714 results on '"Levy MJ"'
Search Results
2. Significant benefits of AIP testing and clinical screening in familial isolated and young-onset pituitary tumors
- Author
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Marques, P, Caimari, F, Hernández-Ramírez, LC, Collier, D, Iacovazzo, D, Ronaldson, A, Magid, K, Lim, CT, Stals, K, Ellard, S, Grossman, AB, Korbonits, M, Abraham, P, Aflorei, E, Agha, A, Ahlquist, J, Akker, SA, Alexandraki, K, Alföldi, S, Anselmo, J, Arlt, W, Atkinson, B, Aulinas-Masó, A, Aylwin, SJ, Baborie, A, Backeljauw, PF, Badiu, C, Baldeweg, S, Ball, S, Bano, G, Barkan, A, Barton, J, Barwell, J, Bates, P, Bernal-González, C, Besser, M, Bevan, JS, Bickerton, A, Blair, J, Bolanowski, M, Bouloux, P, Bradley, L, Bradley, K, Brain, C, Brooke, A, Brown, R, Buchfelder, M, Burren, C, Cakir, M, Canham, N, Capraro, J, Carroll, P, Carter, P, Carty, D, Cavlan, D, Chahal, HS, Cheetham, T, Chentli, F, Choong, C, Christ-Crain, M, Chung, T-T, Clayton, P, Clayton, RN, Cohen, M, Courtney, H, Cove, D, Crowne, E, Cuthbertson, D, Dal, J, Dalantaeva, N, Damjanovic, S, Daousi, C, Darzy, K, Dattani, M, Davies, M, Davies, J, Davis, J, de Castro, M, de Marinis, L, Deal, C, Dénes, J, Dimitri, P, Dorward, N, Dow, G, Drake, W, Druce, M, Drummond, J, Dutta, P, Dzeranova, L, Edén-Engström, B, Eeles, R, Elfving, M, Ellis, K, Elston, M, Emmerson, L, Ezzat, S, Fersht, N, Fica, S, Fischli, S, Fleseriu, M, Forsythe, E, Foulkes, W, Freda, P, Friedman, T, Gadelha, M, Gainsborough, M, Gallacher, S, Gallego, P, Gan, H-W, Georgescu, C, Gevers, E, Gilkes, C, Glynn, N, Goldman, JE, Goldstone, AP, Góth, M, Green, A, Greenhalgh, L, Grieve, J, Griz, L, Guitelman, M, Gürlek, A, Gurnell, M, Hamblin, PS, Hana, V, Harding, P, Hay, E, Hilton, DA, Ho, W, Hong, G, Horváth, K, Howell, S, Howlett, TA, Höybye, C, Hunter, S, Idampitiya, C, Igaz, P, Imran, A, Inder, WJ, Iwata, T, Izatt, L, Jagadeesh, S, Johnston, C, Jose, B, Kaltsas, G, Kaplan, F, Karavitaki, N, Kastelan, D, Katz, M, Kearney, T, Kershaw, M, Khoo, B, Kiraly-Borri, C, Knispelis, R, Kovács, GL, Kumar, A, Kumar, AV, Kun, IZ, Kyriaku, A, Lambrescu, I, Lampe, AK, Laws, ER, Lebek-Szatanska, A, Lechan, RM, Leese, G, Levy, A, Levy, MJ, Lewandowski, K, Lin, E, Lo, J, Lyons, C, Maartens, N, Maghnie, M, Makaya, T, Marcus, H, Niedziela, M, Martin, N, Matsuno, A, McGowan, B, McQuaid, SE, Medic-Stojanoska, M, Mendoza, N, Mercado-Atri, M, Mettananda, S, Mezősi, E, Miljic, D, Miller, KK, Modenesi, S, Molitch, ME, Monson, J, Morris, DG, Morrison, PJ, Mosterman, B, Munir, A, Murray, RD, Musat, M, Musolino, N, Nachtigall, L, Nagi, D, Nair, R, Nelson, R, Newell-Price, J, Nikookam, K, Ogilivie, A, Orme, SM, O´Weickert, M, Pal, A, Pascanu, I, Patócs, A, Patterson, C, Pearce, SH, Giraldi, FP, Penney, L, Perez-Rivas, LG, Pfeifer, M, Pirie, F, Poplawski, N, Popovic, V, Powell, M, Pullan, P, Quinton, R, Radian, S, Randeva, H, Reddy, N, Rees, A, Renals, V, de Oliveira, AR, Richardson, T, Rodd, C, Ross, RJM, Roncaroli, F, Ryan, F, Salvatori, R, Schöfl, C, Shears, D, Shotliff, K, Skelly, R, Snape, K, Soares, BS, Somasundaram, N, Spada, A, Sperber, J, Spoudeas, H, Stelmachowska-Banas, M, Stewart, S, Storr, HL, Strasburger, C, Street, ME, Suter-Widmer, I, Suthers, G, Swords, F, Syro, LV, Swantje, B, Sze, C, Taylor, J, Thakker, RV, Tham, E, Thompson, C, Thorner, MO, Tóth, M, Trainer, PJ, Tsagarakis, S, Twine, G, Tzanela, M, Vadasz, J, Vaidya, B, Vaks, V, Vance, ML, Verkauskiene, R, Von Esch, H, Wass, JA, Waterhouse, M, Webb, S, Weber, A, Wernig, F, Widell, H, Yamada, S, Yap, P, Yarman, S, Yeoh, P, Yoshimoto, K, Yuen, K, and Zammitt, NN
- Abstract
Context\ud \ud Germline mutations in the aryl hydrocarbon receptor-interacting protein (AIP) gene are responsible for a subset of familial isolated pituitary adenoma (FIPA) cases and sporadic pituitary neuroendocrine tumors (PitNETs).\ud \ud \ud \ud Objective\ud \ud To compare prospectively diagnosed AIP mutation-positive (AIPmut) PitNET patients with clinically presenting patients and to compare the clinical characteristics of AIPmut and AIPneg PitNET patients.\ud \ud \ud \ud Design\ud \ud 12-year prospective, observational study.\ud \ud \ud \ud Participants & Setting\ud \ud We studied probands and family members of FIPA kindreds and sporadic patients with disease onset ≤18 years or macroadenomas with onset ≤30 years (n = 1477). This was a collaborative study conducted at referral centers for pituitary diseases.\ud \ud \ud \ud Interventions & Outcome\ud \ud AIP testing and clinical screening for pituitary disease. Comparison of characteristics of prospectively diagnosed (n = 22) vs clinically presenting AIPmut PitNET patients (n = 145), and AIPmut (n = 167) vs AIPneg PitNET patients (n = 1310).\ud \ud \ud \ud Results\ud \ud Prospectively diagnosed AIPmut PitNET patients had smaller lesions with less suprasellar extension or cavernous sinus invasion and required fewer treatments with fewer operations and no radiotherapy compared with clinically presenting cases; there were fewer cases with active disease and hypopituitarism at last follow-up. When comparing AIPmut and AIPneg cases, AIPmut patients were more often males, younger, more often had GH excess, pituitary apoplexy, suprasellar extension, and more patients required multimodal therapy, including radiotherapy. AIPmut patients (n = 136) with GH excess were taller than AIPneg counterparts (n = 650).\ud \ud \ud \ud Conclusions\ud \ud Prospectively diagnosed AIPmut patients show better outcomes than clinically presenting cases, demonstrating the benefits of genetic and clinical screening. AIP-related pituitary disease has a wide spectrum ranging from aggressively growing lesions to stable or indolent disease course.
- Published
- 2020
3. A Novel Case of Maffucci Syndrome and a Likely High-Grade Lymphoma
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Fleming, S, primary, Player, P, additional, Ladani, S, additional, Miall, F, additional, Goldney, J, additional, and Levy, MJ, additional
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- 2020
- Full Text
- View/download PDF
4. International Cancer of the Pancreas Screening (CAPS) Consortium summit on the management of patients with increased risk for familial pancreatic cancer
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Canto MI, Harinck F, Hruban RH, Offerhaus GJ, Poley JW, Kamel I, Nio Y, Schulick RS, Bassi C, Kluijt I, Levy MJ, Chak A, Fockens P, Goggins M, Bruno M, International Cancer of Pancreas Screening (CAPS) Consortium, Arcidiacono P.G., (Milan, Italy), Detlef Bartsch (Marburg, Germany), Katharina Biermann (Rotterdam, The Netherlands), Terri Brentnall (Washington, USA), Amitabh Chak (Ohio, Petr Dite (Brno, Czech Republic), Timothy Donahue (California, Dayna Early (Missouri, James Farrell (California, Carlos Fernandez-Del Castillo (Massachusetts, Harold Frucht (New York, Noriyoshi Fukushima (Tochigi, Japan), Jenny Geurts (Wisconsin, Pascal Hamell (Clichy, France), Julio Iglesias-Garcia (Santiago de Compostela, Spain), Alison Klein (Maryland, Guenter Kloeppel (Munich, Jesse Lachter (Haifa, Israel), Peter Langer (Marburg, Jeffrey Lee (Texas, Michael Levy (Minnesota, Hiroyuki Maguchi (Sapporo, Daniel Margolis (Los Angeles, Takao Ohtsuka (Fukuoka, Sara Olson (New York, NY), Gloria Petersen (Minnesota, Thomas Savides (California, Sapna Syngal (Massachusetts, Eric Tamm (Texas, Masao Tanaka (Fukuoka, Hans Vasen (Leiden, Anja Wagner (Erasmus, Huamin Wang (Texas, David Williams (Sydney, Australia), Kenjii Yamao (Nagoya, Canto, Mi, Harinck, F, Hruban, Rh, Offerhaus, Gj, Poley, Jw, Kamel, I, Nio, Y, Schulick, R, Bassi, C, Kluijt, I, Levy, Mj, Chak, A, Fockens, P, Goggins, M, Bruno, M, International Cancer of Pancreas Screening (CAPS), Consortium, Arcidiacono, P. G., (Milan, Italy), Detlef Bartsch, (Marburg, Germany), Katharina, Biermann (Rotterdam, The, Netherlands), Terri Brentnall, (Washington, USA), Amitabh, Chak (Ohio, Petr Dite, (Brno, Czech, Republic), Timothy Donahue, (California, Dayna Early, (Missouri, James Farrell, (California, Carlos Fernandez-Del Castillo, (Massachusett, Harold Frucht (New, York, Noriyoshi, Fukushima (Tochigi, Japan), Jenny Geurts, (Wisconsin, Pascal Hamell, (Clichy, France), Julio Iglesias-Garcia (Santiago de, Compostela, Spain), Alison Klein, (Maryland, Guenter Kloeppel, (Munich, Jesse Lachter, (Haifa, Israel), Peter, Langer (Marburg, Jeffrey Lee, (Texa, Michael Levy, (Minnesota, Hiroyuki Maguchi, (Sapporo, Daniel Margolis (Los, Angele, Takao Ohtsuka, (Fukuoka, Sara Olson (New, York, NY), Gloria Petersen, (Minnesota, Thomas Savides, (California, Sapna Syngal, (Massachusett, Eric Tamm, (Texa, Masao Tanaka, (Fukuoka, Hans Vasen, (Leiden, The Netherlands), Anja Wagner, (Erasmu, Huamin Wang, (Texa, David Williams, (Sydney, Australia), Kenjii Yamao, (Nagoya, Pathology, Radiology and Nuclear Medicine, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, CCA -Cancer Center Amsterdam, Gastroenterology and Hepatology, and Gastroenterology & Hepatology
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medicine.medical_specialty ,Cholangiopancreatography, Magnetic Resonance ,Colorectal cancer ,Pancreatic Intraepithelial Neoplasia ,Endosonography ,Pancreatectomy ,SDG 3 - Good Health and Well-being ,Risk Factors ,Pancreatic cancer ,Internal medicine ,medicine ,Humans ,Genetic Predisposition to Disease ,Magnetic Resonance ,Early Detection of Cancer ,Intraepithelial neoplasia ,Magnetic resonance cholangiopancreatography ,Endoscopic retrograde cholangiopancreatography ,medicine.diagnostic_test ,Intraductal papillary mucinous neoplasm ,business.industry ,General surgery ,Carcinoma ,Gastroenterology ,Age Factors ,Cancer ,medicine.disease ,Cholangiopancreatography ,Pedigree ,Pancreatic Neoplasms ,Treatment Outcome ,Follow-Up Studies ,Mutation ,Neoplasm Grading ,business - Abstract
Background Screening individuals at increased risk for pancreatic cancer (PC) detects early, potentially curable, pancreatic neoplasia. Objective To develop consortium statements on screening, surveillance and management of high-risk individuals with an inherited predisposition to PC. Methods A 49-expert multidisciplinary international consortium met to discuss pancreatic screening and vote on statements. Consensus was considered reached if ≥75% agreed or disagreed. Results There was excellent agreement that, to be successful, a screening programme should detect and treat T1N0M0 margin-negative PC and high-grade dysplastic precursor lesions (pancreatic intraepithelial neoplasia and intraductal papillary mucinous neoplasm). It was agreed that the following were candidates for screening: first-degree relatives (FDRs) of patients with PC from a familial PC kindred with at least two affected FDRs; patients with Peutz–Jeghers syndrome; and p16, BRCA2 and hereditary non-polyposis colorectal cancer (HNPCC) mutation carriers with ≥1 affected FDR. Consensus was not reached for the age to initiate screening or stop surveillance. It was agreed that initial screening should include endoscopic ultrasonography (EUS) and/or MRI/magnetic resonance cholangiopancreatography not CT or endoscopic retrograde cholangiopancreatography. There was no consensus on the need for EUS fine-needle aspiration to evaluate cysts. There was disagreement on optimal screening modalities and intervals for follow-up imaging. When surgery is recommended it should be performed at a high-volume centre. There was great disagreement as to which screening abnormalities were of sufficient concern to for surgery to be recommended. Conclusions Screening is recommended for high-risk individuals, but more evidence is needed, particularly for how to manage patients with detected lesions. Screening and subsequent management should take place at high-volume centres with multidisciplinary teams, preferably within research protocols.
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- 2013
5. Structured education programme for women with polycystic ovary syndrome: a randomised controlled trial
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Mani, H, Chudasama, Y, Hadjiconstantinou, M, Bodicoat, DH, Edwardson, C, Levy, MJ, Gray, LJ, Barnett, J, Daly, H, Howlett, TA, Khunti, K, Davies, MJ, Mani, H, Chudasama, Y, Hadjiconstantinou, M, Bodicoat, DH, Edwardson, C, Levy, MJ, Gray, LJ, Barnett, J, Daly, H, Howlett, TA, Khunti, K, and Davies, MJ
- Abstract
OBJECTIVE: To evaluate the effectiveness of a structured education programmes in women with polycystic ovary syndrome (PCOS). METHODS: Single-centre, randomised controlled trial, testing a single exposure to a group-based, face-to-face, structured education programme. Inclusion criteria were women with PCOS, aged 18-49 years inclusive and body mass index ≥23 kg/m2 for black and minority ethnicities or ≥25 kg/m2 for white Europeans. Primary outcome was step-count/day at 12 months. Secondary outcomes included indices of physical activity, cardiovascular risk factors, quality of life (QoL) and illness perception (IP). RESULTS: 161 women were included (78 control, 83 intervention); 69% white; mean age 33.4 (s.d. 7.6) years, of whom 100 (48 intervention; 52 control) attended their 12-month visit (38% attrition). 77% of the intervention arm attended the education programme. No significant change in step-count was observed at 12 months (mean difference: +351 steps/day (95% confidence interval -481, +1183); P = 0.40). No differences were found in biochemical or anthropometric outcomes. The education programme improved participants' IP in 2 dimensions: understanding their PCOS (P < 0.001) and sense of control (P < 0.01) and improved QoL in 3 dimensions: emotions (P < 0.05), fertility (P < 0.05), weight (P < 0.01) and general mental well-being (P < 0.01). DISCUSSION: A single exposure to structured education programme did not increase physical activity or improve biochemical markers in overweight and obese women with PCOS. However, providing a structured education in parallel to routine medical treatment can be beneficial for participants' understanding of their condition, reducing their anxiety and improving their QoL.
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- 2018
6. Polycystic ovary syndrome: An underestimated problem in primary care
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Mani, H, Levy, MJ, Khunti, K, Mani, H, Levy, MJ, and Khunti, K
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- 2018
7. Panel one: Marketing strategies and informing the patient/consumer
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Levy Mj
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Health (social science) ,business.industry ,media_common.quotation_subject ,Maternity and Midwifery ,Public Health, Environmental and Occupational Health ,Obstetrics and Gynecology ,Fertility ,Center (algebra and category theory) ,Business ,Marketing ,Public relations ,media_common - Published
- 1997
8. International Cancer of Pancreas Screening (CAPS) Consortium. International Cancer of the Pancreas Screening (CAPS) Consortium summit on the management of patients with increased risk for familial pancreatic cancer
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Canto, Mi, Harinck, F, Hruban, Rh, Offerhaus, Gj, Poley, Jw, Kamel, I, Nio, Y, Schulick, Rs, Bassi, Claudio, Kluijt, I, Levy, Mj, Chak, A, Fockens, P, Goggins, M, and Bruno, M.
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Cancer ,Pancreas ,International Cancer of Pancreas Screening (CAPS) - Published
- 2013
9. Histopathologic and Clinical Subtypes of Autoimmune Pancreatitis
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Chari, St, Deshpande, V, Fernandez del Castillo, C, Freeman, Ml, Frulloni, Luca, Gardner, Tb, Go, Vl, Irisawa, A, Ito, T, Kamisawa, T, Kawa, S, Kim, Mh, Kloeppel, G, Kojima, M, Lerch, Mm, Levy, Mj, Lohr, M, Longnecker, Ds, Mayerle, J, Mino Kenudson, M, Mizuno, N, Notohara, K, Okazaki, K, Rodriguez Justo, M, Shimosegawa, T, Smyrk, Tc, Srivastava, A, Sugumar, A, Takahashi, N, Webster, G, Zamboni, Giuseppe, Zen, Y, and Zhang, L.
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autoimmune pancreatitis ,hystological features ,classification - Published
- 2010
10. International Cancer of the Pancreas Screening (CAPS) Consortium summit on the management of patients with increased risk for familial pancreatic cancer
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Canto, MI, Harinck, Femme, Hruban, RH, Offerhaus, GJ, Poley, Jan-werner, Kamel, I, Nio, Y, Schulick, RS, Bassi, C, Kluijt, I, Levy, MJ, Chak, A, Fockens, P, Goggins, M, Bruno, Marco, Canto, MI, Harinck, Femme, Hruban, RH, Offerhaus, GJ, Poley, Jan-werner, Kamel, I, Nio, Y, Schulick, RS, Bassi, C, Kluijt, I, Levy, MJ, Chak, A, Fockens, P, Goggins, M, and Bruno, Marco
- Abstract
Background Screening individuals at increased risk for pancreatic cancer (PC) detects early, potentially curable, pancreatic neoplasia. Objective To develop consortium statements on screening, surveillance and management of high-risk individuals with an inherited predisposition to PC. Methods A 49-expert multidisciplinary international consortium met to discuss pancreatic screening and vote on statements. Consensus was considered reached if >= 75% agreed or disagreed. Results There was excellent agreement that, to be successful, a screening programme should detect and treat T1N0M0 margin-negative PC and high-grade dysplastic precursor lesions (pancreatic intraepithelial neoplasia and intraductal papillary mucinous neoplasm). It was agreed that the following were candidates for screening: first-degree relatives (FDRs) of patients with PC from a familial PC kindred with at least two affected FDRs; patients with Peutz-Jeghers syndrome; and p16, BRCA2 and heredit Conclusions Screening is recommended for high-risk individuals, but more evidence is needed, particularly for how to manage patients with detected lesions. Screening and subsequent management should take place at high-volume centres with multidisciplinary teams, preferably within research protocols.
- Published
- 2013
11. Octreotide is not Effective in the Acute Treatment of Migraine
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Levy, MJ, primary, Matharu, MS, additional, Bhola, R, additional, Meeran, K, additional, and Goadsby, PJ, additional
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- 2005
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12. EUS-guided diagnosis and successful endoscopic transpapillary management of an intrahepatic pancreatic pseudocyst masquerading as a metastic pancreatic adenocarcinoma metastatic pancreatic adenocarcinoma (with videos)
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Chahal P, Baron TH, Topazian MD, and Levy MJ
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- 2009
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13. Secondary linitis plastica of the rectum: EUS features and tissue diagnosis (with video)
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Gleeson FC, Clain JE, Rajan E, Topazian MD, Wang KK, Wiersema MJ, Zhang L, and Levy MJ
- Abstract
BACKGROUND: Luminal metastases to the GI tract may be seen at the time of the primary diagnosis or may represent evidence of a distant recurrence. OBJECTIVES: To determine the prevalence of rectal-wall metastases in patients undergoing an EUS and to describe the EUS features and yield of EUS-guided FNA (EUS-FNA) and Trucut biopsy (TCB). DESIGN: A case series. SETTING: A single tertiary-referral center. PATIENTS: Patients undergoing lower GI (LGI) EUS from July 1, 2005, to October 31, 2007. INTERVENTION: EUS-FNA and/or TCB. MAIN OUTCOME MEASUREMENTS: EUS features and cytologic and/or histologic confirmation of secondary rectal linitis plastica. RESULTS: Over the 28-month period, an LGI-EUS was performed in 598 patients with presumed primary rectal cancer, of whom 6 (1%) were diagnosed with rectal-wall metastases. The EUS features were that of diffuse, circumferential, hypoechoic wall-thickening that mimics that of linitis plastica, breaching the muscularis propria in all cases. EUS-FNA and/or TCB of the rectal wall or perirectal lymph node established a diagnosis in all cases. The primary cancers originated from the bladder (n = 3), breast (n = 1), stomach (n = 1), and a right forearm cutaneous melanoma (n = 1). The time interval from the initial primary cancer diagnosis to that of GI-tract rectal metastasis ranged from 0 days (simultaneous diagnoses) to 119 months (mean +/- SD 49 +/- 43 months). LIMITATIONS: Although firm EUS criteria of rectal-wall metastases cannot be established based on 6 patients alone, certain features may prove useful for the diagnosis in the clinical practice. CONCLUSIONS: EUS-FNA and/or TCB can confirm the diagnosis of secondary linitis plastica of the rectum. [ABSTRACT FROM AUTHOR]
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- 2008
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14. EUS features of annular pancreas (with video)
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Papachristou GI, Topazian MD, Gleeson FC, and Levy MJ
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BACKGROUND: An annular pancreas is a rare congenital anomaly that results in a band of pancreatic tissue, either partially or completely encircling the duodenum. OBJECTIVES: In patients referred for an upper-GI (UGI) EUS (1) to determine the prevalence of an annular pancreas identified by EUS versus CT and (2) to describe the EUS features of an annular pancreas. DESIGN: After review of UGI EUS procedures from January 1, 2000, through June 1, 2006, we conducted a retrospective review of EUS annular pancreas images to identify characteristic EUS features. PATIENTS: This is the largest report describing the EUS findings in 5 patients. RESULTS: Of 9776 patients undergoing UGI EUS, 5 patients (0.05%) (2 men; median age, 64 years; range, 44-69 years) were found to have an annular pancreas. EUS detected a band of pancreatic tissue that encircled the duodenum by 360 degrees (n = 3), 270 degrees (n = 1), or 180 degrees (n = 1). Within this band of tissue, the pancreatic duct was identified in 4 of 5 patients. The ductal and parenchymal features within the annular band were identical to those within the remaining pancreas in all patients. None of the patients had hypoechoic ventral anlage. LIMITATIONS: Whereas, firm EUS criteria of an annular pancreas cannot be established based on 5 patients, certain features may prove useful for diagnosis. CONCLUSIONS: Although a diagnosis of an annular pancreas is rare, it should be considered in situations when a patient with possible associated symptoms has a normal CT. [ABSTRACT FROM AUTHOR]
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- 2007
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15. Know when to biopsy 'em, know when to walk away.
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Levy MJ
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- 2006
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16. Routine vs. selective EUS-guided FNA approach for preoperative nodal staging of esophageal carcinoma.
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Vazquez-Sequeiros E, Levy MJ, Clain JE, Schwartz DA, Harewood GC, Salomao D, and Wiersema MJ
- Abstract
BACKGROUND: EUS-guided FNA (EUS-FNA) is the most accurate method for lymph-node staging of esophageal carcinoma; however, it may not be necessary when EUS features are present that strongly suggest a benign or a malignant origin. AIMS: (1) To identify a combination of EUS criteria that have a sufficient sensitivity and specificity to preclude the need for EUS-FNA and (2) to assess the cost savings derived from a selective EUS-FNA approach. METHODS: A total of 144 patients with esophageal carcinoma were prospectively evaluated with EUS. Accuracy of standard (hypoechoic, smooth border, round, or width > 5 mm) and modified (4 standard plus EUS identified celiac lymph nodes, >5 lymph nodes, or EUS T3/4 tumor) criteria were compared (receiver operating characteristic curves). Resource utilization of two diagnostic strategies, routine (all patients with lymph nodes) and selective EUS-FNA (FNA only in those patients in whom the number of EUS malignant criteria provides a sensitivity and a specificity <100%), were compared. RESULTS: Modified EUS criteria for lymph-node staging were more accurate than standard criteria (area under the curve 0.88 vs. 0.78, respectively). No criterion alone was predictive of malignancy; sensitivity and specificity reached 100% when a cutoff value of >1 and >6 modified criteria were used, respectively. The EUS-FNA selective approach may avoid performing FNA in 61 patients (42%). CONCLUSIONS: Modified EUS lymph-node criteria are more accurate than standard criteria. A selective EUS-FNA approach reduced the cost by avoiding EUS-FNA in 42% of patients with esophageal carcinoma. These results require confirmation in future studies. [ABSTRACT FROM AUTHOR]
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- 2006
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17. International survey of knowledge of indications for EUS.
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Yusuf TE, Harewood GC, Clain JE, and Levy MJ
- Abstract
BACKGROUND: The knowledge level for EUS indications among gastroenterologists across different locations and practices is not known. The aim of this study was to assess knowledge of EUS indications among a diverse group of gastroenterologists, both nationally and internationally. METHODS: A web-based survey was designed to assess knowledge of EUS with respect to 4 organ systems: esophagus, gastroduodenum, hepatopancreatobiliary, and colorectum. The survey was distributed by electronic mail (e-mail) to members of the American Society for Gastrointestinal Endoscopy. RESULTS: The survey was distributed to 3848 physicians, of whom 2848 had an active e-mail address. There were 323 respondents (11.3%), of whom 210 were U.S. members and 113 international. Overall, the mean score for the different organ systems for all respondents was highest for gastroduodenum (93% correct) and lowest for colorectum (71%) compared with esophagus (79%) and hepatopancreatobiliary (83%) systems. The mean total score was higher for U.S. respondents (84% correct) compared with international respondents (79%, p < 0.0001). Endosonographers fared better than those who were not endosonographers (85% vs. 81%, p = 0.0002). CONCLUSIONS: Knowledge levels of colorectal applications of EUS are poorest among the 4 organ systems studied. Future educational initiatives should focus on applications of EUS in this category. Studies are required to assess the impact of this education on the appropriateness of EUS referral patterns. [ABSTRACT FROM AUTHOR]
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- 2006
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18. EUS-guided Trucut biopsy.
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Levy MJ and Wiersema MJ
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- 2005
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19. Subcutaneous octreotide in cluster headache: randomized placebo-controlled double-blind crossover study.
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Matharu MS, Levy MJ, Meeran K, and Goadsby PJ
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- 2004
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20. Ureteral Substitute by Fallopian Tube
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Vidne B, Levy Mj, Gassner S, and Erdman S
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Genitourinary system ,business.industry ,Genitalia.female ,Urology ,Research methodology ,Urinary system ,Anatomy ,Long segment ,Ureter ,medicine.anatomical_structure ,medicine ,business ,Distal anastomosis ,Fallopian tube - Abstract
Experimental substitution of a long segment of ureter by a fallopian tube was performed in dogs. Three different techniques of proximal and distal anastomosis for reconstruction of the urinary tract w
- Published
- 1975
21. Partial cardiopulmonary bypass, hypothermia, and total circulatory arrest
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Levy Mj, Craig W. Lillehei, Ellis Rj, and Todd Db
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,business.industry ,Cardiac pathology ,Hypothermia ,law.invention ,medicine.anatomical_structure ,Ventricle ,law ,Internal medicine ,Circulatory system ,Cardiology ,medicine ,Cardiopulmonary bypass ,Surgery ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Published
- 1969
22. EUS-guided coil embolization for refractory ectopic variceal bleeding (with videos)
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Levy MJ, Song LMW, Kendrick ML, Misra S, and Gostout CJ
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- 2008
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23. Double aortic arch anomalies: diagnosis by countercurrent right brachial arteriography
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Garti, IJ, primary, Aygen, MM, additional, and Levy, MJ, additional
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- 1979
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24. EUS Needle Identification Comparison and Evaluation study (with videos)
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Peter P Fink, Edward Chen, Mohammad Adel Ali, Khanh Pham, Ali A. Siddiqui, Fauze Maluf-Filho, Paul Fockens, Adrian Saftoiu, Enrique Vazquez-Sequeiros, Raj J. Shah, Maor Lahav, Pramod Kumar Garg, James M. Scheiman, Field F. Willingham, Rabindra R. Watson, Elisabetta Buscarini, Rastislav Kunda, Norbert Gritzmann, Uzma D. Siddiqui, Costin Teodor Streba, Wanmei Wang, Garth Campbell, Paul S. Sidhu, Peter Vilmann, Marcus Kantowski, Harry R. Aslanian, Michael Hocke, Alberto Larghi, Malay Sharma, Pierre Henri Deprez, Andrew Y. Wang, Michael Griswold, Christian Pállson Nolsøe, Jürgen Pohl, Michael B. Wallace, Andreas Slot Vilmann, Roald Flesland Havre, Arnold J. Markowitz, Shou-Jiang Tang, Anand V. Sahai, Timothy C. McCowan, Vanessa M. Shami, Pietro Fusaroli, Fabio Piscaglia, Odd Helge Gilja, Christoph F. Dietrich, Manoop S. Bhutani, Niels Bang, Jinga Mariana, James Buxbaum, Ruonan Wu, Cyrillo Rodrigues de Araujo, Jouke T. Annema, T. Lorentzen, Simon Freeman, Girish Mishra, Maija Radzina, Gerard Isenberg, Linda S. Lee, Erik H.F.M. van der Heijden, Mirko D'Onofrio, Rajesh Puri, Christian Jenssen, AM Patel, William R. Brugge, Zeno Sparchez, Cynthia L. Harris, Michael J. Levy, Sten Mellerup Sørensen, Tang SJ, Vilmann AS, Saftoiu A, Wang W, Streba CT, Fink PP, Griswold M, Wu R, Dietrich CF, Jenssen C, Hocke M, Kantowski M, Pohl J, Fockens P, Annema JT, van der Heijden EH, Havre RF, Do-Cong Pham K, Kunda R, Deprez PH, Mariana J, Vazquez-Sequeiros E, Larghi A, Buscarini E, Fusaroli P, Lahav M, Puri R, Garg PK, Sharma M, Maluf-Filho F, Sahai A, Brugge WR, Lee LS, Aslanian HR, Wang AY, Shami VM, Markowitz A, Siddiqui AA, Mishra G, Scheiman JM, Isenberg G, Siddiqui UD, Shah RJ, Buxbaum J, Watson RR, Willingham FF, Bhutani MS, Levy MJ, Harris C, Wallace MB, Nolsøe CP, Lorentzen T, Bang N, Sørensen SM, Gilja OH, D'Onofrio M, Piscaglia F, Gritzmann N, Radzina M, Sparchez ZA, Sidhu PS, Freeman S, McCowan TC, Rodrigues de Araujo C Jr, Patel A, Ali MA, Campbell G, Chen E, Vilmann P, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, CCA -Cancer Center Amsterdam, Gastroenterology and Hepatology, AII - Amsterdam institute for Infection and Immunity, and Pulmonology
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medicine.medical_specialty ,Endosonography ,03 medical and health sciences ,0302 clinical medicine ,030202 anesthesiology ,Radiologists ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Sampling (medicine) ,biopsy ,EUS-guided FNA ,Endoscopic Ultrasound-Guided Fine Needle Aspiration ,business.industry ,Phantoms, Imaging ,EUS-guided FNA, biopsy ,Significant difference ,Gastroenterologists ,Other Research Radboud Institute for Health Sciences [Radboudumc 0] ,fine needle aspiration ,Gastroenterology ,Echogenicity ,Videotape Recording ,Surgery ,Needles ,High definition ,030211 gastroenterology & hepatology ,Radiology ,business ,Rare cancers Radboud Institute for Health Sciences [Radboudumc 9] - Abstract
Item does not contain fulltext BACKGROUND AND AIMS: EUS-guided FNA or biopsy sampling is widely practiced. Optimal sonographic visualization of the needle is critical for image-guided interventions. Of the several commercially available needles, bench-top testing and direct comparison of these needles have not been done to reveal their inherent echogenicity. The aims are to provide bench-top data that can be used to guide clinical applications and to promote future device research and development. METHODS: Descriptive bench-top testing and comparison of 8 commonly used EUS-FNA needles (all size 22 gauge): SonoTip Pro Control (Medi-Globe); Expect Slimline (Boston Scientific); EchoTip, EchoTip Ultra, EchoTip ProCore High Definition (Cook Medical); ClearView (Conmed); EZ Shot 2 (Olympus); and BNX (Beacon Endoscopic), and 2 new prototype needles, SonoCoat (Medi-Globe), coated by echogenic polymers made by Encapson. Blinded evaluation of standardized and unedited videos by 43 EUS endoscopists and 17 radiologists specialized in GI US examination who were unfamiliar with EUS needle devices. RESULTS: There was no significant difference in the ratings and rankings of these needles between endosonographers and radiologists. Overall, 1 prototype needle was rated as the best, ranking 10% to 40% higher than all other needles (P < .01). Among the commercially available needles, the EchoTip Ultra needle and the ClearView needle were top choices. The EZ Shot 2 needle was ranked statistically lower than other needles (30%-75% worse, P < .001). CONCLUSIONS: All FNA needles have their inherent and different echogenicities, and these differences are similarly recognized by EUS endoscopists and radiologists. Needles with polymeric coating from the entire shaft to the needle tip may offer better echogenicity.
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- 2016
25. Coaxial plastic stent placement within lumen-apposing metal stents for the management of pancreatic fluid collections: a systemic review and meta-analysis.
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AbiMansour J, Jaruvongvanich V, Velaga S, Law R, Storm AC, Topazian M, Levy MJ, Alexander R, Vargas EJ, Bofill-Garica A, Martin JA, Petersen BT, Abu Dayyeh BK, and Chandrasekhara V
- Abstract
Background/aims: Coaxial placement of double pigtail plastic stents (DPPS) through lumen-apposing metal stents (LAMSs) is commonly performed to reduce the risk of LAMS obstruction, bleeding, and stent migration when used for the drainage of pancreatic fluid collections (PFCs). A systematic review and meta-analysis were performed to compare the outcomes of LAMS alone and LAMS with coaxial DPPS placement in the management of PFCs., Methods: A systematic review was conducted to identify studies comparing LAMS and LAMS/DPPS for PFC drainage. Primary outcomes included the rate of clinical success, overall adverse events (AEs), bleeding, infection, occlusion, and stent migration. The pooled effect size was summarized using a random-effects model and compared between LAMS and LAMS/DPPS by calculating odds ratios (ORs)., Results: Nine studies involving 709 patients were identified (338 on LAMS and 371 on LAMS/DPPS). LAMS/DPPS was associated with a reduced risk of stent obstruction (OR, 0.59; p=0.004) and infection (OR, 0.55; p=0.001). No significant differences were observed in clinical success (OR, 0.96; p=0.440), overall AEs (OR, 0.57; p=0.060), bleeding (OR, 0.61; p=0.120), or stent migration (OR, 1.03; p=0.480)., Conclusions: Coaxial DPPS for LAMS drainage of PFCs is associated with a reduced risk of stent occlusion and infection; however, no difference was observed in the overall AE rates or bleeding.
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- 2024
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26. EUS for the evaluation of esophageal injury after catheter ablation for atrial fibrillation.
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Akiki K, Minteer WB, Chandrasekhara V, Mahmoud T, Law RJ, Rajan E, Sugrue AM, Killu AM, Gleeson FC, Abu Dayyeh BK, Levy MJ, Topazian M, and Storm AC
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Background and Aims: Atrial fibrillation (AF) ablation is an increasingly used rhythm control strategy that can damage adjacent structures in the mediastinum including the esophagus. Atrioesophageal fistulas and esophagopericardial fistulas are life-threatening adverse events that are believed to progress from early esophageal mucosal injury (EI). EUS has been proposed as a superior method to EGD to survey EI and damage to deeper structures. We evaluated the safety of EUS in categorizing postablation EI and quantified EUS-detected lesions and their correlation with injury severity and clinical course., Methods: We retrospectively reviewed 234 consecutive patients between 2006 and 2020 who underwent AF ablation followed by EUS for the purpose of EI screening. The Kansas City classification was used to classify EI (type 1, type 2a/b, or type 3a/b)., Results: EUS identified pleural effusions in 31.6% of patients, mediastinal adventitia changes in 22.2%, mediastinal lymphadenopathy in 14.1%, pulmonary vein changes in 10.6%, and esophageal wall changes in 7.7%. EGD revealed 175 patients (75%) without and 59 (25%) with EI. Patients with type 2a/b EI and no EI were compared with multivariate logistic regression, and the presence of esophageal wall abnormality on EUS (odds ratio [OR], 72.85; 95% confidence interval [CI], 13.9-380.7), female sex (OR, 3.97; 95% CI 1.3-12.3), and number of energy deliveries (OR, 1.01; 95% CI, 1.003-1.03) were associated with EI type 2a or 2b. Preablation use of proton pump inhibitors was not associated with a decreased risk of EI., Conclusions: EUS safely assesses mediastinal damage after ablation for AF and may excel over EGD in evaluating mucosal lesions of uncertain significance, with a reduced risk of gas embolization in the setting of a full-thickness injury (enterovascular fistula). We propose an EUS-first guided approach to post-AF ablation examination, followed by EGD if it is safe to do so., Competing Interests: Disclosure The following authors disclosed financial relationships: V. Chandrasekhara: Consultant for Boston Scientific; research support from STARMed and MicroTech Endoscopy; stock options with Nevakar Corporation. R. J. Law: Consultant Olympus America, Boston Scientific, Conmed, and Medtronic; research support from Olympus America and Boston Scientific; royalties form UpToDate. E. Rajan: Intellectual property with Medtronic and Ruhiff; consultant for Olympus and J&J. B. K. Abu Dayyeh: Consultant for Endogenex, Endo-TAGSS, Metamodix, BFKW, USGI, Apollo Endosurgery, Medtronic, Spatz Medical, EndoGastric Solutions, Aspire Bariatrics, and Boston Scientific; research support from USGI, Apollo Endosurgery, Medtronic, Spatz Medical, EndoGastric Solutions, Aspire Bariatrics, Boston Scientific, Cairn Diagnostics, and GI Dynamics; speaker for Olympus and Johnson & Johnson. A. C. Storm: Consultant for Apollo Endosurgery, Boston Scientific, MGI Medical, Envision Endoscopy, Olympus Corporation, Intuitive Surgical, Medtronic, and Micro-Tech Medical; research support from Apollo Endosurgery, Boston Scientific, Endogenex, Endo-TAGGS, EnteraSense Ltd, and OnePass Medical. All other authors disclosed no financial relationships., (Copyright © 2024 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.)
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- 2024
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27. Utilization of an artificial intelligence-enhanced, web-based application to review bile duct brushing cytologic specimens: A pilot study.
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Marya NB, Powers PD, Bois MC, Hartley C, Kerr SE, Thangaiah JJ, Norton D, Abu Dayyeh BK, Cantley R, Chandrasekhara V, Gores G, Gleeson FC, Law RJ, Maleki Z, Martin JA, Pantanowitz L, Petersen B, Storm AC, Levy MJ, and Graham RP
- Abstract
Background: The authors previously developed an artificial intelligence (AI) to assist cytologists in the evaluation of digital whole-slide images (WSIs) generated from bile duct brushing specimens. The aim of this trial was to assess the efficiency and accuracy of cytologists using a novel application with this AI tool., Methods: Consecutive bile duct brushing WSIs from indeterminate strictures were obtained. A multidisciplinary panel reviewed all relevant information and provided a central interpretation for each WSI as being "positive," "negative," or "indeterminate." The WSIs were then uploaded to the AI application. The AI scored each WSI as positive or negative for malignancy (i.e., computer-aided diagnosis [CADx]). For each WSI, the AI prioritized cytologic tiles by the likelihood that malignant material was present in the tile. Via the AI, blinded cytologists reviewed all WSIs and provided interpretations (i.e., computer-aided detection [CADe]). The diagnostic accuracies of the WSI evaluation via CADx, CADe, and the original clinical cytologic interpretation (official cytologic interpretation [OCI]) were compared., Results: Of the 84 WSIs, 15 were positive, 42 were negative, and 27 were indeterminate after central review. The WSIs generated on average 141,950 tiles each. Cytologists using the AI evaluated 10.5 tiles per WSI before making an interpretation. Additionally, cytologists required an average of 84.1 s of total WSI evaluation. WSI interpretation accuracies for CADx (0.754; 95% CI, 0.622-0.859), CADe (0.807; 95% CI, 0.750-0.856), and OCI (0.807; 95% CI, 0.671-0.900) were similar., Conclusions: This trial demonstrates that an AI application allows cytologists to perform a triaged review of WSIs while maintaining accuracy., (© 2024 American Cancer Society.)
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- 2024
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28. Incidence and Effect Duration of Immune Checkpoint Inhibitor-Related Pancreas Adverse Events.
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Gleeson FC, Dunleavy KA, Levy MJ, Carr RM, Hartgers ML, Kottschade LA, McWilliams RR, Ma WW, Kudva YC, and Egan AM
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- Humans, Incidence, Male, Female, Middle Aged, Aged, Time Factors, Pancreas drug effects, Pancreas immunology, Pancreas pathology, Adult, Immune Checkpoint Inhibitors adverse effects
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- 2024
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29. Utility of methylated DNA markers for the diagnosis of malignant biliary strictures.
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Cooley MA, Schneider AR, Barr Fritcher EG, Milosevic D, Levy MJ, Bridgeman AR, Martin JA, Petersen BT, Abu Dayyeh BK, Storm AC, Law RJ, Vargas EJ, Garimella V, Zemla T, Jenkins SM, Yin J, Gores GJ, Roberts LR, Kipp BR, and Chandrasekhara V
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Background and Aims: Early identification of malignant biliary strictures (MBSs) is challenging, with up to 20% classified as indeterminants after preliminary testing and tissue sampling with endoscopic retrograde cholangiopancreatography. We aimed to evaluate the use of methylated DNA markers (MDMs) from biliary brushings to enhance MBS detection in a prospective cohort., Approach: Candidate MDMs were evaluated for their utility in MBS diagnosis through a series of discovery and validation phases. DNA was extracted from biliary brushing samples, quantified, bisulfite-converted, and then subjected to methylation-specific droplet digital polymerase chain reaction. Patients were considered to have no malignancy if the sampling was negative and there was no evidence of malignancy after 1 year or definitive negative surgical histopathology., Results: Fourteen candidate MDMs were evaluated in the discovery phase, with top-performing and new markers evaluated in the technical validation phase. The top 4 MDMs were TWIST1, HOXA1, VSTM2B, and CLEC11A, which individually achieved AUC values of 0.82, 0.81, 0.83, and 0.78, respectively, with sensitivities of 59.4%, 53.1%, 62.5%, and 50.0%, respectively, at high specificities for malignancy of 95.2%-95.3% for the final biologic validation phase. When combined as a panel, the AUC was 0.86, achieving 73.4% sensitivity and 92.9% specificity, which outperformed cytology and fluorescence in situ hybridization (FISH)., Conclusions: The selected MDMs demonstrated improved performance characteristics for the detection of MBS compared to cytology and FISH. Therefore, MDMs should be considered viable candidates for inclusion in diagnostic testing algorithms., (Copyright © 2024 American Association for the Study of Liver Diseases.)
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- 2024
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30. Bleeding Control Protections Within US Good Samaritan Laws - CORRIGENDUM.
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Levy MJ, Wend CM, Flemming WP, Lazieh A, Rosenblum AJ, Pineda CM, Wolfberg DM, Jenkins JL, Goolsby CA, and Margolis AM
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- 2024
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31. Point-of-care ultrasound is a useful adjunct tool to a clinician's assessment in the evaluation of severe hyponatraemia.
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Rahman LR, Melson E, Alousi SA, Sardar M, Levy MJ, Shafiq S, Rahman F, Coats T, and Reddy NL
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- Humans, Female, Male, Aged, Aged, 80 and over, Middle Aged, Retrospective Studies, Adult, Hyponatremia diagnostic imaging, Point-of-Care Systems, Ultrasonography methods
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Introduction: Hyponatraemia is the most common electrolyte disorder in inpatients resulting mainly from an imbalance in water homeostasis. Intravascular fluid status assessment is pivotal but is often challenging given multimorbidity, polypharmacy and diuretics use. We evaluated the utility of point-of-care ultrasound (POCUS) as an adjunct tool to standard practice for fluid assessment in severe hyponatraemia patients., Methods: Patients presenting with severe hyponatremia (Serum Sodium [Na] < 120 mmol/L; Normal range: 135-145 mol/L), managed by standard care were included. Hyponatraemia biochemistry work-up and POCUS examination were undertaken. Both clinician and POCUS independently assigned one of the three fluid status groups of hypovolaemia, hypervolaemia or euvolaemia. The final diagnosis of three fluid status groups at admission was made at the time of discharge by retrospective case review. Clinician's (standard of care) and POCUS fluid assessments were compared to that of the final diagnosis at the time of discharge., Results: n = 19 patients were included. Median Na on admission was 113 mmol/L (109-116), improved to 129 ± 3 mmol/L on discharge. POCUS showed the higher degree of agreement with the final diagnosis (84%; n = 16/19), followed by the clinician (63%; n = 12/19). A trend towards higher accuracy of POCUS compared to clinician assessment of fluid status was noted (84% vs. 63%, p = 0.1611). Biochemistry was unreliable in 58% (n = 11/19) likely due to renal failure, polypharmacy or diuretic use. Inappropriate emergency fluid management was undertaken in 37% (n = 7/19) of cases based on initial clinician assessment. Thirst symptom correlated to hypovolaemia in 80% (4/5) cases., Conclusion: As subjective clinical and biochemistry assessments of fluid status are often unreliable due to co-morbidities and concurrent use of medications, POCUS can be a rapid objective diagnostic tool to assess fluid status in patients with severe hyponatraemia, to guide accurate emergency fluid management., (© 2024 The Authors. Clinical Endocrinology published by John Wiley & Sons Ltd.)
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- 2024
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32. Smoking and Alcohol Consumption and Risk of Incident Diverticulitis in Women.
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Gunby SA, Ma W, Levy MJ, Giovannucci EL, Chan AT, and Strate LL
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- Humans, Female, Middle Aged, Prospective Studies, Adult, Risk Assessment, Incidence, Risk Factors, Alcohol Drinking adverse effects, Alcohol Drinking epidemiology, Diverticulitis epidemiology, Diverticulitis etiology, Smoking epidemiology, Smoking adverse effects
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Background & Aims: Much of what is known about the effects of alcohol and tobacco use on diverticular disease derives from studies of asymptomatic diverticulosis or complicated diverticulitis. We examined smoking and alcohol consumption and risk of incident diverticulitis in a large cohort of women., Methods: We conducted a prospective study of 84,232 women in the Nurses' Health Study II (NHS II) who were 39-52 years old and without known diverticulitis at baseline in 2003. Smoking was ascertained every 2 years and alcohol use every 4 years. We used Cox proportional hazards regression to estimate multivariable-adjusted hazards ratios (HRs) and 95% confidence intervals (CIs)., Results: During 1,139,660 person-years of follow up, we identified 3018 incident cases of diverticulitis. After adjustment for other risk factors, current (HR, 1.20; 95% CI, 1.04-1.39) and past smoking (HR, 1.20; 95% CI, 1.11-1.30) were associated with increased risk of diverticulitis when compared with never smokers. Women who consumed ≥30 g/d of alcohol had a multivariate HR of 1.26 (95% CI, 1.05-1.50) when compared with women who did not drink. A joint analysis of smoking and alcohol found that individuals who ever smoked and consumed ≥15 g/d of alcohol were at highest risk of diverticulitis (multivariate HR, 1.60; 95% CI, 1.16-2.21), compared with participants who never smoked and reported no alcohol use., Conclusions: In this large prospective study of women, smoking and alcohol consumption were associated with an increased risk of incident diverticulitis. These data highlight additional modifiable risk factors for diverticulitis that may aid in prevention., (Copyright © 2024 AGA Institute. Published by Elsevier Inc. All rights reserved.)
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- 2024
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33. Dispatch Categories as Indicators of Out-of-Hospital Time Critical Interventions and Associated Emergency Department Outcomes.
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Levy MJ, Crowe RP, Abraham H, Bailey A, Blue M, Ekl R, Garfinkel E, Holloman JB, Hutchens J, Jacobsen R, Johnson C, Margolis A, Troncoso R, Williams JG, and Myers JB
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Objectives: Emergency medical services (EMS) systems increasingly grapple with rising call volumes and workforce shortages, forcing systems to decide which responses may be delayed. Limited research has linked dispatch codes, on-scene findings, and emergency department (ED) outcomes. This study evaluated the association between dispatch categorizations and time-critical EMS responses defined by prehospital interventions and ED outcomes. Secondarily, we proposed a framework for identifying dispatch categorizations that are safe or unsafe to hold in queue., Methods: This retrospective, multi-center analysis encompassed all 9-1-1 responses from 8 accredited EMS systems between 1/1/2021 and 06/30/2023, utilizing the Medical Priority Dispatch System (MPDS). Independent variables included MPDS Protocol numbers and Determinant levels. EMS treatments and ED diagnoses/dispositions were categorized as time-critical using a multi-round consensus survey. The primary outcome was the proportion of EMS responses categorized as time-critical. A non-parametric test for trend was used to assess the proportion of time-critical responses Determinant levels. Based on group consensus, Protocol/Determinant level combinations with at least 120 responses (∼1 per week) were further categorized as safe to hold in queue (<1% time-critical intervention by EMS and <5% time-critical ED outcome) or unsafe to hold in queue (>10% time-critical intervention by EMS or >10% time-critical ED outcome)., Results: Of 1,715,612 EMS incidents, 6% (109,250) involved a time-critical EMS intervention. Among EMS transports with linked outcome data (543,883), 12% had time-critical ED outcomes. The proportion of time-critical EMS interventions increased with Determinant level (OMEGA: 1%, ECHO: 38%, p-trend < 0.01) as did time-critical ED outcomes (OMEGA: 3%, ECHO: 31%, p-trend < 0.01). Of 162 unique Protocols/Determinants with at least 120 uses, 30 met criteria for safe to hold in queue, accounting for 8% (142,067) of incidents. Meanwhile, 72 Protocols/Determinants met criteria for unsafe to hold, accounting for 52% (883,683) of incidents. Seven of 32 ALPHA level Protocols and 3/17 OMEGA level Protocols met the proposed criteria for unsafe to hold in queue., Conclusions: In general, Determinant levels aligned with time-critical responses; however, a notable minority of lower acuity Determinant level Protocols met criteria for unsafe to hold. This suggests a more nuanced approach to dispatch prioritization, considering both Protocol and Determinant level factors.
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- 2024
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34. Celiac artery mesenteric fat measurement with endosonography (CAMEUS) reliably correlates with obesity and related comorbidities.
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Bazerbachi F, Baroud S, Levy MJ, Maselli DB, Vargas EJ, Bofill-Garcia A, Law RJ, Chandrasekhara V, Storm AC, Gleeson FC, Rajan E, Iyer PG, Watt KD, and Abu Dayyeh BK
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Background: Visceral fat represents a metabolically active entity linked to adverse metabolic sequelae of obesity. We aimed to determine if celiac artery mesenteric fat thickness can be reliably measured during endoscopic ultrasound (EUS), and if these measurements correlate with metabolic disease burden., Methods: This was a retrospective analysis of patients who underwent celiac artery mesenteric fat measurement with endosonography (CAMEUS) measurement at a tertiary referral center, and a validation prospective trial of patients with obesity and nonalcoholic steatohepatitis who received paired EUS exams with CAMEUS measurement before and after six months of treatment with an intragastric balloon., Results: CAMEUS was measured in 154 patients [56.5% females, mean age 56.5 ± 18.0 years, body mass index (BMI) 29.8 ± 8.0 kg/m
2 ] and was estimated at 14.7 ± 6.5 mm. CAMEUS better correlated with the presence of non-alcoholic fatty liver disease (NAFLD) ( R2 = 0.248, P < 0.001) than BMI ( R2 = 0.153, P < 0.001), and significantly correlated with metabolic parameters and diseases. After six months of intragastric balloon placement, the prospective cohort experienced 11.7% total body weight loss, 1.3 points improvement in hemoglobin A1c ( P = 0.001), and a 29.4% average decrease in CAMEUS (-6.4 ± 5.2 mm, P < 0.001). CAMEUS correlated with improvements in weight ( R2 = 0.368), aspartate aminotransferase to platelet ratio index ( R2 = 0.138), and NAFLD activity score ( R2 = 0.156) (all P < 0.05)., Conclusions: CAMEUS is a novel measure that is significantly correlated with critical metabolic indices and can be easily captured during routine EUS to risk-stratify susceptible patients. This station could allow for EUS access to sampling and therapeutics of this metabolic region., Competing Interests: R.J.L. consults for ConMed, Boston Scientific, and Medtronic. V.C. consults for Boston Scientific and Covidien, and serves as a shareholder in Nevakar Corporation. A.C.S. receives research grants from Apollo Endosurgery, Boston Scientific, Endogenex, Endo-TAGSS, and EnteraSense, and consults for Apollo Endosurgery, ERBE Elektromedizin, GI Dynamics, Intuitive Surgical, and Olympus. E.R. consults for Olympus and Johnson & Johnson, and owns intellectual property for Medtronic. P.G.I. consults for Exact Sciences, Pentax Medical, CDx Medical, Castle Biosciences, Ambu, and Symple Surgical, and receives research funding from Exact Sciences, Pentax Medical, CDx Medical, and Castle Biosciences. B.K.A.D. consults for Endogenex, Endo-TAGSS, Metamodix, BFKW, USGI, and Boston Scientific, and received research grants from USGI, Boston Scientific, Medtronic, and EndoGastric Solutions, and received research support from Apollo Endosurgery and Spatz Medical, and serves as a speaker for Olympus, Johnson & Johnson, Medtronic, and EndoGastric Solutions. Other authors declare that there are no conflicts of interest in this study., (© The Author(s) 2024. Published by Oxford University Press and Sixth Affiliated Hospital of Sun Yat-sen University.)- Published
- 2024
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35. Endoscopic Ultrasound-based Shear Wave Elastography for Detection of Advanced Liver Disease.
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AbiMansour J, Chin JY, Kaur J, Vargas EJ, Abu Dayyeh BK, Law R, Garimella V, Levy MJ, Storm AC, Dierkhising R, Allen A, Venkatesh S, and Chandrasekhara V
- Abstract
Background and Aims: Endoscopic ultrasound shear wave elastography (EUS-SWE) is a novel modality for liver stiffness measurement. The aims of this study are to evaluate the performance and reliability of EUS-SWE for detecting advanced liver disease in a prospective cohort., Methods: EUS-SWE measurements were prospectively obtained from patients undergoing EUS between August 2020 and March 2023. Liver stiffness measurements were compared between patients with and without advanced liver disease (ALD), defined as stage ≥3, to determine diagnostic accuracy for advanced fibrosis and portal hypertension. Logistic regression was performed to identify variables that impact the reliability of EUS-SWE readings. Select patients underwent paired magnetic resonance elastography (MRE) for liver fibrosis correlation., Results: Patients with ALD demonstrated higher liver stiffness compared to healthy controls (left lobe: 17.6 vs. 12.7 kPa, P<0.001; median right lobe: 24.8 vs. 11.0 kPa, P<0.001). The area under the receiver operator characteristic (AUROC) for the detection of ALD was 0.73 and 0.80 for left and right lobe measurements, respectively. General anesthesia was associated with reliable EUS-SWE liver readings (odds ratio: 2.73, 95% CI: 1.07-7.39, P=0.040). Left lobe measurements correlated significantly with MRE with an increase of 0.11 kPa (95% CI: 0.05-0.17 kPA) for every 1 kPa increase on EUS-SWE. D., Conclusions: SWE is a promising technology that can readily be incorporated into standard EUS examinations for the assessment of ALD., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2024
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36. Diverticulosis morphology is associated with risk of diverticulitis.
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Levy MJ, Osterkamp RL, Glauninger K, and Strate LL
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- Humans, Child, Preschool, Retrospective Studies, Case-Control Studies, Risk Factors, Colonoscopy, Diverticulitis diagnostic imaging, Diverticulitis epidemiology, Diverticulum diagnostic imaging, Diverticulum epidemiology
- Abstract
The size, number and distribution of diverticula vary greatly in patients with diverticulosis. We aimed to study the association between the morphology of diverticulosis assessed on colonoscopy and the risk of diverticulitis. We performed a retrospective, case-control study of cases with a history of diverticulitis and controls with diverticulosis without diverticulitis matched on sex, age (within 5 years) and year of colonoscopy. Diverticulosis characteristics were obtained from endoscopy reports and were categorized according to severity, extent, number and size. We used conditional logistic regression on matched pairs to calculate the odds of diverticulitis among patients with diverticulosis according to differing morphologic characteristics. We identified 85 cases with computed tomography-documented diverticulitis and 85 matched controls with diverticulosis without a diagnosis of diverticulitis. In cases, 60% had left-sided only diverticulosis, 2% had right-sided only and 38% had both right and left-sided diverticulosis; whereas in controls, the distribution was 53%, 18% and 29%, respectively. Cases were more likely to have large diverticula [odds ratio (OR), 3.33; 95% confidence interval (CI), 1.30-8.56 for left colon only and 1.89, 95% CI, 0.78-4.57 for both right and left]. Similarly, when the severity of diverticulosis was compared between the groups, cases were more likely to have moderate or severe diverticulosis (OR, 3.44; 95% CI, 1.51-7.84 for moderate and OR, 8.87; 95% CI, 2.98-26.37 for severe). Diverticulitis cases were more likely to have large diverticula and severe diverticulosis when compared to controls suggesting that size and severity are novel risk factors for diverticulitis., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2024
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37. Implementation of a prehospital whole blood program: Lessons learned.
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Levy MJ, Garfinkel EM, May R, Cohn E, Tillett Z, Wend C, Sikorksi RA, Troncoso R Jr, Jenkins JL, Chizmar TP, and Margolis AM
- Abstract
Early blood administration by Emergency Medical Services (EMS) to patients suffering from hemorrhagic shock improves outcomes. Prehospital blood programs represent an invaluable resuscitation capability that directly addresses hemorrhagic shock and mitigates subsequent multiple organ dysfunction syndrome. Prehospital blood programs must be thoughtfully planned, have multiple safeguards, ensure adequate training and credentialing processes, and be responsible stewards of blood resources. According to the 2022 best practices model by Yazer et al, the four key pillars of a successful prehospital program include the following: (1) the rationale for the use and a description of blood products that can be transfused in the prehospital setting, (2) storage of blood products outside the hospital blood bank and how to move them to the patient in the prehospital setting, (3) prehospital transfusion criteria and administration personnel, and (4) documentation of prehospital transfusion and handover to the hospital team. This concepts paper describes our operational experience using these four pillars to make Maryland's inaugural prehospital ground-based low-titer O-positive whole blood program successful. These lessons learned may inform other EMS systems as they establish prehospital blood programs to help improve outcomes and enhance mass casualty response., Competing Interests: M. J. L. is the noncompensated Chairperson of the nonprofit Stop the Bleed Coalition. M. J. L. and A. M. M. are consultants for Stryker Medical Education. The remaining authors have no conflicts of interest relevant to this article to disclose., (© 2024 The Authors. Journal of the American College of Emergency Physicians Open published by Wiley Periodicals LLC on behalf of American College of Emergency Physicians.)
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- 2024
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38. Ethanol Ablation for Benign Insulinoma: Intraoperative and Endoscopic Approaches.
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Sada A, Ramachandran D, Oberoi M, Habermann EB, Lyden ML, Dy BM, Foster TR, Halfdanarson TR, Levy MJ, Vella A, and McKenzie TJ
- Subjects
- Adult, Female, Humans, Aged, Male, Ethanol therapeutic use, Ultrasonography, Endosonography methods, Insulinoma diagnostic imaging, Insulinoma surgery, Insulinoma complications, Pancreatic Neoplasms surgery, Pancreatic Neoplasms pathology, Hypoglycemia etiology
- Abstract
Introduction: Ethanol ablation can be utilized to manage insulinoma. We aimed to analyze our outcomes of endoscopic ultrasound (EUS) and intraoperative ultrasound (IOUS) guided Ethanol ablation of insulinoma., Methods: A single institution retrospective review of adults undergoing Ethanol ablation of benign pancreatic insulinoma (2007-2022) was performed. Outcomes were categorized as resolution of hypoglycemia, improvement, or no change at last follow-up., Results: A total of 16 patients underwent Ethanol ablation of benign insulinoma (N = 8 EUS, N = 8 IOUS): median age was 68 y, 8 (50%) were females, and 2 (12.5%) were associated with multiple endocrine neoplasia type-1. Median insulinoma size was 12 (range 7, 25) mm. Ethanol ablation was preferred over resection to avoid pancreaticoduodenectomy when it was not possible to enucleate the tumor in 10 (62.5%) patients while the rest underwent ablation due to being poor surgical candidates or because of a history of previous pancreatic resection. The median follow-up (interquartile range) was 43 (19.5, 81.5) mo. Resolution of hypoglycemia occurred in 11 patients (5 EUS, 6 IOUS), while the rest (3 EUS, 2 IOUS) experienced improvement in the severity and frequency of hypoglycemia. A single patient underwent resection following a previous ablation for symptomatic hypoglycemia 5 y after EUS guided ablation., Conclusions: Ethanol ablation provides an alternative therapeutic option for patients with insulinoma. Both EUS and IOUS guided approaches are associated with a favorable resolution rate although EUS guided ablation may require multiple procedures to optimize outcomes., (Copyright © 2023. Published by Elsevier Inc.)
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- 2024
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39. Lumen-apposing metal stents with or without coaxial plastic stent placement for the management of pancreatic fluid collections.
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AbiMansour JP, Jaruvongvanich V, Velaga S, Law RJ, Storm AC, Topazian MD, Levy MJ, Alexander R, Vargas EJ, Bofill-Garcia A, Matin JA, Petersen BT, Abu Dayyeh BK, and Chandrasekhara V
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- Humans, Retrospective Studies, Stents adverse effects, Drainage adverse effects, Hemorrhage etiology, Pancreatic Diseases surgery, Pancreatic Diseases etiology
- Abstract
Background and Aims: Coaxial double-pigtail plastic stent (DPPS) placement is often performed within lumen-apposing metal stents (LAMSs) for drainage of pancreatic fluid collections (PFCs) to prevent adverse events (AEs) such as stent occlusion and bleeding. This study compares the safety and outcomes of LAMSs alone versus LAMSs with coaxial DPPSs for PFC management., Methods: Patients undergoing drainage of a PFC with LAMSs were retrospectively identified and categorized as LAMS or LAMS/DPPS based on initial drainage strategy. The AE rate, AE type, and clinical success were extracted by chart review., Results: One hundred eighty-five individuals (83 LAMS, 102 LAMS/DPPS) were identified. No significant differences were found in rates of clinical success (75.9% LAMS vs 69.6% LAMS/DDPS, P = .34) or overall AEs (15.7% LAMS vs 15.7% LAMS/DPPS, P = .825)., Conclusions: In this comparative single-center study, placement of a coaxial DPPS for drainage of PFCs with LAMSs did not affect rates of AEs or clinical success., Competing Interests: Disclosure The following authors disclosed financial relationships: R. Law: Consultant for ConMed and Medtronic; royalties from UpToDate. A. C. Storm: Consultant for Apollo Endosurgery; research support from Apollo Endosurgery and Boston Scientific. B. T. Petersen: Consultant for Olympus America; investigator for Boston Scientific and Ambu. B. K. Abu Dayyeh: Consultant for Endogenex, Endo-TAGSS, Metamodix, BFKW, USGI, Apollo Endosurgery, Medtronic, Spatz Medical, EndoGastric Solutions, Aspire Bariatrics, and Boston Scientific; research support from Cairn Diagnostics, USGI, Apollo Endosurgery, Medtronic, Spatz Medical, EndoGastric Solutions, Aspire Bariatrics, and Boston Scientific; speaker for Olympus and Johnson & Johnson. V. Chandrasekhara: Consultant for Covidien LP and Boston Scientific; shareholder in Nevakar Corporation. All other authors disclosed no financial relationships., (Copyright © 2024 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.)
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- 2024
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40. Development of a Computer-aided Prediction Tool for Evaluating Brushing Samples of Biliary Strictures.
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Marya NB, Hartley C, Powers PD, Bois MC, Kerr SE, Graham RP, and Levy MJ
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- Humans, Constriction, Pathologic diagnosis, Cholangiopancreatography, Endoscopic Retrograde, Cholestasis, Bile Duct Neoplasms
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- 2024
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41. The antiproliferative effect of FGF2 in K-Ras-driven tumor cells involves modulation of rRNA and the nucleolus.
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de Luna Vitorino FN, Levy MJ, Mansano Wailemann RA, Lopes M, Silva ML, Sardiu ME, Garcia BA, Machado Motta MC, Oliveira CC, Armelin HA, Florens LA, Washburn MP, and Pinheiro Chagas da Cunha J
- Subjects
- RNA, Ribosomal genetics, RNA, Ribosomal metabolism, Transcription, Genetic, DNA, Ribosomal genetics, Chromatin genetics, Chromatin metabolism, Fibroblast Growth Factor 2 genetics, Fibroblast Growth Factor 2 pharmacology, Fibroblast Growth Factor 2 metabolism, Cell Nucleolus metabolism
- Abstract
The nucleolus is sensitive to stress and can orchestrate a chain of cellular events in response to stress signals. Despite being a growth factor, FGF2 has antiproliferative and tumor-suppressive functions in some cellular contexts. In this work, we investigated how the antiproliferative effect of FGF2 modulates chromatin-, nucleolus- and rDNA-associated proteins. The chromatin and nucleolar proteome indicated that FGF2 stimulation modulates proteins related to transcription, rRNA expression and chromatin-remodeling proteins. The global transcriptional rate and nucleolus area increased along with nucleolar disorganization upon 24 h of FGF2 stimulation. FGF2 stimulation induced immature rRNA accumulation by increasing rRNA transcription. The rDNA-associated protein analysis reinforced that FGF2 stimulus interferes with transcription and rRNA processing. RNA Pol I inhibition partially reversed the growth arrest induced by FGF2, indicating that changes in rRNA expression might be crucial for triggering the antiproliferative effect. Taken together, we demonstrate that the antiproliferative FGF2 stimulus triggers significant transcriptional changes and modulates the main cell transcription site, the nucleolus., Competing Interests: Competing interests The authors declare no competing or financial interests., (© 2023. Published by The Company of Biologists Ltd.)
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- 2023
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42. Utility of Urgent Endoscopic Retrograde Cholangiopancreatography in Patients with Predicted Mild Acute Pancreatitis and Cholestasis.
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Kaur J, Martin JA, Vege SS, Garimella V, Majumder S, Levy MJ, Abu Dayyeh BK, Storm AC, Vargas EJ, Law RJ, Bofill AM, Decker GA, Petersen BT, and Chandrasekhara V
- Abstract
Background: Endoscopic retrograde cholangiopancreatography (ERCP) within 72 h is suggested for patients presenting with acute biliary pancreatitis (ABP) and biliary obstruction without cholangitis. This study aimed to identify if urgent ERCP (within 24 h) improved outcomes compared to early ERCP (24-72 h) in patients admitted with predicted mild ABP., Methods: Patients admitted for predicted mild ABP defined as a bedside index of severity in acute pancreatitis score < 3 and underwent ERCP for biliary obstruction within 72 h of presentation during the study period were included. Patients with prior biliary sphincterotomy or surgically altered anatomy preventing conventional ERCP were excluded. The primary outcome was the development of moderately severe or severe pancreatitis based on the revised Atlanta classification. Secondary outcomes were the length of hospital stay, the need for ICU admission, and ERCP-related adverse events (AEs)., Results: Of the identified 166 patients, baseline characteristics were similar between both the groups except for the WBC count (9.4 vs. 8.3/µL; p < 0.044) and serum bilirubin level (3.0 vs. 1.6 mg/dL; p < 0.0039). Biliary cannulation rate and technical success were both high in the overall cohort (98.8%). Urgent ERCP was not associated with increased development of moderately severe pancreatitis (10.4% vs. 15.7%; p = 0.3115). The urgent ERCP group had a significantly shorter length of hospital stay [median 3 (IQR 2-3) vs. 3 days (IQR 3-4), p < 0.01]., Conclusion: Urgent ERCP did not impact the rate of developing more severe pancreatitis in patients with predicted mild ABP but was associated with a shorter length of hospital stay and a lower rate of hospital readmission., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
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- 2023
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43. Uncovered versus fully covered self-expandable metal stents for the management of distal malignant biliary obstruction.
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Ghazi R, AbiMansour JP, Mahmoud T, Martin JA, Law RJ, Levy MJ, Abu Dayyeh BK, Storm AC, Petersen BT, and Chandrasekhara V
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- Humans, Cohort Studies, Retrospective Studies, Stents adverse effects, Self Expandable Metallic Stents adverse effects, Cholestasis etiology, Cholestasis surgery
- Abstract
Background and Aim: Self-expandable metal stents (SEMSs) are widely used for palliation of distal malignant biliary obstruction (dMBO). However, previous studies comparing the outcomes between uncovered SEMSs (UCSEMSs) and fully covered SEMSs (FCSEMSs) report conflicting results. This large cohort study aimed to compare the clinical outcomes between UCSEMSs and FCSEMSs for dMBO., Methods: A retrospective cohort study was performed in patients with dMBO who underwent either UCSEMS or FCSEMS placement between May 2017 and May 2021. Primary outcomes were rates of clinical success, adverse events (AEs), and unplanned endoscopic reintervention. Secondary outcomes were types of AEs, intervention-free stent patency, and management and outcomes of stent occlusion., Results: The cohort included 454 patients (364 in the UCSEMS group and 90 in the FCSEMS group). Median follow-up duration was 9.6 months and was similar between the 2 groups. Use of UCSEMSs and FCSEMSs had comparable clinical success (P = .250). However, use of UCSEMSs had significantly higher rates of AEs (33.5% vs 21.1%; P = .023) and unplanned endoscopic reintervention (27.0% vs 11.1%; P = .002). UCSEMSs had a higher rate of stent occlusion (26.9% vs 8.9%; P < .001) and shorter median time to stent occlusion (4.4 months vs 10.7 months; P = .002). Stent reintervention-free survival was higher in the FCSEMS group. FCSEMSs had a significantly higher rate of stent migration (7.8% vs 1.1%; P < .001), but patients in the FCSEMS group had similar rates of cholecystitis (.3% vs 1.1%; P = .872) and post-ERCP pancreatitis (6.3% vs 6.6%; P = .90). When UCSEMSs did occlude, placement of a coaxial plastic stent had a higher rate of stent reocclusion compared with coaxial SEMS placement (46.7% vs 19.7%; P = .007)., Conclusion: FCSEMSs should be considered for the palliation of dMBO because of lower rates of AEs, longer patency rates, and lower rates of unplanned endoscopic intervention., (Copyright © 2023 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.)
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- 2023
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44. Nelson syndrome and perinatal challenges: A case report and systematic review of the literature.
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Jones K, Reis I, Levy MJ, and Potdar N
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- Pregnancy, Infant, Humans, Infant, Newborn, Female, Pregnancy Outcome, Prenatal Care, Nelson Syndrome
- Abstract
Nelson syndrome is a rare and potentially life-threatening complication of treatment with total bilateral adrenalectomy for women with Cushing disease. A successful term pregnancy following fertility treatment in a patient with Nelson syndrome is presented. Our study provides guidance in the prenatal and intrapartum management of this condition. A case report and a systematic review of 14 papers describing 50 pregnancies are presented. An electronic database search included Medline (1946 to September 2022), Embase (1980 to September 2022), Cochrane Library, and UKOSS. A small number of pregnancies in women with Nelson syndrome are reported in literature, but there are no guidelines. Some authors detail the prenatal care provided to their patients. Four studies report prenatal monitoring with visual field checks and two report monitoring with X-rays. Five studies report the use of parenteral hydrocortisone at the time of delivery. Where described, women delivered appropriately grown newborns at term, with timing and mode of delivery dictated by obstetric indications. Preconception counseling and optimization of maternal health status improve pregnancy outcomes in women with Nelson syndrome. Multidisciplinary review in a combined obstetric-endocrine prenatal clinic is ideal. Awareness about potential complications during pregnancy and the postnatal period is crucial in providing optimal care to the mother and baby., (© 2023 International Federation of Gynecology and Obstetrics.)
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- 2023
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45. Risk of post-sphincterotomy bleeding in patients with thrombocytopenia.
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AbiMansour JP, Garimella V, Petersen BT, Law RJ, Storm AC, Martin JA, Levy MJ, Abu Dayyeh BK, and Chandrasekhara V
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Background: Reports suggest that the rate of adverse events (AEs) post-endoscopic sphincterotomy (ES) to be as high as 10%, with gastrointestinal bleeding being most common after post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis., Objective: The aim of this study was to characterize the incidence of bleeding in patients with thrombocytopenia following ES., Design: Retrospective observational cohort study., Methods: Patients with thrombocytopenia (defined as <150,000 platelets/μL) who underwent ES between May 2017 and December 2020 were identified at a tertiary care medical center. The incidence of immediate (intraprocedural oozing >5 min or requiring intervention) or delayed (clinical bleeding with associated hemoglobin drop within 14 days) post-ES bleeding was determined via manual chart review., Results: A total of 221 patients with a mean platelet count of 108,000 ± 13,000 platelets/μL underwent ERCP with ES. Immediate bleeding occurred in 11 (5%) patients with no significant drop in hemoglobin or transfusion requirement. Two patients (0.9%), both of whom were noted to have immediate bleeding, also developed delayed bleeding. Presence of malignancy was associated with an increased risk of bleeding (36.4% versus 11.4%, p = 0.037) while platelet count was not., Conclusion: In a cohort of patients with thrombocytopenia, rates of immediate and delayed bleeding are similar to previously reported AE rates of ES in the general patient population. Careful attention should be given to patients with a history of active malignancy as well as those who develop immediate bleeding as they appear to be at increased risk for bleeding complications., Competing Interests: The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: ACS is a consultant for Apollo Endosurgery and received research support from Apollo Endosurgery and Boston Scientific. RL is a consultant for ConMed and Medtronic and receives royalties from UpToDate. BP is a consultant for Olympus America and investigator for Boston Scientific and Ambu. BKA reports consultant roles with Endogenex, Endo-TAGSS, Metamodix, and BFKW; consultant and grant or research support from USGI, Cairn Diagnostics, Aspire Bariatrics, and Boston Scientific; speaker roles with Olympus, Johnson and Johnson; speaker and grant or research support from Medtronic, Endogastric Solutions; and research support from Apollo Endosurgery and Spatz Medical. VC is a consultant for Covidien LP, is on the advisory board for Interpace Diagnostics, and is a shareholder in Nevakar, Inc. The remaining authors have no conflicts or funding to disclose., (© The Author(s), 2023.)
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- 2023
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46. Endoscopic ultrasound-guided versus percutaneous drainage for the management of post-operative fluid collections after distal pancreatectomy.
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Fogwe DT, AbiMansour JP, Truty MJ, Levy MJ, Storm AC, Law RJ, Vargas EJ, Fleming CJ, Andrews JC, Cleary SP, Kendrick ML, Martin JA, Bofill-Garcia AM, Dayyeh BKA, and Chandrasekhara V
- Subjects
- Adult, Humans, Female, Middle Aged, Male, Retrospective Studies, Postoperative Complications etiology, Postoperative Complications surgery, Drainage, Endosonography, Ultrasonography, Interventional, Treatment Outcome, Pancreatectomy, Pancreatic Diseases surgery
- Abstract
Background: Post-operative pancreatic fluid collections (POPFCs) can be drained using percutaneous or endoscopic approaches. The primary aim of this study was to compare rates of clinical success between endoscopic ultrasound-guided drainage (EUSD) with percutaneous drainage (PTD) in the management of symptomatic POPFCs after distal pancreatectomy. Secondary outcomes included technical success, total number of interventions, time to resolution, rates of adverse events (AEs), and POPFC recurrence., Methods: Adults who underwent distal pancreatectomy from January 2012 to August 2021 and developed symptomatic POPFC in the resection bed were retrospectively identified from a single academic center database. Demographic data, procedural data, and clinical outcomes were abstracted. Clinical success was defined as symptomatic improvement and radiographic resolution without requiring an alternate drainage modality. Quantitative variables were compared using a two-tailed t-test and categorical data were compared using Chi-squared or Fisher's exact tests., Results: Of 1046 patients that underwent distal pancreatectomy, 217 met study inclusion criteria (median age 60 years, 51.2% female), of whom 106 underwent EUSD and 111 PTD. There were no significant differences in baseline pathology and POPFC size. PTD was generally performed earlier after surgery (10 vs. 27 days; p < 0.001) and more commonly in the inpatient setting (82.9% vs. 49.1%; p < 0.001). EUSD was associated with a significantly higher rate of clinical success (92.5% vs. 76.6%; p = 0.001), fewer median number of interventions (2 vs. 4; p < 0.001), and lower rate of POPFC recurrence (7.6% vs. 20.7%; p = 0.007). AEs were similar between EUSD (10.4%) and PTD (6.3%, p = 0.28), with approximately one-third of EUSD AEs due to stent migration., Conclusion: In patients with POPFCs after distal pancreatectomy, delayed drainage with EUSD was associated with higher rates of clinical success, fewer interventions, and lower rates of recurrence than earlier drainage with PTD., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
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- 2023
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47. A Protocolized Management of Walled-Off Necrosis (WON) Reduces Time to WON Resolution and Improves Outcomes.
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Baroud S, Chandrasekhara V, Storm AC, Law RJ, Vargas EJ, Levy MJ, Mahmoud T, Bazerbachi F, Bofill-Garcia A, Ghazi R, Maselli DB, Martin JA, Vege SS, Takahashi N, Petersen BT, Topazian MD, and Abu Dayyeh BK
- Subjects
- Humans, Retrospective Studies, Endoscopy methods, Drainage methods, Necrosis etiology, Treatment Outcome, Endosonography, Stents adverse effects, Pancreatitis, Acute Necrotizing surgery
- Abstract
Background and Aims: Patients with infected or symptomatic walled-off necrosis (WON) have high morbidity and health care utilization. Despite the recent adoption of nonsurgical treatment approaches, WON management remains nonalgorithmic. We investigated the impact of a protocolized early necrosectomy approach compared with a nonprotocolized, clinician-driven approach on important clinical outcomes., Methods: Records were reviewed for consecutive patients with WON who underwent a protocolized endoscopic drainage with a lumen-apposing metal stent (cases), and for patients with WON treated with a lumen-apposing metal stent at the same tertiary referral center who were not managed according to the protocol (control subjects). The protocol required repeat cross-sectional imaging within 14 days after lumen-apposing metal stent placement, with regularly scheduled endoscopic necrosectomy if WON diameter reduction was <50%. Control patients were treated according to their clinician's preference without an a priori strategy. Inverse probability of treatment weighting-adjusted analysis was used to evaluate the influence of being in the protocolized group on time to resolution., Results: A total of 24 cases and 47 control subjects were included. There were no significant differences in baseline characteristics. Although numbers of endoscopies and necrosectomies were similar, cases had lower adverse event rates, shorter intensive care unit stay, and required nutritional support for fewer days. On matched multivariate Cox regression, cases had earlier WON resolution (hazard ratio, 5.73; 95% confidence interval, 2.62-12.5). This was confirmed in the inverse probability of treatment weighting-adjusted analysis (hazard ratio, 3.4; 95% confidence interval, 1.92-6.01)., Conclusions: A protocolized strategy resulted in faster WON resolution compared with a discretionary approach without the need for additional therapeutic interventions, and with a better safety profile and decreased health care utilization., (Copyright © 2023 AGA Institute. Published by Elsevier Inc. All rights reserved.)
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- 2023
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48. Do prehospital sepsis alerts decrease time to complete CMS sepsis measures?
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Troncoso R Jr, Garfinkel EM, Hinson JS, Smith A, Margolis AM, and Levy MJ
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- Humans, Aged, United States, Adolescent, Adult, Retrospective Studies, Centers for Medicare and Medicaid Services, U.S., Medicare, Lactic Acid, Anti-Bacterial Agents therapeutic use, Emergency Medical Services methods, Sepsis therapy, Sepsis drug therapy
- Abstract
Introduction: In an effort to improve sepsis outcomes the Centers for Medicare and Medicaid Services (CMS) established a time sensitive sepsis management bundle as a core quality measure that includes blood culture collection, serum lactate collection, initiation of intravenous fluid administration, and initiation of broad-spectrum antibiotics. Few studies examine the effects of a prehospital sepsis alert protocol on decreasing time to complete CMS sepsis core measures., Methods: This study was a retrospective cohort study of patients transported via EMS from December 1, 2018 to December 1, 2019 who met the criteria of the Maryland Statewide EMS sepsis protocol and compared outcomes between patients who activated a prehospital sepsis alert and patients who did not activate a prehospital sepsis alert. The Maryland Institute for Emergency Medical Services Systems developed a sepsis protocol that instructs EMS providers to notify the nearest appropriate facility with a sepsis alert if a patient 18 years of age and older is suspected of having an infection and also presents with at least two of the following: temperature >38 °C or <35.5 °C, a heart rate >100 beats per minute, a respiratory rate >25 breaths per minute or end-tidal carbon dioxide less than or equal to 32 mmHg, a systolic blood pressure <90 mmHg, or a point of care lactate reading greater than or equal to 4 mmol/L., Results: Median time to achieve all four studied CMS sepsis core measures was 103 min [IQR 61-153] for patients who received a prehospital sepsis alert and 106.5 min [IQR 75-189] for patients who did not receive a prehospital sepsis alert (p-value 0.105). Median time to completion was shorter for serum lactate collection (28 min. vs 35 min., p-value 0.019), blood culture collection (28 min. vs 38 min., p-value <0.01), and intravenous fluid administration (54 min. vs 61 min., p-value 0.025) but was not significantly different for antibiotic administration (94 min. vs 103 min., p-value 0.12) among patients who triggered a sepsis alert., Conclusion: This study questions the effectiveness of prehospital sepsis alert protocols on decreasing time to complete CMS sepsis core measures. Future studies should address if these times can be impacted by having EMS providers independently administer antibiotics., Competing Interests: Declaration of Competing Interest The authors report there are no competing interests to declare. This study was approved by the Institutional Review Board (IRB00218034) and partially supported under grant number R18 HS026640–02 from the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services (HHS). The authors are solely responsible for this document's contents, findings, and conclusions, which do not necessarily represent the views of AHRQ. Readers should not interpret any statement in this report as an official position of AHRQ or of HHS., (Copyright © 2023 Elsevier Inc. All rights reserved.)
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- 2023
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49. Natural history of non-functioning pituitary microadenomas: results from the UK non-functioning pituitary adenoma consortium.
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Hamblin R, Fountas A, Lithgow K, Loughrey PB, Bonanos E, Shinwari SK, Mitchell K, Shah S, Grixti L, Matheou M, Isand K, McLaren DS, Surya A, Ullah HZ, Klaucane K, Jayasuriya A, Bhatti S, Mavilakandy A, Ahsan M, Mathew S, Hussein Z, Jansz T, Wunna W, MacFarlane J, Ayuk J, Abraham P, Drake WM, Gurnell M, Brooke A, Baldeweg SE, Sam AH, Martin N, Higham C, Reddy N, Levy MJ, Ahluwalia R, Newell-Price J, Vamvakopoulos J, Krishnan A, Lansdown A, Murray RD, Pal A, Bradley K, Mamoojee Y, Purewal T, Panicker J, Freel EM, Hasan F, Kumar M, Jose B, Hunter SJ, and Karavitaki N
- Subjects
- Male, Female, Humans, Adult, Middle Aged, Retrospective Studies, Cohort Studies, United Kingdom epidemiology, Pituitary Neoplasms diagnostic imaging, Pituitary Neoplasms epidemiology, Pituitary Neoplasms complications, Adenoma diagnostic imaging, Adenoma epidemiology, Hypopituitarism complications
- Abstract
Objective: The optimal approach to the surveillance of non-functioning pituitary microadenomas (micro-NFPAs) is not clearly established. Our aim was to generate evidence on the natural history of micro-NFPAs to support patient care., Design: Multi-centre, retrospective, cohort study involving 23 endocrine departments (UK NFPA consortium)., Methods: Clinical, imaging, and hormonal data of micro-NFPA cases between January, 1, 2008 and December, 21, 2021 were analysed., Results: Data for 459 patients were retrieved [median age at detection 44 years (IQR 31-57)-152 males/307 females]. Four hundred and nineteen patients had more than two magnetic resonance imagings (MRIs) [median imaging monitoring 3.5 years (IQR 1.71-6.1)]. One case developed apoplexy. Cumulative probability of micro-NFPA growth was 7.8% (95% CI, 4.9%-8.1%) and 14.5% (95% CI, 10.2%-18.8%) at 3 and 5 years, respectively, and of reduction 14.1% (95% CI, 10.4%-17.8%) and 21.3% (95% CI, 16.4%-26.2%) at 3 and 5 years, respectively. Median tumour enlargement was 2 mm (IQR 1-3) and 49% of micro-NFPAs that grew became macroadenomas (nearly all >5 mm at detection). Eight (1.9%) patients received surgery (only one had visual compromise with surgery required >3 years after micro-NFPA detection). Sex, age, and size at baseline were not predictors of enlargement/reduction. At the time of detection, 7.2%, 1.7%, and 1.5% patients had secondary hypogonadism, hypothyroidism, and hypoadrenalism, respectively. Two (0.6%) developed hypopituitarism during follow-up (after progression to macroadenoma)., Conclusions: Probability of micro-NFPA growth is low, and the development of new hypopituitarism is rare. Delaying the first follow-up MRI to 3 years and avoiding hormonal re-evaluation in the absence of tumour growth or clinical manifestations is a safe approach for micro-NFPA surveillance., Competing Interests: Conflicts of interest: None declared., (© The Author(s) 2023. Published by Oxford University Press on behalf of European Society of Endocrinology.)
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- 2023
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50. Interventional vs surgical procedures in localized/nonmetastatic insulinomas (ablation vs surgery).
- Author
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Sada A, McKenzie TJ, Vella A, Levy MJ, and Halfdanarson TR
- Subjects
- Humans, Pancreas pathology, Prognosis, Insulinoma surgery, Insulinoma pathology, Pancreatic Neoplasms pathology, Hypoglycemia etiology
- Abstract
Localized insulinoma is an uncommon entity that can result in substantial morbidity due to the associated hypoglycemia. Recent studies have suggested an increase in the incidence of insulinoma in recent decades that may possibly be secondary to increased awareness, incidental diagnoses, and better diagnostic methods. Diagnosing and localizing insulinoma within the pancreas can be challenging, but advances in nuclear imaging may improve diagnostic accuracy. Delays in diagnosis are common, but once a localized insulinoma is diagnosed and appropriately treated, the long-term prognosis is excellent. Surgical resection is considered the standard of care management option for localized insulinoma, but tumor ablation with endoscopic ultrasound guidance has also been shown to be an effective and safe method for therapy.
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- 2023
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