Madhav Desai

Lenalidomide in relapsed or refractory mantle cell lymphoma: Overview and perspective

Lenalidomide, a novel immunomodulatory agent, was approved by the US Food and Drug Administration for the treatment of myelodysplastic syndrome and relapsed multiple myeloma. Data from preclinical studies paved the way for clinical trials of lenalidomide in mantle cell lymphoma (MCL). Initial phase I and II clinical trials of lenalidomide alone and as part of combination regimens in patients with relapsed/refractory MCL have shown promising results. Its immunomodulatory, T cell costimulatory, anti-inflammatory and anti-angiogenic actions working together in the tumor cell microenvironment seem to be responsible for its enhanced antitumor efficacy. Lenalidomide’s nature of action and safety profile favor it over other agents studied in relapsed/refractory MCL. This review summarizes the data from preclinical and clinical studies of lenalidomide in relapsed/refractory MCL and compares the results with those of other novel agents being used for relapsed/refractory MCL.

Outcomes of Clostridium difficile infection in pediatric solid organ transplant recipients.

The incidence of Clostridium difficile infection (CDI) is increasing in the pediatric population. Pediatric recipients of solid organ transplantation (SOT) may be at a higher risk for CDI in part because of chemotherapy and prolonged hospitalization.

Hepatorenal syndrome in hospitalized patients with chronic liver disease: results from the Nationwide Inpatient Sample 2002-2012.

Hepatorenal syndrome (HRS) is one of the leading causes of hospitalizations in patients with chronic liver disease (CLD). We conducted a retrospective national database study to determine the epidemiology of HRS in hospitalized patients with CLD. Data from a Nationwide Inpatient Sample were extracted from 2002 to 2012 using ICD-9-CM codes related to CLD and HRS. The following outcomes were examined: in-hospital mortality, total charges, length of stay (LOS), patient demographics, procedures, complications, and comorbidities. Statistical analysis including regression was performed to examine factors associated with HRS. During 2002–2012, hospital discharges related to CLD increased from 407,246 to 836,475 with an increase of 37.9% for HRS as a complication in this population. Patients with CLD and HRS had worse outcomes compared with patients with CLD without HRS. This was manifested as a higher mortality rate (32.0% vs 10.3%), increased LOS (median 7 vs 5 days), and increased hospital costs (median

Cap-assisted colonoscopy: a meta-analysis of high-quality randomized controlled trials

16,000 vs

Su1069 Esophageal Variceal Bleeding in Hospitalized Patients With Cirrhosis: Results From the NIS Database 2002 - 2012

11,000). Logistic regression demonstrated that HIV/AIDS (adjusted OR 2.9, 95% CI 2.2 to 3.9), pneumonia (aOR 2.8, 95% CI 2.3 to 3.2), and esophageal variceal bleeding (aOR 1.9, 95% CI 1.7 to 2.0) were associated with higher mortality in patients with HRS. Conversely, liver transplantation (aOR 0.1, 95% CI 0.1 to 0.1), transjugular intrahepatic portosystemic shunt (aOR 0.5, 95% CI 0.4 to 0.6), and hospitalization in the Midwest region of the USA (aOR 0.7, 95% CI 0.6 to 0.7) were associated with reduced mortality. The incidence of HRS in hospitalized patients with CLD increased during 2002–2012. HRS is associated with significant mortality and morbidity in these patients.

Management of Inflammatory Bowel Diseases in Jehovah’s Witness

Background and study aims  Standard colonoscopy (SC) is the preferred modality for screening for colon cancer; however, it carries a significant polyp/adenoma miss rate. Cap-assisted colonoscopy (CC) has been shown to improve polyp/adenoma detection rate, decrease cecal intubation time and increase cecal intubation rate when compared to standard colonoscopy (SC). However, data on adenoma detection rate (ADR) are conflicting. The aim of this meta-analysis was to compare the performance of CC with SC for ADR among high-quality randomized controlled trials. Patients and methods  We performed an extensive literature search using MEDLINE, EMBASE, Scopus, Cochrane and Web of Science databases and abstracts published at national meetings. Only comparative studies between CC and SC were included if they reported ADR, adenoma per person (APP), cecal intubation rate, and cecal intubation time. The exclusion criterion for comparing ADR was studies with Jadad score ≤ 2. The odds ratio (OR) was calculated using Mantel-Haenszel method. I 2 test was used to measure heterogeneity among studies. Results  Analysis of high-quality studies (Jadad score ≥ 3, total of 7 studies) showed that use of cap improved the ADR with the results being statistically significant (OR 1.18, 95 % CI 1.03 – 1.33) and detection of 0.16 (0.02 – 0.30) additional APP. The cecal intubation rate in the CC group was 96.3 % compared to 94.5 % with SC (total of 17 studies). Use of cap improved cecal intubation (OR 1.61, 95 % CI 1.33 – 1.95) when compared to SC ( P value < 0.001). Use of cap decreased cecal intubation time by an average of 0.88 minutes (95 % CI 0.37 – 1.39) or 53 seconds. Conclusions  Meta-analysis of high-quality studies showed that CC improved the ADR compared to SC.

Adverse Events After Radiofrequency Ablation in Patients With Barrett’s Esophagus: A Systematic Review and Meta-analysis

BACKGROUND: Esophageal variceal bleeding (EVB) is a frequent complication in cirrhotic patients resulting in considerablemortality andmorbidity. However, recent large-scale studies are lacking. We AIMS: To conduct a retrospective analysis using a national U.S. database to study the differences in demographic characteristics, rate of complications, and outcomes, and temporal trends in hospitalized cirrhotic patients with and without EVB. METHODS: We interrogated data from the Nationwide Inpatient Sample 2002 2012. Utilizing International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes, we studied hospital discharges for cirrhosis and related EVB in adult patients. Cases were queried for complications well-recognized in cirrhotic patients. These included infections including Clostridium difficile infection and spontaneous bacterial peritonitis, hepatic encephalopathy and hepatorenal syndrome. Comorbid conditions were assessed using the Elixhauser comorbidity. We used high-dimensional propensity scores in a 1:5 matching ratio with a greedy matching algorithm generated by regression analysis. For trend analysis, we used the Cochrane-Armitage test. RESULTS: Patients with EVB suffered a significantly higher rate of alcohol abuse (63.90% versus 48.80%; p<0.01). EVB was also associated with an overall lower incidence of infection (13.50% versus 24.10%; p<0.01). EVB in cirrhotic patients was independently associated with overall worse outcomes with respect to in-hospital mortality (10.00% versus 5.00%; p<0.01) and hospital charges (median

Efficacy and safety outcomes of multimodal endoscopic eradication therapy in Barrett's esophagus-related neoplasia: a systematic review and pooled analysis

41,000 versus

Normal saline solution versus other viscous solutions for submucosal injection during endoscopic mucosal resection: a systematic review and meta-analysis

26,000; p<0.01). In the period from 2002 2012, the number of cirrhosis-related hospitalizations increased from 337,956 to 570,220 (p<0.01). Concurrently, the incidence of EVB declined from 8.60% to 5.78% with an overall decreased trend (p<0.01). CONCLUSION: EVB in cirrhotic patients was associated with a significantly higher mortality and increased hospital charges. The incidence of EVB in hospitalized cirrhotic patients declined significantly from 2002 2012. This is consistent with earlier trends from 1988 2002 and likely reflects the effectiveness of primary and secondary prophylaxis.

Impact of cap-assisted colonoscopy on detection of proximal colon adenomas: systematic review and meta-analysis

1Department of Gastroenterology and Hepatology, University of Kansas, School of Medicine, Kansas City, MO 64108, USA 2Department of Interventional Gastroenterology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA 3Department of Internal Medicine, University of Kansas, School of Medicine, Kansas City, MO 64108, USA 4Department of Gastroenterology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA *Corresponding author Shreyas Saligram, MD, MRCP Department of Gastroenterology and Hepatology University of Kansas, School of Medicine Kansas City, MO 64108, USA; Department of Interventional Gastroenterology Moffitt Cancer Center, 12902 USF Magnolia Drive Tampa, FL 33612, USA Tel. 412-708-5548 E-mail: drsaligram@yahoo.com