Subhas Banerjee

All Publications

• Cost utility analysis of strategies for minimizing risk of duodenoscope related infections. Gastrointestinal endoscopy Barakat, M. T., Ghosh, S., Banerjee, S. 1800

  Abstract

  BACKGROUND: Transmission of multi-drug resistant organisms by duodenoscopes during ERCP is problematical. The FDA recently recommended transitioning away from reusable fixed endcap duodenoscopes to those with innovative device designs that make reprocessing easier, more effective, or unnecessary. Partially disposable duodenoscopes with disposable endcap (PD) and fully disposable duodenoscopes (FD) are now available. We assess the relative cost of approaches to minimizing infection transmission, taking into account duodenoscope-transmitted infection cost.METHODS: We developed a Monte Carlo analysis model in R with a multi-state trial framework to assess the cost-utility of various approaches: (1) Single HLD, (2) Double HLD, (3) Ethylene oxide (EtO) sterilization, (4) Culture & hold, (5) PD and (6) FD. We simulated quality adjusted life years (QALY) lost by duodenoscope-transmitted infection and factored this into the average cost for each approach.RESULTS: At infection transmission rates <1%, PD was most favorable from a cost utility standpoint in our base model. The FD minimizes the potential for infection transmission and is more favorable from a cost utility standpoint than use of reprocessable duodenoscopes after single/double HLD at all infection rates, more favorable from a cost utility standpoint than EtO for infection rates >0.32%, and culture & hold for infection rates >0.56%. Accounting for alternate scenarios of variation in hospital volume, QALY value, post-ERCP lifespan and environmental cost shifted cost utility profiles.CONCLUSIONS: Our model indicates that PD represent the option most favorable from a cost utility standpoint for ERCP, with anticipated very low infection transmission rate and a low-cost disposable element. These data underscore the importance of cost calculations which account for the potential for infection transmission and associated patient morbidity/mortality.

  View details for DOI 10.1016/j.gie.2022.01.002

  View details for PubMedID 35026281

• Initial application of deep learning to borescope detection of endoscope working channel damage and residue ENDOSCOPY INTERNATIONAL OPEN Barakat, M. T., Girotra, M., Banerjee, S. 2022; 10 (01): E112-E118

  Abstract

  Background and study aims  Outbreaks of endoscopy-related infections have prompted evaluation for potential contributing factors. We and others have demonstrated the utility of borescope inspection of endoscope working channels to identify occult damage that may impact the adequacy of endoscope reprocessing. The time investment and training necessary for borescope inspection have been cited as barriers preventing implementation. We investigated the utility of artificial intelligence (AI) for streamlining and enhancing the value of borescope inspection of endoscope working channels. Methods  We applied a deep learning AI approach to borescope inspection videos of the working channels of 20 endoscopes in use at our academic institution. We evaluated the sensitivity, accuracy, and reliability of this software for detection of endoscope working channel findings. Results  Overall sensitivity for AI-based detection of borescope inspection findings identified by gold standard endoscopist inspection was 91.4 %. Labels were accurate for 67 % of these working channel findings and accuracy varied by endoscope segment. Read-to-read variability was noted to be minimal, with test-retest correlation value of 0.986. Endoscope type did not predict accuracy of the AI system ( P  = 0.26). Conclusions  Harnessing the power of AI for detection of endoscope working channel damage and residue could enable sterile processing department technicians to feasibly assess endoscopes for working channel damage and perform endoscope reprocessing surveillance. Endoscopes that accumulate an unacceptable level of damage may be flagged for further manual evaluation and consideration for manufacturer evaluation/repair.

  View details for DOI 10.1055/a-1591-0258

  View details for Web of Science ID 000742436800014

  View details for PubMedID 35047341

  View details for PubMedCentralID PMC8759945

• Establishment of Patient-derived Succinate Dehydrogenase-deficient Gastrointestinal Stromal Tumor Models For Predicting Therapeutic Response. Clinical cancer research : an official journal of the American Association for Cancer Research Yebra, M., Bhargava, S., Kumar, A., Burgoyne, A. M., Tang, C., Yoon, H., Banerjee, S., Aguilera, J., Cordes, T., Sheth, V., Noh, S., Ustoy, R., Li, S., Advani, S. J., Corless, C. L., Heinrich, M. C., Kurzrock, R., Lippman, S. M., Fanta, P. T., Harismendy, O., Metallo, C., Sicklick, J. K. 2021

  Abstract

  PURPOSE: Gastrointestinal stromal tumor (GIST) is the most common sarcoma of the gastrointestinal tract with mutant succinate dehydrogenase (SDH) subunits (A-D) comprising less than 7.5% (i.e. 150-200/year) of new cases annually in the United States. Contrary to GISTs harboring KIT or PDGFRA mutations, SDH-mutant GISTs affect adolescents/young adults, often metastasize, and are frequently resistant to tyrosine kinase inhibitors (TKIs). Lack of human models for any SDH-mutant tumors, including GIST, has limited molecular characterization and drug discovery.EXPERIMENTAL DESIGN: We describe methods for establishing novel patient-derived SDH-mutant (mSDH) GIST models and interrogated the efficacy of temozolomide on these tumor models in vitro and in clinical trials of mSDH GIST patients.RESULTS: Molecular and metabolic characterization of our patient-derived mSDH GIST models revealed that these models recapitulate the transcriptional and metabolic hallmarks of parent tumors and SDH-deficiency. We further demonstrate that temozolomide elicits DNA damage and apoptosis in our mSDH GIST models. Translating our in vitro discovery to the clinic, a cohort of SDH-mutant GIST patients treated with temozolomide (n=5) demonstrated a 40% objective response rate and 100% disease control rate suggesting that temozolomide represents a promising therapy for this subset of GIST.CONCLUSION: We report the first methods to establish patient-derived mSDH tumor models, which can be readily employed for understanding patient-specific tumor biology and treatment strategies. We also demonstrate that temozolomide is effective in mSDH GIST patients who are refractory to existing chemotherapeutic drugs (namely TKIs) in clinic for GISTs, bringing a promising treatment option for these patients to clinic.

  View details for DOI 10.1158/1078-0432.CCR-21-2092

  View details for PubMedID 34426440

• Quality metrics in the performance of EUS: a population-based observational cohort of the United States. Gastrointestinal endoscopy Huang, R. J., Barakat, M. T., Park, W. n., Banerjee, S. n. 2021

  Abstract

  There exist few data on the quality of endoscopic ultrasound (EUS) in the community setting. We characterized EUS performance at the individual facility level in 3 large American states, using need for repeat biopsy (NRB) as a metric for procedural failure, and rate of unplanned hospital encounter (UHE) as a metric for adverse event.We collected data on 76,614 EUS procedures performed at 166 facilities in California, Florida, and New York (2009-2014). The endpoints for the study were 7-day rate of UHE after EUS, and 30-day rate of NRB after EUS with fine-needle aspiration. Facility-level factors analyzed included annual procedure volume, urban/rural location, and free-standing status (facilities not attached to a larger hospital). Predictors for UHE and NRB were analyzed in both multivariable regression and nonparametric local regression.Facility volume did not predict risk for UHE. However, high facility volume protected against NRB (p-trend <0.001) even after adjustment for other facility-level factors. When regressing facility volume against risk for NRB in local regression, a join-point (inflection point) was identified at 97 procedures per annum. Once facilities reached this threshold volume, there appeared little additional protective effect of higher volume. Rural facility location (OR, 1.81; 95% CI, 1.36-2.40) and free-standing status (OR, 1.57; 95% CI, 1.16-2.13) also associated with NRB.Facility volume does not predict risk for adverse events after EUS. However, high facility volume is associated with decreased rates of technical failure (as assessed by NRB). These data provide one of the first descriptions of EUS practice in community settings and highlight opportunities to improve endoscopic quality nationally.

  View details for DOI 10.1016/j.gie.2020.12.055

  View details for PubMedID 33476611

• Incidental biliary dilation in the era of the opiate epidemic: High prevalence of biliary dilation in opiate users evaluated in the Emergency Department. World journal of hepatology Barakat, M. T., Banerjee, S. 2020; 12 (12): 1289–98

  Abstract

  BACKGROUND: Biliary dilation is frequently related to obstruction; however, non-obstructive factors such as age and previous cholecystectomy have also been reported. In the past two decades there has been a dramatic increase in opiate use/dependence and utilization of cross-sectional abdominal imaging, with increased detection of biliary dilation, particularly in patients who use opiates.AIM: To evaluate associations between opiate use, age, cholecystectomy status, ethnicity, gender, and body mass index utilizing our institution's integrated informatics platform.METHODS: One thousand six hundred and eighty-five patients (20% sample) presenting to our Emergency Department for all causes over a 5-year period (2011-2016) who had undergone cross-sectional abdominal imaging and had normal total bilirubin were included and analyzed.RESULTS: Common bile duct (CBD) diameter was significantly higher in opiate users compared to non-opiate users (8.67 mm vs 7.24 mm, P < 0.001) and in patients with a history of cholecystectomy compared to those with an intact gallbladder (8.98 vs 6.72, P < 0.001). For patients with an intact gallbladder who did not use opiates (n = 432), increasing age did not predict CBD diameter (r 2= 0.159,P= 0.873). Height weakly predicted CBD diameter (r 2= 0.561,P= 0.018), but weight, body mass index, ethnicity and gender did not.CONCLUSION: Opiate use and a history of cholecystectomy are associated with CBD dilation in the absence of an obstructive process. Age alone is not associated with increased CBD diameter. These findings suggest that factors such as opiate use and history of cholecystectomy may underlie the previously-reported association of advancing age with increased CBD diameter. Further prospective study is warranted.

  View details for DOI 10.4254/wjh.v12.i12.1289

  View details for PubMedID 33442455

• Clinical and Quality of Life Outcomes With Chronic Total Occlusion: The ISCHEMIA CTO Substudy Bangalore, S., Mancini, G. B., Leipsic, J., Budoff, M. J., Xu, Y., Anthopolos, R., Dwivedi, A., Spertus, J., Jones, P., Mark, D. B., Hague, C., Min, J. K., Reynolds, H., Elghamaz, A., Nair, R., Mavromatis, K., Gosselin, G., Banerjee, S., Pejkov, H., Lindsay, S., Williams, D. O., Stone, G. W., O'Brien, S. M., Hochman, J. S., Maron, D. J. LIPPINCOTT WILLIAMS & WILKINS. 2020: E477–E478

  View details for Web of Science ID 000639226400032

• Clinical and Quality of Life Outcomes With Chronic Total Occlusion: The ISCHEMIA CTO Substudy Bangalore, S., Mancini, G. B., Leipsic, J., Budoff, M. J., Xu, Y., Anthopolos, R., Dwivedi, A., Spertus, J., Jones, P., Mark, D. B., Hague, C., Min, J. K., Reynolds, H., Elghamaz, A., Nair, R., Mavromatis, K., Gosselin, G., Banerjee, S., Pejkov, H., Lindsay, S., Williams, D. O., Stone, G. W., O'Brien, S. M., Hochman, J. S., Maron, D. J. LIPPINCOTT WILLIAMS & WILKINS. 2020: E477–E478

  View details for Web of Science ID 000598973900032

• Novel Algorithms for Reprocessing, Drying and Storing Endoscopes. Gastrointestinal endoscopy clinics of North America Barakat, M. T., Banerjee, S. 2020; 30 (4): 677–91

  Abstract

  After outbreaks of duodenoscope-transmitted infection with multidrug-resistant organisms, it has become clear that institutions must optimize their endoscope reprocessing programs. Standard endoscope reprocessing practices may not represent the ideal approach for preventing transmission of infection related to endoscopy. We discuss multiple approaches to enhance and optimize reprocessing, drying, and storage of standard duodenoscopes. The optimal enhanced duodenoscope reprocessing modality remains to be determined. Acknowledging the challenges and limitations in effectively reprocessing duodenoscopes, the FDA issued a safety communique recommending transitioning to either single use disposable duodenoscopes or duodenoscopes with innovative designs that allow more effective reprocessing.

  View details for DOI 10.1016/j.giec.2020.06.003

  View details for PubMedID 32891225

• Sequential endoscopist-driven phone calls improve capture rate of adverse events after ERCP: a prospective study. Gastrointestinal endoscopy Barakat, M. T., Banerjee, S. 2020

  Abstract

  BACKGROUND AND AIMS: ERCP is a high-risk endoscopic procedure, yet reports of ERCP-related adverse events are largely limited to early adverse events, based on immediate postprocedure assessment. We hypothesize that immediate/1-day follow-up underestimates the true adverse event rate, and later follow-up calls may enable a more accurate assessment of adverse events, leading to enhanced postprocedural patient care.METHODS: Consecutive patients undergoing ERCP at our tertiary care academic medical center from 2018 to 2019 were analyzed. Patients were encouraged to contact us with postprocedure symptoms and additionally received phone calls at 1, 7, 14, and 30 days after the procedure using a standardized script to assess for delayed adverse events and unplanned healthcare encounters.RESULTS: This study is notable for a high rate of successful patient follow-up at day 1 (94%) and day 7 (93%). The assessed overall adverse event rate was 1.9% immediately postprocedure, 3.3% on day 1, and 9.8% on day 7. Increased detection of adverse events was accomplished by the day 7 call relative to the day 1 call (pancreatitis 2% vs 0.5%; bleeding 0.5% vs 0.2%; infection 0.9% vs 0.5%). 14- and 30-day follow-up calls were lower yield in detection of post-ERCP adverse events.CONCLUSIONS: Initial postprocedure assessment and day 1 follow-up calls underestimate adverse event rates/UHE related to ERCP, due to delayed evolution of some adverse events. The day 7 call is optimal in that it resulted in a >3-fold higher rate of detection of adverse events and successful direction of over 10% of symptomatic patients to appropriate assessment and follow-up heath care.

  View details for DOI 10.1016/j.gie.2020.07.036

  View details for PubMedID 32721489

• Use of an Ultra-slim Gastroscope to Accomplish Endoscopist-Facilitated Rescue Intubation During ERCP: A Novel Approach to Enhance Patient and Staff Safety. Digestive diseases and sciences Barakat, M. T., Angelotti, T. P., Banerjee, S. 2020

  Abstract

  BACKGROUND: ERCP is often performed under monitored anesthesia care (MAC) rather than general anesthesia (GA), with patients positioned semi-prone on the fluoroscopy table. Rarely, a MAC ERCP must be converted to GA due to hypoxia or retained food in the stomach. In these circumstances, standard intubation is associated with a significant delay and potential for patient/staff injury during repositioning. We report a novel endoscopist-driven approach to intubation during ERCP using an ultra-slim, flexible gastroscope with an endotracheal tube backloaded onto it.MATERIALS AND METHODS: We identified patients who underwent ERCP from 2014 to 2019, and MAC to GA conversion events. Mode of intubation (standard vs. endoscopist-facilitated) and patient/procedure characteristics were evaluated. All endoscopist-facilitated intubations were performed under anesthesiologist supervision.RESULTS: A total of 3409 patients underwent ERCP; 1568 (46%) GA and 1841 (54%) MAC. Of these, 42 (2.3%) required intubation during ERCP and 16 underwent endoscopist-facilitated intubation due to retained food in the stomach and/or hypoxia. In 3 patients, aspirated material was suctioned from the trachea and bronchi using the ultra-slim gastroscope. Immediate post-procedure extubation was successful in all endoscopist-facilitated intubation patients and none exhibited radiographic evidence of aspiration pneumonia.CONCLUSIONS: Endoscopist-facilitated intubation using an ultra-slim flexible gastroscope is feasible and expeditious for MAC to GA conversion during ERCP. This technique is readily accomplished in the semi-prone position, while standard intubation requires patient transfer from fluoroscopy table to gurney, with associated delay/risks. These data suggest that further study of this approach is warranted, and this may be the most favorable approach for intubation during ERCP.

  View details for DOI 10.1007/s10620-020-06360-w

  View details for PubMedID 32504349

• INCREASED CAPTURE OF POST-ERCP ADVERSE EVENTS BY DELAYED (DAY 7) FOLLOW-UP CALLS: A PROSPECTIVE COMPARISON OF PHYSICIAN AND NURSE-INITIATED CALLS Barakat, M., Banerjee, S. MOSBY-ELSEVIER. 2020: AB342–AB343

  View details for Web of Science ID 000545678400682

• COST UTILITY ANALYSIS COMPARING DUODENOSCOPE REPROCESSING/STERILIZATION, NOVEL DUODENOSCOPES WITH DISPOSABLE ENDCAPS AND FULLY DISPOSABLE DUODENOSCOPES Barakat, M., Ghosh, S., Banerjee, S. MOSBY-ELSEVIER. 2020: AB67–AB68

  View details for Web of Science ID 000545678400127

• ENDOSCOPIST FACILITATED ENDOTRACHEAL INTUBATION FOR GENERAL ANESTHESIA ENHANCES EFFICIENCY, PATIENT AND STAFF SAFETY DURING ERCP: A PROSPECTIVE RANDOMIZED STUDY Barakat, M., Angelotti, T., Banerjee, S. MOSBY-ELSEVIER. 2020: AB78–AB79

  View details for Web of Science ID 000545678400145

• ENDOSCOPIST FACILITATED ENDOTRACHEAL INTUBATION FOR GENERAL ANESTHESIA ENHANCES EFFICIENCY, PATIENT AND STAFF SAFETY DURING ERCP: A PROSPECTIVE RANDOMIZED STUDY Barakat, M., Angelotti, T., Banerjee, S. MOSBY-ELSEVIER. 2020: AB18

  View details for Web of Science ID 000545678400032

• Triaging advanced GI endoscopy procedures during the COVID-19 Pandemic: consensus recommendations using the Delphi method. Gastrointestinal endoscopy Sawhney, M. S., Bilal, M., Pohl, H., Kushnir, V., Khashab, M. A., Schulman, A. R., Berzin, T. M., Chalal, P., Muthusamy, V. R., Varadarajulu, S., Banerjee, S., Ginsberg, G. G., Raju, G. S., Feuerstein, J. D. 2020

  Abstract

  Background and Aims: There remains a lack of consensus on which gastrointestinal endoscopic procedures should be performed during the COVID-19 pandemic, and which procedures could be safely deferred without significantly impacting outcomes.Methods: We selected a panel of 14 expert endoscopists. We identified 41 common indications for advanced endoscopic procedures from the ASGE Appropriate Use of GI Endoscopy guidelines. Using a modified Delphi method, we first achieved consensus on patient-important outcome for each procedural indication. Panelists prioritized consensus patient-important outcome when categorizing each indication into one of the following 3 procedural time periods: (1) time-sensitive emergent (schedule within 1 week), (2) time-sensitive urgent (schedule within 1 to 8 weeks), and (3) non-time sensitive (defer for >8 weeks and then reassess the timing). Three anonymous rounds of voting were allowed before attempts at consensus were abandoned.Results: All 14 invited experts agreed to participate in the study. The prespecified consensus threshold of 51% was achieved for assigning patient-important outcome/s to each advanced endoscopy indication. The prespecified consensus threshold of 66.7% was achieved for 40 out of 41 advanced endoscopy indications in stratifying them into 1 of 3 procedural time periods. For 12 out of 41 indications 100% consensus, and for 20 out of 41 indications 75% to 99% consensus was achieved.Conclusions: By using a Modified Delphi method that prioritized patient-important outcomes, we developed consensus recommendations on procedural timing for common indications for advanced endoscopy. These recommendations and the structured decision framework provided by our study can inform decision-making as endoscopy services are reopened.

  View details for DOI 10.1016/j.gie.2020.05.014

  View details for PubMedID 32425235

• Recent Trends and the Impact of the Affordable Care Act on Emergency Department Visits and Hospitalizations for Gastrointestinal, Pancreatic, and Liver Diseases JOURNAL OF CLINICAL GASTROENTEROLOGY Barakat, M. T., Mithal, A., Huang, R. J., Sehgal, A., Sehgal, A., Singh, G., Banerjee, S. 2020; 54 (3): E21–E29

  View details for DOI 10.1097/MCG.0000000000001102

  View details for Web of Science ID 000513527700002

• Goff Septotomy Is a Safe and Effective Salvage Biliary Access Technique Following Failed Cannulation at ERCP. Digestive diseases and sciences Barakat, M. T., Girotra, M., Huang, R. J., Choudhary, A., Thosani, N. C., Kothari, S., Sethi, S., Banerjee, S. 2020

  Abstract

  BACKGROUND: Biliary cannulation is readily achieved in>85% of patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). When standard cannulation techniques fail, salvage techniques utilized include the needle knife precut, double wire technique, and Goff septotomy.METHODS: Records of patients undergoing ERCP from 2005 to 2016 were retrospectively examined using a prospectively maintained endoscopy database. Patients requiring salvage techniques for biliary access were analyzed together with a control sample of 20 randomly selected index ERCPs per study year. Demographic and clinical variables including indications for ERCP, cannulation rates, and adverse events were collected.RESULTS: A total of 7984 patients underwent ERCP from 2005 to 2016. Biliary cannulation was successful in 94.9% of control index ERCPs, 87.2% of patients who underwent Goff septotomy (significantly higher than for all other salvage techniques, p≤0.001), 74.5% of patients in the double wire group and 69.6% of patients in the needle knife precut group. Adverse event rates were similar in the Goff septotomy (4.1%) and index ERCP control sample (2.7%) groups. Adverse events were significantly higher in the needle knife group (27.2%) compared with all other groups.CONCLUSIONS: This study represents the largest study to date of Goff septotomy as a salvage biliary access technique. It confirms the efficacy of Goff septotomy and indicates a safety profile similar to standard cannulation techniques and superior to the widely employed needle knife precut sphincterotomy. Our safety and efficacy data suggest that Goff septotomy should be considered as the primary salvage approach for failed cannulation, with needle knife sphincterotomy restricted to Goff septotomy failures.

  View details for DOI 10.1007/s10620-020-06124-6

  View details for PubMedID 32052216

• Implementation and Impact of Universal Pre-procedure Testing of Patients for COVID-19 prior to Endoscopy. Gastroenterology Podboy, A. n., Cholankeril, G. n., Cianfichi, L. n., Guzman, E. n., Ahmed, A. n., Banerjee, S. n. 2020

  View details for DOI 10.1053/j.gastro.2020.06.022

  View details for PubMedID 32562723

• Escalating complexity of endoscopic retrograde cholangiopancreatography over the last decade with increasing reliance on advanced cannulation techniques. World journal of gastroenterology Barakat, M. T., Girotra, M. n., Thosani, N. n., Kothari, S. n., Banerjee, S. n. 2020; 26 (41): 6391–6401

  Abstract

  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.To evaluate this phenomenon of perceived escalation in complexity of cannulation at ERCP and assessed potential underlying factors.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).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).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.

  View details for DOI 10.3748/wjg.v26.i41.6391

  View details for PubMedID 33244200

  View details for PubMedCentralID PMC7656203

• Risk of ambulatory colonoscopy in patients with cirrhosis: a propensity-score matched cohort study. Endoscopy international open Huang, R. J., Banerjee, S. n., Friedland, S. n., Ladabaum, U. n. 2020; 8 (10): E1495–E1501

  Abstract

  Background and study aims  Patients with cirrhosis demonstrate alterations in physiology, hemodynamics, and immunity which may increase procedural risk. There exist sparse data regarding the safety of performing ambulatory colonoscopy in patients with cirrhosis. Patients and methods  From a population-based sample of three North American states (California, Florida, and New York), we collected data on 3,590 patients with cirrhosis who underwent ambulatory colonoscopy from 2009 to 2014. We created a control cohort propensity score-matched for cirrhotic severity who did not undergo colonoscopy (N = 3,590) in order to calculate the attributable risk for adverse events. The primary endpoint was the rate of unplanned hospital encounters (UHEs) within 14 days of colonoscopy (or from a synthetic index date for the control cohort). Predictors for UHE were assessed in multivariable regression. Results  The attributable risk for any UHE following colonoscopy was 3.1 % (confidence interval [CI] 2.1-4.1 %, P  < 0.001). There was increased risk for infection (0.9 %, CI 0.7-1.1 %), spontaneous bacterial peritonitis (0.1 %, CI 0.0-0.3 %), decompensation of ascites (0.3 %, CI 0.2-0.4 %), and cardiovascular event (0.4 %, CI 0.3-0.5 %). There was no increased attributable risk for gastrointestinal bleeding, perforation, or development of the hepatorenal syndrome. The presence of ascites at time of procedure was the only predictor for UHE in the fully-adjusted model (OR 2.6, CI 1.9-3.5, P  < 0.001). Conclusions  There is a moderate though detectable increase in risk for adverse event following ambulatory colonoscopy in patients with cirrhosis. The presence of ascites in particular portends higher risk. These data may guide clinicians when counseling patients with cirrhosis on the choice of colorectal cancer screening modality.

  View details for DOI 10.1055/a-1242-9958

  View details for PubMedID 33043119

  View details for PubMedCentralID PMC7541192

• Protocols, Personal Protective Equipment Utilization and Psychological/Financial Stressors within Endoscopy Units in Mid-Pandemic: A Large Survey of Hospital-based and Ambulatory Endoscopy Centers in the U.S. Gastroenterology Moraveji, S. n., Thaker, A. M., Muthusamy, V. R., Banerjee, S. n. 2020

  View details for DOI 10.1053/j.gastro.2020.05.061

  View details for PubMedID 32464147

• Basket Case: Fluoroscopy-Free Capture and Retrieval of Biliary and Pancreatic Duct Stones DIGESTIVE DISEASES AND SCIENCES Barakat, M. T., Banerjee, S. 2019; 64 (10): 2776–79

  View details for DOI 10.1007/s10620-019-05649-9

  View details for Web of Science ID 000485950500015

• Radiation Training, Radiation Protection, and Fluoroscopy Utilization Practices Among US Therapeutic Endoscopists DIGESTIVE DISEASES AND SCIENCES Sethi, S., Barakat, M. T., Friedland, S., Banerjee, S. 2019; 64 (9): 2455–66

  View details for DOI 10.1007/s10620-019-05564-z

  View details for Web of Science ID 000482238300016

• Setting minimum standards for training in EUS and ERCP: results from a prospective multicenter study evaluating learning curves and competence among advanced endoscopy trainees GASTROINTESTINAL ENDOSCOPY Wani, S., Han, S., Simon, V., Hall, M., Early, D., Aagaard, E., Abidi, W. M., Banerjee, S., Baron, T. H., Bartel, M., Bowman, E., Brauer, B. C., Buscaglia, J. M., Carlin, L., Chak, A., Chatrath, H., Choudhary, A., Confer, B., Cote, G. A., Das, K. K., DiMaio, C. J., Dries, A. M., Edmundowicz, S. A., El Chafic, A., El Hajj, I., Ellert, S., Ferreira, J., Gamboa, A., Gan, I. S., Gangarosa, L., Gannavarapu, B., Gordon, S. R., Guda, N. M., Hammad, H. T., Harris, C., Jalaj, S., Jowell, P., Kenshil, S., Klapman, J., Kochman, M. L., Komanduri, S., Lang, G., Lee, L. S., Loren, D. E., Lukens, F. J., Mullady, D., Muthusamy, R. V., Nett, A. S., Olyaee, M. S., Pakseresht, K., Perera, P., Pfau, P., Piraka, C., Poneros, J. M., Rastogi, A., Razzak, A., Riff, B., Saligram, S., Scheiman, J. M., Schuster, I., Shah, R. J., Sharma, R., Spaete, J. P., Singh, A., Sohail, M., Sreenarasimhaiah, J., Stevens, T., Tabibian, J. H., Tzimas, D., Uppal, D. S., Urayama, S., Vitterbo, D., Wang, A. Y., Wassef, W., Yachimski, P., Zepeda-Gomez, S., Zuchelli, T., Keswani, R. N. 2019; 89 (6): 1160-+

  View details for DOI 10.1016/j.gie.2019.01.030

  View details for Web of Science ID 000468106800012

• Basket Case: Fluoroscopy-Free Capture and Retrieval of Biliary and Pancreatic Duct Stones. Digestive diseases and sciences Barakat, M. T., Banerjee, S. 2019

  View details for PubMedID 31055718

• Radiation Training, Radiation Protection, and Fluoroscopy Utilization Practices Among US Therapeutic Endoscopists. Digestive diseases and sciences Sethi, S., Barakat, M. T., Friedland, S., Banerjee, S. 2019

  Abstract

  BACKGROUND: Fluoroscopy use during ERCP exposes patients and providers to deleterious effects of radiation. Formal training in fluoroscopy/radiation protection is not widely emphasized during therapeutic endoscopy training, and radiation use during GI endoscopy has not previously been characterized in the USA. In this study, we evaluated radiation training, fluoroscopy use patterns, and radiation protection practices among US therapeutic endoscopists.METHODS: An anonymous electronic survey was distributed to US therapeutic endoscopists, and responses were analyzed using descriptive statistics. State-specific requirements for fluoroscopy utilization were determined from state radiologic health branches.RESULTS: A total of 159 endoscopists (response rate 67.8%) predominantly those working in university hospitals (69.2%) with >5years of experience performing ERCP (74.9%) completed the questionnaire. Although the majority of endoscopists (61.6%) reported that they personally controlled fluoroscopy during ERCP, most (56.6%) had not received training on operating their fluoroscopy system. Only a minority (18-31%) of all respondents reported consistently utilizing modifiable fluoroscopy system parameters that minimize patient radiation exposure (pulsed fluoroscopy, frame rate modification or collimation). Endoscopists appear to undertake adequate personal radiation protective measures although use of a dosimeter was not consistent in half of respondents. The majority of states (56.8%) do not have any stated requirement for certification of non-radiologist physicians who intend to operate fluoroscopy.CONCLUSIONS: Most US gastroenterologists performing ERCP have not received formal training in operating their fluoroscopy system or in minimizing radiation exposure to themselves and to their patients. Such formal training should be included in all therapeutic endoscopy training programs, and fluoroscopy system-specific training should be offered at all hospitals.

  View details for PubMedID 30911863

• Setting minimum standards for training in EUS and ERCP: results from a prospective multicenter study evaluating learning curves and competence among advanced endoscopy trainees. Gastrointestinal endoscopy Wani, S., Han, S., Simon, V., Hall, M., Early, D., Aagaard, E., Abidi, W. M., Banerjee, S., Baron, T. H., Bartel, M., Bowman, E., Brauer, B. C., Buscaglia, J. M., Carlin, L., Chak, A., Chatrath, H., Choudhary, A., Confer, B., Cote, G. A., Das, K. K., DiMaio, C. J., Dries, A. M., Edmundowicz, S. A., El Chafic, A. H., El Hajj, I., Ellert, S., Ferreira, J., Gamboa, A., Gan, I. S., Gangarosa, L., Gannavarapu, B., Gordon, S. R., Guda, N. M., Hammad, H. T., Harris, C., Jalaj, S., Jowell, P., Kenshil, S., Klapman, J., Kochman, M. L., Komanduri, S., Lang, G., Lee, L. S., Loren, D. E., Lukens, F., Mullady, D., Muthusamy, R. V., Nett, A. S., Olyaee, M. S., Pakseresht, K., Perera, P., Pfau, P., Piraka, C., Poneros, J. M., Rastogi, A., Razzak, A., Riff, B., Saligram, S., Scheiman, J. M., Schuster, I., Shah, R. J., Sharma, R., Spaete, J. P., Singh, A., Sohail, M., Sreenarasimhaiah, J., Stevens, T., Tabibian, J. H., Tzimas, D., Uppal, D. S., Urayama, S., Vitterbo, D., Wang, A. Y., Wassef, W., Yachimski, P., Zepeda-Gomez, S., Zuchelli, T., Keswani, R. N. 2019

  Abstract

  BACKGROUND AND AIMS: Minimum EUS and ERCP volumes that should be offered per trainee in "high quality" advanced endoscopy training programs (AETPs) are not established. We aimed to define the number of procedures required by an "average" advanced endoscopy trainee (AET) to achieve competence in technical and cognitive EUS and ERCP tasks to help structure AETPs.METHODS: ASGE-recognized AETPs were invited to participate; AETs were graded on every fifth EUS and ERCP examination using a validated tool. Grading for each skill was done using a 4-point scoring system and learning curves (LCs) using cumulative sum (CUSUM) analysis for overall, technical, and cognitive components of EUS and ERCP were shared with AETs and trainers quarterly. Generalized linear mixed effects models with a random intercept for each AET were used to generate aggregate LCs allowing us to use data from all AETs to estimate the average learning experience for trainees.RESULTS: Among 62 invited AETPs, 37 AETs from 32 AETPs participated. The majority of AETs reported hands-on EUS (52%, median 20 cases) and ERCP (68%, median 50 cases) experience before starting an AETP. The median number of EUS and ERCPs performed/AET was 400 (range 200-750) and 361 (250-650), respectively. Overall, 2616 examinations were graded (EUS: 1277; ERCP-biliary: 1143; pancreatic: 196). The majority of graded EUS examinations were performed for pancreatobiliary indications (69.9%) and ERCP examinations for ASGE biliary grade of difficulty 1 (72.1%). The average AET achieved competence in core EUS and ERCP skills at approximately 225 and 250 cases, respectively. However, overall technical competence was achieved for Grade 2 ERCP at about 300 cases.CONCLUSIONS: The thresholds provided for an average AET to achieve competence in EUS and ERCP may be used by ASGE and AETPs in establishing the minimal standards for case volume exposure for AETs during their training.

  View details for PubMedID 30738985

• When Experts Fail: Use of a Short Turning Radius Colonoscope Facilitates Successful Completion of Colonoscopy in Patients with Bowel Fixity. Digestive diseases and sciences Girotra, M. n., Sethi, S. n., Barakat, M. T., Huang, R. J., Friedland, S. n., Ladabaum, U. n., Banerjee, S. n. 2019

  Abstract

  Rates of incomplete colonoscopy in non-expert settings range up to 13%. Expert colonoscopists can complete ~ 95% colonoscopies when other endoscopists fail; however, a small number remain incomplete even in expert hands, typically due to bowel fixity.Pentax Retroview™ (EC-3490TLi) is a new slim colonoscope with a short turning radius (STR) and greater tip deflection (210°), which allows easy maneuverability across sharply angulated/fixed colonic bends. We evaluated the utility of this colonoscope for completing colonoscopies that fail even in the hands of expert colonoscopists.Retrospective chart review was performed, and main outcomes measured included cecal intubation rate, lesions detected, dosage of sedation used, and complications.Using the STR colonoscope, complete colonoscopy to the cecum was possible in 34/37 patients (91.9%). No loss of lumen/blind advancement was necessary in any of the procedures. No adverse events occurred. Among the completed colonoscopies, 6/34 (17.6%) patients had adenomas, all proximal to the site of prior failure, including one advanced adenoma. All failures (n = 3, 8.1%) had a history of cancer surgeries, with peritoneal carcinomatosis/extensively fixed/frozen bowel (two patients) and an additional diverticular stricture with colo-vesical fistula (one patient).STR colonoscope facilitates completion of a high proportion (91.9%) of colonoscopies that previously failed in expert hands. Its STR allows easy maneuverability across segments of sharp angulation with bowel fixity without need for blind advancement. The use of this colonoscope led to the detection of adenomas in 17.6% of patients, all proximal to the site of prior failed colonoscopy.

  View details for DOI 10.1007/s10620-019-05882-2

  View details for PubMedID 31630343

• Simethicone is retained in endoscopes despite reprocessing: impact of its use on working channel fluid retention and adenosine triphosphate bioluminescence values GASTROINTESTINAL ENDOSCOPY Barakat, M. T., Huang, R. J., Banerjee, S. 2019; 89 (1): 115–23

  View details for DOI 10.1016/j.gie.2018.08.012

  View details for Web of Science ID 000453397800016

• Essential building blocks for colonoscopy quality improvement initiatives: a dedicated database, automation, and appropriate financial incentives. Endoscopy Banerjee, S. n. 2019; 51 (9): 813–15

  View details for DOI 10.1055/a-0967-1523

  View details for PubMedID 31461771

• Unplanned Hospital Encounters After Endoscopic Retrograde Cholangiopancreatography in 3 Large North American States GASTROENTEROLOGY Huang, R. J., Barakat, M. T., Girotra, M., Lee, J. S., Banerjee, S. 2019; 156 (1): 119-+

  View details for DOI 10.1053/j.gastro.2018.09.037

  View details for Web of Science ID 000453401000028

• SpyCatcher: Use of a Novel Cholangioscopic Snare for Capture and Retrieval of a Proximally Migrated Biliary Stent DIGESTIVE DISEASES AND SCIENCES Barakat, M. T., Banerjee, S. 2018; 63 (12): 3224–27

  View details for DOI 10.1007/s10620-018-5228-8

  View details for Web of Science ID 000450660300009

• Competence in Endoscopic Ultrasound and Endoscopic Retrograde Cholangiopancreatography, From Training Through Independent Practice GASTROENTEROLOGY Wani, S., Keswani, R. N., Han, S., Aagaard, E. M., Hall, M., Simon, V., Abidi, W. M., Banerjee, S., Baron, T. H., Bartel, M., Bowman, E., Brauer, B. C., Buscaglia, J. M., Carlin, L., Chak, A., Chatrath, H., Choudhary, A., Confer, B., Cote, G. A., Das, K. K., DiMaio, C. J., Dries, A. M., Edmundowicz, S. A., El Chafic, A., El Hajj, I., Ellert, S., Ferreira, J., Gamboa, A., Gan, I. S., Gangarosa, L. M., Gannavarapu, B., Gordon, S. R., Guda, N. M., Hammad, H. T., Harris, C., Jalaj, S., Jowell, P. S., Kenshil, S., Klapman, J., Kochman, M. L., Komanduri, S., Lang, G., Lee, L. S., Loren, D. E., Lukens, F. J., Mullady, D., Muthusamy, V., Nett, A. S., Olyaee, M. S., Pakseresht, K., Perera, P., Pfau, P., Piraka, C., Poneros, J. M., Rastogi, A., Razzak, A., Riff, B., Saligram, S., Scheiman, J. M., Schuster, I., Shah, R. J., Sharma, R., Spaete, J. P., Singh, A., Sohail, M., Sreenarasimhaiah, J., Stevens, T., Tabibian, J. H., Tzimas, D., Uppal, D. S., Urayama, S., Vitterbo, D., Wang, A. Y., Wassef, W., Yachimski, P., Zepeda-Gomez, S., Zuchelli, T., Early, D. 2018; 155 (5): 1483-+

  Abstract

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

  View details for PubMedID 30056094

• Pancreatic ERCP Training is Inadequate and Infrequently Performed in Independent Practice: Results From a Prospective Multicenter Study Evaluating Learning Curves and Competence Among Advanced Endoscopy Trainees Han, S., Keswani, R., Hall, M., Early, D., Aagaard, E., Simon, V., Carlin, L., Ellert, S., Abidi, W., Baron, T., Brauer, B., Chatrath, H., Cote, G. A., Das, K., DiMaio, C., Edmundowicz, S., El Hajj, I., Hammad, H., Jalaj, S., Kochman, M., Komanduri, S., Lee, L., Mullady, D., Muthusamy, R., Nett, A., Olyaee, M., Pakseresht, K., Perera, P., Pfau, P., Piraka, C., Rastogi, A., Shah, R., Sharma, R., Scheiman, J., Tabibian, J., Uppal, D., Urayama, S., Wang, A., Zuchelli, T., Bowman, E., Lang, G., Loren, D., El Chafic, A. H., Yachimski, P., Gamboa, A., Poneros, J., Wassef, W., Sohail, M., Stevens, T., Confer, B., Guda, N., Gan, S. I., Razzak, A., Gordon, S., Ferriera, J., Banerjee, S., Choudhary, A., Dries, A., Buscaglia, J., Tzimas, D., Zepeda-Gomez, S., Kenshil, S., Lukens, F., Barte, M., Jowell, P., Spaete, J., Riff, B., Harris, C., Saligram, S., Gannavarapu, B., Chak, A., Singh, A., Wani, S. LIPPINCOTT WILLIAMS & WILKINS. 2018: 1391

  View details for Web of Science ID 000449304600112

• Recent Trends and the Impact of the Affordable Care Act on Emergency Department Visits and Hospitalizations for Gastrointestinal, Pancreatic, and Liver Diseases. Journal of clinical gastroenterology Barakat, M. T., Mithal, A., Huang, R. J., Sehgal, A., Sehgal, A., Singh, G., Banerjee, S. 2018

  Abstract

  BACKGROUND: The Affordable Care Act (ACA) with Medicaid expansion implemented in 2014, extended health insurance to >20-million previously uninsured individuals. However, it is unclear whether enhanced primary care access with Medicaid expansion decreased emergency department (ED) visits and hospitalizations for gastrointestinal (GI)/pancreatic/liver diseases.METHODS: We evaluated trends in GI/pancreatic/liver diagnosis-specific ED/hospital utilization over a 5-year period leading up to Medicaid expansion and a year following expansion, in California (a state that implemented Medicaid expansion) and compare these with Florida (a state that did not).RESULTS: From 2009 to 2013, GI/pancreatic/liver disease ED visits increased by 15.0% in California and 20.2% in Florida and hospitalizations for these conditions decreased by 2.6% in California and increased by 7.9% in Florida. Following Medicaid expansion, a shift from self-pay/uninsured to Medicaid insurance was seen California; in addition, a new decrease in ED visits for nausea/vomiting and GI infections, was evident, without associated change in overall ED/hospital utilization trends. Total hospitalization charges for abdominal pain, nausea/vomiting, constipation, and GI infection diagnoses decreased in California following Medicaid expansion, but increased over the same time-period in Florida.CONCLUSIONS: We observed a striking payer shift for GI/pancreatic/liver disease ED visits/hospitalizations after Medicaid expansion in California, indicating a shift in the reimbursement burden in self-pay/uninsured patients, from patients and hospitals to the government. ED visits and hospitalization charges decreased for some primary care-treatable GI diagnoses in California, but not for Florida, suggesting a trend toward lower cost of gastroenterology care, perhaps because of decreased hospital utilization for conditions amenable to outpatient management.

  View details for PubMedID 30285976

• Scoping the scope: endoscopic evaluation of endoscope working channels with a new high-resolution inspection endoscope (with video) GASTROINTESTINAL ENDOSCOPY Barakat, M. T., Girotra, M., Huang, R. J., Banerjee, S. 2018; 88 (4): 601-+

  View details for DOI 10.1016/j.gie.2018.01.018

  View details for Web of Science ID 000444249600004

• Unplanned Hospital Encounters Following Endoscopic Retrograde Cholangiopancreatography in 3 Large American States. Gastroenterology Huang, R. J., Barakat, M. T., Girotra, M., Lee, J. S., Banerjee, S. 2018

  Abstract

  BACKGROUND & AIMS: We have few population-level data on the performance of endoscopic retrograde cholangiopancreatography (ERCP) in the United States. We investigated the numbers of unplanned hospital encounters (UHEs), patient and facility factors associated with UHEs, and variation in quality and outcomes in the performance of ERCP in 3 large American states.METHODS: We collected data on 68,642 ERCPs, performed at 635 facilities in California, Florida, and New York from 2009 through 2014. The primary endpoint was number of UHEs with an ERCP-related event within 7 days of ERCP; secondary endpoints included numbers of UHE within 30 days and mortality within 30 days. Each facility was assigned a risk-standardized cohort, and variations in numbers of UHE were analyzed using multivariable analysis.RESULTS: Among all ERCPs, 5.8% resulted in an UHE within 7 days, and 10.2% by 30 days. Performance of sphincterotomy was significantly associated with a higher risk of UHE at 7 and 30 days (P<.001). Younger age, female sex, and more advanced comorbidity associated with UHE. There was substantial heterogeneity in rates of UHE among facilities: 4.2% at facilities in the lower 5th percentile and 25.2% at facilities in the 95th percentile. Increasing facility volume and ability to perform endoscopic ultrasound associated inversely with risk. The median number of ERCPs performed each year was 68.7, but 69% of facilities performed 100 or fewer ERCPs per year. Risk for UHE following sphincterotomy decreased with increasing facility volume until an inflection point of 157 ERCPs per year was reached.CONCLUSIONS: In an analysis of outcomes of 68,642 ERCPs performed in three states, we found a higher than expected number of UHEs. There is substantial unexplained variation in risk for adverse event following ERCPs among facilities-volume is the strongest predictor of risk. Annual facility volumes above approximately 150 ERCPs per year may protect against UHE.

  View details for PubMedID 30243620

• Cut and Paste: Endoscopic Management of a Perforating Biliary Stent Utilizing Scissors and Clips DIGESTIVE DISEASES AND SCIENCES Barakat, M. T., Kothari, S., Banerjee, S. 2018; 63 (9): 2202–5

  View details for DOI 10.1007/s10620-017-4837-y

  View details for Web of Science ID 000441941000009

• Comparison of automated and manual drying in the eliminating residual endoscope working channel fluid after reprocessing (with video). Gastrointestinal endoscopy Barakat, M. T., Huang, R. J., Banerjee, S. 2018

  Abstract

  BACKGROUND: Residual fluid within endoscope working channels after reprocessing may promote growth of pathogens. Current reprocessing guidelines therefore recommend endoscope drying with administration of forced filtered air; however, the duration and modality of administered air are not specified. The new DriScope Aid device enables automated administration of filtered air at controlled pressure through all internal endoscope channels. We systematically compared, for the first time, the impact of manual drying and automated drying on retained working channel fluid and bioburden after reprocessing.METHODS: We assessed for residual working channel fluid after reprocessing/drying using the SteriCam borescope. Drying was performed either manually (forced filtered air) or was automated (DriScope Aid) for either 5 or 10 minutes. ATP bioluminescence testing was performed on working channel rinsates after drying, to evaluate for residual bioburden.RESULTS: Significantly more fluid droplets were evident after manual drying (4.55 ± 6.14) than with automated device-facilitated drying for either 5 minutes (0.83 ± 1.29, p=0.007) or 10 minutes (0±0, p=0.001). ATP bioluminescence values were higher for manual drying compared with automated drying at 48 hours (p=0.001) and 72 hours (p=0.014) after reprocessing.CONCLUSIONS: We demonstrate significantly fewer water droplets and delayed ATP bioluminescence values within endoscope working channels after automated drying compared with manual drying. In particular, virtually no retained fluid was evident within endoscope working channels after automated drying for 10 minutes. These findings support recommendations for automation of as many reprocessing steps as possible. Automated drying may decrease the risk of transmission of infection related to endoscopy.

  View details for PubMedID 30148992

• Simethicone is retained in endoscopes despite reprocessing: impact of its use on working channel fluid retention and adenosine triphosphate bioluminescence values (with video). Gastrointestinal endoscopy Barakat, M. T., Huang, R. J., Banerjee, S. 2018

  Abstract

  BACKGROUND: Studies from our group and others demonstrate residual fluid in 42% to 95% of endoscope working channels despite high-level disinfection (HLD) and drying. Additionally, persistent simethicone has been reported in endoscope channels despite reprocessing.METHODS: Endoscopy was performed using water or varied simethicone concentrations (0.5%, 1%, 3%) for flushing. After HLD/drying, we inspected endoscope working channels for retained fluid using the SteriCam borescope. Working channel rinsates were evaluated for adenosine triphosphate (ATP) bioluminescence. Fourier transform infrared spectroscopy was performed on fluid droplets gathered from a colonoscope in which low-concentration simethicone was used.RESULTS: Use of medium/high concentration simethicone resulted in higher mean fluid droplets (13.5/17.3 droplets, respectively) and ATP bioluminescence values (20.6/23 RLUs, respectively) compared with procedures using only water (6.3 droplets/10.9 RLUs, p<0.001). Two automated endoscope reprocessing (AER) cycles resulted in return of fluid droplet and ATP bioluminescence values to ranges similar to procedures using only water (p=0.56). Low-concentration simethicone did not increase mean residual fluid or ATP bioluminescence values compared with procedures using only water (5.8 droplets/15.6 RLUs). FTIR analysis revealed simethicone in the endoscope working channel after use of low-concentration simethicone.CONCLUSIONS: Use of medium/high concentration simethicone is associated with retention of increased fluid droplets and higher ATP bioluminescence values in endoscope working channels, compared with endoscopes in which water or low concentration simethicone was used. However, simethicone is detectable in endoscopes despite reprocessing, even when used in low concentration. Our data suggest that when simethicone is used, it should be used in the lowest concentration possible. Facilities may consider 2 AER cycles for reprocessing of endoscopes when simethicone has been used.

  View details for PubMedID 30125574

• SpyCatcher: Use of a Novel Cholangioscopic Snare for Capture and Retrieval of a Proximally Migrated Biliary Stent. Digestive diseases and sciences Barakat, M. T., Banerjee, S. 2018

  View details for PubMedID 30078117

• RISK OF POST-PROCEDURAL UNPLANNED HOSPITAL ENCOUNTERS FOLLOWING ENDOSCOPIC ULTRASOUND WITH FINE-NEEDLE ASPIRATION OF THE PANCREAS: A POPULATION-LEVEL, PROPENSITY-SCORE CONTROLLED COHORT STUDY Huang, R. J., Barakat, M. T., Park, W. G., Banerjee, S. MOSBY-ELSEVIER. 2018: AB107–AB108

  View details for Web of Science ID 000434248200111

• A PROSPECTIVE MULTICENTER STUDY EVALUATING EUS AND ERCP COMPETENCE DURING ADVANCED ENDOSCOPY TRAINING AND SUBSEQUENT INDEPENDENT PRACTICE: THE RAPID ASSESSMENT OF TRAINEE ENDOSCOPY SKILLS (RATES2) STUDY Wani, S. B., Keswani, R. N., Hall, M., Han, S., Aagaard, E., Simon, V. C., Carlin, L., Ellert, S., Abidi, W. M., Baron, T. H., Brauer, B. C., Chatrath, H., Cote, G. A., Das, K. K., DiMaio, C. J., Edmundowicz, S. A., El Hajj, I. I., Hammad, H. T., Jalaj, S., Kochman, M. L., Komanduri, S., Lee, L. S., Mullady, D., Muthusamy, V., Nett, A. S., Olyaee, M. S., Pakseresht, K., Perera, P., Pfau, P., Piraka, C., Rastogi, A., Shah, R. J., Sharma, R., Scheiman, J. M., Tabibian, J. H., Uppal, D., Urayama, S., Wang, A. Y., Zuchelli, T., Bowman, E., Lang, G., Loren, D. E., El Chafic, A., Yachimski, P., Gamboa, A., Poneros, J. M., Wassef, W., Sohail, M., Stevens, T., Confer, B., Guda, N. M., Gan, S., Razzak, A., Gordon, S. R., Ferriera, J., Banerjee, S., Choudhary, A., Dries, A. M., Buscaglia, J. M., Tzimas, D., Zepeda-Gomez, S., Kenshil, S., Lukens, F., Bartel, M., Jowell, P., Spaete, J. P., Riff, B., Harris, C., Saligram, S., Gannavarapu, B., Chak, A., Singh, A., Early, D. MOSBY-ELSEVIER. 2018: AB46–AB48

  View details for Web of Science ID 000434248200003

• SCOPING THE SCOPE: ENDOSCOPIC EVALUATION OF ENDOSCOPE WORKING CHANNEL DAMAGE/DEBRIS USING A NOVEL FLEXIBLE INSPECTION SCOPE AND ASSESSMENT OF THE IMPACT OF AUTOMATED DRYING AND SIMETHICONE USE ON WORKING CHANNEL FLUID RESIDUE Barakat, M. T., Girotra, M., Huang, R. J., Banerjee, S. MOSBY-ELSEVIER. 2018: AB166–AB167

  View details for Web of Science ID 000434248200240

• NO INCREASED RISK OF POST-PROCEDURAL UNPLANNED HOSPITAL ENCOUNTERS FOLLOWING AMBULATORY COLONOSCOPY IN PATIENTS WITH CIRRHOSIS: A POPULATION-LEVEL, COHORT-CONTROLLED STUDY. Huang, R. J., Barakat, M. T., Friedland, S., Banerjee, S. MOSBY-ELSEVIER. 2018: AB91–AB92

  View details for Web of Science ID 000434248200085

• SETTING MINIMUM STANDARDS FOR TRAINING IN EUS AND ERCP: RESULTS FROM A PROSPECTIVE MULTICENTER STUDY EVALUATING LEARNING CURVES AND COMPETENCE AMONG ADVANCED ENDOSCOPY TRAINEES (AETS) Wani, S. B., Han, S., Simon, V. C., Hall, M., Early, D., Aagaard, E., Carlin, L., Ellert, S., Abidi, W. M., Baron, T. H., Brauer, B. C., Chatrath, H., Cote, G. A., Das, K. K., DiMaio, C. J., Edmundowicz, S. A., El Hajj, I. I., Hammad, H. T., Jalaj, S., Kochman, M. L., Komanduri, S., Lee, L. S., Mullady, D., Muthusamy, V., Nett, A. S., Olyaee, M. S., Pakseresht, K., Perera, P., Pfau, P., Piraka, C., Rastogi, A., Shah, R. J., Sharma, R., Scheiman, J. M., Tabibian, J. H., Uppal, D., Urayama, S., Wang, A. Y., Zuchelli, T., Bowman, E., Lang, G., Loren, D. E., El Chafic, A., Yachimski, P., Gamboa, A., Poneros, J. M., Wassef, W., Sohail, M., Stevens, T., Confer, B., Guda, N. M., Gan, S., Razzak, A., Gordon, S. R., Ferriera, J., Banerjee, S., Choudhary, A., Dries, A. M., Buscaglia, J. M., Tzimas, D., Zepeda-Gomez, S., Kenshil, S., Lukens, F., Bartel, M., Jowell, P., Spaete, J. P., Riff, B., Harris, C., Saligram, S., Gannavarapu, B., Chak, A., Singh, A., Keswani, R. N. MOSBY-ELSEVIER. 2018: AB109

  View details for Web of Science ID 000434248200113

• Effects of a Brief Educational Program on Optimization of Fluoroscopy to Minimize Radiation Exposure During Endoscopic Retrograde Cholangiopancreatography CLINICAL GASTROENTEROLOGY AND HEPATOLOGY Barakat, M. T., Thosani, N. C., Huang, R. J., Choudhary, A., Kochar, R., Kothari, S., Banerjee, S. 2018; 16 (4): 550–57

  Abstract

  Fluoroscopy during endoscopic retrograde cholangiopancreatography (ERCP) is increasingly performed by therapeutic endoscopists, many of whom have not received formal training in modulating fluoroscopy use to minimize radiation exposure. Exposure to ionizing radiation has significant health consequences for patients and endoscopists. We aimed to evaluate whether a 20-minute educational intervention for endoscopists would improve use of fluoroscopy and decrease ERCP-associated exposure to radiation for patients.We collected data from 583 ERCPs, performed in California from June 2010 through November 2012; 331 were performed at baseline and 252 following endoscopist education. The educational intervention comprised a 20-minute video explaining best practices for fluoroscopy, coupled with implementation of a formal fluoroscopy time-out protocol before the ERCP was performed. Our primary outcome was the effect of the educational intervention on direct and surrogate markers of patient radiation exposure associated with ERCPs performed by high-volume endoscopists (HVEs) (200 or more ERCPs/year) vs low-volume endoscopists (LVEs) (fewer than 200 ERCPs/year).At baseline, total radiation dose and dose area product were significantly higher for LVEs, but there was no significant difference between HVEs and LVEs following education. Education was associated with significant reductions in median fluoroscopy time (48% reduction for HVEs vs 30% reduction for LVEs), total radiation dose (28% reduction for HVEs vs 52% for LVEs) and dose area product (35% reduction for HVEs vs 48% reduction for LVEs). All endoscopists significantly increased their use of low magnification and collimation following education.A 20-minute educational program with emphasis on ideal use of modifiable fluoroscopy machine settings results in an immediate and significant reduction in ERCP-associated patient radiation exposure for low-volume and high-volume endoscopists. Training programs should consider radiation education for advanced endoscopy fellows.

  View details for PubMedID 28804031

  View details for PubMedCentralID PMC5809234

• Plastic Surgery: Cholangioscopic Intra-stent Balloon Retrieval of a Proximally Migrated Biliary Stent DIGESTIVE DISEASES AND SCIENCES Barakat, M. T., Girotra, M., Choudhary, A., Banerjee, S. 2018; 63 (4): 851–55

  View details for PubMedID 28965145

  View details for PubMedCentralID PMC5856579

• Scoping the scope: endoscopic evaluation of endoscope working channels with a new high-resolution inspection endoscope (with video). Gastrointestinal endoscopy Barakat, M. T., Girotra, M., Huang, R. J., Banerjee, S. 2018

  Abstract

  BACKGROUND AND AIMS: Outbreaks of transmission of infection related to endoscopy despite reported adherence to reprocessing guidelines warrant scrutiny of all potential contributing factors. Recent reports from ambulatory surgery centers indicated widespread significant occult damage within endoscope working channels, raising concerns regarding the potential detrimental impact of this damage on the adequacy of endoscope reprocessing.METHODS: We inspected working channels of all 68 endoscopes at our academic institution using a novel flexible inspection endoscope. Inspections were recorded and videos reviewed by 3 investigators to evaluate and rate channel damage and/or debris. Working channel rinsates were obtained from all endoscopes, and adenosine triphosphate (ATP) bioluminescence was measured.RESULTS: Overall endoscope working channel damage was rated as minimal and/or mild and was consistent with expected wear and tear (median 1.59 on our 5-point scale). Our predominant findings included superficial scratches (98.5%) and scratches with adherent peel (76.5%). No channel perforations, stains, or burns were detected. The extent of damage was not predicted by endoscope age. Minor punctate debris was common, and a few small drops of fluid were noted in 42.6% of endoscopes after reprocessing and drying. The presence of residual fluid predicted higher ATP bioluminescence values. The presence of visualized working channel damage or debris was not associated with elevated ATP bioluminescence values.CONCLUSION: The flexible inspection endoscope enables high-resolution imaging of endoscope working channels and offers endoscopy units an additional modality for endoscope surveillance, potentially complementing bacterial cultures and ATP values. Our study, conducted in a busy academic endoscopy unit, indicated predominately mild damage to endoscope working channels, which did not correlate with elevated ATP values.

  View details for PubMedID 29425885

• A prospective evaluation of radiation-free direct solitary cholangioscopy for the management of choledocholithiasis GASTROINTESTINAL ENDOSCOPY Barakat, M. T., Girotra, M., Choudhary, A., Huang, R. J., Sethi, S., Banerjee, S. 2018; 87 (2): 584-+

  Abstract

  Endoscopy has replaced many radiologic studies for the GI tract. However, ERCP remains a hybrid endoscopic-fluoroscopic procedure, which limits its portable delivery, creates delays because of fluoroscopy room unavailability, and exposes patients and providers to radiation. We evaluated fluoroscopy/radiation-free management of patients with noncomplex choledocholithiasis using direct solitary cholangioscopy (DSC).Patients underwent fluoroscopy-free biliary cannulation, sphincterotomy, and then cholangioscopy to establish location and number/size of stones and to document distance from ampulla to bifurcation to guide balloon advancement. Stones were extracted using a marked balloon catheter advanced to the bifurcation and inflated to the bile duct diameter, documented on prior imaging. Repeat cholangioscopy was performed to confirm stone clearance.Fluoroscopy-free biliary cannulation was successful in all 40 patients (100%). Advanced cannulation techniques were required in 5 patients. Papillary balloon dilation was performed in 8 patients and electrohydraulic lithotripsy in 3 patients. Discrete stones were visualized in 31 patients and stone debris/sludge in 8 patients. Fluoroscopy-free stone/debris/sludge extraction was successful in all these patients. Brief fluoroscopy was used in 2 patients (5%) to confirm stone clearance. No stone/debris/sludge was noted in 1 patient. Mild pancreatitis was noted in 2 patients (5%) and bleeding in 1 (2.5%).This study establishes the feasibility of fluoroscopy/radiation-free, cholangioscopic management of noncomplex choledocholithiasis with success and adverse event rates similar to standard ERCP. DSC represents a significant procedural advance in the management of biliary disorders that does not need to be confined to the fluoroscopy suite and can be reimagined as bedside procedures in emergency department or intensive care unit settings. (Clinical trial registration number: NCT03074201.).

  View details for PubMedID 28797911

  View details for PubMedCentralID PMC5801123

• Liver transplant-related anastomotic biliary strictures: a novel, rapid, safe, radiation-sparing, and cost-effective management approach GASTROINTESTINAL ENDOSCOPY Barakat, M. T., Huang, R. J., Thosani, N. C., Choudhary, A., Girotra, M., Banerjee, S. 2018; 87 (2): 501–8

  Abstract

  Biliary strictures after orthotopic liver transplantation (OLT) are typically managed by sequential ERCP procedures, with incremental dilation of the stricture and stent exchange (IDSE) and placement of new stents. This approach resolves >80% of strictures after 12 months but requires costly, lengthy ERCPs with significant patient radiation exposure. Increasing awareness of the harmful effects of radiation, escalating healthcare costs, and decreasing reimbursement for procedures mandate maximal efficiency in performing ERCP. We compared the traditional IDSE protocol with a sequential stent addition (SSA) protocol, in which additional stents are placed across the stricture during sequential ERCPs, without stent removal/exchange or stricture dilation.Patients undergoing ERCP for OLT-related anastomotic strictures from 2010 to 2016 were identified from a prospectively maintained endoscopy database. Procedure duration, fluoroscopy time, stricture resolution rates, adverse events, materials fees, and facility fees were analyzed for IDSE and SSA procedures.Seventy-seven patients underwent 277 IDSE and 132 SSA procedures. Mean fluoroscopy time was 64.5% shorter (P < .0001) and mean procedure duration 41.5% lower (P < .0001) with SSA compared with IDSE. SSA procedures required fewer accessory devices, resulting in significantly lower material (63.8%, P < .0001) and facility costs (42.8%, P < .0001) compared with IDSE. Stricture resolution was >95%, and low adverse event rates did not significantly differ.SSA results in shorter, cost-effective procedures requiring fewer accessory devices and exposing patients to less radiation. Stricture resolution rates are equivalent to IDSE, and adverse events do not differ significantly, even in this immunocompromised population.

  View details for PubMedID 28757315

  View details for PubMedCentralID PMC5787034

• (Re)building the Wall: Recurrent Boerhaave Syndrome Managed by Over-the-Scope Clip and Covered Metallic Stent Placement. Digestive diseases and sciences Barakat, M. T., Girotra, M. n., Banerjee, S. n. 2018; 63 (5): 1139–42

  View details for PubMedID 28948439

  View details for PubMedCentralID PMC5867198

• Cut and Paste: Endoscopic Management of a Perforating Biliary Stent Utilizing Scissors and Clips. Digestive diseases and sciences Barakat, M. T., Kothari, S., Banerjee, S. 2017

  View details for PubMedID 29127608

• Practice Patterns for Cholecystectomy Following Endoscopic Retrograde Cholangio-Pancreatography for Patients With Choledocholithiasis. Gastroenterology Huang, R. J., Barakat, M. T., Girotra, M., Banerjee, S. 2017

  Abstract

  Cholecystectomy (CCY) following an episode of choledocholithiasis requiring endoscopic retrograde cholangio-pancreatography (ERCP) with stone extraction reduces recurrent biliary events, compared to expectant management. We studied practice patterns for performance of CCY following ERCP for choledocholithiasis using data from 3 large states and evaluated the effects of delaying CCY.We conducted a retrospective cohort study using the ambulatory surgery, inpatient, and emergency department databases from the states of California (years 2009-2011), New York (2011-2013), and Florida (2012-2014). We collected data from 4516 patients hospitalized with choledocholithiasis who underwent ERCP. We compared outcomes of patients who underwent CCY at index admission (early CCY), elective CCY within 60 days of discharge (delayed CCY), or did not undergo CCY (no CCY), calculating rate of recurrent biliary events (defined as an emergency department visit or unplanned hospitalization due to symptomatic cholelithiasis, cholecystitis, choledocholithiasis, cholangitis, or biliary pancreatitis), mortality, and cost by CCY cohort. We also evaluated risk factors for not undergoing CCY. The primary outcome measure was the rate of recurrent biliary events in the 365 days following discharge from index admission.Of the patients who underwent ERCP for choledocholithiasis, 41.2% underwent early CCY, 10.9% underwent delayed CCY, and 48.0% underwent no CCY. Early CCY reduced relative risk of recurrent biliary events within 60 days by 92%, compared with delayed or no CCY (P<.001). After 60 days following discharge from index admission, patients with early CCY had an 87% lower risk of recurrent biliary events than patients with no CCY (P<.001) and patients with delayed CCY had an 88% lower risk of recurrent biliary events than patients with no CCY (P<.001). A strategy of delayed CCY performed on an outpatient basis was least costly. Performance of early CCY was inversely associated with low facility volume. Hispanic race, Asian race, Medicaid insurance, and no insurance associated inversely with performance of delayed CCY.In a retrospective analysis of over 4500 patients hospitalized with choledocholithiasis, we found that CCY was not performed following ERCP for almost half of the cases. Although early and delayed CCY equally reduce the risk of subsequent recurrent biliary events, patients are at 10-fold higher risk of recurrent biliary event while waiting for a delayed CCY compared with patients who underwent early CCY. Delayed CCY is a cost-effective strategy that must be balanced against the risk of loss to follow up, particularly among patients who are ethnic minorities or have little or no health insurance.

  View details for DOI 10.1053/j.gastro.2017.05.048

  View details for PubMedID 28583822

• Shaking Off the Shackles of Fluoroscopy - Evolving From Standard ERCP to Radiation-Free Endoscopic Retrograde Cholangioscopy (RF-ERC) Barakat, M. T., Girotra, M., Choudhary, A., Huang, R. J., Sethi, S., Banerjee, S. MOSBY-ELSEVIER. 2017: AB618–AB619

  View details for DOI 10.1016/j.gie.2017.03.1426

  View details for Web of Science ID 000403087401628

• Goff Trans-Pancreatic Septotomy Is an Effective and Safe Salvage Technique Following Failed Standard Biliary Cannulation at ERCP Barakat, M. T., Girotra, M., Huang, R. J., Choudhary, A., Liao, C., Kothari, S., Banerjee, S. MOSBY-ELSEVIER. 2017: AB612

  View details for DOI 10.1016/j.gie.2017.03.1413

  View details for Web of Science ID 000403087401615

• Sequential Biliary Stent Addition Without Exchange or Dilation for Post-Operative Biliary Strictures: A Rapid, Cost-Effective Approach that Minimizes Radiation Exposure Barakat, M. T., Choudhary, A., Huang, R. J., Thosani, N., Girotra, M., Banerjee, S. MOSBY-ELSEVIER. 2017: AB88

  View details for DOI 10.1016/j.gie.2017.03.124

  View details for Web of Science ID 000403087400098

• When Experts Fail: Short Turn Radius Colonoscope to the Rescue? Utility of a Novel Colonoscope for Incomplete Colonoscopy Due to Bowel Fixity Girotra, M., Barakat, M. T., Huang, R. J., Sethi, S., Friedland, S., Ladabaum, U., Banerjee, S. MOSBY-ELSEVIER. 2017: AB517

  View details for DOI 10.1016/j.gie.2017.03.1191

  View details for Web of Science ID 000403087401395

• High Endoscopist and Facility Volume Protect Against Emergency Department Visits and Unplanned Hospitalizations Following Ambulatory Ercp Huang, R. J., Barakat, M. T., Girotra, M., Banerjee, S. MOSBY-ELSEVIER. 2017: AB84

  View details for DOI 10.1016/j.gie.2017.03.115

  View details for Web of Science ID 000403087400089

• Evolution in the utilization of biliary interventions in the United States: results of a nationwide longitudinal study from 1998 to 2013. Gastrointestinal endoscopy Huang, R. J., Thosani, N. C., Barakat, M. T., Choudhary, A., Mithal, A., Singh, G., Sethi, S., Banerjee, S. 2017

  Abstract

  Bile duct surgery (BDS), percutaneous transhepatic cholangiography (PTC), and ERCP are alternative interventions used to treat biliary disease. Our aim was to describe trends in ERCP, BDS, and PTC on a nationwide level in the United States.We used the National Inpatient Sample to estimate age-standardized utilization trends of inpatient diagnostic ERCP, therapeutic ERCP, BDS, and PTC between 1998 and 2013. We calculated average case fatality, length of stay, patient demographic profile (age, gender, payer), and hospital characteristics (hospital size and metropolitan status) for these procedures.Total biliary interventions decreased over the study period from 119.8 to 100.1 per 100,000. Diagnostic ERCP utilization decreased by 76%, and therapeutic ERCP utilization increased by 35%. BDS rates decreased by 78% and PTC rates by 24%. ERCP has almost completely supplanted surgery for the management of choledocholithiasis. Fatality from ERCP, BDS, and PTC have all decreased, whereas mean length of stay has remained stable. The proportion of Medicare-insured, Medicaid-insured, and uninsured patients undergoing biliary procedures has increased over time. Most of the increase in therapeutic ERCP and decrease in BDS occurred in large, metropolitan hospitals.Although therapeutic ERCP utilization has increased over time, the total volume of biliary interventions has decreased. BDS utilization has experienced the most dramatic decrease, possibly a consequence of the increased therapeutic capacity and safety of ERCP. ERCPs are now predominantly therapeutic in nature. Large urban hospitals are leading the shift from surgical to endoscopic therapy of the biliary system.

  View details for DOI 10.1016/j.gie.2016.12.021

  View details for PubMedID 28062313

• Affordable Care Act and healthcare delivery: A comparison of California and Florida hospitals and emergency departments. PloS one Barakat, M. T., Mithal, A. n., Huang, R. J., Mithal, A. n., Sehgal, A. n., Banerjee, S. n., Singh, G. n. 2017; 12 (8): e0182346

  Abstract

  The Affordable Care Act (ACA) has expanded access to health insurance for millions of Americans, but the impact of Medicaid expansion on healthcare delivery and utilization remains uncertain.To determine the early impact of the Medicaid expansion component of ACA on hospital and ED utilization in California, a state that implemented the Medicaid expansion component of ACA and Florida, a state that did not.Analyze all ED encounters and hospitalizations in California and Florida from 2009 to 2014 and evaluate trends by payer and diagnostic category. Data were collected from State Inpatient Databases, State Emergency Department Databases and the California Office of Statewide Health Planning and Development.Hospital and ED encounters.Population-based study of California and Florida state residents.Implementation of Medicaid expansion component of ACA in California in 2014.Changes in ED visits and hospitalizations by payer, percentage of patients hospitalized after an ED encounter, top diagnostic categories for ED and hospital encounters.In California, Medicaid ED visits increased 33% after Medicaid expansion implementation and self-pay visits decreased by 25% compared with a 5.7% increase in the rate of Medicaid patient ED visits and a 5.1% decrease in rate of self-pay patient visits in Florida. In addition, California experienced a 15.4% increase in Medicaid inpatient stays and a 25% decrease in self pay stays. Trends in the percentage of patients admitted to the hospital from the ED were notable; a 5.4% decrease in hospital admissions originating from the ED in California, and a 2.1% decrease in Florida from 2013 to 2014.We observed a significant shift in payer for ED visits and hospitalizations after Medicaid expansion in California without a significant change in top diagnoses or overall rate of these ED visits and hospitalizations. There appears to be a shift in reimbursement burden from patients and hospitals to the government without a dramatic shift in patterns of ED or hospital utilization.

  View details for PubMedID 28771602

• Adenoma miss rates associated with a 3-minute versus 6-minute colonoscopy withdrawal time: a prospective, randomized trial. Gastrointestinal endoscopy Kumar, S., Thosani, N., Ladabaum, U., Friedland, S., Chen, A. M., Kochar, R., Banerjee, S. 2016

  Abstract

  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.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).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).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.).

  View details for DOI 10.1016/j.gie.2016.11.030

  View details for PubMedID 27931951

• Adenosine triphosphate bioluminescence for bacteriological surveillance and reprocessing strategies for minimizing risk of infection transmission by duodenoscopes. Gastrointestinal endoscopy Sethi, S., Huang, R. J., Barakat, M. T., Banaei, N., Friedland, S., Banerjee, S. 2016

  Abstract

  Recent outbreaks of duodenoscope-transmitted infections underscore the importance of adequate endoscope reprocessing. Adenosine triphosphate (ATP) bioluminescence testing allows rapid evaluation of endoscopes for bacteriologic/biologic residue. In this prospective study we evaluate the utility of ATP in bacteriologic surveillance and the effects of endoscopy staff education and dual cycles of cleaning and high-level disinfection (HLD) on endoscope reprocessing.ATP bioluminescence was measured after precleaning, manual cleaning, and HLD on rinsates from suction-biopsy channels of all endoscopes and elevator channels of duodenoscopes/linear echoendoscopes after use. ATP bioluminescence was remeasured in duodenoscopes (1) after re-education and competency testing of endoscopy staff and subsequently (2) after 2 cycles of precleaning and manual cleaning and single cycle of HLD or (3) after 2 cycles of precleaning, manual cleaning, and HLD.The ideal ATP bioluminescence benchmark of <200 relative light units (RLUs) after manual cleaning was achieved from suction-biopsy channel rinsates of all endoscopes, but 9 of 10 duodenoscope elevator channel rinsates failed to meet this benchmark. Re-education reduced RLUs in duodenoscope elevator channel rinsates after precleaning (23,218.0 vs 1340.5 RLUs, P < .01) and HLD (177.0 vs 12.0 RLUs, P < .01). After 2 cycles of manual cleaning/HLD, duodenoscope elevator channel RLUs achieved levels similar to sterile water, with corresponding negative cultures.ATP testing offers a rapid, inexpensive alternative for detection of endoscope microbial residue. Re-education of endoscopy staff and 2 cycles of cleaning and HLD decreased elevator channel RLUs to levels similar to sterile water and may therefore minimize the risk of transmission of infections by duodenoscopes.

  View details for DOI 10.1016/j.gie.2016.10.035

  View details for PubMedID 27818222

• Green Sludge: Intraductal Papillary Mucinous Neoplasm of the Bile Duct Presenting with Intermittent Biliary Obstruction Due to Abundant Mucus. Digestive diseases and sciences Choudhary, A., Barakat, M. T., Leal, J. N., Louie, C. Y., Visser, B. C., Banerjee, S. 2016: -?

  View details for PubMedID 27423887

• Choledochoscopic Identification of a Hepatic/Cystic Artery Pseudoaneurysm in a Patient with Hematemesis After Laparoscopic Cholecystectomy. Digestive diseases and sciences Choudhary, A., Barakat, M. T., Higgins, L. J., Banerjee, S. 2016: -?

  View details for PubMedID 27423886

• The need for supplementary surgery after endoscopic treatment of colorectal neoplasms: comparing endoscopic mucosal resection and endoscopic submucosal dissection Response GASTROINTESTINAL ENDOSCOPY Maple, J. T., Banerjee, S. 2016; 83 (6): 1299–1300

  View details for PubMedID 27206591

• Outcomes of endoscopic treatment of second recurrences of large nonpedunculated colorectal adenomas SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES Kim, H. G., Sethi, S., Banerjee, S., Friedland, S. 2016; 30 (6): 2457-2464

  Abstract

  Piecemeal endoscopic mucosal resection (EMR) of large nonpedunculated colorectal adenomas is associated with significant recurrence rates. After salvage endoscopic treatment of recurrences, there is a significant rate of second recurrences. There is a paucity of data on the efficacy and safety of continued endoscopic treatment after a second recurrence.Consecutive patients with recurrent adenomas after initial piecemeal EMR of nonpedunculated colorectal adenomas >2 cm were reviewed. We assessed the feasibility, safety and efficacy of continued endoscopic treatment in these patients.Sixty-four patients with 70 recurrent lesions were identified. All were retreated endoscopically. Follow-up colonoscopy (mean interval 6.4 months) was performed on 62/70 lesions (89 %), and a second recurrence was found in 21/62 (34 %). One patient underwent surgery for a circumferential adenoma of the ileocecal valve. The other 20 lesions were treated endoscopically. Follow-up colonoscopy was performed on 15/20 (75 %) and demonstrated a third recurrence in 3/15 (20 %). One was a deep T1 cancer; curative surgery was performed. The other two patients each had one additional endoscopic treatment and both had no recurrence on subsequent colonoscopy. There were two complications: Both were delayed bleeds after treatment of the first recurrence. A mean of 1.3 endoscopic procedures was required to achieve a cure (range 1-3) for recurrent adenomas after piecemeal EMR.Endoscopic treatment of patients with second recurrences is safe and effective, but is associated with a significant rate of additional recurrences. Continued endoscopic treatment of patients with multiple recurrences is associated with high cure rates, low complication rates and a low risk of progression to malignancy.

  View details for DOI 10.1007/s00464-015-4497-y

  View details for PubMedID 26423413

• Prospective evaluation of bacteremia rates and infectious complications among patients undergoing single-operator choledochoscopy during ERCP ENDOSCOPY Thosani, N., Zubarik, R. S., Kochar, R., Kothari, S., Sardana, N., Tu Nguyen, T., Banerjee, S. 2016; 48 (5): 424-431

  Abstract

  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 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.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.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.clinical trials.gov (NCT01414400).

  View details for DOI 10.1055/s-0042-101407

  View details for PubMedID 26919263

• Uncovered vs. Covered Metallic Stents for Palliation of Malignant Biliary Obstruction: A Systematic Review and Meta-Analysis Choudhary, A., Thosani, N., Huang, R. J., Banerjee, S. MOSBY-ELSEVIER. 2016: AB240

  View details for DOI 10.1016/j.gie.2016.03.334

  View details for Web of Science ID 000381906900315

• 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 GASTROINTESTINAL ENDOSCOPY Thosani, N., Abu Dayyeh, B. K., Sharma, P., Aslanian, H. R., Enestvedt, B. K., Komanduri, S., Manfredi, M., Navaneethan, U., Maple, J. T., Pannala, R., Parsi, M. A., Smith, Z. L., Sullivan, S. A., Banerjee, S. 2016; 83 (4): 684-?

  Abstract

  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.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.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.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.

  View details for DOI 10.1016/j.gie.2016.01.007

  View details for Web of Science ID 000371894300002

  View details for PubMedID 26874597

• Role of self-expanding metal stents in patients with malignant colorectal obstruction: A systematic review and meta-analysis WORLD JOURNAL OF META-ANALYSIS Thosani, N., Banerjee, S., Khanijow, V., Rao, B., Priyanka, P., Ertan, A., Guha, S. 2015; 3 (6): 232–53

  View details for DOI 10.13105/wjma.v3.i6.232

  View details for Web of Science ID 000367893600002

• Rendezvous EndoSeel Technique for Non-operative Closure of Anastomotic Leak After Ileoanal Pouch Operation DIGESTIVE DISEASES AND SCIENCES Thosani, N., Sethi, S., Hovsepian, D., Kochar, R., Welton, M., Banerjee, S. 2015; 60 (12): 3545-3548

  View details for DOI 10.1007/s10620-015-3657-1

  View details for Web of Science ID 000364563600009

  View details for PubMedID 25868632

• Syntheses of Isoquinoline and Substituted Quinolines in Charged Microdroplets. Angewandte Chemie (International ed. in English) Banerjee, S., Zare, R. N. 2015; 54 (49): 14795-14799

  Abstract

  A Pomeranz-Fritsch synthesis of isoquinoline and Friedländer and Combes syntheses of substituted quinolines were conducted in charged microdroplets produced by an electrospray process at ambient temperature and atmospheric pressure. In the bulk phase, all of these reactions are known to take a long time ranging from several minutes to a few days and to require very high acid concentrations. In sharp contrast, the present report provides clear evidence that all of these reactions occur on the millisecond timescale in the charged microdroplets without the addition of any external acid. Decreasing the droplet size and increasing the charge of the droplet both strongly contribute to reaction rate acceleration, suggesting that the reaction occurs in a confined environment on the charged surface of the droplet.

  View details for DOI 10.1002/anie.201507805

  View details for PubMedID 26450661

• Response. Gastrointestinal endoscopy Dayyeh, B. A., Banerjee, S. 2015; 82 (6): 1140-1141

  View details for DOI 10.1016/j.gie.2015.09.010

  View details for PubMedID 26614166

• Primary Gastric Hodgkin's Lymphoma: An Extremely Rare Entity and A Diagnostic Challenge. Digestive diseases and sciences Sethi, S., Higgins, J. P., Arber, D. A., Visser, B., Banerjee, S. 2015; 60 (10): 2923-2926

  View details for DOI 10.1007/s10620-015-3616-x

  View details for PubMedID 25761826

• The Price of Privacy in Untrusted Recommender Systems IEEE JOURNAL OF SELECTED TOPICS IN SIGNAL PROCESSING Banerjee, S., Hegde, N., Massoulic, L. 2015; 9 (7): 1319–31

  View details for DOI 10.1109/JSTSP.2015.2423254

  View details for Web of Science ID 000361769200014

• Radiation-Free ERCP in Pregnancy: A "Sound" Approach to Leaving No Stone Unturned. Digestive diseases and sciences Sethi, S., Thosani, N., Banerjee, S. 2015; 60 (9): 2604-2607

  View details for DOI 10.1007/s10620-014-3502-y

  View details for PubMedID 25577267

• ASGE Bariatric Endoscopy Task Force systematic review and meta-analysis assessing the ASGE PIVI thresholds for adopting endoscopic bariatric therapies GASTROINTESTINAL ENDOSCOPY Abu Dayyeh, B. K., Kumar, N., Edmundowicz, S. A., Jonnalagadda, S., Larsen, M., Sullivan, S., Thompson, C. C., Banerjee, S. 2015; 82 (3): 425-?

  Abstract

  The increasing global burden of obesity and its associated comorbidities has created an urgent need for additional treatment options to fight this pandemic. Endoscopic bariatric therapies (EBTs) provide an effective and minimally invasive treatment approach to obesity that would increase treatment options beyond surgery, medications, and lifestyle measures. This systematic review and meta-analysis were performed by the American Society for Gastrointestinal Endoscopy (ASGE) Bariatric Endoscopy Task Force comprising experts in the subject area and the ASGE Technology Committee Chair to specifically assess whether acceptable performance thresholds outlined by an ASGE Preservation and Incorporation of Valuable endoscopic Innovations (PIVI) document for clinical adoption of available EBTs have been met. After conducting a comprehensive search of several English-language databases, we performed direct meta-analyses by using random-effects models to assess whether the Orbera intragastric balloon (IGB) (Apollo Endosurgery, Austin, Tex) and the EndoBarrier duodenal-jejunal bypass sleeve (DJBS) (GI Dynamics, Lexington, Mass) have met the PIVI thresholds. The meta-analyses results indicate that the Orbera IGB meets the PIVI thresholds for both primary and nonprimary bridge obesity therapy. Based on a meta-analysis of 17 studies including 1683 patients, the percentage of excess weight loss (%EWL) with the Orbera IGB at 12 months was 25.44% (95% confidence interval [CI], 21.47%-29.41%) (random model) with a mean difference in %EWL over controls of 26.9% (95% CI, 15.66%-38.24%; P ≤ .01) in 3 randomized, controlled trials. Furthermore, the pooled percentage of total body weight loss (% TBWL) after Orbera IGB implantation was 12.3% (95% CI, 7.9%–16.73%), 13.16% (95% CI, 12.37%–13.95%), and 11.27% (95% CI, 8.17%–14.36%) at 3, 6, and 12 months after implantation, respectively, thus exceeding the PIVI threshold of 5% TBWL for nonprimary (bridge) obesity therapy. With the data available, the DJBS liner does appear to meet the %EWL PIVI threshold at 12 months, resulting in 35% EWL (95% CI, 24%-46%) but does not meet the 15% EWL over control required by the PIVI. We await review of the pivotal trial data on the efficacy and safety of this device. Data are insufficient to evaluate PIVI thresholds for any other EBT at this time. Both evaluated EBTs had ≤5% incidence of serious adverse events as set by the PIVI document to indicate acceptable safety profiles. Our task force consequently recognizes the Orbera IGB for meeting the PIVI criteria for the management of obesity. As additional data from the other EBTs become available, we will update our recommendations accordingly.

  View details for DOI 10.1016/j.gie.2015.03.1964

  View details for Web of Science ID 000359601300001

  View details for PubMedID 26232362

• Good Vibrations: Successful Endoscopic Electrohydraulic Lithotripsy for Bouveret's Syndrome. Digestive diseases and sciences Sethi, S., Kochar, R., Kothari, S., Thosani, N., Banerjee, S. 2015; 60 (8): 2264-2266

  View details for DOI 10.1007/s10620-014-3424-8

  View details for PubMedID 25381652

• Cyst Fluid Glucose is Rapidly Feasible and Accurate in Diagnosing Mucinous Pancreatic Cysts. American journal of gastroenterology Zikos, T., Pham, K., Bowen, R., Chen, A. M., Banerjee, S., Friedland, S., Dua, M. M., Norton, J. A., Poultsides, G. A., Visser, B. C., Park, W. G. 2015; 110 (6): 909-914

  Abstract

  Better diagnostic tools are needed to differentiate pancreatic cyst subtypes. A previous metabolomic study showed cyst fluid glucose as a potential marker to differentiate mucinous from non-mucinous pancreatic cysts. This study seeks to validate these earlier findings using a standard laboratory glucose assay, a glucometer, and a glucose reagent strip.Using an IRB-approved prospectively collected bio-repository, 65 pancreatic cyst fluid samples (42 mucinous and 23 non-mucinous) with histological correlation were analyzed.Median laboratory glucose, glucometer glucose, and percent reagent strip positive were lower in mucinous vs. non-mucinous cysts (P<0.0001 for all comparisons). Laboratory glucose<50 mg/dl had a sensitivity of 95% and a specificity of 57% (LR+ 2.19, LR- 0.08). Glucometer glucose<50 mg/dl had a sensitivity of 88% and a specificity of 78% (LR+ 4.05, LR- 0.15). Reagent strip glucose had a sensitivity of 81% and a specificity of 74% (LR+ 3.10, LR- 0.26). CEA had a sensitivity of 77% and a specificity of 83% (LR+ 4.67, LR- 0.27). The combination of having either a glucometer glucose<50 mg/dl or a CEA level>192 had a sensitivity of 100% but a low specificity of 33% (LR+ 1.50, LR- 0.00).Glucose, whether measured by a laboratory assay, a glucometer, or a reagent strip, is significantly lower in mucinous cysts compared with non-mucinous pancreatic cysts.

  View details for DOI 10.1038/ajg.2015.148

  View details for PubMedID 25986360

• Predictive Factors for Surgery Among Patients with Pancreatic Cysts in the Absence of High-Risk Features for Malignancy JOURNAL OF GASTROINTESTINAL SURGERY Quan, S. Y., Visser, B. C., Poultsides, G. A., Norton, J. A., Chen, A. M., Banerjee, S., Friedland, S., Park, W. G. 2015; 19 (6): 1101-1105

  Abstract

  Without a reliable biopsy technique for pancreatic cysts, consensus-based guidelines are used to guide surgical utilization. The primary objective of this study was to characterize the proportion of operations performed outside of these guidelines.A 5-year retrospective review between July 1, 2007, and June 30, 2012, was performed of consecutive patients seen at a single tertiary medical center for a pancreatic cyst. Manual chart review for relevant clinical variables and cyst characteristics was performed.During this period, 148 patients underwent surgery, and of these, 23 (16 %) patients had no high-risk criteria by the 2006 Sendai criteria. None of these harbored high-grade dysplastic or cancerous lesions. A high cyst carcinoembryonic antigen (CEA) level (35 %), patient anxiety (26 %), and physician concern (22 %) were explicit reasons to proceed to surgery. An elevated cyst CEA level >192 ng/ml was the most significant predictor (OR 5.14 (95 % confidence interval (CI) 1.47-18.0) for surgery without high-risk criteria.A high cyst CEA level was significantly associated with the decision to operate outside of consensus-based guidelines. The misuse of cyst CEA in the management of pancreatic cysts negatively impacts patient anxiety, increases physician uncertainty, and leads to surgery with minimal benefit.

  View details for DOI 10.1007/s11605-015-2786-3

  View details for PubMedID 25749855

• Adenosine Triphosphate Testing As a Rapid Surveillance Tool for Assessing the Adequacy of Manual Cleaning of Flexible Endoscopes Prior to High Level Disinfection Sethi, S., Friedland, S., Banerjee, S. MOSBY-ELSEVIER. 2015: AB232–AB233

  View details for DOI 10.1016/j.gie.2015.03.1320

  View details for Web of Science ID 000380763600293

• Outcomes of Endoscopic Retreatment of Recurrent Lesions After Initial Salvage Endoscopic Treatment of Recurrent Large Nonpedunculated Colorectal Adenomas. Kim, H., Sethi, S., Banerjee, S., Friedland, S. MOSBY-ELSEVIER. 2015: AB262

  View details for DOI 10.1016/j.gie.2015.03.1351

  View details for Web of Science ID 000209931400074

• US Survey Assessing Current ERCP-Related Radiation Protection Practices Sethi, S., Friedland, S., Banerjee, S. MOSBY-ELSEVIER. 2015: AB352

  View details for DOI 10.1016/j.gie.2015.03.577

  View details for Web of Science ID 000209931500009

• ASGE Technology Committee systematic review and meta-analysis assessing the ASGE PIVI thresholds for adopting real-time endoscopic assessment of the histology of diminutive colorectal polyps GASTROINTESTINAL ENDOSCOPY Abu Dayyeh, B. K., Thosani, N., Konda, V., Wallace, M. B., Rex, D. K., Chauhan, S. S., Hwang, J. H., Komanduri, S., Manfredi, M., Maple, J. T., Murad, F. M., Siddiqui, U. D., Banerjee, S. 2015; 81 (3): 502-502

  Abstract

  In vivo real-time assessment of the histology of diminutive (≤5 mm) colorectal polyps detected at colonoscopy can be achieved by means of an "optical biopsy" by using currently available endoscopic technologies. 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 an ASGE Preservation and Incorporation of Valuable endoscopic Innovations (PIVI) document for clinical adoption of these technologies have been met. We conducted direct meta-analyses calculating the pooled negative predictive value (NPV) for narrow-band imaging (NBI), i-SCAN, and Fujinon Intelligent Color Enhancement (FICE)-assisted optical biopsy for predicting adenomatous polyp histology of small/diminutive colorectal polyps. We also calculated the pooled percentage agreement with histopathology when assigning postpolypectomy surveillance intervals based on combining real-time optical biopsy of colorectal polyps 5 mm or smaller with histopathologic assessment of polyps larger than 5 mm. Random-effects meta-analysis models were used. Statistical heterogeneity was evaluated by means of I(2) statistics. Our meta-analyses indicate that optical biopsy with NBI, exceeds the NPV threshold for adenomatous polyp histology, supporting a "diagnose-and-leave" strategy for diminutive predicted nonneoplastic polyps in the rectosigmoid colon. The pooled NPV of NBI for adenomatous polyp histology by using the random-effects model was 91% (95% confidence interval [CI], 88-94). This finding was associated with a high degree of heterogeneity (I(2) = 89%). Subgroup analysis indicated that the pooled NPV was greater than 90% for academic medical centers (91.8%; 95% CI, 89-94), for experts (93%; 95% CI, 91-96), and when the optical biopsy assessment was made with high confidence (93%; 95% CI, 90-96). Our meta-analyses also indicate that the agreement in assignment of postpolypectomy surveillance intervals based on optical biopsy with NBI of diminutive colorectal polyps is 90% or greater in academic settings (91%; 95% CI, 86-95), with experienced endoscopists (92%; 95% CI, 88-96) and when optical biopsy assessments are made with high confidence (91%; 95% CI, 88-95). Our systematic review and meta-analysis confirms that the thresholds established by the ASGE PIVI for real-time endoscopic assessment of the histology of diminutive polyps have been met, at least with NBI optical biopsy, with endoscopists who are expert in using this advanced imaging technology and when assessments are made with high confidence.

  View details for DOI 10.1016/j.gie.2014.12.022

  View details for Web of Science ID 000351666800002

• Radiation exposure to patients during ERCP is significantly higher with low-volume endoscopists. Gastrointestinal endoscopy Liao, C., Thosani, N., Kothari, S., Friedland, S., Chen, A., Banerjee, S. 2015; 81 (2): 391-8 e1

  Abstract

  Patients are exposed to radiation during ERCP, and this may increase their lifetime risk of the development of cancer and other deleterious radiation effects.To evaluate the association between the endoscopist's ERCP volume and the patient radiation dose during ERCP.Single-center, retrospective study.Tertiary referral center.A total of 197 patients undergoing 331 ERCPs.Patient radiation exposure parameters including fluoroscopy time, total radiation dose, dose area product, and effective dose for all ERCPs performed at our academic medical center by 2 high-volume endoscopists (HVEs) (≥200 ERCPs/year) and 7 low-volume endoscopists (LVEs). Radiation exposure for each ERCP was adjusted against a validated procedure complexity scale and the Stanford Fluoroscopy Complexity Score, which was created based on the numbers of interventions that would mandate additional radiation exposure.ERCPs performed by LVEs were associated with a significantly higher median total radiation dose (98.30 mGy vs 74.13 mGy), dose area product (13.98 Gy-cm(2) vs 8.8 Gy-cm(2)), and effective dose (3.63 mSv vs 2.28 mSv), despite lower median Stanford Fluoroscopy Complexity Scores (3.0 vs 6.0) compared with HVEs. No significant difference was noted in median fluoroscopy time (4.0 minutes vs 3.30 minutes) between LVEs and HVEs.Retrospective, single-center study at a tertiary referral center.ERCPs performed by LVEs are associated with significantly higher radiation exposure to patients compared with those performed by HVEs despite the fact that procedures performed by HVEs are of greater complexity.

  View details for DOI 10.1016/j.gie.2014.08.001

  View details for PubMedID 25293825

• Radiation exposure to patients during ERCP is significantly higher with low-volume endoscopists. Gastrointestinal endoscopy Liao, C., Thosani, N., Kothari, S., Friedland, S., Chen, A., Banerjee, S. 2015; 81 (2): 391-398 e1

  View details for DOI 10.1016/j.gie.2014.08.001

  View details for PubMedID 25293825

• Short turn radius colonoscope in an anatomical model: Retroflexed withdrawal and detection of hidden polyps. World journal of gastroenterology Mcgill, S. K., Kothari, S., Friedland, S., Chen, A., Park, W. G., Banerjee, S. 2015; 21 (2): 593-599

  Abstract

  To evaluate the new RetroView™ colonoscope and compare its ability to detect simulated polyps "hidden" behind colonic folds with that of a conventional colonoscope, utilizing anatomic colon models.Three anatomic colon models were prepared, with twelve simulated polyps "hidden" behind haustral folds and five placed in easily viewed locations in each model. Five blinded endoscopists examined two colon models in random order with the conventional or RetroView™ colonoscope, utilizing standard withdrawal technique. The third colon model was then examined with the RetroView™ colonoscope withdrawn initially in retroflexion and then in standard withdrawal. Polyp detection rates during standard and retroflexed withdrawal of the conventional and RetroView™ colonoscopes were determined. Polyp detection rates for combined standard and retroflexed withdrawal (combination withdrawal) with the RetroView™ colonoscope were also determined.For hidden polyps, retroflexed withdrawal using the RetroView™ colonoscope detected more polyps than the conventional colonoscope in standard withdrawal (85% vs 12%, P = 0.0001). For hidden polyps, combination withdrawal with the RetroView™ colonoscope detected more polyps than the conventional colonoscope in standard withdrawal (93% vs 12%, P ≤ 0.0001). The RetroView™ colonoscope in "combination withdrawal" was superior to other methods in detecting all (hidden + easily visible) polyps, with successful detection of 80 of 85 polyps (94%) compared to 28 (32%) polyps detected by the conventional colonoscope in standard withdrawal (P < 0.0001) and 67 (79%) polyps detected by the RetroView™ colonoscope in retroflexed withdrawal alone (P < 0.01). Continuous withdrawal of the colonoscope through the colon model while retroflexed was achieved by all endoscopists. In a post-test survey, four out of five colonoscopists reported that manipulation of the colonoscope was easy or very easy.In simulated testing, the RetroView™ colonoscope increased detection of hidden polyps. Combining standard withdrawal with retroflexed withdrawal may become the new paradigm for "complete screening colonoscopy".

  View details for DOI 10.3748/wjg.v21.i2.593

  View details for PubMedID 25593483

  View details for PubMedCentralID PMC4294171

• Effect of prior biopsy sampling, tattoo placement, and snare sampling on endoscopic resection of large nonpedunculated colorectal lesions GASTROINTESTINAL ENDOSCOPY Kim, H. G., Thosani, N., Banerjee, S., Chen, A., Friedland, S. 2015; 81 (1): 204-213

  Abstract

  Endoscopic manipulations, including biopsy sampling, tattoo application on the lesion itself, and sampling of the lesion with a polypectomy snare, are frequently performed on large nonpedunculated colorectal lesions ≥ 20 mm (LNCL) before referral for endoscopic resection.To assess the effect of prior manipulations on the technical difficulty and recurrence rates of subsequent endoscopic treatment.Retrospective study.Two referral centers.Patients with LNCL referred for endoscopic resection.Endoscopic resection.En-bloc resection rate, rate of successful complete endoscopic resection without the need for ablation of visible residual, recurrence rate on follow-up, independent predictive factors for en-bloc resection, complete resection without ablation of visible residual, and recurrence.A total of 132 lesions was analyzed: 46 lesions without any prior manipulation, 44 with prior biopsy sampling only, and 42 with prior advanced manipulation including tattoo and/or snare sampling. The en-bloc resection rate was 34.8% for nonmanipulated lesions, 15.9% for lesions with prior biopsy sampling, and 4.8% for lesions with prior advanced manipulation (P = .001). Complete endoscopic resection without the need for ablation of visible residual was performed in 93.5% of nonmanipulated lesions, 68.2% of lesions with prior biopsy sampling, and 50% of lesions with prior advanced manipulation (P < .001). Recurrence rates were 7.7%, 40.7%, and 53.8% in the 3 groups (P = .001). In multivariate analysis, prior biopsy sampling was an independent predictor for inability to perform complete resection without ablation of visible residual (odds ratio .24, P < .05) and for recurrence (odds ratio 11.5, P = .004) compared with nonmanipulated lesions. Prior advanced manipulation was an independent predictor for inability to perform en-bloc resection (odds ratio .024, P = .001), for inability to perform complete resection without ablation of visible residual (odds ratio .081, P < .001), and for recurrence (odds ratio 18.8, P = .001).Retrospective study.Prior biopsy sampling and advanced manipulation have significant deleterious effects on endoscopic treatment of LNCL.

  View details for DOI 10.1016/j.gie.2014.08.038

  View details for PubMedID 25440686

• Underwater endoscopic mucosal resection for recurrences after previous piecemeal resection of colorectal polyps GASTROINTESTINAL ENDOSCOPY Kim, H. G., Thosani, N., Banerjee, S., Chen, A., Friedland, S. 2014; 80 (6): 1094-1102

  Abstract

  Conventional endoscopic treatment of a recurrent adenoma after piecemeal EMR (PEMR) of a colorectal laterally spreading tumor (LST) is technically difficult with low en bloc resection rates because of the inability to snare fibrotic residual.To assess the feasibility of salvage underwater EMR (UEMR) for the treatment of recurrent adenoma after PEMR of a colorectal LST.Retrospective, cross-sectional study.Single, tertiary-care referral center.Patients who have recurrent adenoma after PEMR of colorectal LST (≥2 cm).UEMR versus EMR.En bloc resection rate, endoscopic complete removal rate, recurrence rate on follow-up colonoscopy, adjunctive ablation rate with argon plasma coagulation (APC) during salvage procedure, and independent predictive factors for successful en bloc resection and endoscopic complete removal.Eighty salvage procedures (36 UEMRs vs 44 EMRs) were analyzed. En bloc resection rate (47.2% vs 15.9%, P = .002) and endoscopic complete removal rate (88.9% vs 31.8%, P < .001) were higher in the UEMR group than in the EMR group. APC ablation of visible residual during salvage procedure was lower in UEMR group than EMR group (11.1% vs 65.9%, P < .001). Recurrence rate on follow-up colonoscopy was significantly lower in the UEMR group than the EMR group (10% vs 39.4%, P = .02). UEMR was an independent predictor of successful en bloc resection and endoscopic complete removal.Retrospective, single-center study.UEMR can be a useful and feasible technique as a salvage procedure for recurrent colorectal adenoma after PEMR.

  View details for DOI 10.1016/j.gie.2014.05.318

  View details for PubMedID 25012560

• Diagnostic yield of third eye retroscope on adenoma detection during colonoscopy: A systematic review and meta-analysis WORLD JOURNAL OF META-ANALYSIS Thosani, N., Rao, B., Batra, S., Adeyefa, B., Raju, G. S., Bresalier, R. S., Banerjee, S., Guha, S. 2014; 2 (4): 162–70

  View details for DOI 10.13105/wjma.v2.i4.162

  View details for Web of Science ID 000218660300003

• Endoscopic Retrograde Cholangiopancreatography for Primary Sclerosing Cholangitis CLINICS IN LIVER DISEASE Thosani, N., Banerjee, S. 2014; 18 (4): 899-?

  Abstract

  Although there are no randomized, controlled trials evaluating the efficacy of endoscopic retrograde cholangiography (ERC) in primary sclerosing cholangitis (PSC) patients, substantial indirect evidence supports the effectiveness of ERC in symptomatic PSC patients with a dominant stricture. Currently, cumulative evidence supports the role of ERC with endoscopic dilation with or without additional short-term stent placement for symptomatic PSC patients with a dominant stricture. Differentiating benign dominant strictures from cholangiocarcinoma (CCA) remains difficult; however, newer endoscopic techniques and advanced cytologic techniques are likely to improve sensitivity for the diagnosis of CCA over that achieved by traditional cytology brushing alone.

  View details for DOI 10.1016/j.cld.2014.07.013

  View details for Web of Science ID 000344836100010

• Endoscopic retrograde cholangiopancreatography for primary sclerosing cholangitis. Clinics in liver disease Thosani, N., Banerjee, S. 2014; 18 (4): 899-911

  Abstract

  Although there are no randomized, controlled trials evaluating the efficacy of endoscopic retrograde cholangiography (ERC) in primary sclerosing cholangitis (PSC) patients, substantial indirect evidence supports the effectiveness of ERC in symptomatic PSC patients with a dominant stricture. Currently, cumulative evidence supports the role of ERC with endoscopic dilation with or without additional short-term stent placement for symptomatic PSC patients with a dominant stricture. Differentiating benign dominant strictures from cholangiocarcinoma (CCA) remains difficult; however, newer endoscopic techniques and advanced cytologic techniques are likely to improve sensitivity for the diagnosis of CCA over that achieved by traditional cytology brushing alone.

  View details for DOI 10.1016/j.cld.2014.07.013

  View details for PubMedID 25438290

• Rapid Point-of-Care Measurement of Cyst Fluid Glucose Is Feasible and Accurate in Predicting Mucinous Pancreatic Cysts Zikos, T., Pham, K., Chen, A., Banerjee, S., Friedland, S., Dua, M., Norton, J., Poultsides, G., Visser, B., Park, W. NATURE PUBLISHING GROUP. 2014: S86

  View details for Web of Science ID 000344383100280

• Outcomes of repeat colonoscopy in patients with polyps referred for surgery without biopsy-proven cancer GASTROINTESTINAL ENDOSCOPY Friedland, S., Banerjee, S., Kochar, R., Chen, A., Shelton, A. 2014; 79 (1): 101-107

  Abstract

  Despite advances in endoscopic treatment, many colonic adenomas are still referred for surgical resection. There is a paucity of data on the suitability of these lesions for endoscopic treatment.To analyze the results of routine repeat colonoscopy in patients referred for surgical resection of colon polyps without biopsy-proven cancer.Retrospective review.University hospital.Patients referred to a colorectal surgeon for surgical resection of a polyp without biopsy-proven cancer.Repeat colonoscopy.The rate of successful endoscopic treatment.There were 38 lesions in 36 patients; 71% of the lesions were noncancerous and were successfully treated endoscopically. In 26% of the lesions, previous removal was attempted by the referring physician but was unsuccessful. The adenoma recurrence rate was 50%, but all recurrences were treated endoscopically and none were cancerous. Two patients were admitted for overnight observation. There were no major adverse events.Single center, retrospective.In the absence of biopsy-proven invasive cancer, it is appropriate to reevaluate patients referred for surgical resection by repeat colonoscopy at an expert center.

  View details for DOI 10.1016/j.gie.2013.06.034

  View details for Web of Science ID 000328736700018

  View details for PubMedID 23916398

• Root cause analysis of gastroduodenal ulceration after yttrium-90 radioembolization. Cardiovascular and interventional radiology Lam, M. G., Banerjee, S., Louie, J. D., Abdelmaksoud, M. H., Iagaru, A. H., Ennen, R. E., Sze, D. Y. 2013; 36 (6): 1536-1547

  Abstract

  INTRODUCTION: A root cause analysis was performed on the occurrence of gastroduodenal ulceration after hepatic radioembolization (RE). We aimed to identify the risk factors in the treated population and to determine the specific mechanism of nontarget RE in individual cases. METHODS: The records of 247 consecutive patients treated with yttrium-90 RE for primary (n = 90) or metastatic (n = 157) liver cancer using either resin (n = 181) or glass (n = 66) microspheres were reviewed. All patients who developed a biopsy-proven microsphere-induced gastroduodenal ulcer were identified. Univariate and multivariate analyses were performed on baseline parameters and procedural data to determine possible risk factors in the total population. Individual cases were analyzed to ascertain the specific cause, including identification of the culprit vessel(s) leading to extrahepatic deposition of the microspheres. RESULTS: Eight patients (3.2 %) developed a gastroduodenal ulcer. Stasis during injection was the strongest independent risk factor (p = 0.004), followed by distal origin of the gastroduodenal artery (p = 0.004), young age (p = 0.040), and proximal injection of the microspheres (p = 0.043). Prolonged administrations, pain during administration, whole liver treatment, and use of resin microspheres also showed interrelated trends in multivariate analysis. Retrospective review of intraprocedural and postprocedural imaging showed a probable or possible culprit vessel, each a tiny complex collateral vessel, in seven patients. CONCLUSION: Proximal administrations and those resulting in stasis of flow presented increased risk for gastroduodenal ulceration. Patients who had undergone bevacizumab therapy were at high risk for developing stasis.

  View details for DOI 10.1007/s00270-013-0579-1

  View details for PubMedID 23435742

• Deep sedation or general anesthesia for ERCP? Digestive diseases and sciences Thosani, N., Banerjee, S. 2013; 58 (11): 3061-3063

  View details for DOI 10.1007/s10620-013-2849-9

  View details for PubMedID 23990001

• Deep sedation or general anesthesia for ERCP? Digestive diseases and sciences Thosani, N., Banerjee, S. 2013; 58 (11): 3061-3063

  View details for DOI 10.1007/s10620-013-2849-9

  View details for PubMedID 23990001

• Taller Haustral Folds in the Proximal Colon: A Potential Factor Contributing to Interval Colorectal Cancer? 78th Annual Scientific Meeting of the American-College-of-Gastroenterology Thompson, A., Jones, R., Banerjee, S., Poullos, P., Shin, L. NATURE PUBLISHING GROUP. 2013: S628–S628

  View details for Web of Science ID 000330178102396

• Electrosurgical generators GASTROINTESTINAL ENDOSCOPY Tokar, J. L., Barth, B. A., Banerjee, S., Chauhan, S. S., Gottlieb, K. T., Konda, V., Maple, J. T., Murad, F. M., Pfau, P. R., Pleskow, D. K., Siddiqui, U. D., Wang, A., Rodriguez, S. A. 2013; 78 (2): 197-208

  View details for DOI 10.1016/j.gie.2013.04.164

  View details for Web of Science ID 000321825200001

  View details for PubMedID 23867369

• Tissue adhesives: cyanoacrylate glue and fibrin sealant GASTROINTESTINAL ENDOSCOPY Bhat, Y. M., Banerjee, S., Barth, B. A., Chauhan, S. S., Gottlieb, K. T., Konda, V., Maple, J. T., Murad, F. M., Pfau, P. R., Pleskow, D. K., Siddiqui, U. D., Tokar, J. L., Wang, A., Rodriguez, S. A. 2013; 78 (2): 209-215

  View details for DOI 10.1016/j.gie.2013.04.166

  View details for Web of Science ID 000321825200002

  View details for PubMedID 23867370

• Methods of luminal distention for colonoscopy. Gastrointestinal endoscopy Maple, J. T., Banerjee, S., Barth, B. A., Bhat, Y. M., Desilets, D. J., Gottlieb, K. T., Pfau, P. R., Pleskow, D. K., Siddiqui, U. D., Tokar, J. L., Wang, A., Song, L. W., Rodriguez, S. A. 2013; 77 (4): 519-525

  View details for DOI 10.1016/j.gie.2012.09.025

  View details for PubMedID 23415258

• Infections of the biliary tract. Gastrointestinal endoscopy clinics of North America Kochar, R., Banerjee, S. 2013; 23 (2): 199-218

  Abstract

  Infection of the biliary tract, or cholangitis, is a potentially life-threatening condition. Bile duct stones are the most common cause of biliary obstruction predisposing to cholangitis. The key components in the pathogenesis of cholangitis are biliary obstruction and biliary infection. Several underlying mechanisms of bactibilia have been proposed. Characteristic clinical features of cholangitis include abdominal pain, fever, and jaundice. A combination of clinical features with laboratory tests and imaging studies are frequently used to diagnose cholangitis. Endoscopic retrograde cholangiopancreatography is the best diagnostic test. Less invasive imaging tests may be performed initially in clinically stable patients with uncertain diagnoses.

  View details for DOI 10.1016/j.giec.2012.12.008

  View details for PubMedID 23540957

• Pancreatic and biliary stents GASTROINTESTINAL ENDOSCOPY Pfau, P. R., Pleskow, D. K., Banerjee, S., Barth, B. A., Bhat, Y. M., Desilets, D. J., Gottlieb, K. T., Maple, J. T., Siddiqui, U. D., Tokar, J. L., Wang, A., song, L. W., Rodriguez, S. A. 2013; 77 (3): 319-327

  Abstract

  Biliary and pancreatic stents are used in a variety of benign and malignant conditions including strictures and leaks and in the prevention of post-ERCP pancreatitis.Both plastic and metal stents are safe, effective, and easy to use. SEMSs have traditionally been used for inoperable malignant disease. Covered SEMSs are now being evaluated for use in benign disease. Increasing the duration of patency of both plastic and metal stents remains an important area for future research.

  View details for DOI 10.1016/j.gie.2012.09.026

  View details for Web of Science ID 000314831000001

  View details for PubMedID 23410693

• Monitoring equipment for endoscopy GASTROINTESTINAL ENDOSCOPY Gottlieb, K. T., Banerjee, S., Barth, B. A., Bhat, Y. M., Desilets, D. J., Maple, J. T., Pfau, P. R., Pleskow, D. K., Siddiqui, U. D., Tokar, J. L., Wang, A., song, L. W., Rodriguez, S. A. 2013; 77 (2): 175-180

  View details for DOI 10.1016/j.gie.2012.09.028

  View details for Web of Science ID 000313705700002

  View details for PubMedID 23245799

• Endoscopic management of nonlifting colon polyps. Diagnostic and therapeutic endoscopy Friedland, S., Shelton, A., Kothari, S., Kochar, R., Chen, A., Banerjee, S. 2013; 2013: 412936-?

  Abstract

  Background and Study Aims. The nonlifting polyp sign of invasive colon cancer is considered highly sensitive and specific for cancer extending beyond the mid-submucosa. However, prior interventions can cause adenomas to become nonlifting due to fibrosis. It is unclear whether nonlifting adenomas can be successfully treated endoscopically. The aim of this study was to evaluate outcomes in a referral practice incorporating a standardized protocol of attempted endoscopic resection of nonlifting lesions previously treated by biopsy, polypectomy, surgery, or tattoo placement. Patients and Methods. Retrospective review of patients undergoing colonoscopy by one endoscopist at two hospitals found to have nonlifting lesions from prior interventions. Lesions with biopsy proven invasive cancer or definite endoscopic features of invasive cancer were excluded. Lesions ≥ 8 mm were routinely injected with saline prior to attempted endoscopic resection. Polypectomy was performed using a stiff snare, followed by argon plasma coagulation (APC) if necessary. Results. 26 patients each had a single nonlifting lesion with a history of prior intervention. Endoscopic resection was completed in 25 (96%). 22 required snare resection and APC. 1 patient had invasive cancer and was referred for surgery. The recurrence rate on follow-up colonoscopy was 26%. All of the recurrences were successfully treated endoscopically. There was 1 postprocedure bleed (4%), no perforations, and no other complications. Conclusions. The majority of adenomas that are nonlifting after prior interventions can be treated successfully and safely by a combination of piecemeal polypectomy and ablation. Although recurrence rates are high at 26%, these too can be successfully treated endoscopically.

  View details for DOI 10.1155/2013/412936

  View details for PubMedID 23761952

  View details for PubMedCentralID PMC3666422

• Diagnostic Utility of Metabolomic-Derived Biomarkers for Pancreatic Cysts Park, W. G., Wu, M., Bowen, R., Zheng, M., Fitch, W. L., Pai, R. K., Wodziak, D., Visser, B. C., Poultsides, G. A., NORTON, J. A., Banerjee, S., Chen, A. M., Friedland, S., Pasricha, P. J., Lowe, A. W., Peltz, G. LIPPINCOTT WILLIAMS & WILKINS. 2012: 1394–94

  View details for Web of Science ID 000310360500241

• Esophageal function testing GASTROINTESTINAL ENDOSCOPY Wang, A., Pleskow, D. K., Banerjee, S., Barth, B. A., Bhat, Y. M., Desilets, D. J., Gottlieb, K. T., Maple, J. T., Pfau, P. R., Siddiqui, U. D., Tokar, J. L., song, L. W., Rodriguez, S. A. 2012; 76 (2): 231-243

  View details for DOI 10.1016/j.gie.2012.02.022

  View details for Web of Science ID 000306520400001

  View details for PubMedID 22657403

• Equipment for pediatric endoscopy GASTROINTESTINAL ENDOSCOPY Barth, B. A., Banerjee, S., Bhat, Y. M., Desilets, D. J., Gottlieb, K. T., Maple, J. T., Pfau, P. R., Pleskow, D. K., Siddiqui, U. D., Tokar, J. L., Wang, A., song, L. W., Rodriguez, S. A. 2012; 76 (1): 8-17

  View details for DOI 10.1016/j.gie.2012.02.023

  View details for Web of Science ID 000305616400003

  View details for PubMedID 22579260

• Endoluminal bariatric techniques GASTROINTESTINAL ENDOSCOPY Kethu, S. R., Banerjee, S., Barth, B. A., Desilets, D. J., Kaul, V., Pedrosa, M. C., Pfau, P. R., Pleskow, D. K., Tokar, J. L., Wang, A., song, L. W., Rodriguez, S. A. 2012; 76 (1): 1-7

  Abstract

  The American Society for Gastrointestinal Endoscopy (ASGE) Technology Committee provides reviews of new or emerging endoscopic technologies that have the potential to have an impact on the practice of GI endoscopy. Evidence-based methodology is used, with a MEDLINE literature search to identify pertinent preclinical and clinical studies on the topic and a MAUDE (U.S. Food and Drug Administration Center for Devices and Radiological Health) database search to identify the reported complications of a given technology. Both are supplemented by accessing the "related articles" feature of PubMed and by scrutinizing pertinent references cited by the identified studies. Controlled clinical trials are emphasized, but in many cases, data from randomized, controlled trials are lacking. In such cases, large case series, preliminary clinical studies, and expert opinions are used. Technical data are gathered from traditional and Web-based publications, proprietary publications, and informal communications with pertinent vendors. For this review, the MEDLINE database was searched through January 2011 using the keywords "bariatric," "endoscopic," "intragastric balloon," "duodenojejunal bypass sleeve," and "transoral gastroplasty." Reports on Emerging Technologies are drafted by 1 or 2 members of the ASGE Technology Committee, reviewed and edited by the committee as a whole, and approved by the Governing Board of the ASGE. These reports are scientific reviews provided solely for educational and informational purposes. Reports on Emerging Technologies are not rules and should not be construed as establishing a legal standard of care or as encouraging, advocating, requiring, or discouraging any particular treatment or payment for such treatment.

  View details for DOI 10.1016/j.gie.2012.02.020

  View details for Web of Science ID 000305616400002

  View details for PubMedID 22579259

• Endoscopic mucosal resection with an over-the-counter hyaluronate preparation GASTROINTESTINAL ENDOSCOPY Friedland, S., Kothari, S., Chen, A., Park, W., Banerjee, S. 2012; 75 (5): 1040-1044

  Abstract

  Hyaluronic acid (HA) provides a long-lasting and distinct mucosal elevation for EMR, but expense and inconvenience have limited its adoption.To evaluate the safety and efficacy of an over-the-counter 0.15% HA preparation for EMR.Retrospective study.Veterans Administration Hospital and university hospital.30 patients with a total of 32 colonic lesions and 1 duodenal lesion.EMR by using HA.En bloc resection rate and complications.EMR was successful in all cases. En bloc resection was achieved in 26 of the 28 lesions up to 25 mm in diameter. Two lesions, both with fibrosis from prior attempted resection, had trace residual tissue necessitating cauterization with argon plasma. Five lesions measuring 30 mm to 60 mm all required piecemeal resection. There was one complication, a postpolypectomy bleed.Small number of patients and retrospective design.EMR may be performed safely and effectively by using an inexpensive, over-the-counter 0.15% HA preparation. Further studies are needed to verify the results of this study and to compare the safety and efficacy of this HA preparation with saline solution.

  View details for DOI 10.1016/j.gie.2012.01.010

  View details for Web of Science ID 000303277400016

  View details for PubMedID 22381528

• Is EGD Necessary in Patients With Positive Fecal Occult Blood Test and Negative Colonoscopy? 53rd Annual Meeting of the Society-for-Surgery-of-the-Alimentary-Tract (SSAT) / Digestive Disease Week (DDW) / Meeting of the Pancreas-Club Kothari, S., Liao, C., Friedland, S., Chen, A. M., Park, W., Banerjee, S. MOSBY-ELSEVIER. 2012: 139–40

  View details for Web of Science ID 000304328000117

• Post-Procedural Reading of ERCP Spot Films by Radiologists: Has it Improved in the Era of Electronic Medical Records? 53rd Annual Meeting of the Society-for-Surgery-of-the-Alimentary-Tract (SSAT) / Digestive Disease Week (DDW) / Meeting of the Pancreas-Club Kothari, S. T., Friedland, S., Chen, A. M., Banerjee, S. MOSBY-ELSEVIER. 2012: 137–38

  View details for Web of Science ID 000304328000112

• A New Colonoscope With a Short Turn Radius Allowing Full Withdrawal in Complete Retroflexion Improves Detection of Simulated Polyps Hidden Behind Folds and Flexures in Anatomic Colon Models 53rd Annual Meeting of the Society-for-Surgery-of-the-Alimentary-Tract (SSAT) / Digestive Disease Week (DDW) / Meeting of the Pancreas-Club Mcgill, S. K., Kothari, S., Friedland, S., Chen, A. M., Park, W. G., Pasricha, P. J., Banerjee, S. MOSBY-ELSEVIER. 2012: 215–15

  View details for Web of Science ID 000304328001116

• Radiation Exposure to Patients During ERCP Is Significantly Higher With Low Volume Endoscopists 53rd Annual Meeting of the Society-for-Surgery-of-the-Alimentary-Tract (SSAT) / Digestive Disease Week (DDW) / Meeting of the Pancreas-Club Kothari, S., Liao, C., Friedland, S., Chen, A. M., Park, W., Banerjee, S. MOSBY-ELSEVIER. 2012: 140–41

  View details for Web of Science ID 000304328000119

• Endoscopic Mucosal Resection Using an Inexpensive Over the Counter Hyaluronate Preparation 53rd Annual Meeting of the Society-for-Surgery-of-the-Alimentary-Tract (SSAT) / Digestive Disease Week (DDW) / Meeting of the Pancreas-Club Kothari, S., Banerjee, S., Chen, A. M., Park, W., Friedland, S. MOSBY-ELSEVIER. 2012: 344–45

  View details for Web of Science ID 000304328001497

• Comparison of EUS-Guided Pancreas Biopsy Techniques Using the Procore (TM) Needle 53rd Annual Meeting of the Society-for-Surgery-of-the-Alimentary-Tract (SSAT) / Digestive Disease Week (DDW) / Meeting of the Pancreas-Club Kothari, S., Chen, A. M., Pai, R., Friedland, S., Park, W. G., Banerjee, S. MOSBY-ELSEVIER. 2012: 145–45

  View details for Web of Science ID 000304328000131

• Sphincter of Oddi manometry GASTROINTESTINAL ENDOSCOPY Pfau, P. R., Banerjee, S., Barth, B. A., Desilets, D. J., Kaul, V., Kethu, S. R., Pedrosa, M. C., Pleskow, D. K., Tokar, J., Varadarajulu, S., Wang, A., song, L. W., Rodriguez, S. A. 2011; 74 (6): 1175-1180

  View details for DOI 10.1016/j.gie.2011.07.055

  View details for Web of Science ID 000297992300001

  View details for PubMedID 22032848

• Drug-eluting/biodegradable stents GASTROINTESTINAL ENDOSCOPY Tokar, J. L., Banerjee, S., Barth, B. A., Desilets, D. J., Kaul, V., Kethi, S. R., Pedrosa, M. C., Pfau, P. R., Pleskow, D. K., Varadarajulu, S., Wang, A., song, L. W., Rodriguez, S. A. 2011; 74 (5): 954-958

  View details for DOI 10.1016/j.gie.2011.07.028

  View details for Web of Science ID 000296867300002

  View details for PubMedID 21944310

• Goff Trans-pancreatic Septotomy Is an Effective and Safe Biliary Cannulation Technique for Patients Who Fail Standard Biliary Cannulation 76th Annual Scientific Meeting of the American-College-of-Gastroenterology Liao, C., Park, W., Chen, A., Friedland, S., Banerjee, S. NATURE PUBLISHING GROUP. 2011: S56–S56

  View details for Web of Science ID 000299772000140

• Enteral stents GASTROINTESTINAL ENDOSCOPY Varadarajulu, S., Banerjee, S., Barth, B., Desilets, D., Kaul, V., Kethu, S., Pedrosa, M., Pfau, P., Tokar, J., Wang, A., song, L. W., Rodriguez, S. 2011; 74 (3): 455-464

  Abstract

  The American Society for Gastrointestinal Endoscopy (ASGE) Technology Committee provides reviews of existing, new, or emerging endoscopic technologies that have an impact on the practice of GI endoscopy. Evidence-based methodology is used, with a MEDLINE literature search to identify pertinent clinical studies on the topic and a MAUDE (U.S. Food and Drug Administration Center for Devices and Radiological Health) database search to identify the reported complications of a given technology. Both are supplemented by accessing the "related articles" feature of PubMed and by scrutinizing pertinent references cited by the identified studies. Controlled clinical trials are emphasized, but in many cases, data from randomized, controlled trials are lacking. In such cases, large case series, preliminary clinical studies, and expert opinions are used. Technical data are gathered from traditional and Web-based publications, proprietary publications, and informal communications with pertinent vendors. Technology Status Evaluation Reports are drafted by 1 or 2 members of the ASGE Technology Committee, reviewed and edited by the committee as a whole, and approved by the Governing Board of the ASGE. When financial guidance is indicated, the most recent coding data and list prices at the time of publication are provided. For this review, the MEDLINE database was searched through August 2010 for articles related to enteral, esophageal, duodenal, and colonic stents. Technology Status Evaluation Reports are scientific reviews provided solely for educational and informational purposes. Technology Status Evaluation Reports are not rules and should not be construed as establishing a legal standard of care or as encouraging, advocating, requiring, or discouraging any particular treatment or payment for such treatment.

  View details for DOI 10.1016/j.gie.2011.04.011

  View details for Web of Science ID 000294660200001

  View details for PubMedID 21762904

• Enhanced ultrasound imaging GASTROINTESTINAL ENDOSCOPY Banerjee, S., Barth, B. A., Desilets, D. J., Kaul, V., Kethu, S. R., Pedrosa, M. C., Pfau, P. R., Tokar, J. L., Varadarajulu, S., Wang, A., song, L. W., Rodriguez, S. A. 2011; 73 (5): 857-860

  View details for DOI 10.1016/j.gie.2011.01.058

  View details for Web of Science ID 000290292800001

  View details for PubMedID 21521561

• Endoscopic simulators GASTROINTESTINAL ENDOSCOPY Desilets, D. J., Banerjee, S., Barth, B. A., Kaul, V., Kethu, S. R., Pedrosa, M. C., Pfau, P. R., Tokar, J. L., Varadarajulu, S., Wang, A., song, L. W., Rodriguez, S. A. 2011; 73 (5): 861-867

  View details for DOI 10.1016/j.gie.2011.01.063

  View details for Web of Science ID 000290292800002

  View details for PubMedID 21521562

• Autofluorescence imaging GASTROINTESTINAL ENDOSCOPY song, L. W., Banerjee, S., Desilets, D., Diehl, D. L., Farraye, F. A., Kaul, V., Kethu, S. R., Kwon, R. S., Mamula, P., Pedrosa, M. C., Rodriguez, S. A., Tierney, W. M. 2011; 73 (4): 647-650

  View details for DOI 10.1016/j.gie.2010.11.006

  View details for Web of Science ID 000289131400001

  View details for PubMedID 21296349

• Embracing New Technology in the Gastroenterology Practice CLINICAL GASTROENTEROLOGY AND HEPATOLOGY Banerjee, S., Pasricha, P. J. 2010; 8 (10): 848-850

  View details for DOI 10.1016/j.cgh.2010.07.015

  View details for Web of Science ID 000283042500009

  View details for PubMedID 20883969

• Automated endoscope reprocessors GASTROINTESTINAL ENDOSCOPY Desilets, D., Kaul, V., Tierney, W. M., Banerjee, S., Diehl, D. L., Farraye, F. A., Kethu, S. R., Kwon, R. S., Mamula, P., Pedrosa, M. C., Rodriguez, S. A., song, L. W. 2010; 72 (4): 675-680

  Abstract

  The ASGE Technology Committee provides reviews of existing, new, or emerging endoscopic technologies that have an impact on the practice of GI endoscopy. Evidence-based methodology is used, with a MEDLINE literature search to identify pertinent clinical studies on the topic and a MAUDE (U.S. Food and Drug Administration Center for Devices and Radiological Health) database search to identify the reported complications of a given technology. Both are supplemented by accessing the "related articles" feature of PubMed and by scrutinizing pertinent references cited by the identified studies. Controlled clinical trials are emphasized, but in many cases data from randomized, controlled trials are lacking. In such cases, large case series, preliminary clinical studies, and expert opinions are used. Technical data are gathered from traditional and Web-based publications, proprietary publications, and informal communications with pertinent vendors. Technology Status Evaluation Reports are drafted by 1 or 2 members of the ASGE Technology Committee, reviewed and edited by the committee as a whole, and approved by the Governing Board of the ASGE. When financial guidance is indicated, the most recent coding data and list prices at the time of publication are provided. For this review, the MEDLINE database was searched through February 2010 for articles related to automated endoscope reprocessors, using the words endoscope reprocessing, endoscope cleaning, automated endoscope reprocessors, and high-level disinfection. Technology Status Evaluation Reports are scientific reviews provided solely for educational and informational purposes. Technology Status Evaluation Reports are not rules and should not be construed as establishing a legal standard of care or as encouraging, advocating, requiring, or discouraging any particular treatment or payment for such treatment.

  View details for DOI 10.1016/j.gie.2010.06.019

  View details for Web of Science ID 000282927600001

  View details for PubMedID 20883843

• Endoscopic tattooing GASTROINTESTINAL ENDOSCOPY Kethu, S. R., Banerjee, S., Desilets, D., Diehl, D. L., Farraye, F. A., Kaul, V., Kwon, R. S., Mamula, P., Pedrosa, M. C., Rodriguez, S. A., song, L. W., Tierney, W. M. 2010; 72 (4): 681-685

  Abstract

  The American Society for Gastrointestinal Endoscopy (ASGE) Technology Committee provides reviews of existing, new, or emerging endoscopic technologies that have an impact on the practice of GI endoscopy. Evidence-based methodology is used, with a MEDLINE literature search to identify pertinent clinical studies on the topic and a MAUDE (U.S. Food and Drug Administration Center for Devices and Radiological Health) database search to identify the reported complications of a given technology. Both are supplemented by accessing the "related articles" feature of PubMed and by scrutinizing pertinent references cited by the identified studies. Controlled clinical trials are emphasized, but in many cases, data from randomized, controlled trials are lacking. In such cases, large case series, preliminary clinical studies, and expert opinions are used. Technical data are gathered from traditional and Web-based publications, proprietary publications, and informal communications with pertinent vendors. Technology Status Evaluation Reports are drafted by 1 or 2 members of the ASGE Technology Committee, reviewed and edited by the committee as a whole, and approved by the Governing Board of the ASGE. When financial guidance is indicated, the most recent coding data and list prices at the time of publication are provided. For this review, the MEDLINE database was searched through January 2010 for articles related to endoscopic tattooing by using the Keywords tattooing, colonic, endoscopic, India ink, indocyanine green in different search term combinations. Technology Status Evaluation Reports are scientific reviews provided solely for educational and informational purposes. Technology Status Evaluation Reports are not rules and should not be construed as establishing a legal standard of care or as encouraging, advocating, requiring, or discouraging any particular treatment or payment for such treatment.

  View details for DOI 10.1016/j.gie.2010.06.020

  View details for Web of Science ID 000282927600002

  View details for PubMedID 20883844

• Minimizing occupational hazards in endoscopy: personal protective equipment, radiation safety, and ergonomics GASTROINTESTINAL ENDOSCOPY Pedrosa, M. C., Farraye, F. A., Shergill, A. K., Banerjee, S., Desilets, D., Diehl, D. L., Kaul, V., Kwon, R. S., Mamula, P., Rodriguez, S. A., Varadarajulu, S., song, L. W., Tierney, W. M. 2010; 72 (2): 227-235

  Abstract

  The ASGE Technology Committee provides reviews of existing, new, or emerging endoscopic technologies that have an impact on the practice of GI endoscopy. Evidence-based methodology is used, by using a MEDLINE literature search to identify pertinent clinical studies on the topic and a MAUDE (U.S. Food and Drug Administration Center for Devices and Radiological Health) database search to identify the reported complications of a given technology. Both are supplemented by accessing the "related articles" feature of PubMed and by scrutinizing pertinent references cited by the identified studies. Controlled clinical trials are emphasized, but in many cases, data from randomized, controlled trials are lacking. In such cases, large case series, preliminary clinical studies, and expert opinions are used. Technical data are gathered from traditional and Web-based publications, proprietary publications, and informal communications with pertinent vendors. Technology Status Evaluation Reports are drafted by 1 or 2 members of the ASGE Technology Committee, reviewed and edited by the committee as a whole, and approved by the Governing Board of the ASGE. When financial guidance is indicated, the most recent coding data and list prices at the time of publication are provided. For this review, the MEDLINE database was searched through August 2009 for articles related to personal protection equipment by using the key words "personal protection equipment" (exp Protective Clothing/ or exp Protective Devices/ or exp Masks/ or exp Occupational Exposure/'') "infection control" paired with "Endoscopy." For the radiation section, the following key words were used: "radiation and endoscopy," "radiation and ERCP," and "radiation safety." For the ergonomics section, the following key words were used: "ergonomics of endoscopy," "endoscopist injury," "medical ergonomics," "endoscopy and musculoskeletal strain," "musculoskeletal injury and endoscopists," "occupational diseases and endoscopy," "cumulative trauma disorder and endoscopy," "repetitive strain injury and endoscopy." Technology Status Evaluation Reports are scientific reviews provided solely for educational and informational purposes. Technology Status Evaluation Reports are not rules and should not be construed as establishing a legal standard of care or as encouraging, advocating, requiring, or discouraging any particular treatment or payment for such treatment.

  View details for DOI 10.1016/j.gie.2010.01.071

  View details for Web of Science ID 000280778800001

  View details for PubMedID 20537638

• Enteral nutrition access devices GASTROINTESTINAL ENDOSCOPY Kwon, R. S., Banerjee, S., Desilets, D., Diehl, D. L., Farraye, F. A., Kaul, V., Mamula, P., Pedrosa, M. C., Rodriguez, S. A., Varadarajulu, S., song, L. W., Tierney, W. M. 2010; 72 (2): 236-248

  Abstract

  The ASGE Technology Committee provides reviews of existing, new, or emerging endoscopic technologies that have an impact on the practice of GI endoscopy. Evidence-based methodology is used, performing a MEDLINE literature search to identify pertinent clinical studies on the topic and a MAUDE (U.S. Food and Drug Administration Center for Devices and Radiological Health) database search to identify the reported complications of a given technology. Both are supplemented by accessing the "related articles" feature of PubMed and by scrutinizing pertinent references cited by the identified studies. Controlled clinical trials are emphasized, but, in many cases, data from randomized, controlled trials are lacking. In such situations, large case series, preliminary clinical studies, and expert opinions are used. Technical data are gathered from traditional and Web-based publications, proprietary publications, and informal communications with pertinent vendors. Technology Status Evaluation Reports are drafted by 1 or 2 members of the ASGE Technology Committee, reviewed and edited by the committee as a whole, and approved by the ASGE Governing Board. When financial guidance is indicated, the most recent coding data and list prices at the time of publication are provided. For this review, the MEDLINE database was searched through August 2009 for articles related to endoscopy in patients requiring enteral feeding access by using the keywords "endoscopy," "percutaneous," "gastrostomy," "jejunostomy," "nasogastric," "nasoenteric," "nasojejunal," "transnasal," "feeding tube," "enteric," and "button." Technology Status Evaluation Reports are scientific reviews provided solely for educational and informational purposes. Technology Status Evaluation Reports are not rules and should not be construed as establishing a legal standard of care or as encouraging, advocating, requiring, or discouraging any particular treatment or payment for such treatment.

  View details for DOI 10.1016/j.gie.2010.02.008

  View details for Web of Science ID 000280778800002

  View details for PubMedID 20541746

• Distal Extrahepatic Cholangiocarcinoma Presenting as Cholangitis DIGESTIVE DISEASES AND SCIENCES Lee, M., Banerjee, S., Posner, M. C., Cartwright, C. A. 2010; 55 (7): 1852-1855

  View details for DOI 10.1007/s10620-010-1282-6

  View details for Web of Science ID 000278900200007

  View details for PubMedID 20499173

• Ultrathin endoscopes GASTROINTESTINAL ENDOSCOPY Rodriguez, S. A., Banerjee, S., Desilets, D., Diehl, D. L., Farraye, F. A., Kaul, V., Kwon, R. S., Mamula, P., Pedrosa, M. C., song, L. W., Tierney, W. M. 2010; 71 (6): 893-898

  View details for DOI 10.1016/j.gie.2010.01.022

  View details for Web of Science ID 000277700500002

  View details for PubMedID 20438882

• Screening for Barrett's esophagus in asymptomatic women GASTROINTESTINAL ENDOSCOPY Gerson, L. B., Banerjee, S. 2009; 70 (5): 867-873

  Abstract

  Barrett's esophagus (BE) has been detected in approximately 10% of patients with chronic GERD. Previous studies demonstrated a similar prevalence of BE in asymptomatic adults.To determine the prevalence of BE in asymptomatic women.We invited women scheduled for routine screening colonoscopy (for colorectal cancer) and women undergoing endoscopic examination before bariatric surgery to participate. Patients experiencing heartburn symptoms more than once per month were excluded.Outpatients at Stanford University and Palo Alto VA Health Care System.Biopsies of the esophagogastric junction in the setting of suspected BE, and completion of symptom and health-related quality of life questionnaires to ensure that subjects were asymptomatic.Identification of BE.We detected BE in 8 (6%) of 126 subjects, including 3 (5%) of 61 of the women in the colorectal cancer screening cohort and 5 (8%) of 65 of the women in the pre-bariatric surgery cohort, all of whom had BE measuring 2 cm or less (P = .30). Patients found to have BE were more likely to be older (mean age 60 years vs 49 years, respectively; P = .04), but there was no difference in mean body mass index, ethnicity, or tobacco or alcohol use between patients with and without BE. BE was only present in pre-bariatric surgery subjects younger than the age of 50 and was most common in the 61- to 70-year age cohort in both groups. Erosive esophagitis, microscopic reflux changes, and Helicobacter pylori infection were not more common in the pre-bariatric surgery group.Small number of subjects with BE detected.Short-segment BE was detected in 6% of asymptomatic women undergoing screening endoscopic examinations.

  View details for DOI 10.1016/j.gie.2009.04.053

  View details for Web of Science ID 000271893900008

  View details for PubMedID 19640517

• Endoscopy is accurate, safe, and effective in the assessment and management of complications following gastric bypass surgery. American journal of gastroenterology Lee, J. K., Van Dam, J., Morton, J. M., Curet, M., Banerjee, S. 2009; 104 (3): 575-582

  Abstract

  Roux-en-Y gastric bypass (RYGB) is a common intervention for morbid obesity. Upper gastrointestinal (UGI) symptoms are frequent and difficult to interpret following RYGB. The aim of our study was to examine the role of endoscopy in evaluating UGI symptoms after RYGB and to assess the safety and efficacy of endoscopic therapy.Between 1998 and 2005, a total of 1,079 patients underwent RYGB for clinically severe obesity and were followed prospectively. Patients with UGI symptoms after RYGB who were referred for endoscopy were studied.Of 1,079 patients, 76 (7%) who underwent RYGB were referred for endoscopy to evaluate UGI symptoms. Endoscopic findings included normal surgical anatomy (n=24, 31.6%), anastomotic stricture (n=40, 52.6%), marginal ulcer (n=12, 15.8%), unraveled nonabsorbable sutures causing functional obstruction (n=3, 4%) and gastrogastric fistula (n=2, 2.6%). Patients with abnormal findings on endoscopy presented with UGI symptoms at a mean of 110.7 days from their RYGB, which was significantly shorter than the time of 347.5 days for patients with normal endoscopy (P<0.001). A total of 40 patients with anastomotic strictures underwent 86 endoscopic balloon dilations before complete symptomatic relief. In one patient, a needle knife was used to open a completely obstructed anastomotic stricture. Unraveled, nonabsorbable suture material was successfully removed using endoscopic scissors in three patients.Patients presenting with UGI symptoms less than 3 months after surgery are more likely to have an abnormal finding on endoscopy. Endoscopic balloon dilation is safe and effective in managing anastomotic strictures. Endoscopic scissors are safe and effective in removing unraveled, nonabsorbable sutures contributing to obstruction.

  View details for DOI 10.1038/ajg.2008.102

  View details for PubMedID 19262516

• Endoscopy is accurate, safe and effective in the assessment and management of complications following gastric bypass surgery. American Journal of Gastroenterology. Lee J, Van Dam J, Morton J, Curet M, Banerjee S. 2009; 70: 919-921
• Preoperative endoscopic screening for laparoscopic Roux-en-Y gastric bypass has a low yield for anatomic findings OBESITY SURGERY Mong, C., Van Dam, J., Morton, J., Gerson, L., Curet, M., Banerjee, S. 2008; 18 (9): 1067-1073

  Abstract

  Patients undergoing laparoscopic Roux-en-Y bariatric surgery undergo screening esophagoduodenoscopy (EGD) during preoperative evaluation. The hypothesis is to examine the utility of this examination. The purpose of this study was to evaluate the prevalence of clinically significant upper gastrointestinal (UGI) tract findings at screening EGD in patients undergoing laparoscopic Roux-en-Y bariatric surgery. A secondary aim was to determine whether preprocedure symptoms could predict findings at EGD.We evaluated records of patients undergoing EGD prior to bariatric surgery between 2000 and 2005 at the Stanford University Medical Center. Clinical, endoscopic, and pathological data were analyzed. The prevalence of endoscopic findings of clinical significance was determined.Two hundred seventy two complete patient records were identified and included in the study. Of these, 237 (87%) were female and 197 (72%) were Caucasian. The mean age was 43 +/- 9.68 years and mean body mass index was 48 +/- 7.95 kg/m(2). Of the 272 patients, 33 (12%) had EGD findings of clinical significance including erosive esophagitis (3.7%), Barrett's esophagus (3.7%), gastric ulcers (2.9%), erosive gastritis (1.8%), duodenal ulcers (0.7%), and gastric carcinoid (0.3%). No patients had malignancy. Of these 33 patients, 22 (67%) had UGI symptoms.Significant findings at screening EGD were found in 12% of patients. While EGD may be low-yield, the findings could be useful in guiding clinical decision making.

  View details for DOI 10.1007/s11695-008-9600-1

  View details for Web of Science ID 000258456400003

  View details for PubMedID 18574642

• Use of flexible endoscopic scissors to cut obstructing suture material in gastric bypass patients OBESITY SURGERY Patel, C., Van Dam, J., Curet, M., Morton, J. M., Banerjee, S. 2008; 18 (3): 336-339

  Abstract

  With the epidemic increase in obesity in the USA and consequent increased demand for bariatric surgery, new complications of the surgery are being described. The most common surgery practiced is the Roux-en-Y gastric bypass (RYGBP). Unraveling of suture material at the gastrojejunal anastomosis may occur, which may be troublesome if nonabsorbable suture is employed. We describe, for the first time, two patients who developed obstructive symptoms as a consequence of food matter/bezoars entrapped within a mesh of unraveled nonabsorbable suture material at their anastomoses. One of these patients also developed ulceration, presumably as a result of pressure necrosis from the entrapped bezoar. We describe a third patient where the placement of nonabsorbable sutures led to obstructive symptoms by limiting distensibility at an otherwise satisfactory anastomosis. We also describe for the first time, the use of a new endoscopic scissors in cutting luminal suture material with subsequent resolution of the clinical problem.

  View details for DOI 10.1007/s11695-007-9283-z

  View details for Web of Science ID 000253627700017

  View details for PubMedID 18197458

• Preoperative Endoscopic Screening for Laparoscopic Roux-en-Y Gastric Bypass has a Low Yield for Anatomic Findings Obesity Surgery. Mong C, Van Dam J, Gerson L, Morton JM, Curet MJ, Banerjee S. 2008; 18: 1067-73
• Antibiotic prophylaxis for gastrointestinal endoscopy. Gastrointestinal Endoscopy Banerjee S, Shen B, Nelson DB et al. 2008; 67: 791-798
• Infection control during gastrointestinal endoscopy. Gastrointestinal Endoscopy Banerjee S, Shen B, Nelson DB et al. 2008; 67: 781-790
• Endoscopic mucosal resection of a solitary gastric plasmacytoma DIGESTIVE ENDOSCOPY Roost, J., Mai, H., Banerjee, S., Longacre, T., Van Dam, J. 2007; 19 (3): 139-141

  View details for DOI 10.1111/j.1443-1661.2007.00686.x

  View details for Web of Science ID 000254344800006

• Reprocessing Failure. Gastrointestinal Endoscopy Banerjee S, Nelson DB, Dominitz JA et al. 2007; 66: 869-871
• Colonoscopy or CT colonography for colorectal cancer screening in 2006? NATURE CLINICAL PRACTICE GASTROENTEROLOGY & HEPATOLOGY Banerjee, S., Van Dam, J. 2006; 3 (6): 296-297

  View details for DOI 10.1038/ncpgasthep0502

  View details for Web of Science ID 000237906900002

  View details for PubMedID 16741530

• CT colonography for colon cancer screening Gastrointestinal Endoscopy Banerjee S, Van Dam J 2006; 63: 121-133
• CT colonography for colon cancer screening GASTROINTESTINAL ENDOSCOPY Banerjee, S., Van Dam, J. 2006; 63 (1): 121-133

  View details for DOI 10.1016/j.gie.2005.07.021

  View details for Web of Science ID 000234415000024

  View details for PubMedID 16377329

• Analysis of cystic fibrosis gener product (CFTR) function in patients with pancreas divisum and recurrent acute pancreatitis AMERICAN JOURNAL OF GASTROENTEROLOGY Gelrud, A., SHETH, S., Banerjee, S., Weed, D., Shea, J., Chuttani, R., Howell, D. A., Telford, J. J., Carr-Locke, D. L., Regan, M. M., Ellis, L., Durie, P. R., Freedman, S. D. 2004; 99 (8): 1557-1562

  Abstract

  The mechanism by which pancreas divisum may lead to recurrent episodes of acute pancreatitis in a subset of individuals is unknown. Abnormalities of the cystic fibrosis gene product (CFTR) have been implicated in the genesis of idiopathic chronic pancreatitis. The aim of this study was to determine if CFTR function is abnormal in patients with pancreas divisum and recurrent acute pancreatitis (PD/RAP).A total of 69 healthy control subjects, 12 patients with PD/RAP, 16 obligate heterozygotes with a single CFTR mutation, and 95 patients with cystic fibrosis were enrolled. CFTR function was analyzed by nasal transepithelial potential difference testing in vivo. The outcomes of the PD/RAP patients following endoscopic and surgical treatments were concomitantly analyzed.Direct measurement of CFTR function in nasal epithelium in response to isoproterenol demonstrated that the values for PD/RAP were intermediate between those observed for healthy controls and cystic fibrosis patients. The median value was 13 mV for PD/RAP subjects, which was statistically different from healthy controls (22 mV, p= 0.001) and cystic fibrosis pancreatic sufficient (-1 mV, p < 0.0001) and pancreatic insufficient (-3 mV, p < 0.0001) patients.These results suggest a link between CFTR dysfunction and recurrent acute pancreatitis in patients with pancreas divisum and may explain why a subset of patients with pancreas divisum develops recurrent acute pancreatitis.

  View details for DOI 10.1111/j.1572-0241.2004.30834.x

  View details for Web of Science ID 000223355200030

  View details for PubMedID 15307877

• POISONING WITH OXYBUTYNIN HUMAN & EXPERIMENTAL TOXICOLOGY BANERJEE, S., ROUTLEDGE, P. A., PUGH, S., SMITH, P. M. 1991; 10 (3): 225–26

  Abstract

  A case of poisoning with 100 mg of oxybutynin in a 34-year-old female is reported. The main features were anticholinergic effects, including stupor, followed by disorientation and agitation on awakening, dilated pupils, dry skin and retention of urine. She had a sinus tachycardia which resolved 3 h after admission, and in addition ventricular ectopics and bigeminy which continued for a further 30 h. She recovered fully on symptomatic treatment alone.

  View details for DOI 10.1177/096032719101000313

  View details for Web of Science ID A1991FR55400013

  View details for PubMedID 1678954