المؤلفون: Nagula, Satish, Parasa, Sravanthi, Laine, Loren, Shah, Shailja C.

المصدر: Clinical Gastroenterology & Hepatology; May2024, Vol. 22 Issue 5, p933-943, 11p

مستخلص: The purpose of this Clinical Practice Update (CPU) Expert Review is to provide clinicians with guidance on best practices for performing a high-quality upper endoscopic exam. The best practice advice statements presented herein were developed from a combination of available evidence from published literature, guidelines, and consensus-based expert opinion. No formal rating of the strength or quality of the evidence was carried out, which aligns with standard processes for American Gastroenterological Association (AGA) Institute CPUs. These statements are meant to provide practical, timely advice to clinicians practicing in the United States. This Expert Review was commissioned and approved by the American Gastroenterological Association (AGA) Institute Clinical Practice Updates (CPU) Committee and the AGA Governing Board to provide timely guidance on a topic of high clinical importance to the AGA membership, and underwent internal peer review by the CPU Committee and external peer review through standard procedures of Clinical Gastroenterology & Hepatology. Endoscopists should ensure that upper endoscopy is being performed for an appropriate indication and that informed consent clearly explaining the risks, benefits, alternatives, sedation plan, and potential diagnostic and therapeutic interventions is obtained. These elements should be documented by the endoscopist before the procedure. Endoscopists should ensure that adequate visualization of the upper gastrointestinal mucosa, using mucosal cleansing and insufflation as necessary, is achieved and documented. A high-definition white-light endoscopy system should be used for upper endoscopy instead of a standard-definition white-light endoscopy system whenever possible. The endoscope used for the procedure should be documented in the procedure note. Image enhancement technologies should be used during the upper endoscopic examination to improve the diagnostic yield for preneoplasia and neoplasia. Suspicious areas should be clearly described, photodocumented, and biopsied separately. Endoscopists should spend sufficient time carefully inspecting the foregut mucosa in an anterograde and retroflexed view to improve the detection and characterization of abnormalities. Endoscopists should document any abnormalities noted on upper endoscopy using established classifications and standard terminology whenever possible. Endoscopists should perform biopsies for the evaluation and management of foregut conditions using standardized biopsy protocols. Endoscopists should provide patients with management recommendations based on the specific endoscopic findings (eg, peptic ulcer disease, erosive esophagitis), and this should be documented in the medical record. If recommendations are contingent upon histopathology results (eg, H pylori infection, Barrett's esophagus), then endoscopists should document that appropriate guidance will be provided after results are available. Endoscopists should document whether subsequent surveillance endoscopy is indicated and, if so, provide appropriate surveillance intervals. If the determination of surveillance is contingent on histopathology results, then endoscopists should document that surveillance intervals will be suggested after results are available. [ABSTRACT FROM AUTHOR]

: Copyright of Clinical Gastroenterology & Hepatology is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Rex, Douglas K., Haber, Gregory B., Khashab, Mouen, Rastogi, Amit, Hasan, Muhammad K., DiMaio, Christopher J., Kumta, Nikhil A., Nagula, Satish, Gordon, Stuart, Al-Kawas, Firas, Waye, Jerome D., Razjouyan, Hadie, Dye, Charles E., Moyer, Matthew T., Shultz, Jeremiah, Lahr, Rachel E., Yuen, Poi Yu Sofia, Dixon, Rebekah, Boyd, LaKeisha, Pohl, Heiko

المصدر: Clinical Gastroenterology and Hepatology ; volume 22, issue 3, page 552-561.e4 ; ISSN 1542-3565

مصطلحات موضوعية: Gastroenterology, Hepatology

الإتاحة: https://doi.org/10.1016/j.cgh.2023.09.041Test
https://api.elsevier.com/content/article/PII:S1542356523008431?httpAccept=text/xmlTest
https://api.elsevier.com/content/article/PII:S1542356523008431?httpAccept=text/plainTest

المؤلفون: Rustgi, Sheila D., Zylberberg, Haley M., Amin, Sunil, Aronson, Anne, Nagula, Satish, DiMaio, Christopher J., Kumta, Nikhil A., Lucas, Aimee L.

المصدر: Endoscopy International Open ; volume 10, issue 01, page E19-E29 ; ISSN 2364-3722 2196-9736

الوصف: Background and study aims Pancreatic cancer (PC) is the fourth most common cause of cancer death in the United States. Previous studies have suggested a survival benefit for endoscopic ultrasound (EUS), an important tool for diagnosis and staging of PC. This study aims to describe EUS use over time and identify factors associated with EUS use and its impact on survival. Patients and methods This was a retrospective review of the Surveillance, Epidemiology and End Results (SEER) database linked with Medicare claims. EUS use, clinical and demographic characteristics were evaluated. Chi-squared analysis, Cochran-Armitage test for trend, and logistic regression were used to identify associations between sociodemographic and clinical factors and EUS. Kaplan-Meier and Cox proportional hazard ratios were used for survival analysis. Results EUS use rose during the time period, from 7.4 % of patients in 2000 to 32.4 % in 2015. Patient diversity increased, with a rising share of older, non-White patients with higher Charlson comorbidity scores. Both clinical (receipt of other therapies, PC stage) and nonclinical factors (region of country, year of diagnosis) were associated with receipt of EUS. While EUS was associated with a survival improvement early in the study period, this effect did not persist for PC patients diagnosed in 2012 to 2015 (median survival 3 month ± standard deviation [SD] 9.8 months without vs. 4 months ± SD 8 months with EUS). Conclusions Our data support previous studies, which suggest a survival benefit for EUS when it was infrequently used, but finds that benefit was attenuated as EUS became more widely available.

الإتاحة: https://doi.org/10.1055/a-1608-0856Test

المؤلفون: Livanos, Alexandra E., Jha, Divya, Cossarini, Francesca, Gonzalez-Reiche, Ana S., Tokuyama, Minami, Aydillo, Teresa, Parigi, Tommaso L., Ladinsky, Mark S., Ramos, Irene, Dunleavy, Katie, Lee, Brian, Dixon, Rebekah E., Chen, Steven T., Martinez-Delgado, Gustavo, Nagula, Satish, Bruce, Emily A., Ko, Huaibin M., Glicksberg, Benjamin S., Nadkarni, Girish, Pujadas, Elisabet, Reidy, Jason, Naymagon, Steven, Grinspan, Ari, Ahmad, Jawad, Tankelevich, Michael, Bram, Yaron, Gordon, Ronald, Sharma, Keshav, Houldsworth, Jane, Britton, Graham J., Chen-Liaw, Alice, Spindler, Matthew P., Plitt, Tamar, Wang, Pei, Cerutti, Andrea, Faith, Jeremiah J., Colombel, Jean-Frederic, Kenigsberg, Ephraim, Argmann, Carmen, Merad, Miriam, Gnjatic, Sacha, Harpaz, Noam, Danese, Silvio, Cordon-Cardo, Carlos, Rahman, Adeeb, Schwartz, Robert E., Kumta, Nikhil A., Aghemo, Alessio, Bjorkman, Pamela J., Petralia, Francesca, van Bakel, Harm, Garcia-Sastre, Adolfo, Mehandru, Saurabh

المصدر: Gastroenterology, 160(7), 2435-2450, (2021-06)

مصطلحات موضوعية: COVID-19, SARS-CoV-2, GI symptoms, GI infection, outcomes, host immune response

الوصف: Background & Aims: Given that gastrointestinal (GI) symptoms are a prominent extrapulmonary manifestation of COVID-19, we investigated intestinal infection with SARS-CoV-2, its effect on pathogenesis, and clinical significance. Methods: Human intestinal biopsy tissues were obtained from patients with COVID-19 (n = 19) and uninfected control individuals (n = 10) for microscopic examination, cytometry by time of flight analyses, and RNA sequencing. Additionally, disease severity and mortality were examined in patients with and without GI symptoms in 2 large, independent cohorts of hospitalized patients in the United States (N = 634) and Europe (N = 287) using multivariate logistic regressions. Results: COVID-19 case patients and control individuals in the biopsy cohort were comparable for age, sex, rates of hospitalization, and relevant comorbid conditions. SARS-CoV-2 was detected in small intestinal epithelial cells by immunofluorescence staining or electron microscopy in 15 of 17 patients studied. High-dimensional analyses of GI tissues showed low levels of inflammation, including down-regulation of key inflammatory genes including IFNG, CXCL8, CXCL2, and IL1B and reduced frequencies of proinflammatory dendritic cells compared with control individuals. Consistent with these findings, we found a significant reduction in disease severity and mortality in patients presenting with GI symptoms that was independent of sex, age, and comorbid illnesses and despite similar nasopharyngeal SARS-CoV-2 viral loads. Furthermore, there was reduced levels of key inflammatory proteins in circulation in patients with GI symptoms. Conclusions: These data highlight the absence of a proinflammatory response in the GI tract despite detection of SARS-CoV-2. In parallel, reduced mortality in patients with COVID-19 presenting with GI symptoms was observed. A potential role of the GI tract in attenuating SARS-CoV-2–associated inflammation needs to be further examined. ; © 2021 by the AGA Institute. Received 20 November 2020, ...

العلاقة: https://doi.org/10.1053/j.gastro.2021.02.056Test; oai:authors.library.caltech.edu:tcca5-cff90; https://www.ncbi.nlm.nih.gov/pmc/PMC7931673Test; eprintid:108318; resolverid:CaltechAUTHORS:20210305-070228450

الإتاحة: https://doi.org/10.1053/j.gastro.2021.02.056Test
https://www.ncbi.nlm.nih.gov/pmc/PMC7931673Test

المؤلفون: Hoerter, Nicholas A., Dixon, Rebekah E., DiMaio, Christopher J., Nagula, Satish, Greenwald, David, Kumta, Nikhil A.

المصدر: Endoscopy ; volume 54, issue 07, page E368-E369 ; ISSN 0013-726X 1438-8812

الإتاحة: https://doi.org/10.1055/a-1540-6558Test

المؤلفون: Zylberberg, Haley, Rustgi, Sheila D., Nagula, Satish, Kumta, Nikhil A., DiMaio, Christopher J., Lucas, Aimee

المصدر: American Journal of Gastroenterology ; volume 116, issue 1, page S1324-S1324 ; ISSN 0002-9270 1572-0241

الإتاحة: https://doi.org/10.14309/01.ajg.0000786392.03229.b1Test

المؤلفون: DiMaio, Christopher J., Cheesman, Antonio R., Nagula, Satish, Kumta, Nikhil A.

المصدر: Endoscopy ; volume 53, issue 05, page E172-E173 ; ISSN 0013-726X 1438-8812

الإتاحة: https://doi.org/10.1055/a-1216-0374Test

المؤلفون: Blackett, John W., Kumta, Nikhil A., Dixon, Rebekah E., David, Yakira, Nagula, Satish, DiMaio, Christopher J., Greenwald, David, Sharaiha, Reem Z., Sampath, Kartik, Carr-Locke, David, Guerson-Gil, Arcelia, Ho, Sammy, Lebwohl, Benjamin, Garcia-Carrasquillo, Reuben, Rajan, Anjana, Annadurai, Vasantham, Gonda, Tamas A., Freedberg, Daniel E., Mahadev, Srihari

المصدر: Digestive Diseases and Sciences ; volume 66, issue 8, page 2545-2554 ; ISSN 0163-2116 1573-2568

مصطلحات موضوعية: Gastroenterology, Physiology

الإتاحة: https://doi.org/10.1007/s10620-020-06593-9Test

المؤلفون: Lawrence, Christopher, Nieto, Jose, Parsons, Willis G., Roy, André, Guda, Nalini M., Steinberg, Stephen E., Hasan, Muhammad K., Bucobo, Juan Carlos, Nagula, Satish, Dey, Nicholas D., Buscaglia, Jonathan M.

المساهمون: Cook Research Incorporated

المصدر: BMC Gastroenterology ; volume 20, issue 1 ; ISSN 1471-230X

مصطلحات موضوعية: Gastroenterology, General Medicine

الوصف: Background Biliary decompression can reduce symptoms and improve quality of life in patients with malignant biliary obstruction. Endoscopically placed stents have become the standard of care for biliary drainage with the aim of improving hepatic function, relieving jaundice, and reducing adverse effects of obstruction. The purpose of this study was to evaluate the performance characteristics of a newly-designed, uncovered metal biliary stent for the palliation of malignant biliary obstruction. Methods This post-market, prospective study included patients with biliary obstruction due to a malignant neoplasm treated with a single-type, commercially available uncovered self-expanding metal stent (SEMS). Stents were placed as clinically indicated for palliation of jaundice and to potentially facilitate neo-adjuvant chemotherapy. The main outcome measure was freedom from recurrent biliary obstruction (within the stent) requiring re-intervention within 1, 3, and 6 months of stent insertion. Secondary outcome measures included device-related adverse events and technical success of stent deployment. Results SEMS were placed in 113 patients (73 men; mean age, 69); a single stent was inserted in 106 patients, and 2 stents were placed in 7 patients. Forty-eight patients survived and/or completed the 6 month study protocol. Freedom from symptomatic recurrent biliary obstruction requiring re-intervention was achieved in 108 of 113 patients (95.6, 95%CI = 90.0–98.6%) at study exit for each patient. Per interval analysis yielded the absence of recurrent biliary obstruction in 99.0% of patients at 1 month ( n = 99; 95%CI = 97.0–100%), 96.6% of patients at 3 months ( n = 77; 95%CI = 92.7–100%), and 93.3% of patients at 6 months ( n = 48; 95%CI = 86.8–99.9%). In total, only 5 patients (4.4%) were considered failures of the primary endpoint. Most of these failures (4/5) were due to stent occlusion from tumor ingrowth or overgrowth. Overall technical success rate of stent deployment was 99.2%. There were 2 cases of ...

الإتاحة: https://doi.org/10.1186/s12876-020-01325-9Test

المؤلفون: Singh, Ritu, David, Yakira, Cheesman, Antonio R., Dixon, Rebekah E., Nagula, Satish, DiMaio, Christopher J., Greenwald, David A., Kumta, Nikhil

المصدر: American Journal of Gastroenterology ; volume 115, issue 1, page S10-S11 ; ISSN 0002-9270 1572-0241

الإتاحة: https://doi.org/10.14309/01.ajg.0000697976.05194.d3Test