Publications by authors named "Kahaleh M"
Resected rectal polyps with deep invasion into the submucosa (pT1b-sm2,3) or the muscle layer (pT2) are currently confronted with surgery due to non-curative resection. We evaluated the efficacy, safety, and locoregional control of adjuvant radiotherapy (RT) and/or chemotherapy (CT) following endoscopic KAR (knife-assisted resection) in patients with invasive early rectal cancers who are unwilling or unsuitable for additional surgical resection. Fifty-one patients with early rectal cancers, pT1b or pT2, underwent post-resection adjuvant RT and/or CT in 15 centers worldwide.
View Article and Find Full Text PDFArticle Synopsis
- Primary sclerosing cholangitis (PSC) is a liver disease linked to inflammatory bowel disease and can cause serious liver complications; this study investigates trends in healthcare usage and mortality related to PSC in the U.S. from 2008 to 2017.
- The analysis of the Nationwide Inpatient Sample reveals that while hospital charges for PSC patients rose by 32.2%, the average length of hospital stays decreased during the study period, indicating changes in healthcare practices.
- Additionally, there was a notable increase in the severity of illness and risk of death among PSC patients, with a rise in cases of hepatocellular carcinoma (HCC), while cases of cholangiocarcinoma (CCA) saw a decline.
Article Synopsis
- The study focuses on developing guidelines for the safe use of fluoroscopy in gastrointestinal endoscopy, balancing its benefits with concerns about radiation exposure to patients and healthcare workers.
- A modified Delphi method was used, involving three rounds of surveys with 46 experts, resulting in 43 proposed statements, of which 31 achieved consensus and were prioritized across various categories such as Patient Safety and Staff Safety.
- The final consensus statements highlight the importance of education and safety measures, with a significant majority rated as high priority, aiming to enhance safety culture in healthcare settings while utilizing fluoroscopy.
Article Synopsis
- The text refers to a correction made to a previously published article.
- The specific article mentioned can be identified by its DOI, which is 10.1055/a-2411-1814.
- Corrections like this are common in academic publishing to address errors or inaccuracies in research.
Article Synopsis
- - The study investigated outcomes of lumen-apposing metal stents (LAMS) placement in patients with surgically altered anatomy (SAA), which is not well-documented in existing literature, involving 270 patients across 25 tertiary care centers up to November 2023.
- - Technical success of the procedures was very high at 98%, with clinical success at 97%, although there was a notable adverse event rate of 12%, with various degrees of severity recorded.
- - The results suggest that while LAMS placement in SAA is effective, due to the risk of complications, these procedures should only be performed by experienced endoscopists in specialized centers.
Background & Aims: There is significant variability in the immediate post-operative and long-term management of patients undergoing per-oral endoscopic myotomy (POEM), largely stemming from the lack of high-quality evidence. We aimed to establish a consensus on several important questions on the after care of post-POEM patients through a modified Delphi process.
Methods: A steering committee developed an initial questionnaire consisting of 5 domains (33 statements): post-POEM admission/discharge, indication for immediate post-POEM esophagram, peri-procedural medications and diet resumption, clinic follow-up recommendations, and post-POEM reflux surveillance and management.
Background And Objectives: Management of hepatic abscesses has traditionally been performed by image-guided percutaneous techniques. More recently, EUS drainage has been shown to be efficacious and safe. The aim of this study is to compare EUS-guided percutaneous catheter drainage (PCD) of hepatic abscesses.
View Article and Find Full Text PDFArticle Synopsis
- Nonagenarians are expected to make up 10% of the U.S. population by 2050, but their outcomes related to nonvariceal upper gastrointestinal bleeding (NVUGIB) have not been studied before.
- The study utilized data from the National Inpatient Sample database from 2016 to 2020 and found that nonagenarians had a higher in-hospital mortality rate (4%) compared to octogenarians (3%), with lower rates of esophagogastroduodenoscopy (EGD) and blood transfusions.
- The analysis indicated that nonagenarians are at a greater risk of mortality and less likely to receive EGD for NVUGIB, highlighting the need for additional research to understand these outcomes better in
Approaches to Pancreaticobiliary Endoscopy in Roux-en-Y Gastric Bypass Anatomy.
Gastrointest Endosc Clin N Am
July 2024
The increasing prevalence of bariatric surgery, particularly Roux-en-Y gastric bypass, has necessitated innovative approaches for endoscopic retrograde cholangiopancreatography (ERCP) due to the altered anatomy. Laparoscopy-assisted ERCP offers high success rates but leads to extended hospital stays and an increased risk of adverse events. Enteroscopy-assisted ERCP encounters technical challenges, resulting in lower success rates.
View Article and Find Full Text PDFBackground: Viral infections are known to impact the pancreato-biliary system; however, there are limited data showing that the same is true of COVID-19. Endoscopic retrograde cholangiopancreatography (ERCP) can safely be performed in patients with COVID-19 infection, but outcomes of patients with COVID-19 infections and concomitant pancreatic and biliary disease requiring endoscopic intervention are unknown.
Aims: This study aims to evaluate the severity of pancreaticobiliary diseases and post-ERCP outcomes in COVID-19 patients.
Article Synopsis
- Digital single-operator cholangioscopy (DSOC) is a technique for diagnosing and treating biliary duct disorders, but traditional systems faced issues like cost and image quality.
- A new system called eyeMAX was developed to improve these limitations; the study assessed its diagnostic accuracy and safety across 80 patients from two cohorts—diagnostic and therapeutic.
- Results showed high sensitivity (91.6%) and specificity (87.5%) for diagnosing neoplasms, with successful stone removal for 71% of patients who required treatment, and no adverse events reported during the procedures.
Ablation Therapy of the Biliary Tree: Status and Comprehensive Review.
J Clin Gastroenterol
April 2024
Malignant biliary obstruction is typically referred to endoscopists for palliation. A curative resection is indeed rarely an option in this condition. Photodynamic therapy and radiofrequency ablation are 2 modalities that can be offered in those patients.
View Article and Find Full Text PDFBackground: Nonvariceal upper gastrointestinal bleeding (NVUGIB) is a medical emergency that has significant morbidity and mortality. The available data about the impact of COVID-19 infection on mortality in patients with NVUGIB is limited.
Methods: We identified all hospitalizations with a principal diagnosis of NVUGIB in 2020.
Article Synopsis
- The European Society of Gastrointestinal Endoscopy (ESGE) emphasizes the need for structured training in diagnostic endoscopic ultrasound (EUS), presenting a formal framework to develop and maintain necessary skills.
- Key prerequisites for trainees include competence in upper gastrointestinal endoscopy and exposure to diagnostic EUS training environments with high procedure volumes and expertise.
- Trainees must follow a structured syllabus and complete at least 250 supervised EUS procedures across various categories to demonstrate competence before practicing independently.
Article Synopsis
- Lumen-apposing metal stents (LAMSs) offer a minimally invasive solution for treating small-bowel obstructions (SBO) through a procedure called EUS-guided coloenterostomy (EUS-CE), particularly benefiting patients unable to undergo surgery.
- A study involving 26 patients showed that the procedure had a 100% technical success rate and a 92.3% clinical success rate, with most patients able to resume enteral nutrition.
- While there were some adverse events (15.4%), such as bleeding and diarrhea, the overall findings suggest EUS-CE with LAMSs is a promising option for managing SBO in high-risk patients, warranting further research for confirmation.
Article Synopsis
- Undifferentiated early gastric cancer (UD-EGC) can be treated effectively with endoscopic submucosal dissection (ESD), and this study focused on understanding recurrence rates and risk factors related to this treatment.
- Data was gathered from 17 centers, involving 71 patients, indicating a low recurrence rate of 5.6% after an average follow-up period of about 29 months.
- Factors like lymphovascular and perineural invasion were found to be significantly linked to local recurrence, while lesion size was not a predictor, suggesting that ESD is a viable initial treatment option for UD-EGC when certain risk factors are absent.
Background: Endoscopic ultrasound (EUS)-guided gastroenterostomy (EUS-GE) is a minimally invasive therapy for patients with gastric outlet obstruction without the risks of surgical bypass and the limited long-term efficacy of enteral self-expanding metal stent placement. However, due to its novelty, there is a lack of significant data comparing long-term outcomes of patients with EUS-GE, based on the underlying disease. In this study, we compare outcomes of EUS-GE on benign versus malignant indications.
View Article and Find Full Text PDFVideo 1Presentation of 2 methods of successful endosponge placement for treatment of anastomotic leak in the upper GI tract.
View Article and Find Full Text PDFEndoscopic ultrasound-directed transgastric ERCP (EDGE) is a safe and efficacious procedure to treat pancreaticobiliary diseases in Roux-en-Y gastric bypass (RYGB). This multicenter study aimed to determine the long-term outcomes of EDGE focusing on fistula persistence rates and post-procedure weight change. Information about patients with Roux-en-Y gastric bypass anatomy who underwent EDGE between 2015 and 2021 from 10 institutions was captured in a registry.
View Article and Find Full Text PDFArticle Synopsis
- Peroral endoscopic myotomy (POEM) is an effective treatment for achalasia that requires monitoring of carbon dioxide (CO₂) levels.
- A study comparing invasive (PaCO₂ with arterial line) and noninvasive (etCO₂) monitoring in 71 patients found a strong correlation between the two methods, with average PaCO₂ being slightly higher than etCO₂.
- The results showed that while invasive monitoring increased procedure and anesthesia times, there was no significant difference in adverse events between the two groups, suggesting etCO₂ is sufficient for most patients.
Article Synopsis
- Cholecystectomy (CCY) is the preferred treatment for acute cholecystitis (AC), with alternative nonsurgical options being EUS-guided and PT-guided gallbladder drainage.
- A study compared outcomes of patients undergoing CCY after EUS-GBD vs PT-GBD, looking at demographics, procedure outcomes, and surgical details across 139 patients.
- Results indicated that EUS-GBD led to faster surgical times, quicker symptom resolution, and shorter hospital stays than PT-GBD, while both methods had similar rates of converting to open surgery.
- EUS-GBD is a viable option for gallbladder drainage and does not hinder follow-up CCY.
Background: Duodenoscope-related multidrug-resistant organism (MDRO) infections raise concerns. Disposable duodenoscopes have been recently introduced in the market and approved by regulatory agencies with the aim to reduce the risk of endoscopic retrograde cholangiopancreatography (ERCP) associated infections. The aim of this study was to evaluate the outcome of procedures performed with single-use duodenoscopes in patients with clinical indications to single-operator cholangiopancreatoscopy.
View Article and Find Full Text PDFDrainage Approach for Malignant Biliary Obstruction: A Changing Paradigm.
J Clin Gastroenterol
July 2023
Article Synopsis
- ERCP remains the standard treatment for unresectable malignant biliary obstruction, but EUS-guided biliary drainage is increasingly recognized for complicated cases where ERCP fails or isn't possible.
- Recent studies indicate that EUS-guided methods, like hepaticogastrostomy and choledochoduodenostomy, may be just as effective, if not better, than ERCP for the initial treatment of these obstructions.
- The article discusses the different procedural techniques and evaluates the safety and efficacy of the various methods based on recent comparative literature.