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6. Newly designed OTS Clip for preventing fully-covered self-expandable metal stent migration in the gastrointestinal tract

Author

Raffaele Manta, Lorenzo Del Nero, Baron Todd, Andrea Parodi, Antonella De Ceglie, Francesco Zito, Luigi Pasquale, Angelo Zullo, and Massimo Conio

Subjects
Diseases of the digestive system. Gastroenterology, RC799-869
Abstract

Background and study aims Fully-covered self-expandable metal stents (FCSEMS) are frequently used for endoscopic management of gastrointestinal lesions. However, stent migration occurs in up to one-third of patients. Different tools are used to anchor stents to prevent migration. A specifically designed over-the-scope device (Stentfix OTS Clip system) was recently introduced to prevent fully covered SEMS migration in the gastrointestinal tract. The study aimed to evaluate technical success and stent migration rates with the Stentfix device. Patients and methods Data were collected from consecutive patients at four participating centers who were at high risk of FCSEMS migration and in whom the anchoring system was used to prevent migration. Results A total of 31 patients were enrolled. Technically successful clip placement was achieved in all cases. At follow-up, the distal part of the device dislocated from the duodenum into the antrum at 3 days in one patient, accounting for a 3.2 % (95 % CI = 0–9.4) rate of stent migration. The underlying lesion being treated healed in all patients, but 10 patients died before stent removal due to neoplastic progression. Conclusions A dedicated over-the-scope stent fixation device appears to be safe and effective in preventing fully-covered SEMS migration through the gastrointestinal tract.

Published
2023
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7. Competence in Endoscopic Ultrasound and Endoscopic Retrograde Cholangiopancreatography, From Training Through Independent Practice

Author

Wani, Sachin, Keswani, Rajesh N, Han, Samuel, Aagaard, Eva M, Hall, Matthew, Simon, Violette, Abidi, Wasif M, Banerjee, Subhas, Baron, Todd H, Bartel, Michael, Bowman, Erik, Brauer, Brian C, Buscaglia, Jonathan M, Carlin, Linda, Chak, Amitabh, Chatrath, Hemant, Choudhary, Abhishek, Confer, Bradley, Coté, Gregory A, Das, Koushik K, DiMaio, Christopher J, Dries, Andrew M, Edmundowicz, Steven A, El Chafic, Abdul Hamid, El Hajj, Ihab, Ellert, Swan, Ferreira, Jason, Gamboa, Anthony, Gan, Ian S, Gangarosa, Lisa M, Gannavarapu, Bhargava, Gordon, Stuart R, Guda, Nalini M, Hammad, Hazem T, Harris, Cynthia, Jalaj, Sujai, Jowell, Paul S, Kenshil, Sana, Klapman, Jason, Kochman, Michael L, Komanduri, Srinadh, Lang, Gabriel, Lee, Linda S, Loren, David E, Lukens, Frank J, Mullady, Daniel, Muthusamy, V Raman, Nett, Andrew S, Olyaee, Mojtaba S, Pakseresht, Kavous, Perera, Pranith, Pfau, Patrick, Piraka, Cyrus, Poneros, John M, Rastogi, Amit, Razzak, Anthony, Riff, Brian, Saligram, Shreyas, Scheiman, James M, Schuster, Isaiah, Shah, Raj J, Sharma, Rishi, Spaete, Joshua P, Singh, Ajaypal, Sohail, Muhammad, Sreenarasimhaiah, Jayaprakash, Stevens, Tyler, Tabibian, James H, Tzimas, Demetrios, Uppal, Dushant S, Urayama, Shiro, Vitterbo, Domenico, Wang, Andrew Y, Wassef, Wahid, Yachimski, Patrick, Zepeda-Gomez, Sergio, Zuchelli, Tobias, and Early, Dayna

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Biomedical Imaging, Clinical Research, Digestive Diseases, Cholangiopancreatography, Endoscopic Retrograde, Clinical Competence, Endosonography, Humans, Learning Curve, Prospective Studies, Quality Indicators, Health Care, Quality Indicators, Advanced Endoscopy Training, Learning Curves, The EUS and ERCP Skills Assessment Tool, Neurosciences, Paediatrics and Reproductive Medicine, Gastroenterology & Hepatology, Clinical sciences, Nutrition and dietetics
Abstract

Background & aimsIt is unclear whether participation in competency-based fellowship programs for endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) results in high-quality care in independent practice. We measured quality indicator (QI) adherence during the first year of independent practice among physicians who completed endoscopic training with a systematic assessment of competence.MethodsWe performed a prospective multicenter cohort study of invited participants from 62 training programs. In phase 1, 24 advanced endoscopy trainees (AETs), from 20 programs, were assessed using a validated competence assessment tool. We used a comprehensive data collection and reporting system to create learning curves using cumulative sum analysis that were shared with AETs and trainers quarterly. In phase 2, participating AETs entered data into a database pertaining to every EUS and ERCP examination during their first year of independent practice, anchored by key QIs.ResultsBy the end of training, most AETs had achieved overall technical competence (EUS 91.7%, ERCP 73.9%) and cognitive competence (EUS 91.7%, ERCP 94.1%). In phase 2 of the study, 22 AETs (91.6%) participated and completed a median of 136 EUS examinations per AET and 116 ERCP examinations per AET. Most AETs met the performance thresholds for QIs in EUS (including 94.4% diagnostic rate of adequate samples and 83.8% diagnostic yield of malignancy in pancreatic masses) and ERCP (94.9% overall cannulation rate).ConclusionsIn this prospective multicenter study, we found that although competence cannot be confirmed for all AETs at the end of training, most meet QI thresholds for EUS and ERCP at the end of their first year of independent practice. This finding affirms the effectiveness of training programs. Clinicaltrials.gov ID NCT02509416.

Published
2018

9. Outcomes predictors in endoscopic ultrasound-guided choledochoduodenostomy with lumen-apposing metal stent: Systematic review and meta-analysis

Author

Fugazza, Alessandro, additional, Khalaf, Kareem, additional, Spadaccini, Marco, additional, Facciorusso, Antonio, additional, Colombo, Matteo, additional, Andreozzi, Marta, additional, Carrara, Silvia, additional, Binda, Cecilia, additional, Fabbri, Carlo, additional, Anderloni, Andrea, additional, Hassan, Cesare, additional, Baron, Todd, additional, and Repici, Alessandro, additional

Published
2024
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13. Proposed standards for reporting outcomes of treating biliary injuries

Author

Cho, Jai Young, Baron, Todd H., Carr-Locke, David L., Chapman, William C., Costamagna, Guido, de Santibanes, Eduardo, Dominguez Rosado, Ismael, Garden, O. James, Gouma, Dirk, Lillemoe, Keith D., Angel Mercado, Miguel, Mullady, Daniel K., Padbury, Robert, Picus, Daniel, Pitt, Henry A., Sherman, Stuart, Shlansky-Goldberg, Richard, Tornqvist, Bjorn, and Strasberg, Steven M.

Published
2018
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25. Reply to Petersen

Author

Visrodia, Kavel H., Ofstead, Cori L., Yellin, Hannah L., Wetzler, Harry P., Tosh, Pritish K., and Baron, Todd H.

Published
2014
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35. Migration of covered expandable metal stents after endoscopic ultrasound-guided hepaticogastrostomy: stent covering versus stent design?

Author

Baron, Todd H.

Subjects
*DUODENAL obstructions, *LASER beam cutting, *PALLIATIVE treatment, *MEDICAL drainage, *PERITONEUM
Abstract

The article discusses the issue of stent migration after endoscopic ultrasound-guided hepaticogastrostomy (EUSHGS). The use of covered self-expandable metal stents (SEMS) is recommended to prevent bile leakage, but the coating can lead to stent migration. The study examined the outcomes of patients with partially covered SEMS, comparing different lengths of uncovered portions. The study found that longer uncovered portions were associated with recurrent obstruction due to tissue hyperplasia, but they prevented complete outward stent migration. The author suggests that stent development should focus on fully covered SEMS with better delivery systems to minimize adverse events. [Extracted from the article]

Published
2024
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36. Endoscopic Retrograde Cholangiography Does Not Reliably Distinguish IgG4-Associated Cholangitis From Primary Sclerosing Cholangitis or Cholangiocarcinoma

Author

Kalaitzakis, Evangelos, Levy, Michael, Kamisawa, Terumi, Johnson, Gavin J., Baron, Todd H., Topazian, Mark D., Takahashi, Naoki, Kanno, Atsushi, Okazaki, Kazuichi, Egawa, Naoto, Uchida, Kazushige, Sheikh, Kashif, Amin, Zahir, Shimosegawa, Tooru, Sandanayake, Neomal S., Church, Nicholas I., Chapman, Michael H., Pereira, Stephen P., Chari, Suresh, and Webster, George J.M.

Published
2011
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44. Predictors of Jaundice Resolution and Survival After Endoscopic Treatment of Primary Sclerosing Cholangitis

Author

Eaton, John E., primary, Haseeb, Abdul, additional, Rupp, Christian, additional, Eusebi, Leonardo H., additional, Munster, Kim, additional, Voitl, Robert, additional, Thorburn, Douglas, additional, Ponsioen, Cyriel Y., additional, Enders, Felicity T., additional, Petersen, Bret T., additional, Abu Dayyeh, Barham K., additional, Baron, Todd H., additional, Chandrasekhara, Vinay, additional, Gostout, Christopher J., additional, Levy, Michael J., additional, Martin, John, additional, Storm, Andrew C., additional, Dierkhising, Ross, additional, Kamath, Patrick S., additional, Gores, Gregory J., additional, and Topazian, Mark, additional

Published
2021
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46. Flexible endoscopic management of Zenker diverticulum: the Mayo Clinic experience

Author

Case, David J. and Baron, Todd H.

Subjects
Diverticulum -- Care and treatment -- Diagnosis -- Research, Endoscopy -- Usage -- Health aspects -- Research
Abstract

OBJECTIVE: To describe the outcome of patients undergoing flexible endoscopic therapy for symptomatic Zenker diverticulum. PATIENTS AND METHODS: We retrospectively evaluated the outcome of 22 consecutive patients who underwent flexible [...]

Published
2010
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