781 results on '"Michel Kahaleh"'
Search Results
2. Accurate and safe diagnosis and treatment of neoplastic biliary lesions using a novel 9F and 11F digital single-operator cholangioscope
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Carlos Robles-Medranda, Juan Alcivar-Vasquez, Isaac Raijman, Michel Kahaleh, Miguel Puga-Tejada, Raquel Del Valle, Haydee Alvarado, Carlos Cifuentes-Gordillo, Kenneth F. Binmoeller, Alberto Jose Baptista, Jonathan Barreto-Perez, Jorge Rodriguez, Maria Egas-Izquierdo, Domenica Cunto, Daniel Calle-Loffredo, Hannah Lukashok, Jorge Baquerizo-Burgos, and Daniela Tabacelia
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Cholangioscopy ,Strictures ,Pancreatobiliary (ERCP/PTCD) ,Stones ,Tissue diagnosis ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Published
- 2024
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3. Endoscopic vacuum therapy: 2 methods of successful endosponge placement for treatment of anastomotic leak in the upper GI tract
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Mihajlo Gjeorgjievski, MD, Romy Bareket, MD, Abhishek Bhurwal, MD, Abdelhai Abdelqader, MD, Haroon Shahid, MD, Avik Sarkar, MD, Amy Tyberg, MD, and Michel Kahaleh, MD
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Published
- 2023
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4. Adaptation of peroral endoscopic myotomy for cricopharyngeal bar
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Rodrigo Duarte-Chavez, MD, Bryan Wey, MD, and Michel Kahaleh, MD
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Published
- 2023
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5. Performance of endoscopic submucosal dissection for undifferentiated early gastric cancer: a multicenter retrospective cohort
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Apostolis Papaefthymiou, Michel Kahaleh, Arnaud Lemmers, Sandro Sferrazza, Maximilien Barret, Katsumi Yamamoto, Pierre Deprez, José C. Marín-Gabriel, George Tribonias, Hong Ouyang, Federico Barbaro, Oleksandr Kiosov, Stefan Seewald, Gaurav Patil, Shaimaa Elkholy, Dimitri Coumaros, Clemence Vuckovic, Matthew Banks, Rehan Haidry, and Georgios Mavrogenis
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Endoscopy Upper GI Tract ,Precancerous conditions & cancerous lesions (displasia and cancer) stomach ,Endoscopic resection (ESD, EMRc, ...) ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Published
- 2023
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6. EUS of a submucosal lesion at the appendiceal orifice using a double-balloon endoluminal intervention platform
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Sardar Momin Shah-Khan, MD, Ankoor Patel, MD, Sardar Musa Shah-Khan, MD, Haroon Shahid, MD, Amy Tyberg, MD, Michel Kahaleh, MD, and Avik Sarkar, MD
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Published
- 2023
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7. Comparing palliative treatment options for cholangiocarcinoma: photodynamic therapy vs. radiofrequency ablation
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Tayyaba Mohammad and Michel Kahaleh
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ablation treatment ,bile duct neoplasms ,cholangiocarcinoma ,photodynamic therapy ,Internal medicine ,RC31-1245 ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Referral to an endoscopist is often done once curative resection is no longer an option for cholangiocarcinoma management. In such cases, palliation has become the main objective of the treatment. Photodynamic therapy and radiofrequency ablation can be performed to achieve palliation, with both procedures associated with improved stent patency and survival. Despite the greatly increased cost and association with photosensitivity, photodynamic therapy allows transmission to the entire biliary tree. In contrast, radiofrequency ablation is cheaper and faster to apply, but requires intraductal contact. This paper reviews both modalities and compares their efficacy and safety for bile duct cancer palliation.
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- 2022
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8. Percutaneous endoscopic necrosectomy (PEN) for treatment of necrotizing pancreatitis: a systematic review and meta-analysis
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Mihajlo Gjeorgjievski, Abishek Bhurwal, Abhishek A. Chouthai, Abdelhai Abdelqader, Monica Gaidhane, Haroon Shahid, Amy Tyberg, Avik Sarkar, and Michel Kahaleh
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background and study aims Endoscopic necrosectomy is limited by the proximity of necrosis to the gastrointestinal tract. Percutaneous endoscopic necrosectomy (PEN) is a minimally invasive endoscopic method of percutaneous debridement. Studies regarding its efficacy and safety are lacking. The purpose of this study was to assess the efficacy and safety of PEN in necrotizing pancreatitis. Methods Pubmed, Ovid, Cochrane, Scopus and Web of Science Database were searched from inception through February 2021. Dual extraction and quality assessment of studies using Cochrane risk of bias tool were performed independently by two authors. The primary outcome was defined as clinical success of PEN. Secondary outcomes included periprocedural morbidity, mortality, and long-term morbidity and mortality. Results Sixteen observational studies including 282 subjects were analyzed. The average reported age of the participants was 50.3 years. Patients with reported gender included 39 % females and 61 % males. The success rate as defined by complete resolution of necrosis and removal of drainage catheters/stents was 82 % (95 % confidence interval 77–87). The mean size of pancreatic necrosis was 14.86 cm (5–54 cm). The periprocedural morbidity rate was 10 %, while there was no reported periprocedural mortality. The long-term morbidity rate was reported as 23 % and mortality at follow-up was 16 %. Conclusions PEN is a novel method of endoscopic management of pancreatic necrosis. Based on our meta-analysis of retrospective studies, it represents a safe treatment modality with high rates of clinical success and low rates of perioperative morbidity and mortality. This study supports the use of PEN when conventional endoscopic therapy is not feasible.
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- 2023
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9. Endoscopic Ultrasound-Guided Liver Biopsy in Clinical Practice
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Avik Sarkar, Peter Dellatore, Abhishek Bhurwal, Amy Tyberg, Haroon Shahid, Carlos D. Minacapelli, Michel Kahaleh, Vinod K. Rustgi, and Jose Nieto
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Endoscopic ultrasound-guided liver biopsy ,EUS ,Liver biopsy ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background and Aims: Liver biopsies are traditionally performed using percutaneous, transjugular, or surgical approaches. Endoscopic ultrasound (EUS)-guided liver biopsy is a new modality to sample liver parenchyma. This technique allows sampling of both liver lobes and obviates the need for sampling error. However, there is paucity of literature demonstrating that EUS-guided liver biopsy provides adequate tissue sample for histologic analysis. This study aimed to review the experience of 2 large tertiary care centers to demonstrate the efficacy and safety of EUS-guided liver biopsy. Methods: All patients undergoing EUS-guided liver biopsy between March 2018 and October 2019 between 2 tertiary care centers were included in this retrospective study. The main outcomes of the study included technical success of EUS-guided liver biopsy, details of the specimen (length of the specimen, number of complete portal tracts), and adverse events of EUS-guided liver biopsy. Results: A total of 229 patients underwent EUS-guided liver biopsy at the 2 tertiary care centers. There was 100% technical success. Of the 229 patients, 226 patients (98.7%) had adequate tissue for histopathological evaluation with a mean total length of 3.20 cm and complete portal tracts of 20.2. Overall, 2.6% of patients had adverse events. Conclusion: Our study illustrates that EUS-guided liver biopsy provides adequate specimen for histologic analysis and is a safe, viable alternative to other methods of liver biopsy.
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- 2022
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10. Subepithelial tumors: How does endoscopic full-thickness resection & submucosal tunneling with endoscopic resection compare with laparoscopic endoscopic cooperative surgery?
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Michel Kahaleh, Vicky Bhagat, Peter Dellatore, Amy Tyberg, Avik Sarkar, Haroon M. Shahid, Iman Andalib, Resheed Alkhiari, Monica Gaidhane, Prashant Kedia, Jose Nieto, Nikhil A. Kumta, Rebekah E. Dixon, Habeeb Salameh, Georgios Mavrogenis, Stefanos Bassioukas, Seiichiro Abe, Vitor N. Arentes, Flavio H. Morita, Paulo Sakai, and Eduardo G. de Moura
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background and study aims Endoscopic techniques are rapidly emerging for resection of subepithelial tumors (SETs). Submucosal tunneling for endoscopic resection (STER), endoscopic full-thickness resection (EFTR) and laparoscopic endoscopic cooperative surgery (LECS) are current alternatives to open surgery. In this study, we aimed to compare the three endoscopic techniques. Patients and methods Consecutive patients who underwent resection of a submucosal esophageal or gastric lesion at several tertiary care centers were included in a dedicated registry over 3 years. Demographics, size and location of resected lesion, histology of specimen, length of procedure, adverse events (AEs), duration of hospital stay, and follow-up data were collected. Results Ninety-six patients were included (47.7 % male, mean age 62): STER n = 34, EFTR n = 34, LECS n = 280. The lesions included leiomyoma, gastrointestinal stromal tumors (GISTs) and other. The mean lesion size was 28 mm (STD 16, range 20–72 mm). The majority of lesions in the EFTR and laparoscopic-assisted resection group were GISTs. There was no significant difference in clear resection margins, post-procedure complication rates, recurrence rate and total follow-up duration between the groups. However, the LECS group had a procedure time at least 30 minutes longer than STER or EFTR (P
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- 2022
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11. The Learning Curve for Peroral Endoscopic Myotomy in Latin America: A Slide to the Right?
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Michel Kahaleh, Amy Tyberg, Supriya Suresh, Arnon Lambroza, Fernando Rodriguez Casas, Mario Rey, Jose Nieto, Guadalupe Ma Martínez, Felipe Zamarripa, Vitor Arantes, Maria G Porfilio, Monica Gaidhane, Pietro Familiari, Juan Carlos Carames, Romulo Vargas-Rubio, Raul Canadas, Albis Hani, Guillermo Munoz, Bismarck Castillo, Eduardo T Moura, Farias F Galileu, Hannah P Lukashok, Carlos Robles-Medranda, and Eduardo G de Moura
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achalasia ,chagas ,latin america ,learning curve ,per oral endoscopic myotomy ,Internal medicine ,RC31-1245 ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background/Aims Peroral endoscopic myotomy (POEM) has been increasingly used for achalasia in Latin America, where Chagas disease is prevalent, and this makes POEM more challenging. The aim of this study was to determine the learning curve for POEM in Latin America. Method: Patients undergoing POEM in Latin America with a single operator were included from a prospective registry over 4 years. Non-linear regression and cumulative sum control chart (CUSUM) analyses were conducted for the learning curve. Results A total of 125 patients were included (52% male; mean age, 59 years), of which 80 had type II achalasia (64%), and 38 had Chagas disease (30%). The average pre-procedure and post-procedure Eckardt scores were 6.79 and 1.87, respectively. Technical success was achieved in 93.5% of patients, and clinical success was achieved in 88.8%. Adverse events occurred in 27 patients (22%) and included bleeding (4 patients), pneumothorax (4 patients), mucosal perforation (13 patients), mediastinitis (2 patients), and leakage (4 patients). The CUSUM chart showed a median procedure time of 97 min (range, 45-196 min), which was achieved at the 61st procedure. Procedure duration progressively decreased, with the last 10 procedures under 50 min approaching a plateau (p-value
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- 2021
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12. First interobserver agreement of optical coherence tomography in the bile duct: A multicenter collaborative study
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Amy Tyberg, Isaac Raijman, Monica Gaidhane, Arvind J. Trindade, Haroon Shahid, Avik Sarkar, Jason Samarasena, Iman Andalib, David L. Diehl, Douglas K. Pleskow, Kevin E. Woods, Stuart R. Gordon, Rahul Pannala, Prashant Kedia, Peter V. Draganov, Paul R. Tarnasky, Divyesh V. Sejpal, Nikhil A. Kumta, Gulshan Parasher, Douglas G. Adler, Kalpesh Patel, Dennis Yang, Uzma Siddiqui, Michel Kahaleh, and Viren Joshi
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background and study aims Optical coherence tomography (OCT) is a new technology available for evaluation of indeterminate biliary strictures. It allows under-the-surface visualization and preliminary studies have confirmed standardized characteristics associated with malignancy. The aim of this study is to evaluate the first interobserver agreement in identifying previously agreed upon OCT criteria and diagnosing of malignant versus benign disease. Patients and methods Fourteen endoscopists were asked to review an atlas of reference clips and images of eight criteria derived from expert consensus A total of 35 de-identified video clips were then evaluated for presence of the eight criteria and for final diagnosis of malignant versus benign using the atlas as reference Intraclass correlation (ICC) analysis was done to evaluate interrater agreement. Results Clips of 23 malignant lesions and 12 benign lesions were scored. Excellent interobserver agreement was seen with dilated hypo-reflective structures (0.85) and layering effacement (0.89); hyper-glandular mucosa (0.76), intact layering (0.81), and onion-skin layering (0.77); fair agreement was seen with scalloping (0.58), and thickened epithelium (0.4); poor agreement was seen with hyper-reflective surface (0.36). The diagnostic ICC for both neoplastic (0.8) and non-neoplastic (0.8) was excellent interobserver agreement. The overall diagnostic accuracy was 51 %, ranging from 43 % to 60 %. Conclusions Biliary OCT is a promising new modality for evaluation of indeterminate biliary strictures. Interobserver agreement ranged from fair to almost perfect on eight previously identified criteria. Interobserver agreement for malignancy diagnosis was substantial (0.8). Further studies are needed to validate this data.
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- 2022
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13. Safety and efficacy of endoscopic sleeve gastroplasty for obesity management in new bariatric endoscopy programs: a multicenter international study
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Avik Sarkar, Augustine Tawadros, Iman Andalib, Haroon M. Shahid, Amy Tyberg, Resheed Alkhiari, Monica Gaidhane, Prashant Kedia, Elizabeth S. John, Bryce Bushe, Guadalupe Ma Martinez, Felipe Zamarripa, Mine C. Carames, Juan C. Carames, Fernando Casarodriguez, Vincenzo Bove, Guido Costamagna, Ivo Boskoski, and Michel Kahaleh
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background: Endoscopic sleeve gastroplasty (ESG) is an incisionless procedure that reduces the size of the gastric cavity. In prior studies, it has been proven to be a safe and effective treatment for obesity. In this study, we performed a collaborative study to evaluate the effectiveness of ESG among new endobariatric programs. Methods: This was an international, multicenter study reviewing the outcomes of ESG in centers starting ESG programs. Total body weight loss, change of body mass index (BMI), excess body weight loss (EBWL), technical success, duration of hospitalization, and immediate and delayed adverse events and complications at 24 h, 1 week, and 1, 3, and 6 months post-procedure were evaluated. Results: A total of 91 patients (35 males) from six centers were included. The patients’ mean BMI before the procedure was 38.7 kg/m 2 . BMI reduction at 3 months was 7.3 ( p
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- 2022
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14. Endoscopic or surgical treatment for necrotizing pancreatitis: Comprehensive systematic review and meta-analysis
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Mehdi Mohamadnejad, Amir Anushiravani, Amir Kasaeian, Majid Sorouri, Shirin Djalalinia, Amirmasoud Kazemzadeh Houjaghan, Monica Gaidhane, and Michel Kahaleh
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background and study aims Treatment of necrotizing pancreatitis is changed over the past two decades with the availability of endoscopic, and minimally invasive surgical approaches. The aim of this systematic review was to assess outcomes of endoscopic drainage, and different types of surgical drainage approaches in necrotizing pancreatitis. Methods Medline, Embase, Scopus, and Web of Science were searched from 1998 to 2020 to assess outcomes in endoscopic drainage and various surgical drainage procedures. The assessed variables consisted of mortality, development of pancreatic or enteric fistula, new onset diabetes mellitus, and exocrine pancreatic insufficiency. Results One hundred seventy studies comprising 11,807 patients were included in the final analysis. The pooled mortality rate was 22 % (95 % confidence interval [CI]: 19%–26 %) in the open surgery (OS), 8 % (95 %CI:5 %–11 %) in minimally invasive surgery (MIS), 13 % (95 %CI: 9 %–18 %) in step-up approach, and 3 % (95 %CI:2 %–4 %) in the endoscopic drainage (ED). The pooled rate of fistula formation was 35 % (95 %CI:28 %–41 %) in the OS, 17 % (95 %CI: 12%–23 %) in MIS, 17 % (95 %CI: 9 %–27 %) in step-up approach, and 2 % (95 %CI: 0 %–4 %) in ED. There were 17 comparative studies comparing various surgical drainage methods with ED. The mortality rate was significantly lower in ED compared to OS (risk ratio [RR]: 30; 95 %CI: 0.20–0.45), and compared to MIS (RR: 0.40; 95 %CI: 0.26–0.6). Also, the rate of fistula formation was lower in ED compared to all other surgical drainage approaches. Conclusions This systematic review demonstrated lower rate of fistula formation with ED compared to various surgical drainage methods. A lower rate of mortality with ED was also observed in observational studies. PROSPERO Identifier: CRD42020139354
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- 2022
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15. Endoscopic Therapy for Pancreatic Fluid Collections: A Definitive Management Using a Dedicated Algorithm
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Ming Ming Xu, Iman Andalib, Aleksey Novikov, Enad Dawod, Moamen Gabr, Monica Gaidhane, Amy Tyberg, and Michel Kahaleh
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endoscopic ultrasonography ,enteral feeding ,pancreatic pseudocyst ,pancreatitis ,stents ,Internal medicine ,RC31-1245 ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background/Aims Endoscopic ultrasonography (EUS)-guided drainage is the preferred approach for infected or symptomatic pancreatic fluid collections (PFCs). Here, we developed an algorithm for the management of pancreatitis complicated by PFCs and report on its effcacy and safety. Methods Between September 2011 and October 2017, patients were prospectively managed according to the algorithm. PFCs were classified as poorly organized fluid collections (POFCs), pancreatic pseudocysts (PPs), or walled-off pancreatic necrosis (WOPN). Clinical success was defined as a decrease in PFC size by ≥50% of the maximal diameter or to ≤2 cm. Results A total of 108 patients (62% male; mean age, 53 years) were included: 13 had POFCs, 43 had PPs, and 52 had WOPN. Seventytwo patients (66%) required a pancreatic duct (PD) stent, whereas 65 (60%) received enteral feeding. A total of 103 (95%) patients achieved clinical success. Eight patients experienced complications including bleeding (n=6) and surgical intervention (n=2). Patients with enteral feeding were 3.4 times more likely to achieve resolution within 60 days (p=0.0421), whereas those with PD stenting was five times more likely to achieve resolution within 90 days (p=0.0069). Conclusions A high PFC resolution rate can be achieved when a dedicated algorithm encompassing EUS-guided drainage, PD stenting, and early enteral feeding is adopted.
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- 2020
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16. Impact of the SARS-CoV-2 pandemic on turnover time and revenue in the endoscopy unit: single-center experience
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Abdelhai Abdelqader, Avik Sarkar, Haroon Shahid, Amy Tyberg, Sohini Sameera, Mihajlo Gjeorgjievski, Karoline Escobedo, Alexa Simon, Romy Bareket, Ping He, Eric Zhao, Monica Gaidhane, and Michel Kahaleh
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background and study aims The SARS-CoV-2 pandemic heavily impacted the New York metro area causing most institutions to either reduce case volume or fully close remaining open units incorporated specific guidelines for procedures lockdown potentially leading to a greater turn-over time. We analyzed the quantitative and financial impact of this lost time on our tertiary care center’s endoscopy unit. Patients and methods This single-center, retrospective study included demographics, procedure details and turn-over times (TOT) from all endoscopic procedures between December 1, 2019 to June 30, 2020. Cases were categorized as pre-COVID-19 group from December 1, 2019 to March 15, 2020 and during COVID-19 (lockdown) group from March 16, 2020 to June 30, 2020. The financial impact was assessed using national averages for reimbursement of outpatient endoscopic procedures provided by Center for Medicare and Medicaid Services. Results A total of 3622 procedures were performed during the study period: 2297 in the pre-COVID-19 period, 1325 in the COVID-19 period, representing a 42.32 % decrease. In the COVID-19 lockdown group, there was a significant increase in TOT in both the general endoscopy cases (18.11 minutes, P = 0.000) and advanced endoscopy cases (17.7 minutes, P = 0.000). The 42.3 % decrease in volume equated to at least $1.6 million USD in lost revenue during the lockdown. Conclusions COVID-19 pandemic led to an increase in TOT with overall reduced procedure volume and a negative effect on revenue. Providing continued endoscopic management during a pandemic avoids delays in reopening the endoscopy unit and hampers the post-pandemic surge of delayed cases and its financial impact.
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- 2021
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17. Gastrointestinal mucosal damage in patients with COVID-19 undergoing endoscopy: an international multicentre study
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Lieven Pouillon, Fabiana Zingone, Emilio Di Giulio, Daniel de la Iglesia-Garcia, Philip Roelandt, Paolo Giorgio Arcidiacono, Julio Iglesias-Garcia, Antonio Di Sabatino, Fabio Ciceri, Patrizia Rovere-Querini, Giuseppe Vanella, Gabriele Capurso, Cesare Burti, Lorella Fanti, Luigi Ricciardiello, Andre Souza Lino, Michiel Bronswijk, Amy Tyberg, Govind Krishna Kumar Nair, Aurelio Mauro, Kofi W. Oppong, Ioannis S. Papanikolaou, Pierluigi Fracasso, Carolina Tomba, Edi Viale, Maria Elena Riccioni, Schalk van der Merwe, Haroon Shahid, Avik Sarkar, Jin Woo (Gene) Yoo, Emanuele Dilaghi, R. Alexander Speight, Francesco Azzolini, Francesco Buttitta, Serena Porcari, Maria Chiara Petrone, Edoardo V. Savarino, James J. Farrell, Michel Kahaleh, Franco Bazzoli, Per Alberto Testoni, Salvatore Greco, Stefano Angeletti, and Everson Luiz de Almeida Artifon
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background Although evidence suggests frequent gastrointestinal (GI) involvement during coronavirus disease 2019 (COVID-19), endoscopic findings are scarcely reported.Aims We aimed at registering endoscopic abnormalities and potentially associated risk factors among patients with COVID-19.Methods All consecutive patients with COVID-19 undergoing endoscopy in 16 institutions from high-prevalence regions were enrolled. Mann-Whitney U, χ2 or Fisher’s exact test were used to compare patients with major abnormalities to those with negative procedures, and multivariate logistic regression to identify independent predictors.Results Between February and May 2020, during the first pandemic outbreak with severely restricted endoscopy activity, 114 endoscopies on 106 patients with COVID-19 were performed in 16 institutions (men=70.8%, median age=68 (58–74); 33% admitted in intensive care unit; 44.4% reporting GI symptoms). 66.7% endoscopies were urgent, mainly for overt GI bleeding. 52 (45.6%) patients had major abnormalities, whereas 13 bled from previous conditions. The most prevalent upper GI abnormalities were ulcers (25.3%), erosive/ulcerative gastro-duodenopathy (16.1%) and petechial/haemorrhagic gastropathy (9.2%). Among lower GI endoscopies, 33.3% showed an ischaemic-like colitis.Receiver operating curve analysis identified D-dimers >1850 ng/mL as predicting major abnormalities. Only D-dimers >1850 ng/mL (OR=12.12 (1.69–86.87)) and presence of GI symptoms (OR=6.17 (1.13–33.67)) were independently associated with major abnormalities at multivariate analysis.Conclusion In this highly selected cohort of hospitalised patients with COVID-19 requiring endoscopy, almost half showed acute mucosal injuries and more than one-third of lower GI endoscopies had features of ischaemic colitis. Among the hospitalisation-related and patient-related variables evaluated in this study, D-dimers above 1850 ng/mL was the most useful at predicting major mucosal abnormalities at endoscopy.Trial registration number ClinicalTrial.gov (ID: NCT04318366).
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- 2021
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18. Endoscopic sleeve gastroplasty in peritoneal dialysis
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Mishal Reja, MD, Iman Andalib, MD, Amy Tyberg, MD, Michel Kahaleh, MD, and Avik Sarkar, MD
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Published
- 2020
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19. Reverse Endoscopic Ultrasound-Guided Gastrojejunostomy for the Treatment of Superior Mesenteric Artery Syndrome: A New Concept
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Ming-ming Xu, Enad Dawod, Monica Gaidhane, Amy Tyberg, and Michel Kahaleh
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endoscopic ultrasound ,gastrojejunostomy ,superior mesenteric artery syndrome ,Internal medicine ,RC31-1245 ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Superior mesenteric artery syndrome (SMAS) causes compression and partial or complete obstruction of the duodenum, resulting in abdominal pain, nausea, vomiting, and weight loss. If conservative therapy fails, the patient is typically referred for enteral feeding or laparoscopic gastrojejunostomy. The last few years have seen increasing use of endoscopic ultrasound-guided gastrojejunostomy (EUS-GJ) for gastric obstruction indications. EUS-GJ involves the creation of a gastric bypass via an echoendoscope in cases in which the small intestine can be punctured under ultrasonographic visualization, resulting in an incision-free, efficient, and safe procedure. In this case report, we present the first case of SMAS treated using a reverse EUS-GJ, and describe the steps and advantages of the procedure in this particular case.
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- 2020
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20. Overview of bariatric and metabolic endoscopy interventions
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Augustine Tawadros, Michael Makar, Michel Kahaleh, and Avik Sarkar
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
The rise of endoscopic techniques allowing weight loss offers an attractive alternative to surgical interventions in Western countries where the obesity epidemic has risen dramatically. Endoscopists are well positioned to manage obesity given their broad-based medical knowledge, understanding of gastrointestinal physiology, and training in endoscopic technique. The field of bariatric and metabolic endoscopy has permitted the development of several efficacious and safe technologies. This review focuses on techniques and devices used for endoscopic management of obesity, as well as the fundamental justifications to offer those therapies to obese patients.
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- 2020
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21. How does per-oral endoscopic myotomy compare to Heller myotomy? The Latin American perspective
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Michel Kahaleh, Amy Tyberg, Supriya Suresh, Arnon Lambroza, Monica Gaidhane, Felipe Zamarripa, Guadalupe Ma Martínez, Juan C. Carames, Eduardo T. Moura, Galileu F. Farias, Maria G. Porfilio, Jose Nieto, Mario Rey, Fernando Rodriguez Casas, Oscar V. Mondragón Hernández, Romulo Vargas-Rubio, Raul Canadas, Albis Hani, Guillermo Munoz, Bismarck Castillo, Hannah P. Lukashok, Carlos Robles-Medranda, and Eduardo G de Moura
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background and study aims Both Heller myotomy (HM) and per-oral endoscopic myotomy (POEM) are efficacious therapies for achalasia. The efficacy and safety of POEM vs HM in Latin America and specifically in patients with Chagas disease is unknown. Patients and methods Consecutive patients undergoing either HM or POEM for achalasia were included from nine Latin American centers in a prospective registry over 5 years. Technical success was defined as undergoing a successful myotomy. Clinical success was defined as achieving an Eckardt score
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- 2020
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22. Optical coherence tomography of the pancreatic and bile ducts: are we ready for prime time?
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Amy Tyberg, Isaac Raijman, Aleksey A. Novikov, Divyesh V. Sejpal, Petros C. Benias, Arvind J. Trindade, Ananya Das, Mankanwal Sachdev, Farhoud Khosravi, Paul Tarnasky, Prashant Kedia, Monica Gaidhane, Michel Kahaleh, and Virendra Joshi
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background and study aims First-generation optical coherence tomography (OCT) has been shown to increase diagnostic sensitivity for malignant biliary and pancreatic-duct strictures. A newer OCT imaging system, NVision Volumetric Laser Endomicroscopy (VLE), allows for in vivo cross-sectional imaging of the ductal wall at the microstructure level during endoscopic retrograde cholangiopancreatography (ERCP). The aim of this study was to identify and evaluate characteristics on OCT that are predictive of benign and malignant strictures. Patients and methods Consecutive patients from six centers who underwent OCT between September 2016 and September 2017 were included in a dedicated registry. OCT images were analyzed, and nine recurring characteristics were further assessed. Final diagnosis was based on histology and/or surgical pathology. Results 86 patients were included (49 % male, mean age 64.7). OCT was performed in the bile duct in 79 patients and the pancreatic duct in seven. Nine OCT characteristics were identified: dilated hypo-reflective structures (n = 7), onion-skin layering (n = 8), intact layering (n = 17), layering effacement (n = 25), scalloping (n = 20), thickened epithelium (n = 42), hyper-glandular mucosa (n = 13), prominent blood vessels (n = 6), and a hyper-reflective surface (n = 20). Presence of hyper-glandular mucosa, hyper-reflective surface and scalloping significantly increased the odds of malignancy diagnosis by 6 times more (P = 0.0203; 95 % CI 1.3 to 26.5), 4.7 times more (P = 0.0255; 95 % CI 1.2 to 18.0) and 7.9 times more (P = 0.0035; 95 % CI 1.97 to 31.8) respectively. Conclusion By providing in-vivo cross-sectional imaging of the pancreatic and biliary duct wall, OCT technology may improve sensitivity in diagnosing malignant strictures and provide standardizable criteria predictive of malignancy.
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- 2020
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23. EUS-guided gallbladder drainage: a learning curve modified by technical progress
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Amy Tyberg, Kopal Jha, Shawn Shah, Prashant Kedia, Monica Gaidhane, and Michel Kahaleh
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Introduction Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is an efficacious and safe option for patients who cannot undergo cholecystectomy. It is a technically challenging procedure, requiring skills in EUS, and ERCP. The aim of this study was to define the learning curve for EUS-GBD. Patients and methods Consecutive patients undergoing EUS-GBD by a single operator were included from a prospective registry over 5 years. Demographics, procedure information, post-procedure follow-up data, and information on adverse events were collected. Non-linear regression and CUSUM analyses were conducted for the learning curve. Clinical success was defined as resolution of cholecystitis post-procedure. Results Forty-eight patients were included (58 % male, mean age 76 years). Twenty patients (42 %) had malignant cholecystitis. Most patients had lumen-apposing metal stents (LAMS) (15 mm, n = 29, 60 %; 10 mm, n = 8, 7 %). The remaining patients had FCSEMS (n = 9, 19 %) or plastic stents alone (n = 2, 4 %). Clinical success was achieved in 36 (86 %) of patients. Of the remaining 12, 7 were lost to follow-up and 5 had persistent cholecystitis. 9 patients (19 %) had adverse events including bleeding (n = 4), liver abscesses (n = 2), and hypotension. Two patients passed away post-procedure. Median procedure time was 41 minutes (range 16 – 121 min), with the 41-minute time occurring during the 19th procedure. Procedure durations further reduced, with the last 10 procedures being 20 minutes or under (nonlinear regression p value P
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- 2020
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24. Non-operative management of pancreatic injury
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Elinore J. Kaufman, Caitlin B. Finn, Jennifer Minneman, Michel Kahaleh, Shaun A. Steigman, and Nitsana A. Spigland
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Pediatrics ,RJ1-570 ,Surgery ,RD1-811 - Abstract
Background/purpose: Pancreatic injury is a rare complication of blunt abdominal trauma in pediatric populations. Non-operative management is increasingly common in pediatric pancreatic injury, using endoscopic interventions. We report our institutional experience with non-operative management of pediatric pancreatic trauma, with a focus on the role of endoscopic interventions. Methods: We performed a retrospective review of all cases of blunt pancreatic trauma in children presenting to our urban, academic, level I pediatric trauma center from 1996 to 2016. Results: We identified six cases of blunt pancreatic trauma in children aged 2–15 years. One patient required operative intervention for duodenal perforation, but no patients underwent pancreatic surgery. Endoscopic interventions were used in four cases to manage complications, such as pancreatic fluid collections and ductal stenosis. Conclusions: Pancreatic trauma can be managed safely and effectively using non-operative interventions in the pediatric population. Keywords: Pancreatic injury, Trauma, Non-operative management, Endoscopy, Type of study: therapeutic, Level of evidence: level IV
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- 2020
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25. Fully covered self-expanding metal stents for refractory pancreatic duct strictures in symptomatic chronic pancreatitis, US experience
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Reem Z. Sharaiha, Aleksey Novikov, Kristen Weaver, Pawan Marfatia, Jonathan M. Buscaglia, Christopher J. DiMaio, David Diehl, Moamen M. Gabr, Monica Gaidhane, Ali Siddiqui, and Michel Kahaleh
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background and study aims Fully covered self-expanding metal stents (FCSEMS) have been used to treat refractory pancreatic duct strictures. We aimed to evaluate the feasibility, safety, and efficacy of FCSEMS in chronic pancreatitis with refractory pancreatic duct strictures. Patients and methods This was a retrospective multicenter cases series of patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) with FCSEMS placement in the main pancreatic duct (MPD) at five tertiary care centers between February 2010 and June 2016. Primary endpoints were technical success, clinical success, and procedure-related morbidity. Secondary endpoints were pain relief at the end of follow-up and resolution of the pancreatic stricture on ERCP. Results Thirty-three patients with previously drained stents, 76 % of whom were male, underwent ERCP with FCSEMS placement. Mean duration of follow-up was 14 months. All of the patients had prior therapy. The technical success rate for FCSEMS placement was 100 % (n = 33) and the clinical success rate was 93 % (was n = 31). Stents were removed after a median duration of 14.4 weeks. After stent removal, the diameter of the narrowest MPD stricture had increased significantly from 1 mm to 4.5 mm (P
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- 2019
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26. Safety and Complications of Interventional Endoscopic Ultrasound
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Monica Saumoy and Michel Kahaleh
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Endosonography ,Therapeutics ,Pseudocyst ,EUS-BD ,EUS-GLB ,Internal medicine ,RC31-1245 ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Endoscopic ultrasound (EUS) has become an essential tool for the diagnostic and therapeutic intervention of gastrointestinal diseases. Beyond the drainage of fluid collections, it enables decompression of inaccessible bile and pancreatic ducts, the gallbladder, and the creation of anastomosis within the gastrointestinal tract using fully lumen-apposing stents. This review explored the safety and efficacy of these novel procedures and discussed the training pathway that is necessary to perform them efficiently and safely.
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- 2018
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27. Management of Benign and Malignant Pancreatic Duct Strictures
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Enad Dawod and Michel Kahaleh
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Pancreatic ducts ,Pancreas ,Fully covered metal stent ,Cholangiopancreatography, endoscopic retrograde ,Endosonography ,Internal medicine ,RC31-1245 ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
The diagnosis and management of pancreatic strictures, whether malignant or benign, remain challenging. The last 2 decades have seen dramatic progress in terms of both advanced imaging and endoscopic therapy. While plastic stents remain the cornerstone of the treatment of benign strictures, the advent of fully covered metal stents has initiated a new wave of interest in calibrating the pancreatic duct with fewer sessions. In malignant disease, palliation remains the priority and further data are necessary before offering systematic pancreatic stenting.
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- 2018
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28. Therapeutic endoscopic ultrasound: Between reducing the cost and detection of early complications
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Resheed Alkhiari and Michel Kahaleh
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Published
- 2021
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29. Necrotizing Pancreatitis: Current Management and Therapies
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Christine Boumitri, Elizabeth Brown, and Michel Kahaleh
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Walled-off pancreatic necrosis ,Pseudocyst ,Pancreatitis ,Necrosis ,Internal medicine ,RC31-1245 ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Acute necrotizing pancreatitis accounts for 10% of acute pancreatitis (AP) cases and is associated with a higher mortality and morbidity. Necrosis within the first 4 weeks of disease onset is defined as an acute necrotic collection (ANC), while walled off pancreatic necrosis (WOPN) develops after 4 weeks of disease onset. An infected or symptomatic WOPN requires drainage. The management of pancreatic necrosis has shifted away from open necrosectomy, as it is associated with a high morbidity, to less invasive techniques. In this review, we summarize the current management and therapies for acute necrotizing pancreatitis.
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- 2017
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30. Endoscopic Ultrasound (EUS)-Directed Transgastric Endoscopic Retrograde Cholangiopancreatography or EUS: Mid-Term Analysis of an Emerging Procedure
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Amy Tyberg, Jose Nieto, Sanjay Salgado, Kristen Weaver, Prashant Kedia, Reem Z. Sharaiha, Monica Gaidhane, and Michel Kahaleh
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EUS-directed transgastric ERCP ,Lumen-apposing metal stent ,Cholangiopancreatography, endoscopic retrograde ,Gastric bypass ,Internal medicine ,RC31-1245 ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background/Aims Performing endoscopic retrograde cholangiopancreatography (ERCP) in patients who have undergone Rouxen-Y gastric bypass (RYGB) is challenging. Standard ERCP and enteroscopy-assisted ERCP are associated with limited success rates. Laparoscopy- or laparotomy-assisted ERCP yields improved efficacy rates, but with higher complication rates and costs. We present the first multicenter experience regarding the efficacy and safety of endoscopic ultrasound (EUS)-directed transgastric ERCP (EDGE) or EUS. Methods All patients who underwent EDGE at two academic centers were included. Clinical success was defined as successful ERCP and/or EUS through the use of lumen-apposing metal stents (LAMS). Adverse events related to EDGE were separated from ERCP- or EUS-related complications and were defined as bleeding, stent migration, perforation, and infection. Results Sixteen patients were included in the study. Technical success was 100%. Clinical success was 90% (n=10); five patients were awaiting maturation of the fistula tract prior to ERCP or EUS, and one patient had an aborted ERCP due to perforation. One perforation occurred, which was managed endoscopically. Three patients experienced stent dislodgement; all stents were successfully repositioned or bridged with a second stent. Ten patients (62.5%) had their LAMS removed. The average weight change from LAMS insertion to removal was negative 2.85 kg. Conclusions EDGE is an effective, minimally invasive, single-team solution to the difficulties associated with ERCP in patients with RYGB.
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- 2017
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31. Endoscopic Management of Anastomotic Strictures after Liver Transplantation
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Dong Wook Lee, Hyeong Ho Jo, Juveria Abdullah, and Michel Kahaleh
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Endoscopic retrograde cholangiography ,Liver transplantation ,Biliary stenting ,Self expandable metallic stents ,Internal medicine ,RC31-1245 ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Endoscopic treatment of biliary strictures involving plastic stent placement has been used widely. The use of self-expandable metal stents (SEMSs) has been described for anastomotic strictures following liver transplantation (LT). This review aimed to assess and compare the efficacy of plastic stents with SEMS in LT patients. Information was retrieved regarding technical success, stricture resolution, the number of endoscopic retrograde cholangiography procedures, follow-up, immediate, and late complications. Eight studies involving plastic stents had a stricture resolution rate of 84.5%, with the rates ranging from 63% to 100%. These rates are comparable with the stricture resolution rate of 75% determined from six studies that involved 236 patients who received metal stents and the rates ranged from 53% to 81%. The observed success rate for metal stents used to manage post-LT anastomotic biliary strictures was below the reported rate for multiple plastic stents. Hence, the currently available metal stents should not be offered for the management of post-LT anastomotic biliary strictures.
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- 2016
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32. A Review of Probe-Based Confocal Laser Endomicroscopy for Pancreaticobiliary Disease
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Kunal Karia and Michel Kahaleh
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Confocal endomicroscopy ,Pancreatic cyst ,Indeterminate biliary stricture ,Cholangiopancreatography, endoscopic retrograde ,Internal medicine ,RC31-1245 ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Confocal laser endomicroscopy (CLE) is a novel in vivo imaging technique that can provide real-time optical biopsies in the evaluation of pancreaticobiliary strictures and pancreatic cystic lesions (PCLs), both of which are plagued by low sensitivities of routine evaluation techniques. Compared to pathology alone, CLE is associated with a higher sensitivity and accuracy for the evaluation of indeterminate pancreaticobiliary strictures. CLE has the ability to determine the malignant potential of PCLs. As such, CLE can increase the diagnostic yield of endoscopic retrograde cholangiopancreatography and endoscopic ultrasound, reducing the need for repeat procedures. It has been shown to be safe, with an adverse event rate of ≤1%. Published literature regarding its cost-effectiveness is needed.
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- 2016
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33. Transoral Incisionless fundoplication for reflux after peroral endoscopic myotomy: a crucial addition to our arsenal
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Amy Tyberg, Anthony Choi, Monica Gaidhane, and Michel Kahaleh
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Published
- 2018
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34. Endoscopic versus percutaneous management for symptomatic pancreatic fluid collections: a systematic review and meta-analysis
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Muhammad Ali Khan, Tariq Hammad, Zubair Khan, Wade Lee, Monica Gaidhane, Amy Tyberg, and Michel Kahaleh
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background Symptomatic pancreatic fluid collections (PFCs) are managed by surgical, percutaneous, or endoscopic drainage. Due to morbidity associated with surgical drainage, percutaneous and/or endoscopic options have increasingly been used as initial management. Aims We conducted a systematic review and meta-analysis comparing the efficacy and safety of endoscopic versus percutaneous drainage for management of PFCs. Methods We searched several databases from inception through 31 August 2017 to identify comparative studies using endoscopic or percutaneous drainage for PFCs. Our primary outcome was clinical success. Secondary outcomes were technical success, adverse events (AE), rates of recurrence, requirement for subsequent procedures, and length of stay in hospital. Pooled risk ratios (RR) and mean difference (MD) were calculated for categorical and continuous outcomes, respectively. Results Seven studies with 490 patients were included in the final analysis. Pooled RR for clinical success was 0.40 (0.26, 0.61), I 2 = 42 % in favor of endoscopic management. On sensitivity analysis, after excluding one study on patients with walled-off necrosis (WON), the clinical success was 0.43 (0.28, 0.66) with no heterogeneity. Pooled RR for technical success was 1.50 (0.52, 4.37) with no heterogeneity. Pooled RR for AE and rate of recurrence were 0.77 (0.46, 1.28) and 0.60 (0.29, 1.24), respectively. Pooled MD for length of stay in hospital and rate of re-intervention were – 8.97 (– 12.88, – 5.07) and – 0.66 (– 0.93, – 0.38), respectively, in favor of endoscopic drainage. Conclusions Endoscopic drainage should be the preferred therapeutic modality for PFCs compared to percutaneous drainage as it is associated with significantly better clinical success, a lower re-intervention rate, and a shorter hospital length of stay. This study was presented as an abstract at Digestive Disease Week 2017 in Chicago, USA.
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- 2018
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35. Case Series Review of the Safety and Efficacy of Endoscopic Ultrasound-Guided Splenic Mass Core Biopsy
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Sammy Saab, Youssef Challita, David Holloman, Kelli Hathaway, Michel Kahaleh, and Jose Nieto
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Internal medicine ,RC31-1245 ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Published
- 2018
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36. Utilidad de la endomicroscopia confocal láser basada en probes (Cellvizio) en gastroenterología
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Elías Alfonso Forero Piñeros, Héctor José Cardona, Kunal Karia, Amrita Sethi, and Michel Kahaleh
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Endomicroscopia confocal láser ,cáncer gastrointestinal ,detección temprana ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
La endomicroscopia confocal láser basada en probes (Cellvizio de Mauna Kea Technologies, París) es una nueva tecnología que permite, durante cualquier procedimiento endoscópico, realizar análisis histológicos en tiempo real (biopsia óptica), mejorando el diagnóstico y ayudando a definir el tratamiento de múltiples patologías digestivas. Es de resaltar, para nuestro medio, su utilidad en patologías de difícil diagnóstico como son las estenosis biliares indeterminadas y las neoplasias quísticas pancreáticas, cuyo diagnóstico temprano y exacto es muy difícil con las técnicas actualmente disponibles, y que es necesario para definir la realización o la exclusión de tratamientos quirúrgicos de alta morbimortalidad y alto costo, como por ejemplo, la cirugía de Whipple. En esta revisión se muestran los aportes actuales de esta tecnología, ya disponible en nuestro medio, para el diagnóstico y estudio de las patologías digestivas.
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- 2016
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37. EUS-guided transmural gallbladder drainage: a new era has begun
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Ming-Ming Xu and Michel Kahaleh
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Published
- 2016
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38. Endoscopic ultrasound-guided gastrojejunostomy with a lumen-apposing metal stent: a multicenter, international experience
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Amy Tyberg, Manuel Perez-Miranda, Ramon Sanchez-Ocaña, Irene Peñas, Carlos de la Serna, Janak Shah, Kenneth Binmoeller, Monica Gaidhane, Ian Grimm, Todd Baron, and Michel Kahaleh
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background: Surgical gastrojejunostomy and enteral self-expanding metal stents are efficacious for the management of gastric outlet obstruction but limited by high complication rates and short-term efficacy. Endoscopic ultrasound-guided gastrojejunostomy (EUS-GJ) is a novel alternative option. Patients and methods: Patients who underwent EUS-GJ between March 2014 and September 2015 as part of a prospective multicenter registry at four academic centers in two countries were included. Technical success was defined as successful placement of a gastrojejunal lumen-apposing metal stent. Clinical success was defined as the ability of the patient to tolerate an oral diet. Post-procedural adverse events were recorded. Results: The study included 26 patients, of whom 11 (42 %) were male. Technical success was achieved in 24 patients (92 %). Clinical success was achieved in 22 patients (85 %). Of the 4 patients in whom clinical success was not achieved, 2 had persistent nausea and vomiting despite a patent EUS-GJ and required enteral feeding for nutrition, 1 died before the initiation of an oral diet, and 1 underwent surgery for suspected perforation. Adverse events, including peritonitis, bleeding, and surgery, occurred in 3 patients (11.5 %). Conclusion: EUS-GJ is an emerging procedure that has efficacy and safety comparable with those of current therapies and should hold a place as a new minimally invasive option for patients with gastric outlet obstruction. Clinical trial identification number: NCT01522573
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- 2016
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39. Endoscopic Palliation for Pancreatic Cancer
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Mihir Bakhru, Bezawit Tekola, and Michel Kahaleh
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pancreatic adenocarcinoma ,biliary obstruction ,gastric outlet obstruction ,endoscopy ,stents ,palliation ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Pancreatic cancer is devastating due to its poor prognosis. Patients require a multidisciplinary approach to guide available options, mostly palliative because of advanced disease at presentation. Palliation including relief of biliary obstruction, gastric outlet obstruction, and cancer-related pain has become the focus in patients whose cancer is determined to be unresectable. Endoscopic stenting for biliary obstruction is an option for drainage to avoid the complications including jaundice, pruritus, infection, liver dysfunction and eventually failure. Enteral stents can relieve gastric obstruction and allow patients to resume oral intake. Pain is difficult to treat in cancer patients and endoscopic procedures such as pancreatic stenting and celiac plexus neurolysis can provide relief. The objective of endoscopic palliation is to primarily address symptoms as well improve quality of life.
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- 2011
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40. Probe-Based Confocal Laser Endomicroscopy for Indeterminate Biliary Strictures: Refinement of the Image Interpretation Classification
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Michel Kahaleh, Marc Giovannini, Priya Jamidar, S. Ian Gan, Paola Cesaro, Fabrice Caillol, Bernard Filoche, Kunal Karia, Ioana Smith, Monica Gaidhane, and Adam Slivka
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background. Accurate diagnosis and clinical management of indeterminate biliary strictures are often a challenge. Tissue confirmation modalities during Endoscopic Retrograde Cholangiopancreatography (ERCP) suffer from low sensitivity and poor diagnostic accuracy. Probe-based confocal laser endomicroscopy (pCLE) has been shown to be sensitive for malignant strictures characterization (98%) but lacks specificity (67%) due to inflammatory conditions inducing false positives. Methods. Six pCLE experts validated the Paris Classification, designed for diagnosing inflammatory biliary strictures, using a set of 40 pCLE sequences obtained during the prospective registry (19 inflammatory, 6 benign, and 15 malignant). The 4 criteria used included (1) multiple thin white bands, (2) dark granular pattern with scales, (3) increased space between scales, and (4) thickened reticular structures. Interobserver agreement was further calculated on a separate set of 18 pCLE sequences. Results. Overall accuracy was 82.5% (n=40 retrospectively diagnosed) versus 81% (n=89 prospectively collected) for the registry, resulting in a sensitivity of 81.2% (versus 98% for the prospective study) and a specificity of 83.3% (versus 67% for the prospective study). The corresponding interobserver agreement for 18 pCLE clips was fair (k=0.37). Conclusion. Specificity of pCLE using the Paris Classification for the characterization of indeterminate bile duct stricture was increased, without impacting the overall accuracy.
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- 2015
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41. A Multicenter, Prospective Study of a New Fully Covered Expandable Metal Biliary Stent for the Palliative Treatment of Malignant Bile Duct Obstruction
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Bret T. Petersen, Michel Kahaleh, Richard A. Kozarek, David Loren, Kapil Gupta, Thomas Kowalski, Martin Freeman, Yang K. Chen, Malcolm S. Branch, Steven Edmundowicz, Michael Gluck, Kenneth Binmoeller, Todd H. Baron, Raj J. Shah, Timothy Kinney, William Ross, Paul Jowell, and David Carr-Locke
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background and Study Aims. Endoscopic placement of self-expanding metal stents (SEMSs) is indicated for palliation of inoperable malignant biliary obstruction. A fully covered biliary SEMS (WallFlex Biliary RX Boston Scientific, Natick, USA) was assessed for palliation of extrahepatic malignant biliary obstruction. Patients and Methods. 58 patients were included in this prospective, multicenter series conducted under an FDA-approved IDE. Main outcome measurements included (1) absence of stent occlusion within six months or until death, whichever occurred first and (2) technical success, need for reintervention, bilirubin levels, stent patency, time to stent occlusion, and adverse events. Results. Technical success was achieved in 98% (57/58), with demonstrated acute removability in two patients. Adequate clinical palliation until completion of followup was achievedin 98% (54/55) of evaluable patients, with 1 reintervention due to stent obstruction after 142 days. Mean total bilirubin decreased from 8.9 mg/dL to 1.2 mg/dL at 1 month. Device-related adverse events were limited and included 2 cases of cholecystitis. One stent migrated following radiation therapy. Conclusions. The WallFlex Biliary fully covered stent yielded technically successful placement with uncomplicated acute removal where required, appropriate reduction in bilirubin levels, and low rates of stent migration and occlusion. This SEMS allows successful palliation of malignant extrahepatic biliary obstruction.
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- 2013
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42. A Review on the Use of Confocal Laser Endomicroscopy in the Bile Duct
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Ioana Smith, Pamela E. Kline, Monica Gaidhane, and Michel Kahaleh
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background. Current methods to diagnose malignant biliary strictures are of low sensitivity. Probe-based confocal laser endomicroscopy (pCLE) is a new approach that can be used to evaluate in vivo histopathology of the GI tract. This paper is of studies evidencing pCLE’s application in the diagnosis of indeterminate biliary strictures. Methods. This paper examined peer-reviewed studies conducted between January 2000 and November 2011. A PubMed search for relevant articles was performed using the following keywords:“pCLE”, “confocal”, “endomicroscopy”, “probe-based confocal laser endomicroscopy”, “and “bile duct”. Further individual review was done to assess the screened articles’ relevance to the topic. Results. After individual review, 6 studies were included; with a cumulative sample size of 165, with 75 subjects identified as having a malignancy. These studies included tertiary care centers in Germany, France, and USA, including one multicenter trial. 3 studies assessed pCLE’s specificity (range 67%–88%) ,sensitivity (range 83%–98), and accuracy (range 81%–86%). Conclusion. Confocal endomicroscopy is a novel and promising modality for the biliary tree. Further studies need to be conducted both to establish its usefulness for the diagnosis of indeterminate biliary strictures and to understand the histological meaning of the imaging patterns that are observed.
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- 2012
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43. Endoscopic Ultrasound-Guided Radiofrequency Ablation (EUS-RFA) of the Pancreas in a Porcine Model
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Monica Gaidhane, Ioana Smith, Kristi Ellen, Jeremy Gatesman, Nagy Habib, Patricia Foley, Christopher Moskaluk, and Michel Kahaleh
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Backgrounds. Limited effective palliative treatments exist for pancreatic cancer which includes surgery or chemotherapy. Radiofrequency ablation (RFA) uses high frequency alternating current to ablate diseased tissue and has been used to treat various tumors. In this study, we evaluated a prototype probe adjusted to the EUS-needle to perform EUS-RFA to permit coagulative necrosis in the pancreas. Methods. Five Yucatan pigs underwent EUS-guided radiofrequency ablation of the head of their pancreas. Using an EUS-needle, RFA was applied with 6 mm and then 10 mm of the probe exposed at specific wattage for preset durations. Results. Only one pig showed moderate levels of pancreatitis (20% proximal pancreatitis). The other animals showed much lower areas of tissue damage. In 3 of the 5 pigs, the proximal pancreas showed greater levels of tissue injury than the distal pancreas, consistent with the proximity of the tissue to the procedure site. In 1 pig, both proximal and distal pancreas showed minimal pancreatitis (1%). There was minimal evidence of fat necrosis in intra-pancreatic and/or extra-pancreatic adipose tissue. Conclusion. EUS-guided RFA of the pancreatic head with the monopolar probe through a 19-gauge needle was well tolerated in 5 Yucatan pigs and with minimal amount of pancreatitis.
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- 2012
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44. ENDOSCOPIC ULTRASOUND GUIDED GALLBLADDER DRAINAGE VERSUS PERCUTANEOUS DRAINAGE IN PATIENTS WITH ACUTE CHOLECYSTITIS UNDERGOING ELECTIVE CHOLECYSTECTOMY
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Amy, Tyberg, Rodrigo, Duarte-Chavez, Haroon M, Shahid, Avik, Sarkar, Alexa, Simon, Sardar M, Shah-Khan, Monica, Gaidhane, Tayyaba F, Mohammad, John, Nosher, Susannah S, Wise, Victoria, Needham, Marin, Kheng, Michael, Lajin, Badal, Sojitra, Bryan, Wey, Shivangi, Dorwat, Hameed, Raina, Jaseem, Ansari, Ashish, Gandhi, Amol, Bapaye, Sardar M, Shah-Khan, Matthew R, Krafft, Shyam, Thakkar, Shailendra, Singh, Janele R, Bane, John Y, Nasr, David P, Lee, Prashant, Kedia, Martha, Arevalo-Mora, Raquel S, Del Valle, Carlos, Robles-Medranda, Miguel, Puga-Tejada, Giuseppe, Vanella, Jose Celso, Ardengh, Mohammad, Bilal, DellʼAnna, Giuseppe, Paolo G, Arcidiacono, and Michel, Kahaleh
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- 2023
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45. Endoscopic ultrasound-directed transgastric ERCP (EDGE): A multicenter US study on long-term follow-up and fistula closure
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Prashant Kedia, Sardar Shah-Khan, Amy Tyberg, Monica Gaidhane, Avik Sarkar, Haroon Shahid, Eric Zhao, Shyam Thakkar, Mason Winkie, Matthew Krafft, Shailendra Singh, Eugene Zolotarevsky, Jeremy Barber, Mitchelle Zolotarevsky, Ian Greenberg, Dhiemeziem Eke, David Lee, Frank Gress, Iman Andalib, Gregory Bills, Patrick Carey, Moamen Gabr, Michael Lajin, Enrique Vazquez-Sequeiros, Douglas Pleskow, Neal Mehta, Allison Schulman, Richard Kwon, Kevin Platt, John Nasr, and Michel Kahaleh
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Pharmacology (medical) - Abstract
Background and study aims Endoscopic ultrasound-directed transgastric ERCP (EDGE) is a safe and efficacious procedure to treat pancreaticobiliary diseases in Roux-en-Y gastric bypass (RYGB). This multicenter study aimed to determine the long-term outcomes of EDGE focusing on fistula persistence rates and post-procedure weight change. Patients and methods Information about patients with Roux-en-Y gastric bypass anatomy who underwent EDGE between 2015 and 2021 from 10 institutions was captured in a registry. Patient demographics, procedural details, and clinical outcomes were analyzed. Results One hundred seventy-two patients were included in the study (mean age 60, 25 % male). Technical success of lumen-apposing metal stent (LAMS) placement was 171 of 172 (99.4 %) while clinical success of intervention was 95%. The mean procedure time was 65 minutes. The most commonly reported complication was stent dislodgement/migration (n = 29, 17). Mean length of time of LAMS duration was 69 days. Mean follow-up time was 6 months. Endoscopic fistula closure was performed in 40 % of patients (69/172) at the time of LAMS removal. Persistence of fistula was observed in 19 of 62 patients (31 %) assessed. Length of LAMS indwell time (days) was a predictor of persistent fistula. The average weight gain while the LAMS was in place was 12 lb in 63 patients (36.6 %); 59.4 % of patients gained Conclusions EDGE is a safe and efficacious procedure for RYGB patients requiring ERCP. Post-procedure evaluation and management of the enteral fistula varies widely among centers currently and would benefit from further standardization. Fistula persistence appears to be uncommon and can be managed endoscopically but may be related to length of indwell times of the LAMS.
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- 2023
46. Outcomes Of Lumen Apposing Metal Stent Placement In Patients With Surgically Altered Anatomy: A Multicenter International Experience
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Benedetto Mangiavillano, Daryl Ramai, Michel Kahaleh, Amy Tyberg, Haroon Shahid, Avik Sarkar, Jayanta Samanta, Jahnvi Dhar, Michiel Bronswijk, Schalk Van der Merwe, Abdul Kouanda, Hyun Ji, Sun-Chuan Dai, Pierre Deprez, Jorge Vargas-Madrigal, Giuseppe Vanella, Leone Roberto, Paolo Giorgio Arcidiacono, Carlos Robles-Medranda, Juan Alcivar Vasquez, Martha Arevalo-Mora, Alessandro Fugazza, Christopher Ko, John Morris, Andrea Lisotti, Pietro Fusaroli, Amaninder Dhaliwal, Massimiliano Mutignani, Edoardo Forti, Irene Cottone, Alberto Larghi, Gianenrico Rizzatti, Domenico Galasso, Carmelo Barbera, Francesco Maria Di Matteo, Serena Stigliano, Cecilia Binda, Carlo Fabbri, Khanh Do-Cong Pham, Roberto Di Mitri, Michele Amata, Stefano Francesco Crinó, Andrew Ofosu, Luca De Luca, Abed Al-Lehibi, Francesco Auriemma, Danilo Paduano, Federica Calabrese, Carmine Gentile, Cesare Hassan, Alessandro Repici, and Antonio Facciorusso
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Introduction: While outcomes of lumen-apposing metal stents (LAMS) placement in native anatomy have been reported, data on LAMS placement in surgically altered anatomy (SAA) is sparse. We aim to assess outcomes of LAMS placement in patients with SAA for different indications. Methods: This was an international multicenter retrospective observational study at 25 tertiary-care centers through November 2023. Consecutive patients with SAA who underwent LAMS placement were included. The primary outcome was technical success defined as correct placement of LAMS. Secondary outcomes were clinical success and safety. Results: Two hundred and seventy patients (125 males; average age 61 ± 15 years) underwent LAMS placement with SAA. Procedures included EUS-directed transgastric ERCP (EDGE) and EUS-directed transenteric ERCP (EDEE) (n=82), EUS-guided entero-enterostomy (n=81), EUS-guided biliary drainage (n=57), EUS-guided drainage of peri-pancreatic fluid collections (n=48), and EUS-guided pancreaticogastrostomy (n=2). Most cases utilized AXIOS stents (n=255) compared to SPAXUS stents (n=15). Overall, technical success was 98%, clinical success was 97%, and adverse event rate was 12%. Using AGREE classification, 5 events were rated as Grade II, 21 events as Grade IIIa, and 6 events as IIIb. No difference in adverse events were noted among stent types (P=0.52). Conclusion: This study shows that placement of LAMS is associated with high technical and clinical success rates in patients with SAA. However, the rate of adverse events is noteworthy and thus these procedures should be performed by expert endoscopists at tertiary centers.
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47. Invasive CO2 monitoring with arterial line compared to end tidal CO2 during peroral endoscopic myotomy
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Rodrigo Duarte-Chavez, Amy Tyberg, Avik Sarkar, Haroon M. Shahid, Bhargav Vemulapalli, Sardar Shah-Khan, Monica Gaidhane, and Michel Kahaleh
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Pharmacology (medical) - Abstract
Background and study aims Peroral endoscopic myotomy (POEM) has become a recognized treatment for achalasia. The technique requires CO2 insufflation. It is estimated that the partial pressure of CO2 (PaCO2) is 2 to 5 mm Hg higher than the end tidal CO2 (etCO2), and etCO2 is used as a surrogate for PaCO2 because PaCO2 requires an arterial line. However, no study has compared invasive and noninvasive CO2 monitoring during POEM. Patients and methods Seventy-one patients who underwent POEM were included in a prospective comparative study. PaCO2 plus etCO2 was measured in 32 patients (invasive group) and etCO2 only in 39 matched patients (noninvasive group). Pearson correlation coefficient (PCC) and Spearman’s Rho were used to calculate the correlation between PaCO2 and ETCO2. Results PaCO2 and ETCO2 were strongly correlated: PCC R value: 0.8787 P ≤ 0.00001, Spearman’s Rho R value: 0.8775, P ≤ 0.00001. Within the invasive group, the average difference between PaCO2 and ETCO2 was 3.39 mm Hg (median 3, standard deviation 3.5), within the 2- to 5-mm Hg range. The average procedure time (scope in to scope out) was increased 17.7 minutes (P = 0.044) and anesthesia duration was 46.3 minutes. Adverse events (AEs) included three hematomas and one nerve injury in the invasive group and one pneumothorax in the noninvasive group. There were no differences in AE rates between the groups (13 % vs 3 % P = 0.24). Conclusions Universal PaCO2 monitoring contributes to increased procedure and anesthesia times without any decrease in AEs in patients undergoing POEM. CO2 monitoring with an arterial line should only be performed in patients with major cardiovascular comorbidities; in all other patients, ETCO2 is an appropriate tool.
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- 2023
48. Endoscopic palliation of malignant biliary obstruction
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Andrew, Canakis and Michel, Kahaleh
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Critical Care Nursing ,Pediatrics - Abstract
Malignant biliary obstruction often presents with challenges requiring the endoscopist to assess the location of the lesion, the staging of the disease, the eventual resectability and patient preferences in term of biliary decompression. This review will focus on the different modalities available in order to offer the most appropriate palliation, such as conventional endoscopic retrograde cholangiopancreatography, endoscopic ultrasound guided biliary drainage as well as ablative therapies including photodynamic therapy or radiofrequency ablation.
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- 2022
49. Endoscopic Treatment of Reflux
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Rodrigo, Duarte Chavez, Daniel, Marino, Michel, Kahaleh, and Amy, Tyberg
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Gastroesophageal Reflux ,Gastroenterology ,Humans ,Antacids ,Esophagoscopy ,Anti-Ulcer Agents ,Esophagitis, Peptic - Abstract
The last decade has seen the rise of multiple novel endoscopic techniques to treat gastroesophageal reflux disease, many of which are efficacious when compared with traditional surgical options and allow relief from long-term dependence on antacid medications. This review will explore the latest endoscopic treatment options for gastroesophageal reflux disease including a description of the technique, review of efficacy and safety, and future directions.
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- 2022
50. Endoscopic Ultrasound-Directed Transgastric ERCP (EDGE) Utilization of Trends Among Interventional Endoscopists
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Sardar M. Shah-Khan, Eric Zhao, Amy Tyberg, Sardar Sarkar, Haroon M. Shahid, Rodrigo Duarte-Chavez, Monica Gaidhane, and Michel Kahaleh
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Physiology ,Gastroenterology - Abstract
Endoscopic ultrasound-directed transgastric ERCP (EDGE) has become standard-of-care therapy at many centers for pancreaticobiliary disease in patients with Roux-en-Y Gastric Bypass. In this study, we aimed to evaluate the opinions and practices of endoscopists who perform EDGE.A 22-question utilization of EDGE survey was sent to 36 advanced endoscopists at tertiary care centers in the United States. The two-section survey included questions regarding advanced endoscopy volume and training at the respective facilities, and questions on specific details of EDGE utilization.Among 36 interventional endoscopists (IE) surveyed, 14 (39%) reported performing 1000 ERCPs annually. Thirty (83%) offered EDGE as an option for Roux-en-Y gastric bypass patients with previous cholecystectomy. Other options offered included: 19 (53%) offered Laparoscopy-assisted ERCP (LA-ERCP), 7 (19%) offered Single-Balloon ERCP (SBE), and 10 (28%) offered percutaneous drainage (PTC). Twenty (56%) IE performed 10 or less EDGE procedures, while 16 (44%) performed 11 or more. Single-session EDGE was performed by 7 (19%) IE, while 15 (42%) performed dual session, and 13 (36%) performed both. 19 (53%) actively closed fistulas while 17 (47%) let them close spontaneously. Thirty one (86%) reported a technical success rate of 91% to 100%. The most frequently reported immediate adverse event post-procedurally was abdominal pain, reported by 17 IE (47%). Weight gain was reported by 2 IE (6%).EDGE continues to gain in popularity as an option for Roux-en-Y gastric bypass patients requiring pancreaticobiliary interventions, with 24/36 IE (67%) believing that it should be the new standard. In addition, most report a low frequency of post-procedural weight gain.ClinicalTrials.gov Identifier NCT05041608.
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- 2022
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