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role of endoscopic therapy in early esophageal cancer

World Journal of Gastroenterology 2018年第35期24卷 3965-3973页

作者： Sonika Malik Gautam Sharma madhusudhan r sanaka Prashanthi N Thota Department of Internal Medicine Cleveland Clinic Akron General Medical Center Akron Department of Anesthesiology University Hospitals Cleveland Department of Gastroenterology Digestive Disease Surgery Institute Cleveland Clinic

Esophageal carcinoma is a highly lethal cancer associated with high morbidity and mortality. Esophageal squamous cell carcinoma and esophageal adenocarcinoma are the two distinct histological types. There has been significant progress in endoscopic diagnosis and treatment of early stages of cancer using resection and ablation techniques, as shown in several trials in the recent past. Earlier detection of esophageal cancer and advances in treatment modalities have lead to improvement in the 5-year survival from 5% to about 20% in the past decade. Endoscopic eradication therapy is the preferred modality of treatment in cancer limited to mucosal layer of the esophagus as there is very low risk of lymph node metastasis, leading to high cure rates, low risk of recurrence and with few adverse effects. The most common adverse events seen are strictures, bleeding and rarely perforation which can be endoscopically managed. In patients with recurrent advanced disease or invasive tumor, esophagectomy with lymph node dissection remains the mainstay of treatment. There is debate on post-endoscopic surveillance with some studies suggesting closer follow up with upper endoscopy every 6 mo for the first 1-2 years and then annually for the 3 years while others recommending the appropriate action only if symptoms or other abnormalities develop. Overall, the field of endoscopic therapy is still evolving and focus should be placed on careful patient selection using a multidisciplinary approach.

关键词： Endoscopic mucosal resection Endoscopic submucosal dissection radiofrequency ablation Argon plasma coagulation Esophageal cancer Photodynamic therapy Cryotherapy

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risk of progression of Barrett's esophagus in patients with cirrhosis

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World Journal of Gastroenterology 2017年第18期23卷 3287-3294页

作者： Tehilla Apfel rocio Lopez madhusudhan r sanaka Prashanthi N Thota Department of General Internal Medicine Cleveland Clinic Foundation Department of Biostatistics Cleveland Clinic Foundation Department of Gastroenterology and Hepatology Digestive Disease and Surgery InstituteCleveland Clinic Foundation

To study Barrett’s esophagus (BE) in cirrhosis and assess progression to esophageal adenocarcinoma (EAC) compared to non-cirrhotic BE *** patients who were found to have endoscopic evidence of BE confirmed by the presence of intestinal metaplasia on histology from 1/1/2000 to 12/1/2015 at Cleveland Clinic were included. Cirrhotic patients were matched 1:4 to BE controls without cirrhosis. Age, gender, race, BE length, hiatal hernia size, Child-Pugh (CP) class and histological findings were recorded. Cases and controls without high-grade dysplasia (HGD)/EAC and who had follow-up endoscopies were studied for incidence of dysplasia/EAC and to assess progression rates. Univariable conditional logistic regression was done to assess differences in baseline characteristics between the two *** total of 57 patients with cirrhosis and BE were matched with 228 controls (BE without cirrhosis). The prevalence of dysplasia in cirrhosis and controls were similar with 8.8% vs 12% with low grade dysplasia (LGD) and 12.3 % vs 19.7% with HGD or EAC (P = 0.1). In the incidence cohort of 44 patients with median follow-up time of 2.7 years [interquartile range 1.0, 4.8], there were 7 cases of LGD, 2 cases of HGD, and 2 cases of EAC. There were no differences in incidence rates of HGD/EAC in nondysplastic BE between cirrhotic cases and noncirrhotic controls (1.4 vs 1.1 per 100 person- years, P = 0.8). In LGD, cirrhotic patients were found to have higher rates of progression to HGD/EAC compared to control group though this did not reach statistical significance (13.7 vs 8.1 per 100 person- years, P = 0.51). A significant association was found between a higher CP class and neoplastic progression of BE in cirrhotic patients (Hr =7.9, 95%CI: 2.0-30.9, P = 0.003).CONCLUSIONCirrhotics with worsening liver function are at increased risk of progression of BE. More frequent endoscopic surveillance might be warranted in such patients.

关键词： Liver cirrhosis Barrett’s esophagus Dysplasia Esophageal neoplasm Progression

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Vitamin D in esophageal cancer: Is there a role for chemoprevention?

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World Journal of Gastrointestinal Oncology 2018年第1期10卷 23-30页

作者： Carol rouphael Afrin Kamal madhusudhan r sanaka Prashanthi N Thota Department of Internal Medicine Cleveland Clinic Department of Gastroenterology and Hepatology Cleveland Clinic

Vitamin D has emerged as a promising anti-cancer agent due to its diverse biological effects on tumor differentiation, apoptosis and suppression of cellular proliferation. Current evidence suggests a protective role of vitamin D in colon cancer. The effect of vitamin D on esophageal cancer remains controversial. Multiple studies investigated the association between vitamin D and esophageal cancer, employing different modes of assessment of vitamin D status such as serum 25-hydroxyvitamin D levels, vitamin D dietary intake or exposure to ultraviolet B(UVB) radiation. Genetic variations of the vitamin D receptor(VDr) gene and VDr expression in esophageal specimens have also been investigated. Ecological studies evaluating exposure to UVB radiation yielded an inverse correlation with esophageal cancer. When vitamin D dietary intake was assessed, direct association with esophageal cancer was observed. However, circulating 25-hydroxyvitamin D concentrations showed inconsistent results. In this review article, we present a detailed summary of the current data on the effects of vitamin D on various histological subtypes of esophageal cancer and their precursor lesions. Well-powered prospective studies with accurate measurement of vitamin D status are needed before chemoprevention with vitamin D is recommended, as current evidence does not support a chemopreventive role of vitamin D against esophageal cancer. Future studies looking at the incidence of esophageal cancer in patients with pre-cancerous lesions(Barrett's esophagus and squamous cell dysplasia) receiving vitamin D supplementation are needed.

关键词： vitamin D vitamin D receptor esophageal adenocarcinoma esophageal squamous cell carcinoma genetic polymorphism

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Bile proteomics for differentiation of malignant from benign biliary strictures:a pilot study

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Gastroenterology report 2015年第2期3卷 136-143页

作者： Udayakumar Navaneethan Vennisvasanth Lourdusamy Preethi GK Venkatesh Belinda Willard madhusudhan r sanaka Mansour A Parsi Department of Gastroenterology and Hepatology Digestive Disease InstituteCleveland ClinicClevelandOHUSA Proteomics Core Laboratory Lerner Research InstituteCleveland ClinicClevelandOHUSA

Background:Determining the etiology of biliary strictures is challenging,and the sensitivities of the current tests to diagnose them are *** biomarkers in bile,in combination with other tests,may improve sensitivity in diagnosing biliary ***:To analyse the differential abundance of proteins in benign and malignant biliary strictures through proteomic analysis of ***:In this prospective,cross-sectional study,bile was aspirated in 24 patients undergoing endoscopic retrograde cholangiopancreatography(ErCP)including six patients with primary sclerosing cholangitis(PSC),three with cholangiocarcinoma(CCA),ten with pancreatic cancer,and five with benign biliary *** chromatography/mass spectrometry was used to examine the bile for differential abundance of protein *** relative abundance of various proteins was compared in the malignant *** groups and in CCA ***:The majority of the proteins identified in bile were similar to those of the plasma(plasma proteins)and certain proteins were differentially expressed among the different groups(CCA,pancreatic cancer,PSC or benign).A total of 18 proteins were identified as being more abundant in the malignant group(CCA and pancreatic cancer)than in the benign strictures group,including myeloperoxidase,complement C3,inter-alpha-trypsin inhibitor heavy chain H4,apolipoprotein B-100,and kininogen-1 isoform 2.A total of 30 proteins were identified to be less abundant in the malignant group than in the benign group,including trefoil factor 2,superoxide dismutase[Cu-Zn],kallikrein-1,carboxypeptidase B and trefoil factor ***:Protein biomarkers in bile may differentiate malignant from benign biliary *** studies are warranted to validate these observations.

关键词： pancreatic cancer proteomics bile cholangiocarcinoma

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Healthcare utilization and costs associated with gastroparesis

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World Journal of Gastroenterology 2017年第24期23卷 4428-4436页

作者： Vaibhav Wadhwa Dhruv Mehta Yash Jobanputra rocio Lopez Prashanthi N Thota madhusudhan r sanaka Department of Internal Medicine Fairview HospitalCleveland Clinic Department of Internal Medicine Westchester Medical Center Department of Gastroenterology and Hepatology Digestive Disease InstituteCleveland Clinic Center for Advanced Endoscopy Digestive Disease InstituteCleveland Clinic

To use a national database of United States hospitals to evaluate the incidence and costs of hospital admissions associated with gastroparesis. METHODSWe analyzed the National Inpatient Sample Database (NIS) for all patients in whom gastroparesis (ICD-9 code: 536.3) was the principal discharge diagnosis during the period, 1997-2013. The NIS is the largest publicly available all-payer inpatient care database in the United States. It contains data from approximately eight million hospital stays each year. The statistical significance of the difference in the number of hospital discharges, length of stay and hospital costs over the study period was determined by regression analysis. rESULTSIn 1997, there were 3978 admissions with a principal discharge diagnosis of gastroparesis as compared to 16460 in 2013 (P r gastroparesis decreased by 20 % between 1997 and 2013 from 6.4 d to 5.1 d (P r, during this period the mean hospital charges increased significantly by 159 % from $13350 (after inflation adjustment) per patient in 1997 to $34585 per patient in 2013 (P regate charges (i.e., “national bill”) for gastroparesis increased exponentially by 1026 % from $50456642 ± 4662620 in 1997 to $568417666 ± 22374060 in 2013 (P rcentage of national bill for gastroparesis discharges (national bill for gastroparesis/total national bill) has also increased over the last 16 years (0.0013% in 1997 vs 0.004% in 2013). During the study period, women had a higher frequency of gastroparesis discharges when compared to men (1.39/10000 vs 0.9/10000 in 1997 and 5.8/10000 vs 3/10000 in 2013). There was a 6-fold increase in the discharge diagnosis of gastroparesis amongst type 1 DM and 3.7-fold increase amongst type 2 DM patients over the study period (P r of inpatient admissions for gastroparesis and associated costs have increased significantly over the last 16 years. Inpatient cost

关键词： Inpatient admission rates Gastroparesis Cancer epidemiology National inpatient database

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Endoscopic ultrasound in the diagnosis of cholangiocarcinoma as the etiology of biliary strictures:a systematic review and meta-analysis

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Gastroenterology report 2015年第3期3卷 209-215页

作者： Udayakumar Navaneethan Basile Njei Preethi G.K Venkatesh Vennisvasanth Lourdusamy madhusudhan r sanaka Digestive Disease Institute The Cleveland ClinicClevelandOHUSA Department of Internal Medicine University of Connecticut Health CenterFarmingtonCTUSA

Background and aim:Extrahepatic cholangiocarcinoma(CCA)typically presents as biliary *** ultrasound(EUS)-fine needle aspiration(FNA)may contribute to the diagnosis of CCA as the etiology of extrahepatic biliary *** aim was to study the uselfulness of EUS-FNA in diagnosing CCA as the etiology of biliary *** and methods:In this meta-analysis,PUBMED and EMBASE databases were examined to find studies published to April 2014 where diagnostic correlation of CCA was *** reporting only‘‘positive for malignancy’’were included in our *** main outcome measurements were sensitivity,specificity and likelihood ***:Six studies were included,covering 196 *** overall pooled sensitivity and negative likelihood ratio(Lr-)of EUS-FNA for diagnosis of CCA were 66%[95%confidence interval(CI)57-74%]and 0.34(95%CI 0.26-0.43),*** five studies(146 patients),where a mass lesion was detected during EUS,the pooled sensitivity and Lr-of EUS-FNA for diagnosis of CCA were 80%[95%CI 72-87%]and 0.20(95%CI 0.13-0.28),*** the 49 patients with a negative brush cytology,the pooled sensitivity and Lr-of EUS-FNA for diagnosis of CCA were 59%[95%CI 44-73%]and 0.41(95%CI 0.27-0.56),***:Our study suggests that EUS-FNA is useful in the evaluation of CCA as the etiology of biliary ***-FNA may improve the diagnosis of CCA in patients with negative cytology and no mass on cross-sectional imaging.

关键词： endoscopic ultrasound fine-needle aspiration cholangiocarcinoma

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Nationwide trends of hospital admissions for acute cholecystitis in the United States

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Gastroenterology report 2017年第1期5卷 36-42,I0002页

作者： Vaibhav Wadhwa Yash Jobanputra Sushil K Garg Soumil Patwardhan Dhruv Mehta madhusudhan r.sanaka Department of Internal Medicine Fairview HospitalCleveland ClinicOHUSA Department of Gastroenterology and Hepatology Digestive Disease InstituteCleveland ClinicClevelandOHUSA Department of Internal Medicine University of MinnesotaMinneapolisMNUSA Department of Internal Medicine University of MassachusettsWorcesterMAUSA Department of Internal Medicine Westchester Medical CenterValhallaNYUSA

Background and aims:Acute cholecystitis is a fairly common inpatient diagnosis among the gastrointestinal *** aim of this study was to use a national database of US hospitals to evaluate the incidence and costs of hospital admissions associated with acute ***:We analyzed the National Inpatient Sample Database(NIS)for all patients in which acute cholecystitis(ICD-9 codes:574.00,574.01,574.30,574.31,574.60,574.61 or 575.0)was the principal discharge diagnosis from 1997 to *** NIS is the largest all-payer inpatient database in the United States and contains data from approximately 8 million hospital stays each *** statistical significance of the difference in the number of hospital discharges,lengths of stay and associated hospital costs over the study period was determined by using the Chi-square test for ***:In 1997,there were 149661 hospital admissions with a principal discharge diagnosis of acute cholecystitis,which increased to 215995 in 2012(Pr acute cholecystitis decreased by 17% between 1997 and 2012(*** 4.7 days to 3.9 days);(Pring the same time period,however,mean hospital charges have increased by 195.4% from US$14608 per patient in 1997 to US$43152 per patient in 2012(Pr of inpatient discharges related to acute cholecystitis has increased significantly in the United States over the last 16 years,along with a great increase in the associated hospital ***,there has been a gradual decline in the mean length of *** costs associated with acute cholecystitis contribute significantly to the total healthcare *** research on cost-effective evaluation and management of acute cholecystitis is required.

关键词： inpatient admission rates acute cholecystitis epidemiology trends

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Higher risk of neoplastic progression of Barrett’s esophagus in patients with systemic sclerosis

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Gastroenterology report 2021年第6期9卷 595-596页

作者： Mythri Anilkumar Motasem Alkhayyat Udhayvir S.Grewal madhusudhan r.sanaka Prashanthi N.Thota Center of Excellence for Barrett’s Esophagus Digestive Disease InstituteCleveland ClinicClevelandOHUSA Department of Internal Medicine Louisiana State University Health ShreveportShreveportLAUSA

Systemic sclerosis(SSc)is a multisystem connective-tissue disorder of unknown etiology affecting various internal organs and *** involvement is present in≤70%–90%of the patients and is manifested by severe gastroesophageal-reflux disease and *** Barrett’s esophagus(BE)has been reported in patients with SSc[1,2],the risk of neoplastic progression has not been reported before in the ***,we aimed to study the prevalence of BE in SSc and incidence of neoplastic progression.

关键词： Barrett neoplastic patients

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Healthcare utilization and costs associated with cholangiocarcinoma

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Gastroenterology report 2017年第3期5卷 213-218,I0002页

作者： Vaibhav Wadhwa Yash Jobanputra Prashanthi N.Thota KVNarayanan Menon Mansour A.Parsi madhusudhan r.sanaka Department of Internal Medicine Fairview HospitalCleveland ClinicClevelandOhio Department of Gastroenterology and Hepatology Digestive Disease InstituteCleveland ClinicOhio

Background and *** is a rare but devastating malignancy associated with a poor prognosis and a high mortality *** the recent advances in detection and treatment,it is unclear if the incidence and outcomes of cholangiocarcinoma are improving in the United *** aim of this study was to evaluate the trends in the incidence,costs and mortality rates of cholangiocarcinoma-related hospital admissions in the *** utilized the National Inpatient Sample Database(NIS)from 1997–2012 for all patients in whom cholangiocarcinoma(ICD-9 code 155.1,156)was the principal discharge *** temporal trends in the number of hospital admissions,length of stay and,hospitalization costs along with mortality rates over the study period were determined by using regression analysis for *** was a significant increase in the number of hospital admissions for cholangiocarcinoma as the principal diagnosis from 1997 to 2012(10357 vs 11970,Pr cholangiocarcinoma decreased by 17%between 1997 and 2012 from 9.5 days to 7.9 days(Pr,during the same period,the mean hospital charges per patient(adjusted for inflation)increased 113.25% from $36460 in 1997 to$77753 in *** in-hospital mortality rate decreased from 9.3% in 1997 to 6.4% in 2012(Prease in the number of hospital admissions and associated costs from cholangiocarcinoma in the USA between 1997 and ***,this was accompanied by a decrease in the inpatient mortality rates from cholangiocarcinoma.

关键词： cholangiocarcinoma inpatient admissions hospital charges in-hospital mortality epidemiology

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Effect of quality of bowel preparation on quality indicators of adenoma detection rates and colonoscopy completion rates

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Gastroenterology report 2016年第2期4卷 148-153,I0003页

作者： Tarun rai Udayakumar Navaneethan Tushar Gohel Amareshwar Podugu Prashanthi N.Thota ravi P.Kiran rocio Lopez madhusudhan r.sanaka Digestive Disease Institute The Cleveland ClinicClevelandOHUSA

Background and aim:Adequate bowel preparation is important for safe and effective *** indicators(QI)for colonoscopy include achieving at least 95%completion rate and an adenoma detection rate(ADr)of at least 25%in average-risk men and 15%in average-risk women aged over *** aim was to investigate the impact of bowel preparation on ADr and colonoscopy completion ***:This retrospective cohort study included patients who underwent colonoscopy between January 2008 and December *** main outcome measurements were ADr and colonoscopy completion rates to the ***:A total of 2519 patients was included;1030(41.0%)had excellent preparation,1145(45.5%)good-,240(9.5%)fair-,and 104(4.1%)poor *** completion rates were significantly lower in patients with poor or fair preparation(72.1%and 75.4%,respectively)than in those with good and excellent preparation(99.7%and 99.9%,respectively;Pr than the QI of 95%(Pr in men and women combined was similar in all four grades of preparation(excellent,good,fair and poor)at 24.2%vs.26.8%vs.32.1%vs.22.1%,respectively;P¼*** the groups had ADr above the QI(25%for men and 15%for women)with evidence of significantly higher ADr in the women with excellent or good preparation and in men with excellent,good or fair *** multivariate analysis,male gender was significantly associated with increased ADr(Preparation did not influence ***:Patients with fair and poor standards of preparation have significantly lower colonoscopy completion rates than those with excellent and good ***,there was no difference in ADr between the different grades of preparation.

关键词： bowel preparation adenoma detection rate colonoscopy completion rate quality indicators

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