Publications by authors named "Iman Andalib"

17 Publications

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Polypectomy Using Blended vs Forced Currents: Blue or Yellow? That Is the Question!

Gastroenterology 2020 07 11;159(1):32-33. Epub 2020 May 11.

Icahn School of Medicine at Mount Sinai, Department of Medicine, Division of Gastroenterology & Hepatology, Mount Sinai South Nassau, Long Island, New York. Electronic address:

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http://dx.doi.org/10.1053/j.gastro.2020.05.028DOI Listing
July 2020

Endoscopic sleeve gastroplasty in peritoneal dialysis.

VideoGIE 2020 Mar 2;5(3):107-109. Epub 2020 Feb 2.

Department of Gastroenterology, Robert Wood Johnson Medical Center, New Brunswick, New Jersey, USA.

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http://dx.doi.org/10.1016/j.vgie.2019.12.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7058538PMC
March 2020

Submucosal tunneling endoscopic resection of a gastric lesion: a double-sided approach.

Endoscopy 2020 07 29;52(7):E259-E260. Epub 2020 Jan 29.

Department of Gastroenterology, Robert Wood Johnson Medical Center, New Brunswick, New Jersey, USA.

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http://dx.doi.org/10.1055/a-1089-7279DOI Listing
July 2020

Endoscopic Therapy for Pancreatic Fluid Collections: A Definitive Management Using a Dedicated Algorithm.

Clin Endosc 2020 May 3;53(3):355-360. Epub 2019 Dec 3.

Division of Gastroenterology, Rutgers University, Robert Wood Johnson Medical School, New Brunswick, NJ, USA.

Background/aims:  Endoscopic ultrasonography (EUS)-guided drainage is the preferred approach for infected or symptomatic pancreatic fluid collections (PFCs). Here, we developed an algorithm for the management of pancreatitis complicated by PFCs and report on its effcacy and safety.

Methods: Between September 2011 and October 2017, patients were prospectively managed according to the algorithm. PFCs were classified as poorly organized fluid collections (POFCs), pancreatic pseudocysts (PPs), or walled-off pancreatic necrosis (WOPN). Clinical success was defined as a decrease in PFC size by ≥50% of the maximal diameter or to ≤2 cm.

Results:  A total of 108 patients (62% male; mean age, 53 years) were included: 13 had POFCs, 43 had PPs, and 52 had WOPN. Seventytwo patients (66%) required a pancreatic duct (PD) stent, whereas 65 (60%) received enteral feeding. A total of 103 (95%) patients achieved clinical success. Eight patients experienced complications including bleeding (n=6) and surgical intervention (n=2). Patients with enteral feeding were 3.4 times more likely to achieve resolution within 60 days (p=0.0421), whereas those with PD stenting was five times more likely to achieve resolution within 90 days (p=0.0069).

Conclusion:  A high PFC resolution rate can be achieved when a dedicated algorithm encompassing EUS-guided drainage, PD stenting, and early enteral feeding is adopted.
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http://dx.doi.org/10.5946/ce.2019.113DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7280836PMC
May 2020

Full-thickness septotomy of Zenker's diverticulum.

Endoscopy 2020 04 7;52(4):308-309. Epub 2019 Nov 7.

Department of Gastroenterology, Robert Wood Johnson Medical Center, New Brunswick, New Jersey, United States.

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http://dx.doi.org/10.1055/a-1024-3343DOI Listing
April 2020

Hybrid management of perforated gangrenous gallbladder.

Endoscopy 2019 12 1;51(12):E370-E371. Epub 2019 Jul 1.

Department of Gastroenterology & Hepatology, Rutgers Robert Wood Johnson, New Brunswick, New Jersey, USA.

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http://dx.doi.org/10.1055/a-0929-3218DOI Listing
December 2019

Discontinuation of proton pump inhibitor use reduces the number of endoscopic procedures required for resolution of walled-off pancreatic necrosis.

Endosc Ultrasound 2019 May-Jun;8(3):194-198

Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Utah, Salt Lake City, UT, USA.

Background And Objectives: Endoscopic drainage/debridement of symptomatic walled off necrosis (WON) using lumen-apposing metal stents (LAMS) is both safe and effective. While endoscopic management of WON is the standard approach to treatment, the ideal concomitant medical therapy remains unclear. The purpose of this study was to further elucidate the effect of proton pump inhibitor (PPIs) therapy on the technical and clinical success of endoscopic treatment of WON.

Methods: Two hundred and seventy-two patients in 8 centers with WON managed by endoscopic drainage using LAMS were evaluated. Patients were followed for at least 6 months following treatment. The patients were divided into two groups: Those that used PPIs continuously during the therapy and those not on PPIs continuously during the interval of therapy. Outcomes included but were not limited to technical success, clinical success, number of procedures performed, and adverse events.

Results: From 2013 to 2016, 272 patients underwent WON drainage with successful transmural LAMS placement. The two groups were split evenly into PPI users and non-PPI users, and matched in regards to demographics, etiology of pancreatitis, WON size, and location. There was no difference in the technical success between the two groups (100% vs. 98.8%, P = 1), or in clinical success rates (78.7% vs. 77.9%). There was a significant difference in the required number of direct endoscopic necrosectomies to achieve clinical success in the PPI vs. non-PPI group (3.2 vs. 4.6 respectively, P < 0.01). There were significantly more cases of stent occlusion in the non-PPI group vs. PPI group (9.5% vs. 20.1% P = 0.012), but all other documented adverse events were not significantly different.

Conclusion: Discontinuing PPIs during endoscopic drainage and necrosectomy of symptomatic WON appears to reduce the number of endoscopic procedures required to achieve resolution. Continuous PPI results in higher rates of early stent occlusion.
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http://dx.doi.org/10.4103/eus.eus_59_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6589997PMC
February 2019

POEM in Latin America: The Rise of a New Standard.

J Clin Gastroenterol 2019 09;53(8):e352-e355

Gastrointestinal Endoscopy Unit, University of Sao Paulo Medical School, Sao Paulo, Brazil.

Background: Per-oral endoscopic myotomy (POEM) has become the preferred alternative treatment to standard Heller myotomy for patients with esophageal achalasia, in Latin American countries. The aim of our study was to evaluate the efficacy and safety of a POEM in the management of achalasia with and without Chagas disease in patients receiving POEM.

Methods: Patients who underwent POEM from tertiary centers in Latin America were included in a dedicated registry. Countries included Brazil, Colombia, Ecuador, Mexico, Nicaragua, and Venezuela. Patients enrolled needed to have a preoperative manometry and swallow contrast study confirming achalasia. Clinical success was defined as significant improvement in Eckardt score after therapy.

Results: POEM was technically successful in 81/89 (91%) patients (mean age, 44 y). There was a significant decrease in preprocedure and postprocedure Eckardt score from 8.7 (range, 3 to 12) to 2.15 (0 to 10) (P<0.001), preprocedure and postprocedure barium swallow evaluation (98% vs. 89%; P=0.017), and preprocedure and postprocedure lower esophageal sphincter pressure measurement (from 35 to 13.8 mm Hg; P<0.001). Clinical success was achieved in 93% of patients. Patients with Chagas disease (n=58) were 9.5 times more likely to respond to POEM (P=0.0020; odds ratio, 9.5).

Conclusions: POEM is an efficacious and safe therapeutic modality for treatment of achalasia in Latin America. Chagas disease-related achalasia seems to particularly respond better to POEM when it is performed by experienced endoscopists.
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http://dx.doi.org/10.1097/MCG.0000000000001161DOI Listing
September 2019

Use of volumetric laser endomicroscopy for determining candidates for endoscopic therapy in superficial esophageal squamous cell carcinoma.

United European Gastroenterol J 2018 Jul 22;6(6):838-845. Epub 2018 Feb 22.

Department of Pathology, Long Island Jewish Medical Center, New Hyde Park, NY, USA.

Background: Accurate staging of superficial esophageal squamous cell cancer (ESCC) for endoscopic therapy is challenging. Optical coherence tomography (OCT) has been shown to be superior to high-resolution endoscopic ultrasound (EUS). Volumetric Laser Endomicroscopy (VLE), a second-generation OCT, has recently become commercially available.

Objective: To assess if VLE can determine which patients with superficial ESSC can undergo endoscopic therapy.

Methods: This is a multi-center retrospective study. Patients were included if (a) they had visible ESCC, (b) they underwent VLE and EUS for staging, and c) if superficial disease was suspected then endoscopic resection had to be performed to have accurate histology to compare the VLE scan to. VLE scans were then compared to the gold standard: histology for superficial disease and EUS for disease T1b and greater.

Results: Seventeen patients were included with the following disease: squamous intraepithelial neoplasia (4 patients), T1a disease (6 patients), T1b (2 patients), T2 disease (2 patients) and T3 disease (3 patients). VLE was able to distinguish superficial disease, defined as disease limited up to the lamina propria, from non-superficial disease in all cases.

Conclusions: VLE may be able to determine which ESCC patients are candidates for endoscopic therapy. Prospective studies are needed to confirm this.
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http://dx.doi.org/10.1177/2050640618761701DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6047283PMC
July 2018

Self-Expanding Metallic Biliary Stents: Time to Suit Up?

Dig Dis Sci 2018 09;63(9):2172-2173

New Jersey Division of Gastroenterology and Hepatology, Department of Medicine, Robert Wood Johnson University Hospital, New Brunswick, NJ, USA.

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http://dx.doi.org/10.1007/s10620-018-5114-4DOI Listing
September 2018

Gastric peroral endoscopic myotomy for the treatment of refractory gastroparesis: a multicenter international experience.

Endoscopy 2018 11 12;50(11):1053-1058. Epub 2018 Apr 12.

Aarhus University, Marseille, France.

Background: Gastroparesis is a difficult-to-treat motility disorder with a poor response to medical therapy. Gastric peroral endoscopic pyloromyotomy (G-POEM) has been offered as a novel therapy in the treatment of refractory gastroparesis. We present a multicenter case series of our experience with G-POEM.

Methods: This is an international multicenter case series of patients who underwent G-POEM for the treatment of gastroparesis. The severity of gastroparesis was assessed by delayed gastric emptying scintigraphy (GES) and an elevated gastroparesis cardinal symptoms index (GCSI). Patients then underwent G-POEM using the submucosal tunneling technique. The primary endpoint was improvement in the GCSI score and improvement in gastric emptying on repeat scintigraphy. Secondary endpoints were technical success, complication rate, procedure duration, and length of hospital stay post-procedure.

Results: G-POEM was technically successful in all 33 patients. Symptomatic improvement was seen in 28/33 patients (85 %), with a decrease in symptom score by GCSI from 3.3 to 0.8 at follow-up ( < 0.001). The mean procedure duration was 77.6 minutes (37 - 255 minutes). Mean GES improved significantly from 222.4 minutes to 143.16 minutes (0.001). Complications were minimal and included bleeding (n = 1) and an ulcer (n = 1) treated conservatively. The mean length of hospital stay post-procedure was 5.4 days (1 - 14 days). The mean follow-up duration was 11.5 months (2 - 31 months).

Conclusion: G-POEM is a technically feasible, safe, and successful procedure for the treatment of refractory gastroparesis. A further multicenter comparative study should be performed to compare this technique to laparoscopic pyloromyotomy.
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http://dx.doi.org/10.1055/a-0596-7199DOI Listing
November 2018

Combination therapy could end the recurrence of biliary pancreatitis: It is about time!

Dig Liver Dis 2018 03 13;50(3):283-284. Epub 2018 Feb 13.

Weill Cornell Medical Center, New York, NY, United States. Electronic address:

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http://dx.doi.org/10.1016/j.dld.2018.01.134DOI Listing
March 2018

Endoscopic submucosal tunnel dissection for early squamous cell carcinoma of the esophagus.

Endoscopy 2018 04 19;50(4):E88-E89. Epub 2018 Jan 19.

Division of Gastroenterology and Hepatology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, United States.

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http://dx.doi.org/10.1055/s-0043-125359DOI Listing
April 2018

Modern Management of Pancreatic Fluid Collections.

J Clin Gastroenterol 2018 02;52(2):97-104

Department of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY.

The last decade has seen dramatic shift in paradigm in the management of pancreatic fluid collections with the rise of endoscopic therapy over radiologic or surgical management. Endosonographic drainage is now considered the gold standard therapy for pancreatic pseudocyst. Infected pancreatic necroses are being offered endoscopic necrosectomy that has been facilitated by the arrival on the market of large diameter lumen-apposing metal stent. Severe pancreatitis or failure to thrive should receive enteral nutrition while pancreatic ductal disruption or strictures are best treated by pancreatic stenting.
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http://dx.doi.org/10.1097/MCG.0000000000000940DOI Listing
February 2018

Endoscopic resection of gastric gastrointestinal stromal tumors originating from the muscularis propria layer in North America: methods and feasibility data.

Surg Endosc 2018 04 15;32(4):1787-1792. Epub 2017 Sep 15.

Division of Gastroenterology & Hepatology, SUNY Downstate Medical Center, Brooklyn, NY, USA.

Introduction: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. In recent years, endoscopic procedures such as endoscopic enucleation (EN) and endoscopic full-thickness resection (EFTR) have been used to resect GISTs. This study aimed to investigate the clinical efficacy, safety, and feasibility of endoscopic resection of GISTs in a North American population.

Methods: A total of 25 patients with gastric submucosal lesions (SML) underwent endoscopic resection from December 2014 to April 2016. Data from cases with histologically proven GISTs originating from the muscularis propria layer (MP-GIST) were collected. The main outcome measures were complete resection rate, operative time, postoperative complications, length of hospital stay, narcotic analgesic requirement, and follow-up outcomes. Surveillance was performed with CT abdomen, and/or EGD along with oncology follow-up at 6- to 24-month intervals.

Results: Out of 25 gastric SML, there were 12 histologically proven MP-GIST. Five endophytic MP-GIST were removed by EN, and seven exophytic MP-GIST were removed by EFTR. All lesions were removed en bloc except for one hard to localize exophytic lesion which was completely removed piecemeal. The mean removal time was 79.7 min (range 17-180 min). Nine out of twelve patients required inpatient admission for observation with a mean length of stay of 2.08 days (range 1-4 days). No complications were noted and no narcotic analgesics were required. Pathology reports showed that one GIST was intermediate risk but all others were low-risk lesions. No recurrence has been noted thus far.

Conclusion: Endoscopic removal of MP-GIST by a trained endoscopist appears to be safe and feasible in North American population. Further studies with greater sample size are necessary to compare endoscopic versus surgical resection of MP-GIST. Comparison of outcomes may support wider use of endoscopic techniques for GIST removal.
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http://dx.doi.org/10.1007/s00464-017-5862-9DOI Listing
April 2018

Radiofrequency ablation for pancreatobiliary disease.

Curr Opin Gastroenterol 2016 Sep;32(5):353-357

Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medicine, New York, New York, USA.

Purpose Of Review: Radiofrequency ablation (RFA) has been recognized for its potential in palliative treatment for pancreatic cancer as well as malignant biliary strictures. The purpose of this review is to describe the technology, endoscopic technique, and reported outcomes of endoscopic RFA in the management of malignant biliary strictures and unresectable pancreatic cancer.

Recent Findings: Intraductal biliary RFA is safe and feasible and appears to confer a survival advantage. Pancreatic endoscopic ultrasound-guided RFA is a promising new technique and may result in either resolution of tumor or reduction in size.

Summary: Intraductal biliary RFA and pancreatic endoscopic ultrasound-guided RFA are important modalities in malignant biliary obstruction and unresectable pancreatic cancer. Intraductal biliary RFA should be used as an adjunct to biliary stenting. Further trials are needed to determine if RFA leads to a benefit in pancreatic cancer treatment. Two prospective trials are currently underway to determine if intraductal biliary RFA indeed confers a survival advantage in malignant obstruction.
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http://dx.doi.org/10.1097/MOG.0000000000000300DOI Listing
September 2016

Breath Hydrogen as a Biomarker for Glucose Malabsorption after Roux-en-Y Gastric Bypass Surgery.

Dis Markers 2015 11;2015:102760. Epub 2015 Oct 11.

Department of Surgery and Center for Advanced Laparoscopic & Bariatric Surgery, MedStar-Washington Hospital Center and Georgetown University School of Medicine, Washington, DC 20010, USA.

Objective: Abdominal symptoms are common after bariatric surgery, and these individuals commonly have upper gut bacterial overgrowth, a known cause of malabsorption. Breath hydrogen determination after oral glucose is a safe and inexpensive test for malabsorption. This study is designed to investigate breath hydrogen levels after oral glucose in symptomatic individuals who had undergone Roux-en-Y gastric bypass surgery.

Methods: This is a retrospective study of individuals (n = 63; 60 females; 3 males; mean age 49 years) who had gastric bypass surgery and then glucose breath testing to evaluate abdominal symptoms.

Results: Among 63 postoperative individuals, 51 (81%) had a late rise (≥45 minutes) in breath hydrogen or methane, supporting glucose malabsorption; 46 (90%) of these 51 subjects also had an early rise (≤30 minutes) in breath hydrogen or methane supporting upper gut bacterial overgrowth. Glucose malabsorption was more frequent in subjects with upper gut bacterial overgrowth compared to subjects with no evidence for bacterial overgrowth (P < 0.001).

Conclusion: These data support the presence of intestinal glucose malabsorption associated with upper gut bacterial overgrowth in individuals with abdominal symptoms after gastric bypass surgery. Breath hydrogen testing after oral glucose should be considered to evaluate potential malabsorption in symptomatic, postoperative individuals.
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http://dx.doi.org/10.1155/2015/102760DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4619887PMC
July 2016