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Digital single-operator cholangioscopy interobserver study using a new classification: the Mendoza Classification (with video)

Kahaleh, Michel; Gaidhane, Monica; Shahid, Haroon M; Tyberg, Amy; Sarkar, Avik; Ardengh, Jose Celso; Kedia, Prashant; Andalib, Iman; Gress, Frank; Sethi, Amrita; Gan, S Ian; Suresh, Supriya; Makar, Michael; Bareket, Romy; Slivka, Adam; Widmer, Jessica L; Jamidar, Priya A; Alkhiari, Resheed; Oleas, Roberto; Kim, Dongchoon; Robles-Medranda, Carlos A; Raijman, Isaac
BACKGROUND AND AIMS/OBJECTIVE:Digital single-operator cholangioscopy (DSOC) allows direct visualization of the biliary tree for evaluation of biliary strictures. Our objective was to assess the interobserver agreement (IOA) of DSOC interpretation for indeterminate biliary strictures using newly refined criteria. METHODS:Fourteen endoscopists were asked to review an atlas of reference clips and images of 5 criteria derived from expert consensus. They then proceeded to score 50 deidentified DSOC video clips based on the visualization of tortuous and dilated vessels, irregular nodulations, raised intraductal lesions, irregular surface with or without ulcerations, and friability. The endoscopists then diagnosed the clips as neoplastic or non-neoplastic. Intraclass correlation (ICC) analysis was done to evaluate inter-rater agreement for both criteria sets and final diagnosis. RESULTS:Clips of 41 malignant lesions and 9 benign lesions were scored. Three of 5 revised criteria had almost perfect agreement. ICC was almost perfect for presence of tortuous and dilated vessels (.86), raised intraductal lesions (.90), and presence of friability (.83); substantial agreement for presence of irregular nodulations (.71); and moderate agreement for presence of irregular surface with or without ulcerations (.44). The diagnostic ICC was almost perfect for neoplastic (.90) and non-neoplastic (.90) diagnoses. The overall diagnostic accuracy using the revised criteria was 77%, ranging from 64% to 88%. CONCLUSIONS:The IOA and accuracy rate of DSOC using the new Mendoza criteria shows a significant increase of 16% and 20% compared with previous criteria. The reference atlas helps with formal training and may improve diagnostic accuracy. (Clinical trial registration number: NCT02166099.).
PMID: 34478737
ISSN: 1097-6779
CID: 5208682

Management of severe acute pancreatitis in 2019

Copelin, Eddie; Widmer, Jessica
Pancreatic fluid collections (PFCs) are frequent complications in severe acute pancreatitis that are the result of damage to the pancreas to include but not limited to trauma, surgery, autoimmune diseases, alcohol abuse, infections, medications, gallstones, metabolic disorders, and premalignant or malignant conditions. The majority of these collections resolve spontaneously; however, if the collection is infected or causes symptoms to include abdominal pain, nausea, vomiting, diarrhea, fevers, and tachycardia, drainage is indicated. Drainage of PFCs can be accomplished surgically, percutaneously, or endoscopically and should be approached in a multidisciplinary fashion for best overall patient care and outcomes. Before the introduction of endoscopic procedures, surgical and percutaneous drainage was the preferred modality. Today a minimally-invasive "step-up" approach is generally accepted depending upon the specific characteristics of the PFC and clinical presentation. Endoscopic ultrasound-guided PFC drainage is favored due to high success rates, shorter hospital stays, and lower cost. Direct debridement of walled-off pancreatitis can now be performed endoscopically with higher success rates with larger caliber fully covered metal stents. At large, the field of endoscopic techniques has evolved, and more specifically, the management of PFCs continues to evolve with increasing experience and with the advent of new stents and accessories, leading to increased efficacy with less adverse events.
PMCID:9081916
PMID: 35548476
ISSN: 2415-1289
CID: 5214582

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

ENDOSCOPIC SUBMUCOSAL DISSECTION FOR COLORECTAL CANCER AND ADENOMA: A LARGE SINGLE-OPERATOR COHORT FROM THE USA WITH LONG-TERM FOLLOW UP [Meeting Abstract]

Stavropoulos, Stavros N.; Zhang, Xiaocen; Ly, Erin K.; Xie, Mengdan; Badshah, Maaz B.; Galibov, Iosif; Widmer, Jessica L.; Modayil, Rani J.
ISI:000545678401096
ISSN: 0016-5107
CID: 4790382

EFTR AND STER FOR GASTROINTESTINAL SUBEPITHELIAL TUMORS (SETS): LARGE SERIES FROM A LARGE US REFERRAL CENTER [Meeting Abstract]

Stavropoulos, Stavros N.; Modayil, Rani J.; Zhang, Xiaocen; Peller, Hallie; Brathwaite, Collin E.; Allendorf, John; Widmer, Jessica L.; Friedel, David; Grendell, James H.
ISI:000545678400464
ISSN: 0016-5107
CID: 4790372

DIGITAL SINGLE-OPERATOR CHOLANGIOSCOPY INTEROBSERVER STUDY USING A NEW AND PRACTICAL SCORING SYSTEM: THE MENDOZA CLASSIFICATION [Meeting Abstract]

Kahaleh, Michel; Gaidhane, Monica; Shahid, Haroon M.; Tyberg, Amy; Sarkar, Avik; Ardengh, Jose Celso; Kedia, Prashant; Andalib, Iman; Sethi, Amrita; Gan, S. Ian; Bareket, Romy; Slivka, Adam; Widmer, Jessica L.; Jamidar, Priya A.; Alkhiari, Resheed; Oleas, Roberto; Kim, Dongchoon; Robles-Jara, Carlos A.; Raijman, Isaac
ISI:000545678400078
ISSN: 0016-5107
CID: 4790322

Painless Jaundice: A Rare Presentation of Uterine Leiomyosarcoma With Pancreatic Metastasis [Meeting Abstract]

Ali, Mohammad; Sticco, Kristen; Shah, Rakesh; Schneider, Jeffrey; Allendorf, John; Widmer, Jessica
ISI:000464611003104
ISSN: 0002-9270
CID: 3897702

NOTES FOR SUBEPITHELIAL TUMORS: EFTR AND STER A SINGLE CENTER FIVE YEAR PROSPECTIVE SERIES IN THE US [Meeting Abstract]

Stavropoulos, Stavros N.; Modayil, Rani J.; Zhang, Xiaocen; Khodorskiy, Dmitriy O.; Ly, Erin K.; Neppala, Sivaram; Peller, Hallie; Widmer, Jessica L.; Brathwaite, Collin E.; Grendell, James H.
ISI:000434248200457
ISSN: 0016-5107
CID: 3514232

PER ORAL ENDOSCOPIC MYOTOMY (POEM) FOR ACHALASIA: LONG TERM OUTCOMES FROM A LARGE PROSPECTIVE SINGLE-CENTER US SERIES [Meeting Abstract]

Stavropoulos, Stavros N.; Modayil, Rani J.; Zhang, Xiaocen; Khodorskiy, Dmitriy O.; Taylor, Sharon I.; Kollarus, Maria M.; Brathwaite, Collin E.; Widmer, Jessica L.; Grendell, James H.
ISI:000435509900429
ISSN: 0016-5107
CID: 3514242

IS THERE A DIFFERENCE IN OUTCOMES BETWEEN ANTERIOR AND POSTERIOR PERORAL ENDOSCOPIC MYOTOMY (POEM)? A RANDOMIZED STUDY FROM AN EXPERIENCED HIGH-VOLUME OPERATOR [Meeting Abstract]

Stavropoulos, Stavros N.; Modayil, Rani J.; Zhang, Xiaocen; Khodorskiy, Dmitriy O.; Taylor, Sharon I.; Kollarus, Maria M.; Widmer, Jessica L.; Brathwaite, Collin E.; Peller, Abraham; Halwan, Bhawna; Friedel, David
ISI:000434248200137
ISSN: 0016-5107
CID: 3508502