Faculty Bibliography

IMPORTANCE/UNASSIGNED:As transcatheter aortic valve replacement (TAVR) is considered for younger and lower-risk populations, the durability of bioprosthetic valves is increasingly important. Limited data exist on long-term (7 years and beyond) valve durability. OBJECTIVE/UNASSIGNED:To report 7-year valve durability outcomes for low-risk patients with symptomatic severe aortic stenosis treated with TAVR vs surgery. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:Between March 2016 and October 2017, a total of 1000 patients were enrolled at 71 centers in the US and Canada and randomized to undergo TAVR vs surgery. The patient population for the present analysis consisted of all patients who underwent valve implantation (495 with TAVR and 453 with surgery). The last 7-year follow-up occurred in March 2025. INTERVENTIONS/UNASSIGNED:Patients were randomized to balloon-expandable TAVR with the SAPIEN 3 valve or surgery with any commercially available valve. MAIN OUTCOMES AND MEASURES/UNASSIGNED:The main outcomes of this analysis were stage 2 or 3 bioprosthetic valve dysfunction (BVD) related to structural valve deterioration (SVD), thrombosis, or endocarditis; all-cause bioprosthetic valve failure (BVF); BVF related to SVD; and aortic valve reintervention at 7 years. Analyses are presented as cumulative incidence rates with death as a competing risk. RESULTS/UNASSIGNED:The mean (SD) age of the study population was 73.5 (6.0) years, and 657 participants (69.3%) were male. Of 671 patients who were still alive and enrolled in the study at 7-year follow-up, 537 (80.0%) were available for echocardiographic analysis. Cumulative incidence rates of stage 2 or 3 SVD-related BVD (7.3% vs 7.6%; hazard ratio [HR], 0.96; 95% CI, 0.59-1.57; P = .88), all-cause BVF (6.9% vs 7.5%; HR, 0.91; 95% CI, 0.55-1.49; P = .69), SVD-related BVF (3.9% vs 5.3%; HR, 0.72; 95% CI, 0.39-1.36; P = .31), and valve reintervention (6.0% vs 5.5%; HR, 1.09; 95% CI, 0.62-1.90; P = .77) were low and similar for TAVR and surgery, respectively. Stage 2 or 3 thrombosis-related BVD (subclinical and clinical) occurred more frequently with TAVR (5.2% vs 0.9%; HR, 5.52; 95% CI, 1.92-15.85; P < .001), although most events occurred within 3 years and few progressed to BVF. Rates of stage 2 or 3 endocarditis-related BVD were also low and similar (0.4% in the TAVR group vs 0.5% in the surgery group; HR, 0.85; 95% CI, 0.12-6.07; P = .87). The proportion of patients alive and free of all-cause BVF was 73.4% (331/451) with TAVR vs 74.8% (288/385) with surgery (P = .69). CONCLUSIONS AND RELEVANCE/UNASSIGNED:In this ad hoc analysis of a randomized clinical trial among low-risk patients with symptomatic severe aortic stenosis randomized to TAVR or surgery, both TAVR and surgery demonstrated comparable and sustained valve durability, with low and similar rates of SVD, all-cause BVF, and reintervention through 7 years. These findings may inform discussions of valve replacement strategies. TRIAL REGISTRATION/UNASSIGNED:ClinicalTrials.gov Identifier: NCT02675114.

Although previously B cells had been underestimated in comparison to T cells in their role in autoimmunity, now, their impact is well established. Via secretion of autoantibodies, presentation of autoantigens, regulation of antigen processing and presentation, and release of inflammatory cytokines, B cells can mediate cytotoxicity and lead to organ damage. B cell depletion via CD20 targeting effectively eliminates B cells in the blood and primary lymph organs and has found an effective role in the treatment of both rheumatological and neurological diseases. The neonatal Fc receptor (FcRn) is a key component of immune regulation that prevents IgG (produced by B cells) from degradation by lysosomes, sending it back into the extracellular compartment, thereby extending its half-life. This abundance of pathogenic IgG can lead to the development of autoimmune disease. The interplay between these two mechanisms of autoimmunity provides the great potential for combination therapy to reduce existent pathogenic IgG as well as prevent the production of new autoantibodies, though further investigation is needed to determine the risks, particularly of infection. This paper will explore existing B cell depleting treatments and FcRn inhibitors, and consider the potential impact for autoimmune disease as well as for the treatment of atherosclerosis.

OBJECTIVES/OBJECTIVE:This study evaluates how access to abortion training influenced OBGYN residents who selected residency programs before and after the Dobbs decision. STUDY DESIGN/METHODS:Current OBGYN residents completed a survey in January 2024 as part of their annual in-training exam. Residents rated the importance of abortion training and compared access to abortion training to other factors (e.g., residency culture and happiness, geographic location) when selecting and ranking programs. We computed the percentage of residents reporting abortion training as important and a top factor when ranking programs. We used chi-squared test to compare differences between cohorts. RESULTS:Of the 6,134 residents surveyed, 3,182 consented to participation and had complete responses (52%). Overall, 2,281 (72%) considered abortion training important when choosing programs and 2,179 (69%) when ranking programs; 1,105 (71%) of post-Dobbs and 1,074 (66%) of pre-Dobbs residents considered abortion training important when ranking programs (p<0.01). Access to abortion training was a top three factor for 741 (23%) respondents when ranking programs. More post-Dobbs (392, 25%) than pre-Dobbs residents (349, 21%) considered access to abortion training as a top factor when ranking programs (p=0.01). CONCLUSIONS:Applicants weigh a variety of factors when selecting programs and may match to abortion restricted environments - this includes the 23% who considered abortion training a top factor. Future work should continue to focus on the impact of the Dobbs decision on residency program selection and the ability of all residents to develop abortion-care skills. IMPLICATIONS/CONCLUSIONS:Abortion training is an important consideration in residency program selection and essential for patient care. Without prioritization of abortion education, programs risk losing viable candidates and graduating residents without essential skills.

Prostatic artery embolization (PAE) is a safe and effective minimally invasive treatment for lower urinary tract symptoms (LUTS) attributed to benign prostatic hyperplasia (BPH), including in patients with large prostates, who are poor surgical candidates or wish to avoid the morbidity of conventional surgery or transurethral interventions. As PAE becomes more widely adopted for BPH-related LUTS, objective measures of assessing treatment response are needed beyond symptom-based tools such as the International Prostate Symptom Score (IPSS) and Quality-of-Life (QoL) index. Imaging biomarkers complement these subjective endpoints by quantifying structural, functional, ischemic, and microstructural changes within the prostate before and after embolization. This review summarizes the principal imaging modalities used for biomarker assessment in PAE, with emphasis on ultrasound, magnetic resonance imaging (MRI), and computed tomography (CT) scans, and examines the current literature on imaging biomarkers of treatment response. Volumetric biomarkers, including whole prostate volume, central gland volume, and zonal volumetry index, provide quantitative assessment of gland reduction and may help predict clinical improvement, with zonal parameters showing stronger associations with symptomatic outcomes than whole-gland measurements alone. Functional biomarkers such as postvoid residual volume offer objective evaluation of bladder emptying alongside volumetric assessment, whereas ischemia-based biomarkers derived from contrast-enhanced MRI directly reflect embolization-induced devascularization. Diffusion-weighted imaging and apparent diffusion coefficient mapping provide additional information regarding post-embolization tissue remodeling, with b-value selection influencing early infarct detection. Emerging tools, including ultrasound elastography, radiomics, and artificial intelligence-assisted image analysis, may further refine patient selection, standardize response assessment, and improve predictive modeling, though prospective PAE-specific validation remains needed. Imaging biomarkers provide a more objective framework for evaluating PAE treatment response, with the potential to standardize outcome reporting, facilitate earlier identification of treatment success or failure, and guide biomarker-driven clinical decision-making. Prospective validation in larger PAE-specific cohorts remains essential before broader clinical adoption.

INTRODUCTION/UNASSIGNED:There is uncertainty about the benefits of cerclage in patients with transvaginal cervical length (TVCL) ≤10 mm and no prior spontaneous preterm birth. Our aim was to assess whether cervical cerclage in these patients was associated with prolonged pregnancy latency. METHODS/UNASSIGNED:This was an observational study of asymptomatic singleton pregnancies without a history of spontaneous preterm birth with extremely short cervix (TVCL ≤10 mm) in the second trimester. Exposure and outcome data were extracted manually from medical charts by obstetric providers, with all outcomes occurring prior to study initiation. All patients were prescribed vaginal progesterone and those with a cervical dilation >1.5 cm were excluded. The primary outcome was time interval from diagnosis to delivery (or 37 weeks' gestation, whichever occurred first). Secondary outcomes included gestational age at delivery, mode of delivery, and neonatal outcomes. We adjusted for parity and used log-binomial regression to estimate the relative risk for categorical variables and linear regression to estimate mean differences for continuous variables. RESULTS/UNASSIGNED:There were 247 patients with TVCL ≤10 mm during anatomy scan. After exclusions, 87 remained, of which 55 (63.2%) received cervical cerclage. At the time of diagnosis, the mean cervical length was 5.8 mm (cerclage group) versus 7.4mm (no cerclage group, difference: -1.6, 95% CI -0.6, -2.6) and the gestational age was 21.0 weeks (cerclage group) versus 22.1 weeks (no cerclage group, -1.1, 95% CI -1.8, -0.3). Mean pregnancy latency was longer in the cerclage group compared to the no cerclage group (13.4 vs 11.1 weeks, 2.2, 95% CI -0.3, 4.9), though there was a high level of uncertainty in the estimate. Term delivery occurred 30% more often in the cerclage group compared to the no cerclage group (RR 1.31, 95% CI 0.96, 1.79). CONCLUSION/UNASSIGNED:In our cohort, patients with extremely short cervix who received a cerclage had longer pregnancy latency than those who did not receive cerclage and more patients achieved term gestation, suggesting a potential benefit of cerclage in this population. However, given the high level of uncertainty of our estimates, additional research is needed to investigate these findings.

BACKGROUND AND STUDY AIMS/UNASSIGNED:Cholangiocarcinoma (CCa) is a complex malignancy of the biliary tract, classified as intrahepatic, perihilar, or distal. Digital single-operator cholangioscopy (D-SOC) enhances evaluation of biliary strictures, although it remains limited by suboptimal biopsy yield and technical constraints. Artificial intelligence (AI), particularly convolutional neural networks (CNNs), has emerged as a promising adjunct. However, performance across anatomical subtypes is not well defined. This study evaluated diagnostic performance of an AI-based model in detecting CCa lesions by location. PATIENTS AND METHODS/UNASSIGNED:A YOLOv8-based CNN was trained and validated using 315,993 D-SOC images from 183 patients across six international high-volume centers. Images were labeled as benign or malignant based on expert consensus. Frame-based analysis assessed diagnostic performance using macro-average F1-score, precision, and recall. Subgroup analysis explored anatomical site-specific performance. RESULTS/UNASSIGNED:Among the included patients (mean age 66.1±12.1 years; 64.5% male), 43.2% had perihilar, 37.2% intrahepatic, and 19.7% distal biliary strictures. The model demonstrated high overall performance: F1 score 95.3%, precision 95.5%, and recall 95.1%. Site-specific analysis revealed an F1 score of 89.6% for distal strictures and 91.1% for perihilar strictures. Receiver operating characteristic curves showed areas under the curve of 0.980 for intrahepatic strictures and 0.990 for perihilar and distal strictures. CONCLUSIONS/UNASSIGNED:This is the first study to demonstrate AI-based diagnostic performance across CCa topography using a large, multicenter D-SOC dataset. Although anatomical complexity affects detection, the model's high precision and generalizability suggest potential for clinical utility. These results support application of an AI-enhanced algorithm decision algorithm for cholangioscopy.

Renal papillary necrosis (RPN) is an uncommon but important cause of hematuria in patients with sickle cell trait. We report a 28-year-old female with sickle cell trait and beta thalassemia who developed recurrent, transfusion-dependent gross hematuria. Despite extensive imaging, endoscopic evaluation, and conservative management, bleeding persisted. Ureteroscopy demonstrated findings consistent with RPN. The patient required intensive multidisciplinary care and 21 units of packed red blood cells. Hematuria ultimately resolved following treatment with oral epsilon-aminocaproic acid. This case highlights the potential severity of RPN in sickle cell trait and supports consideration of antifibrinolytics as salvage therapy in refractory cases.

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 adverse events 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 2024 for articles related to endoscopic submucosal dissection. 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.