Rahul A. Shimpi

Infectious complications following endoscopic retrograde cholangiopancreatography: an automated surveillance system for detecting postprocedure bacteremia.

We have developed an automated surveillance system to detect bloodstream infection (BSI) occurring after endoscopic retrograde cholangiopancreatography (ERCP). We retrospectively applied this automated surveillance tool to all patients who underwent ERCP at out institution between July 2004 and April 2006 to determine the baseline rates of BSI after ERCP and identify the epidemiology of the pathogens. A total of 2052 ERCPs were performed during the study period; 46 BSIs occurred within 30 days after ERCP (overall rate of post-ERCP BSI, 2.24/100 procedures). The most commonly isolated organisms were Enterobacteriaceae (n = 18; 29%) and enterococci (n = 14; 22%). Because invasive procedures are performed in various outpatient and inpatient settings, novel methods are needed to conduct effective surveillance for infection.

Gastroesophageal reflux and altered motility in lung transplant rejection

Background  Lung transplantation has become an effective therapeutic option for selected patients with end stage lung disease. Long‐term survival is limited by chronic rejection manifest as bronchiolitis obliterans syndrome (BOS). The aspiration of gastric contents has been implicated as a causative or additive factor leading to BOS. Gastroesophageal reflux (GER) and altered foregut motility are common both before and after lung transplantation. Further, the normal defense mechanisms against reflux are impaired in the allograft. Recent studies using biomarkers of aspiration have added to previous association studies to provide a growing body of evidence supporting the link between rejection and GER. Further, the addition of high‐resolution manometry (HRM) and impedance technology to characterize bolus transit and the presence and extent of reflux regardless of pH might better identify at‐risk patients. Although additional prospective studies are needed, fundoplication appears useful in the prevention or treatment of post‐transplant BOS.

Lung transplantation delays gastric motility in patients without prior gastrointestinal surgery—A single-center experience of 412 consecutive patients

To examine the impact of lung transplantation on gastric motility.

Radiographic and endoscopic regression of metastatic gastric cancer to the colon in the setting of 5-aminosalicylic acid use

Colonic metastases from gastric cancer are a rare phenomenon and sparsely reported in the literature. We report a case of a 59-year-old woman who presented with vague abdominal symptoms and initial computer tomography (CT) imaging suggestive of a colonic apple-core lesion with serial colonoscopic biopsies diagnostic of metastatic signet ring cell gastric adenocarcinoma. This case is unique given the evolving CT and endoscopic findings that suggested a regression in colonic wall thickening in the setting of 5-aminosalicylic acid (5-ASA) use prior to histologic diagnosis.