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LEARNING CURVE FOR ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD): EXPERIENCE OF A SINGLE OPERATOR IN A LARGE US REFERRAL CENTER [Meeting Abstract]

Stavropoulos, Stavros N.; Zhang, Xiaocen; Ly, Erin; Nithyanand, Sagarika; Modayil, Rani J.; Khodorskiy, Dmitriy O.; Galibov, Iosif; Widmer, Jessica L.; Friedel, David
ISI:000434248200082
ISSN: 0016-5107
CID: 3522432

PERORAL CHOLANGIOSCOPY WITH GASTROSCOPES: SEE MORE, DO MORE! [Meeting Abstract]

Widmer, Jessica L.; Modayil, Rani J.; Friedel, David; Allendorf, John; Grendell, James H.; Stavropoulos, Stavros N.
ISI:000434248200310
ISSN: 0016-5107
CID: 3522472

A LARGE SINGLE CENTER ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD) EXPERIENCE IN A WESTERN SETTING [Meeting Abstract]

Stavropoulos, Stavros N.; Khodorskiy, Dmitriy O.; Ly, Erin K.; Modayil, Rani J.; Nithyanand, Sagarika; Bhumi, Sriya; DeMaria, Matthew J.; Zhang, Xiaocen; Widmer, Jessica L.; Grendell, James H.
ISI:000434248200393
ISSN: 0016-5107
CID: 3522492

Fully-covered metal stents with endoscopic suturing vs. partially-covered metal stents for benign upper gastrointestinal diseases: a comparative study

Ngamruengphong, Saowanee; Sharaiha, Reem; Sethi, Amrita; Siddiqui, Ali; DiMaio, Christopher J; Gonzalez, Susana; Rogart, Jason; Jagroop, Sophia; Widmer, Jessica; Im, Jennifer; Hasan, Raza Abbas; Laique, Sobia; Gonda, Tamas; Poneros, John; Desai, Amit; Wong, Katherine; Villgran, Vipin; Brewer Gutierrez, Olaya; Bukhari, Majidah; Chen, Yen-I; Hernaez, Ruben; Hanada, Yuri; Sanaei, Omid; Agarwal, Amol; Kalloo, Anthony N; Kumbhari, Vivek; Singh, Vikesh; Khashab, Mouen A
Background and study aims /UNASSIGNED:Self-expandable metallic stents (SEMS) have been increasingly used in benign conditions (e. g. strictures, fistulas, leaks, and perforations). Fully covered SEMS (FSEMS) were introduced to avoid undesirable consequences of partially covered SEMS (PSEMS), but come with higher risk of stent migration. Endoscopic suturing (ES) for stent fixation has been shown to reduce migration of FSEMS. Our aim was to compare the outcomes of FSEMS with ES (FS/ES) versus PSEMS in patients with benign upper gastrointestinal conditions. Patients and methods /UNASSIGNED:We retrospectively identified all patients who underwent stent placement for benign gastrointestinal conditions at seven US tertiary-care centers. Patients were divided into two groups: FSEMS with ES (FS/ES group) and PSEMS (PSEMS group). Clinical outcomes between the two groups were compared. Results /UNASSIGNED: = 0.005. Conclusions /UNASSIGNED:The proportion of stent migration of FS/ES and PSEMS are similar. Rates of other stent-related AEs were higher in the PSEMS group. PSEMS was associated with tissue ingrowth or overgrowth leading to difficult stent removal, and secondary stricture formation. Thus, FSEMS with ES for stent fixation may be the preferred modality over PSEMS for the treatment of benign upper gastrointestinal conditions.
PMID: 29404384
ISSN: 2364-3722
CID: 3411692

Endoscopic suturing for the prevention of stent migration in benign upper gastrointestinal conditions: a comparative multicenter study

Ngamruengphong, Saowanee; Sharaiha, Reem Z; Sethi, Amrita; Siddiqui, Ali A; DiMaio, Christopher J; Gonzalez, Susana; Im, Jennifer; Rogart, Jason N; Jagroop, Sophia; Widmer, Jessica; Hasan, Raza Abbas; Laique, Sobia; Gonda, Tamas; Poneros, John; Desai, Amit; Tyberg, Amy; Kumbhari, Vivek; El Zein, Mohamad; Abdelgelil, Ahmed; Besharati, Sepideh; Hernaez, Ruben; Okolo, Patrick I; Singh, Vikesh; Kalloo, Anthony N; Kahaleh, Michel; Khashab, Mouen A
BACKGROUND AND STUDY AIMS: Fully covered self-expandable metal stents (FCSEMSs) have increasingly been used in benign upper gastrointestinal (UGI) conditions; however, stent migration remains a major limitation. Endoscopic suture fixation (ESF) may prevent stent migration. The aims of this study were to compare the frequency of stent migration in patients who received endoscopic suturing for stent fixation (ESF group) compared with those who did not (NSF group) and to assess the impact of ESF on clinical outcome. PATIENTS AND METHODS: This was a retrospective study of patients who underwent FCSEMS placement for benign UGI diseases. Patients were divided into either the NSF or ESF group. Outcome variables, including stent migration, clinical success (resolution of underlying pathology), and adverse events, were compared. RESULTS: A total of 125 patients (44 in ESF group, 81 in NSF group; 56 benign strictures, 69 leaks/fistulas/perforations) underwent 224 stenting procedures. Stent migration was significantly more common in the NSF group (33 % vs. 16 %; P = 0.03). Time to stent migration was longer in the ESF group (P = 0.02). ESF appeared to protect against stent migration in patients with a history of stent migration (adjusted odds ratio [OR] 0.09; P = 0.002). ESF was also significantly associated with a higher rate of clinical success (60 % vs. 38 %; P = 0.03). Rates of adverse events were similar between the two groups. CONCLUSIONS: Endoscopic suturing for stent fixation is safe and associated with a decreased migration rate, particularly in patients with a prior history of stent migration. It may also improve clinical response, likely because of the reduction in stent migration.
PMID: 27356125
ISSN: 1438-8812
CID: 2674672

Endoscopic suturing for the prevention of stent migration in benign upper gastrointestinal conditions: a comparative multicenter study

Ngamruengphong, Saowanee; Sharaiha, Reem Z; Sethi, Amrita; Siddiqui, Ali A; DiMaio, Christopher J; Gonzalez, Susana; Im, Jennifer; Rogart, Jason N; Jagroop, Sophia; Widmer, Jessica; Hasan, Raza Abbas; Laique, Sobia; Gonda, Tamas; Poneros, John; Desai, Amit; Tyberg, Amy; Kumbhari, Vivek; El Zein, Mohamad; Abdelgelil, Ahmed; Besharati, Sepideh; Hernaez, Ruben; Okolo, Patrick I; Singh, Vikesh; Kalloo, Anthony N; Kahaleh, Michel; Khashab, Mouen A
PMID: 27494452
ISSN: 1438-8812
CID: 3411682

A Large Multicenter Experience With Endoscopic Suturing for Management of Gastrointestinal Defects and Stent Anchorage in 122 Patients: A Retrospective Review

Sharaiha, Reem Z; Kumta, Nikhil A; DeFilippis, Ersilia M; Dimaio, Christopher J; Gonzalez, Susana; Gonda, Tamas; Rogart, Jason; Siddiqui, Ali; Berg, Paul S; Samuels, Paul; Miller, Larry; Khashab, Mouen A; Saxena, Payal; Gaidhane, Monica R; Tyberg, Amy; Teixeira, Julio; Widmer, Jessica; Kedia, Prashant; Loren, David; Kahaleh, Michel; Sethi, Amrita
GOALS: To describe a multicenter experience using an endoscopic suturing device for management of gastrointestinal (GI) defects and stent anchorage. BACKGROUND: Endoscopic closure of GI defects including perforations, fistulas, and anastomotic leaks as well as stent anchorage has improved with technological advances. An endoscopic suturing device (OverStitch; Apollo Endosurgery Inc.) has been used. STUDY: Retrospective study of consecutive patients who underwent endoscopic suturing for management of GI defects and/or stent anchorage were enrolled between March 2012 and January 2014 at multiple academic medical centers. Data regarding demographic information and outcomes including long-term success were collected. RESULTS: One hundred and twenty-two patients (mean age, 52.6 y; 64.2% females) underwent endoscopic suturing at 8 centers for stent anchorage (n=47; 38.5%), fistulas (n=40; 32.7%), leaks (n=15; 12.3%), and perforations (n=20; 16.4%). A total of 44.2% underwent prior therapy and 97.5% achieved technical success. Immediate clinical success was achieved in 79.5%. Long-term clinical success was noted in 78.8% with mean follow-up of 68 days. Clinical success was 91.4% in stent anchorage, 93% in perforations, 80% in fistulas, but only 27% in anastomotic leak closure. CONCLUSIONS: Endoscopic suturing for management of GI defects and stent anchoring is safe and efficacious. Stent migration after stent anchoring was reduced compared with published data. Long-term success without further intervention was achieved in the majority of patients. The role of endoscopic suturing for repair of anastomotic leaks remains unclear given limited success in this retrospective study.
PMID: 25984980
ISSN: 1539-2031
CID: 2674682

Endoscopic gallbladder drainage compared with percutaneous drainage

Kedia, Prashant; Sharaiha, Reem Z; Kumta, Nikhil A; Widmer, Jessica; Jamal-Kabani, Armeen; Weaver, Kristen; Benvenuto, Andrea; Millman, Jennifer; Barve, Rahul; Gaidhane, Monica; Kahaleh, Michel
BACKGROUND:High-risk patients with cholecystitis have conventionally been offered percutaneous gallbladder drainage (PGBD) for treatment. A growing experience of endoscopic gallbladder drainage (EGBD) has been reported to be effective and safe. OBJECTIVE:To compare the short- and long-term outcomes of EGBD and PGBD. DESIGN/METHODS:A retrospective review. SETTING/METHODS:Single academic tertiary care center. PATIENTS/METHODS:Inpatients diagnosed with cholecystitis. INTERVENTIONS/METHODS:Any patient deemed a nonsurgical candidate and who has undergone either PGBD or EGBD was included in the analysis. MAIN OUTCOME MEASUREMENTS/METHODS:Patient demographics along with procedural and clinical outcomes were recorded for each group. RESULTS:Forty-three patients underwent PGBD and 30 underwent EGBD (24 transpapillary, 6 transmural). Technical (97.6% vs 100%) and clinical (97.6% vs 86.7%) success rates of PGBD and EGBD were similar. However, postprocedure hospital length of stay (16.3 vs 7.6 days), time to clinical resolution (4.6 vs 3.0 days), adverse event rate (39.5% vs 13.3%), number of sessions (2.0 vs 1.0), number of repeat interventions (53.4% vs 13.3%), and postprocedure pain scores (3.8 vs 2.1) were significantly higher for PGBD than EGBD. LIMITATIONS/CONCLUSIONS:Retrospective analysis. CONCLUSION/CONCLUSIONS:Although EGBD has similar technical and clinical success compared with PGBD, it uses fewer hospital resources and results in fewer adverse events, improved pain scores, and decreased need for repeat gallbladder drainage. EGBD may provide a less-invasive, safer, cost-effective option for gallbladder drainage than PGBD with improved clinical outcomes.
PMID: 25952093
ISSN: 1097-6779
CID: 3411662

Endoscopic Gallbladder Drainage for Acute Cholecystitis

Widmer, Jessica; Alvarez, Paloma; Sharaiha, Reem Z; Gossain, Sonia; Kedia, Prashant; Sarkaria, Savreet; Sethi, Amrita; Turner, Brian G; Millman, Jennifer; Lieberman, Michael; Nandakumar, Govind; Umrania, Hiren; Gaidhane, Monica; Kahaleh, Michel
BACKGROUND/AIMS/OBJECTIVE:Surgery is the mainstay of treatment for cholecystitis. However, gallbladder stenting (GBS) has shown promise in debilitated or high-risk patients. Endoscopic transpapillary GBS and endoscopic ultrasound-guided GBS (EUS-GBS) have been proposed as safe and effective modalities for gallbladder drainage. METHODS:Data from patients with cholecystitis were prospectively collected from August 2004 to May 2013 from two United States academic university hospitals and analyzed retrospectively. The following treatment algorithm was adopted. Endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and cystic duct stenting was initially attempted. If deemed feasible by the endoscopist, EUS-GBS was then pursued. RESULTS:During the study period, 139 patients underwent endoscopic gallbladder drainage. Among these, drainage was performed in 94 and 45 cases for benign and malignant indications, respectively. Successful endoscopic gallbladder drainage was defined as decompression of the gallbladder without incidence of cholecystitis, and was achieved with ERCP and cystic duct stenting in 117 of 128 cases (91%). Successful endoscopic gallbladder drainage was also achieved with EUS-guided gallbladder drainage using transmural stent placement in 11 of 11 cases (100%). Complications occurred in 11 cases (8%). CONCLUSIONS:Endoscopic gallbladder drainage techniques are safe and efficacious methods for gallbladder decompression in non-surgical patients with comorbidities.
PMID: 26473125
ISSN: 2234-2400
CID: 3411672

Impact of Radiofrequency Ablation on Malignant Biliary Strictures: Results of a Collaborative Registry

Sharaiha, Reem Z; Sethi, Amrita; Weaver, Kristen R; Gonda, Tamas A; Shah, Raj J; Fukami, Norio; Kedia, Prashant; Kumta, Nikhil A; Clavo, Carlos M Rondon; Saunders, Michael D; Cerecedo-Rodriguez, Jorge; Barojas, Paola Figueroa; Widmer, Jessica L; Gaidhane, Monica; Brugge, William R; Kahaleh, Michel
BACKGROUND:Radiofrequency ablation of malignant biliary strictures has been offered for the last 3 years, but only limited data have been published. AIM/OBJECTIVE:To assess the safety, efficacy, and survival outcomes of patients receiving endoscopic radiofrequency ablation. METHODS:Between April 2010 and December 2013, 69 patients with unresectable neoplastic lesions and malignant biliary obstruction underwent 98 radiofrequency ablation sessions with stenting. RESULTS:A total of 69 patients (22 male, aged 66.1 ± 13.3) were included in the registry. The etiology of malignant biliary stricture included unresectable cholangiocarcinoma (n = 45), pancreatic cancer (n = 19), gallbladder cancer (n = 2), gastric cancer (n = 1), and liver metastasis from colon cancer (n = 3). Seventy-eight percentage of patients had prior chemotherapy. All strictures were stented post-radiofrequency ablation with either plastic stents or metal stents. The mean stricture length treated was 14.3 mm. There was a statistically significant improvement in stricture diameter post-ablation (p < 0.0001). The likelihood of stricture improvement was significantly greater in pancreatic cancer-associated strictures [RR 1.8 (95 % 1.03-5.38)]. Seven patients (10 %) had adverse events, not linked directly to radiofrequency ablation. Median survival was 11.46 months (6.2-25 months). CONCLUSION/CONCLUSIONS:Radiofrequency ablation is effective and safe in malignant biliary obstruction and seems to be associated with improved survival.
PMID: 25701319
ISSN: 1573-2568
CID: 3411652