Browsing by Author "Kushnir, Vladimir"

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    Endoscopic Ultrasound-Guided Drainage of Intra-Abdominal Abscess Using 15-mm vs. 10-mm Lumen-Apposing Metal Stents: An International Case-Matched Study
    (Elsevier, 2025) Ichkhanian, Yervant; Chaudhary, Ammad J.; Veracruz, Nicolette; Faisal, Muhammad Salman; Peller, Matthew; Kushnir, Vladimir; Daugherty, T. Tyler; Genere, Juan Reyes; Pawa, Rishi; Pawa, Swati; Ahmed, Wafaa; Huggett, Matthew T.; Paranandi, Bharat; Aparicio, José Ramón; Martínez-Moreno, Belén; Nimri, Faisal; Ashraf, Taha; Alluri, Spandana; Obri, Mark; Dang, Duyen; Singla, Sumit; Piraka, Cyrus; Zuchelli, Tobias; Medicine, School of Medicine
    Background and Aims Efficacy and safety of EUS-guided placement of lumen-apposing metal stents (LAMS) has been reported yet advantage of using 15-mm LAMS over 10-mm LAMS yet to be explored. Methods International, retrospective, case-matched study of patients with intra-abdominal abscess who underwent EUS-guided drainage with 15-mm (case) and 10-mm (control) LAMS between 03/2019 and 09/2022. Results 51 patients underwent EUS-guided drainage using LAMS [15-mm 29 (57%), 10-mm 22 (43%)]. The most common location of the abscess was peri-pancreatic 43%. Technical success rate was achieved in 97% of cases and 100 % of controls (p=0.412), while clinical success was achieved in 98% and 96%, respectively, (OR 1.3; p=0.089). AE occurred in 7.8% of the cases. Patients with 15-mm LAMS underwent fewer total endoscopic procedures (mean 2.5 vs.3.6; P < 0.023). Conclusion Both sizes showed comparable clinical success and safety profiles, with a significant trend of the need for fewer endoscopic procedures with the 15-mm LAMS.
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    Obesity as a risk factor for sedation-related complications during propofol-mediated sedation for advanced endoscopic procedures
    (Elsevier, 2011) Wani, Sachin; Azar, Riad; Hovis, Christine E.; Hovis, Robert M.; Cote, Gregory A.; Hall, Matthew; Waldbaum, Lawrence; Kushnir, Vladimir; Early, Dayna; Mullady, Daniel K.; Murad, Faris; Edmundowicz, Steven A.; Jonnalagadda, Sreenivasa S.; Medicine, School of Medicine
    Background: There are limited data on the safety of anesthesia-assisted endoscopy by using propofol-mediated sedation in obese individuals undergoing advanced endoscopic procedures (AEPs). Objective: To study the association between obesity (as measured by body mass index [BMI]) and the frequency of sedation-related complications (SRCs) in patients undergoing AEPs. Design: Prospective cohort study. Setting: Tertiary referral center. Patients: A total of 1016 consecutive patients undergoing AEPs (BMI <30, 730 [72%]; 30-35, 159 [16%]; >35, 127 [12%]). Intervention: Monitored anesthesia sedation with propofol alone or in combination with benzodiazepines and/or opioids. Main outcome measurements: SRCs, airway maneuvers (AMs), hypoxemia, hypotension requiring vasopressors, and early procedure termination were compared across 3 groups. Results: There were 203 AMs in 13.9% of patients, hypoxemia in 7.3%, need for vasopressors in 0.8%, and premature termination in 0.6% of patients. Increasing BMI was associated with an increased frequency of AMs (BMI <30, 10.5%; 30-35, 18.9%; >35-26.8%; P < .001) and hypoxemia (BMI <30, 5.3%; 30-35, 9.4%; >35, 13.4%; P = .001); there was no difference in the frequency of need for vasopressors (P = .254) and premature termination of procedures (P = .401). On multivariable analysis, BMI (odds ratio [OR] 2.0; 95% CI, 1.3-3.1), age (OR 1.1; 95% CI, 1.0-1.1), and American Society of Anesthesiologists class 3 or higher (OR 2.4; 95% CI, 1.1-5.0) were independent predictors of SRCs. In obese individuals (n = 286), there was no difference in the frequency of SRCs in patients receiving propofol alone or in combination (P = .48). Limitations: Single tertiary center study. Conclusions: Although obesity was associated with an increased frequency of SRCs, propofol sedation can be used safely in obese patients undergoing AEPs when administered by trained professionals.