145 results on '"Peter P. Stanich"'
Search Results
2. Multiple colorectal adenomas in Lynch syndrome
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Ayushi Jain, Maryam Alimirah, Heather Hampel, Rachel Pearlman, Jianing Ma, Jing Peng, Matthew F. Kalady, and Peter P. Stanich
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lynch syndrome ,adenomas ,colon cancer ,multiple adenomas ,Lynch ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
BackgroundLynch syndrome has not traditionally been considered to have a high colorectal adenoma burden. However, with increasing adenoma detection rates in the general population, the incidence of adenoma detection in Lynch syndrome may also be increasing and leading to higher cumulative adenoma counts.AimTo clarify the prevalence and clinical impact of multiple colorectal adenomas (MCRA) in Lynch syndrome.MethodsA retrospective review of patients with Lynch syndrome at our institution was performed to assess for MCRA (defined as ≥10 cumulative adenomas).ResultsThere were 222 patients with Lynch syndrome among whom 14 (6.3%) met MCRA criteria. These patients had increased incidence of advanced neoplasia (OR 10, 95% CI: 2.7-66.7).ConclusionsMCRA is not unusual in Lynch syndrome and is associated with a significantly increased likelihood of advanced colon neoplasia. Consideration should be given to differentiating colonoscopy intervals based on the presence of polyposis in Lynch syndrome.
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- 2022
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3. Yield of upper gastrointestinal screening in colonic adenomatous polyposis of unknown etiology: a multicenter study
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Filsan Farah, Swati G. Patel, Jeannine M. Espinoza, Nicholas Jensen, Bryson W. Katona, Charles Muller, Sonia S. Kupfer, Jennifer M. Weiss, Alice Hinton, and Peter P. Stanich
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background and study aims The majority of patients with 10 or more cumulative colorectal adenomas have uninformative genetic testing and meet criteria for colonic adenomatous polyposis of unknown etiology (CPUE). The yield of upper gastrointestinal screening in patients with CPUE after multi-gene panel testing is unknown and our objective was to characterize this. Patient and methods A multicenter, retrospective analysis of screening upper endoscopies in adults with CPUE after multi-gene panel testing was performed. Those with a history of gastroduodenal neoplasia prior to CPUE diagnosis were excluded. Demographic and clinical variables were collected and compared. Results One hundred and twenty-eight patients with CPUE were included from five participating centers. Nine (7.0 %) had gastroduodenal neoplasia on initial screening upper endoscopy. Those with over 100 colorectal adenomas had a significantly higher rate of gastroduodenal neoplasia than those with 20–99 or 10–19 colorectal adenomas (44.4 % vs 4.1 % vs 4.4 %, P = 0.002). Similar results were seen when the analysis was restricted to only duodenal or ampullary adenomas. The only malignancy was a gastric cancer in a patient with 20 to 99 colorectal adenomas. When comparing patients with gastroduodenal neoplasia to those without, the only significantly different characteristic was the cumulative number of colorectal adenomas. Conclusions We found a 7 % rate of gastroduodenal neoplasia in patients with CPUE after multi-gene panel testing. Although patients with ≥ 100 colorectal adenomas had a significantly higher risk, over 4 % of patients with 10 to 99 colorectal adenomas had gastroduodenal neoplasia. Given this, we recommend a screening upper endoscopy at the time of a colonoscopy after CPUE diagnosis.
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- 2022
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4. Multicenter case series of patients with small-bowel angiodysplasias treated with a small-bowel radiofrequency ablation catheter
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Luis F. Lara, MD, Rogelio Silva, MD, Shyam Thakkar, MD, Peter P. Stanich, MD, Daniel Mai, MD, and Jason B. Samarasena, MD
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background and Aims: GI angiodysplasia is the most common cause of small-bowel bleeding. Argon plasma coagulation (APC) is preferred for ablation because of its availability, ease of use, and perceived safety, but it has limitations. An instrument capable of repeated use through the enteroscope, which covers more area of intestinal mucosa per treatment with low risk of damage to healthy mucosa, and which improves ablation, is desirable. A series of patients treated with a through-the-scope radiofrequency ablation (RFA) catheter is reported. Methods: Patients with a previous diagnosis of small-bowel angiodysplasia (SBA) and ongoing bleeding with melena, hematochezia, or iron-deficiency anemia were eligible for treatment. A small-bowel radiofrequency ablation (SBRFA) catheter was passed through the enteroscope instrument channel. The treatment paddle was pushed against the SBA, achieving coaptive coagulation, and the SBA was treated up to 2 times at standard settings of 10 J/cm2. The patients’ demographics, pretreatment and posttreatment hemoglobin levels, time to recurrence of bleeding, and need for more therapy were recorded. This study was approved by the institutional review boards of the respective institutions. Results: Twenty consecutive patients were treated from March until October 2018 and followed up until March 2019. There were 6 women (average age 68 years, standard deviation ± 11.1), and 14 men (average age 73 years, standard deviation ± 10.4). All had undergone at least 1 previous EGD and colonoscopy; 14 patients (70%) had SBA on video capsule endoscopy, and 14 patients had undergone previous endoscopic treatment of SBA with APC. A median of 23 treatments were applied (range, 2-99). The median follow-up time was 195 days (range, 30-240 days). Four patients, including 3 with a left ventricular assist device (LVAD), had recurrent bleeding between 45 and 210 days after treatment, and 2 patients received repeated blood transfusions. Three of those patients underwent repeated endoscopies, including a push enteroscopy and an upper endoscopy with no treatment, and a repeated enteroscopy with SBA treated with APC, respectively. One patient with LVAD underwent arterial embolization. Conclusions: In this case series, bleeding recurred in 20% of patients in a follow-up time of ≤240 days. Notably, 3 of the 4 patients who had recurrent bleeding had an LVAD. These rates compare favorably with reported bleeding recurrence after APC of SBA. More studies on the benefits of SBRFA, which may include reduced risk of recurrent bleeding or prolonging the time to recurrent bleeding, resource utilization, and factors associated with bleeding recurrence are needed.
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- 2020
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5. Intraductal Papillary Mucinous Neoplasms in Hereditary Cancer Syndromes
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Devarshi R. Ardeshna, Shiva Rangwani, Troy Cao, Timothy M. Pawlik, Peter P. Stanich, and Somashekar G. Krishna
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intraductal papillary mucinous neoplasms ,hereditary intraductal papillary mucinous neoplasms ,hereditary cancer syndromes ,pancreatic ductal adenocarcinoma ,familial pancreatic cancer ,pancreatic cancer screening ,Biology (General) ,QH301-705.5 - Abstract
Hereditary pancreatic cancer, which includes patients with familial pancreatic cancer (FPC) and hereditary pancreatic cancer syndromes, accounts for about 10% of all pancreatic cancer diagnoses. The early detection of pre-cancerous pancreatic cysts has increasingly become a focus of interest in recent years as a potential avenue to lower pancreatic cancer incidence and mortality. Intraductal papillary mucinous cystic neoplasms (IPMNs) are recognized precursor lesions of pancreatic cancer. IPMNs have high prevalence in patients with hereditary pancreatic cancer and their relatives. While various somatic mutations have been identified in IPMNs, certain germline mutations associated with hereditary cancer syndromes have also been identified in IPMNs, suggesting a role in their formation. While the significance for the higher prevalence of IPMNs or similar germline mutations in these high-risk patients remain unclear, IPMNs do represent pre-malignant lesions that need close surveillance. This review summarizes the available literature on the incidence and prevalence of IPMNs in inherited genetic predisposition syndromes and FPC and speculates if IPMN and pancreatic cancer surveillance in these high-risk individuals needs to change.
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- 2022
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6. Physical activity during video capsule endoscopy correlates with shorter bowel transit time
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Peter P. Stanich, Joshua Peck, Christopher Murphy, Kyle M. Porter, and Marty M. Meyer
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background and study aim Video capsule endoscopy (VCE) is limited by reliance on bowel motility for propulsion, and lack of physical activity has been proposed as a cause of incomplete studies. Our aim was to prospectively investigate the association between physical activity and VCE bowel transit. Patients and methods Ambulatory outpatients receiving VCE were eligible for the study. A pedometer was attached at the time of VCE ingestion and step count was recorded at the end of the procedure. VCE completion was assessed by logistic regression models, which included step count (500 steps as one unit). Total transit time was analyzed by Cox proportional hazards models. The hazard ratios (HR) with 95 % confidence interval (CI) indicated the “hazard” of completion, such that HRs > 1 indicated a reduced transit time. Results A total of 100 patients were included. VCE was completed in 93 patients (93 %). The median step count was 2782 steps. Step count was not significantly associated with VCE completion (odds ratio 1.45, 95 %CI 0.84, 2.49). Pedometer step count was significantly associated with shorter total, gastric, and small-bowel transit times (HR 1.09, 95 %CI 1.03, 1.16; HR 1.05, 95 %CI 1.00, 1.11; HR 1.07, 95 %CI 1.01, 1.14, respectively). Higher body mass index (BMI) was significantly associated with VCE completion (HR 1.87, 95 %CI 1.18, 2.97) and shorter bowel transit times (HR 1.05, 95 %CI 1.02, 1.08). Conclusions Increased physical activity during outpatient VCE was associated with shorter bowel transit times but not with study completion. In addition, BMI was a previously unreported clinical characteristic associated with VCE completion and should be included as a variable of interest in future studies.
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- 2017
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7. Video capsule endoscopy completion and total transit times are similar with oral or endoscopic delivery
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Peter P. Stanich, John Guido, Bryan Kleinman, Kavita Betkerur, Kyle M. Porter, and Marty M. Meyer
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background and study aims: Video capsule endoscopy (VCE) is limited by incomplete procedures. There are also contraindications to the standard ingestion of the capsule that require endoscopic placement. Our aim was to compare the study completion rate of VCE after oral ingestion and endoscopic deployment. Patients and methods: We performed a review of all VCE from April 2010 through March 2013. Inpatient and outpatient cohorts grouped by the method of capsule delivery were formed and compared. Multivariable logistic regression modeling was utilized adjusting for variables with a P value ≤ 0.1 in group comparisons. Log-rank analysis was used to compare transit times. Results: A total of 687 VCE were performed, including 316 inpatient (36 endoscopic deployment, 280 oral ingestion) and 371 outpatient (20 endoscopic deployment, 351 oral ingestion). For VCE on hospitalized patients, the completion rates were similar after endoscopic deployment and oral ingestion (72 % vs 73 %, P = 0.94). The completion rates were also similar for ambulatory patients (90 % vs 87 %, P = 0.69). There remained no difference after multivariable modeling for inpatients (P = 0.71) and outpatients (P = 0.46). Total transit times were not significantly different. Conclusions: VCE completion rates and total transit times are similar after oral or endoscopic deployment for both hospitalized and ambulatory patients. Endoscopic placement is effective in patients with contraindications to standard oral ingestion, but should otherwise be avoided to limit unnecessary procedural risks and costs.
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- 2016
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8. Mismatch repair protein status of non-neoplastic uterine and intestinal mucosa in patients with Lynch syndrome and double somatic mismatch repair protein mutations
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C. Eric Freitag, Wei Chen, Rachel Pearlman, Heather Hampel, Peter P. Stanich, Casey M. Cosgrove, Eric Q. Konnick, Colin C. Pritchard, and Wendy L. Frankel
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Pathology and Forensic Medicine - Published
- 2023
9. Endoscopic Surveillance in Patients with the Highest Risk of Gastric Cancer: Challenges and Solutions
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Jessica M Long, Jessica Ebrahimzadeh, Peter P Stanich, and Bryson W Katona
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Oncology - Abstract
Gastric cancer is one of the most significant causes of cancer-related morbidity and mortality worldwide. Recognized modifiable risk factors include
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- 2022
10. Rising Rates of Severe Obesity in Adults Younger Than 50 Correspond to Rise in Hospitalizations for Non-malignant Gastrointestinal Disease
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Arsheya Patel, Somashekar G. Krishna, Kishan Patel, Darrell M. Gray, Khalid Mumtaz, Peter P. Stanich, Alice Hinton, and Hisham Hussan
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Physiology ,Gastroenterology - Abstract
Colorectal cancer incidence is rising in adults 50 years old, possibly due to obesity. Non-malignant colorectal conditions are understudied in this population. We hypothesize that developing severe obesity in young adulthood also corresponds with increased hospitalization rates for non-malignant colorectal conditions.We examined annual percent change (APC) in the prevalence of obesity in adults 50 using the 2009-2014 National Health and Nutrition Examination Survey. Using the 2010-2014 Nationwide Readmission Database, we then compared yearly hospitalization trends for various gastrointestinal conditions and their outcomes in adults 50 with severe obesity vs. no obesity.The prevalence of obesity increased in adults 50 years in 2009-2014. This increase was most pronounced for severe obesity (APC of + 12.8%). The rate of patients with severe obesity 50 who were admitted for gastrointestinal diseases has increased by 7.76% per year in 2010-2014 (p 0.001). This increase was 10% per year for colorectal conditions such Clostridium difficile infections (APC + 17.3%, p = 0.002), inflammatory bowel disease (APC + 13.1%, p = 0.001), and diverticulitis (APC + 12.7%, p = 0.002). The hospitalization rate for chronic liver diseases and acute pancreatitis also increased by 12.2% and 10.0% per year, respectively (p 0.01). In contrast, young adults without obesity had lower hospitalization rate for most gastrointestinal diseases. Furthermore, adults with no obesity had lower mortality rates for appendicitis, diverticulitis, pancreatitis and chronic liver diseases than adults with severe obesity.Our data suggest that increased adiposity in young adults is associated with more hospitalization and worse outcomes for infectious/inflammatory gastrointestinal conditions. Future prevention strategies are warranted to ameliorate these trends.
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- 2022
11. Colorectal Neoplasia in CDH1 Pathogenic Variant Carriers: A Multicenter Analysis
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Peter P. Stanich, Dareen Elgindi, Elena Stoffel, Erika Koeppe, Ajay Bansal, Rachel Stetson, Debra L. Collins, Dana Farengo Clark, Eve Karloski, Beth Dudley, Randall E. Brand, Michael J. Hall, Yana Chertock, Brian A. Sullivan, Charles Muller, Alice Hinton, Bryson W. Katona, and Sonia S. Kupfer
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Hepatology ,Antigens, CD ,Gastroenterology ,Humans ,Female ,Breast Neoplasms ,Colonoscopy ,Middle Aged ,Colorectal Neoplasms ,Cadherins ,Germ-Line Mutation ,Retrospective Studies - Abstract
Germline variants in CDH1 are associated with elevated risks of diffuse gastric cancer and lobular breast cancer. It is uncertain whether there is an increased risk of colorectal neoplasia.This was a retrospective analysis of colonoscopy outcomes in patients with germline CDH1 pathogenic/likely pathogenic variants.Eighty-five patients were included with a mean age of 46.9 years. Initial colonoscopy found adenomatous polyps in 30 patients (35.3%), including advanced adenomas in 9 (10.6%). No colorectal cancers were identified on index or subsequent colonoscopies (when available).CDH1 carriers have colorectal neoplasia identified at similar rates as in the general population. Despite potential difficulties after gastrectomy, colorectal cancer screening remains important in this population.
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- 2022
12. Endoscopic Management and Surgical Considerations for Familial Adenomatous Polyposis
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Matthew F. Kalady, Alex C. Kim, Peter P. Stanich, and Brian Sullivan
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medicine.medical_specialty ,Duodenum ,Adenomatous polyposis coli ,medicine.medical_treatment ,Colonoscopy ,Endoscopic management ,Malignancy ,Familial adenomatous polyposis ,Stomach Neoplasms ,Humans ,Medicine ,Child ,Colectomy ,Duodenal Neoplasm ,medicine.diagnostic_test ,biology ,business.industry ,General surgery ,Gastroenterology ,Endoscopy ,medicine.disease ,digestive system diseases ,Adenomatous Polyposis Coli ,Upper tract ,biology.protein ,business - Abstract
Familial adenomatous polyposis (FAP) is the development of many adenomatous colorectal polyps. Colonoscopy is recommended to start at age 10 to 12 years at intervals of 1 to 2 years. Colectomy is clearly indicated for malignancy or significant colorectal symptoms. After colectomy, endoscopic surveillance is still critical. Duodenal and gastric polyposis is also found in almost all patients with FAP. Screening with upper endoscopy and ampullary visualization is recommended, generally determined by age and staging of duodenal polyposis, but guidelines are increasingly factoring in ampullary and gastric manifestations. Surgical management of malignancy or advanced upper tract manifestations is needed.
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- 2022
13. Prospective Statewide Study of Universal Screening for Hereditary Colorectal Cancer: The Ohio Colorectal Cancer Prevention Initiative
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Brian H. Shirts, Peter G. Shields, Dan Jones, Lori Nelsen, Sameer Mahesh, Jo L. Freudenheim, Shyamal Bastola, Kisa Weeman, Yinong Liu, Electra D. Paskett, Esther H. Rehmus, Matthew F. Kalady, Wendy L. Frankel, Jeffrey Zangmeister, Paul J. Goodfellow, Brandie Heald, Christopher Bigley, Mitchell Haut, Shelly Cummings, Kristin Miller, Mark Arnold, Sharon Cole, Chaoyang Li, Albert de la Chapelle, Ian M. Paquette, Weiqiang Zhao, Rachel Pearlman, Ahmet Yilmaz, Filix Kencana, Heather Hampel, Peter P. Stanich, Albert Malcolm, Thomas W. Prior, Richard M. Goldberg, Joanna M. Brell, David J Draper, Aruna Gowda, Jason Bacher, Charles Bane, Ilene Lattimer, Angela Jacobson, Colin C. Pritchard, and Benjamin Swanson
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Adult ,Male ,0301 basic medicine ,Oncology ,Cancer Research ,medicine.medical_specialty ,Colorectal cancer ,MEDLINE ,03 medical and health sciences ,0302 clinical medicine ,Neoplastic Syndromes, Hereditary ,Internal medicine ,medicine ,Humans ,Prospective Studies ,Early Detection of Cancer ,Aged ,Ohio ,Aged, 80 and over ,business.industry ,Colorectal Cancer Prevention ,Cancer ,ORIGINAL REPORTS ,Middle Aged ,medicine.disease ,digestive system diseases ,030104 developmental biology ,030220 oncology & carcinogenesis ,Female ,Colorectal Neoplasms ,business - Abstract
PURPOSE Hereditary cancer syndromes infer high cancer risks and require intensive surveillance. Identification of high-risk individuals among patients with colorectal cancer (CRC) needs improvement. METHODS Three thousand three hundred ten unselected adults who underwent surgical resection for primary invasive CRC were prospectively accrued from 51 hospitals across Ohio between January 1, 2013, and December 31, 2016. Universal Tumor screening (UTS) for mismatch repair (MMR) deficiency was performed for all, and pathogenic germline variants (PGVs) were identified using multigene panel testing (MGPT) in those who met at least one inclusion criterion: MMR deficiency, diagnosed < 50 years, multiple primary tumors (CRC or endometrial cancer), or with a first-degree relative with CRC or endometrial cancer. RESULTS Five hundred twenty-five patients (15.9%) had MMR deficiency. Two hundred thirty-four of 3,310 (7.1%; 16% of the 1,462 who received MGPT) had 248 PGVs in cancer susceptibility genes. One hundred forty-two (4.3%) had a PGV in an MMR gene, and 101 (3.1%) had a PGV in a non-MMR gene. Ten with Lynch syndrome (LS) also had a non-MMR PGV and were included in both groups. Two (0.06%) had constitutional MLH1 hypermethylation. Of unexplained MMR-deficient patients, 88.4% (76 of 86) had double somatic MMR mutations. Testing for only MMR genes in MMR-deficient patients would have missed 18 non-MMR gene PGVs (7.3% of total PGVs identified). Had UTS been the only method used to screen for hereditary cancer syndromes, 38.6% (91 of 236) would have been missed, including 6.3% (9 of 144) of those with LS. These results have treatment implications as 5.3% (175 of 3,310) had PGVs in genes with therapeutic targets. CONCLUSION UTS alone is insufficient for identifying a large proportion of CRC patients with hereditary syndromes, including some with LS. At a minimum, 7.1% of individuals with CRC have a PGV and pan-cancer MGPT should be considered for all patients with CRC.
- Published
- 2021
14. Cystic Fibrosis Transmembrane Conductance Regulator Modulator Use Is Associated With Reduced Pancreatitis Hospitalizations in Patients With Cystic Fibrosis
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Peter P. Stanich, Phil A. Hart, Georgios I. Papachristou, Yevgeniya Gokun, Luis F. Lara, Kyle Porter, Darwin L. Conwell, Somashekar G. Krishna, Michael R. Wellner, Stephen Kirkby, Mitchell L. Ramsey, Susan S Li, and Lindsay A. Sobotka
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Adult ,Male ,Subset Analysis ,medicine.medical_specialty ,Adolescent ,Cystic Fibrosis ,Cystic Fibrosis Transmembrane Conductance Regulator ,Rate ratio ,Cystic fibrosis ,Gastroenterology ,Article ,Young Adult ,Internal medicine ,medicine ,Humans ,Prospective Studies ,Child ,Prospective cohort study ,Pancreas enzyme ,Cross-Over Studies ,Hepatology ,biology ,business.industry ,Incidence ,Infant, Newborn ,Infant ,medicine.disease ,United States ,Cystic fibrosis transmembrane conductance regulator ,Hospitalization ,Pancreatitis ,Child, Preschool ,biology.protein ,Acute pancreatitis ,Female ,business - Abstract
Introduction Acute pancreatitis (AP) occurs among patients with pancreas-sufficient cystic fibrosis (PS-CF) but is reportedly less common among patients with pancreas-insufficient cystic fibrosis (PI-CF). The incidence of AP may be influenced by cystic fibrosis transmembrane conductance regulator (CFTR) modulator use. We hypothesized that CFTR modulators would reduce AP hospitalizations, with the greatest benefit in PS-CF. Methods MarketScan (2012-2018) was queried for AP hospitalizations and CFTR modulator use among patients with CF. Multivariable Poisson models that enabled crossover between CFTR modulator treatment groups were used to analyze the rate of AP hospitalizations on and off therapy. Pancreas insufficiency was defined by the use of pancreas enzyme replacement therapy. Results A total of 10,417 patients with CF were identified, including 1,795 who received a CFTR modulator. AP was more common in PS-CF than PI-CF (2.9% vs 0.9%, P = 0.007). Overall, the observed rate ratio of AP during CFTR modulator use was 0.33 (95% confidence interval [CI] 0.10, 1.11, P = 0.07) for PS-CF and 0.38 (95% CI 0.16, 0.89, P = 0.03) for PI-CF, indicating a 67% and 62% relative reduction in AP hospitalizations, respectively. In a subset analysis of 1,795 patients who all had some CFTR modulator use, the rate ratio of AP during CFTR modulator use was 0.36 (95% CI 0.13, 1.01, P = 0.05) for PS-CF and 0.53 (95% CI 0.18, 1.58, P = 0.26) for PI-CF. Discussion CFTR modulator use is associated with a reduction in AP hospitalizations among patients with CF. These observational data support the prospective study of CFTR modulators to reduce AP hospitalizations among patients with CF.
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- 2021
15. Outcomes of inpatient cholecystectomy among adults with cystic fibrosis in the United States
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Stephen Kirkby, Peter P. Stanich, Susan S Li, Michael P. Meara, Mitchell L. Ramsey, Alice Hinton, Darwin L. Conwell, Somashekar G. Krishna, and Lindsay A. Sobotka
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medicine.medical_specialty ,education.field_of_study ,business.industry ,Patient demographics ,medicine.medical_treatment ,Population ,medicine.disease ,Symptomatic biliary disorders ,Cystic fibrosis ,Laparoscopic cholecystectomy ,Hospital outcomes ,Nationwide Inpatient Sample ,Retrospective Study ,Internal medicine ,medicine ,Length of stay ,Cholecystectomy ,In patient ,Mortality ,business ,education ,Resource utilization - Abstract
BACKGROUND Symptomatic biliary and gallbladder disorders are common in adults with cystic fibrosis (CF) and the prevalence may rise with increasing CF transmembrane conductance regulator modulator use. Cholecystectomy may be considered, but the outcomes of cholecystectomy are not well described among modern patients with CF. AIM To determine the risk profile of inpatient cholecystectomy in patients with CF. METHODS The Nationwide Inpatient Sample was queried from 2002 until 2014 to investigate outcomes of cholecystectomy among hospitalized adults with CF compared to controls without CF. A propensity weighted sample was selected that closely matched patient demographics, patient's individual comorbidities, and hospital characteristics. The propensity weighted sample was used to compare outcomes among patients who underwent laparoscopic cholecystectomy. Hospital outcomes of open and laparoscopic cholecystectomy were compared among adults with CF. RESULTS A total of 1239 inpatient cholecystectomies were performed in patients with CF, of which 78.6% were performed laparoscopically. Mortality was < 0.81%, similar to those without CF (P = 0.719). In the propensity weighted analysis of laparoscopic cholecystectomy, there was no difference in mortality, or pulmonary or surgical complications between patients with CF and controls. After adjusting for significant covariates among patients with CF, open cholecystectomy was independently associated with a 4.8 d longer length of stay (P = 0.018) and an $18449 increase in hospital costs (P = 0.005) compared to laparoscopic cholecystectomy. CONCLUSION Patients with CF have a very low mortality after cholecystectomy that is similar to the general population. Among patients with CF, laparoscopic approach reduces resource utilization and minimizes post-operative complications.
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- 2021
16. Predictors of Early Readmissions in Hospitalized Patients With Gastroparesis: A Nationwide Analysis
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Ravi Pavurala, Peter P. Stanich, Gokulakrishnan Balasubramanian, Alice Hinton, Praveen Guturu, Darwin L. Conwell, and Somashekar G. Krishna
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medicine.medical_specialty ,Gastroparesis ,business.industry ,medicine.medical_treatment ,Diabetes ,Gastroenterology ,Odds ratio ,medicine.disease ,Confidence interval ,Patients readmission ,Diabetes mellitus ,Gastrointestinal disorder ,Internal medicine ,Percutaneous endoscopic gastrostomy ,medicine ,Etiology ,Original Article ,Neurology (clinical) ,business ,Prospective cohort study - Abstract
Background/aims Gastroparesis is a chronic gastrointestinal disorder that frequently presents with symptoms that are difficult to manage, necessitating frequent hospitalizations. We sought to determine the predictors of early readmission due to gastroparesis based on etiology. Methods We identified all adults discharged with a principal diagnosis of gastroparesis after hospitalization from the 2014 Nationwide Readmission Database. We compared etiology wise (diabetes, post-surgical, and idiopathic) early readmission. Multivariate regression analyses were performed to identify significant predictors of 30-day readmission. Results A total of 12 689 patients were identified, 30.7% diabetic, 2.6% post-surgical, and 66.7% were idiopathic. Patients with diabetic gastroparesis were more likely to be readmitted within 30 days than idiopathic (adjusted odds ratio [aOR], 0.81; 95% confidence interval [CI], 0.69-0.94) and post-surgical gastroparesis (aOR, 0.58; 95% CI, 0.34-0.98). Pyloroplasty was associated with less likelihood of 30-day readmission (aOR, 0.45; 95% CI, 0.20-0.97). In addition, male gender (aOR, 1.18; 95% CI, 1.02-1.37), modified Elixhauser comorbidity score ≥ 3 (aOR, 1.38; 95% CI, 1.18-1.61), chronic pain syndrome (aOR, 1.41; 95% CI, 1.11-1.78), younger (18-64 years) age (aOR, 1.64; 95% CI, 1.34-2.00), need for percutaneous endoscopic gastrostomy/jejunostomy tube (aOR, 2.06; 95% CI, 1.21-3.52), and need for total parenteral nutrition (aOR, 1.70; 95% CI, 1.24-2.35) were associated with increased risk of 30-day readmission. Conclusion s One in 5 patients was readmitted with gastroparesis within 30 days. In the diabetic group, diabetes-related complications contributed to readmissions than gastroparesis. Pyloroplasty is associated with reduced early hospital readmission. Prospective studies are needed for validation of these results.
- Published
- 2021
17. Postoperative Hospital Outcomes of Elective Surgery for Nonmalignant Colorectal Polyps: Does the Burden Justify the Indication?
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Hisham Hussan, Darrell M. Gray, Andrew J. Kruger, Kyle Porter, Somashekar G. Krishna, Gottumukkala S. Raju, Peter P. Stanich, and Alice Hinton
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,Databases, Factual ,MEDLINE ,Colonic Polyps ,Young Adult ,Postoperative Complications ,Risk Factors ,Humans ,Medicine ,Postoperative Period ,Elective surgery ,Aged ,Aged, 80 and over ,Hepatology ,medicine.diagnostic_test ,business.industry ,Mortality rate ,General surgery ,Gastroenterology ,Odds ratio ,Middle Aged ,Confidence interval ,Endoscopy ,Treatment Outcome ,Increased risk ,Hospital outcomes ,Elective Surgical Procedures ,Female ,business - Abstract
Introduction Despite the increasing availability of advanced endoscopic resections and its favorable safety profile, surgery for nonmalignant colorectal polyps has continually increased. We sought to evaluate readmission rates and outcomes of elective surgery for nonmalignant colorectal polyps on a national level in the United States. Methods The Nationwide Readmissions Database (2010-2014 [International Classification of Diseases, Ninth Revision] and 2016-2018 [International Classification of Diseases, 10th Revision]) was used to identify all adult subjects (age ≥18 years) who underwent elective surgical resection of nonmalignant colorectal polyps. Multivariable analyses were performed for predictors of postoperative morbidity and 30-day readmission. Results Elective surgery for nonmalignant colorectal polyps was performed in 108,468 subjects from 2010 to 2014 and in 54,956 subjects from 2016 to 2018, most of whom were laparoscopic. Postoperative morbidity and 30-day readmission rates were 20.5% and 8.5% from 2010 to 2014, and 13.0% and 7.6% from 2016 to 2018, respectively. Index admission mortality rates were 0.3-0.4%; mortality rates were higher in those with postoperative morbidity. Multivariable analyses revealed that male sex, ≥3 comorbidities, insurance status, and open surgery predicted an increased risk of both postoperative morbidity and 30-day readmission. In addition, postoperative morbidity (2010-2014 [odds ratio 1.58; 95% confidence interval 1.44-1.74] and 2016-2018 [odds ratio 1.55; 95% confidence interval 1.37-1.75]) predicted early readmission. Discussion In this investigation of national practices, elective surgery for nonmalignant colorectal polyps remains common. There is considerable risk of adverse postoperative outcomes, which highlights the importance of increasing awareness of the range of endoscopic resections and referring subjects to expert endoscopy centers.
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- 2021
18. Hereditary Colorectal Cancer
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Heather Hampel, Matthew F. Kalady, Rachel Pearlman, and Peter P. Stanich
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Oncology ,Adenomatous Polyposis Coli ,Neoplastic Syndromes, Hereditary ,Humans ,Hematology ,Colorectal Neoplasms ,Colorectal Neoplasms, Hereditary Nonpolyposis - Abstract
Around 10% to 16% of colorectal cancer patients have a pathogenic variant in a cancer susceptibility gene. Some of these variants are in cancer genes that are associated with colorectal cancer while others are not. The hereditary colorectal cancer syndromes can be divided into two major categories, the nonpolyposis and the polyposis conditions. The nonpolyposis conditions can be divided into those that lead to colorectal tumors with defective mismatch repair and those that do not. The polyposis conditions are further divided by predominant histology into the adenomatous, hamartomatous, serrated, and mixed polyposis conditions. All of these conditions are described in detail herein.
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- 2022
19. Universal tumor screening for lynch syndrome on colorectal cancer biopsies impacts surgical treatment decisions
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Jennifer Vazzano, Jewel Tomlinson, Peter P. Stanich, Rachel Pearlman, Matthew F. Kalady, Wei Chen, Heather Hampel, and Wendy L. Frankel
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Cancer Research ,Oncology ,Genetics ,Genetics (clinical) - Abstract
Universal tumor screening (UTS) for Lynch syndrome (LS) on colorectal cancer (CRC) can be performed on biopsies or resection specimens. The advantage of biopsies is the chance to provide preoperative genetic counseling/testing (GC/T) so patients diagnosed with LS can make informed decisions regarding resection extent. We evaluated utilization of UTS on biopsies, percentage of patients with deficient mismatch repair (dMMR) who underwent GC/T preoperatively, and whether surgical/treatment decisions were impacted. We performed a retrospective review of medical records to assess CRC cases with dMMR immunohistochemical staining from 1/1/2017 to 2/26/2021. 1144 CRC patients had UTS using MMR immunohistochemistry; 559 biopsies (48.9%) and 585 resections (51.1%). The main reason UTS was not performed on biopsy was it occurred outside our health system. 58 (5%) of CRCs were dMMR and did not have MLH1 promoter hypermethylation (if MLH1 and PMS2 absent). 28/58 (48.3%) of dMMR cases were diagnosed on biopsy. Of those 28, 14 (50%) eventually underwent GC/T, and 7 (25%) had GT results prior to surgery. One of the 7 had incomplete documentation of results affecting their treatment plan. Of the remaining 6 with complete documentation, 5 underwent surgery and one was treated with immunotherapy only. Three patients elected a more extensive surgery. 6/28 (21.4%) dMMR patients identified on biopsy made an informed surgical/treatment decision based on their dMMR status/LS diagnosis. When applied, UTS on biopsy followed by genetic counseling and testing informs surgical decision-making. Process and implementation strategies are in place to overcome challenges to more broadly optimize this approach.
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- 2022
20. Clinical Management of Oligopolyposis of Unknown Etiology
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Bryson W. Katona, Jacquelyn Powers, Jessica M. Long, and Peter P. Stanich
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medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Gastroenterology ,Colonoscopy ,medicine.disease ,Familial adenomatous polyposis ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,medicine ,Etiology ,Upper gastrointestinal ,030211 gastroenterology & hepatology ,Intensive care medicine ,business ,Cancer risk ,Genetic testing - Abstract
Cancer risk management for adenomatous oligopolyposis (10–99 colonic adenomas) depends upon whether the oligopolyposis results from a defined hereditary syndrome. Herein, we summarize genetic testing strategies for evaluation of oligopolyposis and outline colonoscopy and extra-colonic surveillance for individuals without a detectable hereditary syndrome, who have a condition referred to as oligopolyposis of unknown etiology (OPUE). Multi-gene panel genetic testing is appropriate for individuals with 10 or more cumulative colonic adenomas, yet a significant proportion of these individuals lack a molecular diagnosis and are defined clinically as having OPUE. Current consensus guidelines for OPUE surveillance support colonoscopy every 1–2 years with consideration of surgery if polyp clearance cannot be achieved. Data regarding extra-colonic surveillance is scant; however, screening of the upper gastrointestinal tract, thyroid, and small bowel may be considered on an individualized basis, similar to current clinical practices for familial adenomatous polyposis, despite a lack of strong supporting evidence. Multi-gene panel genetic testing should be recommended for all individuals with colonic oligopolyposis. Management of OPUE, especially extra-colonic surveillance, remains a challenging area of practice. It is crucial for individuals with OPUE to maintain contact with a specialized gastrointestinal genetics program, as genetic testing capabilities and medical recommendations will continue to evolve.
- Published
- 2021
21. Hospital outcomes and early readmission for the most common gastrointestinal and liver diseases in the United States: Implications for healthcare delivery
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Brandon K. Chu, Darwin L. Conwell, Hisham Hussan, Somashekar G. Krishna, Peter P. Stanich, Alice Hinton, Alecia Blaszczak, Khalid Mumtaz, and Gokulakrishnan Balasubramanian
- Subjects
medicine.medical_specialty ,business.industry ,Cost ,Thirty-day readmission ,Nationwide readmission database ,Outcomes ,medicine.disease ,Gastrointestinal disease ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Healthcare delivery ,Hospital outcomes ,Retrospective Study ,030220 oncology & carcinogenesis ,medicine ,030211 gastroenterology & hepatology ,Mortality ,business ,Intensive care medicine - Abstract
BACKGROUND Gastrointestinal (GI) and liver diseases contribute to substantial inpatient morbidity, mortality, and healthcare resource utilization. Finding ways to reduce the economic burden of healthcare costs and the impact of these diseases is of crucial importance. Thirty-day readmission rates and related hospital outcomes can serve as objective measures to assess the impact of and provide further insights into the most common GI ailments. AIM To identify the thirty-day readmission rates with related predictors and outcomes of hospitalization of the most common GI and liver diseases in the United States. METHODS A cross-sectional analysis of the 2012 National Inpatient Sample was performed to identify the 13 most common GI diseases. The 2013 Nationwide Readmission Database was then queried with specific International Classification of Diseases, Ninth Revision, Clinical Modification codes. Primary outcomes were mortality (index admission, calendar-year), hospitalization costs, and thirty-day readmission and secondary outcomes were predictors of thirty-day readmission. RESULTS For the year 2013, the thirteen most common GI diseases contributed to 2.4 million index hospitalizations accounting for about $25 billion. The thirty-day readmission rates were highest for chronic liver disease (25.4%), Clostridium difficile (C. difficile) infection (23.6%), functional/motility disorders (18.5%), inflammatory bowel disease (16.3%), and GI bleeding (15.5%). The highest index and subsequent calendar-year hospitalization mortality rates were chronic liver disease (6.1% and 12.6%), C. difficile infection (2.3% and 6.1%), and GI bleeding (2.2% and 5.0%), respectively. Thirty-day readmission correlated with any subsequent admission mortality (r = 0.798, P = 0.001). Medicare/Medicaid insurances, ≥ 3 Elixhauser comorbidities, and length of stay > 3 d were significantly associated with thirty-day readmission for all the thirteen GI diseases. CONCLUSION Preventable and non-chronic GI disease contributed to a significant economic and health burden comparable to chronic GI conditions, providing a window of opportunity for improving healthcare delivery in reducing its burden.
- Published
- 2021
22. Double somatic mismatch repair gene pathogenic variants as common as Lynch syndrome among endometrial cancer patients
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Adrian A. Suarez, Albert de la Chapelle, Weiqiang Zhao, Colin C. Pritchard, David E. Cohn, Paul J. Goodfellow, Ritu Salani, Larry J. Copeland, Ahmet Yilmaz, Joseph P. McElroy, David M. O'Malley, Floor J. Backes, Heather Hampel, Dan Jones, Casey Cosgrove, Jeffrey M. Fowler, Wei Chen, Rachel Pearlman, Peter P. Stanich, and Wendy L. Frankel
- Subjects
Adult ,0301 basic medicine ,Oncology ,congenital, hereditary, and neonatal diseases and abnormalities ,medicine.medical_specialty ,MLH1 ,DNA Mismatch Repair ,Article ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,PMS2 ,medicine ,Humans ,neoplasms ,Germ-Line Mutation ,Aged ,Neoplasm Staging ,Aged, 80 and over ,business.industry ,Endometrial cancer ,nutritional and metabolic diseases ,Obstetrics and Gynecology ,Microsatellite instability ,Cancer ,DNA Methylation ,Middle Aged ,medicine.disease ,Colorectal Neoplasms, Hereditary Nonpolyposis ,digestive system diseases ,Lynch syndrome ,Endometrial Neoplasms ,MSH6 ,030104 developmental biology ,MSH2 ,030220 oncology & carcinogenesis ,Female ,MutL Protein Homolog 1 ,business - Abstract
Objective Lynch syndrome is the most common cause of inherited endometrial cancer, attributable to germline pathogenic variants (PV) in mismatch repair (MMR) genes. Tumor microsatellite instability (MSI-high) and MMR IHC abnormalities are characteristics of Lynch syndrome. Double somatic MMR gene PV also cause MSI-high endometrial cancers. The aim of this study was to determine the relative frequency of Lynch syndrome and double somatic MMR PV. Methods 341 endometrial cancer patients enrolled in the Ohio Colorectal Cancer Prevention Initiative at The Ohio State University Comprehensive Cancer Center from 1/1/13–12/31/16. All tumors underwent immunohistochemical (IHC) staining for the four MMR proteins, MSI testing, and MLH1 methylation testing if the tumor was MMR-deficient (dMMR). Germline genetic testing for Lynch syndrome was undertaken for all cases with dMMR tumors lacking MLH1 methylation. Tumor sequencing followed if a germline MMR gene PV was not identified. Results Twenty-seven percent (91/341) of tumors were either MSI-high or had abnormal IHC indicating dMMR. As expected, most dMMR tumors had MLH1 methylation; (69, 75.8% of the dMMR cases; 20.2% of total). Among the 22 (6.5%) cases with dMMR not explained by methylation, 10 (2.9% of total) were found to have Lynch syndrome (6 MSH6, 3 MSH2, 1 PMS2). Double somatic MMR PV accounted for the remaining 12 dMMR cases (3.5% of total). Conclusions Since double somatic MMR gene PV are as common as Lynch syndrome among endometrial cancer patients, paired tumor and germline testing for patients with non-methylated dMMR tumor may be the most efficient approach for LS screening.
- Published
- 2021
23. Confocal Laser Endomicroscopy Interpretation and Differentiation of Pancreatic Cysts: A Randomized Trial of Teaching Modalities
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Arsheya Patel, Srikanth Vedachalam, Kenneth D. Allen, Jennifer Behzadi, Anand Patel, Megan Q. Chan, Mitchell L. Ramsey, Sheryl Pfeil, Anjuli K. Luthra, Hisham Hussan, J. Royce Groce, Dana Lee, Alecia Blaszczak, Sagar Patel, Filsan Farah, Somashekar G. Krishna, Peter P. Stanich, Emmanuel Ugbarugba, Sebastian Strobel, Antoinette Pusateri, and Kyle Porter
- Subjects
Endoscopic ultrasound ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Gastroenterology ,medicine.disease ,law.invention ,Clinical trial ,Fine-needle aspiration ,Randomized controlled trial ,law ,medicine ,Endomicroscopy ,Radiology, Nuclear Medicine and imaging ,Radiology ,Stage (cooking) ,Pancreatic cysts ,business ,Kappa - Abstract
Background EUS-guided needle-based confocal laser endomicroscopy (nCLE) has not been widely adopted for the differentiation of pancreatic cystic lesions (PCLs), perhaps due to a perceived difficulty in learning novel CLE image patterns. Hence, we sought to investigate the optimal teaching modality for interpretation of nCLE imaging from PCLs. Methods Sixteen nCLE-naive observers blinded to clinical data were randomized into didactic (classroom-based) versus self-directed (computer-based) teaching groups to review nCLE videos and differentiate mucinous and non-mucinous PCLs. The study was conducted concurrently for both groups in 3 phases. Phase-1-Teaching: both groups received an overview of EUS-nCLE of PCLs. Phase-2-Training: assessment of 20 EUS-nCLE subject-videos; the didactic group had a feedback session with an nCLE expert while the self-directed group received this information via pre-recorded presentation. Phase-3-Testing: assessment of 50 EUS-nCLE subject-videos. Results For all observers (n = 16), the diagnostic accuracy for nCLE-based differentiation of mucinous from non-mucinous PCLs was higher (p=0.005) in the Phase-3-Testing (94.6%, 95%CI: 92-96%) than in Phase-2-Training (89.9%, 95%CI: 85-93%). During Phase-3-Testing, both the didactic and self-directed teaching groups achieved a comparable (p=0.48) diagnostic accuracy of 93.9% and 95.4%, respectively. The interobserver agreement (kappa, standard error) for the differentiation of mucinous from non-mucinous PCLs improved from Phase-2-Training to Phase-3-Testing stage, and was “substantial” for both the didactic (k=0.81, 0.03) and self-directed (k=0.79, 0.03) training groups. Conclusion Notwithstanding didactic and self-directed teaching, a ‘training’ and ‘test’ strategy accomplished high diagnostic accuracies and considerable interobserver agreement among naive observers for EUS-nCLE image differentiation of PCLs; Clinical trial NCT02516488 ( https://clinicaltrials.gov/ct2/show/NCT02516488 )
- Published
- 2021
24. NCCN Guidelines Insights: Colorectal Cancer Screening, Version 2.2020
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Robert J. Mayer, Folasade P. May, Kathryn M. Glaser, Jennifer M. Weiss, Lillias H. Maguire, Reid M. Ness, Shivan J. Mehta, Swati G. Patel, Rishi Jain, Priyanka Kanth, Amy L. Halverson, Trilokesh D. Kidambi, Dayna S. Early, Mark Friedman, Ndiya Ogba, Francis M. Giardiello, Mary A. Dwyer, Audrey J. Lazenby, Arnold J. Markowitz, Gregory S. Cooper, Xavier Llor, Shajan Peter, Jennifer Keller, Jonathan P. Terdiman, Rachel B. Issaka, Peter P. Stanich, Dawn Provenzale, Suryakanth R. Gurudu, and Benjamin Abbadessa
- Subjects
Oncology ,Average risk ,medicine.medical_specialty ,Modalities ,Genetic syndromes ,Colorectal cancer ,business.industry ,MEDLINE ,Context (language use) ,medicine.disease ,digestive system diseases ,03 medical and health sciences ,0302 clinical medicine ,Increased risk ,Colorectal cancer screening ,030220 oncology & carcinogenesis ,Internal medicine ,medicine ,030212 general & internal medicine ,business - Abstract
The NCCN Guidelines for Colorectal Cancer (CRC) Screening describe various colorectal screening modalities as well as recommended screening schedules for patients at average or increased risk of developing sporadic CRC. They are intended to aid physicians with clinical decision-making regarding CRC screening for patients without defined genetic syndromes. These NCCN Guidelines Insights focus on select recent updates to the NCCN Guidelines, including a section on primary and secondary CRC prevention, and provide context for the panel’s recommendations regarding the age to initiate screening in average risk individuals and follow-up for low-risk adenomas.
- Published
- 2020
25. International Delphi consensus guidelines for follow-up after prophylactic total gastrectomy: the Life after Prophylactic Total Gastrectomy (LAP-TG) study
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Geoffrey, Roberts, Patrick R, Benusiglio, Tanya, Bisseling, Daniel, Coit, Jeremy L, Davis, Sam, Grimes, Theresa A, Guise, Richard, Hardwick, Kirsty, Harris, Paul Furman, Mansfield, Jeremy, Rossaak, Karen Chelcun, Schreiber, Peter P, Stanich, Vivian E, Strong, Pardeep, Kaurah, and Sam, Yoon
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Cancer Research ,Delphi Technique ,Gastroenterology ,General Medicine ,Cadherins ,Oncology ,Stomach Neoplasms ,Gastrectomy ,Tumours of the digestive tract Radboud Institute for Molecular Life Sciences [Radboudumc 14] ,Humans ,Genetic Predisposition to Disease ,Micronutrients ,Germ-Line Mutation ,Follow-Up Studies - Abstract
Item does not contain fulltext BACKGROUND: Prophylactic total gastrectomy (PTG) remains the only means of preventing gastric cancer for people with genetic mutations predisposing to Hereditary Diffuse Gastric Cancer (HDGC), mainly in the CDH1 gene. The small but growing cohort of people undergoing PTG at a young age are expected to have a life-expectancy close to the general population, however, knowledge of the long-term effects of, and monitoring requirements after, PTG is limited. This study aims to define the standard of care for follow-up after PTG. METHODS: Through a combination of literature review and two-round Delphi consensus of major HDGC/PTG units and physicians, and patient advocates, we produced a set of recommendations for follow-up after PTG. RESULTS: There were 42 first round, and 62 second round, responses from clinicians, allied health professionals and patient advocates. The guidelines include recommendations for timing of assessments and specialties involved in providing follow-up, micronutrient supplementation and monitoring, bone health and the provision of written information. CONCLUSION: While the evidence supporting the guidelines is limited, expert consensus provides a framework to best manage people following PTG, and could support the collection of information on the long-term effects of PTG. 01 november 2022
- Published
- 2022
26. Mainstreaming germline genetic testing for patients with pancreatic cancer increases uptake
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Mitchell L. Ramsey, Jewel Tomlinson, Rachel Pearlman, Laith Abushahin, Amber Aeilts, Hui-Zi Chen, Yan Chen, Ashley Compton, Rifat Elkhatib, Levi Geiger, John Hays, Joanne Jeter, Ning Jin, Pannaga Malalur, Sameek Roychowdhury, Jessica Ruple, Jennifer Prebish, Peter P. Stanich, and Heather Hampel
- Subjects
Cancer Research ,Oncology ,Genetics ,Genetics (clinical) - Abstract
Germline genetic testing is recommended for all patients with pancreatic cancer (PC) but uptake rates are low. We implemented a mainstreaming program in oncology clinics to increase testing for PC patients. Genetic counselors trained oncology providers to offer a standardized multigene panel and obtain informed consent using an educational video. Pre-test genetic counseling was available upon request. Otherwise, patients with identified pathogenic variants, strong family history, or questions regarding their results were referred for post-test genetic counseling. We measured rates of testing and genetic counseling visits. From September 2019 to April 2021, 245 patients with PC underwent genetic testing. This represents a 6.5-fold increase in germline testing volume (95% confidence interval 5.2-8.1) compared to previous years. At least one pathogenic or likely pathogenic variant (PV/LPV) was found in 34 (13.9%) patients, including 17 (6.9%) PV/LPVs in high or moderate risk genes and 18 (7.3%) in low risk or recessive genes. Five (2.0%) PVs had implications on treatment selection. 22 of the positive patients (64.7%) and an additional 8 PC patients (1 negative, 3 VUS, and 4 pre-test) underwent genetic counseling during the study period. Genetic counselors saw 2.0 PC patients/month prior to this project, 1.6 PC patients/month during this project, and would have seen 2.2 PC patients/month if all patients with pathogenic variants attended post-test counseling. Conclusions Mainstreaming genetic testing expands access for PC patients without overwhelming genetic counseling resources.
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- 2022
27. A High Percentage of Early-age Onset Colorectal Cancer Is Potentially Preventable
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Keith R. Pelstring, Rachel Pearlman, Peter P. Stanich, and Heather Hampel
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Adult ,Male ,Oncology ,medicine.medical_specialty ,Colorectal cancer ,MEDLINE ,Risk Assessment ,Article ,Young Adult ,Predictive Value of Tests ,Risk Factors ,Internal medicine ,medicine ,Humans ,Genetic Predisposition to Disease ,Prospective Studies ,Age of Onset ,First-degree relatives ,Early Detection of Cancer ,Hepatology ,business.industry ,Gastroenterology ,Colonoscopy ,Middle Aged ,Protective Factors ,medicine.disease ,Female ,Colorectal Neoplasms ,business - Published
- 2021
28. Characterization of Novel Injectable Lifting Agents Used in Colonic Polyp Removal
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Maryam Kherad Pezhouh, Maryam Shirazi, Lysandra Voltaggio, Christina A. Arnold, David A. Cohen, Lawrence J. Burgart, Schuyler O. Sanderson, Peter P. Stanich, Yue Xue, Danielle Hutchings, Ellen D. Willhoit, Christopher J. VandenBussche, and Kenrry Chiu
- Subjects
Male ,Pathology ,medicine.medical_specialty ,medicine.medical_treatment ,Colonic Polyps ,Poloxamer ,Pathology and Forensic Medicine ,03 medical and health sciences ,0302 clinical medicine ,Tubular adenoma ,Submucosa ,Tubulovillous adenoma ,medicine ,Humans ,Digestive System Surgical Procedures ,business.industry ,Histology ,Amyloidosis ,Middle Aged ,medicine.disease ,Polypectomy ,Colon polyps ,Basophilic ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Female ,030211 gastroenterology & hepatology ,Surgery ,Anatomy ,business ,Sessile serrated adenoma - Abstract
Colon polypectomy can require an injection of a submucosal lifting agent to fully visualize and completely remove the polyp. To the best of our knowledge, this is the largest morphologic series on the novel lifting agents Eleview and Orise. The study consisted of 1 polypectomy and 8 colon resections from 9 patients: 6 women, 3 men (mean age=64 y); Orise=6, Eleview=3; the median time interval between injection and resection=16 weeks. Pathologic diagnoses of the polyps included tubular adenoma (n=4), tubulovillous adenoma (n=4), and sessile serrated adenoma/polyp (n=1). We report that a histologically processed Orise aliquot from the manufacturer showed similar histology to that seen in the specimens from patients with confirmed Orise injection. The morphology of the agents in the patient specimens changed with time status postinjection: immediate resection of the lifting agent showed basophilic, amorphous, and bubbly-extracellular material with prominent hemorrhage, and resection ∼3 months after lifting agent injection showed prominent hyalinized, pink-amorphous ribbons and globules with a foreign body giant cell reaction and fibrosis. The epicenter of the lifting agents was in the submucosa, and the agents were neither refractile nor polarizable. Because of the morphologic overlap with amyloid, 5 cases were stained with Congo Red, and all cases were negative. In conclusion, awareness of the morphology of these new lifting agents is important for accurate diagnosis and to avoid the diagnostic pitfall of amyloid. These lesions can be definitively distinguished from amyloid by their nonreactivity on a Congo Red and familiarity with their characteristic clinicopathologic presentation.
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- 2020
29. Diverticulitis in Morbidly Obese Adults: A Rise in Hospitalizations with Worse Outcomes According to National US Data
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Steven K. Clinton, Darwin L. Conwell, Somashekar G. Krishna, Peter P. Stanich, Kyle Porter, Hisham Hussan, Khalid Mumtaz, and Kishan Patel
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medicine.medical_specialty ,Physiology ,business.industry ,medicine.medical_treatment ,Gastroenterology ,Colostomy ,Odds ratio ,Hepatology ,Diverticulitis ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Laparotomy ,Intensive care ,Internal medicine ,medicine ,030211 gastroenterology & hepatology ,Risk factor ,business ,Colectomy - Abstract
Obesity is a known risk factor for diverticulitis. Our objective was to examine the less investigated impact of morbid obesity (MO) on admissions and clinical course of diverticulitis in a US representative database. We retrospectively queried the 2010–2014 Nationwide Readmission Database to compare diverticulitis hospitalizations in 48,651 MO and 841,381 non-obese patients. Outcomes of mortality, clinical course, surgical events, and readmissions were compared using multivariable and propensity-score-matched analyses. The number of MO patients admitted with diverticulitis increased annually from 7570 in 2010 to 11,935 in 2014, while the total number of patients admitted with diverticulitis decreased (p = 0.003). Multivariable analysis demonstrates that MO was associated with increased mortality (adjusted odds ratio [aOR] 1.54; 95% confidence internal [CI]: 1.16, 2.05), intensive care admissions (aOR = 1.92; 95% CI: 1.61, 2.31), emergent surgery (aOR = 1.20; 95% CI: 1.11, 1.30), colectomy (aOR = 1.13; 95% CI: 1.08, 1.18), open laparotomy (aOR = 1.28; 95% CI: 1.21, 1.34), and colostomy (aOR = 1.34; 95% CI: 1.25, 1.43). Additionally, MO was associated with higher risk for multiple readmissions for diverticulitis within 30 days (aOR = 1.45; 95% CI: 1.08, 1.96) and 6 months (aOR = 1.21; 95% CI: 1.03, 1.42). A one-to-one matched propensity-score analysis confirmed our multivariable analysis findings. Analysis of national data demonstrates an increasing trend of MO patients’ admissions for diverticulitis, with a presentation at a younger age. Furthermore, MO is associated with an increased risk of adverse outcomes and readmissions of diverticulitis. Future strategies are needed to ameliorate these outcomes.
- Published
- 2020
30. Hereditary or Not? Understanding Serrated Polyposis Syndrome
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Rachel Pearlman and Peter P. Stanich
- Subjects
medicine.medical_specialty ,business.industry ,Colorectal cancer ,Genetic counseling ,Gastroenterology ,Rectum ,medicine.disease ,Dermatology ,Serrated polyposis ,Human genetics ,03 medical and health sciences ,0302 clinical medicine ,Germline mutation ,medicine.anatomical_structure ,Increased risk ,030220 oncology & carcinogenesis ,medicine ,030211 gastroenterology & hepatology ,Family history ,business - Abstract
To present the current understanding of the diagnosis, management, and potential genetic causes of serrated polyposis syndrome. The clinical criteria for serrated polyposis syndrome was recently updated and now includes individuals with five or more serrated polyps proximal to the rectum that are 5 mm in size or greater and at least two that are 10 mm in size of greater as well as individuals with 20 or more serrated polyps throughout the colon with at least five proximal to the rectum. There is a significant risk for colon cancer in first-degree relatives of individuals with serrated polyposis syndrome. However, less than 3% of serrated polyposis syndrome cases are explained by identifiable germline mutations, with mutations in RNF43 being the only currently validated genetic cause. Serrated polyposis syndrome is rarely explained by identifiable germline mutations, but there remains an increased risk for colorectal cancer in first-degree relatives. Referral for genetic counseling and testing is recommended for individuals with serrated polyposis syndrome and a personal history of coexisting adenomatous polyposis or with a concerning family history and can be considered for all individuals with serrated polyposis syndrome. Close endoscopic surveillance of those with serrated polyposis syndrome and their first-degree relatives is recommended. Continued efforts at identifying hereditary causes of serrated polyposis are needed.
- Published
- 2019
31. Many Polyps but Few Referrals: A Call to Assess and Improve Referral Rates for Colon Polyposis
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Heather Hampel and Peter P. Stanich
- Subjects
medicine.medical_specialty ,Referral ,business.industry ,Colon ,Emergency medicine ,Gastroenterology ,MEDLINE ,Medicine ,Humans ,General Medicine ,business ,Colorectal Neoplasms ,Referral and Consultation - Published
- 2021
32. Upper GI tract screening in Lynch syndrome
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Ayushi Jain, Maryam Alimirah, and Peter P. Stanich
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Carcinoma, Transitional Cell ,Upper Gastrointestinal Tract ,Gastroenterology ,Humans ,Radiology, Nuclear Medicine and imaging ,Colorectal Neoplasms, Hereditary Nonpolyposis - Published
- 2021
33. Implementation of a Defecation Posture Modification Device
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Peter P. Stanich, Daniel Pinkhas, Rohan M. Modi, Alice Hinton, Geoffrey Thomas, Royce J. Groce, Edward A. Levine, and Marty M. Meyer
- Subjects
medicine.medical_specialty ,Hepatology ,business.industry ,Bowel habit ,Gastroenterology ,Healthy subjects ,MEDLINE ,Crossover study ,Physical medicine and rehabilitation ,Healthy volunteers ,Physical therapy ,Medicine ,Defecation ,business ,Prospective cohort study - Abstract
Goals:The goal of this study was to evaluate the influence of defecation postural modification devices (DPMDs) on normal bowel patterns.Background:The introduction of DPMDs has brought increased awareness to bowel habits in western populations.Materials and Methods:A prospective crossover study of v
- Published
- 2019
34. Tu1095: PREVELANCE OF ADENOMATOUS POLYPOSIS IN LYNCH SYNDROME
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Ayushi Jain, Maryam Alimirah, Heather Hampel, Rachel Pearlman, Matthew Kalady, and Peter P. Stanich
- Subjects
Hepatology ,Gastroenterology - Published
- 2022
35. Nausea and Diarrhea with Fingernail and Hair Changes
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Peter P. Stanich, Giovanni Lujan, and Amy Hosmer
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medicine.medical_specialty ,Hepatology ,business.industry ,Nausea ,Gastroenterology ,medicine.disease ,Dermatology ,Diarrhea ,Onychodystrophy ,Medicine ,Hamartoma ,Cronkhite–Canada syndrome ,medicine.symptom ,business - Published
- 2021
36. Multicenter case series of patients with small-bowel angiodysplasias treated with a small-bowel radiofrequency ablation catheter
- Author
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Luis F. Lara, Daniel Mai, Rogelio Silva, Shyam Thakkar, Peter P. Stanich, and Jason B. Samarasena
- Subjects
Enteroscopy ,RFA ,medicine.medical_specialty ,GI angiodysplasia ,LVAD ,Radiofrequency ablation ,SBA, small-bowel angiodysplasia ,Video Case Series ,argon plasma coagulation ,Colonoscopy ,Argon plasma coagulation ,GIAD, GI angiodysplasia ,SBA ,small-bowel angiodysplasia ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Intestinal mucosa ,law ,Melena ,Clinical Research ,medicine ,left ventricular assist device ,Radiology, Nuclear Medicine and imaging ,Angiodysplasia ,small-bowel radiofrequency ablation ,SBRFA, small-bowel radiofrequency ablation ,RFA, radiofrequency ablation ,medicine.diagnostic_test ,APC, argon plasma coagulation ,business.industry ,Gastroenterology ,SBRFA ,Hematology ,medicine.disease ,Hematochezia ,Surgery ,APC ,030220 oncology & carcinogenesis ,LVAD, left ventricular assist device ,030211 gastroenterology & hepatology ,radiofrequency ablation ,medicine.symptom ,business ,Digestive Diseases ,GIAD - Abstract
Background and Aims GI angiodysplasia is the most common cause of small-bowel bleeding. Argon plasma coagulation (APC) is preferred for ablation because of its availability, ease of use, and perceived safety, but it has limitations. An instrument capable of repeated use through the enteroscope, which covers more area of intestinal mucosa per treatment with low risk of damage to healthy mucosa, and which improves ablation, is desirable. A series of patients treated with a through-the-scope radiofrequency ablation (RFA) catheter is reported. Methods Patients with a previous diagnosis of small-bowel angiodysplasia (SBA) and ongoing bleeding with melena, hematochezia, or iron-deficiency anemia were eligible for treatment. A small-bowel radiofrequency ablation (SBRFA) catheter was passed through the enteroscope instrument channel. The treatment paddle was pushed against the SBA, achieving coaptive coagulation, and the SBA was treated up to 2 times at standard settings of 10 J/cm2. The patients’ demographics, pretreatment and posttreatment hemoglobin levels, time to recurrence of bleeding, and need for more therapy were recorded. This study was approved by the institutional review boards of the respective institutions. Results Twenty consecutive patients were treated from March until October 2018 and followed up until March 2019. There were 6 women (average age 68 years, standard deviation ± 11.1), and 14 men (average age 73 years, standard deviation ± 10.4). All had undergone at least 1 previous EGD and colonoscopy; 14 patients (70%) had SBA on video capsule endoscopy, and 14 patients had undergone previous endoscopic treatment of SBA with APC. A median of 23 treatments were applied (range, 2-99). The median follow-up time was 195 days (range, 30-240 days). Four patients, including 3 with a left ventricular assist device (LVAD), had recurrent bleeding between 45 and 210 days after treatment, and 2 patients received repeated blood transfusions. Three of those patients underwent repeated endoscopies, including a push enteroscopy and an upper endoscopy with no treatment, and a repeated enteroscopy with SBA treated with APC, respectively. One patient with LVAD underwent arterial embolization. Conclusions In this case series, bleeding recurred in 20% of patients in a follow-up time of ≤240 days. Notably, 3 of the 4 patients who had recurrent bleeding had an LVAD. These rates compare favorably with reported bleeding recurrence after APC of SBA. More studies on the benefits of SBRFA, which may include reduced risk of recurrent bleeding or prolonging the time to recurrent bleeding, resource utilization, and factors associated with bleeding recurrence are needed.
- Published
- 2020
37. Insights into insulin resistance, lifestyle, and anthropometric measures of patients with prior colorectal cancer compared to controls: A National Health and Nutrition Examination Survey (NHANES) Study
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Samer El-Dika, Hisham Hussan, Kenneth Obi, Peter P. Stanich, Alice Hinton, Mitchell L. Ramsey, Somashekar G. Krishna, and Darrell M. Gray
- Subjects
Adenoma ,Male ,0301 basic medicine ,Cancer Research ,medicine.medical_specialty ,National Health and Nutrition Examination Survey ,Colorectal cancer ,Population ,03 medical and health sciences ,0302 clinical medicine ,Insulin resistance ,Internal medicine ,medicine ,Humans ,Body Weights and Measures ,Obesity ,education ,Life Style ,neoplasms ,Aged ,Retrospective Studies ,Aged, 80 and over ,Metabolic Syndrome ,education.field_of_study ,business.industry ,Retrospective cohort study ,Middle Aged ,Nutrition Surveys ,medicine.disease ,digestive system diseases ,030104 developmental biology ,Oncology ,Case-Control Studies ,030220 oncology & carcinogenesis ,Cohort ,Female ,Insulin Resistance ,Metabolic syndrome ,Colorectal Neoplasms ,business - Abstract
Insulin resistance (IR) increases the risk of index colorectal cancer (CRC) development. Limited data exist on IR values, lifestyle, and anthropometric alterations of patients after CRC diagnosis, a population at high risk for CRC recurrence.This is a retrospective cohort study using the National Health and Nutrition Examination Survey (NHANES), 1999-2010. We identified patients with and without prior CRC above age 50. Our outcomes were lifestyle, anthropometric measures, and IR measured using the triglyceride to high-density lipoprotein ratio and the homeostasis model assessment IR.There were 146,841 patients with prior CRC and 26,979,507 without prior cancer (controls) in our cohort. Prior patients with CRC were significantly older than controls (75.8 vs 62.3, P0.01), however, there were no significant differences in gender, ethnicity, income, caloric intake, tobacco use or alcohol consumption between both groups. Multivariate analysis revealed no difference between prior patients with CRC and controls in triglyceride to high-density lipoprotein ratio (adjusted percentage change = -2.17; 95% CI: -27.96 to 18.43) or homeostasis model assessment IR (adjusted percentage change = -6.85; 95% CI: -35.74 to 15.90). Despite similar weight at age 25, prior CRC subjects had lower weights compared to controls (at time of NHANES survey, one and 10 years before survey and greatest weight). Furthermore prior CRC subjects gained less weight in the 10 years before survey.Patients with prior CRC above age 50 have no conclusive evidence of increased IR compared to non-CRC controls. This is possibly due to lesser weight gain in the peri-CRC diagnosis or treatment period. Future efforts should focus on alternate etiologies for the increased CRC recurrence in this high-risk group.
- Published
- 2018
38. In Defense of Cold Snare Polypectomy for Large Nonpedunculated Polyps
- Author
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Mitchell L. Ramsey and Peter P. Stanich
- Subjects
medicine.medical_specialty ,Hepatology ,business.industry ,medicine.medical_treatment ,Gastroenterology ,Colonic Polyps ,Colonoscopy ,Postoperative Hemorrhage ,Polypectomy ,Surgery ,medicine ,Cold snare ,Humans ,business - Published
- 2021
39. S1998 Acute Dysphagia Due to Malignant Aerodigestive Fistula
- Author
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Peter P. Stanich, Sebastian Strobel, and Mitchell L. Ramsey
- Subjects
medicine.medical_specialty ,Hepatology ,business.industry ,Fistula ,Gastroenterology ,medicine ,medicine.symptom ,business ,medicine.disease ,Dysphagia ,Surgery - Published
- 2020
40. S0320 Rate and Burden of Advanced Colorectal Neoplasia in Adults Approaching the Screening Age: An Opportunity to Reduce the Incidence of Early-Onset Colorectal Cancer
- Author
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Violeta Popov, Kyle Porter, Folasade P. May, Darrell M. Gray, Hisham Hussan, Bryson W. Katona, John M. Carethers, Peter P. Stanich, and Samuel Akinyeye
- Subjects
Oncology ,medicine.medical_specialty ,Hepatology ,business.industry ,Colorectal cancer ,Incidence (epidemiology) ,Internal medicine ,Gastroenterology ,Medicine ,business ,medicine.disease ,Early onset - Published
- 2020
41. 876 APPLICATION OF MACHINE LEARNING TO ENHANCE COLORECTAL CANCER DIAGNOSIS AND PREVENTION STRATEGIES FOR YOUNG ADULTS AGED 35-50 YEARS
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Steven K. Clinton, Qin Ma, Fred K. Tabung, Peter P. Stanich, Hisham Hussan, Jing Zhao, and Darrell M. Gray
- Subjects
Gerontology ,Hepatology ,business.industry ,Colorectal cancer ,Gastroenterology ,Medicine ,Young adult ,business ,medicine.disease - Published
- 2021
42. Physical activity during video capsule endoscopy correlates with shorter bowel transit time
- Author
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Joshua R. Peck, Marty M. Meyer, Kyle Porter, Peter P. Stanich, and Christopher Murphy
- Subjects
Original article ,medicine.medical_specialty ,Proportional hazards model ,business.industry ,Hazard ratio ,Odds ratio ,Logistic regression ,Confidence interval ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Capsule endoscopy ,law ,030220 oncology & carcinogenesis ,Internal medicine ,Pedometer ,Medicine ,lcsh:Diseases of the digestive system. Gastroenterology ,030211 gastroenterology & hepatology ,Pharmacology (medical) ,lcsh:RC799-869 ,business ,Body mass index - Abstract
Background and study aim Video capsule endoscopy (VCE) is limited by reliance on bowel motility for propulsion, and lack of physical activity has been proposed as a cause of incomplete studies. Our aim was to prospectively investigate the association between physical activity and VCE bowel transit. Patients and methods Ambulatory outpatients receiving VCE were eligible for the study. A pedometer was attached at the time of VCE ingestion and step count was recorded at the end of the procedure. VCE completion was assessed by logistic regression models, which included step count (500 steps as one unit). Total transit time was analyzed by Cox proportional hazards models. The hazard ratios (HR) with 95 % confidence interval (CI) indicated the “hazard” of completion, such that HRs > 1 indicated a reduced transit time. Results A total of 100 patients were included. VCE was completed in 93 patients (93 %). The median step count was 2782 steps. Step count was not significantly associated with VCE completion (odds ratio 1.45, 95 %CI 0.84, 2.49). Pedometer step count was significantly associated with shorter total, gastric, and small-bowel transit times (HR 1.09, 95 %CI 1.03, 1.16; HR 1.05, 95 %CI 1.00, 1.11; HR 1.07, 95 %CI 1.01, 1.14, respectively). Higher body mass index (BMI) was significantly associated with VCE completion (HR 1.87, 95 %CI 1.18, 2.97) and shorter bowel transit times (HR 1.05, 95 %CI 1.02, 1.08). Conclusions Increased physical activity during outpatient VCE was associated with shorter bowel transit times but not with study completion. In addition, BMI was a previously unreported clinical characteristic associated with VCE completion and should be included as a variable of interest in future studies.
- Published
- 2017
43. Outcomes of nutritional interventions to treat dysphagia in esophageal cancer: a population-based study
- Author
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Kristen K. Ciombor, Sameh Mikhail, Chengping Zhang, Rohan M. Modi, Alice Hinton, Darwin L. Conwell, Somashekar G. Krishna, Peter P. Stanich, and Kyle A. Perry
- Subjects
Male ,Parenteral Nutrition ,medicine.medical_specialty ,Multivariate analysis ,Databases, Factual ,Esophageal Neoplasms ,Population ,Gastroenterology ,03 medical and health sciences ,Enteral Nutrition ,Esophagus ,0302 clinical medicine ,Esophageal stent ,Internal medicine ,medicine ,Humans ,education ,Feeding tube ,Aged ,education.field_of_study ,business.industry ,Incidence (epidemiology) ,General Medicine ,Middle Aged ,Esophageal cancer ,medicine.disease ,Dysphagia ,Hospitalization ,Logistic Models ,Treatment Outcome ,Parenteral nutrition ,030220 oncology & carcinogenesis ,Multivariate Analysis ,Female ,Stents ,030211 gastroenterology & hepatology ,medicine.symptom ,Deglutition Disorders ,business - Abstract
Esophageal cancer (EC) is increasing in prevalence due to rising incidence and improved treatment strategies. Dysphagia is a significant morbidity in patients with EC requiring nutritional intervention. We sought to evaluate outcomes of nutritional interventions for EC patients hospitalized with dysphagia at a population level. The National Inpatient Sample (2002-2012) was utilized to include all adult inpatients (≥18 years of age) with EC and presence of dysphagia and stricture that underwent nutritional interventions including feeding tube (FT) placement, esophageal stenting, or parenteral nutrition (PN). Temporal trends were examined with multivariate analysis performed for mortality, length of stay (LOS), and cost of hospitalization. A total of 509,593 EC patients had 12,205 hospitalizations related to dysphagia. The hospitalization rates doubled over the study period (1.52% vs. 3.28%, p < 0.001). The most common nutritional intervention was FT (27%), followed by esophageal stenting (13%), and PN (11%). PN was more frequently associated with a diagnosis of sepsis (6.1%, p = 0.023) compared to FT (2.5%) or esophageal stenting (1.8%). Multivariate analysis demonstrated FT and esophageal stenting had comparable mortality (OR 1.06, 95% CI: 0.49, 2.32); however, PN was associated with higher mortality (OR 2.37, 95% CI: 1.22, 4.63), cost of hospitalization ($5,510, 95% CI: 2,262, 8,759), and LOS (2.13 days, 95% CI: 0.72, 3.54). This study shows that hospitalizations for EC with dysphagia and related nutritional interventions are increasing. As a single modality, parenteral nutrition should be avoided. Among our esophageal stent and FT population, further studies are necessary to determine adequate interventions based on disease stage.
- Published
- 2017
44. 617 Outcomes of Patients With Small Bowel Angiodysplasia Treated With a Small Bowel Radiofrequency Ablation Catheter: A Multicenter Case Series
- Author
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Luis F. Lara, Rogelio Silva, Jason B. Samarasena, Shyam Thakkar, and Peter P. Stanich
- Subjects
Radiofrequency ablation catheter ,medicine.medical_specialty ,Hepatology ,business.industry ,Gastroenterology ,medicine ,Radiology ,Angiodysplasia ,medicine.disease ,business - Published
- 2019
45. EUS-guided confocal laser endomicroscopy: prediction of dysplasia in intraductal papillary mucinous neoplasms (with video)
- Author
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John M. DeWitt, Megan Q. Chan, Jon P. Walker, Peter P. Stanich, Sebastian Strobel, Bertrand Napoleon, Mohamed O. Othman, Samer El-Dika, Anjuli K. Luthra, Alecia Blaszczak, Sean T. McCarthy, Christina A. Arnold, Dana Lee, Pradermchai Kongkam, Damien Meng Yew Tan, Anand Patel, Darwin L. Conwell, Somashekar G. Krishna, Kyle Porter, Christopher J. DiMaio, and Phil A. Hart
- Subjects
Male ,medicine.medical_specialty ,Pancreatic Intraductal Neoplasms ,Endosonography ,03 medical and health sciences ,0302 clinical medicine ,Cytology ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Prospective Studies ,Prospective cohort study ,Endoscopic Ultrasound-Guided Fine Needle Aspiration ,Aged ,Microscopy, Confocal ,Intraductal papillary mucinous neoplasm ,Receiver operating characteristic ,business.industry ,Lasers ,Gastroenterology ,Middle Aged ,medicine.disease ,digestive system diseases ,Confidence interval ,Pancreatic Neoplasms ,Dysplasia ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Histopathology ,Female ,Pancreatic cysts ,business ,Nuclear medicine - Abstract
Background and Aims Previous studies have validated EUS-guided needle-based confocal laser endomicroscopy (nCLE) diagnosis of intraductal papillary mucinous neoplasms (IPMNs). We sought to derive EUS-guided nCLE criteria for differentiating IPMNs with high-grade dysplasia/adenocarcinoma (HGD-Ca) from those with low/intermediate-grade dysplasia (LGD). Methods We performed a post hoc analysis of consecutive IPMNs with a definitive diagnosis from a prospective study evaluating EUS-guided nCLE in the diagnosis of pancreatic cysts. Three internal endosonographers reviewed all nCLE videos for the patients and identified potential discriminatory EUS-guided nCLE variables to differentiate HGD-Ca from LGD IPMNs (phase 1). Next, an interobserver agreement (IOA) analysis of variables from phase 1 was performed among 6 blinded external nCLE experts (phase 2). Last, 7 blinded nCLE-naive observers underwent training and quantified variables with the highest IOA from phase 2 using dedicated software (phase 3). Results Among 26 IPMNs (HGD-Ca in 16), the reference standard was surgical histopathology in 24 and cytology confirmation of metastatic liver lesions in 2 patients. EUS-guided nCLE characteristics of increased papillary epithelial “width” and “darkness” were the most sensitive variables (90%; 95% confidence interval [CI], 84%-94% and 91%; 95% CI, 85%-95%, respectively) and accurate (85%; 95% CI, 78%-90% and 84%; 95% CI, 77%-89%, respectively) with substantial (κ = 0.61; 95% CI, 0.51-0.71) and moderate (κ = 0.55; 95% CI, 0.45-0.65) IOAs for detecting HGD-Ca, respectively (phase 2). Logistic regression models were fit for the outcome of HGD-Ca as predictor variables (phase 3). For papillary width (cut-off ≥50 μm), the sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) for detection of HGD-Ca were 87.5% (95% CI, 62%-99%), 100% (95% CI, 69%-100%), and 0.95, respectively. For papillary darkness (cut-off ≤90 pixel intensity), the sensitivity, specificity, and AUC for detection of HGD-Ca were 87.5% (95% CI, 62%-99%), 100% (95% CI, 69%-100%), and 0.90, respectively. Conclusions In this derivation study, quantification of papillary epithelial width and darkness identified HGD-Ca in IPMNs with high accuracy. These quantifiable variables can be used in multicenter studies for risk stratification of IPMNs. (Clinical trial registration number: NCT02516488.)
- Published
- 2019
46. Diverticulitis in Morbidly Obese Adults: A Rise in Hospitalizations with Worse Outcomes According to National US Data
- Author
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Kishan, Patel, Somashekar G, Krishna, Kyle, Porter, Peter P, Stanich, Khalid, Mumtaz, Darwin L, Conwell, Steven K, Clinton, and Hisham, Hussan
- Subjects
Male ,Time Factors ,Databases, Factual ,Age Factors ,Middle Aged ,Prognosis ,Patient Readmission ,Risk Assessment ,United States ,Obesity, Morbid ,Recurrence ,Risk Factors ,Humans ,Female ,Diverticulitis ,Retrospective Studies - Abstract
Obesity is a known risk factor for diverticulitis. Our objective was to examine the less investigated impact of morbid obesity (MO) on admissions and clinical course of diverticulitis in a US representative database.We retrospectively queried the 2010-2014 Nationwide Readmission Database to compare diverticulitis hospitalizations in 48,651 MO and 841,381 non-obese patients. Outcomes of mortality, clinical course, surgical events, and readmissions were compared using multivariable and propensity-score-matched analyses.The number of MO patients admitted with diverticulitis increased annually from 7570 in 2010 to 11,935 in 2014, while the total number of patients admitted with diverticulitis decreased (p = 0.003). Multivariable analysis demonstrates that MO was associated with increased mortality (adjusted odds ratio [aOR] 1.54; 95% confidence internal [CI]: 1.16, 2.05), intensive care admissions (aOR = 1.92; 95% CI: 1.61, 2.31), emergent surgery (aOR = 1.20; 95% CI: 1.11, 1.30), colectomy (aOR = 1.13; 95% CI: 1.08, 1.18), open laparotomy (aOR = 1.28; 95% CI: 1.21, 1.34), and colostomy (aOR = 1.34; 95% CI: 1.25, 1.43). Additionally, MO was associated with higher risk for multiple readmissions for diverticulitis within 30 days (aOR = 1.45; 95% CI: 1.08, 1.96) and 6 months (aOR = 1.21; 95% CI: 1.03, 1.42). A one-to-one matched propensity-score analysis confirmed our multivariable analysis findings.Analysis of national data demonstrates an increasing trend of MO patients' admissions for diverticulitis, with a presentation at a younger age. Furthermore, MO is associated with an increased risk of adverse outcomes and readmissions of diverticulitis. Future strategies are needed to ameliorate these outcomes.
- Published
- 2019
47. The Burden of 30-Day Readmission for Gastrointestinal, Pancreatic, and Liver Diseases in the United States: An Opportunity to Innovate, Strategize, and Deliver
- Author
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Gokulakrishnan Balasubramanian, Peter P. Stanich, Cheng Zhang, Luis F. Lara, Alice Hinton, Khalid Mumtaz, Michael George, Na Li, Darwin L. Conwell, Anita Afzali, Somashekar G. Krishna, Rohan M. Modi, Darrell M. Gray, Hisham Hussan, and Lanla Conteh
- Subjects
medicine.medical_specialty ,Hepatology ,business.industry ,Gastroenterology ,Medicine ,business ,Intensive care medicine - Published
- 2017
48. Video capsule endoscopy completion and total transit times are similar with oral or endoscopic delivery
- Author
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John Guido, Bryan Kleinman, Kyle Porter, Kavita Betkerur, Marty M. Meyer, and Peter P. Stanich
- Subjects
medicine.medical_specialty ,business.industry ,Transit time ,Group comparison ,Article ,Surgery ,Video capsule endoscopy ,03 medical and health sciences ,0302 clinical medicine ,Oral ingestion ,030220 oncology & carcinogenesis ,Completion rate ,Ambulatory ,medicine ,Ingestion ,lcsh:Diseases of the digestive system. Gastroenterology ,030211 gastroenterology & hepatology ,Pharmacology (medical) ,In patient ,lcsh:RC799-869 ,business - Abstract
Background and study aims: Video capsule endoscopy (VCE) is limited by incomplete procedures. There are also contraindications to the standard ingestion of the capsule that require endoscopic placement. Our aim was to compare the study completion rate of VCE after oral ingestion and endoscopic deployment. Patients and methods: We performed a review of all VCE from April 2010 through March 2013. Inpatient and outpatient cohorts grouped by the method of capsule delivery were formed and compared. Multivariable logistic regression modeling was utilized adjusting for variables with a P value ≤ 0.1 in group comparisons. Log-rank analysis was used to compare transit times. Results: A total of 687 VCE were performed, including 316 inpatient (36 endoscopic deployment, 280 oral ingestion) and 371 outpatient (20 endoscopic deployment, 351 oral ingestion). For VCE on hospitalized patients, the completion rates were similar after endoscopic deployment and oral ingestion (72 % vs 73 %, P = 0.94). The completion rates were also similar for ambulatory patients (90 % vs 87 %, P = 0.69). There remained no difference after multivariable modeling for inpatients (P = 0.71) and outpatients (P = 0.46). Total transit times were not significantly different. Conclusions: VCE completion rates and total transit times are similar after oral or endoscopic deployment for both hospitalized and ambulatory patients. Endoscopic placement is effective in patients with contraindications to standard oral ingestion, but should otherwise be avoided to limit unnecessary procedural risks and costs.
- Published
- 2016
49. Morbid Obesity is Associated with Increased Mortality, Surgical Complications, and Incremental Health Care Utilization in the Peri-Operative Period of Colorectal Cancer Surgery
- Author
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Darwin L. Conwell, Somashekar G. Krishna, Hisham Hussan, Peter P. Stanich, Darrell M. Gray, and Alice Hinton
- Subjects
Male ,medicine.medical_specialty ,Cross-sectional study ,Risk Assessment ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Perioperative Period ,Survival rate ,Colectomy ,Aged ,Retrospective Studies ,business.industry ,Incidence ,General surgery ,Retrospective cohort study ,Perioperative ,Middle Aged ,Patient Acceptance of Health Care ,Vascular surgery ,Prognosis ,Hospital Charges ,United States ,Obesity, Morbid ,Cardiac surgery ,Survival Rate ,Cross-Sectional Studies ,Cardiothoracic surgery ,030220 oncology & carcinogenesis ,Female ,Laparoscopy ,030211 gastroenterology & hepatology ,Surgery ,Colorectal Neoplasms ,business ,Abdominal surgery - Abstract
Morbid obesity (Basic Mass Index ≥ 40 kg/m2) leads to increased long-term mortality after colorectal cancer (CRC) surgery. Little is known about its effects on peri-operative CRC surgery outcomes. 85,300 discharges for CRC surgery were identified using the redesigned 2012 National Inpatient Sample. Outcomes of interest were mortality, healthcare charges, and surgical outcomes in morbidly obese patients which were compared to those in nonobese patients. There were 4385 (5.14%) morbidly obese patients who underwent CRC surgery during the study period. Morbid obesity was associated with younger age, females, and African Americans in our study (p
- Published
- 2015
50. Abstract CT236: A phase 1b, multicenter, randomized, blinded, placebo-controlled study to evaluate the efficacy of guselkumab in subjects with familial adenomatous polyposis
- Author
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Daniel A. Sussman, David S. Weinberg, Kelly Raybold, Bryson W. Katona, Jean-Christophe Saurin, Carol A. Burke, Edward F. Attiyeh, Evelien Dekker, Hong Xie, Eduardo Vilar-Sanchez, Thomas J. Prior, Gary V. Borzillo, Douglas L. Riegert-Johnson, Xavier Llor, Peter P. Stanich, Jeffrey R. Infante, Niloy Jewel Samadder, Philippe Grandval, Kurtis E. Bachman, William M. Grady, Marcia Cruz Correa, Devanand Joseph, and Michael Smith
- Subjects
Cancer Research ,medicine.medical_specialty ,Guselkumab ,Oncology ,business.industry ,Internal medicine ,medicine ,Placebo-controlled study ,business ,medicine.disease ,Gastroenterology ,Familial adenomatous polyposis - Abstract
Background: Familial adenomatous polyposis (FAP) is the most common hereditary polyposis syndrome. It is an autosomal dominant inherited disorder characterized by the early onset of hundreds to thousands of adenomatous polyps throughout the colon. If left untreated, nearly all individuals with this syndrome develop colorectal cancer (CRC) by the third decade of life. Prophylactic colectomy is the standard of care, but individuals remain at risk for malignant transformation of duodenal polyps, rectal polyps for those who have undergone rectal-sparing surgeries, and ileal pouch polyps for those with ileal pouch-anal anastomoses. Multiple studies with both nonselective and selective cyclooxygenase inhibitors (such as sulindac or celecoxib) have shown that anti-inflammatory agents may prevent the formation and inhibit the growth of colorectal adenomatous polyps. However, toxicities associated with these agents and their limited efficacy have prevented their further development. Therefore, there is a high unmet need for novel treatment options to reduce polyp burden, delay or eliminate the need for colectomy and recurrent rectal surgery, and intercept the development of adenocarcinomas in individuals with FAP. Polyps from individuals with FAP display inflammatory features associated with the activation of the IL-23/IL-17/JAK/STAT3 pathway. This inflammation is thought to contribute to further carcinogenesis, culminating in tumor development. Specifically, IL-23 is linked to tumor growth and progression in CRC, and adenomas with high-grade dysplasia showed elevated levels of IL-17A and pSTAT3. Guselkumab, a human monoclonal antibody directed against the p19 subunit of IL-23, specifically targets IL-23 and inhibits its interaction with the IL-23 receptor. Pre-clinical models suggest that inhibition of IL-23 signaling will result in less inflammation and reduce tumor development. Methods: This randomized, blind, placebo-controlled study will evaluate the safety and efficacy of guselkumab in adults with FAP (genetic or clinical diagnosis) who have already undergone colectomy. Polyps with a sum of diameters ≥10 mm in the rectum or pouch are required. Subjects will be randomized equally to one of three study arms: 100 mg, 300 mg, or placebo given subcutaneously every 4 weeks for 6 doses. The primary efficacy endpoint is percentage change from baseline in rectal/pouch polyp burden after 24 weeks. Secondary efficacy endpoints include duodenal polyp burden change and changes in InSiGHT and Spigelman staging. Exploratory translational research objectives will explore changes in RNA expression profiles, epigenomic profiles, cytokine levels, and the microbiome. Exclusion criteria include prior IL-23 targeted therapies and any polyps >1 cm that cannot be removed. While participating, subjects are required to stop any other FAP-directed drug therapy except for aspirin. As of January 2019, 18% of the planned 72 subjects have been enrolled. ClinicalTrials.gov Identifier: NCT03649971. Citation Format: Eduardo Vilar-Sanchez, Carol Burke, Marcia R. Cruz Correa, Evelien Dekker, William M. Grady, Philippe Grandval, Bryson W. Katona, Xavier Llor, Douglas L. Riegert-Johnson, Jean-Christophe Saurin, Peter Stanich, Daniel A. Sussman, David Weinberg, Edward F. Attiyeh, Devanand Joseph, Kelly Raybold, Gary V. Borzillo, Thomas J. Prior, Michael Smith, Hong Xie, Kurtis E. Bachman, Jeffrey R. Infante, Niloy Jewel Samadder. A phase 1b, multicenter, randomized, blinded, placebo-controlled study to evaluate the efficacy of guselkumab in subjects with familial adenomatous polyposis [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr CT236.
- Published
- 2020
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