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$Research paper thumbnail of Gastric Electric Stimulation for Refractory Gastroparesis: A Prospective Analysis of 151 Patients at a Single Center$

Digestive diseases and sciences, Jan 18, 2015

Gastric electric stimulation (GES) is used to treat patients with refractory gastroparesis sympto... more Gastric electric stimulation (GES) is used to treat patients with refractory gastroparesis symptoms. However, the effectiveness of GES in clinical practice and the effect of GES on specific symptoms of gastroparesis are not well delineated. To determine the effectiveness of GES for treatment for refractory symptoms of gastroparesis, the improvement in specific symptoms of gastroparesis, and clinical factors impacting on outcome. Enterra GES was used to treat refractory gastroparesis symptoms. Patients filled out a symptom severity questionnaire (PAGI-SYM) prior to insertion. At each follow-up visit, the patient filled out PAGI-SYM and assessed their therapeutic response using the Clinical Patient Grading Assessment Scale (CPGAS). One hundred and fifty-one patients (120 females) with refractory gastroparesis (72 diabetic, 73 idiopathic, 6 other) underwent GES. Of the 138 with follow-up (1.4 ± 1.0 years), the average CPGAS was 2.4 ± 0.3 (SEM): 104 patients (75 %) improved (CPGAS > ...

$Research paper thumbnail of Su1443 Gastric Neuromuscular Pathology and Therapeutic Outcome of Gastric Electric Stimulation in Patients With Refractory Gastroparesis$

Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society, 2015

Pyloric dysfunction has been associated with gastroparesis, particularly diabetic gastroparesis. ... more Pyloric dysfunction has been associated with gastroparesis, particularly diabetic gastroparesis. Endoscopic functional luminal imaging probe (EndoFLIP) uses 16 sensors inside a balloon that is inflated inside a sphincter to assess physiologic characteristics. The aim of this study was to measure the pressure, diameter, cross-sectional area (CSA), and distensibility of the pylorus using EndoFLIP in patients with gastroparesis. In addition, the relationship between pyloric pathophysiology with gastroparesis etiology, symptoms, and gastric emptying was assessed. EndoFLIP was performed in 54 patients (39 idiopathic gastroparesis, 15 diabetic gastroparesis). The EndoFLIP catheter was passed endoscopically so that the balloon straddled the pylorus. Pressure, diameter, CSA, and distensibility of the pylorus were measured at 20, 30, 40, and 50 cc balloon volume. Pyloric sphincter contour was seen best at 40 cc balloon distension (diameter 12.2 ± 0.44 mm, CSA 125.2 ± 9.15 mm(2) , pressure 18...

Gastroenterology Research, 2014

Hemosuccus pancreaticus (bleeding from the pancreatic duct into the gastrointestinal tract via th... more Hemosuccus pancreaticus (bleeding from the pancreatic duct into the gastrointestinal tract via the ampulla of Vater) is a rare, potentially life-threatening and obscure cause of upper gastrointestinal bleeding. It is caused by rupture of the psuedoaneurysm of a peripancreatic vessel into pancreatic duct or pancreatic psuedocyst in the context of pancreatitis or pancreatic tumors. It can pose a significant diagnostic and therapeutic dilemma due to its anatomical location and that bleeding into the duodenum is intermittent and cannot be easily diagnosed by endoscopy. A 61-year-old female with HIV and alcoholism presented with 3 weeks of intermittent abdominal pain and melena. Examination revealed hypotension with pallor and mild epigastric tenderness. She was found to have severe anemia and a high serum lipase. It was decided to perform a contrast-enhanced computed tomography (CT) scan that demonstrated a hemorrhagic pancreatic pseudocyst with possible active bleeding into the cyst. An emergent angiogram showed a large pseudoaneurysm of the pancreaticoduodenal artery that was successfully embolized. Subsequent endoscopy showed blood near ampulla of Vater confirming the diagnosis of hemosuccus pancreaticus. Thus the bleeding pseudocyst was communicating with pancreatic duct. The patient had no further episodes of gastrointestinal bleeding. Hemosuccus pancreaticus should be considered in patients with intermittent crescendo-decrescendo abdominal pain, gastrointestinal bleeding and a high serum lipase. Contrast-enhanced CT scan can be an excellent initial diagnostic modality and can lead to prompt angiography for embolization of the bleeding pseudoaneurysm and can eliminate the need for surgery.

Quality of Life Research, 2012

Purpose To quantify the impact of constipation on health-related quality of life (HRQoL) in Black... more Purpose To quantify the impact of constipation on health-related quality of life (HRQoL) in Black Americans. Methods Case-control design. Black subjects referred for colon cancer screening with a Bristol Stool Score of 3-5 for [75% of bowel movements served as controls. Frequencymatched functional constipation subjects had to fulfill Rome III criteria. Both groups completed demographic and health surveys. Short Form-36 assessed HRQoL. Results We recruited 102 constipated patients and 100 controls. The groups were well matched demographically. After adjustment for comorbidities, SF-36 scores for vitality, bodily pain, social functioning, and role-emotional were significantly lower in constipated patients. Unadjusted physical and mental component summary scores (PCS and MCS) were significantly higher in the control group (47.1 ± 10.6 vs. 43.3 ± 8.6; P = 0.005 and 50.6 ± 12.4 vs. 43.4 ± 11.8; P \ 0.001, respectively). After adjustment for comorbidities, PCS differences were no longer significant (P = 0.54); however, MCS differences were significant (P = 0.004). Marginal mean scores for the MCS for controls and constipated subjects were 49.9 ± 1.2 and 43.6 ± 1.2, respectively. The presence of a comorbidity was independently associated with PCS (P \ 0.001) and MCS (P = 0.026) results.

$Research paper thumbnail of Surgical Outcomes After Gastric Electric Stimulator Placement for Refractory Gastroparesis$

Journal of Gastrointestinal Surgery, 2013

Gastric electric stimulation (GES) is used for refractory gastroparesis symptoms. Although sympto... more Gastric electric stimulation (GES) is used for refractory gastroparesis symptoms. Although symptomatic improvement has been reported with GES, few studies describe the need for additional surgery after placement. Our goal was to evaluate the outcomes of a large series of GES at a single institution. A retrospective review was performed for patients undergoing Enterra GES (Medtronic, Inc.) placement for refractory gastroparesis from October 2000 to October 2011. The main outcome measures were the need/indications for additional procedures and symptom improvement. A total of 266 patients had a GES implanted; 233 had complete records and were included in the analysis. Fifty-eight percent (n = 135) required an additional procedure after GES placement. Nutrition access (45 patients requiring 77 procedures) and subcutaneous pocket issues (n = 21) were the most common indications for subsequent procedures. Twelve percent (n = 29) had the GES explanted, mainly for continued gastroparetic symptoms (n = 11), mechanical issues (n = 9), or infection (n = 4). Ninety patients had subsequent hospitalizations, mainly for gastroparetic flares. Mortality during the follow-up period was 2.1 %. BMI was predictive of additional surgical procedure: when overweight, the risk of pocket revision increased 4.45 times (OR = 4.452). Of 74 most recent patients with prospective long-term outcome data, 70 % reported improved symptoms of pain, bloating, and nausea. Although most patients reported symptomatic improvement after GES implantation, there is often a need for additional surgical procedures as well as associated complications after GES placement. Additional procedures were most frequent for surgical nutrition and subcutaneous pocket issues; pocket revisions were more frequent in obese patients. From our results, we amended our practice to add a jejunostomy tube in malnourished patients and suture the stimulator to the subcutaneous pocket fascia. Further studies will determine if these changes reduce the rate of complications and additional procedures after GES placement.

Gastrointestinal Endoscopy, 2010

Digestive Diseases and Sciences, 2014

Objective To determine symptoms of small intestinal bacterial overgrowth (SIBO) in gastroparesis ... more Objective To determine symptoms of small intestinal bacterial overgrowth (SIBO) in gastroparesis patients. Methods Patients undergoing LBT (lactulose breath test) for evaluation of SIBO were included. LBT was considered positive on the basis of three conventional criteria: (1) hydrogen level increase [20 ppm above baseline by 90 min (H2@90min); (2) dual hydrogen peaks ([10 ppm increase over baseline before second peak [20 ppm (DPHBT); and (3) breath methane increase of [20 ppm above baseline by 90 min. Results of gastric emptying scintigraphy (GES) were recorded. Patients completed the Patient Assessment of Upper Gastrointestinal Disorders-Symptom Severity Index. Results Of 740 patients who underwent LBT from December 2009 to August 2011, 471 underwent GES, with 201 having delayed GES. Of patients with delayed GES who underwent LBT 87 % were female, 23 % diabetic, 49 % used gastric acid suppressants, 29 % used opiate analgesics, 35 % used pro-motility medications, and 27 % had a history of gastrointestinal surgery. Overall, 79 (39 %) patients with gastroparesis had evidence of SIBO by LBT: 30 (15 %) had positive H2@90min, 53 (26 %) positive DPHBT, and 6 (3 %) positive breath methane test.

Digestive Diseases and Sciences, 2012

Background The American College of Gastroenterology recommends colorectal cancer (CRC) screening ... more Background The American College of Gastroenterology recommends colorectal cancer (CRC) screening for average-risk black Americans ages 45-49. This is based on this group's younger age for the development of adenomas and CRC. Our purpose was to determine the yield of CRC screening in average-risk black Americans including those \age 50. We also aimed to identify whether there was a higher prevalence of proximal adenomas in black Americans. Study This was a cross-sectional, retrospective study. All colonoscopy examinations from 2007 through 2010 were reviewed. Complete examinations with a good/excellent preparation in average-risk black patients 45-49 were selected. We excluded patients with signs, symptoms, or family history of CRC. Defined two control groups: average-risk black and white patients ages 50-59 who completed a colonoscopy during the same period. Patient's height, weight, and use of statin medications and aspirin were recorded. Patients currently using tobacco at least weekly were identified.