140 results on '"Thosani, N"'
Search Results
52. Hepatocellular carcinoma masquerading as nodular Barrett's esophagus.
- Author
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Subramanian SK, Bhakta D, Thosani N, and Ertan A
- Subjects
- Esophagoscopy, Humans, Barrett Esophagus diagnosis, Carcinoma, Hepatocellular diagnostic imaging, Esophageal Neoplasms diagnosis, Liver Neoplasms diagnostic imaging
- Published
- 2021
- Full Text
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53. Practice patterns, techniques, and outcomes of flexible endoscopic myotomy for Zenker's diverticulum: a retrospective multicenter study.
- Author
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Mittal C, Diehl DL, Draganov PV, Jamil LH, Khalid A, Khara HS, Khullar V, Law R, Lo SK, Mathew A, Mirakhor E, Sedarat A, Sharma N, Sharzehi S, Tavakkoli A, Thaker A, Thosani N, Yang D, Zelt C, and Wagh MS
- Subjects
- Esophagoscopy, Humans, Retrospective Studies, Treatment Outcome, Deglutition Disorders etiology, Myotomy, Zenker Diverticulum surgery
- Abstract
Background: Flexible endoscopic myotomy has been increasingly performed for Zenker's diverticulum using various endoscopic techniques and devices. The main aims of this study were to assess practice patterns and compare outcomes of endoscopic myotomy for Zenker's diverticulum., Methods: Procedures performed at 12 tertiary endoscopy centers from 1/2012 to 12/2018 were reviewed. Patients (≥ 18 years) with Zenker's diverticulum who had dysphagia and/or regurgitation and underwent endoscopic myotomy were included. Outcomes assessed included technical success, clinical success, and adverse events., Results: 161 patients were included. Traditional endoscopic septotomy was performed most frequently (137/161, 85.1 %) followed by submucosal dissection of the septum and myotomy (24/161, 14.9 %). The hook knife (43/161, 26.7 %) and needle-knife (33/161, 20.5 %) were used most frequently. Overall, technical and clinical success rates were 98.1 % (158/161) and 78.1 % (96/123), respectively. Adverse events were noted in 13 patients (8.1 %). There was no significant difference in technical and clinical success between traditional septotomy and submucosal dissection groups (97.1 % vs. 95.8 %, P = 0.56 and 75.2 % vs. 90.9 %, P = 0.16, respectively). Clinical success was higher with the hook knife (96.7 %) compared with the needle-knife (76.6 %) and insulated tip knife (47.1 %). Outcomes were similar between centers performing > 20, 11 - 20, and ≤ 10 procedures., Conclusions: Flexible endoscopic myotomy is an effective therapy for Zenker's diverticulum, with a low rate of adverse events. There was no significant difference in outcomes between traditional septotomy and a submucosal dissection approach, or with centers with higher volume, though clinical success was higher with the hook knife., Competing Interests: Dr. Diehl is a consultant/speaker for Boston Scientific, Lumendi, US Endoscopy/Steris, Olympus, Pentax, Cook Medical, GI supply, Medtronic, and Merit Endotek. Dr. Draganov is a consultant for Boston Scientific, Olympus, Cook Endoscopy, and Microtek. Dr. Jamil is a consultant/speaker for Aries Pharmaceutical. Dr. Khara is a consultant for Olympus. Dr. Law is a consultant for Olympus and has received royalties from UpToDate. Dr. Thaker is a consultant for Boston Scientific. Dr. Thosani is a consultant for Boston Scientific, Medtronic, Pentax, and Endogastric Solutions, and has received royalties from UpToDate. Dr. Yang is a consultant for Boston Scientific, Lumendi, and US Endoscopy. Dr. Wagh is a consultant for Boston Scientific, Olympus, and Medtronic. All the other authors declare that they have no conflicts of interest., (Thieme. All rights reserved.)
- Published
- 2021
- Full Text
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54. Kras mutation rate precisely orchestrates ductal derived pancreatic intraepithelial neoplasia and pancreatic cancer.
- Author
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Singh K, Pruski M, Bland R, Younes M, Guha S, Thosani N, Maitra A, Cash BD, McAllister F, Logsdon CD, Chang JT, and Bailey-Lundberg JM
- Subjects
- Animals, Disease Models, Animal, Gene Expression Regulation, Neoplastic, Mice, Mice, Transgenic, Pancreatic Ducts cytology, Pancreatic Ducts metabolism, Pancreatic Ducts pathology, Precancerous Conditions genetics, Precancerous Conditions metabolism, Precancerous Conditions pathology, Recombination, Genetic, Carcinoma, Pancreatic Ductal genetics, Carcinoma, Pancreatic Ductal metabolism, Carcinoma, Pancreatic Ductal pathology, Mutation Rate, Pancreatic Neoplasms genetics, Pancreatic Neoplasms metabolism, Pancreatic Neoplasms pathology, Proto-Oncogene Proteins p21(ras) genetics, Proto-Oncogene Proteins p21(ras) metabolism
- Abstract
Pancreatic ductal adenocarcinoma (PDAC) is the third leading cause of cancer-related death in the United States. Despite the high prevalence of Kras mutations in pancreatic cancer patients, murine models expressing the oncogenic mutant Kras (Kras
mut ) in mature pancreatic cells develop PDAC at a low frequency. Independent of cell of origin, a second genetic hit (loss of tumor suppressor TP53 or PTEN) is important for development of PDAC in mice. We hypothesized ectopic expression and elevated levels of oncogenic mutant Kras would promote PanIN arising in pancreatic ducts. To test our hypothesis, the significance of elevating levels of K-Ras and Ras activity has been explored by expression of a CAG driven LGSL-KrasG12V allele (cKras) in pancreatic ducts, which promotes ectopic Kras expression. We predicted expression of cKras in pancreatic ducts would generate neoplasia and PDAC. To test our hypothesis, we employed tamoxifen dependent CreERT2 mediated recombination. Hnf1b:CreERT2 ;KrasG12V (cKrasHnf1b/+ ) mice received 1 (Low), 5 (Mod) or 10 (High) mg per 20 g body weight to recombine cKras in low (cKrasLow ), moderate (cKrasMod ), and high (cKrasHigh ) percentages of pancreatic ducts. Our histologic analysis revealed poorly differentiated aggressive tumors in cKrasHigh mice. cKrasMod mice had grades of Pancreatic Intraepithelial Neoplasia (PanIN), recapitulating early and advanced PanIN observed in human PDAC. Proteomics analysis revealed significant differences in PTEN/AKT and MAPK pathways between wild type, cKrasLow , cKrasMod , and cKrasHigh mice. In conclusion, in this study, we provide evidence that ectopic expression of oncogenic mutant K-Ras in pancreatic ducts generates early and late PanIN as well as PDAC. This Ras rheostat model provides evidence that AKT signaling is an important early driver of invasive ductal derived PDAC.- Published
- 2021
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55. An international study of interobserver variability of "string sign" of pancreatic cysts among experienced endosonographers.
- Author
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Hakim S, Coronel E, González GMN, Ge PS, Chari ST, Thosani N, Ramireddy S, Badillo R, DaVee T, Catalano MF, Sealock RJ, Parupudi S, Hernandez LV, Joshi V, Irisawa A, Rana S, Lakhtakia S, Vilmann P, Saftoiu A, Sun S, Giovannini M, Katz MH, Kim MP, and Bhutani MS
- Abstract
Background and Objectives: No single optimal test reliably determines the pancreatic cyst subtype. Following EUS-FNA, the "string sign" test can differentiate mucinous from nonmucinous cysts. However, the interobserver variability of string sign results has not been studied., Methods: An experienced endosonographer performed EUS-FNA of pancreatic cysts on different patients and was recorded on video performing the string sign test for each. The videos were shared internationally with 14 experienced endosonographers, with a survey for each video: "Is the string sign positive?" and "If the string sign is positive, what is the length of the formed string?" Also asked "What is the cutoff length for string sign to be considered positive?" Interobserver variability was assessed using the kappa statistic (κ)., Results: A total of 112 observations were collected from 14 endosonographers. Regarding string sign test positivity, κ was 0.6 among 14 observers indicating good interrater agreement (P < 0.001) while κ was 0.38 when observers were compared to the index endosonographer demonstrating marginal agreement (P < 0.001). Among observations of the length of the string in positive samples, 89.8% showed >5 mm of variability (P < 0.001), indicating marked variability. There was poor agreement on the cutoff length for a string to be considered positive., Conclusion: String sign of pancreatic cysts has a good interobserver agreement regarding its positivity that can help in differentiating mucinous from nonmucinous pancreatic cysts. However, the agreement is poor on the measured length of the string and the cutoff length of the formed string to be considered a positive string sign., Competing Interests: None
- Published
- 2021
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56. Escalating complexity of endoscopic retrograde cholangiopancreatography over the last decade with increasing reliance on advanced cannulation techniques.
- Author
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Barakat MT, Girotra M, Thosani N, Kothari S, and Banerjee S
- Subjects
- Aged, Catheterization, Humans, Retrospective Studies, Treatment Outcome, Cholangiopancreatography, Endoscopic Retrograde, Sphincterotomy, Endoscopic
- Abstract
Background: At our academic tertiary care medical center, we have noted patients referred for endoscopic retrograde cholangiopancreatography (ERCP) who increasingly require advanced cannulation techniques. This trend is noted despite increased endoscopist experience and annual ERCP volume over the same period., Aim: To evaluate this phenomenon of perceived escalation in complexity of cannulation at ERCP and assessed potential underlying factors., Methods: Demographic/clinical variables and records of ERCP patients at the beginning (2008), middle (2013) and end (2018) of the last decade were reviewed retrospectively. Cannulation approaches were classified as "standard" or "advanced" and duodenoscope position was labeled as "standard" (short position) or "non-standard" ( e.g., long, semi-long)., Results: Patients undergoing ERCP were older in 2018 compared to 2008 (69.7 ± 15.2 years vs 55.1 ± 14.7, P < 0.05). Increased ampullary distortion and peri-ampullary diverticula were noted in 2018 ( P < 0.001). ERCPs were increasingly performed with a non-standard duodenoscope position, from 2.2% (2008) to 5.6% (2013) and 16.1% (2018) ( P < 0.001). Utilization of more than one advanced cannulation technique for a given ERCP increased from 0.7% (2008) to 0.9% (2013) to 6.6% (2018) ( P < 0.001). Primary mass size > 4 cm, pancreatic uncinate mass, and bilirubin > 10 mg/dL predicted use of advanced cannulation techniques ( P < 0.03 for each)., Conclusion: Complexity of cannulation at ERCP has sharply increased over the past 5 years, with an increased proportion of elderly patients and those with malignancy requiring advanced cannulation approaches. These data suggest that complexity of cannulation at ERCP may be predicted based on patient/ampulla characteristics. This may inform selection of experienced, high-volume endoscopists to perform these complex procedures., Competing Interests: Conflict-of-interest statement: None of the authors of this manuscript have relevant conflicts of interest to disclose. , (©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.)
- Published
- 2020
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57. Economic model to restart endoscopy practice needs to consider impact on health disparity in minority groups.
- Author
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Badillo R, Guha S, Ramireddy S, DaVee RT, and Thosani N
- Subjects
- Endoscopy, Humans, Models, Economic, Polymerase Chain Reaction, SARS-CoV-2, COVID-19, Minority Groups
- Published
- 2020
- Full Text
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58. Removal of a lodged pancreatic duct stone using a retrieval snare.
- Author
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Rahimi E and Thosani N
- Published
- 2020
- Full Text
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59. Response.
- Author
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Thosani N, Wani S, and Khashab MA
- Subjects
- Humans, Esophageal Achalasia
- Published
- 2020
- Full Text
- View/download PDF
60. American Society for Gastrointestinal Endoscopy guideline on the role of endoscopy in familial adenomatous polyposis syndromes.
- Author
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Yang J, Gurudu SR, Koptiuch C, Agrawal D, Buxbaum JL, Abbas Fehmi SM, Fishman DS, Khashab MA, Jamil LH, Jue TL, Law JK, Lee JK, Naveed M, Qumseya BJ, Sawhney MS, Thosani N, Wani SB, and Samadder NJ
- Subjects
- Endoscopy, Gastrointestinal, Genetic Testing, Humans, Practice Guidelines as Topic, Retrospective Studies, Societies, Medical, United States, Adenomatous Polyposis Coli genetics, Colorectal Neoplasms
- Abstract
Familial adenomatous polyposis (FAP) syndrome is a complex entity, which includes FAP, attenuated FAP, and MUTYH-associated polyposis. These patients are at significant risk for colorectal cancer and carry additional risks for extracolonic malignancies. In this guideline, we reviewed the most recent literature to formulate recommendations on the role of endoscopy in this patient population. Relevant clinical questions were how to identify high-risk individuals warranting genetic testing, when to start screening examinations, what are appropriate surveillance intervals, how to identify endoscopically high-risk features, and what is the role of chemoprevention. A systematic literature search from 2005 to 2018 was performed, in addition to the inclusion of seminal historical studies. Most studies were from worldwide registries, which have compiled years of data regarding the natural history and cancer risks in this cohort. Given that most studies were retrospective, recommendations were based on epidemiologic data and expert opinion. Management of colorectal polyps in FAP has not changed much in recent years, as colectomy in FAP is the standard of care. What is new, however, is the developing body of literature on the role of endoscopy in managing upper GI and small-bowel polyposis, as patients are living longer and improved endoscopic technologies have emerged., (Copyright © 2020 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.)
- Published
- 2020
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61. ASGE guideline on minimum staffing requirements for the performance of GI endoscopy.
- Author
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Jamil LH, Naveed M, Agrawal D, Fujii-Lau LL, Al-Haddad M, Buxbaum JL, Fishman DS, Jue TL, Law JK, Lee JK, Qumseya BJ, Sawhney MS, Thosani N, Storm AC, Calderwood AH, Gurudu SR, Khashab MA, Yang J, and Wani SB
- Subjects
- Humans, Practice Guidelines as Topic, Systematic Reviews as Topic, United States, Workforce, Endoscopy, Gastrointestinal
- Abstract
Efforts to increase patient safety and satisfaction, a critical concern for health providers, require periodic evaluation of all factors involved in the provision of GI endoscopy services. We aimed to develop guidelines on minimum staffing requirements and scope of practice of available staff for the safe and efficient performance of GI endoscopy. The recommendations in this guideline were based on a systematic review of published literature, results from a nationwide survey of endoscopy directors, along with the expert guidance of the American Society for Gastrointestinal Endoscopy (ASGE) Standards of Practice Committee members, ASGE Practice Operation Committee members, and the ASGE Governing Board., (Copyright © 2020 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.)
- Published
- 2020
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62. American Society for Gastrointestinal Endoscopy guideline on the role of endoscopy in the management of acute colonic pseudo-obstruction and colonic volvulus.
- Author
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Naveed M, Jamil LH, Fujii-Lau LL, Al-Haddad M, Buxbaum JL, Fishman DS, Jue TL, Law JK, Lee JK, Qumseya BJ, Sawhney MS, Thosani N, Storm AC, Calderwood AH, Khashab MA, and Wani SB
- Subjects
- Acute Disease, Cecum surgery, Colostomy methods, Endoscopy, Gastrointestinal methods, Humans, Neostigmine therapeutic use, Societies, Medical, United States, Cholinesterase Inhibitors therapeutic use, Colonic Pseudo-Obstruction therapy, Colonoscopy methods, Conservative Treatment, Decompression, Surgical methods, Intestinal Volvulus therapy, Sigmoid Diseases therapy
- Abstract
Colonic volvulus and acute colonic pseudo-obstruction (ACPO) are 2 causes of benign large-bowel obstruction. Colonic volvulus occurs most commonly in the sigmoid colon as a result of bowel twisting along its mesenteric axis. In contrast, the exact pathophysiology of ACPO is poorly understood, with the prevailing hypothesis being altered regulation of colonic function by the autonomic nervous system resulting in colonic distention in the absence of mechanical blockage. Prompt diagnosis and intervention leads to improved outcomes for both diagnoses. Endoscopy may play a role in the evaluation and management of both entities. The purpose of this document from the American Society for Gastrointestinal Endoscopy's Standards of Practice Committee is to provide an update on the evaluation and endoscopic management of sigmoid volvulus and ACPO., (Copyright © 2020. Published by Elsevier Inc.)
- Published
- 2020
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63. Novel retrieval basket for the extraction of choledocholithiasis.
- Author
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Ramireddy S, DaVee TR, Badillo R, and Thosani N
- Subjects
- Cholangiopancreatography, Endoscopic Retrograde, Humans, Choledocholithiasis surgery
- Abstract
Competing Interests: Nirav Thosani is Boston Scientific consultant.
- Published
- 2020
- Full Text
- View/download PDF
64. ASGE guideline on the management of achalasia.
- Author
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Khashab MA, Vela MF, Thosani N, Agrawal D, Buxbaum JL, Abbas Fehmi SM, Fishman DS, Gurudu SR, Jamil LH, Jue TL, Kannadath BS, Law JK, Lee JK, Naveed M, Qumseya BJ, Sawhney MS, Yang J, and Wani S
- Subjects
- Disease Management, Esophageal Achalasia diagnosis, Humans, Injections, Intramuscular, Manometry methods, Myotomy methods, Societies, Medical, United States, Acetylcholine Release Inhibitors therapeutic use, Botulinum Toxins therapeutic use, Dilatation methods, Endoscopy, Digestive System methods, Esophageal Achalasia therapy, Esophageal Sphincter, Lower surgery, Heller Myotomy methods
- Abstract
Achalasia is a primary esophageal motor disorder of unknown etiology characterized by degeneration of the myenteric plexus, which results in impaired relaxation of the esophagogastric junction (EGJ), along with the loss of organized peristalsis in the esophageal body. The criterion standard for diagnosing achalasia is high-resolution esophageal manometry showing incomplete relaxation of the EGJ coupled with the absence of organized peristalsis. Three achalasia subtypes have been defined based on high-resolution manometry findings in the esophageal body. Treatment of patients with achalasia has evolved in recent years with the introduction of peroral endoscopic myotomy. Other treatment options include botulinum toxin injection, pneumatic dilation, and Heller myotomy. This American Society for Gastrointestinal Endoscopy Standards of Practice Guideline provides evidence-based recommendations for the treatment of achalasia, based on an updated assessment of the individual and comparative effectiveness, adverse effects, and cost of the 4 aforementioned achalasia therapies., (Copyright © 2020. Published by Elsevier Inc.)
- Published
- 2020
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65. ASGE review of adverse events in colonoscopy.
- Author
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Kothari ST, Huang RJ, Shaukat A, Agrawal D, Buxbaum JL, Abbas Fehmi SM, Fishman DS, Gurudu SR, Khashab MA, Jamil LH, Jue TL, Law JK, Lee JK, Naveed M, Qumseya BJ, Sawhney MS, Thosani N, Yang J, DeWitt JM, and Wani S
- Subjects
- Colonoscopy methods, Humans, Severity of Illness Index, Colonoscopy adverse effects, Postoperative Complications etiology
- Abstract
Colonoscopy is the most commonly performed endoscopic procedure and overall is considered a low-risk procedure. However, adverse events (AEs) related to this routinely performed procedure for screening, diagnostic, or therapeutic purposes are an important clinical consideration. The purpose of this document from the American Society for Gastrointestinal Endoscopy's Standards of Practice Committee is to provide an update on estimates of AEs related to colonoscopy in an evidence-based fashion. A systematic review and meta-analysis of population-based studies was conducted for the 3 most common and important serious AEs (bleeding, perforation, and mortality). In addition, this document includes an updated systematic review and meta-analysis of serious AEs (bleeding and perforation) related to EMR and endoscopic submucosal dissection for large colon polyps. Finally, a narrative review of other colonoscopy-related serious AEs and those related to specific colonic interventions is included., (Copyright © 2019. Published by Elsevier Inc.)
- Published
- 2019
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66. Diffuse Villous Tumor Arising in Barrett's Esophagus Presenting With Aspiration Pneumonitis.
- Author
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Kaila V, Thosani N, and Feldman M
- Abstract
Barrett's esophagus (BE) is associated with an increased incidence of adenocarcinoma. The dysplasia in BE that precedes cancer is usually endoscopically flat. Unlike in the colon, polypoid dysplastic lesions superimposed on BE are uncommon. Furthermore, villous tumors of the esophagus are rare, and few cases have been reported in the literature. We report an 85-year-old man who was found to have a circumferential villiform-appearing esophageal tumor with mucus secretions with recurrent bronchopulmonary aspiration. A diffuse villiform tumor of the entire esophagus with mucin production is rare and, to our knowledge, has not been previously described in the literature., (© 2019 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology.)
- Published
- 2019
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67. ASGE guideline on the role of endoscopy for bleeding from chronic radiation proctopathy.
- Author
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Lee JK, Agrawal D, Thosani N, Al-Haddad M, Buxbaum JL, Calderwood AH, Fishman DS, Fujii-Lau LL, Jamil LH, Jue TL, Khashab MA, Law JK, Naveed M, Qumseya BJ, Sawhney MS, Storm AC, Yang J, and Wani SB
- Subjects
- Chronic Disease, Gastrointestinal Hemorrhage etiology, Humans, Radiation Injuries complications, Rectal Diseases etiology, Gastrointestinal Hemorrhage surgery, Proctoscopy standards, Radiation Injuries surgery, Rectal Diseases surgery, Rectum injuries
- Abstract
Chronic radiation proctopathy is a common sequela of radiation therapy for malignancies in the pelvic region. A variety of medical and endoscopic therapies have been used for the management of bleeding from chronic radiation proctopathy. In this guideline, we reviewed the results of a systematic search of the literature from 1946 to 2017 to formulate clinical questions and recommendations on the role of endoscopy for bleeding from chronic radiation proctopathy. The following endoscopic modalities are discussed in our document: argon plasma coagulation, bipolar electrocoagulation, heater probe, radiofrequency ablation, and cryoablation. Most studies were small observational studies, and the evidence for effectiveness of endoscopic therapy for chronic radiation proctopathy was limited because of a lack of controlled trials and comparative studies. Despite this limitation, our systematic review found that argon plasma coagulation, bipolar electrocoagulation, heater probe, and radiofrequency ablation were effective in the treatment of rectal bleeding from chronic radiation proctopathy., (Copyright © 2019. Published by Elsevier Inc.)
- Published
- 2019
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68. Reversal and reloading of a 22-mm duodenal stent for urgent decompression of malignant colonic obstruction in a high-risk patient.
- Author
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Kukreja K, Deep A, Ramireddy S, Badillo R, Thosani N, and DaVee T
- Published
- 2019
- Full Text
- View/download PDF
69. Endoscopic simulators.
- Author
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Goodman AJ, Melson J, Aslanian HR, Bhutani MS, Krishnan K, Lichtenstein DR, Navaneethan U, Pannala R, Parsi MA, Schulman AR, Sethi A, Sullivan SA, Thosani N, Trikudanathan G, Trindade AJ, Watson RR, and Maple JT
- Subjects
- Humans, Models, Anatomic, Virtual Reality, Endoscopy, Gastrointestinal education, Gastroenterology education, Simulation Training methods
- Abstract
Background and Aims: Simulation refers to educational tools that allow for repetitive instruction in a nonpatient care environment that is risk-free. In GI endoscopy, simulators include ex vivo animal tissue models, live animal models, mechanical models, and virtual reality (VR) computer simulators., Methods: After a structured search of the peer-reviewed medical literature, this document reviews commercially available GI endoscopy simulation systems and clinical outcomes of simulation in endoscopy., Results: Mechanical simulators and VR simulators are frequently used early in training, whereas ex vivo and in vivo animal models are more commonly used for advanced endoscopy training. Multiple studies and systematic reviews show that simulation-based training appears to provide novice endoscopists with some advantage over untrained peers with regard to endpoints such as independent procedure completion and performance time, among others. Data also suggest that simulation training may accelerate the acquisition of specific technical skills in colonoscopy and upper endoscopy early in training. However, the available literature suggests that the benefits of simulator training appear to attenuate and cease after a finite period. Further studies are needed to determine if meeting competency metrics using simulation will predict actual clinical competency., Conclusions: Simulation training is a promising modality that may aid in endoscopic education. However, for widespread incorporation of simulators into gastroenterology training programs to occur, simulators must show a sustained advantage over traditional mentored teaching in a cost-effective manner. Because most studies evaluating simulation have focused on novice learners, the role of simulation training in helping practicing endoscopists gain proficiency using new techniques and devices should be further explored., (Copyright © 2019. Published by Elsevier Inc.)
- Published
- 2019
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70. ASGE guideline for endoscopic full-thickness resection and submucosal tunnel endoscopic resection.
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Aslanian HR, Sethi A, Bhutani MS, Goodman AJ, Krishnan K, Lichtenstein DR, Melson J, Navaneethan U, Pannala R, Parsi MA, Schulman AR, Sullivan SA, Thosani N, Trikudanathan G, Trindade AJ, Watson RR, and Maple JT
- Abstract
With the development of reliable endoscopic closure techniques and tools, endoscopic full-thickness resection (EFTR) is emerging as a therapeutic option for the treatment of subepithelial tumors and epithelial neoplasia with significant fibrosis. EFTR may be categorized as "exposed" and "nonexposed." In exposed EFTR, the full-thickness resection is undertaken with a tunneled or nontunneled technique, with subsequent closure of the defect. In nonexposed EFTR, a secure serosa-to-serosa apposition is achieved before full-thickness resection of the isolated lesion. This document reviews current techniques and devices used for EFTR and reviews clinical applications and outcomes.
- Published
- 2019
- Full Text
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71. ASGE guideline on the role of endoscopy in the evaluation and management of choledocholithiasis.
- Author
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Buxbaum JL, Abbas Fehmi SM, Sultan S, Fishman DS, Qumseya BJ, Cortessis VK, Schilperoort H, Kysh L, Matsuoka L, Yachimski P, Agrawal D, Gurudu SR, Jamil LH, Jue TL, Khashab MA, Law JK, Lee JK, Naveed M, Sawhney MS, Thosani N, Yang J, and Wani SB
- Subjects
- Cholangiopancreatography, Magnetic Resonance, Cholecystectomy, Endosonography, Humans, Mirizzi Syndrome diagnosis, Mirizzi Syndrome therapy, Stents, Cholangiopancreatography, Endoscopic Retrograde, Choledocholithiasis diagnosis, Choledocholithiasis therapy, Sphincterotomy, Endoscopic
- Abstract
Each year choledocholithiasis results in biliary obstruction, cholangitis, and pancreatitis in a significant number of patients. The primary treatment, ERCP, is minimally invasive but associated with adverse events in 6% to 15%. This American Society for Gastrointestinal Endoscopy (ASGE) Standard of Practice (SOP) Guideline provides evidence-based recommendations for the endoscopic evaluation and treatment of choledocholithiasis. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework was used to rigorously review and synthesize the contemporary literature regarding the following topics: EUS versus MRCP for diagnosis, the role of early ERCP in gallstone pancreatitis, endoscopic papillary dilation after sphincterotomy versus sphincterotomy alone for large bile duct stones, and impact of ERCP-guided intraductal therapy for large and difficult choledocholithiasis. Comprehensive systematic reviews were also performed to assess the following: same-admission cholecystectomy for gallstone pancreatitis, clinical predictors of choledocholithiasis, optimal timing of ERCP vis-à-vis cholecystectomy, management of Mirizzi syndrome and hepatolithiasis, and biliary stent therapy for choledocholithiasis. Core clinical questions were derived using an iterative process by the ASGE SOP Committee. This body developed all recommendations founded on the certainty of the evidence, balance of risks and harms, consideration of stakeholder preferences, resource utilization, and cost-effectiveness., (Copyright © 2019. Published by Elsevier Inc.)
- Published
- 2019
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72. Management of choledocholithiasis by direct cholangioscopy via freehand intubation using the "J" maneuver.
- Author
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Zhang HC, Dedania B, and Thosani N
- Published
- 2019
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73. Removal of a migrated fully covered metal biliary stent by cholangioscope-assisted inversion technique.
- Author
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Rahimi E, Khuwaja S, and Thosani N
- Subjects
- Aged, Female, Hepatic Duct, Common, Humans, Device Removal methods, Endoscopy, Digestive System methods, Prosthesis Failure adverse effects, Self Expandable Metallic Stents adverse effects
- Abstract
Competing Interests: None, (© Georg Thieme Verlag KG Stuttgart · New York.)
- Published
- 2018
- Full Text
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74. Will Abandoning Fine-Needle Aspiration Increase Diagnostic Yield From Tissues Collected During Endoscopic Ultrasound?
- Author
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Machicado JD, Thosani N, and Wani S
- Subjects
- Humans, Endoscopic Ultrasound-Guided Fine Needle Aspiration, Endosonography
- Published
- 2018
- Full Text
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75. Efficacy and Safety of Flexible Endoscopic Management of Zenker's Diverticulum.
- Author
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Jain D, Sharma A, Shah M, Patel U, Thosani N, and Singhal S
- Subjects
- Aged, Endoscopy, Gastrointestinal adverse effects, Endoscopy, Gastrointestinal instrumentation, Humans, Postoperative Complications epidemiology, Postoperative Hemorrhage epidemiology, Recurrence, Treatment Outcome, Zenker Diverticulum physiopathology, Endoscopes, Gastrointestinal, Endoscopy, Gastrointestinal methods, Zenker Diverticulum surgery
- Abstract
Zenker's diverticulum (ZD), a pulsion diverticulum of hypopharynx is a rare but treatable cause of morbidity in geriatric population. Traditionally a surgical disease but due to its associated high morbidity, flexible endoscopy has become a lucrative option. We reviewed 997 patients from 23 original studies who underwent flexible endoscopic diverticulotomy (FED) of ZD. Composite technical and clinical success rate for the study cohort was 99.4% and 87.9%, respectively. Composite failure rate was 10.0% but close to half of them (45.3%) had success with repeat endoscopic intervention. Composite rate for symptom recurrence after long-term follow-up was 13.6% but more than half (61.8%) had success with repeat endoscopic intervention. Bleeding (6.6%) and perforation (5.3%) were 2 most common complications of FED. All bleeding events were successfully managed with observation or endoscopic therapy. Majority of perforation events (4.4%) were successfully managed with conservative care and only 0.9% required invasive management. No mortality was reported. Efficacy and safety of FED of ZD remained same irrespective of diverticulum size or prior surgical/endoscopic treatment. FED with diverticuloscope (FEDD) and FED with cap (FEDC) had comparable technical success rate (99.6% vs. 100.0%) but FEDD had higher clinical success rate compared with FEDC (86.8% vs. 75.4%). FEDD had twice the risk of symptom recurrence than FEDC (16.5% vs. 9.5%). FEDD had a comparable bleeding risk to FEDC (3.3% vs. 4.0%) but a much lower perforation rate (2.3% vs. 10.3%). Upper esophageal sphincterotomy and adequate length of septotomy are the cornerstones of FED. FED can be considered a safe and efficacious treatment modality for patients with ZD.
- Published
- 2018
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76. Devices and methods to improve colonoscopy completion (with videos).
- Author
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Trindade AJ, Lichtenstein DR, Aslanian HR, Bhutani MS, Goodman A, Melson J, Navaneethan U, Pannala R, Parsi MA, Sethi A, Sullivan S, Thosani N, Trikudanathan G, Watson RR, and Maple JT
- Subjects
- Colonoscopy adverse effects, Colonoscopy instrumentation, Humans, Videotape Recording, Colonoscopes adverse effects, Colonoscopy methods
- Published
- 2018
- Full Text
- View/download PDF
77. Refractory bile leak with biliocutaneous fistula treated by endobiliary coil placement.
- Author
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Kirtane T, Goyal D, Rahimi E, Ertan A, Bynon JS, and Thosani N
- Subjects
- Adult, Bile Ducts diagnostic imaging, Bile Ducts surgery, Digestive System Surgical Procedures instrumentation, Digestive System Surgical Procedures methods, Equipment Design, Female, Humans, Multiple Trauma surgery, Treatment Outcome, Wounds, Gunshot surgery, Abdominal Injuries surgery, Biliary Fistula diagnosis, Biliary Fistula etiology, Biliary Fistula physiopathology, Biliary Fistula surgery, Cholangiopancreatography, Endoscopic Retrograde methods, Cutaneous Fistula diagnosis, Cutaneous Fistula etiology, Cutaneous Fistula physiopathology, Cutaneous Fistula surgery, Digestive System Surgical Procedures adverse effects, Postoperative Complications diagnosis, Postoperative Complications physiopathology, Postoperative Complications surgery, Prosthesis Implantation instrumentation, Prosthesis Implantation methods, Stents adverse effects
- Abstract
Competing Interests: Competing interests: None
- Published
- 2017
- Full Text
- View/download PDF
78. Endoscopic anti-reflux devices (with videos).
- Author
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Thosani N, Goodman A, Manfredi M, Navaneethan U, Parsi MA, Smith ZL, Sullivan SA, Banerjee S, and Maple JT
- Subjects
- Endoscopy, Gastrointestinal methods, Fundoplication methods, Humans, Randomized Controlled Trials as Topic, Endoscopy, Gastrointestinal instrumentation, Fundoplication instrumentation, Gastroesophageal Reflux surgery
- Published
- 2017
- Full Text
- View/download PDF
79. Radiofrequency ablation devices.
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Navaneethan U, Thosani N, Goodman A, Manfredi M, Pannala R, Parsi MA, Smith ZL, Sullivan SA, Banerjee S, and Maple JT
- Published
- 2017
- Full Text
- View/download PDF
80. Adenoma miss rates associated with a 3-minute versus 6-minute colonoscopy withdrawal time: a prospective, randomized trial.
- Author
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Kumar S, Thosani N, Ladabaum U, Friedland S, Chen AM, Kochar R, and Banerjee S
- Subjects
- Aged, Female, Humans, Male, Middle Aged, Odds Ratio, Prospective Studies, Adenoma diagnosis, Colonoscopy methods, Colorectal Neoplasms diagnosis, Diagnostic Errors, Operative Time
- Abstract
Background and Aims: The 6-minute withdrawal time for colonoscopy, widely considered the standard of care, is controversial. The skill and technique of endoscopists may be as important as, or more important than, withdrawal time for adenoma detection. It is unclear whether a shorter withdrawal time with good technique yields an acceptable lesion detection rate. Our objective was to evaluate a 3-minute versus a 6-minute withdrawal time by using segmental tandem colonoscopy., Methods: We performed a prospective, randomized trial by using 4 expert endoscopists. Patients were randomized to a 3-minute or a 6-minute initial withdrawal, each followed by a tandem second 6-minute withdrawal. All polyps were removed. The primary outcomes were adenoma miss rates (AMRs), adenomas per colonoscopy (APC) rates, and adenoma detection rates (ADRs)., Results: A total of 99 and 101 patients were enrolled in the 3-minute and 6-minute withdrawal groups, respectively. The AMR was significantly higher in the 3-minute withdrawal group (48.0% vs 22.9%; P = .0001). After controlling for endoscopist, patient age and/or sex, Boston Bowel Preparation Scale score, and size and/or location and/or morphology of adenoma, the AMR remained significantly higher in the 3-minute withdrawal group (odds ratio, 2.78; 95% confidence interval, 1.35-5.15; P = .0001). The ADR was similar between both groups (39.2% vs 40.6%; P = .84). However, the mean APC rate was significantly lower in the 3-minute withdrawal group (0.55 vs 0.80; P = .0001)., Conclusions: The AMR was significantly higher, and the APC rate was significantly lower in the 3-minute withdrawal group versus the 6-minute withdrawal group. Despite expert technique, a shorter withdrawal time is associated with an unacceptably high AMR and low APC rate. (Clinical trial registration number: NCT01802008.)., (Copyright © 2017 American Society for Gastrointestinal Endoscopy. All rights reserved.)
- Published
- 2017
- Full Text
- View/download PDF
81. EUS-guided portal vein interventions.
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Trikudanathan G, Pannala R, Bhutani MS, Melson J, Navaneethan U, Parsi MA, Thosani N, Trindade AJ, Watson RR, and Maple JT
- Subjects
- Blood Pressure Determination methods, Chemoembolization, Therapeutic methods, Endoscopic Ultrasound-Guided Fine Needle Aspiration, Humans, Liver Neoplasms secondary, Neoplasm Staging, Neoplastic Cells, Circulating pathology, Portal Pressure, Portal Vein pathology, Portasystemic Shunt, Surgical methods, Carcinoma, Hepatocellular pathology, Endosonography, Liver Neoplasms pathology, Liver Neoplasms therapy, Portal Vein diagnostic imaging, Ultrasonography, Interventional
- Published
- 2017
- Full Text
- View/download PDF
82. Interventional EUS (with videos).
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Maple JT, Pannala R, Abu Dayyeh BK, Aslanian HR, Enestvedt BK, Goodman A, Komanduri S, Manfredi M, Navaneethan U, Parsi MA, Smith ZL, Thosani N, Sullivan SA, and Banerjee S
- Subjects
- Choledochostomy methods, Dilatation instrumentation, Dilatation methods, Drainage instrumentation, Drainage methods, Endosonography instrumentation, Esophageal and Gastric Varices diagnostic imaging, Esophageal and Gastric Varices surgery, Gastrostomy methods, Humans, Needles, Stents, Ultrasonography, Interventional instrumentation, Endosonography methods, Ultrasonography, Interventional methods
- Published
- 2017
- Full Text
- View/download PDF
83. Devices for use with EUS.
- Author
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Hwang JH, Aslanian HR, Thosani N, Goodman A, Manfredi M, Navaneethan U, Pannala R, Parsi MA, Smith ZL, Sullivan SA, Banerjee S, and Maple JT
- Published
- 2017
- Full Text
- View/download PDF
84. Cryotherapy in gastrointestinal endoscopy.
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Parsi MA, Trindade AJ, Bhutani MS, Melson J, Navaneethan U, Thosani N, Trikudanathan G, Watson RR, and Maple JT
- Published
- 2017
- Full Text
- View/download PDF
85. Automated endoscope reprocessors.
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Parsi MA, Sullivan SA, Goodman A, Manfredi M, Navaneethan U, Pannala R, Smith ZL, Thosani N, Banerjee S, and Maple JT
- Subjects
- Disinfectants, Duodenoscopes microbiology, Endoscopy, Gastrointestinal instrumentation, Humans, Patient Safety, Disinfection instrumentation, Endoscopes microbiology, Equipment Contamination prevention & control
- Published
- 2016
- Full Text
- View/download PDF
86. Role of enteroscopy in the diagnosis and management of adult small-bowel intussusception.
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Rahimi E, Guha S, Chughtai O, Ertan A, and Thosani N
- Subjects
- Aged, Gastrointestinal Stromal Tumors complications, Gastrointestinal Stromal Tumors pathology, Gastrointestinal Stromal Tumors surgery, Humans, Intestinal Obstruction etiology, Intussusception etiology, Jejunal Diseases etiology, Jejunal Neoplasms complications, Jejunal Neoplasms pathology, Jejunal Neoplasms surgery, Male, Double-Balloon Enteroscopy methods, Gastrointestinal Stromal Tumors diagnosis, Intestinal Obstruction diagnosis, Intussusception diagnosis, Jejunal Diseases diagnosis, Jejunal Neoplasms diagnosis
- Published
- 2016
- Full Text
- View/download PDF
87. Dual-operator technique by use of digital cholangioscope through colonoscope-assisted ERCP in a patient with altered anatomy.
- Author
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Rahimi E, Thosani N, and Catalano M
- Published
- 2016
- Full Text
- View/download PDF
88. Use of quantitative endoscopic ultrasound elastography for diagnosis of pancreatic neuroendocrine tumors.
- Author
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Nemakayala D, Patel P, Rahimi E, Fallon MB, and Thosani N
- Published
- 2016
- Full Text
- View/download PDF
89. Colonoscopy with polypectomy is associated with a low rate of complications in patients with cirrhosis.
- Author
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Huang RJ, Perumpail RB, Thosani N, Cheung R, and Friedland S
- Abstract
Background and Study Aims: Cirrhotic patients are at a theoretically increased risk of bleeding. The safety of polypectomy in cirrhosis is poorly defined., Patients and Methods: We performed a retrospective review of patients with cirrhosis who underwent colonoscopic polypectomy at a tertiary-care hospital. Patient characteristics and polyp data were collected. Development of complications including immediate bleeding, delayed bleeding, hospitalization, blood transfusion, perforation, and death were recorded to 30-day follow-up. Clinical characteristics between bleeders and non-bleeders were compared, and predictors of bleeding were determined., Results: A total of 307 colonoscopies with 638 polypectomies were identified. Immediate bleeding occurred in 7.5 % (95 % CI 4.6 % - 10.4 %) and delayed bleeding occurred in 0.3 % (95 % CI 0.0 % - 0.9 %) of colonoscopies. All cases of immediate bleeding were controlled endoscopically and none resulted in serious complication. The rate of hospitalization was 0.7 % (95 % CI 0.0 % - 1.6 %) and repeat colonoscopy 0.3 % (95 % CI 0.0 % - 0.9 %); no cases of perforation, blood transfusion, or death occurred. Lower platelet count, higher INR, presence of ascites, and presence of esophageal varices were associated with increased risk of bleeding. Use of electrocautery was associated with a lower risk of immediate bleeding. There was no significant difference between bleeding and non-bleeding polyps with regard to size, morphology, and histology., Conclusions: Colonoscopy with polypectomy appears safe in patients with cirrhosis. There is a low risk of major complications. The risk of immediate bleeding appears higher than an average risk population; however, most bleeding is self-limited or can be controlled endoscopically. Bleeding tends to occur with more advanced liver disease. Both the sequelae of portal hypertension and coagulation abnormalities are predictive of bleeding.
- Published
- 2016
- Full Text
- View/download PDF
90. Over-the-scope clip-assisted closure of colocutaneous fistula.
- Author
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Javia SB, Rahimi E, Mehta S, Ertan A, and Thosani N
- Published
- 2016
- Full Text
- View/download PDF
91. Cholangiopancreatoscopy.
- Author
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Komanduri S, Thosani N, Abu Dayyeh BK, Aslanian HR, Enestvedt BK, Manfredi M, Maple JT, Navaneethan U, Pannala R, Parsi MA, Smith ZL, Sullivan SA, and Banerjee S
- Subjects
- Cholangiopancreatography, Endoscopic Retrograde, Humans, Bile Ducts surgery, Endoscopes, Endoscopy methods, Pancreatic Ducts surgery
- Published
- 2016
- Full Text
- View/download PDF
92. Endoscopic ultrasound-assisted gastrointestinal hemostasis: an evolving technique.
- Author
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Jain D, Thosani N, and Singhal S
- Abstract
Gastrointestinal bleeding can range from grossly visible blood in stool or vomitus to microscopic bleed. However, any kind of bleeding can lead to potential life-threatening consequences. A small proportion of patients with gastrointestinal bleeding remain refractory to initial endoscopic hemostasis. While some are successfully managed by repeat endoscopic intervention, a few fail to respond or are not amenable to endoscopic hemostasis. As of now, the next level of intervention is passed on to either surgeons or interventional radiologists. There is new evidence suggesting the increased utility of endoscopic ultrasound (EUS) in diagnosis and treatment of culprit vascular lesions across the gut. In addition, EUS-assisted technique has also been used in the primary prevention of bleeding from gastroesophageal varices. In this review article, we have summarized case series and reports describing the use of EUS-assisted hemostasis. Indications, techniques, complications and success rates reported are discussed. While most of the authors describe their experience with primary and secondary treatment of gastric varices, treatment of other gastrointestinal lesions with EUS assisted hemostatic techniques is also discussed.
- Published
- 2016
- Full Text
- View/download PDF
93. Increased Incidence of Second Primary Pancreatic Cancer in Patients with Prior Colorectal Cancer: A Population-Based US Study.
- Author
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Rahimi E, Batra S, Thosani N, Singh H, and Guha S
- Subjects
- Adult, Aged, Colorectal Neoplasms epidemiology, Female, Humans, Incidence, Male, Middle Aged, Pancreatic Neoplasms epidemiology, Risk Factors, United States epidemiology, Young Adult, Colorectal Neoplasms complications, Pancreatic Neoplasms secondary
- Abstract
Background: Identifying high-risk groups for pancreatic cancer (PC) may lead to earlier detection. We determined the risk of subsequent PC among survivors of sporadic colorectal cancer (CRC)., Methods: We evaluated data from the US Surveillance, Epidemiology, and End Results registry to identify individuals with primary CRC between the years 1973-2006. Standardized incidence ratios (SIRs) and 95 % confidence interval (95 % CI) were calculated to compare the risk of subsequent primary PC in the study cohort to that of the standard population. Analysis was stratified by age at diagnosis of CRC and sex. CRC characteristics were compared among CRC survivors with and without PC. Multivariate sub-hazard ratios were calculated to identify factors associated with subsequent primary PC, using death from non-PC causes as a competing event., Results: Of the 273,144 patients with first primary CRC, 657 (0.24 %) developed subsequent PC. CRC survivors were more likely to develop PC (SIR 1.22; 95 % CI 1.09-1.35). Mean latency period (time between CRC and PC diagnosis) was 1, 3, and 5 years from index age of CRC 20-49, 50-64, and >65 years, respectively. Multivariate analysis showed CRC survivors >50 years had 3.5-fold, those with right-sided CRC had 1.2-fold, and those with localized and regional CRCs had sixfold and fivefold increased risk of PC, respectively., Conclusion: This study suggests that CRC survivors have an increased risk of developing subsequent PC within 1-5 years. CRC survivors age >50 with localized/regional stage, and right-sided CRC have higher predisposition to PC.
- Published
- 2016
- Full Text
- View/download PDF
94. Per-oral endoscopic myotomy (with video).
- Author
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Pannala R, Abu Dayyeh BK, Aslanian HR, Enestvedt BK, Komanduri S, Manfredi M, Maple JT, Navaneethan U, Parsi MA, Smith ZL, Sullivan SA, Thosani N, and Banerjee S
- Subjects
- Esophagoscopy, Humans, Natural Orifice Endoscopic Surgery, Esophageal Achalasia surgery, Esophageal Sphincter, Lower surgery
- Published
- 2016
- Full Text
- View/download PDF
95. Prospective evaluation of bacteremia rates and infectious complications among patients undergoing single-operator choledochoscopy during ERCP.
- Author
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Thosani N, Zubarik RS, Kochar R, Kothari S, Sardana N, Nguyen T, and Banerjee S
- Subjects
- Aged, Blood Culture methods, Cholangiopancreatography, Endoscopic Retrograde methods, Female, Humans, Male, Middle Aged, Outcome and Process Assessment, Health Care, Risk Adjustment methods, Anti-Bacterial Agents therapeutic use, Antibiotic Prophylaxis methods, Bacteremia diagnosis, Bacteremia etiology, Bacteremia prevention & control, Cholangiopancreatography, Endoscopic Retrograde adverse effects, Cholangitis diagnosis, Cholangitis etiology, Cholangitis prevention & control
- Abstract
Background and Study Aims: Choledochoscopy is increasingly performed during endoscopic retrograde cholangiopancreatography (ERCP) for direct bile duct visualization. Choledochoscopy necessitates irrigation of the bile duct with water or saline, which may increase intrabiliary pressure and consequently the risks of bacteremia and cholangitis. The aim of this study was to prospectively evaluate the risk of bacteremia and infectious complications in patients undergoing single-operator choledochoscopy (SOC)., Patients and Methods: Patients requiring ERCP with SOC at two tertiary care centers were enrolled prospectively. Blood cultures were obtained immediately before the ERCP, after completion of the ERCP portion of the procedure (to determine ERCP-related bacteremia), and 15 minutes after completion of SOC., Results: A total of 72 patients (mean age 64 years; 51.4 % male) underwent ERCP with SOC. True positive blood cultures were noted in 20 patients (27.8 %; 95 % confidence interval [CI] 17.86 % - 39.59 %), of whom 6 patients (8.3 %; 95 %CI 3.12 % - 17.26 %) had transient bacteremia following ERCP. Of 14 patients (19.4 %; 95 %CI 11.05 % - 30.46 %) with sustained bacteremia following ERCP or SOC, 10 patients (13.9 %; 95 %CI 6.86 % - 24.06 %) had sustained bacteremia related to SOC. Despite the use of post-procedure intravenous antibiotic administration, seven patients (9.7 %; 95 %CI 3.99 - 19.01 %) required further antibiotic treatment for infectious complications, three of whom (4.2 %; 95 %CI 0.86 % - 11.69 %) were hospitalized in order to receive intravenous antibiotic therapy., Conclusion: The bacteremia associated with ERCP with SOC and the subsequent risk of hospitalization for infectious complications suggest that preprocedure antibiotic prophylaxis should be considered for patients undergoing SOC, particularly in older patients and those with prior stent placement or undergoing intraductal stone lithotripsy., Trial Registration: clinical trials.gov (NCT01414400)., (© Georg Thieme Verlag KG Stuttgart · New York.)
- Published
- 2016
- Full Text
- View/download PDF
96. Endoscopic ultrasound elastography to diagnose sarcoidosis.
- Author
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Rahimi E, Younes M, Zhang S, and Thosani N
- Published
- 2016
- Full Text
- View/download PDF
97. Thymic carcinoma diagnosed by using endoscopic ultrasound with fine-needle aspiration.
- Author
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Patel P, Guider J, Rahimi E, Guha S, Zhang S, and Thosani N
- Abstract
There is a paucity of literature on the use of endoscopic ultrasound (EUS) for evaluating superior mediastinal structures, especially the thymus gland. We report a case of thymic carcinoma diagnosed by using EUS elastography with strain ratio and fine-needle aspiration (FNA). A 64-year-old woman presented with altered mental status and was diagnosed with autoimmune encephalitis. Further work-up suggested a superior mediastinal mass, for which she underwent EUS. A hypoechoic mass was found in the superior mediastinum at the level of the aortic arch. Real-time EUS elastography showed a predominantly blue hue to the mass concerning for malignancy. FNA of the mass was performed, which revealed numerous large neoplastic cells under a background of a small lymphoid infiltrate. Immunohistochemistry was strongly positive for PAX8, pancytokeratin, and CAM5.2. The pathologic and immunohistochemical stains were consistent with thymic carcinoma.
- Published
- 2016
- Full Text
- View/download PDF
98. ASGE Technology Committee systematic review and meta-analysis assessing the ASGE Preservation and Incorporation of Valuable Endoscopic Innovations thresholds for adopting real-time imaging-assisted endoscopic targeted biopsy during endoscopic surveillance of Barrett's esophagus.
- Author
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Thosani N, Abu Dayyeh BK, Sharma P, Aslanian HR, Enestvedt BK, Komanduri S, Manfredi M, Navaneethan U, Maple JT, Pannala R, Parsi MA, Smith ZL, Sullivan SA, and Banerjee S
- Subjects
- Acetic Acid, Biopsy methods, Coloring Agents, Esophagoscopy standards, Humans, Intravital Microscopy standards, Methylene Blue, Microscopy, Confocal standards, Narrow Band Imaging standards, Predictive Value of Tests, Watchful Waiting, Barrett Esophagus diagnostic imaging, Barrett Esophagus pathology, Esophagoscopy methods, Esophagus pathology
- Abstract
Background and Aims: Endoscopic real-time imaging of Barrett's esophagus (BE) with advanced imaging technologies enables targeted biopsies and may eliminate the need for random biopsies to detect dysplasia during endoscopic surveillance of BE. This systematic review and meta-analysis was performed by the American Society for Gastrointestinal Endoscopy (ASGE) Technology Committee to specifically assess whether acceptable performance thresholds outlined by the ASGE Preservation and Incorporation of Valuable Endoscopic Innovations (PIVI) document for clinical adoption of these technologies have been met., Methods: We conducted meta-analyses calculating the pooled sensitivity, negative predictive value (NPV), and specificity for chromoendoscopy by using acetic acid and methylene blue, electronic chromoendoscopy by using narrow-band imaging, and confocal laser endomicroscopy (CLE) for the detection of dysplasia. Random effects meta-analysis models were used. Statistical heterogeneity was evaluated by means of I(2) statistics., Results: The pooled sensitivity, NPV, and specificity for acetic acid chromoendoscopy were 96.6% (95% confidence interval [CI], 95-98), 98.3% (95% CI, 94.8-99.4), and 84.6% (95% CI, 68.5-93.2), respectively. The pooled sensitivity, NPV, and specificity for electronic chromoendoscopy by using narrow-band imaging were 94.2% (95% CI, 82.6-98.2), 97.5% (95% CI, 95.1-98.7), and 94.4% (95% CI, 80.5-98.6), respectively. The pooled sensitivity, NPV, and specificity for endoscope-based CLE were 90.4% (95% CI, 71.9-97.2), 98.3% (95% CI, 94.2-99.5), and 92.7% (95% CI, 87-96), respectively., Conclusions: Our meta-analysis indicates that targeted biopsies with acetic acid chromoendoscopy, electronic chromoendoscopy by using narrow-band imaging, and endoscope-based CLE meet the thresholds set by the ASGE PIVI, at least when performed by endoscopists with expertise in advanced imaging techniques. The ASGE Technology Committee therefore endorses using these advanced imaging modalities to guide targeted biopsies for the detection of dysplasia during surveillance of patients with previously nondysplastic BE, thereby replacing the currently used random biopsy protocols., (Copyright © 2016. Published by Elsevier Inc.)
- Published
- 2016
- Full Text
- View/download PDF
99. Endoscopic and histologic findings in serrated polyposis syndrome.
- Author
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Javia S, Rahimi E, Younes M, Ertan A, and Thosani N
- Subjects
- Aged, Colonoscopy, Humans, Male, Adenomatous Polyposis Coli diagnostic imaging, Adenomatous Polyposis Coli pathology, Colon diagnostic imaging
- Published
- 2016
- Full Text
- View/download PDF
100. Wilted biliary tree in rare Bipolaris infection.
- Author
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Reddy S, Kirtane T, Lamberth J, Younes M, and Thosani N
- Subjects
- Adult, Ascomycota, Bile Ducts microbiology, Bile Ducts pathology, Biliary Tract microbiology, Biliary Tract pathology, Cholangitis microbiology, Cholangitis pathology, Endoscopy, Digestive System, Female, Humans, Mycoses pathology, Biliary Tract diagnostic imaging, Cholangiopancreatography, Endoscopic Retrograde, Cholangitis diagnostic imaging, Mycoses diagnosis
- Published
- 2016
- Full Text
- View/download PDF
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