Browsing by Author "Goyal, Hemant"
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Item Celiac disease hospitalizations: an emerging challenge in the United States(Hellenic Society of Gastroenterology, 2022) Dahiya, Dushyant Singh; Al-Haddad, Mohammad; Perisetti, Abhilash; Singh, Amandeep; Goyal, Hemant; Cheng, Chin-I; Garg, Rajat; Pisipati, Sailaja; Ameyi, Justice; Sanaka, Madhusudhan R.; Inamdar, Sumant; Medicine, School of MedicineBackground: This study aimed to assess the trends and characteristics of celiac disease (CeD) hospitalizations in the United States (US). Methods: The National Inpatient Sample was analyzed from 2007-2017 to identify all adult hospitalizations with a primary discharge diagnosis of CeD. Demographic trends, associations, and other aspects of CeD hospitalizations were analyzed. SAS 9.4 was used for statistical analysis and P-values ≤0.05 were considered statistically significant. Results: From 2007-2017, we noted an increasing trend of CeD hospitalizations from 19,385 in 2007 to 38,395 in 2017 (P-trend <0.001). The mean age was 57.85 years, with a declining trend. Females and patients with a Charlson Comorbidity Index score ≥3 had a rising trend of CeD hospitalizations from 70.68% in 2007 to 73% in 2017 (P-trend <0.001) and from 16.96% in 2007 to 26.59% in 2017 (P-trend <0.001), respectively. Additionally, a White predominance was seen in the study cohort. Furthermore, for CeD hospitalizations, all-cause inpatient mortality increased from 1.30% in 2007 to 1.58% in 2017 (P-trend <0.001) and the mean total hospital charge increased from $26,299 in 2007 to $49,282 in 2017 (P-trend <0.001). However, we noted a decline in the mean length of stay (LOS) from 4.88 days in 2007 to 4.59 days in 2017 (P-trend=0.0015) and rates of esophagogastroduodenoscopy performed from 2.09% in 2007 to 1.89% in 2017 (P-trend <0.001). Conclusion: We noted a rising trend in hospitalizations, inpatient mortality, and hospital costs for CeD hospitalizations in the US; however, inpatient EGDs performed and mean LOS showed a decline.Item Clinical Outcomes and Complications for Achalasia Patients Admitted After Per-Oral Endoscopic Myotomy(Elmer Press, 2023) Dahiya, Dushyant Singh; Nivedita, Fnu; Perisetti, Abhilash; Goyal, Hemant; Inamdar, Sumant; Gangwani, Manesh Kumar; Aziz, Muhammad; Ali, Hassam; Cheng, Chin-I; Sanaka, Madhusudhan R.; Al-Haddad, Mohammad; Sharma, Neil R.; Medicine, School of MedicineBackground: Per-oral endoscopic myotomy (POEM) is a rapidly emerging minimally invasive procedure for management of achalasia. Same-day discharge after POEM is safe and feasible; however, some patients may need hospitalization. We aimed to identify characteristics and outcomes for achalasia patients requiring hospitalizations after POEM in the United States (US). Methods: The US National Inpatient Sample was utilized to identify all adult achalasia patients who were admitted after POEM from 2016 to 2019. Hospitalization characteristics and clinical outcomes were highlighted. Results: From 2016 to 2019, we found that 1,885 achalasia patients were admitted after POEM. There was an increase in the total number of hospitalizations after POEM from 380 in 2016 to 490 in 2019. The mean age increased from 54.2 years in 2016 to 59.3 years in 2019. Most POEM-related hospitalizations were for the 65 - 79 age group (31.8%), females (50.4%), and Whites (68.4%). A majority (56.2%) of the study population had a Charlson Comorbidity Index of 0. The Northeast hospital region had the highest number of POEM-related hospitalizations. Most of these patients (88.3%) were eventually discharged home. There was no inpatient mortality. The mean length of stay decreased from 4 days in 2016 to 3.2 days in 2019, while the mean total healthcare charge increased from $52,057 in 2016 to $65,109 in 2019. Esophageal perforation was the most common complication seen in 1.3% of patients. Conclusion: The number of achalasia patients needing hospitalization after POEM increased. There was no inpatient mortality conferring an excellent safety profile of this procedure.Item COVID-19 and Acute Esophageal Obstruction Management in the Emergency Department: An U.S. multicenter research network propensity-matched analysis(2021) Goyal, Hemant; Perisetti, Abhilash; Gajendran, Mahesh; Ali, Aman; Sharma, Neil R.; Medicine, School of MedicineIntroduction- The Coronavirus Disease-2019 (COVID-19) caused by the novel SARS-CoV-2 led to significant strain on the Emergency Department (ED) visits worldwide. Multiple stay-at-home orders were issued during the pandemic unless medical treatment was urgently needed . Acute esophageal obstruction (AEO) due to food/ foreign body impaction usually present to the ED, given its severe symptoms. Most esophageal foreign bodies pass through the gastrointestinal (GI) tract uneventfully, and related mortality is very low. Still, most of these patients receive endoscopic interventions (up to 76%). The number of non-urgent endoscopies plummeted sharply during the pandemic to reduce exposure and preserve personal protective equipment. It is unclear if ED visits for AEO and their endoscopic management changed due to the COVID-19 pandemic in the United States (US). Methods- We utilized a federated cloud-based network database named TriNetX, which provides access to electronic medical records from 92 healthcare organizations from the US. The AEO adult patients hospitalized from January 1, 2020, to December 1, 2020, were compared to a similar timeline in 2019 from TriNetX. We used ICD-10 codes for food/foreign body in esophagus, causing other injury acute food impaction (T18.128 A, T18.12), foreign body esophagus (T18.198, T18.1, T18.19, T18.108, T18.108A). Outcomes of the study included utilization rates of esophagogastroduodenoscopy (EGD), esophageal perforation, inpatient hospitalization, and mortality. The outcomes were measured before and after 1:1 propensity matching of the groups based on the baseline demographics and comorbidities. Results- Prevalence of AEO among all ED visits in 2020 were 0.12% (5890 AEO ED visits among 4,672,024 total visits), compared to 0.17% (23,478 AEO ED visits among 14,199,648 total visits) in 2019. There was a small but significant decrease (0.05%) in AEO ED visits from pre-pandemic compared to pandemic times (P<0.01). Patient with AEO had higher prevalence of eosinophilic esophagitis (mean 270 [4.6%] vs. 885 [3.8%], p=0.004) and alcohol-related disorders (mean 465 5 [7.9%] vs. 1659 [7.1%], p=0.03) in 2020 group vs. 2019 group. Patients in the 2020-group had a lower EGD utilization (RR 0.63,95%CI:0.58–0.67, p<0.001) but esophageal perforation (RR 0.87,95%CI:0.41–1.82) and inpatient hospitalization rates (RR 0.92,95%CI:0.79-1.05) did not differ between two groups. Interestingly, during the pandemic, the AEO patients had a lower mortality rate (RR 0.23, 95%CI:0.17–0.31, p<0.001) than in 2019. Conclusion With the advent of COVID-19, multiple stay-at-home orders were issued in the US, with widespread healthcare services and utilization disruption. Patients have expressed concerns about visiting healthcare facilities due to the potential of the spread of SARS-CoV-2 . Many GI societies also recommended deferring elective procedures. This was due to a concern for potential transmission of the virus from aerosolization of GI secretions and judicious use of PPE, which resulted in an overall reduction in the number of endoscopies during the pandemic. Our study shows a small reduction (0.05%) of AEO ED visits in 2020 compared to 2019. However, EGD utilization plummeted to 63% for AEO in 2020. If this is due to spontaneous resolution of the food impaction or reduced presentations to the ED needs to be studied prospectively.Item Endoscopic versus surgical management for colonic volvulus hospitalizations in the United States(Korean Society of Gastrointestinal Endoscopy, 2023) Dahiya, Dushyant Singh; Perisetti, Abhilash; Goyal, Hemant; Inamdar, Sumant; Singh, Amandeep; Garg, Rajat; Cheng, Chin-I; Al-Haddad, Mohammad; Sanaka, Madhusudhan R.; Sharma, Neil; Medicine, School of MedicineBackground/aims: Colonic volvulus (CV), a common cause of bowel obstruction, often requires intervention. We aimed to identify hospitalization trends and CV outcomes in the United States. Methods: We used the National Inpatient Sample to identify all adult CV hospitalizations in the United States from 2007 to 2017. Patient demographics, comorbidities, and inpatient outcomes were highlighted. Outcomes of endoscopic and surgical management were compared. Results: From 2007 to 2017, there were 220,666 CV hospitalizations. CV-related hospitalizations increased from 17,888 in 2007 to 21,715 in 2017 (p=0.001). However, inpatient mortality decreased from 7.6% in 2007 to 6.2% in 2017 (p<0.001). Of all CV-related hospitalizations, 13,745 underwent endoscopic intervention, and 77,157 underwent surgery. Although the endoscopic cohort had patients with a higher Charlson comorbidity index, we noted lower inpatient mortality (6.1% vs. 7.0%, p<0.001), mean length of stay (8.3 vs. 11.8 days, p<0.001), and mean total healthcare charge ($68,126 vs. $106,703, p<0.001) compared to the surgical cohort. Male sex, increased Charlson comorbidity index scores, acute kidney injury, and malnutrition were associated with higher odds of inpatient mortality in patients with CV who underwent endoscopic management. Conclusion: Endoscopic intervention has lower inpatient mortality and is an excellent alternative to surgery for appropriately selected CV hospitalizations.Item The Evolution of Device-Assisted Enteroscopy: From Sonde Enteroscopy to Motorized Spiral Enteroscopy(Frontiers Media, 2021) Nehme, Fredy; Goyal, Hemant; Perisetti, Abhilash; Tharian, Benjamin; Sharma, Neil; Tham, Tony C.; Chhabra, Rajiv; Medicine, School of MedicineThe introduction of capsule endoscopy in 2001 opened the last "black box" of the gastrointestinal tract enabling complete visualization of the small bowel. Since then, numerous new developments in the field of deep enteroscopy have emerged expanding the diagnostic and therapeutic armamentarium against small bowel diseases. The ability to achieve total enteroscopy and visualize the entire small bowel remains the holy grail in enteroscopy. Our journey in the small bowel started historically with sonde type enteroscopy and ropeway enteroscopy. Currently, double-balloon enteroscopy, single-balloon enteroscopy, and spiral enteroscopy are available in clinical practice. Recently, a novel motorized enteroscope has been described with the potential to shorten procedure time and allow for total enteroscopy in one session. In this review, we will present an overview of the currently available techniques, indications, diagnostic yield, and complications of device-assisted enteroscopy.Item Gastrointestinal Endoscopy in the Era of COVID-19(Frontiers, 2020-11) Perisetti, Abhilash; Goyal, Hemant; Sharma, Neil; Medicine, School of MedicineCoronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), which led to a worldwide pandemic that started in early 2020. Healthcare systems across the world encountered an unprecedented surge of COVID-19 patients resulting in more than half a million deaths globally. COVID-19 has affected multiple sub-specialties and procedure-related fields, including gastroenterology. Gastrointestinal (GI) endoscopy centers are specialized units where thousands of endoscopies are performed annually. A significant proportion of these procedures are affected due to the national and regional lockdowns across the globe. To adapt to this rapidly evolving situation, endoscopy centers have undergone significant changes and have taken unprecedented precautions to avoid the transmission of the virus. However, endoscopy centers are going through financial strain due to a reduction in the number of procedures from lockdowns and fear of virus transmission. Theoretically, endoscopies could add to the disease transmission as SARS-CoV-2 has shown to be present in the GI secretions. Multiple precautions such as mandatory use of face masks, safe distancing, use of barriers between the endoscopists and patients, negative pressure rooms, extended use of personal protective equipment, and volume reduction have been taken to decrease the risk of disease transmission by these centers. Moreover, pre-endoscopy COVID-19 testing has now become the norm. In this review, we highlight the significant changes assumed by the endoscopy center. Furthermore, we discuss cost-related concerns of pre-endoscopy COVID-19 testing, the downtime and delays related to the procedures, and effects of rescheduling. As the pandemic progresses through multiple phases, endoscopy centers should use a dynamic approach to adapt and strive to provide the best patient care.Item Increasing thirty-day readmissions of Crohn's disease and ulcerative colitis in the United States: A national dilemma(Baishideng Publishing Group, 2022) Dahiya, Dushyant Singh; Perisetti, Abhilash; Kichloo, Asim; Singh, Amandeep; Goyal, Hemant; Rotundo, Laura; Vennikandam, Madhu; Shaka, Hafeez; Singh, Gurdeep; Singh, Jagmeet; Pisipati, Sailaja; Al-Haddad, Mohammad; Sanaka, Madhusudhan R.; Inamdar, Sumant; Medicine, School of MedicineBackground: The prevalence of Crohn's disease (CD) and ulcerative colitis (UC) is on the rise worldwide. This rising prevalence is concerning as patients with CD and UC may frequently relapse leading to recurrent hospitalizations and increased healthcare utilization. Aim: To identify trends and adverse outcomes for 30 d readmissions for CD and UC. Methods: This was a retrospective, interrupted trends study involving all adult (≥ 18 years) 30 d readmissions of CD and UC from the National Readmission Database (NRD) between 2008 and 2018. Patients < 18 years, elective, and traumatic hospitalizations were excluded from this study. We identified hospitalization characteristics and readmission rates for each calendar year. Trends of inpatient mortality, mean length of hospital stay (LOS) and mean total hospital cost (THC) were calculated using a multivariate logistic trend analysis adjusting for age, gender, insurance status, comorbidity burden and hospital factors. Furthermore, trends between CD and UC readmissions were compared using regression of the interaction coefficient after adjusting for age and gender to determine relative trends between the two populations. Stata® Version 16 software (StataCorp, TX, United States) was used for statistical analysis and P value ≤ 0.05 were considered statistically significant. Results: Total number of 30 d readmissions increased from 6202 in 2010 to 7672 in 2018 for CD and from 3272 in 2010 to 4234 in 2018 for UC. We noted increasing trends for 30-day all-cause readmission rate of CD from 14.9% in 2010 to 17.6% in 2018 (P-trend < 0.001), CD specific readmission rate from 7.1% in 2010 to 8.2% in 2018 (P-trend < 0.001), 30-day all-cause readmission rate of UC from 14.1% in 2010 to 15.7% in 2018 (P-trend = 0.003), and UC specific readmission rate from 5.2% in 2010 to 5.6% in 2018 (P-trend = 0.029). There was no change in the risk adjusted trends of inpatient mortality and mean LOS for CD and UC readmissions. However, we found an increasing trend of mean THC for UC readmissions. After comparison, there was no statistical difference in the trends for 30 d all-cause readmission rate, inpatient mortality, and mean LOS between CD and UC readmissions. Conclusion: There was an increase in total number of 30 d readmissions for CD and UC with a trend towards increasing 30 d all-cause readmission rates.Item Is Endoscopic Ultrasound-Guided Hepaticogastrostomy Safe and Effective after Failed Endoscopic Retrograde Cholangiopancreatography?—A Systematic Review and Meta-Analysis(MDPI, 2024-07-01) Alsakarneh, Saqr; Madi, Mahmoud Y.; Dahiya, Dushyant Singh; Jaber, Fouad; Kilani, Yassine; Ahmed, Mohamed; Beran, Azizullah; Abdallah, Mohamed; Al Ta’ani, Omar; Mittal, Anika; Numan, Laith; Goyal, Hemant; Bilal, Mohammad; Kiwan, Wissam; Medicine, School of MedicineBackground/Objectives: Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) has emerged as an alternative option for biliary drainage in cases of failed endoscopic retrograde cholangiopancreatography (ERCP). Limited data exist on the safety and efficacy of EUS-HGS. In this comprehensive meta-analysis, we aim to study the safety and efficacy of EUS-HGS in cases of failed conventional ERCP. Methods: Embase, PubMed, and Web of Science databases were searched to include all studies that evaluated the efficacy and safety of EUS-HGS. Using the random effect model, the pooled weight-adjusted event rate estimate for clinical outcomes in each group were calculated with 95% confidence intervals (CIs). The primary outcomes were technical and clinical success rates. Secondary outcomes included overall adverse events (AEs), rates of recurrent biliary obstruction (RBO), and rates or re-intervention. Results: Our analysis included 70 studies, with a total of 3527 patients. The pooled technical and clinical success rates for EUS-HGS were 98.1% ([95% CI, 97.5–98.7]; I2 = 40%) and 98.1% ([95% CI, 97.5–98.7]; I2 = 40%), respectively. The pooled incidence rate of AEs with EUS-HGS was 14.9% (95% CI, 12.7–17.1), with bile leakage being the most common (2.4% [95% CI, 1.7–3.2]). The pooled incidence of RBO was 15.8% [95% CI, 12.2–19.4], with a high success rate for re-intervention (97.5% [95% CI, 94.7–100]). Conclusions: Our analysis showed high technical and clinical success rates of EUS-HGS, making it a feasible and effective alternative to ERCP. The ongoing development of dedicated devices and techniques is expected to make EUS-HGS more accessible and safer for patients in need of biliary drainage.Item Prevalence, Mechanisms, and Implications of Gastrointestinal Symptoms in COVID-19(Frontiers, 2020-10) Perisetti, Abhilash; Goyal, Hemant; Gajendran, Mahesh; Boregowda, Umesha; Mann, Rupinder; Sharma, Neil; Medicine, School of MedicineCoronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. The infection started as an outbreak of pneumonia-like symptoms in Wuhan, China. Within a few weeks, it spread across the entire globe resulting in millions of cases and thousands of deaths. While respiratory symptoms and complications are well-defined and can be severe, non-respiratory symptoms of COVID-19 are increasingly being recognized. Gastrointestinal manifestations such as nausea, vomiting, diarrhea, and abdominal pain have been added to the list of common COVID-19 symptoms. Their prevalence has been increasing, probably due to increased recognition and experience with the pandemic. Furthermore, diarrhea and stool testing may change prevalence and transmission rates due to suspicion for fecal-oral transmission of the COVID-19. Due to this risk, various countries have started testing wastewater and sewage systems to examine its role in the spread of SARS-CoV-2 among communities. In this review article, we describe the common gastrointestinal manifestations in COVID-19, their prevalence based upon the current literature, and highlight the importance of early recognition and prompt attention. We also note the role of fecal-oral transmission. Furthermore, the mechanisms of these symptoms, the role of medications, and potential contributing factors are also elaborated.Item Scope of Artificial Intelligence in Screening and Diagnosis of Colorectal Cancer(MDPI, 2020-10-15) Goyal, Hemant; Mann, Rupinder; Gandhi, Zainab; Perisetti, Abhilash; Ali, Aman; Aman Ali, Khizar; Sharma, Neil; Saligram, Shreyas; Tharian, Benjamin; Inamdar, Sumant; Medicine, School of MedicineGlobally, colorectal cancer is the third most diagnosed malignancy. It causes significant mortality and morbidity, which can be reduced by early diagnosis with an effective screening test. Integrating artificial intelligence (AI) and computer-aided detection (CAD) with screening methods has shown promising colorectal cancer screening results. AI could provide a "second look" for endoscopists to decrease the rate of missed polyps during a colonoscopy. It can also improve detection and characterization of polyps by integration with colonoscopy and various advanced endoscopic modalities such as magnifying narrow-band imaging, endocytoscopy, confocal endomicroscopy, laser-induced fluorescence spectroscopy, and magnifying chromoendoscopy. This descriptive review discusses various AI and CAD applications in colorectal cancer screening, polyp detection, and characterization.