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Stricter national standards are required for credentialing of endoscopic-retrograde-cholangiopan-creatography in the United States

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World Journal of Gastroenterology 2019年第27期25卷 3468-3483页

作者： Mitchell S Cappell david M friedel Division of Gastroenterology and Hepatology William Beaumont HospitalRoyal OakMI 48073United States Oakland University William Beaumont School of Medicine William Beaumont HospitalMI 48073United States Division of Gastroenterology New York University Winthrop Medical CenterMineolaNY 11501United States

Endoscopic-retrograde-cholangiopancreatography(ERCP) is now a vital modality with primarily therapeutic and occasionally solely diagnostic utility for numerous biliary/pancreatic disorders. It has a significantly steeper learning curve than that for other standard gastrointestinal(GI) endoscopies, such as esophagogastroduodenoscopy or colonoscopy, due to greater technical difficulty and higher risk of complications. Yet, GI fellows have limited exposure to ERCP during standard-three-year-GI-fellowships because ERCP is much less frequently performed than esophagogastroduodenoscopy/colonoscopy. This led to adding an optional year of training in therapeutic endoscopy. Yet many graduates from standard three-year-fellowships without advanced training intensely pursue independent/unsupervised ERCP privileges despite inadequate numbers of performed ERCPs and unacceptably low rates of successful selective cannulation of desired(biliary or pancreatic) duct. Hospital credentialing committees have traditionally performed ERCP credentialing, but this practice has led to widespread flouting of recommended guidelines(e.g., planned privileging of applicant with 20% successful cannulation rate, or after performing only 7 ERCPs);and intense politicking of committee members by applicants, their practice groups, and potential competitors. Consequently, some gastroenterologists upon completing standard fellowships train and learn ERCP 'on the job' during independent/unsupervised practice, which can result in bad outcomes: high rates of failed bile duct cannulation. This severe clinical problem is indicated by publication of ≥ 12 ERCP competency studies/guidelines during last 5 years. However, lack of mandatory, quantitative, ERCP credentialing criteria has permitted neglect of recommended guidelines. This work comprehensively reviews literature on ERCP credentialing;reviews rationales for proposed guidelines;reports problems with current system;and proposes novel criteria for competenc

关键词： Endoscopic retrograde cholangiopancreatography Privileges Credentialing Gastroenterology fellowship training Advanced gastrointestinal endoscopy training Certification Standards

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Per-oral endoscopic myotomy:Major advance in achalasia treatment and in endoscopic surgery

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World Journal of Gastroenterology 2014年第47期20卷 17746-17755页

作者： david friedel Rani Modayil Stavros N Stavropoulos Department of Gastroenterology Hepatology and NutritionWinthrop University HospitalMineolaNY 11501United States

Per-oral endoscopic myotomy(POEM)represents a natural orifice endoscopic surgery(NOTES)approach to laparoscopy Heller myotomy(LHM).POEM is arguably the most successful clinical application of *** growth of POEM from a single center in 2008 to approximately 60 centers worldwide in 2014 with several thousand procedures having been performed attests to the success of *** efficacy,safety and acid reflux data suggest at least equivalence of POEM to LHM,the previous gold standard for achalasia *** techniques used in the West include impedance planimetry for real-time intraprocedural luminal assessment and endoscopic suturing for challenging mucosal defect closures during *** impact of POEM extends beyond the realm of esophageal motility disorders as it is rapidly popularizing endoscopic submucosal dissection in the West and spawning offshoots that use the submucosal tunnel technique for a host of new indications ranging from resection of tumors to pyloromyotomy for gastroparesis.

关键词： Per oral endoscopic myotomy Achalasia Natural orifice transluminal endoscopic surgery Submucosal tunnel endoscopic resection Submucosal tunnel endoscopy Endoscopic suturing Endoscopic myotomy Endoscopic submucosal dissection EndoFLIP

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Potential role of new technological innovations in nonvariceal hemorrhage

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World Journal of Gastrointestinal Endoscopy 2019年第8期11卷 443-447页

作者： david friedel Department of Gastroenterology New York University Winthrop Hospital

The present armamentarium of endoscopic hemostatic therapy for non-variceal upper gastrointestinal hemorrhage includes injection,electrocautery and *** are newer endoscopic options such as hemostatic sprays,endoscopic suturing and modifications of current options including coagulation forceps and over-the-scope *** hemorrhage is the most prevalent type of nonvariceal upper gastrointestinal hemorrhage and traditional endoscopic interventions have demonstrated significant hemostasis ***,the hemostatic success rate is less for other entities such as Dieulafoy’s lesions and bleeding from malignant *** innovations such as endoscopic submucosal dissection and peroral endoscopic myotomy has spawned a need for dependable *** antral vascular ectasias are associated with chronic gastrointestinal bleeding and usually treated by standard argon plasma coagulation (APC),but newer modalities such as radiofrequency ablation,banding,cryotherapy and hybrid APC have been utilized as *** will opine on whether the newer hemostatic modalities have generated success when traditional modalities fail and should any of these modalities be routinely available in the endoscopic toolbox.

关键词： NoN-variceal upper gastrointestinal hemorrhage Endoscopic hemostasis Gastric antral vascular ectasias Over-the-scope clips Endoscopic suturing

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Introduction of endoscopic submucosal dissection in the West

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World Journal of Gastrointestinal Endoscopy 2018年第10期10卷 225-238页

作者： david friedel Stavros Nicholas Stavropoulos Gastroenterology NYU Winthrop Hospital

Endoscopic submucosal dissection(ESD) is well established in Asia as a modality for selected advancedlesions of both the upper and lower gastrointestinal tract, but ESD has not attained the same niche in the West due to a variety of reasons. These include competition from traditional surgery, minimally invasive surgery and endoscopic mucosal resection. Other obstacles to ESD introduction in the West include time commitment for learning and doing procedures, a steep learning curve, special equipment, lack of mentors, cost issues, interdisciplinary conflicts, concern regarding complications and lack of support from institutions and interfacing departments. There are intrinsic differences in pathology prevalence(e.g., early gastric cancer) between the two regions that are less conducive for ESD implementation in the West. We will elaborate on these issues and suggest measures as well as a protocol to overcome these obstacles and hopefully allow introduction of ESD as a tenable option for appropriate patients.

关键词： Endoscopic submucosal dissection Gastric cancer Barrett’s esophagus Endoscopy training Colon cancer Rectal cancer

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Current applications of endoscopic suturing

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World Journal of Gastrointestinal Endoscopy 2015年第8期7卷 777-789页

作者： Stavros N Stavropoulos Rani Modayil david friedel Department of Gastroenterology Hepatology and NutritionWinthrop University Hospital

Endoscopic suturing had previously been considered an experimental procedure only performed in a few centers and often by surgeons. Now, however, endoscopic suturing has evolved sufficiently to be easily implemented during procedures and is more commonly used by gastroenterologists. We have employed the Apollo Over Stitch suturing device in a variety of ways including closure of perforations, closure of full thickness defects in the gastrointestinal wall created during endoscopic full thickness resection, closure of mucosotomies during peroral endoscopic myotomy, stent fixation, fistula closure, post endoscopic submucosal dissection, endoscopic mucosal resection and Natural Orifice Transluminal Endoscopic Surgery defect closures, post-bariatric surgery gastrojejunal anastomosis revision and primary sleeve gastroplasty.

关键词： Endoscopic suturing Peroral endoscopicmyotomy Endoscopic full thickness resection NaturalOrifice Transluminal Endoscopic surgery Endoscopicbariatric surgery Endoscopic sleeve Transoral outletreduction

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Endoscopic management of inflammatory bowel disease strictures

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World Journal of Gastrointestinal Endoscopy 2012年第11期4卷 500-505页

作者： Raluca Vrabie Gerald L Irwin david friedel Winthrop University Hospital 259 First Street Mineola NY 11501 United States

Stricture formation is a common complication of Crohn’s disease, occurring in approximately one third of all patients with this condition. While the traditional management of such strictures has been largely surgical, there have been case series going back three decades high-lighting the potential role of endoscopic balloon dilation in this clinical setting. This review article summarizes the stricture pathogenesis, focusing on known clinical and genetic risk factors. It then highlights the endo-scopic balloon dilation research to date, with particular emphasis on three large recent case series. It concludes by describing the literature consensus regarding specific methodology and presenting avenues for future investigations.

关键词： Stricture Endoscopic dilation Crohn’s disease

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Burgeoning study of sentinel-node analysis on management of early gastric cancer after endoscopic submucosal dissection

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World Journal of Gastrointestinal Endoscopy 2020年第4期12卷 119-127页

作者： david friedel Xiaocen Zhang Stavros Nicholas Stavropoulos Department of Gastroenterology New York University Winthrop HospitalMineolaNY 11501United States Department of Internal Medicine Mount Sinai St.Luke’s West Hospital CenterNew YorkNY 10019United States Department of Gastroenterology Hepatology and NutritionNYU-Winthrop University HospitalMineolaNY 11501United States

Endoscopic submucosal dissection(ESD)represents an organ-preserving alternative to surgical resection of early gastric ***,even with ESD yielding en-bloc resection specimens,there are concerns regarding tumor spread such as with larger lesions,ulcerated lesions,undifferentiated pathology and submucosal *** node navigational surgery(SNNS)when combined with ESD offers a minimally invasive alternative to the traditional extended gastrectomy and lymphadenectomy if lack of lymph node spread can be *** would have a clear advantage in terms of potential complications and quality of ***,SNNS,though useful in other malignancies such as breast cancer and melanoma,may not have a sufficient sensitivity for malignancy and negative predictive value in EGC to justify this as standard practice after *** results of SNNS may improve with greater standardization and more involved dissection,technological innovations and more experience and validation such that the paradigm for post-ESD resection of EGC may change and include SNNS.

关键词： Early gastric cancer Sentinel node Sentinel node navigation surgery Expanded criteria Endoscopic submucosal dissection Function-preserving gastrectomy Organ preserving surgery Lymphadenectomy

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Endoscopic approach to pancreatic pseudocysts:An American perspective

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World Journal of Gastrointestinal Endoscopy 2010年第3期2卷 77-80页

作者： Jay P Babich david M friedel Winthrop University Hospital Division of GastroenterologyHepatology and Nutrition

Pancreatic pseudocysts,abscesses,and walled-off pancreatic necrosis are types of pancreatic fluid colle-ctions that arise as a consequence of pancreatic ***,early satiety,biliary obstruction,and infection are all indications for ***-radiologic drainage,surgical drainage,and endoscopic drainage are the three traditional approaches to the drainage of pancreatic *** endoscopic approach to pancreatic pseudocysts has evolved over the past thirty years and endoscopists are often capable of draining these *** experienced centers endoscopic ultrasound-guided endoscopic drainage avoids complications related to percutaneous drainage and is less invasive than surgery.

关键词： Pancreatic fluid collections Pseudocyst Endoscopic drainage

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Systematic review of safety and efficacy of therapeutic endoscopic-retrograde-cholangiopancreatography during pregnancy including studies of radiation-free therapeutic endoscopic-retrograde-cholangiopancreatography

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World Journal of Gastrointestinal Endoscopy 2018年第10期10卷 308-321页

作者： Mitchell S Cappell Stavros Nicholas Stavropoulos david friedel Division of Gastroenterology and Hepatology William Beaumont HospitalRoyal OakMI 48073United States Oakland University William Beaumont School of Medicine Royal OakMI 48073United States Division of Gastroenterology New York University Winthrop Medical CenterMineolaNY 11501United States

AIM To systematically review safety/efficacy of therapeutic endoscopic-retrograde-cholangiopancreatography(ERCP) performed during pregnancy, considering fetal viability, fetal teratogenicity, premature delivery, and future postpartum development of the *** Systematic computerized literature search performed using PubMed with the key words "ERCP" and "pregnancy". Two clinicians independently reviewed the literature, and decided on which articles to incorporate in this review based on consensus and preassigned priorities. Large clinical trials, meta-analyses, systematic reviews, and controlled trials were assigned higher priority than review articles or small clinical series, and individual case reports were assigned lowest priority. Dr. Cappell has formal training and considerable experience in conducting systematic reviews, with 4 published systematic reviews in peer-reviewed journals indexed in PubM ed during the last 2 years, and with a PhD in neurophysiology that involved 5 years of training and research in biomedical *** Advances in imaging modalities, including abdominal ultrasound, MRCP, and endoscopic ultrasound, have generally obviated the need for diagnostic ERCP in nonpregnant and pregnant patients. Clinical experience with performing ERCP during pregnancy is burgeoning, with > 500 cases of therapeutic ERCP reported in the literature, aside from a national registry study of 58 patients. These studies show that therapeutic ERCP has a very high rate of technical success in clearing the bile duct of gallstones, and has a relatively low and acceptable rate of maternal and fetal complications. The great majority of births after therapeutic ERCP are full-term, have normal birth weights, and are healthy. A recent trend is performing ERCP without radiation to eliminate radiation teratogenicity. Systematic literature review reveals 147 cases of ERCP without fluoroscopy in 8 clinical series. These studies demonstrate extremely high technica

关键词： Minimally invasive therapy Endoscopy Ascending cholangitis Therapeutic endoscopicretrograde-cholangiopancreatography Pregnancy Radiation teratogenicity

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Gastrointestinal endoscopy in the pregnant woman

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World Journal of Gastrointestinal Endoscopy 2014年第5期6卷 156-167页

作者： david friedel Stavros Stavropoulos Shahzad Iqbal Mitchell S Cappel Division of Gastroenterology Winthrop Medical Center Division of Gastroenterology and Hepatology William Beaumont Hospital Oakland University Wiliiam Beaumont School of Medicine

About 20000 gastrointestinal endoscopies are performed annually in America in pregnant women. Gastrointestinal endoscopy during pregnancy raises the critical issue of fetal safety in addition to patient safety. Endoscopic medications may be potentially abortifacient or teratogenic. Generally, Food and Drug Administration category B or C drugs should be used for endoscopy. Esophagogastroduodenoscopy(EGD) seems to be relatively safe for both mother and fetus based on two retrospective studies of 83 and 60 pregnant patients. The diagnostic yield is about 95% when EGD is performed for gastrointestinal bleeding. EGD indications during pregnancy include acute gastrointestinal bleeding, dysphagia > 1 wk, or endoscopic therapy. Therapeutic EGD is experimental due to scant data, but should be strongly considered for urgent indications such as active bleeding. One study of 48 sigmoidoscopies performed during pregnancy showed relatively favorable fetal outcomes, rare bad fetal outcomes, and bad outcomes linked to very sick mothers. Sigmoidoscopy should be strongly considered for strong indications,including significant acute lower gastrointestinal bleeding, chronic diarrhea, distal colonic stricture, suspected inflammatory bowel disease flare, and potential colonic malignancy. Data on colonoscopy during pregnancy are limited. One study of 20 pregnant patients showed rare poor fetal outcomes. Colonoscopy is generally experimental during pregnancy, but can be considered for strong indications: known colonic mass/stricture, active lower gastrointestinal bleeding, or colonoscopic therapy. Endoscopic retrograde cholangiopancreatography(ERCP) entails fetal risks from fetal radiation exposure. ERCP risks to mother and fetus appear to be acceptable when performed for ERCP therapy, as demonstrated by analysis of nearly 350 cases during pregnancy. Justifiable indications include symptomatic or complicated choledocholithiasis, manifested by jaundice, cholangitis, gallstone pancreatitis,

关键词： Gastrointestinal endoscopy Esophagogastroduodenoscopy Flexible sigmoidoscopy Colonoscopy Endoscopic retrograde cholangiopancreatography Teratogenicity Endoscopic indications Endoscopy safety Endoscopic complications Pregnancy

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