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Role of endoscopic-ultrasound-guided biliary drainage with electrocautery-enhanced lumen-apposing metal stent for palliation of malignant biliary obstruction

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World Journal of Gastrointestinal Surgery 2024年第7期16卷 1981-1985页

作者： Smit S Deliwala emad qayed Department of Medicine Division of Digestive DiseasesEmory University School of MedicineAtlantaGA 30303United States

In this editorial,we discuss the article by Peng et al in the recent issue of the World Journal of Gastrointestinal Surgery,focusing on the evolving role of endoscopicultrasound-guided biliary drainage(EUS-BD)with electrocautery lumen apposing metal stent(LAMS)for distal malignant biliary *** endoscopy has rapidly advanced in decompression techniques,with growing evidence of its safety and efficacy surpassing percutaneous and surgical *** endoscopic retrograde cholangiopancreatography(ERCP)has been the gold standard for biliary decompression,its failure rate approaches 10.0%,prompting the exploration of alternatives like *** random-effects meta-analysis demonstrated high technical and clinical success of over 90.0% and an adverse event rate of 17.5%,mainly in the form of stent *** based on stent size were not reported but the majority used 6 mm and 8 mm *** the body of literature continues to demonstrate the effectiveness of this technique,the challenges of stent dysfunction need to be addressed in future *** strategy that has shown promise is placement of double-pigtail stents,only 18% received the prophylactic intervention in this *** expect this to improve with time as the technique continues to be refined and *** results above establish EUS-BD with LAMS as a reliable alternative after failed ERCP and considering EUS to ERCP upfront in the same session is an effective *** the promising results,studies must explore the role of EUS-BD as first-line therapy for biliary decompression.

关键词： Endoscopic-ultrasound Malignant biliary obstruction Lumen apposing metal stent Choledochoduodenostomy Hepaticogastrostomy

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Esophagogastric junction outflow obstruction: Where are we now in diagnosis and management?

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World Journal of Gastroenterology 2019年第4期25卷 411-416页

作者： Salih Samo emad qayed Department of Medicine Division of Digestive Diseases Emory University School of Medicine

Esophagogastric junction outflow obstruction(EGJOO) is a major motility disorder based on the Chicago Classification of esophageal motility *** entity involves a heterogenous group of underlying etiologies. The diagnosis is reached by performing high-resolution manometry. This reveals evidence of obstruction at the esophagogastric junction, manifested by an elevated integrated relaxation pressure(IRP) above a cutoff value(IRP threshold varies by the manometric technology and catheter used), with preserved peristalsis. Further tests like endoscopy, timed barium esophagram, and cross-sectional imaging can help further elucidate the underlying etiology and rule out mechanical *** is tailored to the underlying cause. Similar to achalasia, treatment targeting lower esophageal sphincter disruption like pneumatic dilation, peroral endoscopic myotomy, and botulinum injection are used in patients with functional EGJOO and persistent symptoms.

关键词： Esophagogastric junction outflow obstruction High-resolution manometry

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Distal esophageal spasm:Update on diagnosis and management in the era of high-resolution manometry

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World Journal of Clinical Cases 2020年第6期8卷 1026-1032页

作者： Harika Gorti Salih Samo Nikrad Shahnavaz emad qayed Department of Medicine Atlanta Veteran Affairs Medical Center and Emory University School of MedicineAtlantaGA 30322United States Department of Medicine Division of Digestive DiseasesEmory University School of MedicineAtlantaGA 30303United States

Distal esophageal spasm(DES)is a rare major motility disorder in the Chicago classification of esophageal motility disorders(CC).DES is diagnosed by finding of≥20%premature contractions,with normal lower esophageal sphincter(LES)relaxation on high-resolution manometry(HRM)in the latest version of *** feature differentiates it from achalasia type 3,which has an elevated LES relaxation *** other spastic esophageal disorders,DES has been linked to conditions such as gastroesophageal reflux disease,psychiatric conditions,and narcotic *** addition to HRM,ancillary tests such as endoscopy and barium esophagram can provide supplemental information to differentiate DES from other *** lumen imaging probe(FLIP),a new cutting-edge diagnostic tool,is able to recognize abnormal LES dysfunction that can be missed by HRM and can further guide LES targeted treatment when esophagogastric junction outflow obstruction is diagnosed on *** treatment in DES mostly targets symptomatic relief and often *** toxin injection during endoscopy may provide a temporary therapy that wears off over *** through peroral endoscopic myotomy or via surgical Heller myotomy can provide long term relief in cases with persistent symptoms.

关键词： Distal esophageal spasm High-resolution manometry Esophagus Functional lumenal imaging probe Spastic achalasia Esophageal motility

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Frequency of hospital readmission and care fragmentation in gastroparesis:A nationwide analysis

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World Journal of Gastrointestinal Endoscopy 2018年第9期10卷 200-209页

作者： emad qayed Mayssan Muftah Department of Medicine Division of Digestive DiseasesEmory University School of Medicine Department of Gastroenterology Grady Memorial Hospital Department of Medicine Emory University School of Medicine

AIM To evaluate rates and predictors of hospital readmission and care fragmentation in patients hospitalized with *** We identified all adult hospitalizations with a primary diagnosis of gastroparesis in the 2010-2014 National Readmissions Database,which captures statewide *** excluded patients who died during the hospitalization,and calculated 30 and 90-d unplanned readmission and care fragmentation *** to a non-index hospital(i.e.,different from the hospital of the index admission) was considered as care fragmentation.A multivariate Cox regression model was used to analyze predictors of 30-d *** regression was used to determine hospital and patient factors independently associated with 30-d care *** readmitted within 30 d were followed for 60 d post discharge from the first *** during the first readmission,hospitalization cost,length of stay,and rates of 60-d readmission were compared between those with and without care *** There were 30064 admissions with a primary diagnosis of *** rates of 30 and 90-d readmissions were 26.8% and 45.6%,*** age,male patient,diabetes,parenteral nutrition,≥ 4 Elixhauser comorbidities,longer hospital stay(> 5 d),large and metropolitan hospital,and Medicaid insurance were associated with increased hazards of 30-d *** surgery,routine discharge and private insurance were associated with lower 30-d *** rates of 30 and 90-d care fragmentation were 28.1% and 33.8%,*** age,longer hospital stay(> 5 d),self-pay or Medicaid insurance were associated with increased risk of 30-d care ***,enteral tube placement,parenteral nutrition,large metropolitan hospital,and routine discharge were associated with decreased risk of 30-d *** who were readmitted to a non-index hospital had longer length of stay(6.5 vs 5.8 d,P = 0.03

关键词： Gastroparesis Hospital readmission Care fragmentation

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Early vs late endoscopic retrograde cholangiopancreatography in patients with acute cholangitis: A nationwide analysis

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World Journal of Gastrointestinal Endoscopy 2019年第1期11卷 41-53页

作者： Ramzi Mulki Rushikesh Shah emad qayed Department of Medicine Division of Digestive Diseases Emory University School of Medicine Grady Memorial Hospital Emory University

AIM To assess the effect of early vs late endoscopic retrograde cholangiopancreatography(ERCP) on mortality and readmissions in acute cholangitis, using a nationally representative *** We used the 2014 National Readmissions Database to identify adult patients hospitalized with acute cholangitis who underwent therapeutic ERCP within one week of admission. Early ERCP was defined as ERCP performed on the same day of admission or the next day(days 0 or 1, < 48 h), and late ERCP was performed on days 2 to 7 of admission. Patients with severe cholangitis had any of the following additional diagnoses: Severe sepsis, septic shock, acute renal failure,acute respiratory failure, or thrombocytopenia. Multivariate logistic regression was used to calculate the adjusted odds of association of ERCP timing with inhospital mortality, 30-d mortality, and 30-d readmissions, controlling for age, sex,severe disease and *** Four thousand five hundred and seventy patients satisfied the inclusion criteria;with a mean age of 64.1 years. Of these, 66.6% had early ERCP, while 33.4% had late ERCP. Early ERCP was associated with lower in-hospital mortality [1.2% vs2.4%, adjusted odds ratio(aOR) = 0.50, 95%CI: 0.76-0.83, P = 0.001] and lower 30-d mortality(1.5% vs 3.3%, aOR = 0.48, 95%CI: 0.33-0.69, P < 0.0001) compared to the late ERCP group. Similarly, early ERCP was associated with lower 30-d readmissions(9.7% vs 15.1%, aOR = 0.58, 95%CI: 0.49-0.7, P < 0.0001). When stratified by severity of cholangitis, there was a similar benefit of early ERCP on all outcomes in those with and without severe cholangitis. The mean length of stay was higher in the late ERCP group compared to the early ERCP group(6.9 d vs 4.5 d, P < 0.0001). The mean hospitalization cost was higher in the late ERCP group($21459 vs $16939, P < 0.0001).CONCLUSION Early ERCP is associated with lower in-hospital and 30-d mortality in those with or without severe cholangitis. Regardless of severity, we

关键词： Cholangitis Endoscopic retrograde cholangiopancreatography Mortality Readmissions Severity cholangitis Length of stay Nationwide analysis

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Colonoscopy procedural volume increases adenoma and polyp detection rates in gastroenterology trainees

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World Journal of Gastrointestinal Endoscopy 2017年第11期9卷 540-551页

作者： emad qayed Ravi Vora Sara Levy Roberd M Bostick Department of Medicine Division of Digestive diseases Emory University School of Medicine Grady Memorial Hospital Emory University Rollins School of Public Health Department of Epidemiology Emory University Winship Cancer Institute Atlanta

AIM To investigate changes in polyp detection throughout fellowship training, and estimate colonoscopy volume required to achieve the adenoma detection rate(ADRs) and polyp detection rate(PDRs) of attending *** We reviewed colonoscopies from July 1, 2009 to June 30, 2014. Fellows' procedural logs were used to retrieve colonoscopy procedural volumes, and these were treated as the time variable. Findings from screening colonoscopies were used to calculate colonoscopy outcomes for each fellow for the prior 50 colonoscopies at each time point. ADR and PDR were plotted against colonoscopy procedural volumes to produce individual longitudinal graphs. Repeated measures linear mixed effects models were used to study the change of ADR and PDR with increasing procedural *** During the study period, 12 fellows completed full three years of training and were included in the analysis. The average ADR and PDR were, respectively, 31.5% and 41.9% for all fellows, and 28.9% and 38.2% for attendings alone. There was a statistically significant increase in ADR with increasing procedural volume(1.8%/100 colonoscopies, P = 0.002). Similarly, PDR increased 2.8%/100 colonoscopies(P = 0.0001), while there was no significant change in advanced ADR(0.04%/100 colonoscopies, P = 0.92). The ADR increase was limited to the right side of the colon, while the PDR increased in both the right and left colon. The adenoma per colon and polyp per colon also increased throughout training. Fellows reached the attendings' ADR and PDR after 265 and 292 colonoscopies, *** We found that the ADR and PDR increase with increasing colonoscopy volume throughout fellowship. Our findings support recent recommendations of ≥ 275 colonoscopies for colonoscopy credentialing.

关键词：屏蔽 colonoscopy Colorectal 癌症息肉察觉率 Colonoscopy 体积腺瘤察觉率肠胃病学训练

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Association of trainee participation with adenoma and polyp detection rates

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World Journal of Gastrointestinal Endoscopy 2017年第5期9卷 204-210页

作者： emad qayed Lauren Shea Stephan Goebel Roberd M Bostick Department of Medicine Division of Digestive diseasesEmory University School of Medicine Grady Memorial Hospital Emory University Rollins School of Public Health Department of Epidemiology Emory University Winship Cancer Institute

AIM To investigate whether adenoma and polyp detection rates(ADR and PDR, respectively) in screening colonoscopies performed in the presence of fellows differ from those performed by attending physicians alone. METHODS We performed a retrospective review of all patients who underwent a screening colonoscopy at Grady Memorial Hospital between July 1, 2009 and June 30, 2015. Patients with a history of colon polyps or cancer and those with poor colon preparation or failed cecal intubation were excluded from the analysis. Associations of fellowship training level with the ADR and PDR relative to attendings alone were assessed using unconditional multivariable logistic regression. Models were adjusted for sex, age, race, and colon preparationquality. RESULTS A total of 7503 colonoscopies met the inclusion criteria and were included in the analysis. The mean age of the study patients was 58.2 years; 63.1% were women and 88.2% were African American. The ADR was higher in the fellow participation group overall compared to that in the attending group: 34.5% vs 30.7%(P = 0.001), and for third year fellows it was 35.4% vs 30.7%(a OR = 1.23, 95%CI: 1.09-1.39). The higher ADR in the fellow participation group was evident for both the right and left side of the colon. For the PDR the corresponding figures were 44.5% vs 40.1%(P = 0.0003) and 45.7% vs 40.1%(a OR = 1.25, 95%CI: 1.12-1.41). The ADR and PDR increased with increasing fellow training level(P for trend < 0.05).CONCLUSION There is a stepwise increase in ADR and PDR across the years of gastroenterology training. Fellow participation is associated with higher adenoma and polyp detection.

关键词：屏蔽 colonoscopy 腺瘤察觉率息肉察觉率肠胃病学训练 Colorectal 癌症

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Advances in endoscopic retrograde cholangiopancreatography cannulation

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World Journal of Gastrointestinal Endoscopy 2010年第4期2卷 130-137页

作者： emad qayed Ashley L Reid Field F Willingham Steve Keilin Division of Digestive Diseases Emory University School of MedicineAtlantaGA 30322United States

Endoscopic retrograde cholangiopancreatography is an important tool in the diagnosis and treatment of pancreatobiliary diseases.A critical step in this procedure is deep cannulation of the bile duct as failure of cannulation generally results in an aborted procedure and failed *** endoscopists usually achieve a high rate of successful cannulation while those less experienced typically have a much lower rate and a greater incidence of *** attempts at cannulation can result in significant morbidity to patients,anxiety for endoscopists,unnecessary radiation exposure and inefficient patient *** we review the most common endoscopic techniques used to achieve selective biliary *** aids to cannulation are also discussed briefly in this review.

关键词： Endoscopic retrograde cholangiopancreatog raphy Cannulation techniques Fatty meal EUS guided cholangiography Double-balloon endoscopy

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