Rashmee Patil

Non-alcoholic fatty liver disease and cardiovascular risk

Non-alcoholic fatty liver disease (NAFLD) is a chronic liver disease associated with insulin resistance and metabolic syndrome. The spectrum of disease ranges from simple steatosis to steatohepatitis and progression to cirrhosis. Compelling evidence over the past several years has substantiated a significant link between NAFLD and cardiovascular disease ranging from coronary artery disease to subclinical carotid atherosclerosis. Close follow up, treatment of risk factors for NAFLD, and cardiovascular risk stratification are necessary to predict morbidity and mortality in this subset of patients.

Endoscopic Ultrasound-Guided Radiofrequency Ablation of the Pancreatic Tumors: A Promising Tool in Management of Pancreatic Tumors

Objective. Radiofrequency ablation is a well-established antitumor treatment and is recognized as one of the least invasive therapeutic modalities for pancreatic neoplasm. Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) delivery can be used to treat both pancreatic cancer and asymptomatic premalignant pancreatic neoplasms and may serve as a less invasive alternative to surgical resection. This is an appealing option that may result in less morbidity and mortality. The aim of this review was to summarize and evaluate the clinical and technical effectiveness of EUS-guided RFA of pancreatic neoplasms. Methods. A through literature review was performed to identify the studies describing this novel technique. In this review article, we have summarized human case series. The indications, techniques, limitations, and complications reported are discussed. Results. A total of six studies were included. Overall, a 100% technical success rate was reported in human studies. Complications related to endoscopic ultrasound-guided radiofrequency ablation delivery have been described; however, few cases have presented life-threatening outcomes. Conclusion. We believe that this novel technique can be a safe and effective alternative approach in the management of selected patients.

Endoscopic ultrasound-guided placement of the lumen-apposing self-expandable metallic stent for gallbladder drainage: a promising technique.

Acute cholecystitis and other clinical problems requiring gallbladder removal or drainage have conventionally been treated with surgery, endoscopic retrograde cholangiopancreatography or percutaneous transhepatic drainage of the gallbladder and/or extrahepatic bile duct. Patients unable to undergo these procedures due to functional status or anatomical anomalies are candidates for endoscopic ultrasound (EUS)-guided gallbladder drainage with stent placement. The aim of this review was to evaluate the technical feasibility and efficacy of EUS-guided placement of the recently developed lumen-apposing self-expandable metallic stent (LASEMS). A literature review was performed to identify the studies describing this technique. In this review article we have summarized case series or reports describing EUS-guided LASEMS placement. The indications, techniques, limitations and complications reported are discussed. A total of 78 patients were included across all studies described thus far in the literature. Studies have reported near 100% technical and clinical success rates in selected cases. No major complications were reported. EUS-guided gallbladder drainage and LASEMS placement can be a safe and effective alternative approach in the management of selected patients.

Acute Liver Toxicity due to Efavirenz/Emtricitabine/Tenofovir

The fixed-dose combination of Efavirenz/Emtricitabine/Tenofovir is a first-line agent for the treatment of HIV; however few cases have reported hepatotoxicity associated with the drug. We report a case of Efavirenz/Emtricitabine/Tenofovir-associated hepatotoxicity presenting mainly with hepatocellular injury characterized by extremely elevated aminotransferase levels, which resolved without acute liver failure or need for liver transplant referral.

Characteristics and Risk Stratification of Colon Polyps among Asymptomatic Hispanic Patients Undergoing First Time Screening Colonoscopy: A Retrospective Study

Goals: To determine characteristics of polyps in Hispanic patients undergoing first-time screening colonoscopy and to risk stratify them based on findings. Background: Current guidelines recommend screening colonoscopy beginning at age 50 in the average-risk population. Race has been shown to influence the risk of colorectal cancer, thus leading to the recommendation of initiating screening in blacks at the age of 45. Few data exist on the prevalence and characteristics of colon polyps among U.S. Hispanics. Study: Retrospective study at a community hospital in Brooklyn, NY serving large Hispanic population including patients >50 undergoing first-time screening colonoscopy who met inclusion and exclusion criteria. Results: Our final data analysis of 192 Hispanic patients showed that the majority of polyps (56%) were tubular adenomas with 17% showing dysplastic features. In a risk stratification analysis, 52.6% of patients fell into the low risk category while 47.4% of patients had adenomas with at least one high risk feature for progression to colon cancer. Conclusions: We found that Hispanic patients undergoing first-time screening colonoscopy have increased risk for malignancy based on the features of their polyps. There is need for further, race-specific studies determining the cause of increased progression to neoplasia and the possible need for earlier screening.

Endocuff-Assisted Colonoscopy-A Novel Accessory in Improving Adenoma Detection Rate: A Review of the Literature.

Endocuff (Arc Medical Design) is a U.S. Food and Drug Administration-approved device that is attached like a cap to the distal tip of the colonoscope; it is used to improve adenoma detection rates during colonoscopy. The aim of this review was to summarize and evaluate the clinical and technical efficacy of Endocuff in improving adenoma detection rate. A comprehensive literature review was performed to identify studies describing this technique. In this review article, we have summarized case series and reports describing Endocuff use and results. The reported indications, results, limitations, and complications are discussed.

Mo1168 Urgent Endoscopy Within 12 Hours of Admission Is Associated With Decreased ICU Length of Stay and Overall Length of Stay

Background/Aim: Our study assessed five scoring systems (APACHE II, Charlson comorbidity index, AIMS65, Rockall score, and Glasgow-Blatchford score) for predicting intensive care unit (ICU) length of stay (LOS) and overall LOS in patients admitted to ICU for gastrointestinal bleeding (GIB) at a community teaching hospital.Methods:We prospectively studied all cases of GIB in patients admitted to the ICU from December 2013 to October 2014. Patients were included if they were 18 years of age or older, admitted directly to an ICU from the emergency department, had a hemoglobin (Hb) value of less than 10 g/dL or had a decrease in baseline Hb of at least 2 g/dL within the first 6 hours of admission. Pregnant women and patients with bleeding disorders were excluded. Patient demographics, clinical presentation, laboratory data, and endoscopic findings were recorded to calculate the scoring systems. ICU LOS and overall LOS were also recorded. SPSS 7.0 was used to calculate a Pearson correlation (r) for each independent scoring system and LOS. Results: 64 patients (60% male and 40% female) were included in the study. The mean age was 66 years (range 20-95). Mean ICU LOS was 4 days, whereas the mean overall LOS was 8 days. APACHE II (r=+0.345, p=0.005), AIMS65 (r=+0.412, p=0.001), Charlson comorbidity index (r=+0.497, p= 0.0001), Rockall (r=+0.402, p=0.001) and Glasgow-Blatchford (r=+0.301, p= 0.014) scores had statistically significant positive correlations to overall LOS. ICU LOS was significantly correlated with only APACHE II (r=+0.260, p=0.035) and Charlson comorbidity index (r=+0.309, p=0.011). Conclusion: APACHE II, Charlson comorbidity index, AIMS65, Rockall and Glasgow-Blatchford scores are positively correlated with overall LOS in patients admitted to ICU for GIB. However, only APACHE II and Charlson comorbidity index were significantly associated with ICU LOS.