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Does Anesthesiologist-Directed Sedation Afford Superior Deep Cannulation Rates and Procedural Outcomes for ERCP in the Community Setting?

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Open Journal of Gastroenterology 2016年第2期6卷 46-52页

作者： Brad Bowyer Kathy Geissler robert barclay Sumeet Tewani James Frakes Nicholas Brown Matthew Houlihan Kunal Patel Andrew Spiel Rockford Gastroenterology Associates Rockford IL USA University of Illinois College of Medicine Rockford Rockford IL USA

Aim: To compare outcomes by sedation class in community patients undergoing index endoscopic retrograde cholangiopancreatography (ERCP). Methods: Nineteen hundred sixteen consecutive patients underwent ERCP from May 2005 to May 2011. Eight hundred thirty seven patients were excluded due to prior papillary intervention or attempted ERCP. A total of 1079 patients were included. The 981 patients who underwent gastroenterologist directed sedation (GDS) served as the control population, while the 98 patients who received anesthesiologist directed sedation (ADS) served as the case population. Medical records were analyzed for patient demographics, procedure indication, adverse events, case complexity, procedural failure and sedation failure. Case complexity was defined by the grading system proposed by the working party of the ASGE Quality Committee. Sedation failure was defined by agitation or airway compromise prompting termination of the ERCP. Reasons for procedural failure included surgically altered anatomy, luminal obstruction, and technical failure. Study endpoint was defined as successful deep cannulation of the intended target duct. Results: Demographic distribution did not differ between the GDS and the ADS groups. Cannulation success rates were similar between the two groups, with 89.85% in the GDS group, and 89.58% in the ADS group (P = 0.864). There were no statistical differences between sedation groups in procedural or respiratory adverse events. Technical failure was the predominant basis for deep cannulation failure in both groups. Agitation and airway compromise accounted for deep cannulation failure similarly in both groups. The need for reversal agents was low but similar in both groups. There was no statistical advantage in deep cannulation success rate by complexity grade in either sedation class. Conclusion: Excellent procedural outcomes and low adverse event rates were achieved using GDS, a more accessible and cost-effective method in a community-b

关键词： ERCP Community-Based Medicine Conscious Sedation Anesthesiologist-Directed Sedation Gastroenterologist-Directed Sedation

SLC11A1 polymorphisms in inflammatory bowel disease and Mycobacterium avium subspecies paratuberculosis status

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World Journal of Gastroenterology 2010年第45期16卷 5727-5731页

作者： Lucy C Stewart Andrew S Day John Pearson Murray L barclay Richard B Gearry Rebecca L roberts robert W Bentley Department of Paediatrics University of OtagoChristchurch 8140New Zealand Department of Paediatrics Christchurch HospitalChristchurch 8140New Zealand Department of Pathology University of OtagoChristchurch 8140New Zealand Department of Medicine University of OtagoChristchurch 8140New Zealand Department of Gastroenterology Christchurch HospitalChristchurch 8140New Zealand Department of Biochemistry University of OtagoDunedin 9054New Zealand

AIM: To test for association of SLC11A1 with inflammatory bowel disease (IBD) and Mycobacterium avium subspecies paratuberculosis (MAP) status in a Caucasian cohort. METHODS: Five hundred and seven Crohn's disease (CD) patients, 474 ulcerative colitis (UC) patients, and 569 healthy controls were genotyped for SLC11A1 1730G>A and SLC11A1 469+14G>C using pre-designed TaqMan  SNP assays. χ 2 tests were applied to test for association of single nucleotide polymorphisms (SNPs) with disease, and the presence of MAP ***:SLC11A1 1730G>A and SLC11A 1469+14G>C were not associated with CD, UC, or IBD. The SLC11A1 1730A minor allele was over-represented in patients who did not require immunomodulator therapy (P = 0.002, OR: 0.29, 95% CI: 0.13-0.66). The frequency of the SLC11A1 469+14C allele was higher in the subset of study participants who tested positive for MAP DNA (P = 0.02, OR: 1.56, 95% CI: 1.06-2.29). No association of SLC11A1 1730G>A with MAP was ***: Although SLC11A1 was not associated with IBD, association with MAP suggests that SLC11A1 is important in determining susceptibility to bacteria implicated in the etiology of CD.

关键词： NRAMP1 Crohn’s disease Ulcerative colitis IS900 polymerase chain reaction

Macrophage migration inhibitory factor gene polymorphisms in inflammatory bowel disease: An association study in New Zealand Caucasians and meta-analysis

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World Journal of Gastroenterology 2013年第39期19卷 6656-6664页

作者： James D Falvey robert W Bentley Tony R Merriman Mark B Hampton Murray L barclay Richard B Gearry Rebecca L roberts Department of Medicine University of OtagoChristchurch 8011New Zealand Department of Gastroenterology Christchurch HospitalChristchurch 8011New Zealand Department of Biochemistry University of OtagoDunedin 9054New Zealand Department of Pathology University of OtagoChristchurch 8011New Zealand Department of Surgical Sciences Dunedin School of MedicineDunedin 9054New Zealand

AIM:To investigate the association of macrophage migration inhibitory factor(MIF)promoter polymorphisms with inflammatory bowel disease(IBD)***:One thousand and six New Zealand Caucasian cases and 540 Caucasian controls were genotyped for the MIF SNP-173G>C(rs755622)and the repeat polymorphism CATT5-8(rs5844572)using a predesigned TaqMan SNP assay and capillary electrophoresis,*** were analysed for single site and haplotype association with IBD risk and ***-analysis was employed,to assess cumulative evidence of association of MIF-173G>C with *** published genotype data for MIF-173G>C in IBD were identified using PubMed and subsequently searching the references of all PubMed-identified *** genotypes for MIF-173G>C were generated from the Wellcome Trust Case Control Consortium(and National Institute of Diabetes and Digestive and Kidney Diseases).Separate meta-analyses were performed on Caucasian Crohn’s disease(CD)(3863 patients,6031controls),Caucasian ulcerative colitis(UC)(1260 patients,1987 controls),and East Asian UC(416 patients and 789 controls)datasets using the Mantel-Haenszel *** New Zealand dataset had 93%power,and the meta-analyses had 100%power to detect an effect size of OR=1.40 atα=0.05,***:In our New Zealand dataset,single-site analysis found no evidence of association of MIF polymorphisms with overall risk of CD,UC,and IBD or disease phenotype(all P values>0.05).Haplotype analysis found the CATT5/-173C haplotype occurred at a higher frequency in New Zealand controls compared to IBD patients(0.6 vs 0.01;P=0.03,OR=0.22;95%CI:0.05-0.99),but this association did not survive bonferroni ***-analysis of our New Zealand MIF-173G>C data with data from seven additional Caucasian datasets using a random effects model found no association of MIF polymorphisms with CD,UC,or overall ***,meta-analysis of all published MIF-173G>C data from East Asian datasets(416UC patients

关键词： Crohn’s disease Ulcerative colitis Migration inhibitory factor rs755622 rs5844572 Genetic association study

NOD2 and ATG16L1 polymorphisms affect monocyte responses in Crohn's disease

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World Journal of Gastroenterology 2011年第23期17卷 2829-2837页

作者： Dylan M Glubb Richard B Gearry Murray L barclay Rebecca L roberts John Pearson Jacqui I Keenan Judy McKenzie robert W Bentley Department of Medicine University of ChicagoIL 60637-1470United States Department of Medicine University of OtagoChristchurch8140New Zealand Department of Gastroenterology Christchurch HospitalChristchurch8140New Zealand Department of Biochemistry University of OtagoDunedin9054New Zealand Department of Pathology University of OtagoChristchurch8140New Zealand Department of Surgery University of OtagoChristchurch8140New Zealand Department of Haematology University of OtagoChristchurch8140New Zealand Department of Paediatrics University of OtagoChristchurch8140New Zealand

AIM： TO assess whether polymorphisms in NOD2 and ATG16L1 affect cytokine responses and mycobacterium avium subspecies paratuberculosis （MAP） survival in monocytes from Crohn＇s disease （CD） patients METHODS： Monocytes were isolated from peripheral blood of CD patients of known genotype for common single nucleotide polymorphisms of NOD2 and ATG16L1, Monocytes were challenged with MAP and bacterial per- sistence assessed at subsequent time-points. Cytokine responses were assayed using a Milliplex multi-analyte profiling assay for 13 cytokines. RESULTS： Monooltes heterozygous for a NOD2 polymorphism （R702W, P268S, or 1007fs） were more permissive for growth of MAP （P = 0.045） than those without. There was no effect of NOD2 genotype on subsequent cytokine expression. The T300A polymorphism of ATG16L1 did not affect growth of MAP in our model （P = 0.175）, but did increase expression of cytokines interleukin （IL）-10 （P = 0.047） and IL-6 （P = 0.019）. CONCLUSION： CD-associated polymorphisms affected the eliminaUon of MAP from ex v/vo monooltes （NOD2）, or expression of certain oltokines （ATG16LI）, implying independent but contributory roles in the pathogenesis of CD.

关键词： Inflammatory bowel disease Mycobacteriumavium subspecies paratuberculosis Cytokine CARD15 Autophagy