All Publications

  • Initial Experience with Duodenoscopes with Single-Use End Caps in Pediatric Endoscopic Retrograde Cholangiopancreatography: Infection Prevention Comes at a Cost. Gastrointestinal endoscopy Barakat, M. T., Liman, A., Gugig, R. 2024

    Abstract

    BACKGROUND AND AIMS: Duodenoscopes with single-use end caps were introduced to minimize infection risk, but are unstudied in pediatrics.METHODS: We collected clinical data and endoscopists' evaluations of duodenoscopes with single-use end caps versus reusable duodenoscopes over 18 months.RESULTS: A total of 106 ERCPs were performed for patients aged 1-18 (mean 14.2) years. Forty-six involved single-use end caps, with 9 requiring crossover to reusable duodenoscopes. ERCPs involving single-use end caps resulted in more instances of mucosal trauma (10 vs 0, p<0.05) and post-ERCP pancreatitis (4 vs 1, p<0.05), and accounted for 8 of 9 ERCPs requiring advanced cannulation techniques. No post-ERCP infections occurred. Reported challenges included single-use end cap stiffness and difficulty with their alignment for cannulation.CONCLUSIONS: We report difficulty with advancement, greater reliance on advanced cannulation techniques, and higher rates of PEP when using duodenoscopes with single-use end caps in pediatric ERCP. This area warrants further study.

    View details for DOI 10.1016/j.gie.2024.03.009

    View details for PubMedID 38462055

  • Pediatric ERCP: Evolving into an Outpatient Procedure. Digestive diseases and sciences Barakat, M. T., Liman, A. Y., Gugig, R. 2024

    Abstract

    While most adult ERCPs are performed on an outpatient basis, pediatric ERCPs are typically performed on an inpatient basis, or with ERCP followed by at least one night inpatient admission. We have begun performing a substantial proportion of our pediatric ERCPs on an outpatient basis, using our clinical judgment to guide the decision process. In the present study, we compare patient characteristics, indications, and adverse events associated with outpatient vs. inpatient ERCP.Using our endoscopy database, we identified patients 18 years of age and under who underwent ERCP from 2019 to 2021. Demographics, hospitalization status, indications, findings, interventions, as well as available adverse event and clinical outcomes data were analyzed.147 ERCP procedures were performed during the study period by one of two interventional endoscopists. A subset of 51 (34.7%) patients underwent outpatient ERCP. Comparison of the two groups (outpatient vs. inpatient ERCP) was notable for no statistically significant difference in patient age, range of indications, or proportion of index vs. subsequent ERCP. Overall rates of ERCP-associated adverse events were low and there was no statistically significant difference between adverse events in patients who underwent outpatient vs. inpatient ERCP.We analyzed outpatient and inpatient pediatric ERCP patient demographics and ERCP characteristics to identify factors that guide decision to determine whether pediatric ERCPs are performed on an outpatient vs. inpatient basis. There was no significant difference in adverse events associated with outpatient vs. inpatient pediatric ERCPs, attesting to the safety of outpatient ERCP for this subset of patients in the studied context. This is an area worthy of future prospective and multi-center study.

    View details for DOI 10.1007/s10620-024-08325-9

    View details for PubMedID 38418682

    View details for PubMedCentralID 1412491

  • ENDOSCOPIC ULTRASOUND-PANCREATIC RENDEZVOUS CAN BE SAFELY AND EFFECTIVELY PERFORMED IN PEDIATRIC PATIENTS WHEN PANCREATIC INTERVENTION IS NOT POSSIBLE WITH STANDARD ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY Barakat, M., Liman, A., Gugig, R. MOSBY-ELSEVIER. 2023: AB1187

    View details for Web of Science ID 001038022802580