264 results on '"Nam Q. Nguyen"'
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2. Psychomotor and cognitive effects of 15-minute inhalation of methoxyflurane in healthy volunteers: implication for post-colonoscopy care
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Nam Q. Nguyen, Jenna Burgess, Tamara L. Debreceni, and Leanne Toscano
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background and study aims: Colonoscopy with portal inhaled methoxyflurane (Penthrox) is highly feasible with low sedation risk and allows earlier discharge. It is unclear if subjects can return to highly skilled psychomotor skill task shortly after Penthrox assisted colonoscopy. We evaluated the psychomotor and cognitive effects of 15-minute inhalation of Penthrox in adults. Patients and methods: Sixty healthy volunteers (18 to 80 years) were studied on 2 occasions with either Penthrox or placebo in a randomized, double-blind fashion. On each occasion, the subject’s psychomotor function was examined before, immediately, 30, 60, 120, 180 and 240 min after a 15-minute inhalation of studied drug, using validated psychomotor tests (Digit Symbol Substitution Test (DSST), auditory reaction time (ART), eye-hand coordination (EHC) test, trail making test (TMT) and logical reasoning test (LRT). Results: Compared to placebo, a 15-minute Penthrox inhalation led to an immediate but small impairment of DSST (P
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- 2016
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3. Sugar Responses of Human Enterochromaffin Cells Depend on Gut Region, Sex, and Body Mass
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Amanda L. Lumsden, Alyce M. Martin, Emily W. Sun, Gudrun Schober, Nicole J. Isaacs, Nektaria Pezos, David A. Wattchow, Dayan de Fontgalland, Philippa Rabbitt, Paul Hollington, Luigi Sposato, Steven L. Due, Christopher K. Rayner, Nam Q. Nguyen, Alice P. Liou, V. Margaret Jackson, Richard L. Young, and Damien J. Keating
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serotonin ,5-hydroxytryptamine ,5-HT ,glucose ,enterochromaffin ,obesity ,duodenum ,colon ,Nutrition. Foods and food supply ,TX341-641 - Abstract
Gut-derived serotonin (5-HT) is released from enterochromaffin (EC) cells in response to nutrient cues, and acts to slow gastric emptying and modulate gastric motility. Rodent studies also evidence a role for gut-derived 5-HT in the control of hepatic glucose production, lipolysis and thermogenesis, and in mediating diet-induced obesity. EC cell number and 5-HT content is increased in the small intestine of obese rodents and human, however, it is unknown whether EC cells respond directly to glucose in humans, and whether their capacity to release 5-HT is perturbed in obesity. We therefore investigated 5-HT release from human duodenal and colonic EC cells in response to glucose, sucrose, fructose and α-glucoside (αMG) in relation to body mass index (BMI). EC cells released 5-HT only in response to 100 and 300 mM glucose (duodenum) and 300 mM glucose (colon), independently of osmolarity. Duodenal, but not colonic, EC cells also released 5-HT in response to sucrose and αMG, but did not respond to fructose. 5-HT content was similar in all EC cells in males, and colonic EC cells in females, but 3 to 4-fold higher in duodenal EC cells from overweight females (p < 0.05 compared to lean, obese). Glucose-evoked 5-HT release was 3-fold higher in the duodenum of overweight females (p < 0.05, compared to obese), but absent here in overweight males. Our data demonstrate that primary human EC cells respond directly to dietary glucose cues, with regional differences in selectivity for other sugars. Augmented glucose-evoked 5-HT release from duodenal EC is a feature of overweight females, and may be an early determinant of obesity.
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- 2019
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4. Long-term outcomes of direct percutaneous endoscopic jejunostomy: a 10-year cohort
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Amanda H. Lim, Mark N. Schoeman, and Nam Q. Nguyen
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Study aim: To assess the clinical outcomes of patients who received direct percutaneous endoscopic jejunostomy (DPEJ) for enteral feeding. Materials and methods: This is a 10-year cohort study in a single tertiary center. Main outcome measurements were technical success, and short- and long-term outcomes. DPEJ was attempted in 83 patients (51 men; 55 ± 2 years) for dysphagia (n = 35), gastroparesis with recurrent aspiration (n = 30), and levodopa drug infusion for severe Parkinson’s disease (n = 18). Results: DPEJ was successful in 75 (90 %) patients. All technical failures were related to the inability to find adequate trans-illumination, and were not influenced by BMI, age, gender, or indication. Peri-operative (30-day) adverse events occurred in 11 (13 %) patients, including wound infection (3), leakage around the stoma (4), minor bleeding requiring no intervention (2), and aspiration (1). There was one case (1.2 %) of gastric perforation after PEJ insertion for levodopa drug infusion trial. This 60-year-old woman required an emergency laparotomy with nil complications, and levodopa drug infusion recommenced successfully. One case of intestinal perforation (1.2 %) occurred after jejunostomy tube replacement at 6 months of insertion, which was successfully managed with surgery. There were no peri-operative deaths. Adequate delivery of enteral feeding or Duodopa drug was achieved in 66/73 (90 %) patients, with evidence of weight gain or improvement in Parkinson’s disease. Seven (8 %) continued to have clinical regurgitation but not aspiration. After a median follow-up of 84 months, 27 (33 %) patients died of their underlying diseases. Seven (8 %) had marked improvement in their underlying disease and had PEJ removed after 5 months (range 1 – 8 months). Limitations: Single center study. Conclusions: DPEJ is associated with a high technical success rate (90 %), a relatively low rate of peri-operative adverse events (13 %) and an improvement in long-term nutritional support in the majority of patients (90 %). DPEJ should be the procedure of choice to gain enteral access for feeding or drug delivery prior to considering surgery.
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- 2015
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5. Portable inhaled methoxyflurane is feasible and safe for colonoscopy in subjects with morbid obesity and/or obstructive sleep apnea
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Nam Q. Nguyen, Leanne Toscano, Matthew Lawrence, Vinh-An Phan, Rajvinder Singh, Peter Bampton, Robert J. Fraser, Richard H. Holloway, and Mark N. Schoeman
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background and study aims: Colonoscopy with inhaled methoxyflurane (Penthrox) is well tolerated in unselected subjects and is not associated with respiratory depression. The aim of this prospective study was to compare the feasibility, safety, and post-procedural outcomes of portable methoxyflurane used as an analgesic agent during colonoscopy with those of anesthesia-assisted deep sedation (AADS) in subjects with morbid obesity and/or obstructive sleep apnea (OSA). Patients and methods: The outcomes of 140 patients with morbid obesity/OSA who underwent colonoscopy with either Penthrox inhalation (n = 85; 46 men, 39 women; mean age 57.2 ± 1.1 years) or AADS (n = 55; 27 men, 28 women; mean age, 54.9 ± 1.1 years) were prospectively assessed. Results: All Penthrox-assisted colonoscopies were successful, without any requirement for additional intravenous sedation. Compared with AADS, Penthrox was associated with a shorter total procedural time (24 ± 1 vs. 52 ± 1 minutes, P
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- 2015
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6. A Case of Pancreatic Cancer in the Setting of Autoimmune Pancreatitis with Nondiagnostic Serum Markers
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Manju D. Chandrasegaram, Su C. Chiam, Nam Q. Nguyen, Andrew Ruszkiewicz, Adrian Chung, Eu L. Neo, John W. Chen, Christopher S. Worthley, and Mark E. Brooke-Smith
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Surgery ,RD1-811 - Abstract
Background. Autoimmune pancreatitis (AIP) often mimics pancreatic cancer. The diagnosis of both conditions is difficult preoperatively let alone when they coexist. Several reports have been published describing pancreatic cancer in the setting of AIP. Case Report. The case of a 53-year-old man who presented with abdominal pain, jaundice, and radiological features of autoimmune pancreatitis, with a “sausage-shaped” pancreas and bulky pancreatic head with portal vein impingement, is presented. He had a normal serum IgG4 and only mildly elevated Ca-19.9. Initial endoscopic ultrasound-(EUS-) guided fine-needle aspiration (FNA) of the pancreas revealed an inflammatory sclerosing process only. A repeat EUS guided biopsy following biliary decompression demonstrated both malignancy and features of autoimmune pancreatitis. At laparotomy, a uniformly hard, bulky pancreas was found with no sonographically definable mass. A total pancreatectomy with portal vein resection and reconstruction was performed. Histology revealed adenosquamous carcinoma of the pancreatic head and autoimmune pancreatitis and squamous metaplasia in the remaining pancreas. Conclusion. This case highlights the diagnostic and management difficulties in a patient with pancreatic cancer in the setting of serum IgG4-negative, Type 2 AIP.
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- 2013
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7. Methods of tissue preparation after EUS‐guided tissue acquisition without rapid on‐site assessment: Results of a randomized study
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Vinh‐An Phan, Andrew Ruszkiewicz, Romina Safaeian, Joshua Zobel, and Nam Q. Nguyen
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Hepatology ,Gastroenterology - Published
- 2023
8. Increase in distal esophageal wall thickness with time in adult patients with eosinophilic esophagitis
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Stephanie Wong, Romina Safaeian, Joshua Zobel, Richard H Holloway, Andrew Ruszkiewicz, Nam Q Nguyen, Wong, Stephanie, Safaeian, Romina, Zobel, Joshua, Holloway, Richard H, Ruszkiewicz, Andrew, and Nguyen, Nam Q
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eosinophilic esophagitis ,Hepatology ,esophageal wall thickness ,dysphagia ,eosinophil count ,endoscopic ultrasound ,Gastroenterology - Abstract
Refereed/Peer-reviewed Background and Aim: Eosinophilic esophagitis (EoE) is a chronic disease which may progress to a fibro-stenotic phenotype due to esophageal sub-epithelial fibrosis. Esophageal wall thickening in patients with EoE has been demonstrated in a few studies using endoscopic ultrasound (EUS). The aim of this study was to longitudinally assess the endoscopic appearance, wall thickness, histology, and dysphagia score of EoE patients. Methods: Patients with EoE were recruited and studied between February 2012 and April 2021. Patients were evaluated on two separate occasions at least 12 months apart with endoscopy, EUS, and esophageal mucosal biopsies. The dysphagia score and epidemiology data were also assessed. Results: A total of 16 EoE patients were included with a mean follow-up duration of 2.2 ± 1.2 years. In 14/16 (88%) patients, the total wall thickness of the distal esophagus significantly increased (P = 0.0012) as a result of thickening of the muscularis propria (P = 0.0218). However, only 1/14 (7%) patient had an increase in the dysphagia score, while 8/14 (57%) and 5/14 (36%) had a stable and reduced dysphagia score, respectively. No differences were found in the total thickness of other esophageal regions, dysphagia score, endoscopic appearance, and eosinophil count over time. Conclusion: Distal esophageal wall thickness increases with time in EoE patients, independent of the dysphagia score and eosinophil count.
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- 2023
9. Comparison of Cap-Assisted vs Conventional Endoscopic Technique for Management of Food Bolus Impaction in the Esophagus: Results of a Multicenter Randomized Controlled Trial
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Abdulnasser Lafta, Nam Q. Nguyen, Marie Ooi, Mark Appleyard, Dep Huynh, Richard Holman, Tuan A. Duong, Christopher K. Rayner, and Florian Grimpen
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Adult ,Male ,medicine.medical_specialty ,Cost-Benefit Analysis ,Forceps ,Technical success ,law.invention ,Tertiary Care Centers ,Esophagus ,Postoperative Complications ,Randomized controlled trial ,law ,Food bolus ,Humans ,Medicine ,Adverse effect ,Aged ,Hepatology ,Impaction ,business.industry ,Gastroenterology ,Length of Stay ,Middle Aged ,Foreign Bodies ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,Food ,Female ,Esophagoscopy ,Complication ,business ,Hospitals, High-Volume - Abstract
INTRODUCTION "Push" or "pull" techniques with the use of snares, forceps, baskets, and grasping devices are conventionally used to manage esophageal food bolus impaction (FBI). A novel cap-assisted technique has recently been advocated to reduce time taken for food bolus (FB) removal. This study aimed to compare the effectiveness of the cap-assisted technique against conventional methods of esophageal FB removal in a randomized controlled trial. METHODS Consecutive patients with esophageal FBI requiring endoscopic removal, from 3 Australian tertiary hospitals between 2017 and 2019, were randomized to either the cap-assisted technique or the conventional technique. Primary outcomes were technical success and FB retrieval time. Secondary outcomes were technical success rate, en bloc removal rate, procedure-related complication, length of hospital stay, and cost of consumables. RESULTS Over 24 months, 342 patients with esophageal FBI were randomized to a cap-assisted (n = 171) or conventional (n = 171) technique. Compared with the conventional approach, the cap-assisted technique was associated with (i) shorter FB retrieval time (4.5 ± 0.5 minutes vs 21.7 ± 0.9 minutes, P < 0.001), (ii) shorter total procedure time (23.0 ± 0.6 minutes vs 47.0 ± 1.3 minutes, P < 0.0001), (iii) higher technical success rate (170/171 vs 160/171, P < 0.001), (iv) higher rate of en bloc removal (159/171 vs 48/171, P < 0.001), and (v) lower rate of procedure-related mucosal tear and bleeding (0/171 vs 13/171, P < 0.001). There were no major adverse events or deaths within 30 days in either group. The total cost of consumables was higher in the conventional group (A$19,644.90 vs A$6,239.90). DISCUSSION This multicenter randomized controlled trial confirmed that the cap-assisted technique is more effective and less costly than the conventional approach and should be first-line treatment for esophageal FBI.
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- 2021
10. Pseudoachalasia: a diagnostic challenge. When to consider and how to manage?
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Awni Abu sneineh, Nam Q. Nguyen, and Sara Haj Ali
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Endoscopic ultrasound ,medicine.medical_specialty ,Time Factors ,Achalasia ,Gastroesophageal Junction ,03 medical and health sciences ,0302 clinical medicine ,Gastroscopy ,Biopsy ,medicine ,Advanced disease ,Humans ,medicine.diagnostic_test ,business.industry ,Upper endoscopy ,Gastroenterology ,medicine.disease ,Endoscopy ,Esophageal Achalasia ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Esophagogastric Junction ,Radiology ,Age of onset ,Tomography, X-Ray Computed ,business - Abstract
Pseudoachalasia accounts for up to 4% of patients who present with achalasia-like picture and most often relates to occult malignancy at the cardia or gastroesophageal junction. Thus, any delay in diagnosis might lead to more advanced disease and less chance for curative therapy, not to mention the risk of serious complications resulting from the treatment of supposed achalasia instead of the true underlying cause. The entity should be suspected in patients with advanced age of onset, a shorter duration of symptoms, profound weight loss and difficulty in passing the gastroesophageal junction on endoscopy. The diagnosis of pseudoachalasia can be challenging as upper endoscopy with biopsy might be false negative in 25% of cases and lesions cannot always be detected on computerized tomography scan. Endoscopic ultrasound and guided biopsy play an increasingly important role in the workup of this condition. Treatment of pseudoachalasia depends on the underlying cause. The aim of this review is to highlight the clinicopathological features that distinguish pseudoachalasia from achalasia and the most appropriate diagnostic workup as well as the subsequent management for this condition.
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- 2021
11. Endoscopic ultrasound-guided gastroenterostomy using an oroenteric catheter-assisted technique: a retrospective analysis
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Andrew Nett, Morgan Rigopoulos, Chris M. Hamerski, Rabindra R. Watson, Kenneth F. Binmoeller, and Nam Q. Nguyen
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Male ,Endoscopic ultrasound ,medicine.medical_specialty ,Catheters ,medicine.medical_treatment ,Technical success ,Endosonography ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Retrospective analysis ,Humans ,In patient ,Ultrasonography, Interventional ,Aged ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Gastroenterology ,Stent ,Gastric outlet obstruction ,Gastroenterostomy ,medicine.disease ,digestive system diseases ,Surgery ,Catheter ,030220 oncology & carcinogenesis ,Stents ,030211 gastroenterology & hepatology ,business - Abstract
Background This study evaluated an oroenteric catheter (OEC)-assisted technique to distend the enteric loop for endoscopic ultrasound-guided gastroenterostomy (EUS-GE) in patients with gastric outlet obstruction (GOO). Methods Patient outcomes were reviewed. Proximal enteric loops were filled with water via an OEC (7 Fr or 8 Fr), providing a target for EUS-GE using a lumen-apposing metal stent (15-mm caliber). Clinical success was defined as toleration of a non-liquid diet by Day 3. Results 42 patients (mean age 73.1 [SEM 2.8] years; 23 male) underwent EUS-GE for malignant (n = 37) and benign (n = 5) duodenal strictures. EUS-GE creation was successful in 41/42 (98 %), with mean procedure time of 36 (SEM 3) minutes and no serious complications. Clinical success was achieved in 39/42 (93 %) at 5.7 (SEM 2.6) months’ follow-up. Of 14 patients who died, 13 (93 %) maintained oral intake until death. EUS-GE provided good symptom relief in all 28 surviving patients until follow-up. Conclusions OEC-assisted EUS-GE provided satisfactory relief of GOO symptoms, with high technical success (98 %) and no serious complications.
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- 2021
12. Eosinophilic Esophagitis and IgG4: Is There a Relationship?
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Amanda H. Lim, Stephanie Wong, and Nam Q. Nguyen
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medicine.medical_specialty ,Physiology ,Autoimmunity ,Immunoglobulin E ,Pathogenesis ,Atopy ,03 medical and health sciences ,0302 clinical medicine ,Transplant surgery ,Internal medicine ,parasitic diseases ,Animals ,Humans ,Medicine ,In patient ,Eosinophilic esophagitis ,biology ,business.industry ,Gastroenterology ,Eosinophilic Esophagitis ,respiratory system ,Hepatology ,Prognosis ,medicine.disease ,Immunoglobulin G ,030220 oncology & carcinogenesis ,Immunology ,biology.protein ,030211 gastroenterology & hepatology ,Immunoglobulin G4-Related Disease ,business - Abstract
Our knowledge of the pathophysiology of eosinophilic esophagitis is constantly evolving. There is significant association between eosinophilic esophagitis and atopy; however, multiple studies have refuted the role of IgE in its pathogenesis. Instead, new data have demonstrated an elevated IgG4 level in patients with eosinophilic esophagitis. We review the current understanding of eosinophilic esophagitis pathogenesis and highlight the increasing evidence for the role of IgG4.
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- 2021
13. Combined chemotherapy and endoscopic ultrasound-guided intratumoral 32P implantation for locally advanced pancreatic adenocarcinoma: a pilot study
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Chuan Ping Tan, Karen Ho, Nam Q. Nguyen, William Hsieh, Dylan Bartholomeusz, Jeevinesh Naidu, Andrew Ruszkiewicz, Joshua Zobel, John W. Chen, Nimit Singhal, Benjamin Crouch, Paul M. Dolan, Romina Safaeian, and Deborah Calnan
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Endoscopic ultrasound ,Chemotherapy ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Gastroenterology ,Combination chemotherapy ,medicine.disease ,Confidence interval ,Clinical trial ,Interquartile range ,Multicenter trial ,medicine ,Adenocarcinoma ,Radiology ,business - Abstract
Background This study evaluated clinical outcomes of combined chemotherapy and endoscopic ultrasound (EUS)-guided intratumoral radioactive phosphorus-32 (32P) implantation in locally advanced pancreatic adenocarcinoma (LAPC). Methods Consecutive patients with newly diagnosed LAPC were recruited over 20 months. Baseline computed tomography and 18F-2-fluoro-2-deoxy-D-glucose (18FDG) positron emission tomography–computed tomography were performed and repeated after 12 weeks to assess treatment response. Following two cycles of conventional chemotherapy, patients underwent EUS-guided 32P implantation followed by six chemotherapy cycles. Results 12 patients with LAPC (median age 69 years [interquartile range 61.5–73.3]; 8 male) completed treatment. Technical success was 100 % with no procedural complications. At 12 weeks, median reduction in tumor volume was 8.2 cm3 (95 % confidence interval 4.95–10.85; P = 0.003), with minimal or no 18FDG uptake in nine patients (75 %). Tumor downstaging was achieved in six patients (50 %), leading to successful resection in five (42 %), including four R0 resections (80 %). Conclusions EUS-guided 32P implantation was feasible, well tolerated, and resulted in a 42 % surgical resection rate. Further evaluation in a larger randomized multicenter trial is warranted.
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- 2021
14. Endoscopic ultrasound-guided tissue acquisition with or without macroscopic on-site evaluation: randomized controlled trial
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Majid A Almadi, Anthony W.H. Chan, Qingwei Jiang, Nam Q. Nguyen, Kazuo Hara, Tiing Leong Ang, Mitsuhiro Kida, Sundeep Lakhtakia, Takuji Iwashita, Ai-Ming Yang, Tsu-Yao Cheng, Shinpei Doi, Anthony Yuen Bun Teoh, Shannon M. Chan, Andrew Kwek, Wah-Kheong Chan, Raymond S. Tang, Ichiro Yasuda, Rajesh Puri, Charing C N Chong, and Hsiu-Po Wang
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Adult ,Endoscopic ultrasound ,Randomization ,medicine.diagnostic_test ,business.industry ,Gastroenterology ,Site evaluation ,Endosonography ,law.invention ,Pancreatic Neoplasms ,Tissue acquisition ,Clinical trial ,Randomized controlled trial ,Needles ,law ,Histological diagnosis ,Humans ,Medicine ,Prospective Studies ,business ,Nuclear medicine ,Endoscopic Ultrasound-Guided Fine Needle Aspiration ,Conventional technique - Abstract
Background The use of macroscopic on-site evaluation (MOSE) to estimate the adequacy of a specimen for histological diagnosis during endoscopic ultrasound (EUS)-guided fine-needle tissue acquisition (FNTA) has recently been advocated. This study aimed to evaluate the diagnostic yield of MOSE compared with conventional EUS-FNTA without rapid on-site evaluation (ROSE).Methods This was an international, multicenter, prospective, randomized controlled study. After providing informed consent, consecutive adult patients referred for EUS-FNTA for solid lesions larger than 2 cm were randomized to a MOSE arm or to a conventional arm without ROSE. A designated cytopathologist from each center performed all cytopathological examinations for that center and was blinded to the randomization results. The primary outcome measure was the diagnostic yield, and the secondary outcomes included sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy, and the rate of procedure-related complications.Results 244 patients (122 conventional, 122 MOSE) were enrolled during the study period. No significant differences between the two arms were found in procedure time or rate of procedure-related adverse events. The diagnostic yield for the MOSE technique (92.6 %) was similar to that for the conventional technique (89.3 %; P = 0.37), with significantly fewer passes made (median: conventional 3, MOSE 2; P Conclusions EUS-FNTA with the MOSE technique provided a similar diagnostic yield to conventional EUS-FNTA technique in the absence of ROSE but with fewer passes. This technique can be used when ROSE is not available.
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- 2020
15. Australasian Gastrointestinal Trials Group (AGITG) and Trans-Tasman Radiation Oncology Group (TROG) Guidelines for Pancreatic Stereotactic Body Radiation Therapy (SBRT)
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Sweet Ping Ng, Nam Q. Nguyen, Daniel T. Chang, Adam Briggs, Lois Holloway, Sarat Chander, Julie Chu, David Pryor, Dominique Lee, David Goldstein, Andrew Oar, John Shakeshaft, Hien Le, Andrew Kneebone, J. Samra, Karyn A. Goodman, Mark T Lee, Andrew Barbour, Raymond Dalfsen, and George Hruby
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Male ,medicine.medical_specialty ,Stereotactic body radiation therapy ,Guidelines as Topic ,Radiosurgery ,Dose constraints ,030218 nuclear medicine & medical imaging ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Radiation oncology ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Contouring ,Low toxicity ,business.industry ,Australia ,Radiotherapy Dosage ,Survival Analysis ,Dose prescription ,Pancreatic Neoplasms ,Oncology ,Multicenter study ,030220 oncology & carcinogenesis ,Female ,Radiology ,business - Abstract
Purpose Nonrandomized data exploring pancreas stereotactic body radiation therapy (SBRT) has demonstrated excellent local control rates and low toxicity. Before commencing a randomized trial investigating pancreas SBRT, standardization of prescription dose, dose constraints, simulation technique, and clinical target volume delineation are required. Methods and Materials Specialists in radiation oncology, medical oncology, hepatobiliary surgery, and gastroenterology attended 2 consecutive Australasian Gastrointestinal Trials Group workshops in 2017 and 2018. Sample cases were discussed during workshop contact with specifically invited international speakers highly experienced in pancreas SBRT. Furthermore, sample cases were contoured and planned between workshop contact to finalize dose constraints and clinical target volume delineation. Results Over 2 separate workshops, consensus was reached on dose and simulation technique. The working group recommended a dose prescription of 40 Gy in 5 fractions. Treatment delivery during end-expiratory breath hold with triple-phase contrast enhanced computed tomography was recommended. In addition, dose constraints, stepwise contouring guidelines, and an anatomic atlas for pancreatic SBRT were developed. Conclusions Pancreas SBRT is emerging as a promising treatment modality requiring prospective evaluation in randomized studies. This work attempts to standardize dose, simulation technique, and volume delineation to support the delivery of high quality SBRT in a multicenter study.
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- 2020
16. Distinguishing gastroesophageal reflux disease and eosinophilic esophagitis in adults: The role of esophageal mucosal immunoglobulin G4
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Georgia Smith, Stephanie Wong, Andrew Ruszkiewicz, and Nam Q. Nguyen
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medicine.medical_specialty ,gastroesophageal reflux disease ,RC799-869 ,Gastroenterology ,Stain ,Atopy ,eosinophilic esophagitis ,03 medical and health sciences ,immunoglobulin G4 ,0302 clinical medicine ,Internal medicine ,parasitic diseases ,adults ,medicine ,Esophagus ,Eosinophilic esophagitis ,Hepatology ,business.industry ,fungi ,Reflux ,Original Articles ,Diseases of the digestive system. Gastroenterology ,medicine.disease ,Dysphagia ,digestive system diseases ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,GERD ,Original Article ,030211 gastroenterology & hepatology ,medicine.symptom ,business ,Esophagitis - Abstract
Background and Aim Eosinophilic esophagitis (EoE) and gastroesophageal reflux disease (GERD) can be difficult to distinguish as many of their clinical and histological features overlap. Preliminary data suggest a potential association between EoE and immunoglobulin G4 (IgG4) but not GERD. This study aimed to examine the role of esophageal mucosal IgG4 staining when differentiating EoE from GERD. Methods Esophageal biopsy specimens from patients with proven EoE and GERD were evaluated, and immunohistochemical staining for IgG4 was performed by an experienced gastrointestinal pathologist blinded to the clinical and endoscopic data. The results on IgG4 staining were then correlated with clinical, endoscopic, and histological features. Results Sixty patients were included in the study, with 30 EoE (38.8 ± 12.8 years, 23 M:7 F) and 30 GERD (50.7 ± 14.3 years, 14 M:16 F) patients. The prevalence of a positive intercellular IgG4 stain was significantly higher in the EoE patients than those with GERD (23/29 vs 2/30; P, Eosinophilic esophagitis (EoE) and gastroesophageal reflux disease (GERD) can be difficult to distinguish as many of their clinical and histological features overlap. Preliminary data suggest a potential association between EoE and immunoglobulin G4 (IgG), but not GERD. Our study has shown that positive IgG4 staining in esophageal biopsies has a high specificity and PPV for EoE, and this can be a useful marker to distinguish the disease from GERD.
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- 2020
17. Combined versus single use 20G fine-needle biopsy and 25G fine-needle aspiration for endoscopic ultrasound-guided tissue sampling of solid gastrointestinal lesions
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Djuna L. Cahen, Harry R. Aslanian, Schalk Van der Merwe, Erwin Santo, Alberto Larghi, M C Petrone, Nam Q. Nguyen, Marc Giovannini, Kenneth J. Chang, Julio Iglesias-Garcia, Masayuki Kitano, Juan Carlos Bucobo, Francisco Baldaque-Silva, Paolo Giorgio Arcidiacono, Marco J. Bruno, James J. Farrell, Priscilla A. van Riet, and Gastroenterology & Hepatology
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Endoscopic ultrasound ,medicine.medical_specialty ,Malignancy ,Endosonography ,Specimen Handling ,Fine needle biopsy ,03 medical and health sciences ,0302 clinical medicine ,Biopsy ,medicine ,Humans ,Sampling (medicine) ,Endoscopic Ultrasound-Guided Fine Needle Aspiration ,Pancreas ,Single use ,medicine.diagnostic_test ,business.industry ,Gastroenterology ,Tissue sampling ,medicine.disease ,Pancreatic Neoplasms ,Fine-needle aspiration ,Needles ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Radiology ,business - Abstract
Background Instead of choosing one endoscopic ultrasound (EUS) needle over the other, some advocate the use of fine-needle aspiration (FNA) and fine-needle biopsy (FNB) consecutively. We explored the yield of combined use of 20 G FNB and 25 G FNA needles in patients with a suspicious solid gastrointestinal lesion. Methods Patients from the ASPRO study who were sampled with both needles during the same procedure were included. The incremental yield of dual sampling compared with the yield of single needle use on the diagnostic accuracy for malignancy was assessed for both dual sampling approaches – FNA followed by FNB, and vice versa. Results 73 patients were included. There were 39 (53 %) pancreatic lesions, 18 (25 %) submucosal masses, and 16 (22 %) lymph nodes. FNA was used first in 24 patients (33 %) and FNB was used first in 49 (67 %). Generally, FNB was performed after FNA to collect tissue for ancillary testing (75 %), whereas FNA was used after FNB to allow for on-site pathological assessment (76 %). Diagnostic accuracy for malignancy of single needle use increased from 78 % to 92 % with dual sampling (P = 0.002). FNA followed by FNB improved the diagnostic accuracy for malignancy (P = 0.03), whereas FNB followed by FNA did not (P = 0.13). Conclusion Dual sampling only improved diagnostic accuracy when 25 G FNA was followed by 20 G FNB and not vice versa. As the diagnostic benefit of the 20 G FNB over the 25 G FNA needle has recently been proven, sampling with the FNB needle seems a logical first choice.
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- 2020
18. Distal esophageal wall thickness correlates with dysphagia in adult patients with eosinophilic esophagitis
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Stephanie Wong, Marcus Tippett, Joshua Zobel, Romina Safaeian, Richard H. Holloway, Andrew Ruszkiewicz, and Nam Q. Nguyen
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Adult ,Inflammation ,Gastritis ,Eosinophilia ,Gastroenterology ,Gastroesophageal Reflux ,Humans ,Eosinophilic Esophagitis ,Deglutition Disorders ,Endoscopy, Gastrointestinal ,Enteritis - Abstract
Thickening of the esophageal wall in patients with eosinophilic esophagitis (EoE) and gastro-esophageal reflux disease (GERD) has been shown in studies using endoscopic ultrasound (EUS). We hypothesise that transmural inflammation in EoE results in prominent esophageal wall thickening compared with the mucosal inflammation in GERD. The aim of this study was to compare the relationship among dysphagia, endoscopic appearance, wall thickness, histology, and motility in EoE and GORD.EoE and GERD patients were prospectively studied between February 2012 and April 2021. Patients were studied on 2 separate occasions with endoscopy, EUS and mucosal biopsies, followed by high-resolution manometry. Epidemiology and dysphagia data were obtained.A total of 45 patients (31 EoE, 14 GERD) were included. There were no significant differences in age, sex, duration of disease and presence of esophageal motility disorders. EoE patients had a higher dysphagia score (P 0.001), EREFS score (P 0.001) and peak eosinophil count (P 0.001) compared with GERD patients. Thickness of the submucosa in the distal esophagus in EoE was significantly higher than GERD (P = 0.003) and positively correlated with duration of disease (P = 0.01, R = 0.67). Positive correlation was also found between dysphagia score and distal total esophageal wall thickness (P = 0.03, R = 0.39) in EoE patients. No correlation was found between these variables in GERD patients.Distal esophageal wall thickness positively correlates with dysphagia score in EoE but not GERD. This appears to be related to the composition of the submucosa which can be identified using EUS.
- Published
- 2022
19. BOWEL PREPARATION BEFORE CAPSULE ENDOSCOPY DOES NOT IMPROVE VISUALISATION OR DIAGNOSTIC YIELD: A MULTICENTRE BLINDED RANDOMISED CONTROL TRIAL
- Author
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Mehul Lamba, Kimberley Ryan, Jason Hwang, Florian Grimpen, Gary Lim, Dale Cornelius, Alan Moss, Eu Jin Lim, Gregor J. Brown, Nam Q. Nguyen, Marcus D. Tippett, Andrew M. Taylor, and Mark Appleyard
- Subjects
Gastroenterology ,Radiology, Nuclear Medicine and imaging - Published
- 2022
20. AGITG MASTERPLAN: a randomised phase II study of modified FOLFIRINOX alone or in combination with stereotactic body radiotherapy for patients with high-risk and locally advanced pancreatic cancer
- Author
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Nam Q. Nguyen, Jaswinder S. Samra, Julie Chu, Andrew Oar, Andrew Kneebone, Hien Le, Katrin Marie Sjoquist, Kate Wilson, Val Gebski, Andrew Barbour, John Simes, Alisha Moore, Chris Aiken, David Goldstein, David Espinoza, Mark T Lee, Sonia Yip, and Lorraine A. Chantrill
- Subjects
Male ,Cancer Research ,FOLFIRINOX ,Leucovorin ,Phases of clinical research ,Study Protocol ,Antineoplastic Combined Chemotherapy Protocols ,Stereotactic radiotherapy ,Multicenter Studies as Topic ,Prospective Studies ,RC254-282 ,Randomized Controlled Trials as Topic ,SBRT ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,Middle Aged ,Prognosis ,Combined Modality Therapy ,Oxaliplatin ,mFOLFIRINOX ,Oncology ,Female ,Fluorouracil ,Radiology ,Modified FOLFIRINOX ,medicine.drug ,Adult ,medicine.medical_specialty ,Adolescent ,Nab-paclitaxel ,Irinotecan ,Radiosurgery ,Borderline resectable ,Young Adult ,Clinical Trials, Phase II as Topic ,Pancreatic cancer ,Genetics ,medicine ,Humans ,Pancreas ,Aged ,business.industry ,Induction chemotherapy ,medicine.disease ,Interim analysis ,Gemcitabine ,Pancreatic Neoplasms ,business ,Follow-Up Studies - Abstract
Background Among patients with non-metastatic pancreatic cancer, 80% have high-risk, borderline resectable or locally advanced cancer, with a 5-year overall survival of 12%. MASTERPLAN evaluates the safety and activity of stereotactic body radiotherapy (SBRT) in addition to chemotherapy in these patients. Methods and design MASTERPLAN is a multi-centre randomised phase II trial of 120 patients with histologically confirmed potentially operable pancreatic cancer (POPC) or inoperable pancreatic cancer (IPC). POPC includes patients with borderline resectable or high-risk tumours; IPC is defined as locally advanced or medically inoperable pancreatic cancer. Randomisation is 2:1 to chemotherapy + SBRT (investigational arm) or chemotherapy alone (control arm) by minimisation and stratified by patient cohort (POPC v IPC), planned induction chemotherapy and institution. Chemotherapy can have been commenced ≤28 days prior to randomisation. Both arms receive 6 × 2 weekly cycles of modified FOLFIRINOX (oxaliplatin (85 mg/m2 IV), irinotecan (150 mg/m2), 5-fluorouracil (2400 mg/m2 CIV), leucovorin (50 mg IV bolus)) plus SBRT in the investigational arm. Gemcitabine+nab-paclitaxel is permitted for patients unsuitable for mFOLFIRINOX. SBRT is 40Gy in five fractions with planning quality assurance to occur in real time. Following initial chemotherapy ± SBRT, resectability will be evaluated. For resected patients, adjuvant chemotherapy is six cycles of mFOLFIRINOX. Where gemcitabine+nab-paclitaxel was used initially, the adjuvant treatment is 12 weeks of gemcitabine and capecitabine or mFOLFIRINOX. Unresectable or medically inoperable patients with stable/responding disease will continue with a further six cycles of mFOLFIRINOX or three cycles of gemcitabine+nab-paclitaxel, whatever was used initially. The primary endpoint is 12-month locoregional control. Secondary endpoints are safety, surgical morbidity and mortality, radiological response rates, progression-free survival, pathological response rates, surgical resection rates, R0 resection rate, quality of life, deterioration-free survival and overall survival. Tertiary/correlative objectives are radiological measures of nutrition and sarcopenia, and serial tissue, blood and microbiome samples to be assessed for associations between clinical endpoints and potential predictive/prognostic biomarkers. Interim analysis will review rates of locoregional recurrence, distant failure and death after 40 patients complete 12 months follow-up. Fifteen Australian and New Zealand sites will recruit over a 4-year period, with minimum follow-up period of 12 months. Discussion MASTERPLAN evaluates SBRT in both resectable and unresectable patients with pancreatic ductal adenocarcinoma. Trial registration Australia New Zealand Clinical Trials Registry ACTRN12619000409178, 13/03/2019. Protocol version: 2.0, 19 May 2019
- Published
- 2021
21. Characteristics and progression of childhood-onset and adult-onset eosinophilic esophagitis
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Sara Haj Ali, Jane Collinson, Andrew Ruszkiewicz, Joanne Hawkes, David J. Moore, Richard H. Holloway, Thomas O'Neill, Stephanie Wong, Nam Q. Nguyen, and Samuel Ellison
- Subjects
Adult ,Pediatrics ,medicine.medical_specialty ,Abdominal pain ,Hepatology ,business.industry ,Incidence (epidemiology) ,Gastroenterology ,Disease ,Eosinophilic Esophagitis ,medicine.disease ,Asymptomatic ,Natural history ,Bloating ,Cross-Sectional Studies ,medicine ,Disease Progression ,Humans ,medicine.symptom ,Age of Onset ,Eosinophilic esophagitis ,business ,Child ,Progressive disease - Abstract
The prevalence and incidence of eosinophilic esophagitis (EoE) has been increasing over recent years. However, the natural history remains incompletely understood particularly the differences in disease characteristics and progression of childhood-onset and adult-onset EoE. The aim of this study was to evaluate the disease characteristics and progression of childhood-onset and adult-onset EoE.A cross-sectional, questionnaire-based study, on 87 adults and 67 children from 2 major tertiary hospitals in South Australia was conducted. Data of those who were diagnosed with EoE between 1999 and 2018 were collected and correlated with medical records.Of the 87 adults with EoE, 34 (39%) were diagnosed at the age of 18 years (childhood-onset EoE). Reflux symptoms were more common in childhood-onset EoE, whereas asthma was more common in adult-onset EoE. The median duration of symptoms prior to diagnosis of EoE was 1-4 years in childhood-onset disease (44%) and ≥ 10 years in adult-onset disease (34%). Food impaction was significantly more common on initial presentation in those with adult-onset EoE, whereas weight loss was more common in childhood-onset EoE. At the time of questionnaire, regurgitation, abdominal pain, and bloating were more common in childhood-onset EoE. Those with childhood-onset EoE were more likely to have multiple symptoms at questionnaire when compared with their adult-onset counterparts. In both groups, 15% (5/34 childhood-onset EoE and 8/53 adult-onset EoE) were asymptomatic at the time of questionnaire.Childhood-onset EoE appears to be a progressive disease from childhood to adulthood, however with more inflammatory-type symptoms post transition compared to those with adult-onset EoE.
- Published
- 2021
22. Cholangioscopy-guided lithotripsy for difficult bile duct stone clearance in a single session of ERCP: results from a large multinational registry demonstrate high success rates
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Abdulrahman M Aljebreen, Jorg Reichenberger, Yun Nah Lee, Rungsun Rerknimitr, Benedict Devereaux, Raymond S. Tang, Phonthep Angsuwatcharakon, Mohan K. Ramchandani, Nam Q. Nguyen, Takao Itoi, Surya Prakash Bhandari, Pooja G. Goswamy, Randhir Sud, Joyce Peetermans, Jong Ho Moon, Amit Maydeo, Majid A Almadi, Matthew Rousseau, Tiing Leong Ang, Dong Wan Seo, Jong Kyun Lee, Saad Khalid Niaz, Anthony Yuen Bun Teoh, Mahesh K. Goenka, James Y.W. Lau, and Rakesh Kochhar
- Subjects
Male ,Natural Orifice Endoscopic Surgery ,medicine.medical_specialty ,medicine.medical_treatment ,Gallstones ,Lithotripsy ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Prospective Studies ,Registries ,Prospective cohort study ,Aged ,Cholangiopancreatography, Endoscopic Retrograde ,Endoscopic retrograde cholangiopancreatography ,medicine.diagnostic_test ,business.industry ,Bile duct ,Gastroenterology ,Odds ratio ,Middle Aged ,medicine.disease ,Laser lithotripsy ,Confidence interval ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Pancreatitis ,Female ,030211 gastroenterology & hepatology ,business - Abstract
Background Peroral cholangioscopy (POCS) can be useful for difficult bile duct stone clearance. Large prospective multinational data on POCS-guided lithotripsy for clearing difficult bile duct stones in a single session of endoscopic retrograde cholangiopancreatography (ERCP) are missing. Methods Patients with difficult bile duct stones (defined as one or more of: largest stone diameter ≥ 15 mm, failed prior attempt at stone clearance, impacted, multiple, hepatic duct location, or located above a stricture) were enrolled at 17 centers in 10 countries. The principal endpoint was stone clearance in a single ERCP procedure using POCS. Results 156 patients underwent 174 sessions of POCS-guided electrohydraulic or laser lithotripsy. Stone clearance had failed in a previous ERCP using traditional techniques in 124/156 patients (80 %), while 32 /156 patients (21 %) were referred directly to POCS-guided therapy based on preprocedural assessment of the difficulty of stone clearance. In 101/156 patients (65 %), there were impacted stones. POCS-guided stone clearance was achieved in a single POCS procedure in 125 /156 patients (80 %, 95 % confidence interval [CI] 73 % – 86 %), and was significantly more likely for stones ≤ 30 mm compared with > 30 mm (odds ratio 7.9, 95 %CI 2.4 – 26.2; P = 0.002). Serious adverse events occurred in 3/156 patients (1.9 %, 95 %CI 0.4 % – 5.5 %), and included pancreatitis, perforation due to laser lithotripsy, and cholangitis (n = 1 each), all resolved within 1 week. Conclusion POCS-guided lithotripsy is highly effective for clearance of difficult bile duct stones in a single procedure and successfully salvages most prior treatment failures. It may also be considered first-line therapy for patients with difficult choledocholithiasis to avoid serial procedures.
- Published
- 2019
23. Application of stereotactic body radiotherapy in advanced pancreatic cancers in Australia
- Author
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Laurence Kim, Vinh-An Phan, Nam Q. Nguyen, Nimit Singhal, Ivan Iankov, and Hien Le
- Subjects
Male ,lcsh:Medical physics. Medical radiology. Nuclear medicine ,medicine.medical_specialty ,medicine.medical_treatment ,lcsh:R895-920 ,pancreatic cancer ,Kaplan-Meier Estimate ,unresectable ,Radiosurgery ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Median follow-up ,Pancreatic cancer ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Aged ,Aged, 80 and over ,Chemotherapy ,SBRT ,Radiological and Ultrasound Technology ,business.industry ,Radiotherapy Planning, Computer-Assisted ,Mortality rate ,Australia ,Original Articles ,Chemoradiotherapy ,Middle Aged ,medicine.disease ,Pancreatic Neoplasms ,Radiation therapy ,stereotactic body radiotherapy ,030220 oncology & carcinogenesis ,Toxicity ,Adenocarcinoma ,Original Article ,Female ,Locally advanced ,Dose Fractionation, Radiation ,Radiology ,Safety ,business ,Fiducial marker - Abstract
Introduction The majority of pancreatic cancers present locally advanced and carry a high mortality rate. Treatment is challenging, with mixed data suggesting use of chemotherapy alone or in combination with radiotherapy. The use of radiotherapy has previously been limited due to lack of ability to deliver radiation to the tumour mass without causing significant toxicity to surrounding organs. Stereotactic body radiotherapy (SBRT) allows delivery of higher biologically equivalent dose in a shorter treatment duration. We sought to investigate the safety and application of this technique in our centre. Method We enrolled 27 patients from 2015, identified as locally advanced unresectable with histologically confirmed, non‐metastatic, pancreatic adenocarcinoma. All patients had endoscopically inserted fiducial markers and where possible concurrent chemotherapy was administered. Dose schedules ranged from 25 to 42 Gy in 5 or 3 fractions. Results With an overall median follow up of 9 months (range, 3–32.7), the median survival was 11.6 months. Of those alive at 1 year, the local control rate was 67%. Six patients had Grade 3 toxicity, and other six had Grade 2 toxicity. None had Grade 4 or above toxicity. The most common symptom recorded was fatigue. Conclusion SBRT for locally advanced pancreatic cancer is technically complex but feasible in a high volume centre. SBRT is unique, allowing safe delivery of high radiation dose resulting in good local control and decreases treatment time making it an attractive option for patients with unresectable pancreatic cancer.
- Published
- 2019
24. Precision Oncology in Surgery
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Petra Rümmele, David Miller, Venessa T. Chin, Amber L. Johns, Euan J. Dickson, Jianmin Wu, Anthony J. Gill, James G. Kench, Stephan Dreyer, Neil D. Merrett, Christopher J. Scarlett, Angela Chou, Robert Grützmann, Daniela Aust, Jeremy L. Humphris, Colin J. McKay, Marina Pajic, Adnan Nagrial, Christian Pilarsky, Nigel B. Jamieson, David K. Chang, Emily K. Colvin, Peter Bailey, Marc D. Jones, Jaswinder S. Samra, Mark J. Cowley, C.R. Carter, Andrew V. Biankin, Kim Moran-Jones, Susanna L. Cooke, Nam Q. Nguyen, Elizabeth A. Musgrove, Mark Pinese, Thomas Knösel, Lorraine A. Chantrill, and Fraser Duthie
- Subjects
medicine.medical_specialty ,business.industry ,Proportional hazards model ,medicine.medical_treatment ,Retrospective cohort study ,Nomogram ,medicine.disease ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Surgical oncology ,030220 oncology & carcinogenesis ,Pancreatic cancer ,Medicine ,Biomarker (medicine) ,030211 gastroenterology & hepatology ,business ,Survival analysis ,Neoadjuvant therapy - Abstract
Objective We aimed to define preoperative clinical and molecular characteristics that would allow better patient selection for operative resection. Background Although we use molecular selection methods for systemic targeted therapies, these principles are not applied to surgical oncology. Improving patient selection is of vital importance for the operative treatment of pancreatic cancer (pancreatic ductal adenocarcinoma). Although surgery is the only chance of long-term survival, 80% still succumb to the disease and approximately 30% die within 1 year, often sooner than those that have unresected local disease. Method In 3 independent pancreatic ductal adenocarcinoma cohorts (total participants = 1184) the relationship between aberrant expression of prometastatic proteins S100A2 and S100A4 and survival was assessed. A preoperative nomogram based on clinical variables available before surgery and expression of these proteins was constructed and compared to traditional measures, and a postoperative nomogram. Results High expression of either S100A2 or S100A4 was independent poor prognostic factors in a training cohort of 518 participants. These results were validated in 2 independent patient cohorts (Glasgow, n = 198; Germany, n = 468). Aberrant biomarker expression stratified the cohorts into 3 distinct prognostic groups. A preoperative nomogram incorporating S100A2 and S100A4 expression predicted survival and nomograms derived using postoperative clinicopathological variables. Conclusions Of those patients with a poor preoperative nomogram score, approximately 50% of patients died within a year of resection. Nomograms have the potential to improve selection for surgery and neoadjuvant therapy, avoiding surgery in aggressive disease, and justifying more extensive resections in biologically favorable disease.
- Published
- 2018
25. Common bile duct size in malignant distal obstruction and lumen-apposing metal stents: a multicenter prospective study
- Author
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Germana de Nucci, Ofelia Moșteanu, Takao Itoi, Laurent Palazzo, Arnaldo Amato, Bertrand Napoleon, Theodor Voiosu, Giorgio Valerii, Angels Ginès, Jan Werner Poley, Guido Costamagna, Stefano Francesco Crinò, Andrada Seicean, Roberto Di Mitri, Alessandro Fugazza, Nam Q. Nguyen, Ilaria Tarantino, Anna Cominardi, Edoardo Forti, Yukitoshi Matsunami, Leonardo Minelli Grazioli, Cristian Băicuș, Cecilia Binda, Carlo Fabbri, Radu Bogdan Mateescu, Andrea Anderloni, Maxime Palazzo, Gianenrico Rizzatti, Livia Archibugi, Gloria Fernández-Esparrach, Mihai Rimbas, Alberto Larghi, Pietro Fusaroli, Cristiano Spada, Carmelo Barbera, Massimiliano Mutignani, and Paolo Giorgio Arcidiacono
- Subjects
medicine.medical_specialty ,Original article ,Common bile duct ,business.industry ,Lumen (anatomy) ,Mean age ,RC799-869 ,Diseases of the digestive system. Gastroenterology ,Serum bilirubin ,digestive system diseases ,Large cohort ,Therapy naive ,medicine.anatomical_structure ,Medicine ,Pharmacology (medical) ,Radiology ,business ,Prospective cohort study - Abstract
Background and study aims Feasibility of EUS-guided choledochoduodenostomy (EUS-CDS) using available lumen-apposing stents (LAMS) is limited by the size of the common bile duct (CBD) (≤ 12 mm, cut-off for experts; 15 mm, cut-off for non-experts). We aimed to assess the prevalence and predictive factors associated with CBD size ≥ 12 and 15 mm in naïve patients with malignant distal biliary obstruction (MDBO). Patients and methods This was a prospective cohort study involving 22 centers with assessment of CBD diameter and subjective feasibility of the EUS-CDS performance in naïve jaundiced patients undergoing EUS evaluation for MDBO. Results A total of 491 patients (mean age 69 ± 12 years) with mean serum bilirubin of 12.7 ± 6.6 mg/dL entered the final analysis. Dilation of the CBD ≥ 12 and 15 mm was detected in 78.8 % and 51.9 % of cases, respectively. Subjective feasibility of EUS-CDS was expressed by endosonographers in 91.2 % for a CBD ≥ 12 mm and in 96.5 % for a CBD ≥ 15 mm. On multivariate analysis, age (P Conclusions Our study showed that at presentation in a large cohort of patients with MDBO, EUS-CDS can be potentially performed in three quarters to half of cases by expert and less experienced endosonographers, respectively. Dedicated stents or devices with different designs able to overcome the limitations of existing electrocautery-enhanced LAMS for EUS-CDS are needed.
- Published
- 2021
26. Endoscopic Ultrasound-Guided Fiducial Marker Placement for Stereotactic Body Radiotherapy (SBRT) of Pancreatic Cancer
- Author
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Vinh-An Phan, Jeevinesh Naidu, and Nam Q. Nguyen
- Subjects
Endoscopic ultrasound ,medicine.medical_specialty ,Standard of care ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,medicine.disease ,Radiation therapy ,Pancreatic cancer ,medicine ,External beam radiotherapy ,Radiology ,Fiducial marker ,business ,Stereotactic body radiotherapy ,Median survival - Abstract
The current standard of care for locally advanced pancreatic cancer (LAPC) is chemotherapy which provides patients with a median survival of 6–8 months. The addition of conventional external beam radiotherapy (EBRT) was previously associated with toxicity and is not routinely recommended. The development of stereotactic body radiotherapy (SBRT) potentially allows more selective delivery of radiation to the tumour. However, in order to deliver SBRT precisely, the placement of fiducial markers helps to compensate for tumour motion during respiration by tracking and accurately determining tumour boundaries. Although fiducials can be implanted percutaneously and laparoscopically, the minimally invasive endoscopic ultrasound (EUS)-guided approach has been the methods of choice. This chapter outlined the types, techniques, and related outcomes of EUS-guided fiducial implantation to assist the delivery of radiotherapy for LAPC.
- Published
- 2021
27. A gut-intrinsic melanocortin signaling complex augments L-cell secretion in humans
- Author
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Philippa Rabbitt, Torben Hansen, Alyce M. Martin, Eva W. Iepsen, Nichole J. Isaacs, Nektaria Pezos, Richard L. Young, Gudrun Schober, Nam Q. Nguyen, Amanda L. Lumsden, Paul Hollington, Alice P. Liou, V. Margaret Jackson, Dayan de Fontgalland, Jens-Christian Holm, Christopher K. Rayner, Signe S. Torekov, David A. Wattchow, Damien J. Keating, Emily W. Sun, Sun, Emily W, Iepsen, Eva W, Pezos, Nektaria, Lumsden, Amanda L, Martin, Alyce M, Schober, Gudrun, Isaacs, Nicole J, Rayner, Christopher K, Nguyen, Nam Q, de Fontgalland, Dayan, Rabbitt, Philippa, Hollington, Paul, Wattchow, David A, Hansen, Torben, Holm, Jens-Christian, Liou, Alice P, Jackson, V Margaret, Torekov, Signe S, Young, Richard L, and Keating, Damien J
- Subjects
Blood Glucose ,medicine.medical_specialty ,endocrine system ,Pro-Opiomelanocortin ,Time Factors ,gut hormones ,Enteroendocrine Cells ,enteroendocrine ,030209 endocrinology & metabolism ,Enteroendocrine cell ,MC4R ,03 medical and health sciences ,Paracrine signalling ,0302 clinical medicine ,Glucagon-Like Peptide 1 ,Loss of Function Mutation ,Internal medicine ,Paracrine Communication ,medicine ,Humans ,Secretion ,Peptide YY ,Intestinal Mucosa ,Receptor ,Autocrine signalling ,030304 developmental biology ,2. Zero hunger ,0303 health sciences ,Secretory Pathway ,Hepatology ,PYY ,Chemistry ,digestive, oral, and skin physiology ,Gastroenterology ,Glucose Tolerance Test ,Glucagon-like peptide-1 ,Melanocortin 4 receptor ,Autocrine Communication ,Endocrinology ,Glucose ,alpha-MSH ,Case-Control Studies ,Receptor, Melanocortin, Type 4 ,Melanocortin ,GLP-1 ,hormones, hormone substitutes, and hormone antagonists ,Signal Transduction - Abstract
Objective: Hypothalamic melanocortin 4 receptors (MC4R) are a key regulator of energy homeostasis. Brain-penetrant MC4R agonists have failed, as concentrations required to suppress food intake also increase blood pressure. However, peripherally located MC4R may also mediate metabolic benefits of MC4R activation. Mc4r transcript is enriched in mouse enteroendocrine L cells and peripheral administration of the endogenous MC4R agonist, α-melanocyte stimulating hormone (α-MSH), triggers the release of the anorectic hormones Glucagon-like peptide-1 (GLP-1) and peptide tyrosine tyrosine (PYY) in mice. This study aimed to determine whether pathways linking MC4R and L-cell secretion exist in humans. Design: GLP-1 and PYY levels were assessed in body mass index–matched individuals with or without loss-of-function MC4R mutations following an oral glucose tolerance test. Immunohistochemistry was performed on human intestinal sections to characterize the mucosal MC4R system. Static incubations with MC4R agonists were carried out on human intestinal epithelia, GLP-1 and PYY contents of secretion supernatants were assayed. Results: Fasting PYY levels and oral glucose-induced GLP-1 secretion were reduced in humans carrying a total loss-of-function MC4R mutation. MC4R was localized to L cells and regulates GLP-1 and PYY secretion from ex vivo human intestine. α-MSH immunoreactivity in the human intestinal epithelia was predominantly localized to L cells. Glucose-sensitive mucosal pro-opiomelanocortin cells provide a local source of α-MSH that is essential for glucose-induced GLP-1 secretion in small intestine. Conclusion: Our findings describe a previously unidentified signaling nexus in the human gastrointestinal tract involving α-MSH release and MC4R activation on L cells in an autocrine and paracrine fashion. Outcomes from this study have direct implications for targeting mucosal MC4R to treat human metabolic disorders. Refereed/Peer-reviewed
- Published
- 2021
28. Using single-operator cholangioscopy for endoscopic evaluation of indeterminate biliary strictures: results from a large multinational registry
- Author
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Pooja G. Goswamy, Jong Kyun Lee, Joyce Peetermans, Majid A Almadi, Tae Jun Song, Takao Itoi, Randhir Sud, Akihiko Tsuchida, Matthew Rousseau, James Y.W. Lau, Rakesh Kochhar, Kentaro Kamada, Jong Ho Moon, Ryosuke Tonozuka, Tiing Leong Ang, Saad Khalid Niaz, D. Nageshwar Reddy, Vijay K. Rai, Reina Tanaka, Ichiro Yasuda, Nam Q. Nguyen, Mahesh K. Goenka, Dong Wan Seo, Abdulrahman M Aljebreen, Arthur J. Kaffes, Amit Maydeo, Rungsun Rerknimitr, Benedict Devereaux, Jorg Reichenberger, Yun Nah Lee, Mohan K. Ramchandani, Sundeep Lakhtakia, and Masayuki Kitano
- Subjects
Diagnostic impression ,medicine.medical_specialty ,Asia ,Constriction, Pathologic ,Malignancy ,03 medical and health sciences ,0302 clinical medicine ,Biopsy ,medicine ,Humans ,Endoscopy, Digestive System ,Registries ,Visual impression ,Cholestasis ,medicine.diagnostic_test ,Bile duct ,business.industry ,Gastroenterology ,medicine.disease ,Predictive value ,Patient management ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Radiology ,Indeterminate ,business - Abstract
Background Peroral cholangioscopy (POCS) of indeterminate biliary strictures aims to achieve a diagnosis through visual examination and/or by obtaining targeted biopsies under direct visualization. In this large, prospective, multinational, real-life experience of POCS-guided evaluation of indeterminate biliary strictures, we evaluated the performance of POCS in this difficult-to-manage patient population. Methods This prospective registry enrolled patients, with indeterminate biliary strictures across 20 centers in Asia, the Middle East, and Africa. The primary end points were the ability to visualize the lesion, obtain histological sampling when intended, and an assessment of the diagnostic accuracy of POCS for malignant strictures. Patients were followed for 6 months after POCS or until a definitive malignant diagnosis was made, whichever occurred first. Results 289 patients underwent 290 POCS procedures with intent to biopsy in 182 cases. The stricture/filling defect was successfully visualized in 286/290 (98.6 %), providing a visual diagnostic impression in 253/290 (87.2 %) and obtaining adequate biopsies in 169/182 (92.9 %). Procedure-related adverse events occurred in 5/289 patients (1.7 %). POCS influenced patient management principally by elucidating filling defects or the causes of bile duct stricture or dilation. The visual impression of malignancy showed 86.7 % sensitivity, 71.2 % specificity, 65.8 % positive and 89.4 % negative predictive value, and 77.2 % overall accuracy compared with final diagnosis. Histological POCS-guided samples showed 75.3 % sensitivity, 100 % specificity, 100 % positive and 77.1 % negative predictive value, and 86.5 % overall accuracy. Conclusion In this large, real-life, prospective series, POCS was demonstrated to be an effective and safe intervention guiding the management of patients with indeterminate biliary strictures.
- Published
- 2020
29. EUS-FNB WITH VERSUS WITHOUT ROSE: INTERIM ANALYSIS OF AN INTERNATIONAL RANDOMIZED NON-INFERIORITY STUDY
- Author
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E Manfrin, Nam Q. Nguyen, Stefano Francesco Crinò, Takao Itoi, Armando Gabbrielli, GD Nucci, Silvia Carrara, Vanessa M. Shami, Angels Ginès, RD Mitri, Francisco Baldaque-Silva, Pierre Henri Deprez, Masayuki Kitano, J Iglesias-Garcia, Alberto Larghi, Jan-Werner Poley, A Scarpa, and Ilaria Tarantino
- Subjects
Rose (mathematics) ,medicine.medical_specialty ,Non inferiority ,business.industry ,Medicine ,business ,Interim analysis ,Surgery - Published
- 2020
30. An Update on the Endoscopic Management of Food Bolus Obstruction (FBO)
- Author
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Marie Ooi, Nam Q Nguyen, and Tuan A. Duong
- Subjects
medicine.medical_specialty ,business.industry ,Food bolus ,medicine ,Endoscopic management ,business ,Surgery - Published
- 2020
31. An international, multi-institution survey on performing EUS-FNA and fine needle biopsy
- Author
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Kensuke Kubota, Girish Mishra, Nam Q. Nguyen, Sundeep Lakhtakia, Anand V. Sahai, Adrian Saftoiu, Juan J. Vila, Marc Giovannini, Manoop S. Bhutani, Jan Werner Poley, Ichiro Yasuda, Atsushi Irisawa, Praveer Rai, Sh Untaro Mukai, Evangelos Kalaitzakis, Takeshi Ogura, Bowen Duan, Ali A. Siddiqui, Hsiu-Po Wang, Chalapathi R. Achanta, Brenda Lucia Arturo Arias, Anthony Yuen Bun Teoh, Lachter Jesse, Alberto Larghi, Julio Iglesias-Garcia, Mohamed El-Nady, Mitsuhiro Kida, Christian Jenssen, Todd H. Baron, Paolo Giorgio Arcidiacono, Jinlong Hu, Peter Vilmann, Douglas G. Adler, Fumihide Itokawa, Dong Wan Seo, Pietro Fusaroli, Jintao Guo, Siyu Sun, Ryan Ponnudurai, Luis Sabbagh, Guo, J., Sahai, A., Teoh, A., Arcidiacono, P., Larghi, A., Saftoiu, A., Siddiqui, A., Arturo Arias, B., Jenssen, C., Adler, D., Lakhtakia, S., Seo, D. -W., Itokawa, F., Giovannini, M., Mishra, G., Sabbagh, L., Irisawa, A., Iglesias-Garcia, J., Poley, J., Vila, J., Jesse, L., Kubota, K., Kalaitzakis, E., Kida, M., El-Nady, M., Mukai, S., Ogura, T., Fusaroli, P., Vilmann, P., Rai, P., Nguyen, N., Ponnudurai, R., Achanta, C., Baron, T., Yasuda, I., Wang, H. -P., Hu, J., Duan, B., Bhutani, M., Sun, S., Guo, Jintao, Sahai, Anand V, Teoh, Anthony, Arcidiacono, Paolo Giorgio, Larghi, Alberto, Saftoiu, Adrian, Siddiqui, Ali A, Arturo Arias, Brenda Lucia, Jenssen, Christian, Adler, Douglas G, Lakhtakia, Sundeep, Seo, Dong-Wan, Itokawa, Fumihide, Giovannini, Marc, Mishra, Girish, Sabbagh, Lui, Irisawa, Atsushi, Iglesias-Garcia, Julio, Poley, Jan Werner, Vila, Juan J, Jesse, Lachter, Kubota, Kensuke, Kalaitzakis, Evangelo, Kida, Mitsuhiro, El-Nady, Mohamed, Mukai, Sh Untaro, Ogura, Takeshi, Fusaroli, Pietro, Vilmann, Peter, Rai, Praveer, Nguyen, Nam Q, Ponnudurai, Ryan, Achanta, Chalapathi Rao, Baron, Todd H, Yasuda, Ichiro, Wang, Hsiu-Po, Hu, Jinlong, Duan, Bowen, Bhutani, Manoop S, Sun, Siyu, and Gastroenterology & Hepatology
- Subjects
medicine.medical_specialty ,Fine needle biopsy ,03 medical and health sciences ,0302 clinical medicine ,medicine ,consensu ,Radiology, Nuclear Medicine and imaging ,Sampling (medicine) ,Medical physics ,survey ,fine needle biopsy ,Hepatology ,medicine.diagnostic_test ,Task force ,Practice patterns ,business.industry ,Gastroenterology ,digestive system diseases ,Tissue acquisition ,Fine-needle aspiration ,consensus ,030220 oncology & carcinogenesis ,EUS-FNA ,030211 gastroenterology & hepatology ,Original Article ,business - Abstract
Background and Objectives: Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) and fine needle biopsy (FNB) are effective techniques that are widely used for tissue acquisition. However, it remains unclear how to obtain high-quality specimens. Therefore, we conducted a survey of EUS-FNA and FNB techniques to determine practice patterns worldwide and to develop strong recommendations based on the experience of experts in the field. Methods: This was a worldwide multi-institutional survey among members of the International Society of EUS Task Force (ISEUS-TF). The survey was administered by E-mail through the SurveyMonkey website. In some cases, percentage agreement with some statements was calculated; in others, the options with the greatest numbers of responses were summarized. Another questionnaire about the level of recommendation was designed to assess the respondents' answers. Results: ISEUS-TF members developed a questionnaire containing 17 questions that was sent to 53 experts. Thirty-five experts completed the survey within the specified period. Among them, 40% and 54.3% performed 50–200 and more than 200 EUS sampling procedures annually, respectively. Some practice patterns regarding FNA/FNB were recommended. Conclusion: This is the first worldwide survey of EUS-FNA and FNB practice patterns. The results showed wide variations in practice patterns. Randomized studies are urgently needed to establish the best approach for optimizing the FNA/FNB procedures.
- Published
- 2020
32. Gastro-oesophageal reflux disease and eosinophilic oesophagitis: What is the relationship?
- Author
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Nam Q. Nguyen, Richard H. Holloway, Stephanie Wong, and Andrew Ruszkiewicz
- Subjects
medicine.medical_specialty ,Pathogenesis ,Disease ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Gastro-oesophageal reflux disease ,Gastro ,Internal medicine ,Chronic oesophagitis ,Medicine ,Eosinophilia ,Relationship ,business.industry ,digestive, oral, and skin physiology ,Reflux ,Minireviews ,Eosinophilic oesophagitis ,Dysphagia ,030220 oncology & carcinogenesis ,Histological features ,030211 gastroenterology & hepatology ,medicine.symptom ,business - Abstract
Eosinophilic oesophagitis (EoE) and gastro-oesophageal reflux disease (GORD) are the most common causes of chronic oesophagitis and dysphagia associated with oesophageal mucosal eosinophilia. Distinguishing between the two is imperative but challenging due to overlapping clinical and histological features. A diagnosis of EoE requires clinical, histological and endoscopic correlation whereas a diagnosis of GORD is mainly clinical without the need for other investigations. Both entities may exhibit oesophageal eosinophilia at a similar level making a histological distinction between them difficult. Although the term proton-pump inhibitor responsive oesophageal eosinophilia has recently been retracted from the guidelines, a relationship between EoE and GORD still exists. This relationship is complex as they may coexist, either interacting bidirectionally or are unrelated. This review aims to outline the differences and potential relationship between the two conditions, with specific focus on histology, immunology, pathogenesis and treatment.
- Published
- 2018
33. Value of routine duodenal mucosal biopsies in the evaluation of anemia in a large Australian referral centre
- Author
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Edward Young, Nam Q. Nguyen, and Marie Ooi
- Subjects
medicine.medical_specialty ,Tissue transglutaminase Antibody ,Hepatology ,medicine.diagnostic_test ,Anemia ,business.industry ,Gastroenterology ,nutritional and metabolic diseases ,Disease ,medicine.disease ,Endoscopy ,Large cohort ,Serology ,03 medical and health sciences ,0302 clinical medicine ,Iron-deficiency anemia ,hemic and lymphatic diseases ,Internal medicine ,Referral centre ,medicine ,030211 gastroenterology & hepatology ,030212 general & internal medicine ,business - Abstract
Background and aim Small bowel mucosal biopsies (SBBx) are routinely performed to investigate unexplained anemia; however, previous studies have demonstrated a low yield in diagnosing celiac disease. Our aim was to determine the yield of routine SBBx in a large cohort of patients who underwent gastroscopy for the investigation of anemia. Methods Data from consecutive patients who underwent gastroscopy for the investigation of anemia in a tertiary hospital, from January 2008-December 2011, were prospectively collected. Measured outcomes were the prevalence of celiac disease, the yield of duodenal biopsies, and the correlation between celiac serology and diagnosis. Results Over 4 years, 987 patients (385 M:602 F; 48.27 ± 15.89 years) underwent endoscopy for anemia, of which 534 (54.1%) had proven iron deficiency anemia (IDA). Abnormal SBBx consistent with celiac disease were found in 2% (22/987), with a higher prevalence in females (3.2%, n = 19 vs 0.8%, n = 3 in males) and in those with IDA (3.6%, n = 19 vs 0.7%, n = 3 in non-IDA). Macroscopic endoscopic abnormalities were present in 86% (19/22) of patients with celiac disease. Of the 178 patients who had celiac serology, tissue transglutaminase antibody had the highest sensitivity (80%) and specificity (99%). Combined serology had a sensitivity of 85.7%. Conclusion Only 2% of patients with unexplained anemia had abnormal SBBx consistent with celiac disease and even fewer patients in non-IDA. Given the availability and high sensitivity of celiac serology and macroscopic changes on endoscopy, SBBx should not be routine during endoscopy but should be limited to those with positive celiac serology, abnormal endoscopic appearance, or females with IDA.
- Published
- 2018
34. Effectiveness of a cap-assisted device in the endoscopic removal of food bolus obstruction from the esophagus
- Author
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Nam Q. Nguyen, Edward Young, and Marie Ooi
- Subjects
Adult ,Male ,medicine.medical_specialty ,Operative Time ,Esophageal foreign body ,law.invention ,03 medical and health sciences ,Esophagus ,Postoperative Complications ,0302 clinical medicine ,Randomized controlled trial ,law ,Food bolus ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Endoscopy, Digestive System ,Longitudinal Studies ,Prospective Studies ,Prospective cohort study ,Aged ,Procedure time ,Aged, 80 and over ,medicine.diagnostic_test ,business.industry ,Gastroenterology ,Length of Stay ,Middle Aged ,Foreign Bodies ,Surgery ,Endoscopy ,Treatment Outcome ,medicine.anatomical_structure ,Food ,030220 oncology & carcinogenesis ,Female ,030211 gastroenterology & hepatology ,business ,Hospital stay - Abstract
Background and Aim The use of a transparent cap has been found to be effective for retrieval of an esophageal foreign body. However, data on the use of a cap in food bolus obstruction (FBO) are limited. This study aims to assess the effectiveness of a cap-assisted technique compared with conventional techniques in removal of FBO. Methods All patients who underwent an endoscopy for boneless FBO between 2011 and 2016 were prospectively recruited. The measured outcomes were procedure time, success rate of food bolus (FB) extraction, rate of en bloc removal, procedure-related adverse events, and length of hospital stay (LOS) between the 2 groups. Results Of the 315 patients who had an endoscopy for FBO, 48 (15.2%) had spontaneous passage of FB and 267 (84.8%) had impacted FB. Sixty-eight (25%) patients had the "push" maneuver, and 199 (75%) patients had the "pull" maneuver to remove FB. Of those who had the "pull" maneuver, a cap was used for 93 and conventional device(s) for 106. The use of a cap was associated with a shorter procedural time (34.3 ± 8.0 minutes versus 43.3 ± 22.6 minutes, P = .003), a higher rate of en bloc removal (87.3% versus 22.8%, P P = .01), and a shorter LOS (1.0 ± 0.6 days versus 1.6 ± 1.4 days, P = .0017). Conclusion The cap-assisted technique has been found to be effective and safe in removal of esophageal FBO. This technique was associated with a shorter procedural time and a reduced LOS compared with conventional techniques. However, these findings require further validation in a randomized control study.
- Published
- 2018
35. Augmented capacity for peripheral serotonin release in human obesity
- Author
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Nam Q. Nguyen, Sony S. Thazhath, Christopher K. Rayner, David Wattchow, Luigi Sposato, Nada Cvijanovic, Steven L. Due, Amanda L. Lumsden, Alice P. Liou, V. Margaret Jackson, Nicole J. Isaacs, Gudrun Schober, Damien J. Keating, Emily W. Sun, Nektaria Pezos, Richard L. Young, Tongzhi Wu, Paul Hollington, Alyce M. Martin, Philippa Rabbitt, Dayan de Fontgalland, Young, Richard L, Lumsden, Amanda L, Martin, Alyce M, Schober, Gudrun, and Keating, Damien J
- Subjects
Adult ,Blood Glucose ,Male ,0301 basic medicine ,Serotonin ,obesity ,medicine.medical_specialty ,Colon ,serotonin release ,Endocrinology, Diabetes and Metabolism ,Medicine (miscellaneous) ,Blood sugar ,Real-Time Polymerase Chain Reaction ,gastrointestinal endoscopy ,Endoscopy, Gastrointestinal ,03 medical and health sciences ,Internal medicine ,Peripheral Nervous System ,Enterochromaffin Cells ,Humans ,Medicine ,Lipolysis ,Obesity ,Cells, Cultured ,Nutrition and Dietetics ,hemoglobin blood level ,business.industry ,Middle Aged ,Small intestine ,030104 developmental biology ,Endocrinology ,medicine.anatomical_structure ,Enterochromaffin cell ,Duodenum ,Female ,Animal studies ,business ,Thermogenesis ,signal transduction ,Signal Transduction - Abstract
Background/objectives: Evidence from animal studies highlights an important role for serotonin (5-HT), derived from gut enterochromaffin (EC) cells, in regulating hepatic glucose production, lipolysis and thermogenesis, and promoting obesity and dysglycemia. Evidence in humans is limited, although elevated plasma 5-HT concentrations are linked to obesity. Subjects/methods: We assessed (i) plasma 5-HT concentrations before and during intraduodenal glucose infusion (4 kcal/min for 30 min) in non-diabetic obese (BMI 44 ± 4 kg/m2, N = 14) and control (BMI 24 ± 1 kg/m2, N = 10) subjects, (ii) functional activation of duodenal EC cells (immunodetection of phospho-extracellular related-kinase, pERK) in response to glucose, and in separate subjects, (iii) expression of tryptophan hydroxylase-1 (TPH1) in duodenum and colon (N = 39), and (iv) 5-HT content in primary EC cells from these regions (N = 85). Results: Plasma 5-HT was twofold higher in obese than control responders prior to (P = 0.025), and during (iAUC, P = 0.009), intraduodenal glucose infusion, and related positively to BMI (R2 = 0.334, P = 0.003) and HbA1c (R2 = 0.508, P = 0.009). The density of EC cells in the duodenum was twofold higher at baseline in obese subjects than controls (P = 0.023), with twofold more EC cells activated by glucose infusion in the obese (EC cells co-expressing 5-HT and pERK, P = 0.001), while the 5-HT content of EC cells in duodenum and colon was similar; TPH1 expression was 1.4-fold higher in the duodenum of obese subjects (P = 0.044), and related positively to BMI (R2 = 0.310, P = 0.031). Conclusions: Human obesity is characterized by an increased capacity to produce and release 5-HT from the proximal small intestine, which is strongly linked to higher body mass, and glycemic control. Gut-derived 5-HT is likely to be an important driver of pathogenesis in human obesity and dysglycemia Refereed/Peer-reviewed
- Published
- 2018
36. Impact of gastric emptying and small intestinal transit on blood glucose, intestinal hormones, glucose absorption in the morbidly obese
- Author
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Scott Standfield, Michael Horowitz, Judith M. Wishart, Tamara L. Debreceni, Charles-Henri Malbert, Nam Q. Nguyen, Jenna E. Burgess, Max Bellon, Discipline of medicine, University of Adelaide, Adelaide Royal Hospital (ARH), US 1395 ANI-SCAN [INRA], and Institut National de la Recherche Agronomique (INRA)
- Subjects
Blood Glucose ,Male ,[SDV]Life Sciences [q-bio] ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,Medicine (miscellaneous) ,Scintigraphy ,Gastroenterology ,0302 clinical medicine ,incretin hormones ,Intestine, Small ,high-fat ,2. Zero hunger ,Nutrition and Dietetics ,medicine.diagnostic_test ,digestive, oral, and skin physiology ,Middle Aged ,Obesity, Morbid ,Postprandial ,liqutest meal ,Female ,030211 gastroenterology & hepatology ,hormones, hormone substitutes, and hormone antagonists ,weight-loss ,Adult ,medicine.medical_specialty ,bariatric surgery ,Incretin ,030209 endocrinology & metabolism ,Glucagon ,Gastrointestinal Hormones ,03 medical and health sciences ,Internal medicine ,medicine ,Humans ,insulin sensitivity ,Gastrointestinal Transit ,Radionuclide Imaging ,Gastric emptying ,business.industry ,Insulin ,glucagon receptor ,glp-1 secretion ,medicine.disease ,Obesity ,Endocrinology ,Gastric Emptying ,gastrointestinal symptoms ,type-2 diabetes-mellitus ,business ,Hormone - Abstract
International audience; Objective: This study evaluated gastric emptying (GE) and small intestinal (SI) transit in people with morbid obesity and their relationships to glycaemia, incretin hormones, and glucose absorption Methods: GE and caecal arrival time (CAT) of a mixed meal were assessed in 22 morbidly obese (50.2 +/- 2.5 years; 13 F:9 M; BMI: 48.6 +/- 1.8 kg/m(2)) and 10 lean (38.6 +/- 8.4 years; 5 F:5 M; BMI: 23.9 +/- 0.7 kg/m(2)) subjects, using scintigraphy. Blood glucose, plasma 3-O-methylglucose, insulin, glucagon, glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) were measured. Insulin sensitivity and resistance were also quantified Results: When compared with lean subjects, GE (t50: 60.7 +/- 6.5 vs. 41.1 +/- 7.3 min; P = 0.04) and CAT (221.5 +/- 9.8 vs. 148.0 +/- 7.1 min; P = 0.001) of solids were prolonged in morbid obesity. Postprandial rises in GIP (P = 0.001), insulin (P = 0.02), glucose (P = 0.03) and 3-O-methylglucose (P = 0.001) were less. Whereas GLP-1 increased at 45 mins postprandially in lean subjects, there was no increase in the obese (P = 0.04). Both fasting (P = 0.045) and postprandial (P = 0.012) plasma glucagon concentrations were higher in the obese Conclusions: GE and SI transit are slower in the morbidly obese, and associated with reductions in postprandial glucose absorption, and glycaemic excursions, as well as plasma GIP and GLP-1
- Published
- 2018
37. S1 Machine Learning for Classification of Indeterminate Biliary Strictures During Cholangioscopy
- Author
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Hsi-Wei Hsieh, Anthony Yuen Bun Teoh, Takao Itoi, Adam Slivka, Raymond S. Tang, Mahesh K. Goenka, Jong Ho Moon, Jonathan M. Buscaglia, Mouen A. Khashab, Swaroop Vedula, Venkata S. Akshintala, Emily R. Jonica, Thiruvengadam Muniraj, Arvind J. Trindade, Sooraj Tejaswi, Stuart Sherman, Gregory D. Hager, Claudio Zulli, Vicente Pons-Beltrán, Carlos Robles-Medranda, Arthur J. Kaffes, Lionel S. D’Souza, Priya A. Jamidar, Asim Khokhar, Vladimir Kushnir, Payal Saxena, Vivek Kaul, Michael Bejjani, Daniel Szvarca, Amit Maydeo, Tiing Leong Ang, James Y.W. Lau, Amrita Sethi, Christopher J. DiMaio, Rungsun Rerknimitr, Amar Manvar, Bachir Ghandour, Nam Q. Nguyen, and Benjamin L. Bick
- Subjects
medicine.medical_specialty ,Hepatology ,business.industry ,Gastroenterology ,Medicine ,Medical physics ,Indeterminate ,business - Published
- 2021
38. Endoscopic Ultrasound–guided Fine-needle Biopsy With or Without Rapid On-site Evaluation for Diagnosis of Solid Pancreatic Lesions
- Author
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Gianpiero Manes, Francesca Locatelli, Takao Itoi, Mariangela Curatolo, Jeevinesh Naidu, Elisabetta Conte, Gianenrico Rizzatti, Hannah van Malenstein, Gloria Fernández-Esparrach, Rosa Liotta, Michele Amata, Frediano Inzani, Ilaria Tarantino, Armando Gabbrielli, Silvia Carrara, Yukitoshi Matsunami, Angels Ginès, Franca Di Nuovo, Germana de Nucci, Laura Bernardoni, Erminia Manfrin, Elettra Unti, Stefano Francesco Crinò, Vanessa M. Shami, Ivan Borbath, Masayuki Kitano, Lydi M.J.W. van Driel, Roberto Di Mitri, Oriol Sendino, Alberto Larghi, Jan-Werner Poley, Daniel S. Strand, Aldo Scarpa, Mina Komuta, Laura Lamonaca, Karoly Dolapcsiev, Daoud Rahal, Pierre Henri Deprez, Andrew Y. Wang, Francisco Baldaque-Silva, Loredana Correale, Guido Costamagna, Andrew Ruszkiewicz, Keiichi Hatamaru, Schalk Van der Merwe, Nam Q. Nguyen, Masahiro Itonaga, Marianna Signoretti, UCL - SSS/IREC/GAEN - Pôle d'Hépato-gastro-entérologie, UCL - (SLuc) Centre du cancer, UCL - (SLuc) Service de gastro-entérologie, UCL - (SLuc) Unité d'oncologie médicale, and Gastroenterology & Hepatology
- Subjects
0301 basic medicine ,Endoscopic ultrasound ,Male ,medicine.medical_specialty ,Preoperative Sampling ,law.invention ,03 medical and health sciences ,Pancreatic Cancer ,0302 clinical medicine ,Randomized controlled trial ,law ,Predictive Value of Tests ,Endoscopic Ultrasound Tissue Acquisition ,Biopsy ,Clinical endpoint ,medicine ,Humans ,Sampling (medicine) ,Prospective Studies ,Endoscopic Ultrasound-Guided Fine Needle Aspiration ,Rapid On-site Evaluation ,Aged ,Rose (mathematics) ,Hepatology ,medicine.diagnostic_test ,business.industry ,Gastroenterology ,Absolute risk reduction ,Reproducibility of Results ,Middle Aged ,Confidence interval ,Pancreatic Neoplasms ,030104 developmental biology ,Diagnostic Accuracy ,030211 gastroenterology & hepatology ,Female ,Radiology ,business - Abstract
Background and Aims: The benefit of rapid on-site evaluation (ROSE) on the diagnostic accuracy of endoscopic ultrasound–guided fine-needle biopsy (EUS-FNB) has never been evaluated in a randomized study. This trial aimed to test the hypothesis that in solid pancreatic lesions (SPLs), diagnostic accuracy of EUS-FNB without ROSE was not inferior to that of EUS-FNB with ROSE. Methods: A noninferiority study (noninferiority margin, 5%) was conducted at 14 centers in 8 countries. Patients with SPLs requiring tissue sampling were randomly assigned (1:1) to undergo EUS-FNB with or without ROSE using new-generation FNB needles. The touch-imprint cytology technique was used to perform ROSE. The primary endpoint was diagnostic accuracy, and secondary endpoints were safety, tissue core procurement, specimen quality, and sampling procedural time. Results: Eight hundred patients were randomized over an 18-month period, and 771 were analyzed (385 with ROSE and 386 without). Comparable diagnostic accuracies were obtained in both arms (96.4% with ROSE and 97.4% without ROSE, P = .396). Noninferiority of EUS-FNB without ROSE was confirmed with an absolute risk difference of 1.0% (1-sided 90% confidence interval, –1.1% to 3.1%; noninferiority P < .001). Safety and sample quality of histologic specimens were similar in both groups. A significantly higher tissue core rate was obtained by EUS-FNB without ROSE (70.7% vs. 78.0%, P = .021), with a significantly shorter mean sampling procedural time (17.9 ± 8.8 vs 11.7 ± 6.0 minutes, P < .0001). Conclusions: EUS-FNB demonstrated high diagnostic accuracy in evaluating SPLs independently on execution of ROSE. When new-generation FNB needles are used, ROSE should not be routinely recommended. (ClinicalTrial.gov number NCT03322592.)
- Published
- 2021
39. 663 EUS-FNB WITH VERSUS WITHOUT ROSE: INTERIM ANALYSIS OF AN INTERNATIONAL RANDOMIZED NON-INFERIORITY STUDY
- Author
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Pierre Henri Deprez, Takao Itoi, Silvia Carrara, Julio Iglesias-Garcia, Erminia Manfrin, Ilaria Tarantino, Alberto Larghi, Jan-Werner Poley, Aldo Scarpa, Gloria Fernández-Esparrach, Stefano Francesco Crinò, Angel Ginès, Roberto Di Mitri, Germana de Nucci, Armando Gabbrielli, Francisco Baldaque-Silva, Nam Q. Nguyen, Masayuki Kitano, and Vanessa M. Shami
- Subjects
Rose (mathematics) ,medicine.medical_specialty ,Non inferiority ,business.industry ,General surgery ,Gastroenterology ,Medicine ,Radiology, Nuclear Medicine and imaging ,business ,Interim analysis - Published
- 2020
40. Su1315 DIFFERENCES IN THE DIAGNOSTIC YIELD BETWEEN EUS GUIDED FINE NEEDLE ASPIRATION (FNA) AND CORE BIOPSY (FNB) NEEDLES IN THE EVALUATION OF SUBEPITHELIAL LESIONS IN THE UPPER GASTROINTESTINAL TRACT
- Author
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Romina Safaeian, Jeevinesh Naidu, Joshua Zobel, Amanda H. Lim, Nam Q. Nguyen, Andrew Ruszkiewicz, and Vinh-An Phan
- Subjects
medicine.medical_specialty ,Yield (engineering) ,Fine-needle aspiration ,medicine.diagnostic_test ,business.industry ,Gastroenterology ,medicine ,Upper gastrointestinal ,Radiology, Nuclear Medicine and imaging ,Radiology ,business ,Core biopsy - Published
- 2020
41. Sa1302 OUTCOMES OF EUS-DIRECTED UNDERWATER PERORAL ENDOSCOPIC MYOTOMY (UPOEM) FOR ACHALASIA USING A STANDARDIZED PROTOCOL
- Author
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Kenneth F. Binmoeller, Morgan Rigopoulos, Nam Q. Nguyen, Jona C. Bernabe, Chris M. Hamerski, Rabindra R. Watson, and Andrew Nett
- Subjects
Myotomy ,Protocol (science) ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Gastroenterology ,medicine ,Achalasia ,Radiology, Nuclear Medicine and imaging ,medicine.disease ,business ,Surgery - Published
- 2020
42. Occult upper gastrointestinal mucosal abnormalities in critically ill patients
- Author
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Matthew J. Summers, Marianne J. Chapman, Y. Ali Abdelhamid, Nam Q. Nguyen, Christopher K. Rayner, Luke M Weinel, Christopher D. Ovenden, Mark P. Plummer, Adam M. Deane, SP Selvanderan, T. A. Donaldson, and Mark E. Finnis
- Subjects
Adult ,Male ,medicine.medical_specialty ,Critical Illness ,Gastroenterology ,Endoscopy, Gastrointestinal ,03 medical and health sciences ,0302 clinical medicine ,Intestinal mucosa ,Internal medicine ,Esophagitis ,Humans ,Medicine ,Upper gastrointestinal ,030212 general & internal medicine ,Intestinal Mucosa ,Aged ,business.industry ,Critically ill ,Proton Pump Inhibitors ,030208 emergency & critical care medicine ,General Medicine ,Middle Aged ,Occult ,Intensive Care Units ,Anesthesiology and Pain Medicine ,Gastritis ,Critical illness ,Female ,business - Abstract
The objectives of this study were to estimate the frequency of occult upper gastrointestinal abnormalities, presence of gastric acid as a contributing factor, and associations with clinical outcomes.Data were extracted for study participants at a single centre who had an endoscopy performed purely for research purposes and in whom treating physicians were not suspecting gastrointestinal bleeding. Endoscopic data were independently adjudicated by two gastroenterologists who rated the likelihood that observed pathological abnormalities were related to gastric acid secretion using a 3-point ordinal scale (unlikely, possible or probable).Endoscopy reports were extracted for 74 patients [age 52 (37, 65) years] undergoing endoscopy on day 5 [3, 9] of ICU admission. Abnormalities were found in 25 (34%) subjects: gastritis/erosions in 10 (14%), nasogastric tube trauma in 8 (11%), oesophagitis in 4 (5%) and non-bleeding duodenal ulceration in 3 (4%). The contribution of acid secretion to observed pathology was rated 'probable' in six subjects (rater #1) and five subjects (rater #2). Prior to endoscopy, 39 (53%) patients were receiving acid-suppressive therapy. The use of acid-suppressive therapy was not associated with the presence of an endoscopic abnormality (present 15/25 (60%) vs. absent 24/49 (49%); P = 0.46). Haemoglobin concentrations, packed red cells transfused and mortality were not associated with mucosal abnormalities (P = 0.83, P0.9 and P0.9 respectively).Occult mucosal abnormalities were observed in one-third of subjects. The presence of mucosal abnormalities appeared to be independent of prior acid-suppressive therapy and was not associated with reduced haemoglobin concentrations, increased transfusion requirements, or mortality.
- Published
- 2016
43. Psychomotor and cognitive effects of 15-minute inhalation of methoxyflurane in healthy volunteers: implication for post-colonoscopy care
- Author
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Tamara L. Debreceni, Leanne Toscano, Nam Q. Nguyen, and Jenna Burgess
- Subjects
Psychomotor learning ,Original article ,Psychomotor function ,business.industry ,Sedation ,Trail Making Test ,Placebo ,behavioral disciplines and activities ,03 medical and health sciences ,0302 clinical medicine ,Anesthesia ,Methoxyflurane ,Digit symbol substitution test ,Medicine ,lcsh:Diseases of the digestive system. Gastroenterology ,030211 gastroenterology & hepatology ,Pharmacology (medical) ,030212 general & internal medicine ,Effects of sleep deprivation on cognitive performance ,lcsh:RC799-869 ,medicine.symptom ,business ,medicine.drug - Abstract
Background and study aims: Colonoscopy with portal inhaled methoxyflurane (Penthrox) is highly feasible with low sedation risk and allows earlier discharge. It is unclear if subjects can return to highly skilled psychomotor skill task shortly after Penthrox assisted colonoscopy. We evaluated the psychomotor and cognitive effects of 15-minute inhalation of Penthrox in adults. Patients and methods: Sixty healthy volunteers (18 to 80 years) were studied on 2 occasions with either Penthrox or placebo in a randomized, double-blind fashion. On each occasion, the subject’s psychomotor function was examined before, immediately, 30, 60, 120, 180 and 240 min after a 15-minute inhalation of studied drug, using validated psychomotor tests (Digit Symbol Substitution Test (DSST), auditory reaction time (ART), eye-hand coordination (EHC) test, trail making test (TMT) and logical reasoning test (LRT). Results: Compared to placebo, a 15-minute Penthrox inhalation led to an immediate but small impairment of DSST (P
- Published
- 2016
44. Correction: Cholangioscopy-guided lithotripsy for difficult bile duct stone clearance in a single session of ERCP: results from a large multinational registry demonstrate high success rates
- Author
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Amit P, Maydeo, Rungsun, Rerknimitr, James Y, Lau, Abdulrahman, Aljebreen, Saad K, Niaz, Takao, Itoi, Tiing Leong, Ang, Jörg, Reichenberger, Dong Wan, Seo, Mohan K, Ramchandani, Benedict M, Devereaux, Jong Kyun, Lee, Mahesh K, Goenka, Randhir, Sud, Nam Q, Nguyen, Rakesh, Kochhar, Joyce, Peetermans, Pooja G, Goswamy, Matthew, Rousseau, Surya Prakash, Bhandari, Phonthep, Angsuwatcharakon, Raymond S Y, Tang, Anthony Y B, Teoh, Majid, Almadi, Yun Nah, Lee, and Jong Ho, Moon
- Subjects
Gastroenterology - Published
- 2019
45. The effect of camicinal (GSK962040), a motilin agonist, on gastric emptying and glucose absorption in feed-intolerant critically ill patients: a randomized, blinded, placebo-controlled, clinical trial
- Author
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Nam Q. Nguyen, S. O’Connor, Matthew E. Barton, Robert J. Fraser, Duncan Richards, George E. Dukes, Adam M. Deane, Lakshmi Vasist Johnson, Marianne J. Chapman, and Kimberley Hacquoil
- Subjects
Adult ,Male ,medicine.medical_specialty ,Metoclopramide ,Critical Illness ,Gastric emptying ,Placebo ,Critical Care and Intensive Care Medicine ,Enteral administration ,Gastroenterology ,Piperazines ,Absorption ,Motilin ,Feeding and Eating Disorders ,Placebos ,03 medical and health sciences ,Enteral Nutrition ,0302 clinical medicine ,Double-Blind Method ,Piperidines ,Internal medicine ,South Australia ,medicine ,Humans ,Motilin agonist ,Prospective Studies ,Gastroparesis ,Aged ,Aged, 80 and over ,Gastric Absorption ,Breath test ,medicine.diagnostic_test ,business.industry ,Research ,030208 emergency & critical care medicine ,Middle Aged ,medicine.disease ,Intensive Care Units ,Glucose ,Endocrinology ,Camicinal ,Female ,030211 gastroenterology & hepatology ,Gastrointestinal Motility ,business ,medicine.drug - Abstract
Background The promotility agents currently available to treat gastroparesis and feed intolerance in the critically ill are limited by adverse effects. The aim of this study was to assess the pharmacodynamic effects and pharmacokinetics of single doses of the novel gastric promotility agent motilin agonist camicinal (GSK962040) in critically ill feed-intolerant patients. Methods A prospective, randomized, double-blind, parallel-group, placebo-controlled, study was performed in mechanically ventilated feed-intolerant patients [median age 55 (19–84), 73% male, APACHE II score 18 (5–37) with a gastric residual volume ≥200mL]. Gastric emptying and glucose absorption were measured both pre- and post-treatment after intragastric administration of 50mg (n = 15) camicinal and placebo (n = 8) using the13C-octanoic acid breath test (BTt1/2), acetaminophen concentrations, and 3-O-methylglucose concentrations respectively. Results Following 50mg enteral camicinal, there was a trend to accelerated gastric emptying [adjusted geometric means: pre-treatment BTt1/2117minutes vs. post- treatment 76minutes; 95% confidence intervals (CI; 0.39, 1.08) and increased glucose absorption (AUC240minpre-treatment: 28.63mmol.min/L vs. post-treatment: 71.63mmol.min/L; 95% CI (1.68, 3.72)]. When two patients who did not have detectable plasma concentrations of camicinal were excluded from analysis, camicinal accelerated gastric emptying (adjusted geometric means: pre-treatment BTt1/2121minutes vs. post-treatment 65minutes 95 % CI (0.32, 0.91) and increased glucose absorption (AUC240minpre-treatment: 33.04mmol.min/L vs. post-treatment: 74.59mmol.min/L; 95 % CI (1.478, 3.449). In those patients receiving placebo gastric emptying was similar pre- and post-treatment. Conclusions When absorbed, a single enteral dose of camicinal (50mg) accelerates gastric emptying and increases glucose absorption in feed-intolerant critically ill patients. Trial registration The study protocol was registered with the US NIH clinicaltrials.gov on 23 December 2009 (IdentifierNCT01039805).
- Published
- 2019
46. Sugar Responses of Human Enterochromaffin Cells Depend on Gut Region, Sex, and Body Mass
- Author
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David Wattchow, Nam Q. Nguyen, Steven L. Due, Amanda L. Lumsden, Alice P. Liou, Nicole J. Isaacs, Christopher K. Rayner, Philippa Rabbitt, Dayan de Fontgalland, Richard L. Young, Paul Hollington, Luigi Sposato, Nektaria Pezos, V. Margaret Jackson, Gudrun Schober, Alyce M. Martin, Damien J. Keating, Emily W. Sun, Lumsden, Amanda L, Martin, Alyce M, Sun, Emily W, Schober, Gudrun, Isaacs, Nicole J, Pezos, Nektaria, Wattchow, David A, de Fontgalland, Dayan, Rabbitt, Philippa, Hollington, Paul, Sposato, Luigi, Due, Steven L, Rayner, Christopher K, Nguyen, Nam Q, Liou, Alice P, Jackson, V Margaret, Young, Richard L, and Keating, Damien J
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Male ,0301 basic medicine ,medicine.medical_specialty ,obesity ,Sucrose ,Carbohydrates ,Gastric motility ,5-HT ,lcsh:TX341-641 ,duodenum ,Article ,5-hydroxytryptamine ,enterochromaffin ,03 medical and health sciences ,chemistry.chemical_compound ,Sex Factors ,0302 clinical medicine ,Internal medicine ,Enterochromaffin Cells ,medicine ,Humans ,glucose ,Cells, Cultured ,Nutrition and Dietetics ,Dose-Response Relationship, Drug ,Gastric emptying ,colon ,Body Weight ,Fructose ,Small intestine ,serotonin ,Gastrointestinal Tract ,030104 developmental biology ,medicine.anatomical_structure ,Endocrinology ,chemistry ,Duodenum ,Enterochromaffin cell ,Female ,lcsh:Nutrition. Foods and food supply ,Thermogenesis ,030217 neurology & neurosurgery ,Food Science - Abstract
Gut-derived serotonin (5-HT) is released from enterochromaffin (EC) cells in response to nutrient cues, and acts to slow gastric emptying and modulate gastric motility. Rodent studies also evidence a role for gut-derived 5-HT in the control of hepatic glucose production, lipolysis and thermogenesis, and in mediating diet-induced obesity. EC cell number and 5-HT content is increased in the small intestine of obese rodents and human, however, it is unknown whether EC cells respond directly to glucose in humans, and whether their capacity to release 5-HT is perturbed in obesity. We therefore investigated 5-HT release from human duodenal and colonic EC cells in response to glucose, sucrose, fructose and &alpha, glucoside (&alpha, MG) in relation to body mass index (BMI). EC cells released 5-HT only in response to 100 and 300 mM glucose (duodenum) and 300 mM glucose (colon), independently of osmolarity. Duodenal, but not colonic, EC cells also released 5-HT in response to sucrose and &alpha, MG, but did not respond to fructose. 5-HT content was similar in all EC cells in males, and colonic EC cells in females, but 3 to 4-fold higher in duodenal EC cells from overweight females (p <, 0.05 compared to lean, obese). Glucose-evoked 5-HT release was 3-fold higher in the duodenum of overweight females (p <, 0.05, compared to obese), but absent here in overweight males. Our data demonstrate that primary human EC cells respond directly to dietary glucose cues, with regional differences in selectivity for other sugars. Augmented glucose-evoked 5-HT release from duodenal EC is a feature of overweight females, and may be an early determinant of obesity.
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- 2019
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47. A multicenter randomized trial comparing a 25-gauge EUS fine-needle aspiration device with a 20-gauge EUS fine-needle biopsy device
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Erwan Bories, Andrew Ruszkiewicz, Erez Scapa, Masayuki Kitano, Flora Poizat, Carlos Fernández Moro, Erwin Santo, Takaaki Chikugo, Guido Rindi, Jonathan M. Buscaglia, M C Petrone, Djuna L. Cahen, Marco J. Bruno, Fabia Attili, Harry R. Aslanian, Adebowale J. Adeniran, Priscilla A. van Riet, Maoxin Wu, Francisco Baldaque-Silva, Silvia Marmor, Julio Iglesias-Garcia, Claudio Doglioni, Nam Q. Nguyen, Paolo Giorgio Arcidiacono, Schalk Van der Merwe, Nicole S. Erler, Marie E. Robert, Ihab Abdulkader, Tania Roskams, Juan Carlos Bucobo, Alan Heimann, Katharina Biermann, Marc Giovannini, John G. Lee, Fritz Lin, Alberto Larghi, Jan-Werner Poley, Kenneth J. Chang, James J. Farrell, van Riet, Pa, Larghi, A, Attili, F, Rindi, G, Nguyen, Nq, Ruszkiewicz, A, Kitano, M, Chikugo, T, Aslanian, H, Farrell, J, Robert, M, Adeniran, A, Van Der Merwe, S, Roskams, T, Chang, K, Lin, F, Lee, Jg, Arcidiacono, P. G., Petrone, M, Doglioni, C, Iglesias-Garcia, J, Abdulkader, I, Giovannini, M, Bories, E, Poizat, F, Santo, E, Scapa, E, Marmor, S, Bucobo, Jc, Buscaglia, Jm, Heimann, A, Wu, M, Baldaque-Silva, F, Moro, Cf, Erler, N, Biermann, K, Poley, Jw, Cahen, Dl, Bruno, Mj., Gastroenterology & Hepatology, Epidemiology, and Pathology
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Image-Guided Biopsy ,Male ,medicine.medical_specialty ,Lymphoma ,Gastrointestinal Stromal Tumors ,Lymphadenopathy ,Adenocarcinoma ,Malignancy ,Sensitivity and Specificity ,Endosonography ,Fine needle biopsy ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Pancreatitis, Chronic ,Intestinal Neoplasms ,Biopsy ,Odds Ratio ,Clinical endpoint ,medicine ,Carcinoma ,Humans ,Radiology, Nuclear Medicine and imaging ,Endoscopic Ultrasound-Guided Fine Needle Aspiration ,Aged ,medicine.diagnostic_test ,business.industry ,Gastroenterology ,Middle Aged ,medicine.disease ,Pancreatic Neoplasms ,Clinical trial ,Neuroendocrine Tumors ,Fine-needle aspiration ,Needles ,Lymphatic Metastasis ,030220 oncology & carcinogenesis ,Multivariate Analysis ,Carcinoma, Squamous Cell ,Female ,030211 gastroenterology & hepatology ,Biopsy, Large-Core Needle ,Radiology ,business - Abstract
Several studies have compared EUS-guided FNA with fine-needle biopsy (FNB), but none have proven superiority. We performed a multicenter randomized controlled trial to compare the performance of a commonly used 25-gauge FNA needle with a newly designed 20-gauge FNB needle.Consecutive patients with a solid lesion were randomized in this international multicenter study between a 25-gauge FNA (EchoTip Ultra) or a 20-gauge FNB needle (ProCore). The primary endpoint was diagnostic accuracy for malignancy and the Bethesda classification (non-diagnostic, benign, atypical, malignant). Technical success, safety, and sample quality were also assessed. Multivariable and supplementary analyses were performed to adjust for confounders.A total of 608 patients were allocated to FNA (n = 306) or FNB (n = 302); 312 pancreatic lesions (51%), 147 lymph nodes (24%), and 149 other lesions (25%). Technical success rate was 100% for the 25-gauge FNA and 99% for the 20-gauge FNB needle (P = .043), with no differences in adverse events. The 20-gauge FNB needle outperformed 25-gauge FNA in terms of histologic yield (77% vs 44%, P .001), accuracy for malignancy (87% vs 78%, P = .002) and Bethesda classification (82% vs 72%, P = .002). This was robust when corrected for indication, lesion size, number of passes, and presence of an on-site pathologist (odds ratio, 3.53; 95% confidence interval, 1.55-8.56; P = .004), and did not differ among centers (P = .836).The 20-gauge FNB needle outperformed the 25-gauge FNA needle in terms of histologic yield and diagnostic accuracy. This benefit was irrespective of the indication and was consistent among participating centers, supporting the general applicability of our findings. (Clinical trial registration number: NCT02167074.).
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- 2019
48. Endoscopy and Upper Gastrointestinal Disorders
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Nam Q. Nguyen and Marie Ooi
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Gastrointestinal tract ,Gastrointestinal bleeding ,medicine.medical_specialty ,Endoscopic retrograde cholangiopancreatography ,medicine.diagnostic_test ,Bile duct ,business.industry ,General surgery ,Endoscopic management ,Upper gastrointestinal disorders ,medicine.disease ,Endoscopy ,medicine.anatomical_structure ,Forrest classification ,medicine ,business - Abstract
Few would have predicted the revolution in clinical practice than began with the development of flexible endoscopy approximately 50 years ago. Procedures that facilitated the diagnosis of various gastrointestinal disorders have been progressively upgraded to include endoscopic therapy for gastrointestinal bleeding, endoscopic sphincterotomy for bile duct stones and various stents for benign and malignant strictures of the biliary system and gastrointestinal tract. Most general surgeons will be competent at upper gastrointestinal endoscopy and the endoscopic management of gastrointestinal bleeding. Only a minority will feel competent at endoscopic retrograde cholangiopancreatography [ERCP] or stent insertion, but these procedures can be performed by experienced endoscopists in tertiary centres with high success rates and few complications.
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- 2019
49. EUS-FNB with or without on-site evaluation for the diagnosis of solid pancreatic lesions (FROSENOR): Protocol for a multicenter randomized non-inferiority trial
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Nam Q. Nguyen, Masayuki Kitano, Francisco Baldaque-Silva, Takao Itoi, Pierre Henri Deprez, Jan Werner Poley, Stefano Francesco Crinò, Ilaria Tarantino, Angel Ginès, Roberto Di Mitri, Silvia Carrara, Vanessa M. Shami, Julio Iglesias-Garcia, Ermina Manfrin, Germana de Nucci, Alberto Larghi, Aldo Scarpa, and Gastroenterology & Hepatology
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Endoscopic ultrasound ,medicine.medical_specialty ,Randomization ,Equivalence Trials as Topic ,Diagnostic accuracy ,Surgical pathology ,03 medical and health sciences ,0302 clinical medicine ,Pancreatic cancer ,medicine ,Humans ,Multicenter Studies as Topic ,Sampling (medicine) ,Endoscopic Ultrasound-Guided Fine Needle Aspiration ,Pancreas ,Hepatology ,medicine.diagnostic_test ,business.industry ,Gastroenterology ,Reproducibility of Results ,Gold standard (test) ,medicine.disease ,digestive system diseases ,Pancreatic Neoplasms ,Fine-needle aspiration ,Logistic Models ,Sample size determination ,Needles ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Radiology ,business - Abstract
Background Rapid on-site evaluation (ROSE) of cytological specimensacquired with EUS-guided fine needle aspiration (EUS-FNA) represents the most accurate available technique to reach a definitive diagnosis in patients with pancreatic solid masses. Recently, needles with high histological yield have been developed for EUS-guided fine needle biopsy (EUS-FNB), with which the need for ROSE can be potentially overcome. Aims The primary aim is to compare the diagnostic accuracy of EUS-FNB with or without ROSE. The main endpoint will be measured against the gold standard diagnosis (surgical pathology whenever available or diagnostic work-up in agreement with a clinical course of at least six months). Secondary endpoints include: (a) safety; (b) presence of tissue core; (c) quality of specimens; (d) time of the sampling procedure. Reliability of macroscopic on-site evaluation (MOSE) by endosonographers will be also assessed. Methods FROSENOR is an international randomized non-inferiority ongoing study at sixteen centers in four continents. Eight hundred patients will be randomized in two arms (EUS-FNB + ROSE vs. EUS-FNB alone) and outcomes compared. Sample size has been calculated in order to demonstrate the non-inferiority of FNB alone. Randomization and data collection will be performed online. Discussion This study will ascertain if ROSE is still needed when performing EUS-FNB of solid pancreatic lesions.
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- 2019
50. Contributors
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James L. Achord, Michelle J. Alfa, Mohammad Al-Haddad, Andrea Anderloni, Joseph C. Anderson, Anna Baiges, John Baillie, Alan N. Barkun, Todd H. Baron, Omer Basar, Mark Benson, Lyz Bezerra Silva, Stas Bezobchuk, Kenneth F. Binmoeller, Sarah Blankstein, Daniel Blero, Michael J. Bourke, William R. Brugge, Marco J. Bruno, Anna M. Buchner, Andrés Cárdenas, David Carr-Locke, Kenneth Chang, Saurabh Chawla, John O. Clarke, Jonathan Cohen, Andrew P. Copland, Guido Costamagna, Peter B. Cotton, Amit P. Desai, Jacques Devière, Christopher J. DiMaio, Peter Draganov, Jérôme Dumortier, Jeffrey J. Easler, Gary W. Falk, Francis A. Farraye, Andrew Feld, Kayla Feld, Paul Fockens, Evan L. Fogel, Kyle J. Fortinsky, Martin L. Freeman, Juan Carlos, Hans Gerdes, Joanna A. Gibson, Gregory G. Ginsberg, Marc Giovannini, Ian M. Gralnek, Frank G. Gress, Robert H. Hawes, Virginia Hernández-Gea, Ikuo Hirano, Juergen Hochberger, Douglas A. Howell, Chin Hur, Joo Ha Hwang, Maite Betés Ibáñez, Takao Itoi, Prasad G. Iyer, David A. Johnson, Sreeni Jonnalagadda, Charles J. Kahi, Tonya Kaltenbach, Leila Kia, Michael B. Kimmey, Amir Klein, Michael L. Kochman, Divyanshoo R. Kohli, Andrew Korman, Wilson T. Kwong, Ryan Law, David A. Leiman, Anne Marie Lennon, Michael Levy, David Lichtenstein, Gary R. Lichtenstein, Alisa Likhitsup, Jimmy K. Limdi, Gianluca Lollo, Fauze Maluf-Filho, Jennifer Maranki, Richard W. McCallum, Stephen A. McClave, Klaus Mergener, David C. Metz, Volker Meves, Marcia L. Morris, Daniel K. Mullady, Miguel Muñoz-Navas, V. Raman Muthusamy, Zaheer Nabi, Andrew Nett, Nam Q. Nguyen, Nicholas Nickl, Satoru Nonaka, Ichiro Oda, Robert D. Odze, Edward C. Oldfield, Parth J. Parekh, Patrick R. Pfau, Mathieu Pioche, Heiko Pohl, Thierry Ponchon, Robert J. Ponec, Michael W. Rajala, Nageshwar Reddy, Alessandro Repici, Jérôme Rivory, Marvin Ryou, Yutaka Saito, Jason B. Samarasena, Thomas J. Savides, Mark Schoeman, Allison R. Schulman, Amrita Sethi, Pari M. Shah, Stuart Sherman, Uzma D. Siddiqui, Vikesh K. Singh, Roy Soetikno, Stavros N. Stavropoulos, Tyler Stevens, Christina Surawicz, Barry Tanner, Paul Tarnasky, Christopher C. Thompson, Mark Topazian, George Triadafilopoulos, Emo E. van Halsema, Jeanin E. van Hooft, John Joseph Vargo, Kavel Visrodia, Vaibhav Wadhwa, Kristian Wall, Catharine M. Walsh, Andrew Y. Wang, Kenneth K. Wang, Sachin Wani, C. Mel Wilcox, Field F. Willingham, Patrick S. Yachimski, and Ricardo Zorron
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- 2019
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