Dr. Eldika received his medical education at the American University of Beirut. He completed his General Gastroenterology Fellowship at the State University of New York in Buffalo and Advanced Endoscopy Fellowship at the University of Virginia. At Ohio State University, he served as the Director of Interventional Endoscopy and Endoscopic Quality. His time at Ohio State University contributed to the growth and maturity of his experience and skills in interventional endoscopy. During his tenure there, he played a major role in building the program of interventional endoscopy in general, as well as interventional endoscopy for the pediatric age group, and the endoscopic quality program. Over the years, he was involved in training several gastroenterology fellows and interventional endoscopists. He recently joined Stanford University where he continues to practice interventional endoscopy and train fellows.
He is a board-certified Gastroenterologist with clinical interests in pancreaticobiliary diseases, gastrointestinal neoplasia, and related interventional endoscopic procedures. As an endoscopist, he has extensive experience in performing a variety of interventional endoscopic procedures. These procedures include endoscopic ultrasound (EUS)-guided procedures like fine needle aspiration/biopsy, injections, fiducial placement, pseudocyst drainage/necrosectomy, biliary drainage, gastrojejunostomy, transgastric ERCP, and needle-based confocal endomicroscopy for the evaluation of pancreatic cystic lesions. He also performs endoscopic retrograde cholangiopancreatography (ERCP), endoscopic mucosal resection, enteral and stenting, enteral feeding tube placement, as well as deep enteroscopy.
His research interest evolves around interventional endoscopy, more specifically in the evaluation of pancreatic cystic lesions. Dr. Eldika has received multiple awards in his career, his most recent one being the “Reviewer Award, April 2020,” for his superior contributions to the journal of Gastrointestinal Endoscopy, both through completing high numbers of reviews and for submitting the highest quality of work.
Dr. Eldika is a fellow of the American Society of Gastrointestinal Endoscopy. He is a member of the American Gastroenterological Association, American College of Gastroenterology, and American Pancreatic Association.
When not working Dr. Eldika enjoys reading, listening to music, watching sports and walking in nature.
- Endoscopic Ultrasonography
- endoscopic mucosal resection
Clinical Associate Professor, Medicine - Gastroenterology & Hepatology
Honors & Awards
Top Reviewers Award, Gastrointestinal Endoscopy and Video GIE journals, American Society of Gastrointestinal Endoscopy (April 2020)
Good to Great Award, The Ohio State University-Wexner Medical Center (August 2017)
Six Sigma Yellow Belt, Fisher College of Business-Center for Operational Excellence (April 2016)
Fellow, American Society of Gastrointestinal Endoscopy (July 2015)
The Fred B. Thomas Faculty Teaching Award, The Ohio State University-Wexner Medical Center (June 2015)
Peer Excellence Award, The Ohio State University-Wexner Medical Center (March 2015)
Evidence Based Quality Improvement Award, University at Buffalo (2003-2004)
Medicine Dean’s honors’ list, American University of Beirut (June 1998)
Board Certification: American Board of Internal Medicine, Gastroenterology (2004)
Fellowship: University of Virginia Health System (2009) VA
Fellowship: SUNY Buffalo Gastroenterology Fellowship (2004) NY
Residency: University at Buffalo Internal Medicine Residency (2001) NY
Medical Education: American University of Beirut Office of the Registrar (1998) Lebanon
Confocal Laser Endomicroscopy as an Imaging Biomarker for the Diagnosis of Pancreatic Cystic Lesions
The study schema is shown in Figure 4. (A) All patients referred to one of the participating academic centers for EUS evaluation of the PCL will be enrolled in the protocol if they satisfy inclusion criteria. Patient consent will be obtained during the clinic visit or prior to their EUS. EUS-guided nCLE imaging is first performed (B) followed by EUS-guided FNA and aspiration of cyst fluid. The cyst fluid is analyzed for CEA and cytology. As per institutional standard of care, the cyst fluid is also sent for molecular analysis. The results of the cyst fluid molecular analysis (B) will be utilized for the most likely diagnosis. Based on institutional multidisciplinary tumor board meetings, surgery is performed as indicated (C). Surgical histopathology serves as "gold standard" for diagnosis. It is anticipated that the majority of patients will undergo surgical resection after their EUS.
Prospective, Multi-Institutional, Real-Time Next-Generation Sequencing of Pancreatic Cyst Fluid Reveals Diverse Genomic Alterations that Improve the Clinical Management of Pancreatic Cysts.
BACKGROUND AND AIMS: Next-generation sequencing (NGS) of pancreatic cyst fluid is a useful adjunct in the assessment of pancreatic cyst (PC) patients. However, previous studies have been retrospective or single institutional experiences. The aim of this study was to prospectively evaluate NGS on a multi-institutional cohort of PC patients in real-time.METHODS: The performance of a 22-gene NGS panel (PancreaSeq) was first retrospectively confirmed and then within a two-year timeframe, PancreaSeq testing was prospectively used to evaluate endoscopic ultrasound (EUS)-guided fine-needle aspiration PC fluid from 31 institutions. PancreaSeq results were correlated with EUS findings, ancillary studies, current pancreatic cyst guidelines, follow-up, and expanded testing (Oncomine) of postoperative specimens.RESULTS: Among 1933 PCs prospectively tested, 1887 (98%) specimens from 1832 patients were satisfactory for PancreaSeq testing. Follow-up was available for 1216 (66%) patients (median, 23 months). Based on 251 (21%) patients with surgical pathology, MAPK/GNAS mutations had 90% sensitivity and 100% specificity for a mucinous cyst (PPV, 100%; NPV, 77%). Upon exclusion of low-level variants, the combination of MAPK/GNAS and TP53/SMAD4/CTNNB1/mTOR alterations had 88% sensitivity and 98% specificity for advanced neoplasia (PPV, 97%; NPV, 93%). Inclusion of cytopathologic evaluation to PancreaSeq testing improved the sensitivity to 93% and maintained a high specificity of 95% (PPV, 92%); NPV, 95%). In comparison, other modalities and current pancreatic cyst guidelines, such as the AGA and IAP/Fukuoka guidelines, show inferior diagnostic performance. The sensitivities and specificities of VHL and MEN1/LOH alterations were 71% and 100% for serous cystadenomas (SCAs) (PPV, 100%; NPV, 98%), and 68% and 98% for pancreatic neuroendocrine tumors (PanNETs) (PPV, 85%; NPV, 95%), respectively. Upon follow-up, SCAs with TP53/TERT mutations exhibited interval growth, while PanNETs with LOH of ≥3 genes tended to have distant metastasis. None of the 965 patients who did not undergo surgery developed malignancy. Postoperative Oncomine testing identified mucinous cysts with BRAF fusions and ERBB2 amplification, and advanced neoplasia with CDKN2A alterations.CONCLUSIONS: PancreaSeq was not only sensitive and specific for various PC types and advanced neoplasia arising from mucinous cysts, but also reveals the diversity of genomic alterations seen in PCs and their clinical significance.
View details for DOI 10.1053/j.gastro.2022.09.028
View details for PubMedID 36209796
Accuracy and agreement of a large panel of endosonographers for endomicroscopy-guided virtual biopsy of pancreatic cystic lesions.
Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.]
BACKGROUND: Although emerging data evidences that EUS-guided needle-based confocal laser endomicroscopy (nCLE) accurately diagnoses pancreatic cystic lesions (PCLs), there are a lack of interobserver agreement (IOA) studies utilizing reference histopathological diagnosis and for specific PCL subtypes. Hence, we sought to assess the IOA, intra-observer reliability (IOR), and diagnostic performance of EUS-nCLE using a large cohort of patients with histopathological diagnosis amongst a broad panel of international observers.METHODS: EUS-nCLE videos (n=76) of subjects with PCLs [intraductal papillary mucinous neoplasm (IPMN), mucinous cystic neoplasm (MCN), serous cystadenoma (SCA), pseudocyst, and cystic-neuroendocrine tumors/solid pseudopapillary neoplasm (cystic-NET/SPN)], simulating clinical prevalence rates were obtained from 3 prospective studies. An international panel of 13 endosonographers with nCLE experience, blinded to all PCL data, evaluated the video library twice with a two-week washout for PCL differentiation (mucinous vs. non-mucinous) and subtype diagnosis.RESULTS: The IOA (kappa=0.82, 95% CI 0.77-0.87) and IOR (kappa=0.82, 95% CI 0.78-0.85) were "almost perfect" to differentiate mucinous vs. non-mucinous PCLs. For PCL subtype, IOA was highest for SCA (almost perfect; kappa=0.85), followed by IPMN (substantial, kappa=0.72), and cystic-NET/SPN (substantial, kappa=0.73). The IOA was moderate for MCN (kappa=0.47), and pseudocyst (kappa=0.57). Compared to histopathology, observers differentiated mucinous vs. non-mucinous PCLs with high accuracy (94.8%, 95% CI 93.3-96.1). For detecting specific PCLs subtypes, EUS-nCLE was highly accurate in diagnosing non-mucinous cysts (SCA: 98%; cystic-NET/SPN: 96%; pseudocyst: 96%) and slightly less accurate for mucinous lesions (IPMN: 86%; MCN: 84%).CONCLUSION: Diagnosis of PCLs by EUS-nCLE guided virtual biopsy is very accurate and reliable for the most prevalent pancreatic cysts in clinical practice.
View details for DOI 10.1016/j.pan.2022.08.012
View details for PubMedID 36089484
EUS-guided confocal laser endomicroscopy: prediction of dysplasia in intraductal papillary mucinous neoplasms (with video)
2020; 91 (3): 551-+
Previous studies have validated EUS-guided needle-based confocal laser endomicroscopy (nCLE) diagnosis of intraductal papillary mucinous neoplasms (IPMNs). We sought to derive EUS-guided nCLE criteria for differentiating IPMNs with high-grade dysplasia/adenocarcinoma (HGD-Ca) from those with low/intermediate-grade dysplasia (LGD).We performed a post hoc analysis of consecutive IPMNs with a definitive diagnosis from a prospective study evaluating EUS-guided nCLE in the diagnosis of pancreatic cysts. Three internal endosonographers reviewed all nCLE videos for the patients and identified potential discriminatory EUS-guided nCLE variables to differentiate HGD-Ca from LGD IPMNs (phase 1). Next, an interobserver agreement (IOA) analysis of variables from phase 1 was performed among 6 blinded external nCLE experts (phase 2). Last, 7 blinded nCLE-naïve observers underwent training and quantified variables with the highest IOA from phase 2 using dedicated software (phase 3).Among 26 IPMNs (HGD-Ca in 16), the reference standard was surgical histopathology in 24 and cytology confirmation of metastatic liver lesions in 2 patients. EUS-guided nCLE characteristics of increased papillary epithelial "width" and "darkness" were the most sensitive variables (90%; 95% confidence interval [CI], 84%-94% and 91%; 95% CI, 85%-95%, respectively) and accurate (85%; 95% CI, 78%-90% and 84%; 95% CI, 77%-89%, respectively) with substantial (κ = 0.61; 95% CI, 0.51-0.71) and moderate (κ = 0.55; 95% CI, 0.45-0.65) IOAs for detecting HGD-Ca, respectively (phase 2). Logistic regression models were fit for the outcome of HGD-Ca as predictor variables (phase 3). For papillary width (cut-off ≥50 μm), the sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) for detection of HGD-Ca were 87.5% (95% CI, 62%-99%), 100% (95% CI, 69%-100%), and 0.95, respectively. For papillary darkness (cut-off ≤90 pixel intensity), the sensitivity, specificity, and AUC for detection of HGD-Ca were 87.5% (95% CI, 62%-99%), 100% (95% CI, 69%-100%), and 0.90, respectively.In this derivation study, quantification of papillary epithelial width and darkness identified HGD-Ca in IPMNs with high accuracy. These quantifiable variables can be used in multicenter studies for risk stratification of IPMNs. (Clinical trial registration number: NCT02516488.).
View details for DOI 10.1016/j.gie.2019.09.014
View details for Web of Science ID 000514847000007
View details for PubMedID 31542380
Endoscopic Ultrasound-Guided Confocal Laser Endomicroscopy Increases Accuracy of Differentiation of Pancreatic Cystic Lesions
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY
2020; 18 (2): 432-+
Imaging patterns from endoscopic ultrasound (EUS)-guided needle-based confocal laser endomicroscopy (nCLE) have been associated with specific pancreatic cystic lesions (PCLs). We compared the accuracy of EUS with nCLE in differentiating mucinous from nonmucinous PCLs with that of measurement of carcinoembryonic antigen (CEA) and cytology analysis.We performed a prospective study of 144 consecutive patients with a suspected PCL (≥20 mm) who underwent EUS with fine-needle aspiration of pancreatic cysts from June 2015 through December 2018 at a single center; 65 patients underwent surgical resection. Surgical samples were analyzed by histology (reference standard). During EUS, the needle with the miniprobe was placed in the cyst, which was analyzed by nCLE. Fluid was aspirated and analyzed for level of CEA and by cytology. We compared the accuracy of nCLE in differentiating mucinous from nonmucinous lesions with that of measurement of CEA and cytology analysis.The mean size of dominant cysts was 36.4 ± 15.7 mm and the mean duration of nCLE imaging was 7.3 ± 2.8 min. Among the 65 subjects with surgically resected cysts analyzed histologically, 86.1% had at least 1 worrisome feature based on the 2012 Fukuoka criteria. Measurement of CEA and cytology analysis identified mucinous PCLs with 74% sensitivity, 61% specificity, and 71% accuracy. EUS with nCLE identified mucinous PCLs with 98% sensitivity, 94% specificity, and 97% accuracy. nCLE was more accurate in classifying mucinous vs nonmucinous cysts than the standard method (P < .001). The overall incidence of postprocedure acute pancreatitis was 3.5% (5 of 144); all episodes were mild, based on the revised Atlanta criteria.In a prospective study, we found that analysis of cysts by nCLE identified mucinous cysts with greater accuracy than measurement of CEA and cytology analysis. EUS with nCLE can be used to differentiate mucinous from nonmucinous PCLs. ClincialTrials.gov no: NCT02516488.
View details for DOI 10.1016/j.cgh.2019.06.010
View details for Web of Science ID 000506898700031
View details for PubMedID 31220640
An International External Interobserver and Derivation Study for the Detection of Advanced Neoplasia in IPMNs Using Confocal Laser Endomicroscopy
NATURE PUBLISHING GROUP. 2018: S4–S5
View details for Web of Science ID 000464611000006
DEDICATED MULTIDISCIPLINARY TEAM AND ADHERENCE TO INTERNATIONAL CONSENSUS GUIDELINES PROMOTES APPROPRIATE RESECTION OF PANCREATIC CYSTIC LESIONS: A SINGLE CENTER EXPERIENCE
MOSBY-ELSEVIER. 2018: AB464–AB465
View details for Web of Science ID 000435509900269
Diagnostic Accuracy of Preoperative Imaging for Differentiation of Branch Duct Versus Mixed Duct Intraductal Papillary Mucinous Neoplasms
2018; 47 (5): 556–60
The aim of this study is to determine the diagnostic accuracy of preoperative evaluation to detect main pancreatic duct involvement in pancreatic cystic lesions thus differentiating mixed intraductal papillary mucinous neoplasm (IPMN) from branch duct (BD)-IPMN.The pathology database of pancreatic resections from 2000 to 2014 was reviewed. Main pancreatic duct-IPMNs and IPMNs with intracystic mass/nodules were excluded. The preoperative test characteristics were analyzed using surgical histopathology as the "gold standard."Sixty BD-IPMNs and 23 mixed-IPMNs were identified. Mixed-IPMNs were larger (mean [standard deviation], 4.14 [2.9] vs 2.74 [1.9] mm; P = 0.03) and demonstrated frequent high-grade dysplasia/adenocarcinoma (43% vs 12%, P = 0.004) than BD-IPMNs. Endoscopic ultrasound (EUS) (sensitivity, 80%; specificity, 78%; accuracy, 79%) had the best diagnostic accuracy, whereas magnetic resonance imaging (MRI) (sensitivity, 83%; specificity, 63%; accuracy, 68%) had the highest sensitivity for the diagnosis of mixed-IPMN. A combination of EUS and MRI reached maximum sensitivity but with decreased accuracy (sensitivity, 100%; specificity, 64%; accuracy, 67%). The area under the curve for receiver operation curve was 0.71 whereas the optimal cyst size to detect main duct involvement was 3 cm.For preoperative evaluation of pancreatic cystic lesions without evidence of intracystic nodules, a combination of MRI and EUS should be considered for improved detection of main duct involvement.
View details for DOI 10.1097/MPA.0000000000001040
View details for Web of Science ID 000431180300035
View details for PubMedID 29683969
Insights into insulin resistance, lifestyle, and anthropometric measures of patients with prior colorectal cancer compared to controls: A National Health and Nutrition Examination Survey (NHANES) Study
CURRENT PROBLEMS IN CANCER
2018; 42 (2): 276–85
Insulin resistance (IR) increases the risk of index colorectal cancer (CRC) development. Limited data exist on IR values, lifestyle, and anthropometric alterations of patients after CRC diagnosis, a population at high risk for CRC recurrence.This is a retrospective cohort study using the National Health and Nutrition Examination Survey (NHANES), 1999-2010. We identified patients with and without prior CRC above age 50. Our outcomes were lifestyle, anthropometric measures, and IR measured using the triglyceride to high-density lipoprotein ratio and the homeostasis model assessment IR.There were 146,841 patients with prior CRC and 26,979,507 without prior cancer (controls) in our cohort. Prior patients with CRC were significantly older than controls (75.8 vs 62.3, P < 0.01), however, there were no significant differences in gender, ethnicity, income, caloric intake, tobacco use or alcohol consumption between both groups. Multivariate analysis revealed no difference between prior patients with CRC and controls in triglyceride to high-density lipoprotein ratio (adjusted percentage change = -2.17; 95% CI: -27.96 to 18.43) or homeostasis model assessment IR (adjusted percentage change = -6.85; 95% CI: -35.74 to 15.90). Despite similar weight at age 25, prior CRC subjects had lower weights compared to controls (at time of NHANES survey, one and 10 years before survey and greatest weight). Furthermore prior CRC subjects gained less weight in the 10 years before survey.Patients with prior CRC above age 50 have no conclusive evidence of increased IR compared to non-CRC controls. This is possibly due to lesser weight gain in the peri-CRC diagnosis or treatment period. Future efforts should focus on alternate etiologies for the increased CRC recurrence in this high-risk group.
View details for DOI 10.1016/j.currproblcancer.2017.12.002
View details for Web of Science ID 000435621600016
View details for PubMedID 29395416
Acute Pancreatitis Admission Trends: A National Estimate through the Kids' Inpatient Database
JOURNAL OF PEDIATRICS
2018; 194: 147-+
To evaluate national health care use and costs for pediatric acute pancreatitis.The Kids' Inpatient Database for 2006, 2009, and 2012 was queried for patients with a principal diagnosis of acute pancreatitis. Cases were grouped by age: preschool (<5 years of age), school age (5-14 years of age), and adolescents (>14 years of age).A total of 27 983 discharges for acute pancreatitis were found. The number of admissions increased with age: young n = 1279, middle n = 8012, and older n = 18 692. Duration of stay was highest in preschool children (median, 3.47 days; IQR, 2.01-7.35), compared with school age (median, 3.22 days; IQR, 1.81-5.63) and adolescents (median, 2.87 days; IQR, 1.61-4.81; P < .001). The median cost of hospitalization varied with age: $6726 for preschoolers, $5400 for school-aged children, and $5889 for adolescents (P < .001). Acute pancreatitis-associated diagnoses varied by age. The presence of gallstone pancreatitis, alcohol, and hypertriglyceridemia was more common among older children compared with younger children (P < .001). There was an increasing trend in acute pancreatitis, chronic pancreatitis, and obesity for the 2 older age groups (P < .001).Admission of children for acute pancreatitis constitutes a significant healthcare burden, with a rising number of admissions with age. However, the cost and duration of stay per admission are highest in young children.
View details for DOI 10.1016/j.jpeds.2017.09.061
View details for Web of Science ID 000426440700031
View details for PubMedID 29174078
View details for PubMedCentralID PMC6136833
- Digital Pancreatoscopy for Extent of Disease and Guided Biopsies of Downstream Intraductal Papillary Mucinous Neoplasms of the Pancreas NATURE PUBLISHING GROUP. 2017: S885
Needle-based confocal laser endomicroscopy for the diagnosis of pancreatic cystic lesions: an international external interobserver and intraobserver study
2017; 86 (4): 644-+
EUS-guided needle-based confocal laser endomicroscopy (nCLE) characteristics of common types of pancreatic cystic lesions (PCLs) have been identified; however, surgical histopathology was available in a minority of cases. We sought to assess the performance characteristics of EUS nCLE for differentiating mucinous from non-mucinous PCLs in a larger series of patients with a definitive diagnosis.Six endosonographers (nCLE experience >30 cases each) blinded to all clinical data, reviewed nCLE images of PCLs from 29 patients with surgical (n = 23) or clinical (n = 6) correlation. After 2 weeks, the assessors reviewed the same images in a different sequence. A tutorial on available and novel nCLE image patterns was provided before each review. The performance characteristics of nCLE and the κ statistic for interobserver agreement (IOA, 95% confidence interval [CI]), and intraobserver reliability (IOR, mean ± standard deviation [SD]) for identification of nCLE image patterns were calculated. Landis and Koch interpretation of κ values was used.A total of 29 (16 mucinous PCLs, 13 non-mucinous PCLs) nCLE patient videos were reviewed. The overall sensitivity, specificity, and accuracy for the diagnosis of mucinous PCLs were 95%, 94%, and 95%, respectively. The IOA and IOR (mean ± SD) were κ = 0.81 (almost perfect); 95% CI, 0.71-0.90; and κ = 0.86 ± 0.11 (almost perfect), respectively. The overall specificity, sensitivity, and accuracy for the diagnosis of serous cystadenomas (SCAs) were 99%, 98%, and 98%, respectively. The IOA and IOR (mean ± SD) for recognizing the characteristic image pattern of SCA were κ = 0.83 (almost perfect); 95% CI, 0.73-0.92; and κ = 0.85 ± 0.11 (almost perfect), respectively.EUS-guided nCLE can provide virtual histology of PCLs with a high degree of accuracy and inter- and intraobserver agreement in differentiating mucinous versus non-mucinous PCLs. These preliminary results support larger multicenter studies to evaluate EUS nCLE. (Clinical trial registration number: NCT02516488.).
View details for DOI 10.1016/j.gie.2017.03.002
View details for Web of Science ID 000410624300012
View details for PubMedID 28286093
Routine staging with endoscopic ultrasound in patients with obstructing esophageal cancer and dysphagia rarely impacts treatment decisions
SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES
2017; 31 (8): 3227–33
Endoscopic ultrasound (EUS) has been routinely utilized for the locoregional staging of esophageal cancer. One important aspect of clinical staging has been to stratify patients to treatment with neoadjuvant chemoradiation or primary surgical therapy. We hypothesized that EUS may have a limited impact on clinical decision making in patients with dysphagia and obstructing esophageal masses.This retrospective cohort study included all patients with esophageal adenocarcinoma undergoing esophageal EUS between July 2008 and September 2013. Dysplastic Barrett's esophagus without invasive adenocarcinoma or incomplete staging was excluded. Patient demographics, endoscopic tumor characteristics, the presence of dysphagia, sonographic staging, and post-EUS therapy were recorded. Pathologic staging for patients who underwent primary surgical therapy was also recorded. Locally advanced disease was defined as at least T3 or N1, as these patients are typically treated with neoadjuvant therapy.Two hundred sixteen patients underwent EUS for esophageal adenocarcinoma, with 147 (68.1%) patients having symptoms of dysphagia on initial presentation. Patients with dysphagia were significantly more likely to have locally advanced disease on EUS than patients without dysphagia (p < 0.0001). Additionally, 145 (67.1%) patients had a partially or completely obstructing mass on initial endoscopy, of which 136 (93.8%) were locally advanced (p < 0.0001 vs. non-obstructing lesions).An overwhelming majority of patients presenting with dysphagia and/or the presence of at least partially obstructing esophageal mass at the time of esophageal cancer diagnosis had an EUS that demonstrated at least locally advanced disease. The present study supports the hypothesis that EUS may be of limited benefit for management of esophageal cancer in patients with an obstructing mass and dysphagia.
View details for DOI 10.1007/s00464-016-5351-6
View details for Web of Science ID 000409037100019
View details for PubMedID 27864719
- Risk Factors Determining 30-Day Hospital Readmissions After Gallstone-Related Cholecystectomy in the United States MOSBY-ELSEVIER. 2017: AB534–AB535
- Outcomes of Nutritional Interventions to Treat Dysphagia in Esophageal Cancer: A Population-Based Study MOSBY-ELSEVIER. 2017: AB153
- Endoscopic Ultrasonography-Guided Needle Based Confocal Laser Endomicroscopy Has Improved Accuracy Compared to the Current Standard of Care for Differentiating Mucinous From Non-Mucinous Pancreatic Cystic Lesions MOSBY-ELSEVIER. 2017: AB344
- Supplementing American Gastroenterological Association Guidelines With Confocal Laser Endomicroscopy in the Evaluation of Asymptomatic Pancreatic Cystic Lesions MOSBY-ELSEVIER. 2017: AB346
- A Machine-Learning Decision-Tree Analysis for Differentiation of Pancreatic Cystic Lesions and the Impact of Adding Endoscopic Ultrasonography-Guided Needle Based Confocal Laser Endomicroscopy MOSBY-ELSEVIER. 2017: AB347–AB348
- Phase I study of neoadjuvant 5-fluorouracil (5FU) chemoradiation (CRT) and trametinib in patients with locally advanced rectal cancers (LARC) AMER SOC CLINICAL ONCOLOGY. 2017
Left Ventricular Assist Devices Impact Hospital Resource Utilization Without Affecting Patient Mortality in Gastrointestinal Bleeding
DIGESTIVE DISEASES AND SCIENCES
2017; 62 (1): 150–60
Left ventricular assist devices (LVADs) are being utilized for management of end-stage heart failure and require systemic anticoagulation. Gastrointestinal bleeding (GIB) is one of the most common adverse events following LVAD implantation.To investigate the impact of continuous-flow (CF) LVAD implants on outcomes of patients admitted with GIB.This is a cross-sectional study utilizing the Nationwide Inpatient Sample in the CF-LVAD era from 2010 to 2012. All adult admissions with a primary diagnosis of GIB were included. Among hospitalizations with GIB, patients with (cases) and without (controls) CF-LVAD implants were compared using univariate and multivariate analyses. The main outcome measurements were in-hospital mortality, length of stay, and hospitalization costs.Among 1,002,299 hospitalizations for GIB, 1112 (0.11%) patients had CF-LVADs. Bleeding angiodysplasia accounted for a majority of GIB in CF-LVAD patients (35.4% of 1112). Multivariate analysis adjusting for demographic, hospital and etiological differences, site of GIB, and patient comorbidities revealed that CF-LVADs were not adversely associated with mortality in GIB (OR 0.53, 95% CI 0.07-4.15). However, CF-LVADs independently accounted for prolonged hospitalization (3.5 days, 95% CI 2.6-4.6) and higher hospital charges ($37,032, 95% CI $7991-$66,074).In patients admitted with GIB, CF-LVAD implantation accounts for higher healthcare utilization, but is not adversely associated with mortality despite therapeutic anticoagulation, increased comorbidities, and comparatively delayed endoscopy. These findings are relevant as CF-LVADs are the dominant type of LVAD and are associated with increased risk of GIB compared to their predecessors.
View details for DOI 10.1007/s10620-016-4379-8
View details for Web of Science ID 000392312200022
View details for PubMedID 27858326
Validation of diagnostic characteristics of needle based confocal laser endomicroscopy in differentiation of pancreatic cystic lesions
ENDOSCOPY INTERNATIONAL OPEN
2016; 4 (11): E1124–E1135
Background and aims: Endoscopic ultrasound (EUS)-guided needle-based Confocal Laser Endomicroscopy (nCLE) characteristics of pancreatic cystic lesions (PCLs) have been identified in studies where the gold standard surgical histopathology was available in a minority of patients. There are diverging reports of interobserver agreement (IOA) and paucity of intraobserver reliability (IOR). Thus, we sought to validate current EUS-nCLE criteria of PCLs in a larger consecutive series of surgical patients. Methods: A retrospective analysis of patients who underwent EUS-nCLE at a single center was performed. For calculation of IOA (Fleiss' kappa) and IOR (Cohen's kappa), blinded nCLE-naïve observers (n = 6) reviewed nCLE videos of PCLs in two phases separated by a 2-week washout period. Results: EUS-nCLE was performed in 49 subjects, and a definitive diagnosis was available in 26 patients. The overall sensitivity, specificity, and accuracy for diagnosing a mucinous PCL were 94 %, 82 %, and 89 %, respectively. The IOA for differentiating mucinous vs. non-mucinous PCL was "substantial" (κ = 0.67, 95 %CI 0.57, 0.77). The mean (± standard deviation) IOR was "substantial" (κ = 0.78 ± 0.13) for diagnosing mucinous PCLs. Both the IOAs and mean IORs were "substantial" for detection of known nCLE image patterns of papillae/epithelial bands of mucinous PCLs (IOA κ = 0.63; IOR κ = 0.76 ± 0.11), bright particles on a dark background of pseudocysts (IOA κ = 0.71; IOR κ = 0.78 ± 0.12), and fern-pattern or superficial vascular network of serous cystadenomas (IOA κ = 0.62; IOR κ = 0.68 ± 0.20). Three (6.1 % of 49) patients developed post-fine needle aspiration (FNA) pancreatitis. Conclusion: Characteristic EUS-nCLE patterns can be consistently identified and improve the diagnostic accuracy of PCLs. These results support further investigations to optimize EUS-nCLE while minimizing adverse events.NCT02516488.
View details for DOI 10.1055/s-0042-116491
View details for Web of Science ID 000388642000002
View details for PubMedID 27853737
View details for PubMedCentralID PMC5110338
- Implanted Left Ventricular Assist Devices Impacts Hospital Resource Utilization Without Affecting Patient Mortality: A Population-Based Analysis NATURE PUBLISHING GROUP. 2016: S1277–S1278
- Needle Based Confocal Laser Endomicroscopy Can Reliably Distinguish Mucinous from Non-mucinous Pancreatic Cystic Lesions: An International External Inter- and Intra-observer Study NATURE PUBLISHING GROUP. 2016: S1–S2
- Differentiating Branch Duct IPMN from Mixed IPMN: Test Characteristics of Pre-operative Imaging Modalities NATURE PUBLISHING GROUP. 2016: S53
- The Impact of Patient Navigation on the Quality of Colorectal Cancer Screening: Results from the Provider and Community Engagement (PACE) Program in Franklin County, Ohio NATURE PUBLISHING GROUP. 2016: S107–S108
- Availability of Biliary Intervention and Impact on Patient Outcomes in Biliary Acute Pancreatitis: A Decade Long Analysis of Hospital Practices in the United States NATURE PUBLISHING GROUP. 2016: S445–S446
- An Unusual Endoscopic Finding: "Polka Dot Stomach" NATURE PUBLISHING GROUP. 2016: S688
Routine Cyst Fluid Cytology Is Not Indicated in the Evaluation of Pancreatic Cystic Lesions
JOURNAL OF GASTROINTESTINAL SURGERY
2016; 20 (9): 1581–85
The work-up of cystic lesions of the pancreas often involves endoscopic ultrasound (EUS) with fine needle aspiration (FNA). In addition to CEA and amylase measurement, fluid is routinely sent for cytologic examination. We evaluated the utility of cytologic findings in clinical decision-making.Records of patients who underwent EUS-guided pancreatic cyst aspiration were reviewed. Findings from axial imaging and EUS were compared to cyst fluid cytology as well as fluid amylase and CEA. All results were then compared to final diagnosis, determined by clinical analysis for those patients not resected, and surgical pathology report for those who underwent resection.A total of 167 patients were reviewed. Of 48 patients with suspicious findings on imaging, cytology yielded diagnostic information in 89.6 % of cases (43 patients). However, in the 119 patients where no suspicious components were revealed on imaging, fluid cytology yielded no significant diagnostic results in any case. In all cases where mucin was noted on cytologic review, thick fluid was also seen at the time of aspiration.In our cohort of patients with cystic pancreatic lesions, cytologic analysis of pancreatic cyst fluid yielded no diagnostic benefit over radiologic findings alone. In such cases where fluid is to be aspirated, specimens that would otherwise be sent for cytologic evaluation would be better served for other purposes, such as molecular analysis or banking for future research.
View details for DOI 10.1007/s11605-016-3175-2
View details for Web of Science ID 000381759000006
View details for PubMedID 27230996
Celiac Crisis Associated with Herpes Simplex Virus Esophagitis
ACG CASE REPORTS JOURNAL
2016; 3 (4): e159
Celiac crisis is a rare presentation of celiac disease that is characterized by life-threatening electrolyte abnormalities, vitamin and mineral deficiencies, and diarrhea. Triggers for celiac crisis include major surgeries, pancreatitis, and infections of cytomegalovirus, and salmonella. A 24-year-old woman presented with celiac crisis associated with severe herpes simplex virus (HSV) esophagitis. This case demonstrates that nutritional deficiencies seen in celiac disease can result in a relative immunodeficiency, which may lead to other infectious complications. Additionally, early recognition of celiac crisis is imperative as the metabolic derangements may be life-threatening, and therapy with gluten restriction and nutritional repletion is effective.
View details for DOI 10.14309/crj.2016.132
View details for Web of Science ID 000394566000081
View details for PubMedID 27921058
View details for PubMedCentralID PMC5126499
Effects of Bariatric Surgery on Outcomes of Patients With Acute Pancreatitis
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY
2016; 14 (7): 1001-+
The prevalence of obesity and number of patients undergoing bariatric surgery are increasing. Obesity has adverse effects in patients with acute pancreatitis (AP). We investigated whether bariatric surgery affects outcomes of patients with AP.We performed a retrospective study, collecting data from the US Nationwide Inpatient Sample (2007-2011) on all adult inpatients (≥18 years) with a principal diagnosis of AP (n = 1,342,681). We compared primary clinical outcomes (mortality, acute kidney injury, and respiratory failure) and secondary outcomes related to healthcare resources (hospital stay and charges) among patient groups using univariate and multivariate analyses. We performed a propensity score-matched analysis to compare outcomes of patients with versus without bariatric surgery.Of patients admitted to the hospital with a principal diagnosis of AP, 14,332 (1.07%) had undergone bariatric surgery. The number of patients that underwent bariatric surgery doubled, from 1801 in 2007 to 3928 in 2011 (P < .001). AP in patients that had undergone bariatric surgery was most frequently associated with gallstones. Multivariate analysis associated prior bariatric surgery with decreased mortality (odds ratio, 0.41; 95% confidence interval, 0.18-0.92), shorter duration of hospitalization (0.65 days shorter; P < .001), and lower hospital charges ($3558 lower) than in patients with AP not receiving bariatric surgery (P < .001). A propensity score-matched cohort analysis found that mortality and odds of acute kidney injury were similar between patients with versus without history of bariatric surgery, whereas respiratory failure was less frequent in patients who received bariatric surgery (1.34% vs 4.42%; P < .001).Prior bariatric surgery in patients hospitalized with AP is not adversely associated with in-hospital mortality, development of organ failure, or healthcare resource use. Bariatric surgery may mitigate the obesity-associated adverse prognostication in AP. These observations are pertinent for future research, because the prevalence of obesity and AP-related hospitalizations is increasing.
View details for DOI 10.1016/j.cgh.2016.02.015
View details for Web of Science ID 000378392900019
View details for PubMedID 26905906
- Phase I study of trametinib and neoadjuvant chemoradiation (CRT) in patients with locally advanced rectal cancers (LARC) that harbor KRAS, BRAF, or NRAS mutations AMER SOC CLINICAL ONCOLOGY. 2016
- Training for Endoscopic Retrograde Cholangiopancreatography (ERCP) in Children: Insights From the Kids' Inpatient Database (KID) (2006-2012) MOSBY-ELSEVIER. 2016: AB242–AB243
- Needle-Based Confocal Endomicroscopy for Cystic Pancreatic Lesions: Accuracy and Interobserver Agreement for Detection of Epithelial and Vascular Patterns MOSBY-ELSEVIER. 2016: AB345–AB346
- The Impact of Type 2 Diabetes Control and Related Complications on Outcomes and Health Care Utilization in the Peri-Operative Period of Colorectal Cancer Surgery MOSBY-ELSEVIER. 2016: AB229
- Reaching Safe Harbor: Legal Implications of Clinical Practice Guidelines CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2016; 14 (2): 172–74
- Poorly differentiated pancreatic carcinoma with sarcomatoid differentiation: confocal endomicroscopy of an uncommon pancreatic cystic lesion ENDOSCOPY 2016; 48: E363–E364
Morbid Obesity Is Associated With Adverse Clinical Outcomes in Acute Pancreatitis: A Propensity-Matched Study
AMERICAN JOURNAL OF GASTROENTEROLOGY
2015; 110 (11): 1607–20
Morbid obesity may adversely affect the clinical course of acute pancreatitis (AP); however, there are no inpatient, population-based studies assessing the impact of morbid obesity on AP-related outcomes. We sought to evaluate the impact of morbid obesity on AP-related clinical outcomes and health-care utilization.The Nationwide Inpatient Sample (2007-2011) was reviewed to identify all adult inpatients (≥18 years) with a principal diagnosis of AP. The primary clinical outcomes (mortality, renal failure, and respiratory failure) and secondary resource outcomes (length of stay and hospital charges) were analyzed using univariate and multivariate comparisons. Propensity score-matched analysis was performed to compare the outcomes in patients with and without morbid obesity.Morbid obesity was associated with 3.9% (52,297/1,330,302) of all AP admissions. Whereas the mortality rate decreased overall (0.97%→0.83%, P<0.001), it remained unchanged in those with morbid obesity (1.02%→1.07%, P=1.0). Multivariate analysis revealed that morbid obesity was associated with increased mortality (odds ratio (OR) 1.6; 95% confidence interval (CI) 1.3, 1.9), prolonged hospitalization (0.4 days; P<0.001), and higher hospitalization charges ($5,067; P<0.001). A propensity score-matched cohort analysis demonstrated that the primary outcomes, acute kidney failure (10.8 vs. 8.2%; P<0.001), respiratory failure (7.9 vs. 6.4%; P<0.001), and mortality (OR 1.6, 95% CI 1.2, 2.1) were more frequent in morbid obesity.Morbid obesity negatively influences inpatient hospitalization and is associated with adverse clinical outcomes, including mortality, organ failure, and health-care resource utilization. These observations and the increasing global prevalence of obesity justify ongoing efforts to understand the role of obesity-induced inflammation in the pathogenesis and management of AP.
View details for DOI 10.1038/ajg.2015.343
View details for Web of Science ID 000368269900017
View details for PubMedID 26482857
- Bariatric Surgery-Induced Weight Loss Is Associated With Improved Colorectal Cancer Surgical Outcomes in Morbidly Obese Patients NATURE PUBLISHING GROUP. 2015: S971
- Epidemiology of Esophageal Stent Placement for Benign and Malignant Conditions in the United States: 2003-2012 NATURE PUBLISHING GROUP. 2015: S726
- Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators (PSIs) Are Associated With Increased Healthcare Utilization, Costs, and Mortality Among Patients Hospitalized With Acute Pancreatitis NATURE PUBLISHING GROUP. 2015: S941
- Exploring BIG DATA Predictive Analytics to Identify High Costs of Care in Acute Pancreatitis (AP) NATURE PUBLISHING GROUP. 2015: S943
Groove Pancreatitis, a Masquerading Yet Distinct Clinicopathological Entity Analysis of Risk Factors and Differentiation
2015; 44 (6): 901–8
Our objective was to delineate predictive factors differentiating groove pancreatitis (GP) from other lesions involving the head of the pancreas (HOP).A case-control study of patients older than 10 years was performed comparing patients with GP to those with other surgically resected HOP lesions.Thirteen patients with GP (mean ± SD age, 51.9 ± 10.5 years; 11 males [84.6%]), all with a history of smoking (mean, 37.54 ± 17.8 pack-years), were identified. Twelve patients (92.3%) had a history of heavy alcohol drinking (heavy alcohol [EtOH]). The mean lesion size was 2.6 ± 1.1 cm, and the CA 19-9 was elevated (>37 IU/mL) in 5 patients (45.5%). The most common histopathologic condition was duodenal wall cyst with myofibroblastic proliferation and changes of chronic pancreatitis in the HOP.Univariate analysis revealed decreasing age, male sex, weight loss, nausea/vomiting, heavy EtOH, smoking, and a history of chronic pancreatitis were predictive of GP. A multivariate analysis among smokers demonstrated that weight loss (P = 0.006; odds ratio, 11.96; 95% confidence interval, 2.1-70.2), and heavy EtOH (P < 0.001; odds ratio, 82.2; 95% confidence interval, 9.16-738.1) were most predictive of GP. Compared to pancreatic adenocarcinoma (n = 183), weight loss and heavy EtOH remained predictive of GP.Groove pancreatitis in the HOP is associated with a history of heavy EtOH and weight loss. In the absence of these symptoms, it is essential to rule out a malignant lesion.
View details for DOI 10.1097/MPA.0000000000000351
View details for Web of Science ID 000360628600008
View details for PubMedID 25899649
- Routine Staging With Endoscopic Ultrasound in Patients With Esophageal Cancer and Dysphagia Rarely Impacts Treatment Decisions MOSBY-ELSEVIER. 2015: AB434
- Endoscopic Ultrasound (EUS)-Guided Needle Based Confocal LASER Endomicroscopy (nCLE) for Diagnosis of Cystic Pancreatic Lesions (CPLs): Implications for Management MOSBY-ELSEVIER. 2015: AB428–AB429
- Do Pre-Operative Clinical Features, Imaging and Endoscopic Ultrasound (EUS) Characteristics Accurately Predict Main Duct (MD) Involvement in Intraductal Papillary Mucinous Neoplasm (IPMN)? MOSBY-ELSEVIER. 2015: AB559
- Biliary Intervention in Patients With History of Bariatric Surgery: Associations and Outcomes of Failed-ERCP MOSBY-ELSEVIER. 2015: AB413–AB414
- Pancreatic Duct Stenting for the Prevention of Post-ERCP Pancreatitis: National Trends MOSBY-ELSEVIER. 2015: AB409
- Incidental Subepithelial Sigmoid Colon Lesion CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2015; 13 (1): XXXII
Outcomes in Patients with Obstructive Jaundice from Metastatic Colorectal Cancer and Implications for Management
JOURNAL OF GASTROINTESTINAL SURGERY
2014; 18 (12): 2186–91
Patients with metastatic colorectal cancer can develop jaundice from intrahepatic or extrahepatic causes. Currently, there is little data on the underlying causes and overall survival after onset of jaundice. The purpose of this study was to characterize the causes of jaundice and determine outcomes.Six hundred twenty-nine patients treated for metastatic colorectal cancer between 2004 and 2010 were retrospectively reviewed. Those developing jaundice were grouped as having intrahepatic or extrahepatic obstruction. Demographics, clinicopathologic, and outcome data were analyzed.Sixty-two patients with metastatic colorectal cancer developed jaundice. Intrahepatic biliary obstruction was most common, occurring in younger patients. Time from metastatic diagnosis to presentation of jaundice was similar between groups, as was the mean number of prior lines of chemotherapy. Biliary decompression was successful 41.7 % of the time and was attempted more commonly for extrahepatic causes. Median overall survival after onset of jaundice was 1.5 months and it was similar between groups, but improved to 9.6 months in patients who were able to receive further chemotherapy.Jaundice due to metastatic colorectal cancer is an ominous finding, representing aggressive tumor biology or exhaustion of therapies. Biliary decompression is often difficult and should only be pursued when additional treatment options are available.
View details for DOI 10.1007/s11605-014-2670-6
View details for Web of Science ID 000345281100016
View details for PubMedID 25300799
View details for PubMedCentralID PMC4809042
- Morbid Obesity (MO) Is Associated With Increased Healthcare Utilization and Is an Independent Predictor of Mortality of Acute Pancreatitis (AP) NATURE PUBLISHING GROUP. 2014: S665
- Acute Pancreatitis (AP) in Post-bariatric Surgery (BRS) Status: Analysis of National Trends, Complications, and Outcomes 2007-2011 NATURE PUBLISHING GROUP. 2014: S68–S69
- Biliary Intervention Aft er Bariatric Surgery (BRS): Inferences From a Nationwide Population-Based Study NATURE PUBLISHING GROUP. 2014: S67
- Groove Pancreatitis, A Masquerading Yet Distinct Clinicopathological Entity: Analysis of Risk Factors and Differentiation NATURE PUBLISHING GROUP. 2014: S79
- The Impact of Sphincter of Oddi Dysfunction (SOD) on Health Care Utilization in Patients Admitted for Abdominal Pain NATURE PUBLISHING GROUP. 2014: S84
- Efficacy of Endoscopic Ultrasound Fine Needle Aspiration (EUS-FNA) in Obtaining Optimal Samples for Immunohistochemistry (IHC) in Pancreatic Ductal Adenocarcinoma (PDA) NATURE PUBLISHING GROUP. 2014: S95
- Intraoperative Enteroscopy Remains a Useful Modality in Obscure Gastrointestinal Bleeding NATURE PUBLISHING GROUP. 2014: S449
- Diabetes Is Associated With Socioeconomic Disparities and More Comorbidities in Colorectal Cancer Surgery: A Nationwide Inpatient Sample Study NATURE PUBLISHING GROUP. 2014: S601
- Early Nasoenteral Tube (NET) is Associated With Higher Mortality Compared to Early PEG Tube in Stroke Patients Admitted With Dysphagia in the United States NATURE PUBLISHING GROUP. 2014: S636
Colonic manifestations of PTEN hamartoma tumor syndrome: Case series and systematic review
WORLD JOURNAL OF GASTROENTEROLOGY
2014; 20 (7): 1833–38
To investigate our clinical experience with the colonic manifestations of phosphatase and tensin homolog on chromosome ten (PTEN) hamartoma tumor syndrome (PHTS) and to perform a systematic literature review regarding the same.This study was approved by the appropriate institutional review board prior to initiation. A clinical genetics database was searched for patients with PHTS or a component syndrome that received gastrointestinal endoscopy or pathology interpretation at our center. These patient's records were retrospectively reviewed for clinical characteristics (including family history and genetic testing), endoscopy results and pathology findings. We also performed a systematic review of the literature for case series of PHTS or component syndromes that reported gastrointestinal manifestations and investigations published after consensus diagnostic criteria were established in 1996. These results were compiled and reported.Eight patients from our institution met initial inclusion criteria. Of these, 5 patients underwent 4.2 colonoscopies at mean age 45.8 ± 10.8 years. All were found to have colon polyps during their clinical course and polyp histology included adenoma, hyperplastic, ganglioneuroma and juvenile. No malignant lesions were identified. Two had multiple histologic types. One patient underwent colectomy due to innumerable polyps and concern for future malignant potential. Systematic literature review of PHTS patients undergoing endoscopy revealed 107 patients receiving colonoscopy at mean age 37.4 years. Colon polyps were noted in 92.5% and multiple colon polyp histologies were reported in 53.6%. Common polyp histologies included hyperplastic (43.6%), adenoma (40.4%), hamartoma (38.3%), ganglioneuroma (33%) and inflammatory (24.5%) polyps. Twelve (11.2%) patients had colorectal cancer at mean age 46.7 years (range 35-62). Clinical outcomes secondary to colon polyposis and malignancy were not commonly reported.PHTS has a high prevalence of colon polyposis with multiple histologic types. It should be considered a mixed polyposis syndrome. Systematic review found an increased prevalence of colorectal cancer and we recommend initiating colonoscopy for colorectal cancer surveillance at age 35 years.
View details for DOI 10.3748/wjg.v20.i7.1833
View details for Web of Science ID 000331966100018
View details for PubMedID 24587660
View details for PubMedCentralID PMC3930981
- Tolerability and efficacy of modified FOLFIRINOX (mFOLFIRINOX) in patients with borderline-resectable pancreatic cancer (BRPC) and locally advanced unresectable pancreatic cancer (LAURPC) AMER SOC CLINICAL ONCOLOGY. 2014
- A mechanistic radiographic and biologic phase 2 study of sunitinib in relapsed/refractory esophageal (E) and gastroesophageal (GE) cancers. AMER SOC CLINICAL ONCOLOGY. 2014
- Diagnosis of a Spindle Cell Neoplasm of the Inferior Vena Cava via Endoscopic Ultrasound-guided Fine Needle Aspiration NATURE PUBLISHING GROUP. 2013: S590
- Pancreaticopleural Fistula Complicating Alcoholic Pancreatitis and Pancreas Divisum Successfully Treated with Minor Papillotomy and Stent Placement NATURE PUBLISHING GROUP. 2013: S262
- Obscure Overt Gastrointestinal Bleeding Secondary to Jejunal Metastasis of Urothelial Cell Carcinoma Diagnosed by Deep Enteroscopy NATURE PUBLISHING GROUP. 2012: S350
- Quality Assessment of the Use of Trans-Rectal Endoscopic Ultrasound in Rectal Cancer Staging after Advanced Endoscopic Ultrasound Training NATURE PUBLISHING GROUP. 2009: S542–S543
Dysphagia in a HIV patient: Concern for the etiology?
SOUTHERN MEDICAL JOURNAL
2007; 100 (1): 61–62
Dysphagia in human immunodeficiency virus (HIV) patients is most commonly of infectious etiology; however, less common causes of esophageal injury, such as strictures and medication-induced injuries, should be considered in the differential process. We report a case of a 53-year-old man with a 6-year history of HIV on highly active antiretroviral therapy and minocycline, who presented to the emergency room with abrupt onset dysphagia to solids and liquids. He was found to have pill impaction requiring mechanical disimpaction related to an esophageal web and pseudodiverticulosis. In this case description we would like to highlight the importance of noninfectious causes of dysphagia in HIV patients.
View details for DOI 10.1097/SMJ.0b013e31802e3e0f
View details for Web of Science ID 000246777300015
View details for PubMedID 17269528
The impact of illness in patients with moderate to severe gastro-esophageal reflux disease
2005; 5: 23
Gastro-esophageal reflux disease (GERD) is a common disease. It impairs health related quality of life (HRQL). However, the impact on utility scores and work productivity in patients with moderate to severe GERD is not well known.We analyzed data from 217 patients with moderate to severe GERD (mean age 50, SD 13.7) across 17 Canadian centers. Patients completed three utility instruments--the standard gamble (SG), the feeling thermometer (FT), and the Health Utilities Index 3 (HUI 3)--and several HRQL instruments, including Quality of Life in Reflux and Dyspepsia (QOLRAD) and the Medical Outcomes Short Form-36 (SF-36). All patients received a proton pump inhibitor, esomeprazole 40 mg daily, for four to six weeks.The mean scores on a scale from 0 (dead) to 1 (full health) obtained for the FT, SG, and HUI 3 were 0.67 (95% CI, 0.64 to 0.70), 0.76 (95% CI, 0.75 to 0.80), and 0.80 (95% CI, 0.77 to 0.82) respectively. The mean scores on the SF-36 were lower than the previously reported Canadian and US general population mean scores and work productivity was impaired.GERD has significant impact on utility scores, HRQL, and work productivity in patients with moderate to severe disease. Furthermore, the FT and HUI 3 provide more valid measurements of HRQL in GERD than the SG. After treatment with esomeprazole, patients showed improved HRQL.
View details for DOI 10.1186/1471-230X-5-23
View details for Web of Science ID 000231069100001
View details for PubMedID 16004616
View details for PubMedCentralID PMC1183201
A randomized multicenter trial to evaluate simple utility elicitation techniques in patients with gastroesophageal relflux disease
2004; 42 (11): 1132–42
Despite recommendations that patients rating their own health using utility and preference measures such as the feeling thermometer (FT) and standard gamble (SG) should also rate hypothetical marker states, little evidence supports marker state use. We evaluated whether the administration of marker states improves measurement properties of the FT and SG.We randomized 217 patients with gastroesophageal reflux disease to complete the FT (self-administered) and SG with marker states (FT+ / SG+, n = 112) or without marker states (FT- / SG-, n = 105) before and after 4 weeks of treatment with a proton pump inhibitor, esomeprazole. Patients also completed other health-related quality of life instruments.The use of marker states did not influence baseline utility scores (FT+ 0.66, FT- 0.68; SG+ 0.77, SG- 0.78, on a scale from 0 [dead] to 1.0 [full health]). Improvement after therapy was 0.21 in FT+ and 0.15 in FT- (both P < 0.001; difference between FT+ and FT- = 0.06, P = 0.02). Improvement in SG+ was 0.07 (P < 0.001) and 0.06 in SG- (P = 0.003) (difference between SG+ and SG- = 0.01, P = 0.63). Correlations with other health-related quality of life scores were generally stronger, with some statistically significant differences in correlations, for FT+ compared with FT-, but tended to be weaker for SG+ compared with SG-.The administration of marker states improved the responsiveness and validity of the FT but not of the SG. Decisions about administering marker states should depend on whether the FT and SG is of primary interest and the importance of optimal validity and responsiveness relative to competing objectives such as efficiency.
View details for DOI 10.1097/00005650-200411000-00013
View details for Web of Science ID 000224651400013
View details for PubMedID 15586841
Integrating an evidence-based medicine rotation into an internal medicine residency program
2004; 79 (9): 897–904
To measure the impact of a resident focused evidence-based medicine (EBM) educational intervention on EBM knowledge of residents and students, to assess its feasibility, and to evaluate residents' attitudes regarding this rotation.In 2002, based on the EBM user and EBM practitioner model, the authors designed the EBM elective rotation and conducted a controlled trial of its implementation in the internal medicine residency program in three teaching hospitals affiliated with the University at Buffalo, New York. The intervention group (one hospital, 17 medical students and residents) received a multifaceted intervention. In the control group (two hospitals, 23 medical students and residents), there was no curriculum change. The effectiveness in a pre- and post-test was assessed using the English version of the Berlin Questionnaire. A survey of all internal medicine residents (n = 119) was conducted to evaluate their attitudes toward the EBM elective rotation.In the intervention group, knowledge improved slightly, but not significantly (.71 on a scale ranging from 0-15 on the Berlin questionnaire, p =.3). The mean score in the control group decreased significantly (1.65, p =.005). The difference in change scores between the two groups was significant even after adjustment for covariates (2.52, p =.006). Residents (response rate 83%) had positive attitudes regarding the rotation.An EBM elective rotation was successfully integrated into a residency program. This multifaceted educational approach with an "on-the-ward" EBM resident, may improve the EBM knowledge and skills of targeted students and residents.
View details for DOI 10.1097/00001888-200409000-00018
View details for Web of Science ID 000223562200014
View details for PubMedID 15326018