Citations 2
US multicenter outcomes of endoscopic ultrasound-guided gallbladder drainage with lumen-apposing metal stents for acute cholecystitis
David, Yakira , Kakked, Gaurav, Confer, Bradley , Shah, Ruchit N. , Khara, Harshit S. , Diehl, David L. , Krafft, Matthew , Shah-Khan, Sardar M. , Nasr, John , Benias, Petros C. , Muniraj, Thiruvengadam , Aslanian, Harry R., Chahal, Prabhleen , Rodriguez, John , DuBroff, Jason, Latour, Rabi De, Khanna, Lauren , Haber, Gregory , Hoerter, Nicholas A. , Pandey, Nishi , Bakhit, Mena , Kowalski, Thomas E., Loren, David E. , Chiang, Austin , Schlachterman, Alexander , Nieto, Jose , Ichkhanian, Yervant , Khashab, Mouen A. , Halabi, Maan El , Kwon, Richard S. , Hernandez-Lara, Ariosto, Poneros, John M., Sethi, Amrita, Gonda, Tamas A. , Kushnir, Vladimir , Cosgrove, Natalie , Mullady, Daniel , Al-Shahrani, Abdullah , Buscaglia, Jonathan M. , Bucobo, Juan Carlos , Rolston, Vineet S. , Kedia, Prashant , Kasmin, Franklin, Kumta, Nikhil A. , DiMaio, Christopher J. , Krafft, Matthew Richard , Trindade, Arvind J. , Adler, Douglas G. , Tzimas, Demetrios J. , Goodman, Adam J. , Nieto, José , Deshmukh, Ameya A. , Prabhu, Anoop , Storm, Andrew C. , Berzin, Tyler M. , Sethi, Amrita , D'Souza, Lionel S. , Nagula, Satish
Endoscopy International Open | January 13, 2025 | Volume: 13 | Issue: CP | Pages: No page available
AbstractEUS-guided gallbladder drainage (EUS-GBD) using lumen apposing metal stents (LAMS) has excellent technical and short-term clinical success for acute cholecystitis (AC). The goals of this study were to determine the long-term clinical outcomes and adverse events (AEs) of EUS-GBD with LAMS.A multicenter, retrospective study was conducted at 18 US tertiary care institutions. Inclusion criteria: any AC patient with attempted EUS-GBD with LAMS and minimum 30-day post-procedure follow-up. Long-term clinical success was defined as absence of recurrent acute cholecystitis (RAC) > 30 days and long-term AE was defined as occurring > 30 days from the index procedure.A total of 109 patients were included. Technical success was achieved in 108 of 109 (99.1%) and initial clinical success in 106 of 109 (97.2%). Long-term clinical success was achieved in 98 of 109 (89.9%) over a median follow-up of 140 days (range 30–1188). On multivariable analysis (MVA), acalculous cholecystitis (odds ratio [OR] 15.93, 95% confidence interval [CI] 1.22–208.52, P = 0.04) and the occurrence of a LAMS-specific AE (OR 63.60, 95% CI 5.08–799.29, P <0.01) were associated with RAC. AEs occurred in 38 of 109 patients (34.9%) at any time, and in 10 of 109 (9.17%) > 30 days from the index procedure. Most long-term AEs (7 of 109; 6.42%) were LAMS-specific. No technical or clinical factors were associated with occurrence of AEs. LAMS were removed in 24 of 109 patients (22%). There was no difference in RAC or AEs whether LAMS was removed or not.EUS-GBD with LAMS has a high rate of long-term clinical success and modest AE rates in patients with AC and is a reasonable destination therapy for high-risk surgical candidates.
Endoscopic resection outcomes and predictors of failed en bloc endoscopic mucosal resection of colorectal polyps ≤ 20 mm among advanced endoscopy trainees
King, William , Draganov, Peter V. , Uppal, Dushant, Rumman, Amir , Kumta, Nikhil A. , DiMaio, Christopher J. , Sejpal, Divyesh V., Bucobo, Juan Carlos , Gómez, Victoria , Wallace, Michael B. , Pohl, Heiko , Wallace, Michael B , Wang, Andrew Y. , Trindade, Arvind J. , D'Souza, Lionel S. , Yang, Dennis J.
Endoscopy International Open | November 12, 2021 | Volume: 09 | Issue: 11 | Pages: E1820-E1826
Abstract Background and study aims En bloc endoscopic mucosal resection (EMR) is preferred over piecemeal resection for polyps ≤ 20 mm. Data on colorectal EMR training are limited. We aimed to evaluate the en bloc EMR rate of polyps ≤ 20 mm among advanced endoscopy trainees and to identify predictors of failed en bloc EMR. Methods This was a multicenter prospective study evaluating trainee performance in EMR during advanced endoscopy fellowship. A logistic regression model was used to identify the number of procedures and lesion cut-off size associated with an en bloc EMR rate of ≥ 80 %. Multivariate analysis was performed to identify predictors of failed en bloc EMR. Results Six trainees from six centers performed 189 colorectal EMRs, of which 104 (55 %) were for polyps ≤ 20 mm. Of these, 57.7 % (60/104) were resected en bloc. Trainees with ≥ 30 EMRs (OR 6.80; 95 % CI: 2.80–16.50; P = 0.00001) and lesions ≤ 17 mm (OR 4.56;95 CI:1.23–16.88; P = 0.02) were more likely to be associated with an en bloc EMR rate of ≥ 80 %. Independent predictors of failed en bloc EMR on multivariate analysis included: larger polyp size (OR:6.83;95 % CI:2.55–18.4; P = 0.0001), right colon location (OR:7.15; 95 % CI:1.31–38.9; P = 0.02), increased procedural difficulty (OR 2.99; 95 % CI:1.13–7.91; P = 0.03), and having performed < 30 EMRs (OR: 4.87; 95 %CI: 1.05–22.61; P = 0.04). Conclusions In this pilot study, we demonstrated that a relatively low proportion of trainees achieved en bloc EMR for polyps ≤ 20 mm and identified procedure volume and lesion size thresholds for successful en bloc EMR and independent predictors for failed en bloc resection. These preliminary results support the need for future efforts to define EMR procedure competence thresholds during training.