation. Zachary S. Wallace reports financial support was provided by National Institutes of Health. Guy Katz reports financial support was provided by National Institutes of Health. Guy Katz reports a relationship with Sanofi that includes: funding grants. Guy Katz reports a relationship with GLG Consulting that includes: consulting or advisory. Guy Katz reports a relationship with Evolve Medical Education that includes: speaking and lecture fees. Guy Katz reports a relationship with NEJM Resident 360 that includes: speaking and lecture fees. Guy Katz reports a relationship with IgG4ward that includes: speaking and lecture fees. Guy Katz reports a relationship with Amgen Inc that includes: consulting or advisory. Zachary S. Wallace reports a relationship with Amgen Inc that includes: consulting or advisory and funding grants. Zachary S. Wallace reports a relationship with Bristol Myers Squibb Co that includes: funding grants. Zachary S. Wallace reports a relationship with Sanofi that includes: consulting or advisory and funding grants. Zachary S. Wallace reports a relationship with Viela Bio that includes: consulting or advisory. Zachary S. Wallace reports a relationship with Adicet Bio Inc that includes: consulting or advisory. Zachary S. Wallace reports a relationship with Horizon Therapeutics USA Inc that includes: consulting or advisory. Zachary S. Wallace reports a relationship with Zenas BioPharma that includes: consulting or advisory. Zachary S. Wallace reports a relationship with Pharmaceutical Product Development that includes: consulting or advisory. Zachary S. Wallace reports a relationship with Medpace Inc that includes: consulting or advisory. Zachary S. Wallace reports a relationship with Novartis that includes: consulting or advisory. Zachary S. Wallace reports a relationship with Shinogi that includes: consulting or advisory. Zachary S. Wallace reports a relationship with Visterra Inc that includes: consulting or advisory. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Fundoplication at the time of paraesophageal hernia (PEH) repair is thought to help prevent the development or persistence of postoperative gastroesophageal reflux (GERD) and might also prevent hernia recurrence. However, the published data is not strong enough to definitively recommend this approach. This study was designed to evaluate the effectiveness and complications of a fundoplication at the time of paraesophageal hernia repair., Methods: This was a retrospective cohort study of all patients who underwent a paraesophageal hernia repair at a single institution over a 14 year period from 2010 to 2023. Patients were divided into 2 cohorts, those who underwent fundoplication at the time of PEH repair and those who did not. Rates of PEH recurrence, rates of reoperation for a recurrent PEH, postoperative dysphagia rates, and postoperative GERD rates were then compared between the two cohorts., Results: There were 1,155 patients included in the study. There were 610 (53%) patients who underwent PEH repair with fundoplication and 545 (47%) who did not undergo a fundoplication. 113 (19%) of the patients who underwent fundoplication developed a hernia recurrence compared to 67 (12%) who had a PEH repair alone (p = 0.004). However, each cohort had similar rates of requiring reoperation (p = 0.4). Inclusion of a fundoplication did lead to higher rates of postoperative dysphagia > 30 days postoperatively, 12% vs 7% (p = 0.002), but did not lead to decreased rates of symptomatic GERD postoperatively, 7% with a fundoplication and 7% without (p = 0.93)., Conclusion: In this present study, fundoplication at the time of PEH repair did not prevent hernia recurrence, need for reoperation, or decrease postoperative GERD rates but does increase postoperative dysphagia. While there are definite indications for fundoplication at the time of PEH repair (i.e., type 1 hernia), these data do not support the routine use of fundoplication during PEH repair with a normal gastroesophageal flap valve intraoperatively., Competing Interests: Declarations. Disclosures: Dr. Jeffrey Marks reports consultant fees from Boston Scientific and Steris Endoscopy. He also has served on the ACS Board of Governors and SAGES Governing Board. Dr. Joshua Lyons reports consultant fees from Steris Endoscopy. Drs. Hamza Nasir Chatha, MD; Christina Boutros, DO; Saher-Zahra Khan, MD; Jamie Benson, MD; Guy Katz, MD; Iris Levine, BS; Christine Alvarado, MD; Patrick Wieland, MD have no conflicts of interest or financial ties to disclose., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Per oral pyloromyotomy (POP) has been shown to be effective in patients with gastroparesis. The three most common etiologies of gastroparesis are diabetic, postsurgical, and idiopathic. Our aim was to compare outcomes after POP based on the etiology of gastroparesis., Methods: This was a retrospective cohort study of all patients that underwent POP between 2018 and 2023 at a single tertiary academic center. Patient factors such as demographics, previous interventions, and preoperative symptoms were compared between patients of diabetic, post-surgical, and idiopathic gastroparesis. Primary outcomes of interest included postoperative symptoms, recurrence, time to recurrence, and reinterventions., Results: A total of 46 patients were included in the study of which 12 had diabetic, 23 had post-surgical, and 11 had idiopathic. The overall median age was 56.5 with a female predominance (61%). Twenty patients (43%) had previous endoscopic intervention, 2 (4%) had prior surgical intervention, and 15 (33%) were on medications at the time of referral. Patients had a median of 2 symptoms preoperatively, the most common being nausea (83%) and emesis (76%). There was no difference in demographic and preoperative factors between patients with different etiologies. There was an overall decrease in the number of symptoms for all patients (p < 0.001). There was no difference in postoperative symptoms between cohorts. Fourteen (33%) patients had recurrence of symptoms over a median of 6.5 months with 5 (11%) patients having another endoscopic intervention and 3 (7%) patients having surgical intervention. There were no differences in outcomes between the groups., Conclusions: In our limited cohort, there were no differences in preoperative factors or postoperative outcomes for patients undergoing POP for different etiologies of gastroparesis. There was no differences in recurrence rate or in duration until recurrence. Patients with different etiologies of gastroparesis benefit similarly from POP., Competing Interests: Declarations. Disclosures: This work was not sponsored or funded. Jeffrey Marks receives consulting fees from Steris Endoscopy and Boston Scientific. He has a leadership role on the ACS Board of Governors and the SAGES Governing Board and receives no payments from them. Joshua Lyons receives consulting fees from Steris Endoscopy. Saher-Zahra Khan, Kelly Chambers, Jamie Benson, Christina Boutros, Patrick Wieland, Hamza Nasir Chatha, and Guy Katz have no conflicts of interest or financial ties to disclose., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)