Publications by authors named "Christopher C Thompson"

312 Publications

Endoscopic revision of gastric bypass using plication technique: an adjustable approach.

VideoGIE 2021 Jul 28;6(7):311-315. Epub 2021 May 28.

Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.

Video 1This video case presentation highlights a 65-year-old woman with weight regain after Roux-en-Y gastric bypass and a dilated gastrojejunal anastomosis who presented for endoscopic revision of her gastric bypass involving a plication technique, followed by gastrojejunal anastomosis stenosis dilation.
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http://dx.doi.org/10.1016/j.vgie.2021.04.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8270786PMC
July 2021

Endoscopic management of acute leak after sleeve gastrectomy: principles and techniques.

Endoscopy 2021 Jul 9. Epub 2021 Jul 9.

Gastrointestinal Endoscopy Unit, Gastroenterology Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil.

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http://dx.doi.org/10.1055/a-1525-1661DOI Listing
July 2021

Endoscopic gallbladder drainage for symptomatic gallbladder disease: a cumulative systematic review meta-analysis.

Surg Endosc 2021 Jul 6. Epub 2021 Jul 6.

Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.

Background: Endoscopic ultrasound (EUS)-guided transmural or endoscopic retrograde cholangiography (ERC)-based transpapillary drainage may provide alternative treatment strategies for high-risk surgical candidates with symptomatic gallbladder (GB) disease. The primary aim of this study was to perform a systematic review and meta-analysis to investigate the efficacy and safety of endoscopic GB drainage for patients with symptomatic GB disease.

Methods: Searches of PubMed, EMBASE, Web of Science, and Cochrane Library databases were performed in accordance with PRISMA and MOOSE guidelines. Pooled proportions were calculated for measured outcomes including technical success, clinical success, adverse event rate, recurrence rate, and rate of reintervention. Subgroup analyses were performed for transmural versus transpapillary, transmural lumen apposing stent (LAMS), and comparison to percutaneous transhepatic drainage. Heterogeneity was assessed with I statistics. Publication bias was ascertained by funnel plot and Egger regression testing.

Results: Thirty-six studies (n = 1538) were included. Overall, endoscopic GB drainage achieved a technical and clinical success of 87.33% [(95% CI 84.42-89.77); I = 39.55] and 84.16% [(95% CI 80.30-87.38); I = 52.61], with an adverse event rate of 11.00% [(95% CI 9.25-13.03); I = 7.08]. On subgroup analyses, EUS-guided transmural compared to ERC-assisted transpapillary drainage resulted in higher technical and clinical success rates [OR 3.91 (95% CI 1.52-10.09); P = 0.005 and OR 4.59 (95% CI 1.84-11.46); P = 0.001] and lower recurrence rate [OR 0.17 (95% CI 0.06-0.52); P = 0.002]. Among EUS-guided LAMS studies, technical success was 94.65% [(95% CI 91.54-96.67); I = 0.00], clinical success was 92.06% [(95% CI 88.65-94.51); I = 0.00], and adverse event rate was 11.71% [(95% CI 8.92-15.23); I = 0.00]. Compared to percutaneous drainage, EUS-guided drainage possessed a similar efficacy and safety with significantly lower rate of reintervention [OR 0.05 (95% CI 0.02-0.13); P < 0.001].

Discussion: Endoscopic GB drainage is a safe and effective treatment for high-risk surgical candidates with symptomatic GB disease. EUS-guided transmural drainage is superior to transpapillary drainage and associated with a lower rate of reintervention compared to percutaneous transhepatic drainage.
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http://dx.doi.org/10.1007/s00464-020-07758-3DOI Listing
July 2021

Reply.

Clin Gastroenterol Hepatol 2021 Jun 26. Epub 2021 Jun 26.

Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts.

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http://dx.doi.org/10.1016/j.cgh.2021.06.022DOI Listing
June 2021

Sutureless Duodeno-Ileal Anastomosis with Self-Assembling Magnets: Safety and Feasibility of a Novel Metabolic Procedure.

Obes Surg 2021 Jun 28. Epub 2021 Jun 28.

Department of Surgery, Hospital Alemán of Buenos Aires, Av. Pueyrredón 1640 (ATT 1118), Buenos Aires, Argentina.

Background: Less invasive and safer anastomotic techniques are desirable. We aimed to determine technical feasibility and safety of sutureless duodeno-ileal side-to-side anastomosis in obese patients using self-assembling magnets.

Methods: This was an open-label, prospective, and single-arm study including obese patients (BMI 30-50 kg/m) with type II diabetes. The ileal magnet was deployed laparoscopically, and the duodenal magnet was deployed endoscopically. Both magnets were coupled under laparoscopic and fluoroscopic guidance. The primary endpoints were technical feasibility and safety. The secondary endpoints were patency of the anastomosis, HbA1c reduction, and weight loss 12 months after the procedure.

Results: A total of 8 patients were enrolled in the study; median age was 51.5 years (range: 34-65), and median BMI was 38.8 kg/m (range: 35-47.9). The mean procedural duration was 63.5 min (range: 41-95). No intraoperative complications were recorded, and no major postoperative morbidity related to the procedure occurred. Magnets were expelled at a median of 29.5 days after the procedure with no associated complications. Upper endoscopy at 12 months confirmed patent anastomoses with healthy-appearing mucosa in all patients. HbA1c reduced below 7.0% in 6 out of 8 (75%) patients, and greater than 5% of total body weight loss was observed in 7 out of 8 (87.5%) patients at 12 months.

Conclusions: Sutureless duodeno-ileal side-to-side anastomosis using self-assembling magnets is feasible and safe in obese patients, and a dual-path enteral diversion with large-caliber and durable anastomosis can be achieved.
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http://dx.doi.org/10.1007/s11695-021-05554-zDOI Listing
June 2021

Thirty-Day Readmission After Bariatric Surgery: Causes, Effects on Outcomes, and Predictors.

Dig Dis Sci 2021 Jun 24. Epub 2021 Jun 24.

Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.

Background: Bariatric surgery (BSx) is one of the most common surgical procedures in North America. Readmissions may be associated with a high burden to the healthcare system.

Methods: Retrospective study of the 2016 National Readmission Database of adult patients readmitted within 30 days after an index admission for BSx. Outcomes were: 30-day readmission rate, mortality, healthcare-related utilization resources, and independent predictors of readmission. Comparison groups were index admission, readmitted, and non-readmitted patients.

Results: A total of 161,141 patients underwent BSx. The 30-day readmission rate was 3.3%. Main causes for readmission were dehydration, acute kidney injury, venous thromboembolism events, and sepsis. Readmitted patients were more likely to develop shock (0.5% vs. 0.1%; P < 0.01) with no differences in mechanical ventilation (1.9% vs. 2.0%; P = 0.83) during index admission compared to non-readmitted patients. Readmission was associated with higher in-hospital mortality rate (1.5% vs. 0.1%; P < 0.01) and prolonged length of stay (4.6 vs. 2.4 days; P < 0.01). The total in-hospital economic burden of readmission was $234 million in total charges and $58.7 million in total costs. Independent predictors of readmission were: Charlson comorbidity index of ≥ 3, longer length of stay, admission to larger bed size hospitals, discharge to nursing home, and acute kidney injury. Medicaid, private insurance, BMI of 30-39 kg/m, and 40-44 kg/m were associated with lower odds for readmission.

Conclusion: Readmissions after BSx are associated with higher in-hospital mortality rate and pose a high healthcare burden. We identified risk factors that can be targeted to decrease readmissions after BSx, healthcare burden, and patient morbidity and mortality.
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http://dx.doi.org/10.1007/s10620-021-06934-2DOI Listing
June 2021

Emerging therapies in translational endoscopy: new frontiers in endoscopic submucosal dissection.

VideoGIE 2021 Jun 25;6(6):246-249. Epub 2021 Mar 25.

Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts.

Video 1New frontiers in endoscopic submucosal dissection.
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http://dx.doi.org/10.1016/j.vgie.2021.02.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8187128PMC
June 2021

Endoscopic versus surgical gastrojejunal revision for weight regain in Roux-en-Y gastric bypass patients: 5-year safety and efficacy comparison.

Gastrointest Endosc 2021 Jun 11. Epub 2021 Jun 11.

Division of Gastroenterology, Hepatology and Endoscopy. Brigham and Women's Hospital. Harvard Medical School. Boston, MA. Electronic address:

Background And Aims: An enlarged gastrojejunal anastomosis (GJA) is associated with weight regain after Roux-en-Y (RYGB) and can be corrected with endoscopic (ENDO) or surgical (SURG) revision; however, there has been no direct comparison between techniques. This study aims to compare serious adverse event (SAE) rates and weight loss profiles between ENDO and SURG revisional techniques over a 5-year period.

Methods: Retrospective matched cohort study of RYGB patients who underwent ENDO or SURG revision for weight regain with an enlarged GJA (>12 mm). ENDO patients were matched 1:1 to SURG patients based on completion of 5-year follow-up, age, sex, body mass index (BMI), initial weight loss, and weight regain. Demographics, GJA size, SAEs, and weight profiles were collected. The primary outcome was comparison of SAE rates between groups. Secondary outcomes included weight loss comparisons. A Fisher exact test was used to compare the SAE rate, and a Student t-test was used for weight comparisons.

Results: Sixty-two RYGB patients with weight regain and an enlarged GJA (31 ENDO, 31 matched SURG) were included. Baseline characteristics were similar between groups. The adverse event rate in the ENDO group (6.5%) was lower than the SURG group (29.0%); p=0.043. There was a total of 0 (0%) and 6 (19.4%) serious (severe) adverse events in the ENDO and SURG groups, respectively (p=0.02). There was no significant difference in weight loss at 1, 3, and 5 years.

Conclusions: Endoscopic revision of the gastrojejunal anastomosis is associated with significantly fewer total and severe adverse events and similar long-term weight loss when compared with surgical revision.
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http://dx.doi.org/10.1016/j.gie.2021.06.009DOI Listing
June 2021

Safety and sedation-associated adverse event reporting among patients undergoing endoscopic cholangiopancreatography: a comparative systematic review and meta-analysis.

Surg Endosc 2021 May 8. Epub 2021 May 8.

Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.

Background And Aim: There is wide variation in choice of sedation and airway management for endoscopic retrograde cholangiopancreatography (ERCP). The aim of this study was to perform a systematic review and meta-analysis to investigate safety outcomes of deep sedation with monitored anesthesia care (MAC) versus general endotracheal anesthesia (GETA).

Methods: Individualized search strategies were performed in accordance with PRISMA and MOOSE guidelines. This meta-analysis was performed by calculating pooled proportions using random effects models. Measured outcomes included procedure success, all-cause and anesthesia-associated adverse events, and post-procedure recovery time. Heterogeneity was assessed with I statistics and publication bias by funnel plot and Egger regression testing.

Results: Five studies (MAC: n = 1284 vs GETA: n = 615) were included. Patients in the GETA group were younger, had higher body mass index (BMI), and higher mean ASA scores (all P < 0.001) with no difference in Mallampati scores (P = 0.923). Procedure success, all-cause adverse events, and anesthesia-associated events were similar between groups [OR 1.16 (95% CI 0.51-2.64); OR 1.16 (95% CI 0.29-4.70); OR 1.33 (95% CI 0.27-6.49), respectively]. MAC resulted in fewer hypotensive episodes [OR 0.32 (95% CI 0.12-0.87], increased hypoxemic events [OR 5.61 (95% CI 1.54-20.37)], and no difference in cardiac arrhythmias [OR 0.48 (95% CI 0.13-1.78)]. Procedure time was decreased for MAC [standard difference - 0.39 (95% CI - 0.78-0.00)] with no difference in recovery time [standard difference - 0.48 (95% CI - 1.04-0.07)].

Conclusions: This study suggests MAC may be a safe alternative to GETA for ERCP; however, MAC may not be appropriate in all patients given an increased risk of hypoxemia.
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http://dx.doi.org/10.1007/s00464-020-08210-2DOI Listing
May 2021

How to Incorporate Bariatric Training Into Your Fellowship Program.

Gastroenterology 2021 Jul 19;161(1):15-20. Epub 2021 Apr 19.

Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts. Electronic address:

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http://dx.doi.org/10.1053/j.gastro.2021.04.030DOI Listing
July 2021

Endoscopic gastric plication for the treatment of GERD and underlying class I obesity.

VideoGIE 2021 Feb 24;6(2):74-76. Epub 2020 Nov 24.

Brigham and Women's Hospital, Boston, Massachusettes.

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http://dx.doi.org/10.1016/j.vgie.2020.10.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7859485PMC
February 2021

Obesity Primer for the Practicing Gastroenterologist.

Am J Gastroenterol 2021 05;116(5):918-934

Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA.

With worsening of the obesity pandemic, gastroenterologists will see more patients with this chronic disease. Given the association between obesity and several gastrointestinal conditions and the interplay between obesity pathophysiology and gut hormones, gastroenterologists can play an important role in the management of this disease. Furthermore, because more patients undergo bariatric surgery, an understanding of postsurgical anatomy and medical and endoscopic management of bariatric surgical complications is essential. This article provides clinical tools for the assessment and management of obesity for the general gastroenterologist. Tables containing high-yield practical information are also provided for quick reference.
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http://dx.doi.org/10.14309/ajg.0000000000001200DOI Listing
May 2021

AGA Clinical Practice Update on the Optimal Management of the Malignant Alimentary Tract Obstruction: Expert Review.

Clin Gastroenterol Hepatol 2021 Apr 1. Epub 2021 Apr 1.

Department of Medicine, Case Western Reserve University, and University Hospitals, Cleveland Medical Center, Cleveland, Ohio.

Background & Aims: The purpose of this expert review is to describe the current methodologies available to manage malignant alimentary tract obstructions as well the evidence behind the various methods (including their efficacy and safety), indications, and appropriate timing of interventions.

Methods: This is not a formal systematic review but is based on a review of the literature to provide best practice advice statements. No formal rating of the quality of evidence or strength of recommendation is carried out. BEST PRACTICE ADVICE 1: For all patients with alimentary tract obstruction, the decision about specific interventions should be made in a multidisciplinary setting including oncologists, surgeons, and endoscopists and take into account the characteristics of the obstruction, patient's expectations, prognosis, expected subsequent therapies, and functional status. BEST PRACTICE ADVICE 2: For patients who present with esophageal obstruction from esophageal cancer and who are potential candidates for resection or chemoradiation, clinicians should not routinely insert a self-expanding metal stent (SEMS) without multidisciplinary review because of high rates of stent migration, higher morbidity and mortality, and potentially lower R0 (microscopically negative margins) resection rates. BEST PRACTICE ADVICE 3: For patients who present with esophageal obstruction from esophageal cancer who are potential candidates for resection and who have concerns of malnutrition, clinicians may consider the use of enteral feeding tubes (via nasogastric or percutaneous route). Clinicians should be aware of the potential risk of abdominal wall tumor seeding as well as making subsequent gastric conduit formation difficult with percutaneous endoscopic gastrostomy placement. BEST PRACTICE ADVICE 4: For patients who present with esophageal obstruction from esophageal cancer who are not candidates for resection, clinicians should consider either SEMS insertion or brachytherapy as sole therapy or in combination. Clinicians should not consider the use of laser therapy or photodynamic therapy because of the lack of evidence of better outcomes and superior alternatives. BEST PRACTICE ADVICE 5: For patients with malignant esophageal obstruction who are undergoing SEMS placement, clinicians should use a fully covered or partially covered SEMS and not an uncovered SEMS, with consideration of a stent-anchoring/fixation method. BEST PRACTICE ADVICE 6: For patients with gastric outlet obstruction who have a life expectancy greater than 2 months, have good functional status, and who are surgically fit, surgical gastrojejunostomy should be considered. BEST PRACTICE ADVICE 7: For patients with gastric outlet obstruction who are undergoing surgical gastrojejunostomy, a laparoscopic approach is favored over an open approach because of lower blood loss and shorter hospital stay. BEST PRACTICE ADVICE 8: For patients with gastric outlet obstruction who are not candidates for gastrojejunostomy (surgical or endoscopic ultrasound-guided), clinicians should consider the insertion of an enteral stent. BEST PRACTICE ADVICE 9: Enteral stents should not be used in patients with multiple luminal obstructions or severely impaired gastric motility because of the limited benefit in these scenarios. Clinicians can consider placement of a venting gastrostomy in these patients. BEST PRACTICE ADVICE 10: Depending on the experience of the endoscopist, endoscopic ultrasound-guided gastrojejunostomy is an acceptable alternative to surgical gastrojejunostomy and enteral stent placement. Clinicians should be aware that there are currently no dedicated Food and Drug Administration-approved devices for endoscopic ultrasound-guided gastrojejunostomy. BEST PRACTICE ADVICE 11: For patients with malignant colonic obstruction who are candidates for resection, insertion of SEMS is a reasonable choice as a "bridge to surgery" to allow for one-stage, elective resection. BEST PRACTICE ADVICE 12: For patients with malignant colonic obstruction who are not candidates for resection, either SEMS placement or a diverting colostomy are reasonable choices depending on the patient's goals and functional status. BEST PRACTICE ADVICE 13: SEMS is a reasonable option for patients with proximal (or right-sided) malignant obstructions, both as a "bridge to surgery" and in the palliative setting. BEST PRACTICE ADVICE 14: SEMS placement is a reasonable alternative for patients with extracolonic malignancy who are not candidates for surgery, although their placement is more technically challenging, clinical success rates are more variable, and complications (including stent migration) are more frequent.
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http://dx.doi.org/10.1016/j.cgh.2021.03.046DOI Listing
April 2021

Trends and Socioeconomic Health Outcomes of Cannabis Use Among Patients With Gastroparesis: A United States Nationwide Inpatient Sample Analysis.

J Clin Gastroenterol 2021 Mar 12. Epub 2021 Mar 12.

*Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA †Yale University School of Medicine, New Haven, CT.

Background: Although cannabis may worsen nausea and vomiting for patients with gastroparesis, it may also be an effective treatment for gastroparesis-related abdominal pain. Given conflicting data and a lack of current epidemiological evidence, we aimed to investigate the association of cannabis use on relevant clinical outcomes among hospitalized patients with gastroparesis.

Materials And Methods: Patients with a diagnosis of gastroparesis were reviewed from the National Inpatient Sample (NIS) database between 2008 and 2014. Gastroparesis was identified by International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes with patients classified based on a diagnosis of cannabis use disorder. Demographics, comorbidities, socioeconomic status, and outcomes were compared between cohorts using χ and analysis of variance. Logistic regression was then performed and annual trends also evaluated.

Results: A total of 1,473,363 patients with gastroparesis were analyzed [n=33,085 (2.25%) of patients with concomitant cannabis use disorder]. Patients with gastroparesis and cannabis use disorder were more likely to be younger and male gender compared with nonusers (36.7±18.8 vs. 51.9±16.8; P<0.001 and 52.9% vs. 33.5%; P<0.001, respectively). Race/ethnicity was different between groups (P<0.001). Cannabis users had a lower median household income and were more likely to have Medicaid payor status (all P<0.001). Controlling for confounders, length of stay, and mortality were significantly decreased for patients with gastroparesis and cannabis use (all P<0.001).

Conclusion: While patients with gastroparesis and cannabis use disorder were younger, with a lower socioeconomic status, and disproportionately affected by psychiatric diagnoses, these patients had better hospitalization outcomes, including decreased length of stay and improved in-hospital mortality.
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http://dx.doi.org/10.1097/MCG.0000000000001526DOI Listing
March 2021

Effect of Endoscopic Bariatric and Metabolic Therapies on Nonalcoholic Fatty Liver Disease: A Systematic Review and Meta-analysis.

Clin Gastroenterol Hepatol 2021 Mar 13. Epub 2021 Mar 13.

Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts. Electronic address:

Background & Aims: Weight loss via lifestyle intervention remains the mainstay of treatment for nonalcoholic fatty liver disease (NAFLD). Endoscopic bariatric and metabolic therapies (EBMTs) have recently been developed as an alternative treatment option for obesity. This study aimed to assess the effect of FDA-approved EBMTs on NAFLD.

Methods: We searched MEDLINE, EMBASE, Web of Science and Cochrane Central through December 2020 for studies that assessed changes in liver outcomes following EBMT. Primary Outcomes: Liver fibrosis.

Secondary Outcomes: Liver biochemistry, steatosis, NAFLD histological changes and insulin sensitivity. The Grading of Recommendations, Assessment, Development, and Evidence (GRADE) approach was conducted to assess quality of evidence.

Results: Of 4,994 potential studies, 18 studies with 863 patients were included. Average weight loss was 14.5% of initial weight at a 6 month follow-up. Primary Outcomes: Following EBMT, liver fibrosis significantly reduced by standardized mean difference (SMD) of 0.7 [95% CI, 0.1,1.3] (p = .02).

Secondary Outcomes: There were significant improvements in other NAFLD surrogates including alanine aminotransferase (-9.0 U/L; 95% CI, -11.6,-6.4; p < .0001), hepatic steatosis (SMD: -1.0; 95% CI, -1.2,-0.8, p < .0001) and histologic NAFLD activity score (-2.50; 95% CI, -3.5,-1.5; p < .0001). Other metabolic parameters including insulin resistance and waist circumference also significantly improved. The overall quality of the evidence for primary outcomes was low to very low.

Conclusions: EBMTs appear effective at treating NAFLD with significant improvement in liver fibrosis. Given the worsening NAFLD pandemic and limitations of currently available therapies, EBMTs should be further investigated as a potential treatment option for this patient population.
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http://dx.doi.org/10.1016/j.cgh.2021.03.017DOI Listing
March 2021

Gender disparities in advanced endoscopy fellowship.

Endosc Int Open 2021 Mar 18;9(3):E338-E342. Epub 2021 Feb 18.

Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, United States.

Women remain underrepresented in gastroenterology, especially advanced endoscopy. Women represent 30 % of general gastroenterology fellows; yet in 2019, only 12.8 % of fellows who matched into advanced endoscopy fellowship (AEF) programs were women. We administered a web-based survey to the program directors (PDs) of AEF programs that participated in the 2018-2019 American Society for Gastroenterology (ASGE) match. We assessed PD and program characteristics, in addition to perceived barriers and facilitators (scale 1-5, 5 = most important) influencing women pursuing AEF training. We received 38 (59.3 %) responses from 64 PDs. 15.8 % (6/38) of AEF PDs and 13.2 % (5/38) of endoscopy chiefs were women. By program, women represented 14.8 % (mean) ± 17.0 % (SD) of AEF faculty and 12.0 % (mean) ± 11.1 % (SD) of AEF trainees over the past 10 years. 47.4 % (18/38) programs reported no female advanced endoscopy faculty and 31.6 % (12/38) of programs have never had a female fellow. Percentage of female fellows was strongly associated with percentage of female AEF faculty (ß = 0.43,  < 0.001). Inflexible hours and call (mean rank 3.3 ± 1.1), exposure to fluoroscopy (2.9 ± 1.1), lack of women endoscopists at national conferences/courses (2.9 ± 1.1) and lack of female mentorship (2.9 ± 1.0) were cited as the most important barriers to recruitment. We utilized a survey of AEF PDs participating in the ASGE match to determine program characteristics and identify contributors to gender disparity. Women represent a minority of AEF PDs, endoscopy chiefs, advanced endoscopy faculty and AEF trainees. Our study highlights perceived barriers and facilitators to recruitment, and emphasizes the importance of having female representation in faculty, and leadership positions in endoscopy.
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http://dx.doi.org/10.1055/a-1311-0899DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7892265PMC
March 2021

Healthcare Disparities in the Management of Acute Cholecystitis: Impact of Race, Gender, and Socioeconomic Factors on Cholecystectomy vs Percutaneous Cholecystostomy.

J Gastrointest Surg 2021 04 24;25(4):880-886. Epub 2021 Feb 24.

Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.

Background: While percutaneous cholecystostomy (PC) is a recommended treatment strategy in lieu of cholecystectomy (CCY) for acute cholecystitis among patients who may not be considered good surgical candidates, reports on disparities in treatment utilization remain limited. The aim of this study was to investigate the role of demographic, clinical, and socioeconomic factors in treatment of acute cholecystitis.

Methods: Patients with a diagnosis of acute cholecystitis who underwent CCY versus PC were reviewed from the U.S. Nationwide Inpatient Sample (NIS) database between 2008-2014. Measured variables including age, race/ethnicity, Charlson comorbidity index (CCI), hospital type/region, insurance payer, household income, length of stay (LOS), hospital cost, and mortality were compared using chi-square and ANOVA. Multivariable logistic regression was performed to identify specific predictors of cholecystitis treatment.

Results: A total of 1,492,877 patients (CCY:n=1,435,255 versus PC:n=57,622) were analyzed. The majority of patients that received PC were at urban teaching hospitals (65.2%). LOS was significantly longer with higher associated costs for PC [(11.1±11.0 versus 4.5±5.3 days; P<0.001) and ($99577±138850 versus $48399±58330; P<0.001)]. Mortality was also increased for patients that received PC compared to CCY (8.8% versus 0.6%; P<0.001). Multivariable regression demonstrated multiple socioeconomic and healthcare-related factors influencing the utilization of PC including male gender, Black or Asian race/ethnicity, Medicare payer status, urban hospital location, and household income (all P<0.001).

Conclusion: Although patients receiving PC had higher CCI scores, multiple socioeconomic and healthcare related factors appeared to also influence this treatment decision. Additional studies to investigate these disparities are indicated to improve outcomes for all individuals with this condition.
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http://dx.doi.org/10.1007/s11605-021-04959-6DOI Listing
April 2021

Test Characteristics of Abdominal Computed Tomography for the Diagnosis of Gastro-gastric Fistula in Patients with Roux-en-Y Gastric Bypass.

Obes Surg 2021 06 22;31(6):2471-2476. Epub 2021 Feb 22.

Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital. Harvard Medical School, Boston, MA, 02115, USA.

Introduction: Gastrogastric fistulae (GGF) occur in 1-6% of Roux-en-Y gastric bypass (RYGB) patients. Many patients undergo abdominal computed tomography (CT) as an initial test owing to its wide availability; however, CT diagnostic accuracy for GGF is unclear. Our aim was to evaluate test characteristics of abdominal CT compared to upper gastrointestinal series (UGI) and esophagogastroduodenoscopy (EGD) for diagnosing GGF using surgery as a gold standard.

Methods: Retrospective review of RYGB patients who underwent abdominal CT with oral contrast within 1 year. Demographics, weight parameters, and symptoms were collected. Surgery within 1 year of the diagnostic tests was included as the gold standard comparison. Primary outcomes included CT sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy (DA) for GGF.

Results: One hundred thirty-seven patients were included, where 42 (30.1%) had positive CT and 95 (69.3%) had negative CT for GGF. Compared to surgical confirmation, CT abdomen with PO contrast had sensitivity of 73.1% (59-84.4), specificity of 95.2% (88.3-98.7), PPV 90.5% (77.4-97.3), NPV of 85.1% (76.3-91.2), and DA 89.7%. UGI series had sensitivity of 58.5% (42.1-73.7), specificity of 98.8% (93.5-99.9), PPV of 96% (79.7-99.9), NPV of 82.8% (73.9-89.7), and diagnostic accuracy (DA) of 85.4%. EGD had sensitivity of 78.3% (63.6-89.1), specificity of 98.8% (93.5-99.9), PPV 97.3 (85.8-99.9), and DA 91.5%. There were no significant differences in diagnostic test characteristics among modalities.

Conclusions: Abdominal CT with oral contrast has similar diagnostic test characteristics to UGI and EGD at detecting GGF when using surgical diagnosis as a gold standard.
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http://dx.doi.org/10.1007/s11695-021-05296-yDOI Listing
June 2021

Primary obesity surgery endoluminal (POSE) for the treatment of obesity: a systematic review and meta-analysis.

Surg Endosc 2021 Feb 1. Epub 2021 Feb 1.

Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.

Background: Primary obesity surgery endoluminal (POSE) utilizes an incision-less operating platform system to create full-thickness plications in the gastric fundus and body (original POSE). Many studies have demonstrated the safety and efficacy of original POSE for the treatment of obesity.

Objective: We aimed to conduct a systematic review and meta-analysis of available literature in an attempt to evaluate the outcomes of original POSE per the ASGE task force thresholds.

Methods: Bibliographic databases were systematically searched for studies assessing the outcomes of POSE for the treatment of obesity. All randomized controlled trials (RCTs) and observational studies that assessed outcomes of POSE were included. Studies were included if they reported percent total weight loss (%TWL) or percent excess weight loss (%EWL) and the incidence of serious adverse events (SAE).

Results: A total of seven studies with 613 patients were included. Two included studies were RCTs, while the remaining were observational studies. Pooled mean %EWL at 3-6 months and 12-15 months were 42.62 (95% CI 37.56-47.68) and 48.86 (95% CI 42.31-55.41), respectively. Pooled mean %TWL at 3-6 months and 12-15 months was 13.45 (95% CI 8.93-17.97) and 12.68 (95% CI 8.13-17.23), respectively. Subgroup analysis of two RCTs showed that weight loss at 1 year was significantly higher in POSE patients (%EWL difference in means 19.45 (95% CI 4.65-34.24, p value = 0.01). The overall incidence of serious adverse events was only 2.84% and included GI bleeding, extra-gastric bleeding, hepatic abscess, severe pain, severe nausea, and severe vomiting. The mean number of total anchors placed in the fundus and body was 13.18 (95% CI 11.77-14.58), and the mean procedure time was 44.55 min (95% CI 36.44-52.65).

Conclusion: POSE, a minimally invasive endoscopic bariatric therapy, is a safe and effective modality for the treatment of obesity. The outcomes of POSE meet and surpass the ASGE joint task force thresholds. Future studies should evaluate newer versions of this procedure that emphasize gastric body plication sparing the fundus.
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http://dx.doi.org/10.1007/s00464-020-08267-zDOI Listing
February 2021

Evaluation of socioeconomic and healthcare disparities on same admission cholecystectomy after endoscopic retrograde cholangiopancreatography among patients with acute gallstone pancreatitis.

Surg Endosc 2021 Jan 22. Epub 2021 Jan 22.

Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA.

Background: Despite literature and guidelines recommending same admission cholecystectomy (CCY) after endoscopic retrograde cholangiopancreatography (ERCP) for patients with acute gallstone pancreatitis, clinical practice remains variable. The aim of this study was to investigate the role of clinical and socio-demographic factors in the management of acute gallstone pancreatitis.

Methods: Patients with acute gallstone pancreatitis who underwent ERCP during hospitalization were reviewed from the U.S. Nationwide Inpatient Sample database between 2008 and 2014. Patients were classified by treatment strategy: ERCP + same admission CCY (ERCP + CCY) versus ERCP alone. Measured variables including age, race/ethnicity, Charlson Comorbidity Index (CCI), hospital type/region, insurance payer, household income, length of hospital stay (LOS), hospitalization cost, and in-hospital mortality were compared between cohorts using χ and ANOVA. Multivariable logistic regression was performed to identify specific predictors of same admission CCY.

Results: A total of 205,012 patients (ERCP + CCY: n = 118,318 versus ERCP alone: n = 86,694) were analyzed. A majority (53.4%) of patients that did not receive same admission CCY were at urban-teaching hospitals. LOS was longer with higher associated costs for patients with same admission CCY [(6.8 ± 5.6 versus 6.4 ± 6.5 days; P < 0.001) and ($69,135 ± 65,913 versus $52,739 ± 66,681; P < 0.001)]. Mortality was decreased significantly for patients who underwent ERCP + CCY versus ERCP alone (0.4% vs 1.1%; P < 0.001). Multivariable regression demonstrated female gender, Black race, higher CCI, Medicare payer status, urban-teaching hospital location, and household income decreased the odds of undergoing same admission CCY + ERCP (all P < 0.001).

Conclusion: Based upon this analysis, multiple socioeconomic and healthcare-related disparities influenced the surgical management of acute gallstone pancreatitis. Further studies to investigate these disparities are indicated.
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http://dx.doi.org/10.1007/s00464-020-08272-2DOI Listing
January 2021

Impact of fecal microbiota transplantation with capsules on the prevention of metabolic syndrome among patients with obesity.

Hormones (Athens) 2021 Mar 9;20(1):209-211. Epub 2021 Jan 9.

Department of Biomedical Sciences, Cornell University, Ithaca, NY, 14853, USA.

Background: Fecal microbiota transplantation (FMT) has been studied for the treatment of metabolic syndrome with varying success. However, the possibility of utilizing FMT to prevent metabolic syndrome is to date unknown.

Methods: Secondary analysis of a previously published double-blind, randomized, placebo-controlled pilot trial of FMT in obese metabolically healthy patients was conducted. Post-prandial glucose and insulin levels were measured (NCT02741518).

Results: A total of 22 patients were enrolled, 11 in each arm. There were no baseline differences in the area under the curve (AUC) of glucose or insulin in the FMT group compared to placebo. There was a significant change in glucose AUC at week 12 compared to baseline, and in the insulin AUC at week 6 compared to baseline in the FMT group vs. placebo (change in glucose AUC (mg/dl × 60 min): 579 vs 1978, p = 0.03) (change in insulin AUC (μU/ml × 60 min): 137 vs 2728, p = 0.01).

Conclusions: These data suggest that FMT may have a potential role in preventing the development of metabolic syndrome in patients with obesity.
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http://dx.doi.org/10.1007/s42000-020-00265-zDOI Listing
March 2021

Gastrointestinal Manifestations and Associated Health Outcomes of COVID-19: A Brazilian Experience From the Largest South American Public Hospital.

Clinics (Sao Paulo) 2020 26;75:e2271. Epub 2020 Oct 26.

Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, SP, Brazil.

Objectives: Brazil has rapidly developed the second-highest number of COVID-19 cases in the world. As such, proper symptom identification, including gastrointestinal manifestations, and relationship to health outcomes remains key. We aimed to assess the prevalence and impact of gastrointestinal symptoms associated with COVID-19 in a large quaternary referral center in South America.

Methods: This was a single-center cohort study in a COVID-19 specific hospital in São Paulo, Brazil. Consecutive adult patients with laboratory confirmed SARS-CoV-2 were included. Baseline patient history, presenting symptoms, laboratory results, and clinically relevant outcomes were recorded. Regression analyses were performed to determine significant predictors of the gastrointestinal manifestations of COVID-19 and hospitalization outcomes.

Results: Four-hundred patients with COVID-19 were included. Of these, 33.25% of patients reported ≥1 gastrointestinal symptom. Diarrhea was the most common gastrointestinal symptom (17.25%). Patients with gastrointestinal symptoms had higher rates of concomitant constitutional symptoms, notably fatigue and myalgia (p<0.05). Gastrointestinal symptoms were also more prevalent among patients on chronic immunosuppressants, ACE/ARB medications, and patient with chronic kidney disease (p<0.05). Laboratory results, length of hospitalization, ICU admission, ICU length of stay, need for mechanical ventilation, vasopressor support, and in-hospital mortality did not differ based upon gastrointestinal symptoms (p>0.05). Regression analyses showed older age [OR 1.04 (95% CI, 1.02-1.06)], male gender [OR 1.94 (95% CI, 1.12-3.36)], and immunosuppression [OR 2.60 (95% CI, 1.20-5.63)], were associated with increased mortality.

Conclusion: Based upon this Brazilian study, gastrointestinal manifestations of COVID-19 are common but do not appear to impact clinically relevant hospitalization outcomes including the need for ICU admission, mechanical ventilation, or mortality.
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http://dx.doi.org/10.6061/clinics/2020/e2271DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7561063PMC
November 2020

Targeting the perforator vein: EUS-guided coil embolization for the treatment of bleeding rectal varices.

VideoGIE 2020 Sep 29;5(9):434-436. Epub 2020 Jun 29.

Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts.

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http://dx.doi.org/10.1016/j.vgie.2020.05.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7482247PMC
September 2020

Hybrid endoscopic submucosal dissection (ESD) compared with conventional ESD for colorectal lesions: a systematic review and meta-analysis.

Endoscopy 2020 Sep 18. Epub 2020 Sep 18.

Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States.

Background:  Hybrid endoscopic submucosal dissection (ESD) is increasingly utilized to overcome the complexity of conventional ESD. This systematic review and meta-analysis evaluated the efficacy and safety of hybrid ESD for treatment of colorectal lesions.

Methods:  Search strategies were developed in accordance with PRISMA guidelines. Pooled proportions were calculated with rates estimated using random effects models. Measured outcomes included en bloc resection, procedure-associated complications, recurrence, and need for surgery. Subgroup analyses were performed to compare effectiveness of conventional versus hybrid ESD.

Results:  16 studies (751 patients) were included with a mean (standard deviation [SD]) lesion size of 27.96 (10.55) mm. En bloc resection rate was 81.63 % (95 % confidence interval [CI] 72.07 - 88.44;  = 80.89). Complications, recurrences, and need for surgery occurred in 7.74 % (95 %CI 4.78 - 12.31;  = 65.84), 4.52 % (95 %CI 1.40 - 13.65;  = 76.81), and 3.64 % (95 %CI 1.76 - 7.37;  = 15.52), respectively. Mean procedure duration was 48.83 (22.37) minutes. On subgroup analyses comparing outcomes for conventional (n = 1703) versus hybrid ESD (n = 497), procedure duration was significantly shorter for hybrid ESD (mean difference 18.45 minutes;  = 0.003), with lower complication rates ( = 0.04); however, hybrid ESD had lower en bloc resection rates ( < 0.001). There was no difference in rates of recurrence or surgery ( > 0.05).

Conclusion:  While hybrid ESD was safe and effective for removal of colorectal lesions, with shorter procedure duration, fewer complications, and no difference in recurrence versus conventional ESD, hybrid ESD was associated with a lower en bloc resection rate.
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http://dx.doi.org/10.1055/a-1266-1855DOI Listing
September 2020

Bariatric and Metabolic Therapies Targeting the Small Intestine.

Tech Innov Gastrointest Endosc 2020 Jul 24;22(3):145-153. Epub 2020 Jun 24.

Harvard Medical School, Boston, MA 02115, USA.

The global prevalence of obesity and type 2 diabetes (T2DM) necessitates an increased reliance on effective and safe endoscopic therapies. While surgery is highly effective, endoscopic therapies may be able to reach a greater number of affected individuals and help to reduce the burden of disease worldwide. Although current endoscopic treatments entail space occupying gastric devices as well as suturing or plication, innovative, non-Food and Drug Administration (FDA) approved small bowel specific endoscopic bariatric and metabolic therapies have been developed within the last several years. Small intestine therapies include endoluminal bypass liners, duodenal mucosal resurfacing, endoscopic anastomosis systems, and restricted duodenal flow treatments. These endoscopic bariatric and metabolic therapies rely upon foregut and hindgut mechanisms to achieve weight loss and improve glucose homeostasis. This review will detail these important small bowel mechanisms and evaluates current small bowel endoscopic treatments.
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http://dx.doi.org/10.1016/j.tige.2020.03.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7467427PMC
July 2020

A comparison of clinical outcomes and cost utility among laparoscopy, enteroscopy, and temporary gastric access-assisted ERCP in patients with Roux-en-Y gastric bypass anatomy.

Surg Endosc 2021 Aug 4;35(8):4469-4477. Epub 2020 Sep 4.

Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA.

Background And Aims: Gastric Access Temporary for Endoscopy (GATE), also known as EUS-Directed Trangastric ERCP (EDGE), has demonstrated advantages over device-assisted enteroscopy (DAE) and laparoscopic-assisted ERCP (LA-ERCP) for patients with Roux-en-Y gastric bypass (RYGB) anatomy. We aimed to directly compare clinical outcomes and cost utility among the three ERCP modalities.

Methods: Patients with RYGB anatomy who had DAE, LA-ERCP, or GATE from 2009 to 2019 at 2 tertiary centers were included in our review. We measured outcomes in three areas: success rate, post-procedural adverse events (AEs) and hospitalization, and cost utility per Medicare/Medicaid insurance payments.

Results: Cohort Total 130 patients (70 underwent DAE, 42 LA-ERCP, and 18 GATE). Success rate DAE was successful in 59% of patients, compared to success rates of 98 and 100% for LA-ERCP and GATE, respectively (p < 0.001). For DAE, 62% of unsuccessful cases required rescue therapy. Adverse events and hospitalization Patients who underwent GATE had the lowest rate of hospitalization post procedure (44% vs. 77% and 100% for DAE and LA-ERCP, respectively, p < 0.01) and spent the least amount of time hospitalized (median time 0 days vs 2 and 3 days for DAE and LA-ERCP, respectively, p < 0.0001). GATE had lower AE rates than LA-ERCP (6 vs 31%, p = 0.046), and both had similar rates to DAE. Cost utility LA-ERCP carried the highest total procedural and hospitalization cost per Medicare/ Medicaid insurance payments (median payment difference of $9.7 K vs GATE and $7.9 K vs DAE, p < 0.01 for both). Procedural and hospitalization costs were similar between GATE and DAE (p = 0.76).

Conclusions: GATE is a safe modality for ERCP with high success rates in RYGB patients and exhibits the lowest hospitalization time and rate of adverse events when compared to DAE and LA-ERCP. GATE is similar to DAE from a cost utility approach, and both are less costly than LA-ERCP.
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http://dx.doi.org/10.1007/s00464-020-07952-3DOI Listing
August 2021

Impact of Obesity on Outcomes of Patients With Coronavirus Disease 2019 in the United States: A Multicenter Electronic Health Records Network Study.

Gastroenterology 2020 12 21;159(6):2221-2225.e6. Epub 2020 Aug 21.

Harvard Medical School, Boston, Massachusetts; Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address:

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http://dx.doi.org/10.1053/j.gastro.2020.08.028DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7441935PMC
December 2020

Diagnostic Characteristics of Serological-Based COVID-19 Testing: A Systematic Review and Meta-Analysis.

Clinics (Sao Paulo) 2020 10;75:e2212. Epub 2020 Aug 10.

Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.

Serologic testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) promises to assist in assessing exposure to and confirming the diagnosis of coronavirus disease 2019 (COVID-19), and to provide a roadmap for reopening countries worldwide. Considering this, a proper understanding of serologic-based diagnostic testing characteristics is critical. The aim of this study was to perform a structured systematic review and meta-analysis to evaluate the diagnostic characteristics of serological-based COVID-19 testing. Electronic searches were performed using Medline (PubMed), EMBASE, and Cochrane Library. Full-text observational studies that reported IgG or IgM diagnostic yield and used nucleic acid amplification tests (NAATs) of respiratory tract specimens, as a the reference standard in English language were included. A bivariate model was used to compute pooled sensitivity, specificity, positive/negative likelihood ratio (LR), diagnostic odds ratio (OR), and summary receiver operating characteristic curve (SROC) with corresponding 95% confidence intervals (CIs). Five studies (n=1,166 individual tests) met inclusion criteria. The pooled sensitivity, specificity, and diagnostic accuracy for IgG was 81% [(95% CI, 61-92);I2=95.28], 97% [(95% CI, 78-100);I2=97.80], and 93% (95% CI, 91-95), respectively. The sensitivity, specificity, and accuracy for IgM antibodies was 80% [(95% CI, 57-92);I2=94.63], 96% [(95% CI, 81-99);I2=92.96] and 95% (95% CI, 92-96). This meta-analysis demonstrates suboptimal sensitivity and specificity of serologic-based diagnostic testing for SARS-CoV-2 and suggests that antibody testing alone, in its current form, is unlikely to be an adequate solution to the difficulties posed by COVID-19 and in guiding future policy decisions regarding social distancing and reopening of the economy worldwide.
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http://dx.doi.org/10.6061/clinics/2020/e2212DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7410353PMC
August 2020

Simultaneous liver transplant and sleeve gastrectomy not associated with worse index admission outcomes compared to liver transplant alone - a retrospective cohort study.

Transpl Int 2020 11 3;33(11):1447-1452. Epub 2020 Sep 3.

Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA.

Sleeve gastrectomy (SG) at the time of liver transplant (LT) has been argued to decrease resource utilization. However, larger studies examining outcomes are lacking. We aim to determine the outcomes of simultaneous SG and LT compared to LT alone. This is a retrospective cohort study using the 2011-2017 National Inpatient Sample (NIS). The primary outcome was the odds of inpatient mortality in patients undergoing simultaneous SG and LT compared with LT alone. Secondary outcomes included inpatient morbidity, resource utilization, hospital length of stay (LOS), and inflation-adjusted total hospital costs and charges. A total of 45 361 patients underwent LT in the study period, 49 underwent simultaneous SG. Patients undergoing simultaneous LT and SG had lower crude mortality (0.0%) compared to LT alone (2.97%; P = 0.52). There were no statistically significant differences in morbidity, resource utilization, and hospital costs and charges. Patients undergoing simultaneous LT and SG did not have significantly different mortality rates, morbidity, resource utilization, or LOS during the index admission when compared to LT alone. SG may be feasible at the time of LT in very carefully selected patients. Studies should focus in determining which patients are the optimal candidates to undergo simultaneous LT and SG.
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http://dx.doi.org/10.1111/tri.13713DOI Listing
November 2020

Endoscopic Ultrasound-Guided Coil Embolization With Absorbable Gelatin Sponge Appears Superior to Traditional Cyanoacrylate Injection for the Treatment of Gastric Varices.

Clin Transl Gastroenterol 2020 05;11(5):e00175

Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA.

Introduction: Gastric variceal (GV) bleeding is a feared complication of cirrhosis. Traditional endoscopic treatment with cyanoacrylate (CYA) injection can be challenging. Alternatively, endoscopic ultrasound (EUS)-guided delivery of hemostatic coils has shown high therapeutic success without the complications profile of CYA alone. Our aim was to compare the clinical outcomes of EUS-guided coil embolization with endoscopic CYA injection for the treatment of GV.

Methods: We performed a matched cohort study using a prospective registry involving 2 tertiary centers. A total of 10 patients undergoing EUS-based coil therapy were matched in 1:3 fashion to 30 patients who underwent CYA injection. The matching criteria included type of GV, Charlson comorbidity index, and bleeding severity. Primary outcomes were technical success and complications. Secondary outcomes were rebleeding rates, reinterventions rates, total transfusion requirements, and time-to-event analysis (rebleeding, reintervention, and transfusion).

Results: Technical success was 100% for EUS coil therapy vs 96.7% for CYA injection (P = 1.0). Complication rates were 10% in the EUS coil group vs 20% in the CYA group; P = 0.65. At 9 months, no EUS coil patient had rebled compared with 38% of the CYA group. No EUS coil patient required blood transfusion for GV rebleed, whereas over 50% of CYA patients did. Ten percent of EUS coil patients required reintervention compared with 60% of CYA patients. The EUS coil group had superior time to reintervention, GV rebleed, and transfusions (all P < 0.05).

Discussion: Compared with CYA, EUS-guided coil injection appears superior for the treatment of GV and should be considered initial endoscopic treatment of choice in centers with interventional EUS expertise.
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http://dx.doi.org/10.14309/ctg.0000000000000175DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7263642PMC
May 2020
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