Publications by authors named "Prashansha Vaidya"

5 Publications

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Is Intestinal Diversion an Effective Treatment for Distal Crohn's Disease?

Inflamm Bowel Dis 2021 Jun 2. Epub 2021 Jun 2.

Division of Colon and Rectal Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.

Background: Fecal diversion with an ileostomy is selectively used in cases of medically refractory Crohn's proctocolitis or advanced perianal disease. The aim of this study was to evaluate clinical improvement after fecal diversion in Crohn's disease (CD) and factors associated with clinical improvement.

Methods: A retrospective chart review of adult CD patients undergoing ileostomy formation for distal disease between 2000 and 2019 at 2 CD referral centers was conducted. The primary outcome was the rate of clinical improvement with diversion that allowed for successful restoration of intestinal continuity. Secondary outcomes included the rate of clinical and endoscopic improvement after fecal diversion, ileostomy morbidity, need for subsequent total proctocolectomy and end ileostomy, and factors associated with a clinical response to fecal diversion.

Results: A total of 132 patients with a median age of 36 years (interquartile range, 25-49) were included. Mean duration of disease was 16.2 years (10.4) years. Indication for surgery was medically refractory proctocolitis with perianal disease (n = 59; 45%), perianal disease alone (n = 24; 18%), colitis (n = 37; 28%), proctitis (n = 4; 3%), proctocolitis alone (n = 4; 3%), and ileitis with perianal disease (n = 4; 3%). Medications used before surgery included corticosteroids (n = 59; 45%), immunomodulators (n = 55; 42%) and biologics (n = 82; 62%). The clinical and endoscopic response to diversion was 43.2% (n = 57) and 23.9% (n = 16). At a median follow-up of 35.3 months (interquartile range, 10.6-74.5), 25 patients (19%) had improved and had ileostomy reversal, but 86 (65%) did not improve, with 50 (38%) undergoing total proctocolectomy for persistent symptoms. There were no significant predictors of clinical improvement.

Conclusions: The use of a "temporary" ileostomy is largely ineffective in achieving clinical response.
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http://dx.doi.org/10.1093/ibd/izab126DOI Listing
June 2021

Endoscopic submucosal dissection is safe and feasible, allowing for ongoing surveillance and organ preservation in patients with inflammatory bowel disease.

Colorectal Dis 2021 May 22. Epub 2021 May 22.

Department of Colorectal Surgery, Digestive Disease Surgical Institute, Cleveland Clinic, Cleveland, Ohio, USA.

Aim: Experience of endoscopic submucosal dissection (ESD) for colorectal lesions in the setting of inflammatory bowel disease (IBD) remains limited. The aim of this work was to determine the safety, feasibility and oncological outcomes of ESD in patients with IBD.

Method: A retrospective review of all adult patients (≥18 years) with a known diagnosis of either ulcerative colitis (UC) or Crohn's disease (CD) who underwent advanced colonoscopy and ESD between 1 January 2014 and 1 October 2020. Data collected included patient demographics, disease characteristics, pathological variables and procedure-related complication rates.

Results: A total of 25 patients were included: 19 (76%) were male with a median age of 63 years and disease duration of more than 10 years. Sixteen had UC and nine had CD; the majority were taking corticosteroids, immunomodulators or monoclonal antibodies at the time of ESD. The median procedure time was 41 min and the majority (n = 18; 72%) utilized chromoendoscopy. The median lesion size was 30 mm: eight had low-grade dysplasia, nine had high-grade dysplasia and three had adenocarcinoma and underwent oncological resection. None had surgical intervention for complication of ESD or perforation. A total of 23 (88%) had a complete R0 resection. Over a median follow-up of 19 months, three were found to have dysplasia excised in polyps and none had subsequent adenocarcinoma.

Conclusion: ESD in the setting of IBD is safe and effective for complete removal of large neoplastic lesions, allowing for ongoing endoscopic surveillance and organ preservation rather than surgical intervention.
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http://dx.doi.org/10.1111/codi.15746DOI Listing
May 2021

Anal Squamous Cell Carcinoma in Ulcerative Colitis: Can Pouches Withstand Traditional Treatment Protocols?

Dis Colon Rectum 2021 Apr 26. Epub 2021 Apr 26.

Department of Colorectal Surgery, Digestive Disease Surgical Institute, Cleveland Clinic, Cleveland, Ohio General Surgery, Digestive Disease Surgical Institute, Cleveland Clinic, Cleveland, Ohio Department of Gastroenterology, Digestive Disease Surgical Institute, Cleveland Clinic, Cleveland, Ohio.

Background: Anal squamous cell carcinoma has rarely reported in ulcerative colitis.

Objective: Understand the prognosis of anal squamous cell carcinoma in the setting of ulcerative colitis.

Design: Retrospective review.

Setting: Referral center.

Patients: Adult patients with both ulcerative colitis (556.9/K51.9) and anal squamous cell carcinoma (154.3/C44.520) between January 1, 2000 to August 1, 2019.

Main Outcomes Measures: Treatment and survival of anal squamous cell carcinoma.

Results: Seventeen adult patients with ulcerative colitis and anal dysplasia and/or anal squamous cell carcinoma were included out of 13,499 ulcerative colitis patients treated; 6 had a diagnosis of anal squamous cell carcinoma, 8 had high grade squamous intraepithelial lesions, and 3 had low grade squamous intraepithelial lesions. There were 4 males (23%) and median age of 55 years (range, 32-69) years. At diagnosis, 6 had an ileal pouch anal anastomosis of which 5 had active pouchitis, 1 had an ileorectal anastomosis with active proctitis, 1 had a Hartman's stump with disuse proctitis, 5 had pancolitis, and 4 had left sided colitis. Of the 6 with anal squamous cell carcinoma, all received 5-FU and mitomycin C with external beam radiation therapy. Four patients had an ileal pouch anal anastomosis, all of whom required intestinal diversion or pouch excision due to treatment intolerance. At a median follow-up of 60 months, three patients experienced mortality: one at 0 months (treatment related myocardial infarction), one at 60 months (metastatic anal squamous cell carcinoma), and one at 129 months (malignant peripheral nerve sheath tumor); the remaining had no residual disease.

Limitations: Retrospective, small number of patients.

Conclusion: Anal squamous cell carcinoma in the setting of ulcerative colitis is extremely rare. In the setting of IPAA, diversion may be necessary to prevent radiation intolerance. Careful examination of the perianal region should be performed at the time of surveillance endoscopy. See Video Abstract at http://links.lww.com/DCR/B582.
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http://dx.doi.org/10.1097/DCR.0000000000002011DOI Listing
April 2021

Perioperative safety of tofacitinib in surgical ulcerative colitis patients.

Colorectal Dis 2021 May 3. Epub 2021 May 3.

Division of Colon and Rectal Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.

Aim: The literature regarding monoclonal antibodies and increased postoperative complications in inflammatory bowel disease remains controversial. There have been no studies investigating tofacitinib. The aim of this work was to determine preoperative exposure to the small-molecule inhibitor tofacitinib and postoperative outcomes.

Method: We conducted a retrospective review of all adult patients exposed to tofacitinib within 4 weeks of total abdominal colectomy for medically refractory ulcerative colitis between 1 January 2018 and 1 September 2020 at four inflammatory bowel disease referral centres. Data collected included patient demographics and 90-day postoperative morbidity, readmission and reoperation rates.

Results: Fifty-three patients (32 men, 60%) with ulcerative colitis underwent a total abdominal colectomy (n = 50 laparoscopic, 94%) for medically refractory disease. Previous exposure to monoclonal antibodies included infliximab (n = 34), adalimumab (n = 35), certolizumab pegol (n = 5), vedolizumab (n = 33) and ustekinumab (n = 10). Twenty-seven (51%) patients were on concurrent prednisone at a median daily dose of 30 mg by mouth (range 5-60 mg). There were no postoperative deaths. Ninety-day postoperative complications included ileus (n = 7, 13.2%), superficial surgical site infection (n = 4, 7.5%), intra-abdominal abscess (n = 2, 3.8%) and venous thromboembolism (VTE) (n = 7, 13.2%). Locations of VTE included portomesenteric venous thrombus (n = 4), internal iliac vein (n = 2) and pulmonary embolism (n = 1). Nine (17%) patients were readmitted to hospital and five (9%) patients had a reoperation.

Conclusion: Mirroring the recently issued US Food and Drug Administration black box warning of an increased risk of VTE in medically treated ulcerative colitis patients taking tofacitinib, preoperative tofacitinib exposure may present an increased risk of postoperative VTE events. Consideration should be given for prolonged VTE prophylaxis on hospital discharge.
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http://dx.doi.org/10.1111/codi.15702DOI Listing
May 2021

Impact of Atrial Fibrillation in Aortic Stenosis (From the United States Readmissions Database).

Am J Cardiol 2021 02 21;140:154-156. Epub 2020 Nov 21.

Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address:

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http://dx.doi.org/10.1016/j.amjcard.2020.11.021DOI Listing
February 2021