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Gastroenterology Report 2022年第1期10卷 207-216页

作者： Fateh Bazerbachi Rodger M.White Nauzer Forbes Basavana Goudra barham k.abu dayyeh Vinay Chandrasekhara BobbieJean Sweitzer CentraCare Interventional Endoscopy ProgramSt.Cloud HospitalSt CloudMNUSA Department of Anesthesia Massachusetts General HospitalBostonMAUSA Department of Medicine Division of Gastroenterology and HepatologyUniversity of CalgaryCalgaryAlbertaCanada Department of Anesthesiology and Critical Care Medicine Hospital of the University of PennsylvaniaPhiladelphiaPAUSA Division of Gastroenterology and Hepatology Mayo ClinicRochesterMNUSA Systems Director University of VirginiaPreoperative MedicineInovaHealthFalls ChurchVAUSA

Gastrointestinal(GI)endoscopy has witnessed a Cambrian explosion of techniques,indications,and expanding target populations.GI endoscopy encompasses traditional domains that include preventive measures,palliation,as alternative therapies in patients with prohibitive risks of more invasive procedures,and indicated primary treatments.But,it has expanded to include therapeutic and diagnostic interventional endosonography,luminal endoscopic resection,third space endotherapy,endohepatology,and endobariatrics.The lines between surgery and endoscopy are blurred on many occasions within this paradigm.Moreover,patients with high degrees of co-morbidity and complex physiology require more nuanced peri-endoscopic management.The rising demand for endoscopy services has resulted in the development of endoscopy referral centers that offer these invasive procedures as directly booked referrals for regional and rural patients.This further necessitates specialized programs to ensure appropriate evaluation,risk stratification,and optimization for safe sedation and general anesthesia if needed.This landscape is conducive to the organic evolution of endo-anesthesia to meet the needs of these focused and evolving practices.In this primer,we delineate important aspects of endo-anesthesia care and provide relevant clinical and logistical considerations pertaining to the breadth of procedures.

关键词： endoscopic procedures endoscopy anesthesia

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Turnkey algorithmic approach for the evaluation of gastroesophageal reflux disease after bariatric surgery

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Gastroenterology Report 2023年第1期11卷 123-130页

作者： Omar M.Ghanem Rabih Ghazi Farah Abdul Razzak Fateh Bazerbachi karthik Ravi Leena khaitan Shanu N.kothari barham k.abu dayyeh Department of Surgery Mayo ClinicRochesterMNUSA Department of Medicine Mayo ClinicRochesterMNUSA CentraCare Interventional Endoscopy ProgramSt Cloud HospitalSt CloudMNUSA Department of Surgery CaseWestern Reserve UniversityClevelandOHUSA Department of Surgery Prisma HealthGreenvilleSCUSA

Bariatric surgeries are often complicated by de-novo gastroesophageal reflux disease(GERD)or worsening of pre-existing GERD.The growing rates of obesity and bariatric surgeries worldwide are paralleled by an increase in the number of patients requiring post-surgical GERD evaluation.However,there is currently no standardized approach for the assessment of GERD in these patients.In this review,we delineate the relationship between GERD and the most common bariatric surgeries:sleeve gastrectomy(SG)and Roux-en-Y gastric bypass(RYGB),with a focus on pathophysiology,objective assessment,and underlying anatomical and motility disturbances.We suggest a stepwise algorithm to help diagnose GERD after SG and RYGB,determine the underlying cause,and guide the management and treatment.

关键词： RYGB sleeve gastrectomy bariatric surgery gastroesophageal reflux disease GERD

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Effects on physiologic measures of appetite from intragastric balloon and endoscopic sleeve gastroplasty: results of a prospective study

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Chinese Medical Journal 2022年第10期135卷 1234-1241页

作者： Babusai Rapaka Daniel B.Maselli Gontrand Lopez-Nava Inmaculada Bautista-Castano Reem Matar Veeravich Jaruvongvanich Eric J.Vargas Andrew C.Storm Andres Acosta barham k.abu dayyeh Division of Gastroenterology and Hepatology Mayo ClinicRochesterMN 55905USA Madrid Sanchinarro University Hospital MadridSpain

Background: Endoscopic bariatric therapies can help address widening management gaps in obesity. Their ability to facilitate weight loss is largely tied to influences on appetite through perturbations of gastric emptying and accommodation. As these tools gain traction in obesity therapy, their physiologic underpinnings require exploration, which may enhance efficacy, tolerance, and patient-tailored care.Methods: We prospectively assessed consecutive subjects with fluid-filled intragastric balloons (IGBs) (n = 18) placed between October 2016 and June 2017 or underwent endoscopic sleeve gastroplasty (ESG) (n = 23) from March 2018 to June 2018. Patients underwent physiologic appraisal at 3 months with13C-spirulina-based gastric emptying breath test to determine time to half emptying (T50), as well as maximum tolerated volume (MTV) of a standard nutrient drink test. Changes in T50 and MTV at 3 months were compared with percent total body weight loss (%TBWL) at 3 and 6 months using best-fit linear regression.Results: The change in T50 at 3 months correlated with %TBWL at 3 months for IGB (P = 0.01) and ESG (P = 0.01) but with greater impact on %TBWL in IGB compared to ESG (R2 = 0.42vs. 0.26). Change in T50 at 3 months was predictive of weight loss at 6 months for IGB (P = 0.01) but not ESG (P = 0.11). ESG was associated with greater decrease in MTV compared to IGB (340.25 ± 297.97 mLvs. 183.00 ± 217.13 mL,P = 0.08), indicting an enhanced effect on satiation through decreased gastric accommodation. Changes in MTV at 3 months did not correlate with %TBWL for either IGB (P = 0.26) or ESG (P = 0.49) but trended toward significance for predicting %TBWL at 6 months for ESG (P = 0.06) but not IGB (P = 0.19).Conclusion: IGB and ESG both induce weight loss but likely through distinct gastric motor function phenotypes, and gastric emptying may predict future weight loss in patients with IGB.

关键词： Intragastric balloon Endoscopic sleeve gastroplasty Gastric emptying Gastric accommodation Obesity

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静脉注射异丙酚引起的急性胰腺炎:通过系统综述评估其因果关系

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Gastroenterology Report 2019年第1期7卷 13-23,I0001页

作者： Samir Haffar Ravinder Jeet kaur Sushil kumar Garg Joseph A.Hyder M.Hassan Murad barham k.abu dayyeh Fateh Bazerbachi Digestive Center for Diagnosis&Treatment 29 Ayar StreetDamascusSyrian Arab Republic Division of Gastroenterology and Hepatology Mayo Clinic200 First Street SWRochesterMN 55905USA Division of Anesthesiology and Perioperative Medicine Mayo Clinic200 First Street SWRochesterMN 55905USA Division of Health Care Policy and Research Mayo Clinic200 First Street SWRochesterMN 55905USA

背景:异丙酚注射引起急性胰腺炎(AP)已有报道,但两者之间的因果关系尚不明了。因此,我们通过系统综述对其因果关系进行评估。方法:我们于2017年8月16日对多个数据库进行检索,由两人按预设标准对检索出的研究进行评估和筛选。使用Naranj... 详细信息

背景:异丙酚注射引起急性胰腺炎(AP)已有报道,但两者之间的因果关系尚不明了。因此,我们通过系统综述对其因果关系进行评估。方法:我们于2017年8月16日对多个数据库进行检索,由两人按预设标准对检索出的研究进行评估和筛选。使用Naranjo量表和Badalov分级评估异丙酚注射与AP的因果关系。结果:我们筛选出来自11个国家的18项研究,病例总数为21例,大多数研究都有高质量的方法学。21例患者中位年龄35岁(4-77岁),10例(48%)为男性。8例患者注射异丙酚是用于镇静,13例为麻醉诱导/维持,异丙酚中位注射剂量为200 mg。14例(67%)患者具有一个中等时长(1-30天)的潜伏期(异丙酚注射至AP诊断)。4例患者甘油三酯水平>1000 mg/dL。4例(19%)患者出现严重AP。2例患者在AP治疗好转后再次接受异丙酚注射,其中1例出现了AP复发。AP相关病死率为14%(3/21)。按Naranjo量表评估,在19例(89%)患者中,异丙酚注射是AP的可能原因。结论:在Badalov Ib级别的证据支持下,可以认为异丙酚注射是AP发生的一个可能原因。高甘油三酯血症并不是异丙酚诱发AP的唯一机制。异丙酚引起的AP中,有19%为严重AP,病死率高达14%。未来研究需要评估如果合并应用其他一些本身就有导致胰腺炎风险的操作(如ERCP),异丙酚引起的AP发生概率是否会增加。

关键词： Acute pancreatitis drug-induced pancreatitis propofol systematic review

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内镜下胰管支架置入术用于缓解胰腺癌患者的疼痛:系统综述与meta分析

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Gastroenterology Report 2021年第2期9卷 105-114,I0001页

作者： Pradeep k.Siddappa Fadi Hawa Larry J.Prokop MHassan Murad barham k.abu dayyeh Vinay Chandrasekhara Mark D.Topazian Fateh Bazerbachi Division of Gastroenterology and Hepatology Stanford University School of MedicineStanfordCAUSA Department of Internal Medicine St.Joseph Mercy Ann Arbor HospitalYpsilantiMIUSA Library Public Services Mayo ClinicRochesterMNUSA Robert D and Patricia E kern Center for the Science of Health Care Delivery Mayo ClinicRochesterMNUSA Division of Gastroenterology and Hepatology Mayo ClinicRochesterMNUSA Division of Gastroenterology Massachusetts General Hospital and Harvard Medical SchoolBostonMAUSA

背景:腹痛是一种致人衰弱的症状,大约80%的胰腺癌患者都会出现腹痛。胰管减压虽然未被广泛采纳,但有报道该方法能缓解腹痛症状。本研究旨在评估内镜下胰管减压对于缓解胰腺癌患者餐后梗阻型腹痛的作用、效果及安全性。方法:该系统综述... 详细信息

背景:腹痛是一种致人衰弱的症状,大约80%的胰腺癌患者都会出现腹痛。胰管减压虽然未被广泛采纳,但有报道该方法能缓解腹痛症状。本研究旨在评估内镜下胰管减压对于缓解胰腺癌患者餐后梗阻型腹痛的作用、效果及安全性。方法:该系统综述的文献检索时间截至2020年10月7日。由两位研究者独立地筛选文献、提取数据,并对文献质量进行评估。结果:12篇文献共计192例有腹痛症状且尝试胰管减压的胰腺癌患者纳入研究。其中,167例患者成功完成胰管减压(平均年龄62.5岁,58.7%为男性)。159(95.2%)例患者采用塑料支架。所有被纳入的研究均报道了胰管支架置入术后患者疼痛部分或完全缓解,缓解率为93%(95%CI:79%-100%)。平均的疼痛缓解期为94˘16天。内镜逆行性胰胆管造影(ERCP)相关的不良反应包括括约肌切开术后出血(1.8%)、ERCP后胰腺炎(0.6%)和胰管出血(0.6%)。2例行内镜超声引导的胰管减压患者未报道任何不良反应。在成功置入支架的167例患者中,支架移位和支架阻塞的发生率分别为3.6%和3.0%。未报道不良反应相关的死亡病例。文献质量评估提示,绝大部分文献质量较低或难以评价。结论:初步分析结果表明,对于部分经选择的胰腺癌病例,内镜下胰管引流可能是缓解梗阻型疼痛一种安全有效的方法。但该侵入性方法的作用尚需随机对照研究来进一步明确。

关键词： cancer-associated pain Endoscopic retrograde cholangiopancreatography palliative therapy pancreas cancer systematic review meta-analysis

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Percutaneous transluminal angioplasty balloons for endoscopic ultrasound-guided pancreatic duct interventions

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World Journal of Gastrointestinal Endoscopy 2022年第8期14卷 487-494页

作者： Jad P AbiMansour barham k.abu dayyeh Michael J Levy Andrew C Storm John A Martin Bret T Petersen Ryan J Law Mark D Topazian Vinay Chandrasekhara Department of Gastroenterology and Hepatology Mayo ClinicRochesterMN 55905United States

BACkGROUND Endoscopic ultrasound(EUS)-guided main pancreatic duct(PD)access may be used when conventional endoscopic retrograde cholangiopancreatography(ERCP)techniques fail.The use of a percutaneous transluminal angioplasty balloon(PTAB),originally developed for vascular interventions,can be used to facilitate transmural(e.g.,transgastric)PD access and to dilate high-grade pancreatic strictures.AIM To describe the technique,efficacy,and safety of PTABs for EUS-guided PD interventions.METHODS Patients who underwent EUS with use of a PTAB from March 2011 to August 2021 were retrospectively identified from a tertiary care medical center supply database.PTABs included 3-4 French angioplasty catheters with 3-4 mm balloons designed to use over a 0.018-inch guidewire.The primary outcome was technical success.Secondary outcomes included incidence of adverse events(AEs)and need for early reintervention.RESULTS A total of 23 patients were identified(48%female,mean age 55.8 years).Chronic pancreatitis was the underlying etiology in 13(56.5%)patients,surgically altered anatomy(SAA)with stricture in 7(30.4%),and SAA with post-operative leak in 3(13.0%).Technical success was achieved in 20(87%)cases.Overall AE rate was 26%(n=6).All AEs were mild and included 1 pancreatic duct leak,2 cases of post-procedure pancreatitis,and 3 admissions for post-procedural pain.No patients required early re-intervention.CONCLUSION EUS-guided use of PTABs for PD access and/or stricture management is feasible with an acceptable safety profile and can be considered in patients when conventional ERCP cannulation fails.

关键词： Dilating balloon Pancreatic duct intervention Chronic pancreatitis Anastomotic stricture

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Anabolic steroid abuse causing recurrent hepatic adenomas and hemorrhage

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World Journal of Gastroenterology 2008年第28期14卷 4573-4575页

作者： Nicole M Martin barham k.abu dayyeh Raymond T Chung Gastrointestinal Unit Massachusetts General HospitalBostonMassachusetts 02114United States

Anabolic steroid abuse is common among athletes and is associated with a number of medical complications. We describe a case of a 27-year-old male bodybuilder with multiple hepatic adenomas induced by anabolic steroids. He initially presented with tumor hemorrhage and was treated with left lateral hepatic segmentectomy. Regression of the remaining tumors was observed with cessation of steroid use. However, 3 years and a half after his initial hepatic segmentectomy, he presented with recurrent tumor enlargement and intraperitoneal hemorrhage in the setting of steroid abuse relapse. Given his limited hepatic reserve, he was conservatively managed with embolization of the right accessory hepatic artery. This is the first reported case of hepatic adenoma re- growth with recidivistic steroid abuse, complicated by life-threatening hemorrhage. While athletes and bodybuilders are often aware of the legal and social ramifications of steroid abuse, they should continue to be counseled about its serious medical risks.

关键词：同化剂腺瘤肝出血治疗方法

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End-stage renal disease is associated with increased post endoscopic retrograde cholangiopancreatography adverse events in hospitalized patients

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World Journal of Gastroenterology 2018年第41期24卷 4691-4697页

作者： Tarek Sawas Fateh Bazerbachi Samir Haffar Won k Cho Michael J Levy John A Martin Bret T Petersen Mark D Topazian Vinay Chandrasekhara barham k.abu dayyeh Division of Gastroenterology and Hepatology Mayo Clinic Department of Gastroenterology Digestive Center for Diagnosis and Treatment Division of Gastroenterology and Hepatology Georgetown University Medstar Washington Hospital Center

AIM To determine if end-stage renal disease (ESRD) is a risk factor for post endoscopic retrograde cholangio-pancreatography (ERCP) adverse events (AEs). METHODS We performed a retrospective cohort study using the Nationwide Inpatient Sample (NIS) 2011-2013. We identified adult patients who underwent ERCP using the International Classification of Diseases 9^(th) Revision (ICD-9-CM). Included patients were divided into three groups: ESRD, chronic kidney disease (CkD), and control. The primary outcome was post-ERCP AEs including pancreatitis, bleeding, and perforation determined based on specific ICD-9-CM codes. Secondary outcomes were length of hospital stay, in-hospital mortality, and admission cost. AEs and mortality were compared using multivariate logistic regression analysis.RESULTS There were 492175 discharges that underwent ERCP during the 3 years. The ESRD and CkD groups contained 7347 and 39403 hospitalizations respectively, whereas the control group had 445424 hospitalizations. Post-ERCP pancreatitis (PEP) was significantly higher in the ESRD group (8.3%) compared to the control group (4.6%) with adjusted odd ratio (aOR) = 1.7 (95% CI: 1.4-2.1, ~aP k factor for post-ERCP AEs and is associated with higher hospital mortality. Careful selection and close monitoring is warranted to improve outcomes.

关键词： End-stage renal disease Nationwide Inpatient Sample Endoscopic retrograde cholangiopancreatography

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