18 results on '"Eriksson, Sven E."'
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2. Chevalier Jackson: father of endoscopic surgery, and champion of women in medicine, social justice, and public health
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Eriksson, Sven E., Jobe, Blair A., and Ayazi, Shahin
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- 2023
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3. The Utility of Symptom Association Probability (SAP) in Predicting Outcome After Laparoscopic Fundoplication in Patients with Abnormal Esophageal Acid Exposure
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Vaiciunaite, Donata, Eriksson, Sven E., Sarici, Inanc S., Zheng, Ping, Zaidi, Ali H., Jobe, Blair, and Ayazi, Shahin
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- 2023
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4. Need for frequent dilations after magnetic sphincter augmentation: an assessment of associated factors and outcomes
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Sarici, Inanc S., Eriksson, Sven E., Zheng, Ping, Hoppo, Toshitaka, Jobe, Blair A., and Ayazi, Shahin
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- 2023
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5. Predictors of favorable outcome after pyloroplasty for gastroparesis: should response to pyloric dilation or Botox injection be used as a marker of surgical outcome?
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Eriksson, Sven E., Zheng, Ping, Morton, Scott, Maurer, Nicole, Hoppo, Toshitaka, Jobe, Blair A., and Ayazi, Shahin
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- 2023
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6. Magnetic Sphincter Augmentation for Laryngopharyngeal Reflux: An Assessment of Efficacy and Predictors of Outcome
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Eriksson, Sven E., Sarici, Inanc S., Zheng, Ping, Gardner, Margaret, Jobe, Blair A., and Ayazi, Shahin
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- 2024
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7. Gas-Bloat Syndrome after Magnetic Sphincter Augmentation: Incidence, Natural History, Risk Factors, and Impact on Surgical Outcomes Over Time.
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Eriksson, Sven E., Ayazi, Shahin, Ping Zheng, Sarici, Inanc S., Hannan, Zain, and Jobe, Blair A.
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ESOPHAGEAL surgery , *HERNIA surgery , *RISK assessment , *CONSERVATIVE treatment , *LAPAROSCOPY , *SURGERY , *PATIENTS , *QUESTIONNAIRES , *FISHER exact test , *TREATMENT effectiveness , *HOSPITALS , *RETROSPECTIVE studies , *MULTIVARIATE analysis , *MAGNETIC resonance imaging , *PREOPERATIVE care , *HEARTBURN , *DESCRIPTIVE statistics , *MANN Whitney U Test , *CHI-squared test , *SURGICAL complications , *LONGITUDINAL method , *ODDS ratio , *MEDICAL records , *ACQUISITION of data , *QUALITY of life , *FUNDOPLICATION , *PATIENT satisfaction , *GASTROINTESTINAL agents , *COMPARATIVE studies , *DATA analysis software , *GASTROESOPHAGEAL reflux , *DISEASE incidence , *DEGLUTITION disorders , *DISEASE risk factors , *SYMPTOMS - Abstract
BACKGROUND: The notion that gas-bloat syndrome (GBS) after magnetic sphincter augmentation (MSA) is less detrimental has not been substantiated by data. This study aimed to identify the incidence, natural history, risk factors, and impact on outcomes of GBS after MSA. STUDY DESIGN: Records of patients who underwent MSA at our institution were reviewed. GBS was defined as a score of 4 or more on the gas bloat-specific item within the GERD health-related quality-of-life (GERD-HRQL) questionnaire. Preoperative clinical and objective testing data were compared between those with and without GBS at 1 year using univariate followed by multivariable analysis. GBS evolution over time and its impact on outcomes were assessed in those with 1- and 2-year follow-up. RESULTS: A total of 489 patients underwent MSA. At a mean (SD) follow-up of 12.8 (2.1) months, patient satisfaction was 88.8%, 91.2% discontinued antisecretory medications, and 74.2% achieved DeMeester score normalization. At 1 year, 13.3% of patients developed GBS, and had worse GERD-HRQL scores and antisecretory medication use and satisfaction (p < 0.0001). DeMeester score normalization was comparable (p = 0.856). Independent predictors of GBS were bloating (odds ratio [OR] 1.8, p = 0.043), GERD-HRQL score greater than 30 (OR 3, p = 0.0010), and MSA size 14 or less beads (OR 2.5, p = 0.004). In a subgroup of 239 patients with 2-year follow-up, 70.4% of patients with GBS at 1 year had resolution by 2 years. The GERD-HRQL total score improved when GBS resolved from 11 (7 to 19) to 7 (4 to 10), p = 0.016. Patients with persistent GBS at 2 years had worse 2-year GERD-HRQL total scores (20 [5 to 31] vs 5 [3 to 12], p = 0.019). CONCLUSIONS: GBS affects 13.3% of patients at 1 year after MSA and substantially diminishes outcomes. However, GBS resolves spontaneously with quality-of-life improvement. Patients with preoperative bloating, high GERD-HRQL scores, or small MSA devices are at greatest risk of this complication. [ABSTRACT FROM AUTHOR]
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- 2024
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8. Esophageal body adaptation to Nissen fundoplication: Increased esophagogastric outflow resistance yields delayed and sustained peristaltic contractions without increased amplitude.
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Boris, Lubomyr, Eriksson, Sven E., Sarici, Inanc S., Zheng, Ping, Kuzy, Jacob, Scott, Sarah, Jobe, Blair A., and Ayazi, Shahin
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FUNDOPLICATION , *ESOPHAGOGASTRIC junction , *SMOOTH muscle contraction , *SMOOTH muscle , *PHYSIOLOGY - Abstract
Background: Improvement in lower esophageal sphincter (LES) competency after laparoscopic Nissen fundoplication (LNF) is well established, yet esophageal body physiology data are limited. We aimed to describe the impact of LNF on whole esophagus physiology using standard and novel manometric characteristics. Methods: A cohort of patients with an intact fundoplication without herniation and no postoperative dysphagia were selected and underwent esophageal manometry at one‐year after surgery. Pre‐ and post‐operative manometry files were reanalyzed using standard and novel manometric characteristics and compared. Key Results: A total of 95 patients were included in this study. At 16.1 (8.7) months LNF increased LES overall and abdominal length and resting pressure (p < 0.0001). Outflow resistance (IRP) increased [5.8 (3–11) to 11.1 (9–15), p < 0.0001] with a 95th percentile of 20 mmHg in this cohort of dysphagia‐free patients. Distal contractile integral (DCI) also increased [1177.0 (667–2139) to 1321.1 (783–2895), p = 0.002], yet contractile amplitude was unchanged (p = 0.158). There were direct correlations between pre‐ and post‐operative DCI [R: 0.727 (0.62–0.81), p < 0.0001] and postoperative DCI and postoperative IRP [R: 0.347 (0.16–0.51), p = 0.0006]. Contractile front velocity [3.5 (3–4) to 3.2 (3–4), p = 0.0013] was slower, while distal latency [6.7 (6–8) to 7.4 (7–9), p < 0.0001], the interval from swallow onset to proximal smooth muscle initiation [4.0 (4–5) to 4.4 (4–5), p = 0.0002], and the interval from swallow onset to point when the peristaltic wave meets the LES [9.4 (8–10) to 10.3 (9–12), p < 0.0001] were longer. Esophageal length [21.9 (19–24) to 23.2 (21–25), p < 0.0001] and transition zone (TZ) length [2.2 (1–3) to 2.5 (1–4), p = 0.004] were longer. Bolus clearance was inversely correlated with TZ length (p = 0.0002) and time from swallow onset to proximal smooth muscle initiation (p < 0.0001). Bolus clearance and UES characteristics were unchanged (p > 0.05). Conclusions & Inferences: Increased outflow resistance after LNF required an increased DCI. However, this increased contractile vigor was achieved through sustained, not stronger, peristaltic contractions. Increased esophageal length was associated with increased TZ and delayed initiation of smooth muscle contractions. [ABSTRACT FROM AUTHOR]
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- 2024
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9. Ineffective esophageal motility: The impact of change of criteria in Chicago Classification version 4.0 on predicting outcome after magnetic sphincter augmentation.
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Riccardi, Margaret, Eriksson, Sven E., Tamesis, Steven, Zheng, Ping, Jobe, Blair A., and Ayazi, Shahin
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ESOPHAGEAL motility , *SPHINCTERS , *CLASSIFICATION , *ARTIFICIAL sphincters , *DEGLUTITION disorders , *MANOMETERS , *FORECASTING - Abstract
Background: The most recent update of the Chicago Classification (CCv4.0) attempts to provide a more clinically relevant definition for ineffective esophageal motility (IEM). The impact of this new definition on predicting outcome after antireflux surgery is unknown. The aim of this study was to compare utility of IEM diagnosis based on CCv4.0 to CCv3.0 in predicting surgical outcome after magnetic sphincter augmentation (MSA) and to assess any additional parameters that hold value in future definitions. Methods: Records of 336 patients who underwent MSA at our institution between 2013 and 2020 were reviewed. Preoperative manometry files were re‐analyzed using both Chicago Classification version 3.0 (CCv3.0) and CCv4.0 definitions of IEM. The utility of each IEM definition in predicting surgical outcome was then compared. Individual manometric components and impedance data were also assessed. Key Results: Immediate dysphagia was reported by 186 (55.4%) and persistent dysphagia by 42 (12.5%) patients. CCv3.0 IEM criteria were met by 37 (11%) and CCv4.0 IEM by 18 (5.4%) patients (p = 0.011). CCv3.0 and CCv4.0 IEM were equally poor predictors of immediate (AUC = 0.503 vs. 0.512, p = 0.7482) and persistent (AUC = 0.519 vs. 0.510, p = 0.7544) dysphagia. The predicted dysphagia probability of less than 70% bolus clearance (BC) was 17.4%, higher than CCv4.0 IEM at 16.7%. When BC was incorporated into CCv4.0 IEM criteria, the probability increased significantly to 30.0% (p = 0.0042). Conclusions & Inferences: The CCv3.0 and CCv4.0 of IEM are poor predictors of dysphagia after MSA. Adding BC to the new definition improves its predictive utility and should be considered in future definitions. [ABSTRACT FROM AUTHOR]
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- 2023
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10. Magnetic sphincter augmentation and high-resolution manometry: impact of biomechanical properties on esophageal motility and clinical significance for selection and outcomes.
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Eriksson, Sven E, Jobe, Blair A, and Ayazi, Shahin
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ESOPHAGEAL motility , *SPHINCTERS , *ESOPHAGOGASTRIC junction , *FUNDOPLICATION , *MAGNETISM - Abstract
Magnetic sphincter augmentation (MSA)was introduced as an alternative to laparoscopic Nissen fundoplication (LNF). This reproducible, outpatient procedure addresses the etiology of gastroesophageal reflux disease by implanting a ring of magnetic beads across the esophagogastric junction (EGJ). MSA is designed to resist effacement of the lower esophageal sphincter (LES) and, similar to LNF, results in restoration of anti-reflux barrier competency by increasing overall length, intraabdominal length and resting pressure of the sphincter. However, the novel use of magnets to augment the physiology of the LES poses unique challenges to the physiology of the EGJ and esophagus. These impacts are best revealed through manometry. The degree of restrictive forces at the EGJ, as measured by intrabolus pressure and integrated relaxation pressure, is higher after MSA compared with LNF. In addition, contrary to the LNF, which retains neurohormonal relaxation capability during deglutition, the magnetic forces remain constant until forcibly opened. Therefore, the burden of overcoming EJG resistance is placed solely on the esophageal body contractile force, as measured by distal contractile integral and distal esophageal amplitude. The main utility of preoperative manometry is in determining whether a patient's esophagus has sufficient contractility or peristaltic reserve to adapt to the challenge of an MSA. Manometric thresholds predictive of MSA outcomes deviate from those used to define named Chicago Classification motility disorders. Therefore, individual preoperative manometric characteristics should be analyzed to aid in risk stratification and patient selection prior to MSA. [ABSTRACT FROM AUTHOR]
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- 2023
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11. Long-term clinical and functional results of magnetic sphincter augmentation.
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Sarici, Inanc S, Dunn, Colin P, Eriksson, Sven E, Jobe, Blair A, and Ayazi, Shahin
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FUNDOPLICATION ,SPHINCTERS ,GASTROESOPHAGEAL reflux ,PROTON pump inhibitors ,OPERATIVE surgery ,DEGLUTITION disorders - Abstract
Magnetic sphincter augmentation (MSA) was introduced in 2007 as an alternative surgical procedure for patients with gastroesophageal reflux disease (GERD). The majority of data since MSA's introduction has focused on short and intermediate-term results, demonstrating safety and high efficacy in terms of reflux symptom control, freedom from proton pump inhibitor use and normalization of distal esophageal acid exposure. However, GERD is a chronic condition that demands a long-term solution. Limited available data from studies reporting outcomes at 5 years or later following MSA demonstrate that the promising short- and mid-term efficacy and safety profile of MSA remains relatively constant in the long term. Compared with Nissen fundoplication, MSA has a much lower rate of gas-bloat and inability to belch at a short-term follow-up, a difference that persists in the long-term. The most common complaint after MSA at a short-term follow-up is dysphagia. However, limited data suggest dysphagia rates largely decrease by 5 years. Dysphagia is the most common indication for dilation and device removal in both early- and long-term studies. However, the overall rates of dilation and removal are similar in short- and long-term reports, suggesting the majority of these procedures are performed in the short-term period after device implantation. The indications and standard practices of MSA have evolved over time. Long-term outcome data currently available are all from patient cohorts who were selected for MSA under early restricted indications and outdated regimens. Therefore, further long-term studies are needed to corroborate the preliminary, yet encouraging long-term results. [ABSTRACT FROM AUTHOR]
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- 2023
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12. Impact of Objective Colonic and Whole Gut Motility Data as Measured by Wireless Motility Capsule on Outcomes of Antireflux Surgery.
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Eriksson, Sven E, Maurer, Nicole, Zheng, Ping, Sarici, Inanc S, DeWitt, Ann, Riccardi, Margaret, Jobe, Blair A, and Ayazi, Shahin
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GASTROINTESTINAL motility , *NONPARAMETRIC statistics , *RESEARCH , *STATISTICS , *CONFIDENCE intervals , *CAPSULE endoscopy , *CONTINUING education units , *RETROSPECTIVE studies , *HEALTH outcome assessment , *MANN Whitney U Test , *FISHER exact test , *GASTROESOPHAGEAL reflux , *TREATMENT effectiveness , *PSYCHOLOGICAL tests , *COMPARATIVE studies , *DESCRIPTIVE statistics , *STATISTICAL correlation , *DATA analysis , *DATA analysis software , *EVALUATION - Abstract
BACKGROUND: Studies show higher rates of dissatisfaction with antireflux surgery (ARS) outcomes in patients with chronic constipation. This suggests a relationship between colonic dysmotility and suboptimal surgical outcome. However, due to limitations in technology, there is no objective data available examining this relationship. The wireless motility capsule (WMC) is a novel technology consisting of an ingestible capsule equipped with pH, temperature, and pressure sensors, which provide information regarding regional and whole gut transit times, pH and motility. The aim of this study was to assess the impact of objective regional and whole gut motility data on the outcomes of ARS. STUDY DESIGN: This was a retrospective review of patients who underwent WMC testing before ARS. Transit times, motility, and pH data obtained from different gastrointestinal tract regions were used in analysis to determine factors that impact surgical outcome. A favorable outcome was defined as complete resolution of the predominant reflux symptom and freedom from antisecretory medications. RESULTS: The final study population consisted of 48 patients (fundoplication [n = 29] and magnetic sphincter augmentation [n = 19]). Of those patients, 87.5% were females and the mean age ± SD was 51.8 ± 14.5 years. At follow-up (mean ± SD, 16.8 ± 13.2 months), 87.5% of all patients achieved favorable outcomes. Patients with unfavorable outcomes had longer mean whole gut transit times (92.0 hours vs 55.7 hours; p = 0.024) and colonic transit times (78.6 hours vs 47.3 hours; p = 0.028), higher mean peak colonic pH (8.8 vs 8.15; p = 0.009), and higher mean antral motility indexes (310 vs 90.1; p = 0.050). CONCLUSIONs: This is the first study to demonstrate that objective colonic dysmotility leads to suboptimal outcomes after ARS. WMC testing can assist with preoperative risk assessment and counseling for patients seeking ARS. Patients with GERD frequently have lower abdominal complaints, but little is known about the impact of objective hindgut physiology on antireflux surgery outcomes. Using wireless motility capsule technology, we demonstrate that objective colonic dysmotility and elevated colonic pH predict suboptimal antireflux surgery outcomes. [ABSTRACT FROM AUTHOR]
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- 2023
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13. GERD after Peroral Endoscopic Myotomy: Assessment of Incidence and Predisposing Factors.
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Abu-Nuwar, Mohamad Rassoul, Eriksson, Sven E., Sarici, Inanc S., Ping Zheng, Toshitaka Hoppo, Jobe, Blair A., and Ayazi, Shahin
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STATISTICS , *KRUSKAL-Wallis Test , *CONFIDENCE intervals , *MYOTOMY , *MULTIVARIATE analysis , *RETROSPECTIVE studies , *GASTROESOPHAGEAL reflux , *RISK assessment , *SEVERITY of illness index , *CHI-squared test , *LOGISTIC regression analysis , *ODDS ratio , *LONGITUDINAL method , *ESOPHAGEAL achalasia , *DISEASE risk factors , *EVALUATION ,SURGICAL complication risk factors - Abstract
BACKGROUND: Peroral endoscopic myotomy (POEM) is an effective intervention for achalasia, but GERD is a major postoperative adverse event. This study aimed to characterize post-POEM GERD and identify preoperative or technical factors impacting development or severity of GERD. STUDY DESIGN: This is a retrospective review of patients who underwent POEM at our institution. Favorable outcome was defined as postoperative Eckardt score of 3 or less. Subjective GERD was defined as symptoms consistent with reflux. Objective GERD was based on a DeMeester score greater than 14.7 or Los Angeles grade C or D esophagitis. Severe GERD was defined as a DeMeester score greater than 50.0 or Los Angeles grade D esophagitis Preoperative clinical and objective data and technical surgical elements were compared between those with and without GERD. Multivariate logistic analysis was performed to identify factors associated with each GERD definition. RESULTS: A total of 183 patients underwent POEM. At a mean ± SD follow-up of 21.7 ± 20.7 months, 93.4% achieved favorable outcome. Subjective, objective, and severe objective GERD were found in 38.8%, 50.5%, and 19.2% of patients, respectively. Of those with objective GERD, 24.0% had no reflux symptoms. Women were more likely to report GERD symptoms (p = 0.007), but objective GERD rates were similar between sexes (p = 0.606). The independent predictors for objective GERD were normal preoperative diameter of esophagus (odds ratio [OR] 3.4; p = 0.008) and lower esophageal sphincter (LES) pressure less than 45 mmHg (OR 1.86; p = 0.027). The independent predictors for severe objective GERD were LES pressure less than 45 mmHg (OR 6.57; p = 0.007) and obesity (OR 5.03; p = 0.005). The length of esophageal or gastric myotomy or indication of procedure had no impact on the incidence or severity of GERD. CONCLUSION: The rate of pathologic GERD after POEM is higher than symptomatic GERD. A nonhypertensive preoperative LES is a predictor for post-POEM GERD. No modifiable factors impact GERD after POEM. (J Am Coll Surg 2023;236:58–70. © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American College of Surgeons. [ABSTRACT FROM AUTHOR]
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- 2023
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14. Acute superior mesenteric artery syndrome with complete foregut obstruction following Nissen fundoplication
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Vaiciunaite, Donata, Sarici, Inanc S., Eriksson, Sven E., Ayazi, Shahin, and Jobe, Blair A.
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- 2023
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15. Impact of Change in Sizing Protocol on Outcome of Magnetic Sphincter Augmentation.
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Sarici IS, Eriksson SE, Zheng P, Moore O, Jobe BA, and Ayazi S
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Objective: To evaluate and compare magnetic sphincter augmentation (MSA) device sizing protocols on postoperative outcomes and dysphagia., Summary Background Data: Among predictors of dysphagia after MSA, device size is the only factor that may be modified. Many centers have adopted protocols to increase device size. However, there is limited data on the impact of MSA device upsizing protocols on the surgical outcomes., Methods: Patients who underwent MSA were implanted with 2 or 3-beads above the sizing device's pop-off point (POP). Clinical and objective outcomes >1-year after surgery were compared between patients implanted with POP+2-vs-POP+3 sizing protocols. Multiple subgroups were analyzed for benefit from upsizing. Pre- and postoperative characteristics were compared between size patients received, regardless of protocol., Results: A total of 388 patients were implanted under POP+2 and 216 under POP+3. At a mean of 14.2(7.9) months pH normalization was 73.6% and 34.1% required dilation, 15.9% developed persistent dysphagia, and 4.0% required removal. Sizing protocol had no impact on persistent dysphagia ( P =0.908), pH normalization ( P =0.822), or need for dilation ( P =0.210) or removal ( P =0.191). Subgroup analysis found that upsizing reduced dysphagia in patients with <80 percent peristalsis (10.3-vs-31%, P =0.048) or DCI >5000 (0-vs-30.4%, P =0.034). Regardless of sizing protocol, as device size increased there was a stepwise increase in percent male sex ( P <0.0001), BMI>30 ( P <0.0001), and preoperative hiatal hernia>3 cm ( P <0.0001), LA grade C/D esophagitis ( P <0.0001), and DeMeester score ( P <0.0001). Increased size was associated with decreased pH-normalization ( P <0.0001) and need for dilation ( P =0.043) or removal ( P =0.014)., Conclusions: Upsizing from POP+2 to POP+3 does not reduce dysphagia or affect other MSA outcomes; however, patients with poor peristalsis or hypercontractile esophagus do benefit. Regardless of sizing protocol, preoperative clinical characteristics varied among device sizes, suggesting size is not a modifiable factor, but a surrogate for esophageal circumference., Competing Interests: Disclosure statement : Authors have no relevant conflict of interest or financial relationship to disclose., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)
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- 2024
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16. GERD after Peroral Endoscopic Myotomy: Assessment of Incidence and Predisposing Factors.
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Rassoul Abu-Nuwar M, Eriksson SE, Sarici IS, Zheng P, Hoppo T, Jobe BA, and Ayazi S
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- Humans, Female, Esophageal Sphincter, Lower surgery, Incidence, Causality, Treatment Outcome, Esophagoscopy methods, Esophageal Achalasia diagnosis, Myotomy adverse effects, Myotomy methods, Gastroesophageal Reflux epidemiology, Gastroesophageal Reflux etiology, Gastroesophageal Reflux surgery, Esophagitis complications, Natural Orifice Endoscopic Surgery adverse effects, Natural Orifice Endoscopic Surgery methods
- Abstract
Background: Peroral endoscopic myotomy (POEM) is an effective intervention for achalasia, but GERD is a major postoperative adverse event. This study aimed to characterize post-POEM GERD and identify preoperative or technical factors impacting development or severity of GERD., Study Design: This is a retrospective review of patients who underwent POEM at our institution. Favorable outcome was defined as postoperative Eckardt score of 3 or less. Subjective GERD was defined as symptoms consistent with reflux. Objective GERD was based on a DeMeester score greater than 14.7 or Los Angeles grade C or D esophagitis. Severe GERD was defined as a DeMeester score greater than 50.0 or Los Angeles grade D esophagitis Preoperative clinical and objective data and technical surgical elements were compared between those with and without GERD. Multivariate logistic analysis was performed to identify factors associated with each GERD definition., Results: A total of 183 patients underwent POEM. At a mean ± SD follow-up of 21.7 ± 20.7 months, 93.4% achieved favorable outcome. Subjective, objective, and severe objective GERD were found in 38.8%, 50.5%, and 19.2% of patients, respectively. Of those with objective GERD, 24.0% had no reflux symptoms. Women were more likely to report GERD symptoms (p = 0.007), but objective GERD rates were similar between sexes (p = 0.606). The independent predictors for objective GERD were normal preoperative diameter of esophagus (odds ratio [OR] 3.4; p = 0.008) and lower esophageal sphincter (LES) pressure less than 45 mmHg (OR 1.86; p = 0.027). The independent predictors for severe objective GERD were LES pressure less than 45 mmHg (OR 6.57; p = 0.007) and obesity (OR 5.03; p = 0.005). The length of esophageal or gastric myotomy or indication of procedure had no impact on the incidence or severity of GERD., Conclusion: The rate of pathologic GERD after POEM is higher than symptomatic GERD. A nonhypertensive preoperative LES is a predictor for post-POEM GERD. No modifiable factors impact GERD after POEM., (Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American College of Surgeons.)
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- 2023
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17. Experimental Modal Analysis of an In-situ Clavicle.
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Rusovici RA, Topping DB, Eriksson SES, and Lopez DL
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- Accelerometry, Cadaver, Humans, Clavicle injuries, Fractures, Bone, Models, Anatomic
- Abstract
Clavicle fractures are widespread, and the understanding of their mechanism of occurrence via dynamic loading is important for prevention and design of protection systems. The proposed work will find the natural frequencies and mode shapes of the human clavicles in-situ, by employing experimental modal analysis (EMA) techniques on cadaver clavicles. The clavicle response to impact depends on mechanical energy transmission to the bone and requires an understanding of bone modal characteristics (natural frequencies and mode shapes), as well as the frequency content of the impact force. These dynamic forces include blunt trauma (sport injury or gun stock impact) or falls (i.e. motorcycle accidents) and exhibit a wide frequency spectrum. Clavicle modes are not well understood, and while researchers performed whole body or individual clavicle EMA, no in-situ EMA has been reported. Since an in-situ clavicle features its natural boundary conditions, mode estimation via EMA was more accurate than one performed for an isolated clavicle.The clavicle EMA used instrumented excitation sources (i.e. impact hammer) and sensors (i.e. triaxial accelerometers). The accelerometer responses gathered at several locations along the cadaver clavicle bone and the exciting force was recorded and through time-frequency transformations, the natural frequencies and mode shapes were identified. Mode shape visualization was performed in ModalView software. While material properties of cadaver clavicles may be influenced by embalming, the results, which include natural frequencies, modes and damping constants, would be more relevant than those obtained for isolated clavicles. These results would be used to design protection systems, define global material properties, and calibrate existing analytical models.
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- 2019
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18. EVIDENCE-BASED CURRICULAR CONTENT IMPROVES STUDENT KNOWLEDGE AND CHANGES ATTITUDES TOWARDS TRANSGENDER MEDICINE.
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Eriksson SE and Safer JD
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- Gender Identity, Humans, Transgender Persons, Curriculum, Gender Dysphoria, Health Knowledge, Attitudes, Practice, Students, Medical psychology, Transsexualism
- Abstract
Objective: Previous studies have demonstrated that the addition of transgender medicine content to a medical school curriculum increased students' comfort and willingness to treat transgender patients. We aimed to demonstrate that (1) evidence-based curricular content would improve knowledge of and change attitudes towards transgender medicine, and (2) students would consider cross-sex hormone therapy a legitimate treatment option for transgender patients., Methods: Curricular content with a focus on the biologic evidence for the durability of gender identity was added to the first-year medical program at Boston University School of Medicine. Immediately before and after exposure to the content, students were presented with an assessment of their knowledge of the etiology of gender identity., Results: Immediately following exposure to the content, a significant number of students changed their answer regarding the etiology of gender identity so that the number of correct responses increased from 63% (n = 56) to 93% (n = 121) (P<.001). For transgender treatment, the number of correct responses increased from 20% (n = 56) before exposure to the content to 50% (n = 121) following exposure (P<.001)., Conclusion: The addition of transgender medicine content to a medical school curriculum with a focus on the biologic evidence for a durable gender identity is an effective means of educating students about the etiology of gender identity and the appropriateness of cross-sex hormone therapy as a treatment for transgender patients.
- Published
- 2016
- Full Text
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