Publications by authors named "Bashar Qumseya"

55 Publications

SAGES guidelines for the surgical treatment of gastroesophageal reflux (GERD).

Surg Endosc 2021 Sep 19;35(9):4903-4917. Epub 2021 Jul 19.

Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.

Background: Gastroesophageal Reflux Disease (GERD) is an extremely common condition with several medical and surgical treatment options. A multidisciplinary expert panel was convened to develop evidence-based recommendations to support clinicians, patients, and others in decisions regarding the treatment of GERD with an emphasis on evaluating different surgical techniques.

Methods: Literature reviews were conducted for 4 key questions regarding the surgical treatment of GERD in both adults and children: surgical vs. medical treatment, robotic vs. laparoscopic fundoplication, partial vs. complete fundoplication, and division vs. preservation of short gastric vessels in adults or maximal versus minimal dissection in pediatric patients. Evidence-based recommendations were formulated using the GRADE methodology by subject experts. Recommendations for future research were also proposed.

Results: The panel provided seven recommendations for adults and children with GERD. All recommendations were conditional due to very low, low, or moderate certainty of evidence. The panel conditionally recommended surgical treatment over medical management for adults with chronic or chronic refractory GERD. There was insufficient evidence for the panel to make a recommendation regarding surgical versus medical treatment in children. The panel suggested that once the decision to pursue surgical therapy is made, adults and children with GERD may be treated with either a robotic or a laparoscopic approach, and either partial or complete fundoplication based on surgeon-patient shared decision-making and patient values. In adults, the panel suggested either division or non-division of the short gastric vessels is appropriate, and that children should undergo minimal dissection during fundoplication.

Conclusions: These recommendations should provide guidance with regard to surgical decision-making in the treatment of GERD and highlight the importance of shared decision-making and patient values to optimize patient outcomes. Pursuing the identified research needs may improve future versions of guidelines for the treatment of GERD.
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http://dx.doi.org/10.1007/s00464-021-08625-5DOI Listing
September 2021

Response.

Gastrointest Endosc 2021 07;94(1):205-206

Department of Gastroenterology, University of Florida, Gainesville, Florida, USA.

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http://dx.doi.org/10.1016/j.gie.2021.03.059DOI Listing
July 2021

ASGE guideline on the role of endoscopy in the management of malignant hilar obstruction.

Gastrointest Endosc 2021 08 20;94(2):222-234.e22. Epub 2021 May 20.

Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.

This clinical guideline from the American Society for Gastrointestinal Endoscopy (ASGE) provides an evidence-based approach for the management of patients with malignant hilar obstruction (MHO). This document was developed using the Grading of Recommendations Assessment, Development and Evaluation framework and addresses primary drainage modality (percutaneous transhepatic biliary drainage [PTBD] vs endoscopic biliary drainage [EBD]), drainage strategy (unilateral vs bilateral), and stent selection (plastic stent [PS] vs self-expandable metal stent [SEMS]). Regarding drainage modality, in patients with MHO undergoing drainage before potential resection or transplantation, the panel suggests against routine use of PTBD as first-line therapy compared with EBD. In patients with unresectable MHO undergoing palliative drainage, the panel suggests PTBD or EBD. The final decision should be based on patient preferences, disease characteristics, and local expertise. Regarding drainage strategy, in patients with unresectable MHO undergoing palliative stent placement, the panel suggests placement of bilateral stents compared with a unilateral stent in the absence of liver atrophy. Finally, regarding type of stent, in patients with unresectable MHO undergoing palliative stent placement, the panel suggests placing SEMSs or PSs. However, in patients who have a short life expectancy and who place high value on avoiding repeated interventions, the panel suggests using SEMSs compared with PSs. If optimal drainage strategy has not been established, the panel suggests placing PSs. This document clearly outlines the process, analyses, and decision processes used to reach the final recommendations and represents the official ASGE recommendations on the above topics.
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http://dx.doi.org/10.1016/j.gie.2020.12.035DOI Listing
August 2021

ASGE guideline on the management of cholangitis.

Gastrointest Endosc 2021 08 20;94(2):207-221.e14. Epub 2021 May 20.

Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.

Cholangitis is a GI emergency requiring prompt recognition and treatment. The purpose of this document from the American Society for Gastrointestinal Endoscopy's (ASGE) Standards of Practice Committee is to provide an evidence-based approach for management of cholangitis. This document addresses the modality of drainage (endoscopic vs percutaneous), timing of intervention (<48 hours vs >48 hours), and extent of initial intervention (comprehensive therapy vs decompression alone). Grading of Recommendations, Assessment, Development, and Evaluation methodology was used to formulate recommendations on these topics. The ASGE suggests endoscopic rather than percutaneous drainage and biliary decompression within 48 hours. Additionally, the panel suggests that sphincterotomy and stone removal be combined with drainage rather than decompression alone, unless patients are too unstable to tolerate more extensive endoscopic treatment.
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http://dx.doi.org/10.1016/j.gie.2020.12.032DOI Listing
August 2021

Toward an evidence-based approach for cholangitis diagnosis.

Gastrointest Endosc 2021 08 24;94(2):297-302.e2. Epub 2021 Apr 24.

Division of Gastroenteorlogy and Hepatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.

Background And Aims: Despite improvements in imaging and laboratory medicine, consensus criteria for the diagnosis of cholangitis are lacking. Although ERCP is an effective treatment for cholangitis, it should be reserved for those patients with a high probability of the diagnosis, given the morbidity associated with the procedure.

Methods: A comprehensive literature search of PubMed (from 1898 to present), Web of Science (1900 to July 15, 2019), Embase (1943 to July 15, 2019), and the Cochrane library (1898 to July 15, 2019) was performed to identify studies that reported on diagnostic paradigms and individual diagnostic parameters of cholangitis. This was used to identify domains associated with high probability of cholangitis.

Results: We identified 23 observational studies (10,252 patients) that evaluated the performance of individual and combined criteria for the diagnosis of cholangitis. Traditional paradigms including Charcot's criteria and Ranson's criteria have inadequate sensitivity, and complexity has limited the implementation of the contemporary Tokyo criteria. Furthermore, controlled studies to validate diagnostic criteria for cholangitis are lacking. Existing literature suggests that 4 criteria, summarized by the acronym BILE, identifies those at high risk of cholangitis: Biliary imaging abnormalities or recent intervention, Inflammatory test abnormalities, Liver test abnormalities, and Exclusion of cholecystitis and acute pancreatitis.

Conclusions: There is a need for cholangitis diagnostic criteria that are supported by controlled validation studies, consistent with contemporary clinical values, and amenable to implementation. The BILE criteria are straightforward but require prospective study of their diagnostic performance and ability to avert unnecessary ERCP.
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http://dx.doi.org/10.1016/j.gie.2021.04.016DOI Listing
August 2021

ASGE guideline on the role of endoscopy in the management of benign and malignant gastroduodenal obstruction.

Gastrointest Endosc 2021 02 7;93(2):309-322.e4. Epub 2020 Nov 7.

Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.

This American Society for Gastrointestinal Endoscopy guideline provides evidence-based recommendations for the endoscopic management of gastric outlet obstruction (GOO). We applied the Grading of Recommendations, Assessment, Development and Evaluation methodology to address key clinical questions. These include the comparison of (1) surgical gastrojejunostomy to the placement of self-expandable metallic stents (SEMS) for malignant GOO, (2) covered versus uncovered SEMS for malignant GOO, and (3) endoscopic and surgical interventions for the management of benign GOO. Recommendations provided in this document were founded on the certainty of the evidence, balance of benefits and harms, considerations of patient and caregiver preferences, resource utilization, and cost-effectiveness.
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http://dx.doi.org/10.1016/j.gie.2020.07.063DOI Listing
February 2021

Response.

Gastrointest Endosc 2020 11;92(5):1145-1146

Advent Health Medical Group, Department of Gastroenterology/Hepatology, Advent Health Hospital Altamonte Springs, Altamonte Springs, Florida, USA; Section of Gastroenterology and Hepatology, Beaumont Health-Royal Oak, Royal Oak, Michigan, USA; Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA; Division of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, Florida, USA.

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http://dx.doi.org/10.1016/j.gie.2020.07.049DOI Listing
November 2020

Quality assessment for systematic reviews and meta-analyses of cohort studies.

Authors:
Bashar J Qumseya

Gastrointest Endosc 2021 02 15;93(2):486-494.e1. Epub 2020 Oct 15.

Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, USA. Electronic address:

Background And Aims: There is a growing need for valid, efficient, and easy scoring scales to rate the quality of cohort studies. We aimed to develop and validate a quality assessment score to be used for cohort studies.

Methods: We followed a rigorous process to establish content, face, and construct validity. Most questions were scored at 0 or 1. Inter-rater reliability and test-retest reliability were assessed using the Spearman correlation coefficient (r) and Cohen's κ statistic. Internal consistency was measured using the Kuder-Richardson formula 20 (KR20).

Results: The final tool consists of 9 questions with a maximum score of 10. The inter-rater reliability was high with the Spearman correlation coefficient (r = .66). Agreement for inclusion was 90%. Test-retest reliability was high. For rater 1, r = .91, κ = .38 for scores, and κ = 1 for inclusion. For rater 2, r = .94, 80% agreement for scores, and 100% agreement for inclusion. Internal consistency was reasonable based on 2 studies: KR20 = .21 and KR20 = .65. The novel scale rated highest in efficiency, understandably, ease of use, and ease of interpretation when compared with 3 other scales.

Conclusions: This novel scale has favorable performance characteristics, is efficient to conduct, and is easy to interpret and will be very helpful for physicians and researchers conducting systematic reviews and meta-analyses.
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http://dx.doi.org/10.1016/j.gie.2020.10.007DOI Listing
February 2021

Barrett's esophagus after sleeve gastrectomy: a systematic review and meta-analysis.

Gastrointest Endosc 2021 02 14;93(2):343-352.e2. Epub 2020 Aug 14.

Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, USA.

Background And Aims: Sleeve gastrectomy (SG) has become significantly more common in recent years. Gastroesophageal reflux disease (GERD) is a major concern in patients undergoing SG and is the major risk factor for Barrett's esophagus (BE). We aimed to assess the prevalence of BE in patients who had undergone SG.

Methods: We searched the major search engines ending in July 2020. We included studies on patients who had undergone esophagogastroduodenoscopy (EGD) after SG. The primary outcome was the prevalence of BE in patients who had undergone SG. We assessed heterogeneity using I and Q statistics. We used funnel plots and the classic fail-safe test to assess for publication bias. We used random-effects modeling to report effect estimates.

Results: Our final analysis included 10 studies that included 680 patients who had undergone EGD 6 months to 10 years after SG. The pooled prevalence of BE was 11.6% (95% confidence interval [CI], 8.1%-16.4%; P < .001; I = 28.7%). On logistic meta-regression analysis, there was no significant association between BE and the prevalence of postoperative GERD (β = 3.5; 95% CI, -18 to 25; P = .75). There was a linear relationship between the time of postoperative EGD and the rate of esophagitis (β = 0.13; 95% CI, 0.06-0.20; P = .0005); the risk of esophagitis increased by 13% each year after SG.

Conclusions: The prevalence of BE in patients who had EGD after SG appears to be high. There was no correlation with GERD symptoms. Most cases were observed after 3 years of follow-up. Screening for BE should be considered in patients after SG even in the absence of GERD symptoms postoperatively.
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http://dx.doi.org/10.1016/j.gie.2020.08.008DOI Listing
February 2021

A prediction model for detection of esophageal squamous cell cancer: A new beginning or more of the same?

Gastrointest Endosc 2020 06;91(6):1261-1263

Division of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, Florida, USA.

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http://dx.doi.org/10.1016/j.gie.2020.02.039DOI Listing
June 2020

Correction: Prevalence of Barrett's esophagus in obese patients undergoing pre-bariatric surgery evaluation: a systematic review and meta-analysis.

Endoscopy 2020 Jul 18;52(7):C8. Epub 2020 May 18.

Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida USA.

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http://dx.doi.org/10.1055/a-1174-3656DOI Listing
July 2020

Effect of referral pattern and histopathology grade on surgery for nonmalignant colorectal polyps.

Gastrointest Endosc 2020 09 22;92(3):702-711.e2. Epub 2020 Apr 22.

Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida, USA.

Background And Aims: The incidence of surgery for nonmalignant colorectal polyps is rising. The aims of this study were to evaluate referral patterns to surgery for nonmalignant polyps, to compare outcomes between surgery and endoscopic resection (ER), and to identify factors associated with surgery in a university-based, tertiary care center.

Methods: Patients referred to colorectal surgery (CRS) for nonmalignant colorectal polyps between 2014 and 2019 were selected from the institution's integrated data repository. Clinical characteristics were obtained through chart review. Multivariate analysis was performed to identify factors associated with surgery for nonmalignant polyps.

Results: Six hundred sixty-four patients with colorectal lesions were referred to CRS, of which 315 were for nonmalignant polyps. Most referrals (69%) came from gastroenterologists. Of the 315 cases, 136 underwent surgery and 117 were referred for attempt at ER. Complete ER was achieved in 87.2% (n = 102), with polyp recurrence in 27.2% at a median of 14 months (range, 0-72). When compared with surgery, ER was associated with a lower hospitalization rate (22.2% vs 95.6%; P < .0001), shorter hospital stay (mean, .5 ± .9 vs 2.23 ± 1 days; P < .0001), and fewer adverse events (5.9% vs 22.8%; P = .0002). Intramucosal adenocarcinoma on baseline pathology (odds ratio, 5.7; 95% confidence interval, 1.2-28.2) and referrals by academic gastroenterologists (odds ratio, 2.5; 95% confidence interval, 1.11-5.72) were associated with a higher likelihood of surgery on multivariate analysis.

Conclusions: Gastroenterologists commonly refer nonmalignant colorectal polyps to surgery, even though ER is effective and associated with lower morbidity. Both referrals from academic gastroenterologists and baseline pathology of intramucosal adenocarcinoma were factors associated with surgery. All colorectal polyps should be evaluated in a multidisciplinary approach to identify lesions suitable for ER before embarking in surgery.
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http://dx.doi.org/10.1016/j.gie.2020.04.041DOI Listing
September 2020

Prevalence of Barrett's esophagus in obese patients undergoing pre-bariatric surgery evaluation: a systematic review and meta-analysis.

Endoscopy 2020 07 23;52(7):537-547. Epub 2020 Apr 23.

Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida USA.

Introduction: Obesity is a known risk factor for gastroesophageal reflux disease (GERD), Barrett's esophagus (BE), and esophageal adenocarcinoma (EAC). Obese patients routinely undergo preoperative esophagogastroduodenoscopy (EGD) before bariatric procedures. We aimed to assess the prevalence of BE in this patient population.

Methods: We conducted a comprehensive literature search ending in March 2019. Search results were imported into covidence.org and screened by two independent reviewers. Heterogeneity was assessed using and statistics and publication bias using funnel plots and the Orwin fail-safe test. Random-effects modeling was used in all analyses. RESULTS : Of 4087 citations, 77 were reviewed in full text and 29 were included in the final analysis based on our predetermined inclusion/exclusion criteria. A total of 13 434 patients underwent pre-bariatric surgery EGD. The pooled prevalence of BE using random-effects modeling was 0.9 % (95 % confidence interval [CI] 0.7 % - 1.3 %);  < 0.001;  = 58 %,  = 67). In meta-regression analyses, controlling for sex and GERD, we found a positive association between mean body mass index (BMI) and the prevalence of BE (β = 0.15 [95 %CI 0.02 - 0.28];  = 0.03). A linear relationship between the prevalence of BE and the prevalence of GERD was also noted (β = 3.9 [95 %CI 0.4 - 7.5];  = 0.03). CONCLUSIONS : Obesity has been postulated as a major risk factor for BE, yet we found that the prevalence of BE in morbidly obese patients undergoing preoperative EGD was very low. Therefore, obesity alone may not be a major risk factor for BE.
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http://dx.doi.org/10.1055/a-1145-3500DOI Listing
July 2020

American Society for Gastrointestinal Endoscopy guideline on the role of endoscopy in familial adenomatous polyposis syndromes.

Gastrointest Endosc 2020 05 10;91(5):963-982.e2. Epub 2020 Mar 10.

Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA.

Familial adenomatous polyposis (FAP) syndrome is a complex entity, which includes FAP, attenuated FAP, and MUTYH-associated polyposis. These patients are at significant risk for colorectal cancer and carry additional risks for extracolonic malignancies. In this guideline, we reviewed the most recent literature to formulate recommendations on the role of endoscopy in this patient population. Relevant clinical questions were how to identify high-risk individuals warranting genetic testing, when to start screening examinations, what are appropriate surveillance intervals, how to identify endoscopically high-risk features, and what is the role of chemoprevention. A systematic literature search from 2005 to 2018 was performed, in addition to the inclusion of seminal historical studies. Most studies were from worldwide registries, which have compiled years of data regarding the natural history and cancer risks in this cohort. Given that most studies were retrospective, recommendations were based on epidemiologic data and expert opinion. Management of colorectal polyps in FAP has not changed much in recent years, as colectomy in FAP is the standard of care. What is new, however, is the developing body of literature on the role of endoscopy in managing upper GI and small-bowel polyposis, as patients are living longer and improved endoscopic technologies have emerged.
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http://dx.doi.org/10.1016/j.gie.2020.01.028DOI Listing
May 2020

ASGE guideline on minimum staffing requirements for the performance of GI endoscopy.

Gastrointest Endosc 2020 04 6;91(4):723-729.e17. Epub 2020 Feb 6.

Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.

Efforts to increase patient safety and satisfaction, a critical concern for health providers, require periodic evaluation of all factors involved in the provision of GI endoscopy services. We aimed to develop guidelines on minimum staffing requirements and scope of practice of available staff for the safe and efficient performance of GI endoscopy. The recommendations in this guideline were based on a systematic review of published literature, results from a nationwide survey of endoscopy directors, along with the expert guidance of the American Society for Gastrointestinal Endoscopy (ASGE) Standards of Practice Committee members, ASGE Practice Operation Committee members, and the ASGE Governing Board.
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http://dx.doi.org/10.1016/j.gie.2019.12.002DOI Listing
April 2020

ASGE guideline on the management of achalasia.

Gastrointest Endosc 2020 02 13;91(2):213-227.e6. Epub 2019 Dec 13.

Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.

Achalasia is a primary esophageal motor disorder of unknown etiology characterized by degeneration of the myenteric plexus, which results in impaired relaxation of the esophagogastric junction (EGJ), along with the loss of organized peristalsis in the esophageal body. The criterion standard for diagnosing achalasia is high-resolution esophageal manometry showing incomplete relaxation of the EGJ coupled with the absence of organized peristalsis. Three achalasia subtypes have been defined based on high-resolution manometry findings in the esophageal body. Treatment of patients with achalasia has evolved in recent years with the introduction of peroral endoscopic myotomy. Other treatment options include botulinum toxin injection, pneumatic dilation, and Heller myotomy. This American Society for Gastrointestinal Endoscopy Standards of Practice Guideline provides evidence-based recommendations for the treatment of achalasia, based on an updated assessment of the individual and comparative effectiveness, adverse effects, and cost of the 4 aforementioned achalasia therapies.
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http://dx.doi.org/10.1016/j.gie.2019.04.231DOI Listing
February 2020

American Society for Gastrointestinal Endoscopy guideline on the role of endoscopy in the management of acute colonic pseudo-obstruction and colonic volvulus.

Gastrointest Endosc 2020 02 30;91(2):228-235. Epub 2019 Nov 30.

Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA.

Colonic volvulus and acute colonic pseudo-obstruction (ACPO) are 2 causes of benign large-bowel obstruction. Colonic volvulus occurs most commonly in the sigmoid colon as a result of bowel twisting along its mesenteric axis. In contrast, the exact pathophysiology of ACPO is poorly understood, with the prevailing hypothesis being altered regulation of colonic function by the autonomic nervous system resulting in colonic distention in the absence of mechanical blockage. Prompt diagnosis and intervention leads to improved outcomes for both diagnoses. Endoscopy may play a role in the evaluation and management of both entities. The purpose of this document from the American Society for Gastrointestinal Endoscopy's Standards of Practice Committee is to provide an update on the evaluation and endoscopic management of sigmoid volvulus and ACPO.
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http://dx.doi.org/10.1016/j.gie.2019.09.007DOI Listing
February 2020

ASGE review of adverse events in colonoscopy.

Gastrointest Endosc 2019 12 25;90(6):863-876.e33. Epub 2019 Sep 25.

Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA.

Colonoscopy is the most commonly performed endoscopic procedure and overall is considered a low-risk procedure. However, adverse events (AEs) related to this routinely performed procedure for screening, diagnostic, or therapeutic purposes are an important clinical consideration. The purpose of this document from the American Society for Gastrointestinal Endoscopy's Standards of Practice Committee is to provide an update on estimates of AEs related to colonoscopy in an evidence-based fashion. A systematic review and meta-analysis of population-based studies was conducted for the 3 most common and important serious AEs (bleeding, perforation, and mortality). In addition, this document includes an updated systematic review and meta-analysis of serious AEs (bleeding and perforation) related to EMR and endoscopic submucosal dissection for large colon polyps. Finally, a narrative review of other colonoscopy-related serious AEs and those related to specific colonic interventions is included.
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http://dx.doi.org/10.1016/j.gie.2019.07.033DOI Listing
December 2019

ASGE guideline on the role of endoscopy for bleeding from chronic radiation proctopathy.

Gastrointest Endosc 2019 08 22;90(2):171-182.e1. Epub 2019 Jun 22.

Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA.

Chronic radiation proctopathy is a common sequela of radiation therapy for malignancies in the pelvic region. A variety of medical and endoscopic therapies have been used for the management of bleeding from chronic radiation proctopathy. In this guideline, we reviewed the results of a systematic search of the literature from 1946 to 2017 to formulate clinical questions and recommendations on the role of endoscopy for bleeding from chronic radiation proctopathy. The following endoscopic modalities are discussed in our document: argon plasma coagulation, bipolar electrocoagulation, heater probe, radiofrequency ablation, and cryoablation. Most studies were small observational studies, and the evidence for effectiveness of endoscopic therapy for chronic radiation proctopathy was limited because of a lack of controlled trials and comparative studies. Despite this limitation, our systematic review found that argon plasma coagulation, bipolar electrocoagulation, heater probe, and radiofrequency ablation were effective in the treatment of rectal bleeding from chronic radiation proctopathy.
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http://dx.doi.org/10.1016/j.gie.2019.04.234DOI Listing
August 2019

Systematic review and meta-analysis of prevalence and risk factors for Barrett's esophagus.

Gastrointest Endosc 2019 11 29;90(5):707-717.e1. Epub 2019 May 29.

Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.

Background And Aims: Although screening for Barrett's esophagus (BE) is recommended in individuals with multiple risk factors, the type and number of risk factors necessary to trigger screening is unclear. In this systematic review and meta-analysis, we aimed to assess the relationship between number of risk factors and prevalence of BE.

Methods: Through October 17, 2018 we searched studies that described the prevalence of BE in the general population and based on presence of risk factors that included GERD, male gender, age >50 years, family history of BE and esophageal adenocarcinoma, and obesity (defined as body mass index >35). Risk of BE based on number of risk factors was assessed using meta-regression while controlling for potential confounders.

Results: Of 2741 studies, 49 were included in the analysis (307,273 individuals, 1948 with biopsy specimen-proven BE). Indications varied by study. The prevalence of BE for various populations was as follows: low-risk general population, .8% (95% confidence interval [CI], .6%-1.1%); GERD, 3% (95% CI, 2.3%-4%); GERD plus presence of any other risk factor, 12.2% (95% CI, 10.2%-14.6%); family history, 23.4% (95% CI, 13.7% -37.2%); age >50, 6.1% (95% CI, 4.6%-8.1%); obesity, 1.9% (95% CI, 1.2%-3%); and male sex, 6.8% (95% CI, 5.3%-8.6%). Prevalence of BE varied significantly between Western and non-Western populations. In a meta-regression, controlling for the region of the study, age, and gender, there was a positive linear relationship between the number of risk factors and the prevalence of BE.

Conclusions: Results of this study provide estimates of BE prevalence based on the presence and the number of risk factors. These results add credence to current guidelines that suggest screening in the presence of multiple risk factors.
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http://dx.doi.org/10.1016/j.gie.2019.05.030DOI Listing
November 2019

ASGE guideline on the role of endoscopy in the evaluation and management of choledocholithiasis.

Gastrointest Endosc 2019 06 9;89(6):1075-1105.e15. Epub 2019 Apr 9.

Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA. Electronic address:

Each year choledocholithiasis results in biliary obstruction, cholangitis, and pancreatitis in a significant number of patients. The primary treatment, ERCP, is minimally invasive but associated with adverse events in 6% to 15%. This American Society for Gastrointestinal Endoscopy (ASGE) Standard of Practice (SOP) Guideline provides evidence-based recommendations for the endoscopic evaluation and treatment of choledocholithiasis. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework was used to rigorously review and synthesize the contemporary literature regarding the following topics: EUS versus MRCP for diagnosis, the role of early ERCP in gallstone pancreatitis, endoscopic papillary dilation after sphincterotomy versus sphincterotomy alone for large bile duct stones, and impact of ERCP-guided intraductal therapy for large and difficult choledocholithiasis. Comprehensive systematic reviews were also performed to assess the following: same-admission cholecystectomy for gallstone pancreatitis, clinical predictors of choledocholithiasis, optimal timing of ERCP vis-à-vis cholecystectomy, management of Mirizzi syndrome and hepatolithiasis, and biliary stent therapy for choledocholithiasis. Core clinical questions were derived using an iterative process by the ASGE SOP Committee. This body developed all recommendations founded on the certainty of the evidence, balance of risks and harms, consideration of stakeholder preferences, resource utilization, and cost-effectiveness.
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http://dx.doi.org/10.1016/j.gie.2018.10.001DOI Listing
June 2019

Efficacy and feasibility of G-POEM in management of patients with refractory gastroparesis: a systematic review and meta-analysis.

Endosc Int Open 2019 Mar 28;7(3):E322-E329. Epub 2019 Feb 28.

Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, United States.

 Clinical management of patients with gastroparesis is challenging. Prior pyloric targeted procedures are either invasive or have questionable long-term efficacy. Gastric per-oral endoscopic myotomy (G-POEM) has been recently introduced as a minimally invasive approach. In this review, we performed a meta-analysis to evaluate the feasibility and efficacy of this technique in the management of patients with refractory gastroparesis.  PubMed, Embase, and Scopus databases were searched to identify relevant studies published through May 2018. Weighted pool rates (WPR) of the clinical resolution were calculated. Pooled values of Gastroparesis Cardinal Symptom Index (GCSI) before and after the procedure were compared. Pooled difference in means comparing gastric emptying before and after the procedure was calculated. Fixed or random effect model was used according to the level of heterogeneity.  Seven studies with 196 patients were included in the meta-analysis. The mean value of procedure duration was 69.7 (95 % confidence interval [95 % CI]: 39 - 99 minutes) and average estimate of hospital stay was 1.96 (95 % CI: 1.22 - 2.95) days. The WPR for clinical success was 82 % (95 % CI: 74 % - 87 %, I  = 0). Compared with pre-procedure GCSI values, mean values of GCSI were reduced significantly at 5 days (-1.57 (95 % CI:-2.2,-0.9), I  = 80 %) (  < 0.001). Mean values of gastric emptying were significantly decreased 2 - 3 months after the procedure (-22.3 (95 %CI: -32.9, - 11.6), I  = 67 %) (  < 0.05).  Due to the high rate of clinical success and low rate of adverse events, G-POEM should be considered in management of refractory gastroparesis.
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http://dx.doi.org/10.1055/a-0812-1458DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6400657PMC
March 2019

Wide-Area Transepithelial Sampling in Barrett's Esophagus: Ready for Primetime?

Gastroenterology 2018 Oct 11;155(4):1267-1269. Epub 2018 Sep 11.

University of Colorado Anschutz Medical Campus, Aurora, Colorado.

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http://dx.doi.org/10.1053/j.gastro.2018.09.019DOI Listing
October 2018

A Survey of Expert Practice and Attitudes Regarding Advanced Imaging Modalities in Surveillance of Barrett's Esophagus.

Dig Dis Sci 2018 12 3;63(12):3262-3271. Epub 2018 Sep 3.

University of Colorado Anschutz Medical Center, Mail Stop F735, 1635 Aurora Court, Rm 2.031, Aurora, CO, 80045, USA.

Background: Published guidelines do not address what the minimum incremental diagnostic yield (IDY) for detection of dysplasia/cancer is required over the standard Seattle protocol for an advanced imaging modality (AIM) to be implemented in routine surveillance of Barrett's esophagus (BE) patients. We aimed to report expert practice patterns and attitudes, specifically addressing the minimum IDY in the use of AIMs in BE surveillance.

Methods: An international group of BE experts completed an anonymous electronic survey of domains relevant to surveillance practice patterns and use of AIMs. The evaluated AIMs were conventional chromoendoscopy (CC), virtual chromoendoscopy (VC), volumetric laser endomicroscopy (VLE), confocal laser endomicroscopy (CLE), and wide-area transepithelial sampling (WATS). Responses were recorded using five-point balanced Likert items and analyzed as continuous variables.

Results: The survey response rate was 84% (61/73)-41 US and 20 non-US. Experts were most comfortable with and routinely use VC and CC, and least comfortable with and rarely use VLE, CLE, and WATS. Experts rated data from randomized controlled trials (1.4 ± 0.9) and guidelines (2.6 ± 1.2) as the two most influential factors for implementing AIMs in clinical practice. The minimum IDY of AIMs over standard biopsies to be considered of clinical benefit was lowest for VC (15%, IQR 10-29%) and highest for VLE (30%, IQR 20-50%). Compared to US experts, non-US experts reported higher use of CC for BE surveillance (p < 0.001).

Conclusion: These results should inform benchmarks that need to be met for guidelines to recommend the routine use of AIMs in the surveillance of BE patients.
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http://dx.doi.org/10.1007/s10620-018-5257-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6541486PMC
December 2018

High rate of over-staging of Barrett's neoplasia with endoscopic ultrasound: Systemic review and meta-analysis.

Dig Liver Dis 2018 May 1;50(5):438-445. Epub 2018 Mar 1.

Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, United States.

Background: The use of endoscopic ultrasound (EUS) to stage patients with Barrett's esophagus (BE) with suspected neoplasia is controversial due to high rates of over-staging. However, this rate of over-staging has not been adequately investigated or quantified.

Aim: To determine the rate of over-staging related EUS in this population.

Methods: Search included Medline, Embase, Web of Science, and Cochrane Central ending on 9/30/2016. The primary effect-estimate of interest was the false positive rate of advanced disease on EUS at the tumor level (T1a vs. T1b). Secondary outcomes included false detection rate, false negative rate, accuracy, sensitivity, and specificity. Study heterogeneity was assessed using the I2 and Cochrane's Q.

Results: Of 1872 studies, 11 met our inclusion criteria totaling 895 patients. Based on random effects models, the pooled FPR for advanced disease was 9.1% ([6.5-12.5%], p<0.001). Tests of heterogeneity showed no significant heterogeneity for this outcome. The pooled false negative rate was 9.2% [95%CI: 4.7-17.3%], p<0.01. Overall, the pooled accuracy of EUS results in BE neoplasia patients was low at 74.6% [58.7-85.8%], p=0.004.

Conclusions: The use of EUS in BE patients with dysplasia and early neoplasia results in a large proportion of patients falsely over-staged and under-staged.
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http://dx.doi.org/10.1016/j.dld.2018.02.005DOI Listing
May 2018

Association Between Endoscopist and Center Endoscopic Retrograde Cholangiopancreatography Volume With Procedure Success and Adverse Outcomes: A Systematic Review and Meta-analysis.

Clin Gastroenterol Hepatol 2017 Dec 10;15(12):1866-1875.e3. Epub 2017 Jun 10.

Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado.

Background & Aims: Endoscopic retrograde cholangiopancreatography (ERCP) has become a predominantly therapeutic intervention with a resultant increase in complexity. The relationship between ERCP volume and outcomes is unclear. We aimed to conduct a systematic review and meta-analysis assessing the relationship between endoscopist and center ERCP volume with ERCP success and adverse event (AE) rates.

Methods: A comprehensive search of MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials was conducted from inception to January 2017. Studies providing outcomes stratified by endoscopist and/or center volume were included in the final analysis. Endoscopist/center volume was stratified as low volume (LV) and high volume (HV). The definition of ERCP success varied between studies. The overall AE rate was a composite rate including pancreatitis, perforation, and bleeding.

Results: A literature search resulted in 1264 citations. Of those, 13 articles (n = 59,437 ERCPs) met inclusion criteria. LV endoscopist (<25 to <156 annual ERCPs) and center (<87 to <200 annual ERCPs) definitions varied between studies. HV endoscopists were significantly more likely to achieve ERCP success compared with LV endoscopists (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.2-2.1). HV centers were significantly more likely to achieve ERCP success (OR, 2; 95% CI, 1.6-2.5). The post-ERCP AE risk was lower for HV endoscopists (OR, 0.7; 95% CI, 0.5-0.8) but not HV centers (OR, 0.7; 95% CI, 0.3-1.5).

Conclusions: This study identifies a significant relationship between increasing endoscopist and center ERCP volume with overall procedure success. Increasing endoscopist volume also was associated with a decreased AE rate. Given these compelling findings, we propose that providers and payers consider consolidating ERCP to HV endoscopists to improve ERCP outcomes and value.
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http://dx.doi.org/10.1016/j.cgh.2017.06.002DOI Listing
December 2017

The Role of Endoscopic Ultrasound in the Management of Patients with Barrett's Esophagus and Superficial Neoplasia.

Gastrointest Endosc Clin N Am 2017 Jul;27(3):471-480

Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA. Electronic address:

Endoscopic ultrasound (EUS) is a minimally invasive advanced imaging procedure using high-frequency sound waves to produce detailed images of the esophageal wall with fine-needle aspiration to biopsy adjacent lymph nodes. The role of EUS is well established in patients with locally advanced Barrett esophagus neoplasia. The utility of EUS in the evaluation of Barrett esophagus patients is controversial. This is a review of the evidence using EUS in BE patients. The assessment is that EUS may be a powerful tool in managing patients with BE neoplasia.
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http://dx.doi.org/10.1016/j.giec.2017.03.001DOI Listing
July 2017
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