Clarian Digestive Diseases Center

Indianapolis, IN, United States

Clarian Digestive Diseases Center

Indianapolis, IN, United States
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Al-Haddad M.,Indiana University | Al-Haddad M.,Clarian Digestive Diseases Center | Crook J.E.,Biostatistics Unit
Endoscopy | Year: 2010

Background and study aims: Cystic pancreatic lesions (CPLs) are increasingly detected by various imaging studies. Mucinous CPLs carry a risk of malignant transformation but this is often difficult to diagnose preoperatively. In a previous report of 10 suspected mucinous CPLs, the cellular yield of endoscopic ultrasonography (EUS)-guided cytology brushings was found to be superior to the yield from standard fine-needle aspiration (FNA). The aim of this prospective and blinded study was to compare the cytology yield of mucinous epithelium from brushing with FNA in suspected mucinous CPLs. Patients and methods: In total, 37 patients with 39 CPLs measuring at least 20mm were enrolled between June 2006 and July 2008 for EUS-cytobrushing and EUS-FNA of CPLs. Demographic, clinical, EUS, cytopathologic, and surgical data were recorded whenever available. Yield of cytology brushings was compared with that of FNA. Procedure morbidity was evaluated after 30 days. The main outcome assessed was yield of intracellular mucin (ICM) on cytobrushing specimens compared with EUS-FNA for the diagnosis of suspected mucinous CPL. Results: Cytobrushings were more likely to detect ICM than the EUS-FNA method (P=0.001). In three patients with hypocellular FNA, dysplasia was found on cytology brushing and later confirmed by surgical pathology. Significant complications occurred in three patients (8%): one postbrushing bleeding and two acute pancreatitis. Conclusions: Cytology brushings are more likely to provide an adequate mucinous epithelium specimen than standard FNA and could aid the diagnosis of CPLs in a selective group of patients. © Georg Thieme Verlag KG Stuttgart · New York.

Chalasani N.,Indiana University | Chalasani N.,Clarian Digestive Diseases Center | Bjornsson E.,Reykjavik University
Gastroenterology | Year: 2010

Idiosyncratic drug-induced liver injury (DILI) is a rare disorder that is not related directly to dosage and little is known about individuals who are at increased risk. There are no suitable preclinical models for the study of idiosyncratic DILI and its pathogenesis is poorly understood. It is likely to arise from complex interactions among genetic, nongenetic host susceptibility, and environmental factors. Nongenetic risk factors include age, sex, and other diseases (eg, chronic liver disease or human immunodeficiency virus infection). Compound-specific risk factors include daily dose, metabolism characteristics, and propensity for drug interactions. Alcohol consumption has been proposed as a risk factor for DILI from medications, but there is insufficient evidence to support this. Many studies have explored genetic defects that might be involved in pathogenesis and focused on genes involved in drug metabolism and the immune response. Multicenter databases of patients with DILI (the United States Drug Induced Liver Injury Network, DILIGEN, and the Spanish DILI registry) are important tools for clinical and genetic research. A genome-wide association study of flucloxacillin hepatotoxicity has yielded groundbreaking results and many similar studies are underway. Nonetheless, DILI is challenging to investigate because of its rarity, the lack of experimental models, the number of medications that might cause it, and challenges to diagnosis. © 2010 AGA Institute.

Al-Haddad M.,Indiana University | Al-Haddad M.,Clarian Digestive Diseases Center | Eloubeidi M.A.,University of Alabama at Birmingham
Journal of the Pancreas | Year: 2010

Endoscopic ultrasound (EUS) evolved as the diagnostic test of choice evaluating suspected pancreatic tumors. Coupled with fine needle aspiration (FNA), EUS provides high accuracy for the diagnosis and staging of pancreatic cancer. Novel EUS based techniques have emerged as a safe minimally invasive alternative to the surgical or radiological approaches. By allowing better pain control, delivering antitumor therapies or draining obstructed bile ducts, such techniques hold a big promise to improve the quality of life of patients with unresectable pancreatic cancer. In this review, we will discuss the role EUS-FNA plays in the diagnosis, staging and treatment of patients with locally advanced pancreatic cancer.

Khashab M.,Indiana University | Khashab M.,Clarian Digestive Diseases Center | Helper D.J.,Indiana University | Helper D.J.,Clarian Digestive Diseases Center | And 3 more authors.
Digestive Diseases and Sciences | Year: 2010

The aim of this study was to determine the factors predictive of the depth of maximal insertion (DMI) at double-balloon enteroscopy (DBE). Eligible patients from the DBE database at our institution were stratified based on their anterograde or retrograde approach. The factors predictive of the DMI were calculated using ANOVA, Spearman, univariate, and multivariate regression analysis. A total of 79 patients had 98 procedures, 67 anterograde and 31 retrograde. Fifty-eight (73%) had previous abdominal surgeries. The average anterograde DMI was 187.5 cm, retrograde 116.5 cm. In univariate regression analysis, a history of abdominal surgery and surgery excluding appendectomy were negative predictors of the DMI for both the anterograde and retrograde approaches (P<0.05). A history of bowel surgery and number of surgeries were negative predictive factors only for the anterograde approach (P<0.005). In multivariate analysis, the number of abdominal surgeries (anterograde) and any abdominal surgery (retrograde) were predictors of the DMI (P = 0.02 and P = 0.003, respectively). Patients with three or more surgeries had a significantly lower DMI than those with ≤1 (137 vs. 214 cm, P<0.001 for anterograde and 114 vs. 148 cm, P<0.001 for retrograde). There was no correlation between the DMI and age, BMI, date of the study, or procedure duration for either approach. Previous abdominal surgeries can significantly impact the DMI at DBE. © Springer Science+Business Media, LLC 2009.

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