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Peroral endoscopic myotomy: 10-year outcomes from a large, single-center U.S. series with high follow-up completion and comprehensive analysis of long-term efficacy, safety, objective GERD, and endoscopic functional luminal assessment

Modayil, Rani J; Zhang, Xiaocen; Rothberg, Brooke; Kollarus, Maria; Galibov, Iosif; Peller, Hallie; Taylor, Sharon; Brathwaite, Collin E; Halwan, Bhawna; Grendell, James H; Stavropoulos, Stavros N
BACKGROUND AND AIMS/OBJECTIVE:Peroral endoscopic myotomy (POEM) is becoming the treatment of choice for achalasia. Data beyond 3 years are emerging but limited. We herein report our 10-year experience, focusing on long-term efficacy and safety including the prevalence, management, and sequelae of postoperative reflux. METHODS:This was a single-center prospective cohort study. RESULTS:Six hundred ten consecutive patients received POEM from October 2009 to October 2019 for type I achalasia in 160 (26.2%), II in 307 (50.3%), III in 93 (15.6%), untyped achalasia in 25 (4.1%), and nonachalasia disorders in 23 (3.8%). Two hundred ninety-two (47.9%) patients had prior treatment(s). There was no aborted POEM. Median operation time was 54 minutes. Accidental mucosotomies occurred in 64 (10.5%) and clinically significant adverse events (csAEs) in 21 (3.4%) patients. There were no adverse events (AEs) leading to death, surgery, interventional radiology interventions/drains, or altered functional status. At a median follow-up of 30 months, 29 failures occurred, defined as postoperative Eckardt score >3 or need for additional treatment. The Kaplan-Meier clinical success estimates at year 1, 2, 3, 4, 5, 6, and 7 were 98%, 96%, 96%, 94%, 92%, 91%, and 91%, respectively. These are highly accurate estimates because only 13 (2%) patients were missing follow-up assessments. One hundred twenty-five (20.5%) patients had reflux symptoms more than once per week. At a median of 4 months, the pH study was completed in 406 (66.6%) patients and was positive in 232 (57.1%) and endoscopy in 438 (71.8%) patients and showed reflux esophagitis in 218 (49.8%), mostly mild. CONCLUSION/CONCLUSIONS:POEM is exceptionally safe and highly effective on long-term follow-up, with >90% clinical success at ≥5 years.
PMID: 33989646
ISSN: 1097-6779
CID: 4867862

Gastrostomy tubes in patients with COVID-19: Reduction of in-hospital mortality with a multidisciplinary team-based approach [Meeting Abstract]

Saltiel, J; Lee, B; Tran, J; Kumar, V; Grendell, J; Goodman, A; Petrilli, C; Bosworth, B; Latorre, M
Introduction: Critically-ill patients with COVID-19 often require long-term enteral access due to prolonged ventilator support and slow recovery from neurologic injury. The outcomes of hospitalized patients with SARS-CoV-2 who received gastrostomy tubes (GTs) are unknown and limited guidance exists on how to safely triage GT placement in this population. The Enteral Access Team (EAT) is a multidisciplinary team led by an attending gastroenterologist (GI) hospitalist with advanced practice providers who collaborate with Palliative Care, Geriatrics, Speech-Language Pathology, and Nutrition to reduce unnecessary feeding tube placements at the end-of-life. The EAT reviews the appropriateness of GT placement and triages each case to the indicated procedural service. The EAT's multidisciplinary approach was applied for patients with COVID-19.
Method(s): We performed a retrospective study of 135 hospitalized patients with positive PCR tests for SARS-CoV-2 who received GTs between 3/2020 and 4/2021. The GTs were placed by 3 services (gastroenterology, interventional radiology and surgery) at 3 hospitals within 1 health system in New York. One of the hospitals employed the multidisciplinary EAT approach to its triage of GT placement. Outcomes were compared between the EAT site and control sites where GT placement was decided through direct consultation by the primary team with one of the procedural services.
Result(s): Demographics for the two groups, including overall numbers of COVID-19 admissions, can be seen in Table 1. At the EAT site (n =43) 5% of patients expired prior to discharge following GT placement compared with 25% at the control sites (P <0.05). Patients at the EAT site were older with a mean age of 70 years compared to the control sites with a mean age of 63 years (P=0.01). There was no significant difference in the percentage of COVID-19 patients who received GTs, length-ofstay, or time from gastrostomy to discharge or death. Multivariable analysis showed the odds of in hospital mortality were 10.1 times greater with the standard workflow than with the EAT workflow (OR 10.1, [95% CI: 1.7-60.6], P <0.05).
Conclusion(s): The EAT's novel multidisciplinary team-based approach helps to appropriately select hospitalized patients with SARs-CoV-2 for long-term enteral access leading to reduced in-hospital mortality following GT placement. Additionally, this approach may help to mediate the national shortage of GTs and reduce the risk of exposure to providers involved in GT placement
ISSN: 1572-0241
CID: 5084322

Doxycycline Induced Severe Acute Pancreatitis: A Rare Finding To A Common Medication [Case Report]

Shah, Neal; Razzano, Anthony; Grendell, James
Doxycycline is a commonly prescribed antibiotic with growing evidence suggesting a possible linkage with drug-induced acute pancreatitis. We present an elderly female presenting with severe acute pancreatitis likely secondary to doxycycline therapy after thorough investigation. We reviewed the evidence linking doxycycline-inducing acute pancreatitis and signs and symptoms for severe disease. Early recognition and intervention are critical for positive patient outcomes.
PMID: 33547098
ISSN: 1757-790x
CID: 5229352

Characterizing COVID-19 in Relation to Acute Pancreatitis [Meeting Abstract]

Shah, Neal; Razzano, Anthony; Akerman, Meredith; Divers, Jasmin; Grendell, James
ISSN: 0002-9270
CID: 5229412

Incidental finding of inflammatory fibroid polyp of the appendix in a patient with acute appendicitis

Sy, Alexander M; Vo, Duc; Friedel, David; Grendell, James; Hanna, Iman
PMID: 33361049
ISSN: 2148-5607
CID: 4770942

Learning Curve for Endoscopic Submucosal Dissection With an Untutored, Prevalence-Based Approach in the United States

Zhang, Xiaocen; Ly, Erin K; Nithyanand, Sagarika; Modayil, Rani J; Khodorskiy, Dmitriy O; Neppala, Sivaram; Bhumi, Sriya; DeMaria, Matthew; Widmer, Jessica L; Friedel, David M; Grendell, James H; Stavropoulos, Stavros N
BACKGROUND & AIMS/OBJECTIVE:Endoscopic submucosal dissection (ESD) is widely used in Asia to resect early-stage gastrointestinal neoplasms, but use of ESD in Western countries is limited. We collected data on the learning curve for ESD at a high-volume referral center in the United States to guide development of training programs in the Americas and Europe. METHODS:/hr. RESULTS:/hr in esophagus, stomach, and colon, respectively. CONCLUSIONS:In an analysis of ESDs performed at a large referral center in the United States, we found that an untutored, prevalence-based approach allowed operators to achieve all proficiency benchmarks after ∼250 cases. Compared with Asia, ESD requires more time to learn in the West, where the untutored, prevalence-based approach requires resection of challenging lesions, such as colon lesions and previously manipulated lesions, in early stages of training.
PMID: 31220645
ISSN: 1542-7714
CID: 3954512


Modayil, Rani J.; Zhang, Xiaocen; Rothberg, Brooke; Peller, Hallie; Brathwaite, Collin E.; Kollarus, Maria; Taylor, Sharon; Grendell, James H.; Stavropoulos, Stavros N.
ISSN: 0016-5107
CID: 4790362

Impact of Institutional Enteral Feeding Tube Policy on Medical Nutrition Utilization [Meeting Abstract]

Gindi, Derek; He, Harry; Patil, Sagar; Ballecer, Eric; Pinto, Priya; Grendell, James; Berger, Jeffrey; Islam, Shahidul
ISSN: 0002-9270
CID: 4790402


Stavropoulos, Stavros N.; Modayil, Rani J.; Zhang, Xiaocen; Peller, Hallie; Brathwaite, Collin E.; Allendorf, John; Widmer, Jessica L.; Friedel, David; Grendell, James H.
ISSN: 0016-5107
CID: 4790372

Association of Antibiotic and Proton Pump Inhibitor Usage in Patients with Hospital Acquired Clostridium difficile Infection: A Single Center Experience [Meeting Abstract]

Ballecer, Eric; Ali, Mohammad; Patel, Zinal; Shen, Mark; Islam, Shahidul; Vrabie, Raluca; Grendell, James H.
ISSN: 0002-9270
CID: 3897692