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An international experience with single-operator cholangiopancreatoscopy in patients with altered anatomy

Mony, Shruti; Ghandour, Bachir; Raijman, Isaac; Manvar, Amar; Ho, Sammy; Trindade, Arvind J; Benias, Petros C; Zulli, Claudio; Jacques, Jérémie; Ichkhanian, Yervant; Zuchelli, Tobias; Ghanimeh, Mouhanna Abu; Irani, Shayan; Canakis, Andrew; Sanaei, Omid; Szvarca, Daniel; Zhang, Linda; Bejjani, Michael; Akshintala, Venkata; Khashab, Mouen A
PMID: 35692911
ISSN: 2364-3722
CID: 5264212

Use of Lumen-apposing Metal Stents for Endoscopic Drainage of Intra-abdominal Fluid Collections in Pediatric Patients

Costa, Peter A; Ho, Sammy; Manvar, Amar; Rivas, Yolanda; Novak, Inna
INTRODUCTION:Intraabdominal fluid collections that previously required surgical intervention can now be drained with less invasive techniques. The use of lumen-apposing metal stents (LAMS) to treat pancreatic pseudocysts and perirectal abscesses has been shown to be a safe and effective technique in adults. We aim to evaluate the indications, outcomes, and complications of the use of LAMS in pediatric patients at our institution. METHODS:A retrospective chart review was performed to study patients up to 18 years of age at the Children's Hospital at Montefiore who underwent drainage of intraabdominal fluid collections with the use of LAMS. The main outcome measures were technical and clinical success and associated adverse events with LAMS placement. RESULTS:Seven patients (2 girls) ranging from 9 to 18 years were identified. Four patients had perirectal abscess postperforated appendicitis and 3 patients had pancreatic pseudocysts. All of the patients had complete resolution of the collections, with no recurrence, and our technical and clinical success rate was 100%. Only 1 patient had mild bleeding after placement that spontaneously resolved. DISCUSSION:Our study demonstrates the efficacy and safety of the use of LAMS for the drainage of intraabdominal fluid collections in pediatric patients, although the number of patients included is limited.
PMID: 31978029
ISSN: 1536-4801
CID: 5264202

Endoscopic Ultrasound-Guided Hepaticogastrostomy With Lumen-Apposing Metal Stent for Management of Pyogenic Liver Abscess [Case Report]

Desai, Aditi; Manvar, Amar; Ho, Sammy
A 45-year-old man presented with abdominal pain, fever with chills, nonproductive cough, mild pleurisy, and anorexia. Computed tomography scan showed a heterogeneously enhancing mass in the left hepatic lobe with leukocytosis and elevated C-reactive protein. Interval growth of the lesion was noted on magnetic resonance imaging obtained several days after admission. Given the clinical suspicion for pyogenic liver abscess and favorable location in the left hepatic lobe, endoscopic ultrasound-guided drainage was pursued. The patient underwent endoscopic ultrasound-guided hepaticogastrostomy with a lumen-apposing metal stent. His symptoms gradually abated after procedure. Radiographic resolution of the abscess was noted 1 week after stent placement, and the stent was subsequently removed. He had no clinical or radiographic evidence of recurrence at 1-month follow-up.
PMID: 31750364
ISSN: 2326-3253
CID: 5264192

Histologic Analysis of Endoscopic Ultrasound-Guided Through the Needle Microforceps Biopsies Accurately Identifies Mucinous Pancreas Cysts

Yang, Dennis; Trindade, Arvind J; Yachimski, Patrick; Benias, Petros; Nieto, Jose; Manvar, Amar; Ho, Sammy; Esnakula, Ashwini; Gamboa, Anthony; Sethi, Amrita; Gupte, Anand; Khara, Harshit S; Diehl, David L; El Chafic, Abdul; Shah, Janak; Forsmark, Christopher E; Draganov, Peter V
BACKGROUND & AIMS/OBJECTIVE:It is a challenge to accurately assess pancreatic cystic lesions (PCLs) and determine their risk. We compared the yield of tissue acquired with endoscopic ultrasound (EUS)-guided microforceps (through the needle tissue biopsy [TTNB]) with that of samples collected by EUS-guided fine-needle-aspiration (EUS-FNA), and the accuracy of analyses of each sample type in the diagnosis of mucinous PCLs. METHODS:We performed a prospective open-label study of 114 consecutive adults (56.1% women; mean age, 64.2 y) undergoing EUS-FNA evaluation of PCLs (mean size, 35 mm) at 7 centers, from June 20, 2016, through August 31, 2018. Samples were collected from each cyst by FNA and microforceps; samples collected by FNA were analyzed by cytology and samples collected by TTNB were analyzed by histology. Acquisition yield was defined as the percentage of specimens collected that were adequate for cytologic or histologic analysis. Diagnoses of mucinous cysts were made based on identification of pancreatic mucinous epithelium by cytology analysis of FNA samples or histologic analysis of TTNB samples. Surgical specimens were used as the reference standard when available. RESULTS:The EUS-guided microforceps were successfully inserted into 97.4% (111 of 114) of PCLs. Tissue acquisition yield was significantly higher with TTNB (95 of 114; 83.3%) than FNA (43 of 114; 37.7%) (P < .001). Sixty-one PCLs were determined to be mucinous based on TTNB analysis (53.5%) vs 11 with FNA analysis (9.6%) (P < .001). Among PCLs categorized as equivocal, based on the level of carcinoembryonic antigen, TTNB analysis found 50% (41 of 82) to be mucinous and FNA analysis found 8.5% (7 of 82) to be mucinous (P < .001). Findings from analyses of samples collected by TTNB were 100% concordant with findings from histologic analysis of surgical specimens (14 of 14), whereas only 3 of 14 findings from analysis of samples collected by FNA were in agreement with findings from surgical specimens (21.4%) (P < .001). Four of 5 mucinous PCLs with advanced neoplasia (80%) were detected with TTNB compared with none with FNA (P = .04). Self-limited intracystic bleeding occurred in 7 patients (6.1%), and acute pancreatitis in 6 patients (5.3%). CONCLUSIONS:In a multicenter prospective study of patients undergoing EUS-FNA for evaluation of PCLs, we found TTNB collection of tissues for histologic analysis to be safe and feasible, with an acquisition yield of 83.3%. Histologic analysis of samples collected by TTNB identified a larger proportion of mucinous PCLs compared with cytologic analysis of samples collected by FNA-even among samples categorized as equivocal, based on the level of carcinoembryonic antigen. More samples collected by TTNB than FNA were found to have advanced neoplasia. no: NCT02979509.
PMID: 30471456
ISSN: 1542-7714
CID: 3677372

Afferent Loop Syndrome Due to Volvulus of the Afferent Limb [Case Report]

Desai, Aditi; Manvar, Amar; Ho, Sammy
A 78-year-old woman with a history of stage IIB gastric adenocarcinoma with previous Billroth II subtotal gastrectomy was admitted with pancreatitis, with subsequent development of fevers and acute jaundice. Transabdominal ultrasound demonstrated bile duct obstruction. An endoscopic retrograde cholangiopancreatography was attempted, but the lumen of the afferent limb appeared distorted without an obstructing lesion. A computed tomography scan demonstrated volvulus of the afferent limb near the gastrojejunal anastomosis, with afferent limb dilation and significant biliary dilation.
PMID: 31620523
ISSN: 2326-3253
CID: 5264182

Safety and rate of delayed adverse events with lumen-apposing metal stents (LAMS) for pancreatic fluid collections: a multicenter study

Yang, Dennis; Perbtani, Yaseen B; Mramba, Lazarus K; Kerdsirichairat, Tossapol; Prabhu, Anoop; Manvar, Amar; Ho, Sammy; Pannu, Davindebir; Keswani, Rajesh N; Strand, Daniel S; Wang, Andrew Y; Quintero, Eduardo; Buscaglia, Jonathan M; Muniraj, Thiruvengadam; Aslanian, Harry R; Draganov, Peter V; Siddiqui, Ali S
PMID: 30302385
ISSN: 2364-3722
CID: 5264172

Efficacy and Safety of Digital Single-Operator Cholangioscopy for Difficult Biliary Stones

Brewer Gutierrez, Olaya I; Bekkali, Noor L H; Raijman, Isaac; Sturgess, Richard; Sejpal, Divyesh V; Aridi, Hanaa D; Sherman, Stuart; Shah, Raj J; Kwon, Richard S; Buxbaum, James L; Zulli, Claudio; Wassef, Wahid; Adler, Douglas G; Kushnir, Vladimir; Wang, Andrew Y; Krishnan, Kumar; Kaul, Vivek; Tzimas, Demetrios; DiMaio, Christopher J; Ho, Sammy; Petersen, Bret; Moon, Jong Ho; Elmunzer, B Joseph; Webster, George J M; Chen, Yen-I; Dwyer, Laura K; Inamdar, Summant; Patrick, Vanessa B; Attwell, Augustin; Hosmer, Amy; Ko, Christopher; Maurano, Attilio; Sarkar, Avik; Taylor, Linda J; Gregory, Martin H; Strand, Daniel S; Raza, Ali; Kothari, Shivangi; Harris, Jessica P; Kumta, Nikhil A; Manvar, Amar; Topazian, Mark D; Lee, Yun Nah; Spiceland, Clayton M; Bukhari, Majidah A; Sanaei, Omid; Ngamruengphong, Saowanee; Khashab, Mouen A
BACKGROUND & AIMS/OBJECTIVE:It is not clear whether digital single-operator cholangioscopy (D-SOC) with electrohydraulic and laser lithotripsy is effective in removal of difficult biliary stones. We investigated the safety and efficacy of D-SOC with electrohydraulic and laser lithotripsy in an international, multicenter study of patients with difficult biliary stones. METHODS:We performed a retrospective analysis of 407 patients (60.4% female; mean age, 64.2 years) who underwent D-SOC for difficult biliary stones at 22 tertiary centers in the United States, United Kingdom, or Korea from February 2015 through December 2016; 306 patients underwent electrohydraulic lithotripsy and 101 (24.8%) underwent laser lithotripsy. Univariate and multivariable analyses were performed to identify factors associated with technical failure and the need for more than 1 D-SOC electrohydraulic or laser lithotripsy session to clear the bile duct. RESULTS:The mean procedure time was longer in the electrohydraulic lithotripsy group (73.9 minutes) than in the laser lithotripsy group (49.9 minutes; P < .001). Ducts were completely cleared (technical success) in 97.3% of patients (96.7% of patients with electrohydraulic lithotripsy vs 99% patients with laser lithotripsy; P = .31). Ducts were cleared in a single session in 77.4% of patients (74.5% by electrohydraulic lithotripsy and 86.1% by lithotripsy; P = .20). Electrohydraulic or laser lithotripsy failed in 11 patients (2.7%); 8 patients were treated by surgery. Adverse events occurred in 3.7% patients and the stone was incompletely removed from 6.6% of patients. On multivariable analysis, difficult anatomy or cannulation (duodenal diverticula or altered anatomy) correlated with technical failure (odds ratio, 5.18; 95% confidence interval, 1.26-21.2; P = .02). Procedure time increased odds of more than 1 session of D-SOC electrohydraulic or laser lithotripsy (odds ratio, 1.02; 95% confidence interval, 1.01-1.03; P < .001). CONCLUSIONS:In a multicenter, international, retrospective analysis, we found D-SOC with electrohydraulic or laser lithotripsy to be effective and safe in more than 95% of patients with difficult biliary stones. Fewer than 5% of patients require additional treatment with surgery and/or extracorporeal shockwave lithotripsy to clear the duct.
PMID: 29074446
ISSN: 1542-7714
CID: 2956682

Endoscopic ultrasound-guided drainage of pelvic abscesses with lumen-apposing metal stents [Editorial]

Manvar, Amar; Karia, Kunal; Ho, Sammy
PMID: 28820143
ISSN: 2303-9027
CID: 5264162

An International Multicenter Study on Digital Single Operator Cholangioscopy for the Management of Difficult Bile Duct Stones in 271 Patients [Meeting Abstract]

Gutierrez, Olaya Isabella Brewer; Ngamruengphong, Saowonee; Raijman, Isaac; Sturgess, Richard; Sejpal, Divyesh V.; Sherman, Stuart; Shah, Raj J.; Kwon, Richard; Buxbaum, James L.; Zulli, Claudio; Wassef, Wahid; Adler, Douglas G.; Mullady, Daniel; Wang, Andrew Y.; Krishnan, Kumar; Kaul, Vivek; Tzimas, Demetrios; DiMaio, Christopher J.; Ho, Sammy; Petersen, Bret T.; Webster, George; Lee, Moon Sung; Chen, Yen-I.; Dwyer, Laura K.; Inamdar, Sumant; Lynch, Sheryl; Attwell, Augustin; Hosmer, Amy; Manvar, Amar; Ko, Christopher; Maurano, Attilio; Sarkar, Avik; Taylor, Linda J.; Kushnir, Vladimir M.; Harris, Jessica P.; Gupta, Sanchit; Martin, John A.; Bekkali, Noor L.; Lee, Yun Nah; Strand, Daniel S.; Raza, Ali; Bukhari, Majidah A.; Sanaei, Omid; Kothari, Shivangi; Gregory, Martin H.; Ullah, Asad; Kothari, Truptesh; Gostout, Christopher; Topazian, Mark; Uppal, Dushant; Trindade, Arvind J.; Bucobo, Juan Carlos; Kumta, Nikhil A.; Patrick, Vanessa B.; Khashab, Mouen A.
ISSN: 0016-5107
CID: 2956722