Browsing by Author "Sharaiha, Reem Z."

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    Efficacy of Endoscopic Submucosal Dissection for Superficial Gastric Neoplasia in a Large Cohort in North America
    (Elsevier, 2020) Ngamruengphong, Saowanee; Ferri, Lorenzo; Aihara, Hiroyuki; Draganov, Peter V.; Yang, Dennis J.; Perbtani, Yaseen B.; Jue, Terry L.; Munroe, Craig A.; Boparai, Eshandeep S.; Mehta, Neal A.; Bhatt, Amit; Kumta, Nikhil A.; Othman, Mohamed O.; Mercado, Michael; Javaid, Huma; Aadam, Abdul Aziz; Siegel, Amanda; James, Theodore W.; Grimm, Ian S.; DeWitt, John M.; Novikov, Aleksey; Schlachterman, Alexander; Kowalski, Thomas; Samarasena, Jason; Hashimoto, Rintaro; Chehade, Nabil El Hage; Lee, John; Chang, Kenneth; Su, Bailey; Ujiki, Michael B.; Mehta, Amit; Sharaiha, Reem Z.; Carr-Locke, David L.; Chen, Alex; Chen, Michael; Chen, Yen-I.; Khoshknab, MirMilad Pourmousavi; Wang, Rui; Kerdsirichairat, Tossapol; Tomizawa, Yutaka; von Renteln, Daniel; Kumbhari, Vivek; Khashab, Mouen A.; Bechara, Robert; Karasik, Michael; Patel, Neej J.; Fukami, Norio; Nishimura, Makoto; Hanada, Yuri; Wong Kee Song, Louis M.; Laszkowska, Monika; Wang, Andrew Y.; Hwang, Joo Ha; Friedland, Shai; Sethi, Amrita; Kalloo, Antony N.; Medicine, School of Medicine
    Background & Aims Endoscopic submucosal dissection (ESD) is a widely accepted treatment option for superficial gastric neoplasia in Asia, but there are few data on outcomes of gastric ESD from North America. We aimed to evaluate the safety and efficacy of gastric ESD in North America. Methods We analyzed data from 347 patients who underwent gastric ESD at 25 centers, from 2010 through 2019. We collected data on patient demographics, lesion characteristics, procedure details and related adverse events, treatment outcomes, local recurrence, and vital status at the last follow up. For the 277 patients with available follow-up data, the median interval between initial ESD and last clinical or endoscopic evaluation was 364 days. The primary endpoint was the rate of en bloc and R0 resection. Secondary outcomes included curative resection, rates of adverse events and recurrence, and gastric cancer-related death. Results Ninety patients (26%) had low-grade adenomas or dysplasia, 82 patients (24%) had high-grade dysplasia, 139 patients (40%) had early gastric cancer, and 36 patients (10%) had neuroendocrine tumors. Proportions of en bloc and R0 resection for all lesions were 92%/82%, for early gastric cancers were 94%/75%, for adenomas and low-grade dysplasia were 93%/ 92%, for high-grade dysplasia were 89%/ 87%, and for neuroendocrine tumors were 92%/75%. Intraprocedural perforation occurred in 6.6% of patients; 82% of these were treated successfully with endoscopic therapy. Delayed bleeding occurred in 2.6% of patients. No delayed perforation or procedure-related deaths were observed. There were local recurrences in 3.9% of cases; all occurred after non-curative ESD resection. Metachronous lesions were identified in 14 patients (6.9%). One of 277 patients with clinical follow up died of metachronous gastric cancer that occurred 2.5 years after the initial ESD. Conclusions ESD is a highly effective treatment for superficial gastric neoplasia and should be considered as a viable option for patients in North America. The risk of local recurrence is low and occurs exclusively after non-curative resection. Careful endoscopic surveillance is necessary to identify and treat metachronous lesions.
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    EUS-directed transgastric interventions in Roux-En-Y Gastric Bypass anatomy: a multicenter experience
    (Elsevier, 2022-05) Ghandour, Bachir; Shinn, Brianna; Dawod, Qais M.; Fansa, Sima; El Chafic, Abdul Hamid; Irani, Shayan S.; Pawa, Rishi; Gutta, Aditya; Ichkhanian, Yervant; Paranandi, Bharat; Pawa, Swati; Al-Haddad, Mohammad A.; Zuchelli, Tobias; Huggett, Matthew T.; Bejjani, Michael; Sharaiha, Reem Z.; Kowalski, Thomas E.; Khashab, Mouen A.; Medicine, School of Medicine
    Background and Aims Placement of a Lumen Apposing Metal Stent (LAMS) between the gastric pouch and the excluded stomach allows for EUS Guided Transgastric Interventions (EDGI) in patients with Roux-en-Y gastric bypass (RYGB). Although EUS guided transgastric ERCP (EDGE) outcomes have been reported, there is a paucity of data on other endoscopic interventions. We aimed to evaluate the outcomes and safety of EDGI. Methods This is a retrospective study involving 9 centers (8 USA, 1 Europe) and included patients with RYGB who underwent EDGI between 06/2015 and 09/2021. The primary outcome was the technical success of EDGI. Secondary outcomes included adverse events, length of hospital stay, and fistula follow-up and management. Results 54 EDGI procedures were performed in 47 patients (mean age 61yr, F 72%), most commonly for the evaluation of a pancreatic mass (n=16) and management of pancreatic fluid collections (n=10). A 20mm LAMS was utilized in 26 patients and a 15mm LAMS in 21, creating a gastrogastrostomy (GG) in 37 patients and jejunogastrostomy (JG) in 10. Most patients (n=30, 64%) underwent a dual-session EDGI, with a median interval of 17d between the 2 procedures. Single-session EDGI was performed in 17 patients, of whom 10 (59%) had anchoring of the LAMS. The most common interventions were diagnostic EUS (+/-FNA/B) (n=28) and EUS-guided cystgastrostomy (n=8). The mean procedural time was 97.6 ± 78.9 mins. Technical success was achieved in 52 (96%). AEs occurred in 5 (10.6%) patients, of which only 1 (2.1%) was graded as severe. Intraprocedural LAMS migration was the most common AE, occurring in 3 patients (6.4%), while delayed spontaneous LAMS migration occurred in 2 (4.3%). 4 of the 5 LAMS migration events were managed endoscopically, and one required surgical repair. LAMS anchoring was found to be protective against LAMS migration (p=0.001). The median duration of hospital stay was 2.1 ± 3.7d. Of the 17 patients who underwent objective fistula assessment endoscopically/radiologically after LAMS removal, 2 (11.7%) were found to have persistent fistulas. In one case the fistula was intentionally left open to assist with weight gain. The other fistula was successfully closed endoscopically. Conclusion EDGI is effective and safe for the diagnosis and management of pancreatobiliary and foregut disorders in RYGB patients. It is associated with high rates of technical success and low rates of severe AEs. LAMS migration is the most common AE with evidence that anchoring can be protective against its occurrence. Persistent fistulas may occur, but endoscopic closure seems effective.