Publications by authors named "Mehdi Mohamadnejad"

66 Publications

Multiple Raised White Plaques in the Right Colon.

Middle East J Dig Dis 2019 Oct 5;11(4):234-236. Epub 2019 Nov 5.

Liver and pancreatobilliary Disease Research Center, Digestive Disease Research Institute, Tehran university of Medical sciences, Tehran, Iran.

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http://dx.doi.org/10.15171/mejdd.2019.155DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6895851PMC
October 2019

The Prevalence of Nonalcoholic Fatty Pancreas by Endoscopic Ultrasonography.

Pancreas 2019 10;48(9):1220-1224

From the Liver and Pancreaticobiliary Research Center.

Objectives: Pancreatic steatosis or fatty pancreas refers to the fat accumulation in the pancreas, which can lead to inflammation and fibrosis, β-cell dysfunction, fibrosis, and, possibly, pancreatic cancer. This study aimed to study the prevalence of fatty pancreas and its risk factors in patients referred to an endosonography center.

Methods: During 18 months, 228 patients who were referred to our endosonography center for various reasons were evaluated for fatty pancreas. Fatty pancreas was defined as hyperechoic pancreas echotexture compared with spleen echotexture. Demographic characteristics, past medical history, and laboratory measurements were compared between groups with and without fatty pancreas to determine the risk factors for fatty pancreas.

Results: The prevalence of fatty pancreas was 25.9%. Patients with fatty pancreas had a significantly higher mean level of uric acid (P = 0.04), frequency of ischemic heart disease (P = 0.03), hyperlipidemia (P = 0.04), frequency of fatty liver (P < 0.001), and aortic intima thickness (P = 0.01). There was no significant difference in age, sex, body mass index, smoking status, substance abuse, and use of oral contraceptives in the 2 groups.

Conclusions: Fatty pancreas is a common disorder. There are meaningful relationships between coronary artery disease, nonalcoholic fatty liver, and atherosclerosis with fatty pancreas.
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http://dx.doi.org/10.1097/MPA.0000000000001396DOI Listing
October 2019

Pharmacological prophylaxis versus pancreatic duct stenting plus pharmacological prophylaxis for prevention of post-ERCP pancreatitis in high risk patients: a randomized trial.

Endoscopy 2019 10 27;51(10):915-921. Epub 2019 Aug 27.

Liver and Pancreaticobiliary Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran.

Background: Acute pancreatitis is a serious complication of endoscopic retrograde cholangiopancreatography (ERCP). The aim of this noninferiority study was to evaluate the effectiveness of pancreatic duct (PD) stenting plus pharmacological prophylaxis vs. pharmacological prophylaxis alone in the prevention of post-ERCP pancreatitis (PEP) in high risk patients.

Methods: In this randomized, controlled, double-blind, noninferiority trial, patients at high risk of developing PEP were randomly allocated to pharmacological prophylaxis (rectal indomethacin, sublingual isosorbide dinitrate, and intravenous hydration with Ringer's lactate) plus PD stenting (group A) or pharmacological prophylaxis alone (group B). The rate and severity of PEP, serum amylase levels, and length of hospital stay after ERCP were assessed.

Results: During 21 months, a total of 414 patients (mean age 55.5 ± 17.0 years; 60.2 % female) were enrolled (207 in each group). PEP occurred in 59 patients (14.3 %, 95 % confidence interval [CI] 11.1 % - 17.9 %: 26 patients [12.6 %, 95 %CI 8.6 % - 17.6 %] in group A and 33 [15.9 %, 95 %CI 11.4 % - 21.4 %] in group B). There was no significant difference between the two groups in PEP severity ( = 0.59), amylase levels after 2 hours ( = 0.31) or 24 hours ( = 0.08), and length of hospital stay ( = 0.07).

Conclusions: The study failed to demonstrate noninferiority or inferiority of pharmacological prophylaxis alone compared with PD stenting plus pharmacological prophylaxis in the prevention of PEP in high risk patients.
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http://dx.doi.org/10.1055/a-0977-3119DOI Listing
October 2019

Pancreatic hydatid cyst diagnosed on EUS-guided FNA.

VideoGIE 2019 Aug 30;4(8):379-380. Epub 2018 Nov 30.

Division of Gastroenterology, Section of Interventional Endoscopy, Indiana University School of Medicine, Indianapolis, Indiana, USA.

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http://dx.doi.org/10.1016/j.vgie.2018.10.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6669307PMC
August 2019

Prevalence and Clinical Outcomes of Common Bile Duct Dilation in Patients Who Use Opium.

Am J Med Sci 2018 07 7;356(1):39-46. Epub 2018 Apr 7.

Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

Background: This study aimed to evaluate the association of various opium-related factors with common bile duct (CBD) diameter in individuals who use opium in the general population and investigate the clinical importance and long-term outcomes.

Materials And Methods: In this prospective study, 2,400 participants were randomly selected from the Golestan Cohort study. Opium consumption data were recorded. CBD diameter was measured by ultrasound. Transient elastography was performed at enrollment and 3 years later. Participants were followed up for at least 5 years.

Results: A total of 1,599 individuals, aged above 50 years, were enrolled and 167 subjects were users of opium. CBD diameter was significantly higher in users of opium than controls (mean ± standard deviation:5.54 ± 1.95 versus 4.74 ± 1.34mm, P < 0.001). This difference was noted with all opium types, but mostly by users of heroin (P < 0.001). Ingestion of opium caused greater CBD dilatation than inhalation (coefficient: 1.16; 95% CI: 0.05-2.27, P = 0.04 versus coefficient: 0.98; 95% CI: 0.75-1.20, P < 0.001). Transient elastography results did not show any association between fibroscan score change and CBD diameter. No major related malignancy was seen during follow-up.

Conclusions: This study strengthened the evidence of an association of opium use with increased CBD diameter in a population-based setting without significantly increased risk of pancreaticobiliary malignancies or liver fibrosis. We cautiously suggest that opium-induced CBD dilatation may not require further diagnostic work-up.
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http://dx.doi.org/10.1016/j.amjms.2018.04.003DOI Listing
July 2018

Per-Pass Performance Characteristics of Endoscopic Ultrasound-Guided Fine-Needle Aspiration of Malignant Solid Pancreatic Masses in a Large Multicenter Cohort.

Pancreas 2018 03;47(3):296-301

Objectives: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is widely performed for the evaluation of pancreatic masses. We evaluated the performance characteristics of EUS-FNA in obtaining a diagnosis of pancreatic malignancy.

Methods: We performed a multicenter study of patients who underwent EUS-FNA for a solid pancreatic mass. Endoscopic ultrasound-guided FNA was standardized using a 25-gauge needle, slow-pull stylet technique for specimen acquisition, and on-site cytopathology. For the primary analysis, only malignant cytology was regarded as positive. A secondary analysis was performed in which malignant and/or suspicious cytology was regarded as positive.

Results: A total of 138 patients underwent EUS-FNA. In the primary analysis, the sensitivity of EUS-FNA for malignancy was 56.7% on first pass, 73.3% on second pass, 83.3% on third pass, 89.2% on fourth pass, and 90.8% on fifth pass, with no increase beyond the fifth pass. In the secondary analysis, the sensitivity was 75.0% on first pass, 89.2% on second pass, 93.3% on third pass, and 95.8% on fourth pass, with no increase beyond the fourth pass. No significant relationship was seen between lesion size and diagnostic yield.

Conclusions: Using a 25-gauge needle, the maximal diagnostic yield of EUS-FNA for a solid pancreatic mass is reached after 4 needle passes.
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http://dx.doi.org/10.1097/MPA.0000000000001003DOI Listing
March 2018

Opium Use and Risk of Pancreatic Cancer: A Prospective Cohort Study.

Cancer Epidemiol Biomarkers Prev 2018 03 20;27(3):268-273. Epub 2017 Dec 20.

Liver and Pancreatobiliary Diseases Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran.

We examined the association between opium consumption and pancreatic cancer incidence in a large-scale prospective cohort of the general population in northeastern Iran. A total of 50,045 adults were systematically followed up (median of 7.4 years), and incident cases of pancreatic cancer were identified. Self-reported data on opium consumption was collected at baseline. Cumulative use (-year) was defined as number of nokhods (a local unit, approximately 0.2 g) of opium consumed per day multiplied by number of years consuming. Adjusted HRs and 95% confidence intervals (CIs) for the association between opium consumption and pancreatic cancer were calculated using Cox proportional hazards regression models. Overall, 54 confirmed cases of pancreatic cancer were identified. Opium use of more than 81 nokhod-years (high cumulative use), compared with never use, was strongly associated with pancreatic cancer even after adjustments for multiple potential confounding factors [HR = 3.01; 95% CI, 1.25-7.26]. High cumulative consumption of opium was significantly associated with risk of pancreatic cancer after adjusting for cumulative dose of cigarette smoking [HR = 3.56; 95% CI, 1.49-8.50]. In a sensitivity analysis, we excluded participants (including 2 pancreatic cancer cases) who were recruited within the first 5 years of starting opium consumption; high cumulative use of opium was still associated with pancreatic cancer risk [HR = 2.75; 95% CI, 1.14-6.64]. Our results showed a positive association between opium consumption and pancreatic cancer. This is the first prospective large-scale study to show the association of opium consumption with pancreatic cancer as a risk factor. .
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http://dx.doi.org/10.1158/1055-9965.EPI-17-0592DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5835180PMC
March 2018

Ulcerative Colitis Following Orthotopic Cardiac Transplantation.

Middle East J Dig Dis 2017 Oct;9(4):235-238

Liver and Pancreatobiliary Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran.

Inflammatory bowel disease following a solid organ transplantation while the patient is receiving immunosuppressive therapy is a rare phenomenon. Here we present a 48-year-old man who underwent cardiac transplantation 9 years earlier and was receiving cyclosporine as immunosuppressive therapy since then, presenting with complaints of rectorrhagia and diarrhea. In follow-up, he was diagnosed as having ulcerative colitis. We also reviewed the literature for similar cases, which yielded very few similar ones.
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http://dx.doi.org/10.15171/mejdd.2017.79DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5726337PMC
October 2017

Increasing Number of Passes Beyond 4 Does Not Increase Sensitivity of Detection of Pancreatic Malignancy by Endoscopic Ultrasound-Guided Fine-Needle Aspiration.

Clin Gastroenterol Hepatol 2017 Jul 23;15(7):1071-1078.e2. Epub 2016 Dec 23.

University of Colorado Anschutz Medical Campus, Aurora, Colorado. Electronic address:

Background & Aims: It is not clear exactly how many passes are required to determine whether pancreatic masses are malignant using endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). We aimed to define the per-pass diagnostic yield of EUS-FNA for establishing the malignancy of a pancreatic mass, and identify factors associated with detection of malignancies.

Methods: In a prospective study, 239 patients with solid pancreatic masses were randomly assigned to groups that underwent EUS-FNA, with the number of passes determined by an on-site cytopathology evaluation or set at 7 passes, at 3 tertiary referral centers. A final diagnosis of pancreatic malignancy was made based on findings from cytology, surgery, or a follow-up evaluation at least 1 year after EUS-FNA. The cumulative sensitivity of detection of malignancy by EUS-FNA was calculated after each pass; in the primary analysis, lesions categorized as malignant or suspicious were considered as positive findings.

Results: Pancreatic malignancies were found in 202 patients (84.5% of the study population). EUS-FNA detected malignancies with 96% sensitivity (95% confidence interval [CI], 92%-98%); 4 passes of EUS-FNA detected malignancies with 92% sensitivity (95% CI, 87%-95%). Tumor size greater than 2 cm was the only variable associated with positive results from cytology analysis (odds ratio, 7.8; 95% CI, 1.9-31.6). In masses larger than 2 cm, 4 passes of EUS-FNA detected malignancies with 93% sensitivity (95% CI, 89%-96%) and in masses ≤2 cm, 6 passes was associated with 82% sensitivity (95% CI, 61%-93%). Sensitivity of detection did not increase with increasing number of passes.

Conclusions: In a prospective study, we found 4 passes of EUS-FNA to be sufficient to detect malignant pancreatic masses; increasing the number of passes did not increase the sensitivity of detection. Tumor size greater than 2 cm was associated with malignancy, and a greater number of passes may be required to evaluate masses 2 cm or less. ClinicalTrials.gov number, NCT01386931.
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http://dx.doi.org/10.1016/j.cgh.2016.12.018DOI Listing
July 2017

Opium use, cigarette smoking, and alcohol consumption in relation to pancreatic cancer.

Medicine (Baltimore) 2016 Jul;95(28):e3922

Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran Digestive Disease Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran Department of Public Health Analysis, School of Community Health and Policy, Morgan State University, Baltimore, MD Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences Gastrointestinal and Liver Disease Research Center, Firoozgar Hospital, Iran University of Medical Sciences Sasan Alborz Biomedical Research Center, Masoud Gastroenterology and Hepatology Clinic, Tehran, Iran Division of Gastroenterology and Hepatology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins Medical Institutions, Baltimore, MD American Cancer Society, Atlanta, GA Institute for Transitional Epidemiology and the Tisch Cancer Institute, Mount Sinai School of Medicine, New York, NY.

Background And Aims: Although several studies have suggested opium as a risk factor for cancers of the esophagus, stomach, larynx, lung, and bladder, no previous study has examined the association of opium with pancreatic cancer. We aimed to study the association between opium use and risk of pancreatic cancer in Iran, using a case-control design. We also studied the association of cigarette smoking and alcohol consumption with pancreatic cancer, for which little information was available from this population.

Methods: Cases and controls were selected from patients who were referred to 4 endoscopic ultrasound centers in Tehran, Iran. We recruited 316 histopathologically (all adenocarcinoma) and 41 clinically diagnosed incident cases of pancreatic cancer, as well as 328 controls from those with a normal pancreas in enodosonography from January 2011 to January 2015. We used logistic regression models to calculate odds ratios (ORs) and 95% confidence intervals (CIs).

Results: After adjustment for potential confounders, opium use (OR 1.91; 95% CI 1.06-3.43) and alcohol consumption (OR 4.16; 95% CI 1.86-9.31) were significantly associated with an increased risk of pancreatic cancer. We did not find an association between ever tobacco smoking and pancreatic cancer risk (OR 0.93; 95% CI 0.62-1.39).

Conclusion: In our study, opium use and alcohol consumption were associated with an increased risk of pancreatic cancer, whereas cigarette smoking was not.
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http://dx.doi.org/10.1097/MD.0000000000003922DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4956779PMC
July 2016

Risk factors associated with the transmission of carbapenem-resistant Enterobacteriaceae via contaminated duodenoscopes.

Gastrointest Endosc 2016 Jun 16;83(6):1121-9. Epub 2016 Mar 16.

Division of Digestive Diseases, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California, USA.

Background And Aims: The duodenoscopes used to perform ERCP have been implicated in several outbreaks of carbapenem-resistant Enterobacteriaceae (CRE) infection. The risk factors for CRE transmission via contaminated duodenoscopes remain unclear.

Methods: In this retrospective, single-center, case-control study, all patients who underwent ERCP with either 1 of 2 contaminated duodenoscopes were evaluated. We compared the patients who acquired CRE (active infection or colonization) with those who did not.

Results: Between October 3, 2014, and January 28, 2015, a total of 125 procedures were performed on 115 patients by using either of the contaminated duodenoscopes. Culture data were available for 104 of the 115 exposed patients (90.4%). Among these patients, 15 (14.4%) became actively infected (n = 8, 7.7%) or colonized (n = 7, 6.7%) with CRE. On univariate analysis, recent antibiotic exposure (66.7% vs 37.1%; P = .046), active inpatient status (60.0% vs 28.1%; P = .034), and a history of cholangiocarcinoma (26.7% vs 3.4%; P = .008) were patient characteristics associated with an increased risk of CRE infection. Biliary stent placement (53.3% vs 22.5%; P = .024) during ERCP was a significant procedure-related risk factor. After adjusting for cholangiocarcinoma, biliary stent placement (odds ratio 3.62; 95% confidence interval, 1.12-11.67), and active inpatient status (odds ratio 3.74; 95% confidence interval, 1.15-12.12) remained independent risk factors for CRE transmission.

Conclusions: In patients undergoing ERCP with a contaminated duodenoscope, biliary stent placement, a diagnosis of cholangiocarcinoma, and active inpatient status are associated with an increased risk of CRE transmission.
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http://dx.doi.org/10.1016/j.gie.2016.03.790DOI Listing
June 2016

Repeated Intraportal Injection of Mesenchymal Stem Cells in Combination with Pioglitazone in Patients with Compensated Cirrhosis: A Clinical Report of Two Cases.

Arch Iran Med 2016 Feb;19(2):131-6

Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran.

Background: Transplantation of mesenchymal stem cells (MSCs) in combination with pioglitazone, an agonist of peroxisome proliferator-activated receptor-γ (PPAR-γ), can reduce liver fibrosis in models of liver injury. In this study, we conducted a pilot study of intraportal infusion of autologous MSCs in combination with pioglitazone to assess safety, feasibility, and effectiveness in patients with compensated cirrhosis.

Methods: Two patients with compensated cirrhosis were enrolled in this study. Intraportal autologous bone marrow-derived MSCs were transplanted twice (6 months interval) to the patients. Meanwhile, 30 mg/day pioglitazone was prescribed for 12 months.  Patients were assessed at baseline and months 1, 3, 6, and 12 post-infusion.

Results: Procedural complications or any major adverse effects did not occur in this pilot study.  The patients' clinical conditions remained stable with no evidence of deterioration during the course of the study. A transient improvement in the Model for End-Stage Liver Disease (MELD) score was observed at month 3 post-infusion in one patient, which eventually returned to baseline at month 12.

Conclusion: The combination of pioglitazone with MSCs is safe and feasible. The data justify further study of the combination therapy in cirrhotic patients.
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http://dx.doi.org/0161902/AIM.0011DOI Listing
February 2016

Intraportal Infusion of Bone Marrow Mononuclear or CD133+ Cells in Patients With Decompensated Cirrhosis: A Double-Blind Randomized Controlled Trial.

Stem Cells Transl Med 2016 Jan 10;5(1):87-94. Epub 2015 Dec 10.

Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, Academic Center for Education, Culture and Research, Tehran, Iran

Unlabelled: The present study assessed the effects of intraportal infusions of autologous bone marrow-derived mononuclear cells (MNCs) and/or CD133+ cells on liver function in patients with decompensated cirrhosis. We randomly assigned 27 eligible patients to a placebo, MNCs, and/or CD133+ cells. Cell infusions were performed at baseline and month 3. We considered the absolute changes in the Model for End-Stage Liver Disease (MELD) scores at months 3 and 6 after infusion as the primary outcome. The participants and those who assessed the outcomes were unaware of the treatment intervention assignments. After 6 months, 9 patients were excluded because of liver transplantation (n=3), hepatocellular carcinoma (n=1), loss to follow-up (n=3), and death (n=2). The final analysis included 4 patients from the CD133+ group, 8 from the MNC group, and 6 from the placebo group. No improvement was seen in the MELD score at month 6 using either CD133+ cells or MNC infusions compared with placebo. However, at month 3 after infusion, a trend was seen toward a higher mean absolute change in the MELD score in patients who had received CD133+ cells compared with placebo (-2.00±1.87 vs. -0.13±1.46; p=.08). No significant adverse events occurred in the present study. A transient improvement in the MELD score was observed in subjects treated with CD133+ cells but not in the MNC or placebo group. Although the study was not powered to make definitive conclusions, the data justify further study of CD133+ therapy in cirrhotic patients.

Significance: Cell therapy is a new approach in liver disease. Several clinical experiments have been reported on the safety of bone marrow-derived stem cells to treat liver disorders. However, the effectiveness of these approaches in the long-term follow-ups of patients initiated controversial discussions among the scientific community. A double-blind randomized controlled trial was designed to address this concern scientifically. A transient improvement in the patients' signs occurred; however, for a sustainable result, more work is needed. The results of multiple administrations of cells reported in the present study can be compared with the results from other single-injection studies.
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http://dx.doi.org/10.5966/sctm.2015-0004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4704869PMC
January 2016

Diagnostic yield of EUS-guided FNA for malignant biliary stricture: a systematic review and meta-analysis.

Gastrointest Endosc 2016 Feb 28;83(2):290-8.e1. Epub 2015 Sep 28.

Anniston Digestive Health, Anniston, Alabama, USA.

Background And Aims: EUS-guided FNA (EUS-FNA) is increasingly being used for tissue diagnosis of extrahepatic biliary strictures. The aim of this study was to determine the diagnostic yield of EUS-FNA in malignant biliary strictures.

Methods: A comprehensive literature review was carried out by 2 reviewers for studies evaluating the accuracy of EUS-FNA in biliary stricture. A meta-analysis was performed to determine the pooled estimates of sensitivity, specificity, likelihood ratios, and diagnostic odds ratio for EUS-FNA of extrahepatic biliary stricture. A Quality Assessment of Diagnostic Accuracy Studies questionnaire was used to assess the quality of the selected studies. Several sensitivity analyses were performed to assess the effect of the quality of the studies on the accuracy of the final results of the meta-analysis.

Results: Twenty studies involving 957 patients met inclusion criteria and were included in the meta-analysis. The pooled sensitivity and specificity of EUS-FNA for diagnosis of malignant biliary stricture were 80% (95% confidence interval [CI], 74%-86%), and 97% (95% CI, 94%-99%), respectively. The pooled positive likelihood ratio was 12.35 (95% CI, 7.37-20.72), and the negative likelihood ratio was 0.26 (95% CI, 0.18-0.38). The pooled diagnostic odds ratio for diagnosing a malignant biliary stricture was 70.53 (95% CI, 38.62-128.82). The area under the receiver-operating characteristic curve was 0.97. Sensitivity analyses showed that the quality of the included studies did not affect the accuracy of the final results of the meta-analysis.

Conclusion: This meta-analysis demonstrates that EUS-FNA is sensitive and highly specific for diagnosing malignancy in biliary strictures. Further studies are needed to compare EUS--FNA with emerging methods including cholangioscopy-guided biopsy and laser endomicroscopy.
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http://dx.doi.org/10.1016/j.gie.2015.09.024DOI Listing
February 2016

Primary pancreatic Hodgkin's lymphoma diagnosed on EUS-guided FNA.

Gastrointest Endosc 2016 Apr 28;83(4):844-5; discussion 845. Epub 2015 Sep 28.

Department of Medicine, Division of Gastroenterology, American University of Beirut, Beirut, Lebanon.

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http://dx.doi.org/10.1016/j.gie.2015.09.028DOI Listing
April 2016

Biliary fascioliasis diagnosed by EUS.

Gastrointest Endosc 2016 Mar 21;83(3):658-9. Epub 2015 Sep 21.

Anniston Digestive Health, Anniston, Alabama, USA.

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http://dx.doi.org/10.1016/j.gie.2015.09.012DOI Listing
March 2016

Prevalence of colorectal polyps in a group of subjects at average-risk of colorectal cancer undergoing colonoscopic screening in Tehran, Iran between 2008 and 2013.

Asian Pac J Cancer Prev 2014 ;15(22):9773-9

Gastrointestinal and Liver Disease Research Center, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran E-mail :

Background: Colorectal cancer (CRC) is one of the prime causes of mortality around the globe, with a significantly rising incidence in the Middle East region in recent decades. Since detection of CRC in the early stages is an important issue, and also since to date there are no comprehensive epidemiologic studies depicting the Middle East region with special attention to the average risk group, further investigation is of significant necessity in this regard.

Aim: Our aim was to investigate the prevalence of preneoplastic and neoplastic lesions of the colon in an average risk population.

Materials And Methods: A total of 1,208 eligible asymptomatic, average- risk adults older than 40 years of age, referred to Firuzgar Hospotal in the years 2008-2012, were enrolled. They underwent colonoscopy screening and all polypoid lesions were removed and examined by an expert gastrointestinal pathologist. The lesions were classified by size, location, numbers and pathologic findings. Size of lesions was measured objectively by endoscopists.

Results: The mean age of participants was 56.5±9.59 and 51.6% were male. The overall polyp detection rate was 199/1208 (16.5 %), 26 subjects having non-neoplastic polyps, including hyperplastic lesions, and 173/1208 (14.3%) having neoplastic polyps, of which 26 (2.15%) were advanced neoplasms .The prevalence of colorectal neoplasia was more common among the 50-59 age group. Advanced adenoma was more frequent among the 60-69 age group. The majority of adenomas were detected in the distal colon, but a quarter of advanced adenomas were found in the proximal colon; advance age and male gender was associated with the presence of adenoma.

Conclusions: It seems that CRC screening among average-risk population might be recommended in countries such as Iran. However, sigmioidoscopy alone would miss many colorectal adenomas. Furthermore, the 50-59 age group could be considered as an appropriate target population for this purpose in Iran.
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http://dx.doi.org/10.7314/apjcp.2014.15.22.9773DOI Listing
August 2015

Cohort profile: golestan hepatitis B cohort study- a prospective long term study in northern iran ​.

Middle East J Dig Dis 2014 Oct;6(4):186-94

Liver and Pancreatobiliary Diseases Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran university of Medical Sciences, Tehran, Iran.

Hepatitis B virus (HBV) infection is the most common cause of end stage liver disease in Iran and in Golestan province. Large-scale population-based prospective cohort studies with long term follow-up are the method of choice to accurately understand the natural course of HBV infection. To date, several studies of HBV epidemiology, natural history, progression to cirrhosis and association with HCC have been reported from other countries. However, few of these are prospective and fewer still are population-based. Moreover, the underlying molecular mechanisms and immunogenetic determinants of the outcome of HBV infection especially in low and middle income countries remains largely unknown. Therefore, the hepatitis B cohort study (HBCS), nested as part of the Golestan Cohort Study (GCS), Golestan, Iran was established in 2008 with the objective to prospectively investigate the natural course of chronic hepatitis B with reference to its epidemiology, viral/host genetic interactions, clinical features and outcome in the Middle East where genotype D HBV accounts for >90% of infections. In 2008, a baseline measurement of HBV surface antigen (HBsAg) was performed on stored serum samples of all GCS participants. A sub-cohort of 3,505 individuals were found to be HBsAg positive and were enrolled in the Golestan HBCS. In 2011, all first degree relatives of HBsAg positive subjects including their children and spouses were invited for HBV serology screening and those who were positive for HBsAg were also included in the Golestan HBCS.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4208926PMC
October 2014

Utility of endoscopic ultrasound to diagnose remnant stones in symptomatic patients after cholecystectomy.

Endoscopy 2014 Aug 30;46(8):650-5. Epub 2014 Jun 30.

Department of Medicine, Division of Gastroenterology, American University of Beirut, Beirut, Lebanon.

Background And Study Aims: Stones in the cystic duct stump (CDS) or gallbladder remnant after cholecystectomy are difficult to identify. The aim of this study was to evaluate the utility of endoscopic ultrasound (EUS) in the diagnosis of stones in the CDS or gallbladder remnant in patients with postcholecystectomy syndrome.

Methods: A prospective study was conducted between January 2011 and December 2012 in consecutive patients with pancreaticobiliary-type pain or acute pancreatitis (n = 112) following cholecystectomy. Diagnostic modalities including EUS were used to diagnose the cause of postcholecystectomy syndrome.

Results: A total of 11 patients (10 %) were found to have stones in the gallbladder remnant (n = 8), CDS (n = 2), or both (n = 1). In eight patients, EUS was the first imaging procedure to make the diagnosis. Seven patients agreed to undergo repeat surgery, and six of them remained free of symptoms postoperatively after a median follow-up period of 4 months (range 1 - 13 months).

Conclusion: EUS may be an important procedure to consider in the study of patients with symptoms after cholecystectomy, as the diagnosis of residual stones is frequently missed by other imaging modalities.
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http://dx.doi.org/10.1055/s-0034-1365721DOI Listing
August 2014

Can hepatitis e virus be considered as an etiology of cryptogenic cirrhosis?

Int J Prev Med 2014 Apr;5(4):527-8

Gastrointestinal and Liver Disease Research Center, Iran University of Medical Sciences, Firoozgar Hospital, Tehran, Iran.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4018605PMC
April 2014

Photoclinic.

Arch Iran Med 2014 Mar;17(3):215-6

Digestive Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran.

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http://dx.doi.org/0141703/AIM.0015DOI Listing
March 2014

Impact of preoperative endoscopic ultrasound-guided fine needle aspiration on postoperative recurrence and survival in cholangiocarcinoma patients.

Endoscopy 2013 Nov 28;45(11):883-9. Epub 2013 Oct 28.

Department of Gastroenterology and Hepatology, Indiana University, Indianapolis, United States.

Background And Study Aim: Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is frequently performed for suspected biliary tumors for diagnosis and staging but carries a theoretical risk of needle-track seeding. We aimed to evaluate the impact of preoperative EUS-FNA on long-term outcomes for patients with cholangiocarcinoma (CCA).

Patients And Methods: In a retrospective single-center study of consecutive patients with CCA with preoperative EUS-FNA, main outcome measures were overall survival and progression-free survival.

Results: In 150 patients with confirmed CCA, 61 underwent preoperative FNA. Median overall survival was 18.5 months (95% confidence limits [CL] 15.4, 25.7): 111 patients died and 39 survived. Of the 150 patients, 119 underwent curative-intent surgical resection, with median progression-free survival of 17.8 months (95% CL 14.5, 22.8); 89/119 patients had tumor recurrence or died, and 30/119 remained alive and disease-free. On multivariable analysis, overall survival was associated with: undergoing curative-intent surgery (hazard ratio [HR] 5.79, P = 0.001), lack of lymph node involvement (HR 1.89, P = 0.011), younger age (HR 1.51 for every 10 years, P < 0.0015), and small tumor size (HR 1.11 for every 1 cm, P = 0.029). For patients undergoing curative-intent surgery, on multivariable analysis, improved progression-free survival was associated with: lack of lymph node involvement (HR 1.88, P = 0.010), smaller tumor size (HR 1.16 for every 1 cm smaller, P = 0.003), and younger age (HR 1.53 for every 10 years, P < 0.001). Number of needle passes showed no statistically significant impact on overall survival.

Conclusion: Preoperative EUS-FNA in patients with CCA does not appear to adversely affect overall or progression-free survival.
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http://dx.doi.org/10.1055/s-0033-1344760DOI Listing
November 2013

Randomized placebo-controlled trial of mesenchymal stem cell transplantation in decompensated cirrhosis.

Liver Int 2013 Nov 14;33(10):1490-6. Epub 2013 Jun 14.

Digestive Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Background & Aims: There has been great interest in recent years to take advantage of bone marrow stem cells to treat cirrhosis. Our uncontrolled trial showed promising results for bone marrow mesenchymal stem cell (MSC) transplantation in cirrhosis. Therefore, we conducted a randomized, placebo-controlled trial to evaluate the efficacy of autologous MSC transplantation in cirrhosis.

Methods: The enrolled patients with decompensated cirrhosis were randomly assigned to receive MSC or placebo infusions. A median of 195 million (range: 120-295 million) cultured MSCs were infused through a peripheral vein. The primary outcome was absolute changes in MELD score. Secondary outcomes were absolute changes in Child score, liver function tests and liver volumes between the MSC and placebo group 12 months after infusion.

Results: A total of 27 patients were enrolled. Of these, 15 patients received MSC and 12 patients received placebo. One patient in the MSC group and one patient in the placebo group were lost to follow-up. Three patients in the MSC group died of liver failure 3 months (one patient), or 5 months (two patients) after cellular infusion. The baseline MELD scores of the deceased patients were significantly higher than those who remained alive in either group (20.0 vs. 15.1; P = 0.02). The absolute changes in Child scores, MELD scores, serum albumin, INR, serum transaminases and liver volumes did not differ significantly between the MSC and placebo groups at 12 months of follow-up.

Conclusion: Based on this randomized controlled trial, autologous bone marrow MSC transplantation through peripheral vein probably has no beneficial effect in cirrhotic patients. Further studies with higher number of patients are warranted to better clarify the impact of MSC infusion through peripheral vein or portal vein in cirrhosis.
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http://dx.doi.org/10.1111/liv.12228DOI Listing
November 2013

Squamous cell carcinoma of the pancreas.

Arch Iran Med 2013 Jun;16(6):369-70

Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran.

Squamous cell carcinoma (SCC) of the pancreas is a controversial entity of uncertain origin, as the pancreas is entirely devoid of squamous cells. Cases of pancreatic carcinomas that exhibit primary squamous morphology are rarely described in the literature. We report a case of primary SCC of the pancreas in a 66-year-old woman with complaints of epigastric pain of five months duration. Imaging studies demonstrated a solid tumor in the body of the pancreas that invaded the superior mesenteric (SMA) and celiac arteries, as well as regional lymph nodes. Cytological examination of an endosonography-guided fine needle aspiration (EUS-FNA) specimen confirmed the diagnosis of well-differentiated SCC of the pancreas. On the basis of diagnosis and examinations prior to chemotherapy, we did not detect any SCC lesions that might have metastasized to the pancreas. Primary SCC of the pancreas is a rare entity that comprises 0.05% of all exocrine pancreatic carcinomas. The clinical profile and biological behavior of pancreas SCC are similar to typical pancreatic ductal adenocarcinomas.
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http://dx.doi.org/013166/AIM.0012DOI Listing
June 2013

Cystsic lesions of the pancreas.

Arch Iran Med 2013 Apr;16(4):233-9

Digestive Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Pancreatic cysts (PCs) are being increasingly detected due to the widespread use of high-resolution abdominal imaging. The main imaging modalities to diagnose PCs include high-resolution spiral CT scan, MRI, and endoscopic ultrasound (EUS). EUS has the added benefit of enabling cyst fluid sampling through FNA and significantly improves clinical diagnosis of PCs. Some PCs like pseudocysts, serous cystadenomas, and lymphoepethelial cysts are entirely benign lesions and can be managed non-operatively. However, other lesions like mucinous cystic neoplasms, or cystic neuroendocrine tumors are pre-malignant or malignant lesions and require surgical intervention. In this review, we describe diagnosis and management of common pancreatic cystic lesions.
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http://dx.doi.org/013164/AIM.009DOI Listing
April 2013

Endoscopic ultrasonography to diagnose common bile duct transection after laparoscopic cholecystectomy: with video.

Dig Endosc 2012 Nov;24(6):475

Digestive Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran.

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http://dx.doi.org/10.1111/j.1443-1661.2012.01313.xDOI Listing
November 2012

Surveillance for hepatocellular carcinoma after autologous stem cell transplantation in cirrhosis.

Middle East J Dig Dis 2012 Jul;4(3):145-9

Digestive Disease Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Background: During the resent years there has been interest in using bone marrow stem cells to treat liver cirrhosis. However, there is a potential concern for malignant transformation after stem cell therapy. The aim of this study was to evaluate the development of hepatocellular carcinoma (HCC) after autologous bone marrow stem cell transplantation for liver cirrhosis.

Methods: All the patients who underwent autologous stem cell transplantation for liver cirrhosis between 2005 and 2011 at our center were enrolled. Cellular infusion was made through peripheral vein, portal vein, or hepatic artery.The patients were invited to undergo screening for hepatocellular carcinoma. The screening was made with ultrasonography and alpha-feto protein (AFP) measurement.

Results: Thirty two patients (18 males) were included in the study. Mean age of patients was 45.7 years. Fifteen patients (47%) received mesenchymal stem cell (MSC), 9 (28%) received bone marrow mononuclear cells, 5 (16%) were given CD 133-positive bone marrow cells, and 3 (9%) patients received CD 34-positive bone marrow cells. Mean duration of follow up was 20.5months. Mean serum level of AFP was 2.8 ng/ml at baseline and 3.4ng/ml at the end of follow up (p= 0.3). One patient was found to have hepatocellular carcinoma three months after infusion of bone marrow mononuclear cells. The incidence rate for HCC was 1.8 cases per 100 person-years in this study.

Conclusion: Autologous bone marrow stem cell infusion does not appear to increase the risk of hepatocellular carcinoma. The incidence rate of HCC in this study is comparable or even less than the reported rates of HCC in cohort studies of cirrhotic patients.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3990114PMC
July 2012

Utility of EUS-guided biopsy of extramural pelvic masses.

Gastrointest Endosc 2012 Jan 21;75(1):146-51. Epub 2011 Oct 21.

Indiana University Medical Center, Indianapolis, IN, USA.

Background: The diagnostic utility of EUS-guided FNA (EUS-FNA) and EUS-guided Trucut biopsy (EUS-TCB) of pelvic masses has not been well described.

Objective: To evaluate the utility of EUS in the diagnosis of pelvic masses.

Design: Retrospective cohort study.

Setting: Single tertiary referral hospital in Indianapolis, Indiana.

Patients: Consecutive patients referred for EUS evaluation of pelvic mass from January 2002 to July 2009. Patients with newly diagnosed rectal cancer or a known/suspected intramural mass were excluded.

Interventions: EUS-FNA and/or EUS-TCB.

Main Outcome Measurements: Endosonographic features and cytological and pathological findings were evaluated. The final diagnosis was confirmed by surgical pathology or cytology and clinical follow-up. The sensitivities and specificities of EUS-TCB were calculated in a subset of patients with available surgical pathology.

Results: A total of 69 patients were identified, and 40 with intramural lesions (n = 36) or incomplete follow-up (n = 4) were excluded. The remaining 29 patients (15 men, mean age 58.5 ± 10.8 years) with pelvic masses (mean size 40.8 ± 20.1 mm) were evaluated. EUS-FNA or EUS-TCB helped to make the diagnosis in 25 of 29 patients (86%). Compared with surgical pathology (available in 17 patients), EUS-FNA had a sensitivity of 88% (95% CI, 53%-98%) and specificity of 100% (95% CI, 65%-100%) for malignancy. EUS-TCB alone had a sensitivity of 67% (95% CI, 21%-94%) and specificity of 100% (95% CI, 34%-100%) for malignancy, but the combination of EUS-FNA and EUS-TCB had a sensitivity of 100% (95% CI, 68%-100%) and a specificity of 100% (95% CI, 68%-100%). Complications after EUS-FNA included a pelvic abscess in 2 patients (7%) with a cystic pelvic mass.

Limitation: Single-center study.

Conclusion: EUS-FNA and EUS-TCB are sensitive for the diagnosis of malignancy in pelvic masses. Sampling of cystic masses in this region is discouraged.
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http://dx.doi.org/10.1016/j.gie.2011.08.031DOI Listing
January 2012

Eosinophilic gastroenteritis: a case series from iran.

Middle East J Dig Dis 2011 Sep;3(2):115-8

Digestive Disease Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran ; Sasan Alborz Biomedical Research, Institute, Tehran, Iran.

BACKGROUND Eosinophilic gastroenteritis (EG) is a rare inflammatory disorder of the gastrointestinal (GI) tract. There have been several case series of patients with EG from the western world and East Asia. However, there has not been a report of patients with EG from the Middle East region. The aim of this study is to describe clinical characteristics and treatment response in a series of EG patients from Iran. METHODS We retrospectively reviewed charts with a diagnosis of EG from 1997 to 2010 at Shariati Hospital and the private clinics of the authors. Clinical characteristics of the patients were evaluated, and the treatment response and relapse rate were assessed. RESULTS Twenty-two patients (9 male) with EG were identified. Mean age of the patients was 45.1±15.5 (range: 27-75) years. Median duration between symptom onset and diagnosis was 12 (range 1- 48) months. Twenty (90%) patients had mucosal involvement, one (5%) had muscular involvement and one (5%) had subserosal involvement. Patients were followed for a median duration of 36.5 (range 4-123) months. Two patients had spontaneous remission with supportive care. The remaining 20 patients responded well to oral corticosteroid treatments. The relapse rate was 33%. Episodes of relapse were successfully controlled with a repeat course of corticosteroids. Two patients with several relapses required maintenance treatment with azathioprine. CONCLUSION The clinical characteristics and treatment responses of EG patients from Iran are similar to reports from other parts of the world. Patients need to undergo close follow up after treatment to detect early signs of relapse.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4154914PMC
September 2011

Hepatitis B Virus Infection during Pregnancy: Transmission and Prevention.

Middle East J Dig Dis 2011 Sep;3(2):92-102

Digestive Disease Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Hepatitis B virus (HBV) infection is a global public health problem. In endemic areas, HBV infection occurs mainly during infancy and early childhood, with mother to child transmission (MTCT) accounting for approximately half of the transmission routes of chronic HBV infections. Prevention of MTCT is an essential step in reducing the global burden of chronic HBV. Natal transmission accounts for most of MTCT, and providing immunoprophylaxis to newborns is an excellent way to block natal transmission. Prenatal transmission is responsible for the minority of MTCT not preventable by immunoprophylaxis. Because of the correlation between prenatal transmission and the level of maternal viremia, some authors find it sound to offer lamivudine in women who have a high viral load (more than 8 to 9 log 10 copies/mL). In addition to considerations regarding the transmission of HBV to the child, the combination of HBV infection and pregnancy raises several unique management issues. Chronic HBV infection during pregnancy is usually mild but may flare after delivery or with discontinuing therapy. Management of chronic HBV infection in pregnancy is mostly supportive with antiviral medications indicated in a small subset of HBV infected women with rapidly progressive chronic liver disease.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4154922PMC
September 2011