Wasif M. Abidi

Novel fork-tip needles versus standard needles for EUS-guided tissue acquisition from solid masses of the upper GI tract: a matched cohort study

Abstract Background: There are very few available data on the novel SharkCore™ needles for EUS-FNB. Aim: Comparison of the performance of the SharkCore™ needles with the standard EUS-FNA needles for the diagnosis of solid upper GI masses. Patients and methods: Single-center, retrospective cohort study in an academic tertiary referral hospital. Patients were matched 1:1 for the site of the lesion and the presence or absence of rapid on-site evaluation (ROSE). Results: A total of 102 patients were included. There was no statistically significant difference in the mean number of passes (3.3 ± 1.3 versus 3.4 ± 1.5; p = .89). Similar results were observed at the subgroup with ROSE (4.3 ± 1.3 versus 3.7 ± 1.5; p = .26). More histological specimens were obtained with the SharkCore™ needles compared to standard needles (59 versus 5%; p < .001). Diagnostic test characteristics were not significantly different (sensitivity: 91.5 versus 85.7; specificity: 100 versus 100%; accuracy: 92.2 versus 85.4% for SharkCore™ versus standard needles, p > .05 in all cases). At multivariable analysis, there was no statistically significant difference in the mean number of passes in all patients (p = .23) and in the ROSE subgroup (p = .66). However, the SharkCore™ needle obtained significantly more histological material than the standard needle (odds ratio 66; 95% confidence interval: 11.8, 375.8, p < .001). There was no significant difference in complication rates (p = .5). Limitations: Retrospective study, single-center. Conclusion: The SharkCore needles were similar to standard FNA needles in terms of the number of passes to reach diagnosis, but obtained significantly more histological specimen.

Preclinical endoscopic training using a part-task simulator: learning curve assessment and determination of threshold score for advancement to clinical endoscopy

BackgroundPreclinical simulator training has the potential to decrease endoscopic procedure time and patient discomfort. This study aims to characterize the learning curve of endoscopic novices in a part-task simulator and propose a threshold score for advancement to initial clinical cases.MethodsTwenty novices with no prior endoscopic experience underwent repeated endoscopic simulator sessions using the part-task simulator. Simulator scores were collected; their inverse was averaged and fit to an exponential curve. The incremental improvement after each session was calculated. Plateau was defined as the session after which incremental improvement in simulator score model was less than 5%. Additionally, all participants filled out questionnaires regarding simulator experience after sessions 1, 5, 10, 15, and 20. A visual analog scale and NASA task load index were used to assess levels of comfort and demand.ResultsTwenty novices underwent 400 simulator sessions. Mean simulator scores at sessions 1, 5, 10, 15, and 20 were 78.5 ± 5.95, 176.5 ± 17.7, 275.55 ± 23.56, 347 ± 26.49, and 441.11 ± 38.14. The best fit exponential model was [time/score] = 26.1 × [session #]−0.615; r2 = 0.99. This corresponded to an incremental improvement in score of 35% after the first session, 22% after the second, 16% after the third and so on. Incremental improvement dropped below 5% after the 12th session corresponding to the predicted score of 265. Simulator training was related to higher comfort maneuvering an endoscope and increased readiness for supervised clinical endoscopy, both plateauing between sessions 10 and 15. Mental demand, physical demand, and frustration levels decreased with increased simulator training.ConclusionPreclinical training using an endoscopic part-task simulator appears to increase comfort level and decrease mental and physical demand associated with endoscopy. Based on a rigorous model, we recommend that novices complete a minimum of 12 training sessions and obtain a simulator score of at least 265 to be best prepared for clinical endoscopy.

Endoscopic treatment of a chronic fistula by resection and sutured closure.

A 67-year-old woman with esophageal varices from primary biliary cirrhosis presented to an outside hospital with GI bleeding. Upper endoscopy showed grade 2 esophageal varices without bleeding. Esophageal variceal band ligation was performed. During banding, opposite walls of the esophagus were suctioned, completely occluding the esophagus. Two hours after the procedure, the patient experienced difficulty with controlling secretions; a nasoesophageal tube was placed for suctioning. The patient was transferred to our facility. She experienced hepatic encephalopathy, agitation, and aspiration. Intervention to remove the band was deemed necessary. In the event of recurrent hemorrhage, interventional radiology was on standby for placement of a transjugular intrahepatic portosystemic shunt; fibrin glue was available in the procedure suite. Complete esophageal obstruction from the band was noted during EGD (Fig. 1A; Video 1, available online

Time-Dependent Molecular Responses Differ between Gastric Bypass and Dieting but Are Conserved Across Species

The effectiveness of Roux-en-Y gastric bypass (RYGB) against obesity and its comorbidities has generated excitement about developing new, less invasive treatments that use the same molecular mechanisms. Although controversial, RYGB-induced improvement of metabolic function may not depend entirely upon weight loss. To elucidate the differences between RYGB and dieting, we studied several individual organ molecular responses and generated an integrative, interorgan view of organismal physiology. We also compared murine and human molecular signatures. We show that, although dieting and RYGB can bring about the same degree of weight loss, post-RYGB physiology is very different. RYGB induces distinct, organ-specific adaptations in a temporal pattern that is characterized by energetically demanding processes, which may be coordinated by HIF1a activation and the systemic repression of growth hormone receptor signaling. Many of these responses are conserved in rodents and humans and may contribute to the remarkable ability of surgery to induce and sustain metabolic improvement.

Treatment of recurrent esophageal stricture with an insulated-tip electrosurgical knife and mitomycin C

An 82-year-old woman presented with dysphagia due to a refractory esophageal stricture. The stricture was thought to have been caused 2 years previously after hospitalization for a hip fracture and prolonged nasogastric tube placement at a subacute care facility. Numerous attempts at stricture dilation, initially every 2 weeks, had been made at another institution using a hydrostatic balloon and an esophageal stent, which was later removed because of complications. At our center, the patient underwent upper gastrointestinal (GI) endoscopy under general anesthesia, during which a severe benign-appearing intrinsic stenosis (4-mm wide and 1-cm long) that prohibited passage of the endoscope was encountered 31 cm from the incisors (▶Video1). The stenosis was incised using an insulated-tip electrosurgical knife along the aspect opposite to the aorta. Balloon dilation was performed to a diameter of 15mm before the stenosis was traversed and a 4-cm hiatus hernia was noted. The remainder of the upper GI endoscopy was normal. Repeat balloon dilation to 15mm was then performed. The upper GI endoscope was removed and an overtube was advanced to the level of the stricture to minimize mucosal contact with mitomycin C. A gauze soaked with 1mL of mitomycin C solution (0.4mg/mL) was delivered to the level of stricture with a rat-toothed forceps that was fed through the endoscope (▶Fig. 1). The gauze was applied to the level of the stenosis for 3 minutes and this was followed by a second 2-minute treatment. The patient was discharged home on a full liquid diet for 2 days followed by soft diet for 2 days. She was seen in clinic 7 months later with no recurrent symptoms. Esophageal stricture due to prolonged nasogastric tube placement has been previously reported [1]. Data on the use of topical mitomycin C for esophageal strictures are limited, but similar techniques have been shown to be safe and effective in children with strictures due to caustic injury or after repair of esophageal atresia [2–5]. Endoscopy_UCTN_Code_TTT_1AO_2AN

Countertraction in endoscopic submucosal dissection

n transcript of the video audio is available online at www.VideoGIE.org. re 1. A, The first stitch was placed at the wall opposite to the lesion. A helical grasper (arrow) was used to ensure placement of the thickness suture. ture slack was made to allow for the second stitch. C, The second stitch was placed at the edge of the lesion, proximal to the endoscope. It is critical ake sure that the muscularis propria is not involved by the needle. D, The scope was withdrawn, and the suture end was held with a hemostat outside atient’s body. E, The suture-pulley method provided a wider view of the dissection plane. The dissection line is indicated in yellow. F, Multiple oed areas are noted at the ulcer bed (arrows). G, The specimen was successfully retrieved with a net together with the attached anchor and suture. ter being held by a reopenable hemoclip, a 5-mm small rubber band attached to a 5-mm suture loop (3-0 nylon suture) was passed through the scope nel. I, The rubber band was fixed at the edge of the lesion with a hemoclip. J, The tip of another hemoclip was used to pick up the suture loop. Then uture loop was directed to the opposite wall. K, The clip was deployed at the opposite wall, and the suture loop was successfully fixed. L, The rubber method effectively applied countertraction to the lesion. Dissection line is indicated in yellow. M, The lesion was successfully removed in en bloc on. (Tattooed area, arrow.) N, The suture loop was cut with endoscopic scissors, and the specimen was retrieved.

Endoscopic choledochoduodenostomy and gastrojejunostomy in the treatment of biliary and duodenal obstruction.

re 1. A, Duodenal obstruction engulfing the papilla, which did not allow successful ERCP, EUS-guided rendezvous procedure, and enteral placement. B, Endoscopic choledochoduodenostomy was successfully completed to relieve the biliary obstruction. Arrow points to the n-apposing stent; arrowheads point to a plastic pigtail stent. C, An endoscopic gastrojejunostomy was successfully completed to treat the duodenal uction. Arrows point to the electrocautery-enhanced lumen-apposing metal stent.

Endoscopic Management of Complications in Acute Pancreatitis

Common complications of acute pancreatitis include pancreatic duct leaks and pancreatic collections, which were recently reclassified into acute peripancreatic fluid collection, pseudocyst, acute necrotic collection, and walled-off pancreatic necrosis. Various endoscopic techniques can definitively treat many of these complications. Pancreatic leaks and fistulae are addressed with ERCP and placement of a transpapillary stent that bridges the site of a pancreatic duct disruption. Pseudocysts can be drained via cystgastrostomy with efficacy approaching 80 %. Furthermore, walled-off pancreatic necrosis can be managed via endoscopic necrosectomy with drainage and debridement resulting in a high degree of success and significant reduction in complications compared to surgery or radiologic drainage. The current chapter reviews the workup of these complications in acute pancreatitis and discusses the indications, timing, technique, outcomes, and complications of the endoscopic procedures employed to address these complications.

556 Accuracy and Inter-Rater Reliability in the Pre-Clinical Evaluation of Fluorescent Deoxyglucose As a Topical Contrast Agent for the Detection of Colonic Neoplasia During Confocal Imaging

participation. FS was performed by specialist gastroenterologists in hospital endoscopy units. Bowel preparation was limited to a single enema self-administered at home 2 hours before FS. TCT was performed after low-volume bowel preparation (low-fiber diet + 1 laxative dose at the main meals, in the 3 days preceding TCT) and fecal tagging. CTC examinations were evaluated using a double reading paradigm in which CAD was the first reader (Iussich G, Correale L, Senore C, et al. Invest Radiol. 2014;49(3):173-82). All subjects detected with a polyp ≥ 6 mm at TCT and those with high-risk distal polyps at FS were referred for colonoscopy (TC). Results: The participation rate following the initial invitation and mail reminder was 30.4% (298/980) in the TCT and 27.0% (264/976) in the FS arm (RR: 1.12; 95%CI:0.98-1.29). Compliance was significantly higher among men invited for TCT (34.1%; 168/501) than among those invited for FS (26.6%; 121/464 RR: 1,28; 95%CI:1.05-1.46); no difference (TCT: 26.7%; FS: 27.4%; RR: 0.95; 95%CI:0.78-1.17) was observed among women. Out of 2674 subjects undergoing TCT screening in Proteus 1, 79 (3.0%) had an inadequate test and 265 (9.9%) were referred for TC; the corresponding figures among the 2743 FS screenees were 75 (2.7%) and 270 (10.1%). AN detection rate of FS and CTC was similar. Conclusion TCT showed a similar effectiveness and acceptability as FS in a population screening setting. Comparative cost-effectiveness data are needed to assess the role of screening TCT, but available data already suggest that it could represent a valuable option for screenees refusing TC, or, as a triage test, for those at increased risk for TC side effects (subjects on anticoagulant therapy or suffering with co-morbidities).