Ayesha Kamal - Academia.edu (original) (raw)

Papers by Ayesha Kamal

Research paper thumbnail of Severe Acute Pancreatitis: Is Organ Failure Enough?

Research paper thumbnail of Mo1401 Does Etiology of Pancreatitis Matter? Differences in Outcomes Among Patients With Post-ERCP, Acute Biliary and Alcoholic Pancreatitis

Gastrointestinal Endoscopy, 2015

Research paper thumbnail of 427 Effectiveness of Cholecystectomy to Prevent Recurrent Acute Biliary Pancreatitis

Gastrointestinal Endoscopy, 2015

Research paper thumbnail of CT and MRI assessment of symptomatic organized pancreatic fluid collections and pancreatic duct disruption: an interreader variability study using the revised Atlanta classification 2012

Abdominal Imaging, 2014

Purpose: Compare CT and MRI for fluid/debris component estimate and pancreatic duct (PD) communic... more Purpose: Compare CT and MRI for fluid/debris component estimate and pancreatic duct (PD) communication with organized pancreatic fluid collections in acute pancreatitis. Evaluate fat density globules on CT as marker for debris. Methods: 29 Patients with 46 collections with CECT and MRI performed ≥4 weeks of symptom onset assessed for necrotizing pancreatitis, estimated percentage of fluid volume and PD involvement by two radiologists on separate occasions. T2WI used as standard for estimated percentage of fluid volume. Presence of fat globules and fluid attenuation on CT was recorded. Spearman rank correlation and kappa statistics were used to assess the correlation between imaging techniques and interreader agreement, respectively. Results: Necrotizing pancreatitis seen on CT in 27 (93%, κ 0.119) vs. 20 (69%, κ 0.748) patients on MRI. CT identified 42 WON and 4 pseudocysts vs. 34 WON, and 12 pseudocysts on MRI. Higher interreader agreement for percentage fluid volume on MRI (κ = 0.55) vs. CT (κ = 0.196). Accuracy of CT in evaluation of percentage fluid volume was 65% using T2WI MRI used as standard. Fat globules identified on CT in 13(65%) out of 20 collections containing <75% fluid vs. 4(15%) out of 26 collections containing >75% fluid (p = 0.0001). PD involvement confidently excluded on CT in 68% collections vs. 93% on MRI. Conclusion: MRI demonstrates higher reproducibility for fluid to debris component estimation. Fat globules on CT were frequently seen in organized pancreatic fluid collections with large amount of debris. PD disruption more confidently excluded on MRI. This information may be helpful for pre-procedure planning.

Research paper thumbnail of Tu1392 Differences in Outcomes Among Patients With Post-ERCP Pancreatitis and Acute Gallstone Pancreatitis

Gastrointestinal Endoscopy, 2013

aspiration of pus, a rinsing procedure combined with an antibiotic treatment (cefuroxim or carbap... more aspiration of pus, a rinsing procedure combined with an antibiotic treatment (cefuroxim or carbapenem) was initiated (15-200 mL NaCl/h). After 0-15 days, an EUS-guided drainage (20-mm-balloon dilatation including the placement of 2 pigtails or of a metal stent) into the stomach or duodenum in 103/124 patients with abscesses (83%) and in 52/56 patients with necroses(93%). The external rinsing was performed over a time period of 10 (range, 1-38) days. In subjects with pancreatic necroses, endoscopic debridement was carried out after 2 (range, 0-13) days by an internal translumenal opening (mean, 2 [range, 1-4] necrosectomies). Similar to abscess cases, two 8.5-Fr.-pigtails were inserted after necrosectomy, which were removed after three months. In 96/180 (53%), an ERCP was performed, out of them in 60%, a transpapillary drainage was placed due to the detection of a ruptured pancreatic duct. Complication rate was i) 13.5% in ultrasound-guided drainage (dislocation: 11.5%, pain: 1%, bleeding [not Hb-relevant]: 1%) and ii) 16.6% in internal translumenal drainage (dislocation: 1.5%, bleeding [not Hb-relevant/Hb-relevant]: 7%/1%, okklusion: 1%, perforation: 1%, technical/anatomical problems: 3.5/1.5%). In necrosectomy, one not Hbrelevant bleeding occurred (1%) and one cardiopulmonal resuscitation was necessary because of an acute myocardial infarction (1%). Three patients needed to undergo surgical intervention due to complications. In 8 patients, surgical necrosectomy was required. The 30-day lethality was 1.2%. The recurrency rate amounted 13% (nϭ24/180) out of them 83% were endoscopically managed while four patients were treated surgically. A clinical success rate (range, 6 months to 6 years) of 93.5% (nϭ116/124)/89.2% (nϭ50/56), respectively, was achieved in treatment of abscesses and necroses. Discussion: The combined, patient-adapted complementary use of an external percutaneous with an internal (translumenal) drainage & an endoscopic debridement in pancreatic necrosis can be considered a successful concept in the interventional treatment of consequences of pancreatitis.

Research paper thumbnail of Sa1503 Comparison of Image-Enhancing Modalities for the Detection of Colonic Adenomas: a Systematic Review and Network Meta-Analysis

Gastrointestinal Endoscopy, 2013

ABSTRACT Background: Colonoscopy is the gold standard for the detection of premalignant adenomato... more ABSTRACT Background: Colonoscopy is the gold standard for the detection of premalignant adenomatous colonic lesions. However, up to 25% of adenomas are missed during colonoscopy. Novel endoscopic imaging techniques have been developed to improve detection of colonic adenomas. AIM To perform a systematic review (SR) and network meta-analysis (NMA) of RCTs that compared at least two different imaging modalities in patients undergoing screening, surveillance or diagnostic colonoscopies. The goal of the NMA was to identify priority comparisons for future trials. Methods: The MEDLINE, EMBASE and Cochrane Library databases were searched for RCTs that compared imaging modalities. For inclusion in the NMA, the number of patients with at least one adenoma detected by imaging modality group needed to be reported.Non-randomized studies and trials including patients with IBD, familial adenopolyposis syndrome, hyperpolyposis syndrome or HNPCC were excluded. The modalities of interest were: standard definition white light (SD-WLE), high definition white light (HDWLE), narrow band imaging (NBI), autofluorescence imaging (AFI), I-scan, Fuji intelligent color enhancement (FICE) and dye-based chromoendoscopy. Adenoma detection (AD) comparisons were analyzed using a Bayesian NMA with a random effects model. The yields of the imaging modalities were compared using odds ratios (OR) (higher OR indicated higher AD).To identify the best performing imaging modality, we ranked OR from 100,000 simulations of the data and considered the modality that ranked as one of the top 3 in most cases as the best at AD, and the highest priority for future trials. Results 24 RCTs (patients=11,576) met the inclusion criteria. At least one study that compared each imaging modality of interest was identified. HD-WLE was used as the common comparator (Figure 1). I-scan ranked as one of the top 3 best performing modalities in over 90% of simulations, followed by FICE (Figure 2). The OR comparing I-scan to the other modalities ranged from 1.24 (95% CI 0.72 - 2.35; compared with FICE) to 2.44 (95% CI 1.4 - 4.04; compared with SD-WLE). SD-WLE ranked in the top 3 in > 1% of simulations. The quality of trials was graded moderate because the outcome assessors were not blinded to the colonoscope modality used and the funding source was often a company that produced one of the technologies being compared. Conclusion: This SR and NMA shows that SD-WLE is outperformed by all other imaging modalities. The findings suggest that I-scan and FICE are the highest priority modalities for future trials, but the magnitude of the AD effect may not be as extreme because of the small number of RCTs using I-scan and FICE that met our inclusion criteria. Head to head trials of imaging modalities are unlikely to have blinded outcome assessors, but trials performed independent of industry sponsorship are possible. (Figure presented).

Research paper thumbnail of Resolution of walled-off pancreatic necrosis by EUS-guided drainage when using a fully covered through-the-scope self-expandable metal stent in a single procedure (with video)

Gastrointestinal Endoscopy, 2014

Background: Walled-off pancreatic necrosis (WOPN) is effectively managed with percutaneous and en... more Background: Walled-off pancreatic necrosis (WOPN) is effectively managed with percutaneous and endoscopic techniques such as direct endoscopic necrosectomy. However, they require repeat interventions and lengthy hospital stays.

Research paper thumbnail of Severe Acute Pancreatitis: Is Organ Failure Enough?

Research paper thumbnail of Mo1401 Does Etiology of Pancreatitis Matter? Differences in Outcomes Among Patients With Post-ERCP, Acute Biliary and Alcoholic Pancreatitis

Gastrointestinal Endoscopy, 2015

Research paper thumbnail of 427 Effectiveness of Cholecystectomy to Prevent Recurrent Acute Biliary Pancreatitis

Gastrointestinal Endoscopy, 2015

Research paper thumbnail of CT and MRI assessment of symptomatic organized pancreatic fluid collections and pancreatic duct disruption: an interreader variability study using the revised Atlanta classification 2012

Abdominal Imaging, 2014

Purpose: Compare CT and MRI for fluid/debris component estimate and pancreatic duct (PD) communic... more Purpose: Compare CT and MRI for fluid/debris component estimate and pancreatic duct (PD) communication with organized pancreatic fluid collections in acute pancreatitis. Evaluate fat density globules on CT as marker for debris. Methods: 29 Patients with 46 collections with CECT and MRI performed ≥4 weeks of symptom onset assessed for necrotizing pancreatitis, estimated percentage of fluid volume and PD involvement by two radiologists on separate occasions. T2WI used as standard for estimated percentage of fluid volume. Presence of fat globules and fluid attenuation on CT was recorded. Spearman rank correlation and kappa statistics were used to assess the correlation between imaging techniques and interreader agreement, respectively. Results: Necrotizing pancreatitis seen on CT in 27 (93%, κ 0.119) vs. 20 (69%, κ 0.748) patients on MRI. CT identified 42 WON and 4 pseudocysts vs. 34 WON, and 12 pseudocysts on MRI. Higher interreader agreement for percentage fluid volume on MRI (κ = 0.55) vs. CT (κ = 0.196). Accuracy of CT in evaluation of percentage fluid volume was 65% using T2WI MRI used as standard. Fat globules identified on CT in 13(65%) out of 20 collections containing <75% fluid vs. 4(15%) out of 26 collections containing >75% fluid (p = 0.0001). PD involvement confidently excluded on CT in 68% collections vs. 93% on MRI. Conclusion: MRI demonstrates higher reproducibility for fluid to debris component estimation. Fat globules on CT were frequently seen in organized pancreatic fluid collections with large amount of debris. PD disruption more confidently excluded on MRI. This information may be helpful for pre-procedure planning.

Research paper thumbnail of Tu1392 Differences in Outcomes Among Patients With Post-ERCP Pancreatitis and Acute Gallstone Pancreatitis

Gastrointestinal Endoscopy, 2013

aspiration of pus, a rinsing procedure combined with an antibiotic treatment (cefuroxim or carbap... more aspiration of pus, a rinsing procedure combined with an antibiotic treatment (cefuroxim or carbapenem) was initiated (15-200 mL NaCl/h). After 0-15 days, an EUS-guided drainage (20-mm-balloon dilatation including the placement of 2 pigtails or of a metal stent) into the stomach or duodenum in 103/124 patients with abscesses (83%) and in 52/56 patients with necroses(93%). The external rinsing was performed over a time period of 10 (range, 1-38) days. In subjects with pancreatic necroses, endoscopic debridement was carried out after 2 (range, 0-13) days by an internal translumenal opening (mean, 2 [range, 1-4] necrosectomies). Similar to abscess cases, two 8.5-Fr.-pigtails were inserted after necrosectomy, which were removed after three months. In 96/180 (53%), an ERCP was performed, out of them in 60%, a transpapillary drainage was placed due to the detection of a ruptured pancreatic duct. Complication rate was i) 13.5% in ultrasound-guided drainage (dislocation: 11.5%, pain: 1%, bleeding [not Hb-relevant]: 1%) and ii) 16.6% in internal translumenal drainage (dislocation: 1.5%, bleeding [not Hb-relevant/Hb-relevant]: 7%/1%, okklusion: 1%, perforation: 1%, technical/anatomical problems: 3.5/1.5%). In necrosectomy, one not Hbrelevant bleeding occurred (1%) and one cardiopulmonal resuscitation was necessary because of an acute myocardial infarction (1%). Three patients needed to undergo surgical intervention due to complications. In 8 patients, surgical necrosectomy was required. The 30-day lethality was 1.2%. The recurrency rate amounted 13% (nϭ24/180) out of them 83% were endoscopically managed while four patients were treated surgically. A clinical success rate (range, 6 months to 6 years) of 93.5% (nϭ116/124)/89.2% (nϭ50/56), respectively, was achieved in treatment of abscesses and necroses. Discussion: The combined, patient-adapted complementary use of an external percutaneous with an internal (translumenal) drainage & an endoscopic debridement in pancreatic necrosis can be considered a successful concept in the interventional treatment of consequences of pancreatitis.

Research paper thumbnail of Sa1503 Comparison of Image-Enhancing Modalities for the Detection of Colonic Adenomas: a Systematic Review and Network Meta-Analysis

Gastrointestinal Endoscopy, 2013

ABSTRACT Background: Colonoscopy is the gold standard for the detection of premalignant adenomato... more ABSTRACT Background: Colonoscopy is the gold standard for the detection of premalignant adenomatous colonic lesions. However, up to 25% of adenomas are missed during colonoscopy. Novel endoscopic imaging techniques have been developed to improve detection of colonic adenomas. AIM To perform a systematic review (SR) and network meta-analysis (NMA) of RCTs that compared at least two different imaging modalities in patients undergoing screening, surveillance or diagnostic colonoscopies. The goal of the NMA was to identify priority comparisons for future trials. Methods: The MEDLINE, EMBASE and Cochrane Library databases were searched for RCTs that compared imaging modalities. For inclusion in the NMA, the number of patients with at least one adenoma detected by imaging modality group needed to be reported.Non-randomized studies and trials including patients with IBD, familial adenopolyposis syndrome, hyperpolyposis syndrome or HNPCC were excluded. The modalities of interest were: standard definition white light (SD-WLE), high definition white light (HDWLE), narrow band imaging (NBI), autofluorescence imaging (AFI), I-scan, Fuji intelligent color enhancement (FICE) and dye-based chromoendoscopy. Adenoma detection (AD) comparisons were analyzed using a Bayesian NMA with a random effects model. The yields of the imaging modalities were compared using odds ratios (OR) (higher OR indicated higher AD).To identify the best performing imaging modality, we ranked OR from 100,000 simulations of the data and considered the modality that ranked as one of the top 3 in most cases as the best at AD, and the highest priority for future trials. Results 24 RCTs (patients=11,576) met the inclusion criteria. At least one study that compared each imaging modality of interest was identified. HD-WLE was used as the common comparator (Figure 1). I-scan ranked as one of the top 3 best performing modalities in over 90% of simulations, followed by FICE (Figure 2). The OR comparing I-scan to the other modalities ranged from 1.24 (95% CI 0.72 - 2.35; compared with FICE) to 2.44 (95% CI 1.4 - 4.04; compared with SD-WLE). SD-WLE ranked in the top 3 in > 1% of simulations. The quality of trials was graded moderate because the outcome assessors were not blinded to the colonoscope modality used and the funding source was often a company that produced one of the technologies being compared. Conclusion: This SR and NMA shows that SD-WLE is outperformed by all other imaging modalities. The findings suggest that I-scan and FICE are the highest priority modalities for future trials, but the magnitude of the AD effect may not be as extreme because of the small number of RCTs using I-scan and FICE that met our inclusion criteria. Head to head trials of imaging modalities are unlikely to have blinded outcome assessors, but trials performed independent of industry sponsorship are possible. (Figure presented).

Research paper thumbnail of Resolution of walled-off pancreatic necrosis by EUS-guided drainage when using a fully covered through-the-scope self-expandable metal stent in a single procedure (with video)

Gastrointestinal Endoscopy, 2014

Background: Walled-off pancreatic necrosis (WOPN) is effectively managed with percutaneous and en... more Background: Walled-off pancreatic necrosis (WOPN) is effectively managed with percutaneous and endoscopic techniques such as direct endoscopic necrosectomy. However, they require repeat interventions and lengthy hospital stays.