Browsing by Author "Komanduri, Srinadh"

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    AGA White Paper: Roadmap for the Future of Colorectal Cancer Screening in the United States
    (Elsevier, 2020) Melson, Joshua E.; Imperiale, Thomas F.; Itzkowitz, Steven H.; Llor, Xavier; Kochman, Michael L.; Grady, William M.; Schoen, Robert E.; Burke, Carol; Shaukat, Aasma; Rabeneck, Linda; Ladabaum, Uri; Bresalier, Robert; Spiegel, Brennan; Yee, Judy; Wang, Thomas; Lieberman, David; Komanduri, Srinadh; Muthusamy, V. Raman; Dey, Neelendu; Medicine, School of Medicine
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    Clinical outcomes of EUS-guided drainage of debris-containing pancreatic pseudocysts: a large multicenter study
    (Thieme, 2017-02) Yang, Dennis; Amin, Sunil; Gonzalez, Susana; Mullady, Daniel; Edmundowicz, Steven A.; DeWitt, John M.; Khashab, Mouen A.; Wang, Andrew Y.; Nagula, Satish; Buscaglia, Jonathan M.; Bucobo, Juan Carlos; Wagh, Mihir S.; Draganov, Peter V.; Stevens, Tyler; Vargo, John J.; Khara, Harshit S.; Diehl, David L.; Keswani, Rajesh N.; Komanduri, Srinadh; Yachimski, Patrick S.; Prabhu, Anoop; Kwon, Richard S.; Watson, Rabindra R.; Goodman, Adam J.; Benias, Petros; Carr-Locke, David L.; DiMaio, Christopher J.; Department of Medicine, IU School of Medicine
    Background and study aims Data on clinical outcomes of endoscopic drainage of debris-free pseudocysts (PDF) versus pseudocysts containing solid debris (PSD) are very limited. The aims of this study were to compare treatment outcomes between patients with PDF vs. PSD undergoing endoscopic ultrasound (EUS)-guided drainage via transmural stents. Patients and methods Retrospective review of 142 consecutive patients with pseudocysts who underwent EUS-guided transmural drainage (TM) from 2008 to 2014 at 15 academic centers in the United States. Main outcome measures included TM technical success, treatment outcomes (symptomatic and radiologic resolution), need for endoscopic re-intervention at follow-up, and adverse events (AEs). Results TM was performed in 90 patients with PDF and 52 with PSD. Technical success: PDF 87 (96.7 %) vs. PSD 51 (98.1 %). There was no difference in the rates for endoscopic re-intervention (5.5 % in PDF vs. 11.5 % in PSD; P = 0.33) or AEs (12.2 % in PDF vs. 19.2 % in PSD; P = 0.33). Median long-term follow-up after stent removal was 297 days (interquartile range [IQR]: 59 - 424 days) for PDF and 326 days (IQR: 180 - 448 days) for PSD (P = 0.88). There was a higher rate of short-term radiologic resolution of PDF (45; 66.2 %) vs. PSD (21; 51.2 %) (OR = 0.30; 95 % CI: 0.13 - 0.72; P = 0.009). There was no difference in long-term symptomatic resolution (PDF: 70.4 % vs. PSD: 66.7 %; P = 0.72) or radiologic resolution (PDF: 68.9 % vs. PSD: 78.6 %; P = 0.72) Conclusions There was no difference in need for endoscopic re-intervention, AEs or long-term treatment outcomes in patients with PDF vs. PSD undergoing EUS-guided drainage with transmural stents. Based on these results, the presence of solid debris in pancreatic fluid collections does not appear to be associated with a poorer outcome.
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    GA White Paper: Challenges and Gaps in Innovation for the Performance of Colonoscopy for Screening and Surveillance of Colorectal Cancer
    (Elsevier, 2022) Komanduri, Srinadh; Dominitz, Jason A.; Rabeneck, Linda; Kahi, Charles; Ladabaum, Uri; Imperiale, Thomas F.; Byrne, Michael F.; Lee, Jeffrey K.; Lieberman, David; Wang, Andrew Y.; Sultan, Shahnaz; Pohl, Heiko; Muthusamy, V. Raman; Medicine, School of Medicine
    In 2018 the American Gastroenterological Association’s (AGA) Center for GI Innovation and Technology (CGIT) convened a consensus conference, entitled, “Colorectal Cancer Screening and Surveillance: Role of Emerging Technology and Innovation to Improve Outcomes.” The conference participants, which included more than 60 experts in colorectal cancer (CRC), considered recent improvements in CRC screening rates and polyp detection, persistent barriers to colonoscopy uptake, and opportunities for performance improvement and innovation. This white paper originates from that conference. It aims to summarize current patient- and physician-centered gaps and challenges in colonoscopy, diagnostic and therapeutic challenges affecting colonoscopy uptake, and the potential use of emerging technologies and quality metrics to improve patient outcomes.
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    Multicenter evaluation of the clinical utility of laparoscopy-assisted ERCP in patients with Roux-en-Y gastric bypass
    (Elsevier, 2017) Abbas, Ali M.; Strong, Andrew T.; Diehl, David L.; Brauer, Brian C.; Lee, Iris H.; Burbridge, Rebecca; Zivny, Jaroslav; Higa, Jennifer T.; Falcão, Marcelo; El Hajj, Ihab I.; Tarnasky, Paul; Enestvedt, Brintha K.; Ende, Alexander R.; Thaker, Adarsh M.; Pawa, Rishi; Jamidar, Priya; Sampath, Kartik; de Moura, Eduardo Guimarães Hourneaux; Kwon, Richard S.; Suarez, Alejandro L.; Aburajab, Murad; Wang, Andrew Y.; Shakhatreh, Mohammad H.; Kaul, Vivek; Kang, Lorna; Kowalski, Thomas E.; Pannala, Rahul; Tokar, Jeffrey; Aadam, A. Aziz; Tzimas, Demetrios; Wagh, Mihir S.; Draganov, Peter V.; Ponsky, Jeffrey; Greenwald, Bruce D.; Uradomo, Lance T.; McGhan, Alyson A.; Hakimian, Shahrad; Ross, Andrew; Sherman, Stuart; Bick, Benjamin L.; Forsmark, Christopher E.; Yang, Dennis; Gupte, Anand; Chauhan, Shailendra; Hughes, Steven J.; Saks, Karen; Bakis, Gennadiy; Templeton, Adam W.; Saunders, Michael; Sedarat, Alireza; Evans, John A.; Muniraj, Thiruvengadam; Gardner, Timothy B.; Ramos, Almino C.; Santo, Marco Aurelio; Nett, Andrew; Coté, Gregory A.; Elmunzer, Joseph; Dua, Kulwinder S.; Nosler, Michael J.; Strand, Daniel S.; Yeaton, Paul; Kothari, Shivangi; Ullah, Asad; Taunk, Pushpak; Brady, Patrick; Pinkas, Haim; Faulx, Ashley L.; Shahid, Haroon; Holmes, Jordan; Pannu, Davinderbir; Komanduri, Srinadh; Bucobo, Juan Carlos; Dhaliwal, Harry; Rostom, Alaa; Acker, Brent W.; Medicine, School of Medicine
    Background and Aims The obesity epidemic has led to increased use of Roux-en-Y gastric bypass (RYGB). These patients have an increased incidence of pancreaticobiliary diseases yet standard ERCP is not possible due to surgically altered gastroduodenal anatomy. Laparoscopic-ERCP (LA-ERCP) has been proposed as an option but supporting data are derived from single center small case-series. Therefore, we conducted a large multicenter study to evaluate the feasibility, safety, and outcomes of LA-ERCP. Methods This is retrospective cohort study of adult patients with RYGB who underwent LA-ERCP in 34 centers. Data on demographics, indications, procedure success, and adverse events were collected. Procedure success was defined when all of the following were achieved: reaching the papilla, cannulating the desired duct and providing endoscopic therapy as clinically indicated. Results A total of 579 patients (median age 51, 84% women) were included. Indication for LA-ERCP was biliary in 89%, pancreatic in 8%, and both in 3%. Procedure success was achieved in 98%. Median total procedure time was 152 minutes (IQR 109-210) with median ERCP time 40 minutes (IQR 28-56). Median hospital stay was 2 days (IQR 1-3). Adverse events were 18% (laparoscopy-related 10%, ERCP-related 7%, both 1%) with the clear majority (92%) classified as mild/moderate whereas 8% were severe and 1 death occurred. Conclusion Our large multicenter study indicates that LA-ERCP in patients with RYGB is feasible with a high procedure success rate comparable with that of standard ERCP in patients with normal anatomy. ERCP-related adverse events rate is comparable with conventional ERCP, but the overall adverse event rate was higher due to the added laparoscopy-related events.
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    A Prospective Multicenter Study Evaluating Learning Curves and Competence in Endoscopic Ultrasound and Endoscopic Retrograde Cholangiopancreatography Among Advanced Endoscopy Trainees: The Rapid Assessment of Trainee Endoscopy Skills (RATES) Study
    (Elsevier, 2017) Wani, Sachin; Keswani, Rajesh; Hall, Matt; Han, Samuel; Ali, Meer Akbar; Brauer, Brian; Carlin, Linda; Chak, Amitabh; Collins, Dan; Cote, Gregory A.; Diehl, David L.; DiMaio, Christopher J.; Dries, Andrew; El-Hajj, Ihab; Ellert, Swan; Fairley, Kimberley; Faulx, Ashley; Fujii-Lau, Larissa; Gaddam, Srinivas; Gan, Seng-Ian; Gaspar, Jonathan P.; Gautamy, Chitiki; Gordon, Stuart; Harris, Cynthia; Hyder, Sarah; Jones, Ross; Kim, Stephen; Komanduri, Srinadh; Law, Ryan; Lee, Linda; Mounzer, Rawad; Mullady, Daniel; Muthusamy, V. Raman; Olyaee, Mojtaba; Pfau, Patrick; Saligram, Shreyas; Piraka, Cyrus; Rastogi, Amit; Rosenkranz, Laura; Rzouq, Fadi; Saxena, Aditi; Shah, Raj J.; Simon, Violette C.; Small, Aaron; Sreenarasimhaiah, Jayaprakash; Walker, Andrew; Wang, Andrew Y.; Watson, Rabindra R.; Wilson, Robert H.; Yachimski, Patrick; Yang, Dennis; Edmundowicz, Steven; Early, Dayna S.; Department of Medicine, IU School of Medicine
    Background and aims Based on the Next Accreditation System, trainee assessment should occur on a continuous basis with individualized feedback. We aimed to validate endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) learning curves among advanced endoscopy trainees (AETs) using a large national sample of training programs and to develop a centralized database that allows assessment of performance in relation to peers. Methods ASGE recognized training programs were invited to participate and AETs were graded on ERCP and EUS exams using a validated competency assessment tool that assesses technical and cognitive competence in a continuous fashion. Grading for each skill was done using a 4-point scoring system and a comprehensive data collection and reporting system was built to create learning curves using cumulative sum analysis. Individual results and benchmarking to peers were shared with AETs and trainers quarterly. Results Of the 62 programs invited, 20 programs and 22 AETs participated in this study. At the end of training, median number of EUS and ERCP performed/AET was 300 (range 155-650) and 350 (125-500). Overall, 3786 exams were graded (EUS:1137; ERCP–biliary 2280, pancreatic 369). Learning curves for individual endpoints, and overall technical/cognitive aspects in EUS and ERCP demonstrated substantial variability and were successfully shared with all programs. The majority of trainees achieved overall technical (EUS: 82%; ERCP: 60%) and cognitive (EUS: 76%; ERCP: 100%) competence at conclusion of training. Conclusions These results demonstrate the feasibility of establishing a centralized database to report individualized learning curves and confirm the substantial variability in time to achieve competence among AETs in EUS and ERCP.
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    Transpapillary drainage has no added benefit on treatment outcomes in patients undergoing EUS-guided transmural drainage of pancreatic pseudocysts: a large multicenter study
    (Elsevier, 2016-04) Yang, Dennis; Amin, Sunil; Gonzalez, Susana; Mullady, Daniel; Hasak, Stephen; Gaddam, Srinivas; Edmundowicz, Steven A.; Gromski, Mark A.; DeWitt, John M.; El Zein, Mohamad; Khashab, Mouen A.; Wang, Andrew Y.; Gaspar, Jonathan P.; Uppal, Dushant S.; Nagula, Satish; Kapadia, Samir; Buscaglia, Jonathan M.; Bucobo, Juan Carlos; Schlachterman, Alex; Wagh, Mihir S.; Draganov, Peter V.; Jung, Min Kyu; Stevens, Tyler; Vargo, John J.; Khara, Harshit S.; Huseini, Mustafa; Diehl, David L.; Keswani, Rajesh N.; Law, Ryan; Komanduri, Srinadh; Yachimski, Patrick S.; DaVee, Tomas; Prabhu, Anoop; Lapp, Robert T.; Kwon, Richard S.; Watson, Rabindra R.; Goodman, Adam J.; Chhabra, Natasha; Wang, Wallace J.; Benias, Petros; Carr-Locke, David L.; DiMaio, Christopher J.; Department of Medicine, IU School of Medicine
    Background and Aims The need for transpapillary drainage (TPD) in patients undergoing transmural drainage (TMD) of pancreatic fluid collections (PFCs) remains unclear. The aims of this study were to compare treatment outcomes between patients with pancreatic pseudocysts undergoing TMD versus combined (TMD and TPD) drainage (CD) and to identify predictors of symptomatic and radiologic resolution. Methods This is a retrospective review of 375 consecutive patients with PFCs who underwent EUS-guided TMD from 2008 to 2014 at 15 academic centers in the United States. Main outcome measures included TMD and CD technical success, treatment outcomes (symptomatic and radiologic resolution) at follow-up, and predictors of treatment outcomes on logistic regression. Results A total of 375 patients underwent EUS-guided TMD of PFCs, of which 174 were pseudocysts. TMD alone was performed in 95 (55%) and CD in 79 (45%) pseudocysts. Technical success was as follows: TMD, 92 (97%) versus CD, 35 (44%) (P = .0001). There was no difference in adverse events between the TMD (15%) and CD (14%) cohorts (P = .23). Median long-term (LT) follow-up after transmural stent removal was 324 days (interquartile range, 72-493 days) for TMD and 201 days (interquartile range, 150-493 days) (P = .37). There was no difference in LT symptomatic resolution (TMD, 69% vs CD, 62%; P = .61) or LT radiologic resolution (TMD, 71% vs CD, 67%; P = .79). TPD attempt was negatively associated with LT radiologic resolution of pseudocyst (odds ratio, 0.11; 95% confidence interval, 0.02-0.8; P = .03). Conclusions TPD has no benefit on treatment outcomes in patients undergoing EUS-guided TMD of pancreatic pseudocysts and negatively affects LT resolution of PFCs.