Publications by authors named "Zachary Zator"

7 Publications

  • Page 1 of 1

A prospective, head-to-head comparison of 2 EUS-guided liver biopsy needles in vivo.

Gastrointest Endosc 2021 May 9;93(5):1133-1138. Epub 2020 Oct 9.

Department of Gastroenterology, Lehigh Valley Health Network, Allentown, Pennsylvania, USA.

Background And Aims: Procedural standardization in endoscopic ultrasound-guided liver biopsy (EUS-LB) is necessary to obtain core biopsy specimens for accurate diagnosis. The objective of this study was to directly compare the diagnostic yield of 2 EUS-LB fine-needle biopsy (FNB) systems in vivo.

Methods: In this prospective, single-center study, 108 adult patients undergoing EUS-LB over a 1-year period were included. Each EUS-LB consisted of an EGD, followed by EUS-guided biopsy of the left lobe of the liver sequentially using 2 different 19-gauge needles: the fork-tip (SharkCore) and Franseen (Acquire) FNB systems. Specimens were then reviewed by a GI histopathologist to determine diagnostic adequacy as well as the number of complete portal tracts, specimen length, and degree of fragmentation.

Results: In 79.4% of cases, the fork-tip FNB system yielded a final diagnosis compared with 97.2% of the Franseen FNB specimens (P < .001). The mean number of complete portal tracts in the fork-tip FNB samples was 7.07 compared with 9.59 in the Franseen FNB samples (P < .001). The mean specimen length was 13.86 mm for the fork-tip FNB and 15.81 mm for the Franseen FNB (P = .004). Cores were intact in 47.6% of the fork-tip FNB samples and in 75.2% of the Franseen FNB samples (P = .004).

Conclusions: In EUS-LB, we found that the 19-gauge Franseen FNB system resulted in a statistically significant increase in diagnostic adequacy compared with biopsy using the fork-tip FNB system.
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May 2021

One step endoscopic ultrasound guided management of pelvic abscesses: a case series.

Therap Adv Gastroenterol 2018 28;11:1756284818785574. Epub 2018 Jun 28.

Presbyterian University Hospital, M2, C-wing, 200 Lothrop Street, Pittsburgh, PA 15213, USA.

Background: Endoscopic management of pelvic abscesses not amenable to percutaneous drainage has been described. The technique employs endoscopic ultrasound (EUS)-guided placement of stents or drains, which may require multiple procedures, is cumbersome and uncomfortable for the patient. We describe the successful management of these abscesses in a single step involving EUS-guided lavage and instillation of antibiotics.

Methods: Six consecutive patients with seven symptomatic pelvic abscesses not amenable to percutaneous drainage were referred for EUS-guided drainage. The abscesses were aspirated with a 19-gauge needle under EUS guidance and serially lavaged with an equal aspirate to instillation volume of sterile saline until cleared of pus. The residual cavity was then instilled with gentamicin 40 mg/ml. Patients were followed clinically and radiographically with repeat computed tomography or magnetic resonance imaging.

Results: All patients had rapid resolution of symptoms. The abscesses disappeared completely in four patients. One patient with recurrent diverticulitis and abscess had marked decrease in abscess size and inflammation to permit planned sigmoid resection. One patient with Crohn's disease had clinical improvement and marked decrease in abscess size, permitting outpatient management of Crohn's disease.

Conclusions: EUS-guided lavage and instillation of antibiotics is a simple, one-step approach in the management of pelvic abscesses and may obviate the need for prolonged drain management and repeat procedures in select cases.
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June 2018

Diagnosis and Management of Rectal Neuroendocrine Tumors.

Clin Endosc 2017 Nov 30;50(6):530-536. Epub 2017 Nov 30.

Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

The incidence of rectal neuroendocrine tumors (NETs) has increased by almost ten-fold over the past 30 years. There has been a heightened awareness of the malignant potential of rectal NETs. Fortunately, many rectal NETs are discovered at earlier stages due to colon cancer screening programs. Endoscopic ultrasound is useful in assessing both residual tumor burden after retrospective diagnosis and tumor characteristics to help guide subsequent management. Current guidelines suggest endoscopic resection of rectal NETs ≤10 mm as a safe therapeutic option given their low risk of metastasis. Although a number of endoscopic interventions exist, the best technique for resection has not been identified. Endoscopic submucosal dissection (ESD) has high complete and resection rates, but also an increased risk of complications including perforation. In addition, ESD is only performed at tertiary centers by experienced advanced endoscopists. Endoscopic mucosal resection has been shown to have variable complete resection rates, but modifications to the technique such as the addition of band ligation have improved outcomes. Prospective studies are needed to further compare the available endoscopic interventions, and to elucidate the most appropriate course of management of rectal NETs.
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November 2017

Insights into the genetic risk factors for the development of pancreatic disease.

Therap Adv Gastroenterol 2017 Mar 5;10(3):323-336. Epub 2017 Jan 5.

Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, Department of Cell Biology and Molecular Physiology, Department of Human Genetics, University of Pittsburgh, Gastroenterology, Room 401.4, 3708 Fifth Ave, Pittsburgh, PA 15213, USA.

Diseases of the exocrine pancreas such as recurrent acute pancreatitis (RAP), chronic pancreatitis (CP) and pancreatic ductal adenocarcinoma (PDAC) represent syndromes defined according to traditional clinicopathologic criteria. The failure of traditional approaches to identify primary mechanisms underlying these progressive disorders illustrates a greater problem of failure of the germ theory of disease for complex disorders. Multiple genetic discoveries and new complex disease models force consideration of a new paradigm of 'precision medicine', requiring a new mechanistic definition of CP. Recognizing the advances in understanding complex gene and environment interactions, as well as the development of new strategies that limit or prevent the development of devastating end-stage diseases of the pancreas may lead to substantial improvements in patient care.
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March 2017

After the cure: management of HCV after achievement of SVR.

Curr HIV/AIDS Rep 2013 Dec;10(4):428-35

Massachusetts General Hospital, 55 Fruit Street, White 1003, Boston, MA, 02114, USA,

Co-infection with HIV and HCV is associated with accelerated progression of liver disease and increased complications compared with HCV infection alone. Treatment of HCV and achievement of a sustained virologic response (SVR) can improve outcomes in these patients. Even after clearance of the hepatitis C virus, however, patients remain at risk, albeit diminished, for the complications of chronic liver disease. As such, longitudinal monitoring of treated patients remains important for clinicians caring for this population. This article summarizes the benefits and persistent risks after attaining SVR. It reviews the natural history of fibrosis and addresses the monitoring and management of progressive liver disease.
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December 2013

Pretreatment 25-hydroxyvitamin D levels and durability of anti-tumor necrosis factor-α therapy in inflammatory bowel diseases.

JPEN J Parenter Enteral Nutr 2014 Mar-Apr;38(3):385-91. Epub 2013 Oct 2.

Department of Medicine, Massachusetts General Hospital, Boston.

Introduction: Emerging evidence supports an immunologic role for 25-hydroxyvitamin D (25(OH)D) in inflammatory bowel disease (IBD). Here we examined if pretreatment vitamin D status influences durability of anti-tumor necrosis factor (TNF)-α therapy in patients with Crohn's disease (CD) or ulcerative colitis (UC).

Methods: All IBD patients who had plasma 25(OH)D level checked <3 months prior to initiating anti-TNF-α therapy were included in this retrospective single-center cohort study. Our main predictor variable was insufficient plasma 25(OH)D (<30 ng/mL). Cox proportional hazards model adjusting for potential confounders was used to identify the independent effect of pretreatment vitamin D on biologic treatment cessation.

Results: Our study included 101 IBD patients (74 CD; median disease duration 9 years). The median index 25(OH)D level was 27 ng/mL (interquartile range, 20-33 ng/mL). One-third of the patients had prior exposure to anti-TNF-α therapy. On multivariate analysis, patients with insufficient vitamin D demonstrated earlier cessation of anti-TNF-α therapy (hazard ratio [HR], 2.13; 95% confidence interval [CI], 1.03-4.39; P = .04). This effect was significant in patients who stopped treatment for loss of response (HR, 3.49; 95% CI, 1.34-9.09) and stronger for CD (HR, 2.38; 95% CI, 0.95-5.99) than UC (P = NS).

Conclusions: Our findings suggest that vitamin D levels may influence durability of anti-TNF-α induction and maintenance therapy. Larger cohort studies and clinical trials of supplemental vitamin D use with disease activity as an end point may be warranted.
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October 2014

Older age is associated with higher rate of discontinuation of anti-TNF therapy in patients with inflammatory bowel disease.

Inflamm Bowel Dis 2013 Feb;19(2):309-15

Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.

Background: In increasingly aging populations, awareness of outcomes of older patients treated with biologics is becoming more important. However, few studies to date have investigated the safety and durability of anti-tumor necrosis factor (TNF) therapy in this subgroup.

Methods: This was a retrospective single-center study with cases comprising all IBD patients who began anti-TNF treatment at age >60 years. Cases of Crohn's disease (CD) and ulcerative colitis (UC) were identified from medical record review. Our controls consisted of patients younger than age 60 years on anti-TNF treatment and patients >60 years on treatment with immunomodulators. Kaplan-Meier survival estimates were used to calculate the probability of remaining on anti-TNF therapy.

Results: We identified a total of 54 IBD patients who initiated anti-TNF therapy over the age of 60 years (mean 73, range 61-97 years). Among these, a total of 38 patients (70%) discontinued anti-TNF therapy after a mean of 24.1 months. At 12 months after initiation, 75% of patients older than age 60 years were still on anti-TNF agents compared to 93% among younger users and 82% among older AZA users (P < 0.05). Compared to older AZA users, older anti-TNF users remained more likely to require early therapy cessation (hazard ratio 2.21, 95% confidence interval 1.29-3.78).

Conclusions: The IBD population older than age 60 at the time of initiation of anti-TNF therapy is at higher risk for discontinuation of therapy. They may also be particularly vulnerable to infectious complications requiring hospitalization, suggesting the need for careful monitoring during therapy.
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February 2013