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

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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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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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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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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Utility of urgent colonoscopy in acute lower gastro-intestinal bleeding:a single-center experience

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Gastroenterology report 2014年第4期2卷 300-305页

作者： Mazen Albeldawi Duc Ha Paresh Mehta rocio Lopez Sunguk Jang madhusudhan r.sanaka John J.Vargo Department of Gastroenterology and Hepatology Cleveland ClinicClevelandOHUSA Department of Internal Medicine Cleveland ClinicClevelandOHUSA Department of Quantitative Sciences Cleveland ClinicClevelandOHUSA

*** role of urgent colonoscopy in lower gastro-intestinal bleeding(LGIB)remains *** the last two decades,a number of studies have indicated that urgent colonoscopy may facilitate the identification and treatment of bleeding lesions;however,studies comparing this approach to elective colonoscopy for LGIB are *** determine the utility and assess the outcome of urgent colonoscopy as the initial test for patients admitted to the intensive care unit(ICU)with acute *** patients who underwent colonoscopy at our institution for the initial evaluation of acute LGIB between January 2011 and January 2012 were analysed *** were grouped into urgent *** colonoscopy,depending on the timing of colonoscopy after admission to the *** colonoscopy was defined as being performed within 24 hours of admission and those performed later than 24 hours were considered *** included length of hospital stay,early re-bleeding rates,and the need for additional diagnostic or therapeutic *** logistic regression analysis was performed to identify factors associated with increased transfusion ***-seven patients underwent colonoscopy for the evaluation of suspected LGIB,24 of which were *** was no significant difference in patient demographics,co-morbidities,or medications between the two *** who underwent urgent colonoscopy were more likely to present with hemodynamic instability(P=0.019)and require blood transfusions(P=0.003).No significant differences in length of hospital stay,re-bleeding rates,or the need for additional diagnostic or therapeutic interventions were *** requiring blood transfusions(n=27)were more likely to be female(P=0.016)and diabetics(P=0.015).Fourteen patients re-bled at a median of 2 days after index *** with hemodynamic instability were more likely to re-bleed[Hr 3.8(CI 1.06–13.

关键词： acute lower gastro-intestinal bleeding urgent colonoscopy elective colonoscopy outcomes

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Higher prevalence of colon polyps in patients with Barrett’s esophagus:a case-control study

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Gastroenterology report 2014年第4期2卷 281-287页

作者： Arthi Kumaravel Prashanthi N.Thota Hyun-Ju Lee Tushar Gohel Mehulkumar K.Kanadiya rocio Lopez madhusudhan r.sanaka Center of Excellence for Barrett’s Esophagus Department of Gastroenterology and HepatologyCleveland ClinicClevelandOhioUSA Department of Biostatistics Cleveland ClinicClevelandOhioUSA

Background and aims:Barrett’s esophagus(BE)and colorectal neoplasms share similar risk *** studies have shown variable prevalence of colon polyps in patients with *** aims were to determine the prevalence and incidence of colon polyps in patients with BE,compared to those without ***:In this case-control study,the study group included patients,aged 50–75 years,with biopsy-proven BE,who underwent colonoscopy at Cleveland Clinic from January 2002 to December *** control group consisted of age-and sex-matched patients who underwent colonoscopy and also an endoscopy with no evidence of BE during the same time *** criteria for both groups were family-or personal previous history of colon cancer or polyps,prior colonic resection,inflammatory bowel disease and familial polyposis *** demographics,comorbidities,medication use and endoscopic and colonoscopic details were collected,including biopsy ***:A total of 519 patients were included in the study;173 patients with BE in the study group and 346 without BE in the control *** age at index colonoscopy was 618 years and 75%of patients were *** index colonoscopy,patients with BE were more likely to have polyps than controls(45%vs 32%,respectively;P=0.003).Patients underwent between one and five colonoscopies during the *** multivariate analysis—after adjusting for age,gender and diabetes—patients with BE were 80%more likely to have any type of polyp,and 50%more likely to have adenomas found during ***:Patients with BE had higher prevalence and incidence of colon *** has important clinical implications for screening and surveillance in BE patients.

关键词： Barrett’s esophagus colon polyps cancer prevention

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Association of procedure length on outcomes and adverse events of endoscopic retrograde cholangiopancreatography

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Gastroenterology report 2014年第2期2卷 140-144页

作者： Paresh P.Mehta madhusudhan r.sanaka Mansour A.Parsi Mazen J.Albeldawi John A.Dumot rocio Lopez Gregory Zuccaro John J.Vargo Digestive Disease Institute Department of Gastroenterology and HepatologyCleveland ClinicCleveland OHUSA Department of Quantitative Health Sciences Cleveland ClinicClevelandOHUSA

Objective:The aims of this study were to determine the effects of length of procedure on endoscopic retrograde cholangiopancreatography(ErCP)outcomes and adverse ***:All ErCP procedures,performed by experienced advanced endoscopists,in patients without prior papillary intervention from 2006 to 2008 were *** were arbitrarily divided into two groups:shorter procedures(SP),with a duration shorter than the overall mean procedure length,and longer procedures(LP),with a duration longer than overall mean procedure *** of procedure was defined as the time from endoscope insertion to endoscope ***:Two hundred and ninety-five procedures were included in the *** procedure length was 45.630.1 *** hundred and seventy-seven procedures(60%)were SP and 118(40%)were *** were no differences between the groups with regard to patients’ages,genders,race,or trainee *** cases were more likely to be biliary vs pancreatic or bi-ductal evaluations(P=0.03).LP had significantly higher complexity scores(34%with>3 vs 13%;P=0.046)and were more likely to require pre-cut papillotomy(39%vs 15%;Pre was no significant difference between the groups in overall completion rates(91.5%LP vs 96%SP;P=0.10)or adverse events(10.2%LP vs 6.2%SP;P=0.21).However,LP cases were associated with higher rates of post-ErCP bleeding(4.2%vs 0.6%;P=0.029).Conclusion:There was no significant difference in outcomes or overall adverse events between shorter and longer ErCP ***,longer procedures were associated with higher procedure complexity,higher utilization of pre-cut technique,and increased risk of bleeding.

关键词： endoscopic retrograde cholangiopancreatography(ErCP) duration of procedure adverse events pancreatitis

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role of endoscopic therapy in early esophageal cancer

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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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