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Role of small bowel capsule endoscopy in the diagnosis and management of iron deficiency anemia in elderly: A comprehensive review of the current literature

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World Journal of Gastroenterology 2014年第26期20卷 8416-8423页

作者： Adnan Muhammad gitanjali vidyarthi Patrick Brady Division of Digestive Diseases and Nutrition University of South FloridaMorsani College of Medicine Division of Gastroenterology James A Haley VA Hospital

Iron deficiency anemia(IDA)is common and often under recognized problem in the *** may be the result of multiple factors including a bleeding lesion in the gastrointestinal *** percent of elderly patients with IDA have a negative upper and lower endoscopy and two-thirds of these have a lesion in the small bowel(SB).Capsule endoscopy(CE)provides direct visualization of entire SB mucosa,which was not possible *** is superior to push enteroscopy,enteroclysis and barium radiography for diagnosing clinically significant SB pathology resulting in *** is one of the commonest lesions seen on the CE in elderly with *** diagnostic yield of CE for IDA progressively increases with advancing age,and is highest among patients over 85 years of *** assisted enteroscopy is used to treat the lesions seen on *** has some limitations mainly lack of therapeutic capability,inability to provide precise location of the lesion and false positive *** CE is a very safe and effective procedure for the evaluation of IDA in elderly.

关键词： Small bowel Capsule endoscopy Iron deficiency anemia Elderly Diagnostic yield

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Comparative effectiveness of traditional chemoembolization with or without sorafenib for hepatocellular carcinoma

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World Journal of Hepatology 2013年第7期5卷 364-371页

作者： Adnan Muhammad Manish Dhamija gitanjali vidyarthi Donald Amodeo William Boyd Branko Miladinovic Ambuj Kumar Department of Gastroenterology University of South Florida Department of Gastroenterology James A Haley VA Hospital Department of Internal Medicine Morsani College of Medicine Center for Evidence Based Medicine

AIM: To compare the overall survival (OS) and progression-free survival (PFS) with associated adverse events (AE) in patients with unresectable hepatocellular carcinoma (HCC) treated with transarterial chemoembolization (TACE) + sorafenib vs TACE alone. METHODS: In this retrospective cohort study we collected data on all consecutive patients with a diagnosis of unresectable HCC between 2007 and 2011 who had been treated with TACE + sorafenib or TACE alone. We hypothesized that the combination therapy is superior to TACE alone in improving the survival in these patients. Data extracted included patient's demographics, etiology of liver disease, histology of HCC, stage of liver disease with respect to model of end stage liverdisease score and Child-Turcotte-Pugh (CTP) classification and Barcelona Clinic Liver Cancer (BCLC) staging for HCC. Computed tomography scan findings, alpha fetoprotein levels, number of treatments and related AE were also recorded and analyzed. RESULTS: Of the 43 patients who met inclusion criteria, 13 were treated with TACE + sorafenib and 30 with TACE alone. There was no significant difference in median survival: 20.6 mo (95%CI: 13.4-38.4) for the TACE + sorafenib and 18.3 mo (95%CI: 11.8-32.9) for the TACE alone (P = 0.72). There were also no statistically significant differences between groups in OS (HR = 0.82, 95%CI: 0.38-1.77; P = 0.61), PFS (HR = 0.93, 95%CI: 0.45-1.89; P = 0.83), and treatment-related toxicities (P = 0.554). CTP classification and BCLC staging for HCC were statistically significant (P = 0.001, P = 0.04 respectively) in predicting the survival in patients with HCC. The common AE observed were abdominal pain, nausea, vomiting and mild elevation of liver enzymes. CONCLUSION: Combination therapy with TACE + sorafenib is safe and equally effective as TACE alone in patients with unresectable HCC. CTP classification and BCLC staging were the significant predictors of survival. Future trials with large number of patients are nee

关键词： Hepatocellular carcinoma Transarterial chemoembolization Sorafenib Survival Adverse events

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Safety of gastrointestinal endoscopy with conscious sedation in obstructive sleep apnea

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World Journal of Gastrointestinal Endoscopy 2017年第11期9卷 552-557页

作者： Christian M Andrade Brijesh Patel Meghana Vellanki Ambuj Kumar gitanjali vidyarthi the James A. Haley Veterans Affairs Department of Gastroenterology Division of Digestive Diseases and Nutrition University of South Florida Morsani College of Medicine University of South Florida Tampa Comparative Effectiveness Research Morsani College of Medicine University of South Florida

AIM To perform a systematic review and meta-analysis to assess the safety of conscious sedation in patients with obstructive sleep apnea(OSA).METHODS A comprehensive electronic search of MEDLINE and EMBASE was performed from inception until March 1, 2015. In an effort to include unpublished data, abstracts from prior gastroenterological society meetings as well as other reference sources were interrogated. After study selection, two authors utilizing a standardized data extraction form collected the data independently. Any disagreements between authors were resolved by consensus among four authors. The methodological quality was assessed using the Newcastle Ottawa tool for observational studies. The primary variables of interest included incidence of hypoxia, hypotension, tachycardia, and bradycardia. Continuous data were summarized as odds ratio(OR) and 95%CI and pooled using generic inverse variance under the random-effects model. Heterogeneity between pooled studies was assessed using the I2 *** Initial search of MEDLINE and EMBASE identified 357 citations. A search of meeting abstracts did not yield any relevant citations. After systematic review and exclusion consensus meetings, seven studies met the a priori determined inclusion criteria. The overall methodological quality of included studies ranged from moderate to low. No significant differences between OSA patients and controls were identified among any of the study variables: Incidence of hypoxia(7 studies, 3005 patients; OR = 1.11; 95%CI: 0.73-1.11; P = 0.47; I2 = 0%), incidence of hypotension(4 studies, 2125 patients; OR = 1.10; 95%CI: 0.75-1.60; P = 0.63; I2 = 0%), incidence of tachycardia(3 studies, 2030 patients; OR = 0.94; 95%CI: 0.53-1.65; P = 0.28; I2 = 21%), and incidence of bradycardia(3 studies, 2030 patients; OR = 0.88; 95%CI: 0.63-1.22; P = 0.59; I2 = 0%).CONCLUSION OSA is not a significant risk factor for cardiopulmonary complications in patients undergoing endoscopic procedures

关键词： Conscious sedation Obstructive sleep apnea Endoscopy Complications Safety Meta-analysis

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